Coronary Artery Research Articles

Balloon Aortic Valvuloplasty with Simultaneous Aortic Root Injection: A case report of an Adjunctive Strategy to Computed Tomography for Predicting Coronary Obstruction in transcatheter aortic valve-in-transcatheter aortic valve (TAV-in-TAV) Procedures

Abstract Background Computed tomography (CT) assessment is the standard for predicting coronary obstruction (CO) caused by sinus sequestration (SS) during transcatheter aortic valve (TAV) implantation in degenerated TAV (TAV-in-TAV) procedure, but it may not always be accurate. This report describes a prediction method for CO by using balloon aortic valvuloplasty (BAV) during TAV-in-TAV. Case summary An 87-year-old woman with a history of balloon-expandable transcatheter heart valve (BE-THV) implantation 7 years prior was admitted with worsening dyspnea. Echocardiography revealed severe THV deterioration, and CT confirmed calcium proliferation in the THV. Our heart team decided to perform a TAV-in-TAV procedure using a 23-mm BE-THV. Preoperative CT imaging indicated an intermediate risk of CO. To evaluate CO risk more precisely, the top of a 20-mm balloon was positioned near the top of a BE-THV stent and inflated, followed by simultaneous aortic root injection (SARI). During SARI, contrast flowed into both coronary arteries, predicting a low risk of CO. Based on these findings, TAV-in-TAV was performed without coronary protection. The procedure was completed successfully without CO. After the procedure, the patient’s symptoms improved, and echocardiography showed normal valve function. She was discharged without complications and remains under outpatient follow-up care. Discussion The diagnostic method for predicting CO using BAV with SARI could serve as a valuable adjunctive diagnostic tool in patients with an intermediate or high risk of SS anatomy after TAV-in-TAV. In such cases, this method may provide additional insights concerning precise CO risk and the indication of leaflet modification technique during TAV-in-TAV.

Percutaneous Coil Embolization of a Post-traumatic Left Anterior Descending Coronary Artery Pseudoaneurysm: A Case Report

Abstract Background Coronary artery pseudoaneurysm is a rare occurrence linked to percutaneous coronary interventions (PCI), infection, or chest trauma, lacking established management guidelines due to its low incidence. Case summary A 78-year-old male with a medical history of triple vessel disease, post coronary artery bypass grafting (CABG), heart failure, and chronic obstructive pulmonary disease (COPD), presented with intractable left-sided chest pain following a mechanical fall. The initial workup was positive for mildly elevated high sensitivity troponin and brain natriuretic peptide (BNP) raising suspicion for a pulmonary embolism; but chest computed tomography angiography (CTA) revealed an enlarging pericardial haematoma. Further computed tomographic coronary angiography exposed a mid-left anterior descending (LAD) interrupted segment concerning for a contained ruptured pseudoaneurysm. Left heart catheterization confirmed the suspicion, showing a collection of contrast at the haematoma site following injection of contrast into the saphenous vein graft to the diagonal artery. The patient underwent percutaneous pseudoaneurysm coiling, successfully occluding blood inflows from both the first diagonal and distal LAD. There were no subsequent electrocardiogram (EKG) changes or further elevation in troponin levels ensuring the integrity of the LAD vital branches. Discussion Coronary pseudoaneurysm results from the dissection of at least one layer of the vessel wall leading to blood extravasation. Although they are usually associated with PCI complications, the absence of haemopericardium in prior imaging makes the recent blunt chest trauma the most likely cause of this patient’s presentation. Percutaneous coiling of inflow vessels to pseudoaneurysms proved to be a suitable option in this case of a patient with a history of sternotomy and an expanding pericardial haematoma.

