Coronary Stenosis In Patients Research Articles

The change in high-sensitivity troponin-T as a risk factor for significant coronary stenosis in patients with acute coronary syndrome.

Background/AimsHigh-sensitivity cardiac troponin (hs-TnT) assays detect very low levels of cardiac troponin. This study examined the interval change between initial and subsequent hs-TnT levels and evaluated its ability to predict significant coronary stenosis.MethodsThe study analyzed 163 patients who presented with acute coronary syndrome (ACS) and underwent coronary angiography (CAG) between April 2014 and May 2018. The 0 and 3-hour hs-TnT were checked. The patients were subdivided into positive (n = 32) and negative (n = 131) interval change groups. The presence of significant coronary artery stenosis on CAG in the two groups was compared.ResultsThe positive interval change group was older and had higher 0 and 3-hour hs-TnT and blood glucose levels than the negative interval change group. Significant coronary stenosis was more common in the positive interval change group than in the negative interval change group (68.8% vs. 23.7%, p = 0.001). However, vasospasm was more common in the negative interval change group (6.3% vs. 31.3%, p = 0.003). The positive interval change group had higher rates of bifurcation lesions and received more percutaneous coronary intervention. In multivariate analysis, age, interval change of serial hs-TnT and diabetes mellitus were independent predictors of significant coronary artery stenosis.ConclusionsThis study identified a relationship between the serial change in cardiac biomarkers and the presence of significant coronary stenosis in patients with ACS. Serial hs-TnT change was associated with real angiographic stenosis in patients with ACS.

Coronary stenoses in patients suspected to have obstructive coronary artery disease: the exemption rather than the rule!

Abstract

The potential value of Copeptin and Pentraxin3 for evaluating the severity of coronary stenosis in patients with coronary artery disease

IntroductionCoronary artery disease (CAD) is an ischemic heart disease due to the narrowing of the coronary arteries resulting from atherosclerosis. Blood biomarkers have been well utilized for the diagnosis and prognosis of CAD. However, the value of biomarkers for evaluating coronary atherosclerosis remains to be clarified. This clinical investigation aimed to explore the potential value of biomarkers for evaluating the severity of coronary stenosis in CAD patients. MethodsThe extent of coronary atherosclerosis was accessed by the angiography-based quantitative measurement Gensini score (GS). Blood levels of Brain natriuretic peptide, Copeptin (CPP), Phosphodiesterase 9A, and Pentraxin3 (PTX3) were measured in 56 patients divided into three levels as low GS (n = 17), intermediate GS (n = 19) and high GS (n = 20) based on GS tertiles. ResultsWe found that plasma concentrations of CPP and PTX3 were significantly elevated in patients with high GS compared with the low GS group. In addition, Pearson correlation analysis showed that CPP and PTX3 were positively correlated with the GS. Furthermore, Receiver operating characteristics analysis demonstrated that both CPP and PTX3 exhibited discriminative capacities for evaluating the extent of coronary stenosis. ConclusionsLaboratory tests of CPP and PTX3 via non-invasive means may provide novel information for risk stratification and disease management in CAD patients before invasive angiographic approaches. This study opens the door for enormous opportunities to explore new biomarkers with better efficiency, sensitivity and specificity as alternative/additional methods for evaluating the severity of coronary atherosclerosis in CAD patients in future research.

Multidisciplinary approach to treat ruptured abdominal aortic aneurysm into the vena cava.

