Coronary Artery Research Articles

Effectiveness of Cardiac Rehabilitation for Patients after Coronary Artery Bypass Graft: Randomized Controlled Trial

Introduction: Cardiac rehabilitation is a program designed to help patients adopt healthy lifestyle changes. This study aims to investigate the effectiveness of a comprehensive cardiac rehabilitation program (CCRP) on anxiety, depression, perceived health status (PHS) and 90- day readmission rate in patients who underwent coronary artery bypass grafting (CABG). Materials and Methods: A total of 122 patients were randomized into two groups: The intervention group received CCRP. The program lasted for 12 weeks. Anxiety and depression were assessed using the hospital anxiety and depression scale (HADS) and PHS was assessed using the short form-36 health survey. The CCRP’s effectiveness was measured using analysis of variance (ANOVA). Results: The sample comprised 122 participants, of whom 85(69.7%) were male, with a mean age of 53.01±7.26 years. At baseline, the groups showed no significant differences. At 12 weeks and one month later, significant differences were observed between the groups for anxiety (F =937.69, P<0.001, partial η2=0.90), depression (F =1036.00, P<0.001, partial1 11η2=0.91), physical component summary (PCS) (F =14.73, P<0.001, partial η2=0.13) and mental component summary (MCS) (F =13.87, P<0.001, partial η2=0.121) of PHS, respectively. Conclusion: CCRP is an effective intervention that can significantly improve anxiety, depression, and PHS. Although the readmission rate difference was insignificant, it may have resulted in substantial rewards. The protocol of the present study was registered and approved in ClinicalTrials.gov PRS.

Cytokine profile of patients with coronary artery calcification without ischemic heart disease.

Objective: to study the cytokine profile in patients with coronary calcification of varying severity, without clinical manifestations of coronary artery disease. Materials and methods: the study included 68 male patients matched for age, including 25 people with coronary atherocalcinosis — corresponding to the moderate-risk group (group 1), 23 people with coronary atherocalcinosis — corresponding to the high-risk group (group 2) and 20 respondents of the control group, without clinical manifestations of coronary artery disease, for whom the coronary index was calculated using the Agatston method. Exclusion criteria were: diabetes mellitus, oncopathology, connective tissue diseases, chronic viral infections. Coronary calcium (CC) assessment and Agatston index calculation were performed using Smart Score software for coronary calcium calculation. Serum cytokine levels (IL-4, IL-6, IL-10, IL-17, FNO-α and IFN-γ) were measured using enzyme-linked immunosorbent assay (ELISA) with Cytokine test systems from Cytokin LLC, St. Petersburg, Russia. Statistical analysis of the study results was performed using Statistica 12.0 (StatSoft, USA). Results: elevated proinflammatory cytokine values were detected in both coronary calcification groups. Assessment of proinflammatory to antiinflammatory cytokine ratio indices reflects polarization of the cytokine profile in patients with coronary calcification via the proinflammatory pathway and prevalence of anti-inflammatory reserve in patients with less severe coronary artery calcification. Conclusion: a comprehensive assessment of the cytokine profile in patients with varying degrees of coronary calcification without clinical manifestations of coronary artery disease is demonstrated, showing the predominance of the proinflammatory response in both groups while maintaining suppressive immunoregulatory effects in patients with less pronounced coronary calcification. The data obtained are not unambiguous due to the peculiarities of the pleiotropic effect of cytokines, which requires a comparison of the results with quantitative and functional indicators of immunocompetent cells responsible for their synthesis.

