Coronary Artery Anatomy Research Articles

Hypertensive Disorders of Pregnancy Increase the Risk for Myocardial Infarction: APopulation-Based Study.

Angiographic evidence of the anatomy of coronary arteries and the type of coronary artery lesions in women with a history of hypertensive disorders of pregnancy (HDP) are poorly documented. This study sought to determine the role of a history of HDP as a unique risk factor for early coronary artery disease (CAD) and type of acute coronary syndrome (ACS) (ie, atherosclerotic vs myocardial infarction with nonobstructive coronary arteries [MINOCA]) in women who underwent coronary angiography. This study used a population-based cohort of parous female patients with incident CAD who underwent coronary angiography and age-matched control subjects. The SYNTAX (Synergy between PCI [percutaneous coronary intervention] with TAXUS [Boston Scientific] and Cardiac Surgery) score was assessed to determine the complexity and degree of CAD; MINOCA was diagnosed in the presence of clinical acute myocardial infarction in the absence of obstructive coronary disease. A total of 506 parous female Olmsted County, Minnesota (USA) residents had incident CAD and angiographic data from November 7, 2002 to December 31, 2016. Women with HDP were younger than normotensive women at the time of the event (median: 64.8 years vs 71.8 years; P=0.030). There was a strong association between HDP and ACS (unadjusted P=0.018). Women with HDP compared with women with normotensive pregnancies were more likely to have a higher SYNTAX score (OR: 2.28; 95%CI: 1.02-5.12; P=0.046), and MINOCA (OR: 2.08; 95%CI: 1.02-4.25; P=0.044). A history of HDP is associated with CAD earlier in life and with a future risk for myocardial infarction with both obstructive and nonobstructive coronary arteries. This study underscores the need for timely detection and treatment of nonobstructive disease, in addition to traditional risk factors.

Impact of chronic kidney disease on patients with Myocardial Infarction with Non Obstructive Coronary Arteries (MINOCA)

Abstract Background Chronic kidney disease (CKD) in patients with myocardial infarction (MI) is associated with more advanced disease, a higher risk of complications and poorer prognosis, as well as increased mortality. The aim of this study is to assess the impact of CKD in patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and its influence on the prognosis of these patients. Methods it was an observational, prospective and analytic study. We analyzed all consecutive patients with MI who underwent coronary angiography admitted to our Hospital between 2016 and 2023; MINOCA patients were classified following the 2023 ESC Guidelines definition. The patients were divided into two groups depending on whether they had CKD or not. Median follow-up was 43 months [20-71]. Results we included 136 patients with MINOCA, of whom 11 (8.1%) had CKD. Patients with impaired kidney function were older and mostly male. They also exhibited a higher prevalence of classic cardiovascular risk factors such as hypertension, diabetes, or dyslipidemia. However, there were fewer smokers in this group. We did not find significant differences in coronary artery anatomy (smooth or small plaques) between both groups. Additionally, the majority of patients in both groups had preserved left ventricular function. Despite that, patients with CKD typically had ST segment elevation in the ECG and higher myocardial injury biomarkers’ levels as well as NT-proBNP. During hospitalization, patients without renal dysfunction had more complications (11.2% vs 0%, p=0.062) such as inotropic requirements, stroke or cardiogenic shock, but overall there were very few. In terms of treatment, it was fairly similar in both groups, although patients with kidney disease received diuretics significantly more often. Throughout the follow up, there were no significant differences in MACE (major adverse cardiovascular events) between death (27.3% vs 7.4%, p=0.06), readmission (10% vs 10.8%, p=1) or MI (0% vs 3.4%, p=1), but patients with CKD suffered more frequently from stroke (40% vs 4.2%, p<0.01). Conclusions 1) Patients with MINOCA and CKD are typically older and predominantly male with a high prevalence of cardiovascular comorbidities (hypertension, diabetes, dyslipidaemia). 2) The severity of MI appears to be slightly higher in this group, as evidenced by more ST-segment elevation upon admission and higher hs Troponine T levels. However, they experience fewer cardiovascular complications and maintain normal left ventricular function. 3) Although we found no significant differences in major adverse cardiovascular events (MACE), patients with CKD were more likely to suffer from stroke.Table 1Table 1

