Coronary Artery Stenosis In Patients Research Articles

Clinical significance of the m6A methyltransferase METTL3 in peripheral blood of patients with coronary heart disease.

This study aims to explore the association of methyltransferase-like protein 3 (METTL3) expression with severity of coronary artery stenosis in patients with coronary heart disease (CHD). A total of 100 patients administrated in the Fourth Affiliated Hospital of China Medical University between October 2022 and June 2023 with primary symptoms of chest pain or tightness, or cardiac discomfort, and who underwent coronary angiography for a definitive diagnosis, were included in the study. The baseline characteristics, including TG, TC, LDL-C, HDL-C, uric acid and past history were recorded. Peripheral blood samples were collected to assess the expression levels of METTL3, YT521-B homology domains 1 (YTHDF1), YT521-B homology domains 2 (YTHDF2), and YT521-B homology domains 3 (YTHDF3) using the PCR method. Relative expression levels of METTL3 protein were determined by Western blotting. Correlation analysis were conducted to evaluate the relationship between METTL3/YTHDF1 gene expression and clinical data. Receiver operating characteristic (ROC) curve analysis was employed to assess the predictive value of METTL3 and YTHDF1 for CHD. Binary logistic regression was used to determine whether the expression of METTL3 and YTHDF1 in peripheral blood were risk factors for CHD. The study found no significant differences in baseline characteristics between CHD patients and controls, except for length of stay, Lymphocytes, Neutrophils, AST, HDL-C and modified Gensini score. The gene expression levels of METTL3 and YTHDF1 were significantly higher in CHD patients compared to controls (p < 0.05). Furthermore, METTL3 protein expression was also significantly elevated in the CHD group compared to the control group (p < 0.05). METTL3 gene expression correlated with HDL-C and Gensini score, while YTHDF1 gene expression correlated with Age, WBC, Neutrophils, RDW-CV, modified Gensini score. ROC curve analysis demonstrated an AUC of 0.692 for METTL3 in CHD, with a sensitivity of 66.7% and a specificity of 69.8% at a cut-off value of >0.052. The AUC for YTHDF1 in CHD was 0.623, with a sensitivity of 47.4% and a specificity of 74.4% at a cut-off value of >0.027. Binary logistic regression revealed that only increased METTL3 expression in peripheral blood was an independent risk factor for CHD (p < 0.05). The increased expression of METTL3 in peripheral blood may serve as a potential biomarker and predictive factor for CHD.

Dietary antioxidant status indices may not interact with CETP Taq1B polymorphism on lipid profile and severity of coronary artery stenosis in patients under coronary angiography.

The association of CETP Taq1B polymorphism with some metabolic traits is still controversial. The interaction of adherence to dietary indices with this polymorphism on the severity of coronary artery stenosis and serum lipid parameters needs to be investigated. This study aimed to test this hypothesis. This cross-sectional study included 453 patients who were referred from Afshar Hospital of Yazd and undergoing coronary angiography from 2020 to 2021. Dietary intake was evaluated by a 178-item validated and reliable dietary questionnaire. Dietary indices such as dietary antioxidant index (DAI), dietary antioxidant quality score (DAQS), and dietary phytochemical index (DPI) are determined according to dietary guidelines. The Taq1B variant was genotyped by the polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP). Two-way ANOVA was used to test the interaction between Taq1B polymorphism and dietary indices. The results of the frequency analysis of Taq1B genotypes showed that 10.4% were B1B1, 72.4% B1B2, and 17.2% B2B2. No significant interaction was found between the Taq1B variant with high adherence to DAQS, DAI, and DPI on total cholesterol (TC), high-density lipoprotein cholesterol (HDL), low-density lipoprotein cholesterol (LDL), triglyceride (TG) levels, and Gensini score (GS) and Syntax score (SS). In high-adherence dietary indices, lipid profile and coronary artery stenosis scores did not differ significantly in Taq1B genotypes. Due to the insignificant results in this research, further studies are needed to investigate the role of Taq1B SNP in modulating dyslipidemia and the severity of the CAD in interaction with dietary indices.

