Chronic Stable Coronary Artery Disease Research Articles

Atherogenic index of plasma and coronary artery disease: a systematic review and meta-analysis of observational studies

BackgroundAtherogenic index of plasma (AIP), a novel logarithmic index that combines fasting triglyceride and high-density lipoprotein cholesterol concentrations, is associated with the burden of atherosclerosis. This study aimed to evaluate the relationship between AIP and coronary artery disease (CAD) risk, severity, and prognosis in populations with and without established CAD.MethodsPubMed, Embase, and Web of Science were systematically searched from the inception of each database to August 13, 2024. Cross-sectional studies, case-control studies, and prospective or retrospective cohort studies using multivariate analysis were included. Given that the true effect size may differ across studies, a random-effects model for all analyses was applied.ResultsFifty-one observational studies were included in this study. Patients with higher AIP were more likely to have CAD (odds ratio (OR): 2.79, 95% CI 1.75–4.45, P < 0.00001). Furthermore, these patients were more likely to have coronary artery calcification (OR: 2.28, 95% CI 1.74–3.00, P < 0.00001), multivessel CAD (OR: 2.04, 95% CI 1.50–2.77, P < 0.00001), and an increased risk of plaque progression (OR: 1.49, 95% CI 1.17–1.91, P = 0.001). In populations without established CAD, higher AIP levels were associated with an increased risk of Major adverse cardiovascular events (MACE) (hazard ratio (HR): 1.28, 95% CI 1.22–1.35, P < 0.00001). Interestingly, this finding was consistent in patients presenting with acute coronary syndrome (HR: 1.59, 95% CI 1.33–1.89, P < 0.00001) and patients with chronic coronary syndrome or stable CAD (HR: 1.65, 95% CI 1.15–2.37, P = 0.007).ConclusionsThis meta-analysis demonstrates that elevated AIP is strongly associated with increased CAD risk, greater severity, and poorer prognosis in populations with and without established CAD. However, more studies are needed to evaluate the predictive performance and determine the optimal cut-off for AIP in different populations.Graphical abstract

A 3-year Follow-up and Management of Patients with Stable Chronic Coronary Artery Disease: Is There a Role of Reverse Redistribution in Better Prognosis?

A 3-year Follow-up and Management of Patients with Stable Chronic Coronary Artery Disease: Is There a Role of Reverse Redistribution in Better Prognosis?

Study of Serum bilirubin in relation to stable chronic coronary artery disease severity and outcome after percutaneous intervention

Study of Serum bilirubin in relation to stable chronic coronary artery disease severity and outcome after percutaneous intervention

Laboratory Predictors of Mortality in Patients with Heart Failure and Reduced Left Ventricular Ejection Fraction

Introduction. Heart failure (HF) is a growing epidemic with high morbidity and mortality rates. In general, mortality in patients with HF is 10.4% after 30 days from admission, 22% after 1 year, and 42.3% after 5 years, despite the introduction of new evidence-based drug therapy and advance in surgical interventions. There is a range of predictors/ factors that need to be addressed to reduce the risk of mortality and to assess prognosis in patients with heart failure and reduced left ventricular ejection fraction.&#x0D; The aim. To determine the laboratory factors predicting 2-year mortality in patients with coronary artery disease and heart failure and reduced left ventricular ejection fraction after percutaneous coronary intervention (PCI) by analysis of basic patient data.&#x0D; Materials and methods. This one-center analysis, conducted at the Ukrainian Children’s Cardiac Center, Clinic for Adults, included 178 patients who had chronic stable coronary artery disease with heart failure and reduced left ventricular ejection fraction, who underwent PCI in the period between January 2020 and January 2022. The endpoint of our study was all-cause mortality. The studied group of patients was divided into two subgroups: S (“survival”) with patients who survived during the observation period after PCI, and D (“death”) including patients who died before the end of this observation period after the PCI. A p-value of less than 0.05 was considered statistically significant.&#x0D; Results. The mean length of hospital stay was 3 (1-5) days. Total bilirubin, total cholesterol, sodium, N-terminal pro B-type natriuretic peptide (NT-proBNP) level, hemoglobin, albumin and lymphocytes were significantly different in the two subgroups. In the multivariate model, the strongest independent predictors of patient mortality were: elevated NT-proBNP (adjusted hazard ratio [HR] for one standard deviation 1.44, 95% confidence interval [CI] 1.32 to 1.57, p&lt;0.0001), low albumin (HR 1.64, 95% CI 1.10 to 2.23, p=0.008), hyponatremia (HR 1.69, 95% CI 1.16 to 2.22, p&lt;0.001), lymphopenia (HR 1.54, 95% CI 1.10 to 2.20, р&lt;0.001, decreased hemoglobin level (HR 1.25, 95% CI 1.10 to 1.40, p&lt;0.001) and low cholesterol (HR 1.59, 95% CI 1.17 to 2.01, p&lt;0.001).&#x0D; Conclusion. In a population of patients with chronic stable coronary artery disease after myocardial revascularization with PCI, a decrease in the level of albumin, cholesterol, sodium, lymphocytes, hemoglobin, as well as an increase in the level of NT-proBNP were prognostic and statistically significant predictors of unfavorable prognosis in the form of all-cause mortality during 2 years of observation.

