Coronary Artery Narrowing Research Articles

Application of apical myocardial perfusion quantitative analysis by contrast-enhanced ultrasound utilizing high-frequency linear probe.

Due to insufficient near-field resolution and artifacts, it is challenging to evaluate the left ventricular apical perfusion with phased-array probes. By combining high-frequency linear probe and contrast-enhanced ultrasound (CEUS), imaging of apical myocardial perfusion could be improved. The study aims to evaluate the preliminary application of CEUS by high-frequency linear probes to assess the apical perfusion. The study enrolled retrospectively 91 patients to test the feasibility of the novel method. In protocol 1, patients were stratified into a group with left anterior descending artery (LAD) stenosis (N=40) and a group without LAD stenosis or coronary artery disease (N=41) based on the degree of coronary artery narrowing, quantified by>50% stenosis in coronary angiography. Receiver operating characteristics (ROC) analysis was performed to test the diagnostic value of perfusion parameters. In protocol 2, the reproducibility of high-frequency linear probe in apical perfusion analysis was compared with the conventional phased-array probe in 30 patients. (1) The novel method is feasible in 81(89.01%) patients. (2) In protocol 1, to detect LAD stenosis, the best cut-off of β, T, A, and MBF were 10.32, 3.28, 9.39, and 4.99, respectively. Area under the curve of β, T, A, and MBF were.880,.881,.761, and.880, respectively. (3) In protocol 2, compared with phased-array probe, the quantitative analysis of high-frequency linear probe is of high reproducibility and could get good curve fitting (R2=.29vs. R2=.71, P<.01). Observation of apical perfusion using this method is feasible and quantitative analysis allows an accurate and convenient identification of LAD stenosis. This method provides an alternative for patients who have difficulties in visualizing the apical region with a phased-array probe.

Comparison of Small Blood Vessel Diameter with Intravascular Ultrasound and Coronary Angiography for Guidance of Percutaneous Coronary Intervention.

Major cardiovascular events (MACEs) are a cause of major mortality worldwide. The narrowing and blockage of coronary arteries with atherosclerotic plaques are diagnosed and treated with percutaneous coronary intervention (PCI). During this procedure, coronary angiography (CAG) remains the most widely used guidance modality for the evaluation of the affected blood vessel. The measurement of the blood vessel diameter is an important factor to consider in order to decide if stent colocation is suitable for the intervention. In this regard, a small blood vessel (<2.75 mm) is majorly left without stent colocation; however, small vessel coronary artery disease (SvCAD) is a significant risk factor for the recurrence of MACEs, maybe due to the lack of a standardized treatment related to the diameter of the affected blood vessel; therefore, a more precise measurement is needed. The use of CAG for the measurement of the blood vessel diameter has some important limitations that can be improved with the use of newer techniques such as intravascular ultrasound (IVUS), although at higher costs, which might explain its underuse. To address differences in blood vessel diameter measurements and identify specific cases where IVUS might be of additional benefit for the patient, we conducted a retrospective study in patients who underwent PCI for MACEs with affection for at least one small blood vessel. We compared the measurements of the affected small blood vessels' diameter obtained by CAG and IVUS to identify cases of reclassification of the affected blood vessel; additionally, we underwent a multivariate analysis to identify risk factors associated with blood vessel reclassification. We included information from 48 patients with a mean ± SD age of 69.1 ± 11.9 years; 70.8% were men and 29.2% were women. The mean diameter with CAG and IVUS was 2.1 mm (95% CI 1.9-2.2), and 2.8 (2.8-3.0), respectively. The estimated difference was of 0.8 mm (95% CI 0.7-0.9). We found a significant positive low correlation in diameter measurements of small blood vessels obtained with CAG and IVUS (r = 0.1242 p = 0.014). In total, 37 (77%) patients had a reclassification of the affected blood vessel with IVUS. In 21 cases, the affected blood vessel changed from a small to a medium size (2.75-3.00 mm), and in 15 cases, the affected vessel changed from a small to a large size (<3.00 mm). The Bland-Altman plot was used to evaluate agreement in measurements with CAG and IVUS. The change in blood vessel classification with IVUs was important for the decision of intervention and stent collocation. The only variable associated with reclassification of blood vessels after adjustment in a multivariate analysis was T2D (type 2 diabetes) (p = 0 0.035). Our findings corroborate that blood vessels might appear smaller with CAG, especially in patients with T2D; therefore, at least in these cases, the use of IVUS is recommended over CAG.

