Coronary Bed Research Articles

Features of the course of myocardial infarction without coronary artery obstruction

Objective. To study the clinical and laboratory features and the early post-infarction period in patients suffering from myocardial infarction with non-obstructive coronary arteries (MINOCA).
 Materials and methods. A survey of 62 patients hospitalized to the Republican Clinical and Diagnostic Center of the Ministry of Health of the Republic of Udmurtia with a diagnosis of "myocardial infarction" was conducted, 30 of whom had a single-vessel lesion of the coronary bed, 32 myocardial infarction without coronary artery obstruction.
 Results. Differences in the clinical manifestations of the acute period were noted by the presence of syncope, isolated shortness of breath, and a difficult-to-explain feeling in the chest. The time from the onset of symptoms to hospitalization in the MINOCA group exceeds 1.7 hours. The MINOCA group had a much higher level of markers of myocardial necrosis (troponin I level of 8.9 ng/ml compared to 1.75 ng/ml), despite a significantly lower frequency of detection of hypokinesia zones and the number of affected segments.
 Conclusions. It is necessary to improve public awareness of the symptoms of acute coronary syndrome, including its atypical manifestations. Routine PCI does not "save" from subsequent angina pectoris if it is present before MI.

Rotational coronary angiography in heart transplant recipients

As a screening method for detecting coronary lesions, coronary angiography (CAG) is becoming increasingly important in the activities of transplant centers. Angiography examination of coronary arteries is performed in potential recipients of various organs, related donors, and annually in heart recipients. Given the grave condition of recipients in the early post-transplant period and annual angiographic studies, it is necessary to strive for reduction of radiation load on the body and reduction of dose of X-ray contrast agents used.Objective: to assess the possibilities of using rotational CAG in the activities of transplant centers.Materials and methods. We observed 254 patients who underwent CAG. Their ages ranged from 21 to 79 years (mean 46.92 ± 1), and 90% were men. All patients were divided into two groups: group 1 included 142 patients who underwent rotational CAG, while group 2 was the control group (where classical polyprojection CAG was performed) and included 112 patients. Group 1 was divided into 2 subgroups – the subgroup of patients after heart transplantation who underwent endomyocardial biopsy along with CAG (n = 51), and the subgroup of patients who underwent only rotational CAG.Results. In 91% of patients, CAG was performed by radial access. In group 1, stenotic lesions were detected in 33 patients: 19 had single-vessel lesions, 9 had two-vessel lesions, and 5 had three-vessel lesions. A total of 56 hemodynamically significant stenoses were detected, 9 of which were chronic total occlusions. In 83 patients (60%), performing only 2 series of rotational scans (one left and one right coronary artery) was sufficient. In 32 (23%) patients, one more clarifying projection was required, in 17 patients two and in 9 – 3–5 additional projections. In 3 cases, we switched to polyprojection CAG. The average amount of contrast agent used was 24.4 ± 0.9 ml, the average X-ray dose was 34561.3 ± 1695.2 mGycm2. The need for a contrast agent was significantly higher in the comparison group – 24.4 ± 0.9 mL and 103.5 ± 1.7 mL, respectively. The average X-ray dose in the main group was 34561.3 ± 1695.2 mGycm2, in the comparison group 41430.9 ± 4141.7 mGycm2. However, there was no significant difference between the groups. Subgroup analysis showed that patients who underwent only rotational CAG had lower radiation exposure compared to patients who underwent CAG combined with endomyocardial biopsy biopsy (EMB), as well as significantly lower load compared to the control group.Conclusion. Rotational CAG can be considered as the method of choice at transplant centers, where screening diagnostics of the state of the coronary bed is required, which is equivalent in terms of information content and safety. Rotational CAG allows to reduce the amount of injected contrast agent by more than three times, which in turn reduces the number of associated complications, as well as the radiation exposure of patients and medical personnel.