Diagnostic performance of noninvasive computed tomography-derived fractional flow reserve in patients with severe aortic stenosis

Abstract Background Noninvasive fractional flow reserve derived from coronary computed tomography angiography (FFRct) is developed as a decision-making tool in daily clinical practice. However, its diagnostic performance has not been sufficiently explored in patients with severe aortic stenosis (AS). Purpose To identify the diagnostic performance of FFRct in patients with severe AS using invasive fractional flow reserve (FFR) as the reference standard. Methods This study was a retrospective observational that included consecutive patients with severe AS undergoing TAVI who had concomitant intermediate coronary artery stenosis based on preoperative invasive coronary angiography. Preoperative invasive FFR and CT data preoperatively before TAVI were prospectively collected. Results We analyzed the data of patients with severe AS demonstrating intermediate coronary artery stenosis and compared the FFRct values with the invasive FFR values. Among 93 patients (100 vessels), the median FFR and FFRct (Q1, Q3) were 0.85 (0.78, 0.90) and 0.83 (0.72, 0.88), respectively. The FFRct values significantly correlated with the FFR values (r = 0.57; p &amp;lt; 0.0001). The vessel-based analysis of the accuracy of FFRct showed a sensitivity of 90.3%, specificity of 73.9%, positive predictive value of 60.9%, and negative predictive value of 94.4%. Conclusions FFRct demonstrated a significant correlation with invasive FFR and a high negative predictive value in patients with severe AS. These findings suggest that FFRct would be a clinically beneficial noninvasive tool for excluding functional coronary artery stenosis in patients with severe AS.

Incremental value of a CCTA-derived AI-based ischemia algorithm over standard CCTA interpretation for coronary ischemia in patients with suspected coronary artery disease

Abstract Background Coronary computed tomography angiography (CCTA) is a widely used non-invasive test to diagnose coronary artery stenosis in patients with suspected coronary artery disease (CAD). Positive predictive value for ischemia has been suboptimal using clinical reading. A novel AI-based ischemia algorithm applying machine learning that considers an array of atherosclerotic and vascular morphology features from CCTA images has been suggested to improve the diagnostic performance for ischemia. Purpose This study aims to evaluate the incremental diagnostic performance of CCTA derived AI-based ischemia algorithm in evaluating myocardial ischemia. Methods Patients with suspected CAD referred for CCTA at Turku University Hospital from February 2007 to December 2016 were analysed. The AI-based ischemia algorithm was calculated by analysts blinded for patient characteristics and clinical outcomes using typically-acquired CCTA images. In diagnostic reading significant stenosis defined by a stenosis &amp;gt; 50% on CCTA. The reference standard was ischemia detected by stress 15O-H2O positron emission tomography (PET). Results A total of 1445 patients (mean age 63 ± 9 years, 46% male) were included in this analysis. Myocardial ischemia by PET was detected in 384 (27%) patients while the other patients had either normal PET or had non-obstructive CAD by CCTA. A positive AI-based ischemia algorithm was found in 431 (30%) patients. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the AI-based ischemia algorithm for the assessment of myocardial ischemia were 83%, 74%, 86%, 66%, and 90%, respectively. Compared with diagnostic reading of CCTA (area under the receiver operating characteristic curve [AUC], 0.853; 95%CI 0.832-0.874), the model including clinical reading and AI-based ischemia algorithm demonstrated superior discrimination of myocardial ischemia (AUC 0.883; 95%CI 0.863-0.904, p-value &amp;lt;0.001). (Figure) Conclusions A novel AI-based ischemia algorithm derived from CCTA improves diagnostic accuracy compared with clinical reading of CCTA in assessing myocardial ischemia by PET perfusion imaging in patients with suspected CAD.Figure

Incidence of flow-limiting coronary artery stenoses in patients with diabetes - a coronary angiography natural history study

Abstract Background Diabetes is an established risk factor for the development of coronary atherosclerosis. We sought to assess the association between diabetes and the incidence of coronary artery atherosclerosis progression on coronary angiography. Methods Using the Swedish Coronary Angiography and Angioplasty Registry (SCAAR), we included all coronary artery segments with mild to no atherosclerosis defined as &amp;lt;50% luminal obstruction in patients undergoing a first-time coronary angiography in Sweden between 1989 and 2017. Patients with two or more vessel disease were excluded as were patients with a previous history of coronary artery disease. In patients with one vessel disease, the diseased vessel including all its branches were excluded. Patients were followed for 15 years until a clinically indicated re-angiography was done, death occurred or end of follow-up (April 2018). The primary outcome was plaque progression to flow-limiting coronary artery stenosis defined as ≥50% luminal obstruction on repeat angiography assessed using epidemiological tables, Kaplan Meier event rates, and Cox proportional hazard models. The importance of selected risk factors (smoking, hypertension, hyperlipidemia, and established coronary artery disease) was assessed. Results A total of 2 661 245 coronary segments in 248 736 patients were included in the study. Diabetes was present in 30 533 patients and 320 815 coronary artery segments. Kaplan-Meier event rates and incidence rates (IR) per 1000 segment-years were higher in patients with diabetes (5.5%, IR 2.78 [95% CI 2.70–2.85] vs. 3.0%, 1.44 [1.42–1.46]) resulting in an almost two-folded hazard ratio (HR) of plaque progression (HR 1.93 [95% CI 1.87– 2.00]). The anatomical distribution of plaque progression was similar between the two cohorts on all levels of analysis (coronary artery level, main artery and branches level, and coronary segment level artery). Diabetic patients with established coronary artery disease had a significantly higher risk of future events compared to those without clinically significant coronary artery disease. Conclusions Diabetes was associated with an almost twofold higher incidence rate of plaque progression but did not appear to alter the anatomical location of plaque development compared to the absence of diabetes. Once coronary artery disease is established, the rate of atherosclerotic events accelerates. Therefore, adopting aggressive primary prevention strategies is crucial to reduce the risk of adverse outcomes in diabetic patients.Event rates and anatomical distributionProgression of stenoses by risk factor