[15O]H2O myocardial perfusion positron emission tomography: Added value of relative stress perfusion deficit in the prediction of significant coronary artery stenosis in a mixedpopulation

BackgroundIt remains unknown whether estimation of the relative stress perfusion deficit offers added value in the prediction of significant coronary artery stenosis in myocardial perfusion imaging with [15O]H2O positron emission tomography (PET) in a population with high prevalence of established cardiac disease. MethodsDuring eight months, we consecutively included all patients undergoing [15O]H2O PET and subsequent invasive coronary angiography (ICA). Significant stenosis was defined from ICA as fractional flow reserve ≤.8 or coronary artery narrowing of ≥70%. We calculated absolute and relative total perfusion deficits (aTPD and rTPD, respectively) as semiquantitative measures of the extent and severity of reduced stress perfusion. A multivariate logistic regression analysis was performed to test the adjusted associations (odds ratio (OR) with 95% CI) with significant coronary artery stenosis. ResultsOf 800 patients undergoing [15O]H2O PET, 144 underwent ICA, where 142 patients had aTPD of ≥3% and 79 (55%) of these had at least one significant stenosis. In an adjusted analysis, rTPD (OR10% increase = 2.12 (1.44-3.12), P < .001), previous coronary artery bypass grafting (CABG) (OR = .11 (.03-.36), P < .001) and reduced left ventricular ejection fraction (LVEF) (OR = .25 (.08-.84), P = .02) were independently associated with significant stenosis, whereas the association with aTPD (OR10% increase = 1.14 (.98-1.32), P = .08) was modest. ConclusionsIn the presence of an absolute perfusion deficit (aTPD of ≥3%), rTPD may improve the prediction of significant stenosis in a heterogeneous population of patients examined with [15O]H2O PET. Furthermore, previous CABG and reduced LVEF are associated with nonstenotic perfusion deficiencies, suggesting caution when interpreting myocardial perfusion imaging in such patients.

Effects of Coronary Stenosis on Coronary Vascular Impedance

Introduction: The impedance analysis for circulation system is a powerful tool to comprehensively measure the afterload of the entire circulation system. The spectrum of vascular mechanical parameters derived from the impedance analysis can reveal the compliance and resistance changes in proximal and distal vessels, as well as the wave reflections. However, the similar investigation in the opposition of the coronary circulation is limited, and it is unknown how coronary stenosis affects the vascular impedance of the coronary circulation. In this study, we aimed to quantify and compare the changes in the vascular impedance of coronary circulation from the dynamic pressure and flow relations in healthy and patients with stenosis. Method: The pressure and flow rate waveforms from the main coronary artery were obtained from a lumped-parameter computational model that coupled the systemic circulation with the coronary perfusion within a closed system. Both healthy and diseased (coronary stenosis) pressure-flow relations were examined. A Fourier transform was performed to analyze the pressure and flow data, and the resistance (Z0), characteristic impedance (ZC), wave reflections (RW), total arterial compliance (C), and other hemodynamic parameters were derived. Results: Compared to the healthy subject, the diseased subject presented an increased resistance (Z0 was elevated from 0.44 mmHg ▪ min/ml to 0.59 mmHg ▪ min/ml), increased characteristic impedance (ZC was elevated from 0.07 mmHg ▪ min/ml to 0.14 mmHg ▪ min/ml), and reduced wave reflection (RW was decreased from 0.72 to 0.6). These changes indicate elevated distal arteries and arterioles narrowing and proximal artery stiffening in the entire coronary vasculature. Moreover, the coronary flow and the total arterial compliance (stroke volume divided by pulse pressure) were reduced with the disease progression. These data suggest a reduced coronary perfusion and stiffening of the artery in the coronary circulation. Discussion: The impedance analysis has been widely used for systemic and pulmonary circulations previously to quantify the total afterload of the left and right ventricles, respectively. The distribution of the impedance in different frequencies reflects the anatomical and mechanical properties of the vasculature in the circulation system. This study originally found that the coronary artery impedance is altered by coronary stenosis. The key characteristics include the narrowing of distal coronary arteries and stiffening of proximal coronary arteries. However, since both proximal and distal arteries are altered, the wave reflection was reduced, and this may explain a reduced pulse pressure observed in the diseased subject. The reduction in overall coronary perfusion indicates an impaired blood supply to the ventricle and may be responsible for the dysfunction of the heart. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

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.

