Coronary Artery Stenosis Research Articles

Correlation analysis between the expression of serum microRNA-665 and the degree of coronary artery stenosis and major adverse cardiovascular events in patients with acute myocardial infarction

BackgroundThe purpose of this study was to explore the expression of miR-665 in acute myocardial infarction (AMI) and evaluate its significance in the diagnosis and prognosis of AMI.Methods100 patients with AMI were selected as the study group and 80 healthy subjects were chosen as the control group. The levels of miR-665 were detected by reverse transcription quantitative polymerase chain reaction (RT-qPCR) in the two groups. The diagnostic value of miR-665 expression level in AMI was analyzed by the receiver operator characteristic (ROC) curve. Kaplan-Meier curve and Cox regression were used to evaluate the predictive value of miR-665 for major adverse cardiovascular events (MACEs) in patients with AMI within 30 days after percutaneous coronary intervention (PCI).ResultsThe serum miR-665 level of the study group was significantly lower than that of the control group. The level of miR-665 was significantly correlated with clinical indicators of patients with AMI. ROC curve showed that miR-665 has a high diagnostic value for AMI. Survival analysis showed that Gensini score and miR-665 were independent risk factors for the occurrence of MACEs within 30 days after PCI in patients with AMI.ConclusionsAbnormal decrease of serum miR-665 expression level in patients with AMI may increase the risk of MACEs occurrence after PCI.

Functional and morphological improvement of significant non-culprit coronary artery stenosis by LDL-C reduction with a PCSK9 antibody: Rationale and design of the randomized FITTER trial

Non-culprit coronary artery lesions are commonly present in patients presenting with an acute coronary syndrome (ACS). Additional stenting of non-culprit lesions in addition to the culprit lesion intends to prevent secondary events caused by these lesions. At the same time, multiple trials have demonstrated the potential of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in reducing plaque size and changing plaque composition of non-culprit lesions. Whether intensive low-density lipoprotein cholesterol (LDL-C) reduction with PCSK9 inhibitor evolocumab improves non-culprit vessel hemodynamics, reduces the risk of plaque rupture of important non-culprit lesions, and might obviate the need for additional stenting has not been investigated. The “Functional Improvement of non‐infarcT related coronary artery stenosis by Extensive LDL‐C Reduction with a PCSK9 Antibody” (FITTER) trial is a multi-center, randomized, double-blind, placebo-controlled clinical trial for patients presenting with ACS and multivessel disease (MVD). After treatment of the culprit lesion, fractional flow reserve (FFR) is performed in non-culprit vessels amenable for percutaneous coronary intervention (PCI). Coronary intervention in patients with hemodynamically important non-critical lesions (FFR: 0.67–0.85) is staged after baseline imaging using near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS). Eligible patients are randomized and treated for 12 weeks with either evolocumab or placebo, in addition to high-intensity statin therapy. Follow-up angiography with repeat FFR and IVUS-NIRS is scheduled at 12 weeks. Staged PCI is performed at the operator's discretion.The FITTER trial is the first study to evaluate the effect of maximal LDL-C reduction by the PCSK9 inhibitor evolocumab on invasively measured FFR, plaque size, and plaque composition in hemodynamically important non-culprit lesions, during a treatment period of just 12 weeks after an ACS. Currently, all patients have been included (August 2023) and data analysis is ongoing. Trial registration numberclinicaltrials.gov NCT04141579.

Accuracy of deep learning in the differential diagnosis of coronary artery stenosis: a systematic review and meta-analysis

