Assessment Of Coronary Artery Disease In Patients Research Articles

Assessment of atherosclerosis in patients with suspected coronary artery disease by carotid artery doppler ultrasound and coronary calcium score

Assessment of atherosclerosis in patients with suspected coronary artery disease by carotid artery doppler ultrasound and coronary calcium score

Influence of Obesity on Coronary Artery Disease and Clinical Outcomes in the ADVANCE Registry.

The relationship between body size and cardiovascular events is complex. This study utilized the ADVANCE (Assessing Diagnostic Value of Noninvasive FFRCT in Coronary Care) Registry to investigate the association between body mass index (BMI), coronary artery disease (CAD), and clinical outcomes. The ADVANCE registry enrolled patients undergoing evaluation for clinically suspected CAD who had >30% stenosis on cardiac computed tomography angiography. Patients were stratified by BMI: normal <25 kg/m2, overweight 25-29.9 kg/m2, and obese ≥30 kg/m2. Baseline characteristics, cardiac computed tomography angiography and computed tomography fractional flow reserve (FFRCT), were compared across BMI groups. Adjusted Cox proportional hazards models assessed the association between BMI and outcomes. Among 5014 patients, 2166 (43.2%) had a normal BMI, 1883 (37.6%) were overweight, and 965 (19.2%) were obese. Patients with obesity were younger and more likely to have comorbidities, including diabetes and hypertension (all P<0.001), but were less likely to have obstructive coronary stenosis (65.2% obese, 72.2% overweight, and 73.2% normal BMI; P<0.001). However, the rate of hemodynamic significance, as indicated by a positive FFRCT, was similar across BMI categories (63.4% obese, 66.1% overweight, and 67.8% normal BMI; P=0.07). Additionally, patients with obesity had a lower coronary volume-to-myocardial mass ratio compared with patients who were overweight or had normal BMI (obese BMI, 23.7; overweight BMI, 24.8; and normal BMI, 26.3; P<0.001). After adjustment, the risk of major adverse cardiovascular events was similar regardless of BMI (all P>0.05). Patients with obesity in the ADVANCE registry were less likely to have anatomically obstructive CAD by cardiac computed tomography angiography but had a similar degree of physiologically significant CAD by FFRCT and similar rates of adverse events. An exclusively anatomic assessment of CAD in patients with obesity may underestimate the burden of physiologically significant disease that is potentially due to a significantly lower volume-to-myocardial mass ratio.

Clinical impact of cardiac magnetic resonance in patients with suspected coronary artery disease associated with chronic kidney disease (AQUAMARINE-CKD study): study protocol for a randomized controlled trial

BackgroundAlthough screening for coronary artery disease (CAD) using computed tomography coronary angiography in patients with stable chest pain has been reported to be beneficial, patients with chronic kidney disease (CKD) might have limited benefit due to complications of contrast agent nephropathy and decreased diagnostic accuracy as a result of coronary artery calcifications. Cardiac magnetic resonance (CMR) has emerged as a novel imaging modality for detecting coronary stenosis and high-risk coronary plaques without contrast media that is not affected by coronary artery calcification. However, the clinical use of this technology has not been robustly evaluated.MethodsAQUAMARINE-CKD is an open parallel-group prospective multicenter randomized controlled trial of 524 patients with CKD at high risk for CAD estimated based on risk factor categories for a Japanese urban population (Suita score) recruited from 6 institutions. Participants will be randomized 1:1 to receive a CMR examination that includes non-contrast T1-weighted imaging and coronary magnetic angiography (CMR group) or standard examinations that include stress myocardial scintigraphy (control group). Randomization will be conducted using a web-based system. The primary outcome is a composite of cardiovascular events at 1 year after study examinations: all-cause death, death from CAD, nonfatal myocardial infarction, nonfatal ischemic stroke, and ischemia-driven unplanned coronary intervention (percutaneous coronary intervention or coronary bypass surgery).DiscussionIf the combination of T1-weighted imaging and coronary magnetic angiography contributes to the risk assessment of CAD in patients with CKD, this study will have major clinical implications for the management of patients with CKD at high risk for CAD.Trial registrationJapan Registry of Clinical Trials (jRCT) 1,052,210,075. Registered on September 10, 2021.

Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography.

We aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM). We prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients' overall body composition. T1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05). STCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis.

Carotid Artery Doppler Ultrasound and Coronary Calcium Score in Assessment of Atherosclerosis in Patients with Suspected Coronary Artery Disease

AbstractBackground: Cardiovascular Disease (CVD) is the leading cause of morbidity and mortality in both industrialized and low income to middle-income countries. As atherosclerosis is the underlying cause for most of CAD, so identification of subclinical disease in the asymptomatic phase has emerged as a public health and economic imperative.Aim of Study: The aim of the study was to evaluate the ability of carotid artery Doppler ultrasound and coronary artery calcium score as screening tools for atherosclerosis in patients who underwent CT coronary angiography for suspect-ed coronary artery disease.Patients and Methods: This study was conducted on 30 patients (17 males and 13 females) with mean age of 58 years with atypical chest pain underwent Cardiac CT (CCT) and carotid Ultrasound (US) on the same day. Carotid artery atherosclerosis was evaluated by detection of Carotid Intimal Thickness (CIMT) & Carotid Plaque Score (CPS) then coro-nary arteries were evaluated by CCT. Coronary artery calcium score was obtained from axial non contrast cardiac CT and finally Coronary Artery Disease (CAD) was evaluated by Gensini score. The relation between both carotid artery Doppler findings & CACS and severity of coronary artery disease were detected.Results: There were significant association between carotid artery disease that was estimated by CIMT, CPS and Gensini score (p=0.045 & 0.004). There was also a significant associ-ation between CACS and Gensini score (p=0.039).Conclusion: Subclinical atherosclerosis as defined by CIMT, CPS and CACs can be simple, non-invasive yet sensi-tive risk-prediction tools to promptly identify those individuals at risk of CVD.

Psoriasis: Tumor Necrosis Factor –α, Interleukin 18, C Reactive Protein Polymorphism , and Osteopontin Role

&#x0D; Background: Psoriasis is a common chronic skin disorder with prevalence of 2.7% in Iraqi community. Many factors affect the prevalence of psoriasis which include genetic, environmental, infectious, immunological, biochemical, endocrinological and psychological. Psoriasis is a chronic inflammatory disease with unknown exact pathogenesis, which may be started as skin condition that subsequently associated with systemic complications. The recurrent proliferative inflammatory processes in subject with psoriasis may lead to abnormal lipid metabolism and associated with cardiovascular diseases. Gene polymorphisms represent either a protective or risk factors for development of psoriasis and cardiovascular disease. &#x0D; Aim of the Study: The aim of the present study is to provide a picture about the association between psoriasis and atherosclerosis. &#x0D; Objectives: To:&#x0D; 1. Estimate the prevalence of impending atherosclerosis in patients with psoriasis.&#x0D; 2. Identify the pattern of association among inflammatory markers in one hand and lipoproteins as traditional markers in another.&#x0D; 3. Clarify the risk assessment of atherosclerosis in patients with psoriasis using multi- biomarkers score.&#x0D; 4. Appraise the inter – traditional and new markers.&#x0D; 5. Evaluate the role of IL-18, TNF -α, osteopontin in the pathogenesis of psoriasis and atherosclerosis.&#x0D; 6. Illustrate the association between disease susceptibility and different gene polymorphism such as IL-18, TNF-α and CRP.&#x0D;

Diagnostic and prognostic testing to evaluate coronary artery disease in patients with diabetes mellitus

Coronary artery disease (CAD) continues to be the most common cause of morbidity and mortality in patients with diabetes mellitus (DM). In recent years, the strategies for treatment of CAD in DM have undergone much evolution. Currently, all patients with DM, regardless of symptoms or diagnosed CAD, are treated aggressively for CAD risk factor reduction. In this clinical climate, the ability to specifically identify patients with disease that will benefit from more aggressive and invasive therapies remains a challenge. In this article we review the current literature on diagnostic and prognostic utility of conventional non-invasive modalities for assessment of CAD in patients with DM, as well as on novel and emerging methods for CAD risk stratification.