Application of ultrasound diagnosis in cardiac and liver diseases

Ultrasonography is a non-invasive imaging modality widely used to evaluate and diagnose many diseases. The purpose of this article is to provide a more detailed overview of the use of ultrasound in the diagnosis of heart and liver disease. In addition to a basic introduction to heart and liver disease, this article will explore specific applications of ultrasound in specific heart and liver diseases. In terms of heart disease, ultrasound plays an important role in the diagnosis of coronary atherosclerotic heart disease, valvular heart disease and congenital heart disease. Ultrasound can assess the degree of narrowing and blood flow in coronary arteries to help determine a patient's cardiovascular risk. For valvular heart disease, ultrasound can detect and evaluate the function and abnormality of the heart valves, providing information about valve stenosis or regurgitation. For congenital heart disease, ultrasound can reveal structural abnormalities and hemodynamic changes in the heart, helping to determine the type and severity of the lesion. In liver disease, ultrasound plays an important role in the evaluation of pathologies such as cirrhosis and hepatocellular carcinoma. Ultrasound can assess the shape, size, and texture of the liver, help detect and diagnose cirrhosis, and assess liver function and disease progression. In addition, ultrasound is also of great significance for the early diagnosis and monitoring of hepatocellular carcinoma, which can reveal the location, size and blood flow of the tumor. The role of ultrasound in diagnosing and monitoring disease will expand further with advances in technologies such as artificial intelligence and elastography. In conclusion, ultrasound plays a key role in the assessment, diagnosis and monitoring of heart and liver diseases and has many advantages. With the further development of technology and the expansion of application, the position of ultrasound in clinical practice will be further strengthened.

Abstract B042: Chemotherapy in a patient with the malignant inter-arterial course of the right coronary artery A choice between cancer or the heart?

Abstract Introduction: Congenital coronary artery anomalies can increase the risk of sudden cardiac death, especially during exercise. Cancer patients with concurrent coronary artery disease face higher mortality rates due to delayed percutaneous coronary intervention. Furthermore, anthracycline chemotherapy, a common cancer treatment, can worsen pre-existing cardiac abnormalities. Despite the complexity of managing cancer patients with coronary artery anomalies, there is a lack of clear guidelines. This report presents a case of malignant interarterial course of the right coronary artery in a patient with Human T-lymphotropic virus type I-associated adult T-cell leukemia/lymphoma and discusses the challenges of chemotherapy in such cases. Case presentation: A 38-year-old male presented with weakness and palpitations. Laboratory findings revealed abnormalities, including elevated troponin and severe narrowing of the right coronary artery. Electrocardiograms showed ST elevations initially, followed by T-wave inversions. Although the patient had a pre-existing coronary anomaly, chemotherapy was initiated due to life-threatening tumor lysis syndrome and refractory lactic acidosis. Cardiac catheterization or surgical intervention was not possible due to comorbidities. A follow-up echocardiogram after six months of chemotherapy showed no acute changes. Discussion: Managing cancer patients with congenital coronary artery anomalies is challenging. Malignant interarterial course of the right coronary artery is particularly concerning due to the risk of sudden cardiac death. In this case, the patient's symptoms and abnormal electrocardiogram led to the identification of the coronary anomaly. However, immediate intervention was not feasible due to the patient's critical condition. The initiation of anthracycline-based chemotherapy in this patient posed a dilemma. Anthracyclines can cause cardiotoxicity, worsening pre-existing cardiac anomalies. Despite the lack of guidelines, chemotherapy was administered due to the urgent need for cancer treatment. Regular monitoring was essential to detect any cardiac changes. Conclusion: Managing cancer patients with coronary artery anomalies and administering anthracycline chemotherapy remains challenging due to limited guidelines. The case highlights the importance of recognizing and managing these anomalies to reduce the risk of sudden cardiac death. Guidelines for managing cardiac complications in cancer patients with pre-existing anomalies are needed. Further research is necessary to provide evidence-based guidance for such cases. Citation Format: Aliya M. Khan. Chemotherapy in a patient with the malignant inter-arterial course of the right coronary artery A choice between cancer or the heart? [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr B042.

