Concomitant Coronary Artery Disease Research Articles

Carotid Interventions in Patients Undergoing Coronary Artery Bypass Grafting: A Narrative Review

Simultaneous carotid artery stenosis (CS) and coronary artery disease (CAD) is a common condition among patients with several cardiovascular risk factors; however, its optimal management still remains under investigation, such as the assumption that carotid disease is causally related to perioperative stroke and that preventive carotid revascularization decrease the risk of this complication. Synchronous surgical approach to both conditions, performing carotid endarterectomy (CEA) before coronary artery bypass graft (CABG) during the same procedure, should still be considered in selective patients, in order to reduce the risk of perioperative stroke during coronary cardiac surgery. For the same purpose, staged approaches, such as CEA followed by CABG or CABG followed by CEA during the same hospitalization or a few weeks later have been described. Hybrid approach with carotid artery stenting (CAS) and CABG can also be an option in selected cases, offering a minimally invasive procedure to treat CS among patients whom CABG cannot be postponed. When carotid intervention is indicated in patients with concomitant CAD requiring CABG, a personalized and tailored approach is mandatory, especially in asymptomatic patients, in order to define the ideal surgical strategy. The aim of this paper is to summarize the current “state of the art” of the different approaches to carotid artery diseases in patients undergoing CABG.

IMPACT OF CORONARY ARTERY DISEASE ON STEATOTIC LIVER DISEASE PROGRESSION

Introduction. Metabolic dysfunction-associated steatotic liver disease and coronary artery disease often exacerbate each other, leading to a more severe course of both conditions. The aim of this study is to evaluate the role of coronary artery disease in dislipidemia and liver fibrosis progression in patients with metabolic dysfunction-associated steatotic liver disease. Materials and methods. Forty-six patients with metabolic dysfunction-associated steatotic liver disease were examined. Patients were divided into two groups based on the presence of concomitant coronary artery disease: group I (n=24) included patients with both metabolic dysfunction-associated steatotic liver disease and coronary artery disease, while group II (n=22) included patients with metabolic dysfunction-associated steatotic liver disease only. A third group (Group III) comprised healthy individuals. Specific lipid metabolism parameters, obesity stage, alanine aminotransferase (ALT), aspartate aminotransferase (AST), γ-glutamyl transpeptidase (GGT) activity, and platelet count were examined. Fibrosis stage was evaluated using the FIB-4 score. The findings obtained were statistically processed. Results. Arterial hypertension was more prevalent in patients with metabolic dysfunction-associated steatotic liver disease and concomitant coronary artery disease. In group I, arterial hypertension was observed in 95.8% of cases, whereas in group II, it was observed in 40.9% of cases (χ2=16.35, p=0.00005). Patients with metabolic dysfunction-associated steatotic liver disease exhibited elevated levels of total cholesterol, low-density lipoproteins, and triglycerides, leading to an increased atherogenic index. Conversely, high-density lipoprotein levels were decreased (p>0.05). The degree of fibrosis according to the FIB-4 score was 1.45 times higher in patients with metabolic dysfunction-associated steatotic liver disease and concomitant coronary artery disease compared to those without coronary artery disease.

Outcomes of Complete Transcatheter versus Complete Surgical Treatment in Patients with Severe Aortic Valve Stenosis and Concomitant Coronary Artery Disease

Outcomes of Complete Transcatheter versus Complete Surgical Treatment in Patients with Severe Aortic Valve Stenosis and Concomitant Coronary Artery Disease

Subgingival microbiome in periodontal disease and comorbid pathology (meta-analysis)

The problem of chronic periodontitis (CP) is actively discussed due to the recognition of the fact that periodontal microbial damage is closely related to a number of systemic diseases and probably plays an important role in the occurrence of comorbid pathology. The aim of the meta-analysis was to characterize the composition of the subgingival microbiome and to determine the peculiarities of the formation of associations of the new periodontal pathogen Filifactor alocis with other I and II order periodontal pathogenic bacteria, as well as with the commensal bacteria colonizing this biotope. The study presents data of patient examination with obligatory use of polymerase chain reaction methods and sequencing of 16S rRNA genes in 1529 healthy individuals and 2394 patients with CP, 136 patients with CP and concomitant atherosclerosis, 258 patients with CP and concomitant type 2 diabetes mellitus. It was confirmed that the basis of the oral microbiome under normal circumstances is composed of representatives of microaerophilic streptococci, corynebacteria, lactobacilli, as well as representatives of the Veillonella and Sphingobacterium genera. 16S sequencing and bioinformatic analysis allowed us to specify the taxonomic place of the new pathogen F. alocis, as well as representatives of normal microbiota in CP and comorbid somatic pathology.

