Coronary Artery Disease In Coronary Angiography Research Articles

Platelet Parameters May be Predictors of Coronary Artery Disease in Prediabetes: Rural Hospital-based Cross-sectional Study

Introduction: Prediabetes is a state of impaired glucose tolerance that often precedes overt diabetes mellitus and is frequently underdiagnosed. Glycation of platelet proteins leads to increased platelet reactivity which can be an essential predisposing event in the pathogenesis of coronary artery disease (CAD). Although research has been conducted to diagnose CAD in prediabetes and to assess platelet indices in prediabetes, there has been no attempt to assess platelet indices in prediabetic patients who have CAD. Methods: This cross-sectional study was carried out in a rural tertiary care center in Central India from September 2019 to August 2021. A total of 180 patients were enrolled in this study, having documented CAD in coronary angiography (CAG) and blood glucose levels in the diagnostic range of prediabetes by the criteria set by the World Health Organization. Platelet indices, glycosylated hemoglobin, blood sugar levels, and CAG findings were documented for all participants. Results: The mean platelet volume (MPV) in our study population was 9.58 ± 1.14 fL, platelet distribution width (PDW) was 15.69% ± 1.36%, plateletcrit was 0.3% ± 0.07%, and platelet count was 319 ± 44 × 103 cells/mm3. PDW was the best tool to predict double-vessel disease (P < 0.0001), while MPV (P = 0.6146) and PDW (P = 0.0266) were best predictors of triple-vessel disease. Conclusion: Platelet indices that are readily available investigations prescribed by clinicians routinely are significantly associated with blood sugar levels and can predict the severity of CAD in prediabetics in terms of the number of vessels involved. Early assessment of platelet indices in prediabetics can aid in the diagnosis and prognosis of CAD, thereby helping in planning early intervention.

Association of Growth Differentiation Factor 15 with Arterial Stiffness and Endothelial Function in Subpopulations of Patients with Coronary Artery Disease: A Proof-of-Concept Study.

Growth-differentiation factor-15 (GDF-15) is a biomarker belonging to the transforming growth factor-beta cytokine superfamily, which is linked to many pathological conditions, including inflammation and myocardial injury. Pulse wave velocity (cfPWV) and augmentation index (AIx) are indices of arterial stiffness, which are associated with the severity of coronary artery disease (CAD). Flow-mediated dilatation (FMD) is a well-studied surrogate marker of endothelial-dependent dysfunction and systemic inflammation. In this proof-of-concept study, we aimed to investigate the relationship between circulating GDF-15, endothelial dysfunction, and indices of arterial stiffness in different settings of coronary artery disease and myocardial injury. In this cross-sectional single-center study, we enrolled patients (n = 22) after interventional treatment for acute myocardial infarction (AMI), patients (n = 11) admitted with chest pain and elevated cardiac enzymes but without evidence of obstructing CAD (MI-NOCAD) in percutaneous coronary angiography (CAG), and patients (n = 20) who underwent CAG according to indications without evident obstructive CAD in CAG (NOCAD). FMD was assessed at the brachial artery. AIx of the central aortic pressure and cfPWV were estimated by applanation tonometry at the radial and carotid-femoral site, respectively, with a validated acquisition system (Sphygmo- Cor, AtCor Medical, Sydney (NSW), Australia). ELISA was used to determine circulating GDF- 15 serum levels (R&D Systems, Minneapolis, MN). Clinical and demographic data and values of routine biochemical biomarkers were obtained. The highest high-sensitive cardiac Troponin I (hsTpnI) value during hospitalization was also recorded. Left ventricular ejection fraction (LVEF) was assessed with a transthoracic echocardiogram. Patients with AMI were older, had worse LVEF, higher values of hsTpnI and increased circulating GDF-15 levels. Importantly, AMI patients had increased cfPWV values, deteriorated AIx values, blunted FMD and worse serum creatinine levels compared to MI-NOCAD and NOCAD patients, respectively, whereas MI-NOCAD and NOCAD did not differ from each other significantly on these biomarkers. Both AMI and MI-NOCAD patients presented a higher but comparable white blood cell count than NOCAD patients. A strong linear correlation between GDF-15 and cfPWV, hsTpnI, AIx, white blood cell count and creatinine but not with FMD was demonstrated in the general study population. This proof-of-concept study showed that higher circulating levels of GDF-15, an inflammatory biomarker, were associated significantly with increased arterial stiffness only in AMI patients, whereas elevated GDF-15 demonstrated a linear relationship with the severity of the myocardial injury.

