Atherosclerotic Coronary Artery Disease Research Articles

Low-Density Lipoprotein Cholesterol Level Trends and the Development of Cardiac Allograft Vasculopathy After Heart Transplantation

BackgroundUnlike the relationship with atherosclerotic coronary artery disease, that between low-density lipoprotein cholesterol (LDL-C) and cardiac allograft vasculopathy (CAV) is unclear. Our objectives were to characterize lipid profiles early after heart transplantation (HT) and evaluate the relationship between early LDL-C and the development of CAV. MethodsWe retrospectively reviewed consecutive adults who underwent HT at 2 centres during the time period 2010-2018. The primary outcome was the incidence of angiographic CAV. The relationship between LDL-C and CAV was assessed using Cox proportional hazards and logistic regression models adjusted a priori for clinically important covariates, including recipient and donor age, recipient sex, ischemic time, and pre-HT diabetes. ResultsA total of 386 patients followed for a median (range) of 4.4 (2.8-6.8) years were included. LDL-C at baseline (2.11 ± 0.86 mmol/L) and 1 year after HT (2.20 ± 0.88 mmol/L) was similar (P = 0.21), but it was lower at the end of follow-up (1.89 ± 0.74 mmol/L, P < 0.01). Of 309 patients who underwent angiography, 54% had CAV. The risk of CAV did not vary according to baseline, 1-year, or change from baseline to 1-year LDL-C. The odds of CAV at 1 year were equally likely across LDL-C values (adjusted odds ratio 1.00, 95% confidence interval: 0.61-1.63 for baseline, and adjusted odds ratio 1.25, 95% confidence interval: 0.74-2.10 for 1-year LDL-C). ConclusionsNo association was identified between early LDL-C and the development of CAV. Our findings do not support targeting a specific LDL-C for patients who do not otherwise meet criteria for guideline-recommended LDL-C target levels. Randomized studies are warranted to determine if lipid-lowering to a specific LDL-C target level modifies the risk of CAV.

CASE SERIES OF PREGNANCY-ASSOCIATED MYOCARDIAL INFARCTION: AN EPIDEMIC IN WAITING

Acute myocardial infarction during pregnancy or postpartum period is a rare but life-threatening condition associated with poor maternal and fetal outcome. Although atherosclerotic coronary artery disease is the most common etiology in general population, the causation is more diverse in pregnancy and this may have therapeutic implications. Early diagnosis and timely management with collaboration among Maternal-fetal medicine specialist, interventional cardiologist, cardiac anaesthetist, intensivist and neonatologist is essential to prevent maternal cardiac deaths. We present a case series of two patients with postpartum and antepartum acute MI, respectively and their diagnosis, management and outcomes in a tertiary care center.

Predicting mortality and no-reflow in STEMI patients using epicardial adipose tissue.

BackgroundAcute myocardial infarction is a leading cause of morbidity and mortality worldwide. It occurs when irreversible myocardial cell damage or death occurs. ST‐segment elevation myocardial infarction (STEMI) is the most serious presentation of atherosclerotic coronary artery disease. STEMI results from the occlusion of a major coronary artery. Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy. It should be performed by an experienced team within the shortest time possible from the first medical contact.HypothesisIncreased mortality risk and no‐reflow in STEMI patients with epicardial adipose tissue thickness (EAT) more than 5 mm compared to STEMI patients with EAT less than 5 mm.MethodsThis study was conducted on 113 patients who presented to the cardiology department of Ain Shams university hospital with the first STEMI and underwent primary PCI. Medical treatment for STEMI was given to all subjects as per the guidelines. All patients underwent an echocardiographic evaluation of epicardial adipose tissue and left ventricular ejection fraction. Patients were divided into two groups using epicardial adipose tissue thickness of 5 mm as a cutoff point; this number was derived from the ROC curve. Group I: Included patients with EAT thickness less than 5 mm, including 44 patients (38.9%). Group II: Included patients with EAT thickness greater than 5 mm, including 69 patients (61.1%).ResultsThe current study showed that epicardial fat thickness significantly correlated with the no‐reflow phenomenon in the cath lab and overall prognosis in patients with STEMI.ConclusionIncreased EAT thickness may be an independent predictor of the no‐reflow phenomenon and mortality. Therefore, our study emphasizes that EAT thickness measured by echocardiography may provide additional and substantial information on the risk of no‐reflow and mortality in STEMI patients.