The value of CCTA combined with machine learning for predicting angina pectoris in the anomalous origin of the right coronary artery

BackgroundAnomalous origin of coronary artery is a common coronary artery anatomy anomaly. The anomalous origin of the coronary artery may lead to problems such as narrowing of the coronary arteries at the beginning of the coronary arteries and abnormal alignment, which may lead to myocardial ischemia due to the compression of the coronary arteries. Clinical symptoms include chest tightness and dyspnea, with angina pectoris as a common symptom that can be life-threatening. Timely and accurate diagnosis of anomalous coronary artery origin is of great importance. Coronary computed tomography angiography (CCTA) can provide detailed information on the characteristics of coronary arteries. Therefore, we combined CCTA and artificial intelligence (AI) technology to analyze the CCTA image features and clinical features of patients with anomalous origin of the right coronary artery to predict angina pectoris and the relevance of different features to angina pectoris.MethodsIn this retrospective analysis, we compiled data on 15 characteristics from 126 patients diagnosed with anomalous right coronary artery origins. The dataset encompassed both CCTA imaging attributes, such as the positioning of the right coronary artery orifices and the alignment of coronary arteries, and clinical parameters including gender and age. To identify the most salient features, we employed the Chi-square feature selection method, which filters features based on their statistical significance. We then focused on features yielding a Chi-square score exceeding a threshold of 1, thereby narrowing down the selection to seven key variables, including cardiac function and gender. Subsequently, we evaluated seven classifiers known for their efficacy in classification tasks. Through rigorous training and testing, we conducted a comparative analysis to identify the top three classifiers with the highest accuracy rates.ResultsThe top three classifiers in this study are Support Vector Machine (SVM), Ensemble Learning (EL), and Kernel Approximation Classifier. Among the SVM, EL and Kernel Approximation Classifier-based classifiers, the best performance is achieved for linear SVM, optimizable Ensembles Learning and SVM kernel, respectively. And the corresponding accuracy is 75.7%, 75.7%, and 73.0%, respectively. The AUC values are 0.77, 0.80, and 0.75, respectively.ConclusionsMachine learning (ML) models can predict angina pectoris caused by the origin anomalous of the right coronary artery, providing valuable auxiliary diagnostic information for clinicians and serving as a warning to clinicians. It is hoped that timely intervention and treatment can be realized to avoid serious consequences such as myocardial infarction.

Letter: Deciphering a "curious" coronary artery anatomy.

Letter: Deciphering a "curious" coronary artery anatomy.

CXCL12 drives natural variation in coronary artery anatomy across diverse populations.

To efficiently distribute blood flow to cardiac muscle, the coronary artery tree must follow a specific branching pattern over the heart. How this pattern arises in humans is unknown due to the limitations of studying human heart development. Here, we leveraged a natural variation of coronary artery anatomy, known as coronary dominance, in genetic association studies to identify the first known driver of human coronary developmental patterning. Coronary dominance refers to whether the right, left, or both coronary arteries branch over the posterior left ventricle, but whether this variability is heritable and how it would be genetically regulated was completely unknown. By conducting the first large-scale, multi-ancestry genome-wide association study (GWAS) of coronary dominance in 61,043 participants of the VA Million Veteran Program, we observed moderate heritability (27.7%) with ten loci reaching genome wide significance. An exceptionally strong association mapped DNA variants to a non-coding region near the chemokine CXCL12 in both European and African ancestries, which overlapped with variants associated with coronary artery disease. Genomic analyses predicted these variants to impact CXCL12 levels, and imaging revealed dominance to develop during fetal life coincident with CXCL12 expression. Reducing Cxcl12 in mice to model the human genetics altered septal artery dominance patterns and caused coronary branches to develop away from Cxcl12 expression domains. Cxcl12 heterozygosity did not compromise overall artery coverage as seen with full deletion, but instead changed artery patterning, reminiscent of the human scenario. Together, our data support CXCL12 as a critical determinant of human coronary artery growth and patterning and lay a foundation for the utilization of developmental pathways to guide future precision 'medical revascularization' therapeutics.

Pulmonary Atresia with Intact Ventricular Septum: Correlation of Preoperative Computed Tomography-Derived Parameters with Echocardiographic Tricuspid Valve Z-Score and Surgical Outcomes.

