Conventional Coronary Angiography Research Articles

Intravascular Imaging-Guided Versus Coronary Angiography-Guided Complex PCI: A Meta-analysis of Randomized Controlled Trials.

Trials evaluating the role of intravascular imaging in percutaneous coronary intervention (PCI) for complex coronary artery disease have yielded mixed results. This study aimed to compare the outcomes of intravascular imaging specifically intravascular ultrasound (IVUS) with those from conventional coronary angiography in complex PCI. Comprehensive electronic search of MEDLINE, EMBASE, and Cochrane databases was performed until March 2023 for randomized clinical trials (RCTs) comparing intravascular imaging with coronary angiography in patients undergoing complex PCI. Complex PCI was defined per each study, and included PCI for American College of Cardiology/American Heart Association (ACC/AHA) type B2/C lesions, unprotected left main coronary artery disease, or multivessel stenting. The primary study outcome was major adverse clinical events (MACE). The meta-analysis included 10 RCTs with a total of 6615 patients (3576 in the intravascular imaging group and 3039 in the coronary angiography group). The weighted mean-follow up was 28.9months. Compared with coronary angiography, intravascular imaging reduced MACE (8% vs. 13.3%; relative risk [RR] 0.63; 95% confidence interval [CI] 0.54-0.73), cardiac death (RR 0.47; 95%CI 0.31-0.73), definite/probable stent thrombosis (RR 0.48; 95%CI 0.24-0.97), target vessel revascularization (RR 0.62; 95%CI 0.46-0.83), and target lesion revascularization (RR 0.61; 95%CI 0.47-0.79). There was no difference between both groups in all-cause death (RR 0.79; 95%CI 0.53-1.18) and myocardial infarction (RR 0.80; 95%CI 0.61-1.04). In patients undergoing complex PCI, intravascular imaging-specifically IVUS-reduced MACE by decreasing the incidence of cardiac death, stent thrombosis, and target vessel and target lesion revascularization.

Characteristics of coronary arterial lesions in elderly patients with hypertension

Background: Aging is a physiological progress in everyone’s life, combined with a decrease in many functions and comorbidities. Coronary heart disease is a common condition because of cumulative age and risk factors: hypertension, diabetes, dyslipidemia... Hypertension is also a new problem, the main and independent coronary disease risk factor. Large trials that describe a characteristic of coronary lesions by conventional coronary angiography often collect fewer very older patients. Objectives: 1. To dDescribe the clinical and subclinical coronary lesions characteristic of older patients with hypertension who are indicated conventional coronary angiography. 2. Finding an association between the characteristics of coronary lesions and cardiovascular risk factors in elderly patients with primary hypertension (Vietnam Society of Hypertension guidelines 2022). Subjects and method: 159 patients older than 60 who have primary hypertension combined with acute coronary syndrome or chronic coronary syndrome are indicated for conventional coronary angiography at Hue Central Hospital from 05/2021 to 05/2022. They are divided into 2 groups: elderly (60 - 79 years old) and very elderly (≥ 80 years old) with cross-sectional method. Results: Different hypertension grades, pulse pressure, mean blood pressure and cardiovascular risk factors such as diabetes with control HbA1C well, chronic kidney disease, dyslipidemia, and previous coronary diseases are not significant. Contrast this, LDL-C, TG/HDL-C ratio, LDL-C/HDL-C ratio, obesity, arrhythmia, and dilating cardiac chamber on echocardiography is significantly different between 2 groups. Severe coronary stenosis LAD>RCA>LCx>LM. One or two severe coronary diseases is higher in very elderly patient than elderly patient, but three or non-severe coronary diseases is higher in elderly patient. The type of lesion that ACC/AHA classifies is almost type B and type C at three vessels but the only difference at RCA is significant. Severe coronary stenosis is higher in very elderly patients than elderly patients and is significantly different in grade 2 hypertension, systolic blood pressure ≥ 140 mmHg, diastolic blood pressure ≥ 90 mmHg, pulse pressure ≥ 50 mmHg. Complexity coronary lesion or type C ACC/AHA significantly correlates with systolic blood pressure and HbA1C at medium level. SYNTAX II score correlates positively with systolic blood pressure, pulse pressure, age, and LDL-C/HDL-C ratio and significantly correlates with negative glomerular filtration. Severe tortuosity coronary disease significantly correlates with positive diastolic and mean blood pressure. Chronic total occlusion coronary diseases significantly correlate at a medium level with the TG/HDL-C ratio. Conclusions: Coronary lesions of elderly patients are more complex and have a higher ratio, especially uncontrol cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes. Key words: characteristic of coronary lesions, elderly, conventional coronary angiography, elderly and hypertension.