Small Dense Low-Density Lipoprotein for Risk Prediction of Acute Coronary Syndrome.

BackgroundElevated Low density Lipoprotein (LDL) levels have been traditionally associated with development of atherosclerotic coronary artery disease (CAD). As LDL-cholesterol levels are not always raised in acute coronary syndrome (ACS) patients, sd-LDL is an emerging risk factor. The purpose of the present study was tri-fold. Firstly, it aimed to investigate the association of sd-LDL as a risk factor in ACS patients. Secondly, it aimed to correlate the presence of sd-LDL with severity of coronary artery disease as determined by coronary angiography. Lastly, it aimed to correlate the presence of sd-LDL with short-term outcomes.MethodsThis was a prospective, hospital-based, cross-sectional, case-control study conducted over a 1-year study duration. Patients above the age of 18 years diagnosed with ACS within 24 h of admission were studied. Blood samples were collected after all patients had undergone coronary angiography and sd-LDL levels were measured.ResultsACS patients had significantly higher sd-LDL levels than non-ACS patients (16.10 ± 1.42 mg/dL vs. 12.67 ± 0.71 mg/dL, P = 0.036). Males had significantly higher sd-LDL levels than females (16.79 ± 1.55 mg/dl vs. 10.77 ± 2.62 mg/dl, P=0.047). Patients with non-left anterior descending coronary artery (LAD) involvement had significantly higher sd-LDL levels compared to patients with LAD involvement (21.92 ± 3.55 mg/dL vs. 14.03 ± 1.35 mg/dL, P = 0.007).ConclusionThese results suggest that sd-LDL is a risk factor for the development of ACS in an Indian population.

Pathophysiology of Takotsubo Cardiomyopathy: Reopened Debate.

Takotsubo cardiomyopathy (TTC), a persistently obscure dysfunctional condition of the left ventricle, is uniquely transient but nevertheless dangerous. It features variable ventricular patterns and is predominant in women. For 30 years, pathophysiologic investigations have progressed only slowly and with inadequate focus. It was initially proposed that sudden-onset spastic obliteration of coronary flow induced myocardial ischemia with residual stunning and thus TTC. Later, it was generally accepted without proof that, in the presence of pain or emotional stress, the dominant mechanism for TTC onset was a catecholamine surge that had a direct, toxic myocardial effect. We think that the manifestations of TTC are more dynamic and complex than can be assumed from catecholamine effects alone. In addition, after reviewing the recent medical literature and considering our own clinical observations, especially on spasm, we theorize that atherosclerotic coronary artery disease modulates and physically opposes obstruction during spasm. This phenomenon may explain the midventricular variant of TTC and the lower incidence of TTC in men. We continue to recommend and perform acetylcholine testing to reproduce TTC and to confirm our theory that coronary spasm is its initial pathophysiologic factor. An improved understanding of TTC is especially important because of the condition's markedly increased incidence during the ongoing COVID-19 pandemic.

Acute Coronary Syndromes Due to Atherosclerotic Coronary Artery Disease in Young Patients.

Young patients represent about 4-10% of the population presenting with acute coronary syndrome. In this focused mini-review, we highlight the data regarding acute coronary syndromes in young patients with atherosclerotic coronary artery disease. Differences in the underlying pathologies and pathophysiological mechanisms should yield to different clinical management and treatment strategies.

