Coronary Arteries In Patients Research Articles

The significance of symptoms before and after surgery for anomalous aortic origin of coronary arteries in adolescents and adults.

The aim of this study is to describe the significance of symptoms preoperatively and at medium-term follow-up in adolescent and adult patients who underwent surgery of anomalous aortic origin of a coronary artery (AAOCA). Consecutive patients who underwent surgery for AAOCA in our tertiary referral centre between 2001 and 2018 were included. Clinical characteristics and symptoms were evaluated and medium-term outcomes were recorded. Symptoms were classified according to the '2019 ESC guidelines on chronic coronary syndromes'. A total of 53 (55% male) patients with mean age of 44 at time of surgery underwent surgical repair of AAOCA. Data on symptoms and events ˃3 months after surgery were available in 34 patients with a median follow-up of 3 years (interquartile range 1.0-5.3). Preoperatively, only 35% patients had typical anginal complaints. After surgical correction of AAOCA, 59% of the patients were free of symptoms, compared to 6% preoperatively (P < 0.001). A total of 3 (9%) patients needed a reoperation/reintervention related to the operated AAOCA. All 3 patients presented postoperatively with novel typical anginal complaints. Adolescent and adult patients with AAOCA present with varying symptoms. Only 35% have typical anginal complaints. Surgical correction of AAOCA reduces the symptoms in the vast majority of patients. One should be aware of potential lesions of the operated coronary artery in patients presenting with typical anginal complaints postoperatively.

Predictors of Coronary Plaque Vulnerability in Patients with Stable Coronary Artery Disease

Aim To identify new predictors for vulnerability of atherosclerotic coronary plaques in patients with stable ischemic heart disease (sIHD).Material and methods This prospective, single-center study included 58 patients with sIHD. Unstable plaques were detected with virtual histology intravascular ultrasound of proximal and medium segments of a coronary artery without significant lesions according to coronarography data. Indexes of inflammation, dyslipidemia and carbohydrate metabolism were considered as candidate predictors for coronary plaque vulnerability.Results In 56 coronary arteries, 58 plaques were detected, 12 of which (20.7 %) were unstable. Vulnerable plaques differed morphologically from stable ones by a greater size of the necrotic core (35.1±8.5 % vs. 24.0±13.2 %; р=0.008), calcified nodules (2.0 [1.0; 5.0] % vs. 1.0 [0; 2.0] %; р=0.006), and a lower content of fibrous components (54.9±10.2 % vs. 66.4±15.8 %; р=0.02). In addition, vulnerable plaques more frequently narrowed the arterial lumen by &gt;70 % of the lumen area (33.3 % vs. 2.2 %; р=0.0006). Correlation analysis showed a negative correlation between the level of high-density lipoproteins (HDL) and calcium volume (r= -0.4104; р=0.023); a positive correlation between the blood glucose level as determined by the oral glucose tolerance test and the lipid component (r=0.48198; р=0.033); and a negative correlation between the apolipoprotein A level and the calcium volume (r= -0.4297; р=0.008).Conclusion The study demonstrated a high prevalence of vulnerable plaques in nontarget coronary arteries in patients with sIHD. In this process, dyslipidemia indexes (LDL, apolipoproteins A) correlate with the calcium volume whereas blood glucose, as measured in the oral glucose tolerance test, correlates with the lipid component of coronary plaque.

Feasibility of morphological assessment of coronary artery calcification with electrocardiography-gated non-contrast computed tomography: a comparative study with optical coherence tomography.