Basic Overview of Conventional Coronary Angiography for Planning Cardiac Surgery.

Coronary angiography is a common procedure performed by the cardiologist to evaluate coronary atherosclerotic disease (CAD) and the result is utilized by both cardiologists and cardiac surgeons to perform catheter and surgical interventions on the coronary artery. In addition to evaluating CAD, other useful investigative modalities such as left ventriculography and aortography can be performed at the time of coronary angiography. Despite its limitations and the emergence of newer investigative modalities like coronary computed tomography angiography, intravascular ultrasound scan, and magnetic resonance coronary angiography, conventional coronary angiography has remained the gold standard for the evaluation of coronary artery disease. Hence, it remains an investigative modality that every member of the cardiothoracic team performing coronary artery bypass grafting must learn how to interpret.

Fully automated artificial intelligence-based coronary CT angiography image processing: efficiency, diagnostic capability, and risk stratification.

To prospectively investigate whether fully automated artificial intelligence (FAAI)-based coronary CT angiography (CCTA) image processing is non-inferior to semi-automated mode in efficiency, diagnostic ability, and risk stratification of coronary artery disease (CAD). Adults with indications for CCTA were prospectively and consecutively enrolled at two hospitals and randomly assigned to either FAAI-based or semi-automated image processing using equipment workstations. Outcome measures were workflow efficiency, diagnostic accuracy for obstructive CAD (≥ 50% stenosis), and cardiovascular events at 2-year follow-up. The endpoints included major adverse cardiovascular events, hospitalization for unstable angina, and recurrence of cardiac symptoms. The non-inferiority margin was 3 percentage difference in diagnostic accuracy and C-index. In total, 1801 subjects (62.7 ± 11.1 years) were included, of whom 893 and 908 were assigned to the FAAI-based and semi-automated modes, respectively. Image processing times were 121.0 ± 18.6 and 433.5 ± 68.4 s, respectively (p<0.001). Scan-to-report release times were 6.4 ± 2.7 and 10.5 ± 3.8 h, respectively (p< 0.001). Of all subjects, 152 and 159 in the FAAI-based and semi-automated modes, respectively, subsequently underwent invasive coronary angiography. The diagnostic accuracies for obstructive CAD were 94.7% (89.9-97.7%) and 94.3% (89.5-97.4%), respectively (difference 0.4%). Of all subjects, 779 and 784 in the FAAI-based and semi-automated modes were followed for 589 ± 182 days, respectively, and the C-statistic for cardiovascular events were 0.75 (0.67 to 0.83) and 0.74 (0.66 to 0.82) (difference 1%). FAAI-based CCTA image processing significantly improves workflow efficiency than semi-automated mode, and is non-inferior in diagnosing obstructive CAD and risk stratification for cardiovascular events. Conventional coronary CT angiography image processing is semi-automated. This observation shows that fully automated artificial intelligence-based image processing greatly improves efficiency, and maintains high diagnostic accuracy and the effectiveness in stratifying patients for cardiovascular events. • Coronary CT angiography (CCTA) relies heavily on high-quality and fast image processing. • Full-automation CCTA image processing is clinically non-inferior to the semi-automated mode. • Full automation can facilitate the application of CCTA in early detection of coronary artery disease.

Coronary CT Angiography-Based Assessment of Coronary in-Stent Restenosis: A Journey through Past and Present Trends

Treatment of patients with coronary artery disease commonly involves the use of balloon-expandable stent placements, currently recognized as the most prevalent approach for coronary artery revascularization. Nevertheless, the occurrence of restenosis remains a significant complication following percutaneous coronary interventions. The diagnostic role of coronary CT angiography (CCTA) in detecting stent restenosis has limitations primarily attributable to challenges in accurately discerning the lumen, due to issues such as blooming and motion artifacts. As a result, many cases often necessitate a transition to conventional coronary angiography. However, recent advancements in CT technology have led to notable improvements in both sensitivity and specificity, underscoring the growing significance of CCTA as a diagnostic tool. The consistent reporting of high negative predictive value is particularly noteworthy. This review aims to explore the historical context, current status, and recent trends in diagnosing coronary artery stent restenosis using CCTA.

