Coronary Origin Research Articles

Abstract 4137965: D-dimer as a 5-year predictor of death in females admitted with chestpain of suspected coronary origin surpasses that of males.

Background: D-dimer (DD) and fibrin monomer (FM) are endstage markers of activated coagulation and reflect prothrombotic states, and α2-antiplasmin (SERPINF2 -SF2) is the main inhibitor of fibrinolysis at the level of plasmin. Women may experience a higher rate of morbidity and mortality compared to men following a myocardial infarction (MI). We present the prognostic potential of DD, FM and SF2 in females as compared to males during 5 years follow-up in a population admitted with chest pain of suspected coronary origin. Methods: A total of 871 consecutive patients with a median age of 72.6 years (females 77.3, males 69.1) were admitted in the study. Of these, 386 were diagnosed with an acute MI based on Troponin-T (TnT) levels >50 ng/L. Stepwise Cox regression models, applying normalized continuous log e /SD values, were fitted for the biomarkers with total mortality within 5 years as the dependent variable. Results: Death was recorded in 246 patients; 34.4% females vs. 27.2% males (Chi-squared test p-value = 0.02). Blood samples were available for analysis of DD, FM and SF2 in 820, 810 and 846 patients, respectively. Females had a signficantly higher mean of DD (p<0.0001) and FM (p=0.0020) than males and SF2 did not differ (p=0.0825). In the univariate analysis, a highly significant association between DD and total death was observed in both sexes (p<0.001). However, after adjusting for confounders in the multivariable analysis, the associations remained significant in females but not in males, with an HR of 1.62 (95%CI 1.36 – 1.93), p<0.0001 vs. 1.16 (95%CI 0.98 - 1.39, p=0.094, respectively, (p for interaction <0.001). Similar findings were noted in the multivariable analysis of FM with HR 1.46 (95%CI 1.19 – 1.80), p=0.0003 in females vs. 1.12 (95%CI 0.93 -1.35), p=0.22 in males (p for interaction 0.056). In the univariate analysis, SF2 was not associated with all-cause mortality; p=0.56 in females vs. p=0.83 in males, and remained essentially unchanged after adjustment; p=0.84 vs. HR 0.92 (95%CI 0.78 – 1.09). p=0.35 in males, yielding a p=0.36 for interaction. Conclusion: Activated endstage coagulation was associated with total death at 5 years FU in females admitted with chest pain of suspected coronary origin, whereas plasmin inhibition was not. A significant p-value for interaction between the two sexes indicates that the prognostic value of DD surpasses that of men.

Do anomalous aortic origin of a coronary artery patients have higher risk of myocardial ischaemia and adverse cardiac events during aortic and mitral valve replacements?

We assessed the effect of anomalous aortic origin of a coronary artery on the risk of early and late postoperative events after aortic or mitral valve replacement in adults. Between 2005 and 2022, 29,579 adults underwent surgical aortic or mitral valve replacement at Cleveland Clinic. Among these, 29 had an unrepaired coronary artery rising anomalously from the aorta that was not intervened upon during valve surgery, 19 (65%) an anomalous circumflex, and 9 (31%) an anomalous right. Operative outcomes were compared between the 29 patients with anomalous coronary arteries and 87 balancing score (1:3) matched patients with normal coronary origin. Median follow-up was 6.5 years. Among matched groups, major morbidity and mortality 24% (n = 7) in patients with anomalous coronaries and 20% (n = 17) among patients with normal coronary origin (P = .7). Ten-year freedom from coronary reintervention was 83% versus 100% (P[log-rank] = .005), and 10-year survival was 59% versus 53% (P[log-rank] = .8). One patient experienced a coronary injury from valve surgery, in which the incidentally found anomalous retroaortic circumflex was immediately repaired without further complication. There was no coronary reintervention after discharge in the normal coronary origin group and three in the anomalous coronary group; however, only one of these patients required intervention on the anomalous coronary. Anomalous coronaries were uncommon in surgical valve replacement patients at a high-volume centre. The origin and course of each coronary should be assessed before valve replacement. With careful planning, valve replacement does not result in a significantly higher prevalence of postoperative ischaemia, mortality, or reintervention.

