Degree Of Coronary Atherosclerosis Research Articles

Predictive Value of CFIm25 Expression in Peripheral Blood Monocytes for Coronary Atherosclerosis.

Background: Cleavage factor Im25 (CFIm25) regulates cell function by affecting mRNA editing processes and plays diverse roles in various diseases. Studies have found that peripheral blood monocytes are valuable in diagnosing and prognosing coronary atherosclerosis. However, no studies have examined the predictive value of CFIm25 expression in peripheral blood monocytes for coronary atherosclerosis. Methods and Results: We collected the coronary angiography results of 267 patients and calculated the Gensini score to evaluate their degree of coronary atherosclerosis. We isolated peripheral blood monocytes and detected CFIm25 RNA expression. Based on their Gensini score, we divided the patients into negative (0, n = 46), mild lesion (≤ 8, n = 71), moderate lesion (8-23, n = 76), and severe lesion (≥ 23, n = 74) groups. Results showed that CFIm25 expression correlated negatively with the Gensini score and the number of involved coronary vessels. Univariate and multivariate binary logistic regression analyses showed that CFIm25 expression in peripheral blood monocytes was a protective factor for severe lesions, ≥ 50% stenosis, and three-vessel lesions. The areas under the receiver operating characteristic curve of CFIm25 expression for predicting lesions, severe lesions, ≥50% stenosis, and three-vessel lesions were 0.743, 0.735, 0.791, and 0.736, respectively. Conclusions: CFIm25 expression in peripheral blood monocytes correlates negatively with the degree of coronary atherosclerosis and helps predict the severity and number of coronary artery lesions.

Social, Geographical and Income Inequality as Demonstrated by the Coronary Calcium Score: An Ecological Study in Sydney, Australia

The coronary calcium score is a non-invasive biomarker of coronary artery disease. The concept of "arterial age" transforms the coronary calcium score to an expected age based on the degree of coronary atherosclerosis. This study aimed to investigate the relationship of socioeconomic status with the burden of coronary artery disease within Sydney, Australia. This was an ecological study at the postcode level of patients aged 45 and above who had completed a CT coronary calcium scan within New South Wales (NSW), Australia from January 2012 to December 2020. Arterial age difference was calculated as arterial age minus chronological age. Socioeconomic data was obtained for median income, Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) score and median property price. Linear regression was used for analysis. There were 17,102 patients across 325 postcodes within NSW, comprising 9129 males with a median arterial age difference of 7 years and 7972 females with -9 years. Income, IRSAD score and property price each had an inverse relationship with arterial age difference (p-values < 0.05). Income, socioeconomic status and local property prices are significantly correlated with premature coronary aging. Healthcare resource allocation and prevention should target the inequalities identified to reduce the burden of coronary artery disease.

Galectin-3 Is Associated with Cardiac Fibrosis and an Increased Risk of Sudden Death.

Myocardial fibrosis is a common postmortem finding among individuals with Sudden Cardiac Death (SCD). Numerous in vivo and in vitro studies have shown that increased galectin-3 (gal3) expression into the myocardium is associated with higher incidence of fibrosis. Although elevated gal3 expression is linked with myocardial fibrosis, its role in predicting the risk of SCD is unknown. We reviewed the clinical datasets and post-mortem examination of 221 subjects who had died suddenly. We examined myocardial pathology including the extent of cardiac hypertrophy, fibrosis, and the degree of coronary atherosclerosis in these subjects. In a select group of SCD subjects, we studied myocardial gal3 and periostin expression using immunohistochemistry. To further examine if a higher level of circulating gal3 can be detected preceding sudden death, we measured serum gal3 in a porcine model of subtotal coronary artery ligation which shows an increased tendency to develop lethal cardiac arrhythmias, including ventricular tachycardia or fibrillation. Of the total 1314 human subjects screened, 12.7% had SCD. Comparison of age-matched SCD with non-SCD subjects showed that SCD groups had excessive myocardial fibrosis involving both the left ventricular free wall and interventricular septum. In pigs with subtotal coronary artery ligation and SCD, we detected significantly elevated circulating gal3 levels approximately 10 days preceding the SCD event. Immunohistochemistry showed increased myocardial gal3 and periostin expression in pigs that died suddenly, compared to the controls. Our study shows that increased gal3 is associated with a higher risk of myocardial fibrosis and the risk of SCD. This supports the importance of larger translational studies to target gal3 to prevent cardiac fibrosis and attenuate the risk of SCD.