Abstract 13615: Diagnostic Accuracy of Cardiac MRI for Detecting Wall Motion Abnormalities and Coronary Artery Stenosis - A Systematic Review and Umbrella Meta-Analysis

Introduction: Conventional coronary angiography (CCA) is the gold standard for the diagnosis of coronary artery disease (CAD). It is an invasive test and carries risks. Increased mortality is linked with reduced coronary flow, thus aggressively measuring coronary flow is important. Cardiac MRI (cMRI) is an emerging non-invasive test that can also help in assessing ventricular function, myocardial perfusion, and detecting anomalies. Aim: We aimed to analyze the diagnostic accuracy of cMRI compared to CCA through an umbrella meta-analysis. Methods: We searched PubMed articles comparing the diagnostic accuracy of cMRI with CCA in patients having CAD published from 2000 to 2022 according to PRISMA guidelines. We used the generic inverse variance method to pool sensitivity (SN), specificity (SP), negative likelihood ratio, positive likelihood ratio, and diagnostic odds ratio (DOR) with 95% confidence interval keeping alpha criteria of 0.05 as significant. RevMan 5.4 was used to calculate random effects models. Results: In this umbrella meta-analysis, 9 studies with 14615 patients met inclusion criteria. Overall pooled SN was 0.88 (95% CI: 0.87-0.90), SP was 0.85 (0.81-0.89), PLR was 6.07 (5.02-7.33), NLR was -1.99 (-2.10 to -1.87), and DOR 38.94 (31.96-47.46). (p&lt;0.00001) Conclusion: The diagnostic accuracy of a non-invasive, cMRI is comparable, if not superior to an invasive test like CCA.

Coronary computed tomography angiography-based SYNTAX score for comprehensive assessment of advanced coronary artery disease

BackgroundSince the initial attempt to adapt the anatomical SYNTAX score (aSS) to coronary computed tomography angiography (CCTA), CCTA imaging technology has evolved, and is currently used as a “decision-maker” for revascularization strategy in complex coronary artery disease (CAD) and has rendered necessary some updating of the aSS to the CCTA modality. ObjectivesThe aim is to provide updated definitions of the aSS derived from CCTA in patients with complex CAD undergoing CABG. MethodsThe modifications of CCTA-aSS are the following; (i) updated definition and detection criteria of total occlusion (TO) in CCTA based on length assessment, (ii) inclusion of scoring points for serial bifurcations located in one single coronary segment. (iii) inclusion of weighing score points for lesions located distal to a TO, not visualized on conventional coronary angiography, but visible in CCTA, (iv) removal of thrombus and bridging collateral items from the weighing score, considering the limited diagnostic capability of CCTA in detecting these specific lesion characteristics. Resultsthe updated CCTA-aSS was tested in a first-in-man study using the sole guidance of CCTA for the planning and performance of bypass surgery in complex CAD (n ​= ​114). An interobserver analysis showed excellent reproducibility (ICC ​= ​0.96, 95 ​% confidence interval 0.94–0.97). ConclusionThe updated CCTA-aSS was implemented in a cohort of patients with complex CAD undergoing CABG with the sole guidance of CCTA and FFRCT and the Inter-reproducibility of the analysis of the updated score was found excellent. The prognostic value of the modified CCTA-aSS will be examined in future studies.

Self-navigated coronary MR angiography for coronary aneurysm detection in Kawasaki disease at 3T: comparison with conventional diaphragm-navigated coronary MR angiography.