Prevalence, characteristics and significance of anomalous coronary arteries in adults undergoing cardiac CT scans

Abstract Background/introduction The widespread use of CT coronary angiogram (CTCA) for the evaluation of patients with suspected coronary artery disease has resulted in increased identification of anomalous coronary arteries. These are often incidental findings and their prevalence and significance remains unknown. Purpose To identify the prevalence, characteristics and significance of anomalous coronary arteries in patient undergoing cardiac CT for suspected coronary artery disease. Methods This is a retrospective analysis of all cardiac CT scans (n= 5727 CTCAs) performed at two tertiary centres in the UK from 2015 to 2022. For the purpose of this study, we excluded separate LAD and circumflex artery coronary origins given it is clinical non-significance. Results Eighty three patients (1.45%) were identified as having anomalous coronary arteries. The average age of patients with anomalous coronary arteries was 57 years (range 18 - 86 years) and 36% were female. The most common coronary anomaly was the left circumflex artery arising from the right side (49 patients, 59%) and all had a retroaortic course. This was followed by an anomalous right coronary artery arising from the left side (29 patients, 35%) with 93% of them taking an interarterial course whilst 7% had a subpulmonic course. We also identified an anomalous left main stem (14 patients, 17%) arising from the right side (5 retroaortic, 5 subpulmonic, 2 prepulmonic, 1 anterior and 1 interarterial course). Four patients (5%) had an anomalous LAD arising from the right (2 prepulmonic, 1 subpulmonic and 1 anterior course). Four patients had other coronary anomalies (left circumflex artery arising from right pulmonary artery, OM arising from left ventricle, congenital atresia of left main stem and an ALCAPA). Majority of the patients with an anomalous coronary artery taking an interarterial course underwent a stress test. During a mean follow-up period of 4 years, four patients (5%) underwent cardiac surgery for treatment of anomalous coronary artery (ALCAPA, left main stem atresia and two anomalous right with interarterial course), seven patients underwent cardiac surgery for other reasons (significant atherosclerotic coronary artery disease and/or valve disease), five patients underwent PCI for treatment of atherosclerotic coronary artery disease and two patients died for reasons unrelated to their coronary anomaly. Conclusion This study of a large and unselected cohort of CTCA patients demonstrates an overall prevalence of coronary artery anomalies (as defined above) of 1.45%. We also report the prevalence and characteristics of different coronary anomalies and their outcomes. In the majority of patients, coronary artery anomalies are incidental findings and can be managed conservatively.

Use of Esmolol to treat resistant electrical storm in a patient with decompensated heart failure

BackgroundVentricular tachycardia storm is a syndrome defined by the presence of at least three episodes of ventricular tachycardia over a 24-h period, requiring termination by intervention. Standard therapy consists initially of using intravenous betablockers (if left ventricular ejection fraction is preserved) and Amiodarone, in addition to intravenous Lidocaine (in case of ischemic etiology) and light sedation. In the present case, a ventricular tachycardia storm episode is terminated by Esmolol, a particular intravenous betablocker, despite acute decompensated heart failure.Case presentationWe report the case of an 89-year-old patient presenting for a ventricular tachycardia storm and acute heart failure with reduced left ventricle ejection fraction of coronary ischemic origin that persisted despite coronary revascularization, oral betablocker, intravenous Amiodarone and Lidocaine, light sedation, and multiple electrical cardioversion. Emergency catheter ablation was not feasible due to meteorological conditions. We decided to use an intravenous betablocker despite the presence of acute heart failure. We favored use of intravenous Esmolol over other intravenous betablockers due to its short half-life and thus his rapid elimination, a unique characteristic for Esmolol. Intravenous Esmolol has successfully terminated the ventricular tachycardia without causing cardiogenic shock.ConclusionsIntravenous Esmolol can be used safely in patients with acute decompensated heart failure to terminate an electrical storm after failure of other measures. Close monitoring of the patient remains essential.

Intra-Atrial Right Coronary Artery: A Condition Revealed by Coronary CT Scan.

Coronary artery anomalies are rare and may involve the coronary origin, course, or termination. Most are benign; however, some can lead to myocardial damage, sudden death, or potential hazards during interventional or surgical procedures. The advancement of imaging studies has led to an increase in their diagnosis. Coronary computed tomography angiography (CCTA) especially has characterized new anomalies that were previously anecdotal. This is the case of the intra-atrial course of the right coronary artery. The present is a brief review about this rare congenital anomaly.