To investigate the feasibility of pre-procedural morphological assessment of coronary artery calcification in severely calcified lesions with electrocardiography (ECG)-gated non-contrast computed tomography (CT). Severely calcified coronary arteries in patients who underwent ECG-gated non-contrast CT prior to optical coherence tomography (OCT)-guided percutaneous coronary intervention (PCI) were studied retrospectively. CT and OCT data were co-registered by marking landmark structures such as side branches and reviewed side by side with cross-sectional images. The maximum calcium angle (MCA) and presence of nodular calcification (NC) were evaluated. A total of 496 cross-sections in 16 lesions were included in this analysis. The Pearson correlation coefficient between CT- and OCT-derived MCA was 0.92 (p < 0.001). Bland-Altman plots of OCT-derived MCA in relation to CT-derived MCA showed a mean bias of 4.8 degrees with 95% limits of agreement of -69.7 to 79.4 degrees. Sensitivity, specificity, and positive and negative predictive values of CT in identifying MCA > 270 degrees were 90.3%, 79.7%, 92.1%, and 97.4%, respectively. Sensitivity, specificity, and positive and negative predictive values of CT in identifying NC were 73.3%, 97.5%, 47.8%, and 99.2%, respectively. ECG-gated non-contrast coronary CT might be helpful to obtain detailed information of severe coronary artery calcification before PCI.

Aggressive therapy to prevent contrast-induced kidney damage during percutaneous coronary interventions

Abstract Introduction In the era of the development of medical technology percutaneous coronary intervention (PCI) has become the most common method of surgical treatment of coronary arteries in patients with coronary heart disease (CHD). Contrast-induced nephropathy (CIN) is a harbinger of chronic renal failure. The recommendations for myocardial revascularization for the prevention of CIN recommend the use of statin treatment. The choice of the optimal statin, the duration of its administration and the effectiveness of loading doses of statins in preventing CIN still remain unresolved topical issues. The purpose of research work: 1) to evaluate the effectiveness of the prevention of contrast-induced kidney damage when using a loading dose of statins; 2) to study the possibility of early diagnosis of renal damage by examining serum creatinine levels, calculating the glomerular filtration rate (GFR) and the index of a new biomarker of cystatin C. Material and methods All patients with CHD, hemodynamically significant stenosis of the coronary arteries were sent to elective endovascular myocardial revascularization. All patients underwent: general clinical examination, a serial study of biochemical blood analysis parameters: creatinine, c-reactive protein (CRP), cystatin C level, GFR. Using the envelope method, the patients were divided into two groups. Patients of the first group were prescribed atorvastatin at a dose of 80 mg for 7 days: 3 days before PCI and 4 days after it. The second group included patients who were treated with rosuvastatin at a dose of 40 mg for 7 days: 3 days before PCI and 4 days after PCI. Conclusion The incidence of CI AKI in patients with planned PCI during the administration of high doses of rosuvastatin was less frequent compared with loading therapy with atorvastatin, respectively 3.33% and 12.12%. On average, an increase in the concentration of serum creatinine to the maximum level in patients receiving atorvastatin was higher than in the second group with loading therapy of rosuvastatin (14.3% versus 8.1%, p=0.024). The decrease in GFR calculated by the formula CKD-Epi was detected 48 and 72 hours after PCI. At the same time, a study of plasma cystatin C showed a decrease in renal function 12 and 24 hours after surgery with the introduction of a contrast agent. This biomarker is an effective marker for early detection of renal failure, even with normal creatinine levels. The anti-inflammatory effect was evaluated by a highly sensitive CRP. In patients with CHD after PCI during therapy with rosuvastatin it was significantly stronger compared with the group of patients using atorvastatin. Thus, the use of rosuvastatin in order to prevent CI of AKI during CPI in patients with CHD seems to be preferable in comparison with atorvastatin due to a more pronounced nephroprotective and anti-inflammatory effect. Aggressive statin therapy Funding Acknowledgement Type of funding source: None

Intracoronary Versus Intravenous Administration of Eptifibatide During Percutaneous Coronary Intervention in Patients With Acute Coronary Syndromes