Quantitative myocardial perfusion should be interpreted in the light of sex and comorbidities in patients with suspected chronic coronary syndrome - a cardiac positron emission tomography study

Abstract Background and aim Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion (1). However, myocardial perfusion can be affected by factors other than coronary stenosis (2-6). The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected CCS. Methods Eighty-six patients (median age 69, range 46-86 years, 24 females) planned for elective coronary angiography due to suspected CCS were included. All patients underwent cardiac positron emission tomography (PET) using 13N-NH3 to quantify myocardial perfusion at rest and at adenosine stress. The stenosis degree of the culprit lesion for each main coronary artery was related to the myocardial segment with lowest myocardial perfusion (perfusionmin) at stress and lowest myocardial perfusion reserve (MPRmin) for its corresponding myocardial territory. Results Degree of coronary artery stenosis, male sex, increasing age, diabetes and smoking were independently associated with myocardial perfusionmin at stress (Table 1). Degree of coronary artery stenosis, age, diabetes and hypertension were independently associated with MPRmin (Table 1). Male sex was independently associated with a significantly lower myocardial perfusionmin at stress at 0-50% coronary artery stenosis but not for higher degree of stenosis (&amp;gt;50%) or MPRmin (Figure 1). Conclusion Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independently of coronary artery stenosis in patients with suspected CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected CCS. Fig. 1 Myocardial perfusionmin at stress (A) and lowest myocardial perfusion reserve (B) in males and females with 0-50% and 51-100% stenoses. Solid lines indicate mean perfusion in each group. Dashed lines indicate the lower boundary of the current reference interval for myocardial perfusion at 2.0 ml/min/g. Univariable linear mixed model analyses were performed to compare the groups and obtain the p-values.

The potential role of radiochemical analysis of CT images of epicardial adipose tissue in the prognosis of acute myocardial infarction

Introduction. Multispiral computed tomography (MSCT) coronary angiography (CAG) is a highly informative method of visualizing atherosclerotic plaques in the coronary arteries and assessing their structure. At the same time, this method has a few significant drawbacks associated with the intravenous administration of iodine-containing radiopaque agents as well as high radiation exposure. The radiomic analysis of contrast-free MSCT images allows calculating many additional quantitative parameters, which can potentially be associated with atherosclerotic plaque instability and the degree of coronary artery stenosis. At the same time, the prognostic and diagnostic value of radiomic characteristics has not been investigated.Aim: To assess whether there is an association between radiomic indexes of EAT on non-contrast MSCT cardiac images with the degree of atherosclerotic coronary artery stenosis in patients with stable CAD, as well as the incidence of acute coronary syndrome (ACS) within 5 years in this category of patients.Material and Methods. We retrospectively reviewed 100 MSCT-CAG studies performed to diagnose coronary heart disease in patients. 39 patients with signs of coronary stenosis up to 50% and registered in Tomsk medical information systems (MIS) for at least 5 years were selected, as well as 15 people without signs of coronary arteries (CA) atherosclerosis as a control group. Epicardial adipose tissue (EAT) volume was assessed and 837 radiomic characteristics were calculated on non-contrasted MSCT cardiac images of all patients (54 people). The presence or absence of ACS within 5 years after MSCT-CAG in each patient was monitored according to Tomsk MIS data. Statistical analysis and comparison of indices were performed in control group (group 2) and study group (group 1), as well as in subgroups of patients who had suffered AMI (group 1a) and those who had not (group 1b).Results. When comparing group 1 with the control group, significant differences (p &lt; 0.05) were found for all radiomic parameters, density, and volume of EAT. Correlation analysis did not reveal any relationship between the radiomic characteristics of EAT and the degree of coronary artery stenosis, as well as the calcium index. According to the results of the MIS of Tomsk analysis, group 1 was divided into 2 subgroups: without ACS (group 1a; n = 27 (50%)) and with ACS (group 1b; n = 12 (22%)). When comparing subgroups 1a and 1b, there were no significant differences in the volume and density of EAT (p &gt; 0.05), however, 8 out of 837 radiomic parameters differed significantly. Multiple regression analysis has shown that the Size Zone Nonuniformity gray level zone matrix (SZN-GLSZM) and Gray Level Variance (GLCM) gray co-occurrence matrix are independent predictors of the development of ACS within 5 years. According to the results of the ROC analysis, the logistic model with the inclusion of radiomic data showed high sensitivity and specificity in predicting the development of ACS (cut-off point &lt;8025.7; specificity 96%, sensitivity 75%, AUC = 0.806, p &lt; 0.001 for SZN; cut-off point &lt;4.08; specificity 93%, sensitivity 83%, AUC = 0.861 for GLV; p &lt; 0.001).Conclusion. SZN GLSZM and GLV GLCM radiomic features on non-contrast MSCT images of EAT are associated with the incidence of ASC in patients with coronary artery atherosclerosis. Radiomic analysis of EAT could potentially be used for personalized assessment of the ACS risk.