BackgroundIn recent years, as deep learning has received widespread attention in the field of heart disease, some studies have explored the potential of deep learning based on coronary angiography (CAG) or coronary CT angiography (CCTA) images in detecting the extent of coronary artery stenosis. However, there is still a lack of a systematic understanding of its diagnostic accuracy, impeding the advancement of intelligent diagnosis of coronary artery stenosis. Therefore, we conducted this study to review the accuracy of image-based deep learning in detecting coronary artery stenosis.MethodsWe retrieved PubMed, Cochrane, Embase, and Web of Science until April 11, 2023. The risk of bias in the included studies was appraised using the QUADAS-2 tool. We extracted the accuracy of deep learning in the test set and performed subgroup analyses by binary and multiclass classification scenarios. We performed a subgroup analysis based on different degrees of stenosis and applied a double arcsine transformation to process the data. The analysis was done by using R.ResultsOur systematic review finally included 18 studies, involving 3568 patients and 13,362 images. In the included studies, deep learning models were constructed based on CAG and CCTA. In binary classification tasks, the accuracy for detecting > 25%, > 50% and > 70% degrees of stenosis at the vessel level were 0.81 (95% CI: 0.71–0.85), 0.73 (95% CI: 0.58–0.88) and 0.61 (95% CI: 0.56–0.65), respectively. In multiclass classification tasks, the accuracy for detecting 0–25%, 25–50%, 50–70%, and 70–100% degrees of stenosis at the vessel level were 0.78 (95% CI: 0.73–0.84), 0.86 (95% CI: 0.78–0.93), 0.83 (95% CI: 0.70–0.97), and 0.70 (95% CI: 0.42–0.98), respectively.ConclusionsOur study shows that deep learning models based on CAG and CCTA appear to be relatively accurate in diagnosing different degrees of coronary artery stenosis. However, for various degrees of stenosis, their accuracy still needs to be further improved.

Myocardial infarction with non-obstructive coronary arteries in a young seropositive woman with human immunodeficiency virus: a case report and review of the literature

BackgroundElevated susceptibility to acute myocardial infarction and various cardiovascular diseases has been observed in individuals infected with the human immunodeficiency virus compared with the uninfected population, as demonstrated in numerous studies. The precise mechanism by which human immunodeficiency virus infection heightens the risk of acute myocardial infarction remains elusive. The manifestation of acute coronary syndrome in young patients with human immunodeficiency virus may deviate from the typical, displaying distinct pathophysiological and clinical characteristics. The occurrence of myocardial infarction with non-obstructive coronary arteries in young patients with human immunodeficiency virus poses diagnostic and treatment challenges.Case presentationWe present the case of a 46-year-old African woman with no traditional atherosclerotic risk factors. She was diagnosed with human immunodeficiency virus-1 infection 2 years prior to her current admission for chest pain. Her troponin levels were elevated, suggestive of acute coronary syndrome. Although coronary angiography ruled out coronary artery stenosis, it revealed mild myocardial bridging in the left anterior descending artery. Cardiac magnetic resonance imaging confirmed myocardial infarction, indicating a myocardial infarction with non-obstructive coronary arteries with an apical thrombus in the left ventricle. Following medical treatment, the patient experienced resolution of chest pain and improvement in ST-segment elevation.ConclusionsIn young female patients without traditional risk factors, human immunodeficiency virus infection is a possible etiological factor for myocardial infarction with non-obstructive coronary arteries. The likely pathophysiological pathway is superficial endothelial cell denudation as a result of chronic inflammation and immune activation.

Duration of Dual Antiplatelet Therapy after Percutaneous Coronary Intervention of Unprotected Left Main Coronary Artery Stenosis: 6 versus 12 Months.

Background/Objectives: For patients with percutaneous coronary intervention (PCI) of an unprotected left main coronary artery (uLMCA) stenosis, the optimal duration of dual antiplatelet therapy (DAPT) remains a matter of debate. The purpose of this study was to compare clinical outcomes of 6- versus 12-month DAPT duration in patients with PCI of an uLMCA and stable angina. Methods: In this retrospective analysis, we included consecutive patients of our centre who underwent PCI of uLMCA stenosis for stable angina and who received DAPT with acetylsalicylic acid and clopidogrel for either 6 or 12 months. The primary endpoint was the composite of all-cause mortality, myocardial infarction, and target lesion revascularization at one year. Secondary endpoints included individual components of the primary endpoint, definite/probable stent thrombosis, and bleeding. Clinical outcomes were assessed by unadjusted analysis and by inverse probability of treatment weighting (IPTW). Results: Out of 984 included patients, 339 (34.5%) received DAPT for 6 months and 645 (65.5%) for 12 months. The primary endpoint occurred in 51 patients (15.2%) in the 6-month group and in 104 (16.3%) in the 12-month group (p = 0.674). Incidences of stent thrombosis (0.9% versus 0.3%, p = 0.224) and BARC 3,4,5 bleeding (6% versus 5.8%, p = 0.808) were also comparable in both groups. We found no significant differences in the primary endpoint and its components or BARC 3,4,5 bleeding between 6 and 12 months. Conclusions: Our findings do not support the extension of DAPT beyond 6 months after PCI for uLMCA in patients with stable angina.

