Coronary Arteries In Patients Research Articles

Гендерно-возрастные особенности состояния коронарных артерий у лиц с впервые возникшей стенокардией

In order to study the gender and age characteristics of the state of the coronary arteries in patients with first-time acute coronary syndrome in the form of first-time angina pectoris, 103 patients of both sexes hospitalized for emergency indications in the primary vascular center of the Krasnoyarsk City Emergency Hospital were examined by a continuous sampling method. All patients underwent emergency or delayed coronary angiography according to the generally accepted method. According to coronary angiography data, hemodynamically significant atherosclerotic plaques requiring angioplasty were recorded in patients with first-time angina pectoris in the form of first-time acute coronary syndrome in approximately 18.5% of cases. At the same time, "diffuse lesions" of the coronary arteries, "narrowing of the coronary arteries by 30% or more" and "narrowing of the coronary arteries by 70% or more" were more often detected among elderly men compared to women of the same age range. Therefore, from the standpoint of therapeutic tactics, it is reasonable to conduct coronary angiography in these patients, which, if necessary, can be transformed into percutaneous transluminal coronary angioplasty.

Prognostic significance of equivalent density of calcium deposits of coronary arteries in men with osteopenic syndrome and prior coronary artery bypass grafting: prospective study

Determination of the clinical and prognostic value of the equivalent density of calcium deposits (EDCD) of coronary arteries in patients with stable coronary heart disease (CHD) and concomitant osteopenic syndrome (OS) after coronary artery bypass grafting (CABG), based on five-year follow-up. A prospective study included 393 patients with stable CHD hospitalized for CABG. All patients underwent multispiral computed tomography of coronary arteries to assess the degree of calcification and EDCD, and Х-ray absorptiometry. During the five-year observation we studied mortality and adverse cardiovascular events. The average duration of the observation period was 58.91.8 months. Data were obtained on the correlation of EDCD with the presence of OS (r=0.19; p0.001), a decrease in the T-criterion of the thigh (r=-0.21; p0.001) and lumbar vertebrae (r=-0.19; p0.001). With a decrease in the EDCD of coronary arteries below the level of 0.19 mg/mm3, an increased mortality risk is noted (odds ratio 2.84, 95% confidence interval 1.545.25). Linear regression analysis revealed that predictors of adverse outcomes over the course of a follow-up were the presence of carotid artery stenosis 30%, low left ventricular contractility, elevated triglyceride levels, and low EDCD. According to the results of the study the negative prognostic significance of the low EDCD of coronary arteries in relation to mortality, myocardial infarction, and revascularization in patients after CABG, regardless of the presence of concomitant OS.

Accuracy and Potential Benefit of Ultraselective Invasive Coronary Angiography Guided by Computed Tomographic Coronary Angiography.

It is unknown whether computed tomographic coronary angiography (CTCA) can be used to perform ultraselective invasive coronary angiography (ICA) by only visualizing the abnormal coronary artery on CTCA and defer visualization of the normal contralateral coronary artery. This study assessed the accuracy of CTCA in patients with coronary artery disease (CAD) on CTCA limited to either the left (LCA) or right coronary artery (RCA) in predicting a contralateral coronary artery without abnormalities on CTCA determined to be normal by ICA. This retrospective analysis included patients with CAD limited to the LCA or RCA on CTCA. Primary endpoint was the accuracy of CTCA to predict a contralateral coronary artery without abnormalities on CTCA to be normal by ICA. Secondary endpoints were potential reductions in procedure time and radiation exposure if an ultraselective ICA approach would be used compared to standard ICA. In total, 202 patients were included. CTCA was correct in predicting a normal contralateral coronary artery in 201 of the 202 patients (99.5%). Deferring ICA of the normal contralateral coronary artery on CTCA resulted in a potential reduction in procedure time and dose area product of 4.22 ± 2.67 minutes (61 ± 16% reduction) and 1501 ± 1304 mGy•cm² (29 ± 13% reduction). In this retrospective study, CTCA was extremely accurate in predicting a normal contralateral coronary artery in patients with LCA- or RCA-limited CAD on CTCA. A potential CTCA-guided ultraselective ICA approach was feasible and would have led to a considerable decrease in procedure time and radiation exposure.