The co-occurrence of pulmonary embolism and aortic valve thrombosis complicated by myocardial infarction as a clinical manifestation of antithrombin III deficiency: a case report

Abstract Background Hypercoagulable states may lead to vascular complications in both the systemic and pulmonary systems, and these conditions may even co-occur. Thrombosis of the native aortic valve, unlike thrombotic events on prosthetic valves, is a very rare condition that may result from thrombophilia and can mimic other valvular disorders. Most significantly, it can serve as a source of further embolic events. Case summary A 48-year-old man, a smoker, diagnosed in the emergency department with a small acute pulmonary embolism, was referred to the cardiology department for further treatment. After a transthoracic echocardiogram showed regional contractility dysfunction of the left ventricle, the patient underwent coronary angiography. Following the detection of acute occlusion of the posterior descending branch of the right coronary artery, an effective balloon coronary angioplasty was performed. Due to the suspicion of embolic etiology of the myocardial infarction, the diagnostic workup was expanded to include a transesophageal echocardiogram, which revealed a pathological structure on the aortic valve. Ultimately, thrombosis of a normally structured native aortic valve, coexisting with a slight pulmonary embolism, was diagnosed. Discussion The low incidence of native aortic valve thrombosis as a manifestation of thrombophilia, along with its transient nature, may lead to the underestimation of this clinical issue and presents challenges in diagnostic and treatment workflows, especially in case of co-occurring pulmonary embolism.

Clinical differences among types of in-stent calcifications in coronary arteries: how can this be better managed?

In-stent calcification is recognized as a significant contributor to unfavorable clinical outcomes. Understanding the various types and underlying mechanisms of in-stent calcification can help interventional operators to make decisions. This review will describe the distinct types of in-stent calcification, which are categorized into in-stent smooth calcification and in-stent calcified nodule. The mechanisms and characteristics of in-stent smooth calcification and calcified nodule will be summarized. Given the differences between these two types, treatment approaches will be discussed. This review will focus on histopathology and intracoronary imaging. For the purpose of this review, evidence was gathered from electronic literature searches via PubMed, with a particular focus on primary evidence published in the last 5 years. Several treatment devices are available such as conventional balloon, modified balloon, atherectomy device and intravascular lithotripsy, etc. In-stent smooth calcification and calcified nodule might result in different clinical courses after repeated target lesion revascularization. Understanding the mechanisms with the various types of in-stent calcification may assist operators in selecting appropriate treatment strategies.

Incidental Finding of Coronary and Non-Coronary Artery Calcium: What Do Clinicians Need To Know?

This review summarizes the role of incidentally and non-incidentally discovered coronary artery calcification (CAC) and the evolving role of non-coronary artery calcification in atherosclerotic cardiovascular disease (ASCVD) risk assessment. Additionally, this review explores the emerging use of artificial intelligence (AI), machine learning (ML), radiomics, and natural language processing (NLP) for automated detection, quantification, and communication of these incidentally discovered findings. This review summarizes recent findings in the space, including the development of various AI/ML-based approaches for automated calcification quantification and detection. Recent work leverages the use of incidentally discovered CAC and non-coronary calcification (e.g. aortic valve, aortic arch, carotid artery, breast arterial calcification) and their influence on clinical decision-making and prescribing practices. CAC and various forms of non-coronary artery calcifications are increasingly recognized as powerful and additive predictors of ASCVD risk. Advances in AI, ML, and radiomics enable scalable, automated measurement of both incidental and non-incidental CAC and non-coronary calcifications, which will facilitate more precise, personalized ASCVD risk stratification.

Genetic Susceptibility to Cardio-Cerebrovascular Diseases and White Matter Integrity in Asymptomatic Older Adults: A UK Biobank Observational Cohort Study.

