Angiographically-proven Coronary Artery Disease Research Articles

Diagonal Earlobe Crease as a Significant Marker for Coronary Artery Disease: A Case-control Study.

Objectives:To investigate the association between diagonal earlobe crease (DELC) and coronary artery disease (CAD). Limited data exists in South Asia and no prior studies have been performed in Pakistan to assess this relationship.Methods:In this case-control study, 200 participants from December 2015 to March 2016 at Shifa International Hospital, Islamabad, Pakistan were enrolled. Consecutive non-probability sampling was used to recruit patients. Cases were enrolled from cardiac care unit (CCU) of the hospital with angiography-proven CAD. Controls were selected from surgical, medical and neurology units of the hospital if they had no previously established evidence or symptoms of CAD. Patients were evaluated in terms of age and any history of hypertension, diabetes and/or smoking. Cases and controls were examined separately by two investigators for the unilateral or bilateral presence of DELC of the lobular portion of either auricle. Patients with ear piercings were excluded from the study. The data was analyzed in statistical product and service solutions (SPSS) (IBM, Delaware, Chicago), and an online statistical software.Results:Out of the 200 patients, 126 (63%) were males and 74 (37%) were females. In the 100 cases, 76 had DELC and 24 had no crease whereas, among the 100 controls, 36 had DELC and 64 had no DELC (p <0.001, OR = 5.63, CI = 2.91-10.93). The prevalence of diseases such as hypertension, diabetes, smoking among the cases and controls were 66%, 53%, 27% and 27%, 18%, 25% respectively. The effect of hypertension and diabetes on the presence of DELC was statistically significant (p <0.05) but the impact of smoking on DELC presence was insignificant (p >0.05).Conclusion:There is a significant association between DELC and CAD. This is the first case-control study from South Asia disclosing this important correlation. Our study also reports a high frequency of DELC in patients suffering from hypertension and diabetes mellitus. No association between smoking and DELC was found.

Cytomegalovirus Infection and Coronary Artery Disease: A Single-Center Serological Study in Northwestern Iran

Te role of chronic Cytomegalovirus (CMV) infection and inflammation in the pathogenesis of atherosclerosis and Coronary Artery Disease (CAD) is still not clear. Objectives: Tis study aimed to explore the seroprevalence of anti-CMV antibodies and inflammatory markers in patients with stable angina who had undergone diagnostic coronary angiography for clinical suspicion of CAD. Patients and Methods: Tis cross-sectional, descriptive study was conducted on 181 patients with stable angina selected randomly among the patients referred to Seyyedoshohada Heart Hospital of Urmia, Iran for diagnostic coronary angiography between August 2012 and December 2013. Te patients were categorized into CAD and non-CAD groups based on their angiographic fndings. Ten, anti-CMV IgG and IgM antibodies were tested using the Enzyme-Linked Immunosorbent Assay (ELISA) method (Diapron, Rome, Italy). Serum C-Reactive Protein (CRP) was also measured by a qualitative method (Aniston Kit). Results: Based on angiographic fndings, 141 patients (77.9%) had atheromatous plaques in their coronary arteries, while coronary arteries were free of any plaques in 40 cases (22.1%). Besides, 99.3% of the patients in the CAD group and all the patients in the non-CAD group were anti-CMV IgG positive. Te rate of anti-CMV IgM seropositivity was 11.7% in the CAD group and 13.2% in the non-CAD group (P = 0.78). However, no signifcant difference was observed between the groups with and without angiographicallydocumented CAD in terms of CRP seropositivity (64.7% vs. 56.4%, P = 0.34). Conclusions: Regardless of having angiographically-proven CAD, almost all the cases referred for coronary angiography in our study had a previous exposure to CMV infection as determined by the presence of anti-CMV IgG antibodies in their sera. In fact, the results indicated no signifcant associations between CMV infection and the presence of CAD.