Prevalence and risk factors associated with coronary artery disease in Iranian patients with peripheral artery disease

IntroductionIt is well known that peripheral artery disease (PAD) and coronary artery disease (CAD) coexist and therefore, patients diagnosed with PAD have an increased chance of developing concomitant CAD. CAD-related complications could be a leading cause of postoperative mortality in individuals with PAD undergoing vascular surgery. We present a case series of 48 patients who underwent coronary angiography before vascular surgery and an updated review of previous reports to determine the prevalence of concomitant CAD in a convenience sample of Iranian patients. MethodsThis cross-sectional study was performed on 48 patients with confirmed PAD admitted to Imam Ali Hospital, affiliated with the Kermanshah University of Medical Sciences (KUMS), Kermanshah Province, Iran. A vascular surgeon diagnosed PAD based on the patient's symptoms, Doppler ultrasound, and CT angiography (CTA). All patients underwent coronary angiography to determine if they also had CAD. We defined significant CAD as a ≥70% luminal diameter narrowing of a major epicardial artery or a ≥50% narrowing of the left main coronary artery. ResultsOf 48 patients, 35 (72.9%) were male, 13 (27.1%) were female, and the mean age was 64.18±12.11 years (range, 30 to 100 years). The incidence of CAD in patients with PVD was 85.42% (41/48). The patients with CAD were more likely to be hypertensive than those without CAD (80.5 vs. 14.3, p-value<0.001). Of 41 patients with CAD, 9 (22.0%) had one-vessel disease, 10 (24.3%) had two-vessel disease, and 22 (53.7%) had three-vessel disease. ConclusionHypertension was a significant risk factor for CAD. Patients with hypertension and multiple major coronary risk factors scheduled for PVD surgery should be carefully evaluated for concomitant CAD.

FEATURES OF LIPID METABOLISM DISORDERS IN INDIVIDUALS WITH GENETIC PREDISPOSITION TO ARTERIAL HYPERTENSION AND PATIENTS WITH ESSENTIAL ARTERIAL HYPERTENSION

Objective: To determine the peculiarities of lipid metabolism indicators’ changes in healthy individuals with a genetic predisposition to arterial hypertension (AH) and patients with essential arterial hypertension (EAH). Design and method: 231 patients with second stage of EAH (105 men and 126 women; average age was 52.3±1.2 years) were examined. The duration of EAH was 9.7±0.45 years. 121 of them had a concomitant stable coronary artery disease (CAD). The control group included 30 healthy people of similar age and gender. A comparison group consisted of 23 healthy individuals with a AH family history. Additionally to lipid spectrum, levels of lipoprotein (a) (Lp(a)), apolipoprotein B100 (apoB100) and apolipoprotein A-1 (apoA-1) were determined. Statistical calculations were performed using Statistica for Windows 10.0. Results: Patients with genetic predisposition to AH had similar to indicators in patients with II EAH stage proatherogenic changes in lipid fractions. Their Lp(a) levels increased to 29.9 (24.5; 32.1) mg/dl, which is 67.0% higher than the levels in the control group (p=0.0005). Levels of apolipoproteins (apoB100 and apoA1) in the serum of healthy persons with AH predisposition did not differ from the control group. Patients with stage II EAH showed an increase in proatherogenic fractions of lipoproteins, apoB100, Lp(a), and a decrease in high-density lipoprotein cholesterol (HDL-C) and apoA-1 compared to control (p&lt;0.0001). Analysis of lipid indicators in patients with concomitant CAD compared to patients without CAD revealed no significant differences between these two groups, except of increasing in the Lp(a) level by 24.4% (p&lt;0.05). A significant positive correlations were found between the Lp(a) level with both the sum of scores on the SCORE scale and the CAD presence (r=0.25 and r=0.35, p=0.002), respectively. Conclusions: The lipid metabolism disorders in people with determinism for AH begin even before an increase in blood pressure and are genetically determined. The addition of hypertension contributes to the further progression of lipid metabolism disorders. The obtained data indicate the high prognostic significance of Lp(a) in patients with EAH in the development and establishment of both hypertension itself and CAD and increasing of patients’ cardiovascular risk.

