Candidates For Coronary Angiography Research Articles

Association between parities and duration of breastfeeding and the severity of coronary artery disease in women above 30 years old age (A pilot study).

The prevalence and mortality of CVD in women increase over time. We conducted this research to evaluate the severity of coronary artery disease with the number of live births and breastfeeding duration. Patients aged 30-50 years old with positive exercise tests or evidence of cardiac ischemia who were candidates for coronary angiography were included. All the participants had at least one child. Syntax score was used to evaluate the severity of coronary arteries. Mean number of children was 3.72±1.85, in those patients with <2 live births no one had a syntax score≥1, but in the>5 live births group most patients had a syntax score≥1. In patients with zero syntax score, it was estimated as 4.91±39.7; in patients with 1≤ syntax score, it was 4.48±7.29 (P =0.76). Among patients with > 5 birth lives, those with higher syntax scores had older ages (P=0.497). After adjusting age, the association between live births and syntax score became non-significant (P=0.850). By increasing the number of live births >5, the severity of coronary artery disease, increases. However, this association was not significant after adjusting the age of patients.

The Influence of Low and Iso-osmolar Contrast Media on Diagnostic Performance of Contrast Fractional Flow Reserve Measurement.

For fractional flow reserve measurement, contrast media can be used as an alterna- tive for adenosine. However, contrast media with different physical characteristics (e.g., osmo- lality and viscosity) may have different effects on hyperemia. This study aimed to determine if the diagnostic accuracy of contrast fractional flow reserve was influenced by 2 commonly used contrast media (Visipaque and Ultravist). In this diagnostic study, candidates for coronary angiography with intermediate cor- onary lesion were enrolled and randomized to receive either an iso-osmolar contrast media (Visipaque) or a low osmolar contrast media (Ultravist) for fractional flow reserve measure- ment. The gold standard was fractional flow reserve measured by adenosine fractional flow reserve. Then cFFR and adenosine fractional flow reserve were compared between the groups, and the diagnostic values of both contrasts were calculated. Finally, the cut-point for diagnos- ing adenosine fractional flow reserve ≤ 0.8 was calculated for cFFR in both groups. In this study, 46 patients were studied (24 patients received Ultravist and 22 patients received Visipaque). There was no significant difference between the groups in adenosine frac- tional flow reserve. Also, the mean cFFR was not different from the mean adenosine fractional flow reserve in both groups. There was a strong correlation between cFFR and adenosine frac- tional flow reserve for each of the contrasts (r = 0.937 for Ultravist and r = 0.927 for Visipaque). Both contrasts had high specificity to diagnose fractional flow reserve ≤ 0.8 (specificity = 1), and the sensitivities of cFFR for Ultravist and Visipaque were 83.3% and 94.7%. The cut-point to predict adenosine fractional flow reserve ≤ 0.80 was 0.845 for Ultravist and 0.835 for Visipaque. Both iso-osmolar or low osmolar contrast media have an acceptable diagnostic accuracy in measuring cFFR.

Evaluation of Serum Levels of Interlukine-17A (IL-17A), Fibrinogen, and Red Distribution Width (RDW) in Patients with Coronary Artery Ectasia, Candidate for Coronary Angiography: A Cross-Sectional Study

Background: Coronary stenosis and ectasia are cardiovascular diseases characterized by dysfunction of endothelial cells. Studies have shown that impaired blood flow due to inflammation and deposition in the endothelial cell wall can be effective in disease occurrence and progression. Although the etiologies of these diseases have not been identified accurately, it has been shown that inflammation and coagulation can be the main causes in these patients. Objectives: The aim of this study was to evaluate the levels of fibrinogen, Interlukine-17A (IL-17A), and red distribution width (RDW) in patients with coronary artery disease (CAD) and ectasia. Methods: In this study, 140 patients with CAD admitted to Shariati Hospital of Tehran University of Medical Sciences, Iran, were included from from Jun 2020 to October 2021. Based on the severity of CAD, the participants were divided into two equal groups (n = 70 in each) of mild CAD (patients with CAD less than 50%) and multi-vessels CAD (patients with more than 50% stenosis in coronary arteries) according to the number of involved vessels (one, two, or three). Then, 5 cc of peripheral blood was collected from each patient in ethylenediaminetetraacetic acid (EDTA) containing tubes. IL-17A and fibrinogen were measured using enzyme-linked immunosorbent assay (ELISA) kit, and RDW was calculated by cell counter. Results: The mean age of participants was 63.0 ± 11.0 years in the mild group (35% males vs. 65% females) and 60.1 ± 12.1 years in the multi-vessels group (28% males vs. 72% females). The results showed that IL-17A, fibrinogen, and RDW levels in patients with ectasia and multi-vessels group were significantly higher than those in patients without coronary ectasia and mild CAD, respectively (P-value = 0.01 for fibrinogen; P-value = 0.05 for IL-17A; and P-value = 0.03 for RDW). Conclusions: According to our results, identification and evaluation of fibrinogen and IL-17A, along with laboratory indices including RDW can be helpful in diagnosing high-risk individuals. Ectasia can be prevented, and it is possible to increase the patients’ survival through using some preventive and therapeutic strategies.