Unraveling the gut: the pivotal role of intestinal mechanisms in Kawasaki disease pathogenesis

Kawasaki disease (KD), an acute systemic vasculitis that primarily affects children under 5 years of age, is the leading cause of acquired heart disease in this age group. Recent studies propose a novel perspective on KD’s etiology, emphasizing the gastrointestinal (GI) tract, particularly the role of gut permeability. This review delves into how disruptions in gut barrier function trigger systemic inflammatory responses, exacerbate vascular inflammation, and contribute to coronary artery aneurysms. Evidence suggests that children with KD often exhibit increased gut permeability, leading to an imbalance in gut immunity and subsequent gut barrier damage. These changes impact vascular endothelial cells, promoting platelet aggregation and activation, thereby advancing severe vascular complications, including aneurysms. Additionally, this review highlights the correlation between GI symptoms and increased resistance to standard treatments like intravenous immunoglobulin (IVIG), indicating that GI involvement may predict therapeutic outcomes. Advocating for a new paradigm, this review calls for integrated research across gastroenterology, immunology, and cardiology to examine KD through the lens of GI health. The goal is to develop innovative therapeutic interventions targeting the intestinal barrier, potentially revolutionizing KD management and significantly improving patient outcomes.

Analysis of the Prognostic Impact of Heart Rate Deceleration Capacity on Type 2 Diabetes Mellitus with Ventricular Premature Contractions

At present, one of the greatest life-threatening risks for patients with type 2 diabetes is cardiovascular complications. According to relevant research, approximately 70% to 80% of these patients die due to cardiovascular disease. Compared to non-diabetic individuals, diabetic patients face a two- to four-fold higher risk of developing cardiovascular and cerebrovascular diseases, with vascular complications resulting in an average life expectancy reduction of about 12 years. Increasing evidence indicates that cardiovascular-related indicators become abnormal as early as the initial stages of type 2 diabetes. During this period, the likelihood of adverse cardiovascular events rises, and cardiac autonomic dysfunction (CAD) begins, disrupting the balance between the parasympathetic and sympathetic nervous systems and thereby increasing cardiovascular disease risk. Cardiac autonomic dysfunction is one of many severe complications, and ventricular premature contractions are common arrhythmias in patients with type 2 diabetes, often seen as key indicators of declining cardiac function. Continuous heart rate deceleration, observed as deceleration runs (DRs) in Holter ECGs, manifests as a gradual prolongation of consecutive RR intervals, an indicator useful in assessing cardiac autonomic neuropathy. Persistent hyperglycemia or pre-diabetic states are associated with coronary artery disease (CAD), and strict blood glucose control helps slow the progression of microvascular complications. HRV monitoring is an effective method for evaluating early-stage cardiovascular autonomic neuropathy (CAN), providing a quantitative assessment of autonomic function and aiding in diagnosing other vascular complications.

Urinary metabolomics provide insights into coronary artery disease in individuals with type 1 diabetes.

Type 1 diabetes increases the risk of coronary artery disease (CAD). High-throughput metabolomics may be utilized to identify metabolites associated with disease, thus, providing insight into disease pathophysiology, and serving as predictive markers in clinical practice. Urine is less tightly regulated than blood, and therefore, may enable earlier discovery of disease-associated markers. We studied urine metabolomics in relation to incident CAD in individuals with type 1 diabetes. We prospectively studied CAD in 2501 adults with type 1 diabetes from the Finnish Diabetic Nephropathy Study. 209 participants experienced incident CAD within the 10-year follow-up. We analyzed the baseline urine samples with a high-throughput targeted urine metabolomics platform, which yielded 54 metabolites. With the data, we performed metabolome-wide survival analyses, correlation network analyses, and metabolomic state profiling for prediction of incident CAD. Urinary 3-hydroxyisobutyrate was associated with decreased 10-year incident CAD, which according to the network analysis, likely reflects younger age and improved kidney function. Urinary xanthosine was associated with 10-year incident CAD. In the network analysis, xanthosine correlated with baseline urinary allantoin, which is a marker of oxidative stress. In addition, urinary trans-aconitate and 4-deoxythreonate were associated with decreased 5-year incident CAD. Metabolomic state profiling supported the usage of CAD-associated urinary metabolites to improve prediction accuracy, especially during shorter follow-up. Furthermore, urinary trans-aconitate and 4-deoxythreonate were associated with decreased 5-year incident CAD. The network analysis further suggested glomerular filtration rate to influence the urinary metabolome differently between individuals with and without future CAD. We have performed the first high-throughput urinary metabolomics analysis on CAD in individuals with type 1 diabetes and found xanthosine, 3-hydroxyisobutyrate, trans-aconitate, and 4-deoxythreonate to be associated with incident CAD. In addition, metabolomic state profiling improved prediction of incident CAD.

