Critical Coronary Artery Disease Research Articles

Elevated high-sensitivity troponin does not indicate the presence of coronary artery disease in patients presenting with supraventricular tachycardia.

Patients with supraventricular tachycardia (SVT) and patients with coronary artery disease (CAD) often present with similar symptoms (chest pain, shortness of breath), similar electrocar¬diographic changes and elevated high-sensitivity troponin (Tn). It is not clear whether troponin reflects critical CAD or is elevated due to other causes in patients presenting with SVT. The aim of this study was to assess the role of elevated troponin in patients presenting with SVT. Patients undergoing radiofrequency ablation (RFA) for SVT and simultaneous coronary an¬giography at the Heart Centre Lucerne, Switzerland between January 2010 and October 2014 were in¬cluded in this analysis. Significant CAD was defined as diameter-stenosis ≥ 75% in vessels > 2.0 mm. The level of Tn was compared between patients with the presence or absence of CAD on coronary angi¬ography. A Tn value of ≥ 0.014 μg/L was considered as elevated. During the study period a total of 473 patients underwent RFA for SVT. The study population consisted of 326 patients (69%, mean age 60 ± 12 years) who underwent invasive coronary angiogra¬phy during the same session. The prevalence of significant CAD was 14% (45/326 patients). The highest prevalence of CAD was found in patients with atrial flutter (35%, 18/45 patients). Tn was elevated in 83% (10/12 patients) with significant CAD and in 47% (26/55 patients) without CAD. The prevalence of CAD is low in patients with SVT, which questions the role of routine invasive coronary angiography during RFA. Tn measurement did not reliably exclude or confirm CAD in these patients.

Abstract 21149: Long-Term Clinical Outcomes of Patients With Critical Limb Ischemia Underwent Percutaneous Transluminal Angioplasty and Routine Coronary Angiography

Background: Critical limb ischemia (CLI) and coronary artery disease (CAD) are associated with a high risk of mortality and cardiovascular events. Also, CAD is well-known for its higher prevalence in CLI patients (pts). We evaluated long-term clinical outcomes of the strategy of routine coronary angiography and subsequent coronary revascularization, if clinically indicated, in patients with CLI who underwent percutaneous transluminal angioplasty (PTA). Methods: A total 674 consecutive CLI patients underwent PTA and coronary angiography. Coronary artery disease (CAD) was defined as angiographic stenosis ≥70 %. Patients were divided into two groups according to the presence of CAD (CAD group: 413 pts, Non-CAD group: 261 pts). To adjust for any potential confounders that could cause bias, propensity score matching (PSM) analysis was performed. Clinical outcomes were assessed in a follow-up of 5 years by Kaplan-Meier curved analysis. Results: After PSM analysis, two matched groups (160 pairs, n=320 pts) were generated and their baseline characteristics were balanced. During the 5-year clinical follow-up, there were no differences between the two group regarding mortality, myocardial infarction, strokes, peripheral revascularization, and target extremity surgery except that the coronary revascularization was higher in the CAD group than the non-CAD group [Table]. Conclusion: A strategy of routine coronary angiography and coronary revascularization may be a reasonable treatment option for patients who have high risk for severe CAD at least for 5 years. A randomized trial is needed to determine if this is the preferred strategy for CLI patients.

Contemporary Management of Patients with Concomitant Coronary and Carotid Artery Disease.

The ideal management of concomitant carotid and coronary artery occlusive disease remains elusive. Although researchers have advocated the potential benefits of varying treatment strategies based on either concomitant or staged surgical treatment, there is no consensus in treatment guidelines among national or international clinical societies. Clinical studies show that coronary artery bypass grafting (CABG) with either staged or synchronous carotid endarterectomy (CEA) is associated with a high procedural stroke or death rate. Recent clinical studies have found carotid artery stenting (CAS) prior to CABG can lead to superior treatment outcomes in asymptomatic patients who are deemed high risk of CEA. With emerging data suggesting favorable outcome of CAS compared to CEA in patients with critical coronary artery disease, physicians must consider these diverging therapeutic options when treating patients with concurrent carotid and coronary disease. This review examines the available clinical data on therapeutic strategies in patients with concomitant carotid and coronary artery disease. A treatment paradigm for considering CAS or CEA as well as CABG and percutaneous coronary intervention is discussed.

