Chronic Coronary Artery Disease Patients Research Articles

Incremental prognostic utility of left ventricular and left atrial strains in coronary artery disease patients with reduced systolic function.

This study aimed to investigate the predictive value of left ventricular global longitudinal strain (GLS) and left atrial reservoir strain (LARS) on adverse events in chronic coronary artery disease (CAD) patients with reduced systolic function. A total of 192 consecutive patients clinically diagnosed with chronic CAD and left ventricular ejection fraction (LVEF)≤50% were finally included. Multiple strain parameters were analyzed with speckle tracking echocardiography. The composite endpoint included all-cause mortality, rehospitalization due to heart failure, myocardial infarction, and stroke. Patients experiencing the endpoint showed lower LVEF, lower absolute GLS and LARS than those without events. Both GLS (AUC=0.82 [GLS] vs. 0.58 [LVEF], p < 0.001) and LARS (AUC=0.71 [LARS] vs. 0.58 [LVEF], p=0.033) were superior to LVEF in predicting adverse events. Multivariate cox regression analysis showed that both GLS (hazard ratio, 0.71; 95% CI, 0.63-0.79; p < 0.001) and LARS (hazard ratio, 0.96; 95% CI, 0.93-0.98; p < 0.001) were independent predictors for the endpoint. The addition of LARS (global chi-squared, 35.7vs. 17.4; p < 0.05), GLS (global chi-squared, 58.6vs. 17.4; p < 0.05) or both LARS and GLS (global chi-squared, 79.6vs. 17.4; p < 0.05) to LVEF in the prediction model significantly improved its performance. The same significant improvement was also shown in the subgroups of mild (30%<LVEF≤50%) and severe (LVEF≤30%) reduced systolic function. Regarding CAD patients with reduced LVEF, both GLS and LARS are superior to LVEF in predicting adverse events, providing significant incremental value to LVEF.

Enhancing Prediction of Myocardial Recovery After Coronary Revascularization: Integrating Radiomics from Myocardial Contrast Echocardiography with Machine Learning.

Chronic coronary artery disease (CAD) management often relies on myocardial contrast echocardiography (MCE), yet its effectiveness is limited by subjective interpretations and difficulty in distinguishing hibernating from necrotic myocardium. This study explores the integration of machine learning (ML) with radiomics to predict functional recovery in dyskinetic myocardial segments in CAD patients undergoing revascularization, aiming to overcome these limitations. This prospective study enrolled 55 chronic CAD patients, dividing into training (39 patients, 205 segments) and testing sets (16 patients, 68 segments). Dysfunctional myocardial segments were identified by initial wall motion scores (WMS) of ≥2 (hypokinesis or higher). Functional recovery was defined as a decrease of ≥1 grade in WMS during follow-up echocardiography. Radiomics features were extracted from dyssynergic segments in end-systolic phase MCE images across five cardiac cycles post- "flash" impulse and processed through a five-step feature selection. Four ML classifiers were trained and compared using these features and MCE parameters, to identify the optimal model for myocardial recovery prediction. Functional improvement was noted in 139 out of 273 dyskinetic segments (50.9%) following revascularization. Receiver Operating Characteristic (ROC) analysis determined that myocardial blood flow (MBF) was the most precise clinical predictor of recovery, with an area under the curve (AUC) of 0.770. Approximately 1.34 million radiomics features were extracted, with nine features identified as key predictors of myocardial recovery. The random forest (RF) model, integrating MBF values and radiomics features, demonstrated superior predictive accuracy over other ML classifiers. Validation of the RF model on the testing dataset demonstrated its effectiveness, evidenced by an AUC of 0.821, along with consistent calibration and clinical utility. The integration of ML with radiomics from MCE effectively predicts myocardial recovery in CAD. The RF model, combining radiomics and MBF values, presents a non-invasive, precise approach, significantly enhancing CAD management.

Who may benefit from low-dose Rivaroxaban plus Aspirin? Practical implications for outpatients with cardiovascular disease.

Despite the availability of effective preventive therapies based on guidelines, patients with vascular diseases continue to be at a high risk for recurrent ischemic events. Therefore, novel therapeutic strategies are required to further reduce the residual risk present in these patients at high risk. Platelet aggregation and fibrin organization are involved in arterial thrombosis, and rivaroxaban is capable of targeting both processes and has a synergistic effect when used in combination with acetylsalicylic acid (ASA), the so-called dual pathway inhibition (DPI). The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial showed that the DPI (a combination of rivaroxaban 2.5 mg/bid (vascular dose) and ASA 100 mg once daily), reduced cardiovascular death, stroke, or myocardial infarction by 24% in patients with chronic coronary artery disease (CAD) and peripheral artery disease (PAD). Subsequently, the VOYAGER PAD (Vascular Outcomes Study of ASA Along with Rivaroxaban in Endovascular or Surgical Limb Revascularization for PAD) trial confirmed the effectiveness of the vascular dose of rivaroxaban in patients with PAD after lower-extremity revascularization, compared to ASA alone. Therefore, DPI is recommended in patients with CAD (+/- PAD) or symptomatic PAD at high ischaemic risk. The purpose of this review is to examine the clinical benefits and practical implications of DPI in CAD and PAD patients.