Advances in Cardiac Imaging and Genetic Testing for Diagnosis and Risk Stratification in Cardiomyopathies: 2024 Update

Cardiomyopathies represent a diverse group of heart muscle diseases marked by structural and functional abnormalities that are not primarily caused by coronary artery disease. Recent advances in non-invasive imaging techniques, such as echocardiography, cardiac magnetic resonance, and computed tomography, have transformed diagnostic accuracy and risk stratification, reemphasizing the role of cardiac imaging in diagnosis, phenotyping, and management of these conditions. Genetic testing complements imaging by clarifying inheritance patterns, assessing sudden cardiac death risk, and informing therapeutic choices. Integrating imaging data, such as left ventricular wall thickness, fibrosis, and apical aneurysms, with genetic findings enhances decision-making for implantable cardioverter-defibrillators in high-risk patients. Emerging technologies like artificial intelligence, strain imaging, and molecular imaging, alongside genetic testing, hold the promise of further refining diagnosis and personalized treatment approaches. This article summarizes the current state and future perspectives of cardiac imaging and genetic testing for diagnosis and risk stratification in cardiomyopathies, offering practical insights for patients’ management.

Correlation of the FIB-4 Liver Biomarker Score with the Severity of Heart Failure

Background and Objectives: Heart failure is associated with high morbidity and mortality and linked with several pre-existing health conditions and risk factors. Early detection and prompt management in heart failure improves patient outcomes. Liver involvement is associated with heart failure disease progression, and hence liver biomarkers and liver fibrosis may have a prognostic impact. Several blood test based markers and scoring systems estimate liver fibrosis and hence can be useful prognostic tools. Materials and Methods: We retrospectively analyzed a series of 303 patients with decompensated heart failure in a city in western Romania over a period of 6 months. Several biochemical parameters were measured, the FIB-4 score was estimated and echocardiography was performed. Results for targeted variables are presented using descriptive statistics. Patients were analyzed based on their LVEF categories. Statistical analysis was based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables. Pairwise comparisons were performed based on Bonferroni adjusted significance tests. The correlations between FIB-4 score, LVEF and NT-pro BNP in patients with and without diabetes and hypertension were explored using Spearman’s correlation coefficient. Result: Age, gender, NYHA class, death, history of (h/o) type 2 diabetes mellitus (T2DM), h/o coronary artery disease (CAD), h/o arrhythmias, sodium, potassium, creatinine, eGFR, uric acid, NT-pro BNP, left atrial volume, LDL, HDL, and TG were analyzed by LVEF categories using ANOVA one-way tests, Chi-square tests, and Bonferroni correction comparisons. We found a strong statistically significant correlation between each of NT-pro BNP, left atrial volume, LDL, and HDL with the LVEF categories. Discussion: Early detection of cardiac dysfunction leads to better management in patients with cardiovascular risk factors including diabetes and hypertension. High LDL and low HDL levels contribute to a reduction in left ventricular (LV) function. Available literature suggests the FIB-4 score as superior to other non-invasive markers of fibrosis. It utilizes the patient’s age, platelet count, AST, and ALT, which can be available retrospectively, making it an easy and inexpensive tool. FIB-4 score has a few limitations. Conclusions: Our study has shown a statistically significant positive correlation between severity categories of LVEF and FIB-4 score for heart failure patients with and without diabetes, and for heart failure patients with or without hypertension. We propose the implementation of FIB-4 score as a prognostic tool for heart failure.

The intersection of allergy and acute coronary syndrome: a type II Kounis syndrome case report.

This case report discusses a rare occurrence of type II Kounis syndrome, characterised by an acute myocardial infarction triggered by an allergic reaction. The patient, a young adult male, experienced urticaria soon after eating oysters, which quickly escalated to severe chest discomfort. Despite lacking typical cardiac risk factors, the electrocardiogram showed indications of ST-elevation myocardial infarction. This condition was further complicated by ventricular fibrillation, necessitating urgent life-saving measures. This case demonstrates the intricate and often overlooked relationship between hypersensitivity reactions and cardiovascular events. It highlights the necessity for increased vigilance and rapid diagnostic and treatment approaches in handling Kounis Syndrome, especially in emergency situations. The case underscores the importance of considering allergic causes in acute cardiac scenarios, particularly in patients who do not have standard risk factors for coronary artery disease.

