Early Diagnosis Of Coronary Artery Disease Research Articles

Serum anti-DIDO1, anti-CPSF2, and anti-FOXJ2 antibodies as predictive risk markers for acute ischemic stroke

BackgroundAcute ischemic stroke (AIS) is a serious cause of mortality and disability. AIS is a serious cause of mortality and disability. Early diagnosis of atherosclerosis, which is the major cause of AIS, allows therapeutic intervention before the onset, leading to prevention of AIS.MethodsSerological identification by cDNA expression cDNA libraries and the protein array method were used for the screening of antigens recognized by serum IgG antibodies in patients with atherosclerosis. Recombinant proteins or synthetic peptides derived from candidate antigens were used as antigens to compare serum IgG levels between healthy donors (HDs) and patients with atherosclerosis-related disease using the amplified luminescent proximity homogeneous assay-linked immunosorbent assay.ResultsThe first screening using the protein array method identified death-inducer obliterator 1 (DIDO1), forkhead box J2 (FOXJ2), and cleavage and polyadenylation specificity factor (CPSF2) as the target antigens of serum IgG antibodies in patients with AIS. Then, we prepared various antigens including glutathione S-transferase-fused DIDO1 protein as well as peptides of the amino acids 297–311 of DIDO1, 426–440 of FOXJ2, and 607–621 of CPSF2 to examine serum antibody levels. Compared with HDs, a significant increase in antibody levels of the DIDO1 protein and peptide in patients with AIS, transient ischemic attack (TIA), and chronic kidney disease (CKD) but not in those with acute myocardial infarction and diabetes mellitus (DM). Serum anti-FOXJ2 antibody levels were elevated in most patients with atherosclerosis-related diseases, whereas serum anti-CPSF2 antibody levels were associated with AIS, TIA, and DM. Receiver operating characteristic curves showed that serum DIDO1 antibody levels were highly associated with CKD, and correlation analysis revealed that serum anti-FOXJ2 antibody levels were associated with hypertension. A prospective case–control study on ischemic stroke verified that the serum antibody levels of the DIDO1 protein and DIDO1, FOXJ2, and CPSF2 peptides showed significantly higher odds ratios with a risk of AIS in patients with the highest quartile than in those with the lowest quartile, indicating that these antibody markers are useful as risk factors for AIS.ConclusionsSerum antibody levels of DIDO1, FOXJ2, and CPSF2 are useful in predicting the onset of atherosclerosis-related AIS caused by kidney failure, hypertension, and DM, respectively.

Circulating miRNA in Atherosclerosis: A Clinical Biomarker and Early Diagnostic Tool.

Atherosclerosis, a vascular disease, is characterized by narrowing the arteries and forming plaque inside arteries. There is a record of 17.5 million associated deaths recorded annually, representing 31% of global death. It has been noted that there is an association between vascular fibrosis and atherosclerosis. The thickening of the arterial wall and reduction of the lumen diameter may cause unwarranted deposition of extracellular matrix (ECM), and these conditions help in the progression of many clinical diseases and pathological conditions, such as atherosclerosis. Here, we reviewed the involvement of various circulating microRNAs (miRNAs) in the very early diagnosis of atherosclerosis. We have also tried to provide an insight into the advantages and validation of circulating miRNAs through different techniques. We have discussed different circulating miRNAs, such as miR-17, miR-17-5p, miR-29b, miR-30, miR-92a, miR-126, miR-143, miR-145, miR-146a, miR-212, miR-218, miR-221, miR-222 and miR- 361-5p as a biomarker for clinical diagnosis of atherosclerosis. The insightful demonstration in this review will offer a better opportunity for the researchers and technology developers in understanding the current scenario of circulating miRNA, which could facilitate them in improving the current diagnostic technologies of atherosclerosis in clinics.

Detection of Coronary Artery Disease by an Erectile Dysfunction Questionnaire.