Frequency of Coronary Artery Anomalies Undergoing Coronary Interventions Patients at Tertiary Hospital

Aims: This study aims to identify the frequency of Coronary Artery Anomalies (CAA) in coronary intervention receiving patients at tertiary care hospital.
 Sample: To obtain the sample size of the study i.e., 228 were selected at a Confidence level of 95%.
 Study Design: Cross-sectional study.
 Place and Duration of Study: This Descriptive cross-sectional study was conducted at Tertiary care hospital - National Institute of Cardiovascular Disease, Sindh-Karachi. Six months after the approval from IRB-NICVD (April 2018 – October 2018).
 Methodology: Nonprobability consecutive sampling was used to collect the study data. All Patients of either gender from age 18 to 60 years of age undergoing Primary Coronary Intervention (PCI)/ coronary artery angiography because of substernal chest pain were included.
 Results: Total 228 sample population was enrolled in the study, among which 88 (38.6%) were females and 140 (61.4%) were males. CAA was found in the coronary arteries of patients with abnormal aortic valves with a frequency of 1.3 percent. The most often occurring anomaly in our analysis is the separation of the origins of Left Anterior Descending Artery (LAD) and Left Circumflex Artery (LCx) from the Left Coronary Artery (LCA). The Circumflex Artery resulting from Right Coronary Sinus (RCS)/ Right Coronary Artery (RCA) was the second most often seen anomaly in our analysis, accounting for 22.78 percent of all anomalies. The RCA caused by LCS was the next abnormality, with a 7.59 percent frequency. In three cases, the left major coronary artery was derived from RCS, accounting for 3.8 percent of abnormalities.
 Conclusion: Among patients receiving diagnostic coronary angiography, we discovered a 0.9 percent incidence of coronary artery abnormalities. In our research, the prevalence of coronary artery abnormalities was 7% among patients who had coronary procedures. The drawback of our research is that we only included individuals who had had coronary angiograms rather than a random sample of the different cardiac tertiary care hospitals.

Distal coronary artery abnormalities in Kawasaki disease: experience on CT coronary angiography in 176 children.

Precise evaluation of coronary artery abnormalities (CAAs) in Kawasaki disease (KD) is essential. The aim of this study is to determine role of CT coronary angiography (CTCA) for detection of CAAs in distal segments of coronary arteries in patients with KD. CTCA findings of KD patients with distal coronary artery involvement were compared with those on transthoracic echocardiography (TTE) during the period 2013-21. Among 176 patients with KD who underwent CTCA (128-Slice Dual Source scanner), 23 (13.06%) had distal CAAs (right coronary-15/23; left anterior descending-14/23; left circumflex-4/23 patients). CTCA identified 60 aneurysms-37 proximal (36 fusiform; 1 saccular) and 23 distal (17 fusiform; 6 saccular); 11 patients with proximal aneurysms had distal contiguous extension; 9 patients showed non-contiguous aneurysms in both proximal and distal segments; 4 patients showed distal segment aneurysms in absence of proximal involvement of same coronary artery; 4 patients had isolated distal CAAs. On TTE, only 40 aneurysms could be identified. Further, distal CAAs could not be identified on TTE. CTCA also identified complications (thrombosis, mural calcification and stenosis) that were missed on TTE. CAAs can, at times, occur in distal segments in isolation and also in association with, or extension of, proximal CAAs. CTCA demonstrates CAAs in distal segments of coronary arteries, including branches, in a significant number of children with KD-these cannot be detected on TTE. CTCA may therefore be considered as a complimentary imaging modality in children with KD who have CAAs on TTE.

Anomalous origin of the left coronary artery in patient with reduction of right coronary artery flow reserve detected by CZT camera

Anomalous origin of the left coronary artery in patient with reduction of right coronary artery flow reserve detected by CZT camera

Phasic flow patterns of right versus left coronary arteries in patients undergoing clinical physiological assessment.

