Angiographic Findings In Patients Research Articles

Angiographic findings in patients with Non-ST-elevation myocardial infarction

Background & Objective: Acute coronary syndrome (ACS) can be divided into subgroups of ST-segment elevation myocardial infarction (STEMI), Non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (USA). Patients diagnosed with NSTEMI are either treated conservatively or early invasive strategy is adopted. In NSTEMI it is believed that either one or more vessel is transiently occluded or that the blood flow is critically reduced in a patent vessel i.e. subtotal occlusion. This study was conducted to find the angiographic characteristics of NSTEMI patients undergoing coronary angiography. Methods: This study was conducted in Department of Cardiology, Lady Reading Hospital Peshawar. It was Cross Sectional Study. Data was collected from 8th November 2022 to 8th May 2023. Consecutive non-probability sampling technique was used to collect data from the patients. Results: Total of 300 patients were studied. The mean age was 56.95 years ±1.176 standard deviation. Male patients were 201 (67%) and remaining were female. It was found that 51(17%) of total NSTEMI patients were having totally obstructed coronary artery (OCA) in one or more coronary arteries. In NSTEMI, non-obstructive CAD (<50%) were found in 81 (27%) of patients whereas 219 (73%) were having significant CAD. It was found that 40% were having single vessel CAD, 32% were having double vessel CAD and 28% were having triple vessel CAD. TVCAD was present significantly higher in advance age, Diabetes mellitus, hyperlipidemia and family history of CAD. Conclusion: Patients having NSTEMI are usually having multiple risk factors and having usually severe and multivessel CAD. doi: https://doi.org/10.12669/pjms.40.10.9499 How to cite this: Ikramullah, Ahmad F, Haq A, Khan SW. Angiographic findings in patients with Non-ST-elevation myocardial infarction. Pak J Med Sci. 2024;40(10):2228-2232. doi: https://doi.org/10.12669/pjms.40.10.9499 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Investigation of optical coherence tomography angiography findings in patients with bipolar disorder

ObjectivesBipolar Disorder (BD) is an important psychiatric disease that progresses with attacks, can be chronic and causes serious mental problems. In this study, we aimed to identify the retinal vascular pathologies in BD patients by optical coherence tomography angiography (OCTA) imaging. MethodsRetinal vascular analysis from 35 BD patients and 30 healthy controls (HCs) were scanned using the OCTA machine. In addition, psychometric tests such as the Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale (CGI-S) were applied to BD patients to assess the severity of the disease and determine the patient's level of functionality. ResultsAs a result of OCTA scans, there were significant differences between the groups as following; Deep retinal vessel density (VD) in the total, parafoveal and perifoveal area, Macular thickness in the inner parafoveal area, VD of retinal capillary plexuses in the inside disk and the Choroidal thickness (p < 0.05). Furthermore, according to the results of Pearson correlation analysis between OCTA scans and YMRS and CGI-S scores, it was determined that there was no significant relationship in any measurement (p > 0.05). ConclusionIn our study, it was determined that there were general differences in deep retinal vascular density and inner macular thickness in BD patients. These findings demonstrate that the deep and inner zone of the retina is affected in BD patients.

Optical coherence tomography angiography findings in patients affected by giant cell arteritis, with and without ocular involvement: a pilot study.