The effect of virtual reality distraction on reducing patients' anxiety before coronary angiography: a randomized clinical trial study

BackgroundCoronary angiography is used as a qualified method to diagnose coronary heart disease. However, patients undergoing coronary angiography experience a great deal of anxiety. The present study is aimed at investigating the effect of virtual reality on anxiety before coronary angiography. In a randomized controlled trial, 60 candidates for coronary angiography were randomly assigned to two intervention and control groups from April to July 2019. Data were collected by Spielberger’s situational anxiety questionnaire. The participants’ anxiety level and their heart rate, respiratory rate, and blood pressure were measured before and immediately after the intervention. The Intervention group received virtual reality intervention, and the control group was cared for based on the hospital routine. Data were entered into the SPSS version 24.0 software (SPSS Inc.) and analyzed using Chi-square, Paired samples, and independent sample t tests.ResultsThe majority of participants were male (71.25%) and the Mean ± SD age of them in the intervention and control groups was 50.95 ± 4.120 and 52.08 ± 4.002 years, respectively. The mean score of anxiety (p < 0.01), heart rate (p = 0.001), and systolic blood pressure (p = 0.016) after the intervention in the intervention group decreased significantly.ConclusionsThis study indicated the implementation of a VR distraction protocol in the patients could effectively reduce perioperative anxiety and its indices. It showed that VR is a safe method without any complications related to the device and with good acceptability.Registration code IRCT201 40515017693N3.

Correlation of Serum Cystatin C level with Coronary Artery Disease and Its Severity

Background: Atherosclerosis is an important cause of cardiovascular mortality and morbidity in the world and its progression might be slowed in many people with appropriate lifestyle and drug interventions. Hence a lot of researches are targeting the atherosclerotic process and its mediators. Cystatin C is considered to be an active cysteine protease inhibitor found in all body fluids and expressed in all nucleated cells in the body and is a better marker of renal function when compared to creatinine. Elevated plasma levels of cystatin C is thought to be associated with increased risk of cardiovascular disease (CVD) and mortality in different populations. This may be due to the fact that it represents occult impaired renal function, which is associated with increased risk of CVD. However, in several studies, cystatin C has been associated with CVD even within normal ranges of eGFR. Aim: To evaluate the relation of the serum cystatin C level and atherosclerotic burden in coronary arteries Methods: Our study included 80 patients of both sexes with known or suspected ischemic heart disease who were candidates for coronary angiography. Their serum Cystatin C level was measured using ELISA technique and correlated with coronary atherosclerosis using Gensini score. Results: No association was found between coronary atherosclerosis severity and serum cystatin C level. There was also no difference in serum cystatin C level between patients presenting with acute coronary syndrome and those presenting with stable ischaemic heart disease. Conclusion: The relation between serum cystatin C level and coronary atherosclerosis is still unclear

Lack of Association between Interarm Systolic Blood Pressure Difference and Coronary Artery Disease in Patients Undergoing Elective Coronary Angiography.