Background Erectile dysfunction (ED) has been become an important health challenge in recent years affecting the quality of life significantly. In addition to imposed social problems, it may warn the existence of cardiovascular diseases especially that of ischemic heart disease (IHD). We aimed to investigate the association between ED and coronary artery disease (CAD) in a population of patients with stable angina based on angiographic findings. Methods In this cross-sectional study, among patients who are diagnosed with stable angina referring for coronary angiography (excluding those with acute coronary syndrome), 200 patients were selected. They were divided equally into two groups of case and control. The former were positively CAD patients and the latter were normal peers, with respect to angiographic results. International index of erectile function (IIEF) questionnaire was used in order to evaluate erectile function during recent four weeks. Statistical analyses of the t-test and logistic regression were performed. The significance level was considered as a P value less than 5%. Results The age range of the patients was 40–65 years old. The case group was significantly older (P=0.001). There was a remarkable relation between the low score from IIEF (ED) and existence of CAD. Also, the severity of ED was in a close relationship with severity of CAD. In addition, dyslipidemia in terms of high LDL and low HDL was associated with both ED and severity of CAD. Conclusion Other than CAD, ED could be considered as one of the manifestations of atherosclerosis. Accordingly, the IIEF questionnaire is a useful tool to early diagnosis of CAD. Also, IIEF-derived scores estimate CAD severity. We suggest subjects with low score of IIEF examine their cardiovascular health with special attention to possible existence of IHD.

Peculiarities of Immune Regulation in Men of Perm Region with Atherosclerosis Related to Polymorphism of Candidate Genes.

The study examined peculiarities of immune regulation and associated polymorphic variants of candidate genes in men with atherosclerosis in Perm region. The revealed deficiency of CD127 lymphocytes and Annexin V-FITC+7AAD- cells, as well as enhanced level of CD3+CD4+ lymphocytes against the background of variant alleles of candidate genes FAS (rs1159120), CPOX (rs1131857) and wild-type alleles SULT1A1 (rs9282861), MMP9 (rs17576) are responsible for peculiar features of hereditary determination and pathogenesis of atherosclerosis in examined sample (p<0.05). The genetically determined degradation of extracellular matrix in vascular wall and implication of regulated Fas/APO1 apoptosis in the development of progressive atherosclerotic lesions indicate important role of immune system in atherogenesis. The revealed immunological and genetic features are recommended as the markers for early diagnosis of atherosclerosis and its prevention in men of Perm region.

Numerical Studies of Blood Flow in Left Coronary Model

Introduction: Artery blockage is the most prevailing cause of Coronary Artery Disease (CAD). The presence of blockage inside the artery breaks the continuity of blood supply to the other part of the body and therefore causes for heart attack. Objective: Two different three-dimensional models namely; normal and 50% plaque are used for the numerical studies. Five inlet velocities 0.10, 0.20, 0.50, 0.70 and 0.80 m/s are considered corresponding to different blood flow conditions to study the effect of velocity on the human heart. Methods: Finite Volume Method (FVM) based Computational Fluid Dynamics (CFD) technique is executed for the numerical simulation of blood flow. Hemodynamic factors are computed and compared for the two geometrical models (Normal Vs. Blockage model). Results: Blood hemodynamic factor i.e. Area Average Wall Shear Stress (AAWSS) ranges from 4.1-33.6 Pa at the façade of the Left Anterior Descending (LAD) part of the Left Coronary Artery (LCA) for the constricted artery. Conclusion: The predominantly low WSS index is analogous to the normal artery affirms the existence of plaque. From the medical point of view, this can prove as an excellent factor for early diagnosis of CAD. Therefore, a hindrance can be created in the increasing frequency of Myocardial Infarction (MI). In future research we will adopt the unsteady flow with both rigid and elastic arterial wall.