Non-ST-elevation infarction, the stepchild of interventional myocardial salvage: experience of a single institute

The diagnosis of acute myocardial infarction is based on ECG abnormalities besides to chest pain and dyspnea. It is caused by myocardial hypoperfusion, in most patients due to severe coronary artery narrowing or occlusion, but it can also occur without visible coronary artery changes. The non-ST-elevation form (NSTEMI) is usually associated with less complaints compared to the ST-elevation form (STEMI), the ECG changes are not so typical, so its recognition is more difficult in the early stage. Possibility of myocardial cell damage reduction is the restoration of perfusion with coronary intervention. To investigate how much time elapses in acute NSTEMI from the onset of the complaint to the opening of the coronary vasodilator balloon. From 3733 acute coronary interventions performed in NSTEMI between 01. 01. 2016 and 12. 31. 2020, in 1376 patients who underwent percutaneous intervention for the first time, the onset of the complaints, the date of the first medical contact and opening of the balloon, as well as the 30-day or 1-year mortality were known. The median values of the time differences and the mortality data were compared with the similar data of 1718 STEMI patients of this period. The median times were given in hours:minutes, incidence in percent, a two-sample t-test was calculated for the comparison of mortality data. In NSTEMI, the median time between the first medical contact (5:35 vs. 2:05 h:min) and PTCA balloon opening (18:12 vs. 4:05 h:min) was longer compared to the onset of the complaint as in STEMI. Within 2 hours, 21.3% of NSTEMI patients reached the first medical contact and 1.2% had the PTCA balloon opened, in STEMI this ratios were 48.7% and 11.7%. Within 4 hours, these were in NSTEMI 36.3% and 6.1%, in STEMI 64.1% and 46.8%. The 30-day mortality rate in NSTEMI was lower than in STEMI (5.9% vs. 7.9%, p = 0.03), the 1-year rate was higher (16.1% vs. 12.5%, p = 0.004). In 554 primarily admitted patients who met the study criteria, the median P-B time intervals were shorter (10:55 h:min), the mortality data showed a mild but statistically insignificant difference (5.6% at 30 days, 13.9% at 1 year). Based on the 1-year mortality data, NSTEMI cannot be considered less harmful compared to STEMI. After the onset of hypoperfusion, myocardium necrosis proportional to the elapsed time increases the likelihood of subsequent heart failure. For this reason, it seems advisable for patients to reach the intervention center earlier than at present due to the invasive diagnostic and therapeutic options. Orv Hetil. 2023; 164(47): 1865-1870.

Anesthetic considerations in supravalvular aortic stenosis: A case series

Supravalvular aortic stenosis (SVAS), characterized by elastin arteriopathy, presents either as a localized narrowing at the sinotubular junction or as a diffuse form with additional involvement of the ascending aorta, aortic arch, and its branches. Associated lesions of the aortic valve, coronary artery narrowing, and pulmonary artery stenosis can further complicate the disease process. These patients are inherently at risk for developing myocardial ischemia, particularly in the setting of anesthesia or sedation. The left ventricular hypertrophy, secondary to the obstruction, results in increased left ventricular wall tension and myocardial oxygen consumption. Associated anatomic factors in the coronary arteries can further impair coronary blood flow. Any anesthetic drug that further increases oxygen consumption or decreases the coronary blood flow will result in an imbalance and increase the risk of cardiac arrest. We present a series of three patients with SVAS who were operated at our institute and subsequently discharged with good outcomes. The hemodynamic goal during the perioperative should aim to balance the myocardial oxygen supply-demand ratio. Extreme vigilance and aggressive resuscitative measures are needed to prevent any adverse myocardial event that can happen immediately after anesthetic induction or during periods of intense sympathetic stimulation such as laryngoscopy, sternotomy, aortic cannulation, or during emergence from anesthesia.