Machine Learning-Based Cardiac Output Estimation Using Photoplethysmography in Off-Pump Coronary Artery Bypass Surgery

Background/Objectives: Hemodynamic monitoring is crucial for managing critically ill patients and those undergoing major surgeries. Cardiac output (CO) is an essential marker for diagnosing hemodynamic deterioration and guiding interventions. The gold standard thermodilution method for measuring CO is invasive, prompting a search for non-invasive alternatives. This pilot study aimed to develop a non-invasive algorithm for classifying the cardiac index (CI) into low and non-low categories using finger photoplethysmography (PPG) and a machine learning model. Methods: PPG and continuous thermodilution CO data were collected from patients undergoing off-pump coronary artery bypass graft surgery. The dataset underwent preprocessing, and features were extracted and selected using the Relief algorithm. A CatBoost machine learning model was trained and evaluated using a validation and testing phase approach. Results: The developed model achieved an accuracy of 89.42% in the validation phase and 87.57% in the testing phase. Performance was balanced across low and non-low CO categories, demonstrating robust classification capabilities. Conclusions: This study demonstrates the potential of machine learning and non-invasive PPG for accurate CO classification. The proposed method could enhance patient safety and comfort in critical care and surgical settings by providing a non-invasive alternative to traditional invasive CO monitoring techniques. Further research is needed to validate these findings in larger, diverse patient populations and clinical scenarios.

Unveiling shared therapeutic targets and pathological pathways between coronary artery disease and major depressive disorder through bioinformatics analysis.

Coronary artery disease (CAD) is a predominant cardiovascular condition influenced by risk factors, with an emphasis on major depressive disorder (MDD). However, the shared mechanisms and therapeutic targets for CAD and MDD remain incompletely comprehended. Functional enrichment analyses were conducted to investigate the pathways associated with the differentially expressed genes (DEGs) in the CAD and MDD datasets. Hub genes were identified utilizing the Protein-Protein Interaction network and Cytoscape software. The single sample gene set variation analysis was applied to assess immune cell infiltration in the CAD and MDD datasets. Weighted gene co-expression network analysis and molecular biological experiments were executed to evaluate these hub genes. Molecular docking was conducted to identify drug candidates targeting these hub genes. The overlapping DEGs between the CAD and MDD datasets were mainly enriched in the Herpes simplex virus 1 infection and the NF-kappa B signaling pathways. CDC42, NDUFB3, and TXN were validated within the eigengenes of the blue module, which exhibited a significant association with the CAD phenotype. The drug candidate GS-9620 was identified as a potential protective agent against both disorders. In conclusion, CDC42, NDUFB3, and TXN held potential as molecular biomarkers and therapeutic targets for the simultaneous treatment of CAD and MDD.

Fractional flow reserve measurement using dynamic CT perfusion imaging in patients with coronary artery disease

Fractional flow reserve measurement using dynamic CT perfusion imaging in patients with coronary artery disease

Clinical characteristics of coronary artery involvement in children with Behcet's syndrome.

To review the clinical features, treatment, and prognosis of coronary involvement in Behcet's syndrome in children. Retrospectively analyzed medical records of BS patients admitted to our institution from 2012 to 2024. Six children with BS with coronary involvement were admitted, including 2 males and 4 females. The mean age was 5.7years and the mean course was 17.2months. All of them had coronary dilatation, including 1 case with aneurysmal dilatation, 2 cases with bilateral coronary dilatation, 4 cases with unilateral dilatation, and 4 cases with valvular disease. No symptom for coronary artery dilation and all of coronary dilatation were detected by echocardiography. Manifestations of extracardiac vascular involvement included arteriovenous wall thickness and thrombosis. Five cases had only arterial involvement and one case had both artery and vein involvement. Pulmonary artery was involved in 1 case. All of them were treated with glucocorticoid and immunosuppressant, 1 child was treated with TNF-α, and 1 received aortic valvuloplasty due to a large number of aortic regurgitations. The patient with coronary aneurysm died suddenly after giving up treatment, and the other 4 cases were all improved to varying degrees. Vascular involvement is an important factor affecting the prognosis of Behcet's syndrome. Patients with coronary involvement are occultic and difficult to diagnose. Both arteries and veins can be involved, and some patients have severe symptoms. Clinicians should attach great importance to early vascular screening, especially coronary artery. Early combined medication may help improve the prognosis. Key Points • Vascular involvement is an important factor affecting the prognosis of Behcet's syndrome. • Coronary involvement in BS is rare in children, which is predominantly coronary dilatation. • The onset of BS with coronary involvement is insidious and easy to be missed, so early coronary artery screening in children with BS should be emphasized. • Early combined medication may help improve the prognosis of BS with coronary involvement.