Exercise-induced cardiac troponin release in middle-aged and older athletes with different degrees of coronary atherosclerosis

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Radboud University Medical CenterAcademic Alliance Fund Maastricht - Nijmegen Background Current sports medical examinations do not appropriately detect occult coronary atherosclerosis in athletes, whereas coronary atherosclerosis is more prevalent in middle-aged and older athletes compared to physically active controls. Therefore, new diagnostic approaches need to be developed to identify individuals at risk. Cardiac troponin (cTn) is the standard biomarker to assess myocardial injury. Exercise is known to increase cTn concentrations and a delayed recovery of cTn concentrations after exercise cessation is suggested to be indicative of occult obstructive coronary artery disease. We hypothesized that the magnitude of exercise-induced cTn elevations may be associated with the degree of coronary atherosclerosis. Purpose To compare serial measures of exercise-induced cTnT elevations across middle-aged and older athletes with different degrees of coronary atherosclerosis. Methods A subgroup of 59 men from the Measuring Athlete’s Risk of Coronary events-2 study (MARC-2, n=291) were invited for this add-on study. All participants had undergone a cardiac computed tomography (CT) scan and coronary CT angiography to determine the prevalence and magnitude of coronary atherosclerosis. Athletes were stratified based on the degree of coronary atherosclerosis: I) n=20 with a coronary artery calcium score (CACS) of 0, II) n=20 with CACS ≥300 or ≥75th MESA-percentile, and III) n=19 with a &amp;gt;50% stenosis in any coronary artery, but without ischemia on a stress imaging tests. Participants performed an individualized exercise test (&amp;gt;1 hour, cycling) until volitional exhaustion. High-sensitivity cTnT concentrations were measured at baseline, after 30 minutes of exercise and at 0, 30, 60, 120, and 180 minutes post-exercise. Results Participants (age 60.8 [57.9-72.6] years, BMI 24.5 [23.9-27.3]) exercised for 76±14 minutes, up to 97.6 [94.4-101.8] % of their expected maximum heart rate. Exercise duration and workload did not differ across groups. Baseline hs-cTnT was detectable in everyone. Exercise induced a 1.98±1.63 fold increase in hs-cTnT concentrations. Peak hs-cTnT concentrations occurred at 180 minutes post-exercise (13.9 [9.4-17.0] ng/L versus 12.1 [10.0-21.5] ng/L versus 13.8 [9.1-19.9] ng/L, for group I, II and III, respectively) and the incidence of hs-cTnT concentrations above the URL (n=9 (45%) vs n=7 (35.0%) vs n=9 (47.4%)) was comparable across groups (p=0.92 and p=0.71, respectively). Patterns of time-dependent changes in hs-cTnT concentrations did not differ across groups (p=.49). Conclusion Exercise-induced elevations in hs-cTnT concentrations did not differ among middle-aged and older athletes with different degrees of coronary atherosclerosis. Our findings suggest that hs-cTnT sampled before, during or within 180 minutes following an exhaustive endurance cycling exercise test is not suitable to detect occult coronary atherosclerosis in athletes.

Abstract 11711: Quantification of Atherosclerotic Coronary Artery Disease in the Pre/Peri-Menopausal Female Using Cardiac CTA

Introduction: Coronary Artery Disease (CAD) occurs equally in males and females and is the most common cause of death in both genders worldwide. The pre/peri-menopausal female is believed to have minimal coronary atherosclerosis based primarily on non-invasive techniques, with limited coronary angiography data. Cardiac computed tomography angiography (CCTA) is a more sensitive, non-invasive anatomical diagnostic tool for quantifying coronary atherosclerosis, but pre/peri-menopausal women have been underrepresented and underdiagnosed. The goal of this study was to quantify coronary atherosclerosis in this population. Methods: We conducted a retrospective chart review on 510 females aged 35-60 presenting with atypical chest pain and shortness of breath. These were consecutive admissions in which CCTA was performed from January 2014 to December 2019. The degree of coronary atherosclerosis was quantified using the CAD-RADS scoring system. Results: Analysis showed 68.82% of patients had no evidence of coronary atherosclerosis. 4.31% had minimal CAD, 18.24% had mild CAD, 6.47% had moderate CAD and 2.16% were found to have severe CAD. Each category of stenosis typically had multiple vessels involved. Over 65% of patients were Non-Hispanic White, 27% Hispanic, 8% African American and 4% Asian. Less than 5% of patients were discharged with statin therapy. Conclusions: This is the first study to quantify coronary atherosclerosis in the pre/peri-menopausal female. Quantification was based on coronary angiograms obtained by CCTA, currently the most sensitive diagnostic imaging technique. Despite the perceived protective nature of the premenopausal state in women, 30% of patients had detectable CAD by CCTA. 10% had greater than 50% stenosis (moderate to severe CAD), suggesting the potential for future ischemic heart disease. So few patients were discharged on statin therapy, showing the paucity of guideline therapy used in this population. These results suggest targeting preventative therapy, even late in the pre or peri-menopausal stage, such as favorable lifestyle changes and reducing known modifiable cardiac risk factors, should significantly prevent the progression of coronary atherosclerosis and its subsequent sequelae in menopause.