Diabetic microvascular complications are associated with reduced global longitudinal strain independent of atherosclerotic coronary artery disease in asymptomatic patients with diabetes mellitus: a cross-sectional study

BackgroundReduced left ventricular function, assessed by global longitudinal strain (GLS), is sometimes observed in asymptomatic patients with diabetes mellitus (DM) and is often present in patients with diabetes-related microvascular complications. Our aim was to assess the association between microvascular complications, coronary artery plaque burden (PB) and GLS in asymptomatic patients with DM and non-obstructive coronary artery disease (CAD).MethodsThis cross-sectional study included patients with DM without any history, symptoms or objective evidence of obstructive CAD. All patients were identified in the outpatient Clinic of Endocrinology at Odense University Hospital Svendborg. An echocardiography and a coronary computed tomography angiography were performed to assess GLS and the degree of CAD, respectively. A coronary artery stenosis < 50% was considered non-obstructive. A linear regression model was used to evaluate the impact of potential confounders on GLS with adjustment of body mass index (BMI), mean arterial pressure (MAP), microvascular complications, type of diabetes, tissue Doppler average early diastolic mitral annulus velocity (e’) and PB.ResultsTwo hundred and twenty-two patients were included, of whom 172 (77%) had type 2 DM and 50 (23%) had type 1 diabetes. One hundred and eleven (50%) patients had microvascular complications. GLS decreased as the burden of microvascular complications increased (P-trend = 0.01): no microvascular complications, GLS (− 16.4 ± 2.5%), 1 microvascular complication (− 16.0 ± 2.5%) and 2–3 microvascular complications (− 14.9 ± 2.8%). The reduction in GLS remained significant after multivariable adjustment (β 0.50 [95% CI 0.11–0.88], p = 0.01). BMI (β 0.12 [95% CI 0.05–0.19]) and MAP (β 0.05 [95% CI 0.01–0.08]) were associated with reduced GLS. In addition, an increased number of microvascular complications was associated with increased PB (β 2.97 [95% CI 0.42–5.51], p = 0.02) in a univariable linear regression model, whereas there was no significant association between PB and GLS.ConclusionsThe burden of microvascular complications was associated with reduced GLS independent of other cardiovascular risk factors in asymptomatic patients with DM and non-obstructive CAD. In addition, the burden of microvascular complications was associated with increasing PB, whereas PB was not associated with GLS.

383-P: Comparative Study of Serum Testosterone Levels in Male T2DM and Nondiabetic Subjects as a Risk Marker for Atherosclerotic Coronary Artery Disease

Background: Historically, higher levels of serum testosterone were presumed deleterious to the cardiovascular system. cardiovascular disease (CVD) risk factors prevalence were increased due to low testosterone levels. Material and Methods: This was a prospective observational study, conducted among men with type 2 diabetes with documented CAD (n = 60) and controls healthy men (n = 50). Pearson correlation between sex hormones and CAD risk factors was done. The association between sex hormones and CAD risk factors among patients was analyzed by multiple logistic regression. The statistical significance was set at the 0.05 level. Result: Mean age of diabetics was 44.5 ±7.9 years and non diabetics was 42.54 ± 5.63 years. 56% of Diabetics and 20 % non diabetics had lower levels of total testosterone. 68% of Diabetics and 26 % non diabetics had lower levels of free testosterone. Mean SHBG levels in Diabetics and non - diabetics was 8.6 ± 1.8 and 16 ± 3.2. Prevalence of Hypogonadism was 22% in Diabetics and 10% in Non diabetics. Among the cases, a significant positive correlation was found between total testosterone/FTI and waist circumference, W/H ratio, triglyceride levels, hs-CRP, and CIMT (P &amp;lt; 0.01). In addition, a significant negative correlation was found between total testosterone and FTI with high-density lipoprotein-cholesterol levels (P &amp;lt; 0.01). The multiple logistic regression analysis showed that total testosterone levels (P &amp;lt; 0.01) and SHBG (P &amp;lt; 0.01) are independently associated with the occurrence of atherosclerotic CAD in T2DM men. Conclusion: We conclude that increased serum testosterone levels and low SHBG in T2DM men are associated with the development of atherosclerotic cardiovascular risk factors. Disclosure A. K. Das: None. A. Bhagat: None. N. Sinha: None.