Clinical impact of complex percutaneous coronary intervention in the pre-TAVR workup

Introduction and objectivesIn patients undergoing percutaneous coronary intervention (PCI) in the workup for transcatheter aortic valve replacement (TAVR), the clinical impact of coronary revascularization complexity remains largely unknown. This study sought to examine the impact of PCI complexity on clinical outcomes after TAVR in patients undergoing PCI in the preprocedural workup. MethodsThis was a multicenter study including consecutive patients scheduled for TAVR with concomitant significant coronary artery disease. Complex PCI was defined as having at least 1 of the following features: 3 vessels treated, ≥ 3 stents implanted, ≥ 3 lesions treated, bifurcation with 2 stents implanted, total stent length >60mm, or chronic total occlusion. The rates of major adverse cardiac events (MACE), including cardiovascular mortality, myocardial infarction, and coronary revascularization were evaluated. ResultsA total of 1550 patients were included, of which 454 (29.3%) underwent complex PCI in the pre-TAVR workup. After a median follow-up period of 2 [1-3] years after TAVR, the incidence of MACE was 9.6 events per 100 patients-years. Complex PCI significantly increased the risk of cardiovascular death (HR, 1.44; 95%CI, 1.01-2.07), nonperiprocedural myocardial infarction (HR, 1.52; 95%CI, 1.04-2.21), and coronary revascularization (HR, 2.46; 95%CI, 1.44-4.20). In addition, PCI complexity was identified as an independent predictor of MACE after TAVR (HR, 1.44; 95%CI, 1.09-1.83; P=.009). ConclusionsIn TAVR candidates with significant coronary artery disease requiring percutaneous treatment, complex revascularization was associated with a higher risk of MACE. The degree of procedural complexity should be considered a strong determinant of prognosis in the PCI-TAVR population.

Monitoring of infusion therapy in patients with reduced cardiac reserve during abdominal operations

Background. In the pathogenesis of many intra- and postoperative complications, the composition, volume and rate of infusion therapy (IT) play a significant role. This problem is especially relevant for patients with concomitant chronic pathology of the cardiovascular, respiratory systems and kidneys. Informative indicators for assessing the correctness of IT and early diagnosis of intraoperative complications associated with errors in its implementation are complex monitoring of functional indicators of the cardiovascular and respiratory systems. Purpose – of the study is to investigate changes in biochemical markers of heart failure and ultrasound signs of venous stasis in two modes of infusion therapy (restrictive and liberal), on the basis of a comparative study, to determine the optimal mode of perioperative IT in patients undergoing elective surgery for diseases of the abdominal cavity and have comorbid pathology in the form of coronary heart disease (CHD) and heart failure (HF). Materials and Methods. 86 patients were included in a single-center, prospective, randomized study. All patients were randomly divided into two groups depending on the mode of intraoperative IT: in the first group (n = 44) – a restrictive mode of 5–8 ml/kg/hour was applied, in the second (n = 42) – a liberal mode. Echocardiography was performed at the stages of the study. Heart contractility, central hemodynamics, and ejection fraction were evaluated. An ultrasound scan of the inferior vena cava (IVC) was performed during breathing as a non-invasive method of assessing the intravascular blood volume. The diameter of the vein during inhalation and exhalation was evaluated. Based on the respiratory change in the diameter of the IVC, the caval index is calculated, which is expressed as a percentage. An index approaching 100% indicates near-complete collapse and probable volume depletion, while an index close to 0% indicates minimal collapse and intravascular overflow. Ultrasound of the lungs was performed according to the BLUE protocol with a convex sensor in 8 zones along the front chest wall. The severity of pulmonary congestion was assessed based on the sum of B-lines: 5 and less – no congestion, 6 to 15 – slight congestion, 15 to 29 – moderate, 30 and more – significant. Results. The conducted study shows the advantage of the restrictive regimen of IT in patients with concomitant coronary artery disease and minimal signs of congestive heart failure during abdominal surgical operations. The regime with restriction of intravenous fluid administration was better, as it reduces venous congestion, reduces the amount of fluid in the interstitial space of the lungs, causes a smaller compensatory reaction of the cardiovascular system to infusion with normal values of NT-proBNP. The task of the anesthesiologist in this case is careful control of daily and cumulative water balance, adequate monitoring of indicators of the cardiovascular system, use of modern ultrasound technologies and protocols for controlling volemic status, assessment of the dynamics of biomarkers of heart failure, which will allow complex abdominal operations to be safely performed in patients with reduced cardiac reserve. Conclusions. As a result of the conducted research, it was established that: the use of a liberal regimen of infusion therapy in the perioperative period in patients with coronary heart disease and HF I, I-II FC compared to a restrictive regimen leads to a statistically significant increase in biomarkers of heart failure and ultrasound signs of volemic overload. The restrictive regimen of IT in a dose of 5–8 ml/kg/hour, in comparison with a liberal one in a dose of 12–15 ml/kg/hour, can be recognized as optimal and safe in patients with coronary heart disease and HF I, I-II FC during surgery on the organs of the abdominal cavity. The use and widespread implementation in practice of complex determination of the level of the amino-terminal prohormone of brain natriuretic peptide (NT-proBNP) NT-proBNP, non-invasive methods of ultrasound of the heart – echocardiography, ultrasound of the lungs and central vessels – assessment of the dynamic filling of the inferior vena cava (IVC) allows significantly supplement clinical information on volemic status, venous stasis, contractility of the heart and fluid retention in the interstitial space of the lungs and may be key in the prevention of cardiac complications in this category of patients.