To assess the scan time, image quality, and diagnostic performance of self-navigated coronary MR angiography (SN-CMRA) for coronary aneurysm (CAA) detection in Kawasaki disease (KD) patients and compare it with diaphragm-navigated CMRA (DN-CMRA). SN-CMRA and DN-CMRA were performed on 76 pediatric patients with KD (48 males, 6.75 ± 3.59 years). Thirty-three of whom underwent coronary CT angiography (CCTA)/invasive coronary angiography (ICA). The scan time and qualitative and quantitative image quality assessment were compared between the two sequences. The diagnostic performance for CAA detection by the two approaches using CCTA/ICA as the reference standard was compared on per-patient, per-vessel, and per-segment basis. The scan time of SN-CMRA was significantly shorter than that of DN-CMRA (7.49 ± 2.31 min vs. 10.03 ± 4.47 min, p< 0.001). There was no difference in overall and segmental image quality to reach the clinical diagnostic criteria between the two sequences (all p> 0.05). No significant difference in vessel length of the three main coronary arteries was found between the two approaches (all p> 0.05). Moreover, SN-CMRA showed no difference from DN-CMRA in contrast ratio of blood-myocardium (1.25 (interquartile range [IQR], 1.06 to 1.51) vs. 1.18 (IQR, 0.95 to 1.64), p= 0.706). There was no difference in the diagnostic accuracy of SN-CMRA and DN-CMRA for CAA detection on per-patient, per-vessel, or per-segment basis (all p> 0.05). SN-CMRA at 3T showed reliable diagnostic performance and application value for CAA detection in children with KD. Compared with DN-CMRA, SN-CMRA can simplify the scanning procedure and shorten the scan time, achieving comparable image quality and diagnostic accuracy. Coronary aneurysm in children with Kawasaki disease (KD) can be detected by self-navigated coronary MR angiography (CMRA) non-invasively and without radiation, achieving comparable image quality and diagnostic performance as diaphragm-navigated CMRA while shortening scanning time. It can provide reference for risk stratification and treatment management of KD. • Evaluating the size of coronary aneurysm is important for risk stratification and treatment of Kawasaki disease. • Self-navigated coronary MR angiography (SN-CMRA) shortens scan time and achieves comparable image quality and diagnostic performance compared with diaphragm-navigated coronary MR angiography. • SN-CMRA can evaluate coronary aneurysm non-invasively and without radiation, providing information for risk stratification and treatment.

Predictors of Coronary Artery Disease in Heart Failure with Reduced Ejection Fraction at the Aga Khan University Hospital in Nairobi.

This was a retrospective study at the Aga Khan University Hospital, Nairobi, which is equipped with diagnostic capabilities for heart failure and coronary artery assessment. We evaluated patients with HFrEF based on echocardiographic data over a 12-year period. Patients with coronary anatomical evaluation data were included. A multivariable model of CAD was generated using stepwise logistic regression. Of the 1329 patients screened, 514 met the inclusion criteria. The mean age was 61.0 ± 12.8 years. There were 381 male cases (75.2%), and the predominant race was African, numbering 386 (75.2%). Most patients, 97%, were evaluated through conventional coronary angiography. Further, 310 (60.3%) cases had significant CAD. The prevalence of CAD in HFrEF was 52.3% in Africans, 85% in Asians, and 79% in Caucasians. In the multivariable logistic regression, the odds of having significant CAD was higher among participants with diabetes mellitus (aOR: 1.86; 95%CI: 1.15-3.03), Q waves (aOR: 2.12; 95%CI: 1.12-4.10), significant ST segment deviation (aOR: 4.14; 95%CI: 2.23-8.03), and regional wall motion abnormalities on echocardiogram (aOR: 6.53; 95%CI: 3.94-11.06). In this population, CAD was a major etiology in HFrEF among the African population. The most powerful predictors of CAD were type 2 diabetes, the presence of pathological Q waves, or ST segment shift on a 12-lead electrocardiogram, and regional wall motion abnormality on 2D echocardiogram. There is an epidemiological transition in the cause of heart failure in sub-Saharan Africa (SSA) in keeping with the steady increase in cardiovascular risk factors for coronary artery disease (CAD).The prevalence of CAD in African patients with heart failure with reduced ejection fraction (HFrEF) was 52.3%.In the multivariable logistic regression, diabetic mellitus, pathological Q waves, significant ST segment deviation, and regional wall motion abnormalities were significantly associated with CAD.

Combined Computed Tomography Angiography-Computed Tomography Perfusion in the Identification and Prognostic Assessment of Myocardial Bridging from the CORE320 Study: 5-Year Follow-Up