MTOR signalling controls the formation of smooth muscle cell-derived luminal myofibroblasts during vasculitis

The accumulation of myofibroblasts within the intimal layer of inflamed blood vessels is a potentially catastrophic complication of vasculitis, which can lead to arterial stenosis and ischaemia. In this study, we have investigated how these luminal myofibroblasts develop during Kawasaki disease (KD), a paediatric vasculitis typically involving the coronary arteries. By performing lineage tracing studies in a murine model of KD, we reveal that luminal myofibroblasts develop independently of adventitial fibroblasts and endothelial cells, and instead derive from smooth muscle cells (SMCs). Notably, the emergence of SMC-derived luminal myofibroblasts—in both mice and patients with KD, Takayasu’s arteritis and Giant Cell arteritis—coincided with activation of the mechanistic target of rapamycin (mTOR) signalling pathway. Moreover, SMC-specific deletion of mTOR signalling, or pharmacological inhibition, abrogated the emergence of luminal myofibroblasts. Thus, mTOR is an intrinsic and essential regulator of luminal myofibroblast formation that is activated in vasculitis patients and therapeutically tractable. These findings provide molecular insight into the pathogenesis of coronary artery stenosis and identify mTOR as a therapeutic target in vasculitis.

Clinical features of acute coronary syndrome in elderly patients with chronic obstructive pulmonary disease

Aim. To study the clinical features of the course of acute coronary syndrome (ACS) in elderly patients with chronic obstructive pulmonary disease (COPD).Materials and methods. The study included 78 patients with ACS: 43 patients with ACS and COPD (group 1) and 35 patients with ACS without COPD (group 2). All patients underwent comprehensive clinical, instrumental, and laboratory examinations.Results. Among the risk factors for cardiovascular diseases (CVD), the most significant contributors to the development of ACS in patients with COPD were smoking, arterial hypertension, and elevated levels of C-reactive protein (CRP). Patients with ACS and COPD more frequently had non- ST-segment elevation myocardial infarction (NSTEMI). For patients with comorbid pathology, more pronounced changes in the coronary arteries were characteristic due to an increase in the total number of stenoses (p=0.02), hemodynamically significant stenosis (p=0.01), occlusions and critical stenoses (p=0.02), and extensive stenoses (p=0.04). Group 1 patients, compared to group 2, had hemodynamically significant stenosis located in the proximal (p=0.04) and distal (p=0.02) segments of the coronary arteries, as well as in second-order branches (p=0.02). No significant differences were found between the groups in the number of stenoses of the left main coronary artery and the middle segments of the major coronary arteries.Conclusion. In elderly patients with COPD, ACS development was more often preceded by angina symptoms and atypical myocardial infarction presentations, with NSTEMI predominating in the myocardial infarction structure. The main CVD risk factors in COPD patients were smoking, arterial hypertension, and elevated CRP levels. Atherosclerotic coronary artery disease in ACS patients with COPD was characterized by multivessel disease, predominance of middle and distal coronary artery stenosis. A significant feature of coronary artery disease in comorbid elderly patients was the increased total number of stenoses and the number of extensive stenoses.

Effects of intracoronary administration of small doses of nicorandil and verapamil on blood pressure and heart rate