A 63-year-old man with a ruptured abdominal aortic aneurysm (AAA) into the inferior vena cava (IVC) underwent aortobifemoral bypass and closure of the aortocaval fistula (ACF). An additional bypass graft from the right iliac limb to the right internal iliac artery was placed to avoid colonic and pelvic ischemia. Preoperative computed tomography angiography (CTA) revealed an 8.6 cm AAA with rupture into the IVC through an 8.5 mm ACF (A). In addition, there was a 5.8 cm right common iliac and a 5.3 cm left common iliac artery aneurysm (B). The patient became hemodynamically unstable during CTA, and suffered a cardiac arrest with prompt cardiac resuscitation, intubation, and immediate transfer to the operating room. Ten hours after successful surgery the patient was awake and stable. He had no cardiac history, no symptoms suggestive of coronary artery disease (CAD) and had no electrocardiographic changes. However, the troponin level increased to 217,479.7 ng/L and the creatine kinase MB level increased to 504.6 ng/mL. Coronary angiography revealed left main coronary stenosis and subocclusion of the right coronary artery (C). Percutaneous coronary revascularization was performed with implantation of drug-eluting stents in the left main and right coronary artery. The patient recovered uneventfully. The 6-month follow-up CTA demonstrated patent aortobifemoral and right internal iliac bypass grafts and the IVC without signs of stenosis (D). Written informed consent was obtained from the patient for his anonymized information to be published in this article. AAA rupture into the IVC is rare and is associated with high mortality.1Davidovic L. Dragas M. Cvetkovic S. Kostic D. Cinara I. Banzic I. Twenty years of experience in the treatment of spontaneous aorto-venous fistulas in a developing country.World J Surg. 2011; 35: 1829-1834Crossref PubMed Scopus (19) Google Scholar, 2Simons J. Baril D. Goodney P. Bertges D. Robinson W. Cronewett J. et al.The effect of postoperative myocardial ischemia on long -term survival after vascular surgery.J Vasc Surg. 2013; 58: 1600-1608Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar, 3Krievins D. Zellans E. Erglis A. Zvaigzne L. Lacis A. Jegere S. et al.High prevalence of asymptomatic ischemia-producing coronary stenosis in patients with critical limb ischemia: anatomic and functional assessment with coronary CT-derived fractional flow reserve (FFRCT).Vasc Dis Manag. 2018; 15: E96-E101Google Scholar, 4Aboyans V. Ricco J.B. Bartelink M.E.L. Björck M. Brodmann M. Cohnert T. et al.2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS).Eur Heart J. 2018; 39: 763-816Crossref PubMed Scopus (1389) Google Scholar Preoperative diagnosis of ACF with CTA facilitated expeditious surgical treatment in this patient. Patients who survive surgery but have biomarker evidence of myocardial injury have reduced long-term survival.2Simons J. Baril D. Goodney P. Bertges D. Robinson W. Cronewett J. et al.The effect of postoperative myocardial ischemia on long -term survival after vascular surgery.J Vasc Surg. 2013; 58: 1600-1608Abstract Full Text Full Text PDF PubMed Scopus (33) Google Scholar Patients with AAA commonly have coexistent CAD. Pre-operative diagnosis of silent coronary ischemia with coronary CTA and fractional flow reserve derived from CT (FFRCT) can identify high risk patients who may benefit from coronary revascularisation.3Krievins D. Zellans E. Erglis A. Zvaigzne L. Lacis A. Jegere S. et al.High prevalence of asymptomatic ischemia-producing coronary stenosis in patients with critical limb ischemia: anatomic and functional assessment with coronary CT-derived fractional flow reserve (FFRCT).Vasc Dis Manag. 2018; 15: E96-E101Google Scholar Ruptured AAA into IVC with unsuspected CAD can be successfully treated with prompt image-based diagnosis and involvement of a multidisciplinary vascular team.4Aboyans V. Ricco J.B. Bartelink M.E.L. Björck M. Brodmann M. Cohnert T. et al.2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS).Eur Heart J. 2018; 39: 763-816Crossref PubMed Scopus (1389) Google Scholar

Pericardial adiposity versus body adiposity measured by BMI in the assessment of coronary atherosclerosis burden in patients with hypertension

ABSTRACT Objectives The link between obesity and hypertension with coronary atherosclerosis is complex. We aimed to assess the association of cardiac fat deposition measured by pericardial fat volume(PFV) using by multi-detector CT(MDCT) and general obesity measured by BMI with subclinical coronary atherosclerotic markers (coronary artery calcium score (CAC), coronary plaque and stenosis) in patients with hypertension and suspected coronary artery disease. Methods Among 496 patients presenting with chest pain who underwent 64-slice MDCT angiography to exclude occlusive coronary disease, 261 patients with hypertension (age: 57 ± 8 years, 45% males) enrolled in the present study. Results PFV showed a significant association with CAC(r = 0.2,P = .001),coronary stenosis severity(PFV median(IQR) 88(63–161) in patients with coronary stenosis<50% compared to PFV median(IQR) 125(85–140) in patients with coronary stenosis ≥ 50%, P = .001) and coronary plaque presence (PFV median (IQR) 89(65–128) in patients without plaque compared to PFV median (IQR) 115(74–150) in patients with plaque presence = 0.03).the significant association of PFV with CAC[odds ratio(95% confidence interval = 0.5(0.19–0.97),P = .001] and coronary stenosis severity [odds ratio(95% confidence interval = 1.1(1.00–1.01),P = .01]persisted after adjustment for conventional cardiac risk. BMI showed a significant association with significant coronary stenosis presence (P = .02).The association of BMI with significant coronary stenosis presence after adjustment for conventional cardiac risk factors (P = .03).BMI showed no significant association with CAC and coronary plaque presence (P > .05). Conclusion PFV showed a significant independent association with coronary calcification and significant coronary stenosis in patients with hypertension rather than BMI.