Construction and validation of a clinical prediction model for asymptomatic obstructive coronary stenosis in patients with carotid stenosis.

Coronary artery stenosis occurs frequently in patients with carotid artery stenosis. We developed a clinical predictive model to investigate the clinical risk of asymptomatic obstructive coronary artery stenosis in patients with carotid artery stenosis ≥ 50%. From January 2018 to January 2022, carotid stenosis patients hospitalized at the First Affiliated Hospital of Zhengzhou University's Department of Endovascular Surgery were subjected to a retrospective analysis of their clinical information and imaging results. Excluded criteria were patients with lacking data, symptomatic coronary stenosis, prior coronary artery bypass grafting, and coronary stent implantation. Patients were separated into case and control groups according to whether or not they had obstructive coronary stenosis. Independent predictors were screened using univariate and multivariate logistic regression, and their accuracy was confirmed using least absolute shrinkage and selection operator (LASSO) regression. A Nomogram prediction model was developed using the aforementioned filtered factors. The model's discrimination and specificity were evaluated using the receiver operating characteristic curve (ROC) and Hosmer-Lemeshow goodness-of-fit test. Internal validation employed the Bootstrap procedure. The clinical decision curve analysis (DCA) of the prediction model was developed to assess the clinical applicability of the model. The investigation included a total of 227 patients, of whom 132 (58.1%) had coronary artery stenosis. Hypertension, Grade I plaque, HbA1c ≥ 7.0%, MPV ≥ 9.2fl, and Fib ≥ 3.0 g/L were independent predictors, with OR values of (2.506, 0.219, 0.457, 1.876, 2.005), according to multivariate logistic regression. Risk factor screening and validation using lasso regression. The predictors chosen based on the optimal λ value are consistent with the predictors identified by multiple regression. The area under the ROC curve (AUC) of the model based on the above predictors was 0.701 (0.633-0.770), indicating that the model discriminated well. The calibration curve of the model closely matched the actual curve, and P > 0.05 in the Hosmer-Lemeshow goodness-of-fit test indicated the model's accuracy. The results of the DCA curve demonstrate the clinical applicability of the prediction model. Hypertension, grade I plaque, HbA1c ≥ 7.0%, MPV ≥ 9.2 fl, and Fib ≥ 3.0 g/L are predictors of asymptomatic coronary stenosis in patients with carotid stenosis ≥50%. The diagnostic model is clinically applicable and useful for identifying patients at high risk.

Quantitative myocardial perfusion should be interpreted in the light of sex and comorbidities in patients with suspected chronic coronary syndrome: A cardiac positron emission tomography study.