Angiographic profiles in patients of persistent non-valvular atrial fibrillation from a tertiary care center in north india

Abstract Funding Acknowledgements Type of funding sources: None. Background The relationship of atrial fibrillation (AF) with coronary artery disease (CAD) is well established. Atrial ischemia due to obstructive CAD has been identified as one of the key risk factors, leading to AF. However, sufficient evidence exists as to the presence of myocardial ischemia on stress imaging, even without the presence of obstructive CAD in AF patients. Slow flow and coronary tortuosity on angiogram can lead to downstream myocardial ischemia independent of CAD. Purpose We aimed to delineate the angiographic profiles in AF patients with attention to slow flow and tortuosity leading to ischemia in those without obstructive CAD. Methods The study was a nonrandomised, prospective, single-centre observational study of consecutive patients of persistent non valvular AF. Symptomatic patients despite optimal medical therapy (OMT) for 3 months were recruited and all underwent coronary angiograms (CAG). Patients with known CAD or prior history of myocardial infarction were excluded. Further angiographic analysis was done in those without obstructive CAD to determine incidence of slow flow (&amp;gt;27 corrected TIMI frame count) and tortuosity (presence of ≥3 fixed bends in an epicardial artery). Results A total of 70 patients were recruited and followed for a mean duration of 12 ± 1.4 months. The mean age of the study group was 66.07 (±11.49). Hypertension (74%) was the commonest comorbidity followed by obesity (35%) and diabetes (30%). At CAG, 32/70 (45%) had obstructive CAD, 17/70 (24%) had non obstructive (&amp;lt;50-70% stenosis) CAD and 21/70 (30%) had normal coronaries without atherosclerosis. Amongst patients without obstructive CAD (n = 38) slow flow was seen in 16/38 (42%) and coronary tortuosity in 11/38 (29%) patients. There ware no differences in terms of death, HF and FVR hospitalisations or stroke at follow up between the obstructive CAD vs no obstructive CAD. However in patients without obstructive CAD, hospitalisations for FVR was significantly increased in those having slow flow on CAG, 9/12 (75%) vs 7/26 (27%) in those without slow flow (p value = 0.005). The mean TIMI frame count was also significantly higher in those with FVR hospitalisations 35.3 ± 11 vs 25.8 ± 8.9 (p value = 0.005). TIMI frame count &amp;gt;31 had a sensitivity of 83% and a specificity of 69% for predicting hospitalisations for FVR on ROC curve(AUC = 0.71). Conclusions CAD is closely related to AF and majority (70%) of our patients had evidence of atherosclerotic CAD on CAG in our study. A large proportion of patients with no evidence of obstructive CAD on CAG had slow flow or coronary tortuosity. Significantly increased hospitalisation for FVR seen in the slow flow group shows its significance and may lead to newer treatment modalities in future. Further larger studies looking at these aspects on CAG may give further insight as to the nature and prognosis of these entities.

History of Severe Hypoglycemia in Type 2 Diabetes Mellitus Unmasked Significant Atherosclerotic Coronary Artery Disease: A Comparative Case Control Study.

ObjectivesA history of severe hypoglycemia (SH) is associated with cardiovascular (CV) events among patients with type 2 diabetes mellitus (T2DM). In this study, we compared the severity of atherosclerotic coronary artery disease (ACAD) in T2DM patients with and without a history of SH.MethodologyWe conducted a comparative case-control study involving 28 T2DM patients with a history of SH within the last 5 years with no documented ACAD, and matched them with 28 T2DM patients with no history of SH. All subjects underwent coronary artery calcium scoring (CACS) with or without coronary computed tomographic angiography (CCTA) to evaluate the severity of ACAD.ResultsA history of SH in T2DM was associated with a higher prevalence of significant ACAD (79% versus 46%, p=0.026). A high CACS (≥100) was seen in a greater number of patients with a history of SH compared to those without (75% versus 43%, p=0.029). Similarly, there was a higher prevalence of obstructive CAD in those with a history of SH compared to those without (72% versus 39%, p=0.036). Median C-reactive protein level was also higher among patients with a history of SH (0.41 mg/dL versus 0.16 mg/dL, p=0.029).ConclusionIn patients with T2DM, a history of SH is significantly associated with ACAD compared to those without SH. A history of SH warrants screening for ACAD.