The role of preoperative cardiac computed tomography (CT) in neonates with pulmonary atresia and intact ventricular septum (PA-IVS) remains unclear. This study was aimed to elaborate the role of preoperative CT-derived anatomical and functional findings in planning treatment strategies in neonates with PA-IVS. The presence of ventriculocoronary arterial connections was evaluated by CT. CT-derived ventricular volumetric parameters were compared and correlated with echocardiographic tricuspid valve (TV) z-score in 12 neonates with PA-IVS. Cardiac CT and echocardiographic findings were compared between definite surgical types (median follow-up, 4years). Ventriculocoronary arterial connections were identified with CT in 58.3% of cases (7/12) and associated with higher incidence of Fontan procedure (42.9%, 3/7) and high mortality (28.6%, 2/7). The CT-derived and echocardiographic TV z-scores exhibited a high correlation (R = 0.924, p < 0.001). The CT-derived right ventricle (RV) volume and RV-left ventricle volume ratio also displayed high correlations (R = 0.875 and 0.867, respectively; p < 0.001) with echocardiographic TV z-score. More positive echocardiographic TV z-score, high CT-derived RV end-diastolic volume and RV-left ventricle volume ratio, and low CT-derived left ventricular end-diastolic volume were observed in biventricular surgery group (N = 2), compared to Fontan operation (N = 3) and 1.5 ventricular surgery (N = 3) groups, and mortality cases (N = 3). Preoperative CT-derived coronary artery anatomy and ventricular volumetric parameters may supplement treatment planning in neonates with PA-IVS especially when multifactorial decision including echocardiographic TV z-score is in a gray zone.W.

A Pictorial Essay of Coronary Artery Anomalies on Coronary CT Angiography: A Single-Centre Observational Study.

Background Congenital anomalies of the coronary artery anatomy (CAAs) encompass a spectrum of disorders, often asymptomatic but potentially carrying severe clinical implications such as arrhythmia, chest pain, myocardial infarction, or sudden death. The estimated prevalence of CAAs in the general population ranges from 0.3% to 1.3%, with underdiagnosis in asymptomatic individuals. Multidetector computed tomography angiography (CTA) has emerged as a vital non-invasive tool for diagnosing and characterising CAAs, offering improved visualisation and aiding in appropriate management decisions. This study aims to analyse the spectrum of CAAs in a tertiary care setting, focusing on imaging features, prevalence, and potential clinical significance, utilising data from patients who underwent multidetector CTA. Methodology A single-centre, retrospective analysis of consecutive coronary angiograms over a five-year period identified patients with CAAs, with imaging conducted using a 128-slice, single-source CT scanner. Detailed imaging evaluation was performed by experienced radiologists, with anomalies classified according to established criteria. Results Among 756 coronary CTA examinations analysed, 37 instances of anomalous coronary vessels were identified. The study revealed a diverse range of anomalies, including myocardial bridging, anomalous origin of coronary arteries, and extracardiac abnormalities. Conclusions This study contributes valuable insights into the prevalence and imaging features of CAAs, enhancing our understanding of these anomalies and guiding improved patient outcomes in cardiovascular care. Future research should focus on elucidating pathophysiological mechanisms and establishing multicenter registries to address the challenges associated with studying these infrequent but clinically significant anomalies.

SECT and DECT coronarography

Coronary artery disease is an atherosclerotic disease of the coronary arteries with consequent development of ischemic heart disease and is one of the leading causes of death in developed and developing countries. The “golden” standard in the diagnosis of coronary disease is invasive coronarography, but with the development of coronary CT angiography, a sub-millimetre precise assessment of the anatomy of coronary arteries and heart has been made possible. While in the earlier stages, SECT devices were used for the needs of coronary CT angiography with synchronization with the ECG, the development of DECT devices enabled a significant rise in the performance of coronary CT angiography in the form of a better assessment of anatomy and stenoses of the coronary arteries caused by plaque, the possibility of assessing heart perfusion, obtaining an image with a minimal amount of artifacts, a smaller amount of applied iodine contrast agent, better characterization of the atherosclerotic plaque and its components, and all of the above with a lower radiation dose for the patient. While most of the conducted research speaks in favour of DECT devices versus SECT devices, the issue of inadequate utilization of the numerous possibilities of DECT devices in everyday clinical practice remains. The DECT technique can be implemented in several ways, depending on the structure of the DECT device (on the number of radiation sources, the structure/arrangement of detectors, or the use of filters), but the question of which type of DECT technique/device to use depends on the disadvantages and advantages of individual devices as well as on the final goal of diagnostic procedures.

