Categories Of Coronary Artery Disease Research Articles

Calcium Scoring on CT Coronary Angiography in Hypertensive Patients as a Criterion for the Prediction of Coronary Artery Disease

Introduction: Hypertension is the strongest independent predictor of Coronary Artery Disease (CAD) identified by Computed tomography of coronary arteries (CTCA). In this study, CTCA-assessed Coronary Calcium Scoring (CCS) was studied in hypertensive subjects referred for CTCA. Methods: After excluding TAVI and graft assessment patients, the individual electronic health records of 410 consecutive patients who underwent CTCA between July and November 2020, were reviewed with a mean age of 58.7 years. Risk factors were recorded including smoking (38%), hyperlipidaemia (33%), positive family history (22%), systemic hypertension (48%), diabetes mellitus (30%), and male gender (46%). Referral criteria, ethnicity, cardiac, and past medical history were recorded. Patients were stratified into four groups according to CAD severity: absent, mild, moderate, and severe disease, as seen on CTCA. The mean CCS for each CAD category was compared between hypertensive and non-hypertensive patients. Mean CCS were further compared according to the number of coronary arteries affected and the severity of CAD in each artery. Results: Out of all CTCA reports, 200 (48.8%) CCS were interpreted in the very low-risk category, 80 (19.5%) low risk, 58 (14.1%) moderate risk, 23 (5.6%) moderately high risk and 49 (12.0%) high risk. A significant difference in mean CCS and CAD severity was observed between mild, moderate, and severe CAD (p = 0.015 and p < 0.001). Comparison of CCS between hypertensives and non-hypertensives, across the four CAD severity categories, revealed a significant difference in mean CCS in the severe CAD category (p = 0.03). There was no significant difference in the CCS between hypertensives with chest pain and hypertensives without chest pain. A higher number of affected coronary arteries was associated with a higher mean CCS and a significant difference in CCS was observed between hypertensive and non-hypertensive subjects for the number of arteries affected. Similar results were observed when comparing mean CCS in moderate-severely affected coronary arteries. Conclusion: Hypertensive patients with a high CCS were associated with a higher incidence of severe CAD independent of the presence of chest pain. These results suggest that the incorporation of CCS in the investigation of CAD on CT angiography may pose a powerful adjunct in proposing an alternative paradigm for the assessment of patients with hypertension, in the progress of coronary artery disease.

The value of calcium scoring in hypertensive patients as a referral criterion for the prediction of coronary artery disease detected on computed tomography coronary angiography

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The current national guidelines do not address the inequity between the increasing demand of Computed Tomography Coronary Angiography (CTCA) and the contrasting constrained imaging capacity. In a previous study we showed hypertension to be the strongest independent predictor of Coronary Artery Disease (CAD) detected on CTCA. In this study, the use of Coronary Calcium Scoring (CCS) for CTCA referrals is reviewed to identify the main parameters upon which CTCA referrals for the investigation of CAD, should be based. Methods After excluding TAVI and graft assessment patients, the individual electronic health records of 420 consecutive patients who underwent CTCA between July and November 2020, were reviewed with a mean age 59.1 years. Risk factors were recorded including smoking (23%), hyperlipidaemia (37%), positive family history (22%), systemic hypertension (51%), diabetes mellitus (30%) and male gender (50%). Referral criteria were also recorded for statistical analyses. Ethnicity, cardiac and past medical history were recorded. Patients were stratified into four groups according to CAD severity: absent, mild, moderate and severe disease, as seen on CTCA reports. The mean CCS for each CAD category was compared between hypertensive and non-hypertensive patients. Mean CCS were further compared in regard to the number of coronary arteries affected and the severity of CAD in each artery. Results Out of the total cohort, 247 (50.9%) patients were hypertensive. 249 (59.3%) CCS were interpreted in the very low risk category, 57 (13.6%) low risk, 58 (13.8%) moderate risk, 23 (5.48%) moderately high risk and 33 (7.86%) high risk. A significant difference in mean CCS and CAD severity was observed between mild, moderate and severe CAD (P = 0.015 and P < 0.001). Comparison of CCS between hypertensives and non-hypertensives, across the four CAD severity categories, revealed a significant difference in mean CCS in the severe CAD category (P = 0.013). Further comparison of CCS between hypertensives with chest pain and hypertensives without chest pain was non-significant. A higher number of affected coronary arteries was associated with a higher mean CCS and a significant difference in CCS was observed between hypertensives and non-hypertensives for the number of arteries affected. Similar results were observed when comparing mean CCS in moderate-severely affected coronary arteries. Conclusions Hypertensive patients with a high CCS were associated with higher incidence of severe CAD. Further, in those with hypertension, additional symptoms appear to have no effect on CCS. These results suggest that the incorporation of CCS in the investigation of CAD on CT angiography, may pose a powerful adjunct in proposing an alternative paradigm for the assessment of patients with hypertension and stable chest pain, in the progress of angiographic coronary disease.