ARTERIAL STIFNESS AND SYMPATHETIC OVERDRIVE IN HYPERTENSIVE PATIENTS WITH ANGINA AND NON-OBSTRUCTIVE CORONARY ARTERY DISEASE

Objective: Existing data support that hypertension is related to sympathetic overdrive and arterial stiffness. Non-obstructive coronary artery disease (CAD) is frequent among hypertensive patients with angina. Nowadays, there are scarce evidence on the role of sympathetic nervous system (SNS) in the above population. The aim of this preliminary analysis of our study was to assess whether hypertensive patients with angina and non-obstructive CAD, hypertensives without angina and normotensive controls are characterized by different level of SNS activation and arterial stifness. Design and method: We studied 13 hypertensive patients with angina and non-obstructive CAD in coronary angiography [9 females, mean age: 61.2 ± 9.9 years, office blood pressure (BP): 159/96 ± 14/10 mmHg], 16 treated hypertensive patients without angina (9 females, mean age: 59.5 ± 7.5 years, office BP:142/88 mmHg) and 11 normotensive controls (8 females, mean age: 51.8 ± 11 years, BP:125/87 mmHg). In all participants, sympathetic drive was assessed by muscle sympathetic nerve activity (MSNA) estimated by microneurography and arterial stiffness, measured with heart rate-corrected aortic augmentation index (Aix@75), calculated by analyzing the ambulatory blood pressure monitoring (ABPM) waveforms. Results: Hypertensives with angina and non-obstructive CAD (n = 13) compared to hypertensive patients without angina (n = 16) and normotensive individuals (n = 11) exhibited higher levels of MSNA (59.6 ± 6.6 vs 43 ± 8.4 vs 45 ± 9.5 bursts per minute, respectively; p < 0.01 for all) and 24-h BP (146/85 ± 18/11 vs 141/83 ± 7/10 vs 125/81 ± 7/6 mmHg, respectively; p < 0.001 for all). Hypertensives with and without angina did not differ regarding renal function based on eGFR (p = NS). Moreover, there were no differences in left ventricular mass index, total cholesterol and low-density lipoprotein between hypertensive patients with and without angina and no gender related effects on MSNA and Aix@75 (p = NS). Furthermore, patients with angina and non-obstructive CAD patients compared to hypertensives without angina were characterized by increased levels of Aix@75 (36.13 ± 7.4 vs 22.5 ± 11.7, p < 0.05). Conclusions: Patients with hypertension and non-obstructive CAD are characterized by higher MSNA and increased Aix levels compared to hypertensives without angina and normotensive controls. These preliminary results suggest that therapies targeting sympathetic overdrive and vascular stiffening could provide additional clinical benefit in this special category of hypertensive patients.

HYPERTENSIVE PATIENTS WITH ANGINA AND NON-OBSTRUCTIVE CORONARY ARTERY DISEASE ARE CHARACTERIZED BY INCREASED SYMPATHETIC NERVOUS SYSTEM ACTIVATION

Objective: There are data supporting that sympathetic nervous system (SNS) is implicated in the regulation of endothelium function and vascular tone in different cardiovascular disease states. Patients with hypertension and angina frequently present non-obstructive coronary artery disease (CAD) in angiography. The aim of our study was to assess the level of SNS activation in hypertensive patients with angina and non-obstructive CAD, in hypertensives without angina and normotensive controls. Design and method: Our population consisted of 10 treated hypertensive patients with angina who had non-obstructive CAD in coronary angiography [7 females, mean age: 60.5 ± 9.6 years, office blood pressure (BP): 157/93 ± 13/11 mmHg], 16 treated hypertensive patients without angina (9 females, mean age: 59.5 ± 7.5 years, office BP:142/88 mmHg) and 11 normotensive individuals without angina (8 females, mean age: 51.8 ± 11 years, BP:125/87 mmHg). In all participants, muscle sympathetic nerve activity (MSNA) was assessed. Results: Hypertensives with angina and non-obstructive CAD (n = 10) compared to hypertensive patients without angina (n = 16) and normotensives without angina (n = 11) exhibited higher levels of MSNA (57.6 ± 6.1 vs 43 ± 8.4 vs 45 ± 9.5 bursts per minute, respectively; p < 0.01 for all) and 24-h ambulatory BP (144/83 ± 20/14 vs 141/83 ± 7/10 vs to normotensives 125/81 ± 7/6 mmHg, respectively; p < 0.001 for all). There were no differences in renal function between groups and no gender related effects on MSNA values (p = NS). Conclusions: Hypertensive patients with angina and non-obstructive CAD are characterized by higher SNS drive compared to hypertensives without angina and normotensive controls, as reflected by MSNA levels. These preliminary results indicate that therapies targeting SNS tone could be of potential clinical benefit in this high-risk hypertension phenotype.