Современное оперативное лечение пациентов с камнями почек размером до 2 см и сопутствующей ИБС.

Introduction. While providing urological care to patients suffering with nephrolithiasis, prior attention is to be paid to choosing the appropriate surgical approach. Assessment of risk for commorbidities such as coronary artery disease (CAD) should affect the choice of surgical technique. The treatment tactics for such comorbid patients have not been sufficiently developed and are poorly covered in the scientific literature. An appropriate choice of surgical technique is not presented. Aim: to study the effectiveness and safety of high-tech surgical lithotripsy techniques in comorbid patients with CAD, taking into account the functional state of the cardiovascular system. Materials and methods. The study is retrospective, multicenter. Subject of the study: adult patients suffering from nephrolithiasis (single kidney stones 15-20 mm) and concomitant CAD (200 people); control group - similar patients without CAD (190 people). The examined groups were distinguished according to the surgical intervention performed (extracorporeal shock wave nephrolithotripsy, percutaneous nephrolithotripsy, transurethral nephrolithotripsy) and concomitant CAD. Primary endpoint: Stone-free rate, which was determined using ultrasound scanning and Х-ray techniques. The frequency of achieving the endpoint, the number of stages of surgical treatment, and the frequency of complications were also assessed. Results. In terms of the frequency of achieving Stone-free rate, all contact lithotripsy techniques were comparable in effectiveness, which in all groups exceeded 85%. Neither the presence of CAD nor chronic heart failure (CHF) affected the results. With extracorporeal shock wave lithotripsy, the presence of CAD did not in any way affect the likelihood of achieving a stone-free rate, however, with CHF, the percentage of complete sanitation of the urinary tract from stones decreased to 53.8%, which seems unacceptable for clinical work. When using extracorporeal shock wave lithotrypsin against the background of CHF in «mono mode», the average number of stages is significantly higher (2.79) than with contact techniques (&lt;1.05). There is a clear inverse relationship between CHF, the number of stages of surgical treatment on the one hand, and the frequency of achieving stone-free rate on the other hand. Postoperative pyelonephritis more often develops in comorbid patients after contact lithotripsy techniques (up to 26.0%). Postoperative bleeding and cardiac risks occurred sporadically, mainly in the same situation – contact nephrolithotripsy in a patient with CHF. Conclusion. The more severe the patient’s comorbidities are, the more indications he has for immediate surgical treatment of nephrolithiasis. Of course, only if he is compensated for coronary artery disease. Percutaneous nephrolithotripsy is the method of choice. For small (&lt;2 cm) stones, a mini-approach should be preferred, giving a better safety approach.

Diagnostic accuracy of Murray law-based quantitative flow ratio in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement.

Murray law-based quantitative flow ratio (μQFR) is a novel computational method that enables accurate estimation of fractional flow reserve (FFR) using a single angiographic projection. However, its diagnostic value in patients with severe aortic stenosis (AS) remains unclear. We included 25 consecutive patients who underwent transcatheter aortic valve replacement (TAVR) for severe AS with intermediate or greater (30-90%) coronary artery disease (CAD). Pre- and post-TAVR μQFR, QFR, instantaneous flow reserve (iFR), and post-TAVR invasive FFR values were measured. We evaluated the diagnostic performance of pre-TAVR μQFR, QFR, and iFR using post-TAVR FFR ≤ 0.80 as a reference standard of ischemia. Pre-TAVR μQFR was significantly correlated with post-TAVR FFR (r = 0.73, p < 0.0001). The area under the curve of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 was 0.91 (95% confidence interval [CI] 0.77-0.98), comparable to that of pre-TAVR iFR (0.86 [95% CI 0.71-0.98], p = 0.97). The accuracy, sensitivity, specificity, and positive and negative predictive values of pre-TAVR μQFR on post-TAVR FFR ≤ 0.8 were 84.2% (95% CI 68.7-93.4), 61.6% (95% CI 31.6-86.1), 96.0% (95% CI 79.6-99.9), 88.9% (95% CI 52.9-98.3), and 82.8% (95% CI 70.6-90.6), respectively. For pre-TAVR iFR, these values were 76.5% (95% CI 58.8-89.3), 90.9% (95% CI 58.7-99.8), 69.6% (95% CI 47.1-86.8), 58.8% (95% CI 42.8-73.1), and 94.1% (95% CI 70.8-99.1), respectively. μQFR could be useful for the physiological evaluation of patients with severe AS with concomitant CAD.