P5191Long term outcomes of patients with both critical limb ischemia and coronary artery disease after endovascular therapy or surgical treatment

P5191Long term outcomes of patients with both critical limb ischemia and coronary artery disease after endovascular therapy or surgical treatment

The Association Between Apelin Gene Polymorphism and Coronary Artery Disease in Young Patients with Acute Obstructive Coronary Syndrome

The purpose of this study was to evaluate the association between V103V, 6140AG, TGA-Stop-TAA Stop, and 6016CA polymorphisms of the apelin (APLN) gene detected for the first time among young patients with acute coronary syndrome (ACS) and coronary artery disease (CAD). This was a prospective cross-sectional study. The study population was divided into 2 groups. The first group included 132 patients who were found to have critical lesions in their coronary arteries, while the control group consisted of 41 patients who were found to have normal coronary arteries or non-critical atherosclerotic lesions. Among the gene polymorphisms, V103V was found to be more common in the critical CAD patients with the GG genotype compared with the control group (67.4% vs. 46.3%). On the other hand, the GT genotype was more common in the control group (53.7% vs. 32.6%). Univariate and multivariate logistic regression analysis revealed that the GG genotype of V103V was an independent predictor for the presence of critical CAD (odds ratio: 2.397; 95% confidence interval, 1.174-4.892; p=0.016). In cases of V103V polymorphism of the APLN gene, patients with the GG genotype were at a greater risk for the presence of atherosclerotic critical lesions compared with the control group.

Association of Circulating IGFBP1 Level with the Severity of Coronary Artery Lesions in Patients with Unstable Angina.

Aims. Local IGFBP1 level was reported to affect the development of coronary artery plaque. This study investigated the association of circulating IGFBP1 level with the severity of coronary artery lesions in patients with unstable angina. Materials and Methods. In 112 consecutive patients with clinically diagnosed unstable angina, admitted from July 2014 to July 2015, we studied the correlations of circulating IGFBP1 and the severity of coronary artery disease (CAD). Results. All patients underwent scheduled coronary angiography, and 67 cases were diagnosed with critical and 45 with noncritical CAD. Of the 67 critical CAD patients, 41 (61.19%) presented with multivessel and 26 (38.81%) with single-vessel lesions. IGFBP1 levels were higher in patients with multivessel than those with single-vessel lesions. Moreover, the IGFBP1 level was positively correlated with the GRACE score. Among clinical variables, the IGFBP1 level was correlated with HDL-C. IGFBP1 alone (cutoff 20.86 ng/ml) demonstrated a sensitivity of 0.448 and specificity of 0.933 in predicting CAD. Combination of IGFBP1 and HDL-C had a sensitivity of 0.821 and specificity of 0.800 in predicting CAD. Conclusions. Circulating IGFBP1 level positively correlated with the severity of CAD. IGFBP1, when combined with HDL-C, might be useful in screening for high risk CAD patients.

Imbalance between angiotensin II and angiotensin-(1-7) in human coronary atherosclerosis.

Objective:Our previous studies found that angiotensin-(1–7) (Ang-(1–7)) is an endogenous counter-factor of angiotensin II (Ang-II). However, the balance between Ang-II and Ang-(1–7) in the development of human coronary atherosclerosis is not determined.Methods and results:The plasma levels of Ang-II and Ang-(1–7) were detected by enzyme-linked immunosorbent assay (ELISA) in 112 patients with known or suspected coronary artery disease (CAD) undergoing coronary angiography. Patients were divided into three groups based on the coronary angiography as follows: (1) normal (n = 13); (2) noncritical CAD (<50% stenosis, n = 17); and (3) critical CAD (⩾50% stenosis, n = 82). The plasma levels of Ang-II, Ang-(1–7) and the ratio of Ang-II and Ang-(1–7) (Ang-II/Ang-(1–7) were comparable between the normal and noncritical CAD groups. However, Ang-II, Ang-(1–7), and especially Ang-II/Ang-(1–7), were elevated in patients with critical CAD, compared with patients with normal or noncritical CAD. The level of Ang-II/Ang-(1–7) was positively associated with serious coronary stenosis, and correlated with tumor necrosis factor-alpha (TNF-α) level.Conclusion:Both Ang-II and Ang-(1–7) expression are significantly increased in patients with critical CAD. However, increased Ang-II/Ang-(1–7) ratios may lead to Ang-II over-activation and aggravate atherosclerosis progression.

