Form Of Atherosclerosis Research Articles

The Structure of SleepDisordered Breathing and Cognitive Impairment in Cerebrovascular Diseases

Abstract. Obstructive sleep apnea syndrome (OSAS) is considered one of the risk factors for cognitive impairment (CogI). The role of central apnea (CA) in the development of CI has not been established. Aim — to study the features of the structure of sleep-disordered breathing (SDB) in patients with chronic cerebrovascular disease (CVD) and clarify their significance as a risk factor for CogI. Material and methods. 100 patients (50 men, 50 women) at the age of 65 (58; 74.5) years were examined. Most had arterial hypertension (AH) and atherosclerosis of the brachiocephalic arteries; less commonly, stable forms of coronary artery disease and diabetes mellitus (DM) type 2. All patients were diagnosed with stage I–II dyscirculatory encephalopathy. Previously, non-disabling stroke was suffered by 37% of patients (mRS 0–2 points). Everyone completed the MoCA test. SDB was verified during cardiorespiratory monitoring (CT-04-3R (M), “INKART”, St. Petersburg). We estimated the number of episodes of SDB, obstructive apnea, CA, apnea/hypopnea index (AHI), duration and degree of desaturation. The correlation, discriminant and ROC analysis, the calculation of the odds ratio (OR) and the confidence interval (CI) of the occurrence of the event are performed. Results. SDB (AHI ≥ 5) according to the type of OSAS and CA were detected in 82% of patients. The average AHI was 13 (8; 21). CogI (MoCA < 26) were detected in 28% of patients without SDB and 52% of patients with SDB (p = 0.03). The relationship between the assessment of MoCA and AHI (Spearman, r = –0.24, p = 0.02) was established. A discriminant analysis with step-by-step inclusion of cardiovascular risk factors and SDB parameters revealed that CA, the degree of AH, age and DM are associated with the development of CN (Wilks’s Lambda: 0.75542; approx. F(4,73) = 5.9087, p < 0.0004). A threshold value of CA ≥ 5 was established (AUC 0.741, 95% CI 0.595–0.828; sensitivity 64%, specificity 76%), while the OR is 5.5 (95% CI 2.09–14.90). Conclusion. In 82% of patients with chronic CVD, SDB is detected, which is associated with a twofold increase in the frequency of CogI. Moreover, the most significant is the presence in the SDB structure of 5 or more episodes of CA, which serve not as a cause of CogI, but as a marker of more severe structural and functional cerebral changes.

Use of Cardiac CT in the Routine Assessment of Cardiac Allograft Vasculopathy in Heart Transplant Patients: Results from the First 100 Consecutive Patients

Cardiac allograft vasculopathy (CAV) is an accelerated form of coronary artery disease that affects heart transplant patients (HTx). Routine screening for CAV is warranted. We evaluated the feasibility and utility of cardiac CT to screen for CAV in 100 consecutive HTx patients at our center. From Feb 2018 to Jan 2019 all consecutive HTxs who were more than five-years post-transplant were converted from using stress myocardial perfusion imaging to cardiac CT for the annual assessment of CAV. CAV was scored (0 (absent), 1 (mild), 2 (moderate), 3 (severe)) based on coronary CT angiography (CCTA) findings and compared with the most recently known CAV score before CCTA. CCTA was performed in 99 out of 100 patients who were planned for cardiac CT (56 (42-63) years, 65% men, and 11 (8-16) years post-transplant), 1 patient underwent only a calcium scan due to IV access problems. The median Agatston calcium score was 6 (0-85), and 38 patients had no detectable calcium. CCTA showed new obstructive coronary disease (>50% stenosis) in 20 patients. The CAV score was reclassified based on CCTA findings in 37 patients (p<0.001) (Figure 1). There were 53 CAV0, 22 CAV1, 11 CAV2 and 14 CAV3 patients. Mean heart rate during scanning was 75±11 beats per minute and beta-blockers were required in 63 patients. Median radiation dose was 2.5 (1.9-3.5) mSv. Two cases are presented in Figure 2. Cardiac CT can be successfully performed in HTxs with a low radiation dose. CCTA detects patients with significant coronary disease which leads to substantial reclassification of CAV grades.

Discussion of a new classification for coronary artery disease

The article discusses the creation of a new classification for coronary artery disease. The classification of acute and chronic forms of coronary artery disease is proposed as one of the variants.

Effects of Percutaneous Coronary Intervention on Death and Myocardial Infarction Stratified by Stable and Unstable Coronary Artery Disease: A Meta-Analysis of Randomized Controlled Trials.