Predictive value of pericoronary fat attenuation index for graft occlusion after coronary artery bypass grafting.

Based on coronary computed tomography angiography (CCTA), this study aimed to evaluate the predictive value of pericoronary fat attenuation index (FAI) for graft occlusion in patients following coronary artery bypass grafting (CABG). The clinical and imaging data of 100 patients with coronary artery disease (CAD) who underwent CCTA and subsequently received successful CABG between December 2012 and March 2024 were retrospectively collected. According to the subsequent CCTA evaluation of grafts, they were categorized into occlusion group (n = 27) and patency group (n = 73). Based on CCTA images, FAI of the proximal segment of the three coronary arteries and epicardial adipose tissue (EAT) parameters were measured and compared between the two groups. The Cox regression model was employed to screen the independent predictors of graft occlusion. The predictive model was constructed, and the receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic performance of the model. Among the 100 cases, 74 were males, with a mean age was 62.42 ± 7.57years. During the 15.50 (5.00, 36.75) months follow-up period, grafting vessel occlusion occurred in 27 patients (27.0%). The right coronary artery (RCA) in occlusion group was -73.36 ± 7.24HU, which was notably higher compared to patency group (-79.93 ± 9.75HU) (P < 0.05). Multivariable Cox regression analysis indicated that RCA FAI (HR = 5.205, 95% CI 1.938-13.979; P = 0.001) was independently correlated with graft occlusion, with an optimal cutoff value of -79.39 HU.RCA FAI added incremental prognostic value beyond clinical characteristics for patients following CABG (AUC 0.784 vs. 0.677, P = 0.027). The RCA FAI can serve as a crucial predictor for graft occlusion in patients following CABG, enabling early identification of high-risk individuals and facilitating timely and effective intervention measures to enhance patient prognosis.

It's Probably Just Heart Burn! A Case of Pregnancy-Associated Spontaneous Coronary Artery Dissection.

Pregnancy-associated spontaneous coronary artery dissection (P-SCAD) poses a rare yet critical concern among postpartum individuals, increasingly recognized as a significant trigger for acute myocardial infarction. Timely identification, accurate diagnosis, and prompt treatment are paramount for clinicians confronted with this condition. Patients with P-SCAD commonly manifest signs and symptoms akin to acute coronary syndrome but have different etiology and treatment. SCAD is defined as a non-traumatic, non-iatrogenic separation of the coronary artery wall, not associated with atherosclerosis. The predominant mechanism of myocardial injury is coronary artery obstruction caused by an intramural hematoma or intimal disruption compromising the lumen at the site of dissection. Diagnosis is made with a comprehensive history and physical examination, cardiac biomarkers, a 12-lead ECG, transthoracic echocardiogram, and confirmed with coronary angiography. Stable patients are managed medically, while more severe cases may require additional intervention.

Correlation between remnant cholesterol and premature coronary artery disease and the severity of coronary artery lesions in men: a retrospective study