Epidemiological and clinical characteristics of patients with unstable angina and critical coronary stenosis detected by angiography

Certain clinical predictors like age, cardiac biomarker positivity, ST segment depression and congestive heart failure (CCF) can help effectively in predictinghigh risk group patients with critical coronary artery disease. Khat chewing is a significant risk factor for ACS in Yemenite patients, but correlation of heavy Khat chewing with critical artery stenosis in unstable angina (UA) patients is notstudied. The aim of this study is to define the epidemiological and clinicalcharacteristics in UA patients included in this prospective clinical study. Based onthe angiographic findings, patients with UA were classified into 2 groups: Group (I): patients with coronary stenosis (≥70%), significant enough to require PCI or CABG, (n=213) and Group II (control) patients who had insignificant coronary stenosis (≤50%), (n=42). Our results showed that group I patients were more likely to be males, elderly, with a prior history of CAD and MI, heavy khat chewers and in heart failure. Mean of age was 66.54 years, and 78.87 % were males. Age ≥ 65 years was found in 29.11%. Predictors of high risk CAD (critical stenosis) were found to be significantly in group I, compared to group II patients. We concluded that age ≥ 65 years, male gender, aspirin use and heavy Khat chewing during the last week, CCF with EF

Relationship Between Echocardiographically Evaluated Aortic Stiffness and Prolidase Activity in Aortic Tissue of Patients with Critical Coronary Artery Disease

The aim of this study was to determine the relationship between echocardiographically evaluated aortic stiffness and prolidase activity in aortic tissue of patients with critical coronary occlusion. Thirty six patients with coronary artery disease (CAD) scheduled for CABG and 30 control patients with no CAD proven angiographically were enrolled in this study. Plasma prolidase activities were quantified spectrophotometrically. During performance of the proximal anastomoses in the study group, a piece of aortic tissue was taken by punch and tissue prolidase activity was quantified spectrophotometrically and also evaluated pathologically by prolidase immunostaining. Eventually, the correlation of plasma prolidase activity, aortic tissue prolidase activity and aortic prolidase immunohistochemical staining with aortic stiffness was studied. The correlation of aortic stiffness with aortic tissue prolidase activity (rs= 0.364; p=0.029) and aortic prolidase immunohistochemical staining (rs=0.354; p=0.034) was significant in the study group. However, the correlation of plasma prolidase activity with aortic stiffness was not statistically significant (rs=0.083; p=0.292). Linear regression analysis showed that the aortic stiffness β index was significantly associated with aortic tissue prolidase activity (β=0.354; p=0.034) and statin usage (β=-0.334; 0.047) in the study group. Regression analysis revealed that ATPA and statin use were predictors of aortic stiffness, and API+ was found to be the predictor for ATPA (β=0.449; p=0.006). Aortic tissue prolidase activity was more significant than plasma prolidase activity and aortic tissue prolidase immunohistochemical staining in the relationship with aortic stiffness in the critical CAD group.

Epicardial Adipose Tissue Thickness Is an Independent Predictor of Critical and Complex Coronary Artery Disease by Gensini and Syntax Scores.

Epicardial adipose tissue thickness is associated with the severity and extent of atherosclerotic coronary artery disease. We prospectively investigated whether epicardial adipose tissue thickness is related to coronary artery disease extent and complexity as denoted by Gensini and Syntax scores, and whether the thickness predicts critical disease. After performing coronary angiography in 183 patients who had angina or acute myocardial infarction, we divided them into 3 groups: normal coronary arteries, noncritical disease (≥1 coronary lesion with <70% stenosis), and critical disease (≥1 coronary lesion with <70% stenosis). We used transthoracic echocardiography to measure epicardial adipose tissue thickness, then calculated Gensini and Syntax scores by reviewing the angiograms. Mean thicknesses were 4.3 ± 0.9, 5.2 ± 1.5, and 7.5 ± 1.9 mm in patients with normal coronary arteries, noncritical disease, and critical disease, respectively (P <0.001). At progressive thicknesses (<5, 5-7, and >7 mm), mean Gensini scores were 4.1 ± 5.5, 19.8 ± 15.6, and 64.9 ± 32.4, and mean Syntax scores were 4.7 ± 5.9, 16.6 ± 8.5, and 31.7 ± 8.7, respectively (both P <0.001). Thickness had strong and positive correlations with both scores (Gensini, r =0.82, P <0.001; and Syntax, r =0.825, P <0.001). The cutoff thickness value to predict critical disease was 5.75 mm (area under the curve, 0.875; 95% confidence interval, 0.825-0.926; P <0.001). Epicardial adipose tissue thickness is independently related to coronary artery disease extent and complexity as denoted by Gensini and Syntax scores, and it predicts critical coronary artery disease.