Diabetic Retinopathy as a Predictor of Angiographic Coronary Atherosclerosis Severity in Patients with Type 2 Diabetes Mellitus.

BackgroundDiabetic retinopathy (DR) is one of the most prevalent consequences of diabetes mellitus (DM). Much emphasis has been focused on the link between DR and cardiovascular disorders in patients with type 2 diabetes (T2DM). However, there is little information about the relation between the degree of DR and coronary atherosclerosis severity in Egyptian patients.AimTo assess the correlation between the degree of DR and the coronary atherosclerosis severity in T2DM.Patients and MethodsThis work included 140 diabetic patients with T2DM who underwent diagnostic coronary angiography because of suspected coronary artery disease (CAD). All participants were evaluated by history, fundus assessment, laboratory tests (lipid profile and glycated hemoglobin [HbA1c]), and selective coronary angiography. The severity of coronary artery lesion was detected by Gensini score and vessel score.ResultsPatients with DR had a significantly higher Gensini score (67.86± 44.56 versus 5.93± 9.02, P < 0.001) and a vessel score (2.29± 0.86 versus 0.50± 0.66, P < 0.001). There was a significant relation between the degree of DR, Gensini score (P < 0.001), and vessel score (P < 0.001), as both scores increased according to the severity of DR. The presence and degree of retinopathy were the only independent factors linked to the severity score in multivariate linear regression analyses (P < 0.001).ConclusionThe presence and degree of DR are independent predictors of severe coronary atherosclerosis. Therefore, when evaluating whether a patient with T2DM is at high risk for CAD, the DR degree should be taken into consideration.

Anemia of Chronic Disease in Patients With Cardiovascular Disease.

Objective: Anemia is often found in patients with coronary artery disease (CAD) or acute coronary syndrome (ACS) and related to disease severity. Our study investigated the relationship between anemia, iron homeostasis and inflammation in CAD and examined their influence on the outcome of patients.Patients and Methods: Markers of immune activation (neopterin, interleukin [IL]-12, IL-6, high sensitive C-reactive protein (hsCRP), fibrinogen, serum amyloid A [SAA]) and iron metabolism (ferritin, transferrin saturation, hemoglobin) were determined in 2,082 patients (68.7 % men, median age 63 years) from the Ludwigshafen Risk and cardiovascular Health (LURIC) cohort. Patients were followed-up for a median of 9.81 years.Results: 960 patients (46.1 %) presented with chronic CAD, 645 patients (31.0 %) had an ACS, and 477 patients (22.9 %) presented with no CAD in coronary angiography (CAG). Anemia (n = 357, 17.1 %) was associated with disease severity (reflected by more progressed stenosis in CAG, CCS, and NYHA classes, and a lower LV-EF), a higher cardio-cerebrovascular event rate and higher levels of inflammatory markers. Interestingly, anemia was only predictive for an adverse outcome in patients with elevated inflammatory markers. Accordingly, anemia of chronic disease (ACD) was associated with a higher cardio-cerebrovascular event-rate in the subsequent 2 years as compared to patients with other types of anemia or without anemia (14.3 vs. 6.1 vs. 4.0%, p < 0.001).Conclusions: This study confirms that anemia and immune activation are strongly related to cardiovascular disease progression and an adverse outcome. Our data suggest that the association of anemia with disease severity and outcome might mainly be due to underlying inflammation.

Diagnostic utility of chest pain characteristics in discriminating obstructive coronary artery disease: A ‘Historic' Dilemma