Diagnostic Value of Circulating MicroRNAs for Middle Aged Coronary Artery Disease Patients: A Case-control Study

Introduction: Coronary Artery Disease (CAD) remains a major problem worldwide. New and useful biomarkers for early diagnosis are necessary. MicroRNAs (miR) are short, non-coding RNAs that post transcriptionally regulate gene expression through degradation and translational repression of mRNAs. Aim: The current case-control study was designed to assess strength and relevance of diagnostic miR-126, 122 and Vascular Endothelial Growth Factor (VEGF) level in the diagnoses of angiographically proven CAD cases. Materials and Methods: Circulating levels of miR-126 and miR-122 and VEGF levels were measured in serum from 100 middle aged 46-58 years patients with CAD and 100 patients without CAD through quantitative real-time polymerase chain reaction (qRT-PCR) analysis. Results: Circulating miR-122 level was significantly higher in CAD cases compared to control (1.60±1.06 and 0.93±0.43, p=0.001), however miR-126 was significantly lowered in CAD cases compared to control (0.82±0.51 and 1.01±0.47, p=0.02). Circulating VEGF level was significantly higher in CAD cases compared to control (182.97±156.49 and 105.49±103.88, p=0.02). Circulating miR-122, 126 and VEGF level did not show any association with demographic and clinical parameters. Area Under the Curve (AUC) for circulating miR-122, 126 and VEGF were 0.700, 0.644 and 0.649 with sensitivity and specificity of 66.67%, 56.41%, 61.18% and 70%, 60% and 64%, respectively. The combined diagnostic efficacy of miR-122 and 126 showed higher sensitivity and specificity. Conclusion: Circulating miR-122 and 126 might be novel, non-invasive biomarkers for early diagnosis of CAD. Further exposition of the role of miR-122, 126 and VEGF in the progression of CAD will add to the understanding of the disease process leading to a new diagnostic approach. However, further studies on larger patient cohorts are required to validate the findings.

Ateroma arteri karotis pada radiograf panoramik sebagai diagnosis awal aterosklerosis

Objectives: This review aimed to understand the radiographic features of carotid artery atheroma on panoramic radiographs as an early diagnosis of atherosclerosis. &#x0D; Literature Review: Carotid artery calcification is caused by a plaque known as an atheroma. Atheroma is a plaque composed of lipids and rich in calcium. If atheroma formation in the carotid arteries increases, it would cause stenosis of the blood vessels and increase the risk of stroke. On panoramic radiographs, carotid artery atheroma appears as a heterogeneous radiopaque image with an irregular shape and well-defined borders. Radiopaque image located inferior to the angle of the mandible, close to the cervical spine (C3-C5) and above the hyoid bone.&#x0D; Conclusion: Incidental findings on panoramic radiograph could be an initial reference for further examination and evaluation of atherosclerosis.

ROLE OF miRNAs IN CORONARY ARTERY DISEASE: A MINI REVIEW

While coronary artery disease (CAD) has become a major threat worldwide, early diagnosis of CAD, based on timely biomarkers, remains a major unmet clinical challenge. Micro-RNAs (miRNAs) play a pivotal role in development of the cardiovascularsystem while they are associated with multiple cardiovascular diseases. Several cardiac miRNAs (circulating miRNAs) are observable in circulation and function as biomarkers for CVDs diagnosis and therapy. C-miRNAs display various critical features as biomarkers although their distribution is incredibly stable in circulation; their expression is tissue-/diseasespecific and can be easily identified using sequence-specific amplification methods. Such circulating-miRNAs features are useful in designing non-invasive assays to track the development of CVDs. Given substantial success in serum and plasma identification of c-miRNAs. There are several conflicting studies on the alterations of circulating miRNAs concentration in circulation system. Measurements of microRNA (miRNA, miR) in patients with coronary heart disease are impeded by the confoundingeffects of medication commonly used in cardiovascularpatients.