We evaluated the clinical features and retinal and disk perfusion characteristics by using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in a subset of giant cell arteritis (GCA) patients who manifested anterior ischemic optic neuropathy (AION), in a subset of GCA patients without ocular involvement, and in a control group composed of healthy controls. We performed an observational study on the eyes of GCA patients affected by arteritic AION both in acute and chronic phases, unaffected eyes of AION, eyes of GCA patients without ocular involvement, and in a control group of healthy eyes of healthy individuals. All patients underwent a complete ophthalmic examination and an OCT and OCTA of the macula and the disk. The study evaluated 10 eyes of GCA patients with AION (AION group), 8 unaffected eyes of GCA patients with AION in another eye (unaffected eyes of AION group), 16 eyes of GCA patients without ocular involvement (non-ocular group), and 22 eyes of healthy patients (healthy group). The ganglion cell complex (GCC) superior and inferior thicknesses were significantly lower in the AION group compared to the unaffected eyes of the AION group (p = 0.045 and p = 0.034, respectively). All OCTA vascular density parameters of the optic disk analyzed in this study (optic nerve head (ONH) whole, superior, inferior, radial peripapillary capillary plexus (RPCP) whole, superior, inferior, lamina cribrosa (LC) whole, superior, inferior) resulted significantly lower in the AION group compared to the unaffected eyes group (p < 0.05 for all the comparisons). The ONH whole and inferior were statistically higher in the healthy group in comparison to the group of GCA patients without ocular involvement (p = 0.008 and p = 0.006, respectively). The ONH inferior was also statistically higher in the unaffected eyes of the AION group in comparison to the non-ocular group (p = 0.045). Regarding the OCTA macular vessel density parameters, the superficial capillary plexus (SCP), whole and inner, were statistically lower in the AION group compared with the unaffected eyes of the AION group. We found a profound vascular impairment in eyes affected by AION and areas of hypoperfusion in the eyes of patients with GCA without ocular involvement, good BCVA, and no clinically significant features. We hypothesized that these areas of lower vessel density might represent areas of subclinical hypoperfusion that cannot be detected ophthalmoscopically.

ANGIOGRAPHIC FINDINGS IN PATIENTS PRESENTING WITH CHEST PAIN IN EASTERN ZONE OF AFGHANISTAN

Aim: Coronary artery disease is the leading cause of mortality and morbidity globally. Its diagnosis starts with workup of routine examinations and is confirmed by coronary angiography. The main purpose of the study was to find out angiographic findings in patients presenting with chest pain with or without electrocardiogram abnormalities.&#x0D; Methods: It was a retrospective descriptive single setting hospital based study conducted at Afghan Momand Medical complex, a tertiary care center in Nangarhar, Afghanistan. The study included 372 patients with chest pain with or without electrocardiogram abnormalities.&#x0D; Results: Mean age of the study population was 56.6 ± 11.7 years. 50 (13.4%) patients with chest pain had normal coronary angiography (CAG) while 64 (17.2%) patient had non critical CAG and the rest had significant disease on CAG described as64 (17.2%) patients had single vessel disease (SVD) while 40 (10.8%)had double vessel disease (DVD) and the rest 82 (22%) had triple vessel disease (TVD). Left anterior descending coronary artery was the leading involved artery (206, 45%) followed by right coronary artery (133, 29%) and left circumflex (119, 26%) respectively. Incidences of TVD increased with increasing age as it was not involved in the lowest two age groups (0. 0%) while it was in involved in 24 (29.3%), 33 (40.2%), and 15 (18.3%) in the age groups 50-59, 60-69, and 70 through highest age groups respectively.&#x0D; Conclusion: We concluded that coronary angiography precisely prescribed is a gold standard investigation to find out ischemic heart disease in patients with chest pain and/or electrocardiogram abnormalities. In fact, left anterior descending coronary artery was the most leading diseased artery in the forms of both single vessel disease and multiple vessel disease. Moreover, prevalence of triple vessel disease significantly increased with increasing age. Angioplasty was a matter of concern which needs to be evaluated with further researches about why some patients with single vessel disease did not undergo subsequent angioplasty and some with triple vessel disease underwent angioplasty.

LONGITUDINAL ANALYSIS OF MICROVASCULAR CHANGES IN SICKLE CELL DISEASE USING SWEPT-SOURCE OPTICAL COHERENCE TOMOGRAPHY ANGIOGRAPHY.

