Degree Of Atherosclerosis Research Articles

The use of optical coherence tomography imaging of the vascular wall of the coronary arteries before and after stenting

Introduction. Optical coherence tomography (OCT) is an intravascular imaging method that allows to evaluate the structure of the vascular wall, as well as to monitor the process of stent installation and healing.The aim of this work was to identify factors affecting neointimal vascular healing after implantation of drug­eluting stents.Material and methods. In 35 patients with acute coronary syndrome without ST elevation, everolimus­eluted stents with permanent and biodegradable polymer were installed. After 6 months patients underwent control coronary angiography with OCT, the state of neointima of previously implanted stents was analyzed. Clinical, anamnestic and laboratory parameters were evaluated.Results. 28750 struts of stents were analyzed and the healing score was calculated. The healing score depended on the patient’s age (r=0.60710, p=0.0003), a history of diabetes mellitus (p=0.0477), current myocardial infarction (p=0.0183), and the degree of coronary artery disease (p=0.0355). The healing score was signifcantly lower in patients with a Syntax score <22 (p=0.004).Conclusion. The results of the research showed that main factors that impair neointimal healing are age, the presence of diabetes, the characteristics of the lesion of the coronary arteries; they may affect the duration of dual antiplatelet therapy.

Relationship between Perioperative Hypotension and Perioperative Cardiovascular Events in Patients with Coronary Artery Disease Undergoing Major Noncardiac Surgery.

Perioperative hypotension is associated with cardiovascular events in patients having noncardiac surgery. It is unknown if the severity of preexisting coronary artery disease determines susceptibility to the cardiovascular risks of perioperative hypotension. In this retrospective exploratory analysis of a substudy of an international prospective blinded cohort study, 955 patients 45 yr of age or older with history or risk factors for coronary artery disease underwent coronary computed tomographic angiography before elective inpatient noncardiac surgery. The authors evaluated the potential interaction between angiographic findings and perioperative hypotension (defined as systolic blood pressure less than 90 mmHg for a total of 10 min or more during surgery or for any duration after surgery and for which intervention was initiated) on the composite outcome of time to myocardial infarction or cardiovascular death up to 30 days after surgery. Angiography assessors were blinded to study outcomes; patients, treating clinicians, and outcome assessors were blinded to angiography findings. Cardiovascular events (myocardial infarction or cardiovascular death within 30 days after surgery) occurred in 7.7% of patients (74/955), including in 2.7% (8/293) without obstructive coronary disease or hypotension compared to 6.7% (21/314) with obstructive coronary disease but no hypotension (hazard ratio, 2.51; 95% CI, 1.11 to 5.66; P = 0.027), 8.8% (14/159) in patients with hypotension but without obstructive coronary disease (hazard ratio, 3.85; 95% CI, 1.62 to 9.19; P = 0.002), and 16.4% (31/189) with obstructive coronary disease and hypotension (hazard ratio, 7.34; 95% CI, 3.37 to 15.96; P < 0.001). Hypotension was independently associated with cardiovascular events (hazard ratio, 3.17; 95% CI, 1.99 to 5.06; P < 0.001). This association remained in patients without obstructive disease and did not differ significantly across degrees of coronary disease (P value for interaction, 0.599). In patients having noncardiac surgery, perioperative hypotension was associated with cardiovascular events regardless of the degree of coronary artery disease on preoperative coronary computed tomographic angiography.