Single-Cell Immune Profiling in Coronary Artery Disease: The Role of State-of-the-Art Immunophenotyping With Mass Cytometry in the Diagnosis of Atherosclerosis.

Coronary artery disease remains the leading cause of death globally and is a major burden to every health system in the world. There have been significant improvements in risk modification, treatments, and mortality; however, our ability to detect asymptomatic disease for early intervention remains limited. Recent discoveries regarding the inflammatory nature of atherosclerosis have prompted investigation into new methods of diagnosis and treatment of coronary artery disease. This article reviews some of the highlights of the important developments in cardioimmunology and summarizes the clinical evidence linking the immune system and atherosclerosis. It provides an overview of the major serological biomarkers that have been associated with atherosclerosis, noting the limitations of these markers attributable to low specificity, and then contrasts these serological markers with the circulating immune cell subtypes that have been found to be altered in coronary artery disease. This review then outlines the technique of mass cytometry and its ability to provide high‐dimensional single‐cell data and explores how this high‐resolution quantification of specific immune cell subpopulations may assist in the diagnosis of early atherosclerosis in combination with other complimentary techniques such as single‐cell RNA sequencing. We propose that this improved specificity has the potential to transform the detection of coronary artery disease in its early phases, facilitating targeted preventative approaches in the precision medicine era.

Circulating miR-133b and miR-21: potential non-invasive diagnostic biomarkers of coronary artery disease

Abstract Background While coronary artery disease (CAD) has become a major threat worldwide, the timely biomarker-based early diagnosis of CAD remains a major unmet clinical challenge. Purpose We aimed towards assessing the level of circulatory microRNAs as candidates of novel biomarkers in early diagnosis of CAD. Methods A total of 147 subjects were recruited from Delhi and surrounding regions which includes 78 subjects with angiographically proven CAD, 15 pre-atherosclerotic normal coronary artery (NCA) subjects and 54 healthy individuals. Quantitative real-time PCR assays were performed using total RNA isolated from plasma of CAD patients and healthy individuals in order to measure the relative expression profiles of circulating miR-133b and miR-21. The severity level of the disease in each individual was assessed on the basis of number of diseased vessels involved and extent of stenosis. Results MiR-133b was found to be significantly downregulated (p&amp;lt;0.05) by 4.6 fold whereas miR-21 was significantly upregulated (p&amp;lt;0.05) by ∼2 fold in plasma samples of CAD patients as compared to healthy individuals. Importantly, both the miRNAs showed an association with disease severity as miR-133b was downregulated by 8.45 fold in acute coronary syndrome (ACS), 3.38 fold in Stable angina (SA) and 2.08 fold in NCA. MiR-21 was upregulated by 2.46 fold in ACS, 1.90 fold in SA and 1.12 fold in NCA. Moreover, miR-133b could significantly differentiate subjects with ST-elevation myocardial infarction (STEMI) from Non-STEMI. Both the miRNAs exhibited a noteworthy diagnostic potential as translated through an upstanding sensitivity and specificity. MiR-133b showed an area under the curve (AUC): 0.80 with 75.6% sensitivity and 76% specificity at recommended optimal cut-off point of 14.0 whereas, miR-21 showed and AUC value of 0.79 with 72.2% sensitivity and 69.4% specificity at optimal cut-off point of 5.59 as assessed by receiver operating characteristics (ROC) curve analysis. Conclusions The reduced expression of miR-133b and elevated expression level of miR-21 in plasma suggest their significant role in the pathophysiology as well as their implication towards the individual's susceptibility in developing CAD. Thus, we conclude that these two circulating miRNAs could be possible candidates of non-invasive biomarkers in the early prediction and diagnosis of CAD. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Department of Science and Technology, New Delhi, India; University Grant Commission (JRF/SRF Fellowship: Ref no. 22/12/2013(ii)EU-V

Small dense low-density lipoprotein-lowering agents.