Noninvasive Assessment of Atherosclerosis in Patients with Isolated Hypertension

Endothelial dysfunction is considered the first stage in the development of atherosclerosis. Brachial artery flow-mediated dilatation (FMD) has been used to assess endothelial dysfunction. An impaired FMD response may reflect a vascular phenotype prone to atherosclerosis. The thickness of the common carotid intima-media (CIMT) as measured by ultrasound represents a marker of structural atherosclerosis. Recently, it has been shown that color M-mode propagation velocity measured along the origin of descending thoracic aorta (AVP) may reflect atherosclerosis. In this study, the effects of isolated hypertension on these atherosclerosis markers are investigated. Fifty patients with newly diagnosed hypertension and forty healthy people were enrolled. Patients were evaluated with transthoracic echocardiography. Diastolic functions were evaluated by transmitral filling parameters of deceleration time (DT), E/A ratio, and isovolumetric relaxation time (IVRT). Carotid intima-media thickness, FMD, and AVP were measured. Age, gender, and BMI of both groups were similar. Compared to control group CIMT, DT and IVRT values were significantly higher, and FMD and AVP values were significantly lower in hypertensive patients. There were significant correlations between AVP and CIMT (r =-0.699, P < 0.001), AVP and FMD (r = 0.400, P < 0.001), and FMD and CIMT (r =-0.600, P < 0.001). Carotid intima-media thickness, AVP, and FMD were significantly correlated with systolic and diastolic blood pressures and DT and IVRT. In patients with isolated hypertension, AVP and FMD decrease and CIMT increases. In addition, CIMT is inversely correlated with AVP and FMD, and AVP is directly correlated with FMD.

Prognostic role of myocardial single photon emission computed tomography in the elderly

The increase in average life expectancy will move the burden of coronary artery disease (CAD) to older patients. Myocardial perfusion imaging by single photon emission computed tomography (SPECT) has been extensively validated for diagnosis and prognostic evaluation in large population series. Yet, its use is usually limited in elderly patients in whom, despite increased absolute cardiovascular risk, diagnostic and therapeutic work-up is often underperformed. American College of Cardiology/American Heart Association guidelines recommend exercise ECG testing as the initial noninvasive method for assessment of CAD in patients with a normal or near-normal resting ECG, regardless of age. However, a considerable proportion of elderly patients is unable to reach an adequate workload during the exercise test and the majority of those undergoing for standard exercise treadmill score are classified as intermediate risk. In elderly patients, SPECT imaging may provide valuable diagnostic and prognostic information for clinical management. In particular, normal or near normal SPECT identifies elderly patients at low risk of major adverse cardiac events at the short-term follow-up.

Accuracy of low-dose computed tomography coronary angiography using prospective electrocardiogram-triggering: first clinical experience

To evaluate the accuracy of low-dose computed tomography coronary angiography (CTCA) using prospective ECG-triggering for the assessment of coronary artery disease (CAD). A total of 30 patients (19 males, 11 females, mean age 58.8 +/- 9.9 years) underwent low-dose CTCA and invasive coronary angiography (CA) [median 2 days (0, 41)]. Before CT scanning, intravenous beta-blocker was administered in 18 of 30 patients as heart rate (HR) was >65 b.p.m., achieving a mean HR of 55.7 +/- 7.9 b.p.m. CAD was defined as coronary artery narrowing > or =50%, using CA as standard of reference. The estimated mean effective radiation dose was 2.1 +/- 0.7 mSv (range: 1.0-3.3), yielding 96.0% (383/399) of evaluable segments. On an intention-to-diagnose-base, all non-evaluative segments were included in the analysis. Vessels with a non-evaluative segment and no further finding were censored as false positive. Patient-based analysis revealed sensitivity, specificity, positive predictive value, and negative predictive value of 100, 83.3, 90.0, and 100%, respectively. The respective values per vessel were 100, 88.9, 85.7, and 100%, respectively. Prospective ECG-triggering allows low-dose CTCA and provides high diagnostic accuracy in the assessment of CAD in patients with stable sinus rhythm and a low heart rate.