Role of Computed Tomography Angiography (CTA) In The Diagnosis Of Coronary Artery Anomalous Origins and Extracardiac Vascular Malformation Of Congenital Heart Disease In Pediatric Age Group

Role of Computed Tomography Angiography (CTA) In The Diagnosis Of Coronary Artery Anomalous Origins and Extracardiac Vascular Malformation Of Congenital Heart Disease In Pediatric Age Group

Late gadolinium enhancement and anomalous coronary aortic origin in a large paediatric cohort.

Late gadolinium enhancement and anomalous coronary aortic origin in a large paediatric cohort.

Anomalous origin of left coronary artery. RAC-sign. A case report

Anomalous coronary origin is a rarely diagnosed condition, the first manifestation of which may be sudden cardiac death. Diagnosis of this pathology, as well as other cardiac and coronary anomalies, is based on imaging diagnostic methods. Transthoracic echocardiography is the most accessible screening method to describe the retroaortic anomalous coronary (RAC) sign. However, due to the low detection rate of this condition and the suboptimal sensitivity of echocardiography, anomalous aortic origin often remains undiagnosed. This article presents the diagnosis of an anomalous origin of the left coronary artery through echocardiography and computed tomography in an elderly patient who had previously been observed for a long time for other cardiovascular diseases. With this case report, we want to emphasize the importance of awareness about congenital coronary artery pathology for the timely routing of patients and providing proper care.

Progress of surgical treatment of anomalous left coronary artery from the pulmonary artery.

Anomalous left coronary artery from the pulmonary artery is a rare CHD. It is the most common type of anomalous coronary origin. It may cause myocardial ischaemia or infarction, mitral regurgitation, congestive heart failure, and early death in infancy if left untreated. Surgery is the only treatment for anomalous left coronary artery from the pulmonary artery. In recent years, with advancements in surgical techniques and the widespread utilisation of extracorporeal cardiac assist devices such as extracorporeal membrane oxygenation, the treatment outcomes for anomalous left coronary artery from the pulmonary artery have demonstrated significant improvements. However, the surgical indications and methods of anomalous left coronary artery from the pulmonary artery, especially the surgical methods of anomalous left coronary artery from the pulmonary artery with intramural coronary artery, and whether to treat mitral regurgitation at the same time are still controversial. The long-term complications and prognosis remain discouraging simultaneously, with significant variations in outcomes across different centres. The present review specifically addresses these aforementioned concerns. Based on the literature published at home and abroad, we found that no matter what type of anomalous left coronary artery from the pulmonary artery patients, even asymptomatic patients, regardless of the collateral circulation between the left and right coronary arteries, should immediately undergo surgical treatment to promote the recovery of left ventricular function. Based on different coronary artery anatomical morphology and preoperative cardiac function, the long-term follow-up results of individualised surgical treatment of anomalous left coronary artery from the pulmonary artery children show good prognosis, and most children have significant improvement in cardiac function. Patients with moderate to severe mitral regurgitation should undergo mitral valve operation at the same time as anomalous left coronary artery from the pulmonary artery repair. Mitral valvuloplasty can quickly improve mitral regurgitation and promote the early recovery of cardiac function after operation, and does not increase the risk of operation. Mechanical circulatory support is a safe and effective means of early postoperative transition for children with severe anomalous left coronary artery from the pulmonary artery. Anomalous left coronary artery from the pulmonary artery with intramural coronary artery is a rare anomaly. According to different anatomical types, different surgical methods can be used for anatomical correction, and satisfactory early and mid-term results can be obtained.

Impact of commissural versus coronary alignment on risk of coronary obstruction following transcatheter aortic valve implantation.