Cardio-cerebrovascular diseases are linked to neuroanatomical changes that may arise from genetic risk profiles, with structural brain alterations often preceding clinical onset. The pathways connecting genetic susceptibility to early neuroimaging phenotypes remain unclear. To examine the effects of polygenic risk for cardio-cerebrovascular diseases (PRSCCVD) on brain structure in healthy middle-aged and older adults. Observational cohort study. 29,714 healthy White British individuals (mean age 54.86 ± 7.44 years; 13,691 male). 3T MRI; 3D-MPRAGE T1, DTI (monopolar Stejskal-Tanner). Brain structural measurements were derived from 48 white matter tracts (Johns Hopkins University atlas) using eight diffusion MRI metrics for white matter microstructure, and from 62 cortical regions (Desikan-Killiany-Tourville atlas) for cortical thickness and surface area measurements. Confirmatory factor analysis was applied to calculate the polygenic risk score for PRSCCVD based on PRS scores for cardiovascular disease, coronary artery disease, and ischemic stroke. Associations between PRSCCVD and 508 brain structural MRI phenotypes were examined using multivariate linear regression with Bonferroni correction. Comparative analyses between gray and white matter phenotypes, as well as between older (≥ 60 years) and middle-aged (< 60 years) participants, were performed using Wilcoxon signed-rank tests (p < 0.05). Propensity score matching was applied to balance covariates in age-related effect analyses. PRSCCVD was significantly associated with 117 white matter (β range: -0.042 to 0.051, partial R2 range: 0.29% to 0.05%) and two cortical phenotypes (bilateral insular: β = -0.023, partial R2 range: 0.05%-0.06%) in healthy middle-aged and older adults. White matter microstructure was more vulnerable than cortical morphometry (W = 37,912). Older adults had more severe white matter microstructure damage than the middle-aged people (W = 49,046). PRSCCVD preferentially affects white matter microstructure over cortical morphometry in asymptomatic individuals, with exacerbated effects in older adults. 3. 2.

Perioperative outcomes of lung resection patients after coronary stent implantation

Objective: to assess the perioperative outcomes of discontinuing antiplatelet agents for patients who have undergone surgery for lung neoplasm with coronary stents. Materials and methods: from January 2015 to June 2024, 12,738 patients underwent myocardial revascularization using percutaneous coronary angioplasty (PCI) at the State Budgetary Healthcare Institution «Research Institute - Regional Clinical Hospital No. 1 n. a. prof. S.V. Ochapovsky» (RI-RCH No. 1), Krasnodar. The average age of patients was 64.1 ± 12.4 years (minimum 28, maximum 90 years). All patients were divided into two groups: Group C — coronary artery disease and concomitant diagnosis of lung tumor (94 patients); Group D — coronary artery disease without concomitant lung tumor, selected using a random number generator due to the large number of the initial cohort (150 patients). Results: all patients stopped taking antiplatelet drugs more than 5 days before lung surgery, and 67 cases stopped taking the drugs within 2 weeks. In 20 cases, the duration of treatment exceeded 2 weeks, since the surgical plan was superimposed on preoperative outpatient bronchoscopy or puncture biopsy, and the patients did not take the drug again. The overall incidence of in-hospital cardiovascular complications was 17.02%. One patient developed low-risk pulmonary embolism on the second postoperative day, two patients developed symptoms of congestive heart failure and their condition improved after treatment with diuretics and vasodilators, 10 cases of new-onset atrial fibrillation were recorded, and three patients developed hypotension requiring inotropic support in the first 5 postoperative days. Conclusions: for patients with lung neoplasms with coronary stents who required surgery, it was safe to stop oral antiplatelet drugs before lung surgery, and no serious adverse cardiovascular events or death occurred in the perioperative period.

Comparative Evaluation of Transthoracic Echocardiography and Multislice Computed Tomography in the Preoperative Assessment of Tetralogy of Fallot