Coronary blood flow in humans is known to be predominantly diastolic. Small studies in animals and humans suggest that this is less pronounced or even reversed in the right coronary artery (RCA). This study aimed to characterise the phasic patterns of coronary flow in the left versus right coronary arteries of patients undergoing invasive physiological assessment. We analysed data from the Iberian-Dutch-English Collaborators (IDEAL) study. A total of 482 simultaneous pressure and flow measurements from 301 patients were included in our analysis. On average, coronary flow was higher in diastole both at rest and during hyperaemia in both the RCA and LCA (mean diastolic-to-systolic velocity ratio [DSVR] was, respectively, 1.85±0.70, 1.76±0.58, 1.53±0.34 and 1.58±0.43 for LCArest, LCAhyp, RCArest and RCAhyp, p<0.001 for between-vessel comparisons). Although the type of RCA dominance affected the DSVR magnitude (RCAdom=1.55±0.35, RCAco-dom=1.40±0.27, RCAnon-dom=1.35; standard deviation not reported as n=3), systolic flow was very rarely predominant (DSVR was greater than or equal to 1.00 in 472/482 cases [97.9%] overall), with equal prevalence in the LCA. Stenosis severity or microvascular dysfunction had a negligible impact on DSVR in both the RCA and LCA (DSVR x hyperaemic stenosis resistance R2 =0.018, p=0.03 and DSVR x coronary flow reserve R2 <0.001, p=0.98). In patients with coronary artery disease undergoing physiological assessment, diastolic flow predominance is seen in both left and right coronary arteries. Clinical interpretation of coronary physiological data should therefore not differ between the left and the right coronary systems.

CRT-100.33 Incidence and Impact of Totally Occluded Culprit Coronary Artery in Patients With Non-ST Segment Elevation Myocardial Infarction Acute Coronary Syndrome

CRT-100.33 Incidence and Impact of Totally Occluded Culprit Coronary Artery in Patients With Non-ST Segment Elevation Myocardial Infarction Acute Coronary Syndrome

Dosimetric Comparison of the Heart and Left Anterior Descending Artery in Patients With Left Breast Cancer Treated With Three-Dimensional Conformal and Intensity-Modulated Radiotherapy.

BackgroundAdjuvant radiotherapy plays an important role in the management of breast cancer, along with surgery and chemotherapy. However, postoperative radiotherapy poses an increased risk of radiation-induced heart diseases in patients with left-sided breast cancer due to damage of the coronary arteries, which can cause myocardial fibrosis and coronary artery disease; however, there is a lack of sufficient evidence for it. Hence, the present study aimed to assess the dosimetric parameters of the heart and left anterior descending (LAD) coronary artery in patients with left breast cancer treated with three-dimensional conformal radiotherapy (3DCRT) and intensity-modulated radiotherapy (IMRT).MethodologyThis study included 20 patients with left-sided breast cancer treated between January and July 2019. Patients were equally divided into two groups as follows: group I included those treated with 3DCRT and group II included those treated with IMRT. Radiotherapy was administered to the chest wall and regional lymph nodes. The dose administered for the planning target volume was 50 Gy in 25 daily fractions over five weeks with 6 MV photons. Dosimetric parameters of planning tumor volume (PTV; V95%, V90%, Dmax, Dmin, Dmean, V53.5 Gy, conformity index, and homogeneity index) along with the heart (V5%, V30%, and Dmean) and LAD artery (mean and V25%) were evaluated. Dose-volume histograms were generated and compared. The LAD artery was contoured virtually retrospectively during the study to determine the dosimetric parameters; the dose to the LAD artery was not considered during planning.ResultsDosimetric parameters of the PTV were similar for 3DCRT and IMRT; D95 (38.53 vs. 41.61 Gy), D90 (43.67 vs. 44.77 Gy), Dmean (48.3 vs. 48.72 Gy), conformity index (1.10 vs. 1.06), and homogeneity index (0.50 and 0.28) did not show a significant difference. The Dmean for the LAD artery was significantly higher than that for the heart on 3DCRT (23.66 Gy vs. 8.46 Gy; p < 0.0000) and IMRT (31.53 vs. 17.7 Gy; p < 0.0000). The V25 for the LAD artery was significantly higher than that for the heart on 3DCRT (40.27 vs. 14.13 Gy; p < 0.0024) and IMRT (66.21 vs. 27.74 Gy; p < 0.0002).ConclusionsRadiation doses to the LAD artery and heart must be evaluated prior to radiotherapy in patients with left breast cancer. Long-term follow-up is needed to evaluate cardiac complications and their association with dosimetric parameters.