Our objective is to use computed tomography angiography (CTA) and computed tomography perfusion (CTP) to identify the ischemic significance of myocardial bridging (MB). We also seek to determine the long-term prognostication of MB in the presence or absence of obstructive coronary artery disease (CAD). The CORE320, a prospective, multicenter study including 381 patients with known or suspected CAD clinically referred for invasive coronary angiography who underwent combined (CTA-CTP) and single-photon emission computed tomography before conventional coronary angiography. The incidence of MB was identified in 135 patients (35.4%) with 93.9% identified in the left anterior descending artery. MB were divided as partially encased versus fully encased. There was no difference in ischemia identified between partially encased MB and fully encased MB (37 [40%] vs 25 [35%], p=0.54]. Ischemia was identified at similar rates in partially versus fully encased MB by single-photon emission computed tomography at (8 [9%] vs 8 [11%], p=0.57] and CTP (34 [37%] vs 21 [30%], p=0.33]. There was no difference in the primary outcome of 5-year outcome of combined incidence of myocardial infarction or death. The restricted mean survival time in patients with CTA with <50% stenosis with or without a MB was 4.906 years (95% confidence interval 4.759 to 5.000) and 4.891 years (95% confidence interval 4.718 to 5.000), respectively (p=0.824). Cardiac computed tomography perfusion imaging can assess both anatomic and functional significance of myocardial bridging with diagnostic accuracy similar to current standard imaging. Furthermore, 5-year cardiovascular events were not different with the presence of MB in both obstructive and non-obstructive CAD.

Correlation between Global Longitudinal and Circumferential Peak Systolic Strain and Coronary Artery Disease Severity as Assessed by the Angiographically Derived SYNTAX Score

Abstract Aim and objectives the main objective of the current study is to assess the correlation between the SYNTAX score in patients undergoing elective coronary angiography and the longitudinal and circumferential peak systolic strain performed at rest by speckle tracking echocardiography to predict the presence, extent and severity of coronary artery disease. Patients and Methods The study included 60 patients suspected to have coronary artery disease either by symptoms or done a positive non-invasive test for myocardial ischemia with no history of previous ischemia and no previously detected segmental wall motion abnormalities in previous resting echocardiogram. All patients were recruited from the catheter laboratory at the cardiology department of Ain Shams university hospitals and they underwent echocardiographic assessment before elective coronary angiography. Results The study included 60 symptomatic patients suspected to have chronic coronary syndrome aging 31 to 77 years (excluding those with significant structural heart disease). All patients underwent clinical evaluation, surface electrocardiogram, transthoracic echocardiographic, twodimensional speckle tracking, and conventional coronary angiography with SYNTAX score calculation. Patients were divided into 3 groups based on the results of the coronary angiogram: normal CAD on angiogram (n = 12), low SS (n = 28, SS &amp;lt; 22), and high SS (n = 20, SS ≥ 22). Age, sex and most of the risk factors had no statistically significant correlation with the SYNTAX score while There was a significant inverse correlation between GLPSS and GCPSS and SS values (r = 0.458, P = 0.0002), (r = 0.411, P = 0.0011) respectively. Conclusion The results of our study suggest that GLPSS and GCPSS might be promising for the detection of patients with high SYNTAX score on coronary angiogram. There is an inverse correlation between resting GLPSS and GCPSS and SYNTAX score as assessed by coronary angiography.

Comparison between the Computed Tomography (CT) Coronary Angiography by Using “Coronary Artery Disease - Reporting and Data System (CAD-RADS)” and the Conventional Coronary Angiography in Assessment of the Coronary Artery Stenosis Severity

Background Coronary CTA is established as the first-line diagnostic imaging tool to exclude coronary artery disease (CAD) at low to intermediate risk. Reporting and interpretation of the findings gap between the referring physicians and radiologist are wide. Aim of the Work To evaluate the clinical efficacy of Computed Tomography (CT) coronary angiography by using Coronary Artery Disease - Reporting and Data System (CAD-RADS) versus invasive coronary angiography in the assessment of coronary artery stenosis severity. Patients and Methods The study included 24 patients suffered from typical chest pain or fatigue, 9 were female patients and 15 were male patients, with mean patient ages above 40 years old. The study was conducted at Ain Shams University Hospitals. Results The main goals of the CAD-RADS are to decrease variability between readers and enhance communication between interpreting and referring doctors, which affects the best patient care outcome. Many clinical case scenarios are not accurately addressed by CAD-RADS and in which classes of CAD-RADS category is not straightforward. Multiple scenarios are still vague and at the maximum point of conflict about the adoption of CAD-RADS role in practice. Conclusion Hoping the next new versions of CAD-RADS classification would have addressed those vague situations and scenarios.

Deep and long myocardial bridge.