Abstract Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease, requiring precise anatomical assessment for optimal surgical planning. Transthoracic echocardiography (TTE) and multislice computed tomography (MSCT) are widely used imaging modalities for TOF evaluation, yet their relative diagnostic value, particularly in infants, remains an area of active investigation. This study aims to compare the diagnostic performance of TTE and MSCT in assessing intracardiac and extracardiac abnormalities in infants with TOF, with surgical findings as the reference standard.A prospective, single-center study was conducted on 35 infants diagnosed with TOF who underwent both TTE and 128-slice MSCT before surgical repair. Imaging findings were compared with intraoperative measurements, evaluating the sensitivity, specificity, and agreement (Cohen's kappa) between modalities.TTE and MSCT demonstrated comparable accuracy in assessing intracardiac abnormalities, with TTE showing slightly better agreement with surgical findings for ventricular septal defect (VSD) localization (κ = 0.581) than MSCT (κ = 0.485). Both modalities underestimated VSD size compared with intraoperative measurements, with MSCT showing a greater degree of underestimation (p &lt; 0.001). In contrast, MSCT exhibited superior sensitivity in detecting extracardiac abnormalities, including coronary artery anomalies (100 vs. 50%) and major aortopulmonary collateral arteries (90 vs. 25%). While higher-generation MSCT scanners offer improved image resolution, the use of a 128-slice MSCT scanner proved to be a feasible alternative when more advanced technology is unavailable.TTE remains a reliable imaging modality for intracardiac assessment and is not inferior to MSCT in evaluating cardiac deformities in TOF. However, MSCT provides superior anatomical delineation of extracardiac structures, making it valuable for comprehensive preoperative planning. Despite its operator dependency, TTE remains the preferred first-line imaging tool due to its noninvasiveness and real-time functional assessment, whereas MSCT serves as a complementary modality, particularly for extracardiac evaluation. Further multicenter studies with larger cohorts are warranted to refine imaging protocols and optimize TOF assessment strategies in infants.

H2O2-mediated relaxation in a swine model of ischemic heart disease and exercise training: mechanistic insights and the role of Kv7 channels.

We previously reported that H2O2-mediated arteriolar dilation impaired by chronic occlusion is corrected with exercise training and that BKCa and Kv channels both contribute to these adaptations. To gain additional understanding of the specific Kv channel isoforms influenced by ischemia and exercise, we hypothesized that the redox-sensitive Kv1, Kv2, and Kv7 channel subfamily isoforms would be the primary end effectors of this exercise-augmented channel contribution. Yucatan miniature swine were surgically instrumented with an ameroid occluder around the proximal left circumflex coronary artery, inducing an ischemic vascular bed, while arterioles fed by the left anterior descending artery served as nonoccluded, control vessels for each animal. Animals were randomly assigned to sedentary (normal pen activity) or exercise-trained (treadmill; 5days/week; 14 weeks) groups. Kv channels were targeted, ex vivo, in wire myography and electrophysiology studies for functional analyses, while arteriolar lysates and isolated vascular smooth muscle cells were utilized for immunoblot and immunofluorescence. We show that coronary occlusion impairs Kv7 channel contribution to H2O2-mediated relaxation that is reversed with exercise training. Whole-cell voltage clamp recordings demonstrated no changes in XE991-sensitive currents among groups, and no significant differences in Kv7 channel protein were detected. Immunofluorescent analyses revealed a decrease in colocalization of PKA with Kv7.1 channels following occlusion and increased localization with both Kv7.1 and Kv7.5 channels following exercise training. Taken together, these studies demonstrate that Kv7 channel uncoupling from a prominent vasorelaxation signaling axis results from coronary occlusion and is restored following exercise training, highlighting this subfamily as a potential therapeutic target.

Anomalous Origin of the Left Coronary Artery From the Right Pulmonary Artery (ALCARPA): A Case Report

Anomalous Origin of the Left Coronary Artery From the Right Pulmonary Artery (ALCARPA): A Case Report

Prediction of Percutaneous Coronary Intervention Success in Patients With Moderate to Severe Coronary Artery Calcification Using Machine Learning Based on Coronary Angiography: Prospective Cohort Study.