To analyze the changes in macular vascular densities (VDs) and foveal avascular zone (FAZ) over a 6-year period using swept-source optical coherence tomography angiography in patients with sickle cell disease compared with unaffected control subjects. Thirty eyes of patients with sickle cell disease and 12 eyes of unaffected control subjects matched for age and ethnicity were examined at a 6-year interval using the same imaging protocol, including ultra-wide-field angiography, swept-source OCT, and 3 × 3-mm optical coherence tomography angiography. The macular VD and FAZ were measured on ImageJ software according to previously reported algorithms. In sickle cell eyes, the mean FAZ significantly increased ( P < 0.01), and the VD decreased in the foveal (within a circle of 1.5 mm in diameter around the foveal center) and temporal areas in both the superficial and the deep capillary plexuses ( P < 0.01). The VD did not change over time in the parafoveal area (annulus between two circles of 1.5 and 3 mm in diameter) and in the superior, inferior, and nasal sectors. No worsening of peripheral retinopathy was observed in the cohort during the follow-up, except for one eye that developed sea-fan. In the control eyes, no microvascular change was observed over time in FAZ size and VD. These longitudinal optical coherence tomography angiography findings in patients with sickle cell disease showed an enlargement of the FAZ and a decrease in VD in the temporal and perifoveal regions despite the absence of progression of peripheral retinopathy, suggesting a worsening of the macular nonperfusion over time in sickle cell disease.

Incremental prognostic value of metabolic dysfunction-associated fatty liver disease over coronary computed tomography angiography findings in patients with suspected coronary artery disease

Abstract Background Fatty liver caused by nutritional metabolic disorders regardless of other chronic liver diseases has been proposed as a new liver disease concept, metabolic dysfunction-associated fatty liver disease (MAFLD). With the alteration from non-alcoholic fatty liver disease to MAFLD, MAFLD can be recognized as higher CVD risk. However, the association of MAFLD with adverse coronary CT angiography (CCTA) findings, such as the presence of obstructive and high-risk plaque, and cardiovascular events has not been fully elucidated. Purpose This study was aimed to investigate additional risk stratification benefits of MAFLD diagnosed by hepatic steatosis assessed during CCTA in patients with suspected coronary artery disease (CAD). Methods A total of 2289 patients without a history of CAD who underwent CCTA in our institute from August 2011 and December 2016 were enrolled. Hepatic steatosis, defined on CT as a hepatic-to-spleen attenuation ratio of &amp;lt;1.0, was examined just before the evaluation of CCTA. Adverse CCTA findings were defined as obstructive and/or high-risk plaque. The major adverse cardiovascular events (MACE) were composite coronary events including cardiovascular death, acute coronary syndrome, and late coronary revascularization. The incremental predictive value of MAFLD was evaluated using the global chi-square values and C-statistic. Results Among 2289 patients (60% men, mean age 68 years), MAFLD was identified in 382 (17%) patients. The presence of adverse CCTA findings in patients with MAFLD was significantly greater than that in patients without MAFLD (40% and 35%, p=0.039). During a median follow-up of 4.4 years, 103 (4.4%) MACE were observed. In the multivariate Cox regression analysis, MAFLD was significantly associated with MACE in a model included traditional risk factors and adverse CCTA findings (HR 1.73, 95%CI 1.10–2.72, P = 0.017). The Kaplan–Meier analysis showed that patients with both MAFLD and adverse CCTA findings had highest event rates compared with patients without MAFLD or adverse CTA findings (log rank test, p=0.004). By adding MAFLD to a prediction model including adverse CCTA findings, the global chi-square values and C-statistic significantly increased from 80.6 to 86.2 (P = 0.017) and 0.72 to 0.74 (P = 0.044), respectively. Conclusions MAFLD concurrently assessed during CCTA enables more accurate detection of patients at higher risk of MACE In patients with suspected stable CAD.

Angiographic Findings in Patients With De Novo Heart Failure With Reduced Ejection Fraction (HFrEF) Referred for Early Inpatient Coronary Angiography During Their Index Admission

Angiographic Findings in Patients With De Novo Heart Failure With Reduced Ejection Fraction (HFrEF) Referred for Early Inpatient Coronary Angiography During Their Index Admission

Dr. Salih Uzun et al. Letter to the Editor: Comment on 'Optical coherence tomography angiography findings in patients with chronic thromboembolic pulmonary hypertension.

Department of Ophthalmology, Medical University of Warsaw, Warsaw, Poland None of the authors has any financial/conflicting interests to disclose.