The Effect of Zinc Oxide Scallop-Shell Powder and Complications After Coronary Angiography

Introduction: Coronary angiography is often associated with complications such as hemorrhage and hematoma that should be considered and be minimized. Objective: This study aimed to determine the effect of Zinc oxide scallop-shell powder as a topical hemostatic agent (composed mainly of calcium) on complications after coronary angiography. These complications include hemostasis time, low back pain, hemorrhage, hematoma, the necessity of sandbags, and patient ambulation. Materials and Methods: The current research was a blind, parallel, randomized clinical trial done on 150 patients under coronary angiography. They were randomly divided into three equal groups of A (control), B (case 1), and C (case 2). In group A, hemostasis was done with manual compression, use of ChitoHem powder, putting sandbag for 4-6 h in a supine position, and getting out of bed after 24 h. In group B, instead of ChitoHem powder, we used Zinc oxide scallop-shell powder. In group C, hemostasis was done with manual compression, Zinc oxide scallop-shell powder, putting sandbag for 1 h in a supine position, and getting out of bed after 2 h. The duration of hemostasis, bleeding, and hematoma after hemostasis and the severity of low back pain were investigated at 8 point intervals during 24 h. Data analysis was done using descriptive statistics indicators and Kolmogorov-Smirnov, ANOVA, Chi Square, Fisher exact test and Kruskal-Wallis tests. Results: The mean ±SD ages of groups of A, B, and C were 60.08 ±11.32, 60.22 ±10.30, and 61.69 (10.61), respectively, which was not statistically different. Furthermore, there was no significant difference between these three groups regarding their demographic information. There were statistically significant differences between groups about the amount of low back pain at the second, third, and fourth hours after angiography (P= 0.001). There was a significant difference in the amount of bleeding between the three groups (P=0.017). The difference in time of hemostasis in the three groups was not statistically significant. Conclusion: The Zinc oxide scallop-shell powder reduces catheter site bleeding after coronary angiography and bed rest time and ultimately the severity of low back pain. Performing a similar study is recommended.

Adenosine-Induced Coronary Steal Is Observed in Patients Presenting With ST-Segment-Elevation Myocardial Infarction.

BackgroundAdenosine is used to treat no‐reflow in the infarct‐related artery (IRA) during ST‐segment–elevation myocardial infarction intervention. However, the physiological effect of adenosine in the IRA is variable. Coronary steal—a reduction of blood flow to the distal coronary bed—can occur in response to adenosine and this is facilitated by collaterals. We investigated the effects of adenosine on coronary flow reserve (CFR) in patients presenting with ST‐segment–elevation myocardial infarction to better understand the physiological mechanism underpinning the variable response to adenosine.Methods and ResultsPressure‐wire assessment of the IRA after percutaneous coronary intervention was performed in 93 patients presenting with ST‐segment–elevation myocardial infarction to calculate index of microvascular resistance, CFR, and collateral flow index by pressure. Modified collateral Rentrop grade to the IRA was recorded, as was microvascular obstruction by cardiac magnetic resonance imaging. Coronary steal (CFR <0.9), no change in flow (CFR=0.9–1.1), and hyperemic flow (CFR >1.1) after adenosine occurred in 19 (20%), 15 (16%), and 59 (63%) patients, respectively. Patients with coronary steal had higher modified Rentrop score to the IRA (1 [0, 1.75] versus 0 [0, 1], P<0.001) and a higher collateral flow index by pressure (0.25±0.10 versus 0.15±0.10, P=0.004) than the hyperemic group. The coronary steal group also had significantly higher index of microvascular resistance (61.68 [28.13, 87.04] versus 23.93 [14.67, 37.00], P=0.006) and had more disease (stenosis >50%) in the donor arteries (52.63% versus 22.03%, P=0.02) than the hyperemic group.ConclusionsAdenosine‐induced coronary steal may be responsible for a reduction in coronary flow reserve in a proportion of patients presenting with ST‐segment–elevation myocardial infarction.RegistrationURL: https://www.clinicaltrials.gov; Unique identifier: NCT03145194. URL: https://www.isrctn.com; Unique identifier: ISRCTN3176727.

