Artery Disease Patients Research Articles

The influence of hypothyroidism on the course of coronary artery disease in patients with reduced left ventricular ejection fraction

Background. Thyroid hormones play a fundamental role in the homeostasis of the cardiovascular system. Cardiovascular diseases are among the most common diseases worldwide, causing a significant percentage of mortality, hospitalizations, and disability. The purpose of the study is to evaluate the impact of hypothyroidism on the course of atherosclerotic lesions of coronary arteries and major cardiovascular events in patients with heart failure with reduced left ventricular ejection fraction after myocardial revascularization using percutaneous coronary intervention (PCI). Materials and methods. This prospective observational one-center study included 103 patients with ischemic cardiomyopathy, heart failure with reduced left ventricular ejection fraction, with and without hypothyroidism who underwent PCI. The result of revascularization was evaluated within 2 years. Inclusion criteria: age over 18 years, coronary artery disease, left ventricular ejection fraction less than 40%. Results. Patients with hypothyroidism had a worse lipid profile and, as expected, a higher baseline thyroid-stimulating hormone (TSH). According to echocardiography, patients with hypothyroidism had thickening of the left ventricular myocardium walls, which is indicated by a probable increase in the dimensions of the left ventricular posterior wall (11.40±0.98 mm; p<0.001). In the first group, patients had higher myocardial mass indicators as one of the criteria for left ventricular hypertrophy (172.73±12.72g/m2; p<0.001). After multivariate analysis using Cox proportional hazards regression, an elevated TSH level was still associated with significantly higher rates of cardiovascular mortality (risk ratio (RR) 0.85; 95% confidence interval (CI) 0.75–0.95; p<0.001), repeat PCI (RR 0.75; 95% CI 0.65–0.85; p<0.05) and decompensation due to heart failure (RR 0.88; 95% CI 0.78–0.96; p<0.05). Conclusions. Hypothyroidism is associated with a higher incidence of the primary composite endpoint of repeat PCI, hospitalizations for decompensated heart failure, and the secondary endpoint of cardiovascular mortality compared to euthyroid patients over two years of follow-up. Maintaining adequate control of TSH in patients with coronary artery disease and heart failure with reduced ejection fraction is prognostically important for preventing cardiovascular events.

"Prevalence of Coronary Artery Disease in Patients with Peripheral Arterial Disease at the Hospital de Especialidades CMN La Raza”"

"Prevalence of Coronary Artery Disease in Patients with Peripheral Arterial Disease at the Hospital de Especialidades CMN La Raza”"

Pre-test probability for coronary artery disease in patients with chest pain based on machine learning techniques

A correct and prompt diagnosis of coronary artery disease (CAD) is a crucial component of disease management to reduce the risk of death and improve the quality of life in patients with CAD. Currently, the American College of Cardiology (ACC)/American Heart Association (AHA) and the European Society of Cardiology (ESC) guidelines recommend selecting an appropriate pre-diagnosis test for an individual patient according to the CAD probability. The purpose of this study was to develop a practical pre-test probability (PTP) for obstructive CAD in patients with chest pain using machine learning (ML); also, the performance of ML-PTP for CAD is compared to the final result of coronary angiography (CAG). We used a database from a single-center, prospective, all-comer registry designed to reflect real-world practice since 2004. All subjects underwent invasive CAG at Korea University Guro Hospital in Seoul, South Korea. We used logistic regression algorithms, random forest (RF), supporting vector machine, and K-nearest neighbor classification for the ML models. The dataset was divided into two consecutive sets according to the registration period to validate the ML models. ML training for PTP and internal validation used the first dataset registered between 2004 and 2012 (8631 patients). The second dataset registered between 2013 and 2014 (1546 patients) was used for external validation. The primary endpoint was obstructive CAD. Obstructive CAD was defined as having a stenosis diameter of >70% on the quantitative CAG of the main epicardial coronary artery. We derived an ML-based model consisting of three different models according to the subject used to obtain the information, such as the patient himself (dataset 1), the community's first medical center (dataset 2), and doctors (dataset 3). The performance range of the ML-PTP models as the non-invasive test had C-statistics of 0.795 to 0.984 compared to the result of invasive testing via CAG in patients with chest pain. The training ML-PTP models were adjusted to have 99% sensitivity for CAD so as not to miss actual CAD patients. In the testing dataset, the best accuracy of the ML-PTP model was 45.7% using dataset 1, 47.2% using dataset 2, and 92.8% using dataset 3 and the RF algorithm. The CAD prediction sensitivity was 99.0%, 99.0%, and 98.0%, respectively. We successfully developed a high-performance model of ML-PTP for CAD which is expected to reduce the need for non-invasive tests in chest pain. However, since this PTP model is derived from data of a single medical center, multicenter verification is required to use it as a PTP recommended by the major American societies and the ESC.

