Coronary Atherosclerotic Burden In Patients Research Articles

The Association of Plasma Trimethylamine N-Oxide with Coronary Atherosclerotic Burden in Patients with Type 2 Diabetes Among a Chinese North Population.

PurposeWe aimed to examine the association between plasma trimethylamine N-oxide (TMAO), a gut microbial metabolite from dietary phosphatidylcholine, and coronary atherosclerotic burden in patients with type 2 diabetes (T2D).MethodsIn total, 349 patients with T2D were studied, including 70 controls and 279 patients with coronary artery disease (CAD) by coronary angiography. Coronary atherosclerotic burden is quantified by the number of diseased coronary branches and SYNTAX (Synergy between PCI with Taxus and Cardiac Surgery) score. Plasma TMAO levels were determined by UHPLC–MS/MS technique.ResultsThe TMAO concentration was significantly higher in the patients with triple vessel disease (TVD) (3.33 [IQR: 1.81–6.65] μM) than those without TVD (2.62 [IQR: 1.50–4.73] μM) (P = 0.015). A similar difference was found between patients with SYNTAX score >22 (3.93 [IQR: 1.81–6.82] μM) and those with SYNTAX score ≤22 (2.54 [IQR: 1.44–4.54] μM) (P = 0.014). TMAO was not significantly correlated with the presence of CAD. Among patients with eGFR <60 mL/min/1.73 m2, the highest tertile of TMAO was significantly associated with TVD (OR = 25.28, 95% CI [2.55–250.33], P = 0.006) and SYNTAX score >22 (OR = 7.23, 95% CI [1.51–34.64], P = 0.013) independent of known risk factors of CAD, compared with lower TMAO tertiles.ConclusionTMAO was not independently correlated with the presence of CAD and severity of coronary atherosclerosis in the included population. Nevertheless, the significant association between circulating TMAO and higher coronary atherosclerotic burden was observed in patients with eGFR of lower than 60 mL/min/1.73 m2.

Associations of Lipoprotein(a) With Coronary Atherosclerotic Burden and All-Cause Mortality in Patients With ST-Segment Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention.

Background: The coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction (STEMI) has been identified as the main predictor of prognosis. However, the association of lipoprotein(a) [Lp(a)], a well-established proatherogenic factor, with atherosclerotic burden in patients with STEMI is unclear.Methods: In total, 1,359 patients who underwent percutaneous coronary intervention (PCI) for STEMI were included in analyses. Three prespecified models with adjustment for demographic parameters and risk factors were evaluated. Generalized additive models and restricted cubic spline analyses were used to assess the relationships of Lp(a) with Gensini scores and the no-reflow phenomenon. Kaplan–Meier curves were generated to explore the predictive value of Lp(a) for long-term all-cause mortality. Furthermore, mRNA expression levels of LPA in different groups were compared using the GEO database.Results: Patients in the highest tertile according to Lp(a) levels had an increased incidence of heart failure during hospitalization. Furthermore, patients with high levels of Lp(a) (>19.1 mg/dL) had sharply increased risks for a higher Gensini score (Pfor trend = 0.03) and no-reflow (Pfor trend = 0.002) after adjustment for demographic parameters and risk factors. During a median follow-up of 930 days, 132 deaths (9.95%) were registered. Patients with high levels of Lp(a) (>19.1 mg/dL) had the worst long-term prognosis (Pfor trend < 0.0001). In a subgroup analysis, patients with higher Lp(a) still had the highest all-cause mortality. Additionally, the mRNA expression levels of LPA in patients with STEMI with lower cardiac function were higher than those in other groups (P = 0.003). A higher coronary atherosclerotic burden was correlated with higher LPA expression (P = 0.01).Conclusion: This study provides the first evidence that Lp(a) (at both the protein and mRNA levels) is independently associated with coronary atherosclerotic lesions and prognosis in patients with STEMI treated with PCI.Clinical Trial Registration: http://www.chictr.org.cn/index.aspx, identifier: ChiCTR1900028516.