Correlation of Duke Treadmill Score with Coronary angiographic Findings in Patients with Stable Ischemic Heart Disease

Aim: To determine the correlation of Duke treadmill score with angiographically determined obstructive coronary artery disease (CAD) Study design: observational cross sectional study, comparative type Place and duration: The study was done at Cardiac Center Bahawalpur from August 2020 to July 2021. Methods: The patients who had stable angina and underwent exercise tolerance testing as well as coronary angiography were included in the study. The data was collected on a predesigned proforma. The difference in the prevalence of obstructive CAD with regards to Duke treadmill score (DTS), gender, diabetes mellitus, hypertension, smoking and family history was determined with Chi square test using SPSS 20; ap value of &lt; 0.05 was taken as significant. Results: Total 71 patients were enrolled for study. Mean ageof the participants was 48.25 ± 8.7 years. It was a male dominant population. A significant difference in the prevalence of obstructive CADwas noted in low, intermediate and high risk groups according to DTS. The prevalence of obstructive coronary artery disease was not significantly different with regards to gender, diabetes mellitus, hypertension, smoking and family history. However obstructive CAD was more prevalent in those who presented with typical angina as compared to those who had atypical symptoms. Conclusion: Obstructive CAD significantly differs in low, intermediate and high risk groups according to DTS. Keywords: Duke treadmill score, coronary artery disease

Assessment of bypass patency using transcranial Doppler sonography: correlations with computerized tomography angiography findings in patients with moyamoya disease

To explore the utility of transcranial Doppler (TCD) findings when assessing bypass patency in patients with Moyamoya disease (MMD). Computed tomography angiography (CTA) and TCD sonography (TCDS) were performed before and after surgery to evaluate bypass patency. The peak systolic flow velocity (PSV) of the superficial temporal artery (STA) and the pulsatility index (PI) were compared between the groups that achieved patency and not, and receiver operating characteristic (ROC) curve analyses were used to define the TCDS criteria revealing patency. This study included 35 hemispheres (15 women; mean age 47 years) with Moyamoya disease who underwent STA-middle carotid artery bypass in our institution between January 2022 and October 2022. The PSV first increased on postoperative days 4-5 and then decreased on postoperative days 6-7 and 7-8. Patients with transient neurological diseases (TNDs), compared to those without, evidenced a significantly lower PSV value (P < 0.05). Compared with the non-patency group, the PSV was higher (P < 0.001) in the patency group. The cutoff values reflecting patency with good sensitivity and specificity were PSV > 49.00; PSV ratio (postoperative/preoperative) > 1.218; PSV ratio (operation side/contralateral side) > 1.082; and PSV ratio (adjusted) > 1.202. In the patency group, the PSV and PI significantly increased (P < 0.001) and decreased (P < 0.001) respectively. Bypass patency can be noninvasively and accurately evaluated via TCDS, affording an objective basis for assessment of the effect of revascularization surgery on patients with MMD.

Association of Hs-CRP Levels in Patients with Acute Coronary Syndromes and it’s Correlation with Angiographic Severity of Coronary Artery Stenosis

Objectives: Significant advances have been made toward the development of biomarkers for prognostication of patients with atherosclerotic cardiovascular disease. One such marker is high-sensitivity C-reactive protein (hsCRP). It is a marker of inflammation mainly used to predict the risk of adverse cardiovascular (CV) events. Recent research also supports its role in atherogenesis. It is involved throughout the process of atheromatous plaque development. However, limited information is available about the relationship between levels of hs-CRP levels in patients presenting with acute coronary syndromes (ACS) and its association with outcomes. We conducted this study to assess the correlation between the levels of hs-CRP and the coronary angiographic findings in patients presenting with ACS and its correlation with outcomes. Materials and Methods: we carried an observational prospective study in patients presenting with ACS admitted to cardiology intensive coronary care unit in a tertiary care hospital. Patients underwent invasive coronary angiogram and serum Hs-CRP levels testing apart from other routine investigations. Correlation between severity of coronary stenosis, Hs-CRP levels and left ventricular ejection fraction (LVEF) at discharge was then assessed using statistical analysis. Results: Positive correlation was found between Hs-CRP levels and severity of coronary stenosis. Negative correlation was found between Hs-CRP levels and LVEF at discharge. Conclusion: We found that hs-CRP levels correlate well with angiographic severity. It was also observed that higher the hs-CRP levels more the number of vessels involved with patients with the left main + triple vessel disease (TVD) and TVD having maximum scores.