Measurement of Ankle Brachial Index for Assessment of Atherosclerosis in Patients with Stroke

Background: Though atherosclerosis is generally regarded as a risk factor for stroke, its quantitative assessment in patients with stroke has not yet been reported. Recently, the ankle brachial index (ABI) has been receiving increasing attention as a noninvasive measurement of atherosclerosis. In this study, we investigated ABI to determine the degree of atherosclerosis in patients with stroke. Methods: ABI was measured in 114 patients who had suffered a stroke, and the significance of differences between the ABI of the stroke subgroups and that of the normal group was investigated. The correlation of ABI with the degree of cerebral artery stenosis was also investigated. Results: There was no significant difference in ABI between the hemorrhagic groups and the normal group, but in the infarction group (p = 0.0002) ABI was significantly less than the normal group. ABI was significantly correlated with the degree of stenosis in the intracranial internal carotid artery and middle cerebral artery (p < 0.0001, respectively). Conclusions: A strong relationship between ischemic stroke and atherosclerosis was demonstrated quantitatively by ABI measurement. A decrease in ABI may be a risk factor for ischemic stroke.

Echotomographic carotid B-mode ultrasound (ECBUS) in assessment of carotid atherosclerosis in patients with coronary artery disease (CAD)

Echotomographic carotid B-mode ultrasound (ECBUS) in assessment of carotid atherosclerosis in patients with coronary artery disease (CAD)

Stress cine MRI for detection of coronary artery disease

Stress testing is the cornerstone in the diagnosis of patients with suspected coronary artery disease (CAD). Stress echocardiography has become a well-established modality for the detection of ischemia-induced wall motion abnormalities. However, display and reliable interpretation of stress echocardiography studies are user-dependent, the test reproducibility is low, and 10 to 15 % of patients yield suboptimal or non-diagnostic images. Due to its high spatial and contrast resolution, MRI is known to permit an accurate determination of left ventricular function and wall thickness at rest. Early stress MRI studies provided promising results with respect to the detection of CAD. However, the clinical impact was limited due to long imaging time and problematic patient monitoring in the MRI environment. Recent technical improvements - namely ultrafast MR image acquisition - led to a significant reduction of imaging time and improved patient safety. Stress can be induced by physical exercise or pharmacologically by administration of a beta1-agonist (dobutamine) or vasodilatator (dipyridamole and adenosine). The best developed and most promising stress MRI technique is a high-dose dobutamine/atropine stress protocol (10, 20, 30, 40 microgram/kg/min; optionally 0.25-mg fractions of atropine up to maximal dose 1 mg). Severe complications (myocardial infarction, ventricular fibrillation and sustained tachycardia, cardiogenic shock) may be expected in 0.25 % of patients. Currently, data of three high-dose dobutamine stress MRI studies are available, revealing a good sensitivity (83 - 87 %) and specificity (83 - 86 %) in the assessment of CAD. The direct comparison between echocardiography and MRI for the detection of stress-induced wall motion abnormalities yielded better results for dobutamine-MRI in terms of sensitivity (86.2 % vs. 74.3 %; p < 0.05) and specificity (85.7 % vs. 69.8 % p < 0.05) as compared to dobutamine stress echocardiography. The superior results of MRI can mainly be explained by the better image quality with sharp delineation of the endocardial and epicardial borders. Currently, stress MRI is already a realistic clinical alternative for the non-invasive assessment of CAD in patients with impaired image quality in echocardiography.