Relationship between abdominal fat distribution and degree of coronary artery disease in patients with coronary heart disease

Objective The body mass index (BMI), waist to height ratio (RWH), visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) were used to measure the effect of abdominal fat distribution on the degree of coronary artery disease in patients with coronary heart disease. Methods A total of 376 patients with suspected coronary heart disease underwent coronary angiography. The degree of coronary artery disease was evaluated by Judkins method. The coronary artery stenosis ≥50% was coronary artery stenosis (coronary heart disease group), and the coronary artery diameter stenosis was <50%. For non-coronary stenosis (control group), the Gensini method was used to quantitatively evaluate coronary lesions, and the patient's height, body mass, waist circumference, blood lipids, blood pressure and other data were recorded, and BMI and RWH were calculated. All patients underwent upper abdominal CT examination. Measurement of VAT, SAT; Pearson correlation analysis of BMI, RWH, VAT/SAT and Gensini score correlation, multivariate Logistic regression analysis of BMI, RWH, VAT/SAT on coronary heart disease, stepwise linear regression analysis of BMI, RWH, VAT/SAT's impact on Gensini points. Results Of 376 patients with suspected coronary heart disease, 240 patients with coronary heart disease were diagnosed as coronary heart disease by coronary angiography, including 108 with single-vessel disease, 80 with double-vessel disease, 52 with three-vessel disease, and 136 with non-coronary heart disease. The systolic blood pressure, fasting blood glucose, total cholesterol, triglyceride, low-density lipoprotein cholesterol, BMI, RWH, VAT/SAT, and Gensini scores in the coronary heart disease group were higher than those in the control group, and high-density lipoprotein cholesterol was lower than the control group (P 0.05). The results of Pearson correlation analysis showed that Gensini score and RWH (r=0.838, P=0.023), VAT/SAT (r=0.892, P=0.001) had a significant positive correlation, which was related to BMI (r=0.651, P=0.328). Multivariate Logistic regression analysis showed that BMI>26 kg/m2 (OR=1.75, 95% CI 1.53-2.36, P=0.043), RWH>0.7 (OR= 2.81, 95% CI 1.39-5.67, P=0.015), VAT/SAT>0.6 (OR=4.85, 95% CI 2.86-8.92, P=0.008) was a risk factor for coronary heart disease; stepwise multiple linear regression analysis showed that BMI had no significant effect on Gensini scores. RWH and VAT/SAT are the influencing factors of Gensini scores. The standardized regression coefficients were 0.368 and 0.796, respectively, and the effect is greater with VAT/SAT. Conclusions BMI, RWH, and VAT/SAT are elevated in patients with coronary heart disease. Compared with BMI, RWH and VAT/SAT can reflect the degree of coronary artery disease, and VAT/SAT has a greater impact on coronary artery disease. Key words: Coronary heart disease; Coronary artery; Obesity; Severity

Abnormal Nail Fold Capillaroscopy Findings in Patients with Chronic Total Occlusions (CTO)

Aims: Nail fold capillaroscopy (NFC) allows a simple, non-invasive direct examination of the microvasculature. NFC abnormalities have previously been associated with a number of coronary artery disease processes, in particular microvascular dysfunction. We sought to determine the prevalence of NFC abnormalities in patients with a CTO. Methods & Results: 81 patients presenting for coronary angiography between June 2018 and January 2019 were studied. NFC was performed in 77 patients using a standardised protocol, prior to coronary angiography. An abnormal NFC was defined as the presence of microhaemorrhages, dilated capillaries or tortuous capillaries. Of those patients who underwent NFC, 27 (35.1%) had a CTO, whilst 50 (64.9%) had non-obstructive coronary artery disease (CAD). An abnormal NFC was seen more commonly in patients with a CTO as compared to those with non-obstructive CAD (33.3% vs 8%, p < 0.05). Patients with an abnormal NFC were more likely to have hypercholesterolaemia, than those without (100% vs 89.1%, p < 0.01). In patients with an abnormal NFC compared with those without, there was no difference in age, gender, presence of atrial fibrillation or other cardiovascular risk factors. In those with a CTO, there was no correlation between NFC findings and degree of collateralisation. Conclusions: An abnormal NFC is more commonly seen in patients with a CTO, which may reflect higher degree of coronary artery disease and microvascular dysfunction. NFC should be further investigated to determine its utility in routine cardiovascular screening and assessment (Fig. 1).