Double rule-out technique for evaluation of acute chest pain using 128-row multidetector CT

To evaluate the feasibility and image quality of the double rule-out (DRO) technique using 128-row multidetector computed tomography (CT) for simultaneous evaluation of the aorta and coronary arteries in patients with acute non-specific chest pain. Sixty-eight patients underwent electrocardiography (ECG)-gated coronary CT followed by non-ECG-gated abdominal CT. The contrast-to-noise ratio and signal-to-noise ratio between the vessels and adjacent perivascular fat tissue were calculated for both the aorta and coronary arteries. Dose-length products were recorded. Two blinded readers graded the image quality of the aorta and coronary arteries on a two-point and a four-point scale, respectively. In addition, the severity of coronary stenosis was independently analysed for each coronary vessel. The average attenuation was more than 350 HU for the aorta and >330 HU for the coronary arteries. The average (±standard deviation) volume of contrast media was 69.5±12.5 ml. Interobserver agreement on the image quality of aortic and coronary data sets was perfect and substantial, respectively. There was almost perfect interobserver agreement for the all observations of the severity of coronary stenosis. The DRO technique with a standard volume (approximately 70 ml) of contrast media is useful for acute chest pain evaluation in patients suspected of having acute aortic syndrome or acute coronary syndrome. It is also accurate and safe while maintaining the average CT attenuation of the aorta and coronary arteries >330 HU.

Epicardial Adipocyte-derived TNF-α Modulates Local Inflammation in Patients with Advanced Coronary Artery Disease.

Epicardial Adipose Tissue (EAT) surrounds the epicardium and can mediate harmful effects related to Coronary Artery Disease (CAD). We explored the regional differences between adipose stores surrounding diseased and non-diseased segments of coronary arteries in patients with advanced CAD. We enrolled 32 patients with known CAD who underwent coronary artery bypass graft (CABG) surgery. Inflammatory mediators were measured in EAT biopsies collected from a region of the Left Anterior Descending Artery (LAD) with severe stenosis (diseased segment) and without stenosis (non-diseased segment). Mean age was 64.3±11.1 years, and mean EAT thickness was 7.4±1.9 mm. Dyslipidemia was the most prevalent comorbidity (81% of the patients). Out of a total of 11 cytokines, resistin (p=0.039), matrix metallopeptidase 9 (MMP-9) (p=0.020), C-C motif chemokine ligand 5 (CCL-5) (p=0.021), and follistatin (p=0.038) were significantly increased in the diseased compared with the non-diseased EAT segments. Indexed tumor necrosis factor-alpha (TNF-α), defined as the diseased to non-diseased cytokine levels ratio, was significantly correlated with increased EAT thickness both in the whole cohort (p=0.043) and in a subpopulation of patients with dyslipidemia (p=0.009). Treatment with lipid-lowering agents significantly decreased indexed TNF-α levels (p=0.015). No significant alterations were observed in the circulating levels of these cytokines with respect to CAD-associated comorbidities. Perivascular EAT is a source of cytokine secretion in distinct areas surrounding the coronary arteries in patients with advanced CAD. Adipocyte-derived TNF-α is a prominent mediator of local inflammation.

ОСОБЕННОСТИ ЛИПИДЕМИИ И АТЕРОСКЛЕРОТИЧЕСКОГО ПОРАЖЕНИЯ КОРОНАРНОГО РУСЛА У ЛИЦ С ОСТРЫМ КОРОНАРНЫМ СИНДРОМОМ И СУБКЛИНИЧЕСКИМ ГИПОТИРЕОЗОМ