Postmortem coronary artery calcium score in cases of myocardial infarction.

Sudden cardiac death (SCD) related to atherosclerotic coronary artery disease (ACAD) resulting in myocardial infarction is the most prevalent cause of death in western countries. In clinical practice, coronary artery calcium score (CACS) is considered an independent predictor of coronary events, closely related to atherosclerotic burden and is quantified radiologically by the Agatston score being calculated through computed tomography. Postmortem computed tomography (PMCT) allows the visualization and quantification of coronary calcifications before the autopsy. However, it was reported that some patients who died from severe ACAD had a zero CACS in PMCT. In this study, a retrospective evaluation of CACS in adult’s myocardial infarction cases related to ACAD, with available CACS and histological slides of coronary arteries, was performed in order to gain a deeper understanding of coronary calcifications and their role in myocardial infarction cases. The CACS was calculated by using the software Smartscore 4.0 after the radiological examination on a 64-row CT unit using a specific cardiac protocol. Thirty-six cases were identified out of 582 autopsies, recorded during a 2-year study period (29 men, 7 women; age 56.3 ± 11.7). CACS was 0–10 in 5 cases (5 men, 44.8 ± 13.7), 11–100 in 8 cases (6 men, 2 women, 53.1 ± 7.7), 101–400 in 13 cases (11 men, 2 women, 57.4 ± 9.6), and > 400 in 10 cases (9 men, 1 woman, 63.1 ± 11.9). Coronary thrombosis was found in 28 cases, histologically identified as plaque erosions in 6 cases and as plaque ruptures in 22 cases. Statistical analyses showed that CACS increases significantly with age (p-value < 0.05) and does not show significant correlation with gender, body weight, body mass index, and heart weight. CACS was significantly higher in plaque ruptures than in plaque erosions (p-value < 0.01). Zero or low CACS on unenhanced PMCT cannot exclude the presence of myocardial infarction related to ACAD. This paradoxical discrepancy between imaging and autopsy findings can be explained considering the histological aspect of fatal coronary plaques.

Author Response: First-Ever Ischemic Stroke and Increased Risk of Incident Heart Disease in Older Adults.

We thank Dr. Sioka et al. for their positive comments about our article1 showing a high risk of major adverse cardiovascular events after acute ischemic stroke. They also summarized the results of their study on myocardial perfusion tests among patients with a recent (<30 days) ischemic stroke.2 Dr. Sioka et al. found changes suggestive of myocardial ischemia in 62% of the cases.2 Notably, this was a wittingly selected population of patients with atherosclerotic strokes and a high prevalence of smokers (63%) and hyperlipidemia (58%). Thus, the high prevalence of asymptomatic coronary artery disease (CAD) in this study is somehow expected. Indeed, consistent with their interpretation, asymptomatic CAD is the most likely explanation for the impaired myocardial perfusion tests. However, in less selected populations, cardiovascular complications may not be due to asymptomatic CAD, since the reported prevalence of severe coronary artery atherosclerosis in patients with acute ischemic stroke and no history of CAD undergoing systematic coronary angiography is only 16%.3 Interestingly, the meaning of impaired myocardial perfusion scanning in stroke patients is not well understood. Takotsubo myocardiopathy can occur after stroke and is associated with transiently impaired myocardial perfusion tests in the absence of atherosclerotic CAD.4

Metabolic syndrome and coronary artery disease in adults with congenital heart disease.