Chest pain (CP) is the major presenting symptom of coronary artery disease (CAD) wherein history remains to be a fundamental and challenging diagnostic step. Despite the clarity of ‘typical’ CP characteristics in guidelines; interpretation and description of CP by patients are open to wide variations. The aim of this study was to define the components of CP that most closely associate to presence of obstructive CAD and determine the influence of gender on CP features. Herein, consecutive patients with suspected stable CAD who were scheduled for a coronary angiography(CAG) were prospectively enrolled. The data on demographic and pain characteristics were collected by a questionnaire. Patients were categorized into ‘CAD’ and ‘Normal’ groups with respect to presence of obstructive CAD in CAG. Among 402 patients, 86 had chest discomfort or equivalent symptoms but denied ‘CP’. Patients with CAD were more commonly male; with older age, lower BMI, more frequent prior revascularization, clopidogrel use, higher creatinine and lower HDL levels. When classical features of CP such as quality; location, duration, relationship to exertion were compared; stabbing/sharp pain, CP related to cold or emotional stress and CP that radiates to back were significant factors against CAD; while absence of precipitating factors was related to CAD. Yet, none of the features of typical angina pectoris were significantly related to presence of CAD. Determinants of CAD were; prior revascularization (OR= 22.7, p=0.021), body mass index (OR=1.4, p=0.007), clopidogrel use(OR=55.5, p=0.018) and blood glucose (OR=1.02, p=0.046) in women; and age (OR=1.2, p=0.029) was the single predictor of CAD in men. This study demonstrated no association between classical features of typical CP and presence of CAD in patients with stable angina pectoris. Clinical factors that influenced presence of CAD in different genders were also different.

Serum Salusin-β Levels Are Associated With the Presence and Severity of Coronary Artery Disease

ObjectivesWe sought to assess whether serum salusin-β levels are correlated with the presence and severity of coronary artery disease (CAD).MethodsWe measured serum salusin-β levels in 278 consecutive patients undergoing coronary...

Clinical correlation between N-terminal pro-b-type natriuretic peptide and angiographic coronary atherosclerosis

OBJECTIVES:This study aimed to investigate the clinical correlation between angiographic coronary atherosclerosis and N-terminal pro-B-type natriuretic peptide along with other known correlated factors.METHODS:In total, 153 patients with a diagnostic hypothesis of stable angina, unstable angina or acute myocardial infarction were classified as group A (patients with angiographically normal coronary arteries) or group B (patients with angiographic coronary atherosclerosis). The two groups were analyzed with respect to the following factors: gender, age, body mass index, abdominal circumference, smoking, diabetes mellitus, arterial hypertension, early family history of atherosclerosis, statin use, the presence of metabolic syndrome, clinical presentation and biochemical factors, including cholesterol, creatinine and fibrinogen plasma concentrations, monocyte counts and N-terminal pro-B-type natriuretic peptide.RESULTS:Univariate analyses comparing the two groups revealed that group B patients more frequently had diabetes, used statins and had systolic dysfunction, N-terminal pro-B-type natriuretic peptide levels ≥250 pg/mL, fibrinogen levels >500 mg/dL and ≥501 monocytes/mm3 compared with group A patients (p<0.05). Nevertheless, multivariate logistic regression analysis demonstrated that the independent predictors of angiographic coronary atherosclerosis were an N-terminal pro-B-type natriuretic peptide level ≥250 pg/mL, diabetes mellitus and increased monocyte numbers and fibrinogen plasma concentration, regardless of the creatinine level or the presence of systolic dysfunction.CONCLUSIONS:An N-terminal pro-B-type natriuretic peptide plasma concentration of ≥250 pg/mL is an independent predictor of angiographic coronary atherosclerosis.

Serum levels of γ-glutamyltransferase and progression of coronary atherosclerosis

Progression of coronary atherosclerosis (ATS) has clinical implications. Serum levels of γ-glutamyltransferase (GGT), a marker of oxidative stress, predict the risk of cardiovascular events. However, the role of GGT levels in the progression of coronary ATS has never been established. Consecutive patients undergoing two coronary angiographies (CAs) separated by at least 6 months were prospectively enrolled between May 2008 and June 2010. All patients were discharged on statins after the first CA. The severity and extent of coronary ATS were graded according to Bogaty's score, and the variation (Δ) in stenosis score and extent index between follow-up (S2 and E2) and basal values (S1 and E1) were calculated. Predictors of ΔS2-1 and ΔE2-1 were assessed among clinical and laboratory data, including GGT levels, analyzed as Δ between follow-up and basal values (ΔGGT2-1). We enrolled 100 consecutive patients (age 64±11 years, 68% men). Compliance with statin therapy was 100%. At multiple regression analysis, ΔGGT2-1 was the only independent predictor of ΔS2-1 (B=0.18, SE=0.07, P=0.05), with Δlow-density lipoprotein-cholesterol2-1 levels being of borderline statistical significance (P=0.07). On multiple regression analysis, ΔGGT2-1 was the only independent predictor of ΔE2-1 (B=0.32; SE=0.11; P=0.04), with active smoking habit and Δfibrinogen2-1 levels being of borderline statistical significance (P=0.08 and 0.06, respectively). ΔGGT2-1 is associated with angiographic coronary ATS progression in patients with ischemic heart disease on statin treatment, suggesting that oxidative stress may be another therapeutic target for preventing ATS progression beyond that of lipid-lowering therapies.