In patients presenting with ST-segment-elevation myocardial infarction, percutaneous coronary intervention (PCI) reduces mortality when compared with fibrinolysis. In other forms of coronary artery disease (CAD), however, it has been controversial whether PCI reduces mortality. In this meta-analysis, we examine the benefits of PCI in (1) patients post-myocardial infarction (MI) who did not receive immediate revascularization; (2) patients who have undergone primary PCI for ST-segment-elevation myocardial infarction but have residual coronary lesions; (3) patients who have suffered a non-ST-segment-elevation acute coronary syndrome; and (4) patients with truly stable CAD with no recent infarct. This analysis includes data from the recently presented International Study of Comparative Health Effectiveness with Medical and Invasive Approaches (ISCHEMIA) and Complete versus Culprit-Only Revascularization Strategies to Treat Multivessel Disease after Early PCI for STEMI (COMPLETE) trials. We systematically identified all randomized trials of PCI on a background of medical therapy for the treatment of CAD. The ISCHEMIA trial, presented in November 2019, was eligible for inclusion. Data were combined using a random-effects meta-analysis. The primary end point was all-cause mortality. Forty-six trials, including 37 757 patients, were eligible. In the 3 unstable scenarios, PCI had the following effects on mortality: unrevascularized post-MI relative risk (RR) 0.68 (95% CI, 0.45-1.03); P=0.07; multivessel disease following ST-segment-elevation myocardial infarction (RR, 0.84 [95% CI, 0.69-1.04]; P=0.11); non-ST-segment-elevation acute coronary syndrome (RR, 0.84 [95% CI, 0.72-0.97]; P=0.02). Overall, in these unstable scenarios PCI was associated with a significant reduction in mortality (RR, 0.84 [95% CI, 0.75-0.93]; P=0.02). In unstable CAD, PCI also reduced cardiac death (RR, 0.69 [95% CI, 0.53-0.90]; P=0.007) and MI (RR, 0.74 [95% CI, 0.62-0.90]; P=0.002). For stable CAD, PCI did not reduce mortality (RR, 0.98 [95% CI, 0.87-1.11]), cardiac death (RR, 0.89 [95% CI, 0.71-1.12]; P=0.33), or MI (RR, 0.96 [95% CI, 0.86-1.08]; P=0.54). PCI prevents death, cardiac death, and MI in patients with unstable CAD. For patients with stable CAD, PCI shows no evidence of an effect on any of these outcomes.

ST2 PLASMA LEVEL IN PATIENTS WITH ACUTE MYOCARDIAL INFARCTION WITHOUT ST ELEVATION AND DIFFERENT CLINICAL CHARACTERISTICS

The aim. Estimation of ST2 plasma level in patients with acute myocardial infarction without ST elevation (NSTEMI) and its relationship with different clinical characteristics. Materials and methods. 165 patients aged from 35 to 79 (average of 60.7±0.8 years) with various forms of coronary artery disease (CAD) with and without arterial hypertension were examined. The variability of plasma ST2 level in different forms of CAD and in NSTEMI group was analyzed depending on gender-age and clinical characteristics and features of the disease course. Results: The results of the present investigation were that the ST2 level in the main cohort was in range from 5.5 to 233.9 (in the middle – 49.8±3.5 ng / ml (median indicator – 34.7 and the interquartile range – 21.9 and 59.1 respectively). Significantly higher ST2 levels were found in patients with NSTEMI, unlike the comparison group, in the median analysis (35.9 vs. 27.7 ng/ml, p=0.047) and no statistical differences were observed in the mean values. In patients with NSTEMI, a certain association of ST2 level in plasma with the MI course was detected. A higher level of neurohormone is registered with anterior unlike posterior ECG localization of MI; at high unlike moderate risk on the GRACE scale; when complicated unlike the uncomplicated course of MI; in the case of acute HF and cardiac arrhythmias unlike patients with the absence of these manifestations in the acute period of MI. Conclusions. High variability of ST2 level in plasma was demonstrated in patients with NSTEMI on the first day after destabilization (minimum and maximum values – 12.7 and 233.9 respectively, median – 35.9 and interquartile range – 25.9 and 55.7 ng / ml). It is shown that significantly higher ST2 level in plasma is determined in patients with acute MI regardless of its variant among different clinical forms of CAD. It is found that significantly higher level of ST2 in patients with NSTEMI is recorded in the case of concomitant HTN and type 2 diabetes, with smoking and heavy cardiovascular heredity. Proved influence of the character of MI course on the level of ST2 in plasma, significantly higher level of neurohormone was determined with anterior localization of MI, high risk on the GRACE scale (≥ 140 points), complicated course of MI, development of cardiac arrhythmias and HF in the acute period of MI.