Impact of catheter ablation procedure on optical coherence tomography angiography findings in patients with ventricular arrhythmia.

Catheter ablation procedure may cause retinal complications associated with the risk of thromboembolism. We aimed to evaluate retina and optic disc microvascularity with optical coherence tomography angiography before and after the catheter ablation process in patients with ventricular arrhythmia. A total of 40 eyes of 21 ventricular arrhythmia patients were included in this cross-sectional study. Demographic characteristics and ophthalmic examination findings of patients were recorded. optical coherence tomography angiography measurements were evaluated before (group 1) and after (group 2) catheter ablation. Optical coherence tomography angiography was applied to all eyes with 6×6 mm sections for the macula and 4.5×4.5 mm sections for the optic nerve head. Foveal retinal thickness, peripapillary retinal nerve fiber layer thickness, vessel density in different parts of the retina, and optic disc were analyzed. The mean age of ventricular arrhythmia patients was 53.48±13.02 years. In all, 13 (61.9%) of the patients were males and 8 (38.1%) were females. There was no significant difference between the groups in terms of average, inferior, superior, and temporal retinal nerve fiber layer thicknesses, foveal avascular area, flow areas, superficial and deep vessel densities, and optic disc capillary densities of the optic disc. However, when compared with group 1, significantly lower values in foveal retinal thickness and higher values in nasal retinal nerve fiber layer thickness were observed in group 2 (248.42±20.50 vs. 247.20±20.44, p<0.001 and 94.22±18.43 vs. 96.12±20.18, p=0.044, respectively). Although foveal retinal thickness and nasal retinal nerve fiber layer thickness are affected in patients undergoing catheter ablation for ventricular arrhythmia, the stable retinal and optic disc vessel densities can be explained by the administration of effective anticoagulants during the procedure.

Optical coherence tomography angiography findings in patients with essential hypertension

AbstractPurpose: To study the variation of retinal and choroidal density in patients with essential hypertension using Swept Source Optical Coherence Tomography Angiography (SS‐OCT A).Methods: Prospective cross‐sectional study carried out at the Ophthalmology department of Habib Thameur University Hospital of Tunis between June, 1st 2021 and March, 30th 2022. Fifteen volunteer healthy patients (30 eyes) were included. All patients underwent complete ophthalmic examination, measurements of resting systolic and diastolic blood pressure and 3 × 3 and 4.5 × 4.5 SS‐OCT A angiograms in both eyes. Perimeter of avascular central zone (ACZ), superficial retinal plexus density (SRPD), deep retinal plexus density (DRPC) and choriocapillaris capillary vessel density (CVD) were calculated on exported jpg format images using the Fiji Software. Comparative Mann Whitney and Spearman tests were performed using 21.0 SPSS.Results: Eleven males and four females were eligible for the study. Mean age was 53.33 ± 9.73 years. Eight patients (53.3%) with chronic essential hypertension were compared to seven healthy volunteers (46.7%). Mean ACZ, SRPD, DRPD and CVD were respectively 2.62 ± 0.52 mm, 13.20 ± 2.10%, 17.14 ± 1.17% and 51.05 ± 0.85%. Mean systolic blood pressure was 13 ± 5 mmHg and mean diastolic blood pressure was 7.67 ± 5.16 mmHg. CVD was lower in patients with chronic hypertension than in the control group (50.59 vs 51.41, p = 0.047). There were no significant differences between hypertension group and normal group in ACZ, SRPD and DRPC measurements (p = 0.089, p = 0.90 and p = 0.70, respectively). No correlations were found between resting blood pressure values and ACZ measurements.Conclusions: Chronic hypertension does not affect retinal vessels and capillaries quantitative parameters. However, it may alter choroidal vascular structures by decreasing choriocapillaris vessel density. Larger studies are needed to strengthen these results.