Accelerated In Vivo Thrombin Formation Independently Predicts the Presence and Severity of CT Angiographic Coronary Atherosclerosis

This study sought to investigate the association between thrombin generation in plasma and the presence and severity of computed tomography angiographically defined coronary atherosclerosis in patients with suspected coronary artery disease (CAD). Besides its pivotal role in thrombus formation, experimental data indicate that thrombin can induce an array of pro-atherogenic and plaque-destabilizing effects. Although thrombin plays a role in the pathophysiology of atherosclerosis progression and vascular calcification, the clinical evidence remains limited. Using 64-slice coronary computed tomographic angiography, we assessed the presence and characteristics of CAD in patients (n = 295; median age 58 years) with stable chest pain. Coronary artery calcification was graded as absent (Agatston score 0), mild (Agatston score 1 to 100), moderate (Agatston score 101 to 400), and severe (Agatston score >400). Calibrated automated thrombography was used to assess endogenous thrombin potential in plasma in vitro. Thrombin-antithrombin complex (TATc) levels were measured as a marker for thrombin formation in vivo. TATc plasma levels were substantially higher in patients with CAD versus patients without CAD (p = 0.004). Significant positive correlations were observed between steadily increasing TATc levels and the severity of CAD (r = 0.225, p < 0.001). In multinomial logistic regression models, after adjusting for established risk factors, TATc levels predicted the degree of coronary artery calcification: mild (odds ratio: 1.56, p = 0.006), moderate (odds ratio: 1.56, p = 0.007), and severe (odds ratio: 1.67, p = 0.002). Trends were comparable between the groups when stratified according to the degree of coronary luminal stenosis. This study provides novel clinical evidence indicating a positive independent association between enhanced in vivo thrombin generation and the presence and severity of coronary atherosclerosis, which may suggest that thrombin plays a role in the pathophysiology of vascular calcification and atherosclerosis progression.

Tu1515 Endoscopic Ultrasound (EUS) for Measurement of Aortic Intima-Media Thickness: A Marker for Presence of Coronary Artery Disease

Tu1515 Endoscopic Ultrasound (EUS) for Measurement of Aortic IntimaMedia Thickness: A Marker for Presence of Coronary Artery Disease Seyed Amir Mirbagheri*, Mohammad R. Ostovaneh, Elham Mortazavi Department of Internal Medicine, Gastroenterology, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran Background: Previous studies highlighted the superior independent and incremental value of measures of vascular function like aortic distensibility for predicting atherosclerosis and identification of high risk individuals. Despite the controversies, some consensus statements suggest the use of carotid intimamedia thickness for further clarification of coronary artery disease (CAD) risk assessment. There are studies that evaluated the relationship between Aortic intima-media thickness measured by transesophageal echocardiography and CAD. Endoscopic Ultra-Sound (EUS) technique can serve as a highly accurate technique for measuring the Aortic Intima-Media Thickness (AIMT). To our best knowledge, there is no study to measure the AIMT with EUS and evaluate its relationship with CAD .Aim: to evaluate the relationship between EUS-measured AIMT and presence of coronary artery disease in patients who underwent coronary angiography (CAG). Methods: Two hundred and fifty eight patients who previously underwent CAG and needed to perform EUS for a gastrointestinal reason involved in the study. After obtaining demographic data, AIMT was measured at the aortic arch level with a radial EUS (frequency 10 MHz) for all patients. The endosonologist was blind in regard of CAG result. The patients were then subgrouped into normal individuals without CAD and those with CAD, based on cardiologist-reported CAG and the AIMT was compared between two groups. Results: In patients with normal CAG, the AIMT was 1.49 0.53 mm (CI 0.84-1.14), while it was 1.89 0.53 (CI 1.23-2.55) in presence of CAD(p 0.001). The AIMT increased with age (correlation coefficient 0.557, P 0.001). When compared to normal 20 to 30 years old individuals without CAD risk factors, patients with CAD in CAG had significantly higher AIMT (1.89 0.53 compared to 1.47 .47, P 0.01). On the other hand, AIMT did not differ in normal 20 to 30 years old patients without CAD risk factors compared to the remaining individuals with normal CAG (1.47 0.53 vs 1.63 0.55, P 0.151). When adjusting for age and presence of diabetes mellitus and hyperlipidemia in a logistic regression model, the regression coefficient for AIMT for predicting the presence of CAD in CAG as outcome variable was 0.581 (P 0.001) and subsequently odds ratio was 1.79. Conclusion: AIMT is significantly different in presence or absence of CAD. Even though, it increases with age but adjustment for age revealed its pure effect to predict presence of CAD. AIMT could be used as an independent predictor for presence of CAD. EUS is one of the most accurate techniques to measure AIMT. Evaluation of AIMT in patients who are candidates for EUS for any reason may be useful for detecting the subclinical CAD and optimizing patient management.