Relation between serum uric acid levels with the degree of coronary artery disease: A prospective study from Ecuador

To analyze the relationship between serum levels of uric acid and the severity of coronary disease. MethodsThis observational, descriptive and cross-sectional study included 77 patients previously selected using inclusion criteria, from September 2014 to May 2015. It was conducted in a third level regional hospital from Guayaquil, Ecuador. Patients enrolled in this study were older than 30 years with coronary disease undergoing coronary angiography, without prior diagnosis of any other condition that could influence in serum uric acid values. Results(1) Direct relation between serum uric acid levels and the severity of coronary disease, with a 0.600 Spearman correlation coefficient (p<0.001); (2) other variables such as hypertension and medical history did not have an influence on the study's results; (3) serum uric acid levels didn’t show difference among the different groups (p˃0.05). ConclusionsBased on the results, it was possible to conclude that there is a relation between serum uric acid level and the severity of coronary artery disease; this relation was independent of clinical diagnosis and hypertension. According to this, serum uric acid levels can be taken as a practical and inexpensive parameter related to the severity of coronary artery disease. As a primary preventive intervention, we recommend maintaining levels within normal parameters in patients with cardiovascular risk.

Computed Tomographic Coronary Angiography and Coronary Artery Calcium Score as a Risk Stratification Tool Prior to Non-Cardiac Surgery: A Meta-Analysis

Background: Current CSANZ guidelines are unclear about the role of computed tomographic coronary angiography (CTA) and coronary artery calcium score (CACS) in risk stratification prior to non-cardiac surgery (NCS). We performed a systematic review and meta-analysis evaluating perioperative risk prediction using these modalities in NCS. Methods: Electronic databases were used to identify studies of preoperative CTA and CACS reporting 30-day perioperative major adverse cardiovascular events (MACE). Summary odds ratios (OR) for degree of coronary artery disease (CAD) and MACE were pooled using a random-effects method. Results: Eleven studies were included. 246 (7.1%) MACE occurred in 3480 patients. Risk of perioperative MACE rose with the severity and extent of CAD on CTA (p < 0.001; Fig. 1 top ). Multivessel disease (≥2 vessels, >50% stenosis) demonstrated the greatest risk (OR 8.8 95% CI 5.1–15.3, p < 0.001; Fig. 1 bottom). Increasing CACS was also associated with higher perioperative MACE (CACS: ≥100 OR 5.1, p < 0.01). In a cohort deemed high risk by established clinical indices, absence of multivessel disease on CTA demonstrated a negative predictive value of 96% (95% CI 92.8–98.4) for predicting freedom from MACE. Conclusion: Severity and extent of CAD on CTA conferred incremental risk for perioperative MACE post noncardiac surgery. The ‘rule-out’ capability of CTA is comparable to other non-invasive modalities and may be a viable alternative in perioperative risk stratification.

Relation between serum uric acid levels with the degree of coronary artery disease: A prospective study from Ecuador

To analyze the relationship between serum levels of uric acid and the severity of coronary disease. MethodsThis observational, descriptive and cross-sectional study included 77 patients previously selected using inclusion criteria, from September 2014 to May 2015. It was conducted in a third level regional hospital from Guayaquil, Ecuador. Patients enrolled in this study were older than 30 years with coronary disease undergoing coronary angiography, without prior diagnosis of any other condition that could influence in serum uric acid values. Results(1) Direct relation between serum uric acid levels and the severity of coronary disease, with a 0.600 Spearman correlation coefficient (p<0.001); (2) other variables such as hypertension and medical history did not have an influence on the study's results; (3) serum uric acid levels didn’t show difference among the different groups (p˃0.05). ConclusionsBased on the results, it was possible to conclude that there is a relation between serum uric acid level and the severity of coronary artery disease; this relation was independent of clinical diagnosis and hypertension. According to this, serum uric acid levels can be taken as a practical and inexpensive parameter related to the severity of coronary artery disease. As a primary preventive intervention, we recommend maintaining levels within normal parameters in patients with cardiovascular risk.