Metabolic disorders, including obesity, diabetes, and hyperlipidemia, as well as cardiovascular diseases (CVD), particularly atherosclerosis, are still leading causes of death worldwide. Plasma levels of low-density lipoprotein (LDL) are currently being considered as a critical risk factor for the diseases mentioned above, especially atherosclerosis. Because of the heterogeneous nature of LDL, many studies have already been conducted on its subclasses, especially small dense LDL (sdLDL). According to available evidence, sdLDL levels can be considered as an ideal alternative to LDL levels for monitoring CVD and early diagnosis of atherosclerosis. Recently, several researchers have focused on factors that are able to decrease sdLDL levels and improve health quality. Therefore, the purpose of this study is to describe the production process of sdLDL particles and review the effects of pharmaceutical and dietary agents as well as lifestyle on sdLDL plasma levels. In brief, their mechanisms of action are discussed. Apparently, cholesterol and LDL-lowering compounds are also effective in the reduction of sdLDL levels. In addition, improving lipid profile, especially the reduction of triglyceride levels, appropriate regimen, and lifestyle can decrease sdLDL levels. Therefore, all the aforementioned parameters should be taken into consideration simultaneously in sdLDL levels reducing strategies.

Troponins, Adhesion Molecules, and Interleukins as Diagnostic Markers of CVDs: Expression in Peripheral Tissues

Cardiovascular disease (CVD) is one of the main causes of mortality for middle-aged and elderly people in developed countries. The early diagnostic of CVD in middle-aged and elderly people is often hampered by the absence of characteristic clinical picture of the disease. The early diagnosis of atherosclerosis, coronary heart disease (CHD), and myocardial infarction (MI) and their correction improves the survival prognosis and the quality of life of patients. The concentration of the cardinal troponins hs-cTnT and hs‑cTnI, ICAM-1, the adhesion molecules V-CAM1, E-LAM1, and the IL-1α, 1β, -4, -5, -6, -13, -17 cytokines in blood plasma were studied in order to assess the effectiveness of the treatment of atherosclerosis, CHD, and MI. The study of the concentration of ICAM-1, growth factor GDF15, and the NOTCH1 transmembrane protein in blood plasma and urine was recommended for the predictive diagnostic of these diseases. Assessment of the expression of these signal molecules in peripheral tissues for the prediction and prognosis of CVD is a rapidly developing area of molecular medicine and gerontology.

Circulatory miR-133b and miR-21 as Novel Biomarkers in Early Prediction and Diagnosis of Coronary Artery Disease

While coronary artery disease (CAD) has become a major threat worldwide, the timely biomarker-based early diagnosis of CAD remains a major unmet clinical challenge. We aimed towards assessing the level of circulatory microRNAs as candidates of novel biomarkers in patients with CAD. A total of 147 subjects were recruited which includes 78 subjects with angiographically proven CAD, 15 pre-atherosclerotic normal coronary artery (NCA) subjects and 54 healthy individuals. Quantitative real-time PCR assays were performed. MiR-133b was downregulated by 4.6 fold (p < 0.0001) whereas miR-21 was upregulated by ~2 fold (p < 0.0001) in plasma samples of CAD patients. Importantly, both the miRNAs showed association with disease severity as miR-133b was downregulated by 8.45 fold in acute coronary syndrome (ACS), 3.38 fold in Stable angina (SA) and 2.08 fold in NCA. MiR-21 was upregulated by 2.46 fold in ACS, 1.90 fold in SA and 1.12 fold in NCA. Moreover, miR-133b could significantly differentiate subjects with ST-elevation myocardial infarction (STEMI) from Non-STEMI. Area under the curve (AUC) for miR-133b was 0.80 with >75.6% sensitivity and specificity, AUC for miR-21 was 0.79 with >69.4% sensitivity and specificity. Our results suggest that miR-133b and miR-21 could be possible candidates of novel biomarkers in early prediction of CAD.