Transcatheter aortic valve implantation (TAVI) with commissural alignment aims to limit the risk of coronary occlusion and maintain good coronary access. However, due to coronary origin eccentricity within the coronary cusp, coronary-commissural overlap (CCO) may still occur. TAVI using coronary alignment, rather than commissural alignment, may further improve coronary access. To compare rates of CCO after TAVI using commissural versus coronary alignment methodology. Cardiac CT scans from 102 patients with severe (tricuspid) aortic stenosis referred for TAVI were analysed. Native cusp asymmetry and coronary eccentricity were defined and used to simulate TAVI using commissural versus coronary alignment. Rates of optimal coronary alignment (< 10° from cusp centre) and severe misalignment (< 15° from coronary-commissural overlap) were compared. Additionally, the impact of valve misalignment during implantation was assessed. The native right coronary artery (RCA) origin was 15.8° (9.5 to 24°) closer to the right coronary cusp/non-coronary cusp (RCC-NCC) commissure than the centre of the right coronary cusp. The native left coronary artery (LCA) origin was 4.5° (0 to 11.5°) closer to the left coronary cusp/non-coronary cusp (LCC-NCC) commissure than the centre of the left coronary cusp (p < 0.01). Compared to commissural alignment, coronary alignment doubled the proportion of optimally-aligned RCAs (62/102 [60.8%] vs. 31/102 [30.4%]; p < 0.001), without a significant change in optimal LCA alignment (62/102 [60.8% vs. 74/102 [72.6%]; p = 0.07). There were no cases of severe misalignment with either strategy. Simulating 15° of valve misalignment resulted in severe RCA compromise risk in 7/102 (6.9%) of commissural alignment cases, compared to none using coronary alignment. Fluoroscopic projection was similar with both approaches. Coronary alignment resulted in a 2-fold increase of optimal TAVI positioning relative to the RCA ostium when compared to commissural alignment without impacting the LCA. Use of coronary alignment rather than commissural alignment may improve coronary access after TAVI and is less sensitive to valve rotational error, particularly for the right coronary artery.

Chemokine ligand 18 predicts all-cause mortality in patients hospitalized with chest pain of suspected coronary origin

IntroductionChemokines mediate recruitment and activation of leucocytes. Chemokine ligand 18 (CCL18) is mainly expressed by monocytes/macrophages and dendritic cells. It is highly expressed in chronic inflammatory diseases, and locally in atherosclerotic plaques, particularly at sites of reduced stability, and systemically in acute coronary syndrome patients. Reports on its prognostic utility in the latter condition, including myocardial infarction (MI), are scarce. AimTo assess the utility of CCL18 as a prognostic marker of recurrent cardiovascular events in patients hospitalized with chest pain of suspected coronary origin. MethodsThe population consisted of 871 consecutive chest-pain patients, of whom 386 were diagnosed with acute myocardial infarction (AMI) based on Troponin-T (TnT) levels >50 ng/L. Stepwise Cox regression models, applying normalized continuous loge/SD values, were fitted for the biomarkers with cardiac mortality within 2 years and total mortality within 2 and 7 years as the dependent variables. ResultsPlasma samples from 849 patients were available. By 2 years follow-up, 138 (15.8%) patients had died, of which 86 were cardiac deaths. Univariate analysis showed a positive, significant association between CCL18 and total death [HR 1.55 (95% 1.30–1.83), p < 0.001], and for cardiac death [HR 1.32 (95% 1.06–1.64), p = 0.013]. Associations after adjustment were non-significant. By 7 years follow-up, 332 (38.1%) patients had died. CLL18 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.01–1.29), p = 0.030], but not with MI (n = 203) or stroke (n = 55). ConclusionCCL18 independently predicts long-term all-cause mortality but had no independent prognostic bearing on short-term cardiac death and CVD events.

Should Coronary Artery Fistula Be Treated? A Review Throughout a Case Series

Background: Coronary artery disease (CAD) includes a wide spectrum of entities beyond the atherosclerotic disease. Coronary artery fistulas (CAF) represent an uncommon vascular abnormality that may cause several cardiovascular complications and symptoms, due to the coronary steal phenomena. Surgical or percutaneous closure should always be considered. The authors present a case series of patients with CAFs who developed cardiovascular manifestations, and underwent percutaneous closure safely and feasibly, with good clinical results. Case Summary: Five patients with CAFs were treated from 2021–2023; three were male (60%), the mean age was 59 years, the most common symptom was chest pain, and two patients presented in the context of unstable angina. The authors documented pulmonary hypertension in three patients, none of them with haemodynamic compromise of right ventricle. Two of the patients had documented ischaemia or haemodynamic significance due to the CAF. Finally, in two cases, no CAD was noted in coronary angiography. Percutaneous closure was done using a 6 Fr or 7 Fr sheath; guiding catheter 6 or 7 Fr through a workhorse guidewire, a microcatheter was placed in the coronary origin of the fistula, closure was done using a liquid embolisation system or delivering coils into the defect. The number and length of coils may vary depending on the fistula’s size. Discussion: The authors present five successful cases of percutaneous closure of symptomatic CAF, who presented with angina or dyspnoea as main symptoms. Once the diagnosis was made and further studies performed, the closure was decided based on the pulmonary hypertension or coronary steal phenomena.