Sex differences in long-term outcomes of patients across the spectrum of coronary artery disease

Patients with nonobstructive coronary artery disease (CAD) have worse outcomes compared with those without CAD; however, few studies have compared the intermediate- and long-term impact of CAD severity as a function of patient sex. We evaluated 5-year and long-term all-cause mortality of women and men undergoing elective coronary angiography at a single center by degree of CAD: no CAD (1%-24% stenosis), nonobstructive CAD (25%-69% epicardial stenosis or 25%-49% left main stenosis), or obstructive CAD (epicardial stenosis ≥70% or left main stenosis ≥50%), both overall and after adjusting for baseline clinical risk factors using Cox proportional-hazards models. Between January 1986 and July 2010, 8,766 women and 11,638 men underwent angiography and were followed for a median of 9.2 years. The majority (67%) of women had no CAD or nonobstructive CAD, whereas the majority of men had obstructive CAD (56%, P < .001). In both sexes, increasing CAD was associated with increased 5-year risk of mortality. Risk-adjusted hazard ratios (vs no CAD) for women were 1.36 (95% CI, 1.16-1.60) and 1.86 (1.61-2.16) for nonobstructive and obstructive CAD, respectively; corresponding hazard ratios for men were 1.24 (1.06-1.45) and 1.38 (1.20-1.59). After risk adjustment, 5-year mortality risk was higher in men than in women at all levels of CAD severity. The relationships between severity of CAD and mortality risk during long-term follow-up in women and men were similar to the 5-year relationships above. Although women undergoing elective catheterization have less severe CAD than men, nonobstructive CAD is prevalent in both sexes and carries a worse prognosis than no CAD. These data suggest a need for further investigation to establish optimal therapies for this at-risk group of patients with nonobstructive CAD.

Association between circulating proprotein convertase subtilisin/kexin type 9 levels and prognosis in patients with severe chronic kidney disease.

Chronic kidney disease is a risk factor for premature development of coronary atherosclerosis and mortality. A high level of proprotein convertase subtilisin/kexin type 9 (PCSK9) is a recently recognized cardiovascular risk factor and has become the target of effective inhibitory treatment. In 167 kidney transplantation candidates, we aimed to: (i) compare levels of PCSK9 with those of healthy controls, (ii) examine the association between levels of PCSK9 and low-density lipoprotein cholesterol (LDL-c) and the degree of coronary artery disease (CAD) and (iii) evaluate if levels of PCSK9 predict major adverse cardiac events (MACE) and mortality. Kidney transplant candidates (n = 167) underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) before transplantation. MACE and mortality data were extracted from the Western Denmark Heart Registry, a review of patient records and patient interviews. A group of 79 healthy subjects were used as controls. Mean PCSK9 levels did not differ between healthy controls and kidney transplant candidates. In patients not receiving lipid-lowering therapy, PCSK9 correlated positively with LDL-c (rho = 0.24, P < 0.05). Mean PCSK9 was similar in patients with and without obstructive CAD at both CCTA and ICA. In a multiple regression analysis, PCSK9 was associated with neither LDL-c (β=-6.45, P = 0.44) nor coronary artery calcium score (β=2.17, P = 0.84). During a follow-up of 3.7 years, PCSK9 levels were not associated with either MACE or mortality. The ability of PCSK9 levels to predict cardiovascular disease and prognosis does not seem to apply to a cohort of kidney transplant candidates.

Cardiac Versus Non-Cardiac Related Mortality Following Percutaneous Coronary Intervention in Patients with Insulin-Treated Type 2 Diabetes Mellitus: A Meta-Analysis.