Diagnosis and treatment of patients with suspected chronic coronary syndrome (CCS) currently relies on the degree of coronary artery stenosis and its significance for myocardial perfusion. However, myocardial perfusion can be affected by factors other than coronary stenosis. The aim of this study was to investigate to what extent sex, age, diabetes, hypertension and smoking affect quantitative myocardial perfusion, beyond the degree of coronary artery stenosis, in patients with suspected or established CCS. Eighty-six patients [median age 69 (range 46-86)years, 24 females]planned for elective coronary angiography due to suspected or established CCS were included. All patients underwent cardiac 13 N-NH3 positron emission tomography to quantify myocardial perfusion at rest and stress. Lowest myocardial perfusion (perfusionmin ) at stress and rest and lowest myocardial perfusion reserve (MPRmin ) for all vessel territories was used as dependent variables in a linear mixed model. Independent variables were vessel territory, degree of coronary artery stenosis (as a continuous variable of 0%-100% stenosis), sex, age, diabetes, hypertension and smoking habits. Degree of coronary artery stenosis (p < 0.001), male sex (1.8 ± 0.6 vs. 2.3 ± 0.6 mL/min/g, p < 0.001), increasing age (p = 0.025), diabetes (1.6 ± 0.5 vs. 2.0 ± 0.6 mL/min/g, p = 0.023) and smoking (1.9 ± 0.6 vs. 2.1 ± 0.6 mL/min/g, p = 0.052) were independently associated with myocardial perfusionmin at stress. Degree of coronary artery stenosis (p < 0.001), age (p = 0.040), diabetes (1.8 ± 0.6 vs. 2.3 ± 0.7, p = 0.046) and hypertension (2.2 ± 0.7 vs. 2.5 ± 0.6, p = 0.033) were independently associated with MPRmin . Sex, increasing age, diabetes, hypertension and smoking affect myocardial perfusion independent of coronary artery stenosis in patients with suspected or established CCS. Thus, these factors need to be considered when assessing the significance of reduced quantitative myocardial perfusion of patients with suspected or established CCS.

Interaction of dietary patterns with rs28362491 on severity of coronary artery stenosis in patients undergoing coronary angiography

Coronary artery disease (CAD) is one of the most important cardiovascular diseases. Lifestyle and genetic factors play important roles in the development of CAD. The aim of the study is to examine the interaction of dietary patterns and genes on the likelihood of abnormal lipid profile and coronary artery stenosis in Iranians undergoing coronary angiography. This cross-sectional study was performed on 440 patients who underwent coronary angiography. The factor analysis method was used to extract dietary patterns. Commercial kits have been used to assess biochemical parameters. The detection of the rs28362491 genotype was carried out by the method of restriction fragment length polymorphism. Traditional (TDP) and western dietary pattern (WDP) were extracted. We observed an interaction of adherence to TDP and rs28362491 on the odds of having a high Gensini score. These interactions indicated that higher adherence to TDP was associated with higher odds of having a high Gensini score for patients with DD genotype than for those with II genotype. (OR 2.33, 95%CI 1.00–5.44; P = 0.05). These interactions remained statistically significant even after confounder variables. We observed an interaction between higher adherence to TDP and rs28362491 variants on the odds of high low-density lipoprotein cholesterol levels (P = 0.04) in the unadjusted model. We found a significant interaction of this polymorphism and higher adherence to WDP on the odds of having a high Gensini score in the unadjusted model (P = 0.04). This study provides a basis for future research on NF-KB1 gene and diet interaction. More large-scale longitudinal studies are needed to validate these findings.

Artificial intelligence-based opportunistic detection of coronary artery stenosis on aortic computed tomography angiography in emergency department patients with acute chest pain.

To evaluate a deep-learning model (DLM) for detecting coronary stenoses in emergency room patients with acute chest pain (ACP) explored with electrocardiogram-gated aortic computed tomography angiography (CTA) to rule out aortic dissection. This retrospective study included 217 emergency room patients (41% female, mean age 67.2 years) presenting with ACP and evaluated by aortic CTA at our institution. Computed tomography angiography was assessed by two readers, who rated the coronary arteries as 1 (no stenosis), 2 (<50% stenosis), or 3 (≥50% stenosis). Computed tomography angiography was categorized as high quality (HQ), if all three main coronary arteries were analysable and low quality (LQ) otherwise. Curvilinear coronary images were rated by a DLM using the same system. Per-patient and per-vessel analyses were conducted. One hundred and twenty-one patients had HQ and 96 LQ CTA. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and accuracy of the DLM in patients with high-quality image for detecting ≥50% stenoses were 100, 62, 59, 100, and 75% at the patient level and 98, 79, 57, 99, and 84% at the vessel level, respectively. Sensitivity was lower (79%) for detecting ≥50% stenoses at the vessel level in patients with low-quality image. Diagnostic accuracy was 84% in both groups. All 12 patients with acute coronary syndrome (ACS) and stenoses by invasive coronary angiography (ICA) were rated 3 by the DLM. A DLM demonstrated high NPV for significant coronary artery stenosis in patients with ACP. All patients with ACS and stenoses by ICA were identified by the DLM.