The association between cardiovascular risk factors and coronary CT angiography findings for predicting obstructive coronary artery disease in Korean patients with stable chest pain

Abstract Background/Introduction The 2019 European Society of Cardiology (ESC) guidelines currently recommend the use of coronary computed tomography angiography (CCTA) as the initial test for diagnosing coronary artery disease (CAD) in symptomatic patients in whom obstructive CAD cannot be excluded by clinical assessment alone. Purpose The purpose of this study is to identify the prevalence of obstructive CAD in patients with stable chest pain, and the correlation between several clinical cardiovascular disease (CVD) risk factors and CCTA findings presented by Coronary Artery Disease Reporting and Data System (CAD-RADS). Methods The present study is a single-center retrospective cross-sectional study. A total of 1,892 patients with stable chest pain who underwent CCTA were enrolled in this study. Diamond-Forrester classification, Framingham risk score (FRS), atherosclerotic CVD (ASCVD) 10-year risk score, coronary artery calcium score (CACS) and CAD-RADS category were obtained from every patient. Results Among 1,892 patients (mean age, 60.5±8.6 years; men, 59.3%), 356 (18.8%) had obstructive CAD according to CCTA. Patients with high and intermediate ASCVD 10-year risk score had 2.59 times (aOR 2.59, 95% CI; 1.58 to 4.23) and 1.66 times (aOR 1.66, 95% CI; 1.04 to 2.65) higher odds of having obstructive CAD than patients with low ASCVD 10-year risk score, respectively (adjusted for Diamond-Forrester classification and CACS group). Higher ASCVD risk scores were significantly associated with higher CAD-RADS category (p<0.001), and patients with CAD-RADS category 3 had ASCVD 10-year risk score of 20.1±12.7. CACS showed the highest discrimination in presence of obstructive CAD, followed by ASCVD 10-year risk score, FRS, and Diamond-Forrester classification (AUC: 0.821 [95% CI; 0.797–0.845]; 0.711 [95% CI; 0.683–0.740]; 0.675 [95% CI; 0.646–0.704]; 0.600 [95% CI; 0.569–0.632], respectively). Conclusion This is the first study of CCTA findings in stable chest pain patients in Korea. The prevalence of obstructive CAD in patients with stable chest pain was 18.8%. Higher ASCVD score is significantly associated with presence of obstructive CAD and higher CAD-RADS category. As coronary stenosis of 50%-69% had a mean ASCVD score of 20.1, we should consider CCTA for identifying obstructive CAD in patients with ASCVD score over 20 with stable chest pain. Funding Acknowledgement Type of funding sources: None.

Assessment of proportion and prescribing trends of coronary artery diseases in a tertiary care hospital, Kerala: a prospective observational study

Background: The aim of the study is to assess the proportion of types of coronary artery diseases and to analyze the trends of drug prescribing in coronary artery disease (CAD) by checking the compliance with the standard guidelines provided by the American College of Cardiology Foundation / American Heart Association (ACCF/AHA).Methods: A prospective observational study was conducted in the department of Cardiology for a period of 6 months. A total of 94 patients with varied categories of CAD were screened and analyzed. Study related data was collected from case records and by a structured interview. Data analysis was done by analyzing the prescribing trends of drug and assessing the proportion of CAD.Results: The current study found that most of the patients were of the age group of 61-70 years. The proportion of Non-ST segment elevation myocardial infarction (NSTEMI) was remarkably higher in patients with CAD (55.3%) followed by ST-elevated myocardial infarction (STEMI) (39.4%) and Unstable angina (5.3%). Chi square test shows that prescription of Antiplatelets were apparent in all the prescriptions (100%), followed by Statins (Atorvastatin 98.9%), Antihypertensives (94.7%), Anticoagulants (90.4%), Nitrates (76.6%), Antidiabetics (75.5%) and Potassium channel opener (Nicorandil 36.2%). By analyzing the prescription, it was observed that most of the drugs were prescribed rationally according to the standard treatment guidelines (ACCF/AHA).Conclusions: This study provides an overall insight of proportion of CAD and prescribing pattern in patients with CAD which reveals the rational prescribing of drugs in accordance with the standard guidelines.