Prognostic value of gamma-glutamyl transferase in patients with diabetes mellitus and coronary artery disease

ObjectivesThe aim of the study was to investigate the association between gamma-glutamyl transferase (GGT) activity and mortality in patients with diabetes mellitus and coronary artery disease (CAD). Design and methodsThe study included 1448 patients with diabetes and angiography-proven CAD who underwent percutaneous coronary intervention (PCI). Baseline GGT measurements were available in all patients. The primary outcome was 3-year mortality. ResultsPatients were divided into 3 groups: a group consisting of patients with a GGT activity in the 1st tertile (GGT≤29.4U/L; n=487), a group consisting of patients with a GGT activity in the 2nd tertile (GGT>29.4–52.5U/L; n=479) and a group consisting of patients with GGT in the 3rd tertile (GGT>52.5U/L; n=482). Overall, there were 179 deaths: 46 (11.9%), 49 (12.1%) and 84 deaths (21.4%) among patients of the 1st, 2nd and 3rd GGT tertiles, respectively (adjusted hazard ratio [HR]=1.25, 95% confidence interval [CI] 1.05–1.49, P=0.011). Cardiac death occurred in 101 patients: 22 (5.8%), 30 (7.2%) and 49 deaths (12.9%) among patients of the 1st, 2nd and 3rd GGT tertiles, respectively (adjusted HR=1.23 [0.96–1.58], P=0.104, with risk estimates calculated per standard deviation increase in the logarithmic scale of GGT). GGT improved the risk prediction of models of all-cause (P=0.020) but not cardiac (P=0.135) mortality (P values show the difference in C-statistics between the models without and with GGT). ConclusionIn patients with diabetes and CAD treated with PCI, elevated GGT was independently associated with the risk of 3-year all-cause mortality.

In Vivo and protease-activated receptor-1-mediated platelet activation in patients presenting for cardiac catheterization

Pathways of platelet activation that are not targeted by current antithrombotic therapy may be crucial for the development of ischemic events in patients undergoing coronary angiography. We therefore investigated whether in vivo and thrombin receptor activating peptide (TRAP)-stimulated platelet activation and monocyte-platelet aggregate (MPA) levels can serve as independent risk markers for adverse outcomes in aspirin-treated patients presenting for cardiac catheterization. In vivo and TRAP-stimulated platelet surface P-selectin, activated glycoprotein IIb/IIIa (GPIIb/IIIa) and MPA levels were determined in 682 consecutive patients undergoing cardiac catheterization and in 47 healthy controls. Two-year follow-up data were obtained from 562 patients. In vivo platelet surface P-selectin, activated GPIIb/IIIa and MPA levels were significantly higher in patients with angiographically-proven coronary artery disease than in healthy controls (all p≤0.02). Patients with an acute coronary syndrome (ACS; n=125) had significantly higher levels of in vivo MPA than patients without ACS (n=437; p=0.01). In the overall study population (n=562) the surface expression of P-selectin and activated GPIIb/IIIa, and the levels of MPA in vivo and in response to TRAP were similar in patients without and with subsequent ischemic events (all p>0.05). Similar results were obtained when only patients with angiographically-proven coronary artery disease (n=459), stent implantation (n=205) or ACS (n=125) were analyzed. Receiver-operating characteristic curve analyses did not reveal cut-off values for P-selectin, activated GPIIb/IIIa, and MPA levels for the prediction of ischemic events. In conclusion, in vivo and TRAP-stimulated platelet activation and MPA levels did not predict adverse ischemic outcomes in aspirin-treated patients presenting for cardiac catheterization.

Risk Factors, Coronary Severity, Outcome and ABO Blood Group: A Large Chinese Han Cohort Study.