Platelet activation and aggregation play a major role in thrombosis formation of coronary arteries in patients with Acute Coronary Syndrome (ACS) and is responsible for most ischemic complications during PCI. There is little information on the benefits and side effects of intracoronary and intravenous injection of Eptifibatide, a potent antiplatelet agent; therefore, this study was performed with the aim to compare coronary blood flow velocity by measurement of TIMI frame count. In intravenous versus intracoronary bolus administration of Eptifibatide during PCI in ACS patients. This non-randomized clinical trial study was performed on 103 patients with acute coronary syndromes who referred to the cardiac emergency ward of Ghaem hospital, Mashhad University of Medical Sciences, and were candidates for urgent coronary angiography and PCI. Forty-eight cases received intracoronary bolus Eptifibatide and 55 intravenous Eptifibatide. TIMI Frame Count and Corrected TIMI Frame Count were used to comparing the effect of these two methods on coronary blood flow velocity. Data were analyzed by SPSS software (version 22). To compare the quantitative variables in the two groups, according to the distribution of variables, the t-test was used if it was normal or the Mann-Whitney test was used if it was not normal. A Chi-square test was also used to compare qualitative variables into two groups. P&lt;0.05 was considered statistically significant. Mean of age, gender, and cardiovascular risk factors were similar in the two groups. There was no significant difference in terms of serum Creatine Kinase MB (CKMB) level, Left Ventricular Ejection Fraction (LVEF), coronary artery lesion length, coronary artery diameter, coronary thrombosis, and coronary artery thrombectomy in two groups. Based on Student's t-test, there was no significant difference between mean TIMI Frame Count in different coronary arteries in the intracoronary and intravenous injection groups (In LAD, P=0.518; For LCX, P=0.576; and in RCA, P=0.964). The complications were observed in 11 patients (22.9%) of the intracoronary injection group and 9 (16.4%) of the intravenous injection group; the difference was not significant (P=0.402). The effects and complications of Eptifibatide were not significantly different in Intracoronary and intravenous administration in ACS patients during PCI and at the time of patients' hospitalization.

Evaluation of the Correlation between Serum Concentrations of Asymmetric Dimethylarginine and Corrected TIMI Frame Count in Patients with Slow Coronary Flow.

Coronary slow flow (CSF) is an important angiographic entity that is characterized by delayed opacification of coronary arteries in the absence of epicardial occlusive disease. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide synthase. Elevated levels of ADMA cause the induction of endothelial dysfunction and thus promote atherosclerosis. This study was aimed at determining the role of ADMA in the development of CSF. One hundred twenty-nine subjects who fulfilled the inclusion criteria were enrolled in this study. According to coronary angiography results, these subjects were divided into five groups. The serum concentration of ADMA was measured in these subjects. In this study, there was no significant correlation between serum concentrations of ADMA and mean corrected TIMI frame count (CTFC) (P > 0.05). However, the ADMA level was significantly correlated with CTFC in the left anterior descending (LAD) coronary artery in patients with CSF (r = −0.381, P = 0.045). Also, plasma ADMA levels were significantly higher in patients with CSF and without CAD compared to patients without CSF and with CAD (50-90%) (P = 0.034). Besides, serum concentrations of ADMA were significantly higher in subjects with BMI < 25 kg/m2 compared with those having BMI > 30 kg/m2 (P = 0.003). It was also shown that the levels of ADMA were significantly higher in subjects with age as a cardiovascular risk factor compared with those without this risk factor (P = 0.024). Further studies with larger population sizes are needed to confirm the present findings on the association between the serum concentrations of ADMA and CSF.

Correlation between the Serum Platelet-Derived Growth Factor, Angiopoietin-1, and Severity of Coronary Heart Disease.