Features of coronary pathology and its relationship with myocardial fibrosis markers in patients with resistant hypertension

Aim. To evaluate the severity of coronary atherosclerosis and its association with biochemical markers of fibrosis in patients with coronary artery disease (CAD) and resistant hypertension (RHT).Material and methods. The study included 39 patients with CAD and RHT. All patients underwent 24-hour blood pressure (BP) monitoring, office BP numbers were measured. Laboratory diagnostics included routine tests, as well as determination of serum lipocalin, plasma concentration of matrix metalloproteinases 2 and 9 (­MMP-2, MMP-9), tissue inhibitor of matrix metalloproteinases-1 (TIMP 1). Coronary atherosclerosis in patients was assessed retrospectively according to medical records with an assessment of the protocols of invasive coronary angiography and multislice computed tomography, performed no more than a year ago from the moment of inclusion in the study with no clinical signs of CAD progression. Obstructive atherosclerosis was considered a coronary artery narrowing by more than 50%.Results. Considering the results of previous coronary angiography, the patients were divided into two groups. In the first group (n=20), coronary artery stenosis was &lt;50%, in the second (n=19) &gt;50% (p&lt;0,05). The compared groups of patients were comparable in sex, age, duration of hypertension, blood pressure level, and the number of antihypertensive drugs taken. There were no differences in blood lipid profile, basal glycemia, uric acid levels, and the frequency of previous cerebral accidents. However, the incidence of diabetes in group 2 was significantly higher (p&lt;0,05). Additionally, there was a significant difference in serum levels of lipocalin and MMP-2 with higher values of these indicators in patients with coronary atherosclerosis stenosis (p=0,02).Conclusion. In patients with RHT with symptoms and signs of myocardial ische­­mia, the incidence of obstructive coronary atherosclerosis according to coronary angiography is 50%. Diabetes in this category of patients indicates a more frequent obstruction of coronary bed. An increase in the level of MMP-2 and lipocalin in this category of patients is associated with more severe coronary damage and can be considered as an indirect indicator of obstructive coronary atherosclerosis.

Association between Serum Galectin-3 and Growth Differentiation Factor-15 Levels and Coronary Slow Flow Phenomenon.

Coronary slow flow phenomenon (CSFP) is characterized by delay in the progression of contrast material in the coronary tree that is not accompanied by significant coronary artery narrowing. Pathophysiologic pathways underpinning CSFP still remain poorly understood. To evaluate the relationship between serum galectin-3 (GAL-3) and growth differentiation factor-15 (GDF-15) levels with CSFP. Fifty CSFP patients and 40 subjects with normal coronary arteries were included in this retrospective study. The patients' serum GDF-15 and GAL-3 concentration levels were measured using relevant kits. Thrombolysis in myocardial infarction frame count (TFC) of each patients was determined. We did not find any differences with respect to clinical and demographic features between the two groups. GDF-15 and GAL-3 concentration levels were significantly higher in the patients with CSFP. Moreover GDF-15 and GAL-3 concentration levels were positively correlated with TFC (GDF-15; r = 0.448, GAL-3; r = 0.642, p < 0.001 for both). Multivariate logistic regression showed that GAL-3 and GDF-15 were predictors of the CSFP. Similarly, GDF-15 and GAL-3 were the only predictors of TFC. More specifically, GDF-15 and GAL-3 concentration levels of 182.18 pg/mL and 8.58 ng/mL predicted CSFP with sensitivities of 76% and 87.5%, respectively, and specificities of 84% and 75%, respectively. GDF-15 and GAL-3 levels were increased in the CSFP patients and predicted the presence and severity of CSFP. Thus, these two biomarkers might prove useful in relation to the diagnosis of CSFP.

Treatment of Ostial Right Coronary Artery Narrowings: Outcomes From the Multicenter Prospective e-ULTIMASTER Registry.