Plasm trimethylamine-N-oxide level and association with lesion severity in coronary heart disease patients with type 2 diabetes mellitus

Objective: To investigate the association between trimethylamine-N-oxide (TMAO) and the degree of coronary atherosclerosis in coronary heart diseases (CHD) patients with type 2 diabetes mellitus. Methods: Consecutive patients, who underwent coronary angiography due to suspected CHD in Beijing Hospital from November 2016 to January 2018, were screened in this cross-sectional study. According to blood glucose level, previous medical history and coronary angiography results, they were divided into CHD without type2 diabetes mellitus(CHD-nDM) group and CHD with type2 diabetes mellitus(CHD-DM) group. Plasma TMAO levels in each group were measured by LC-MS/MS. Spearman correlation analysis was used to evaluate the correlation between TMAO and the number of diseased vessels and Gensini scores. Multivariate logistic regression was used to analyze the correlation between TMAO and high Gensini scores. Results: A total of 590 patients were enrolled in the study, including 238 patients in CHD-DM group and 352 patients in CHD-nDM group. Patients were older, body mass index, blood pressure level, prevalence of history of hypertension and statins use were higher in CHD-DM group than in CHD-nDM group (all P<0.05). The proportion of patients with multivessel disease (2 or more vessels) was also higher in CHD-DM group than in CHD-nDM group (P<0.001). Gensini score was higher in CHD-DM group than in CHD-nDM group (P<0.05). Fasting blood glucose, glycosylated hemoglobin and urea were significantly higher, while low-density lipoprotein cholesterol and hemoglobin were significantly lower in CHD-DM group than in CHD-nDM group (all P<0.05). The levels of TMAO was significantly higher in CHD-DM group than in CHD-nDM group (P<0.001). Spearman correlation analysis showed that TMAO was positively correlated with the number of diseased vessels, Gensini score, age and blood glucose level (r=0.178, 0.189, 0.260, 0.111, respectively, all P<0.01). Multivariate logistic regression analysis showed that, TMAO level was still positively correlated with high Gensini score in CHD-DM group (OR=2.25, 95%CI 1.16-4.38, P=0.017), but not in CHD-nDM group (OR=1.29, 95%CI 0.72-2.31, P=0.386) after adjusting for age, sex, body mass index, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglyceride, history of hypertension, hyperlipidemia, smoking and statin use. Conclusions: In CHD patients with tupe 2 diabetes mellitus, the plasma TMAO level is significantly increased and is independent and positively correlated with the degree of coronary artery disease.

Impact of glycemic control on the association of endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus

BackgroundWe investigated whether glycemic control affects the relation between endothelial dysfunction and coronary artery disease in patients with type 2 diabetes mellitus (T2DM).MethodsIn 102 type 2 diabetic patients with stable angina, endothelial function was evaluated using brachial artery flow-mediated dilation (FMD) with high-resolution ultrasound, and significant stenosis of major epicardial coronary arteries (≥ 50% diameter narrowing) and degree of coronary atherosclerosis (Gensini score and SYNTAX score) were determined. The status of glycemic control was assessed by blood concentration of glycated hemoglobin (HbA1c).ResultsThe prevalence of significant coronary artery stenosis (67.9% vs. 37.0%, P = 0.002) and degree of coronary atherosclerosis (Gensini score: 48.99 ± 48.88 vs. 15.07 ± 21.03, P < 0.001; SYNTAX score: 15.88 ± 16.36 vs. 7.28 ± 10.54, P = 0.003) were higher and FMD was lower (6.03 ± 2.08% vs. 6.94 ± 2.20%, P = 0.036) in diabetic patients with poor glycemic control (HbA1c ≥ 7.0%; n = 56) compared to those with good glycemic control (HbA1c < 7.0%; n = 46). Multivariate regression analysis revealed that tertile of FMD was an independent determinant of presence of significant coronary artery stenosis (OR = 0.227 95% CI 0.056–0.915, P = 0.037), Gensini score (β = − 0.470, P < 0.001) and SYNTAX score (β = − 0.349, P = 0.004) in diabetic patients with poor glycemic control but not for those with good glycemic control (P > 0.05).ConclusionPoor glycemic control negatively influences the association of endothelial dysfunction and coronary artery disease in T2DM patients.