64-Slice ECG-gated computed tomographic angiography for assessment of coronary arteries in brachycephalic dogs with pulmonary stenosis.

Brachycephalic dogs with pulmonary stenosis are known to have a higher incidence of concurrent coronary artery abnormalities than non-brachycephalic breeds, which increases risk when performing balloon valvuloplasty. The use of ECG-gated CT angiography has been reported for the evaluation of coronary arteries in normal dogs and dogs with pulmonary stenosis. The purpose of this study was to report findings of coronary artery origination and morphology of main branches using ECG-gated CT angiography in brachycephalic dogs with pulmonary stenosis. An ECG-gated CT angiographic protocol was used to image coronary artery anatomy in nine brachycephalic dogs with pulmonary stenosis. Images were assessed for quality as well as coronary artery morphology by one veterinary radiologist, one veterinary cardiologist and one veterinary radiology resident. All nine dogs had good to excellent image quality. Coronary artery anomalies were identified in three of nine dogs: one R2A anomaly, one L2A anomaly and one L2C anomaly. Two dogs were assessed to be poor balloon valvuloplasty candidates based on CT angiographic images. Coronary artery morphology was not confirmed via postmortem examination in all patients. ECG-gated CT angiography is a minimally invasive imaging modality capable of diagnosing various coronary artery anomalies in brachycephalic dogs with pulmonary stenosis and aiding in the determination of patient candidacy for balloon valvuloplasty.

Unique Case of Anomalous Anatomy of the Right Coronary Artery from the Pulmnary Artery

Anomalous origin of the right coronary artery from the pulmonary artery is one of the rare congenital coronary diseases. The percentage of population damage is 0.002 %. In most cases this occurrence is asymptomatic and diagnosed accidentally like our case. Here, we report a 9-month-old female infant who was admitted with a diagnosis multiple muscle ventricular septal defects. For diagnostic we used echocardiogram, as a result an anomalous origin of the right coronary artery from the pulmonary artery was suspected. After that, coronary computed tomography angiography confirmed the diagnosis. The patient underwent surgical correction by redeployment of the coronary artery in aorta. The aim of our report is to describe the successful correction of a potentially fatal disease. Early diagnostic can provide effective treatment.&#x0D; &#x0D; &#x0D;

Coronary anatomy in neotropical carnivores: A comparative analysis.

This study aims to investigate the anatomy of coronary arteries and their primary branches in neotropical carnivores, given the functional significance of coronary circulation and the limited existing descriptions in this order. For this purpose, coronary arteries were dissected, and their branches were counted in 74 hearts from 20 species belonging to five families: Canidae, Mustelidae, Procyonidae, Mephitidae, and Felidae. In all specimens of the suborder Caniformia, the subsinuosal interventricular branch originated at the end of the circumflex branch of the left coronary artery (LCA). In contrast, in all hearts of Felidae specimens, the subsinuosal branch was derived from the right coronary artery. Among the 50 neotropical specimens of the suborder Caniformia, 13.1 ± 5.2 ventricular branches originated from the LCA and only 4.6 ± 1.4 from the right (p < 0.0001), characterizing a consistent left dominance. However, in the 24 specimens of the Felidae family, 10.5 ± 4.0 ventricular branches were found originating from the LCA and 10.4 ± 3.4 from the right, with no difference between the means (p = 0.82), defining a balanced pattern. It is suggested that the type of coronary circulation may correlate with the phylogeny of carnivorans.

Aortic valve leaflets are asymmetric and correlated with the origin of coronary arteries.