Plasma ceramides are associated with coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction

BackgroundPlasma ceramides (Cer), a subset of bioactive lipids, have mechanistic links to atherosclerotic coronary artery disease (CAD) pathogenesis and are related to major adverse cardiovascular events (MACEs). ObjectivesThis study aimed to explore the associations between plasma Cer and atherosclerotic burden evaluated by Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score. Methods and resultsA retrospective series of 248 ST-segment elevation myocardial infarction (STEMI) patients undergoing interventional procedures and plasma ceramides measurement were enrolled. Rapid resolution liquid chromatography coupled with quadrupole time-of-flight mass spectrometry (RRLC-Q-TOF/MS) was used to evaluate plasma Cer concentrations. SYNTAX score was automatically calculated on the SYNTAX website (http://www.syntaxscore.com/). Patients with STEMI had higher plasma MACEs-related ceramide levels than normal donors (p < .001). Pearson correlation analysis showed positive correlations between SYNTAX score and Cer(d18:1/16:0) (r = 0.176, p = .006), Cer(d18:1/18:0) (r = 0.290, p < .001), Cer(d18:1/24:1) (r = 0.209, p = .001) and Cer(d18:1/24:0) (r = 0.134, p = .036). Adjustments for all traditional risks, higher Cer(d18:1/16:0) level (per SD increase, β (95%CI) =10.681 (1.912–19.923), p = .032), Cer(d18:1/18:0) level (per SD increase, β (95%CI) =38.830 (15.444–62.126), p = .001), Cer(d18:1/24:1) level (per SD increase, β (95%CI) =6.122 (1.640–10.605), p = .008) (except for and Cer(d18:1/24:0) level (per SD increase, β (95%CI) =0.999 (−0.508–2.506), p = .193)) were independently associated with higher levels of SYNTAX score. ConclusionsElevated plasma levels of Cer (d18:1/16:0), Cer(d18:1/18:0) and Cer(d18:1/24:1)) are independent predictors for a high atherosclerotic burden in patients with STEMI. Our findings provide evidence supporting proatherogenic roles of Cer.

Pericardial fat versus BMI in the assessment of coronary atherosclerotic burden in patients with diabetes mellitus.

To investigate the association of obesity measured by body mass index (BMI) versus pericardial fat volume (PFV) measured by multi-detector computed tomography (MDCT) with coronary atherosclerotic markers (coronary artery calcium score (CAC), coronary stenosis severity and coronary plaque presence) in patients with type 2 diabetes mellitus (DM). Among 496 patients with suspected coronary artery disease who underwent 64-slice MDCT angiography to exclude occlusive coronary artery disease, 102 patients with DM were enrolled in the present study. PFV showed a significant association with CAC (r = 0.2, P = 0.01) and significant coronary artery stenosis [PFV median (IQR) = 75 (51-136) in patients with coronary stenosis < 50% versus PFV median (IQR) = 113 (68-140) in patients with coronary stenosis ≥ 50%, P = 0.01] while there was no significant association of PFV with coronary plaque presence (PFV median (IQR) = 84 (56-140) in patients without plaque versus PFV median (IQR) = 109 (70-136) in patients with plaque presence, P = 0.4). The association between PFV with CAC persisted after adjustment for conventional cardiac risk factors. BMI showed no significant association with CAC, coronary stenosis severity and coronary plaque presence (P > 0.05). PFV was independently associated with CAC in diabetic patients. PFV, rather than obesity measured by BMI, could be used as an imaging biomarker for assessing coronary atherosclerotic burden in patients with DM.