Холтеровское мониторирование электрокардиограммы у пациентов со стабильной ишемической болезнью сердца: новые возможности

Background. Noninvasive diagnosis of coronary artery disease (CAD) represents a real problem in clinical practice and can be improved by use of novel additional Holter ECG options. Aim. To evaluate the markers of electrical inhomogeneity of repolarization process in patients with various degree of coronary atherosclerosis. Materials and methods. All 116 patients, hospitalized for diagnostic coronary angiography, were divided into three groups: 1 – severe coronary atherosclerosis, 2 – initial atherosclerosis, 3 – normal coronary arteries (control group). A 12-lead Holter electrocardiography was performed to evaluate microvolt T-wave alternans (MTWA), QT and QTc dispersion on maximal and minimal heart rate (QTdmax and QTcdmax, QTdmin and QTcdmin respectively). Results. Results of a comparative analysis have demonstrated significant differences between three mentioned groups referring to MTWA (p=0,015). QTdmax (p1-2&lt;0.001, p1-3=0.002) as well as QTcdmax (p1-2&lt;0.0001, p1-3=0.001) were significantly higher in group 1 compared to others. At the same time, QTdmin and QTcdmin values didn't differ between the groups. The results of a current study indicated increased absolute values of the markers of an impaired repolarization in individuals with severe coronary atherosclerosis (compared to initial atherosclerosis and normal coronary arteries). Conclusion. The markers of electrical inhomogeneity of repolarization process in the myocardium (MTWA, QTdmax and QTcdmax) represent perspective ECG instruments in evaluation of the severity of coronary atherosclerosis in patients with stable CAD, still requesting futher investigation.

Prediction of coronary atherosclerosis in young patients with coronary artery disease using a non-invasive biomarker

Aim . To develop a combined biomarker for non-invasive diagnostics of the severity of coronary artery (CA) atherosclerosis in patients with coronary artery disease (CAD) and in those without clinical manifestations of atherosclerosis under 50 years of age using structural and functional parameters of large arteries and the lipid profile. Material and methods . A total of 92 patients with CAD and 28 healthy ones were included. Depending on the results of coronary angiography, patients with CAD were divided into 3 groups: without hemodynamically significant stenosis (HSS) (HSS 1&lt;50% , n=30), with HSS of one CA (HSS 1&gt;50% , n=37), with HSS of 2 and more CA (HSS 2&gt;50% , n=25). The subjects underwent a biochemical blood test, carotid duplex ultrasound, volumetric sphygmography. Results . In individuals with HSS1&lt;50%, lipid metabolism disorders were diagnosed in 63,3% (n=19), in HSS 1&gt;50% group — 78,4% (n=29), in HSS2&gt;50% group — 92% of cases (n=23) (p 1-3 &lt;0,05). Carotid intima-media thickness exceeding the threshold level was found in 40% of patients with HSS 1&lt;50% , in 51% of patients with HSS 1&gt;50% and 64% of patients with HSS 2&gt;50% (p 1-3 &lt;0,05). According to the results of volumetric sphygmography, the severity of CA atherosclerosis was associated with a higher pulse wave velocity and L-/CAVI 1 . At the next stage, a complex parameter for predicting coronary atherosclerosis (CA biomarker) was developed, including sex, structural and functional indicators of the arteries (intima-media thickness, в-stiffness index, L-/CAVI 1 ) and biochemical parameters (total cholesterol, triglycerides, low density lipoproteins). In healthy people, the level of CA biomarker was 2,7 (95% CI, 2,3-3,9); in patients with CAD with any degree of CA lesion — 6,4 (95% CI, 5,2-9,6). The CA biomarker threshold of 5 points with a sensitivity of 87,5% and a specificity of 90,5% was determined as the optimal cut-off point; area under the curve — 0,965 (95% CI, 0,943-0,987) (p&lt;0,0001). Conclusion . In patients with CAD, the presence and degree of coronary atherosclerosis are associated with the deterioration of most structural and functional artery parameters. The developed complex CA biomarker is of interest for non-in-vasive screening of preclinical CA atherosclerosis in patients with a low relative risk.