Role of biomarkers of collagen metabolism and systemic inflammation in myocardial remodeling in patients with stable chronic coronary artery disease and obstructive sleep apnea

Aim. To study the relationship of biomarkers of collagen metabolism and systemic inflammation with left ventricular (LV) remodeling in patients with stable coronary artery disease (CAD) and obstructive sleep apnea (OSA).Material and methods. The study included 195 patients with stable CAD, of which 63 without OSA and 132 patients with combination of CAD and OSA. The mean age of patients was 63,4±3,7 years. Biomarkers of collagen metabolism and systemic inflammation were assessed by determining the concentration of matrix metalloproteinase (MMP)-9, tissue inhibitor of matrix metalloproteinase-1, monocyte chemoattractant protein-1 (MCP-1) and calculating the neutrophil-to-lymphocyte (NLR) and platelet-tolymphocyte ratio (PLR). Echocardiography was performed according to a standard protocol.Results. There were no significant differences in systemic inflammation parameters (MCP-1, NLR, PLR) between the group of patients with CAD and CAD with mild OSA and a significantly higher level of MCP-1, NLR, PLR in more severe OSA. In patients with CAD and severe OSA, the eccentric LV remodeling was diagnosed in 75% of individuals, while the concentric type was diagnosed in only 25%.Conclusion. In patients with stable CAD, the more severe the OSA, the more pronounced systemic inflammation (MCP-1, NLR, PLR), and there are higher proportion of eccentric LV hypertrophy, which may be associated with an imbalance of fibrosis markers (high concentration of MMP-9 with an almost unchanged level of tissue inhibitor of MMP-1).

Cytokine profile in patients with obstructive coronary artery disease

Background. Studies of the role of cytokines in the pathogenesis of coronary artery disease (CAD) are quite relevant. Significant cytokine imbalance is mostly observed in patients with acute coronary syndrome. However, there are limited reports of serum cytokine levels in patients with chronic stable CAD. The problem of relationship between cytokines to the severity of coronary atherosclerosis is still urgent.Aim: To investigate the relationship between serum levels of cytokines and the severity of CAD.Material and Methods. Serum levels of IL-2, IL-4, IL-6, IL-10, TNF-a was analyzed in 24 healthy control patients and 70 patients with stable CAD who underwent coronary angiography. Coronary atherosclerosis was assessed with Gensini scoring system. Depending on the median of GS (38.0), the patients were divided into moderate CAD group (GS = 8–37) and severe CAD group (GS ≥ 38). The data were analyzed using Statistical Package for the Social Sciences (SPSS) software 26.0.Results. Patients with obstructive CAD presented higher TNF-α levels and lower IL-4. Patients with severe CAD increased IL-6 and reduced IL-2 levels. Logistic regression analysis showed that the IL-6 was independently related to the presence of obstructive CAD (OR = 3.836; 95% CI= 1.8–8.177). ROC analysis of the IL-6 logistic regression model showed that a cut-off of 5.19 pg/mL had 75.0 % sensitivity and 70.0 % specificity to predict severe atherosclerosis.Conclusion. Pro-inflammatory TNF-α and IL-6 cytokines increased, while regulatory IL-2 and anti-inflammatory IL-4 decreased in patients with stable CAD. Cytokine imbalance contributes to CAD progression. Elevated IL-6 levels and the pro-inflammatory potential of the blood increases in case of severe coronary atherosclerosis. It has been shown that with an increase in IL-6 levels, the odds of detecting severe CAD increases 3.5-folds.