Background The expression of the platelet-derived growth factor (PDGF), angiopoietin-1 (Ang-1) in patients with coronary artery disease of different studies was inconsistent. This study was to investigate the expression of the PDGF and Ang-1 in peripheral blood and coronary artery in patients with acute coronary syndrome (ACS) and the relationship between the expression of the PDGF and Ang-1 and the severity of coronary artery disease. Methods A total of 81 patients with acute coronary syndrome undergoing coronary angiography were enrolled from September 2012 to December 2013. Patients with ACS included 61 patients with acute myocardial infarction (AMI group) and 20 patients with unstable angina pectoris (UAP group). The 29 patients who were hospitalized for chest pain undergoing coronary angiography without stenosis and with TIMI level 3 blood flow were selected as the control group. During coronary arteriography (CAG) or percutaneous coronary intervention (PCI), blood in the peripheral artery and in the local coronary artery was collected from all the patients. Serum PDGF and Ang-1 levels were measured by ELISA. We calculated the Gensini score of each patient with CHD according to the result of CAG. Patients with ACS were followed up, and the major adverse cardiovascular and cerebrovascular adverse events were recorded. Results In peripheral blood, the concentration of the PDGF was significantly elevated in the ACS group than that of the control group. The level of the PDGF in the AMI group was significantly higher than that in the UAP group. In coronary artery blood, the level of the PDGF in the ACS group was significantly higher than that of the UAP group. There was no significant difference in the concentration of Ang-1 in peripheral blood between patients with coronary heart disease and the control group. The concentration of Ang-1 in the coronary artery was significantly lower than that in peripheral blood. The coronary Ang-1 concentrations in the ACS group were significantly higher than those in the UAP group. The concentrations of the PDGF and Ang-1 in peripheral and coronary artery blood were positively correlated with the severity of coronary lesions. Patients with MACCE had higher PDGF and Ang-1 levels in the coronary sinus. Conclusion The serum PDGF concentration in patients with acute coronary syndrome was significantly increased, especially in the local coronary artery. The serum Ang-1 in the coronary artery was significantly increased in patients with acute myocardial infarction and was related to the degree of coronary artery stenosis. Coronary sinus PDGF and Ang-1 levels can reflect the severity of lesions in patients with acute coronary syndrome.

Low Rate of Invasive Coronary Angiography Following Transcatheter Aortic Valve Implantation: Real-World Prospective Cohort Findings

AimTo evaluate the real need for coronary access after transcatheter aortic valve implantation (TAVI). Methods and resultsProspective observational single-center registry, including 563 consecutive patients who underwent TAVI between April 2008 and November 2018, with both self- and balloon-expandable valves in a tertiary European center. Mean age was 82.4 ± 6.9 years, 53.3% were female, 16% had previous history of coronary artery bypass grafting, 33% of previous percutaneous coronary intervention (PCI), and 16.6% of myocardial infarction (MI). Twenty-four percent of the patients were revascularized within one year before TAVI in preparation for the procedure. Median Society of Thoracic Surgeons score was 4.82 (IQ 2.84).In a median follow-up of 24 months (IQ 21.5), 18 patients (3.2%) were identified as potentially in need for invasive coronary angiography: 9 (1.6%) in the setting of stable coronary artery disease and 9 (1.6%) for an acute coronary syndrome.A total of 11 PCIs were performed in 9 patients, with a complete success rate of 63.6%. Procedures that were unsuccessful or partially unsuccessful were due to the inability to cross the stent or the drug-eluting balloon through the valve struts or misplacement within the coronary artery due to lack of catheter support. ConclusionIn this population, a strategy of previous guideline-directed revascularization before TAVI was associated with a low rate of MI and repeated need of coronary access, with a scattered distribution over time. Assuring future access to coronary arteries in patients at increased risk may depend on the revascularization strategy rather than device selection.

Coronary arteries hemodynamics: effect of arterial geometry on hemodynamic parameters causing atherosclerosis.

Coronary arteries hemodynamics: effect of arterial geometry on hemodynamic parameters causing atherosclerosis.

P1003New onset atrial fibrillation after stenting of the right coronary artery in patients with ischemic disease of the heart

Abstract Background Atrial fibrillation (AF) is a major heart rhythm disorder among population older age. Percutaneous coronary intervention (PCI) with stenting of the right coronary artery may increase the new onset AF. Aim of the study was to estimate the new onset AF after stenting of the right coronary artery (RCA) in patients with stable ischemic disease of the heart and its effect on short-term prognosis. Methods 765 patients in whom performed PCI with stenting of the proximal and medial segment of RCA were enrolled in this study (aged 41-71 years; mean age 55.8 ± 12.0 years; male 51%). Short-term outcomes were analyzed in median 1.1-year follow-up due to the development of new onset AF. Results Among 765 patients, after PCI in RCA developed AF in 58 patients (7.5%) within follow-up. Among them, 40 patients (5.2%) with type 2 diabetes mellitus, 37 patients (4.8%) hypertension, 34 patients (4.4%) older than 60 years old, 30 patients (3.9%) myocardial infarction in history. Restoration of sinus rhythm (cardioversion rate) was in 86%. Majority of the patients in whom sinus rhythm was not recovered were older (11.0%) and diabetic mellitus (8.0%). The propensity-matched model showed that new onset AF was associated with an increased risk of bleeding during the procedure (OR 1.4; 95% confidence interval, 1.27-1.74) and heart failure (OR 1.27; 95% confidential interval, 1.16-1.45). Conclusion: New onset AF is common within short-term period after PCI in proximal and distal segments of the RCA and it was independently associated with post procedural complications and heart failure.