α1-Antichymotrypsin Complex (SERPINA3) Is an Independent Predictor of All-Cause but Not Cardiovascular Mortality in Patients Hospitalized for Chest Pain of Suspected Coronary Origin

Introduction: SERPINA3 is an acute-phase protein triggered by inflammation. It is upregulated after an acute myocardial infarction (AMI). Data on its long-term prognostic value in MI patients are scarce. We aimed to assess the utility of SERPINA3 as a prognostic marker in patients hospitalized for chest pain of suspected coronary origin. Methods: A total of 871 consecutive patients, 386 diagnosed with AMI, were included. Stepwise Cox regression models, applying continuous loge-transformed values, were fitted for the biomarker with all-cause mortality and cardiac death within 2 years or all-cause mortality within the median 7 years as dependent variables. An analysis of MI and stroke, and combined endpoints, respectively, was added. The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model. Results: Plasma samples from 847 patients were available. By 2-year follow-up, 138 (15.8%) patients had died, of which 86 were cardiac deaths. The univariate analysis showed a significant association between SERPINA3 and all-cause mortality (HR 1.41 [95% 1.19–1.68], p < 0.001) but not for cardiac death. Associations after adjustment were non-significant. By 7-year follow-up, 332 (38.1%) patients had died. SERPINA3 was independently associated with all-cause mortality from the third year onward. The HR was 1.14 (95% CI, 1.02–1.28), p = 0.022. Similar results applied to combined endpoints, but not for MI and stroke, respectively. The prognostic value of SERPINA3 was limited to non-AMI patients. No independent associations were noted among AMI patients. Conclusions: SERPINA3 predicts long-term all-cause mortality but fails to predict outcome in AMI patients.

Tiger Catheter for Difficult Femoral Artery Approach Coronary Catheterization

Background: While most catheters are designed for the natural anatomy of the coronaries at the origin, we often end up using multiple catheters in failed attempts to hook the coronary ostia in case of unusual origins. We had similar issues where we used multiple catheters in vain during femoral approach catheterizations and ended up successfully hooking with a tiger (TIG) catheter in a few of our cases in the catheterization laboratory. We mostly used Judkins left (JL) and Judkins right (JR) catheters as the first choice for femoral approach catheterizations. Hence, we wanted to see how frequently we had to use catheters other than JL and JR and which catheter was most useful in such cases. Methods: This is a retrospective study of catheterization laboratory angiographic data and recordings involving femoral artery approach coronary catheterization at King George Hospital, Visakhapatnam, from January 2022 to December 2022. We analyzed and interpreted the data of difficult femoral artery catheterizations where JL/JR catheters could not hook the coronaries successfully. We tabulated such data in percentages to understand which catheter was most useful in such cases. We analyzed the angiograms of such cases to understand the coronary origins. Results: Overall, 1130 cases underwent femoral artery approach coronary angiograms. Of them, 1100 (97.3%) cases could be hooked with JL and JR catheters. Thirty (2.65%) cases were found to be difficult femoral artery approach catheterizations where either JL or JR catheter could not be used successfully. Out of those difficult ones (30 cases – 100%), 22 (73.3%) cases could be hooked with TIG catheter, 4 (13.33%) cases with extra backup (EBU) catheter, 1 (3.33%) case with JR side hole (JRSH) catheter, 2 (6.66%) cases with no torque right (NTR) catheter, and 1 (3.33%) case with multipurpose catheter (MPA). Out of these 30 cases, a left coronary angiogram was needed other than a JL catheter in 8 cases, while a right coronary angiogram was needed other than a JR catheter in 25 cases, showing that the right coronary artery (RCA) was mostly involved in difficult catheterizations. For left coronary angiograms, 4 cases hooked with TIG (1 case – posteriorly/low takeoff, 1 – high takeoff, 1 – mid-takeoff, and 1 – RCA/left main coronary artery [LMCA] from left sinus) and 4 cases with EBU catheter (1 – anterior/high takeoff, 2 – high takeoffs, and 1 – posteriorly/high takeoff). For right coronary angiograms, 21 cases hooked with TIG (3 cases – left sinus/anteriorly, 3 – high takeoff/anteriorly, 3 – low takeoff, 2 – mid takeoff/anteriorly, 3 – posterior/high takeoff, 1 – RCA/LMCA from left sinus, 1 – posteriorly/left sinus, 3 – high takeoff, 1 – anteriorly/low takeoff, and 1 – right sinus/mid-takeoff), 1 case with JRSH, 1 case with MPA (anterior/high takeoff) and 2 cases with NTR (1 – low takeoff and 1 – high takeoff). Conclusion: We found that the TIG catheter was useful in difficult femoral approach catheterizations in the majority of cases and it can be tried in difficult cases.