Objective: To assess the derangements in lipid metabolism and the severity of atherosclerotic disease of the coronary arteries in patients with the acute coronary syndrome (ACS) and subclinical hypothyroidism (SHT). Methods: 146 medical records of inpatients of working age with newly developed ACS and various thyroid hormonal statuses were analysed. The lipid profile, high-sensitivity C-reactive protein (hs-CRP), thyroid-stimulating hormone (TSH), and free thyroid hormones (free thyroxine, FT4, and free triiodothyronine, FT3) levels were investigated. Coronary angiography results were used to assess coronary atherosclerotic plaque burden. The study group comprised 67 patients with ACS and SHT (TSH level &gt;4.0 mIU/l with normal thyroid hormone levels), and the control group included 79 ACS patients without thyroid hormonal abnormalities. The groups were matched for the presence of unhealthy habits, gender, age, and severity of arterial hypertension. Before admission to the hospital, patients did not receive preventive therapy for coronary artery disease (CAD) or hormone replacement therapy. Results: In SHT patients, in comparison with the group of patients with normal thyroid function, the proportion of individuals with type IIa hyperlipidemia was higher – 82.0% (n=55) and 46.8% (n=37), respectively (χ2=19.33; p&lt;0.001). A medium strength direct correlation was established between laboratory confirmed SHT and atherogenic dyslipidemia (r=0.62; p&lt;0.01), an increase in the level of hs-CRP (r=0.74; p&lt;0.01), and multivessel CAD (r=0.58; p&lt;0.05). Conclusion: In patients with CHT, the proportion of individuals with multivessel coronary artery stenosis is higher, and CAD occurs in the presence of hs-CRP and atherogenic dyslipidemia. Keywords: Acute coronary syndrome, coronary artery disease, atherosclerosis, hyperlipidemia, subclinical hypothyroidism, thyroid gland.

БЕССОБЫТИЙНАЯ ВЫЖИВАЕМОСТЬ ПАЦИЕНТОВ С ОСТРЫМ ИНФАРКТОМ МИОКАРДА С ПРИМЕНЕНИЕМ КОМБИНИРОВАННОГО ДИСТАНТНОГО ИШЕМИЧЕСКОГО КОНДИЦИОНИРОВАНИЯ В ТЕЧЕНИЕ 36 МЕСЯЦЕВ

Background. Reperfusion injury occurs after revascularization of the coronary artery in patients with myocardial infarction (MI) significantly contributing to the development of chronic heart failure. This article describes the results of studying the effectiveness of one of the promising cardioprotection strategies aimed at limiting reperfusion injury. Materials and methods. Patients with acute anterior MI with ST elevation (STEMI) (n = 87) were included in an open-label prospective randomized controlled trial. Intervention group (IG) patients underwent primary percutaneous coronary intervention (PPCI) and remote ischemic preconditioning in combination with delayed postconditioning (RIPerPostC) (n = 43). Control group patients (CG) underwent only standard PPCI (n = 44). Event-free survival was estimated by Kaplan-Meier curves. Results. A comparative analysis of the frequency of the composite endpoint (re-hospitalizations for the underlying disease, repeated MI and death from cardiac causes) by the 36th month of follow-up had shown that the proportion of patients who reached the endpoint was significantly higher in the CG: 45.5% vs 20.9% in the IG (p = 0.015). According to the results of the log-rank test, there are statistically significant differences in the event-free survival of the analyzed groups (LR = 1.99, p = 0.047). The Kaplan-Meier curves of the CG and IG during the first 12 months after AMI did not differ visually in height and slope, which indicated the absence of intergroup differences in the cumulative functions of event-free survival during the indicated observation period. After 12 months, there was a discrepancy between the Kaplan-Meier curves due to the fact that the survival rate continued to decrease rapidly only in the CG. According to the survival function, in 25% of CG patients, adverse events occurred within the first 13 months after AMI. Taking into account censored observations, the cumulative proportion of patients without major clinical events 36 months after AMI in the IG was 74% versus 38% in the CG. Conclusion. In patients with STEMI the DIPerPostC method in combination with PPCI has a positive effect on patient survival over 36 months in comparison with isolated PPCI. The highest number of adverse events occurred during the period from 12 to 36 months of observation in the CG.

Common coronary artery occlusions in patients with myocardial infarction.