A 67-year-old man presented with left-sided chest pain that occurred while he was sleeping. He had experienced similar symptoms once a month for the past three years but did not experience any chest pain during physical activity. Variant angina pectoris was suspected based on clinical manifestations, and an electrocardiogram-gated computed tomography coronary angiography (CTCA) was performed for excluding coronary artery stenosis. A three-dimensional (3D) reconstruction image of CTCA revealed the midportion of the left anterior descending artery (LAD) coursing within the myocardium. While the curved multiplanar reconstruction (MPR) at 75% of the R-R interval revealed patency of the segment during diastole, the curved MPR at 40% of the R-R interval revealed severe stenosis of the segment during systole. The patient was diagnosed as having deep and long myocardial bridge (MB) of the LAD. Generally, MB is considered a benign condition with a favorable long-term outcome. However, severe systolic stenosis and delayed diastolic relaxation of the tunneled artery can impair coronary blood flow, potentially leading to effort and variant angina, myocardial infarction, life-threatening arrhythmias, or sudden death. Although conventional coronary angiography was previously considered the gold standard for diagnosing MB, new imaging techniques such as intravascular ultrasonography, optical coherence tomography, and multi-detector CT are now available. CTCA can noninvasively show not only the morphological characteristics of MB but also the changes of MB from diastole to systole phase with a multiple-phase reconstruction technique using electrocardiogram-gated data acquisition.

Comparing of Peak Longitudinal strain and Post Systolic Shortening in detecting ischemia at rest in stable coronary artery disease: an angiography verified study

Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary artery disease is a major public health problem. Early diagnosis and treatment of coronary artery disease is crucial. There is a need for a practical, reliable and cost-effective non-invasive imaging tool. We aimed to evaluate the rest ischemia with speckle tracking echocardiography (STE) compare to the two methods in patients who were scheduled coronary angiography according to the stress tests. Methods We included fifty patients with stable angina pectoris who were scheduled for conventional coronary angiography after the stress tests in our study. Speckle tracking echocardiography was performed just before coronary angiography. The association of 2 parameters with coronary artery disease was investigated and compared. Results Among 50 patients recruited for the study, 38 of them had severe CAD (&amp;gt;50%), whereas 12 patients had non-significant CAD. Post systolic shortening (PSS) was significantly related with CAD (p&amp;lt;0.0001). The relationship of PLS with the area at risk was found to be statistically insignificant but global longitudinal strain (GLS) was significantly lower in patients with severe CAD (p = 0.011). Conclusion PSS may detect coronary ischemia in patients with stable coronary artery disease and it is more sensitive and specific in patients with stable CAD. PSS is a very useful, practical and easy applicable non invasive tool for the detection of severe coronary artery disease at rest.

FREQUENCY OF SIGNIFICANT CORONARY ARTERY DISEASE IN CASES WITH ST SEGMENT DEPRESSION DURING RECOVERY PHASE OF EXERCISE

Coronary Artery Disease (CAD) imposes physical, social, and economic burden. It is amongst the leading causes of mortality and morbidity. Exercise-induced ST segment depression is considered reliable ECG finding for the diagnosis of obstructive coronary atherosclerosis. Exercise testing has an excellent safety record. The aim of the study is to determine the frequency of significant coronary artery disease in cases with ST-segment depression during recovery phase of exercise tolerance test. This descriptive case series was carried out at the Department of Cardiology, Rehmatul-Lil-Alamin Institute of Cardiology, Lahore, from 11-01-2021 to 10-07-2021. A total of 89 patients were taken in this study. Conventional coronary angiography via femoral or radial route was performed. Lesions were quantified by QCA technique in addition to visual assessment. Significant CAD was labelled as per operational definition. Patients ranged between 30-70 years of age with mean age of 51.8±10.8 years. There were 56 males (62.9%) while remaining 33 (37.1%) were females. History of diabetes mellitus was reported in 31 patients (34.8%), hypertension in 38 patients (42.7%) and smoking 51 (57.3%). Family history of CAD found in 46 patients (51.7%). Hyperlipidemia reported in 38 patients (42.7%). Significant CAD was observed in 76 patients (85.4%). Stratification for age, gender, diabetes mellitus, hypertension and smoking were carried out and found no association with significant CAD. In conclusion, 85.4% frequency rate of significant coronary artery disease in cases with ST segment depression during recovery phase of exercise tolerance test was observed. Thus, careful evaluation of ST segment depression occurring in recovery phase may add significantly to the clinical information derived from the results of ETT.