BackgroundNicorandil and verapamil can improve coronary blood flow and coronary microcirculation during percutaneous coronary intervention. However, the effects of intracoronary (IC) administration of nicorandil and verapamil on hemodynamics remain unclear. AimsTo clarify the safety and effects of IC administration of nicorandil and verapamil on blood pressure (BP) and heart rate (HR) to provide evidence-based basis for clinical intervention. MethodsThe study cohort included 70 patients with coronary artery stenosis recruited from Zhejiang Provincial Hospital of Traditional Chinese Medicine. The patients were randomly assigned to the intervention group (IC administration of 2 mg/2 ml of nicorandil and 200 μg/2 ml of verapamil) or the control group (IC administration of 2 ml of saline). BP and HR were compared before medication, after medication, and when stabilized. ResultsIC administration of verapamil at 200 μg significantly reduced systolic BP as compared to the control group (113.72 ± 3.40 vs. 123.63 ± 3.33 mmHg, respectively, p < 0.05) for a short period of time, and returned to baseline within 2 min, but had no effect on diastolic BP and HR. IC administration injection of nicorandil at 2 mg had no effect on BP or HR. There were no instances of major cardiovascular events. ConclusionIC administration of nicorandil at 2 mg is safe as an adjunctive medication during interventional angiography. Verapamil can also be used as an IC adjuvant, although BP and HR must be monitored for patients with low basal BP, especially systolic BP.

Role of computed tomographic dynamic myocardial perfusion in the diagnosis of functional significance of coronary artery stenosis

Role of computed tomographic dynamic myocardial perfusion in the diagnosis of functional significance of coronary artery stenosis

The Effect of Vitamin D Deficiency Treatment on Lipid Profile and C-reactive Protein in Patients with Ischemic Heart Disease: Double-blind Randomized Clinical Trial

Background: Atherosclerosis is the main process in coronary artery stenosis, which is exacerbated by vitamin D deficiency. This study aims to investigate the relationship between vitamin D deficiency treatment, lipid profile, and C-reactive protein (CRP) in ischemic heart disease (IHD). Materials and Methods: This is a double-blind, randomized clinical trial involving 44 IHD patients with hypovitaminosis, aged 40–65 years, who were referred to Chamran Specialty Heart Hospital, Isfahan, Iran. Participants were randomly divided into two groups: The intervention group received weekly doses of 50,000 units of vitamin D3 for 5 weeks, while the placebo group received a control substance. CRP and serum lipid profiles, including total cholesterol (TC), triglycerides (TGs), high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C), were assessed before and after the intervention. Trial registration number: IRCT20200905048622N1. Results: The mean age of the IHD patients was 57.84 ± 9.66 years, and among all 44 patients, 40 patients (91%) were male In the intervention group receiving vitamin D3, serum levels of HDL (P = 0.048) and 25-hydroxyvitamin D (25(OH)D) (P &lt; 0.001) increased, while serum level of TG (P = 0.008) decreased significantly. In the placebo group, HDL level (P = 0.007) was increased and alanine transaminase (ALT) (P = 0.05) was significantly decreased. The results showed that the correlation between serum 25(OH)D treatment and CRP level was not significant. Conclusion: Vitamin D supplementation in IHD patients led to notable improvements in lipid profiles, including increased HDL-C levels and decreased TG levels. These findings hold potential clinical implications for healthcare professionals in managing risk factors in IHD patients.

Abstract P130: Predictive value of the MCG-based Nomogram model for the anatomical and functional evaluation of coronary artery lesions

Objective: Optical coherence tomography (OCT) is an intravascular imaging technology that can provide cross-sectional images of coronary arteries, which can more accurately assess the condition of coronary artery lesions and the degree of vascular stenosis. It is an important method for the anatomical evaluation of coronary artery lesions. Radionuclide myocardial perfusion imaging (MPI) is a commonly used non-invasive method for functional evaluation of myocardial ischemia in clinical practice. The clinical application of these two methods is greatly limited due to operational risk and high cost. This study aimed to explore the potential predictive value of the MCG-based Nomogram model for the anatomical and functional evaluation of coronary artery lesions. Methods: We reviewed the patients who were hospitalized in the cardiovascular department of our hospital from October 2021 to July 2023 for MCG test. A total of 137 patients were included in the OCT subgroup, including 48 patients in the severe coronary artery stenosis group (inclusion criteria: OCT showed coronary artery area stenosis ≥70.0%) and 89 patients in the control group (inclusion criteria: OCT showed coronary artery area stenosis &lt;50.0% or CCTA showed no coronary artery stenosis). A total of 46 patients were included in the MPI subgroup, including 10 patients in the severe myocardial ischemia group (inclusion criteria: MPI showed abnormal perfusion scores of at least one ventricular segment ≥3 points) and 36 patients in the control group (inclusion criteria: MPI showed abnormal perfusion scores of all ventricular segments ≤2 points). The Nomogram model was used to predict the results of patients in the two subgroups, and the results were compared with the OCT and MPI results. The sensitivity, specificity and Youden index were calculated. Results: The Nomogram model based on MCG had a sensitivity of 70.8%, a specificity of 85.4%, and a Youden index of 0.562 for predicting OCT results. The sensitivity, specificity and Youden index of Nomogram model for predicting MPI results were 70.0%, 72.2% and 0.422, respectively. Conclusions: The MCG-based Nomogram model has good prediction accuracy for the anatomical and functional evaluation of coronary artery lesions, which has potential application value.