Creation of a Scorecard to Predict In-Hospital Death in Patients Undergoing Operations for Acute Type A Aortic Dissection

This study evaluated preoperative predictors of in-hospital death for the surgical treatment of patients with acute type A aortic dissection (Type A) and created an easy-to-use scorecard to predict in-hospital death. We reviewed retrospectively all consecutive patients who underwent operations for acute Type A between 1996 and 2011 at 2 tertiary care institutions. A logistic regression model was created to identify independent preoperative predictors of in-hospital death. The results were used to create a scorecard predicting operative risk. Emergency operations were performed in 534consecutive patients for acute Type A. Mean age was 61 ± 14 years and 36.3% were women. Critical preoperative state was present in 31% of patients and malperfusion of one or more end organs in 36%. Unadjusted in-hospital mortality was 18.7% and not significantly different between institutions. Independent predictors ofin-hospital death were age 50 to 70 years (odds ratio [OR], 3.8; p= 0.001), age older than 70 years (OR, 2.8; p=0.03), critical preoperative state (OR, 3.2; p < 0.001), visceral malperfusion (OR, 3.0; p= 0.003), and coronary artery disease (OR, 2.2; p= 0.006). Age younger than 50 years (OR, 0.3; p= 0.01) was protective for early survival. Using this information, we created an easily usable mortality risk score based on these variables. The patients were stratified into four risk categories predicting in-hospital death: less than 10%, 10% to 25%, 25% to 50%, and more than 50%. This represents one of the largest seriesof patients with Type A in which a risk model wascreated. Using our approach, we have shown that age, critical preoperative state, and malperfusion syndrome were strong independent risk factors for early death andcould be used for the preoperative risk assessment.

Role of Intra-Aortic Balloon Pump in Off-Pump Coronary Artery Bypass &amp;lt;br/&amp;gt;—A Vettath Modification

Objective: Hemodynamic deterioration during positioning of the heart has been the most critical complication of off-pump coronary artery bypass surgery. Pre-operative use of intra-aortic balloon pump has been shown to prevent this complication in high risk patients. The role of balloon pump in high risk patients has been questioned by our group. We modified the role of balloon pump in our patients, thus avoiding the conversion to cardiopulmonary bypass. Methods: 4063 off-pump coronary bypass surgeries were performed by a single surgeon in our center, over thirteen years. 130 intra-aortic balloons used between July 2002 and December 2015 were removed from the the-ater, once the distal anastomosis was performed. We studied this group of patients for—time and need for insertion, duration of balloon used, local insertion problems and survival. Results: Initially, we inserted intra-aortic balloons in high risk patients. We observed that, patients with low ejection fraction and patients with critical left main coronary artery disease were not the ones who actually needed balloon pump support. It was the patients who had ongoing ischemia, with preserved left ventricular function, and ST depression intra-operatively, who needed balloon pump support to perform complete anatomical revascularization. Conclusions: Intra-aortic balloon pump has helped us to position the heart without hemodynamic instability, thereby avoiding conversion to cardio-pulmonary bypass. This enabled us to perform off-pump surgery in virtually all areas of the heart, thus maintaining perfect hemodynamics.