ABO blood type locus has been reported to have ethnic difference and to be a pivotal genetic determinant of cardiovascular risk, whereas few prospective data regarding the impact on cardiovascular outcomes are available in a large cohort of patients with angiography-proven coronary artery disease, especially from the Chinese population. The objective of this study was to assess the prognostic role of blood type in future cardiovascular events (CVEs) in Chinese Han patients undergoing coronary angiography.The population of this prospective cohort study consisted of 3823 eligible patients, and followed annually to capture all CVEs. Baseline characteristics and ABO blood type were obtained. Cox proportional hazards models were used to evaluate the risk of ABO blood type on CVEs.New CVEs occurred in 348 patients [263 (10.3%) non-O and 85 (7.8%) O] during a median period of 24.6 months follow-up. Significantly, non-O blood group was related to the presence and severity of coronary atherosclerosis and several risk factors including inflammatory markers. The log-rank test revealed that there was a significant difference between non-O and O blood groups in event-free survival analysis (P = 0.026). In particular, the Cox proportional hazards models revealed that non-O blood type was associated with increased CVEs risk [hazard ratio (95% confidence interval) 1.320 (1.033-1.685)], even after adjusting for potential confounders [adjusted hazard ratio (95% confidence interval) non-O: 1.289 (1.003-1.656); A: 1.083 (0.797-1.472); B: 1.481 (1.122-1.955); AB: 1.249 (0.852-1.831), respectively].Non-O blood type is associated with future CVEs in Chinese Han patients undergoing coronary angiography.

Soluble CD40 Ligand in Aspirin-Treated Patients Undergoing Cardiac Catheterization.

Plasma soluble CD40 ligand (sCD40L) is mainly generated by cleavage of CD40L from the surface of activated platelets, and therefore considered a platelet activation marker. Although the predictive value of sCD40L for ischemic events has been demonstrated in patients with acute coronary syndromes (ACS), studies on the association of sCD40L with cardiovascular outcomes in lower risk populations yielded heterogeneous results. We therefore sought to investigate factors influencing sCD40L levels, and the predictive value of sCD40L for long-term ischemic events in unselected, aspirin-treated patients undergoing cardiac catheterization. sCD40L was determined by a commercially available enzyme-linked immunosorbent assay in 682 consecutive patients undergoing cardiac catheterization. Two-year follow-up data were obtained from 562 patients. Dual antiplatelet therapy with aspirin and clopidogrel was associated with significantly lower levels of sCD40L and lower platelet surface expressions of P-selectin and activated GPIIb/IIIa compared to aspirin monotherapy (all p≤0.01). Hypertension was linked to lower plasma concentrations of sCD40L, whereas female sex, increasing high-sensitivity C-reactive protein, and hematocrit were associated with higher sCD40L concentrations (all p<0.05). sCD40L levels were similar in patients without and with the primary endpoint in the overall study population (p = 0.4). Likewise, sCD40L levels did not differ significantly between patients without and with the secondary endpoints (both p≥0.4). Similar results were obtained when only patients with angiographically-proven coronary artery disease (n = 459), stent implantation (n = 205) or ACS (n = 125) were analyzed. The adjustment for differences in patient characteristics by multivariate regression analyses did not change the results. ROC curve analyses did not reveal cut-off values for sCD40L for the prediction of the primary or secondary endpoints. In conclusion, plasma sCD40L levels are reduced by antiplatelet therapy with clopidogrel, but not associated with long-term ischemic outcomes in unselected consecutive aspirin-treated patients undergoing cardiac catheterization.

Classification of risk factors for coronary artery disease (CAD) in young patients (=

Classification of risk factors for coronary artery disease (CAD) in young patients (=<45 years) with angiographically-proven CAD

Association of serum uric acid and coronary artery disease in premenopausal women.