Algorithmic Approaches in Diagnostic Decision Support for Combined Use of Speckle-Tracking Echocardiography and Coronary Angiography in Patients with Coronary Artery Disease

Background. Improving methods of coronary artery disease (CAD) diagnosis involves determining the most informative and less expensive methods. Speckle tracking echocardiography (STE) is now widely used for early myocardial ischemia diagnosis, allowing better verification of ambivalent results of coronary angiography (CAG).&#x0D; The aim. To develop algorithmic approaches to early CAD diagnosis through the combined use of STE and CAG in order to increase accuracy and reduce the cost of diagnosis and treatment of CAD.&#x0D; Methods. We examined 568 patients (425 [74.8%] men and 143 [25.2%] women) aged 62.3±8.9 years admitted to our center for diagnosis verification and establishing indications for coronary interventions. All the patients underwent CAG directly before or after STE.&#x0D; Results. Through both methods no pathology was detected in 5.2% of men and 16.8% of women. In 2.6% of men and 4.2% of women, STE found no regional strain disorders in the absence of significant alterations in coronary arteries (CA) according to CAG. Such false-positive STE results may witness of: 1) insignificant myocardial ischemia due to congenital distal coronary branches tortuosity or intramural (I/M) CA course, as well as myocardial ischemia due to microcirculation disorders not diagnosed by CAG; 2) non-coronary myocardial dysfunction. In 1.2% of men and 4.2% of women, CAG found significant or insignificant (up to 50–70%) atherosclerotic stenotic lesions in the absence of data suggestive of myocardial ischemia by longitudinal strain “drop” during STE. Such false-negative STE results may witness of high coronary reserve due to advanced collateral circulation in viable myocardium in ischemic coronary area. Myocardial ischemia according to both coronary beds visualization through CAG, as well as according to characteristic regional strain decrease revealed by STE, was found in 91.1% men and 74.8% women, witnessing of high correlation of the results obtained through both methods. Such results show coincidence of signs of hemodynamically significant CA stenoses according to both methods, including I/M CA segments course.&#x0D; Conclusions. Combination of CAG and STE in patients with CAD allows better determination of CA lesions hemodynamic significance, including I/M CA segments course, and to use STE as a non-invasive imaging technique in CAD, including pharmacological stress test. Combined CAG and STE use with integrated analysis thereof allows identification of coronary circulatory disorders that could not be detected separately, helping to increase diagnostic accuracy and to improve cost-effectiveness of diagnosis and treatment.

Coronary artery aneurysm. Literature review and cases report in Venezuela

Coronary artery aneurysm (CAA) is an uncommon condition and is defined as dilatation of the coronary artery exceeding 50 % of the reference vessel diameter or more than 1.5 times the diameter of normal adjacent segments or the diameter of the patient’s largest coronary artery. The reported incidence of coronary aneurysms ranges from 0.3 % to 5 %, with a predilection to men more than to women, and proximal than to distal segments of the coronary bed.

Principles of Intravascular Lithotripsy for Calcific Plaque Modification.

A significant proportion of lesions treated with transcatheter interventions in the coronary and peripheral vascular beds exhibit moderate to severe calcific plaques known to portend lower procedural success rates, increased peri-procedural adverse events, and unfavorable clinical outcomes compared with noncalcific plaques. Adapted from lithotripsy technology used for treatment of ureterorenal calculi, intravascular lithotripsy (IVL) is a novel technique for the treatment of severely calcific plaque lesions that uses acoustic shockwaves in a balloon-based delivery system. Shockwaves induce calcium fractures, which facilitate stent expansion and luminal gain. In this review, the authors summarize the physics, preclinical and clinical data on IVL use in the coronary and peripheral vasculature, and future directions of IVL in transcatheter cardiovascular therapies.

Retinal vasodilatory responses are inversely associated with plasminogen activator inhibitor-1: The African-PREDICT study

AimsPlasminogen activator inhibitor-1 (PAI-1), traditionally associated with fibrinolysis, is increasingly implicated in impaired vascular function. However, studies on its association with microvascular function are limited to the cutaneous and coronary microvascular beds in older and diseased individuals. To better understand its potential involvement in the early stages of disease development, we investigated the associations of retinal vasodilatory responses to flicker light with PAI-1 activity (PAI-1act) in young and healthy individuals. MethodsWe included healthy Black and White women and men (n = 518; aged 20–30 years), and measured plasma PAI-1act and retinal vasodilatory responses to flicker light provocation. We also collected demographic and lifestyle data, measured blood pressure, anthropometry, blood lipids, inflammatory and other biomarkers. ResultsIn multivariate regression analyses, maximal retinal venular dilation associated independently and inversely with PAI-1act (adj. R2 = 0.11; β = −0.15; p = 0.001) in the total group. In exploratory subgroup analyses, this association remained in White women (adj. R2 = 0.07; β = −0.23; p = 0.005), and was more robust with younger age and lower blood pressure and in non-smokers, but also with greater central adiposity, higher low-density lipoprotein cholesterol and inflammation (all p < 0.05). ConclusionsOur data suggest that in young individuals, PAI-1 may already be associated with subclinical microvascular dysfunction.