Comprehensive electrocardiographic diagnosis based on deep learning.

Cardiovascular disease (CVD) is the leading cause of death worldwide, and coronary artery disease (CAD) is a major contributor. Early-stage CAD can progress if undiagnosed and left untreated, leading to myocardial infarction (MI) that may induce irreversible heart muscle damage, resulting in heart chamber remodeling and eventual congestive heart failure (CHF). Electrocardiography (ECG) signals can be useful to detect established MI, and may also be helpful for early diagnosis of CAD. For the latter especially, the ECG perturbations can be subtle and potentially misclassified during manual interpretation and/or when analyzed by traditional algorithms found in ECG instrumentation. For automated diagnostic systems (ADS), deep learning techniques are favored over conventional machine learning techniques, due to the automatic feature extraction and selection processes involved. This paper highlights various deep learning algorithms exploited for the classification of ECG signals into CAD, MI, and CHF conditions. The Convolutional Neural Network (CNN), followed by combined CNN and Long Short-Term Memory (LSTM) models, appear to be the most useful architectures for classification. A 16-layer LSTM model was developed in our study and validated using 10-fold cross-validation. A classification accuracy of 98.5% was achieved. Our proposed model has the potential to be a useful diagnostic tool in hospitals for the classification of abnormal ECG signals.

MiR-15a Functions as a Diagnostic Biomarker for Coronary Artery Disease.

The present study aimed to explore the diagnostic value of miR-15a in coronary artery disease (CAD). After recruiting all the participants, peripheral blood samples were obtained according to the instructions. miR-15a expression was evaluated using real-time quantitative polymerase chain reaction (RT-qPCR) and IL-6, TNF-α, and hs-CRP expressions were detected using ELISA kits. The results elucidated a significantly decreased expression of miR-15a in peripheral blood samples from CAD patients compared to non-CAD controls (p < 0.01). Meanwhile, miR-15a expression was negatively correlated with LDL-C and Gensini score (p = 0.0059, 0.0243, respectively). Moreover, miR-15a expression was negatively correlated with inflammatory cytokines IL-6, TNF-α, and hs-CRP (p = 0.0009, 0.0178, 0.0005, respectively). The receiver operating curve (ROC) curve analysis demonstrated that miR-15a was a promising biomarker for early diagnosis of CAD with an area under the curve (AUC) of 0.9368. The present study elucidated a decreased miR-15a expression in CAD patients and showed negative correlations with LDL-C, Gensini score, and inflammatory cytokines. miR-15a may serve as a promising biomarker for early diagnosis of CAD.

Clinical significance of circulating microRNAs as diagnostic biomarkers for coronary artery disease.

Coronary artery disease (CAD) is one of the biggest threats to human life. Circulating microRNAs (miRNAs) have been reported to be linked to the pathogenesis of CAD, indicating the possible role in CAD diagnosis. The present study aimed to explore the expression profile of plasma miRNAs and estimate their value in diagnosis for CAD. 67 Non‐CAD control subjects and 88 CAD patients were enrolled. We conducted careful evaluation by RT‐PCR analysis, Spearman rank correlation coefficients analysis, Receiver Operating Characteristic (ROC) curves analysis and so on. The plasma levels of six miRNAs known to be related to CAD were measured and three of them showed obvious expression change. Circulating miR‐29a‐3p, miR‐574‐3p and miR‐574‐5p were all significantly increased. ROC analysis revealed the probability of the three miRNAs as biomarkers with AUCs (areas under the ROC curve) of 0.830, 0.792 and 0.789, respectively. They were significantly correlated with each other in CAD patients, suggesting the possibility of joint diagnosis. The combined AUC was 0.915, much higher than each single miRNA. Therefore, our study revealed three promising biomarkers for early diagnosis of CAD. The combination of these miRNAs may act more effectively than individual ones for CAD diagnosis.