Incidence of coronary anomalies in patients with D-transposition of great arteries (D-TGA) after arterial switch operation (ASO)

Abstract Background and purpose D-transposition of great arteries (D-TGA) is a congenital cardiac defect defined by atrioventricular concordance and ventriculo-arterial discordance. Arterial switch operation (ASO) is currently the surgical repair and implies reimplantation of the coronary arteries from the aorta into the neo-aortic root. As such, long-term coronary anomalies and complications are possible and potentially dangerous. Recently, coronary computed tomography angiography (CCTA) has gained a prominent role for characterization of the coronary anatomy in these patients (pts) and its relationship with adjacent structures. However, routine coronary evaluation among asymptomatic pts after ASO remains controverse, as the reported incidence of coronary-related complications is low. The purpose of this study is to perform a descriptive analysis of CCTA findings in pts with D-TGA after ASO. Methods We performed a retrospective single center study that included patients with D-TGA submitted to ASO who underwent CCTA. Demographic, clinical and imaging data were collected. Results We identified 57 pts with D-TGA submitted to ASO. Of these, 39 (68%) performed a CCTA. Mean age of pts was 20.4 (± 3.8) years; 54% were male; 32% had complex D-TGA. In 35 patients (90%), CCTA was performed as part of a routine screening. In 4 (10%) pts CCTA was done due to symptoms or an abnormal non-invasive test suggestive of myocardial ischemia. Eighteen (46%) pts had coronary anomalies: 5 (13%) had an acute angulation at the coronary origin; 13 (33%) pts had anomalous origin of the coronary arteries, ranging from presence of a single coronary artery in 3 (8%) pts, common independent origin from a single sinus of Valsalva in 6 (15%) cases and anomalous origin of the circumflex artery from the right coronary artery (RCA) in 4 (10%) pts. An interarterial course was described in 2 (5%) pts and a retroaortic course was reported in 8 (21%) cases. One patient had anomalous course of the LAD into the right ventricle, a mild calcified ostial stenosis of the left main coronary artery and a chronic total occlusion of the RCA. Conclusions D-TGA patients submitted to ASO have a high incidence of coronary anomalies. Routine screening with CCTA may be justified to identify patients who may be at higher risk of coronary events.

Abstract 17723: Non-Contrast Cardiac Magnetic Resonance BOOST Whole Heart Acquisition to Evaluate Coronaries in Children and Young Adults

Introduction: Cardiac magnetic resonance (CMR) coronary evaluation remains challenging in teenagers and young adults using conventional respiratory navigation strategies due to irregular respiratory patterns. Motion correction strategies have shown promise in improving efficiency and quality. We sought to evaluate a non-contrast 3D whole-heart sequence with bright-blood (BB) and dark-blood (DB) phase sensitive inversion recovery (BOOST) using image-based navigation (iNAV) and a variable-density cartesian spiral profile order trajectory (VD-CASPR). Hypothesis: BOOST acquisitions improves delineation of coronary origins and proximal courses. Methods: Pts undergoing clinically indicated CMRs were prospectively enrolled and scanned at 1.5T (AVANTO FIT, Siemens) using 2 different imaging methods: 1) BOOST research sequence employing either T2 or magnetization transfer preparation at 1.0-1.4 mm isotropic resolution. When clinically indicated, 2) a standard navigated inversion recovery gradient echo sequence (IR-FLASH) acquired after gadolinium or ferumoxytol infusion. Both coronary imaging methods were rated on a 1-4 scale: 1=non-diagnostic, 2=coronary origins with significant image degradation, 3=mild image degradation, and 4=sharp delineation of the proximal coronaries. A composite BOOST score (highest score between BB and DB images) was compared to IR-FLASH. Group comparisons used a paired t-test (two-tailed, p&lt;0.05). Results: 18 pts, mean age 18.8 years (range=10-31) underwent BOOST imaging. 15 had an IR-FLASH for comparison. BOOST acquisition times were 7-12 minutes. Three pts had coronary anomalies (2 with right coronary from the left sinus, 1 single coronary). Coronary origins were delineated on all BOOST exams with a mean score=3.6 for BB BOOST and 2.9 for DB compared to 3.1 for the IR-FLASH, neither of which was significantly different. The composite BOOST mean score was 3.8, which was significantly higher than IR-FLASH. Conclusions: In our series in children and young adults, contrast-free BOOST imaging delineated coronary origins in all pts, even in challenging cases of anomalous origins. When utilizing both BB and DB BOOST images, image quality exceeded that of a conventional post-contrast IR-FLASH sequence.