Microcirculation in Patients with Takotsubo Syndrome-The Prospective CIRCUS-TTS Study.

The pathophysiology of Takotsubo syndrome (TTS) is incompletely understood. A sympathetic overdrive with coronary microvascular dysfunction might play a central role. The aim of our study was to assess the status of the systemic microcirculation (MC) of patients with TTS, compared to patients with myocardial infarction (MI) and healthy subjects. The systemic microvascular function of 22 TTS patients, 20 patients with MI and 20 healthy subjects was assessed via sublingual sidestream dark-field imaging. In TTS and MI patients, measurements were performed during the acute phase (day 1, 3 and 5) and after 3 months. The measurement in healthy subjects was performed once. The assessed parameters were number of vessel crossings, number of perfused vessel crossings, proportion of perfused vessels, total vessel density and perfused vessel density. The results did not show relevant differences between the investigated groups. Some minor, albeit statistically significant, differences occurred rather randomly. The MC parameters of the TTS group did not show any relevant changes in the temporal course. A systemic microvascular dysfunction could not be identified as a contributing factor in the pathogenesis of TTS. A possible microvascular dysfunction might instead be caused by a local effect restricted to the coronary microvascular bed.

I nverse Relationship Between Vascular Size and Stiffness in the Presence and Absence of Diabetes

Vascular stiffness is increasingly garnering more interest in part as a result of data over the recent past demonstrating that macrovascular stiffness is associated with increased cardiovascular disease and mortality. Our past data has demonstrated vascular bed-specific differences in stiffness among the diabetic aorta, mesenteric, and coronary beds. Recent pilot data from our laboratory suggested that macrovessels appeared to have reduced stiffness when compared to microvessels from the same animal; however, there is a paucity of data in the literature to support this notion in a well-controlled study. The current study sought to test the hypothesis that macrovessels are less stiff compared to microvessels under normal and diabetic conditions. Large mesenteric arteries (1°/2° branches; average internal diameters: ~325-380 µm), small mesenteric arteries (3°/4° branches; average internal diameters: ~200-208 µm), and small mesenteric microvessels (5°/6° branches; average internal diameters: ~121-132 µm) were dissected from the same 16 week-old normal Db/db and type 2 diabetic db/db mice and mounted on a pressure myograph for passive structural and biomechanical measurements. In normal mice, incremental elastic modulus (Einc between 75-125 mmHg), a measure of vascular stiffness, of large arteries averaged 3.29x105 ± 1.00x105 dyn/cm2, which was significantly lower than small artery (7.47x106 ± 0.72x106 dyn/cm2, p<0.01) and microvessel Einc (9.95x106 ± 1.68x106 dyn/cm2, p<0.001). Similarly in db/db mice, Einc of large arteries averaged 9.35x105 ± 3.95x105 dyn/cm2, which was significantly lower than small artery (7.80x106 ± 1.10x106 dyn/cm2, p<0.01) and microvessel Einc (9.21x106 ± 1.76x106 dyn/cm2, p<0.05). The clinically-relevant beta stiffness index followed a similar pattern in vessels isolated from both normal and diabetic mice. Pearson correlation analyses revealed significant inverse correlations between mesenteric internal diameter and Einc (Normal: r=-0.71, p<0.001; db/db: r=-0.63, p<0.05). A similar association was found between internal diameter and beta stiffness index (Normal: r=-0.74, p<0.001; db/db: r=-0.57, p<0.05). These data show that, in a well-controlled animal model and within the same vascular bed, as vessel size increases, stiffness decreases regardless of glycemic status. The reasons for this finding are currently unclear, but they could involve differences in the composition and biomechanics of the extracellular matrix, vascular cell stiffness, and/or linkage of the ECM and cell cytoskeleton through integrins.