Diagnosis and management of silent coronary ischemia in patients undergoing carotid endarterectomy

BackgroundCoronary artery disease is the primary cause of death in patients with carotid artery disease and silent ischemia is a marker for adverse coronary events. A new noninvasive cardiac diagnostic test, coronary computed tomography-derived fractional flow reserve (FFRCT) can reliably identify ischemia-producing coronary stenosis in patients with coronary artery disease and help to select patients for coronary revascularization. The purpose of this study is to determine the prevalence of silent coronary ischemia in patients undergoing carotid endarterectomy (CEA) and to evaluate the usefulness of FFRCT in selecting patients for coronary revascularization to decrease cardiac events and improve survival. MethodsPatients with no cardiac history or symptoms admitted for elective CEA were enrolled in a prospective, open-label, institutional review board-approved study and underwent preoperative coronary computed tomography angiography (CTA) and FFRCT with results available to physicians for patient management. Lesion-specific coronary ischemia was defined as FFRCT of 0.80 or less distal to a focal coronary stenosis with an FFRCT of 0.75 or less, indicating severe ischemia. Primary end point was incidence of major adverse cardiovascular events (MACE; defined as cardiovascular death, myocardial infarction, or stroke) at 30 days and 1 year. ResultsCoronary CTA and FFRCT was performed in 90 CEA patients (age 67 ± 8 years; male 66%). Lesion-specific coronary ischemia was found in 51 patients (57%) with a mean FFRCT of 0.71 ± 0.14. Severe coronary ischemia was present in 39 patients (43%), 26 patients had multivessel ischemia, and 5 had left main disease. CEA was performed as scheduled in all patients with no postoperative deaths or myocardial infarctions. There were no MACE events at 30 days. After recovery from surgery, 36 patients with significant lesion-specific ischemia underwent coronary angiography with coronary revascularization (percutaneous coronary intervention or coronary artery bypass grafting) in 30 patients (33%). Survival at 1 year was 100% and freedom from MACE was 98%. ConclusionsPatients undergoing CEA have a high prevalence of unsuspected (silent) coronary ischemia, which may place them at risk for coronary events. Preoperative diagnosis of silent ischemia using CTA and FFRCT can identify high-risk patients and help to guide patient management. Selective postoperative coronary revascularization of patients with significant ischemia may decrease the risk of cardiac events and improve survival, but longer follow-up is needed and prospective, controlled trials are indicated.

Comparing the effects of different management strategies on long-term outcomes for significant coronary stenosis in patients with Takayasu arteritis

BackgroundThe long-term outcomes and optimal treatment strategy for patients with Takayasu arteritis (TA) and significant coronary stenosis remain unclear. We aim to investigate the prognosis of these patients according to the initial management strategy. MethodsA total of 57 consecutive patients with TA and significant coronary stenosis were included between 2002 and 2018. The cohort was divided into the percutaneous coronary intervention (PCI) group (n = 18), coronary artery bypass graft (CABG) group (n = 10), and medical-therapy group (n = 29). The primary outcome was major adverse cardiac events (MACEs) defined as a composite of cardiac death, myocardial infarction, and coronary revascularization. ResultsOver a median follow-up of 4.5 (IQR 3.5–8.0) years, 24 (42.1%) patients experienced at least one MACE. The long-term rates of MACEs and re-revascularization were significantly higher in the PCI group than in the other 2 groups (HR 5.306, 95% CI 2.160–13.036, p < 0.001; HR 12.286, 95% CI 3.257–46.343, p < 0.001, respectively). The cumulative incidences of MACEs and subsequent revascularization were similar between the CABG and medical-therapy group. Active disease at baseline and PCI were independent predictors of MACEs (HR, 7.039, 95% CI 2.031–24.396; p = 0.002; HR, 4.400; 95% CI 1.804–10.727; p = 0.001, respectively) and revascularization (HR 4.632, 95% CI 1.010–21.235, p = 0.048; HR 9.820, 95% CI 2.641–36.514, p = 0.001, respectively). ConclusionsThe initial baseline active disease is an important predictor of long-term outcome and subsequent revascularization in patients with TA and significant coronary artery stenosis. Also, PCI is independently associated with higher risk of MACEs and re-revascularization.