Severe aortic stenosis, critical coronary artery disease, and transfusion-dependent angiodysplasia – A management conundrum

The combination of severe aortic stenosis, bleeding due to Heyde's syndrome and critical coronary artery disease presents a management challenge. We report the case of an 86-year-old who underwent percutaneous coronary intervention to the right coronary artery, simultaneous balloon aortic valvuloplasty to treat aortic stenosis and address bleeding from Heyde's syndrome, and subsequent staged transcatheter aortic valve implantation.<Learning objective: The combination of severe aortic stenosis (AS), bleeding due to Heyde's syndrome and critical coronary artery disease presents a management challenge. This case demonstrated the efficacy of balloon aortic valvuloplasty in resolving gastrointestinal bleeding, with intravascular ultrasound-guided percutaneous coronary intervention with a bare metal stent and single anti-platelet therapy safely and effectively addressing critical coronary stenosis, allowing definitive treatment of AS by transcatheter aortic valve implantation to be performed as a staged procedure.>

Abstract 10115: The Diagnostic Value of Global and Territorial Longitudinal Strain at Rest for the Detection of Coronary Artery Disease in Patients Without Type 2 Diabetes Mellitus

Background: Global longitudinal strain (GLS) at rest aids the detection of coronary artery disease (CAD). However, myocardial strains are affected by both ischemia and diabetes mellitus (DM), and previous studies that evaluated the performance of GLS for detecting ischemia always included a certain DM patients in the study population. Thus, we sought to investigate in patients with no DM the power of GLS for detecting three-vessel CAD, and whether territorial longitudinal strain (TLS) could help identifying individual coronary artery stenosis Methods and results: We retrospectively studied 211 consecutive patients with suspected CAD and normal left ventricular (LV) ejection fraction. The patients with DM were excluded. All patients underwent echocardiography and subsequently coronary angiography. LV global and segmental peak systolic longitudinal strain (PSLS) parameters were quantified by two-dimensional speckle tracking echocardiography (2D STE). Territorial PSLSs were calculated based on the perfusion territories of the 3-epicardial coronary arteries in a 17-segment LV model. Critical CAD was defined as luminal diameter stenosis ≥ 70% in ≥ 1 epicardial coronary artery. Totally 145 patients had critical CAD on coronary angiography. Significant differences were observed in all strain parameters between patients with and without CAD. The AUC for GLS in the detection of three-vessel CAD was 0.875 at a cutoff value of -19.05% with sensitivity 78.1% and specificity 72.7%, which increased to 0.926 after excluding apical segments (cutoff value -18.66%; sensitivity 84.4% and specificity 81.8%). The TLS values were significantly lower in regions supplied by stenotic compared with non-stenotic coronary arteries. It has better power to identify LCX and LAD stenosis than RCA stenosis. An area under the curve (AUC) for the TLS to identify critical LCX, LAD and RCA stenosis, in order of diagnostic accuracy, is 0.818 for LCX, 0.764 for LAD and lastly 0.723 for RCA. Conclusions: In patients with no DM and suspected CAD, GLS is an excellent predictor of three-vessel CAD with high accuracy. A higher cut point than that reported before was obtained and should be used. TLS could identify which coronary artery is stenotic with fair sensitivity and specificity.

Role of medical therapy in critical coronary disease, a single center experience.

2015;10(9-10):240. 4 Dubrovnik Cardiology Highlights an ESC Update Programme in Cardiology In our hospital cardio-surgical medical council has over time developed into a genuine heart-team jointly and equally discussing the best possible treatment strategies in patients displayed. What we found interesting to see is what happened to the patients suffering from critical coronary artery disease for whom were on our cardio-surgical council further conservative treatment indicated. The study included all patients with coronary artery disease (no of patients = 85) who were in the last five years presented on our cardio-surgical council, for whom we gave up on any active revascularization strategy (percutaneous coronary intervention or coronary artery bypass graft surgery), and conservative treatment was indicated. Further more included were only patients who were not operable (coronary artery bypass graft surgery) due to anatomical and pathological constellation on their coronary arteries, and percutaneous revascularization was not possible because of extremely high risk of the procedure itself, or intervention was not technically feasible. Inclusion and exclusion criteria were as follows: significant left anterior descending artery disease, the absence of significant valvular disease, the absence of significant comorbidities that could lead to the shortening of life expectancy. Retrospective analysis of collected data, included 85 patients who were shown to our cardio-surgical council in last 5 years, we made a telephone follow-up, which found an mortality of 9.8%, 15.3% of patients were re-hospitalized because of persistent symptoms of coronary artery disease. Only 2 patients subsequently underwent surgical revascularization, none of the patients received further percutaneous revascularization. The results obtained show that in advanced coronary artery disease, which is technically not suitable for any form of revascularization, optimal medical therapy is a feasible treatment strategy.1,2 Igor Sesto*, Kresimir Stambuk, Hrvoje Stipic, Tomislav Sipic, Ante-Zvonimir Korda, Igor Alfirevic, Davor Richter, Janko Szavits Nossan, Goran Milasin, Mihajlo Sesto