ObjectiveTo date, no study in the published literature has investigated the role of various serum uric acid (SUA) concentrations in the development of angiographically-proven coronary artery disease (CAD) in premenopausal women. Therefore, the aim of this study was to investigate the role SUA levels may play in the prevalence, severity, and prognosis of CAD in premenopausal women.MethodsThis cross-sectional retrospective study included 607 premenopausal women who had undergone coronary angiography. The CAD diagnosis was based upon stenosis affecting ≥50% of the luminal diameter. Association of the SUA levels with CAD prevalence, severity, and clinical outcomes were assessed by statistical analysis.ResultsIn total, 369 (60.8%) of the patients were diagnosed with CAD. The CAD patients had significantly higher SUA levels than those without CAD (5.3±1.9 vs. 4.8±1.7 mg/dL, P = 0.001). The SUA levels were found to be significantly associated with CAD prevalence (P = 0.013). Patients with higher levels of SUA also showed increased rates of multivessel disease and composite end-points, such as major adverse cardiac events. Furthermore, multivariate analysis identified abnormally high levels of uric acid (hyperuricemia) as an independent risk factor for CAD (OR 1.51 (1.11–2.53), P<0.05).ConclusionsThe SUA levels are significantly associated with the prevalence of CAD. The SUA levels may be a predictor for incidence of major cardiovascular events in premenopausal women.

THU0376 Cardiovascular and Metabolic Risk Factors in Inherited Auto-Inflammation

BackgroundLow-grade inflammation is a risk factor for coronary artery disease. Yet, clinical data on patients with inherited auto-inflammation are limited.ObjectivesTo assess the natural progression of cardiovascular and metabolic risk among...

Implications of Coronary Artery Disease in Heart Failure With Preserved Ejection Fraction

This study investigated the characteristics, evaluation, prognostic impact, and treatment of coronary artery disease (CAD) in patients with heart failure and preserved ejection fraction (HFpEF). CAD is common in patients with HFpEF, but it remains unclear how CAD should be categorized, evaluated for, and treated in HFpEF. Clinical, hemodynamic, echocardiographic, treatment, and outcome characteristics were examined in consecutive patients with previous HFpEF hospitalizations who underwent coronary angiography. Of the 376 HFpEF patients examined, 255 (68%) had angiographically-proven CAD. Compared with HFpEF patients without CAD, patients with CAD were more likely to be men, to have CAD risk factors, and to be treated with anti-ischemic medications. However, symptoms of angina and heart failure were similar in patients with and without CAD, as were measures of cardiovascular structure, function, and hemodynamics. Compared with patients without CAD, HFpEF patients with CAD displayed greater deterioration in ejection fraction and increased mortality, independent of other predictors (hazard ratio: 1.71, 95% confidence interval: 1.03 to 2.98; p= 0.04). Complete revascularization was associated with less deterioration in ejection fraction and lower mortality compared with patients who were not completely revascularized, independent of other predictors (hazard ratio: 0.56, 95% confidence interval: 0.33 to 0.93; p= 0.03). CAD is common in patients with HFpEF and is associated with increased mortality and greater deterioration in ventricular function. Revascularization may be associated with preservation of cardiac function and improved outcomes in patients with CAD. Given the paucity of effective treatments for HFpEF, prospective trials are urgently needed to determine the optimal evaluation and management of CAD in HFpEF.

Response: A1c Variability Can Predict Coronary Artery Disease in Patients with Type 2 Diabetes with Mean A1c Level Greater than 7 (Endocrinol Metab 2013;28:125-32, Eun Ju Lee et al.)