Association of PCSK9 plasma levels with metabolic patterns and coronary atherosclerosis in patients with stable angina

ObjectiveAim of this study was to evaluate the relationship of plasma PCSK9 with metabolic and inflammatory profile and coronary atherosclerotic burden in patients with suspected CAD enrolled in the EVINCI study.MethodsPCSK9 was measured in 539 patients (60.3 ± 8.6 years, 256 males) with symptoms of CAD characterized by risk factors, bio-humoral profiles, and treatment. N = 412 patients underwent coronary computed tomography angiography (CTA) to assess the presence and characteristics of coronary atherosclerosis. A CTA score, combining extent, severity, composition, and location of plaques was computed.ResultsPatients were divided according to PCSK9 quartiles: I (< 136 ng/mL), II–III (136–266 ng/mL), and IV quartile (> 266 ng/mL). Compared with patients in quartile IV, patients in quartile I had a higher prevalence of the metabolic syndrome and higher values of body mass index. LDL- and HDL-cholesterol were significantly lower in patients in the quartile I than in those in quartile IV. Coronary CTA documented normal vessels in 30% and obstructive CAD in 35% of cases without differences among PCSK9 quartiles. Compared with patients with the highest levels, patients with the lowest PCSK9 levels had a higher CTA score mainly due to higher number of mixed non-obstructive coronary plaques. At multivariable analysis including clinical, medications, and lipid variables, PCSK9 was an independent predictor of the CTA score (coefficient − 0.129, SE 0.03, P < 0.0001), together with age, male gender, statins, interleukin-6, and leptin.ConclusionIn patients with stable CAD, low PCSK9 plasma levels are associated with a particular metabolic phenotype (low HDL cholesterol, the metabolic syndrome, obesity, insulin resistance and diabetes) and diffuse non-obstructive coronary atherosclerosis.Trial registration ClinicalTrials.gov NCT00979199. Registered September 17, 2009

P6168Low PCSK9 plasma level is an independent predictor of coronary atherosclerotic burden in patients with stable coronary artery disease

Abstract Background Circulating proprotein convertase subtilisin/kexin type 9 (PCSK9) is a key regulator of LDL cholesterol levels and has emerged as a new therapeutic target in coronary artery disease (CAD). Plasma PCSK9 levels have also been related to other components of the lipid profile associated with atherosclerotic risk. Purpose Aim of the present study was to evaluate the relationship of plasma PCSK9 levels with lipid profile and measures of coronary atherosclerotic burden and risk in patients with stable CAD enrolled in the European EValuation of INtegrated Cardiac Imaging (EVINCI) study. Methods PCSK9 was measured in 412 patients (60.3±8.6 years, 256 males) with symptoms of stable CAD fully characterized by clinical risk factors, bio-humoral profiles, and treatment. All patients underwent coronary computed tomography (CT) angiography to assess the presence and characteristics of coronary atherosclerosis. We calculated an individual CT risk score, expressing the coronary atherosclerotic burden, combining extent, severity, composition, and location of plaques. Results Patients were divided in groups according to PCSK9 quartiles: I (&lt;136 ng/mL), II-III (136–266 ng/mL), and IV quartile (&gt;266 ng/mL). LDL and HDL-cholesterol levels were significantly lower while total/HDL-cholesterol ratio was significantly higher in patients in the quartile I than in those in quartile IV (Figure A). CT angiography documented normal vessels in 30 and obstructive CAD in 35% of cases. Compared with patients with the highest levels (quartile IV), patients with the lowest PCSK9 levels (quartile I) had a higher CT risk score, a higher number of mixed plaque and higher hs-cTnI plasma levels (Figure B). PCSK9 itself was not associated with obstructive CAD. At multivariable analysis including clinical variables, medications and lipid variables PCSK9 was an independent predictor of the CT risk score (Coefficient - 0.129 (SE 0.03), p&lt;0.0001), together with age, male gender and statin treatment. Figure 1 Conclusion PCSK9 levels are independently and inversely associated with the coronary atherosclerotic burden in patients with stable CAD. Acknowledgement/Funding AMGEN grant, EU FP7-CP-FP506 2007 project (grant agreement no. 222915)

ASSOCIATION OF CIRCULATING TRIMETHYLAMINE N-OXIDE WITH CORONARY ATHEROSCLEROTIC BURDEN IN PATIENTS WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

The gut microbial metabolite trimethylamine N-oxide (TMAO) can promote atherosclerosis and cardiovascular diseases. A previous study demonstrated that TMAO levels are associated with coronary atherosclerotic burden in patients with stable coronary artery disease. However, the relationship between

Renal haemodynamics and coronary atherosclerotic burden are associated in patients with hypertension and mild coronary artery disease.