Asymmetry of the aortic valve leaflets has been known since Leonardo Da Vinci, but the relationship between size and shape and origin of the coronary arteries has never been examined. Our aim was to evaluate this anatomy in a population of pediatric patients using a cross-sectional study design. Consecutive pediatric patients with trans-esophageal echocardiography (TEE), with or without trans-thoracic echocardiography (TTE), were included in our study. Exclusion criteria: (I) bicuspid aortic valve; (II) aortic valve stenosis; (III) hypoplasia of aortic valve annulus, or aortic root; (IV) truncal valve; (V) coronary artery atresia; (VI) previous surgery on aortic valve and/or coronary arteries. In pre-operative TTE and intra-operative TEE inter-commissural distance and length of aortic valve leaflets were measured in short axis view in the isovolumic phase of systole. Echocardiography investigations, anonymized and randomly coded, were independently reviewed by at least two readers. Echocardiography, angiography, cardiac computed tomography (CT) scan and magnetic resonance imaging (MRI), and operative notes were reviewed to identify origin of coronary arteries. Two hundred sixty-one pediatric patients were identified, 93 excluded per our criteria, leaving 168 patients, age 2.6±4.3 years, weight 12.87±17.34 kg, 128 (76%) with normal and 40 (24%) with abnormal coronary arteries. In TTE and TEE measurements the non-coronary leaflet had larger area (P<0.001), while the right and left had equal areas, but different shape, with the left leaflet longer (P<0.001) and narrower (P=0.005) than the right. With the major source of blood flow from the right coronary sinus, the non-coronary leaflet was still the longest. However, there was no statically significant difference between the size and shape previously observed between the right and left leaflets. Our study showed asymmetry of size and shape among aortic valve leaflets, and a relationship with coronary artery origin. The complex aortic root anatomy must be approximated to optimize function of any surgical repair. These findings also may prove useful in the pre-operative definition of coronary artery anatomy and in the recognition of coronary artery anomalies.

Functional Syntax score based on quantitative flow ratio vs. anatomical Syntax score

Abstract Background/Introduction Percutaneous Coronary Intervention With Taxus and Cardiac Surgery (SYNTAX) score takes into consideration only the anatomy of the coronary network, while the Functional Syntax Score based on Quantitative Flow Ratio (FSSQFR) combines all the information derived from both anatomy and physiology of coronary arteries. Purpose To investigate the level of agreement between anatomical SYNTAX Score I (SS) and FSSQFR and its possible impact on risk re-stratification of patients and on revascularization options. Methods We performed an offline QFR analysis in consecutive patients who underwent coronary angiography in a single Greek center. A total of 410 patients with accountable FSSQFR were included. The latter was counted by summing the individual points only of physiologically significant lesions (vessel QFR ≤0.8). Patients were divided into low-, intermediate- and high risk according to SS and FSS with the same cutoff. The primary endpoint was the estimation of the predictive value of FSSQFR for the composite outcome of cardiovascular death, myocardial infarction and ischemia-driven revascularization at follow-up. Results FSSQFR and SS were estimated for all patients. After calculating the FSSQFR, 12% (48/410) of study patients changed the risk group. Most of them moved from higher-risk group by SS to lower-risk group and only three of them presented the opposite movement. Moreover, 5.9% (24/410) of patients, for whom coronary artery bypass grafting would be recommended according to SS, converted to favor percutaneous coronary intervention after FSSQFR calculation. After a median 30.2 (25.7-33.7) months follow-up period, the cumulative incidence of a composite of cardiac death, myocardial infarction or ischemia-driven revascularization was 4.6%, 10.7%, and 24.1%, in the low, intermediate, and high FSSQFR group correspondingly (log-rank P&amp;lt;0.001) (Figure 1). After multivariate regression analysis, FSSQFR was an independent predictor of the primary endpoint after adjustment for age, gender, smoking, and hypertension (adjusted OR: 1.08 [95% CI, 1.05–1.12]; P&amp;lt;0.001). The area under the curve for FSSQFR to predict the 2-year composite endpoint was higher than that of the classic anatomic SYNTAX score (0.711 vs. 0.706; p&amp;lt;0.001) (Figure 2). Conclusions In our study, FSSQFR found to be an independent predictor of higher cardiovascular adverse events. Also, compared with SS, FSSQFR significantly improved risk classification of patients with coronary disease widening the possible therapeutic options.