Monocyte-to-High Density Lipoprotein Cholesterol Ratio Positively Predicts Coronary Artery Disease and Multi-Vessel Lesions in Acute Coronary Syndrome.

We investigated the hypothesis that MHR (monocyte-to-high density lipoprotein cholesterol ratio) is related to the severity of coronary artery in ACS (acute coronary syndrome). In this case-control study, we recruited 15,853 participants undergoing the first time percutaneous coronary intervention (PCI) including 4093 normal controls, 10,518 chronic coronary artery disease (CAD), and 1242 ACS cases. Examination of demographic clinical data and biochemical profiles, as well as MHR values, were performed before PCI. The relationship between MHR and severity of coronary artery lesion in ACS was analyzed. We also used a flow cytometric assay to distinguish CD14+/CD16- classical monocyte subsets in peripheral blood mononucleated cells from CAD patients. MHR was higher in patients with ACS compared with MHR in normal control and chronic CAD (normal control vs chronic CAD vs ACS: 0.46 ± 0.27 × 109/mmol vs 0.53 ± 0.29 × 109/mmol vs 0.73 ± 0.47 × 109/mmol, P < 0.001). MHR showed a significantly progressive increase as the angiographic severity of coronary lesions increased (single vessel lesion vs multi-vessel lesions in ACS: 0.54 ± 0.31 × 109/mmol vs 0.58 ± 0.35 × 109/mmol, P < 0.001), and classical monocyte subset to HDL-C ratio (CMHR) was increased in with CAD patients compared with control [4.69 (IQR, 1.06, 2.97) × 103/mmol vs 1.92 (IQR, 0.92, 3.04) × 103/mmol, P = 0.02]. Using a multivariate analysis, after adjusting for age, gender, body mass index (BMI), diabetes, and dyslipidemia, MHR was positively associated with multi-vessel lesions in ACS [OR (odds ratio): 1.28 (95% CI: 1.03-1.59, P = 0.029)]. MHR level could be a potential predictor of coronary artery lesion severity in ACS.

Relation Between Serum Uric Acid to Albumin Ratio and Severity of Chronic Coronary Artery Disease.

Uric acid (UA) to albumin ratio (UAR) is an emerging marker to predict coronary artery disease (CAD)-related events. There is limited data on the relationship between UAR and the severity of the disease in chronic CAD patients. We aimed to evaluate UAR as an indicator for CAD severity using the Syntax score (SS). We retrospectively enrolled 558 patients with stable angina pectoris and underwent coronary angiography (CAG). Patients were divided into 2 groups, according to CAD severity: low SS (≤22) and intermediate-high SS (>22) groups. UA levels were higher and albumin levels were lower in the intermediate-high SS score group (P < .001). UAR levels were significantly higher in the intermediate-high SS group (P < .001). Also, there was a significant correlation between UAR levels and SS (r = .55, 95% confidence interval (CI): .49-.60, P < .001). In multivariable analysis, UAR >1.34 (Odds ratio, 3.8 [2.3-6.2]; P < .001) was an independent predictor of intermediate-high SS while albumin and UA levels were not. In conclusion, UAR predicted disease burden in chronic CAD patients. It may prove useful as a simple and readily available marker to select patients for further evaluation.

The Presence of Residual Vascular and Adipose Tissue Inflammation on 18F-FDG PET in Patients with Chronic Coronary Artery Disease

PurposeWe evaluated the residual vascular and adipose tissue inflammation in patients with chronic coronary artery disease (CAD) using positron emission tomography (PET).MethodsOur study population consisted of 98 patients with known CAD and 94 control subjects who had undergone 18F-fluorodeoxyglucose (18F-FDG) PET due to non-cardiac reasons. Aortic root and vena cava superior 18F-FDG uptake were measured to obtain the aortic root target-to-background ratio (TBR). In addition, adipose tissue PET measurements were done in pericoronary, epicardial, subcutaneous, and thoracic adipose tissue. Adipose tissue TBR was calculated using the left atrium as a reference region. Data are presented as mean ± standard deviation or as median (interquartile range).ResultsThe aortic root TBR was higher in CAD patients compared to control subjects, 1.68 (1.55–1.81) vs. 1.53 (1.43–1.64), p < 0.001. Subcutaneous adipose tissue uptake was elevated in CAD patients 0.30 (0.24–0.35) vs. 0.27 (0.23–0.31), p < 0.001. Metabolic activity of CAD patients and control subjects was comparable in the pericoronary (0.81 ± 0.18 vs. 0.80 ± 0.16, p = 0.59), epicardial (0.53 ± 0.21 vs. 0.51 ± 0.18, p = 0.38) and thoracic (0.31 ± 0.12 vs. 0.28 ± 0.12, p = 0.21) adipose tissue regions. Aortic root or adipose tissue 18F-FDG uptake was not associated with the common CAD risk factors, coronary calcium score, or aortic calcium score (p value > 0.05).ConclusionPatients with a chronic CAD had a higher aortic root and subcutaneous adipose tissue 18F-FDG uptake compared to control patients, which suggests residual inflammatory risk.