Risk factors and prognosis of perioperative acute heart failure in elderly patients with hip fracture: case-control studies and cohort study

BackgroundElderly patients with hip fracture who develop perioperative acute heart failure (AHF) have a poor prognosis. The aim of the present study is to investigate the potential risks of AHF in elderly hip-fracture patients in the postoperative period and to evaluate the prognostic significance of AHF.MethodsA retrospective analysis was conducted on hip fracture patients at the Third Hospital of Hebei Medical University, who were continuously in hospital from September 2018 to August 2020. To identify independent risk factors for AHF in elderly patients with hip fracture, univariate and multivariate Logistic regression analysis was employed. The Kaplan-Meier survival curve illustrated the relationship between all-cause mortality in the AHF and non-AHF groups. An assessment of the correlation between baseline factors and all-cause mortality was conducted by means of univariable and multivariable Cox proportional hazards analysis.ResultsWe eventually recruited 492 patients,318 of whom were in the AHF group. Statistical significance was found between the two groups for age group, concomitant coronary heart disease, COPD, haemoglobin level below 100 g/L on admission, albumin level below 40 g/L on admission, and increased intraoperative blood loss. Age over 75, concomitant coronary artery disease, hemoglobin level below 100 g/L and albumin level below 40 g/L on admission were independent risk factors for AHF in older hip fracture patients. The AHF group exhibited a higher incidence of perioperative complications, such as anemia, cardiovascular issues, and stress hyperglycemia, as well as all-cause mortality. Based on our COX regression analysis, we have identified that the main risk factors for all-cause mortality in AHF patients are concomitant coronary heart disease, absence of pulmonary infection, absence of diabetes, absence of cancer, and absence of urinary tract infection.ConclusionEnhancing hip fracture prevention for AHF is particularly important. It is crucial to make informed decisions to avoid poor prognoses. Patients whose age over 75 years old, concomitant coronary heart disease, hemoglobin < 100 g/L and album< 40 g/L on admission are more likely to develop perioperative AHF. To avert complications and potential fatalities, patients with AHF must receive appropriate care during the perioperative period.

Left ventricular hypertrophy: hypertensive or hypertrophic cardiomyopathy? What a dilemma! A case report.

In the presence of the left ventricle hypertrophy (LVH), the differential diagnosis with hypertrophic cardiomyopathy (HCM) or some phenocopy must be always considered, which can be easily suspected when the hypertrophy is markedly asymmetric. However, when the hypertrophy is homogeneous, especially if the patient has concomitant hypertension, it may be a challenge to distinguish between hypertensive and HCM, although some clinical features may help us to suspect it. In addition, patients with HCM may present with exertional angina due to microcirculation involvement in the setting of the hypertrophy itself or dynamic obstruction in the left ventricular outflow tract, but in some cases, the presence of concomitant coronary artery disease must be suspected as the cause of angina, especially if the patient has an intermediate or high-risk probability of having ischemic heart disease. We present the case of a 46-year-old Afro-American man with poorly controlled hypertension who was found to have severe LVH, and who presented with symptoms of exertional angina during follow-up. We will review the clinical features that can help us in the differential diagnosis in this context.