Can HDL cholesterol be replaced by paraoxonase 1 activity in the prediction of severe coronary artery disease in patients with type 2 diabetes?

Background and aimsNovel biomarkers are required to improve cardiovascular disease prediction in patients with type 2 diabetes (T2D) as a high-risk population. This study was conducted to examine whether coronary artery disease (CAD) risk assessment can be improved by substituting high-density lipoprotein (HDL)-bound paraoxonase 1 (PON1) activity for HDL cholesterol (HDL-C) concentration in patients with T2D. Methods and resultsIn this study, we studied 139 patients with T2D (mean age 64.12 ± 8.17 years) who underwent coronary angiographic examination. The initial rate of substrate hydrolysis was spectrophotometrically assayed in kinetic mode for measuring PON1 activity. Receiver operating characteristic (ROC) graphs are created by plotting true positivity versus false positivity. In patients with HbA1c ≥ 7%, PON1 (AUC = 0.7, p = 0.029) and nonHDL-C/PON1 (AUC = 0.75, p = 0.013) were significantly more capable of differentiating patients with CAD from those without CAD compared to HDL-C and nonHDL-C/HDL-C. Also, the predictive power of PON1 (AUC = 0.64, p = 0.029) and nonHDL-C/PON1 (AUC = 0.71, p = 0.004) were significantly higher in comparison with HDL-C and nonHDL-C/HDL-C for CAD characterization in patients aged ≥50 years. Moreover, PON1 and nonHDL-C/PON1 are associated with the incidence of CAD with an AUC of 0.7 (p = 0.026) and AUC of 0.64 (p = 0.087), respectively, among subjects with low HDL-C. ConclusionPON1 and the ratio of nonHDL-C/PON1 significantly improve the prediction of severe CAD in T2D patients and in patients with HbA1c ≥ 7%, age ≥50 years, or low HDL-C. PON1 activity and lipid ratios using this enzyme may be valuable as substitutes of HDL-C for increasing clinical efficacies in cardiovascular risk assessment.

Association between the Japanese Diet and Coronary Artery Disease in Patients Undergoing Coronary Angiography.

Several cohort studies have reported that the Japanese diet is associated with reduced cardiovascular disease mortality. However, the results were not always consistent, and most of those studies conducted dietary surveys around 1990. We investigated the association between the Japanese diet and coronary artery disease (CAD) in 802 patients undergoing coronary angiography. The Japanese diet score was defined as the sum of scores of the intakes of fish, soy products, vegetables, seaweed, fruits, and green tea. CAD was found in 511 patients, of whom 173 had myocardial infarction (MI). Intakes of fish, soy products, vegetables, seaweed, fruits, and green tea were lower in patients with CAD, especially in those with MI, than in those without CAD. As a result, the Japanese diet score was significantly lower in patients with CAD than in those without CAD (p < 0.001). To clarify the association between the Japanese diet and CAD, the 802 study patients were divided into three tertiles by the Japanese diet score. The proportion of CAD decreased with the Japanese diet score, reaching 72% in patients at T1 (lowest score), 63% at T2, and 55% at T3 (highest) (p < 0.05). The proportion of MI also decreased with the Japanese diet score, reaching 25% at T1, 24% at T2, and 15% at T3 (p < 0.05). In a multivariate analysis, compared with T1, the adjusted odds ratios for CAD and MI were 0.41 (95% confidence interval [CI]: 0.26-0.63) and 0.61 (95% CI: 0.38-0.99) for T3, respectively. Thus, the Japanese diet was found to be inversely associated with CAD in Japanese patients undergoing coronary angiography.