Given the challenges faced during percutaneous coronary intervention (PCI) for heavily calcified lesions, accurately predicting PCI success is crucial for enhancing patient outcomes and optimizing procedural strategies. This study aimed to use machine learning (ML) to identify coronary angiographic vascular characteristics and PCI procedures associated with the immediate procedural success rates of PCI in patients exhibiting moderate to severe coronary artery calcification (MSCAC). This study included patients who underwent PCI between January 2017 and December 2018 in a cardiovascular hospital, comprising 3271 patients with MSCAC and 17,998 with no or mild coronary artery calcification. Six ML models-k-nearest neighbor, gradient boosting decision tree, Extreme Gradient Boosting (XGBoost), logistic regression, random forest, and support vector machine-were developed and validated, with synthetic minority oversampling technique used to address imbalance data. Model performance was compared using multiple parameters, and the optimal algorithm was selected. Model interpretability was facilitated by Shapley Additive Explanations (SHAP), identifying the top 6 coronary angiographic features with the highest SHAP values. The importance of different PCI procedures was also elucidated via SHAP values. Testing validation was performed in a separate cohort of 1437 patients with MSCAC in 2013. External validation was conducted in a general hospital of 204 patients with MSCAC in 2021. Sensitivity analyses were conducted in patients with acute coronary syndrome and chronic coronary syndrome. In the development cohort, 7.6% (n=248) of patients with MSCAC experienced PCI failure compared to 4.3% (n=774) of patients with no or mild coronary artery calcification. The XGBoost model demonstrated superior performance, achieving the highest area under the receiver operator characteristic curve (AUC) of 0.984, average precision (AP) of 0.986, F1-score of 0.970, and G-mean of 0.970. Calibration curves indicated reliable predictive accuracy. The key predictive factors identified included lesion length, minimum lumen diameter, thrombolysis in myocardial infarction flow grade, chronic total occlusion, reference vessel diameter, and diffuse lesion (SHAP value 1.65, 1.40, 0.92, 0.60, 0.54, and 0.47, respectively). The use of modified balloons for calcified lesions had a positive effect on PCI success in patients with MSCAC (SHAP value 0.16). Sensitivity analyses showed consistent model performance across subgroups with similar top 5 coronary angiographic variables. The optimized XGBoost model maintained robust predictive performance in the testing cohort, with an AUC of 0.972, AP of 0.962, and F1-score of 0.940, and in the external validation set, with an AUC of 0.810, AP of 0.957, and F1-score of 0.892. This study successfully revealed the important PCI failure risk factors, such as lesion length and modified balloons, using ML models to help clinicians manage PCI strategies in patients with complex coronary artery disease such as MSCAC.

Age-stratified differences in coronary artery plaque phenotypes in women and men with non-obstructive coronary artery disease.

Coronary artery disease (CAD) progression and risk of cardiac events differ between women and men during the lifespan. Accordingly, we aimed to explore the impact of sex and age on plaque phenotype in non-obstructive CAD. We included 1189 patients with non-obstructive CAD (48% women) from the Norwegian Registry of Invasive Cardiology and quantitatively assessed each patient's plaque phenotype by coronary CT angiography. Plaque subtypes included calcified (>350 Hounsfield units [HU]), fibrous (131 to 350 HU), fibrofatty (76 to 130 HU) and necrotic core plaques (-30 to 75 HU). The impact of sex on plaque phenotype was assessed after age stratification (≤50, 51-64 and ≥65 years). Total plaque burden adjusted for vessel volume was higher in middle-aged and older women compared with men (all p<0.05). Women had lower proportions of fibrofatty plaques compared with men across all age groups, while middle-aged and older women had higher proportions of calcified and fibrous plaques compared with men. Middle-aged and older men had higher proportions of necrotic core plaques compared with women (all p<0.05). After adjusting for cardiovascular risk factors, female sex remained independently associated with total plaque burden (β=1.0 [0.5 to 1.5], p<0.001), and younger age and male sex with fibrofatty plaque burden (β=-2.8 [-4.4 to -1.2], p<0.001, and β=-3.8 [-4.9 to -2.8], p<0.001, respectively). In non-obstructive CAD, female sex was associated with a higher total plaque burden, whereas male sex and younger age were associated with a higher proportion of vulnerable fibrofatty plaques. Our results highlight important sex differences in plaque phenotypes among patients with non-obstructive CAD during the lifespan, which may impact risk-stratification. NCT04009421.