ObjectiveTo investigate the correlation between remnant cholesterol (RC) and premature coronary artery disease (PCAD) and the severity of coronary artery lesions in men.MethodsA total of 630 male subjects who underwent coronary angiography were included in the study. The general data, laboratory tests, and coronary angiography data of each group were statistically analyzed, and RC levels were calculated. According to the Gensini score, PCAD was divided into mild and severe lesion groups. The relationship between RC and PCAD and coronary artery lesions was analyzed using multivariate logistic regression and spearman correlation analysis, and the predictive value of RC for coronary artery lesions was evaluated using receiver operating characteristic (ROC) curves.ResultsThe RC levels in the PCAD group were significantly higher than those in the non-PCAD group (p &amp;lt; 0.05), and RC was an independent risk factor for PCAD (p &amp;lt; 0.05).The RC levels in the severe lesion group were higher than those in the mild lesion group (p &amp;lt; 0.05), and RC levels were positively correlated with the Gensini score (r = 0.335, p &amp;lt; 0.001).Multivariate logistic regression analysis showed that RC was an independent risk factor for severe coronary artery lesions (p &amp;lt; 0.05).The ROC curve calculated the value of RC in predicting severe coronary artery lesions, with an area under the curve of 0.693, a cutoff value of 0.485 mmol/L, a sensitivity of 64.7%, and a specificity of 66.2%.ConclusionRC is an independent risk factor for PCAD and the severity of coronary artery lesions in adult men. RC levels are positively correlated with the severity of coronary artery lesions and can be used as an auxiliary indicator for clinical assessment of PCAD.

Investigating the Relationship Between Cigarettes and Hookah Smoking with Coronary Artery Disease

Background: Cardiovascular disease (CVD) is recognized as a leading global cause of mortality, with tobacco use being one of the established risk factors responsible for 29% of related deaths. Although tobacco smoking, particularly through hookah, is increasing globally, limited data are available to evaluate its impact on CVD. This study aimed to investigate the relationship between cigarette and hookah smoking and coronary artery disease (CAD). Objectives: This study evaluated the relationship between cigarette and hookah smoking and coronary artery involvement based on coronary angiography findings. Methods: In this hospital-based cross-sectional study, 256 patients were included, with 128 patients in the CAD group (showing at least 50% stenosis in the left main artery or over 70% stenosis in other coronary arteries) and 128 patients in the normal angiography group. We assessed their smoking status, categorizing participants as current smokers, ex-smokers, or never-smokers. To ensure the collection of accurate and reliable data, we conducted face-to-face interviews, observations, and administered a questionnaire and medical checklist. Results: Based on multivariable logistic regression models, after adjusting for additional risk factors, individuals who smoked exhibited an approximately eight-fold higher likelihood of developing CAD compared to non-smokers. Additionally, hookah users showed a five-fold increase in CAD risk compared to non-hookah users (P = 0.001). Conclusions: Cigarette and hookah smoking are significantly associated with CAD, with cigarette smoking showing a comparatively stronger association with CAD than hookah use when considering other risk factors.

Coronary Artery Disease and Microvascular Ischemia in Patients with Cardiac Amyloidosis

Introduction: The prevalence of pre-existing obstructive coronary artery disease (CAD) and the occurrence of anginal chest pain as a presenting symptom in patients with light chain (AL) and transthyretin (ATTR) cardiac amyloidosis (CA) are undetermined. Methods: A single-center analysis of clinical, laboratory, imaging and angiographic characteristics of CA cohort. Results: Included were 98 CA patients (43 AL, 47 wtATTR, 8 mutant ATTR). Eighteen patients (18%) had pre-existing obstructive CAD at the time of CA diagnosis. These patients were older and had worse left ventricular ejection fraction, yet revealed similar cardiac biomarkers’ levels. The 3-year survival rate was comparable between patients with versus without pre-existing CAD (p=0.974). Anginal chest pain was a presenting symptom of newly-diagnosed CA in 24% (n=19) of patients with no pre-existing CAD, 53% (n=10) of which had AL-CA. Two patients had an acute myocardial infarction. The prevalence of diabetes mellitus, dyslipidemia, hypertension and smoking was similar among CA patients presenting with versus without chest pain. Of the newly-diagnosed CA patients with no pre-existing CAD who underwent symptoms evaluation (n=37), 99mTc-Sestamibi myocardial perfusion scintigraphy demonstrated stress-induced perfusion defects in 45% (9/20) and normal study in 45% (9/20) of patients. Coronary evaluation revealed non-obstructive coronary artery lesions or normal coronaries in 75% of patients (18/24). Conclusion: CA patients may initially present with anginal chest pain and myocardial perfusion defects which may reflect coronary microvascular ischemia. CA should be considered in the differential diagnosis of patients presenting with chest pain, non-obstructive CAD and elevated cardiac biomarkers.

Evaluating the Prognostic Nutritional Index for Predicting the Clinical Relevance of Angiographically Intermediate Coronary Lesions.