Abstract 13751: Clinical Characteristics With High Extracellular Volume Fraction in Patients Who Performed Cardiac Computed Tomography Angiography for the Purpose of Evaluating Coronary Arteries

Background: Cardiac computed tomography angiography (CCTA) is useful for the evaluation of anatomical coronary artery lesions. Recently, extracellular volume fraction by computed tomography (ECV CT ) have become possible by imaging the delay phase after coronary CT angiography. ECV CT has been reported to be useful for detailed examination and prognosis prediction after therapeutic intervention of cardiomyopathy. Cardiac amyloidosis is known as a cardiomyopathy with noticeable increased ECV, and cardiac amyloidosis should be suspected in patients with high ECV. The aim of this study was to evaluate clinical characteristics of high ECV CT and incidental detection of cardiac amyloidosis in patients who underwent CCTA for the purpose of evaluation of coronary arteries. Methods and Results: We examined consecutive 875 patients (mean age; 74.3 ± 7.1 years, men; 64%) who underwent CCCA in men aged ≥ 60 years and women aged ≥ 70 years. ECV CT quantification was performed with pre-contrast and post-contrast delayed phase CT images with the subtraction-derived method. Mean ECV CT was 29.7 ± 5.2%, and a total of 109 patients (12.3%) had ECV CT ≥ 35%. The patients with ECV CT ≥ 35% were significantly older (75.8±8.1 years vs. 74.1±6.9 years; P=0.038) and male dominant 75.4% vs 63.1%; P=0.007). Increased of high-sensitivity cardiac troponin T and B-type natriuretic peptide levels, left ventricular diastolic diameter, left ventricular thickness, impaired left ventricular ejection fraction, and E/e’ were significantly associated with ECV CT ≥ 35%. The prevalence of cardiac amyloidosis was estimated to be at least 1.7% (15/875) in entire study patients and 14.2% (15/106) in patients with ECV CT ≥ 35%. In these cases, increased ECV CT was a clue of the diagnosis of cardiac amyloidosis. Conclusion: CCTA was useful not only for evaluation of coronary arteries but also for evaluation of myocardial properties by ECV CT . Elevated ECV CT was associated with elevated cardiac biomarkers and structural changes of myocardium. There is an incidental diagnosis of cardiac amyloidosis in approximately 1.7% of cases underwent CCTA for the purpose of coronary artery evaluation detected by increased ECV CT .

A Physics-Guided Deep Learning Approach for Functional Assessment of Cardiovascular Disease in IoT-Based Smart Health

The rapid development of the Internet of Things (IoT) widely supports the smart healthcare system. IoT-based smart health has significant importance for the diagnosis of cardiovascular disease in clinical practice. Combined with advanced artificial intelligence techniques, IoT-based smart health provides valuable and accurate diagnosis information remotely for cardiovascular disease. The functional assessment of cardiovascular disease is an essential task in clinical practice. It aims to determine the extent of myocardial ischemia through the measurement of the hemodynamic parameters of the coronary artery. However, the clinical adoption of the hemodynamic parameters is limited due to the potential risks and high health costs during measurements. Recent advances in artificial intelligence have enabled the computation of hemodynamic parameters based on the anatomical features of coronary arteries. However, the existing methods still lack explainability in the prediction. To address this issue, we present a physics-guided deep learning network for the functional assessment of cardiovascular disease in an IoT-based manner. We specifically design an attentive network to determine the effective features by considering the importance of coronary artery anatomy features and artery segments. To obtain the functional assessment with explainability, we incorporate physical knowledge related to the blood flow into the loss function. It can ensure that functional assessment follows the physical laws. Extensive experiments are performed on a synthetic dataset and a real-world clinical dataset. The results show that our approach can achieve accurate and physically consistent assessment. Moreover, our method promotes deeper adoption of IoT and deep learning in the field of smart health.