Severe-Extensive Coronary Atherosclerosis in Low-Risk Individuals and Absence of Coronary Atherosclerosis in High-Risk Individuals: The SCAPIS Extremes Project.

Factors associated with unexpected absence or presence of coronary atherosclerosis in individuals at high/low estimated cardiovascular (CV) risk are largely unexplored. We assessed two extreme phenotypes: 1) no coronary atherosclerosis despite very high CV risk; and 2) severe-extensive coronary atherosclerosis despite low CV risk. A multicenter, cross-sectional nationwide, population-based cohort of 30,154 randomly invited individuals (age 50-64 years; 51% women). Coronary plaque burden was assessed by coronary computed tomography angiography using coronary artery calcium score and segment involvement score. CVD risk was estimated by the Systematic Coronary Risk Evaluation (SCORE2) and SCORE2-Diabetes, as appropriate. In total 10,628 individuals without and 189 with diabetes were eligible. Absence of coronary plaques despite high SCORE2-risk occurred in 1.2% non-diabetic and 14.0% diabetic subjects. Severe-extreme coronary plaques despite low SCORE2-risk occurred in 0.7% non-diabetic and 0.3% diabetic subjects. In non-diabetic subjects, severe-extensive coronary plaque burden despite low SCORE2-risk was more likely in men, with increasing age, more pack-years of smoking, previous smoking, hypertension, hyperlipidemia, family history of CVD, and higher systolic blood pressure (all p<0.002). A similar but reverse pattern was observed among subjects without coronary plaques despite high SCORE2-risk. In addition, diabetic subjects without coronary plaques and high SCORE2-risk demonstrated a higher likelihood of moderate physical activity, higher education levels, and lower body mass index (p<0.05). SCORE2-risk correlated well with presence of coronary atherosclerosis, yet 1.9% non-diabetic subjects and 14.3% diabetic subjects display extreme coronary phenotypes with a mismatch between estimated cardiovascular risk and signs of coronary atherosclerosis.

Beyond Blood Sugar: A Scoping Review of GLP-1Receptor Agonists in Cardiovascular Care.

Glucagon-like peptide1 receptor agonists (GLP-1RAs) have emerged as a transformative class of therapies initially developed for glycemic control in type2 diabetes mellitus. Now, they are also getting recognized for their broader cardiometabolic effects. In this review, we discuss the mechanism of action of GLP-1RAs, focusing on their proposed cardiometabolic impact and the key clinical trials that have demonstrated improvement in cardiovascular outcomes. GLP-1RAs have demonstrated benefits in coronary artery disease, heart failure, blood pressure, and atrial fibrillation irrespective of type2 diabetes mellitus status, with new possible applications in peripheral arterial disease. Findings thus far have been translated into recommendations in clinical guidelines by the American College of Cardiology, American Heart Association, European Society of Cardiology, and American Diabetes Association. As GLP-1RAs become more prevalent in treating diabetes and patients with cardiovascular disease (CVD) or risk factors for CVD, clinicians will ultimately manage the practical aspects of patient selection, dosing, special considerations, and side effects of these medications. Ongoing and future clinical trials are expected to further define the cardiovascular role of GLP-1RAs, expand their therapeutic indications, and solidify their place in the evolving landscape of cardiovascular care.