Coronary artery disease (CAD) is a widespread health issue globally, linked to significant morbidity and mortality. While oxidative stress, dysregulated lipid metabolism, and unhealthy lifestyle choices contribute to CAD, recent research highlights the role of immune responses and inflammation. Malnutrition, a modifiable risk factor, notably impacts CAD prognosis. The prognostic nutritional index (PNI), derived from serum albumin and lymphocyte count, predicts outcomes in various diseases. This study aims to elucidate the relationship between malnutrition, as assessed by the PNI score, and the functional significance of coronary artery stenosis, evaluated by fractional flow reserve (FFR) measurements. A retrospective analysis involved 232 patients with single intermediate-grade coronary stenosis who underwent FFR measurement between January 2022 and January 2024. Prognostic nutritional index values were calculated from serum albumin and lymphocyte counts. Patients were divided into 2 groups based on FFR values. Patients with hemodynamically significant coronary stenosis (FFR ≤ 0.80) exhibited higher inflammatory markers and triglycerides, while those with FFR > 0.80 showed elevated albumin and PNI levels. Triglycerides and PNI emerged as independent predictors of significant coronary stenosis. This study demonstrates that PNI is independently associated with the functional significance of coronary artery stenosis as determined by FFR. Since lymphocytes, total protein and albumin values, which are readily available from routine blood tests, form the basis for PNI, this index can be easily used in clinical settings to predict hemodynamically significant coronary artery stenosis. However, the results of this study should be further expanded and validated through studies involving larger samples and prospective designs.

Impact of perioperative high-intensity statin treatment on the occurrence of postoperative atrial fibrillation after coronary artery bypass grafting: a meta-analysis.

This meta-analysis was conducted to evaluate the impact of high-intensity statin treatment on new-onset postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG). Four databases were searched for studies that enrolled patients who underwent CABG and investigated the impact of perioperative use of high-intensity statins on the occurrence rate of POAF. The primary outcome was the incidence of POAF. Secondary outcomes were operative mortality and perioperative myocardial infarction (PMI). Publication bias was assessed using a funnel plot and Egger's test. Nine articles (eight randomized controlled trials and one non-randomized study: n=3,072) were selected. Rosuvastatin (20 mg) was used in four studies, while atorvastatin (40-80 mg) was used in the other five studies. Reported incidences of POAF in the included studies ranged from 11% to 48.8%. Pooled analyses showed that the incidence of POAF was significantly lower in patients treated with high-intensity statins than in patients in the control group patients (odds ratio, 0.43; 95% CI, 0.27-0.68; P<0.001). Subgroup analyses showed that the impact of high-intensity statins was significant in studies using atorvastatin but not in studies using rosuvastatin. There was no significant subgroup difference in the primary endpoint between studies using a placebo and those using low-dose statins. Secondary outcomes, including operative mortality and the incidence of PMI, were not affected by high-intensity statin treatment. Perioperative use of high-intensity statins is associated with a 57% reduction in the occurrence of POAF among patients undergoing CABG.

Coronary angiography: a review of the state of the art and the evolution of angiography in cardio therapeutics

Traditionally, coronary angiography was restricted to visual estimation of contrast-filled lumen in coronary obstructive diseases. Over the previous decades, considerable development has been made in quantitatively analyzing coronary angiography, significantly improving its accuracy and reproducibility. Notably, the integration of artificial intelligence (AI) and machine learning into quantitative coronary angiography (QCA) holds promise for further enhancing diagnostic accuracy and predictive capabilities. In addition, non-invasive fractional flow reserve (FFR) indices, including computed tomography-FFR, have emerged as valuable tools, offering precise physiological assessment of coronary artery disease without the need for invasive procedures. These innovations allow for a more comprehensive evaluation of disease severity and aid in guiding revascularization decisions. This review traces the development of QCA technologies over the years, highlighting key milestones and current advancements. It also explores prospects that could revolutionize the field, such as AI integration and improved imaging techniques. By addressing both historical context and future directions, the article underscores the ongoing evolution of QCA and its critical role in the accurate assessment and management of coronary artery diseases. Through continuous innovation, QCA is poised to remain at the forefront of cardiovascular diagnostics, offering clinicians invaluable tools for improving patient care.