TransCatheter aortic valve implantation and fractional flow reserve-guided percutaneous coronary intervention versus conventional surgical aortic valve replacement and coronary bypass grafting for treatment of patients with aortic valve stenosis and multivessel or advanced coronary disease: The transcatheter valve and vessels trial (TCW trial): Design and rationale

Background: Patients with severe aortic stenosis (AS) frequently present with concomitant obstructive coronary artery disease (CAD). In those, current guidelines recommend combined coronary artery bypass grafting (CABG) and surgical aortic valve replacement (SAVR) as the preferred treatment option, although this surgical approach is associated with a high rate of clinical events. Combined transcatheter aortic valve implantation (TAVI) and percutaneous coronary intervention (PCI) with or without FFR have evolved as a valid alternative for cardiac surgery in patients with AS and multivessel or advanced CAD. To date, no dedicated trial has prospectively evaluated the outcomes of a percutaneous versus surgical treatment for patients with both severe AS and CAD. Aims: To investigate whether fractional-flow reserve (FFR)-guided PCI and TAVI is non-inferior to combined CABG and SAVR for the treatment of severe AS and multivessel or advanced CAD. Methods: The Transcatheter Valve and Vessels (TCW) trial (clinicaltrial.gov: NCT03424941) is a prospective, randomized, controlled, open label, international trial. Patients ≥ 70 years with severe AS and multivessel (≥ 2 vessels) or advanced CAD, deemed feasible by the heart team for both; a full percutaneous or surgical treatment, will be randomised in a 1:1 fashion to either FFR-guided PCI followed by TAVI (intervention arm) vs. CABG and SAVR (control arm). The primary endpoint is a patient-oriented composite of all-cause mortality, myocardial infarction, disabling stroke, unscheduled clinically-driven target vessel revascularization, valve re-intervention, and life threatening or disabling bleeding at one year. The TCW trial is powered for non-inferiority, and if met, superiority will be tested. Assuming a primary endpoint rate of 30% in the CABG-SAVR arm, with a significance level α of 5%, a non-inferiority limit delta of 15% and a loss to follow-up of 2%, a total of 328 patients are needed to obtain a power of 90%. The primary endpoint analysis is performed on an intention-to-treat basis. Summary: The TCW Trial is the first prospective randomized trial that will study if a less invasive percutaneous treatment for severe AS and concomitant advanced CAD (i.e., FFR-guided PCI - TAVI) is non-inferior to the guidelines recommended approach (CABG-SAVR).

Impact of untreated chronic obstructive coronary artery disease on outcomes after transcatheter aortic valve replacement.

In transcatheter aortic valve replacement (TAVR) recipients, the optimal management of concomitant chronic obstructive coronary artery disease (CAD) remains unknown. Some advocate for pre-TAVR percutaneous coronary intervention, while others manage it expectantly. The aim of this study was to assess the impact of varying degrees and extent of untreated chronic obstructive CAD on TAVR and longer-term outcomes. The authors conducted a retrospective cohort study of TAVR recipients from January 2015 to November 2021, separating patients into stable non-obstructive or varying degrees of obstructive CAD. The major outcomes of interest were procedural all-cause mortality and complications, major adverse cardiovascular events, and post-TAVR unplanned coronary revascularization. Of the 1911 patients meeting inclusion, 75%, 6%, 10%, and 9% had non-obstructive, intermediate-risk, high-risk, and extreme-risk CAD, respectively. Procedural complication rates overall were low (death 0.4%, shock 0.1%, extracorporeal membrane oxygenation 0.1%), with no difference across groups. At a median follow-up of 21 months, rates of acute coronary syndrome and unplanned coronary revascularization were 0.7% and 0.5%, respectively, in the non-obstructive population, rising in incidence with increasing severity of CAD (P < .001 for acute coronary syndrome/unplanned coronary revascularization). Multivariable analysis did not yield a significantly greater risk of all-cause mortality or major adverse cardiovascular events across groups. One-year acute coronary syndrome and unplanned coronary revascularization rates in time-to-event analyses were significantly greater in the non-obstructive (98%) vs. obstructive (94%) subsets (Plog-rank< .001). Transcatheter aortic valve replacement can be performed safely in patients with untreated chronic obstructive CAD, without portending higher procedural complication rates and with relatively low rates of unplanned coronary revascularization and acute coronary syndrome at 1 year.

Evaluation and management of coronary artery disease in patients undergoing transcatheter aortic valve implantation

Significant coronary artery disease (CAD) and severe aortic stenosis (AS) are frequent findings in patients who undergo transcatheter aortic valve implantation (TAVI). With the extension of TAVI in patients who have intermediate and even low surgical risk, the optimal evaluation and management of concomitant CAD needs to be determined. Both pre-TAVI evaluation of CAD and indications for revascularization remain a matter of debate. In this review, we provide an updated overview of the prevailing landscape of CAD in patients undergoing TAVI with a focus on its prognostic impact, diagnostic evaluation pre-procedure, indications for revascularization, optimal timing of revascularization, and future directions.