CT Coronary Angiography Studies After a Mean Follow-up of 3.8 Years in Children With Kawasaki Disease and Spontaneous Defervescence.

Background: There is paucity of literature on follow-up of children with Kawasaki disease (KD) who have spontaneous defervescence during the acute stage and do not receive intravenous immunoglobulin. We report herein the role of computed tomography coronary angiography (CTCA) as an imaging modality in such situations.Methods: This prospective observational study was carried out during the period January 2016–June 2017. Children underwent CTCA on 128-slice Dual Source CT (DSCT) scanner (Somatom Definition Flash, Siemens; Germany), and 2D-echocardiography on the same day.Results: Mean age at time of diagnosis was 6.52 ± 3.13 years; range 2–14 years. Mean age at time of study was 11.03 ± 5.10 years; range 3.75–23.30 years. Mean interval between diagnosis of KD and time of present study was 3.84 ± 2.27 years. None of the patients showed any coronary artery abnormalities on either 2D-echocardiography or CTCA. While assessment of proximal segments of left main coronary artery, proximal right coronary artery, and left anterior descending artery was comparable on both 2D-echocardiography and CTCA, left circumflex artery, and distal right coronary artery could be clearly visualized only on CTCA.Conclusion: In our experience, patients with KD who have spontaneous defervescence during the acute stage and do not receive IVIg may not have significant long-term coronary sequelae. CTCA is a useful imaging modality for delineation of coronary artery in patients with KD on long term follow-up especially in older children with thick chest walls and poor acoustic windows.

Multivessel vs. culprit-lesion only percutaneous coronary intervention in ST-elevation myocardial infarction.

The optimal treatment of non-infarct-related coronary arteries in patients presenting with ST-elevation myocardial infarction (STEMI) has been asubject of debate for many years. Earlier medium-sized randomized controlled trials reported abenefit of multivessel percutaneous coronary intervention (PCI) primarily due to areduction of subsequent revascularizations. Recently, the well-powered COMPLETE trial showed areduction in the composite endpoint of cardiovascular mortality and myocardial reinfarction through complete revascularization. The present review summarizes the current evidence regarding revascularization strategies in STEMI patients.

Patient-specific modelling of stent overlap: Lumen gain, tissue damage and in-stent restenosis

This paper investigates the effects of multiple stents, with and without overlap, on the outcome of stent deployment in a patient-specific coronary artery using the finite element method. Specifically, the objective of this study is to reveal the effect of stent overlap on lumen gain, tissue damage and in-stent restenosis in percutaneous coronary intervention. Based on intravital optical coherency tomography imaging, three-dimensional model of a specific patient's coronary artery was developed, with two constituent layers (media and adventitia) and plaque, using Mimics. Hyperelastic models with damage, verified against experimental results, were used to describe stress-stretch responses of arterial layers and plaque. Abaqus CAE was used to create the models for Resolute Integrity™ drug-eluting stents and tri-folded expansion balloons. The results showed that lumen gain was improved by the overlapping stents than a single stent after deployment; however, damage to the media layer was greater, promoting a higher rate of in-stent restenosis. Meanwhile, the lumen gain achieved with the non-overlapping stents was smaller than that with the overlapping ones, due to an increased recoiling effect. Also, non-overlapping stents induced more tissue damage and higher rate of in-stent restenosis than overlapping stents. With respect to long-term clinical outcomes, the study recommended the use of a single stent where possible or multiple stents with minimal overlaps to treat long or angulated lesions.