The authors would like to thank the reviewers for their kind comments concerning our manuscript. We sought to determine the effect of long-term A1c variability on the prediction of coronary artery disease (CAD) in type 2 diabetes mellitus (T2DM) in this study. We concluded that A1c variability determined by standard deviation (SD) of serial A1c can be an independent predictor for angiography-proven CAD in T2DM with mean A1c levels over 7%. We agree with the reviewer's comments. Renal function or urine albumin excretion of the subjects can be independent factors of cardiovascular disease (CVD) outcome [1]. Recently, there have been studies about the relationship between A1c variability and microvascular complications, including microalbuminuria, in patients with T2DM [2,3]. We also have investigated the relationships between A1c variability and diabetic nephropathy using the data of other subjects. This study, however, was a retrospective observational study and there were many limitations, despite our efforts to minimize them. We included subjects who were admitted to the cardiology department due to chest pain. Thus, we did not have enough data including microalbuminuria. We feel that additional analysis including microalbuminuria is needed. As mentioned in the letter, another study has been released with contrary results suggesting that A1c variability does not have a major impact on macrovascular complications in patients with T2DM [4]. In that study, risk factors of the subjects, including renal function or urine albumin excretion, were included in multiple regression analysis, but prevalent CVD at baseline included acute myocardial infarction (AMI), stroke, foot ulcer or gangrene, amputation, coronary, carotid, lower limb revascularization, and surgery for aortic aneurysm. Intra-individual standard deviation of HbA1c (HbA1c-SD) and adj-HbA1c-SD (HbA1c-SD adjusted by number of HbA1c assessment) were not higher in patients with a history of any CVD, but HbA1c-SD and adj-HbA1c-SD were significantly higher in subjects with AMI. Our study included only subjects with CAD according to coronary angiography. To investigate whether A1c SD was an independent predictor of CAD, we analyzed the incidence of CAD according to tertiles of A1c SD. In contrast, Penno et al. [4] used the CAD as dependent variable. We surmise that our results differed from those of Penno et al. [4] because of these factors. We feel that a prospective study is needed to further investigate the relationship between of A1c variability and diabetic nephropathy. Thank you again for your interest and comprehensive review of our paper.

Uric acid and prognosis in angiography‐proven coronary artery disease

The optimal uric acid (UA) level associated with the lowest mortality and the strength of association between UA and mortality in various subgroups of patients with coronary artery disease (CAD) are unknown. This study included 13 273 patients with angiographic confirmation of CAD and UA measurements available. The primary outcome analysis was 1-year mortality. Based on the receiver operating characteristic curve analysis, the best cut-off of UA for mortality prediction was 7·11 mg/dL. Using this cut-off, patients were divided into two groups: the group with UA ≤ 7·11 mg/dL (n = 9075) and the group with UA > 7·11 mg/dL (n = 4198). Cardiac mortality was 6·3% (256 deaths) in patients with UA > 7·11 mg/dL and 2·3% (201 deaths) in patients with UA ≤ 7·11 mg/dL [hazard ratio (HR) = 2·82, 95% confidence interval (CI) 2·36-3·36; P < 0·001]. After adjustment for cardiovascular risk factors, UA remained an independent correlate of cardiac mortality (HR = 1·20, 95% CI 1·08-1·34; P = 0·001, for each standard deviation increase in the logarithmic scale of UA). The relationship between cardiac or all-cause mortality and UA showed a J-shaped pattern with lowest mortality in patients with UA between 5·17 and 6·76 mg/dL. UA predicted mortality across all subgroups of patients, with strongest association in women and patients without arterial hypertension. UA predicted an increased risk of cardiac mortality across all subgroups of patients with CAD. The association between UA and cardiac or all-cause mortality had a 'J-shaped' pattern with lowest risk of death in patients with UA levels between 5·17 and < 6·76 mg/dL.

Prognostic value of uric acid in patients with Type 2 diabetes mellitus and coronary artery disease