Prevalence of new Onset Right Bundle Branch Block in Acute Myocardial Infarction and its Coronary Angiographic Findings in Patients Attending NICVD

Background and Aim: Acute myocardial infarction patients with left and right bundle branch block significantly contributes to higher risk of mortality. Right bundle branch block (RBBB) has clinical implications in acute myocardial infarction setting. The present study aimed to determine the prevalence of new onset RBBB in acute myocardial infarction and its association with coronary angiographic findings. Methodology: This cross-sectional study was conducted on 82 acute myocardial infarction (AMI) patients in National Institute of Cardiovascular Diseases (NICVD), Karachi from January 2022 June 2022. Study protocol was approved from the institution research and ethical committee. All the patients of either gender with an age range 25 years to 85 years having acute myocardial infarction were included. Written informed consent was taken. Patients with previous RBBB, had implanted pacemaker, and presentation of symptoms &gt;24 hours were excluded. Detailed history and clinical examination of each individual was done. Patients’ angiographic findings after eligibility based on coronary angiography was done and recorded. All the data were entered into pre-designed profroma. SPSS version 26 was used for data analysis. Results: Of the total 82 AMI patients, there were 48 (58.5%) male and 34 (41.5%) females. Age-wise distribution of AMI patients were as follows; 17 (20.7%) 25-45 years, 28 (34.2%) 46-65 years, and 37 (45.1%) 66-85 years. The overall mean age was 54.62±6.82 years. The prevalence of new onset RBBB and without RBBB was 17 (20.7%) and 65 (79.3%) respectively. Of the 17 AMI with RBBB patients, the incidence of single vessel disease, double vessel disease, triple vessel disease, and left main stem disease was 3 (17.6%), 5 (29.4%), 6 (35.3%) and 3 (17.6%) respectively. Majority of patients aged 46 years to 65 years had RBBB in 9 (32.1%), followed by 6 (16.2%) in patients 66-85 years and 2 (11.8%) in patients aged 25-45 years. Conclusion: The present study concluded that the prevalence of new onset RBBB was 20.7% among acute myocardial infarction patients. The incidence of triple vessel disease was prominent in acute myocardial infarction patients with RBBB followed by double vessel disease. Also, elderly patients of acute myocardial infarction patients were more susceptible to RBBB than younger one. Keywords: Right bundle branch blockage, Acute myocardial infarction, Coronary angiography

Optic nerve head optical coherence tomography angiography findings in patients with thyroid eye disease: a case–control study

BackgroundTo evaluate changes in the vessel density (VD) of the optic nerve head (ONH) microvasculature in thyroid eye disease (TED) using optical coherence tomography angiography (OCTA). This study aimed to applicate the OCTA as a noninvasive modality in screening TED patients to assess sub-clinical changes.MethodsIn a cross-sectional study, the control group patients were healthy individuals with no ocular abnormalities and were euthyroid. All patients with TED had clinical features of the disease. We divided them into two groups using the clinical activity score (CAS). Patients with CAS scores 0–2 were categorized as group A, and scores three or more as group B. All vessels (AV) and small vessels (SV) VD inside disc and radial peripapillary capillary network were measured using the ONH-OCTA.ResultsWe evaluated 29 patients with TED and 28 healthy controls. The mean whole image AV VD (mean ± SD: 56.33 ± 2.56, p-value = 0.17) and the mean whole image SV VD (mean ± SD: 49.94 ± 2.56, p-value = 0.16) in the TED group had no statically significant difference compared with the control group (AV mean ± SD: 57.20 ± 20.22, SV mean ± SD: 50.84 ± 2.23). We found a non-significant decrease in AV and SV radial peripapillary capillary VD in the TED group. There was a significant decrease in the mean whole image AV VD (mean ± SD: 54.83 ± 3.07, p-value = 0.005) and the mean whole image SV VD (mean ± SD: 48.60 ± 3.18, p-value = 0.013) in CAS group B compared to group A (AV mean ± SD: 57.45 ± 1.33, SV mean ± SD: 50.95 ± 1.37).ConclusionOur study showed non-significant ONH vascular alterations in patients with TED, including reduced VD of ONH in the radial peripapillary capillary. Patients with higher CAS scores had a more noticeable decrease in ONH microvasculature.