IntroductionCardiovascular mortality is a major concern for patients with type 2 diabetes mellitus (T2DM). Insulin therapy significantly contributes to a high rate of death in these patients. We have performed a meta-analysis comparing cardiac and non-cardiac-related mortality following percutaneous coronary intervention (PCI) in a sample of patients with insulin-treated type 2 diabetes mellitus (ITDM).MethodsStudies were included in the meta-analysis if: (1) they were trials or cohort studies involving patients with T2DM post-PCI; (2) the outcomes in ITDM were separately reported; and (3) they reported cardiac death and non-cardiac death among their clinical endpoints. ITDM patients with any degree of coronary artery disease were included. The analysis was carried out using RevMan version 5.3 software, and data were reported with odds ratios (OR) and 95% confidence intervals (CI) as the main parameters.ResultsA total of 4072 participants with ITDM were included, of whom 1658 participants and 2414 participants were extracted from randomized controlled trials and observational cohorts, respectively. Analysis of all data showed that death due to cardiac causes was significantly higher in patients with ITDM (OR 2.16, 95% CI 1.79–2.59; P = 0.00001). At 1 year of follow-up, cardiac death was still significantly higher compared to non-cardiac death (OR 2.39, 95% CI 1.47–3.88; P = 0.0004), and this result did not change with a longer follow-up period (3–5 years) (OR 2.09, 95% CI 1.70–2.56; P = 0.00001). Death due to cardiac causes was still significantly higher in the subpopulations of patients with everolimus-eluting stents (OR 2.31, 95% CI 1.26–4.26; P = 0.007), paclitaxel-eluting stents (OR 2.36, 95% CI 1.63–3.39; P = 0.00001), sirolimus-eluting stents (OR 2.11, 95% CI 1.67–2.67; P = 0.00001), and zotarolimus-eluting stents (OR 2.12, 95% CI 1.11–4.05; P = 0.02), respectively.ConclusionsMortality due to cardiac causes was significantly higher than that due to non-cardiac causes in patients with ITDM who had undergone PCI. The same conclusion could be drawn from analyses focused on different follow-up periods, types of coronary stents, and type of study data used.

Obesity and sudden cardiac death in the young: Clinical and pathological insights from a large national registry.

Aims Obesity is an increasing public health problem and a risk factor for cardiovascular diseases. The aim of the study was to determine the main features and aetiologies in a large cohort of sudden cardiac deaths that occurred in obese subjects. Methods Between 1994 and 2014, 3684 consecutive cases of unexpected sudden cardiac death were referred to our cardiac pathology centre. This study was confined to young individuals (age ≤ 35 years) for whom information about body mass index was available and consisted of 1033 cases. Results Two-hundred and twelve individuals (20%) were obese. In obese sudden cardiac death victims the main post-mortem findings were: normal heart (sudden arrhythmic death syndrome) ( n = 108; 50%), unexplained left ventricular hypertrophy ( n = 25; 12%) and critical coronary artery disease ( n = 25; 12%). Less common were hypertrophic cardiomyopathy ( n = 4; 2%) and arrhythmogenic right ventricular cardiomyopathy ( n = 4;2%). When compared with non-obese sudden cardiac death victims, sudden arrhythmic death syndrome was less common (50% vs. 60%, P < 0.01), whereas left ventricular hypertrophy and critical coronary artery disease were more frequent (12% vs. 2%, P < 0.001 and 12% vs. 3%, P < 0.001, respectively). The prevalence of critical and non-critical coronary artery disease was significantly higher in obese individuals (23% vs. 10% in non-obese individuals, P < 0.001). Conclusions Various conditions underlie sudden cardiac death in obesity, with a prevalence of sudden arrhythmic death syndrome, left ventricular hypertrophy and coronary artery disease. The degree of left ventricular hypertrophy measured by heart weight is excessive even after correction for body size. Almost one in four young obese sudden death patients show some degree of coronary artery disease, underscoring the need for primary prevention in this particular subgroup.