Roles of Hematopoietic Stem and Progenitor Cells in Ischemic Cardiovascular Disease.

Macrophage proliferation and skewed myelopoiesis-induced monocytosis, as well as neutrophils, enhance the generation of atherogenic inflammatory cells in a lesion area, leading to plaque formation and Cardiovascular Disease (CVD). Among all risk factors, accumulated data have shown that hyperlipidemia activates Hematopoietic Stem/Progenitor Cells (HSPCs) in the Bone Marrow (BM) niche. Recently, proliferation of Granulocyte-Monocyte Progenitors (GMPs) has been demonstrated to drive skewed myelopoiesis, while HSPCs remain quiescent. In this review, we discuss how HSPCs and GMPs participate in atherosclerosis of mice in terms of proliferation and cell mobilization from BM to peripheral blood and the lesion area. We also describe how the spleen, an extramedullary organ, is involved in skewed myelopoiesis and inflammation in atherosclerosis. We further summarize the clinical evidence of the relationship of HSPCs with coronary stenoses in patients with CVD. Ultimately, this review facilitates understanding the pathological roles of HSPCs and GMPs in atherosclerosis for future treatments.

Identification of severe coronary stenosis by two-dimensional strain in acute coronary syndrome without ST segment elevation.

Background: The main objective of our study was to identify, by means of global longitudinal strain (GLS), territorial strain (TS), and postsystolic shortening (PSS) of left ventricle, which patients with acute coronary syndrome without ST elevation (NSTE-ACS) had ≥ 70% coronary stenosis. Methods: One hundred patients (PTS) with diagnosis of NSTE-ACS were stratified according to GRACE risk score, and underwent coronary angiography. GLS and TS were calculated. We also evaluated the strain curves in the 18 segments to identify the presence of the PSS and to calculate the post systolic index (PSI). Results: Mean age was 60 ± 11. 4, 62% was male. The majority were low and moderate cardiovascular risk. They were divided into group A (34 PTS) with coronary stenosis<70% and group B (66 PTS) with coronary stenosis ≥ 70%. Clinical score was higher in group B (GRACE=88. 7 ± 24. 18, p=0. 040) and 98. 5% was in low/moderate risk by GRACE score. GLS allowed the identification of PTS with coronary stenosis ≥ 70% in this group (AUC=0. 72, p=0. 001, sensitivity=58%, specificity=88%, positive predictive value=75. 1% and negative predictive value=74. 9%). Regarding the TS, the accuracy to determine coronary stenosis ≥ 70% was 0. 70 (p=0,001). The accuracy of the PSS in detecting coronary stenosis ≥ 70% was 69. 3%, with sensitivity estimated at 73. 3% and specificity at 60. 7%. Conclusion: The GLS, territorial strain, and PSS may improve the detection of severe coronary stenosis in patients with low/moderate risk by GRACE risk score. Thus, it can be an additional tool for a better stratification of such patients in the emergency unit.

ADAMTS-5 Decreases in Coronary Arteries and Plasma from Patients with Coronary Artery Disease.

The current study demonstrates that a disintegrin and metalloproteinase with thrombospondin type 1 motif- (ADAMTS-) 5 is a key extracellular matrix protease and associated with cardiovascular diseases. However, the plasma ADAMTS-5 levels and relevance of coronary artery disease (CAD) remain largely unknown. This study is aimed at examining the relationship between the plasma ADAMTS-5 levels and the severity of coronary stenosis in patients with CAD. In the present study, the expression of ADAMTS-5 was analyzed in coronary artery samples and blood. The results showed that the plasma ADAMTS-5 levels were lower in the CAD group than in the control group. In addition, significantly higher matrix metalloproteinase- (MMP-) 2 and MMP-9 levels were also observed in the patients with CAD, and the ADAMTS-5 levels were negatively correlated with the MMP-2 and MMP-9 levels. Spearman's correlation analysis showed that the Gensini score was negatively correlated with the ADAMTS-5 levels but was positively correlated with the MMP-2 and MMP-9 levels. Receiver-operating characteristic (ROC) analysis revealed that ADAMTS-5, MMP-2, and MMP-9 may have a certain diagnostic value in CAD and that the combination of all three metalloproteinases had a higher diagnostic value. The findings provided a better understanding of the role of ADAMTS-5 in the diagnosis of CAD.