Intrarenal hemodynamic alterations are independent predictors of cardiovascular events in different populations. It has been hypothesized that there is an association between renal hemodynamics and coronary atherosclerotic burden in patients with hypertension. Therefore, the present study examined the associations between renal hemodynamics, coronary atherosclerotic burden and carotid atherosclerotic disease. A total of 130 patients with hypertension aged between 30-80 years who had been referred for an elective coronary angiography were enrolled in the present study. A duplex ultrasound of the intrarenal vasculature was performed to evaluate the resistive index (RI), pulsatility index (PI) and acceleration time (AT). The carotid intima-media thickness was additionally assessed. A coronary angiography was performed to detect the atherosclerotic burden using the Gensini Score (GS). Based on the GS values, subjects were divided into quintiles (I: ≤9; II: 9-17; III: 17-30; IV: 30-44; and V: GS >44) as well as in subjects with mild (GS ≤30) or severe coronary disease (GS >30). A weak significant difference in PI was identified among quintiles (P=0.041), whereas, RI and AT did not differ significantly. PI was associated with GS in the group with low coronary atherosclerotic burden (GS ≤30; P=0.047), whereas, no association was detected in subjects with GS >30. This association remained following adjustment for age and left ventricular ejection fraction (P=0.025). In conclusion, renal vascular alterations were associated with coronary atherosclerotic burden in patients with hypertension with mild coronary disease.

Relation of Circulating Trimethylamine N-Oxide With Coronary Atherosclerotic Burden in Patients With ST-segment Elevation Myocardial Infarction

The gut microbial metabolite trimethylamine N-oxide (TMAO) promotes atherosclerosis and cardiovascular diseases. TMAO levels are associated with the coronary atherosclerotic burden in patients with stable coronary artery disease. However, the relation between TMAO levels and the coronary atherosclerotic burden in patients with ST-segment elevation myocardial infarction (STEMI) is unknown. We prospectively enrolled 2 cohorts in this study, including 335 patients with STEMI and 53 healthy controls. The coronary atherosclerotic burden was quantified by the number of diseased coronary arteries and the SYNTAX score. The median TMAO levels in patients with STEMI and healthy controls were 2.18 (interquartile range [IQR]: 1.34 to 3.90) μM and 1.23 [IQR: 0.84 to 2.42] μM, respectively. Of the 335 patients with STEMI, TMAO levels were significantly higher in the multivessel disease group than in the single-vessel disease group (p <0.001) and in the group with intermediate-high SYNTAX scores (SYNTAX score ≥23) than in the group with low SYNTAX scores (SYNTAX score ≤22; p <0.001). Based on the ordinal logistic regression analysis adjusted for traditional risk factors, elevated TMAO levels predicted both a high SYNTAX score (adjusted odds ratio [OR]: 1.16; 95% confidence interval [CI] 1.06 to 1.29; p = 0.001) and the presence of multivessel disease (adjusted OR: 1.15; 95% CI 1.01 to 1.32; p = 0.035). In conclusion, plasma TMAO levels are associated with a high coronary atherosclerotic burden in patients with STEMI.

Quantification of coronary atherosclerotic burden with coronary computed tomography angiography: adapted Leaman score in Croatian patients