Stress-only dynamic computed tomography perfusion protocol (CTP) alone without computed tomography coronary angiography (CCTA) has limited specificity to diagnose ischemia: A retrospective two-center study

PurposeTo investigate diagnostic performance of stress-only dynamic myocardial computed tomography perfusion (CTP) without computed tomography coronary angiography (CCTA) to diagnose ischemia with invasive fractional flow reserve (FFR) as a reference standard. Method135 datasets (68 positive for ischemia with invasive FFR < 0.8) acquired with a 256-slice CT system (Revolution, GE Healthcare, Chicago, IL, USA) were retrieved, postprocessed with a deep learning-based algorithm (Advanced intelligent Clear-IQ Engine (AiCE), Canon Medical Systems, Otawara, Japan) (FC03/cardiac kernel, 8 mm slice thickness), analyzed using a dedicated workstation (Vitrea research 7.11.0. Vital Images, Minnetonka, MN, USA), and loaded into a clinical workstation (CardIQ, GE Healthcare, Chicago, IL, USA) for review. Ten observers with various experience from two research sites evaluated the post-processed images, perfusion slices and maps to indicate presence vs absence of perfusion defect and its probability (five-point Likert scale). Binary decisions and probability scores were used to calculate sensitivity and specificity for each reader, and to create receiver operating characteristics (ROC) curves, respectively. Furthermore, the correlation coefficient (ICC) was computed. ROC AUC of a purely quantitative analysis was obtained thanks to a color-coded map with a fixed scale superimposed on myocardial walls displaying myocardial blood flow (MBF) values. ResultsThe overall case-based sensitivity and specificity for the detection of perfusion deficit were 0.79 and 0.30, respectively. No significant differences were detected in the AUC across readers (p value = 0.66). The AUC values were 0.50, 0.58, 0.63, 0.59, 0.45, 0.60, 0.56, 0.61, 0.52, 0.61. Absolute reader agreement ICC was 0.60 (good agreement) for an average case. ConclusionDynamic CTP alone has good sensitivity, but low specificity when analyzed without CCTA. These findings reinforce the need to guide the interpretation functional test with the knowledge of coronary artery anatomy.

Identification of Potential Abnormal Methylation-Modified Genes in Coronary Artery Ectasia.

Coronary artery ectasia (CAE) is an easily recognized abnormality of coronary artery anatomy and morphology. However, its pathogenesis remains unclear. This study aimed to identify abnormal methylation-modified genes in patients with CAE, which could provide a research basis for CAE. Peripheral venous blood samples from patients with CAE were collected for RNA sequencing to identify differentially expressed genes (DEGs), followed by functional enrichment. Then, the DNA methylation profile of CAE was downloaded from GSE87016 (HumanMethylation450 BeadChip data, involving 11 cases and 12 normal controls) to identify differentially methylated genes (DMGs). Finally, after taking interaction genes between DEGs and DMGs, abnormal methylation-modified genes were identified, followed by protein-protein interaction analysis and expression validation using reverse transcriptase polymerase chain reaction. A total of 152 DEGs and 4318 DMGs were obtained from RNA sequencing and the GSE87016 dataset, respectively. After taking interaction genes, 9 down-regulated DEGs due to hypermethylation and 11 up-regulated DEGs due to hypomethylation were identified in CAE. A total of 10 core abnormal methylation-modified genes were identified, including six down-regulated DEGs due to hypermethylation (netrin G1, ADAM metallopeptidase domain 12, immunoglobulin superfamily member 10, sarcoglycan dela, Dickkopf WNT signaling pathway inhibitor 3, and GATA binding protein 6), and four up-regulated DEGs due to hypomethylation (adrenomedullin, ubiquitin specific peptidase 18, lymphocyte antigen 6 family member E, and MX dynamin-like GTPase 1). Some signaling pathways were identified in patients with CAE, including cell adhesion molecule, O-glycan biosynthesis, and the renin-angiotensin system. Abnormal methylation-modified DEGs involved in signaling pathways may be involved in CAE development.

Fasting before coronary angiography: a scoping review protocol

Abstract Funding Acknowledgements Type of funding sources: None. Background/Introduction Nowadays, coronary heart disease is one of the major threats to a long and healthy life. The widespread demand for a tool to assess coronary artery anatomy has made coronary angiography a mainstream procedure. As with many other procedures, a fasting period before and after it is required. Despite this, the current practice does not rely on any study and therefore, if the procedure is to be delayed, which, unfortunately, often occurs, this might have major implications on the patient’s well-being and safety. Purpose To map the literature on fasting before coronary angiography. Methods This review follows the Joanna Briggs Institute methodology of scoping reviews, thus two reviewers independently will perform the study selection regarding their eligibility. Data synthesis will be presented in tabular form and a narrative summary that align with the review's objective. Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension to scoping reviews guidelines will be used to report the results. An initial limited search of MEDLINE (PubMed) and CINAHL (EBSCO) will be undertaken, followed by a search on the following databases: the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials and Scopus. Additionally, to further increase the evidence available, unpublished studies will be included, and a search on: OpenGrey (OpenGrey.eu), DART-Europe and publications of interventional cardiology reference sites will be conducted. Results Mapping the evidence will contribute to identifying the focus of the study. Conclusion It is expected that this review serves as a gateway for the development of future studies and guidelines which could improve daily clinical practice.