P6152Incremental prognostic utility of functionally non-significant coronary stenosis in patients undergoing coronary computed tomogram angiography

Abstract Background In patients with suspected coronary artery disease (CAD) who underwent coronary computed tomographic angiography (CCTA), the prognostic value of nonobstructive stenosis is not entirely understood. Aims We sought to assess the long-term incremental prognostic utility of functionally non-significant CAD in patients without known prior CAD who underwent CCTA. Methods We included 2142 consecutive patients (51±14 years, 53% men) without prior documented CAD who underwent CCTA between 2008–2016 (excluding anomalous coronaries and functionally significant CAD). Traditional risk factors were recorded and pretest likelihood of CAD was calculated. All epicardial coronary arteries were classified as follows: No plaque, minimal luminal irregularities (&lt;25%), mild (25–49%) stenosis and moderate (50–69%) stenosis. All moderate stenoses were confirmed to be not functionally significant by follow-up stress testing/invasive angiography with fractional flow reserve assessment. Plaque was characterized as noncalcified, calcified or mixed. High-risk plaque features (spotty calcification, napkin ring, low attenuation plaque and positive remodeling) were recorded. During follow-up, a composite of death or myocardial infarction was recorded. Results 188 (9%) patients had low, 1712 (80%) had intermediate and 242 (11%) patients had high pre-test likelihood of CAD. 45%, 10%, 52% and 22% had hypertension, diabetes, Dyslipedimia and history of smoking respectively. Breakdown of CAD severity was: 1197 (56%) none, 480 (22%) minimal, 267 (13%) mild and 198 (9%) moderate stenoses. 82 (4%) had noncalcified, 245 (11%) had calcified and 618 (29%) had mixed plaque. 465 (22%) had high-risk plaque features. At 6±3 years, 90 (4%) patients had composite events (68 deaths) and 24 (1%) needed coronary revascularization &gt;90 days post-CCTA. 880 (41%) were on statins post-CCTA. Results of multivariable Cox Survival Analysis are shown in Figure 1A. Kaplan-Meier survival curves for a) more severe CAD and b) high-risk plaque features (vs. not) are shown in Figure 1B and C. Longer-term event rates for increasing CAD were 2.8%, 4.6%, 6% and 9.6%, respectively. Conclusion In mostly low/intermediate risk patients without documented CAD who underwent CCTA, a higher burden of nonobstructive coronary plaque (or presence of high-risk features) provide incremental prognostic value. Initiating statin therapy following detection of plaque on CCTA was associated with improved longer-term freedom from composite events.

P6172Management of silent myocardial ischemia in patients with peripheral arterial disease needing surgery