RETINAL VASODILATORY RESPONSES ARE INVERSELY ASSOCIATED WITH PLASMINOGEN ACTIVATOR INHIBITOR-1: THE AFRICAN-PREDICT STUDY

Objective: Aims: Plasminogen activator inhibitor-1 (PAI-1), traditionally associated with fibrinolysis, is increasingly implicated in impaired vascular function. However, studies on its association with microvascular function are limited to the cutaneous and coronary microvascular beds in older and diseased individuals. To better understand its potential involvement in the early stages of disease development, we investigated the associations of retinal vasodilatory responses to flicker light with PAI-1 activity (PAI-1act) in young and healthy individuals. Methods: We included healthy Black and White women and men (n = 518; aged 20–30 years), and measured plasma PAI-1act and retinal vasodilatory responses to flicker light provocation. We also collected demographic and lifestyle data, measured blood pressure, anthropometry, blood lipids, inflammatory and other biomarkers. Results: In multivariate regression analyses, maximal retinal venular dilation associated independently and inversely with PAI-1act (Adj. R2 = 0.11; ? = -0.15; p = 0.001) in the total group. In exploratory subgroup analyses, this association remained in White women (Adj. R2 = 0.07; ? = -0.23; p = 0.005), and was more robust with younger age and lower blood pressure and in non-smokers, but also with greater central adiposity, higher low-density lipoprotein cholesterol and inflammation (all p &lt; 0.05). Conclusions: Our data suggest that in young individuals, PAI-1 may already be associated with subclinical microvascular dysfunction.

ANALYSIS OF THE RELATIONSHIP OF COMORBID PATHOLOGY AND CORONARY DISEASES IN ACUTE MYOCARDIAL INFARCTION

Abstract Objective: To identify the relationship of comorbid pathology and the degree of coronary lesion. Design and method: A retrospective analysis of cases of acute myocardial infarction (AMI) was carried out in 4 cardiology departments of the “City Cardiology Center” in Almaty (CCC) this year. Results: During the study period, 148 patients with AMI were treated, mainly men — 59.4% (88), the average age of the patients was 61.3 ± 7.8 years (p -0.0001), with the following average level of LDL-4.013 - mol / l and a preserved ejection fraction - average 52.375%. The most common comorbid pathologies were hypertension in 83.7% (124), diabetes mellitus (DM) 25% (37), chronic kidney disease (CKD) 25.6% (38), and cardiac arrhythmias (LDCs) 8.7% (13), COPD in 2.7% (4), and 38.9% (59) other diseases (gastrointestinal tract, thyroid gland, anemia, etc.). It was determined that according to the Charlson comorbidity index, these were mainly in 51.3% (76) cases - more than 8 points, which correspond to a very high risk of an unfavorable prognosis, in the remaining 26.3% (39) and 21.6% (32) cases high and moderate risk, respectively. It was revealed that only 4 patients had no comorbid pathology, while they were younger than 45 years old, had these risk factors: burdened heredity, smoking and dyslipidemia. 18.2% (4) cases had 1–2 concomitant pathology 37.1% (55), a combination of 3–4 comorbid pathologies was detected in 45.9% (68), 5 and more met 14.3% (21 cases). By the results of coronarography, the most common multivascular lesion of the coronary vessels - 62.1% (92), single-vascular lesion - 27.7% (41), stem lesion - 10.2% (15). According to the linear regression analysis, a reliable relationship between the presence of a combined pathology of more than two nosological forms and a multivascular lesion of the coronary bed, especially the combination of AH + DM, AH + SD_KHB, was revealed (p &lt; 0.05). Conclusions: The most common nosological forms of comorbid pathology were determined, the relationship between combined pathology and multivascular coronary lesion in patients with AMI in the conditions of the cardiological department of the CCC was revealed.

Diagnostic findings in patients with chest pain, cough, and shortness of breath during the COVID-19 pandemic: what else besides pneumonia?