Individual lifetime benefit from low-dose colchicine in chronic coronary artery disease patients

Abstract Background Low-dose colchicine reduces the risk of cardiovascular events in patients with chronic coronary artery disease (CAD), but the absolute benefit may vary between patients. Individual benefit from preventive therapies can be estimated using the guideline-recommended SMART-REACH model. Purpose This study aimed to assess the range of individual absolute 10-year and lifetime benefit from low-dose colchicine according to patient risk profile. Methods The SMART-REACH model was combined with the relative treatment effect of low-dose colchicine, and applied to all participants from the LoDoCo2 trial (n=5,522), and patients with chronic CAD from the UCC-SMART cohort (n=5,308). Individual treatment benefit was expressed as (i) 10-year absolute risk reductions (ARRs) for myocardial infarction, ischemic stroke, or cardiovascular death (MACE), and (ii) life-years gained free of MACE. Predictions were also performed for MACE plus ischemia-driven coronary revascularization (MACE+), through development of a new competing risk-adjusted lifetime prediction model in data from the REACH registry (n=14,522). Low-dose colchicine was compared to alternative intensive prevention goals, i.e. low density lipoprotein-cholesterol (LDL-c) reduction to &amp;lt;1.4 mmol/L, and systolic blood pressure (SBP) reduction to &amp;lt;130 mmHg. Results Median individual 10-year ARR for MACE from low-dose colchicine therapy was 4.6% (interquartile range [IQR] 3.6–6.0%), and median gain in life expectancy free of MACE was 2.0 (IQR 1.6–2.5) years. Median 10-year ARR for MACE+ was 8.6% (IQR 7.6–9.8%), and median gain in MACE+-free life expectancy was 3.4 (IQR 2.6–4.2) years. For intensified LDL-c and SBP reduction respectively, median 10-year ARRs were 3.0% (IQR 1.5–5.1%) and 1.7% (IQR 0.0–5.7%) for MACE, and 5.2% (IQR 2.5–8.7%) and 2.9% (IQR 0.0–9.5%) for MACE+. Median life-years gained from LDL-c and SBP reduction were 1.2 (IQR 0.6–2.1) and 0.7 (IQR 0.0–2.3) years free of MACE, and 1.8 (IQR 0.8–3.3) and 0.9 (IQR 0.0–3.4) years free of MACE+. Conclusion The individual absolute benefit from low-dose colchicine varies between patients. In an era where lipid- and blood pressure-lowering therapies are already routinely used, the benefits of low-dose colchicine are expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in patients with chronic CAD. Funding Acknowledgement Type of funding sources: None.

Assessment of Trimetazidine Treatment in Acute Myocardial Infarction Patients Undergoing Percutaneous Coronary Intervention.

Aims Trimetazidine (TMZ) is effective at improving clinical outcomes in chronic heart failure and stable coronary artery disease patients. However, no single study has comprehensively evaluated the efficacy of TMZ in acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention (PCI). Methods We enrolled 401 Chinese patients. All patients received the same drug prescription except for TMZ. In blinded fashion, patients were randomized to either a control or an experimental group in which 60 mg TMZ was provided at admission and then at 20 mg three times a day thereafter. At 2 and/or 6 days, we evaluated creatine kinase (CK and CK-MB), cardiac troponin I (cTnI), C-reaction protein (CRP), serum tumor necrosis factor (TNF-α), serum creatinine (Cr), serum urea, glucose, glutamic pyruvic transaminase (ALT), and glutamic oxaloacetic transaminase (AST). Additionally, by echocardiography, we assessed left ventricular ejection fraction (LVEF), left ventricular end-diastolic dimension (LVEDD), and cardiac output (CO). Results CK and CKMB, which were recorded on the second day in the hospital (each p=0.022), and cTNI, which was recorded on the sixth day in the hospital (p=0.003), were reduced with TMZ treatment compared to control. In addition, ALT and AST (p=0.001, p=0.000, respectively) and glucose after 6 days (p=0.011) were significantly lower in the study group than in the control group. Furthermore, LVEF after 10–14 days and 6 months after discharge (p=0.039 and p=0.047, respectively) was increased with TMZ treatment. The effects of TMZ on CRP, TNF-α, Cr, urea, LVEDD, and CO were not significant (all p > 0.05). Conclusions For AMI patients undergoing PCI, TMZ reduced circulating biomarkers of myocardial infarction, reduced values of ALT, AST, and glucose, and improved cardiac function compared with the control group.