Treatment of right coronary artery (RCA) aorto-ostial (AO) lesions with bare-metal stents and first-generation drug-eluting stents (DES) was associated with worse outcomes. This study aimed to assess the effect of RCA-AO stenting with current-generation DES on the clinical outcome. The large all-comer, multicontinental e-ULTIMASTER registry included 37,198 patients of whom 4775 underwent ostial and proximal RCA percutaneous coronary intervention (PCI) using the Ultimaster stent (Terumo). The primary clinical end point was 1-year target lesion failure (TLF), a composite of cardiac death; target vessel-related myocardial infarction; or clinically indicated target lesion revascularization. We compared 591 (12.4%) patients who underwent RCA-AO PCI with 4184 (87.6%) patients who underwent proximal RCA PCI. The RCA-AO group included more men and recorded significantly more comorbidities and more complex coronary anatomy. After propensity matching, the primary end point TLF occurred in 4.49% of the RCA-AO group compared with 3.00% of the proximal RCA group (P = .06). Target vessel revascularization (3.29% vs 1.90%; P = .03) and stent thrombosis (1.23% vs 0.42%, P = .01) were significantly higher among patients with RCA-AO lesions than those among patients with proximal RCA lesions. All-cause mortality was similar between the groups (2.97% vs 2.26%; P = .30). The treatment of RCA-AO with DES is feasible, with similar rates of TLF but with an increased risk of target vessel revascularization and stent thrombosis.

Compression of the Pulmonary Artery and Coronary Artery Caused by Pulmonary Epithelioid Hemangioendothelioma: A Case Report.

A 63-year-old woman with a five-month history of pulmonary epithelioid hemangioendothelioma (PEH) presented to the emergency department, due to worsening dyspnea and chest pain. The electrocardiography showed a pattern of ST-segment elevation in leads I, AVL, and poor R-wave progression consistent with anterolateral ischemia. Emergent coronary angiography revealed severe stenosis of the left main coronary artery. Then, contrast-enhanced computed tomography scan indicated the right pulmonary artery and left main coronary artery narrowing by compression of metastasized PEH. Finally, the patient died of deteriorated multi-organ failure.

Assessment of Major Behavioral Risk Factors for Coronary Heart Disease among Patients Admitted to coronary care unit in Rania General Hospital

Coronary Heart Disease (CHD) occurs when decreases or stops blood flow to the heart muscles. This is resulting from the gradual narrowing of coronary arteries and atherosclerosis. Tobacco use, abnormal lipid profile, obesity, high blood pressure, diabetes, physical inactivity, emotional distress, high alcohol consumption and reduction in the consumption of fruit and vegetables are the predominant risks of cardiovascular diseases such as CHD. The study aims to assess the behavioral risk factors for coronary heart disease among patients admitted to the coronary care unit. This is to identify the major behavioral risk factors for coronary heart disease in patients who admitted to the coronary care unit and to determine whether there are any relations between modifiable risk factors and socio-demographic characteristics of the data. This descriptive study of quantitative method was carried out, with a non-probability (convenience) sample of (50) Adults diagnosed with coronary heart disease and admitted to the coronary care unit in Rania general hospital. In the study, physical inactivity and smoking are the most common behaviors that worsen CHD among participants. Moreover, smoking behavior is increasingly detected in males. This study therefore, recommends that further studies on this topic need to be conducted. Public awareness should be raised toward unhealthy behaviors, in particular physical inactivity and smoking

The value of regional and global CACS combined with SPECT MPI in detecting obstructive CAD: a retrospective real-world comparative study