The aim of the study was to quantify the total coronary atherosclerotic burden in patients with suspected coronary artery disease (CAD) defined by coronary computed tomography adapted Leaman score (CT-LeSc) and to estimate its cut-off level for high coronary atherosclerotic burden. We enrolled 434 consecutive patients referred to coronary computed tomography angiography, of which 261 patients fulfilled the study inclusion criteria. Demographic and clinical characteristics, as well as CAD risk factors were obtained. CAD pre-test probabilities were estimated by the Diamond-Forrester model and Morise score. The coronary atherosclerotic burden was estimated using CT-LeSc. As a cut-off for a high coronary atherosclerotic burden, we used 3rd tercile (Tc3) (CT-LeSc ≥ 5.52). We evaluated the association of clinical characteristics and risk factors with Tc3 in univariate and multivariate analysis. There were 60.9% males and 39.1% females, 81% of patients had above-normal weight, 68.2% hypertension, 54.0% dyslipidemia, 15.3% diabetes mellitus, 12.3% positive smoking history and 11.9% had a family history of CAD. According to the Diamond-Forrester model and Morise score the majority of patients had intermediate risk, 59.7 and 52.8%, followed by the high-risk group, 36.0 and 34.4%, respectively. Age, dyslipidemia, hypertension and pre-test risk scores in the univariate analysis significantly predicted Tc3. In the multivariate analysis, male sex (p = 0.004), dyslipidemia (p = 0.002) and coronary calcium score (< 0.001) were identified as predictors of Tc3. CT-LeSc quantified the total coronary atherosclerotic burden and showed an association of risk factors and pre-test probabilities with Tc3.

P854Procalcitonin is an independent predictor for coronary atherosclerotic burden in patients with stable coronary artery disease

P854Procalcitonin is an independent predictor for coronary atherosclerotic burden in patients with stable coronary artery disease

Validation of the CHA2DS2-VASc Score in Predicting Coronary Atherosclerotic Burden and In-Hospital Mortality in Patients With Acute Coronary Syndrome

Although the CHA2DS2-VASc score has been initially recommended for the assessment of the risk of thromboembolic event in patients with atrial fibrillation, in recent years, it is used to predict adverse outcomes in various cardiovascular diseases. However, little is known about its predictive value for coronary atherosclerotic burden in patients with acute coronary syndrome (ACS). The aim of the present study is to investigate whether the CHA2DS2-VASc score could predict higher coronary atherosclerotic burden assessed by SYNTAX score (SS) in ACS. A total of 2,222 ACS patients (mean age 59.8 ± 12.7years) who underwent coronary angiography were divided into 3 SS tertiles stratified by SS: low (≤22) (n= 1,445); intermediate (23 to 32) (n= 556); and high (≥33) (n= 221). The mean CHA2DS2-VASc score was 2.71 ± 1.51 (range 1 to 9) and CHA2DS2-VASc score was higher in patients with high SS than in those with intermediate and low SS (4.24 ± 1.49, 2.89 ± 1.49, and 2.40 ± 1.36, respectively, p <0.001). In multivariate analysis, CHA2DS2-VASc score ≥4 (odds ratio [OR] 3.048, 95% confidence interval 1.658 to 5.617, p <0.001) was an independent predictor of high SS, as well as body mass index (OR 0.929, p= 0.015), chronic total occlusion (OR 11.363, p <0.001), current smoking (OR 0.476, p= 0.026), and chronic renal disease (OR 1.828, p= 0.033). The CHA2DS2-VASc score was also an independent predictor for in-hospital mortality in multivariate Cox regression analysis. In conclusion, CHA2DS2-VASc, as a simply calculated and reliable score, is independently associated with high SS and in-hospital mortality in patients with ACS. Thus, this score provides an additional level of risk stratification regarding coronary atherosclerotic burden and prognosis beyond that provided by traditional risk factors.

Procalcitonin is an independent predictor for coronary atherosclerotic burden in patients with stable coronary artery disease