The impact of affective disorders on self-assessment of the quality of life in patients with chronic coronary artery disease

Aim. To determine the differences in self-assessment of social functioning by patients with chronic coronary artery disease (CAD), depending on the presence of comorbid affective disorders (ADs).Materials and methods. Using the Social Adaptation Self-Evaluation Scale (SASS), which makes it possible to assess the degree of social functioning and satisfaction with various aspects of social life, we studied the features of the social functioning of heart hospital patients with chronic CAD with (n = 248) and without AD (n = 291). In 290 patients (average age 56.6 ± 6.7 years) with chronic CAD, chronic ADs (45%) were revealed; depressive episodes (DEs) were diagnosed for the first time in 24% of patients, and 24.5% of patients had recurrent DEs. Bipolar disorder was found in 6.5% of cases. Qualitative and quantitative parameters were investigated using the Mann – Whitney U test and Student’s t-test. To assess the frequencies, the Pearson’s chi-squared test was used.Results. The mean total SASS score in the patients with chronic CAD with AD corresponded to difficult social adaptation (33.7 [29.5; 39]), while the patients without AD had good social adaptation score of 40.8 ± 6.3 (p &lt; 0.05). In the group without AD, patients with normal social adaptation prevailed (n = 215; 73.8%), while patients with AD more often had difficulties with social adaptation (n = 148; 59.7%). In the CAD patients, depending on the presence of AD, the frequency of disturbances in various spheres of social adaptation differed: employment, interest in and pleasure from activities, disposition of income, pleasure from and interest in seeking information, social support (p = 0.001).Conclusion. Higher frequency of pronounced impairment in social functioning in patients with chronic CAD with AD determines the need for taking this fact into consideration when planning rehabilitation measures in this group of patients.

Comparative evaluation of standard maintenance-dose clopidogrel versus low-dose prasugrel in patients with stable coronary artery disease after percutaneous coronary intervention

BackgroundTreatment with low-dose prasugrel might be more beneficial even in chronic stable coronary artery disease (CAD) patients treated with clopidogrel. We compared platelet reactivity between standard maintenance-dose and low-dose prasugrel in stable CAD patients. MethodsThis multicenter study enrolled 164 stable CAD patients receiving dual antiplatelet therapy with aspirin and clopidogrel. Patients were randomly assigned to continue treatment with 75-mg clopidogrel daily (n = 80) or switch to 3.75-mg prasugrel daily (n = 84). Platelet reactivity was evaluated by measuring P2Y12 reaction unit (PRU) before randomization and at 5 and 30 days thereafter using the VerifyNow® assay. Patients were classified into three groups according to CYP2C19-clopidogrel metabolic phenotype: extensive (without a *2 or *3 allele), intermediate (one *2 or *3 alleles), or poor (two *2 or *3 alleles) metabolizers. ResultsThe PRU level was comparable between the two groups at baseline but was significantly lower in the prasugrel group than in the clopidogrel group on days 5 (133.0 vs. 156.8 PRU, P = 0.005) and 30 (124.3 vs. 158.0 PRU, P < 0.001). On day 30, the PRU level was lower in the prasugrel group among patients categorized as poor and intermediate metabolizers but not among extensive metabolizers. ConclusionsLow-dose prasugrel achieves more consistent antiplatelet effects than clopidogrel irrespective of the metabolic phenotype in Japanese patients with stable CAD. Low-dose prasugrel might be also beneficial in the chronic phase without increasing the bleeding risk among stable CAD patients in other countries.

Colchicine may become a new cornerstone therapy for coronary artery disease: a meta-analysis of randomized controlled trials.

Colchicine is an ancient anti-inflammatory drug. In recent years, an increasing number of studies have shown that colchicine improves the prognosis of patients with coronary artery disease (CAD), while other studies have reported the opposite. The aim of this study was to evaluate the relative efficacy and safety of colchicine in treating CAD. PubMed, EMBASE, the Cochrane Library, and ClinicalTrials.gov were searched from inception to 20 October 2020 for randomized controlled trials (RCTs) comparing colchicine and placebo in patients with CAD. The primary outcomes were the primary composite outcomes of cardiovascular death, myocardial infarction (MI), ischemic stroke, or ischemia-driven coronary revascularization after colchicine administration. The secondary outcomes were cardiovascular death, death from any cause, noncardiac death, MI, ischemic stroke, coronary revascularization, gastrointestinal (GI) symptoms, and the different effects of colchicine in acute and chronic CAD. We assessed the pooled odds ratio (OR) of all-cause and cardiovascular mortality for CAD in fixed-effects models, the pooled risk ratio (RR) of the primary composite outcomes, MI, ischemic stroke, and ischemia-driven coronary revascularization in fixed-effects models and the pooled RR of GI symptoms in random-effects models. The Cochrane risk of bias tool was used to assess the risk of bias in the included RCTs. Eleven of the 894 identified studies (n = 12,899 patients) were included (6501 subjects in the colchicine group; 6389 subjects in the control group). The colchicine group had significantly lower pooled RRs of the primary composite outcomes (0.73, 95% confidence interval (CI) 0.64-0.84, P < 0.0001), MI (0.77, 95% CI 0.64-0.92, P = 0.004), ischemic stroke (0.47, 95% CI 0.30-0.76, P = 0.002), and ischemia-driven coronary revascularization (0.77, 95% CI 0.66-0.89, P = 0.0007), while the pooled RR of adverse GI events (2.15 95% CI 1.40-3.31, P = 0.0005) was significantly higher. Colchicine had a lower pooled RR of ischemic stroke (0.28, 95% CI 0.12-0.65, P = 0.003) for patients with acute compared with chronic CAD. Colchicine treatment significantly decreased the risk of primary cardiovascular composite outcomes, MI, ischemic stroke, and ischemia-driven coronary revascularization in CAD patients but increased adverse GI events. There was no significant difference in all-cause mortality, cardiovascular mortality, and non-cardiovascular death between the colchicine and control groups. Colchicine performs better in acute CAD patients with ischemic stroke than chronic CAD patients. Colchicine might be a new treatment for patients with CAD.