The SNP rs7865618 of 9p21.3 locus emerges as the most promising marker of coronary artery disease in the southern Indian population

Development of coronary artery disease (CAD) is primarily due to the process of atherosclerosis, however the prognosis of CAD depends on pleiotropic effects of the genes located at 9p21.3 region. Genome wide association studies revealed association of variants in this region with CAD pathology. However, specific marker in predicting CAD development or progression is not yet identified. In the present study, 35 SNPs at 9p21.3 region, located in the cyclin dependent kinase inhibitor (CDKN2A/CDKN2B) genes, were genotyped among 350 CAD cases and 480 controls from the southern Indian population of Hyderabad using fluidigm nanofluidic SNP genotyping system and the data were analyzed using PLINK and R softwares. Of the 35 SNPs analysed, only one SNP, rs7865618, was found to be highly significantly associated with CAD, even after correction for multiple testing (p = 0.008). The AG and GG genotypes of this SNP conferred 3.08 and 1.93 folds increased risk for CAD respectively. In particular, this SNP was significantly associated with severe anatomic (triple vessel disease p = 0.023) and phenotypic (acute coronary syndrome p = 0.007) categories of CAD. Pair wise SNP interaction analysis between the SNPs of 9p21.3 and 11q23.3 regions revealed significantly increased risk of three SNPs of 11q23.3 region that were not associated individually, in conjunction with rs7865618 of 9p21.3.

Prognostic value of coronary computed tomography angiography in patients with prior percutaneous coronary intervention

ObjectiveWe sought to determine the prognostic value of coronary computed tomography angiography (CCTA) in patients with a history of percutaneous coronary intervention (PCI). BackgroundAlthough the prognostic value of CCTA has been well studied, its incremental value in patients with previous PCI has not been robustly investigated. MethodsConsecutive patients with previous PCI were prospectively enrolled and CCTA images were evaluated for coronary artery disease (CAD) severity. Patients were followed for major adverse cardiovascular events (MACE) which was a composite of cardiac death and non-fatal myocardial infarction. All-cause death was assessed as a secondary endpoint. ResultsA total of 501 patients were analyzed with a mean follow-up time of 59.5 ± 32.0 months and 52 patients (10.4%) experienced MACE. Multivariable Cox regression analysis showed that CAD severity was a predictor of MACE with 0, 1, 2, and 3 vessel disease having annual rates of 1.3%, 2.2%, 2.2%, and 5.3%, respectively. All-cause death was similar in all categories of CAD. ConclusionsIn patients with previous PCI, CAD severity as measured with CCTA has independent and incremental prognostic value.

Transient ischemic dilation as a diagnostic marker in myocardial perfusion SPECT protocols: a systematic review and meta-analysis

Abstract
 Background: Transient ischemic dilation (TID) measures left ventricle (LV) volume changes which can be associated with combination of myocardial and endocardial ischemia. Various stress methods, single photon emission computerized tomography (SPECT) imaging protocol, camera and software incite controversy on TID cut off. The purpose of this study was to evaluate the TID ratio in detection of coronary artery disease (CAD) categories in a systematic review and meta-analysis. Method: We conducted a systematic search of electronic databases (PubMed, Scopus, Embase and Web of Science) up to 1 January 2017. The reference lists of all included studies were searched for a higher accuracy. The search strategy was according a defined PICO as P: none, I: Transient ischemic dilation, O: Coronary Artery Diseases, C: Angiographies. Statistical analysis was done by Comprehensive meta-analysis software version 2 (CMA-2).
 Result: After study selection process, 7 studies were selected for data extraction. TID was studied from 1987. The sample size of included studies ranged between 86 and 545. The mean age of included patients varied between 58 and 69 years old. Ranges of TID in CAD categories were excluded. The pooled estimates of TID in single and dual pharmacological stress test in three CAD categories were calculated.
 Conclusion: Our findings show that more studies are needed to compare the TID variability. Although in this study meta-analysis was done and TID was summarized from studies but the software differences were ignored.