Abstract 17065: Performance of Cardiovascular Disease Risk Scores to Identify Coronary Artery Calcium Burden in Retired National Football League Players

Introduction: Coronary artery calcium (CAC) is a robust predictor of coronary events in asymptomatic individuals with latent atherosclerotic cardiovascular disease (CVD). While evidence suggests CAC scoring may augment traditional CVD risk scores in clinical decision making, evidence is limited on the compared ability of CVD risk scores to identify the degree of coronary atherosclerosis as quantified by absolute CAC, particularly in former elite athlete populations. We investigated this in a cohort of retired National Football League (NFL) players. Methods: We analyzed data on 752 retired NFL players (aged 55.2 ± 9.0 years, 53.7% African-American] that underwent health screening and CAC scoring with the NFL Player Care Foundation. Three 10-year CVD risk scores were compared: Framingham Coronary Heart Disease (FCHD), Framingham CVD (FCVD), and Atherosclerotic CVD Risk Pooled Cohort Equations (PCE). Receiver operating characteristic curves were fitted in 3 models: FCHD (Model 1), FCVD (Model 2), and PCE (Model 3, used as reference based on 2013 AHA guidelines). Contrast analyses identified the model with highest discriminative ability (c statistic) versus CAC = 0 for each CAC score category: &gt;0 and &lt;100, 100-400, and &gt;400. Results: Compared to PCE , FCVD exhibited the highest discriminative ability for CAC &gt; 0 and &lt; 100 ( c statistic 0.7071 vs 0.6706, p&lt;0.0001), while FCHD had the lowest for both CAC 100-400 ( c statistic 0.7198 vs 0.7664, p=0.0165) and CAC &gt;400 ( c statistic 0.7728 vs 0.8460, p&lt;0.0001). No additional differences were identified (Figure 1). Conclusion: Traditional CVD risk scores differ in performance to predict absolute CAC among retired NFL players, underscoring a need for refinement of coronary event risk prediction models to enhance the ability of such models to identify, specifically, low CAC, as even low CAC burden confers increased risk compared to CAC absence. This may include accounting for elite athlete-specific characteristics.

Correlation of Transluminal Attenuation Gradientdistal with Corrected Contrast Opacification with Anterior Coronary Atherosclerosis

Objective To explore the correlation between the transluminal attenuation gradient with corrected contrast opacification(TAG-CCO)and the severity of atherosclerotic stenosis in the anterior segment of myocrardial bridge(MB). Methods The imaging data of 200 patients diagnosed with left anterior descending branch(LAD)single MB and coronary atherosclerosis in the anterior segment of MB were retrospectively analyzed.According to MB types,the patients were divided into two groups:incomplete and complete.There were some significant differences in TAG-CCO between patients with the same degree of coronary atherosclerosis(mild,moderate,and severe stenosis)in two groups.The relationships among groups with different degrees(mild,moderate,and severe stenosis)of the same type of MB were further compared. Results Among 84 patients with complete MB,36,30,and 18 patients had mild,moderate,or severe coronary atherosclerosis in the anterior segment of MB;among 116 patients with incomplete MB,45,42,and 29 patients had mild,moderate,or severe coronary atherosclerosis in the anterior segment of MB.In the complete MB group,the TAG-CCO in the anterior segment of MB subgroups were(-0.0086±0.0014)/10 mm,(-0.0170±0.0180)/10 mm,and(-0.0230±0.0026)/10 mm,respectively,in mild,moderate,and severe subgroups(F = 404.728, P<0.001).In the incomplete MB group,the TAG-CCO of patients with mild,moderate and severe coronary stenosis in the anterior segment of MB were(-0.0039±0.0011)/10 mm,(-0.0100±0.0140)/10 mm,and(-0.0160±0.0020)/10 mm,respectively,and the difference among the different stenosis groups was statistically significant(F = 17.756, P < 0.001);the TAG-CCO of patients with mild(t = 16.519, P < 0.001),moderate(t = 2.570, P = 0.012)and severe anterior segment coronary stenosis(t = 10.714, P < 0.001)were significantly lower in the complete MB group than in the incomplete MB group. Conclusions TAG-CCO is correlated with the MB type and the degree of anterior coronary artery stenosis.Thus,TAG-CCO can be used as a predictive indicator for the degree of atheroscleratic stenosis in the anterior segment of MB.

Platelet aggregation is not altered among men with diabetes mellitus.