In adults with congenital heart disease (ACHD), conditions acquired with aging, such as metabolic syndrome, hypertension, diabetes mellitus, and obesity, can negatively influence the original cardiovascular disease. Metabolic syndrome has a higher prevalence in ACHD than in the general population. In contrast, coronary artery disease shows a similar prevalence in adults with acyanotic CHD and the general population, while adults with cyanotic CHD, even after repair, have an even lower incidence of coronary artery disease than the general population/adults with acyanotic CHD. However, even in those with cyanotic CHD, coronary artery disease can develop when they have risk factors such as obesity, dyslipidemia, hypertension, diabetes mellitus, smoking habit, or limited exercise. The prevalence of risk factors for cardiovascular disease is similar between ACHD and the general population, but an increased risk of coronary atherosclerosis has been observed for congenital coronary artery anomalies, dextro-transposition of the great arteries after arterial switch operation, Ross procedure, and coarctation of the aorta. Aortopathy may be an additional risk factor for cardiovascular disease. As ACHD have other abnormalities that may make the heart more vulnerable to both the development of atherosclerosis and adverse cardiovascular sequelae, regular evaluation of their cardiovascular disease risk status is recommended. Metabolic syndrome is more common among ACHD than in the general population, and may therefore increase the future incidence of atherosclerotic coronary artery disease even in ACHD. Thus, ACHD should be screened for metabolic syndrome to eliminate risk factors for atherosclerotic coronary artery disease.

ATHEROSCLEROTIC CORONARY ARTERY DISEASE IN PATIENTS WITH CARDIOMETABOLIC SYNDROME: FROM THREE FUKUOKA UNIVERSITY REGISTRY IN JAPAN

Abstract Objective: Major coronary risk factors were included in aging, gender, family history, hypertension, diabetes, high cholesterol and smoking. Metabolic syndrome includes abdominal obesity, high blood pressure, high triglyceride (TG) and/or low high-density lipoprotein cholesterol (HDL-C) and diabetes. We determined the critical risk factors for the onset and progression of coronary artery disease (CAD). Design and method: We have been going on three Fukuoka University Registry in Japan to define the risk factors for primary and secondary prevention of atherosclerotic CAD: Coronary Computed Tomography Angiography (FU-CCTA) Registry, Coronary Intravascular Ultrasound (FU-IVUS) Registry and Quantitative Coronary Angiography (FU-QCA) Registry. We analyzed the data from three Registry. Results: First, HDL-C levels were most closely associated with the presence of CAD from the FU-CCTA registry, and we need to perform CCTA for suspected CAD patients with lower HDL-C levels under statin treatment. In addition, in the five groups classified according to the number of metabolic factors, the number of significantly coronary stenosed vessels was significantly increased as the number of metabolic factors increased. Second, we found that among CAD patients treated with statins, TG levels were associated with lipid-rich coronary plaques in females, but not in males according to the FU-IVUS Registry. TG levels may be more important indicators of residual risk after statin treatment in females than in males. Lastly, HDL-C &lt; 40 mg/dl and low-density lipoprotein cholesterol (LDL-C) equal to or more than 100 mg/dl were even more strongly related to major adverse cardiac events in female patients, whereas the combination of LDL-C and HDL-C was not related to MACEs in male patients on the FU-QCA Registry. Conclusions: Although an increased metabolic factors induces more severe CAD and lower HDL-C and higher LDL-C induce the onset and progression of CAD, there may be gender differences in the significance of lipid profiles.

A Case of Recurrent Coronary Artery Restenosis Associated with Suspected Arteritis in a Young Woman

Approximately 5% of patients with Acute Myocardial Infarction (AMI) do not have atherosclerotic Coronary Artery Disease (CAD) but present other factors responsible for luminal narrowing. A 24-year-old woman presented with angina and AMI without any known risk factors and recurrent coronary restenosis in the 7 year-follow-up period. Thorough tests revealed no suggestive factors besides increased amounts of tumor necrosis factor-a and interleukins. A diagnosis of arteritis was suspected. Therefore, glucocorticoid and immunosuppressor administration was performed, and the patient’s condition was relieved. Severe coronary artery disease with smooth distal coronary vessels in a young female without apparent risk factors could suggest a non-atherosclerotic etiology.