Abstract Background Patients with peripheral arterial disease (PAD) needing surgery have increased risk for post-operative myocardial infarction (MI)/death due to coexisting coronary artery disease (CAD). Coronary CT angiography (CTA)-derived fractional flow reserve (FFRCT) can reliably identify ischemia-producing coronary stenosis in patients with suspected CAD but its value in PAD patients is unknown. Purpose To determine the prevalence of silent coronary ischemia in PAD patients undergoing surgery and to assess the value of FFRCT in guiding management of patients with multisite arterial ischemia. Methods Patients admitted for elective carotid, aortic or peripheral vascular surgery with no cardiac history or CAD symptoms were enrolled in a prospective, open-label, ethics committee-approved study and underwent pre-op CTA and FFRCT evaluation with results available to treating physicians. Ischemia-producing coronary stenosis was defined as FFRCT≤0.80 distal to stenosis in &gt;2mm diameter vessels. Patient management was guided by a multidisciplinary team of cardiologists, cardiovascular surgeons and anaesthesiologists. Primary endpoint was major adverse cardiac events (MACE= cardiac death, MI, urgent revasc) at 30 days with follow up at 3,6,12 months. Results Coronary CTA and FFRCT analysis was performed in 179 consecutive patients (age 66±8 years, male 78%, hypertension 79%, diabetes 10%, dyslipidemia 31%, smoking 37%). CTA revealed extensive coronary calcification (Agatston score 995±1004, range 0–4810) and ≥50% stenosis in 64% of patients. Ischemic coronary stenosis (FFRCT≤0.80) was present in 114 patients (64%) with FFRCT ≤0.75 in 97 (54%) and multivessel ischemia in 63 (35%). Clinically indicated vascular surgery was performed as planned in 170/179 patients (95%) with cardiac anaesthesia and close monitoring and postponed in 9 patients for coronary revascularization (3) or medical/other therapy (6). There were no post-op cardiac complications. Elective coronary angiography, performed 1–3 months post surgery in 86 patients with left main, severe or multivessel ischemia, confirmed significant stenosis in each patient with revascularization in 58 patients (53 PCI and 5 CABG) including 8 for LM disease. There have been no cardiovascular deaths; 3 patients have died of lung cancer which was first discovered on CTA. One patient had peri-procedural MI at time of PCI and one had MI and urgent PCI at 6 months. MACE at 30 days=0/179, 3 months = 1/154, 6 months=2/123, 12 months=0/65. Conclusions Patients undergoing elective PAD surgery have a high prevalence (64%) of unsuspected ischemia-producing coronary stenosis. Pre-op diagnosis with CTA- FFRCT can help guide a multidisciplinary team approach with optimum medical management and staged peripheral and coronary revascularization. Favourable early results are promising and suggest the need for prospective controlled studies to define the role of coronary revascularization in PAD patients. Acknowledgement/Funding Heartflow, Inc.; Mikrotikls Ltd

Circulating microRNA-378 levels serve as a novel biomarker for assessing the severity of coronary stenosis in patients with coronary artery disease.

Background: Circulating microRNAs (miRNA) are steady preserved in blood plasma. Multiple evidences have shown that miRNAs play a crucial role in cardiovascular disease including miRNA-378, which has been illustrated to participate in diverse physiological and pathological processes of cardiovascular disease. In the present study, we aim to explore the expression of plasma miRNA-378 and its clinical significance in patients with coronary artery disease (CAD).Methods: MiRNA-378 expression in blood plasma was performed by quantitative real-time PCR (qRT-PCR) in 215 CAD patients and 52 matched controls of healthy populations. Medical information of all patients including the results of coronary angiography (CAG) was acquired through hospital information system (HIS). Spearman’s correlation, binary linear regression, and covariance analysis were used to examine the association between miRNA-378 and relative clinical risk factors. Receiver operating characteristic curve analysis was applied to evaluate the value of miRNA-378 in predicting the disease severity of coronary lesion.Results: Plasma miR-378 expression was significantly down-regulated in CAD patients compared with healthy controls. Relative miR-378 level was shown conversely correlated with Gensini score, which present the severity of coronary artery lesions. Moreover, it is indicated that miR-378 expression can effectively distinguish patients with or without coronary artery stenosis.Conclusions: Plasma miR-378 levels appear to be a promising non-invasive biomarker, but require to be further validated by a large cohort study in future.

Correlation between angiopoietin-like proteins in inflammatory mediators in peripheral blood and severity of coronary arterial lesion in patients with acute myocardial infarction

The effects of angiopoietin-like protein 2 (Angptl 2) and interleukin-6 (IL-6) in inflammatory mediators on the severity of coronary arterial lesion in patients with acute myocardial infarction were investigated. One hundred and twenty-six patients with acute myocardial infarction admitted to Tianjin Union Medical Center (the myocardial infarction group) and 133 healthy individuals (the control group) were selected for retrospective analysis from January 2013 to December 2015. The levels of Angptl 2 and IL-6 in serum of patients were detected by enzyme linked immunosorbent assay (ELISA), and the correlation analysis between the levels and the degree of coronary stenosis in patients with myocardial infarction was conducted. The expression level of Angptl 2 and IL-6 in the myocardial infarction group was significantly higher than that in the control group P<0.001. In the myocardial infarction group, the expression levels of Angptl 2 and IL-6 were the highest in the patients with severe stenosis, followed by the moderate stenosis, and the lowest in the patients with mild stenosis (P<0.050). Pearson's correlation analysis showed that Angptl 2 and IL-6 were positively correlated with the diameter of coronary stenosis (r=0.696, 0.750, P<0.001). In conclusion, both Angptl 2 and IL-6 are highly expressed in the peripheral blood of patients with acute myocardial infarction and involved in the occurrence and development of the disease. Moreover, Angptl2 and IL-6 are positively correlated with the severity of coronary arterial lesion in patients with acute myocardial infarction, and they are expected to become a target for the diagnosis and treatment of coronary atherosclerosis (CA) in the future.