Utilization trends of drugs in patients admitted with ischemic heart disease in a tertiary care teaching hospital

Background: Coronary artery disease (CAD) takes the highest toll of lives across the world as well as India. Prompt diagnosis and effective treatment is lifesaving. Drug utilization studies scrutinize the appropriateness of treatment and provide favourable feedbacks to strengthen clinical practices. Several other studies have reported underuse of four evidence-based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD. Polypharmacy, injection overuse is some of the shortcomings. The objectives of this study was to describe treatment practices in terms of different disease spectrum and drug utilization (group-wise and individually) for inpatients with CAD using core prescription indicators by WHO.Methods: A cross-sectional study of 4-month duration was undertaken for patients with CAD admitted to cardiology indoor of a tertiary care hospital. A total no of 143 prescriptions was screened and analyzed.Results: Males (67.13%) were more in number than females (32.87%). Age group from (57-66) topped in frequency (61.05%) ahead of (67 to 76) group (38.46%). Average no of drugs per patient were 8.056±1.97 and 5.86±0.14 for cardiovascular drugs. Prescription in generics (45.49%), antibiotics (0.61%), fixed-dose combinations (FDCs) (0.52%) and injectables (28.47%) were noted. The most common categories of CAD were ST-segment elevated myocardial infarction (69.23%) followed by chronic stable angina (17.48%). Antiplatelets (100%), hypolipidemics (99.3%), antianginals (60.14%), β-blockers (37.06%) and ACE-I/ARBs (27.97%) were utilized. Drugs from the national list of essential medicines were 66.49%.Conclusions: Among four evidence-based drugs, use of β-blockers and ACE-I/ARBs were inappropriately low. Polypharmacy and overuse of Injectable drugs are noted.

Transient ischemic dilation as a diagnostic marker in myocardial perfusion SPECT protocols: a systematic review and meta-analysis

Abstract
 Background: Transient ischemic dilation (TID) measures left ventricle (LV) volume changes which can be associated with combination of myocardial and endocardial ischemia. Various stress methods, single photon emission computerized tomography (SPECT) imaging protocol, camera and software incite controversy on TID cut off. The purpose of this study was to evaluate the TID ratio in detection of coronary artery disease (CAD) categories in a systematic review and meta-analysis. Method: We conducted a systematic search of electronic databases (PubMed, Scopus, Embase and Web of Science) up to 1 January 2017. The reference lists of all included studies were searched for a higher accuracy. The search strategy was according a defined PICO as P: none, I: Transient ischemic dilation, O: Coronary Artery Diseases, C: Angiographies. Statistical analysis was done by Comprehensive meta-analysis software version 2 (CMA-2).
 Result: After study selection process, 7 studies were selected for data extraction. TID was studied from 1987. The sample size of included studies ranged between 86 and 545. The mean age of included patients varied between 58 and 69 years old. Ranges of TID in CAD categories were excluded. The pooled estimates of TID in single and dual pharmacological stress test in three CAD categories were calculated.
 Conclusion: Our findings show that more studies are needed to compare the TID variability. Although in this study meta-analysis was done and TID was summarized from studies but the software differences were ignored.

Validity of epicardial fat volume as biomarker of coronary artery disease in symptomatic individuals: Results from the ALTER-BIO registry

BackgroundTo determine if an increased epicardial fat volume (EFV) is associated with coronary artery disease (CAD) in individuals with symptoms of cardiovascular (CV) disease. MethodsCoronary Computed Tomographic Angiography (CCTA), demographic and clinical variables of 1344 individuals were retrieved: semi-automated measurements for EFV and coronary artery calcifications (CAC) were obtained. Individuals were grouped into three categories according to the presence of CAD, resulting in absent (CAD0), non-obstructive (CAD1) or obstructive (CAD2) disease-groups.Relation of EFV with CAD was assessed with two approaches: 1) presence of any CAD; 2) each individual CAD category. ResultsMedian EFV was 90.52 ml (range 11.27–442.21 ml); median CAC was 56.5 (range 0–10,144); 848 individuals (63.1%) were categorized as CAD0, 326 (24.3%) as CAD1, 170 (12.6%) as CAD2.EFV was lower in subjects without CAC (EFVmedian = 66.5 ml), as compared to those with CAC 0.1–100 (EFVmedian = 91.47), CAC 100.1–400 (EFVmedian = 97.46) and CAC >400 (EFVmedian = 109.48) (p < 0.001).EFV was lower in CAD0 (EFVmedian = 87.21 ml), as compared to CAD1 (EFVmedian = 93.89 ml) and CAD2 (EFVmedian = 102.98 ml) individuals (p < 0.001).A logistic regression model built by including demographic and clinical variables showed inconsistent predictive value of EFV for either CAD1 or CAD2 (p > 0.05). ConclusionsIn the setting of symptomatic individuals, an increased amount of epicardial fat was associated with larger amount of coronary artery calcifications and was observed in individuals with obstructive CAD, however without predictive value to confidently determine CAD presence and severity.