Impacts of opium addiction on patterns of angiographic findings in patients with acute coronary syndrome

Opium is one of the most abused substances in the Middle East. The effects of opium use on coronary artery disease (CAD) are a matter of debate. This study aimed to assess the association between opium use and angiographic findings as well as the complexity of CAD in patients with acute coronary syndrome (ACS) diagnosis. In this case–control study, all patients admitted for coronary angiography from 2019 to 2020 were evaluated. After applying the eligibility criteria, they were categorized into two groups opium and non-opium based on their history of opium use. Both groups were matched regarding the demographic features. The prevalence, location, and severity of obstruction of the vessels were compared between the non-opium and opium groups. The SYNTAX score was also calculated and compared between the two groups. The scores ≤ 22 are considered low risk and the higher scores are a non-low risk. P value < 0.05 is considered significant. A total of 170 patients with a mean age of 61.59 ± 9.07 years were finally enrolled in our study. Regarding the severity of vascular involvement, there was a significant difference between the non-opium and opium groups in LAD (P = 0.025), and PLV (P = 0.018) vessels. From the location points of view of obstructive coronary artery involved segments, only in the PDA (P = 0.006), and LCX (P = 0.004) vessels, a significant difference was observed. Moreover, 47.1% of opium and 30.6% of non-opium use group were in the non-low risk SYNTAX score classification which is a statistically significant difference between these two groups (P value = 0.048). Opium, as an independent risk factor for cardiovascular diseases, can have specific effects on angiographic findings in patients with acute coronary syndrome. Likewise, the complexity of CAD in opium users who undergo percutaneous coronary intervention is significantly higher.

Coronary anomalies associated with ventricular septal defect.

Coronary anomalies encompass different conditions in terms of anomalous origin, coursing, and branching, which are occasionally associated with congenital heart disease. This study aimed to explore coronary anomalies associated with ventricular septal defect that was a stereotypical congenital heart disease. We retrospectively reviewed angiographic findings in patients with ventricular septal defect who required corrective surgery, and identified coronary abnormalities, including anomalous origin, coursing, and branching of coronary arteries based on angiography. We studied the prevalence and types of coronary anomalies among them. A total of 998 patients with ventricular septal defect was studied. Age and weight were 2.0 (2.1-15.2) months and 5.7 (4.1-8.7) kg, respectively. There were 115 patients (12%) with syndrome or genetic disorder, and 34 patients (3%) with extracardiac major organ anomalies. The overall prevalence of coronary anomalies was 6.2%. All coronary anomalies were anomalous origin and coursing, among 3 patients accompanied anomalous intrinsic coronary anatomy. Originating within aortic root above the Valsalva sinus was the most common coronary anomaly. Coronary anomalies were independently correlated with bicuspid aortic valve (odds ratio [OR]: 8.02, 95% confidence interval [CI]: 2.34-23.4) and persistent left superior caval vein (OR: 5.02, 95% CI: 1.93-11.7). We showed the possibility that minor cardiac variants, such as bicuspid aortic valve and persistent left superior caval vein, contribute to higher prevalence of coronary anomalies in patients with ventricular septal defect.