Minimally invasive coronary artery bypass grafting using the skeletonized right gastroepiploic artery

ObjectiveTo evaluate the clinical outcomes of right gastroepiploic artery use in minimally invasive coronary artery bypass grafting. MethodsA total of 428 patients who underwent minimally invasive coronary artery bypass grafting from February 2012 to February 2024 were included into this retrospective cohort study. The selection criteria for right gastroepiploic artery use included satisfactory artery size and length, significant stenosis (99% to 100%) of the right coronary artery, and unsuitable ascending aorta for partial clamping. ResultsThe study cohort comprised 70 men and 8 women, with an average age of 63.6 ± 10.5 years. The right gastroepiploic artery was used in 18.2% (78 out of 428) of cases, without the aorta being touched in all these cases. Total arterial revascularization was achieved in 93.6% of cases and complete revascularization was achieved in 98.7%. Notable postoperative outcomes included zero in-hospital mortality, an incidence of new-onset atrial fibrillation of 9.0%, and a median intensive care unit stay of 2 days. Surgical site infections occurred in 7.5% of patients. ConclusionsThe use of the right gastroepiploic artery in minimally invasive coronary artery bypass grafting is a viable option for achieving total arterial revascularization without touching the ascending aorta, enhancing the rate of optimal clinical outcomes.

INav-based, Automated Coronary Magnetic Resonance Angiography for the Detection of Coronary Artery Stenosis (iNav-AUTO CMRA)

BackgroundCoronary computed tomography angiography (CCTA) is recommended as the first line diagnostic imaging modality in low to intermediate risk individuals suspected of stable coronary artery disease (CAD). However, CCTA exposes patients to ionising radiation and potentially nephrotoxic contrast agents. Invasive coronary angiography (ICA) is the gold-standard investigation to guide coronary revascularisation strategy, however, invasive procedures incur an inherent risk to the patient. Coronary magnetic resonance angiography (Coronary MRA) avoids these issues. Nevertheless, clinical implementation is currently limited due to extended scanning durations, inconsistent image quality, and consequent lack of diagnostic accuracy. Several technical Coronary MRA innovations including advanced respiratory motion correction with 100% scan efficiency (no data rejection), fast image acquisition with motion-corrected undersampled image reconstruction and deep-learning (DL)-based automated planning have been implemented and now await clinical validation in multi-centre trials. MethodsThe objective of the iNav-AUTO CMRA prospective multi-centre study is to evaluate the diagnostic accuracy of a newly developed, state-of-the-art, standardised, and automated Coronary MRA framework compared to CCTA in 230 patients undergoing clinical investigation for CAD. The study protocol mandates the administration of oral beta-blockers to decrease heart rate to below 60bpm and the use of sublingual nitroglycerine spray to induce vasodilation. Additionally, the study incorporates the utilisation of standardised postprocessing with sliding-thin-slab multiplanar reformatting, in combination with evaluation of the source images, to optimize the visualisation of coronary artery stenosis. DiscussionIf proven effective, Coronary MRA could provide a non-invasive, needle-free, yet also clinically viable, alternative to CCTA. Trial RegistrationThis study is registered at clinicaltrials.gov (NCT05473117).

Preliminary Results of Iran Premature Coronary Artery Disease (IPAD study) and Implementation of IPAD Biobank: A Case-Control Study.