Abstract 14503: Chemokine Ligand 18 (CCL18) is a Long-Term Predictor of All-Cause Mortality, but Did Not Predict CVD Events

Introduction: Chemokines mediate leukocyte recruitment and activation. Chemokine ligand 18 (CCL18) is mainly expressed by a broad range of cells such as monocytes/macrophages and dendritic cells. It is highly expressed in chronic inflammatory diseases, and locally in atherosclerotic plaques, particularly at sites of reduced stability. Circulating CCL18 levels are transiently elevated in patients admitted with unstable angina pectoris, but data on myocardial infarction (MI) are scarce. Aim: To assess the utility of CCL18 as a prognostic marker of CVD in patients hospitalized for chest pain of suspected coronary origin. Methods: The population consisted of 871 consecutive patients (ClinicalTrials.gov Identifier: NCT00521976). Stepwise Cox regression models, applying continuous log e -transformed values, were fitted for each of the biomarkers with all-cause mortality and cardiac death within 24-months and all-cause mortality within median 7 years (y) as the dependent variables, adding an analysis of 1) all-cause mortality or MI, and 2) all-cause mortality or MI or stroke at 7 y follow up (FU). The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model, adjusting for traditional clinical cardiovascular risk factors, adding BNP, hsCRP, and TnT. Results: Plasma samples from 849 patients were available. By 24 months FU, 138 (15.8%) patients had died; 86 were cardiac deaths. The univariate analysis showed a positive, significant association between CCL18 and total death [HR 1.55 (95% 1.30-1.83), p=0.000], and for cardiac death [HR 1.32 (95% 1.06-1.64), p=0.013]. Applying multivariable analysis, the associations were no longer significant. At 7 y FU, a total of 332 (38.1%) patients had died. After multivariable adjustment, CLL18 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.01-1.29), p=0.030], but not for MI (n=203) or stroke (n=55). The positive association between CCL18 and all-cause mortality was lost when combined with CVD events; all-cause mortality or MI (n=404, p=0.75), and all-cause mortality or MI or stroke (n=422, p=0.79). Conclusions: CCL18 predicts long-term all-cause mortality, but had no independent prognostic bearing on short-term cardiac death and CVD events during long-term FU.

Abstract 14288: α1-Antichymotrypsin Complex (SERPINA3) is an Independent Predictor of Long-Term All-Cause Mortality, but Did Not Predict CVD Events