Correlation between epicardial adipose tissue thickness and the degree of coronary artery atherosclerosis

Background/aim: The purpose of the current study was to evaluate the thickness of the epicardial adipose tissue and its association with the degree of coronary artery disease in a group of autopsied cases. Materials and methods: A number of 79 cases were included in the study. Five preestablished incisions of the epicardial adipose tissue (EAT) were made on each of the hearts. These five points were next to/on the path of the major coronary vessels. The degree of coronary atherosclerosis was evaluated during the autopsy. Results: The results revealed the greatest thickness of the EAT on the incision made on the anterior and posterior wall of the right ventricle. EAT was thicker in cases presenting atherosclerosis degree I or II in two of the coronary arteries, the left circumflex artery and left main artery; on the left anterior descending artery, higher EAT thickness associated with fourth degree atherosclerosis. Conclusion: Epicardial adipose tissue thickness was greater at the incision points situated on the right side of the heart. Greater EAT thickness was associated significantly with early atherosclerosis development in three of the coronary arteries (LCx, LMA, LADA).

Long-term prognosis of patients with non-ST-segment elevation myocardial infarction according to coronary arteries atherosclerosis extent on coronary angiography: a historical cohort study

BackgroundPatients with non-ST-segment elevation myocardial infarction (NSTEMI) without obstructive coronary artery disease (CAD) are often managed differently than those with obstructive CAD, therefore we aimed in this study to examine the long-term prognosis of patients with NSTEMI according to the degree of CAD on coronary angiography (CAG).MethodsWe examined 8.889 consecutive patients admitted for first time NSTEMI during 2000–2011, to whom CAG was performed. Patients were classified by CAG into: 0-vessel disease (0VD), diffuse atherosclerosis (DA) (0% < stenosis <50%), 1-vessel disease (1VD), 2VD, and 3VD with stenosis ≥50%. Follow-up period: 13 years (median 4.5).ResultsOne-year mortality for NSTEMI patients with 0VD was 3.7%, DA 5.7%, 1VD 2.5%, 2VD 4.8%, and 3VD 11.5%. Non-diabetic 0VD patients had higher risk of mortality than 1VD patients (HR:1.59; 95% CI:1.21–2.02; P < 0.001), while those with diabetes mellitus (DM) had not significantly different risk. In addition 0VD group had higher risk of heart failure (HF) (HR 1.61; 95% CI: 1.39–1.88; P < 0.001), and lower risk of recurrent MI (HR:0.55; 95% CI:0.39–0.77; P < 0.001) compared with 1VD. For patients with DA; mortality and HF risks were higher than 1VD and not different than 2VD, while recurrent MI risk was not different than 1VD and lower than 2VD.Finally, the DA group had higher risk of mortality if they had DM, higher risk of recurrent MI, and not different risk of HF and stroke compared with the 0VD group patients.ConclusionPatients with NSTEMI and non-obstructive CAD (both normal coronaries and diffuse atherosclerosis) have a comparable prognosis to patients with one- or two-vessel disease. Patients with diffuse atherosclerosis have worse prognosis than those with angiographically normal coronary arteries.

TCT-648 Percutaneous coronary intervention modulates the natural humoral immune response in relation to the degree of coronary artery disease

Auto antigens such as oxidized LDL have been implicated as atherogenic agents found in atheromatous lesions. It has not been observed whether percutaneous coronary intervention (PCI) can modulate the natural or adaptive humoral immune response to auto antigens according to the degree of

The correlation between speckle tracking echocardiography and coronary artery disease in patients with suspected stable angina pectoris