ObjectivesHigher coronary atherosclerotic burden has been associated with increased cardiovascular events including mortality. The SYNTAX score (SXs) reflects coronary atherosclerotic burden. Given the body of evidence implicating inflammation in atherosclerotic process, we hypothesized that procalcitonin (PCT) as an inflammatory marker may be related to coronary atherosclerotic burden. Thus, we aimed to investigate the relationship between serum PCT levels and SXs in patients with stable CAD. Material and methodsA total of 400 patients (mean age 62.8±10.6years) with evidence of significant CAD were included in this study. Serum PCT and high-sensitivity c-reactive protein (hs-CRP) levels were measured. To calculate the burden of CAD, the SX scoring algorithm system was applied. Patients with a SXs<23 (n=320) were classified as the low SXs group and those with a SXs≥23 (n=80) were classified as the high SXs group. ResultsSerum PCT levels were higher in the high SXs group compared to the low SXs group (p<0.001). Receiver operating characteristic curve analysis showed that the cut-off value of PCT was 0.0335ng/mL for the prediction of high SXs (area under the curve: 0.753, sensitivity: 72.5%, specificity: 61.3%) After multivariate analysis, PCT, together with current smoking (OR 2.237, p=0.027), triglyceride (OR 1.005, p=0.001), and hs-CRP (OR 1.119, p=0.018), remained an independent predictor of high SXs (OR 3.021; 95% CI [1.492–6.097]; p=0.002). ConclusionsSerum PCT is independently and positively associated with SXs. Thus, elevated PCT levels may be useful to identify patients with high coronary atherosclerotic burden in patients with stable CAD.

Kararlı Koroner Arter Hastalığı Olan Hastalarda Nitratların Oluşturduğu Baş Ağrısının Aterosklerotik Yükü Öngörmedeki Değeri

Introduction: Nitrates, which lead to vasodilation in vessels, is one of the cornerstone drugs of antianginal therapy. The most frequently encountered side effect of nitrates is headache, which is linked to vasodilation of the cerebral arteries. Vasodilator response to nitrates is significantly reduced in patients with atherosclerosis. The aim of present study was to assess the relationship between nitrate-induced headache (NIH) and systemic and coronary atherosclerotic burden in patients with stable coronary artery disease. Patients and Methods: Overall, 40 patients with NIH (group I: 61.2 ± 8.56 years, 32 males) and 62 patients without headache (group II: 63.5 ± 8.45 years, 41 males) were included in the study. Systemic atherosclerotic burden was evaluated by carotid intima-media thickness (CIMT) and cardio-ankle vascular index (CAVI). Coronary atherosclerotic burden was assessed by the Gensini score. Results: CIMT and CAVI were significantly greater in group II than in group I (0.8 ± 0.20 vs. 0.6 ± 0.20 and 9.5 ± 1.0 vs. 8.4 ± 1.2, respectively; p< 0.001). The Gensini score was also higher in group II than in group I [median 32 (16.7-45.2) vs 12.5 (5.2-19.2); p< 0.001]. In multivariate analysis, headache was found as an independent determinant of CIMT, CAVI, and Gensini score (p< 0.001). Conclusion: Patients with NIH had a low level systemic and coronary atherosclerotic burden, evaluated by CIMT, CAVI, and Gensini score, compared with those without NIH.

Characteristics of coronary artery lesion in patients with and without diabetes mellitus.

The goal of this study was to compare the coronary atherosclerotic burden in patients with and without type-2 diabetes by using CT coronary angiography (CTCA). A total of 206 diabetic (mean age 67±11years; male: 136) and 523 non-diabetic patients (mean age 62±13years; male: 323) without history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined, and each diseased segment was classified as showing obstructive lesion (luminal narrowing>50%) or not. Coronary angiography was then performed to confirm diagnosis. Diabetics showed a higher rate of abnormal CAD (76 vs. 53% of patients; p<0.0001) and fewer normal coronary arteries (24 vs. 47%; p<0.0001) compared with non-diabetics. Multi-vessel disease was seen more frequently in patients with diabetes than in patients without diabetes [15% (n=22) vs. 7% (n=62), respectively; p=0.0004]. The per-patient number of segments with plaque (4.5 vs. 2.0, respectively; p<0.0001) and the number of segments with obstructive disease (0.9 vs. 0.5, respectively; p=0.0001) were higher for diabetic patients than for non-diabetic patients. Diabetes was associated with higher coronary plaque burden.