Stenting of Unprotected Left Main Coronary Artery Stenosis: Immediate out comes in NICVD our Initial Experience

This study aims to describe the initial experiences and immediate outcomes of percutaneous coronary intervention (PCI) in patients with significant left main coronary artery disease with normal LV function in National Institute of Cardiovascular Diseases (NICVD), Dhaka. Left main coronary artery disease is regarded as an absolute contraindication for coronary angioplasty. Recently several reports on protected or unprotected LMCA stenting or both suggested the possibility of percutaneous intervention for this prohibited area. The study was conducted in National Institute of Cardiovascular diseases &amp; Hospital, Dhaka, Bangladesh. Participants of the study were 100 patients with a diagnosis of critical left main coronary artery disease. Information was collected on their demographic characteristics and clinical history. Relevant physical examination and laboratory investigation were performed. Percutaneous transluminal coronary angioplasty (PTCA) with stent implantation were done in the left main coronary artery and other culprit vessel where required. They were followed up thoroughly during the hospital stay. The study subjects were from 35 to 70 years old. 70 male and 30 female were included in this study. According to the clinical history, 12 lead surface ECG reading and cardiac enzyme analysis 40% patient was diagnosed as unstable angina, 40% presented with chronic stable angina and rest of them presented with old myocardial infarction. Among the study population critically isolated LM disease were 30%, critical left main with other vessels disease were 70%. The pattern of LM disease involvement were osteal 40%, mid shaft 10%, distal bifurcation 30%, entire LM involving bifurcation 20%. Procedural success rate was 100%. No patient faced major advance cardiac events (MACE) during hospital stay. Stenting of unprotected LM coronary artery stenosis may be safe effective alternative to CABG in carefully selected patients with normal LV function. Further studies in larger population of this group are needed to assess late out comes.University Heart Journal Vol. 10, No. 1, January 2014; 7-12

Atherosclerosis and Liver Function Tests in Coronary Angiography Patients.

Elevated aminotransferase levels indicating liver function, even in the normal range, have attracted great concern as potential novel markers of cardiovascular risk assessment. We hypothesized the possibility that liver function test variations in the normal range might be meaningfully associated to coronary artery disease (CAD). Eighty-eight patients were randomly selected from those who underwent coronary angiography from June 2010 to June 2011 after applying to the outpatient cardiology clinic in Gulhane Military Medical Academy. According to the results of angiographies, patients were classified into three groups as normal, non-critical (< 50% involvement in coronaries), and critical (≥ 50% involvement in coronaries). In addition to angiographic intervention, measurements of serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) concentrations, albumin and the other serum parameters were performed in all patients. The patient groups of CAD were balanced (28 critical cases, 30 non-critical cases and 30 normal cases). Mean age was 51.93 ± 9.3 (range 32-65) years and 19.3 per cent (n = 17) were females. Multiple linear regression analysis of all three liver function tests explained a significant portion of the variance, but adjusted r-squares were small (AST = 0.174, ALT = 0.242, albumin = 0.124). Albumin was significantly higher for patients with critical CAD than for patients with no CAD (beta = 3.205, p = 0.002). Non-critical CAD was not significantly different from no CAD for any of the dependent variables. Mean AST was significantly higher for patients taking aspirin (beta = 0.218, p = 0.049), as was mean ALT (beta = 0.264, p = 0.015). Alanine aminotransferase and AST may not be associated with angiographically determined coronary atherosclerosis. Albumin may be more sensitive to demonstrate the burden of atherosclerosis. These results indicate that the association between the liver function tests and coronary atherosclerosis may be more complex than generally appreciated.