Platelets are pivotal in arterial thrombosis, and platelet hyperresponsiveness may contribute to the increased incidence of cardiovascular events in diabetes mellitus. Consequently, we hypothesized that increased in vitro platelet aggregation responses exist in men with diabetes mellitus. The Danish Cardiovascular Screening Trial (DANCAVAS) is a community-based cardiovascular screening trial including men aged 65-74years. Platelet aggregation was tested using 96-well light transmission aggregometry with thrombin receptor-activating peptide (TRAP), adenosine diphosphate, collagen type 1, arachidonic acid and protease-activated receptor-4 in three concentrations. Further, cardiovascular risk factors and coronary artery calcification (CAC), estimated by CT scans and ankle-brachial index, were obtained. Included were 720 men aged 65-74years, 110 with diabetes mellitus. Overall, there was no difference in platelet aggregation among men with versus without diabetes mellitus when adjusting for or excluding platelet inhibitor treatment and men with established cardiovascular disease (CVD). This was true for all agonists, e.g., 10µM TRAP-induced platelet aggregation of median 69% (IQR 53-75) versus 70% (IQR 60-76) in men with versus without diabetes mellitus. Platelet aggregation did not correlate with HbA1c or CAC. Men with diabetes mellitus displayed higher CAC, median 257 Agatston units (IQR 74-1141) versus median 111 Agatston units (IQR 6-420) in the remaining individuals, p < 0.0001. Among outpatients with diabetes mellitus, but no CVD and no platelet inhibitor treatment, neither are platelets hyperresponsive in diabetes mellitus, nor is platelet aggregation associated with glycemic status or with the degree of coronary atherosclerosis. ISRCTN12157806.

Association of calciprotein particles measured by a new method with coronary artery plaque in patients with coronary artery disease: A cross-sectional study

BackgroundCalciprotein particles (CPPs) have been suggested to be associated with the degree of coronary atherosclerosis, and have also been established as a molecular marker for clinical outcome in patients with chronic kidney disease (CKD). However, there are several concerns with regard to conventional measurement of CPPs. We therefore developed a new CPP measurement system that can detect both smaller and lower-density CPPs. MethodsWe analyzed 71 consecutive patients who underwent percutaneous coronary intervention for acute coronary syndrome (ACS, n=29) and/or stable angina pectoris (AP, n=42) who did not have CKD of stage 4 or greater. CPP measurement was made using an infrared fluorescent bisphosphonate (OsteoSense, PerkinElmer, Waltham, MA, USA) and a gel filtration method. The coronary artery plaque was analyzed by gray-scale intravascular ultrasound (IVUS) and integrated backscatter (IB)-IVUS. ResultsThe median CPP level (interquartile range) was 40,953 (19,171–74,131) arbitrary units (AU). When we divided the CPP level into quintiles, the total and lipid plaque volume were incrementally higher with increasing quintile from lowest to highest (both p<0.02). After adjustment by age, body mass index, and estimated glomerular filtration rate, which factors were correlated with the above-described plaque components, the top quintile of CPP (>86,751AU) had significantly higher total plaque (263mm3 vs. 161mm3; p=0.001) and lipid plaque volume (156mm3 vs. 89mm3; p<0.001) than the other quintiles. However, these associations were not found for the fibrous or calcified plaque volume. The CPP level was higher in the ACS group than the stable AP group (p=0.02), and the total and lipid plaque volume were also higher in the ACS group than the stable AP group (both p<0.05). ConclusionsThe results suggested that a high CPP level, as measured by the novel assay, is a surrogate marker for coronary atherosclerosis, especially in lipid-rich plaques, contributing to an increased risk of plaque vulnerability.

DNA methylation and hydroxymethylation are associated with the degree of coronary atherosclerosis in elderly patients with coronary heart disease

AimsDNA methylation and hydroxymethylation are significantly related to the occurrence and development of coronary heart disease (CHD) and atherosclerosis (AS). 5-Methylcytosine (5-mC) and 5-hydroxymethylcytosine (5-hmC) are used to assess DNA methylation and hydroxymethylation levels, respectively. However, 5-mC and 5-hmC levels associated with CHD remain controversial. In the present study, we aimed to investigate the association of the peripheral blood levels of 5-mC and 5-hmC and the degree of coronary atherosclerosis in elderly CHD patients. Main methods5-mC and 5-hmC levels in peripheral blood mononuclear cells (PBMCs) were measured in 44 CHD patients and 42 matched control subjects by ELISA and dot blot analysis. Immunohistochemical staining was used to observe 5-mC, 5-hmC and TET2 expression in human aortic tissue. Gensini score was used to evaluate the degree of coronary atherosclerosis. Key findings5-mC and 5-hmC levels in PBMCs from CHD patients and in human aortic atherosclerosis plaque were both higher than those in control subjects and in tissue samples. TET2 expression was significantly upregulated in CHD patients compared with control subjects, while only an increasing trend in the expression of DNMT1, DNMT3A and all the other TET genes were found. Spearman correlation analysis demonstrated that 5-mC and 5-hmC levels were positively correlated with Gensini score. 5-mC and 5-hmC were considered as the risk factors for CHD after adjustment. SignificanceDNA methylation and hydroxymethylation levels in PBMCs from elderly CHD patients were significantly increased, showing a positive correlation with the degree of coronary atherosclerosis.