Influence of 9p21.3 Genetic Variants on Clinical and Angiographic Outcomes in Early-Onset Myocardial Infarction

The purpose of this study was to test whether the 9p21.3 variant rs1333040 influences the occurrence of new cardiovascular events and coronary atherosclerosis progression after early-onset myocardial infarction. 9p21.3 genetic variants are associated with ischemic heart disease, but it is not known whether they influence prognosis after an acute coronary event. Within the Italian Genetic Study of Early-onset Myocardial Infarction, we genotyped rs1333040 in 1,508 patients hospitalized for a first myocardial infarction before the age of 45 years who underwent coronary angiography without index event coronary revascularization. They were followed up for major cardiovascular events and angiographic coronary atherosclerosis progression. Over 16,599 person-years, there were 683 cardiovascular events and 492 primary endpoints: 77 cardiovascular deaths, 223 reoccurrences of myocardial infarction, and 383 coronary artery revascularizations. The rs1333040 genotype had a significant influence (p = 0.01) on the primary endpoint, with an adjusted hazard ratio of 1.19 (95% confidence interval [CI]: 1.08 to 1.37) for heterozygous carriers and 1.41 (95% CI: 1.06 to 1.87) for homozygous carriers. Analysis of the individual components of the primary endpoints provided no significant evidence that the rs1333040 genotype influenced the hazard of cardiovascular death (p = 0.24) or the reoccurrence of myocardial infarction (p = 0.57), but did provide significant evidence that it influenced on the hazard of coronary revascularization, with adjusted heterozygous and homozygous ratios of 1.38 (95% CI: 1.17 to 1.63) and 1.90 (95% CI: 1.36 to 2.65) (p = 0.00015), respectively. It also significantly influenced the angiographic endpoint of coronary atherosclerosis progression (p = 0.002). In early-onset myocardial infarction, the 9p21.3 variant rs1333040 affects the progression of coronary atherosclerosis and the probability of coronary artery revascularization during long-term follow-up.

The Management of Cognitive Problems in Primary Care

Chest pain (CP) is the major presenting symptom of coronary artery disease (CAD) wherein history remains to be a fundamental and challenging diagnostic step. Despite the clarity of ‘typical’ CP characteristics in guidelines; interpretation and description of CP by patients are open to wide variations. The aim of this study was to define the components of CP that most closely associate to presence of obstructive CAD and determine the influence of gender on CP features. Herein, consecutive patients with suspected stable CAD who were scheduled for a coronary angiography(CAG) were prospectively enrolled. The data on demographic and pain characteristics were collected by a questionnaire. Patients were categorized into ‘CAD’ and ‘Normal’ groups with respect to presence of obstructive CAD in CAG. Among 402 patients, 86 had chest discomfort or equivalent symptoms but denied ‘CP’. Patients with CAD were more commonly male; with older age, lower BMI, more frequent prior revascularization, clopidogrel use, higher creatinine and lower HDL levels. When classical features of CP such as quality; location, duration, relationship to exertion were compared; stabbing/sharp pain, CP related to cold or emotional stress and CP that radiates to back were significant factors against CAD; while absence of precipitating factors was related to CAD. Yet, none of the features of typical angina pectoris were significantly related to presence of CAD. Determinants of CAD were; prior revascularization (OR= 22.7, p=0.021), body mass index (OR=1.4, p=0.007), clopidogrel use(OR=55.5, p=0.018) and blood glucose (OR=1.02, p=0.046) in women; and age (OR=1.2, p=0.029) was the single predictor of CAD in men. This study demonstrated no association between classical features of typical CP and presence of CAD in patients with stable angina pectoris. Clinical factors that influenced presence of CAD in different genders were also different.