A machine-learning based bio-psycho-social model for the prediction of non-obstructive and obstructive coronary artery disease

BackgroundMechanisms of myocardial ischemia in obstructive and non-obstructive coronary artery disease (CAD), and the interplay between clinical, functional, biological and psycho-social features, are still far to be fully elucidated.ObjectivesTo develop a machine-learning (ML) model for the supervised prediction of obstructive versus non-obstructive CAD.MethodsFrom the EVA study, we analysed adults hospitalized for IHD undergoing conventional coronary angiography (CCA). Non-obstructive CAD was defined by a stenosis < 50% in one or more vessels. Baseline clinical and psycho-socio-cultural characteristics were used for computing a Rockwood and Mitnitski frailty index, and a gender score according to GENESIS-PRAXY methodology. Serum concentration of inflammatory cytokines was measured with a multiplex flow cytometry assay. Through an XGBoost classifier combined with an explainable artificial intelligence tool (SHAP), we identified the most influential features in discriminating obstructive versus non-obstructive CAD.ResultsAmong the overall EVA cohort (n = 509), 311 individuals (mean age 67 ± 11 years, 38% females; 67% obstructive CAD) with complete data were analysed. The ML-based model (83% accuracy and 87% precision) showed that while obstructive CAD was associated with higher frailty index, older age and a cytokine signature characterized by IL-1β, IL-12p70 and IL-33, non-obstructive CAD was associated with a higher gender score (i.e., social characteristics traditionally ascribed to women) and with a cytokine signature characterized by IL-18, IL-8, IL-23.ConclusionsIntegrating clinical, biological, and psycho-social features, we have optimized a sex- and gender-unbiased model that discriminates obstructive and non-obstructive CAD. Further mechanistic studies will shed light on the biological plausibility of these associations.Clinical trial registrationNCT02737982.Graphical abstract

CORRELATION OF CORONARY CALCIUM SCORE AND ANGIOGRAPHIC FINDINGS IN PATIENTS WITH ISCHEMIC HEART DISEASE

Background &#x0D; Acute myocardial infarction and sudden cardiac death was reported to be the initial presentation in 50% of patients with coronary artery disease (CAD); coronary artery calcium score can be regarded as one of the potential tools to improve risk stratification and predict coronary events in these patients.&#x0D; Objectives &#x0D; To find the correlation between coronary calsuim score calculated by CT scan and significant coronary stenosis by conventional coronary angiography.&#x0D; Materials and Methods&#x0D; A hundred patients who were referred for conventional coronary angiography having CAC score calculated by CT scan, 50 patients with CAC &lt;400 and 50 patients with &gt;400 were randomly selected to be involved.&#x0D; Results&#x0D; The age ranged from 32 to 70 years with a mean of 56.7 ±8.9. There were 59 males with 41 females. Chest pain was our study’s main reason for undergoing imaging (67%). The mean coronary calcium score was 528.54 for total coronary vessels and 19,236.8, 115.45 and 157.98 for LMS, LAD, LCX and RCA, respectively. The mean of the calculated syntax score was 23.4. Stenosis of &gt;50% was 9% for LMS, and stenosis of ≥75% was found in 41%, 27%, and 8% of LAD, LCX and RCA, respectively. A significant correlation between total coronary calcium score at a threshold of 400 and age, being diabetic, LAD stenosis, LCX stenosis, RCA stenosis, mean syntax score and syntax score categories. Also, the mean total coronary calcium score was significantly correlated to age, gender and syntax score. Moreover, the stenosis in LAD, LCX and RCA was significantly correlated to the mean of the calcium score of respective vessels. &#x0D; Conclusion&#x0D; Total CAC score was significantly associated with angiographic coronary stenosis, and the correlation is stronger at 400 and above. This study may support using calcium screening as an initial filter before further sophisticated imaging or invasive angiography. However, a zero or low CACS does not exclude CAD.

Evaluation Of Coronary Artery Bypass Graft Using Multidetector CT Angiography Versus Conventional Coronary Angiography: Comparative Study