Prognostic Value Of Type 2 Diabetes Mellitus And Visfatin Level In Patients After Coronary Artery Bypass Grafting

Objective — Our study aimed to evaluate the prognostic value of type 2 diabetes mellitus (DM) and the level of visfatin in patients undergoing coronary artery bypass grafting (CABG). Methods — Our study included 103 patients with chronic heart failure and stable coronary artery disease. The clinical outcomes and adverse cardiovascular events were analyzed 12 months after the CABG. Results — The patients were distributed between two groups: Group 1 (without registration of composite endpoints, n=71) and Group 2 (patients with the development of composite endpoints, n=32). In Group 1, 22.5% of patients were diagnosed with DM vs. 31.2% in Group 2 (p=0.346). Kaplan-Meier estimator demonstrated that patients with duration of DM over 5 years experienced significantly earlier and more frequent adverse cardiovascular events after CABG vs. patients without DM or with duration of DM less than 5 years. The visfatin level before CABG did not differ between the groups (p=0.416), whereas 10 days after CABG it was higher in Group 2. Correlation between the difference in visfatin levels before and after CABG and duration of type 2 DM was calculated (r=0.54, p=0.041). Conclusion — In patients after CABG, the duration of DM had a negative impact on the development of cardiovascular events. With a duration of DM exceeding 5 years, the risk of adverse events increased significantly. An increase in visfatin level 10 days after CABG was associated with the duration of DM and the development of adverse cardiovascular events in patients.

Inflammation and coronary flow reserve in chronic stable coronary artery disease: Evidence for a long standing interplay

Abstract Funding Acknowledgements Type of funding sources: None. Background Low grade inflammation is involved in pathogenesis of ischemia and outcome in coronary artery disease (CAD). Dobutamine stress echo (DSE) and coronary flow reserve (CFR) are both related with incident CAD and respective outcome as well. Purpose To evaluate the potential relationship between inflammation, evaluated by high-sensitivity C-reactive protein as surrogate, and DSE outcome/left anterior descending artery (LAD) CFR in stable chronic CAD. Methods We studied 132 consecutive pts (age 58±12years, 18 females, 33 diabetics) with stable CAD, by DSE with concomitant evaluation of LAD CFR. A cut off 3 mg/dL was used to define high and low CRP groups (CRPH/30pts, CRPL/92pts). CRP distribution was positive skewed (median 1.7mg/l) and CRP was then normalized by log transformation (CRP 0.72±0.9, logCRP 3.2±3.3). Sixty-three out of 132 pts had a follow up DSE with a concomitant reevaluation of CFR at 98±74 months. Absolute and % changes of CFR were estimated. Results CRPH and CRPL groups had similar baseline: CFR (CRPH: 2.3±0.6, CRPL: 2.4±0.6mg/dl), creatinine (1.0±0.2 vs 1.1±0.4mg/dl), HbA1c (5.4±1.0 vs 5.6±1.3%) and LDL (109±46 vs 102±35mg/dl). CRPH and CRPL groups had also similar hemodynamic burden at DSE and incidence of positive DSE. dCFR and %dCFR were lower in CRPL (0.20±0.70 vs 0.69±0.92, p = 0.02 and 0.13±0.33 vs 0.46±0.67 p = 0.01). Further clustering based on optimal CAD treatment achieved at baseline (guidelines defined optimal resting heart rate and LDL) did not change the findings. CFR was inversely related with logCRP (figure 1: r=-0.21, p = 0.04) and creatinine (r=-0.18 p = 0.05). Moreover, during follow up the improvement in CFR (%dCFR) was related with baseline logCRP (figure 2: r=0.30 p = 0.03). In stepwise logistic regression analysis for prediction of a CFR&amp;gt;2, including categorical classification of CRP (&amp;gt;3), diabetes, LDL (&amp;gt;80), Lpa(&amp;gt;50) and resting heart rate, then only CRP&amp;gt;3 classification was finally selected (exp(B)=0.38, p = 0.01). Conclusion Inflammation activity evaluated by CRP in stable CAD is related with the estimated LAD CFR irrespectively from the DSE outcome, both at baseline evaluation as well as dynamically during a long term follow up. The relationship is independent from LDL, Lpa levels and diabetic substrate, thus implying a strong pathophysiological interplay.