Microalbuminuria is not associated with endothelial dysfunction and coronary atherosclerosis in patients with acute coronary syndromes

Background: Microalbuminuria is associated with atherosclerosis and it is a strong and independent predictor of increased risk for cardiovascular morbidity and mortality. However, the underlying mechanisms of the association of albuminuria and cardiovascular disease are not well understood. We examined the association of endothelial dysfunction with microalbuminuria in non-diabetic and non-hypertensive patients with acute coronary syndromes (ACS). Methods: We compared endothelial function by flow-mediated dilatation (FMD) and glyceryl trinitrate-mediated dilatation (GTN) and angiographic properties among 27 microalbuminuric and 106 normoalbuminuric patients. Severity of coronary arteriosclerosis was evaluated using the Gensini score and number of diseased vessels. Results: We evaluated 133 patients (106 males; mean age 59 ± 11 years). Microalbuminuria was present in 27 (20.3%) subjects. Patients with microalbuminuria and normoalbuminuria had similar baseline characteristics. FMD and GTN responses were not different in microalbuminuric patients compared with normoalbuminuric patients (FMD 8.2 ± 5.3 vs. 7.9 ± 6.5%, p = 0.54 and GTN 9.3 ± 5.4 vs. 10.2 ± 6.9%, p = 0.82). Microalbuminuria was not associated with endothelial dysfunction (p = 0.49). Morphological properties of coronary lesion were not different. Conclusion: The presence of microalbuminuria is not associated with endothelial dysfunction and severity of angiographic coronary atherosclerosis in non-diabetic and non-hypertensive patients with ACS.

Serum levels of total p-cresylsulphate are associated with angiographic coronary atherosclerosis severity in stable angina patients with early stage of renal failure

Objective p-Cresylsulphate (PCS), a protein-bound uraemic retention solute, is known to cause endothelial dysfunction and possibly plays a role in coronary atherosclerosis. We aimed to investigate the relationship of total PCS with traditional biomarkers associated with chronic coronary atherosclerosis. In addition, the relationship between serum total PCS levels and the severity of coronary artery stenosis was also explored. Methods and results Serum total PCS concentrations were measured by using the Ultra Performance LC System in 202 consecutive stable angina patients, and their associations with angiographic indexes of the number of diseased vessels and modified Gensini score were estimated. Patients with significant coronary artery stenosis have higher median serum total PCS levels than patients with normal coronary arteries. Statistically significant associations were observed between the serum total PCS levels and the number of diseased vessels ( β = 0.261, p = 0.0002), and modified Gensini score ( β = 0.171, p = 0.016). Using multivariate analysis, serum total PCS level was independently associated with the presence and severity of CAD. Conclusions This study indicates that serum total PCS levels are significantly higher in the presence of CAD and are correlated with the severity of the disease, which suggest that increased serum total PCS may be involved in the pathogenesis of coronary atherosclerosis.

Vascular Compliance is Reduced in Geriatric People with Angiographic Coronary Atherosclerosis

This study investigated the value of arterial elasticity measurement in the early diagnosis of angiographic coronary artery atherosclerosis in 105 consecutive elderly patients. They were divided into two groups according to the results of selective coronary angiography: 55 with coronary atherosclerosis and 50 with a normal coronary angiogram. The Gensini score of the coronary artery was acquired and capacitive arterial compliance (C1) and oscillatory arterial compliance (C2) were measured. An independent-sample t-test was used to evaluate the difference in C1 and C2 between the two groups. Bivariate analyses were performed to study the association between the Gensini score and C1 and C2. A significant difference between the two groups in C2 was found and the Gensini score of the coronary artery was significantly correlated with C2. Identification of early coronary atherosclerosis in geriatrics may be aided by the prognostic value of C2.

Decreased ratio of high-molecular-weight to total adiponectin is associated with angiographic coronary atherosclerosis severity but not restenosis