Diagnostic performance of coronary angiography utilizing intraprocedural 320-row computed tomography with minimal contrast medium.

Recently developed coronary angiography with intraprocedural 320-row computed tomography can be performed in a catheterization laboratory (XACT) by injecting contrast medium from a place close to the coronary arteries, thereby requiring a minimal amount of contrast medium. However, its clinical application has not yet been established. This study aimed to evaluate the diagnostic accuracy of XACT angiography with a minimal volume of contrast medium in patients with suspected coronary artery disease (CAD). A total of 167 coronary segments were analyzed in 14 patients (9 males, median age 70years) with suspected CAD by XACT angiography with 7.5ml of contrast medium and invasive coronary angiography (ICA) with standard techniques. The segmental-based diagnostic accuracy of XACT angiography in detecting stenosis of ≥50% and ≥75% and visualized by ICA was good (sensitivity: 74% and 62%, specificity: 99% and 99%, positive predictive value: 93% and 80%, and negative predictive value: 97% and 97%, respectively). These results suggest that XACT angiography with a very low amount of contrast medium may have strong clinical utility for screening coronary arteries in patients with renal dysfunction or undergoing clinical procedures such as pacemaker implantation.

Contouring of the left anterior descending coronary artery in patients with breast cancer – the radiation oncologist’s view

Breast cancer is the cancer with the largest prevalence, both in Poland and worldwide. The standard treatment in patients with this disease is breast-conserving therapy (BCT), followed by whole breast radiotherapy (WBRT) with a boost dose applied to the area of the bed created after tumour resection. In women who have undergone breast amputation – in the presence of poor prognostic factors – the chest wall is irradiated with or without the irradiation of the axillary fossa and clavicular area. Radiotherapy is used as an adjuvant treatment in connection with the high rate of relapses in the area of the treated breast – as much as 20% after 10 years. Some patients, before the commencement of the irradiation, are treated systemically with the use of regimens comprising drugs with a high degree of cardiotoxicity. This effect may even be increased during the course of radiotherapy – mainly in patients after amputation of the left breast. The side-effects induced by radiotherapy depend on area of the heart within the field of irradiation. Studies suggest that the vulnerable parts of the heart are the coronary vessels, and primarily, the left anterior descending (LAD) artery, which is located close to the chest wall. The objective of this study is to present practical guidelines concerning contouring the left anterior descending (LAD) artery in patients with cancer of the left breast, who have qualified for radiotherapy. Contouring the LAD seems to be significant as a method of assessing the critical organ during radiotherapy. The results may cause a modification of the treatment strategy: a change to the planned radiotherapy, the quantity of the beams and/or their angle of incidence or a change in the beam weight.

Inborn errors of apolipoprotein A-I metabolism: implications for disease, research and development.

We review current knowledge regarding naturally occurring mutations in the human apolipoprotein A-I (APOA1) gene with a focus on their clinical complications as well as their exploitation for the elucidation of structure-function-(disease) relationships and therapy. Bi-allelic loss-of-function mutations in APOA1 cause HDL deficiency and, in the majority of patients, premature atherosclerotic cardiovascular disease (ASCVD) and corneal opacities. Heterozygous HDL-cholesterol decreasing mutations in APOA1 were associated with increased risk of ASCVD in several but not all studies. Some missense mutations in APOA1 cause familial amyloidosis. Structure-function-reationships underlying the formation of amyloid as well as the manifestion of amyloidosis in specific tissues are better understood. Lessons may also be learnt from the progress in the treatment of amyloidoses induced by transthyretin variants. Infusion of reconstituted HDL (rHDL) containing apoA-I (Milano) did not cause regression of atherosclerosis in coronary arteries of patients with acute coronary syndrome. However, animal experiments indicate that rHDL with apoA-I (Milano) or apoA-I mimetic peptides may be useful for the treatment of heart failure of inflammatory bowel disease. Specific mutations in APOA1 are the cause of premature ASCVD or familial amyloidosis. Synthetic mimetics of apoA-I (mutants) may be useful for the treatment of several diseases beyond ASCVD.