Cardiac Troponin I in Patients Undergoing Percutaneous and Surgical Myocardial Revascularization: Comparison of Analytical Methods

The myocardial infarction (MI) types 4a and 5 guidelines recommend cardiac troponin (cTn) diagnostic decision limits of 5 and 10 times the 99th percentile, respectively. Different cTn kits elicit different responses, so the MI diagnosis is still challenging. The study aimed to establish the cutoff values and the accuracy of three different cTnI kits in the diagnosis of post-procedural MI. We analyzed 115 patients with multivessel stable chronic coronary artery disease; 26 underwent percutaneous coronary intervention, and 89 underwent coronary artery bypass graft. Delayed-enhancement magnetic resonance imaging was performed before and after each intervention for definitive MI diagnoses. Two contemporary and one high-sensitivity cTnI immunoassays were used. ROC curves determined the accuracy of each assay. Low accuracy was observed after applying the current guidelines recommendations. The three cTnI assays accuracies improved when adjusted by the new ROC cutoffs, reaching 82% for MI type 5 for all assays, and 78%, 88%, and 87% for MI type 4 for Siemens, Beckman, and Abbott, respectively. The ultrasensitive and contemporary tests' accuracy for MI types 4a and 5 diagnoses are equivalent when adjusted for these new cutoffs. The hs-cTnI assays had lower accuracy than contemporary tests for MI types 4a and 5 diagnoses.

Impact of COVID-19 on Chronic Stable Coronary Artery Disease

Impact of COVID-19 on Chronic Stable Coronary Artery Disease

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.

P205 PROGNOSTIC VALUE OF AMYLOID–Β (1–40) IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION

Abstract Background Survivors of acute myocardial infarction (AMI) have an increased risk of various cardiovascular complications during follow–up; therefore, adequate risk stratification remains the main challenge in the clinical setting. Amyloid β 1–40 (Aβ (1–40)) has already emerged as a negative prognostic marker for cardiovascular mortality, both in patients with stable chronic coronary artery disease and in patients with NSTEMI–type infarction. This is probably due to the pro–inflammatory and pro–atherosclerotic role of this peptide. Methods Plasma Aβ (1–40) values were tested acutely in a large prospective cohort of patients hospitalized for AMI (both NSTEMI and STEMI). The primary end–point was defined as all–cause mortality during the period of follow–up. Results 894 individuals were enrolled in the study (607 with STEMI and 287 with NSTEMI). The median plasma concentration of Aβ (1–40) at the time of admission was 96.59 (60.94–134.5) pg/ml. During a median follow–up of 43 months, 123 patients died (primary endpoint). Higher Aβ (1–40) concentrations were associated with an increased risk of mortality, both on univariate analysis and after correction for other confounding variables. Furthermore, we found a strong positive correlation between plasma Aβ (1–40) values and age. The prognostic value of Aβ (1–40) was maintained only in the subgroup of patients with greater than the median age of 67 years. Conclusions This is currently the largest single–centre study evaluating the role of plasma Aβ (1–40) concentrations in predicting outcome in a population of patients admitted for AMI, both STEMI and NSTEMI. Our data represent a strong correlation between plasma (1–40) values and the increased risk of all–cause mortality during follow–up.