Studies investigating the prognostic role of UA (uric acid) in patients with Type 2 diabetes mellitus have given conflicting findings. We undertook the present study to assess the association between UA and outcome in patients with Type 2 diabetes mellitus and CAD (coronary artery disease). The study included 3705 patients with diabetes mellitus and angiography-proven CAD. UA was measured before coronary angiography. The primary outcome was 1-year all-cause mortality. The UA concentration [median (25th-75th quartiles)] was 6.44 mg/dl (5.40-7.70 mg/dl). There were 264 deaths (7.1%) during follow-up: 45 deaths in patients of the first UA quartile, 43 deaths in patients of the second UA quartile, 51 deaths in patients of the third UA quartile and 125 deaths in patients of the fourth UA quartile {Kaplan-Meier estimates of mortality, 5.1, 4.8, 5.6 and 14.0% respectively; unadjusted HR (hazard ratio), 2.81 [95% CI (confidence interval), 2.21-3.58]; P<0.001 for fourth quartile compared with first-third quartiles combined}. In the multivariable analysis, UA predicted all-cause mortality with an adjusted HR of 1.29 (95% CI, 1.12-1.48; P<0.001), for each S.D. increase in the logarithmic scale of UA level. The inclusion of UA in the multivariable model alongside known cardiovascular risk factors and other relevant variables increased the discriminatory power of the model regarding prediction of all-cause mortality [absolute and relative IDI (integrated discrimination improvement) 0.034 and 20.5% respectively; P<0.001]. In conclusion, in patients with Type 2 diabetes mellitus and confirmed CAD, elevated levels of UA predict mortality independently of known cardiovascular risk factors.

Association between SUMO4 polymorphisms and coronary artery disease with and without type 2 diabetes mellitus

To assess the role of small ubiquitin-like modifier 4 (SUMO4) gene polymorphisms (rs237025, rs237024 and rs600739) in the susceptibility to coronary artery disease (CAD) with and without type 2 diabetes mellitus (T2DM) in Chinese Han ethnic population in Beijing. In this case-control study, 558 subjects with angiography-proven CAD were divided into two groups according to the WHO 1999 criteria: 369 with normal glucose tolerance (CAD group) and 189 with T2DM (T2DM+ CAD group). Meanwhile 500 healthy subjects free of T2DM and CAD were selected as normal controls (control group). Allelic and genotypic distributions of the three single nucleotide polymorphisms (SNPs) were determined with polymerase chain reaction-high resolution melting curve (PCR-HRM) and gene sequencing. Clinical and biochemical data were compared among carriers of different genotypes through a stratified analysis. No significant difference was found in the distribution of genotypes and alleles of each SNP between different groups (P> 0.05). Nevertheless, stratified analysis indicated a significant difference in plasma triglycerides (rs237025) and body mass index (rs600739) among individuals of different genotypes from the T2DM+ CAD group (P= 0.020 and P= 0.049, respectively). Multiple comparison also indicated that GG genotype of rs237025 had a higher level of plasma triglycerides than AA genotype (P< 0.01). No association between SUMO4 gene polymorphisms and CAD with and without T2DM was detected. Such polymorphisms may not be a risk factor for Chinese Han ethnic patients in Beijing.

Two- and three-locus haplotypes of the paraoxonase (PON1) gene are associated with coronary artery disease in Asian Indians

IntroductionIn view of the reported association of SNPs in the paraoxonase (PON1) gene with coronary artery disease (CAD), and the absence of conclusive data from India, we investigated the relationship of three SNPs at different loci (‐108C/T, L55M and Q192R) of the PON1 gene and their haplotypes with CAD among people residing in the northern plains of India. Materials and methodsOne hundred and seventy-eight healthy controls and two hundred and four angiographically-proven CAD patients were genotyped using PCR-RFLP. ResultsOf the three SNPs, only the R allele of Q192R polymorphism was associated with CAD (p<0.05). Two locus haplotypes QT (OR 0.55, p=0.0004, 95% CI 0.39–0.77, significant) and LQ (odds ratio 0.73, p=0.03, 95% CI 0.55–0.97, trend) showed protective effects, while haplotypes MR (OR=5.36, p=0.0001, 95% CI 2.045–14.049) and MC (OR=2.71, p=0.011, 95% CI 1.221–6.046) were associated with increased risk of CAD. MRT, a minor three-locus haplotype also displayed significant association (OR 4.93, 95% CI 1.7–13.5) with the disease. Significance was assessed after applying Bonferroni's correction. ConclusionsOur study revealed that only one SNP at a single locus but several haplotype combinations of PON1 coding and promoter-region polymorphisms were associated with the risk of or protection against CAD. Thus, haplotype analysis brought better insights into the association of PON1 gene polymorphisms with CAD in Asian Indians.