Aim Peripheral vascular disease (PVD) and coronary artery disease (CAD) are, in many cases, asymptomatic and not usually diagnosed. The timely diagnosis of peripheral vascular diseases can act as an indicator or practical evidence of CAD. Therefore, this study was conducted to determine the relationship between interarm systolic blood pressure difference (IASBPD) and severity and number of coronary artery stenosis. Methods The samples in this cross-sectional study consisted of 578 patients who were candidates for coronary angiography, with an average age of 57.5 ± 10.5 years. Patients were classified according to CAD and number and severity of coronary artery stenosis. The relationship between IASBPD and presence or lack of CAD as well as the number and severity of coronary artery stenosis was studied. The sensitivity, specificity, and positive predictive value of IASBPD index were calculated for the detection of CAD using the Kappa coefficient. Results There was no statistically significant relationship between IASBPD, CAD, and severity and number of coronary artery stenosis. This index had low sensitivity and predictive value in the diagnosis of CAD and stenosis in coronary arteries in comparison with angiography. Conclusion The results showed that the IASBPD index cannot be a valid criterion for the diagnosis of CAD as well as the number and severity of coronary artery stenosis. More studies with larger sample sizes and different designs are needed in this regard to achieve more conclusive results.

The effects of clinical simulation on stress, anxiety, and hemodynamic parameters among the candidates for coronary angiography

Background and aims: Stress and anxiety during coronary angiography (CA) can lead to serious complications such as cardiac dysrhythmias, coronary artery spasm, and coronary artery rupture. This study aimed to evaluating the effects of clinical simulation on stress, anxiety, and hemodynamic parameters among the candidates for CA. Methods: This clinical trial was conducted on eighty candidates for CA. Participants were conveniently recruited from Tehran Heart Center, Tehran, Iran, and randomly allocated to a control and an intervention group through block randomization with a block size of 2. The Beck Anxiety Inventory, the Cohen Perceived Stress Scale, and a datasheet for hemodynamic parameters were used to assess participants’ anxiety, stress, and hemodynamic parameters before and after the study intervention. Participants in the intervention group received routine care services and a clinical simulation intervention, while participants in the control group solely received routine care services. Data were analyzed using the chi-square, independent-sample t, and paired-sample t tests. Results: The mean scores of stress and anxiety and the mean values of systolic blood pressure (SBP), diastolic blood pressure (DBP), and heart rate (HR) significantly decreased in the intervention group (P&lt;0.05), but did not significantly change in the control group (P&gt;0.05). The pretest posttest differences in the means of stress, anxiety, SBP, DBP, and HR in the intervention group were significantly greater than the control group (P&lt;0.05). Conclusion: Clinical simulation is effective in significantly reducing stress, anxiety, and hemodynamic parameters among the candidates for CA. Therefore, clinical simulation is recommended before CA.

Comparing the effects of saffron, lippia, and saffron-lippia combination on anxiety among candidates for coronary angiography.

Objective:Coronary artery disease (CAD) is among the most prevalent diseases in the world, and its severity is usually assessed through coronary angiography (CA). Anxiety is the most prevalent problem before angiography. The aim of this study was to evaluate Crocus sativus (saffron) and Lippia citriodora Kunth (lippia) extracts and saffron-lippia extract combination on anxiety among the candidates for CA. Materials and Methods:This double-blind randomized placebo-controlled trial in four month was conducted on 120 angiography candidates in Valiasr hospital, Birjand, Iran. The random allocation was doing through block randomization to saffron, lippia, saffron-lippia, and placebo groups; four hours before angiography, participants in these groups respectively received a single dose of saffron extract capsule (40 mg), lippia extract capsule (40 mg), saffron-lippia extract capsule (20 mg saffron and 20 mg lippia), and lactulose capsule (40 mg). Participants’ anxiety was assessed before, thirty minutes after, and three hours after the intervention via Spielberger State-Trait Anxiety Inventory. Results:The mean scores of state, trait, and total anxiety in the saffron group reduced significantly (p<0.05), while the mean scores in the other groups did not change significantly, except for the mean score of trait anxiety in the saffron-lippia group which decreased significantly (p=0.05). Therefore, after the intervention, the mean scores of state, trait, and total anxiety in the saffron group were significantly lower than the other groups (all, p<0.05). Conclusion:This study suggests that the oral use of a single-dose of 40 mg saffron extract is effective in alleviating anxiety among the candidates for CA.