Low Level Of Neutrophil Gelatinase-Associated Lipocalin (NGAL) In Patients With Chronic Heart Failure And Multivessel Coronary Atherosclerosis

Rationale — Several biomarkers are used to determine the prognosis of patients with heart failure (HF), including neutrophil gelatinase-associated lipocalin (NGAL, Lipocalin-2). We investigated NGAL serum levels in patients with HF and coronary artery disease (CAD). Methods — Fifty-three patients with chronic HF and stable multivessel CAD were included in the study. Patients were grouped on the basis of the NGAL level: low NGAL group (NGAL&lt;37 ng/mL, n=19) and normal NGAL group (NGAL ≥37 ng/mL, n=34). Results and Discussion — The main findings from our study of patients with HF and multivessel CAD were: 1) Plasma NGAL levels were below reference values in 35.8% of cases. 2) We detected a strong positive correlation between neutrophil count and NGAL level (0.573, р&lt;0.001). 3) Neutropenia was present in 15.8% of patients in the low NGAL group and in none in the group with a normal NGAL level (p=0.041). 4) Postinfarction left ventricular aneurysms were more often diagnosed in patients of the first group (15.8%) and in none of patients in the second group (p=0.041). Conclusion — Low NGAL has been associated with neutropenia in patients with heart failure and multivessel atherosclerotic CAD. Left ventricular aneurysms were diagnosed in 15.8% (n=3) patients with low NGAL and in none with normal NGAL levels. These changes may be due to maladaptive remodeling of the heart after myocardial infarction, but further research is needed.

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.

Abstract 13782: Platelet Aggregation and Adenosine Levels Among Patients With Stable Chronic Coronary Artery Disease Taking Ticagrelor or Prasugrel

Introduction: Both, ticagrelor and prasugrel are important anti-ADP drugs, being superior to clopidogrel in patients with acute coronary syndromes (ACS). Whether those drugs have different effects among patients in the long run (&gt; 1 year) after ACS, however, is not completely understood. We therefore sought to directly compare the pharmacodynamic action of ticagrelor vs prasugrel in patients with chronic coronary artery disease (CCAD). Methods: This was a prospective, double blinded, randomized trial that compared platelet inhibition and adenosine levels with ticagrelor (180mg loading dose, followed by 90 mg BID) versus prasugrel (60mg loading dose, followed by 10 mg QD). Patient was eligible if suffered a documented episode of ACS at least 1 year before randomization, had age between 18 and 75 years, and was using aspirin 100 mg chronically. Platelet aggregation between groups was compared with the Multiplate ADP® assay, performed at baseline and after 15 days on study medication. Adenosine plasma levels were measured with high performance liquid chromatography at the same time points. Results: We randomized 87 patients (mean age 61,3 years, 83,9% with prior coronary angioplasty), being 40 allocated to ticagrelor and 47 to prasugrel. The study main results are described at Figure 1 (platelet aggregation) and Figure 2 (plasma adenosine levels). Conclusion: In stable patients after ACS, despite significant higher levels of adenosine plasma levels in the ticagrelor group, in comparison with the prasugrel group, similar levels of platelet inhibition were observed in both groups, suggesting that the role of adenosine in platelet aggregation is not an important one.

Сlinical and hemodynamic characteristics and coronary blood flow in patients with chronic coronary artery disease and type 2 diabetes