Validation of Coronary Angiography-Derived Vessel Fractional Flow in Heart Transplant Patients with Suspected Graft Vasculopathy

<h3>Purpose</h3> Cardiac transplant-related arteriopathy remains a leading cause of morbidity and mortality in heart transplant (HTx) recipients. Recently, vessel fractional flow reserve (vFFR) derived from coronary angiography has emerged as a new diagnostic computational tool to functionally evaluate the severity of coronary artery disease (CAD). Although vFFR estimates have been shown to perform well against invasive FFR in atherosclerotic CAD, data on the use of vFFR in HTx recipients are lacking. The aim was to validate coronary angiogram-derived FFR to calculate FFR in HTx patients with and without cardiac transplant-related arteriopathy. <h3>Methods</h3> Prospective, single center study of HTx patients referred for annual check-up, undergoing surveillance coronarography. Invasive FFR was measured using a motorized device at the speed of 1.0 mm/sec in all three major coronary arteries. Angiography-derived pullback FFR was derived from the angiogram and compared with invasive FFR pullback curve. <h3>Results</h3> Overall, 13634 FFR values were extracted from the FFR pullback curves from 19 HTx patients. The mean age was 60.8 ± 9.10 years, the mean time after transplantation was 5.88 years [IQR 1.10, 12.0]. A total of 29 vessels (19 LAD, 6 LCX, 4 RCA) were analysed. Mean distal vFFR was 0.91 ± 0.05 whereas invasive distal FFR was 0.92 ± 0.07. A good correlation was found between invasive distal FFR and vFFR (r =0.635; p <0.001). The correlation of the pullback tracing was high with a correlation coefficient between vFFR and invasive FFR pullback values of 0.72 (95% CI 0.71 to 0.73, p <0.001) (<b>Figure A</b>). The mean difference between vFFR and invasive FFR pullback values was -0.02 with 0.03 of SD (limits of agreements -0.08 to 0.04; <b>Figure B</b>). <h3>Conclusion</h3> In HTx patients coronary angiography-derived FFR correlates well with invasively measured wire-derived FFR. Angiography-derived FFR could be used as a novel diagnostic tool to quantify the functional severity of graft vasculopathy.

Cardiovascular Risk Assessment in the Older Athlete

Limited data are available to guide cardiovascular screening in adult or masters athletes (≥35 years old). This review provides recommendations and the rationale for the cardiovascular risk assessment of older athletes. Review of available clinical guidelines, original investigations, and additional searches across PubMed for articles relevant to cardiovascular screening, risk assessment, and prevention in adult athletes (1990-2020). Clinical review. Level 3. Atherosclerotic coronary artery disease (CAD) is the leading cause of exercise-induced acute coronary syndromes, myocardial infarction, and sudden cardiac death in older athletes. Approximately 50% of adult patients who experience acute coronary syndromes and sudden cardiac arrest do not have prodromal symptoms of myocardial ischemia. The risk of atherosclerotic cardiovascular disease (ASCVD) can be estimated by using existing risk calculators. ASCVD 10-year risk is stratified into 3 categories: low-risk (≤10%), intermediate-risk (between 10% and 20%), and high-risk (≥20%). Coronary artery calcium (CAC) scoring with noncontrast computed tomography provides a noninvasive measure of subclinical CAD. Evidence supports a significant association between elevated CAC and the risk of future cardiovascular events, independent of traditional risk factors or symptoms. Statin therapy is recommended for primary prevention if 10-year ASCVD risk is ≥10% (intermediate- or high-risk patients) or if the Agatston score is >100 or >75th percentile for age and sex. Routine stress testing in asymptomatic, low-risk patients is not recommended. We propose a comprehensive risk assessment for older athletes that combines conventional and novel risk factors for ASCVD, a 12-lead resting electrocardiogram, and a CAC score. Available risk calculators provide a 10-year estimate of ASCVD risk allowing for risk stratification and targeted management strategies. CAC scoring can refine risk estimates to improve the selection of patients for initiation or avoidance of pharmacological therapy.

COVID-19: The Heart of the Matter-Pathological Changes and a Proposed Mechanism.

The SARS-CoV-2 virus has resulted in over 88 million cases worldwide of COVID-19 as of January 2021. The heart is one of the most commonly affected organs in COVID-19, but the nature and extent of the cardiac pathology has remained controversial. It has been shown that patients infected with SARS-CoV-2 can sustain type 1 myocardial infarction in the absence of significant atherosclerotic coronary artery disease. However, many patients present with small elevations of troponin enzymes of unclear etiology which correlate with overall COVID-19 disease outcome. Early autopsy reports indicated variable levels of typical lymphocytic myocarditis, while radiology reports have indicated that myocarditis can be a persistent problem after recovery from acute illness, raising concern about participation in college athletics. In this communication, we review the literature to date regarding the gross and microscopic findings of COVID-19 cardiac involvement, present the findings from over 40 cases from our academic medical center, and propose mechanisms by which patients develop small elevations in troponin. .