Evaluation of prescribing pattern of drugs use in patients of coronary artery disease at a tertiary care hospital

Background: Coronary artery disease (CAD) is a major cause responsible for mortality more in younger age group than in elderly. Studies have reported underuse of four evidence based medicines namely aspirin, β-blockers, angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin receptor blockers (ARB), and statins in patients with CAD, particularly in developing countries. Therefore, this study was planned to analyse the prescriptions of patients with CAD to determine the appropriateness of the prescriptions.Methods: After obtaining the Institutional ethics committee permission, a cross sectional observational study was conducted at a tertiary care hospital. Total 150 patients were enrolled from the outpatient department, wards and intensive care unit of medicine department. Total 150 patients’ prescriptions presenting with varied category of CAD were screened and analysed.Results: The most common categories of CAD encountered was ST segment elevated myocardial infarction (N=50, 33%) followed by chronic stable angina (N=29, 20%). Among the drugs prescribed, antiplatelet drugs were prescribed to 135 (90%), hypolipidemics to 134 (89%), nitrates to 114 (76%), beta blockers to 97 (65%), ACE inhibitors to 94 (64%), anticoagulants to 60 (40%) and miscellaneous drugs to 52 (35%), patients. Of 68 (45%) patients with type 2 diabetes mellitus, 15 (22%) were prescribed only metoprolol and others were given ACE-I or ARBs.Conclusions: Among four evidence based drugs, use of 3 drugs, antiplatelets, beta blockers and hypolipidemics was apparent in 90% of prescriptions. Use of ACE inhibitors and ARBs was observed in type 2 diabetic patients with CAD, reflecting rational prescribing behavior of clinicians.

Transient Ischemic Dilation Ratio in Regadenoson, Single Isotope Gated Single-photon Emission Computed Tomography Myocardial Perfusion Imaging.

Single isotope 99mTc single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) is the most commonly used protocol for nuclear stress testing. Transient ischemic dilation of the left ventricle (TID) has been considered a specific marker of severe coronary artery disease (CAD). Recent publications have questioned the clinical utility of TID, specifically with regadenoson as a stressor and 4DM-SPECT software for TID analysis. These findings have not been demonstrated using other imaging packages. The goal of our study was to establish the TID threshold in the identification of Multi-vessel CAD using Quantitative Perfusion SPECT (QPS) software. Included in this study are 190 patients that had undergone regadenoson-stress, same day, single-isotope 99mTc MPI and had a coronary angiography within a designated 3-month period. QPS (Cedars-Sinai, LA, CA) automated image analysis software was used to calculate TID ratios which were compared across different CAD categories. Coronary angiograms were reviewed to identify both obstructive and nonobstructive CAD. The mean TID for patients with nonobstructive CAD (n = 91) was 1.02 ± 0.11, and the threshold for TID was 1.24. A receiver operating characteristic curve showed that TID had a poor discriminatory capacity to identify MVD (area under the curve 0.58) with a sensitivity of 3% and a specificity of 97%. In our study with regadenoson MPI in a predominantly African-American population, TID was found to be a poor predictor of MVD using QPS software. The reason is unclear but possibly related to the significant decline in the prevalence of severe CAD in the area where our study took place.

Reduction in CD16/CD56 and CD16/CD3/CD56 Natural Killer Cells in Coronary Artery Disease

ABSTRACTBackground: Natural killer (NK) cells are the potential modulators of inflammatory reactions that exert several unique biological effects and could lead to future adverse events of coronary artery disease (CAD).Hypothesis: The purpose of this study was to find out the possible association of modulation in NK cell, TNK cells, T cells, B cells, and tumor necrosis factor alpha (TNF-α) in CAD patients and various forms of myocardial infarction.Methods: The present study included total 190 subjects (98 confirmed CAD patients both men and women and 92 healthy control individuals). Serum concentration of TNF-α was measured by ELISA method. For the measurement of various immune cells, viz., NK cell, TNK cells, T cells, and B cells, flow-cytometric analysis was performed.Results: A significant reduction by 15% (P < 0.001) in CD16/CD56 NK cells was observed in CAD patients. Moreover, non-ST segment elevation myocardial infarction (NSTEMI), ST segment elevation myocardial infarction (STEMI), unstable angina (UA), and combined UA + NSTEMI group also showed a significant decline in NK cells compared with control individuals. CD16/CD56/CD3 TNK cells showed a significant reduction in CAD, NSTEMI, STEMI, and UA categories. However, UA + NSTEMI group did not show any significant change in TNK cells. On the other hand, the level of TNF-α was found to be significantly elevated in CAD, STEMI, and UA groups. NSTEMI and combined UA + NSTEMI group did not show any significant change in TNF-α level.Conclusion: Current study provides an insight toward the association of immune cells and inflammation with CAD.