The Condition of the Coronary Arteries in Patients with Ischemic Mitral Insufficiency

Secondary (or functional) mitral regurgitation is the result of myocardial dysfunction due to ischemic injury with relatively normal cusps. In patients with ischemic mitral insufficiency, only surgical coronary artery bypass grafting can affect the reverse remodeling of the left ventricle and reduce the degree of mitral regurgitation. One of the main pathogenetic factors for the development of this type of mitral insufficiency is myocardial ischemia. Studying the state of coronary blood flow in patients with ischemic mitral insufficiency is a primary task in the surgical treatment of this pathology.&#x0D; The aim. To study the condition of the coronary arteries in patients with ischemic mitral insufficiency.&#x0D; Material and methods. From January 2015 to December 2019, 194 patients with ischemic mitral insufficiency underwent surgical intervention at the Amosov National Institute of Cardiovascular Surgery of the NAMS of Ukraine.&#x0D; Results and Discussion. Coronarography revealed haemodynamically significant coronary artery stenosis in 190 (97.9%) patients. In 4 (2.1%) patients there was no hemodynamically significant coronary arteries stenosis. Analysis of the data of selective angiography showed that the majority of patients with ischemic mitral insufficiency had three-vessel disease (75.2%). Occlusion of the left circumflex coronary artery was observed in 33 (17.4%), and sub-occlusive changes were detected in 3 (1.6%) of patients. A completely different lesion pattern is observed for the branches of the right coronary artery. Thus, in 56 (29.4%) cases, occlusion of a particular branch was found on angiogram. Sub-occlusion of the right coronary artery was observed in 15 (7.9%) cases.&#x0D; Conclusions. In patients with ischemic mitral insufficiency, hemodynamically significant stenosis was most often observed in the anterior interventricular artery (81.6%). Comparison of the status of the right coronary artery and circumflex artery showed that the right coronary artery lesions occurred more frequently. The section of the right coronary artery between the outflow of the acute marginal branch and the branching to the posterior interventricular and lateral branches was the most vulnerable site of the coronary bed, where the frequency of occurrence of critical stenosis was 28.4%.

Vulnerable atherosclerotic plaques of coronary arteries in patients with stable coronary artery disease: 12-months follow-up

A key objective of modern cardiology is the assessment of acute coronary syndrome (ACS) risk in patients with coronary artery disease (CAD) to develop preventive measures and choose optimal treatment strategies. Detect vulnerable plaques of non-target coronary arteries in patients with stable CAD during routine percutaneous coronary intervention using virtual-histology intravascular ultrasound (VH-IVUS) and view their morphology over time. The prospective observational cohort study included 58 patients with stable CAD. After stenting ofatarget vessel, VH-IVUS was carried out in proximal and middle segments (6-8 cm) of a non-target coronary artery with no significant stenosis according to coronary angiography. Twelve months later, all patients underwent coronary angiography with re-IVUS of previously detected lesions. Death, myocardial infarction, rehospitalization, and unplanned myocardial revascularization due to vulnerable plaques were the endpoints of the study. IVUS with virtual histology revealed 58 lesions of non-target coronary arteries in 56 (96.5 %) patients. Two patients had no lesions in non-target coronary arteries. A large necrotic core with thin cap (thin-cap fibroatheroma) was detected in 12 (20.7 %) plaques, six of which had additional ACS risk criteria (stenosis area &gt;70 % and / or lumen area &lt;4 mm2). Within the 12‑month follow-up period, three patients (one with a vulnerable plaque in IVUS) were hospitalized with a clinical picture of ACS. One cardiac death was registered in a patient with the IVUS vulnerable plaque. 7 of 12 vulnerable plaques stabilized in 12 months. 1) The data presented indicate a high rate (20.7 %) of vulnerable plaques of non-target coronary arteries in patients with stable CAD who underwent stenting; 2) Two (16.6 %) patients with vulnerable plaques reached endpoints (death and rehospitalization) within the 12‑month follow-up period; 3) An analysis ofatherosclerotic plaques in non-target coronary arteries over time showed that vulnerable plaques stabilized and did not cause ACS in more than half of cases (7 of 12); 4) Plaques that were not vulnerable according to IVUS were not likely to destabilize within the 12‑month follow-up period.