Strain Rate Changes during Stress Echocardiography Are the Most Accurate Predictors of Significant Coronary Artery Disease in Patients with Previously Treated Acute Coronary Syndrome.

Dobutamine stress echocardiography (DSE) is a well-established non-invasive investigation for the detection of ischemic myocardial dysfunction. The aim of this study was to evaluate the accuracy of myocardial deformation parameters measured by speckle tracking echocardiography (STE) in predicting culprit coronary artery lesions in patients with prior revascularization and acute coronary syndrome (ACS). We prospectively studied 33 patients with ischemic heart disease, a history of at least one episode of ACS and prior revascularization. All patients underwent a complete stress Doppler echocardiographic examination, including the myocardial deformation parameters of peak systolic strain (PSS), peak systolic strain rate (SR) and wall motion score index (WMSI). The regional PSS and SR were analyzed for different culprit lesions. The mean age of patients was 59 ± 11 years and 72.7% were males. At peak dobutamine stress, the change in regional PSS and SR in territories supplied by the LAD showed smaller increases compared to those in patients without culprit LAD lesions (p < 0.05 for all). Likewise, the regional parameters of myocardial deformation were reduced in patients with culprit LCx lesions compared to those with non-culprit LCx lesions and in patients with culprit RCA legions compared to those with non-culprit RCA lesions (p < 0.05 for all). In the multivariate analysis, the △ regional PSS (1.134 (CI = 1.059-3.315, p = 0.02)) and the △ regional SR (1.566 (CI = 1.191-9.013, p = 0.001)) for LAD territories predicted the presence of LAD lesions. Similarly, in a multivariable analysis, the △ regional PSS and the △SR predicted LCx culprit lesions and RCA culprit lesions (p < 0.05 for all). In an ROC analysis, the PSS and SR had higher accuracies compared to the regional WMSI in predicting culprit lesions. A △ regional SR of -0.24 for the LAD territories was 88% sensitive and 76% specific (AUC = 0.75; p < 0.001), a △ regional PSS of -1.20 was 78% sensitive and 71% specific (AUC = 0.76, p < 0.001) and a △ WMSI of -0.35 was 67% sensitive and 68% specific (AUC = 0.68, p = 0.02) in predicting LAD culprit lesions. Similarly, the △ SR for LCx and RCA territories had higher accuracies in predicting LCx and RCA culprit lesions. The myocardial deformation parameters, particularly the change in regional strain rate, are the most powerful predictors of culprit lesions. These findings strengthen the role of myocardial deformation in increasing the accuracy of DSE analyses in patients with prior cardiac events and revascularization.

Increased selenium and decreased iron levels in relation to risk of coronary artery disease in patients with diabetes.

Observational studies have reported inconsistent associations between micronutrient levels and the risk of coronary artery disease (CAD) in diabetic patients. We aim to explore the causal association between genetically predicted concentrations of micronutrients (phosphorus, magnesium, selenium, iron, zinc, and copper) and CAD in patients with diabetes. Single nucleotide polymorphisms (SNPs) connected to serum micronutrient levels were extracted from the corresponding published genome-wide association studies (GWASs). Summary-level statistics for CAD in diabetic patients were obtained from a GWAS of 15,666 patients with diabetes. The primary analysis was carried out with the inverse variance weighted approach, and sensitivity analyses using other statistical methods were further employed to assess the robustness of the results. Genetically predicted selenium level was causally associated with a higher risk of CAD in diabetic patients (odds ratio [OR]: 1.25; 95% confidence interval [CI]: 1.10-1.42; p = 5.01 × 10-4). While, genetically predicted iron concentrations in patients with diabetes were inversely associated with the risk of CAD (OR: 0.82; 95% CI: 0.75-0.90; p = 2.16 × 10-5). The association pattern kept robust in most sensitivity analyses. Nominally significant associations were observed for magnesium and copper with the risk of CAD in patients with diabetes. No consistent evidence was found for the causal associations between phosphorus and zinc levels, and the risk of CAD in patients with diabetes. We provide consistent evidence for the causal effect of increased selenium and decreased iron levels on CAD in patients with diabetes, highlighting the necessity of micronutrient monitoring and application in these patients.