coronary artery disease (CAD) is a significant cardiovascular disease (CVD) that affects people worldwide. This study aimed to determine the main occluded coronary arteries in patients with myocardial infarction in Najran, Kingdom of Saudi Arabia (KSA). a retrospective cross-sectional study conducted between March 2020 and March 2021 and involving 661 myocardial infarction patients recruited from two hospitals (King Khalid Hospital and Prince Sultan Centre for Healthcare in Najran) used sampling for enrolled patients. Patients over the age of 15 years, current residents of KSA, and diagnosed with coronary artery occlusion based on at least one identifiable coronary lesion on a coronary angiography were considered eligible. We created generalized linear mixed models to investigate patients´ clinical and coronary angiographic features and identify statistically relevant components. there were 661 CAD cases in this study: 548 (82.9%) males and 113 (17.1%) females, with a mean and standard deviation (SD) age of 4.03 ± 1.370 years. Ages of the 661 participants ranged from 15 to 85, who had been diagnosed with myocardial infarction were evaluated. It was found that most of the patients were in the 55-64 age range. The majority of cases (366 (55.4%) had ST-segment elevation myocardial infarction (STEMI), 187 (28.3%) had non-ST-segment elevation (NSTEMI), 101 (15.3%) had acute coronary syndrome-non-ST-segment elevation (ACS-NSTEMI), and 7 (1.1%) had acute coronary syndrome-ST-segment elevation (ACS-STEMI). the left anterior descending artery (LAD) is the commonest lesion found in both ST-segment elevation and non-ST-segment elevation myocardial infarction patients.

Long-term results of balloon angioplasty of coronary arteries in patients with coronary artery disease

Long-term results of balloon angioplasty of coronary arteries in patients with coronary artery disease

Echocardiographic evolution of posterolateral left ventricular aneurysm with normal coronary arteries in patient recently COVID-19 vaccinated: A complicated atypical case of takotsubo syndrome vaccine-related?

A 72-year-old woman, recently COVID-19 vaccinated with a third dose, was referred to our center for acute chest pain and dyspnea. On admission, the electrocardiography showed a STEMI on inferior derivations and the dyskinesia of the inferior wall was found at the first transthoracic echocardiogram. The coronary angiography did not show coronary artery disease. After 1 week, a huge posterolateral left ventricular (LV) aneurysm with initial signs of rupture was found and the patient underwent a Dor's procedure to exclude the LV aneurysm. As far as we know, this is the first reported case of Takotsubo following the COVID-19 vaccination requiring cardiac surgery.

Angiographic Severity of Coronary Artery Disease in Diabetic and Non-diabetic Acute STEMI Patients in a Tertiary Care Centre of Nepal

Background Patients with diabetes mellitus have a higher prevalence of atherosclerotic heart disease and a higher incidence of myocardial infarction than the general population. Definitive diagnosis and precise assessment of anatomic severity of Coronary Artery Disease requires invasive diagnostic modality like coronary angiography.&#x0D; Objective To study angiographic characteristics and severity involving coronary arteries in patients with acute ST segment elevation Myocardial infarction and to compare the same in diabetics and non-diabetics.&#x0D; Method Among 150 patients with acute coronary syndrome, 75 diabetics and 75 nondiabetics admitted in Manmohan Cardiothoracic vascular and transplant Centre were selected randomly during a period of one year formed the study group. Random Blood Sugar, Fasting Blood Sugar was done in all 150 patients, HbA1c in all diabetics. All subjects with acute ST Elevation Myocardial Infarction were taken up for coronary angiography intended for primary PCI.&#x0D; Result In our study, 35 (46.7%) out of 75 diabetic patients had triple or multi-vessel disease compared to 10 (13.4%) out of 75 non diabetics. Non-diabetic patients had significantly higher single vessel disease (65.3%). There was a statistically significant association of duration of DM with vessels involved. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration &gt; 10 years compared to patients with DM duration &lt; 10 years (64.7% vs. 35.3%, P &lt; 0.001), however there was no significant difference in type of vessel involved. Similarly, a significantly higher proportion of Triple vessel disease was observed in patients with poor glycemic control (HbA1c &gt; 8.5%). 72.2% of the patients with HbA1c &gt; 8.5% had Triple vessel disease/Multi vessel disease, whereas patients with good glycemic control (HbA1c &lt; 7.0%) had predominantly Single vessel disease (90.0%), with no occurrence of Triple vessel disease/Multi vessel disease&#x0D; Conclusion Diabetic patients presenting with ST Elevation Myocardial Infarction are likely to have triple/multiple vessel disease compared to non-diabetic patients. The occurrence of Triple Vessel Disease/Multivessel Disease was significantly higher in the patients with DM duration &gt; 10 years compared to patients with DM duration &lt;10 years.