Serum levels of IgG4 and soluble interleukin-2 receptor in patients with coronary artery disease

BackgroundImmunoglobulin G4 (IgG4)-related immuno-inflammation has been suggested to play a role in the development of remodeling of arterial wall. We investigated the association between serum concentrations of IgG4 or soluble interleukin-2 receptor (sIL-2R) and coronary artery disease (CAD). MethodsSerum concentrations of IgG4 and sIL-2R were measured in 286 patients who underwent coronary angiography. ResultsIn patients with CAD, the medians of serum concentrations of IgG4 (39.3mg/dl) and sIL-2R (388 U/ml) were significantly higher than corresponding values in patients without CAD (IgG4 27.0mg/dl, sIL-2R 312 U/ml). In receiver-operating characteristic curve analysis, the area under the curve of sIL-2R and IgG4 for the presence of CAD was 0.634 and 0.632, respectively. Age- and gender-adjusted logistic regression analysis showed that both of the fourth quartile of sIL-2R concentrations (≥509 U/ml) and that of IgG4 concentrations (≥57.7mg/dl) were found to be associated with CAD with an odds ratio of 2.82 and 4.08, respectively, compared with the corresponding lowest quartile. ConclusionsSerum concentrations of IgG4 and sIL-2R were increased in patients with angiographically-proven CAD, suggesting that IgG4-related immuno-inflammation may also have a role in the development and/or progression of coronary artery atherosclerosis.

Abstract 9946: Serum Immunoglobulin G4 Levels Are Increased in Patients with Coronary Artery Disease but Not in Atherosclerotic Aortic Aneurysm

Objectives: Immunoglobulin G4 (IgG4)-related sclerosing disease may manifest as cardiovascular disorders, such as inflammatory abdominal aortic aneurysm and lymphoplasmacytic aortitis. Immune inflammatory process is recognized to underlie the pathogenesis of atherosclerosis, thus we investigated the serum levels of IgG4. Methods: Serum levels of IgG4 and soluble interleukin-2 receptor (sIL-2R), another marker for lymphocytic activation, were measured in 571 patients (424 males) who underwent coronary angiography. Among the 571 patients enrolled, 409 patients had angiographically-proven coronary artery disease (CAD). In addition, 86 patients had aortic aneurysm: abdominal aortic aneurysm alone, 49; thoracic aortic aneurysm alone, 21, and both abdominal and thoracic aortic aneurysm, 16. Results: The mean age of the 571 patients was 66.9 ± 10.3 years. In patients with CAD, the medians of serum levels of IgG4 (34.1 mg/dL) and sIL-2R (396 U/mL) were significantly higher than in those without CAD (IgG4, 30.5 mg/dL, P=0.045; sIL-2R, 322 U/mL, P&lt;0.001). Age and gender-adjusted logistic regression analysis showed that the first (151-292 U/mL), second (293-378 U/mL), third (379-509 U/mL), and fourth (510-3180 U/mL) quartiles of sIL-2R levels had the graded association with CAD with the odds ratio of 1 (reference), 2.21 (95% CI 1.32-3.71), 2.25 (95% CI 1.32-3.85), and 2.50 (95% CI 1.45-4.30), respectively. The fourth quartiles of IgG4 (≥ 57.1 mg/dL) and sIL-2R (≥ 510 U/mL) were also predictive of CAD with an odds ratio of 2.21 and 2.13, respectively, compared with the lowest quartiles among 371 subjects without PCI/CABG history. The medians of IgG4 and sIL-2R levels in patients with aortic aneurysm were 36.6 mg/dL and 384 U/mL, respectively, and these did not significantly differ from those without aortic aneurysm (IgG4, 32.5 mg/dL; sIL-2R, 374 U/mL). Conclusions: Serum levels of IgG4, as well as sIL-2R, were significantly higher in patients with CAD than in those without CAD among subjects without previous coronary interventions, suggesting that IgG4-related immune inflammation may play a role in the coronary atherogenesis. On the other hand, values of these markers did not significantly differ according to the presence or absence of the aortic aneurysm.