Utility of soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1) in the postmortem diagnosis of ischemic heart disease

PurposeIschemic heart disease (IHD) is a major cause of death in developed countries. Postmortem IHD diagnosis using biochemical markers is difficult because of the postmortem changes. In the present study, we investigated the utility of soluble lectin-like low-density lipoprotein receptor-1 (sLOX-1) in body fluids obtained from forensic autopsy cases. MethodsWe measured pericardial fluid, urine, and serum sLOX-1 levels; these samples were obtained from medicolegal autopsy cases (n = 149, postmortem interval <72 h), and the utility of these biomarkers postmortem acute IHD diagnosis was evaluated. ResultsThe pericardial fluid and urine of patients with acute IHD had higher sLOX-1 levels (p < .05) compared to the controls. No significant differences were found between the sLOX-1 level and the degree of coronary atherosclerosis, body mass index, and postmortem interval. ConclusionsLOX-1 levels in pericardial fluid and urine samples obtained postmortem are useful markers of acute IHD.

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).

The Relationship Between the Level of Parathormone and the Existence and the Degree of Coronary Atherosclerosis

The Relationship Between the Level of Parathormone and the Existence and the Degree of Coronary Atherosclerosis

Fibrinogen in relation to degree and composition of coronary plaque on intravascular ultrasound in patients undergoing coronary angiography.

The aim of this study was to provide additional insight into the role of fibrinogen in coronary artery disease by investigating the associations between plasma fibrinogen with both degree and composition of coronary atherosclerosis as determined by virtual histology-intravascular ultrasound. In 581 patients undergoing coronary angiography for acute coronary syndrome (ACS) or stable angina pectoris, preprocedural blood samples were drawn for fibrinogen, C-reactive protein (CRP), interleukin-6, and plasminogen activator inhibitor-1 measurements, and virtual histology-intravascular ultrasound of a nonculprit coronary artery was performed. The degree [plaque volume, plaque burden (PB), and lesions with PB≥70%] and the composition of coronary atherosclerotic plaque (fibrous, fibrofatty, dense calcium, necrotic core tissue, and thin-cap fibroatheroma lesions) were assessed. Fibrinogen showed a tendency toward a positive association with PB [β (95% CI): 2.55 (-0.52-5.61) increase in PB per ln(g/l) fibrinogen, P=0.09], which was driven significantly by an association in the ACS subgroup [β (95% CI): 4.11 (0.01-8.21) increase in PB per ln(g/l) fibrinogen, P=0.049]. Fibrinogen was also related to the presence of lesions with PB 70% or more in both the full cohort [OR (95% CI): 2.27 (1.17-4.43), P=0.016] and ACS patients [OR (95% CI): 2.92 (1.17-7.29), P=0.022]. All associations were independent of established cardiovascular risk factors, but not CRP. Interleukin-6 and plasminogen activator inhibitor-1 did not provide incremental value to fibrinogen when examining the associations with degree of atherosclerosis. Substantial associations with plaque composition were absent. Fibrinogen is associated with degree of coronary atherosclerosis, especially in ACS patients. However, whether this association is independent of CRP might be questioned and needs further investigation.

Advanced glycation end products, fibroblast growth factors and the development of atherosclerosis in patients with diabetes