Addition of gadolinium contrast to three-dimensional SSFP MR sequences improves the visibility of coronary artery anatomy in young children.

This study aims to compare the value of a gadolinium contrast-enhanced 1.5-T three-dimensional (3D) steady-state free precession (SSFP) sequence with that of a noncontrast 3D SSFP sequence for magnetic resonance coronary angiography in a pediatric population. Seventy-nine patients from 1 month to 18 years old participated in this study. A 3D SSFP coronary MRA at 1.5-T was applied before and after gadolinium-diethylenetriaminepentaaceticacid (DTPA) injection. The detection rates of coronary arteries and side branches were assessed by McNemar's χ2 test. The image quality, vessel length, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) of the coronary arteries were analyzed by the Wilcoxon signed-rank test. The intra- and interobserver agreements were evaluated with a weighted kappa test or an intraclass correlation efficient test. A contrast-enhanced scan detected more coronary arteries than a noncontrast-enhanced scan in patients under 2 years old (P < 0.05). The SSFP sequence with contrast media detected more coronary artery side branches in patients younger than 5 years (P < 0.05). The image quality of all the coronary arteries was better after the injection of gadolinium-DTPA in children younger than 2 years (P < 0.05) but not significantly improved in children older than 2 years (P > 0.05). The contrast-enhanced 3D SSFP protocol detected longer lengths for the left anterior descending coronary artery in children younger than 2 years and the left circumflex coronary artery (LCX) in children younger than 5 years (P < 0.05). SNR and CNR of all the coronary arteries in children younger than 5 years and the LCX and right coronary artery in children older than 5 years enhanced after the injection of gadolinium-DTPA (P < 0.05). The intra- and interobserver agreements were high (0.803-0.998) for image quality, length, SNR, and CNR of the coronary arteries in both pre- and postcontrast groups. The use of gadolinium contrast in combination with the 3D SSFP sequence is necessary for coronary imaging in children under 2 years of age and may be helpful in children between 2 and 5 years. Coronary artery visualization is not significantly improved in children older than 5 years.

Impact of right coronary artery dominance on the long-term mortality in the patients with acute total/subtotal occlusion of unprotected left main coronary artery

BackgroundPatients with a right dominant coronary artery anatomy account for a significant proportion of acute myocardial infarction cases, and this condition is associated with a better prognosis. However, there are limited data on the impact of coronary dominance on patients with acute total/subtotal occlusion of unprotected left main coronary artery (ULMCA). MethodsThis study aimed to assess the impact of right coronary artery (RCA) dominance on long-term mortality in patients with acute total/subtotal occlusion of the ULMCA. From a multicenter registry, 132 cases of consecutive patients who had undergone emergent percutaneous coronary intervention (PCI) due to acute total/subtotal occlusion of the ULMCA were reviewed. ResultsPatients were classified into two groups according to the size of their RCA (dominant RCA group, n = 29; non-dominant RCA group, n = 103). Long-term outcomes were examined according to the presence of dominant RCA. Cardiopulmonary arrest (CPA) occurred in 52.3 % of patients before revascularization. All-cause death was significantly lower in the dominant RCA group than in the non-dominant RCA group. In the Cox regression model, dominant RCA was an independent predictor of all-cause death, as well as total occlusion of ULMCA, collateral from RCA, chronic kidney disease, and CPA. Patients were further analyzed according to the degree of stenosis of the ULMCA; patients with non-dominant RCA and total occlusive ULMCA had the worst outcome compared with the other groups. ConclusionsA dominant RCA might improve long-term mortality in patients with acute total/subtotal occlusion of the ULMCA who were treated with PCI.