Comparing the effects of muscle relaxation and music therapy on anxiety among candidates for coronary angiography: A randomized clinical trial

Background: Coronary angiography is associated with some levels of anxiety. Anxiety in turn can cause different complications, and hence, interventions are needed for its management. Recently, nonpharmacological therapies for anxiety management have gained great attention. Objectives: This study aimed to evaluate the effects of muscle relaxation and music therapy on anxiety among candidates for coronary angiography. Methods: This randomized controlled trial was conducted on 105 candidates for coronary angiography. Participants were consecutively recruited from the cardiology wards of Namazi hospital, Shiraz, Iran, and were randomly assigned to three 35-person groups, namely music, relaxation, and control groups. Participants in the music and the relaxation groups received 20-min music therapy and were performed 20-min muscle relaxation. Anxiety level was assessed both before and after the interventions using the Spielberger State Anxiety Inventory. Data were analyzed through the Chi-square test, the paired-sample t-test, and the one-way analysis of variance. Results: The mean score of anxiety in the relaxation and the music groups significantly reduced from 51.08 ± 6.98 and 49.02 ± 7.74 at the baseline to 41.88 ± 5.16 and 44.28 ± 5.21 at posttest (P < 0.01); however, it did not significantly change in the control group (P = 0.081). Conclusion: Both muscle relaxation and music therapy are effective in significantly reducing anxiety among candidates for angiography.

Association of epicardial fat thickness assessed by echocardiography with the severity of coronary artery disease.

Introduction: Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD. Methods: Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion. Results: PLAX (EFTS) (EFT in systole) and PLAX (EFTd) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFTS) (P = 0.05), PLAX (EFTd) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score. Conclusion: EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

P874Role of Genetic Polymorphisms of ion channels in the pathophysiology of coronary microvascular dysfunction and ischemic heart disease: an update

Abstract Background Ischemic heart disease (IHD) is classically associated with coronary artery disease (CAD) and conventional cardiovascular risk factors. However, IHD may exhibit in the absence of CAD, because of different pathophysiological mechanisms, such as the presence of specific genetic variants of ion channels, which act mainly in the microcirculation. Recently, we reported the correlation between some single nucleotide polymorphisms (SNPs) of ion channels genes and the presence of IHD, independently from the presence of conventional cardiovascular risk factors. The goal of this study is to confirm the results of the previous study on a bigger population and discover new SNPs of ion channels genes which may be associated with IHD. Methods A prospective, observational, single-center study was conducted on patients candidates for coronary angiography. Patients were divided in three groups: G1, coronary artery disease; G2, microvascular disfunction; G3, normal. Genetic polymorphisms relative to KCNJ11 encoding for the Kir6.1 and Kir6.2 subunits of K-ATP channels and KCNE1 encoding for the MinK subunit of IKs channels were analyzed. Results 603 consecutive patients (G1: 409; G2:76; G3:118) were enrolled. Genetic analysis for the three groups showed a statistically significant difference for the SNP S38G of KCNE1 (p=0.001) and for the variants rs5215, rs5218, rs5219 of KCNJ11 (p&lt;0.0001), as well as comparing G1-G3 (S38G p=0.006; rs5215, rs5218 and rs5219 p&lt;0.0001). Regarding G1-G2 we confirmed differences only for the variants rs5215 (p&lt;0.0001), rs5218 (p=0.005) and rs5219 (p=0.024), while regarding G2-G3 we found differences for the variants S38G, rs5215 e rs5219 (p&lt;0.0001). A multivariate analysis was performed and highlighted that the SNP rs5215_GG of KCNJ11 may represent an IHD independent protective factor (p&lt;0.0001; OR: 0.036; 95.0% CI: 0.018–0.069). Conclusion These results confirm the importance of genetic susceptibility and the role of SNPs of ion channels genes in the determinism of IHD, independently from the conventional cardiovascular risk factors. Moreover, these results may represent a future perspective for a genic therapy for IHD.