Study design for a randomized crossover study investigating myocardial strain analysis in patients with coronary artery disease at hyperoxia and normoxemia prior to coronary artery bypass graft surgery (StrECHO-O2)

BackgroundSupplemental oxygen (O2) is used routinely during anesthesia. In the treatment of acute myocardial infarction, it has been established that hyperoxia is to be avoided, whereas information on benefit and risk of hyperoxia in patients with stable coronary artery disease (CAD) remain scarce, especially in the setting of general anesthesia. This study will compare the immediate effects of normoxemia and hyperoxia on cardiac function, with a primary focus on changes in peak longitudinal left-ventricular strain, in anesthetized stable chronic CAD patients using peri-operative transesophageal echocardiography (TEE). MethodsA single-center randomized cross-over clinical trial will be conducted, enrolling 106 patients undergoing elective coronary artery bypass graft surgery. After the induction of anesthesia and prior to the start of surgery, cardiac function will be assessed by 2D and 3D TEE. Images will be acquired at two different oxygen states for each patient in randomized order. The fraction of inspired oxygen (FIO2) will be titrated to a normoxemic state (oxygen saturation of 95–98%) and adjusted to a hyperoxic state (FIO2 = 0.8). TEE images will be analyzed in a blinded manner for standard cardiac function and strain parameters. ConclusionBy using myocardial strain assessed by TEE, early and subtle signs of biventricular systolic and diastolic dysfunction can be promptly measured intraoperatively prior to the onset of severe signs of ischemia. The results may help anesthesiologists to better understand the effects of FIO2 on cardiac function and potentially tailor oxygen therapy to patients with CAD undergoing general anesthesia.

Effects of n-3 Polyunsaturated Fatty Acid-Enriched Hen Egg Consumption on the Inflammatory Biomarkers and Microvascular Function in Patients with Acute and Chronic Coronary Syndrome—A Randomized Study

Simple SummaryThere is a strong potential of n-3 polyunsaturated fatty acid (n-3 PUFA) consumption to reduce cardiovascular risk and prevent adverse outcomes in existing cardiovascular diseases. This study aimed to test the effect of n-3 PUFA supplementation in the form of enriched hen eggs on serum lipid and free fatty acid profiles, inflammatory and oxidative stress biomarkers, and microvascular reactivity in patients with acute and chronic coronary artery disease. Consumption of three n-3 PUFA-enriched hen eggs for three weeks had a favorable effect on serum free fatty acid profile (a lower n-6/n-3 PUFA ratio) and mild anti-inflammatory effects but did not significantly affect microvascular reactivity in patients with coronary artery disease. Because consumption of both regular and n-3 PUFA eggs had no negative effects on any of the measured biological and functional vascular parameters, the results of the present study indicate that eggs can be safely consumed in the daily diet of patients with coronary artery disease.This study aimed to test the effect of n-3 polyunsaturated fatty acid (PUFA)-enriched hen egg consumption on serum lipid and free fatty acid profiles, inflammatory and oxidative stress biomarkers, and microvascular reactivity in patients with coronary artery disease (CAD). Forty CAD patients participated in this study. Of those, 20 patients had acute CAD (Ac-CAD), and 20 patients had chronic CAD (Ch-CAD). The control group (N = 20) consumed three regular hen eggs/daily (249 mg n-3 PUFAs/day), and the n-3 PUFAs group (N = 20) consumed three n-3 PUFA-enriched hen eggs/daily (1053 g n-3 PUFAs/day) for 3 weeks. Serum n-3 PUFA concentration significantly increased (in all CAD patients), while LDL cholesterol and IL-6 (in Ac-CAD patients), and hsCRP and IL-1a (in all CAD patients) significantly decreased in the n-3 PUFAs group. Glutathione peroxidase (GPx) activity significantly decreased, and forearm skin microvascular reactivity in response to vascular occlusion (postocclusive reactive hyperemia (PORH)) remained unchanged in both the n-3 PUFAs and control groups in total CAD, Ac-CAD, and Ch-CAD patients. Potentially, n-3 PUFA-enriched hen eggs can change the free fatty acid profile to a more favorable lower n6/n3 ratio, and to exhibit mild anti-inflammatory effects but not to affect microvascular reactivity in CAD patients.