Concordance between coronary computed tomography angiography and coronary angiography in assessing the significance of coronary artery stenosis in patients with multivessel coronary artery disease

Concordance between coronary computed tomography angiography and coronary angiography in assessing the significance of coronary artery stenosis in patients with multivessel coronary artery disease

Evaluation of the Relationship Between the Characteristics and Dimensions of Calcified Plaques and Coronary Artery Stenosis in Patients Undergoing Coronary Computed Tomography Angiography

Background: Despite the important role of coronary computed tomography angiography (CCTA) in determining the features of coronary atherosclerotic plaques, very few studies have investigated the role of plaque dimensions in the process of coronary artery obstruction. Therefore, this study aimed to assess the relationship between the characteristics and dimensions of calcified plaques and coronary artery stenosis using CCTA. Objectives: This study aimed to evaluate the relationship between calcified plaque dimensions and coronary artery stenosis in patients undergoing CCTA. Patients and Methods: This cross-sectional study was conducted on 211 plaques of candidate patients for prospective and retrospective electrocardiography (ECG)-gated CCTA, using spiral scanning at 120 kV. The length, width, thickness, and luminal areas of calcified plaques were assessed in all coronary arteries. Results: The mean rate of stenosis was estimated to be 56.1 ± 24.4%. The number of patients with stenosis &lt; 50% was 100 (47.3%). Stenosis had a significant relationship with the plaque luminal area and the luminal dimeter of the normal coronary artery proximal and distal to the plaque (P &lt; 0.05). However, there was no significant correlation between stenosis and normal luminal area (P &gt; 0.05). Meanwhile, a significant relationship was found between stenosis and the width and length of plaques (P &lt; 0.05). Conclusion: The present results indicated a significant association between stenosis and the width, length, and luminal area of plaques. It can be concluded that plaque dimensions are a predictive factor for stenosis.

The correlation between serum matrix metalloproteinase-9 levels and the severity of coronary artery stenosis in patients with acute coronary syndrome

Link of Video Abstract: https://www.youtube.com/watch?v=mzVt00YaibkIntroduction: Atherosclerosis causes coronary artery stenosis in a lot of patients with acute coronary syndrome (ACS). By controlling platelet activity and destroying the extracellular matrix, a group of enzymes known as matrix metalloproteinases (MMPs) contribute to the plaque rupture process that causes ACS. The study aimed to determine whether there was any correlation between the amount of serum MMP-9 and the severity of coronary artery stenosis in ACS patients. Methods: Cross-sectional analytical observational design was employed in this investigation. The research population consisted of ACS patients at the Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia. Patients who were included as samples had to satisfy the inclusion and exclusion requirements. This study used analysis of variance (ANOVA) as a bivariate analysis to examine the connection between blood MMP-9 levels and the severity of coronary artery stenosis. The threshold for statistical significance was a p-value≤0.05. Results: This research comprised 40 patients with ACS, of which 14 had STEMI, 11 had NSTEMI, and 15 had unstable angina pectoris (UAP). Eleven individuals had mild coronary artery stenosis, eleven had moderate stenosis, and eighteen had severe stenosis, according to an analysis of the Gensini score. Bivariate analysis revealed no significant relationship between blood MMP-9 levels and the degree of coronary artery stenosis in ACS patients (p-value = 0.434). Conclusions: In patients with ACS at the Dr. Zainoel Abidin General Hospital in Banda Aceh, Indonesia, there was no statistically significant association between serum MMP-9 levels and the degree of coronary artery stenosis, according to this study.

Correlation Analysis and Diagnostic Value of Serum Homocysteine, Cystatin C and Uric Acid Levels with the Severity of Coronary Artery Stenosis in Patients with Coronary Heart Disease.

Coronary angiography (CAG) is an invasive examination with high risks and costs and various complications may occur. It is necessary to find a diagnostic method, non-invasiveness, inexpensive with low risk. This study aims to analyze the correlation between the levels of serum homocysteine (Hcy), cystatin C (Cys C) and uric acid (UA) and Gensini score in patients with coronary heart disease (CHD) and assess their diagnostic value for CHD. A retrospective analysis was conducted on 1412 patients underwent CAG from October 2019 to December 2021, and we conducted this study from January to July 2022. A total of 765 patients with CHD confirmed by CAG were selected as the research group, while 647 patients revealed as non-obstructive stenosis by CAG as the control group. The serum Hcy, Cys C and UA levels were detected and the correlation between Gensini score and variables was analyzed. The receiver-operating characteristic (ROC) curve was performed to assess the diagnostic value of the Hcy, Cys C and UA for CHD. The serum Hcy, Cys C and UA levels in the research group were higher as compared with the control group (p<0.05). Spearman correlation and multivariate linear regression analysis showed that there was a significantly positive correlation between Gensini score and serum Hcy, Cys C and UA levels (p<0.05). The ROC curve analysis presented the combined Hcy and Cys C with UA having the highest specificity of diagnostic value for CHD (area under the curve (AUC)=0.768, 95% CI 0.706-0.823, specificity = 72.34%, sensitivity = 67.88%, Youden Index = 0.4022). The serum Hcy, Cys C and UA levels in patients with CHD were significantly increased, positive correlation with Gensini score. The combined Hcy and Cys C with UA could be used to assess the severity of coronary artery stenosis and provide predictive and early intervention treatment values for CHD and a new way of diagnosing CHD, which is cheap, safe, effective and deserving of clinical application.