FREQUENCY OF TRIPLE-VESSEL CORONARY ARTERY DISEASE IN ADULT TYPE 2 DIABETICS VERSUS NON-DIABETICS IN CORONARY ARTERY DISEASE POPULATION OF ISLAMABAD, PAKISTAN

Background: Coronary artery disease is a major cause of morbidity and mortality globally as well as in Pakistan. The objective of the study was to compare the frequency of triple-vessel coronary artery disease (triple-vessel CAD) in adult type 2 diabetics versus non-diabetics in coronary artery disease (CAD) population of Islamabad, Pakistan. Materials and Methods: This cross-sectional study was conducted in Department of Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from June 21, 2016 to December 20, 2016. 300 patients were selected from population including adult CAD patients who were candidates for coronary angiography. Those with conduction defects, renal failure and prior CABG surgery were excluded. 150 diabetics and 150 non-diabetics were subjected to coronary angiography. Age, sex and presence of triple-vessel CAD were research variables. Age was analyzed by mean and SD while sex and presence of triple-vessel CAD were analyzed by count and percentage for each group separately. Confidence interval for proportion was calculated at 80% confidence level for each group. Frequency of presence of triple-vessel CAD in two groups was compared using McNemar chi-square test at alpha 0.5. Results: Mean age was 55.02±8.48 for diabetics and 54.02±24.4 years for non-diabetics. Out of 300 patients with CAD, 184 (61.33%) were men and 116 (38.67%) were women. Triple-vessel CAD was present in 60/150 (40%) cases in diabetics and in 3/150 (2%) cases in non-diabetics. Frequency of triple-vessel CAD was significantly higher in adult type 2 diabetics versus non-diabetics in CAD population of Islamabad, Pakistan (p

FREQUENCY OF TRIPLE-VESSEL CORONARY ARTERY DISEASE IN ADULT TYPE 2 DIABETICS VERSUS NON-DIABETICS IN CORONARY ARTERY DISEASE POPULATION OF ISLAMABAD, PAKISTAN

Background: Coronary artery disease is a major cause of morbidity and mortality globally as well as in Pakistan. The objective of the study was to compare the frequency of triple-vessel coronary artery disease (triple-vessel CAD) in adult type 2 diabetics versus non-diabetics in coronary artery disease (CAD) population of Islamabad, Pakistan.&#x0D; Materials and Methods: This cross-sectional study was conducted in Department of Cardiology, Pakistan Institute of Medical Sciences, Islamabad, Pakistan from June 21, 2016 to December 20, 2016. 300 patients were selected from population including adult CAD patients who were candidates for coronary angiography. Those with conduction defects, renal failure and prior CABG surgery were excluded. 150 diabetics and 150 non-diabetics were subjected to coronary angiography. Age, sex and presence of triple-vessel CAD were research variables. Age was analyzed by mean and SD while sex and presence of triple-vessel CAD were analyzed by count and percentage for each group separately. Confidence interval for proportion was calculated at 80% confidence level for each group. Frequency of presence of triple-vessel CAD in two groups was compared using McNemar chi-square test at alpha 0.5.&#x0D; Results: Mean age was 55.02±8.48 for diabetics and 54.02±24.4 years for non-diabetics. Out of 300 patients with CAD, 184 (61.33%) were men and 116 (38.67%) were women. Triple-vessel CAD was present in 60/150 (40%) cases in diabetics and in 3/150 (2%) cases in non-diabetics. Frequency of triple-vessel CAD was significantly higher in adult type 2 diabetics versus non-diabetics in CAD population of Islamabad, Pakistan (p

The Relationship between Epicardial Adipose Tissue Thickness and Coronary Artery Disease

AbstractBackground: Epicardial adipose tissue (EAT) is a complex endocrine organ that express a variety of inflammatory medi-ators which may contribute to the pathogenesis of coronary artery disease (CAD).Aim of Study: To investigate the relation between EAT thickness and presence of coronary artery disease.Patient and Methods: This study included 100 patients who were candidates for coronary angiography. All patients were subjected to full history taking, and clinical examination. Echocardiographic techniques and calculations of different cardiac dimensions were performed and to measure the EAT. Coronary angiography was performed by standard technique to assess the presence or absence of coronary artery disease and the number of coronary arteries diseased.Results: EAT equal or more than 0.45cm is related to the presence of coronary artery disease, with a specificity and a sensitivity of 63.6% and 69.2% respectively. Our study revealed a positive correlation between EAT thickness and the presence of CAD.Conclusions: Epicardial adipose tissue thickness is sig-nificantly associated with presence of coronary artery disease.

The severity of coronary artery disease was not associated with non-alcoholic fatty liver disease in a series of 264 non-diabetic patients who underwent coronary angiography.