Sex Differences in Cardiac Medication Use Post-Catheterization in Patients Undergoing Coronary Angiography for Stable Angina with Nonobstructive Coronary Artery Disease.

Treatment of patients with stable angina and nonobstructive coronary artery disease (CAD) has not been well characterized. We comparatively evaluated medication use in males and females with stable angina with no CAD, nonobstructive CAD, and obstructive CAD. We studied all patients ≥20 years old with stable angina undergoing coronary angiography in British Columbia (BC), Canada, from January 2008 to March 2010 (n = 7,535). No CAD, nonobstructive CAD, and obstructive CAD were defined as 0%, 1%-49%, and ≥50% luminal narrowing in any epicardial coronary artery, respectively. Medication use, 3 months before and 3 months following angiography, was obtained through BC PharmaNet for angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs), beta-blockers, statins, antiplatelet agents, and prescriptions for all three ACE-I/ARBs, beta-blockers, and statins (combination therapy). Following angiography, patients with no and nonobstructive CAD had significantly lower rates of prescription use of all medications, including combination therapy, than patients with obstructive CAD (p < 0.001). Use of ACE-I/ARBs, beta-blockers, statins, and combination therapy did not differ by sex, but females had higher use of CCB in all CAD groups, and clopidogrel in nonobstructive and obstructive CAD groups, compared to males. In patients with stable angina, medication use following angiography is low in nonobstructive CAD with only 58.9% prescribed a statin and 19.4% on combination therapy at 3 months. There are no important sex differences in medication use in any CAD category post-angiography. Future studies should explore methods of improving quality of care in patients with nonobstructive CAD.

Genetic determinants of clinical heterogeneity of the coronary artery disease in the population of Hyderabad, India

BackgroundGenetic predisposition to the clinical categories of coronary artery disease (anatomical viz., insignificant, single, double, and triple vessel diseases and phenotypic severity categories viz., angina, acute coronary syndrome, and myocardial infarction) is poorly understood. Particularly, the apolipoprotein genes clustered at 11q23.3 chromosomal region play a vital role in cholesterol homeostasis, and a large number of SNPs identified in this region need to be explored for their association with the clinical categories of CAD.MethodsUsing fluidigm SNP genotyping platform, a prioritized set of 96 SNPs of 11q23.3 chromosomal region were genotyped on 508 CAD cases and 516 ethnicity matched controls, enrolled from Hyderabad, India, and its vicinity.ResultsThe association analysis suggests 19 and 15 SNPs to be significantly associated (p ≤ 0.05) with at least one of the anatomical and/or phenotypic severity categories, respectively. Overall, the six SNPs rs17440396:G>A, rs6589566:A>G, rs2849165:G>A, rs10488699:G>A, rs1263163:G>A, and rs1263171:G>A were significant even after correction for multiple testing. Three of these (rs17440396:G>A, rs6589566:A>G, and rs2849165:G>A) that belong to BUD13, ZPR1, and APOA5-APOA4 intergenic regions, respectively, were found to be associated across the anatomical categories of CAD. However, no particular trend in the genotypic odds ratios with the increasing severity was apparent. The association analysis of the variants with phenotypic severity categories suggests that a high degree of phenotypic severity could be a result of more number of risk alleles. While the risk score analysis suggests high discriminative power of the variants towards the individual clinical categories of CAD, the complex network of interactions seen between the intronic variants of BUD13 and ZPR1 regulatory genes and intergenic variants of APOA5-APOA4 suggests pleiotropic effects of regulatory genes in the manifestation of these CAD categories.ConclusionThe complex network of interactions observed in the present study between the regulatory and protein-coding genes suggests their role in the manifestation of distinct clinical categories of CAD, which needs to be functionally validated.