Outcomes of peripheral artery disease and polyvascular disease in patients with end-stage kidney disease

ObjectivePatients with peripheral artery disease (PAD) and end-stage kidney disease are a high-risk population, and concomitant atherosclerosis in coronary arteries (CAD) or cerebral arteries (CVD) is common. The aim of the study was to assess long-term outcomes of PAD and the impact of coexistent CAD and CVD on outcomes. MethodsThe United States Renal Data System was used to identify patients with PAD within 6 months of incident dialysis. Four groups were formed: PAD alone, PAD with CAD, PAD with CVD, and PAD with CAD and CVD. PAD-specific outcomes (chronic limb-threatening ischemia, major amputation, percutaneous/surgical revascularization, and their composite, defined as major adverse limb events [MALE]) as well as all-cause mortality, myocardial infarction, and stroke were studied. ResultsThe study included 106,567 patients (mean age, 71.2 years; 40.8% female) with a median follow-up of 546 days (interquartile range, 214-1096 days). Most patients had PAD and CAD (49.8%), 25.8% had PAD alone, and 19.2% had all three territories involved. MALE rate in patients with PAD was 22.3% and 35.0% at 1 and 3 years, respectively. In comparison to PAD alone, the coexistence of both CAD and CVD (ie, polyvascular disease) was associated with a higher adjusted rates of all-cause mortality (hazard ratio [HR], 1.28; 95% confidence interval [CI], 1.24-1.31), myocardial infarction (HR, 1.78; 95% CI, 1.69-1.88), stroke (HR, 1.66; 95% CI, 1.52,1.80), and MALE (HR, 1.07; 95% CI, 1.04-1.11). ConclusionsPatients with end-stage kidney disease have a high burden of PAD with poor long-term outcomes, which worsen, in an incremental fashion, with the involvement of each additional diseased arterial bed.

Characterizing the metabolic divide: distinctive metabolites differentiating CAD-T2DM from CAD patients

ObjectiveTo delineate the metabolomic differences in plasma samples between patients with coronary artery disease (CAD) and those with concomitant CAD and type 2 diabetes mellitus (T2DM), and to pinpoint distinctive metabolites indicative of T2DM risk.MethodPlasma samples from CAD and CAD-T2DM patients across three centers underwent comprehensive metabolomic and lipidomic analyses. Multivariate logistic regression was employed to discern the relationship between the identified metabolites and T2DM risk. Characteristic metabolites' metabolic impacts were further probed through hepatocyte cellular experiments. Subsequent transcriptomic analyses elucidated the potential target sites explaining the metabolic actions of these metabolites.ResultsMetabolomic analysis revealed 192 and 95 significantly altered profiles in the discovery (FDR < 0.05) and validation (P < 0.05) cohorts, respectively, that were associated with T2DM risk in univariate logistic regression. Further multivariate regression analyses identified 22 characteristic metabolites consistently associated with T2DM risk in both cohorts. Notably, pipecolinic acid and L-pipecolic acid, lysine derivatives, exhibited negative association with CAD-T2DM and influenced cellular glucose metabolism in hepatocytes. Transcriptomic insights shed light on potential metabolic action sites of these metabolites.ConclusionsThis research underscores the metabolic disparities between CAD and CAD-T2DM patients, spotlighting the protective attributes of pipecolinic acid and L-pipecolic acid. The comprehensive metabolomic and transcriptomic findings provide novel insights into the mechanism research, prophylaxis and treatment of comorbidity of CAD and T2DM.

Cardiac Masses and Pseudomasses: An Overview about Diagnostic Imaging and Clinical Background.

A cardiac lesion detected at ultrasonography might turn out to be a normal structure, a benign tumor or rarely a malignancy, and lesion characterization is very important to appropriately manage the lesion itself. The exact relationship of the mass with coronary arteries and the knowledge of possible concomitant coronary artery disease are necessary preoperative information. Moreover, the increasingly performed coronary CT angiography to evaluate non-invasively coronary artery disease leads to a rising number of incidental findings. Therefore, CT and MRI are frequently performed imaging modalities when echocardiography is deemed insufficient to evaluate a lesion. A brief comprehensive overview about diagnostic radiological imaging and the clinical background of cardiac masses and pseudomasses is reported.