Backgrounds Adiponectin is thought to protect against atherosclerosis and its expression is decreased in metabolic syndrome and diabetes mellitus. Adiponectin has a high-molecular-weight (HMW) multimer structure in the blood. We determined whether circulating HMW adiponectin, total adiponectin, or their ratio predicts baseline angiographic coronary artery disease (CAD) severity and restenosis after percutaneous coronary intervention (PCI). Methods Patients with stable angina pectoris who underwent PCI for a de novo lesion and had angiographic follow-up at our hospital were retrospectively enrolled. The study patients were grouped as moderate ( N = 68) or severe ( N = 63) coronary atherosclerosis by the baseline median Gensini severity score (moderate < 22, severe ≥ 22). Results Univariate analysis showed that subjects in the severe CAD group had a lower HMW/total adiponectin ratio (0.32 ± 0.19 vs. 0.37 ± 0.16, p = 0.024) while the absolute value of HMW adiponectin (2.17 ± 2.05 vs. 2.27 ± 2.07 µg/ml, p = 0.389) and total adiponectin (5.97 ± 3.12 vs. 5.76 ± 2.91 µg/ml, p = 0.807) were similar between the severe and moderate CAD groups. In a multivariate binary logistic regression model, a higher serum HMW/total adiponectin ratio (odds ratio 0.058, p = 0.018) was negatively, while hypercholesterolemia (OR 2.475, p = 0.029) was positively associated with coronary atherosclerosis disease severity. In terms of restenosis after PCI (mean follow-up at 12 ± 13 months), HMW adiponectin, total adiponectin and their ratio were similar between restenotic ( N = 91) and non-restenotic groups ( N = 40). Conclusions A decreased ratio of circulating HMW adiponectin to total adiponectin is associated with angiographic disease severity but not restenosis in CAD patients undergoing PCI.

Circulating matrix metalloproteinase 9 levels in relation to sampling methods, femoral and carotid atherosclerosis

To examine whether circulating levels of matrix metalloproteinase 9 (MMP-9) were associated with ultrasound-assessed intima-media thickness (IMT) and echolucent plaques in the carotid and femoral arteries. To examine preanalytical sources of variability in MMP-9 concentrations related to sampling procedures. Plasma and serum MMP-9 levels were compared with ultrasound assessed measures of femoral and carotid atherosclerosis, in a cross-sectional study of 61-year-old men (n = 473). Preanalytical sources of variability in MMP-9 levels were examined in 10 healthy subjects. Main outcome measures were circulating levels of MMP-9 in serum and plasma, IMT of the carotid and femoral arteries, and plaque status based on size and echolucency. Research unit at university hospital. Plasma concentrations of total and active MMP-9 were associated with femoral artery IMT independently of traditional cardiovascular risk factors, and were higher in subjects with moderate to large femoral plaques. Plasma MMP-9 concentration was higher in men with echolucent femoral plaques (P = 0.006) compared with subjects without femoral plaques. No similar associations were found for carotid plaques. MMP-9 concentrations were higher in serum than in plasma, and higher when sampling was performed with Vacutainer than with syringe. MMP-9 levels in serum were more strongly associated with peripheral neutrophil count compared with MMP-9 levels in plasma. Plasma MMP-9 levels were associated with atherosclerosis in the femoral artery, and total MMP-9 concentration was higher in men with echolucent femoral plaques. The choice of sample material and sampling method affect the measurements of circulating MMP-9 levels.

Diabetes exacerbates angiographic coronary lesion progression in subjects with metabolic syndrome independent of CRP levels

Background Metabolic syndrome is gaining more attention as a special cluster of cardiovascular risks. However, its role, with or without diabetes, in predicting atherosclerosis progression, remains largely undetermined. We investigated the predictors for angiographic coronary atherosclerosis progression in patients with metabolic syndrome and angina pectoris. Methods Patients with metabolic syndrome and angina pectoris who underwent repeat coronary angiograms and had serum samples at the time of first catheterization were enrolled for analysis ( N = 113). A modified Gensini scoring system was used to define CAD progression between the index and follow-up angiograms. Those who had significant angiographic progression of coronary disease were classified as the progression group ( N = 42) and those who did not as the non-progression group ( N = 71). Results There were more cases of diabetes mellitus (52% vs. 31%, p = 0.040) in the CAD progression group. The progression group also had higher baseline fasting blood glucose (150 ± 73 vs. 117 ± 46 mg/dl, p = 0.010) but similar LDL cholesterol (114 ± 38 vs. 109 ± 33 mg/dl, p = 0.421) than the non-progression group. In terms of inflammatory markers, there was no difference in hs-CRP ( p = 0.208), MCP-1 ( p = 0.514), or sCD40L ( p = 0.549) between the groups. In binary logistic regression, diabetes mellitus remained a significant predictor of CAD progression (OR 2.43, p = 0.030) for patients with metabolic syndrome and angina pectoris, but hs-CRP and LDL-C were not. Conclusion Diabetes mellitus, but not inflammatory marker hs-CRP or LDL-C, is a significant predictor of angiographic CAD progression in patients with metabolic syndrome and angina pectoris.