Serum high concentrations of homocysteine and low levels of folic acid and vitamin B12 are significantly correlated with the categories of coronary artery diseases

BackgroundHomocysteine (Hcy) has been considered as an independent risk factor for coronary artery disease (CAD). Folic acid and vitamin B12 are two vital regulators in Hcy metabolic process. We evaluated the correlations between serum Hcy, folic acid and vitamin B12 with the categories of CAD.MethodsSerum Hcy, folic acid and vitamin B12 from 292 CAD patients, including 73 acute myocardial infarction (AMI), 116 unstable angina pectoris (UAP), 103 stable angina pectoris (SAP), and 100 controls with chest pain patients were measured, and the data were analyzed by SPSS software.ResultsCompared to SAP patients, patients with AMI and UAP had higher Hcy levels with approximately average elevated (4-5) μmol/L, while SAP patients were approximately higher 8 μmol/L than controls. However, the levels of folic acid and vitamin B12 had opposite results, which in AMI group was the lowest, while in controls was the highest. CAD categories were positively correlated with Hcy (r = 0.286, p < 0.001), and negatively correlated with folic acid (r = -0.297, p < 0.001) and vitamin B12 (r = -0.208, p < 0.001). There were significant trend toward increase in the prevalence of high Hcy, low folic acid and vitamin B12 from controls, to SAP, to UAP, and to AMI.ConclusionsThe present study provide the valuable evidence that high concentrations of Hcy and low levels of folic acid and vitamin B12 are significantly correlated with CAD categories.

High Homocysteine Levels are Closely Associated with the Categories of Coronary Artery Diseases as well as Low Status of Folic Acid and Vitamin B12

Background: Homocysteine (Hcy) has been considered as an independent risk factor for coronary artery disease (CAD). Folic acid and vitamin B12 are two vital regulators in Hcy metabolic process. We evaluated the associations between Hcy and the categories of CAD as well as the levels of folic acid and vitamin B12. Methods: Hcy, folic acid and vitamin B12 from 292 CAD patients, including 73 acute myocardial infarction (AMI), 116 unstable angina pectoris (UAP), 103 stable angina pectoris (SAP), and 100 non-CAD controls were measured, and the data were analyzed by SPSS software. Results: Hcy concentrations of AMI patients were the highest, and UAP patients were second, and SAP patients were the third higher, which were significantly higher than controls (p<0.01). Compared to SAP patients, patients with AMI and UAP had higher Hcy levels with approximately average elevated (4-5) μmol/L, while SAP patients were more higher Hcy with approximately 8 μmol/L than controls. However, the levels of folic acid and vitamin B12 had opposite results, whose levels in AMI group had the lowest, while in controls had the highest. There were strongly moderate negative correlations between Hcy and folic acid (r=-0.67, p<0.001) and vitamin B12 (r=-0.56, p<0.001). Conclusions: The present study confirms that high Hcy levels are closely associated with the categories of CAD as well as low status of folic acid and vitamin B12.

Abstract P380: Coronary Artery Disease Extent is Predictive of Heart Failure Incidence After Myocardial Infarction

Background: Little is known about the association between coronary artery disease (CAD) and the risk of heart failure (HF) after myocardial infarction (MI), and whether it differs by reduced (HFrEF) or preserved (HFpEF) ejection fraction (EF) has yet to be determined. Subjects and Methods: Olmsted County, Minnesota residents (n=1,924; mean age, 64 years; 66% male) with first MI diagnosed in 1990-2010 and no prior HF were followed through 2013. Framingham Heart Study criteria were used to define HF, which was further classified according to EF (applying a 50% cutoff). The extent of angiographic CAD was defined at index MI according to the number of major epicardial coronary arteries with ≥50% lumen diameter obstruction. Fine &amp; Gray and Cox proportional hazards regression models were used to assess the association of CAD categories with incidence of HF, and multiple imputation methodology was applied to account for the 19% with missing EF data. Results: During a mean (SD) follow-up of 6.7 (5.9) years, 594 patients developed HF. Adjusted for age and sex, with death considered a competing risk, the cumulative incidence rates of HF among patients with 1- (n=581), 2- (n=622), and 3-vessel disease (n=721) were 11.2%, 14.6% and 20.5% at 30 days; and 18.1%, 22.3% and 29.4% at 5 years after MI, respectively. The increased risk of HF with greater number of occluded vessels was only modestly attenuated after further adjustment for patient and MI characteristics, and did not differ materially by EF (Table). Conclusions: The extent of angiographic CAD expressed by the number of diseased vessels is independently associated with HF incidence after MI. The association is evident promptly after MI and applies to both HFrEF and HFpEF.