IMPACT OF CHEMOTHERAPY ON PROOXIDANT-ANTIOXIDANT STATUS IN PATIENTS WITH MULTIPLE MYELOMA AND CONCOMITANT CORONARY ARTERY DISEASE

Introduction. Multiple myeloma, an oncopathology that remains challenging to treat, is characterized by a 54% 5-year survival rate despite advancements in modern treatment strategies. Numerous studies have substantiated the correlation between high prooxidant concentrations and the progression of multiple myeloma. This progression is often associated with alterations in antioxidant defense mechanisms. Patients with coronary artery disease also experience changes in their antioxidant defense that may enhance the deleterious effects of active oxygen species and elevate the risk of chemotherapy-related organotoxic effects.&#x0D; The aim of this study is to investigate the specificities of the prooxidant-antioxidant status in patients with multiple myeloma and concomitant coronary artery disease during chemotherapy.&#x0D; Materials and methods. 42 patients with multiple myeloma were examined, 22 (52,5%) of them had concomitant coronary artery disease. According to the coronary artery disease, patients with multiple myeloma were divided into two groups. All patients obtain standard chemotherapy schemes. Assessment of the patients was performed four times: before and after the 1st and 5th chemotherapy course. TBA-reactants and catalase activity were measured in blood serum.&#x0D; Results. Both in I and II group of patients, TBA-reactants concentration in blood serum was increased in 1.85 (р1&lt;0,0001) and in 2.35 (р1&lt;0,0001) times respectively compare to healthy people before chemotherapy. Although in the patients with concomitant coronary artery disease TBA-reactants concentration in blood serum was increased in 1,28 (р2&lt;0,0001) times compare to I group of patients. Simultaneously in II group of patients catalase activity was decreased in 1.28 (р4 &lt;0,0001) times compare to healthy people and in 1,37 (р5 &lt;0,0001) times compare to I group patients. Before the second course of chemotherapy in II group of patients, TBA-reactants level was increased in 1.03 (р&lt;0.05) times compared to the first examination and in 1.27 (р&lt;0.05) times compared to I group. In II group of patients, catalase activity was decreased in 1.24 (р&lt;0.05) times compared to the first examination and in 1.38 (р&lt;0.001) times compared to the II group. In II group of patients level of TBA-reactants was decreased in 1,13 (p&lt;0,01) times compare to the first examination, but it was in 1,17(р&lt;0,05) higher than TBA-reactants level in I group. Simultaneously catalase activity was decreased in 1.4 (р&lt;0.05) times compare to the first examination.&#x0D; Conclusions. The progression of multiple myeloma is marked by the development of a prooxidant-antioxidant imbalance. In both the I and II patient groups, the level of TBA-reactants increased significantly by 1.85 (p&lt;0.0001) and 2.35 (p&lt;0.0001) times, respectively, compared to the reference value. The presence of concomitant coronary artery disease in multiple myeloma patients led to a 1.28-fold elevation in TBA-reactants levels (p&lt;0.0001) compared to those without cardiovascular diseases. Simultaneously, catalase activity decreased by 1.37 times (p&lt;0.0001) compared to patients without cardiovascular diseases.&#x0D; During chemotherapy, a progressive increase in the prooxidant-antioxidant imbalance was observed in multiple myeloma patients. This was evidenced by a 1.4-fold decrease in catalase activity (p&lt;0.05) compared to the initial examination.

Clinical predictive factors of coronary stenosis in patients with high‑risk valvular heart disease who received diagnostic coronary angiography prior to cardiac valve surgery.

Valvular heart disease (VHD) may lead to morbidities and mortality due to heart failure or sudden death. Concomitant coronary artery disease (CAD) is a crucial condition that needs to be explored in patients with VHD prior to cardiac valve surgery as it may increase morbidity and mortality. Patient age >40 years and mitral regurgitation are key risk factors for CAD in patients with VHD. The present study aimed to identify clinical risk factors for coronary stenosis in patients with high-risk VHD. The retrospective cohort study recruited patients aged >40 years who received cardiac valve surgery and coronary angiogram prior to cardiac valve surgery. Clinical factors predictive of coronary stenosis were computed by logistic regression analysis. There were 533 patients; 114 patients (21.38%) had coronary stenosis. Four factors were positively associated with coronary stenosis including age, male sex, mitral regurgitation and hypertension, while two factors were negatively associated with coronary stenosis, namely estimated glomerular filtration rate and rheumatic heart disease. Hypertension had the highest adjusted odds ratio at 2.596, while rheumatic heart disease had the lowest adjusted odds ratio at 0.428. Patient age >55 years showed a sensitivity and specificity of coronary stenosis of 80.70 and 37.47%, respectively. Clinical factors predictive of coronary stenosis in patients with high-risk VHD were age >55 years, male sex, mitral regurgitation and hypertension, while a high estimated glomerular filtration rate and presence of rheumatic heart disease were protective factors.