Possibilities of detecting and correcting decreased heart rate variability in patients with coronary artery disease in combination with depressive disorders in a cardiology department

Aim . To identify the presence and the correction method of decreased heart rate variability (HRV) in patients with chronic coronary artery disease (CAD) and comorbid depressive disorders (DD). Materials and methods . 79 patients with CAD (with class II–III angina pectoris and myocardial infarction that occurred more than 6 months ago) were divided into two groups. The first group included 50 CAD patients with depression, and the second – 29 CAD patients without depression. 17 patients received agomelatine (1st subgroup), 12 patients received fluvoxamine and fluoxetine (2nd subgroup), and 21 patients refused to take antidepressants (3rd subgroup). Initially and after 6 months, the HRV parameters were evaluated using the SCHILLER MT-200 Holter-ECG apparatus (Switzerland). Results . A significant decrease in HRV was revealed in the patients with depression compared to the patients without it: SDNN (96 [83; 117] ms vs. 110 [98; 127] ms; p = 0.02), SDANN (80.5 [67; 94] ms vs. 91 [79; 102] ms; p = 0.03), SDNNindex (46.5 [38; 56] ms vs. 55 [48; 66] ms; p = 0.006), rMSSD (29 [23; 38] ms vs. 33 [29; 45] ms; p = 0.04), pNN50% (3.9 [2.4; 5,7] vs. 5.7 [2.9; 12.6]; p = 0.03). Initially, the 1st, 2nd, and 3rd subgroups did not differ in all HRV parameters. Against the background of antidepressant therapy, there were significant differences between the 2nd and 3rd subgroups in SDNN (110 [96; 140] ms vs. 85.5 [75; 103] ms; p = 0.008), SDANN (93.7 ± 22.9 ms vs. 72.7 ± 21.4 ms; p = 0.02), SDNNindex (55.8 ± 16.4 ms vs. 42.4 ± 10.8 ms; p = 0.01) and pNN50% (7.8 ± 6.7 vs. 3.6 ± 1.8; p = 0.02), as well as between the 1st and 3rd subgroups (SDANN (93.6 ± 28.5 ms vs. 72.7 ± 21.4 ms; p = 0.03), rMSSD (36.5 [28.5; 51] ms vs. 26.5 [25; 32] ms; p = 0.02)). Conclusion . In patients with CAD with comorbid DD, significant impairment of heart rhythm regulation occurs due to a pronounced decrease in HRV, which can seriously affect the course and prognosis of CAD. Prescribing modern antidepressants can be used as a method of correcting autonomic dysfunction in patients with CAD with comorbid depression.

Circulating FoxP3+ T-lymphocytes in chronic coronary artery disease: Associations with the severity of atherosclerosis and lipid metabolism

Introduction. The transcription factor forkhead box protein P3 (FoxP3) is a major regulator of T-regulatory (Treg) lymphocytes and may be expressed in T-conventional (Tconv) lymphocytes at the stage of their activation. The aim of the present study was to evaluate the quantities and features of FoxP3+ Tconv and Treg lymphocytes and their relationships with the parameters of lipid metabolism in patients with chronic coronary artery disease (CAD) depending on the severity of coronary atherosclerosis.Material and Methods. The study comprised 14 patients (8 men and 6 women) aged 66.5 ± 9.0 years with verified chronic CAD. All the patients underwent coronary angiography and assessment of atherosclerosis severity by calculation of Gensini Score index (GS). Patients were divided into the following groups: group 1 had GS &lt; 20; group 2 had GS ≥ 20. The absolute and relative counts of FoxP3+ Treg and Tconv lymphocytes and degree of FoxP3 nuclear translocation were evaluated in all patients by imaging flow cytometry. Concentrations of insulin, proprotein convertase subtilisin/kexin type 9 (PCSK9), and sortilin were assessed using enzyme-linked immunosorbent assay. Parameters of glucose metabolism and serum lipid spectrum were determined by the standard methods.Results. Counts of Treg and Tconv lymphocytes did not differ between groups of patients with different severity of atherosclerosis. However, patients with GS ≥ 20 had lower intensity of nuclear FoxP3 fluorescence in Treg and Tconv lymphocytes. GS index in the entire group of CAD patients tended to be negatively associated with the fluorescence intensity of FoxP3 in the nuclei of Treg (rs = –0.476) and Tconv lymphocytes (rs = –0.526). Multiple correlations existed between the quantitative and qualitative parameters of FoxP3+ Treg and FoxP3+ Tconv lymphocytes and metabolic parameters such as concentrations of PCSK9, sortilin, apolipoprotein B, and triglycerides/HDL cholesterol ratio.Conclusion. FoxP3 fluorescence intensity in the nuclei of T conventional lymphocytes was more sensitive marker of immunoregulatory imbalance in chronic CAD compared to counts of FoxP3+ T cells in the peripheral blood, which remained nearly unaltered with the increase in atherosclerosis severity. At the same time, markers of lipid metabolism were tightly associated with both quantitative and qualitative features of FoxP3+ T-lymphocytes.