BackgroundTo examine the value of speckle tracking echocardiography to detect the presence, extent and severity of coronary artery affection in patients with suspected stable angina pectoris. MethodsTwo hundred candidates with suspected stable angina pectoris and normal resting conventional echocardiography were subjected to speckle tracking echocardiography and coronary angiography. Global and segmental longitudinal peak systolic strain were assessed and were correlated to the results of coronary angiography for each patient. ResultsThere was a statistically significant difference in the mean of global longitudinal peak systolic strain between normal coronaries and different degrees of coronary artery disease (CAD) (−20.11±0.8 for normal, −18.34±2.52 for single vessel, −16.14±2.85 for two vessels, −14.81±2.12 for three vessels, −13.01±2.92 for left main disease). GLPSS showed high sensitivity for the diagnosis of single vessel CAD (90%, specificity 95.1%, cutoff value: −18.44, AUC: 0.954); two vessels disease (90%, sensitivity 88.9%, cutoff value −17.35, AUC: 0.906) and for three vessels CAD (cutoff value −15.33, sensitivity 63% and specificity 72.2% AUC 0.681) segmental LPSS also showed statistical significance for localization of the affected vessel for left anterior descending, left circumflex and right coronary artery (ρ=0.001) and inverse correlation with syntax score that was significant with high and intermediate score (ρ=0.001) and insignificant for low syntax score (ρ value 0.05). ConclusionTwo-dimensional speckle tracking echocardiography has good sensitivity and specificity to predict the presence, extent and severity of CAD.

Poor long-term outcomes in stroke patients with asymptomatic coronary artery disease in heart CT

Background and aimsAlthough stroke patients have a high risk of ischemic heart disease, little information is available on the risk of coronary events in stroke patients with asymptomatic coronary artery disease (CAD). We investigated the long-term vascular outcomes in stroke patients with asymptomatic CAD diagnosed with multi-detector coronary computed tomography (MDCT). MethodsThis study was a retrospective analysis using a prospective cohort of ischemic stroke patients. We included consecutive stroke patients without history or symptoms of CAD who underwent MDCT. We investigated the long-term risk of major adverse cardiovascular events (MACE: cardiovascular mortality, ischemic stroke, myocardial infarction, unstable angina, and urgent coronary revascularization) and composite of MACE/all-cause mortality/elective coronary revascularization. We further investigated the value of MDCT for MACE prediction. ResultsAmong the 1893 included patients, 1349 (71.3%) patients had some degree of CAD and 654 patients (34.5%) had significant (≥50%) CAD. At follow-up (median, 4.4 years), MACE occurred in 230 patients (12.2%). Event rates of MACE increased with the increasing extent of CAD. After adjustment for age, sex, and risk factors, the hazard ratios for MACE in mild CAD, 1-VD, 2-VD, and 3-VD or left main coronary disease were 1.28 (95% confidence interval [CI]: 0.88–1.87), 1.39 (95% CI: 0.90–2.16), 2.22 (95% CI: 1.39–3.55), and 2.91 (95% CI: 1.82–4.65), respectively (no CAD as a reference). Diagnosis of asymptomatic CAD significantly improved the prediction of MACE. ConclusionsAsymptomatic CAD detected on MDCT was associated with increased risks of vascular events or deaths in acute stroke patients.

OP-113 [AJC » Acute Coronary Syndromes] “Sclerostin” a Novel Marker for Predicting Severity and Degree of Coronary Artery Disease

OP-113 [AJC » Acute Coronary Syndromes] “Sclerostin” a Novel Marker for Predicting Severity and Degree of Coronary Artery Disease

Association of Vitamin D Deficiency and Degree of Coronary Artery Disease in Cardiac Patients with Type 2 Diabetes.

Several modifiable factors may influence cardiac function in diabetic patients. The aim of the study was to evaluate the influence of vitamin D level on the stage of coronary atherosclerosis in cardiac patients diagnosed with type 2 diabetes. The study was performed in 337 consecutive patients undergoing coronarography. The stage of atherosclerosis was evaluated using Coronary Artery Surgery Study Score. The plasma 25(OH)D concentration was determined by an electrochemiluminescence method. Patients without significant lesions in coronary arteries presented the highest 25(OH)D level, significantly higher than patients with one-, two-, and three-vessel coronary artery disease (CAD) (p < 0.01). Significantly lower level of the 25(OH)D was observed in patients hospitalized due to acute coronary syndrome (ACS) in comparison to patients hospitalized due to stable CAD (p < 0.001). Lower 25(OH)D levels were observed in patients with the history of myocardial infarction (MI) in comparison to patients without previous MI (p < 0.001). In cardiac patients with diabetes, the higher number of stenotic coronary arteries is associated with lower values of the 25(OH)D. A group of male cardiac patients with diabetes with significant stenosis in three coronary arteries, hospitalized due to acute coronary syndrome, with a history of previous MI and hyperlipidemia presented the lowest vitamin D level.