Iran Premature Coronary Artery Disease (IPAD) is one of the first and largest studies of its kind in Asia that investigates different aspects of premature coronary artery disease (PCAD) in different ethnic groups in multiple cities. In this paper, we aim to describe the IPAD biobank establishment and present some preliminary results of the IPAD study. This case-control study was conducted on patients with documented angiography from different ethnicities in more than ten cities of Iran (males aged 60 years and below and females aged 70 years and below). Patients with coronary artery stenosis of more than 75% in at least one vessel (or left-main stenosis of more than 50%) were defined as the case group and patients with normal coronary angiography were considered as the control group. In addition to completing questionnaires and performing physical measurements, samples of serum, buffy coat, plasma, whole blood, saliva, urine, and feces were stored in the freezer at -80 °C. The mean age of patients was 51.1±8.2, of which 43% were women. There were 1221 people in the control group and 1702 in the case group. Our enrollment is completed and data entry and transferring biosamples from different cities is still ongoing. About 30000 biosamples of different ethnicities are saved in the IPAD biobank. This study aims to develop a high-quality biobank and facilitate research on different aspects of PCAD, especially gene-environment interaction regarding ethnicity.

Discrepancies between Coronary Artery Calcium Score and Coronary Artery Disease Severity in Computed Tomography Angiography Studies.

The aim of this paper is to demonstrate the difference in usefulness of the coronary artery calcium score (CACS) and the full assessment of the severity of coronary artery disease in coronary computed tomography angiography (CCTA) studies. The difference between the population risk of coronary artery disease (CAD) assessed by the CACS and the severity of CAD was demonstrated in images from two CCTA studies. The first image is from a patient with a CACS of 0 and significant coronary artery stenosis. In the native phase of CCTA examination, no calcified changes were detected in the topography of the coronary arteries. In the middle section of the left descending artery (LAD), at the level of the second diagonal branch (Dg2), a large non-calcified atherosclerotic plaque was visible. Mid-LAD stenosis was estimated to be approximately 70%. The second image features a patient with a high CACS but no significant coronary artery stenosis. The calcium score of individual coronary arteries calculated using the Agatston method was as follows: left main (LM) 0, LAD 403, left circumflex (LCx) 207.7, right coronary artery (RCA) 12. CACS was 622.7, representing a significant population risk of significant CAD. In the proximal and middle sections of the LAD, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visible, causing stenosis of 25-50%. Similarly, in the proximal and middle sections of the LCx, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visualized, causing stenoses of 25-50%. Calcified atherosclerotic plaques were found in the RCA, causing stenosis <25%. The entire CCTA image met CAD-RADS 2 (coronary artery disease reporting and data system) criteria. In summary, CACS may be applicable in population-based studies to assess the risk of significant CAD. In the evaluation of individual patients, a comprehensive assessment of CAD severity based on the angiographic phase of the CCTA examination should be used.

PCI in Patients Undergoing Transcatheter Aortic-Valve Implantation.

The benefit of percutaneous coronary intervention (PCI) in patients with stable coronary artery disease and severe aortic stenosis who are undergoing transcatheter aortic-valve implantation (TAVI) remains unclear. In an international trial, we randomly assigned, in a 1:1 ratio, patients with severe symptomatic aortic stenosis and at least one coronary-artery stenosis with a fractional flow reserve of 0.80 or less or a diameter stenosis of at least 90% either to undergo PCI or to receive conservative treatment, with all patients also undergoing TAVI. The primary end point was a major adverse cardiac event, defined as a composite of death from any cause, myocardial infarction, or urgent revascularization. Safety, including bleeding events and procedural complications, was assessed. A total of 455 patients underwent randomization: 227 to the PCI group and 228 to the conservative-treatment group. The median age of the patients was 82 years (interquartile range, 78 to 85), and the median Society of Thoracic Surgeons-Procedural Risk of Mortality score (on a scale from 0 to 100%, with higher scores indicating a greater risk of death within 30 days after the procedure) was 3% (interquartile range, 2 to 4). At a median follow-up of 2 years (interquartile range, 1 to 4), a major adverse cardiac event (primary end point) had occurred in 60 patients (26%) in the PCI group and in 81 (36%) in the conservative-treatment group (hazard ratio, 0.71; 95% confidence interval [CI], 0.51 to 0.99; P = 0.04). A bleeding event occurred in 64 patients (28%) in the PCI group and in 45 (20%) in the conservative-treatment group (hazard ratio, 1.51; 95% CI, 1.03 to 2.22). In the PCI group, 7 patients (3%) had PCI procedure-related complications. Among patients with coronary artery disease who were undergoing TAVI, PCI was associated with a lower risk of a composite of death from any cause, myocardial infarction, or urgent revascularization at a median follow-up of 2 years than conservative treatment. (Funded by Boston Scientific and the Danish Heart Foundation; NOTION-3 ClinicalTrials.gov number, NCT03058627.).