Relationship between stress hyperglycemia ratio and the incidence of atrial fibrillation in patients after coronary artery bypass grafting: a retrospective study based on the MIMIC-IV database

BackgroundThe stress hyperglycemia ratio (SHR) is a clinical index that quantifies acute stress-induced hyperglycemia by comparing immediate blood glucose levels with chronic glucose control (reflected by HbA1c). It is especially valuable in cardiovascular disease and surgical prognosis. However, there is still a lack of research on the relationship between SHR and new-onset atrial fibrillation (AF) in patients after coronary artery bypass grafting (CABG). This study investigates the impact of postoperative SHR on AF risk following CABG.MethodsThis study is a retrospective cohort analysis conducted through the MIMIC-IV database, which included adult patients who underwent CABG and were admitted to the ICU. These patients were categorized into three distinct groups according to the tertiles of the baseline SHR level, and the primary outcome was the incidence of postoperative atrial fibrillation (POAF). We employed logistic regression models, restricted cubic splines (RCS), threshold effect analysis, ubgroup analysis, Boruta algorithm, lasso algorithm, and receiver operating characteristics (ROC) to analyze the relationship between SHR and POAF incidence comprehensively.Results2112 patients undergoing CABG were included in this study, with a median age of 69 years (IQR: 62–76), of whom 1643 (77.79%) were male. Logistic regression results showed that the incidence of AF was significantly increased in patients in the highest third of the SHR group compared with the lowest third group (OR = 1.31, 95%CI = 1.03–1.67; P = 0.0275). SHR was an independent risk factor for the incidence of POAF (OR = 1.63, 95%CI = 1.19–2.23; P = 0.0023). At the same time, RCS analysis showed that SHR was positively and linearly correlated with the incidence of POAF in patients after cardiac surgery (P = 0.009, P for Nonliner = 0.848). Threshold effect analysis identified no significant threshold and further supported a linear relationship between SHR and POAF. In addition, SHR was double-screened by Boruta and Lasso algorithms, indicating that it was statistically and biologically significantly associated with AF after CABG.ConclusionSHR is significantly related to AF after CABG. As SHR increases, the risk of POAF increases. Incorporating SHR into post-CABG risk assessment enhances AF prediction, offering a valuable reference for clinical decision-making. It may also be a potential biomarker for studying pathological mechanisms in patients after cardiac surgery. In the future, combining multi-omics data with clinical intervention trials is necessary to verify its clinical application value further.

Factors correlated with non-early achievement of target low-density lipoprotein cholesterol level using PCSK9 inhibitors.

The international guidelines recommend a target low-density lipoprotein cholesterol (LDL-c) level of < 55 mg/dL in very-high-risk patients with dyslipidemia, which were defined as those with history of acute coronary syndrome (ACS), chronic coronary syndrome with multivessel disease, diabetes mellitus, chronic kidney disease, familiar hypercholesterolemia, recurrent coronary artery disease, or polyvascular disease. In addition, an early reduction in LDL-c levels is recommended especially for ACS. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been reported to be very effective for an early reduction in the LDL-c level, but some patients showed non-early reduction. We investigated the factors correlating with non-early lowering LDL-c levels using PSCK9 inhibitors in very-high-risk patients. We enrolled consecutive patients with dyslipidemia who received evolocumab due to very-high-risk. We divided them into the early achievement of the target LDL-c level (EAC) group whose LDL-c level decreased to < 55 mg/dL 1 month later and the non-EAC group. We investigated the various factors possibly correlated with non-EAC. The non-EAC group comprised 25 patients (35.2%). A univariable analysis revealed that a body mass index (BMI) > 23.9kg/m2, history of ACS, LDL-c > 144mg/dL, and high-intensity statins were related to the non-EAC group. A multivariable analysis showed that a history of ACS was negatively and LDL cholesterol level > 144mg/dL positively correlated with non-EAC. In conclusion, we induced PSCK9 inhibitors more aggressively in ACS, and we should pay attention to the patients with higher baseline LDL-c levels during the follow-up.