ObjectivePrevious studies have shown that global coronary artery calcium score (CACS) can improve single photon emission computerized tomography (SPECT) myocardial perfusion imaging (MPI) to detect obstructive coronary artery disease (CAD). Whether regional CACS can improve SPECT MPI to detect obstructive CAD remains unclear. The aim of this study was to verify whether regional CACS has additional diagnostic value for obstructive CAD in suspected patients, compared to SPECT MPI and global CACS.MethodsThe study included 321 suspected CAD patients who underwent one-stop rest-stress SPECT MPI and low-dose computed tomography (CT) scan. All patients underwent coronary angiography within one month after examination. MPI images were visually analyzed by 2 experienced nuclear cardiologists. The regional CACS of left anterior descending coronary artery (LAD), left circumflex coronary artery (LCX), right coronary artery (RCA) and global CACS were calculated. Obstructive CAD was defined as ≥ 70% narrowing of the inner diameter of the LAD, LCX, RCA or their main branches and ≥ 50% narrowing of the left main coronary artery (LM).ResultsAmong the 321 patients, 86 (26.8%, 86/321) had obstructive CAD. With the increased in global and regional CACS, there was an increasing trend of patients with obstructive CAD (P for trend < 0.001). Regional CACS had a better diagnostic performance in RCA territories (AUC 0.856, P < 0.001) compared with LAD, LCX territories (AUC 0.690, 0.674, respectively). The AUC of combined regional CACS and MPI was significantly higher than that of MPI alone (0.735 vs. 0.600, P < 0.001). However, based on MPI, the AUC of combined regional CACS was not significantly higher than that of global CACS (0.735 vs. 0.732, P = 0.898). The sensitivity and specificity of regional CACS combined with MPI for detecting obstructive CAD were 64.0% and 72.8%, respectively.ConclusionsRegional CACS was effective in detecting obstructive CAD in RCA territory. Based on SPECT MPI, regional CACS improved the detection of obstructive CAD, but was not superior to global CACS.

Right Coronary Artery Narrowing by Stretching on Aortic Root Aneurysm

Right Coronary Artery Narrowing by Stretching on Aortic Root Aneurysm

Diagnosis of Coronary Artery Disease by Acoustic Analysis of Turbulent Murmur Caused by Coronary Artery Stenosis: A Single Center Study from China

Aim: Intracoronary murmur results from turbulent flow due to coronary artery narrowing. This study evaluated the diagnostic performance of a method for acoustic analysis of turbulent murmur caused by coronary artery stenosis in coronary artery disease (CAD) in Chinese populations. Method: Patients admitted to the cardiovascular department of the Sixth Medical Center of the Chinese People’s Liberation Army General Hospital between September 2021 and June 2022 for elective coronary angiography were prospectively enrolled. A digital electronic stethoscope was used to record heart sounds before angiography. Quantitative coronary angiography (QCA) served as the “gold standard” for CAD diagnosis to evaluate the diagnostic performance of the acoustic analysis method for CAD. Results: A total of 452 patients had complete QCA and heart sound data. The final interpretation results of the acoustic analysis method indicated 310 disease cases and 142 normal results. Increasing the cut-off values of coronary artery diameter stenosis from 30% to 50%, 70%, and 90% increased the sensitivity and NPV of the acoustic analysis method; the sensitivity was 75.6%, 81.9%, 83.3%, and 85.7%, respectively; the NPV was 33.1%, 57.0%, 69.7%, and 88.0%, respectively; the specificity and PPV decreased (specificity of 75.8%, 70.4%, 51.0%, and 37.5%, respectively; PPV of 95.2%, 89.0%, 69.4%, and 32.9%, respectively); and the AUC values were 0.757, 0.762, 0.672, and 0.616, respectively. The sensitivity of the acoustic analysis method for one-vessel disease was 86.6% when the cut-off value was 50%. The sensitivity for identifying left anterior descending coronary artery lesions was best, at 90.7%. The sensitivity for identifying isolated coronary artery branch lesions was 66.7%, whereas the sensitivity for identifying three-vessel disease in multi-vessel coronary artery lesions was better, at 82.9%. Conclusion: Acoustic analysis of turbulent murmur caused by coronary artery stenosis for diagnosis of CAD may have favorable performance in the Chinese population. This method has good performance in CAD diagnosis with a cut-off coronary artery diameter for stenosis of 50%.