Association of carotid atherosclerosis and peripheral artery disease in patients with type 2 diabetes: risk factors and biomarkers

BACKGROUND: Carotid atherosclerosis (CA) and lower extremity peripheral artery disease (PAD) is a common and potentially life-threatening comorbidity in diabetes.AIM: to determine risk factors and biomarkers of the association of CA and PAD in patients with type 2 diabetes.MATERIALS AND METHODS: A single-center cross-sectional comparative study was carried out. Three hundred ninety one patients with type 2 diabetes were included. Duplex ultrasound of carotid and low limb arteries, screening/monitoring of diabetic complications and associated diseases, and assessment of glycemic control, biochemical and coagulation parameters were performed. Factors involved in vascular wall remodeling, including calponin-1, relaxin, L-citrulline, matrix metalloproteinase-2 and -3, were measured in blood serum by ELISA.RESULTS: The signs of CA and PAD were observed in 330 and 187 patients respectively. In 178 patients, both CA and PAD were revealed. The risk of combined involvement of carotid and lower extremity arteries was higher in patients with diabetic retinopathy (OR=2.57, p&lt;0.001), chronic kidney disease (OR=4.48, p&lt;0.001), history of myocardial infarction (OR=5.09, p&lt;0.001), coronary revascularization (OR=4.31, p&lt;0.001) or cerebrovascular accident (OR=3.07, p&lt;0.001). In ROC-analysis, age ≥65.5 years (OR=3.43, p&lt;0.001), waist-to-hip ratio ≥0.967 (OR=3.01, p=0.001), diabetes duration ≥12.5 years (OR=3.7, p&lt;0.001), duration of insulin therapy ≥4.5 years (OR=3.05, p&lt;0.001), duration of arterial hypertension ≥16.5 years (OR=1.98, p=0.002), serum L-citrulline ≥68 µmol/l (OR=3.82, p=0.003), and mean amplitude of glucose excursions ≥3.72 mmol/l (OR=1.79, p=0.006) were the risk factors for atherosclerosis of two vascular beds. In multivariate logistic regression analysis, age, diabetes duration and waist-to-hip ratio were independent risk factors for association of CA and PAD (p=0.005, p=0.0003, and p=0.004 respectively).CONCLUSION: In subjects with type 2 diabetes, carotid and lower extremity atherosclerotic disease is associated with age, diabetes duration, abdominal obesity, microvascular and macrovascular complications, glucose variability, and high serum levels of L-citrulline.

Predictors of Non-Obstructive Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography.

Appropriate patient selection for coronary angiography (CAG) is essential to minimize the unnecessary risk of morbidities and exposure to radiation and iodinated contrast. This becomes even more relevant in low-to-middle-income settings where most health expenditures are out-of-pocket due to lack of medical insurance. We determined predictors of non-obstructive coronaries (NOC) in patients undergoing elective CAG. CathPCI Registry®, single-center data was extracted for 25,472 patients who had CAG over an eight year period. After excluding patients for compelling conditions or known CAD, 2,984 (11.7%) patients were included in this study. Non-Obstructive Coronaries was defined as <50% left main coronary artery and major epicardial vessel stenosis. Multiple Cox proportional algorithm was employed to report prevalence ratios (PR) of predictors of NOC along with 95% confidence interval. Mean age of patients was 57.9 ± 9.7 years, 23.5% were women. Preprocedural non-invasive testing (NIT) was performed in 46% of the patients; of which 95.5% reported to be positive but only 67.3% were stratified as high risk. Of 2,984 patients undergoing elective CAG, 711 (24%) had NOC. Predictors of NOC included younger age <50 years (PR: 1.3, CI: 1.0-1.5), Women (1.8, 1.5-2.1), low (1.9, 1.5-2.5) and intermediate risk stratification (1.3, 1.0-1.6) on Modified Framingham Risk Score and inappropriate (2.7, 1.6-4.3) and uncertain (1.3, 1.1-1.6) classification of CAG on Appropriate Use Criteria. Patients with heart failure as an indication of CAG (1.7, 1.4-2.0) and No NIT or positive low risk NIT (1.8, 1.5-2.2) were more likely to have NOC. Approximately one out of four patients undergoing elective CAG had NOC. Yield of diagnostic catheterization can be improved by adjudicating NIT especially in younger patients, women, patients with heart failure as an indication of CAG, patients classified as inappropriate on Appropriate Use Criteria and patients categorized as low or intermediate risk on MFRS.