Patients With Non-Obstructive Coronary Artery Disease and Polyvascular Disease. Sub-Analysis of the Real-World Registry KAMMA (Clinical Registry on Patient Population With Polyvascular Disease in the Russian Federation and Eurasian Countries).

To study the clinical status and data of laboratory and instrumental examination of patients with non-obstructive ischemic heart disease (IHD) and multifocal atherosclerosis (MFA) included in the KAMMA registry. The subanalysis included 1,893 IHD patients who underwent coronary angiography (CAG) and ultrasonic examination of peripheral arteries. Based on the CAG data, patients were divided into two groups: group 1, patients with obstructive coronary atherosclerosis (CA) (maximum stenosis ≥50% and/or history of percutaneous coronary intervention/coronary artery bypass grafting, n=1728; 91.3%) and group 2, patients with non-obstructive CA (maximum stenosis &lt;50%, n = 165; 8.7%). A comparative analysis based on the degree of coronary obstruction in patients with verified IHD who were included in the KAMMA registry showed that 8.7% of them had coronary artery stenosis of less than 50%. The overwhelming majority of patients with non-obstructive CA had MFA affecting the brachiocephalic arteries in 94.3% and the lower extremity arteries in 40.2%. Among patients with non-obstructive IHD, women predominated; risk factors such as smoking and type 2 diabetes mellitus were less frequent in this group than in the obstructive IHD group. Patients with non-obstructive CA more frequently had a history of dyslipidemia; they had higher total cholesterol and non-high-density lipoprotein cholesterol; and they more frequently received moderate-intensity statin therapy than patients with obstructive CA (55.8% vs. 34.5%). Characteristic features of patients with non-obstructive CA were less severe IHD and less frequent history of acute coronary syndrome. However, the incidence of stroke, peripheral arterial thrombosis, and chronic arterial insufficiency of the lower extremities did not differ in groups 1 and 2, whereas the incidence of paroxysmal atrial fibrillation was higher in the non-obstructive IHD group. IHD patients without coronary obstruction also require assessment of the peripheral arterial status, as they may have advanced MFA, which should be taken into account when choosing the "aggressiveness" of therapy.

Accuracy of ultra-high resolution and virtual non-calcium reconstruction algorithm for stenosis evaluation with photon-counting CT: results from a dynamic phantom study

BackgroundWe compared ultra-high resolution (UHR), standard resolution (SR), and virtual non-calcium (VNCa) reconstruction for coronary artery stenosis evaluation using photon-counting computed tomography (PC-CT).MethodsOne vessel phantom (4-mm diameter) containing solid calcified lesions with 25% and 50% stenoses inside a thorax phantom with motion simulation underwent PC-CT using UHR (0.2-mm slice thickness) and SR (0.6-mm slice thickness) at heart rates of 60 beats per minute (bpm), 80 bpm, and 100 bpm. A paired t-test or Wilcoxon test with Bonferroni correction was used.ResultsFor 50% stenosis, differences in percent mean diameter stenosis between UHR and SR at 60 bpm (51.0 vs 60.3), 80 bpm (51.7 vs 59.6), and 100 bpm (53.7 vs 59.0) (p ≤ 0.011), as well as between VNCa and SR at 60 bpm (50.6 vs 60.3), 80 bpm (51.5 vs 59.6), and 100 bpm (53.7 vs 59.0) were significant (p ≤ 0.011), while differences between UHR and VNCa at all heart rates (p ≥ 0.327) were not significant. For 25% stenosis, differences between UHR and SR at 60 bpm (28.0 vs 33.7), 80 bpm (28.4 vs 34.3), and VNCa vs SR at 60 bpm (29.1 vs 33.7) were significant (p ≤ 0.015), while differences for UHR vs SR at 100 bpm (29.9 vs 34.0), as well as for VNCa vs SR at 80 bpm (30.7 vs 34.3) and 100 bpm (33.1 vs 34.0) were not significant (p ≥ 0.028).ConclusionStenosis quantification accuracy with PC-CT improved using either UHR acquisition or VNCa reconstruction.Relevance statementPC-CT offers to scan with UHR mode and the reconstruction of VNCa images both of them could provide improved coronary stenosis quantification at increased heart rates, allowing a more accurate stenosis grading at low and high heart rates compared to SR.Key PointsEvaluation of coronary stenosis with conventional CT is challenging at high heart rates.PC-CT allows for scanning with ECG-gated UHR and SR modes.UHR and VNCa images were compared in a dynamic phantom.UHR improves stenosis quantification up to 100 bpm.VNCa reconstruction improves stenosis evaluation up to 80 bpm.Graphical