Association Between Ankle-Brachial Index and Coronary Artery Calcification Score in Patients Beginning Hemodialysis

Association Between Ankle-Brachial Index and Coronary Artery Calcification Score in Patients Beginning Hemodialysis

Flow dynamic differences between Kawasaki Disease patients with coronary artery aneurysms and ectasia.

Flow dynamic differences between Kawasaki Disease patients with coronary artery aneurysms and ectasia.

Association of metabolic dysfunction-associated steatotic liver disease and steatosis-associated fibrosis estimator with subclinical coronary atherosclerosis: observation cohort study

Previous population-based studies have demonstrated differences in cardiovascular events according to the new classification of steatotic liver disease (SLD). However, detailed data on coronary artery status have not been presented. We aimed to investigate the association between subtypes of SLD and coronary artery status using findings from coronary computed tomography angiography (CCTA). We analyzed 8622 asymptomatic individuals without coronary artery disease (CAD) who underwent both abdominal ultrasonography and CCTA. Study participants were divided into four groups: 934 in the no SLD without cardiometabolic (CM) criteria group, 4811 in the no SLD with CM criteria group, 2494 in the metabolic dysfunction-associated steatotic liver disease (MASLD) group, and 252 in the MASLD with increased alcohol intake (Met-ALD) group. Obstructive CAD was defined as coronary arterial stenosis ≥ 50%. Compared with the no SLD without CM group, the no SLD with CM, MASLD, and Met-ALD groups were significantly associated with any coronary plaque (multivariable-adjusted OR 2.05 [95% CI 1.67–2.52], 2.71 [2.18–3.35], and 2.36 [1.69–3.31], respectively); calcified plaques (1.97 [1.59–2.43], 2.54 [2.04–3.16], and 2.10 [1.49–2.96], respectively); non-calcified plaques (2.04 [1.28–3.25], 2.42 [1.51–3.89], and 3.26 [1.73–6.13], respectively); and obstructive CAD (2.57 [1.53–4.32], 3.64 [2.15–6.16], and 3.51 [1.73–7.10], respectively) (p for all < 0.05). In addition, the inverse probability of treatment weighting (IPTW) analyses showed similar ORs for coronary plaques and obstructive CAD. Additionally, higher steatosis-associated fibrosis estimator (SAFE) was strongly associated with all atherosclerotic plaques and obstructive CAD. This association remained significant after multivariable adjustment and IPTW analyses. Subtypes of SLD had significant, yet different strengths of associations with subclinical coronary atherosclerosis. SAFE score classification effectively stratified the distinct associations with subclinical atherosclerosis in subjects with MASLD.

Gut microbiota: a novel strategy affecting atherosclerosis.

Atherosclerosis is a common chronic inflammatory cardiovascular disease affecting both coronary and peripheral arteries, which is influenced by multiple factors. It is increasingly evident that gut microbes and their byproducts play a crucial role in the development of atherosclerosis. The most representative feature of microbial dysbiosis in coronary artery disease patients is the reduction of the abundance of the phylum Bacteroidetes and the increase of the abundance of the phylum Firmicutes, which may cause changes in functional genes and metabolites. The gut microbiota and its metabolites influence the early, intermediate, and late stages of atherosclerosis mainly by inhibiting or promoting inflammatory responses. In addition, the reshaping of gut microbiota through probiotics, prebiotics, and fecal microbiota transplantation (FMT) is discussed as an alternative to traditional therapeutic methods. By summarizing how gut microbiota and their metabolites affect the process of atherosclerosis, we can better understand the complex relationship between gut microbiota and atherosclerosis.IMPORTANCEAtherosclerosis is an inflammatory cardiovascular disease, making it crucial to understand its pathogenesis and develop effective treatments. This review thoroughly examines the literature, emphasizing the gut microbiome as a key factor influencing atherosclerosis. It also explores how the gut microbiota and its metabolites impact the primary, intermediate, and advanced stages of atherosclerosis and proposes that remodeling the gut microbiota is a promising strategy for improving atherosclerosis.