Correlation study of Myocardial strain imaging with angiographic findings in patients with chronic stable angina

Background: Global Longitudinal Strain (GLS) measured by 2D speckle-tracking strain echocardiography (2D-STE) can detect impaired longitudinal left ventricle (LV) function at rest which is associated with significant coronary artery stenosis. Objective: Global longitudinal strain (GLS) may be used to predict the presence, extent and severity of CAD according to coronary angiographic findings in patients with chronic stable angina. Methods: 2D-STE and coronary angiography were performed on 100 individuals with suspected stable angina pectoris who had normal resting conventional echocardiography. Global longitudinal strain were assessed and were correlated with coronary angiography for each patient. Results: Statistically significant difference was found when comparing the mean GLS among patients with normal coronaries and different degrees of coronary artery disease (CAD).Mean GLS was – 20.76±1.39, -17.66±0.65, - 16.05±0.58 and -14.22±0.65 for normal/minor, single vessel, two vessels and three vessels respectively(p&lt;0.001). Patients with significant left main (LM) stenosis had GLS of 14.41±1.27 compared with GLS of 17.1±1.91in patients without LM stenosis (p=&lt;0.001). In our study cutoff value for detection of single vessel disease was -18.300 with good sensitivity and specificity (100% and 96.6%, respectively) with AUC (Area Under the Curve) 0.996 and p value&lt; 0.001.

Frequency of new onset right bundle branch block in acute myocardial infarction and its coronary angiographic findings in patients presenting at Tertiary Care Hospital, Peshawar

Background: Right bundle branch block has prognostic significance in the setting of acute myocardial infarction; this research is intended to determine the incidence of new-onset right bundle branch block in acute myocardial infarction and its angiographic findings.&#x0D; Methodology: This descriptive cross-sectional study was conducted in a tertiary care hospital, i.e., the Cardiology Department, Lady Reading Hospital, Peshawar, from 13/5/2016 to 13/11/2016. A total of 91 patients were included in the study. Baseline investigation, including ECG (Nihan Koden), Coronary angiography (Siemens Healthineers), on patients who qualify for early invasive therapy and angiographic findings. All the information, like age and gender, was recorded. 91 patients with acute myocardial infarction who presented within 24 hours were observed, in which male to female ratio was 1.17:1. The study enrolled the age group from 30 up to 75 years.&#x0D; Results: Average age was52.6±7.71 years. New onset right bundle branch block (RBBB) was found in 13(14.29%) patients in acute myocardial infarction.&#x0D; Conclusion: In conclusion, RBBB was observed in 13% of patients where angiographic findings showed triple vessel disease 38.5%, double vessel coronary artery disease 30.8%, single vessel disease 15.4%, and left main stem disease15.4% respectively, there is a high rate of severe CAD in patients presenting with RBBB in the setting of the acute coronary syndrome, so early reperfusion is recommended.

Sex differences in coronary angiographic findings in patients with stable chest pain: analysis of data from the KoRean wOmen\u2019S chest pain rEgistry (KoROSE)

BackgroundFocused evaluations on potential sex differences in the angiographic findings of the coronary arteries are scarce. This study was performed to compare the angiographic extent and localization of coronary stenosis between men and women.MethodsA total of 2348 patients (mean age 62.5 years and 60% women) with stable chest pain undergoing invasive coronary angiography (CAG) were recruited from the database of the nation-wide chest pain registry. Obstructive coronary artery disease (CAD) was defined as ≥ 50% stenosis of the left main coronary artery and/or ≥ 70% stenosis of any other epicardial coronary arteries.ResultsAlthough women were older than men (64.4 ± 10.3 vs. 59.5 ± 11.4 years, P < 0.001), men had worse risk profiles including high blood pressure, more frequent smoking and elevated triglyceride and C-reactive protein. The prevalence of obstructive CAD was significantly higher in men than in women (37.0% vs. 28.4%, P < 0.001). Men had a higher prevalence of LM disease (10.3% vs. 3.5%, P < 0.001) and three-vessel disease (16.1% vs. 9.5%, P = 0.007) compared to women. In multiple binary logistic regression analysis, the risk of men having LM disease or three-vessel disease was 7.4 (95% confidence interval 3.48–15.97; P < 0.001) and 2.7 (95% confidence interval 1.57–4.64; P < 0.001) times that of women, respectively, even after controlling for potential confounders.ConclusionsIn patients with chest pain undergoing invasive CAG, men had higher obstructive CAD prevalence and more high-risk angiographic findings such as LM disease or three-vessel disease.