Association of Vessel Fractional Flow Reserve (vFFR) with Luminal Obstruction and Plaque Characteristics as Detected by Optical Coherence Tomography (OCT) in Patients With NSTE-ACS: the FAST OCT Study.

There is a paucity of data on the performance of angiography-derived vessel fractional flow reserve (vFFR) in coronary artery lesions of patients presenting with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Optical coherence tomography (OCT) allows for visualization of lumen dimensions and plaque integrity with high resolution. The aim of the present study was to define the association between vFFR and OCT findings in intermediate coronary artery lesions in patients presenting with NSTE-ACS. The FAST OCT study was a prospective, multicenter, single-arm study. Patients presenting with NSTE-ACS with intermediate to severe coronary artery stenosis in one or multiple vessels with TIMI 3 flow suitable for OCT imaging were eligible. Complete pre-procedural vFFR and OCT data were available in 226 vessels (in 188 patients). A significant association between vFFR and minimal lumen area (MLA) was observed, showing an average decrease of 20.4% (95% CI -23.9% - -16.7%) in MLA per 0.10 decrease in vFFR (adjusted p<0.001). vFFR≤0.80 showed a sensitivity of 56.7% and specificity of 92.5% to detect MLA≤2.5 mm². Conversely, vFFR had a poor to moderate discriminative ability to detect plaque instability (sensitivity, 46.9% specificity 71.6%). In patients with NSTE-ACS, vFFR is significantly associated with OCT-detected MLA and a vFFR≤0.80 is highly predictive for the presence of significant disease based on OCT. Conversely, the sensitivity of vFFR≤0.80 to detect OCT-assessed significant disease was low, indicating that the presence of significant OCT findings cannot be ruled out based on a negative vFFR. NCT04683133.

PTPN14 aggravates neointimal hyperplasia via boosting PDGFRβ signaling in smooth muscle cells

Smooth muscle cell (SMC) phenotypic modulation, primarily driven by PDGFRβ signaling, is implicated in occlusive cardiovascular diseases. However, the promotive and restrictive regulation mechanism of PDGFRβ and the role of protein tyrosine phosphatase non-receptor type 14 (PTPN14) in neointimal hyperplasia remain unclear. Our study observes a marked upregulation of PTPN14 in SMCs during neointimal hyperplasia. PTPN14 overexpression exacerbates neointimal hyperplasia in a phosphatase activity-dependent manner, while SMC-specific deficiency of PTPN14 mitigates this process in mice. RNA-seq indicates that PTPN14 deficiency inhibits PDGFRβ signaling-induced SMC phenotypic modulation. Moreover, PTPN14 interacts with intracellular region of PDGFRβ and mediates its dephosphorylation on Y692 site. Phosphorylation of PDGFRβY692 negatively regulates PDGFRβ signaling activation. The levels of both PTPN14 and phospho-PDGFRβY692 are correlated with the degree of stenosis in human coronary arteries. Our findings suggest that PTPN14 serves as a critical modulator of SMCs, promoting neointimal hyperplasia. PDGFRβY692, dephosphorylated by PTPN14, acts as a self-inhibitory site for controlling PDGFRβ activation.