Observational Study on Incidence of Peripheral Arterial Disease in Patients with Varicose Veins and Need for Concomitant Treatment of Both Arterial Disease and Venous Disease in a Tertiary Care Centre

Observational Study on Incidence of Peripheral Arterial Disease in Patients with Varicose Veins and Need for Concomitant Treatment of Both Arterial Disease and Venous Disease in a Tertiary Care Centre

Association between ACE I/D genetic polymorphism and the severity of coronary artery disease in Vietnamese patients with acute myocardial infarction.

The severity of coronary artery disease is a prognostic factor for major adverse cardiovascular events in patients diagnosed with acute myocardial infarction. ACE I/D polymorphism is one of the genetic factors that may affect the severity of coronary artery disease. This study aimed to investigate the association between ACE I/D genotypes and the severity of coronary artery disease in patients with acute myocardial infarction. A single-center, prospective, observational study was conducted at the Department of Cardiology and Department of Interventional Cardiology, Cho Ray Hospital, Ho Chi Minh City, Vietnam from January 2020 to June 2021. All participants diagnosed with acute myocardial infarction underwent contrast-enhanced coronary angiography. The severity of coronary artery disease was determined by Gensini score. ACE I/D genotypes were identified in all subjects by using the polymerase chain reaction method. A total of 522 patients diagnosed with first acute myocardial infarction were recruited. The patients' median Gensini score was 34.3. The II, ID, and DD genotype rates of ACE I/D polymorphism were 48.9%, 36.4%, and 14.7%, respectively. After adjusting for confounding factors, multivariable linear regression analysis showed that the ACE DD genotype was independently associated with a higher Gensini score compared with the II or ID genotypes. The DD genotype of the ACE I/D polymorphism was associated with the severity of coronary artery disease in Vietnamese patients diagnosed with first acute myocardial infarction.

Prior COVID-19 infection is associated with increased coronary artery ectasia and higher thrombus burden in acute coronary syndromes

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This work was part funded by King’s College Hospital R&amp;D Grant and was supported by the Department of Health via a National Institute for Health Research Biomedical Research Centre award to Guy’s &amp; St Thomas’ NHS Foundation Trust in partnership with King’s College London and King’s College Hospital NHS Foundation Trust. AMS is supported by the British Heart Foundation. Background/Introduction The COVID-19 pandemic is associated with a profound inflammatory response and a hypercoagulable state in the acute infection, however little is known on whether endothelial dysfunction and hypercoaguability can persist beyond this phase, as well as its impact on acute coronary syndrome (ACS). Purpose The objective of this study was to investigate the effects of COVID-19 infection on the presentations and outcomes of coronary artery disease in patients with acute coronary syndrome. Methods Blood samples were obtained from all consenting patients aged 18 or over presenting between 10/06/2020 and 06/05/2021 with suspected ACS. Participants were excluded if they had active COVID-19 infection or if they did not undergo coronary angiography on admission. The blood samples were tested for COVID-19 nucleocapsid antibody and anti-SARS-CoV-2 spike protein receptor binding domain (RBD) antibody levels to determine whether the participants had prior COVID-19 infection, COVID-19 vaccination, or neither at the time of their presentation. Baseline demographics, clinical presentation and coronary angiographic findings were recorded. The patients were followed up at 30 days and 1 year. The primary endpoint was all-cause mortality. The pre-specified secondary endpoints were stroke, repeat MI, unplanned revascularisation or death at 1-year, coronary artery ectasia (defined as dilatation of an arterial segment at least 1.5 times that of the adjacent normal coronary artery), presence of thrombus, and thrombectomy requirement. Results Of the 280 patients who consented for the study, 5 patients dropped out, 8 were lost to follow-up, 2 did not undergo coronary angiography, and 98 had uninterpretable blood samples for antibody analysis. In the final analysis of the study population of 167 patients (median age 64), 22 (13.1%) had prior infection, 76 (45.5%) were negative for COVID-19 antibodies and 69 (41.3%) were vaccinated. There were no differences in rates of STEMI between the different study groups. There was no difference in the primary endpoint between the groups. However, patients with prior COVID-19 infection were more likely to have coronary ectasia compared to vaccinated and antibody negative patients (57.71% vs 27.5% and 30.3%, respectively p = 0.034). They were also more likely to have thrombus present on angiography (61.9% vs 33.3% and 52.6%, p = 0.019) and more likely to require thrombectomy (19.0% vs 4.3% and 3.9%, p=0.027). Patients with prior COVID-19 infection were also more likely to present with myocarditis (18.2% vs 1.4% and 1.3%, p&amp;lt;0.001). Conclusion In summary, our findings support the notion that COVID-19 infection leads to persistent endothelial dysfunction and hypercoagulability which portends increased severity of coronary artery ectasia and coronary thrombosis even after recovery from the initial infection.