Investigation of Inflammatory and Oxidative Stress Biomarkers in Multi Vessels Minimally Invasive Coronary Artery Bypass Graft Surgery Versus Off-Pump Coronary Artery Bypass Graft

Traditional Coronary Artery Bypass Graft (CABG) is currently among of the chief methods in dealing with patients suffering from atherosclerotic coronary heart disease. The current study aimed to measure and compare the levels of proinflammatory cytokines and oxidative stress marker in patients who underwent multivessels Minimally Invasive Coronary Artery Bypass Graft Surgery (MICS– CABG) versus off-pump Coronary Artery Bypass Grafting (off-pump CABG) in the cardiothoracic department, Assiut University hospitals, Upper Egypt. the study included 67 patients, all of them suffering from atherosclerotic coronary artery disease, which confirm by cardiac catheter angiography. The patients were divided randomly into two groups, first group (A) included 34 patients to whom Multi Vessels Coronary Artery Bypass Graft Surgery (MICS-CABG) under off pump had been done. The second group (B) included 33 patients whom underwent off pump Coronary Artery Bypass Grafting (off-pump CABG). Tumor Necrosis Factor-Α (TNF-α), interlukin-2 (IL-2), lipid peroxides, Superoxide Dismutase (SOD), total thiols and Nitric Oxide (NO) were estimated in sera of all patients by their corresponding methods; 48 h before the operation, 15 min before the operation end and 72 h after the operation. After testing the normality, Mann-Whitney U test and Spearman correlation coefficient were used to compare the two groups and tested the variables’ correlations with the duration of the operation. p≤0.05 was considered significant. Serum TNF-α, IL-2 and lipid peroxides levels were significantly higher while total thiols and SOD were significantly lower, intraoperative and postoperatively, while No was significantly higher intraoperative only, in off-pump CABG group compared to MICS-CABG group and in both groups, intraoperative and postoperatively compared to preoperative levels. Especially in the postoperative samples, TNF-α, IL-2 and NO levels correlated positively while those of SOD correlated negatively with the operation duration the clinical data obtained presented in details in the result sector and revealed that. MICS-CABG group associated with less post-operative pain, less need for blood transfusion, less hospital stays and rapid regain to normal activity. The current study revealed that MICS-CABG is an effective procedure that is associated with small surgical trauma and lower inflammations and oxidative stress compared to off-pump CABG.

Aortic propagation velocity in the prediction of coronary artery disease severity.

To investigate the association of the aortic propagation velocity (APV) with coronary artery disease (CAD) in patients with stable angina pectoris (SAP) through SYNTAX scores (SS). The study population comprised 214 SAP subjects who received a coronary angiography. The APV and carotid intima-media thickness (CIMT) were examined and SS was calculated. Subjects were grouped following specific SS criteria: SS less than 22 (low) and SS greater than or equal to 22 (high). High SS subjects had lower APV compared to low SS [39.0 (32.0-51.7) vs. 55.0 (45.0-62.0) cm/s, respectively; P<0.001] and higher CIMT (0.86 ± 0.24 vs. 0.74 ± 0.21 mm, respectively; P<0.001). APV demonstrated a negative correlation with the CIMT (r=-0.239, P<0.001), age (r=-0.188, P=0.006) , and SS (r=-0.561, P<0.001) and showed a positive association with LV ejection fraction (r=0.163, P=0.017). APV, CIMT, diabetes, low-density lipoprotein cholesterol (LDL-C), and age were determined to be markers independently of a high SS. APV, CIMT, diabetes, LDL-C and age are independently linked to the CAD severity of SAP subjects. Decreased APV, an indicator of subclinical atherosclerosis, may independently help determine the severity of atherosclerotic CAD in SAP patients.