Ischemia and no obstructive coronary arteries in patients with stable ischemic heart disease

A large proportion of patients with suspected obstructive coronary artery disease (CAD) is found to have ischemia with no obstructive coronary artery disease (INOCA). Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. Importantly, INOCA is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced health-related quality of life, and high healthcare costs. Underlying coronary microvascular dysfunction (CMD), through endothelium-dependent and independent mechanisms contribute to these adverse outcomes in INOCA. While non-invasive and invasive diagnostic testing has typically focused on identification of obstructive CAD in symptomatic patients, functional testing to detect coronary epicardial and microvascular dysfunction should be considered in those with INOCA who have persistent angina. Current diagnostic methods to clarify functional abnormalities and treatment strategies for epicardial and/or microvascular dysfunction in INOCA are reviewed.

Detection of symptom-related coronary arteries in patients with coronary artery disease using real-time three-dimensional stress echocardiography with adenosine triphosphate

Aim 1) To develop normative values of global and regional left ventricular longitudinal deformation (LVLD) during real time three-dimensional stress echocardiography with adenosine triphosphate (ATP) and utilization of automated function imaging technology (4D Stress-Echo + LVLD with ATP); 2) to compare the effectiveness of detection of symptom-related coronary arteries during 4D Stress-Echo with ATP using: a) traditional visual assessment of regional myocardial contractility and b) step-by-step analysis of segmental LVLD.Material and Methods 15 healthy subjects and 32 patients with coronary artery disease (CAD) were examined after coronary angiography. All individuals underwent 4D Stress-Echo + LVLD with ATP (Vivid E95, General Electric).Results The normative values of global LVLD at three stages of the pharmacological stress-test (before, during and after ATP infusion) were –19.5 (95% CI: -20.4 – -19.0), –21.6 (95% CI: -22.8 – -20.4) and –19.5 (95% CI: -20.3 – -18.6), respectively; the values of LVLD in each of the 17 segments of left ventricular myocardium in healthy subjects were also determined. In patients with CAD visual control of contractility during stress test revealed dynamic decrease in local thickening of the myocardium, appearance of new zones of contractility disorders and expansion of previously noted in 31.2% of cases, while analysis of deformation detected the appearance of new zones of deformation disturbances and expansion of previously found – in 68.7% (р = 0.0055). Stress-induced worsening of myocardial deformation during ATP infusion in the zones of blood supply of left anterior descending coronary artery, circumflex artery and right coronary artery (with presence of hemodynamically significant stenoses and occlusions detected during coronary angiography) were found in 28.0, 77.7 and 65.2% respectively (р1-3 = 0.0194; р1-2 = 0.0019; р2-3 = 0.2864).Conclusion The normal values of global and segmental LVLD for each stage of 4D Stress-Echo + LVLD with ATP were determined. 4D Stress-Echo + LVLD with ATP can significantly increase the effectiveness of symptom-related coronary arteries identification in patients with CAD in comparison with traditional Stress-Echo with visual assessment of local myocardial contractility.

18F-Sodium fluoride uptake is associated with severity of atherosclerotic stenosis in stable ischemic heart disease

BackgroundIncreased uptake of 18F-Sodium fluoride (18F-NaF) PET has potential to identify atherosclerotic plaques that are vulnerable to rupture. Whether 18F-NaF PET can evaluate the significance of atherosclerotic plaque in patients with stable coronary artery disease is less clear. We evaluated 18F-NaF PET uptake in coronary arteries in patients without acute coronary artery syndrome to determine the association of 18F-NaF signal uptake with severity of coronary stenosis. Methods and ResultsWe retrospectively identified 114 patients who received both regadenoson stress 82Rb myocardial perfusion PET and 18F-NaF PET study with an average interval of 5 months. Out of this cohort, forty-one patients underwent invasive coronary angiography. In a patient-based analysis, patients with ischemic regadenoson stress 82Rb PET had significantly higher coronary 18F-NaF uptake than patients with normal myocardial perfusion (P < .01). Among the 41 patients who underwent coronary angiography, per-vessel 18F-NaF uptake in both obstructive and nonobstructive coronary arteries was significantly higher than in normal coronary arteries (P < .05) regardless of the severity of coronary calcification. There was poor correlation between calcification and 18F-NaF uptake in coronary arteries (r = 0.41) ConclusionCoronary arterial 18F-NaF uptake is associated with coronary stenosis severity in patients with stable coronary artery disease. 18F-NaF PET studies may be useful for characterizing coronary atherosclerotic plaques.