Peripheral artery disease in patients with acute coronary syndrome without ST-segment elevation: impact on therapy and prognosis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Peripheral artery disease (PAD) is an important co-morbidity in non-ST-segment elevation acute coronary syndromes (NSTEMI), and its presence may affect the therapeutic approach and prognosis of these patients. Purpose To assess the impact of PAD presence on therapeutic approach, clinical outcome, and in-hospital and 1-year mortality in patients with NSTEMI. Methods We studied 7248 patients with NSTEMI included in a national multicenter registry. We considered 2 groups: patients with PAD and patients without PAD. Demographic variables, CV risk factors, inpatient therapy, left ventricular function (LVF), coronary angiography and revascularization strategy performed were recorded. The following in-hospital adverse events (AE) were defined: death, re-infarction, stroke, heart failure (HF), cardiogenic shock (CC), major bleeding (MH), need for blood transfusion (BT). Length of stay (IT) and in-hospital and 1-year mortality were evaluated. Multivariate analysis was performed to assess whether the presence of PAD is a predictor of HAS and/or 1-year mortality. Results The presence of PAD was 7.3% (526 patients). These patients were older (70±11 vs 67±13 years, p&amp;lt;0.001), higher prevalence of males (82.1 vs 70.7%, p&amp;lt;0.001), arterial hypertension (87.4 vs 74.1%, p&amp;lt;0.001), diabetes mellitus ( 55.3 vs 32.3%, p&amp;lt;0.001), dyslipidemia (76 vs 61.9%, p&amp;lt;0.001), previous AMI (48.4 vs 24.6%, p&amp;lt;0.001), previous PCI (28.4 vs 17.5%, p&amp;lt;0.001), CABG ( 20.0 vs 6.5%, p&amp;lt;0.001), stroke (25.4 vs 7.5%, p&amp;lt;0.001) and chronic renal failure (22.9 vs 6.3%, p&amp;lt;0.001). Patients with PAD: evolved more frequently in Killip≥II (26.0 vs 13.9%, p&amp;lt;0.001), with LV dysfunction (LVF&amp;lt;50%: 42.7 vs 28.3%, p&amp;lt;0.001) and the need for non-invasive ventilation (3 vs 1.7%, p=0.019). Patients with PAD were less frequently medicated with beta-blockers (75 vs 87.5%, p&amp;lt;0.001) and more frequently with diuretics (47.3 vs 26.6%, p&amp;lt;0.001). Patients with PAD underwent fewer coronary angiograms (69.8 vs 85.6%, p&amp;lt;0.002), but the femoral approach was more used (35.2 vs 21.4%) and had more multivessel disease (76.7 vs 52.4%, p&amp;lt;0.001). Patients with PAD had a longer in-hospital stay duration (median 7 vs 5 days, p&amp;lt;0.001), higher incidence of re-AMI (3.1 vs 1.4%, p=0.003), HF (26.7 vs 12.4%, p=0.002), CC (3.2 vs 1.8%, p=0.016), MH (2.3 vs 1.1%, p=0.001) and BT (4.6 vs 1.6%, p&amp;lt;0.001), but not stroke. In-hospital mortality was higher (4 vs 2%, p=0.003) as well as 1-year mortality (16.2 vs 6.2%, p&amp;lt;0.001). By multivariate analysis, PAD was an independent predictor of 1-year mortality (OR=1.57, 95% CI [1.04-2.58], p=0.032), but not of AE. Conclusion The presence of PAD affects the therapy and revascularization strategy in patients with NSTEMI, being associated with higher in-hospital morbidity and mortality. This co-morbidity constitutes an independent predictor of death at 1 year.