PP-046 Plasma Thiol-disulfide Homeostasis in Patients with and without Critical Epicardial Coronary Artery Disease

A B S T R A C T S versus 10.80 7.04 mmol/L; p1⁄40.477, respectively). ROCcurve analysis revealed that thiol levels over 260 mmol/L predicted ACS with 65% sensitivity and 62% specificity (area under the curve1⁄40.702; 95% CI 0.626-0.778). Conclusions: These findings indicate that SH and SHHS level decrease in patients with ACS and SA. Decreased SH and SHHS level may be related with pathogenesis of coronary atherosclerosis.

Serum Pentraxin-3 Level in Patients Who Underwent Coronary Angiography and Relationship with Coronary Atherosclerosis

Objectives: To evaluate the role of pentraxin-3 (PTX-3) in determining the presence and severity of coronary atherosclerosis in patients with coronary artery disease (CAD). Subjects and Methods: Ninety-five patients (77 males and 18 females) who underwent elective coronary angiography were enrolled in this study. Patients with heart failure, renal failure, diabetes and thyroid disease were excluded. The study population was divided into 3 groups: individuals with normal coronary arteries, patients with critical CAD (n = 35) and patients with noncritical CAD (n = 36). The association of PTX-3 levels with the presence and severity of CAD and the number of involved vessels were analyzed. Results: The mean age was 53.40 ± 10.25 years. The PTX-3 levels were significantly higher in patients with CAD than without CAD (146.48 ± 48.52 vs. 109.83 ± 49.06 pg/ml, p < 0.001). A statistically significant difference was found among the 3 groups regarding the severity of CAD (165.66 ± 49.10, 127.83 ± 40.51 and 109.83 ± 49.06 pg/ml, p < 0.001, respectively). The serum PTX-3 levels in normal arteries were 110.4 ± 48.11 pg/ml, in single-vessel disease 132.35 ± 32.96 pg/ml, in 2-vessel disease 142.57 ± 55.88 pg/ml, in 3-vessel disease 156.07 ± 50.53 pg/ml, and in 3-vessel disease 160.50 ± 30.41 pg/ml. After adjusting for baseline confounders, older age (OR = 1.107, 95% CI = 1.027-1.193, p = 0.008) and higher PTX-3 levels (OR = 1.017, 95% CI = 1.003-1.032, p = 0.021) were detected as significant predictors for the presence of CAD. Conclusions: Higher PTX-3 levels were associated with the presence of CAD and its increased severity in clinically stable patients. Higher PTX-3 levels may be regarded as a novel diagnostic predictor and may offer therapeutic options in the clinic.

Potential of dietary nitrate in angiogenesis.

Endothelial dysfunction with impaired bioavailability of nitric oxide (NO) is the hallmark in the development of cardiovascular disease. Endothelial dysfunction leads to atherosclerosis, characterized by chronic inflammation of the arterial wall and stepwise narrowing of the vessel lumen. Atherosclerosis causes deprivation of adequate tissue blood flow with compromised oxygen supply. To overcome this undersupply, remodeling of the vascular network is necessary to reconstitute and sustain tissue viability. This physiological response is often not sufficient and therapeutic angiogenesis remains an unmet medical need in critical limb ischemia or coronary artery disease. Feasible approaches to promote blood vessel formation are sparse. Administration of pro-angiogenic factors, gene therapy, or targeting of microRNAs has not yet entered the daily practice. Nitric oxide is an important mediator of angiogenesis that becomes limited under ischemic conditions and the maintenance of NO availability might constitute an attractive therapeutic target. Until recently it was unknown how the organism provides NO under ischemia. In recent years it could be demonstrated that NO can be formed independently of its enzymatic synthesis in the endothelium by reduction of inorganic nitrite under hypoxic conditions. Circulating nitrite derives from oxidation of NO or reduction of inorganic nitrate by commensal bacteria in the oral cavity. Intriguingly, nitrate is a common constituent of our everyday diet and particularly high concentrations are found in leafy green vegetables such as spinach, lettuce, or beetroot. Evidence suggests that dietary nitrate supplementation increases the regenerative capacity of ischemic tissue and that this effect may offer an attractive nutrition-based strategy to improve ischemia-induced revascularization. We here summarize and discuss the regenerative capacity of dietary nitrate on the vascular system.