Purpose. Description and illustration of the most common alternative causes of shortness of breath, cough, and acute chest pain in pandemic COVID-19 conditions. Material and methods. Authors evaluated results of the retrospective single-center study and instrumental data of 67 patients with complaints of sudden chest pain, cough and shortness of breath. For patients admitted to the hospital between March, 27 and June, 30, 2020, the first stage of diagnosis was made with the performed multispiral computed tomography (MSCT) of the chest, confirming the presence of pulmonary manifestations of COVID-19. The study did not include patients with pneumothorax identified at the pre - and hospital stages. We describe early radiographic changes in the chest organs, main vessels, and coronary bed in patients with CT-confirmed COVID-19 admitted to O.M. Filatov Municipal Clinical Hospital No. 15, Moscow for sudden chest pain, cough, and shortness of breath. Results. In CT of the chest organs, combinations of COVID-19 and pulmonary artery thromboembolism, central/peripheral lung cancer, and acute aortic syndrome manifestations were most common. Combinations of radiation techniques in pandemic settings are COVID-19 required by patients with the acute coronary syndrome. However, it will be possible to analyze all cases of a combination of acute chest pain and sudden shortness of breath in patients with COVID-19 only after processing an extensive array of data. Conclusion. In pandemic conditions, COVID-19 performing standard imaging methods should be not lost about the most frequent causes of chest pain and sudden shortness of breath, complementing native MSCT with contrasting enhancement in suspected pathology of the main arteries, and small circulation in high-risk patients.

Experimental Periodontal Disease Triggers Coronary Endothelial Dysfunction in Middle-Aged Rats: Preventive Effect of a Prebiotic β-Glucan.

This study was aimed to verify the hypothesis that periodontal disease contributes to endothelial dysfunction in the coronary arteries of middle-aged rats. Besides we evaluated the effects of a prebiotic (β-glucan isolated from Saccharomyces cerevisiae) in preventing vascular dysfunction. The sample comprised young (sham and induced to periodontal disease) and middle-aged rats (sham, periodontal disease, sham-treated and periodontal disease-treated), at 12 and 57 weeks, respectively. The treated-groups received daily doses of β-glucan (50 mg/kg) orally (gavage) for 4 weeks, and periodontal disease was induced in the last 2 weeks by ligature. A myograph system assessed vascular reactivity. The expression of endothelial nitric oxide synthase (eNOS), cyclooxygenase 1 (COX-1), COX-2, p47phox, gp91phox, NF-KB p65, p53, p21, and p16 was quantified by western blotting. Serum hydroperoxide production was measured by the ferrous oxidation-xylenol orange (FOX-2) assay method. Interleukin-1 beta (IL-1β), IL-10, and tumor necrosis factor-alpha (TNF-α) levels were evaluated by spectroscopic ultraviolet-visible analysis. Periodontal disease in middle-aged rats was associated with reduced acetylcholine-induced relaxations of coronary artery rings affecting the endothelium-dependent hyperpolarization- and the nitric oxide-mediated relaxations. The endothelial dysfunction was related to eNOS downregulation, pronounced impairment of the EDH-mediated relaxation, increased IL-1β and TNF-α proinflammatory cytokines, and also upregulation of NADPH oxidase and COXs, starting accumulate aging markers such as p53/p21 and the p16. Treatment with β-glucan effectively reduced bone loss in periodontal disease and delayed endothelial dysfunction in the coronary artery. Our data show that yeast β-glucan ingestion prevented oxidative stress and synthesis of proinflammatory marker and prevented eNOS reduction induced by periodontal disease in middle-aged rats. These results suggest that β-glucan has a beneficial effect on the coronary vascular bed.

Comparative Assessment of the Clinical Course, Drug Therapy and Outcomes in Myocardial Infarction without or with Obstructive Coronary Artery Disease