Background: Standard treatment for advanced coronary artery disease is CABG surgery. Due to their short lifespan, coronary artery bypass grafts require imaging analysis. Although conventional coronary angiography is the gold standard for imaging coronary arteries and coronary artery bypass grafts, it has a number of drawbacks. Thanks to advancements in MDCT coronary angiography, it plays a crucial role in imaging coronary artery bypass grafts and permits the examination of additional post-operative problems. Aim: This study aimed to compare MDCT coronary angiography and conventional coronary angiography for CABG assessment. Patients and methods: This prospective study included 50 patients with past history of CABG surgery presented to radiology department, Benha university hospital and national heart institute. All patients were evaluated by MDCT coronary angiography as well as conventional coronary angiography as a reference. Results: 122 grafts were included in the study, 48 were arterial and 74 were venous grafts. Regarding arterial grafts, 46 were LIMA-LAD grafts, 39 of which were patent, 3 had significant stenosis and 4 were occluded. The RIMA–RCA was patent and the Radial-OM graft showed significant stenosis. Regarding venous grafts, 17 grafts were patent, 6 grafts showed significant stenosis, and 51 grafts were occluded. Conclusion: MDCT coronary angiography is a reliable non-invasive imaging tool in assessment of CABG.

Intracoronary Diagnostics in Patients with Acute Coronary Syndrome

Despite the increasing number of coronary interventions in China, long-term adverse cardiovascular events remain high, especially in patients with acute coronary syndromes (ACS). The advent of intracoronary imaging and coronary physiological diagnostic techniques, such as optical coherence tomography (OCT), intravascular ultrasound (IVUS), near infrared spectroscopy (NIRS), and flow reserve fraction (FFR), has optimized the diagnosis and risk classification of patients with ACS. Intracoronary diagnostics compensate for the deficiencies of conventional coronary angiography in identifying and incriminating lesions and high-risk lesions. The combination of intracoronary imaging and physiological techniques is expected to achieve a comprehensive evaluation of the structural features and physiology of the coronary arteries, thus further tailoring and improving the prognosis of patients.

Impact of assessment of fractional flow reserve and instantaneous wave-free ratio on clinical outcomes of percutaneous coronary intervention: a systematic review, meta-analysis and meta-regression analysis

Aim. To conduct a systematic review and meta-analysis to compare clinical outcomes in patients with coronary artery disease (CAD) undergoing percutaneous coronary intervention (PCI) using conventional coronary angiography (CAG) or fractional flow reserve (FFR)-guided PCI. In addition, FFR-guided PCI and PCI guided with instantaneous wave-free ratio (iFR) were compared.Material and methods. PubMed, Google Scholar databases were searched for studies comparing clinical outcomes in patients with CAD undergoing CAG-guided or FFR/iFR-guided PCI. Dichotomous data analysis was presented as odds ratio (OR) with 95% confidence interval (CI). Adjusted hazard ratio (HR) values from studies with similar evaluation criteria were pooled for meta-analysis.Results. Six randomized controlled trials (RCTs) from 184 publications were selected for this systematic review and meta-analysis. A total of 2193 patients (mean age, 64,2 years, mean follow-up, 28,0 months) were included. Analysis of RCTs showed that CAG-guided and FFR-guided PCI did not have a significant difference in the incidence of major adverse cardiovascular events (MACE) (OR: 0,78; 95% CI: 0,61-1,00; p=0,05; I2=0%), all-cause death (OR: 0,86; 95% CI: 0,51-1,44; p=0,57; I2=0%) or emergency revascularization (OR: 0,69, 95% CI: 0,46-1,04, p=0,08, I2=0%). However, FFR-guided PCI was associated with a reduced risk of subsequent MI compared with CAG-guided PCI (OR: 0,70; 95% CI: 0,50-0,99; p=0,04; I2=0%). In addition to the results of previous RCTs, we conducted a metaanalysis of 3 observational studies. In total, the CAG-guided and FFR-guided PCI groups included 165012 and 11450 patients, respectively. A meta-analysis showed that FFR-guided PCI was associated with a reduced risk of all-cause mortality (HR: 0,74; 95% CI: 0,63-0,87; P=0,0003) and MI (HR: 0,75; 95% CI: 0,61-0,94; p=0,01). In addition, there was no significant difference between iFRand FFR-guided PCI in terms of MACE (OR: 0,97; 95% CI: 0,76-1,23; p=0,81), all-cause mortality (OR: 0,66; 95% CI: 0,40-1,10; p=0,11), MI (OR: 0,83; 95% CI: 0,56-1,24; p=0,37) or emergency repeated revascularization (OR: 1,16; 95% CI: 0,85-1,58; p=0,34).Conclusion. FFR-guided PCI is associated with a reduced risk of all-cause mortality and subsequent MI compared with CAG-guided PCI. At the same time, the iFR-guided PCI is not inferior to the FFR-guided method in terms of MACE rate.