Increased thrombin generation and platelet activation are associated with deficiency in high molecular weight multimers of von Willebrand factor in patients with moderate-to-severe aortic stenosis

BackgroundHigh molecular weight von Willebrand factor (vWF) multimers (HMWM) are often deficient in patients with severe aortic stenosis (AS) owing to shear stress-enhanced proteolysis of vWF. It has also been...

NON INVASIVE STUDY OF CORONARY FLOW RESERVE AND AORTIC STIFFNESS IN PATIENTS WITH CHEST PAIN AND NEAR NORMAL CORONARY ARTERIES: PP.10.413

Increased aortic stiffness is an independent predictor of cardiovascular events. On the other hand, a decrease in coronary flow reserve (CFR) in patients without significant coronary artery disease (CAD), has been found as a risk factor of long-term myocardial infarction (36–48 months). Experimental studies have shown that a decreased coronary blood flow was associated with a stiffer aorta, but such a relationship has never been investigated in patients without angiography-proven CAD. The aim of our study was to look for a significant association between aortic stiffness and CFR, in patients referred for chest pain, but without any CAD at angiography. Forty-five consecutive patients (27 men, 60 ± 16 years of age) were recruited; all of them fulfilled following criteria: history of angina-like chest pain, normal coronary artery angiography or presence of nonsignificant (<50%) stenosis in any major vessels. All patients underwent a myocardial echography at rest and during adenosine using standard 2D- echography, as well as a CRF evaluation of the left anterior descending coronary artery using doppler. The aortic stiffness was analysed by the measure of the pulse wave velocity (PWV), using doppler ultrasound method. Mean CFR was 2,69  ± 0,78 and 10 patients were found with an abnormal CRF (≤2). Patients with a decreased CRF had a significantly higher PWV, as compared with those having a normal CRF (≥ 3). (95% CI: 8.3–14.1 m/s vs. 7.6–9.8 m/s p = 0,03). Furthermore, there was a positive correlation between aortic stiffness and disorders of left ventricular diastolic function (E/A and PWV: r = -0,53 p < 0,0001, E/Ea and PWV: r = 0,33 p < 0,02, TRI and PWV: r = 0.36 p = 0.01, E mitral deceleration time and PWV: r = 0.62 p < 0.0001). To conclude: in symptomatic patients with angiographically normal or near normal coronary arteries, a higher aortic stiffness has been found to be associated with a lower CFR and more pronounced diastolic TTE parameters alteration. Accordingly, measurement of PWV in such patients should help to propose an appropriate cardiological follow-up.

Hepatitis B Virus Infection and the Risk of Coronary Atherosclerosis

Many studies have reported on the association between human coronary artery disease (CAD) and certain persistent bacterial and viral infections. Currently, it is unclear whether hepatitis B virus infection is associated with the risk of the atherosclerosis. The aim of this study was to investigate the possible association between hepatitis B virus infection and angiography-proven CAD. Sera from 5,004 patients who underwent coronary angiography were tested for hepatitis B surface antigen (HBsAg) by enzyme-linked immunosorbant assay at Madani Heart Hospital, Tabriz University of Medical Sciences, Iran. Our study population comprised 66% male and 34% female, with an age range of 36 to 86 years. The prevalence of HBsAg positivity tended to be higher in CAD patients than in those without CAD (3.28% versus 2.17%), but the difference was not statistically significant. Our results suggest that hepatitis B virus infection is not associated with coronary atherosclerosis in this population.