Aim. To compare clinical features, drug therapy and outcomes in patients with non-obstructive and obstructive coronary artery infarction.Material and methods. The study included 206 patients with a diagnosis of myocardial infraction (MI). According to the results of coronarography, patients were divided into two groups: 103 patients (group 1; MINOCA) did not have obstructive involvement coronary arterial (CA): in 67 (65%) of cases, there is no data for atherosclerotic coronary bed lesion, another 36 (35%) – have CA stenosis up to 50%. 103 patients (group 2) with MI and obstructive CA (MIOCA). The patients of the second group in 100% of cases underwent endoprosthesis of CA, the affection of which caused infraction. The second group was selected by the copy method comparatively to the first group. The analysis of clinical peculiarities, medication and outcomes was made in these groups of patients, in particular.Results and conclusions. The clinical “portrait” of patients with MI in nonobstructive and obstructive CA involvement did not differ significantly. Higher serum level of total cholesterol (5.6 [4.4;6.2] vs 5.1 [4.4;5.8] mmol/l р=0.04) and cholesterol of low-density lipoproteins (2.9 [2.2;3.5] vs 2.5 [2.1;2.9] mmol/l р=0,01), troponin [2.8 [0.7;15.0] vs 1.2 [0.1;7.7] ng/ml р=0.02) were identified in blood tests of MIOCA patients in the comparison with MINOCA group. Antero-lateral (р=0.02) and unspecified localization of MI (р=0.03) was more frequent in the MINOCA group. The differences in therapeutic approach were manifested in the more frequent prescription of double antiplatelet therapy: (99.0% vs 80.6% р&lt; 0.01) in MIOCA patients. In the MINOCA group а more frequent prescription of dihydropyridine calcium channel blocking agents was registered (23.3% vs 2.9% р&lt;0.01). The unfavorable outcomes for MINOCA is comparable to MIOCA in terms of the incidence of hospital mortality (2.9% against 4.9%; p&gt;0.05), annual mortality (5.1% against 7.8%; p&gt;0.05), and combined endpoint (6.8% against 10.7%; p&gt;0.05).Conclusion. Despite the similarity of the clinical presentations of MI with obstructive and nonobstructive CA involvement in real clinical practice, there are differences in the pharmacotherapeutic approach in the management of these groups of patients. MINOCA is characterized by an unfavorable outcomes similar to MIOCA.

Generation of a Novel In Vitro Model to Study Endothelial Dysfunction from Atherothrombotic Specimens

PurposeEndothelial dysfunction is central to the pathogenesis of acute coronary syndrome. The study of diseased endothelium is very challenging due to inherent difficulties in isolating endothelial cells from the coronary vascular bed. We sought to isolate and characterise coronary endothelial cells from patients undergoing thrombectomy for myocardial infarction to develop a patient-specific in vitro model of endothelial dysfunction.MethodsIn a prospective cohort study, 49 patients underwent percutaneous coronary intervention with thrombus aspiration. Specimens were cultured, and coronary endothelial outgrowth (CEO) cells were isolated. CEO cells, endothelial cells isolated from peripheral blood, explanted coronary arteries, and umbilical veins were phenotyped and assessed functionally in vitro and in vivo.ResultsCEO cells were obtained from 27/37 (73%) atherothrombotic specimens and gave rise to cells with cobblestone morphology expressing CD146 (94 ± 6%), CD31 (87 ± 14%), and von Willebrand factor (100 ± 1%). Proliferation of CEO cells was impaired compared to both coronary artery and umbilical vein endothelial cells (population doubling time, 2.5 ± 1.0 versus 1.6 ± 0.3 and 1.2 ± 0.3 days, respectively). Cell migration was also reduced compared to umbilical vein endothelial cells (29 ± 20% versus 85±19%). Importantly, unlike control endothelial cells, dysfunctional CEO cells did not incorporate into new vessels or promote angiogenesis in vivo.ConclusionsCEO cells can be reliably isolated and cultured from thrombectomy specimens in patients with acute coronary syndrome. Compared to controls, patient-derived coronary endothelial cells had impaired capacity to proliferate, migrate, and contribute to angiogenesis. CEO cells could be used to identify novel therapeutic targets to enhance endothelial function and prevent acute coronary syndromes.