PREVALENCE OF MYOCARDIAL SCAR IN WOMEN WITH SIGNS AND SYMPTOMS OF ISCHEMIA BUT NO OBSTRUCTIVE CORONARY ARTERY DISEASE: A REPORT FROM THE WOMEN’S ISCHEMIA SYNDROME EVALUATION

Moderated Poster ContributionsStable Ischemic Heart Disease Moderated Poster Theater, Poster Hall B1Sunday, March 15, 2015, 10:00 a.m.-10:10 a.m.Session Title: Ischemia in Women without Obstructive Coronary Artery DiseaseAbstract Category: 26. Stable Ischemic Heart Disease: ClinicalPresentation Number: 1205M-05Authors: May Bakir, Janet Wei, Louise Thomson, John Petersen, Quanlin Li, Erika Jones, Puja Mehta, Chrisandra Shufelt, Daniel Berman, Eileen Handberg, Sheryl Kelsey, George Sopko, Carl Pepine, C. Noel Bairey Merz, Cedars-Sinai Medical Center, Los Angeles, CA, USABackground: Women with signs and symptoms of ischemia and no obstructive coronary artery disease (CAD) have an elevated major adverse cardiac event rate. We evaluated the presence, extent and distribution of scar using cardiac magnetic resonance imaging (CMRI) late gadolinium enhancement (LGE) in the Women’s Ischemia Syndrome Evaluation.methods: Women (n=344) with signs and symptoms of ischemia and no obstructive CAD underwent 1.5T CMRI LGE. Scans were read blindly for presence and segmental distribution of LGE. Scar size was quantified using Pie Medical Imaging software. LGE type was defined as ischemic when subendocardial or transmural and localized to a coronary artery distribution, and non-ischemic when mid-myocardial or epicardial. Fisher’s exact and two sample t-tests were used for statistical analysis.results: LGE was present in 20 (5.8%) women, including 15 (75%) with ischemic LGE. Women with non-ischemic LGE (n=5) had larger scar size compared to women with ischemic LGE (Table). There were no significant differences in cardiac risk factors among women with no LGE, ischemic LGE, or non-ischemic LGE, and there was no significant correlation between LGE presence and cardiac risk factors.Conclusion: Women with signs and symptoms of ischemia and no obstructive CAD have a 5.8% prevalence of myocardial scar detected by CMRI, with a predominant ischemic LGE pattern. These findings demonstrate that these women can develop irreversible myocardial injury, which may be clinically under-diagnosed.No LGE(n=324)Ischemic LGE(n=15)Non-ischemic LGE(n=5)Age 54 ± 11 years 55 ± 8 years 37 ± 15 yearsBody Mass Index 30 ± 8 32 ± 11 35 ± 7Hypertension 40% 31% 75%Diabetes 11% 14% 50%Dyslipidemia 20% 10% 33%Family History of Coronary Artery Disease 48% 21% 50%Scar pattern n/a4 LAD6 LCX4 RCA1 LAD and RCA3 patchy epicardial1 midmyocardial ASH1 RV insertion pointsScar size n/a 4.83 ± 3.12g* 9.57 ± 6.10g*ASH= asymmetric septal hypertrophy, LAD= left anterior descending artery, LCX= left circumflex artery, LGE= late gadolinium enhancement, RCA= right coronary artery, RV= right ventricular*p=0.0034

Dietary supplementation and engaging in physical activity as predictors of coronary artery disease among middle‐aged women

To explore risk factors for coronary artery disease (CAD) among middle-aged women in Taiwan. Coronary artery disease is a leading cause of death among females. Risk factors for CAD vary due to differences in ethnicity, gender and age. However, few studies have documented risk factors among middle-aged women. We employed a cross-sectional, comparative study design. Sixty-five middle-aged women who were suspected of having CAD and who received cardiac catheterisation were purposively sampled and divided into a CAD group (with at least one coronary artery with >50% stenosis) and a control group, according to the results of catheterisation. Individual questionnaires regarding their medical history, blood test results, sociodemographic characteristics, metabolism, biomarkers and lifestyle risk factors were administered and quantified. The mean age of the 65 women (31 CAD and 34 controls) was 56·2years. Within the CAD group, there was a greater incidence of women with a history of diabetes mellitus (DM), increased fasting blood glucose and increased diastolic blood pressure. Comparatively fewer women within the CAD category used dietary supplements or had a lower level of physical activity. After adjusting for other confounders, it was discovered that women who used dietary supplements (OR=0·28; p=0·04) and engaged in physical activities (OR=0·16; p=0·02) were less likely to develop CAD. Use of dietary supplements and engaging in physical activities can significantly predict the incidence of CAD among middle-aged women in Taiwan. Middle-aged women should be encouraged to take appropriate dietary supplements and engage in physical activity in order to prevent CAD.