It is now suggested an association between non-alcoholic fatty liver disease (NAFLD) and the occurrence of coronary artery disease even in non-diabetic patients. We will determine the rate of NAFLD and its main determinants in non-diabetic patients undergoing coronary angiography. This cross-sectional study was accomplished on 264 patients who were candidates for coronary angiography during the year 2016. Coronary angiography has been done to depict the presence or absence of coronary involvement, and the severity of coronary artery disease by determining the number of vessels involved and also the SYNTAX score. During 48 hours after coronary angiography, the patients underwent abdominal ultrasonography for detection of NAFLD. The overall prevalence of NAFLD in the patients was 72.3%. The prevalence of NAFLD in those with and without coronary involvement was 71.9% and 73.1% respectively, with no notable difference (p = 0.837). The mean SYNTAX score in the patients with and without NAFLD was 22.32 ± 11.10 and 21.75 ± 10.71 respectively with no difference (p = 0.702). According to the multivariable regression models, the presence of NAFLD could not predict the likelihood of coronary artery disease (OR = 0.879, p = 0.669) or its severity assessed by the SYNTAX score (beta = 0.046, p = 0.456). NAFLD grade was also not a determinant for coronary artery disease (OR = 1.139, p = 0.178) or its severity (beta = 0.058, p = 0.165). It seems that the presence and grade of NAFLD may not be correlated with atherosclerotic involvement of coronary arteries and its severity in non-diabetic patients. Future large studies and trials could elucidate the independent role of fatty liver in nondiabetic non-alcoholic patients.

Arterial Stiffness and its Correlation with the Extent of Coronary Artery Disease

Introduction: Coronary artery disease secondary to atherosclerosis is the most common cause of mortality. Coronary angiography is the most precise method for determining the extent of disease in the coronary vascular bed. Arterial stiffness has been proposed as a marker of atherosclerosis in some studies. One of the noninvasive methods for the determination of arterial stiffness is Doppler echocardiography. In this study, we aimed to find the correlation between arterial stiffness as measured by echocardiography and the extent of coronary artery disease as evaluated through angiography. Materials and Methods: Aortic pulse wave velocity (APWV) was measured by using the Doppler method in 70 patients, who were candidates for coronary angiography. The extent of coronary artery disease was determined quantitatively in terms of Friesinger index and semi-quantitatively as the number of vessels with stenosis of over 50%. Then, the correlation between arterial stiffness and these factors was evaluated. Results: The mean APWV was 9.1±5 m/s. There was a direct relationship between APWV and Friesinger index, which was not statistically significant (P=0.67). The mean APWV for patients with one-vessel disease was 4.4±1.8 m/s, while it was 9.9±3.6 m/s in patients with two and 7.9±4 m/s in three-vessel disease which did not show statistically significant difference. Conclusion: Doppler echocardiography to measure APWV was not considered as a promising tool to predict the extent of coronary artery disease.

Cystatin C may not be a precious predictor for coronary artery disease and its severity: an area of uncertainty.

Background and Aim: Cystatin C, an endogenous indicator for kidney function, may be also an original indicator for coronary atherosclerosis. In the current study, we intended to assess its role in establishing the existence of coronary artery disease. We also attempted to present the best cut off point for Cystatin C to discriminate coronary disease from normal coronary condition. Methods: 147 consecutive patients who were candidate for coronary angiography were included into the study. Cystatin C was measured using Auto-analyzer system and by Gentian kit with enzyme calorimetric method. Results: The mean level of Cystatin C in the patients with and without coronary artery disease was 0.97±0.51 mg/l and 1.02±0.40 mg/l with no significant difference (p=0.564). In multivariate logistic regression model, the serum level of Cystatin C could not predict coronary artery disease (OR=1.199, 95% CI: 0.531 to 1.706, p=0.662). According to the area under the ROC curve, Cystatin C was not a good indicator to discriminate coronary artery disease from normal coronary condition (AUC=0.465, 95% CI: 0.372 to 0.559, p=0.470). Considering cut of points of 0.85 and 0.94 for Cystatin C, the sensitivity of this test for predicting coronary artery disease in comparison with coronary angiography was 65% and 51%, respectively. In assessing relationship between serum level of Cystatin C and other chemical biomarkers, Cystatin C was only correlated with serum triglyceride level (r=0.207, p=0.012). Conclusions: Cystatin C measurement may not be a suitable predictor for coronary artery disease and severity of the coronary involvement. Future studies with large sample size are necessitated to demarcate distinct role of Cystatin C in coronary artery disease. (www.actabiomedica.it)

Efficacy and Safety of Coronary Sinus Aspiration During Coronary Angiography to Attenuate the Risk of Contrast-Induced Acute Kidney Injury in Predisposed Patients.