Introduction: SERPINA3 is an acute phase protein triggered by inflammation. It inhibits neutrophil cathepsin which cleaves protease-activated receptor 4 (PAR-4) via a thrombin-independent pathway, and mast cell chymase which mediates the production of angiotensin-II via an ACE-independent pathway. SERPINA3 is upregulated after an acute myocardial infarction (MI), but data on its long-term prognostic value in MI patients are scarce. Aim: To assess the utility of SERPINA3 as a prognostic marker in patients hospitalized for chest pain of suspected coronary origin. Methods: A total of 871 consecutive patients were included (ClinicalTrials.gov Identifier: NCT00521976). Stepwise Cox regression models, applying continuous log e -transformed values, were fitted for each of the biomarkers with all-cause mortality and cardiac death within median 24-months (mo) and all-cause mortality within median 7 years (y) as the dependent variables, adding an analysis of 1) all-cause mortality or MI, and 2) all-cause mortality or MI or stroke at 7 y follow up (FU). The hazard ratio (HR) (95% CI) was assessed in a univariate and multivariable model, adjusting for traditional clinical cardiovascular risk factors, adding BNP, hsCRP, TnT. Results: Plasma samples from 847 patients were available. At 24 mo FU, 138 (15.8%) patients had died, of which 86 were cardiac deaths. The univariate analysis showed a positive, significant association between SERPINA3 and total death [HR 1.42 (95% 1.19-1.68), p =0.000], but was not significant for cardiac death. Associations after multivariable adjustment were statistically non-significant. At 7 y FU, 332 (38.1%) patients had died. After adjustment, SERPINA3 was independently associated with all-cause mortality [HR 1.14 (95% CI, 1.02-1.28), p=0.022], but not for MI (n=203), and stroke (n=55), respectively, and remained essentially unaffected for all-cause mortality or MI combined (n=404) [HR 1.12 (95% CI, 1.01-1.24), p=0.031], slightly weakened when stroke also was added (n=422) [HR 1.10 (95% CI, 1.00-1.22), p=0.060]. Conclusions: SERPINA3 predicts long-term all-cause mortality, but had no prognostic bearing on short-term cardiac death. Introducing non-fatal CVD events during long-term FU did not improve its prognostic value.

Heterogeneous vasomotor responses in segments from Göttingen Minipigs coronary, cerebral, and mesenteric artery: A comparative study

Göttingen Minipigs (GM) are used as an important preclinical model for cardiovascular safety pharmacology and for evaluation of cardiovascular drug targets. To improve the translational value of the GM model, the current study represents a basic characterization of vascular responses to endothelial regulators and sympathetic, parasympathetic, and sensory neurotransmitters in different anatomical origins.The aim of the current comparative and descriptive study is to use myography to characterize the vasomotor responses of coronary artery isolated from GM and compare the responses to those obtained from parallel studies using cerebral and mesenteric arteries. The selected agonists for sympathetic (norepinephrine), parasympathetic (carbachol), sensory (calcitonin gene-related peptide, CGRP), and endothelial pathways (endothelin-1, ET-1, and bradykinin) were used for comparison. Further, the robust nature of the vasomotor responses was evaluated after 24 h of cold storage of vascular tissue mimicking the situation under which human biopsies are often kept before experiments or grafting is feasible.Results show that bradykinin and CGRP consistently dilated, and endothelin consistently contracted artery segments from coronary, cerebral, and mesenteric origin. By comparison, norepinephrine and carbachol, had responses that varied with the anatomical source of the tissues.To support the basic characterization of GM vasomotor responses, we demonstrated the presence of mRNA encoding selected vascular receptors (CGRP- and ETA-receptors) in fresh artery segments.In conclusion, the vasomotor responses of isolated coronary, cerebral, and mesenteric arteries to selected agonists of endothelial, sympathetic, parasympathetic, and sensory pathways are different and the phenotypes are similar to sporadic human findings.

Procollagen type 1 N-terminal propeptide is associated with adverse outcome in acute chest pain of suspected coronary origin.

Extracellular matrix (ECM) is an integral player in the pathophysiology of a variety of cardiac diseases. Cardiac ECM is composed mainly of collagen, of which type 1 is the most abundant with procollagen type 1 N-terminal Propeptide (P1NP) as a formation marker. P1NP is associated with mortality in the general population, however, its role in myocardial infarction (MI) is still uncertain, and P1NP has not been investigated in acute chest pain. The objective of the current study was to assess the role of P1NP in undifferentiated acute chest pain of suspected coronary origin. 813 patients from the Risk in Acute Coronary Syndromes study were included. This was a single-center study investigating biomarkers in consecutively enrolled patients with acute chest pain of suspected coronary origin, with a follow-up for up to 7 years. Outcome measures were a composite endpoint of all-cause death, new MI or stroke, as well as its individual components at 1, 2, and 7 years, and cardiac death at 1 and 2 years. In multivariable Cox regression analysis, quartiles of P1NP were significantly associated with the composite endpoint at 1 year of follow-up with a hazard ratio for Q4 of 1.82 (95% CI, 1.12-2.98). There was no other significant association with outcomes at any time points. P1NP was found to be an independent biomarker significantly associated with adverse clinical outcome at one year in patients admitted to hospital for acute chest pain of suspected coronary origin. This is the first report in the literature on the prognostic value of P1NP in this clinical setting. NCT00521976.