A Prospective Study of Prevalence of Carotid Artery Disease in Patients with Coronary Artery Disease and its Correlation with Traditional Atherosclerotic Risk Factors in Central India

Introduction: Early atherosclerosis mainly involves carotid artery, which leads to increased carotid artery intima media thickness (CIMT).The potential value of CIMT improving the predictive capacity of traditional risk factors of CAD is an understudied and underutilized issue. Because of increasing availability of highly sensitive ultrasonography probes and for a noninvasive procedures, we can predict coronary artery disease (CAD) more precisely in patients having multiple traditional risk factors so it may reduce morbidity and mortality due to CAD and elevated CIMT can be used as surrogate marker of underlying CAD. Methods: This study enrolled 250 admitted patients as a case of CAD. The patients were assessed by detailed history taking, thorough clinical examination, measurement of CIMT, blood sugar and lipid level. Results: Carotid artery disease was present in 88 (35%) of 250 CAD patients. All modifiable cardiovascular risk factors were statistically significantly high in patients of CAD with carotid artery disease. In obese, diabetic, hypertensive, dyslipidemia and smoker patients, carotid artery disease was present in 55% (P = 0.00), 41% (P = 0.00), 43% (P = 0.007), 47% (P = 0.002) and 43% (P = 0.003) respectively. CAD patients who had 1 risk factor, 29% were associated with carotid artery disease. Comparison of single risk factor with patients who had no risk factor, there was non-significant correlation for carotid artery disease. CAD patients who had 2, 3, 4 and 5 risk factors, carotid artery disease was present 24 (32%) (p = 0.02), 15 (55%) (P = 0.0003), 17 (61%) (P = 0.00006) and 6 (67%) (P = 0.0008). Conclusion: elevated CIMT can be used as one of the important risk factor for early diagnosis of CAD and to reduce morbidity and mortality due to CAD.

Significance of Microalbuminuria in Predicting Silent Myocardial Ischemia in Patients with Type 2 Diabetes Using Myocardial Perfusion Imaging

Objectives:In light of increased risk of cardiovascular events and the poor prognosis of coronary artery disease (CAD) in diabetic versus non-diabetic patients and also with respect to the importance of early diagnosis of CAD in this status, the study was aimed to assess the importance of microalbuminuria in predicting silent myocardial ischemia (SMI) in patients with type 2 diabetes using myocardial perfusion imaging (MPI).Methods:This study included 120 patients with diabetes type 2, but without previously known CAD or any cardiac symptoms that were stratified into two groups based on presence/absence of microalbuminuria. All participants underwent CAD evaluation using gated myocardial perfusion single-photon emission computed tomography (MPS) imaging. Other clinical and laboratory indices were also recorded.Results:Studied population consisted of 84 males (70%) and 36 females (30%), totally 120 patients with mean age of 58.61±9.90). In total, asymptomatic ischemia was detected in 78 (65%) of the included diabetic patients. Stress induced ischemia was found in 56 patients (87.5%) of albumin+ (Alb) group and in 22 patients (39.3%) of Alb- group. The frequency of stress induced ischemia was 10.81 times higher in the patients with microalbuminuria compared to Alb- ones [p<0.001, Odds ratio: 10.81, 95% confidence interval: 4.33-26.99]. On the other hand, no relationship was found between the presence of stress induced ischemia and therapy type, diabetes duration, history of evident retinopathy, history of hypertension and also serum levels of hemoglobin A1c (p>0.05).Conclusion:The current study showed that abnormal MPI findings are significantly more common in diabetic patients with microalbuminuria. With respect to low cost and availability of urine Alb detection tests, it might be as a biomarker for prediction of SMI in daibetic population.