The incidence of contrast-induced acute kidney injury is strongly related to the amount of the given contrast. Our objectives were to evaluate the efficacy and safety of coronary sinus aspiration (CSA) procedure to reduce the volume of the given contrast and attenuate the risk of contrast-induced acute kidney injury. The study included 43 patients with type 2 diabetes mellitus and renal impairment (creatinine 1.5-3 mg/dL) who were candidates for coronary angiography. Eighteen patients were subjected to CSA procedure during coronary angiography (CSA group), and 25 patients served as a control group. Periprocedural standard care was given. In CSA group, the coronary sinus was cannulated via subclavian or femoral venous approaches, and aspiration was done directly from a transseptal sheath (8 patients) or through a balloon occlusion catheter placed through the sheath (10 patients) simultaneously during each coronary injection. Estimated volume of aspirated contrast was calculated based on the percentage reduction in hematocrit value of the aspirate in relation to the patient's baseline hematocrit. Fraction of aspirated contrast was calculated by dividing estimated volume of aspirated contrast over the volume of injected contrast×100. Both study groups were matched in clinical and laboratory data, as well as volume of injected contrast. In CSA group, mean fraction of aspirated contrast was 39.35±10.47%. One patient in the CSA group, compared with 9 patients in the control group, developed contrast-induced acute kidney injury (P=0.028). CSA during coronary angiography could effectively remove more than one third of the given contrast and may reduce the incidence of contrast-induced acute kidney injury in selected patients.

Rest 2D speckle tracking echocardiography may be a sensitive but nonspecific test for detection of significant coronary artery disease.

Aims:To detect the significance of coronary artery disease in the patients, who are suspected, was assumed to be one of the advantages of 2D STE, as a novel non-invasive imaging modality with acceptable accuracy.Methods:In this study, 216 patients who were suspected to have coronary artery disease and candidate for coronary angiography, underwent rest two-dimensional speckle tracking echocardiography (2D STE) and negative global systolic longitudinal strain was evaluated. Results: Negative global systolic left ventricular longitudinal strain under 18% in rest 2D-STE was significantly prevalent in patients with significant CAD in coronary angiography (P value<0.0001). Our results revealed sensitivity of 91.1%, specificity of 63.0%, positive predictive value of 80.4%, negative predictive value of 81.0% and accuracy of 80.5% for rest 2D-STE in detection of significant CAD.Conclusion:Here in we showed that rest Two-dimensional speckle tracking echocardiography could be a sensitive but nonspecific imaging modality to determine significant coronary artery disease. Future studies with large size will reveal more detailed findings. (www.actabiomedica.it)

Relationship between Myocardial Performance Index and Severity of Coronary Artery Disease in patients with Stable Coronary Artery Disease.

Objectives: To investigate the relationship between severity of coronary artery disease (CAD) assessed with SYNTAX score (SS) and myocardial performance index (MPI) in stable CAD. Methods: The study included 100 patients who were candidate for coronary angiography. All subjects underwent full history taking, complete clinical examination, echocardiographic examination for calculation of MPI, EF and E/A ratio, and coronary angiography for calculation of syntax score. Results: Among study population 49 female (49.0%) and 51 male (51.0%) with mean age (48.96±7.30), 80 patients (80.0%) were had angiographically proven obstructive CAD, whereas 20 (20.0%) patients were had normal coronary angiography. There is statistically significant positive correlation between MPI and SS in patients with obstructive CAD (P-value < 0.001). Conclusion: MPI showed the ability of being a sensitive marker of LV function in SCAD as its value was impaired in proportion to severity of coronary obstruction and it is correlated well with Syntax score as it is the most recent quantitative and qualitative tool that can characterizes angiographically obstructive lesions, risk stratification and prognostication of patients with CAD.