Circulating Hematopoietic Stem/Progenitor Cells are Associated with Coronary Stenoses in Patients with Coronary Heart Disease

Inflammatory cells in atherosclerotic plaque exclusively originate from hematopoietic stem/progenitor cells (HSPCs). In this study, we investigated whether circulating HSPCs frequency related to coronary stenosis in patients with coronary heart disease (CHD). Coronary angiography was performed in 468 participants who were recruited at Cardiology Centre in LuHe Hospital from March 2016 to May 2017. Among these subjects, 344 underwent echocardiography. Mononuclear cells isolated from peripheral blood were stained with an antibody cocktail containing anti-human CD34, anti-human lineage, anti-human CD38, and anti-human CD45RA. Lineage−CD38−CD45RAdimCD34+HSPCs were quantified by flow cytometry. CHD was defined as coronary stenosis ≥50% and the extent of CHD was further categorised by coronary stenosis ≥70%. A p < 0.0031 was regarded statistically significant by the Bonferroni correction. Circulating HSPCs frequency was 1.8-fold higher in CHD patients than non-CHD participants (p = 0.047). Multivariate-adjusted logistic analysis demonstrated that HSPCs was the only marker that was associated with the odds ratio of having mild vs. severe coronary stenosis (2.08 (95% CI, 1.35–3.21), p = 0.0009). Left ventricular ejection fraction was inversely correlated with HSPCs frequency and CRP in CHD patients (p < 0.05 for both). In conclusion, HSPCs frequency in circulation is intimately related to coronary stenoses in CHD patients.

Reduced Myocardial Flow Reserve Is Associated with Subendocardial Infarction and Coronary Stenosis in Patients with Coronary Artery Disease: A Perfusion MRI Study

Reduced Myocardial Flow Reserve Is Associated with Subendocardial Infarction and Coronary Stenosis in Patients with Coronary Artery Disease: A Perfusion MRI Study

Evaluation of the cut-off value for the instantaneous wave-free ratio of patients with aortic valve stenosis.

The aim of this study was to examine the clinical value of iFR for AS patients. Functional evaluation of coronary stenosis in patients with aortic valve stenosis (AS) is challenging because the stress-induced test is often thought to be a contraindication. AS patients have a unique coronary flow pattern dependent on the diastolic phase. The instantaneous wave-free ratio (iFR) is a vasodilator-free, invasive pressure wire index of the functional severity of coronary stenosis and is calculated under resting conditions. And iFR calculated during a specific period of diastole may have the potential benefit to assess the functional severity of coronary stenosis in AS patients. We examined 158 consecutive patients (217 stenoses) whose iFR and fractional flow reserve (FFR) were measured simultaneously. Among the 158 patients, AS was observed in 13 (8.2%). The iFR showed good correlation with FFR in AS patients. The best cut-off value of iFR for the receiver-operator curve analysis to predict FFR of 0.8 was 0.9 for non-AS patients. However, it was 0.73 for AS patients. The present study demonstrated good correlation between iFR and FFR for AS patients. Vasodilator-free assessment using iFR may provide potential benefits when evaluating coronary stenosis in patients with AS. In AS patients, the best cut-off of iFR value predicting FFR value of 0.8 was lower than 0.9 that is the standard predictive value of iFR.

The effect of radial pulse spectrum on the risk of major adverse cardiovascular events in patients with type 2 diabetes