Development of a Linguistic Approach to the Problem of the Computer Electrocardiogram’s Classifications

Introduction. The linguistic approach, based on the transition from the observed cyclic signal to a sequence of symbols (codeword), which characterize the dynamics of indicators from cycle to cycle, makes it possible to use the procedures of mathematical linguistics to increase the reliability of decisions. The purpose of the article is to expand the diagnostic capabilities of the linguistic approach to the analysis and interpretation of electrocardiograms (ECG). Methods. Each ECG cycle is encoded with one of four symbols characterizing changes in two indicators: traditional (cycle duration) and original (symmetry of the repolarization area). Results. Based on the processing of real clinical data of verified patients and healthy volunteers, standards of patients with chronic coronary artery disease (СAD) and healthy patients. The standards are developed using computational procedures of mathematical linguistics – the Levenshtein distance, which is the minimum number of editing operations (insertion, deletion and replacement of a character), ensuring the transition from one word to another and the frequency of occurrence of substrings in the analyzed word. On the basis of these procedures, decision rules that have been developed allow making diagnostic decisions based on the Levenshtein distance to the standards and the frequency of occurrence of one-, two- and three-symbol patterns in code words. It was found that the combination of these two methods expands the diagnostic capabilities of the linguistic approach to the analysis and interpretation of the ECG. Conclusions. It has been shown that using of the developed decision rules makes it possible to increase the sensitivity and specificity of diagnostics even in cases when the ECG does not show traditional electrocardiological signs of myocardial ischemia.

Effects of agomelatine on heart rate variability in patients with coronary artery disease and depression

Aim. To determine heart rate variability (HRV) in depressed patients with chronic coronary artery disease (CAD) and to assess the effects of agomelatine on HRV.Methods. 74 patients with CAD (class 3-4 angina pectoris) were recruited in a study. Patients (n = 45) with CAD and depression were assigned to Group 1, whereas CAD patients (n = 29) without any signs of depression were assigned to Group 2. 17 patients received agomelatine (Subgroup 1) and 28 patients did not take any antidepressants (Subgroup 2). HRV was measured using SCHILLER MT-200 Holter-ECG apparatus at baseline and after 6 months.Results. Patients with depression demonstrated a significant decrease in HRV compared to non-depressed patients (pNN50% (3.9 [2.2; 5.4] vs 5.7 [2.9; 12.6], p = 0.03), SDANN (81 [63; 97] ms vs 91 [79; 102] ms, p = 0.06), SDNNindx (46 [36; 56] ms vs 55 [48; 66] ms, p = 0.002), rMSSD (28 [21; 36] ms vs 33 [ 29; 45] ms, p = 0.02), SDNN (97 [75; 121] ms vs 110 [98; 127] ms, p = 0.02). Subgroups 1 and 2 did not differ in HRV (p&gt;0.05). After 6 months, significant differences in the following parameters were found in those patients who received agomelatine therapy and those who did not: rMSSD (36.5 [28.5; 51] ms vs 26.5 [25; 32] ms, p = 0.02), SDANN (88 [72,5; 114,5] ms vs 67,5 [58; 83] ms, p = 0.03), SDNN strives to a significant difference - 100 [87; 133.5] ms vs 85.5 [75; 103] ms, p = 0.07.Conclusion. HRV significantly decreased in depressed patients with CAD suggesting autonomic dysfunction and worsening their prognosis. Agomelatine therapy in patients with CAD is effective in treating heart rate variability and reducing the risk of developing life-threatening arrhythmias.Key

Coronary, aortic and carotid artery inflammation by 18F-fluorodeoxyglucose positron emission tomography in acute and chronic coronary artery disease