Links between sleep disordered breathing, coronary atherosclerotic burden, and cardiac biomarkers in patients with stable coronary artery disease

Sleep disordered breathing (SDB) is highly prevalent in patients with cardiovascular disease, although it is not clear whether SDB has any link to coronary atherosclerotic burden in patients with stable coronary artery disease (CAD). This study sought to analyze the links between SDB, coronary atherosclerotic burden, and cardiac biomarkers in stable CAD patients. We studied 83 consecutive patients who underwent coronary angiography or scheduled percutaneous coronary intervention. SDB was evaluated by an ambulatory polysomnographic monitoring device. Coronary atherosclerotic burden was evaluated by the Gensini score, and myocardial stress/injury were assessed by measuring plasma levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) and high sensitivity troponin T (hs-TnT). Patients with an apnea hypopnea index (AHI)≧15 events/h (n=32) showed significantly higher Gensini score (35.7±38.0 vs 20.1±19.7, p=0.033) than those with AHI<15. The higher AHI group showed significantly higher NT-proBNP (275.8±402.6 pg/ml vs 131.9±146.3 pg/ml, p=0.047) and hs-TnT levels (0.011±0.005 ng/ml vs 0.008±0.003 ng/ml, p=0.015). Furthermore it was revealed that AHI significantly correlated with the Gensini score (r=0.253, p=0.036), NT-proBNP (r=0.266, p=0.027), and hs-TnT (r=0.274, p=0.023), and multiple stepwise linear regression analysis revealed that AHI (β=0.257, p=0.029) and history of smoking (β=0.244, p=0.038) were independently correlated with Gensini score among clinical and SDB-related parameters. Severity of SDB has a significant link to the severity of coronary atherosclerotic burden, which also reflected elevated NT-proBNP and hs-TnT as silent myocardial ischemia and minute myocardial injury even in stable CAD patients.

Red Blood Cell Distribution Width (RDW) and its Association with Coronary Atherosclerotic Burden in Patients with Stable Angina Pectoris

Although there are several studies regarding the association between RDW and the vascular events, information is scant about possible role of RDW in cardiovascular system. We aimed to investigate whether RDW is related with the severity and extent of angiographically assessed coronary artery disease (CAD). Two hundred ninety and six stable eligible patients who had undergone coronary angiography with a suspicion of CAD were enrolled consecutively. Two hundred and nine (71%) of 296 patients had CAD (men 70%, mean age±SD: 61±11yrs) and 87 patients (29%) had normal coronary arteries (NCA) without any atherosclerotic lesion (men 48%, 52±11yrs). Red blood cell distribution width values were significantly different among the subgroups determined for the severity and extent of CAD. When 14.8% was accepted as the cut-off value for RDW, the sensitivity and the specificity for the detection of CAD was 68% and 52%. When we performed multiple logistic regression analysis to determine the independent predictors of CAD, we found a positive independent relationship between age, gender, family history of CAD and RDW and CAD. Our results show that RDW has a significant relationship with CAD independent of nonspecific inflammation and circulating inflammatory cells. Although we cannot conclude the underlying pathologic process of RDW, we believe that these findings may pave the way for further studies searching the role of RDW in atherosclerosis.

The relation of serum monocyte chemoattractant protein-1 level with coronary atherosclerotic burden and collateral degree in stable coronary artery disease

We investigated whether serum monocyte chemoattractant protein-1 (MCP-1) level predicted coronary atherosclerotic burden in patients with stable coronary artery disease and its relationship with coronary collateral grade. We prospectively included 196 patients (103 males, 93 females; mean age 59 ± 11 years) who underwent coronary angiography for stable angina pectoris. Serum MCP-1 levels were determined before coronary angiography. Coronary atherosclerotic burden was measured by the Gensini score, and coronary collateral development was assessed by the Rentrop classification. The patients were divided into four groups: those with normal coronary arteries (NCA); those with coronary lesions of <70% luminal obstruction; and those with coronary lesions of ≥ 70% luminal obstruction accompanied by a good or poor collateral grade. The mean serum MCP-1 level was higher in patients with coronary lesions compared to patients with NCA (129 ± 130 vs. 102 ± 55 pg/ml, p=0.048). Although there were no significant differences in the MCP-1 levels of patients with NCA, with <70% luminal obstruction, and those with a significant luminal obstruction and a poor collateral grade, patients with significant luminal obstruction and a good collateral grade had significantly higher MCP-1 levels compared to the remaining groups (p=0.016). However, in multivariate regression analysis, MCP-1 level was not independently associated with the Gensini score. Our findings suggest that serum MCP-1 level is higher in patients with coronary atherosclerosis, without a significant and independent association with coronary atherosclerotic burden. Significantly increased serum MCP-1 levels in patients with a good collateral grade may be an interesting issue of investigation.