Feasibility of Artificial Intelligence–Based Electrocardiography Analysis for the Prediction of Obstructive Coronary Artery Disease in Patients With Stable Angina: Validation Study

Despite accumulating research on artificial intelligence-based electrocardiography (ECG) algorithms for predicting acute coronary syndrome (ACS), their application in stable angina is not well evaluated. We evaluated the utility of an existing artificial intelligence-based quantitative electrocardiography (QCG) analyzer in stable angina and developed a new ECG biomarker more suitable for stable angina. This single-center study comprised consecutive patients with stable angina. The independent and incremental value of QCG scores for coronary artery disease (CAD)-related conditions (ACS, myocardial injury, critical status, ST-elevation myocardial infarction, and left ventricular dysfunction) for predicting obstructive CAD confirmed by invasive angiography was examined. Additionally, ECG signals extracted by the QCG analyzer were used as input to develop a new QCG score. Among 723 patients with stable angina (median age 68 years; male: 470/723, 65%), 497 (69%) had obstructive CAD. QCG scores for ACS and myocardial injury were independently associated with obstructive CAD (odds ratio [OR] 1.09, 95% CI 1.03-1.17 and OR 1.08, 95% CI 1.02-1.16 per 10-point increase, respectively) but did not significantly improve prediction performance compared to clinical features. However, our new QCG score demonstrated better prediction performance for obstructive CAD (area under the receiver operating characteristic curve 0.802) than the original QCG scores, with incremental predictive value in combination with clinical features (area under the receiver operating characteristic curve 0.827 vs 0.730; P<.001). QCG scores developed for acute conditions show limited performance in identifying obstructive CAD in stable angina. However, improvement in the QCG analyzer, through training on comprehensive ECG signals in patients with stable angina, is feasible.

Epidemiological Aspects of the Carotid Artery Disease in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Background and aims: Concomitant carotid artery disease (CaAD) in patients referred to coronary surgical revascularization is a strong hazard to perioperative stroke. The current study addressed the epidemiology features of concomitant CaAD in patients referred to a coronary surgical revascularization center. Methods: This descriptive-analytical cross-sectional study was conducted on all incoming patients to coronary surgical revascularization for two years at a single center who underwent a color duplex-sonography (CDS) interrogation. The demographic, clinical, echocardiographic, coronary angiographic, and color duplex-sonographic data were collected from patients’ medical records. Quantitative and qualitative data were expressed as means and standard deviations, as well as numbers and percentages, respectively. The relationships between quantitative and qualitative variables were investigated using Pearson’s correlation and chi-square test, respectively. Results: In total, 430 patients with a mean age of 66.3±9.9 years were included (35% females) in the study. Preoperative CDS was performed on 82% of patients; in addition, 29% of them presented with an increased intima-media ratio, and CtAD was observed in 51%. Based on the results, 77 and 143 patients were detected with unilateral and bilateral involvement, respectively. Severe carotid stenosis accounted for 4% of patients. Age older than 65 years (P=0.02), unstable angina (P=0.045), and the presence of an occluded coronary artery (P=0.002) were associated with the presence of CtAD. Finally, the severity of the left and right carotid stenosis was associated with diabetes mellitus (P&lt;0.05). Conclusion: The prevalence of concomitant CtAD in patients referred to coronary surgical revascularization remains high. The current data warn of the necessity of performing preoperative CDS routinely.

Management of coronary artery disease in patients undergoing transcatheter aortic valve implantation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions in collaboration with the ESC Working Group on Cardiovascular Surgery.