Calcification of coronary arteries and aortic valve and circulating a-klotho levels in patients with chronic kidney disease.

BackgroundEvidence suggests that the anti-aging protein a-Klotho is a central modulator of mineral homeostasis. Circulating a-Klotho exerts endocrine activity and has been implicated in the process of vascular calcification, which is accelerated in patients with chronic kidney disease (CKD) and portends an unfavorable overall prognosis. However, the role of a-Klotho in this process remains unclear. The purpose of this study was to investigate the possible interaction between a-Klotho and the calcification of the aortic valve and coronary arteries in patients with CKD.MethodsIn this study we enrolled a total of 60 adult patients with CKD. Group 1 included 30 participants with CKD stage V and group 2 included 30 participants with CKD stage III.ResultsParticipants in group 1 had lower levels of circulating a-Klotho compared to group 2 (390; 280–590 vs. 722; 501–897 pg/mL; P=0.001), were of younger age (55.5; 45–63 vs. 69; 62–74 years; P<0.001), had lower body mass index (25.6; 23.8–27.5 vs. 28.2; 25.7–31.1 kg/m2; P=0.036), higher serum phosphate (4.75; 4–5.6 vs. 3.35; 2.9–3.8 mg/dL; P<0.001), higher calcium-phosphate product (41; 35.1–49.2 vs. 31.5; 28.6–35 mg2/dL2; P<0.001), and higher parathyroid hormone (PTH) levels (28.4; 15–44.6 vs. 7.05; 4.3–10.2 pmol /L; P<0.001).ConclusionsNo statistically significant difference was found between the two groups in terms of coronary arteries and aortic valve calcification. Calcitonin, PTH and phosphate were identified as predictors for circulating a-Klotho levels whereas, only hyperlipidemia was identified as predictor for coronary artery calcification. In conclusion, circulating a-Klotho is found to decrease with worsening CKD severity but no correlation was found between the levels of a-Klotho and severity of coronary arteries and aortic valve calcification.

Outcomes in Anomalous Aortic Origin of a Coronary Artery Following a Prospective Standardized Approach

Anomalous aortic origin of a coronary artery (CA) is the second leading cause of sudden cardiac death in young athletes. Management is controversial and longitudinal follow-up data are sparse. We aim to evaluate outcomes in a prospective study of anomalous aortic origin of CA patients following a standardized algorithm. Patients with anomalous aortic origin of a CA were followed prospectively from December 2012 to April 2017. All patients were evaluated following a standardized algorithm, and data were reviewed by a dedicated multidisciplinary team. Assessment of myocardial perfusion was performed using stress imaging. High-risk patients (high-risk anatomy-anomalous left CA from the opposite sinus, presence of intramurality, abnormal ostium-and symptoms or evidence of myocardial ischemia) were offered surgery or exercise restriction (if deemed high risk for surgical intervention). Univariate and multivariable analyses were used to determine predictors of high risk. Of 201 patients evaluated, 163 met inclusion criteria: 116 anomalous right CA (71%), 25 anomalous left CA (15%), 17 single CA (10%), and 5 anomalous circumflex CA (3%). Patients presented as an incidental finding (n=80, 49%), with exertional (n=31, 21%) and nonexertional (n=32, 20%) symptoms and following sudden cardiac arrest/shock (n=5, 3%). Eighty-two patients (50.3%) were considered high risk. Predictors of high risk were older age at diagnosis, black race, intramural course, and exertional syncope. Most patients (82%) are allowed unrestrictive sports activities. Forty-seven patients had surgery (11 anomalous left CA and 36 anomalous right CA), 3 (6.4%) remained restricted from sports activities. All patients are alive at a median follow-up of 1.6 (interquartile range, 0.7-2.8) years. In this prospective cohort of patients with anomalous aortic origin of a CA, most have remained free of exercise restrictions. Development of a multidisciplinary team has allowed a consistent approach and may have implications in risk stratification and long-term prognosis.