Introduction. Atherosclerotic processes are more pronounced at diabetes mellitus (DM). Chronic hyperglycemia activated pathological mechanisms of restructuring the connective tissue, including the vascular wall. Fibroblasts are the main cellular components. Activation of the transforming growth factor (TGFß1), basic fibroblast growth factor (ß-FGF), produced by fibroblasts, inflammatory markers (interleukin-6 (IL-6), tumor necrosis factor (α-TNF), advanced glycation endproducts (AGE) and their receptors (rAGE), may have important prognostic value.Objective. To investigate the level AGE, TGFß1 and ß-FGF in patients with severity atherosclerosis coronary artery disease (CAD), to compare with normal blood glucose and DM.Material and methods. The study involved two groups of patients with CAD: 56 patients of the first group had normal blood glucose and 78 patients suffered from DM type 2. The degree of coronary atherosclerosis was determined by coronary angiography (CAG) in all patients. The blood samples were collected from the aorta during CAG and cubital vein simultaneously, immediately centrifuged (15000g*min), supernatants were stored at –70*C until analysis were done. Serum was analyzed by ELISA (IFA). The critical significance level (p) for statistical hypothesis testing was set at &lt;0.05.Results. Average β-FGF, TGF-ß1, AGE, RAGE in the second group was significantly higher than in the first (p&lt;0.005). Increased level of the AGE, RAGE and TGFß1 was positive correlated with low-density lipoprotein and triglycerides (R=0,049, p&lt;0.005). IL-6 was significantly higher in the second group. There was the significant correlative relationship between the levels AGE, RAGE, TGFß1, ß-FGF and IL-6 with DM duration (R=-0,120; p=0.009), direct association with HbA1C (R=0,429; p=0.006). There were significantly higher level of the AGE, TGFß1 and ß-FGF in aortic blood than in peripheral venous blood p&lt;0,005). IL-6 level had opposite features: serum IL-6 was higher in venous than arterial blood. The patients with DM had three-vessel disease often (73%) then the patients without DM (R = 0,021, p&lt;0.005), which was direct correlated with level TGFß1 (R = 0,03, p&lt;0.005). There weren`t any differences in α-TNF level between two groups.Discussion. High AGE, TGFß1 level and positive correlation with atherogenic lipids may indicate the role of the connective tissue remodeling in pathogenesis of the coronary atherosclerosis. As the longer DM duration led to increasing AGE, TGFß1 and IL-6 levels the chronic hyperglycemia can restructure the vascular wall. Higher AGE, TGFß1 and ß-FGF levels in aorta then in peripheral blood may show the involvement of the cardiomyocytes in these growth factors metabolism.Conclusion. DM existence with CAD was characterized by higher AGE, RAGE, TGFß1 and IL-6 levels, which was direct correlated with the atherogenic lipids. Patients with type 2 DM and CAD had more severe coronary artery disease.

THE ROLE OF MULTIFOCAL ATHEROSCLEROSIS IN DEVELOPMENT OF UNFAVORABLE CARDIOVASCULAR OUTCOMES IN PATIENTS AFTER CORONARY BYPASS GRAFTING

Background: The number of disorders caused by atherosclerosis of various arterial tree is constantly increasing worldwide. Multifocal atherosclerosis (MFA) remains to be an important problem limiting effectiveness of coronary bypass grafting. Aim: To compare one-year rates of unfavorable cardiovascular events in patients, who underwent coronary bypass grafting, depending on the degree of non-coronary stenoses (stenoses of extracranial arteries and lower limb arteries). Materials and methods: Two hundred and thirty two patients, that underwent coronary bypass graft surgery in 2006 due to clinical manifest coronary atherosclerosis, were included into the study. Oneyear outcome (10–12 months) was assessed with the following endpoints: coronary and non-coronary death, myocardial infarction, stroke, angina pectoris and severe chronic heart failure (III–IV functional classes). One-year combined outcome after coronary bypass grafting was considered unfavorable if these events were registered. Results: After initial assessment, patients were divided into 2 groups depending on the degree of coronary atherosclerosis; thereafter, each group was subdivided into subgroups depending on presence or absence of MFA. Compared to patients without MFA, those with hemodynamically significant stenosis (≥ 50%) of non-coronary arteries had higher rates of unfavorable one-year outcomes (р = 0.001). They had higher rates of stroke (20% (5) and 5.8% (12) of patients, respectively, р = 0.03) and of recurrent angina (р = 0.001). Patients with hemodynamically non-significant stenoses (≥ 30%) also had significantly higher rates of unfavorable events, compared to patients without stenoses: myocardial infarction, in 12 (11%) and 3 (2%), respectively (p = 0.006), stroke, in 14 (13%) and 3 (2%) (p = 0.001). Eighty four (79%) patients with MFA had clinical manifestations of angina pectoris, whereas among those without MFA, only 23 (18%) of patients (p = 0.0001). Severe chronic heart failure was significantly more frequent in the MFA group, than in patients with isolated coronary atherosclerosis (38 (36%) and 21 (17%) patients, respectively, p = 0.002). In the MFA group, 10 (9%) patients died, while in the group without MFA there was one death (0.8%) (p = 0.003). Conclusion: Taking into account non-coronary stenoses of ≥ 30%, compared to only hemodynamically significant stenoses of ≥ 50%, produces more significant differences in clinical and historical characteristics of patients.