Assessment of coronary artery disease and calcified coronary plaque burden by computed tomography in patients with and without diabetes mellitus

PurposeTo compare the coronary atherosclerotic burden in patients with and without type-2 diabetes using CT Coronary Angiography (CTCA).Methods and Materials147 diabetic (mean age: 65 ± 10 years; male: 89) and 979 nondiabetic patients (mean age: 61 ± 13 years; male: 567) without a history of coronary artery disease (CAD) underwent CTCA. The per-patient number of diseased coronary segments was determined and each diseased segment was classified as showing obstructive lesion (luminal narrowing >50%) or not. Coronary calcium scoring (CCS) was assessed too.ResultsDiabetics showed a higher number of diseased segments (4.1 ± 4.2 vs. 2.1 ± 3.0; p < 0.0001); a higher rate of CCS > 400 (p < 0.001), obstructive CAD (37% vs. 18% of patients; p < 0.0001), and fewer normal coronary arteries (20% vs. 42%; p < 0.0001), as compared to nondiabetics. The percentage of patients with obstructive CAD paralleled increasing CCS in both groups. Diabetics with CCS ≤ 10 had a higher prevalence of coronary plaque (39.6% vs. 24.5%, p = 0.003) and obstructive CAD (12.5% vs. 3.8%, p = 0.01). Among patients with CCS ≤ 10 all diabetics with obstructive CAD had a zero CCS and one patient was asymptomatic.ConclusionsDiabetes was associated with higher coronary plaque burden. The present study demonstrates that the absence of coronary calcification does not exclude obstructive CAD especially in diabetics.

Coronary atherosclerotic burden in patients with infection by CagA-positive strains of Helicobacter pylori

Cytotoxic associated gene-A (CagA)-positive strains of Helicobacter pylori emerged as a possible atherosclerotic stimulus. Nevertheless, whether CagA-positivity is associated with more extensive or severe atherosclerotic coronary burden has never been studied. Forty consecutive patients with coronary artery disease (CAD) and twenty consecutive patients with normal coronary arteries undergoing coronary angiography were enrolled. All patients underwent evaluation of classical atherogenic risk factors and assessment of anti-urease B and anti-CagA antibodies titer. Either the severity of coronary stenosis (stenosis score) or the extent of coronary atherosclerosis (extent score) was evaluated in CAD patients. The anti-CagA antibody titer was significantly higher in patients with CAD as compared with normal coronary arteries patients [85 (10-108.75) vs. 47.3 (17-64) RU/ml, P=0.02], whereas there were no differences in anti-urease B titer between the two groups. A significant correlation was found between anti-CagA antibody titer and extent score (R=0.35, P=0.03), whereas stenosis score was similar (R=0.25, P=0.11). On the contrary, no significant correlation was found between anti-urease B antibody titer and either extent or stenosis score. Moreover, CagA-positive patients had a more extensive CAD (P=0.029) when compared with CagA-negative patients. Interestingly, whereas serum glucose, LDL levels, anti-urease B, and anti-CagA antibodies were predictors of extent score at univariate analysis, at multivariate analysis anti-CagA antibody titer only was an independent predictor of the extent of coronary atherosclerosis (B=0.051, standard error of B=0.042, P=0.04). These results support the association between CagA-positive H. pylori infection and coronary atherosclerotic burden. Further studies are needed to better elucidate the mechanism by which CagA-positive strains may promote atherosclerosis.