Surgical treatment of patients with abdominal aortic aneurysm and ischaemic heart disease

Presented herein are the results of treatment of 137 patients with infrarenal aneurysms of the abdominal portion of the aorta in a combination with ischaemic heart disease. Severity of lesions to the coronary bed and the risk of cardiac complications were assessed according to the SYNTAX score. Depending on severity of angina pectoris and the clinical course of infrarenal aortic aneurysms, we used different tactical approaches to operative treatment of patients. In a low risk of coronary complications, we performed isolated prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. In patients with haemodynamically significant lesions of the coronary bed and positive non-invasive tests, the first stage consisted in coronary artery bypass grafting or stenting of coronary arteries taking into account the risk of cardiac complications according to the SYNTAX Score. The second stage consisted in prosthetic repair or endoprosthetic reconstruction of the abdominal aorta. The terms of the second stage differed and were determined by the course of abdominal aortic aneurysms. In symptomatic large aneurysms (more than 8 cm), prosthetic repair of the abdominal aorta was carried out within 2 weeks after previous stenting of coronary arteries. Simultaneous myocardial revascularization and abdominal aortic reconstruction were performed only in patients with severe angina pectoris, lesions of the trunk of the left coronary artery, three-vessel lesions of the coronary bed, high risk of cardiac complications according to the SYNTAX Score and a complicated or symptomatic course of an infrarenal aortic aneurysm. During implantation of stent grafts into the abdominal aorta there were neither lethal outcomes nor cardiac complications. In open operations, the 30-day mortality rate amounted to 2.2%, with the 5-year survival rate of 92%.

Prediction of the fact and degree of coronary artery disease using the processing of clinical and instrumental data by artificial intelligence

Aim of the study was to analyze the possibility of using neural network analysis to predict the severity of coronary bed lesion. The study was also designated to determine the performance and accuracy of the trained neural network model receiving input as the structured data and EGG images with the parameters and leads positioning differ from the training sample, and also to compare the efficiency of detecting transient myocardial ischemia with traditional diagnostic methods, such as 24-hour Holter monitoring, treadmill test. Neural network analysis of the available clinical, laboratory and instrumentation data allow to configure the network parameters for further prediction of coronary artery disease. The results obtained in the form of an AUC score allow to consider this method to be effective in the coronary artery disease diagnosis using recorded ECG tape with parameters and lead positioning differ from initial training sample. The efficiency of transient myocardial ischemia detection on the training sample of the trained neural network is higher in comparison with traditional diagnostic methods, such as 24-hour Holter monitoring, treadmill test.

Use of drug-coated balloons for interventions on bifurcation lesions of coronary arteries

Interventions on bifurcation lesions of the coronary bed are one of the most complicated tasks of interventional cardiology. Recent trends are toward active study of using drug-eluting balloons for interventions in this type of lesions. Using such technique makes it possible to minimize the risks associated with implantation of stents in sites of coronary artery bifurcations with good angiographic results. This article is a review of the literature data concerning the use of drug-coated balloons in interventions on bifurcation lesions of the coronary bed, discussing peculiarities of the balloon catheter design, dynamics of delivery of an antiproliferative drug to the vascular wall. This is followed by considering the experience with using innovative sirolimus-coated balloon catheters, as well as future perspectives of these devices for interventions in coronary artery bifurcation lesions.

Оценка риска внезапной сердечной смерти у больных с инфарктом миокарда без обструкции коронарных артерий

The purpose — to study the indicators of the main risk factors for sudden cardiac death in the acute period in patients with myocardial infarction without coronary artery obstruction (MIwCAO). Material and methods. We examined 60 patients admitted to the Republican Clinical and Diagnostic Center of the Ministry of Health of the Udmurt Republic with a diagnosis of myocardial infarction, 30 of whom had a single-vessel lesion of the coronary bed and 32 had a myocardial infarction without obstruction of the coronary arteries. Results. The main indices of intracardiac hemodynamics (LVEF, EDV) were worse in the group of patients with MIwCAO: LVEF was on average 5.2% lower, LV EDV was higher by 26 ml. Heart rate was higher in patients with MIwCAO both in the daytime and at night. Among the ventricular rhythm disorders (VRD) in the group of patients with MIwCAO, most frequent were single VES, unstable paroxysms of VT, and polymorphic ventricular premature beats. In the remote period of myocardial infarction, indicators of SCD risk improved, but more effectively in the MICAO group. Conclusions. The risk of SCD is higher in patients with MIwCAO, mainly due to LVEF, LV EDV, high heart rate both in the daytime and at night, SDNN index, and QT. The drugs used in patients with post-myocardial infarction may reduce the risk of SCD in patients with MICAO.