Global Myocardial Work Is Superior to Global Longitudinal Strain to Predict Significant Coronary Artery Disease in Patients With Normal Left Ventricular Function and Wall Motion

Noninvasive detection of functionally significant coronary artery disease (CAD) by echocardiography remains challenging, with the need to perform stress imaging to detect ischemia. The aim of this study was to determine whether global myocardial work (MW), derived from noninvasive left ventricular (LV) pressure-strain loops at rest, can predict significant CAD in patients without regional wall motion abnormalities and preserved LV ejection fraction (EF). One hundred and fifteen patients referred for coronary angiography who had EF≥55%, no resting regional wall motion abnormalities, and no chest pain were assessed using echocardiography. Global MW was derived from noninvasive LV pressure-strain loops constructed from speckle-tracking echocardiography indexed to brachial systolic blood pressure. Global constructive work represented the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation. Global wasted work represented energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation. Global MW efficiency was derived from the percentage ratio of constructive work to the sum of constructive work and wasted work. Patients with significant CAD demonstrated a significantly reduced global MW (P<.001) compared with those without CAD. Global longitudinal strain was significantly reduced (P<.001) in patients with multivessel CAD but not those with single-vessel CAD (P=.47). Receiver operating characteristic curve analysis demonstrated that global MW was the most powerful predictor of significant CAD (area under the curve=0.786) and was superior to global longitudinal strain (area under the curve=0.693). The optimal cutoff global MW value to predict significant CAD was 1,810mm Hg% (sensitivity, 92%; specificity, 51%). Noninvasive global MW derived using LV pressure-strain loops at rest is a more sensitive index than global longitudinal strain to detect significant CAD in patients with no regional wall motion abnormalities and normal EF. This is a potential valuable clinical tool to assist in the early diagnosis of CAD.

Study on carotid artery elasticity in elderly patients with metabolic syndrome

Objective To analyze motion characteristics of the carotid artery wall and to evaluate changes of carotid artery elasticity in elderly patients with metabolic syndrome(MS)by using velocity vector imaging(VVI). Methods A total of 111 elderly patients with metabolic syndrome were continuously enrolled in this prospective study.Patients received a health questionnaire, physical examinations, blood biochemical indexes tests, and carotid artery ultrasound examination.According to carotid intima-media thickness(IMT)and carotid plaques, patients were divided into a group of MS with carotid plaques(n=34), a group of MS without carotid plaques(n=31)and a control group(n=46). Dynamic images of the short axial section at 1 cm from the bifurcation of the right common carotid artery were collected in all cases, and the VVI offline software was used to detect and record the maximum radial velocity(V), maximum tangential strain(S)and maximum tangential strain(SR)of each segment as well as the average V(EV), average S(ES)and average SR(ESR)of the entire vessel. Results IMT was higher in the group of MS with carotid plaques than in the group of MS without carotid plaques and the control group(P<0.01), and there was no statistical difference between the group of MS without carotid plaques and the control group(P<0.05). V, S, SR, EV, ES and ESR in the two MS groups were lower than in the control group.There were statistically significant differences in V, S, SR, EV, ES and ESR between the MS groups(P<0.01). EV was negatively correlated with hypertension, hyperglycemia, hypertriglyceridemia and low high-density lipoprotein cholesterol(r=-0.305, -0.625, -0.647 and -0.337, respectively, P<0.01). ES was negatively correlated with hypertension, hyperglycemia, hypertriglyceridemia and low high-density lipoprotein cholesterol(r=-0.252, -0.673, -0.528 and -0.273, respectively, P<0.01 or 0.05). ESR was negatively correlated with hypertension, hyperglycemia, hypertriglyceridemia and low high-density lipoprotein cholesterol(r=-0.315, -0.697, -0.609 and -0.385, respectively, P<0.01 or 0.05). Conclusions VVI technology can assess the motion characteristics of the carotid artery wall, evaluate changes of carotid artery elasticity earlier than conventional ultrasound in elderly MS patients, and therefore provide a theoretical basis for the early diagnosis of atherosclerosis. Key words: Metabolic syndrome X; Carotid; Velocity vector imaging