Aim. To assess the features of clinical and hemodynamic characteristics and the severity of coronary involvement in patients with chronic coronary artery disease (CAD) with and without diabetes.Material and methods. The study included 100 patients with stable CAD, which were divided into two groups: group I (mean age, 57,9-1,04 years, male/female 35/14) — 49 patients with CAD and type 2 diabetes, II — (60,2-0,9 years, 34/17) — 51 patients without SD. Along with behavioral and biological risk factors, clinical and hemodynamic characteristics were analyzed. All patients underwent coronary angiography.Results. The presence of diabetes in patients with CAD was associated with abdominal obesity and comorbidity of somatic diseases. Among group I patients, electrocardiographic signs of left ventricular hypertrophy, conduction abnormalities, accompanied by a decrease in the left ventricular ejection fraction, impaired diastolic function, and high mean pulmonary artery pressure were significantly more often detected. In patients with CAD and type 2 diabetes, significant right coronary artery (CA) stenoses were more often recorded (39%), while in patients without diabetes, the anterior descending artery was the most susceptible to atherosclerosis. In group I, stenosis of the distal CA third was detected 1,5 times more often (p&lt;0,001), and their diffuse multivessel lesion prevailed by 28% (73% and 45%, respectively, p&lt;0,005). The average SYNTAX score in patients with and without diabetes was 29,2±0,8 vs 22±0,7, respectively (p&lt;0,0005).Conclusion. In patients with CAD and diabetes, more pronounced atherosclerotic coronary involvement (diffuse multivessel CAD) was revealed, which should be taken into account when planning further treatment. The risk of adverse cardiovascular events will always be present with percutaneous coronary interventions.

Planning the Follow-Up of Patients with Stable Chronic Coronary Artery Disease.

Cardiovascular disease remains the leading cause of death among Europeans, Americans, and around the world. In addition, the prevalence of coronary artery disease (CAD) is increasing, with the highest number of hospital visits, hospital readmissions for patients with decompensated heart failure, and a high economic cost. It is, therefore, a priority to try to plan the follow-up of patients with stable chronic CAD (scCAD) in relation to the published data, experience, and new technology that we have today. Planning the follow-up of patients with scCAD goes beyond the information provided by clinical management guidelines. It requires understanding the importance of a cross-sectional and longitudinal analysis in the clinical history of scCAD, because it has an impact on the cost of healthcare in relation to mortality, economic factors, and the burden of medical consultations. Using the data provided in this work facilitates and standardizes the clinical follow-up of patients with scCAD, and following the marked line makes the work for the clinical physician much easier, by including most clinical possibilities and actions to consider. The follow-up intervals vary according to the clinical situation of each patient and can be highly variable. In addition, the ability to properly study patients with imaging techniques, to stratify at different levels of risk, helps plan the intervals during follow-up. Given the complexity of coronary artery disease and the diversity of clinical cases, more studies are required in the future focused on improving the planning of follow-up for patients with scCAD. The perspective and future direction are related to the valuable utility of integrated imaging techniques in clinical follow-up.

Метаболічна терапія в комплексному лікуванні пацієнтів із коморбідністю хронічного панкреатиту та стабільної ішемічної хвороби серця

Метаболічна терапія — це один із небагатьох способів відновлення нормальної роботи всіх життєво важливих органів і систем. Метою роботи було дослідити ефективність курсового лікування метаболічним препаратом Вазонат (мельдонію дигідрат) щодо корекції прооксидантно-антиоксидантних та трофологічних порушень у хворих із коморбідним перебігом хронічного панкреатиту (ХП) та стабільної ішемічної хвороби серця (СІХС). У дослідження було включено 90 пацієнтів із ХП у поєднанні із СІХС, яких було поділено на дві групи (залежно від програм лікування): І група (45 хворих) отримувала загальноприй­няте лікування; ІІ група (45 хворих) окрім загальноприйнятого лікування додатково отримувала препарат Вазонат за такою схемою: по 5 мл в/в струминно 1 раз на день протягом 10 днів з подальшим прийомом по 1 капсулі (250 мг) 2 рази на день протягом одного місяця. Було доведено, що додавання до комплексної терапії хворих із коморбідністю ХП та СІХС препарату Вазонат більшою мірою сприяє покращенню показників трофологічного та прооксидантно-антиоксидантного статусу, ніж стандартна базисна терапія.