The Relationship between the Serum NLRP1 Level and Coronary Lesions in Patients with Coronary Artery Disease.

The pathogenesis of coronary artery disease is complex, and inflammation is one of the regulatory factors. The nucleotide-binding oligomerization domain (NOD)-like receptor protein 1 (NLRP1) plays an important role in the cellular inflammatory response, cell apoptosis, cell death, and autoimmune diseases. Whether the level of NLRP1 is related to the severity of coronary artery stenosis in patients with coronary artery disease (CAD) has not been reported. To test the serum level of NLRP1 in unstable angina (UA) patients and investigate the effect of NLRP1 on coronary stenosis severity of the coronary artery disease (CAD). 307 patients hospitalized in the Department of Cardiology of the Affiliated Hospital of Xuzhou Medical University for coronary angiography from January 1, 2021, to December 31, 2022 were included. We detect the level of NLRP1 in the serum of the included patients. Patients were divided into UA group and control group according to coronary angiography results and other clinical data. We use logistic regression to screen the influencing factors of UA. Then, subgroups were divided according to the Gensini score and the number of coronary artery lesions, and the difference of serum NLRP1 level between the groups was compared. Spearman correlation analysis was used to explore the correlation between the serum NLRP1 level and Gensini score. We analyze the diagnostic value of NLRP1 for UA by drawing ROC curve. The median level of serum NLRP1 in patients with UA (n = 257) was 49.71 pg/ml, IQR 30.15, 80.21, and that in patients without UA (n = 50) was 24.75 pg/ml, IQR 13.49, 41.95. Serum NLRP1 levels were significantly different among different subgroups. The patient's Gensini score was correlated with the patient's serum NLRP1 level. The serum NLRP1 level is increased in patients with UA, which is increased with the increasing severity of coronary lesions.

Diagnostic significance of myocardial and multimodal contrast exercise stress echocardiography in the detection of hemodynamically significant coronary artery stenosis in stable angina pectoris

Aim. To evaluate the diagnostic significance of myocardial contrast stress echocardiography (MCSE) and multimodal contrast stress echocardiography (MMSE) with dosed exercise in detecting hemo­dynamically significant coronary artery stenosis in patients with stable coronary heart disease (CAD) without impaired regional left ventricular contractility at rest.Material and methods. MCSE and MMSE were performed in 61 pa­­tients with suspected or stable CAD (mean age, 62,9±8,9 years). All patients underwent coronary angiography. During MCSE, perfusion and regional contractility were assessed. With MMSE, regional contractility was assessed. Sensitivity, specificity, and positive (LR+) and negative (LR-) likelihood ratios for MCSE and MMSE were assessed in com­parison with coronary angiography.Results. The sensitivity of MCSE with perfusion assessment was 82% (CI, 67-92%) with specificity of 70% (35-92%), LR+ — 2,74, LR- — 0,26. Sensitivity of MCSE with assessment of perfusion and regional contractility was 67% (50-81%) with specificity of 90% (65-99%), LR+ — 6,67, LR- — 0,37. The sensitivity of MCSE with an estimate of regional contractility of 74% (58-87%) with a specificity of 90% (56-98%), LR+ — 7,4, LR- — 0,28. The sensitivity of MMSE in the mode of cavitary and myocardial contrasting was 72% (55-85%) with a specificity of 90% (56-99%), LR+ — 7,18, LR- — 0,31.Conclusion. MCSE with an assessment of regional contractility and MMSE are of diagnostic importance in the detection of CAD, a positive result of which increases the post-test probability of hemodynamically significant coronary artery stenosis. A positive result of MCSE with dosed exercise with isolated perfusion assessment does not have a diagnostically significant effect on the post-test probability of CAD.

Potential Biomarkers and Therapeutic Targets: Inflammation and Oxidative Stress in Left Carotid Artery Stenosis with Coronary Artery Disease.