Abstract Funding Acknowledgements Type of funding sources: None. Background 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) can detect arterial inflammation in individuals with atherosclerosis, but the associations among different vascular territories for 18F-FDG uptake are not known. Purpose We explored any possible correlation between arterial inflammation quantified by 18F-FDG PET in the aorta, carotid arteries, and coronary arteries in patients presenting with acute coronary syndrome (ACS), or chronic coronary artery disease (CAD). Methods Prospectively, we performed hybrid computed tomography angiography and 18F-FDG PET in 43 patients (26 ACS and 17 chronic CAD) at 6.6 ± 5.7 days following invasive coronary angiography. 18F-FDG PET was performed 90 minutes after injection of 302.2 ± 28.4 MBq 18F-FDG. Arterial 18F-FDG uptake was measured in the thoracic aorta, carotid arteries, and coronary arteries, and expressed as the target-to-background ratio (TBR; the ratio between arterial maximal standardized uptake value normalized to blood pool mean standardized uptake value) in the whole artery, and in the most diseased segment (MDS). Results Mean age was 64.9 ± 9.1 years, 90.7% males. The whole artery 18F-FDG uptake was higher in the aorta than in the carotid arteries (median TBR 2.23, interquartile range [0.36] vs. 1.88 [0.42], p &amp;lt; 0.001); whereas uptake in the coronary arteries was lower than in the aorta or carotid arteries (1.13 [0.23], p &amp;lt; 0.001 both). Similarly, 18F-FDG uptake in the aortic MDS was higher than in the carotid MDS (2.75 [0.62] vs. 2.25 [0.63], p &amp;lt; 0.001); whereas 18F-FDG uptake in the coronary MDS was the lowest (1.40 [0.33], p &amp;lt; 0.001 both). These findings were consistent in both ACS and chronic CAD patients. The whole artery 18F-FDG uptake of the aorta and carotid arteries correlated in patients with ACS (r = 0.58, p = 0.002), but not in patients with chronic CAD (r = 0.21, p = 0.3). There was no correlation between the whole artery 18F-FDG uptake in the coronary arteries and either the aorta or carotid arteries in the whole cohort (r=-0.16, p = 0.2, r = 0.01, p = 0.9, respectively), in patients with ACS (r = 0.06, p = 0.7, r=-0.01, p = 0.9, respectively), or in those with chronic CAD (r=-0.4, p = 0.1, r=-0.09, p = 0.7, respectively). Conclusions In patients with ACS or chronic CAD, large arteries had higher 18F-FDG uptake than the coronary arteries. The intensity of 18F-FDG uptake in the coronary arteries did not correlate with that in the carotid arteries or the aorta, indicating that disease activity differs between large arteries and coronary arteries.

Echolucency of carotid plaque is useful for selecting high-risk patients with chronic coronary artery disease who benefit from intensive lipid-lowering therapy

BackgroundUltrasound assessment of the carotid artery provides prognostic information on coronary events. This study examined whether ultrasound assessments of plaque echolucency of the carotid artery are useful for identifying patients with coronary artery disease (CAD) who are at high risk but could benefit from lipid-lowering therapy for secondary prevention. MethodsUltrasound assessment of carotid plaque echolucency with integrated backscatter (IBS) analysis was performed in 393 chronic CAD patients with low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL on statin therapy. All patients were prospectively followed up for a maximum of 96 months or until the occurrence of one of the following coronary events: cardiac death, nonfatal myocardial infarction, or unstable angina pectoris requiring unplanned revascularization. ResultsDuring the follow-up period, 45 coronary events occurred. Patients were stratified by IBS (≤-16.3 or >-16.3 dB, median value) and LDL-C level (<70 or 70–99 mg/dL). Multivariate Cox proportional hazards analysis showed that patients with lower IBS and LDL-C 70–99 mg/dL had significantly higher probabilities of coronary events compared with those with higher IBS and LDL-C <70 mg/dL, after adjustment for a baseline model of risk factors (hazard ratio 5.15; 95% confidence interval 1.21–22.0, p = 0.03). In contrast, patients with lower IBS and LDL-C <70 mg/dL had an improved prognosis comparable with those with higher IBS. Addition of LDL-C levels to the baseline model of risk factors improved net reclassification improvement (NRI) and integrated discrimination improvement (IDI) in patients with lower IBS (NRI, 0.44, p = 0.04; and IDI, 0.035, p < 0.01), but not in those with higher IBS. ConclusionsEvaluation of echolucency of the carotid artery was useful for selecting CAD patients at high risk of secondary coronary events but who could benefit from lipid-lowering therapy.

Can QT dispersion improve the accuracy of stress ECG TMT in detecting myocardial ischemia in chronic stable CAD patients? A stress myocardial perfusion imaging study

BackgroundQT dispersion (QTd) is related to regional variations in myocardial repolarization. Our study aims to assess the value of QTd in prediction of myocardial ischemia and its severity during stress imaging.We enrolled one hundred patients having stable coronary artery disease (CAD) and fulfilling the “Appropriateness criteria for cardiac radionuclide imaging” (MPI). They were divided into group I including patients with MPI-detected ischemia (50 patients) and group II including patients with normal perfusion scan (50 patients). We excluded unstable CAD and all other causes affecting QTd. During isotope scan, ECGs were taken and QTd was calculated at rest and at maximum heart rate.ResultsQTd was significantly higher in the ischemic group both at rest and exercise (P = 0.000). QTd difference, the difference between QTd at rest and stress, was calculated. QTd difference was significantly lower in normal than in ischemic group (P = 0.003). There was a significant positive correlation between QTd difference and defect size (P = 0.04).ConclusionQTd increases in ischemia and the QTd difference (between rest and stress) correlates positively with severity of ischemia.QTd and QTd difference could be used to improve the accuracy of stress imaging test.