Significant coronary artery disease (CAD) is a frequent finding in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI), and the management of these two conditions becomes of particular importance with the extension of the procedure to younger and lower-risk patients. Yet, the preprocedural diagnostic evaluation and the indications for treatment of significant CAD in TAVI candidates remain a matter of debate. In this clinical consensus statement, a group of experts from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the European Society of Cardiology (ESC) Working Group on Cardiovascular Surgery aims to review the available evidence on the topic and proposes a rationale for the diagnostic evaluation and indications for percutaneous revascularisation of CAD in patients with severe aortic stenosis undergoing transcatheter treatment. Moreover, it also focuses on commissural alignment of transcatheter heart valves and coronary re-access after TAVI and redo-TAVI.

Predictive Value of Global Longitudinal Strain Imaging in Detecting Significant Coronary Artery Disease in Patients with Non-ST-segment Elevation Myocardial Infarction

Background: Two-dimensional speckle-tracking echocardiography (2D-STE) is a newer method for assessing left ventricular (LV) systolic function. The aim of this study was to assess the predictive value of 2D global longitudinal strain (GLS) in the detection of longitudinal LV systolic dysfunction and the identification of significant coronary artery disease (CAD) in non-ST-segment elevation myocardial infarction (NSTEMI) patients without wall motion abnormalities. Materials and Methods: We enrolled 100 patients who were suspected cases of NSTEMI with echocardiography showing LV ejection fraction &gt;50% and no regional wall motion abnormality. LV myocardial function was assessed using conventional echocardiographic measurements and myocardial deformation analysis with 2D-STE. The patients found to have significant CAD on coronary angiography were included in the cases group and those without significant CAD were considered as controls. Results: Mean age of the patients was 58.36 ± 11.21 years versus 56.54 ± 8.10 years in controls. Male preponderance was found in both case and control groups, with 66% (n = 33) and 56% (n = 28) males, respectively. The patients had significantly lower GLS as compared to the controls (-16.31 ± 1.34% vs -19.17 ± 1.63%, P &lt; 0.001). The patients with positive troponin assay had a lower mean GLS −16.49 ± 1.5% as compared to those with negative troponin assay (−19.32 ± 1.54%, P &lt; 0.001). Multivariate analyses indicated that GLS was an independent predictor of CAD in those with NSTEMI (GLS odds ratio = 0.024, P &lt; 0.001). Conclusions: The present study demonstrates that 2D-STE is superior to conventional echocardiography in excluding significant CAD. It is a promising, easy to perform, bedside tool for diagnosis and prognostication in patients with NSTEMI. GLS has a potential to be used in conjugation with other risk stratification strategies to identify patients at high risk.

D-23 | Gender Differences in Coronary Revascularization for Stable Coronary Artery Disease in Patients With End Stage Kidney Disease

D-23 | Gender Differences in Coronary Revascularization for Stable Coronary Artery Disease in Patients With End Stage Kidney Disease

Atherogenic index of plasma and triglyceride-glucose index to predict more advanced coronary artery diseases in patients with the first diagnosis of acute coronary syndrome.

Coronary heart disease (CHD) is the most common cause of mortality and morbidity. Acute coronary syndrome (ACS) is the most advanced form of the CHD spectrum. The triglyceride-glucose index (TGI) and atherogenic plasma index (AIP) are associated with future cardiovascular events. This study investigated the association of these parameters with the severity of CAD and prognosis in the first-diagnosed ACS patients. Our study was designed retrospectively, including 558 patients. Patients were divided into four subgroups: high and low TGI and high and low AIP. SYNTAX scores, in-hospital mortality, major adverse cardiac events (MACE), and survival were compared at 12-month follow-up. More three-vessel disease and higher SYNTAX scores have been detected in the high AIP and TGI groups. More MACEs have been observed in high AIP and TGI groups than low groups. AIP and TGI were found to be independent predictors for SYNTAX ≥23. While AIP has been found to be an independent risk factor for MACE, TGI has not been detected as an independent risk factor. In addition to AIP, age, three-vessel disease, and lower EF were the independent risk factors for MACE. Survival was lower in high TGP and AIP groups. AIP and TGI are costless bedside parameters that can be easily calculated. These parameters can predict the severity of CAD in first-diagnosed ACS patients. Besides, AIP is an independent risk factor for MACE. AIP and TGI parameters can guide our treatment in this patient population.

Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome and the Main Risk factors

Prevalence of Peripheral Arterial Disease in Patients with Acute Coronary Syndrome and the Main Risk factors