A novel approach to ischemic mitral regurgitation (IMR).

Ischemic mitral regurgitation (IMR) is a complicated medical condition with varying degrees of coronary artery disease and mitral regurgitation (MR). The traditional surgical treatment option for those with indications for intervention is coronary artery bypass grafting (CABG) plus or minus mitral valve repair or replacement (MVR). Percutaneous coronary intervention, hybrid coronary revascularization (HCR), and conventional CABG are three techniques available to address coronary artery disease (CAD). Percutaneous edge-to-edge repair, minimally invasive, and traditional sternotomy are accepted approaches for the treatment of MR. When taken in combination, there are nine methods available to revascularize the myocardium and restore competency to the mitral valve. While most of these treatment options have not been studied in detail, they may offer novel solutions to a widely variable and complex IMR patient population. Thus, a comparative analysis including an examination of potential benefits and risks will be helpful and potentially allow for more patient-specific treatment strategies.

The relationship between serum high-mobility group box-1 and prognosis of coronary heart disease in old patients

Objective To investigate the correlation of serum high-mobility group box-1 (HMGB1) with the severity of lesion of coronary artery disease (CAD) and its prognosis in elderly patients. Methods A total of 180 CAD patients with coronary stenosis exceeding 50 percent by coronary angiography were divided into three groups: one branch stenosis; two branches stenosis and three branches stenosis. The control group included 50 patients without coronary stenosis. The degrees of coronary stenosis were diagnosed as mild stenosis, moderate stenosis and severe stenosis based on improved Gensini scores. The severity of decrements of left ventricular ejection fraction (LVEF) by echocardiogram were divided into three groups: mild, moderate and severe LVEF. Levels of HMGB1, hs-CRP and glucose were measured in all the patients. According to whether there was a complication of type 2 diabetic mellitus (T2DM), the 180 patients were classified as two groups. The patients were also divided into two groups according to whether there were adverse events. Results The HMGB1 levels of the CAD group were increased along with the number of affected vessels〔three bunch group (40.5±6.0) ng/ml, double bunch group (33.1±4.9)μg/L, single bunch group (20.5±3.3)μg/L and control group (6.2±1.4)μg/L (all P<0.05)〕. And the HMGB1 levels of the CAD group were increased along with the degrees of CAD stenosis〔severe stenosis group (43.0±5.8)μg/L, medium stenosis group (32.1±4.5)μg/L, mild stenosis group(19.3±2.0)μg/L〕(all P<0.05). Meanwhile, the levels of HMGB1 were increased along with the decrement of left ventricular ejection fraction〔left ventricular severe dysfunction group(41.0±5.5)μg/L, medium dysfunction group(33.1±4.3)μg/L, mild dysfunction group (21.3±2.0)μg/L〕 (all P<0.05). CAD with T2DM had a higher HMGB1 level than non-T2DM group〔(35.7±5.0) Ĉ/L vs. (23.3±3.0) Ĉ/L, P<0.05〕. The adverse events group had a higher HMGB1 level than non- adverse events group〔(38.7±5.5) Ĉ/L vs. (25.3±3.3)μg/L, P<0.05〕. Besides, HMGB1 had a positive correlation with levels of hs-CRP and glucose(r=0.680, 0.571, P<0.05). Conclusions Serum HMGB1 change is closely related to morbid change degree of elderly CAD patients as well as prognosis. As a new type of inflammatory factor, HMGB1 may serve as a new target for disease treatment. Key words: High mobility proteins; Coronary disease; Prognosis