Radial pulse spectrum has been shown to correlate with coronary stenosis in patients with type 2 diabetes mellitus (T2DM). In academia, it has not been demonstrated that the radial artery pulse spectrum is an independent risk factor for major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and all-cause mortality. The primary objective of this study is to assess the risk of MACE, in patients with T2DM and to determine if an increase in MACE would be associated with a first harmonic (C1) increase in the radial artery pulse. 1972 consecutive patients with T2DM were enrolled. All subjects received measurements of radial pulse waves at baseline. Harmonic analysis of radial pressure wave was performed. The hazard ratios for MACE and its 95% confident interval were estimated using Cox proportional hazard model. The follow-up period lasted for one year. MACE was detected in 232 (11.8%) of those with T2DM. The log-rank test demonstrated that the cumulative incidence of patients with C1 above 0.96 was greater than those with C1 bellow 0.96. Comparing the patients with C1 smaller than first quartile to the patients with C1 greater than third quartile, higher C1 increased the cardiovascular risks as follows: MACE (Hazard ratio,1.93; 95% CI,1.31–2.86), stroke (Hazard ratio, 1.61; 95% CI, 0.90–2.90), myocardial infarction (Hazard ratio, 2.23; 95% CI, 1.33–3.74). The risk for the composite MACE increased continuously as C1 increased (P < 0.001 for trend). The hazard ratio and trend for all-cause mortality were not significant. Increased C1 resulted in increased risk for nonfatal stroke, and nonfatal myocardial infarction among patients with T2DM. Our results indicate that the degree of C1 is a risk factor for nonfatal MACE. Therefore, the radial pulse spectrum could identify patients with T2DM at high risk of nonfatal MACE.

Development of a multivariate model to predict significant coronary artery disease in Thai patients with left ventricular systolic dysfunction and determine the applicability of coronary angiography: a single-center, retrospective, case–control study

Abstract Background Coronary angiography (CAG) or stress imaging has been performed in almost all Thai patients with left ventricular (LV) systolic dysfunction. If CAG results reveal insignificant coronary stenosis, such patients are diagnosed with nonischemic cardiomyopathy (NICM); however, CAG is considered to provide no benefit and may even harm these patients because it is invasive. Objectives To identify predictors associated with significant coronary artery disease (CAD) (stenosis) in Thai patients with LV systolic dysfunction without angina and without LV regional wall motion abnormality and create a prediction score. Method Retrospective data from patients at a single tertiary-care center with LV systolic dysfunction (LV ejection fraction &lt;50%) diagnosed between August 2000 and October 2014 were separated into a group with ischemic cardiomyopathy (ICM) and a group with NICM according to CAG. Predictors associated with CAD found in normal populations were determined. Multivariate analysis was used to identify predictors associated with significant coronary stenosis in patients with LV systolic dysfunction to develop a model to create a prediction score. Results We included data registered from 240 Thai patients with LV systolic dysfunction. Predictors associated with ICM were age (&gt;60 years), sex (male), and a history of diabetes mellitus (DM). Predictors associated with NICM were body mass index (BMI) &gt;25 kg/m2 and the presence of left bundle branch block (LBBB) on electrocardiography. A simplified equation to predict significant CAD in patients with LV systolic dysfunction is: 3(male sex) + 3(age &gt;60 y) – 5(BMI &gt;25 kg/m2) - 5(LBBB) + 5(DM) - 5. The sensitivity and specificity of this score are 60.5% and 85.1%, respectively. Conclusion Our prediction score has modest sensitivity, but high specificity for predicting significant CAD and can be used to determine who should not undergo CAG.

Anatomically and functionally relevant coronary stenoses in patients with normal single-photon emission computed tomography but persistent stable angina.

Single-photon emission computed tomography (SPECT) is widely used for the assessment of coronary artery disease and for decision making regarding revascularization. Concerns about possible false negative findings exist. Our aim was to assess the prevalence of stenoses which are both functionally and anatomically significant in patients referred for invasive fractional flow reserve (FFR) measurements following a normal SPECT, because of persistent complaints. One hundred and thirty-three consecutive patients with normal SPECT were included, with a total of 180 FFR measurements. Luminal narrowing of ≥70% (≥50% for left main) together with a FFR ≤0.80 denoted an anatomically and functionally significant coronary artery stenosis. Separate analyses were performed for FFR <0.75. Mean age of the patients was 65, 40% were women. Sixteen percent of the study population had both anatomically and functionally significant stenoses. Besides the use of nitrate, no differences in baseline characteristics, symptoms, coronary history, or pre-test likelihood could be identified for the prediction of functionally relevant obstructive coronary disease. If FFR <0.75 was used, only 7.5% of the patients had both anatomically and functionally significant stenoses. In patients with normal SPECT who undergo FFR measurements because of persistent complaints, the prevalence of stenoses which are both anatomically and functionally significant is low. This suggests that the prevalence of false-negative SPECT is (very) low.