Patients with left carotid artery atherosclerotic stenosis have an increased ischemic stroke risk. Left carotid stenosis, the most common cause of the transient ischemic attack, is related to a higher risk of acute stroke. Left carotid artery stenosis is also associated with cerebral artery infarction. The significant coronary stenosis promotes ST-segment elevation myocardial infarctions. The severe coronary stenosis plays an important role in development and progression of myocardial infarction. However, the dynamic changes of circulating oxidative stress and inflammatory markers in the carotid stenosis combined with coronary artery stenosis are not clear, and it also remains unknown whether markers of oxidative stress and inflammation are potential therapeutic targets for carotid stenosis combined with coronary artery stenosis. This study aims to explore the effects of oxidative stress combined with an inflammatory response on left carotid artery stenosis with coronary artery disease in patients. We, therefore, tested the hypothesis that levels of markers of oxidative stress and inflammation are associated with coexistent severe carotid and coronary artery stenosis in patients. We measured the circulating levels of malondialdehyde (MDA), oxidized low-density lipoprotein (OX-LDL), homocysteine (Hcy), F2-isoprostanes (F2-IsoPs), tumor necrosis factor-alpha (TNF-α), high-sensitivity C-reactive protein (hs-CRP), prostaglandin E2 (PG-E2) and interferon-gamma (IFN-γ) in patients with combined carotid and coronary artery severe stenosis. We also assessed the relationships among oxidative stress, inflammation, and severe stenosis of the carotid with a coronary artery in patients. Levels of MDA, OX-LDL, Hcy, F2-IsoPs, TNF-α, hs-CRP, PG-E2, and IFN-γ were remarkably increased (P < 0.001) in patients with combined carotid and coronary artery severe stenosis. High levels of oxidative stress and inflammation may be related to severe stenosis of the carotid with coronary arteries in patients. Our observations indicated that measurements of oxidative stress and inflammatory markers may be valuable for the assessment of the degree of carotid with coronary artery stenosis. The biomarkers of oxidative stress and inflammatory response may become therapeutic targets for carotid artery stenosis with coronary artery stenosis in patients.

Left atrial strain rate: marker of hemodynamically significant coronary artery stenosis?

Aim: To assess the diagnostic value of left atrial deformation parameters during dobutamine stress echocardiography to predict significant coronary artery stenosis in patients with moderate pretest probability of coronary artery disease (CAD). Materials& methods: Rest and stress echocardiography were performed on 61 patients with a moderate and high probability of CAD. Based on presence of CAD patients were divided into pathological and nonpathological groups. Results: Early diastolic strain rate (LAe SR) was significantly lower among the pathological group at high dobutamine doses. LAe SR was evaluated with receiver operating characteristic curve and threshold prognostic value was set of -2.05 (sensitivity 78%, specificity 50%, area under the curve 0.638; p=0.026). Conclusion: Measuring LAe SR has predictive value and might be a helpful parameter in assessing ischemia.

Diagnostic value of peripheral blood miR-296 combined with vascular endothelial growth factor B on the degree of coronary artery stenosis in patients with coronary heart disease.

Coronary heart disease (CHD) is a disorder resulting from organic and functional coronary artery stenosis (CAS), thus causing reduced oxygenated blood in the heart. miRNAs are useful biomarkers in the diagnosis of atherosclerosis, CHD, and acute coronary syndrome. Vascular endothelial growth factor (VEGF) is closely related to CHD. This study explored the correlation of miR-296 and VEGF-B expression levels in peripheral blood with CAS degree in CHD patients. Totally 220 CHD patients were enrolled and classified into mild-(71 cases)/moderate-(81 cases)/severe-CAS (68 cases) groups, with another 80 healthy cases as controls. The serum miR-296 and VEGF-B expression levels were detected using reverse transcription quantitative polymerase chain reaction. The correlation between miR-296 and CAS-related indexes was assessed via Pearson analysis. The binding relationship of miR-296 and VEGF-B was first predicted and their correlation was further analyzed via the Pearson method. The clinical diagnostic efficacy of miR-296 or VEGF-B on CAS degree was evaluated by the receiver operating characteristic curve. Serum miR-296 was downregulated in CHD patients and was the lowest in patients with severe-CAS. miR-296 was negatively-correlated with high-sensitivity C-reactive protein, brain natriuretic peptide, and cardiac troponin I. miR-296 targeted VEGF-B. VEGF-B was upregulated in CHD patients and inversely-related to miR-296. Low expression of miR-296 and high expression of VEGF-B both had high clinical diagnostic values on CAS degree in CHD patients. miR-296 combined with VEGF-B increased the diagnostic value on CAS. Low expression of miR-296 combined with high expression of its target VEGF-B predicts CAS degree in CHD patients.