Dobutamine stress echocardiography in patients with moderate coronary artery disease detected by coronary computed tomography angiography could reduce the rate of unnecessary coronary angiography

Aims To test the hypothesis that dobutamine stress echocardiography (DSE) reduces the rate of unnecessary invasive coronary angiography (CA) in patients with chronic stable coronary artery disease (CAD) and moderate to severe stenosis detected by coronary computed tomography angiography (CCTA). Methods This study included 49 consecutive, symptomatic CAD patients with coronary lesions greater than 50% detected by CCTA who underwent all DSE and a CA with pressure wire evaluation and FFR measurement. The DSE operators was aware of the CCTA results, but invasive physicians were blinded to DSE results. The primary endpoint was the negative predictive value of a CCTA followed by a DSE test for detecting significant coronary artery disease (CAD). This was defined by the presence of significant coronary lesions (>90% stenosis) or moderate coronary lesions (50–90%) with abnormal FFR value of less than 0.80 evaluated by invasive angiogram (CA). Secondary endpoints included major adverse cardiovascular events (MACEs). Results In patients with abnormal CCTA followed by CA, 33 patients (67.34%) had non-significant CAD lesions. In patients with both abnormal CCTA and DSE only 6 patients (12.24%) presented non-significant CAD. The negative predictive value of a CCTA followed by a DSE was significantly increased to 92.5%, when compared with CCTA alone. Thus DSE on top of abnormal CCTA could reduce unnecessary CA by 5.5 fold. During follow-up (mean 38.75 ± 12.25 months) 1 (2.1%) patient had a cardiac sudden death, 3 (6.12%) patients had an unplanned myocardial revascularization and 1 (2.1%) patient had a stroke, none of which occurred in patients with normal DSE. No patients experienced a myocardial infarction or needed un unplanned surgical revascularization. Conclusions The addition of DSE in case of abnormal CCTA increases significantly the negative predictive value for detecting significant CAD in need for revascularisation and thus reduces markedly the number of unnecessary CA. This diagnostic strategy has a higher diagnostic accuracy and negative predictive value to the opposite approach where an abnormal CCTA mandates a CA without additional functional testing.

Plasma nesfatin-1 and DDP-4 levels in patients with coronary artery disease: Kozani study

BackgroundNesfatin-1, a novel adipokine and dipeptidyl peptidase-4 (DPP4), a mam malian serine protease, are potent factors of atherosclerosis. In the present cross-sectional study, we investigated whether the plasma nesfatin-1 and DPP4 is associated with the prevalence and severity of coronary artery disease (CAD) with and without diabetes mellitus (DM).MethodsWe consecutively enrolled a total of 240 patients with significant CAD (previous revascularization or angiographically-proven coronary artery stenosis > 50%) presented with either unstable angina (UA, N = 76) or stable chronic CAD (SCAD, N = 165). 85 patients with at least 2 classical cardiovascular risk factors but without significant CAD served as controls. The severity of CAD was assessed using coronary angiography by the Gensini score. Clinical parameters, glycemic and lipid profile, high-sensitivity CRP (hsCRP), nesfatin-1 and DPP4 levels were assayed.ResultsNo differences were found for age, sex, hypertension and diabetes distribution between groups. Low nesfatin-1 levels were found in both CAD groups (UA & SCAD) with respect to controls. The difference between UA and SCAD groups was marginally non-significant. There was a significant increase of DPP4 along UA to SCAD and control groups. Differences between groups remained unchanged in non-diabetic participants. Nesfatin-1 significantly correlated to hsCRP (r = − 0.287, p = 0.036), HOMA-IR (r = − 0.587, p = 0.007) and hyperlipidemia (r = − 0.331, p = 0.034). DPP4 was significantly associated with hs-CRP (r = 0.353 p < 0.001) and FPG (r = 0.202, p = 0.020) in univariate analysis, but those correlations were lost in multiple regression analysis. There was a negative correlation between nesfatin-1 and the severity of CAD, quantified by the Gensini score (r = − 0.511, p < 0.001), but no association was found for DPP4.ConclusionsSerum DPP4 levels are increased in patients with CAD, while serum nesfatin-1 levels have a negative association with both the incidence and the severity of CAD. These results are independent of the presence of diabetes mellitus. In addition, both peptides have a strong association with hsCRP.Trial registration ClinicalTrials.gov Identifier: NCT00306176