Semi-supervised segmentation of coronary DSA using mixed networks and multi-strategies

The coronary arteries supply blood to the myocardium, which originate from the root of the aorta and mainly branch into the left and right. X-ray digital subtraction angiography (DSA) is a technique for evaluating coronary artery plaques and narrowing, that is widely used because of its time efficiency and cost-effectiveness. However, automated coronary vessel classification and segmentation remains challenging using a little data. Therefore, the purpose of this study is twofold: one is to propose a more robust method for vessel segmentation, the other is to provide a solution that is feasible with a small amount of labeled data. Currently, there are three main types of vessel segmentation methods, i.e., graphical- and statistical-based; clustering theory based, and deep learning-based methods for pixel-by-pixel probabilistic prediction, among which the last method is the mainstream with high accuracy and automation. Under this trend, an Inception-SwinUnet (ISUnet) network combining the convolutional neural network and Transformer basic module was proposed in this paper. Considering that data-driven fully supervised learning (FSL) segmentation methods require a large set of paired data with high-quality pixel-level annotation, which is expertise-demanding and time-consuming, we proposed a Semi-supervised Learning (SSL) method to achieve better performance with a small amount of labeled and unlabeled data. Different from the classical SSL method, i.e., Mean-Teacher, our method used two different networks for cross-teaching as the backbone. Meanwhile, inspired by deep supervision and confidence learning (CL), two effective strategies for SSL were adopted, which were denominated Pyramid-consistency Learning (PL) and Confidence Learning (CL), respectively. Both were designed to filter the noise and improve the credibility of pseudo labels generated by unlabeled data. Compared with existing methods, ours achieved superior segmentation performance over other FSL and SSL ones by using data with a small equal number of labels. Code is available in https://github.com/Allenem/SSL4DSA.

Inside the “black box”: Embedding clinical knowledge in data-driven machine learning for heart disease diagnosis

Ischemic heart disease (IHD) caused by the narrowing of coronary arteries is a major cause of morbidity and mortality worldwide. Clinical diagnosis involves complex, costly, and potentially invasive procedures. To address this problem, we introduce a novel clinical knowledge-enhanced machine learning (ML) pipeline to assist in timely and cost-effective IHD prediction. Unlike conventional data-driven "black box" ML approaches, we propose an effective mechanism to engage clinical expertise and gain insight into the "black box" at each stage of model development, including data analysis, preprocessing, selecting the most clinically discriminative features, and model evaluation. One-hot feature encoding is introduced to expose hidden bias and highlight the important elements and features. Experimental results on the benchmark Cleveland IHD dataset showed that the proposed clinical knowledge-enhanced ML pipeline overperformed state-of-the-art data-driven ML models, using even fewer features. Our model based on one-hot feature encoding and support vector machine achieved the best accuracy of 94.4% and sensitivity 95% by using only 7 discriminative attributes. We share insights and discuss the effectiveness of incorporating clinical input in machine learning to improve model performance, as well as addressing some practical issues such as data bias and interpretability. We hope this preliminary study on engaging clinical expertise to explore the "black box" would improve the trustworthiness of AI and its potential wider uptake in the medical field.

MiR-7015-3p Targets Nuclear Factor-Kappa-B-Inhibitor Alpha to Aggravate Hypoxia/Reoxygenation Injury in Cardiomyocytes Through the NF-κB Pathway.

Ischemic heart disease (IHD) is a prominent global cause of morbidity and death resulting from the narrowing or blockage of cardiac coronary arteries. Exposing isolated cardiac myocytes to hypoxia-reoxygenation (H/R) might be an efficient tool to investigate the etiology and underlying mechanism of myocardial ischemia-reperfusion (I/R) injury. This study found that miR-7015 is upregulated in mouse myocardial tissues after I/R injury and in cardiomyocytes after H/R injury. A model of H/R-induced cardiomyocyte injury was established; miR-7015 overexpression exacerbated while miR-7015 inhibition partially ameliorated H/R-induced cardiomyocyte injury by inhibiting cytokine release, promoting cell viability, and suppressing apoptosis. Bioinformatics and experimental studies have identified nuclear factor-kappa-B-inhibitor alpha (Nfkbia) as a direct downstream target of miR-7015. miR-7015 inhibited Nfkbia expression. Unlike miR-7015 overexpression, Nfkbia overexpression alleviated H/R-induced injury in cardiomyocytes. Moreover, Nfkbia overexpression partially abolished the effects of miR-7015 overexpression on H/R-induced cardiomyocyte injury. In conclusion, the miR-7015/Nfkbia axis modulates cardiomyocyte injury induced by H/R, possibly through the NF-κB signaling.