ЧРЕСКОЖНЫЕ КОРОНАРНЫЕ ВМЕШАТЕЛЬСТВА – СОВРЕМЕННОЕ СОСТОЯНИЕ ВОПРОСА: ЭВОЛЮЦИЯ СТЕНТОВ

Percutaneous coronary interventions (PCI) are essential for treatment of acute and chronic forms of coronary artery disease (CAD) due to beneficial prognostic effect (reduction in mortality) and improvement of quality of life (exercise tolerance) in patients with coronary atherosclerosis. Coronary angioplasty inevitably results in damage to the vascular wall, activation of inflammation and cellular proliferation within the area of stent implantation. Stent thrombosis and in-stent restenosis limit the effectiveness of the PCI. Recurrent angina, myocardial infarction as well as death are possible outcomes. Repeated myocardial revascularization is required therefore. From the very first angioplasty performed until now technologies of stents production have been subject to continuous development towards decreasing PCI complications and increasing long-term effectiveness of stenting. Technical aspects and evolution of stents are discussed in the current review in line with up-to-date technologies, advantages and disadvantages of interventional treatment of patients with CAD.

ANGIOGRAPHIC EVALUATION OF GRAFT PATENCY AFTER MINIMALLY INVASIVE MULTIVESSEL CORONARY BYPASS SURGERY

The OBJECTIVE was to demonstrate perioperative outcomes and angiographic graft patency rates in the mediumterm period in patients after multivessel minimally invasive coronary artery bypass grafting (MICS CABG) procedures.MATERIAL AND METHODS. In the period from 2014 to 2019, 270 patients with stable forms of coronary artery disease were operated on. All patients received left internal thoracic artery (LITA) and venous or arterial (radial artery) grafts. Off-pump surgery was performed in 264 cases (97.8 %). 127 patients underwent CT-bypass angiography (CT-BA) on a 128-slice computed tomography at least after 1 year after the operation. Mean follow-up duration was (30.3±7.9) months.RESULTS. All patients received full myocardial revascularization. Mean number of grafts was (2.6±0.5). Perioperative mortality rate was 0.4 % (1 patient). Perioperative myocardial infarctions or cerebrovascular accident occurred in 3 (1.1 %) and 1 (0.4 %) patients. Overall graft patency rate in examined patients was 89.8 % (290 of 323). At the time of LITA, the patency of mammary grafts was 98.4 % (124 of 126), venous graft –84.0 % (163 of 194) and radial artery grafts – 100 % (3 of 3).CONCLUSION. MICS CABG was safe and effective and was characterized by minimal rate of perioperative complications. This procedure allowed to achieve complete revascularization of the myocardium without sternotomy and could be performed off-pump (in most cases). MICS CABG provide excellent long-term graft patency rates.The authors declare no conflict of interest.The authors confirm that they respect the rights of the people participated in the study, including obtaining informed consent when it is necessary, and the rules of treatment of animals when they are used in the study. Author Guidelines contains the detailed information.

Characteristics of Acute Cerebral Infarction in Patients with Familial Hypercholesterolemia

Background The patients with familial hypercholesterolemia (FH) suffer from early onset atherosclerotic vascular disease due to high level of cholesterol and subsequent vascular inflammation, especially in the form of coronary artery disease. We investigated the clinical characteristics of FH associated cerebral infarction and its possible mechanism. Methods Between January 2014 and May 2017, acute cerebral infarction patients who admitted to Chung-Ang University Hospital were reviewed from stroke registry and the diagnosis of FH was made based on the Dutch Lipid Clinic Network Diagnostic Criteria for FH. We reviewed their initial laboratory and brain imaging information, prescribed medication and followed lipid profile after discharge. Stroke mechanism was determined based on Trial of ORG 10172 in Acute Stroke Treatment classification. Results Among 1,401 acute cerebral infarction or transient ischemic attack patients, one probable and three possible FH stroke patients were detected. All the patients denied of previous coronary artery disease history and initial lipid panel revealed high levels of total cholesterol (378±75 mg/dL) and low-density lipoprotein-cholesterol (238±56 mg/dL). Stroke mechanisms were heterogeneous, including one atherosclerotic, two vertebral artery dissection cases and one coagulation disorder. All the patients were combined with noticeable degree of intracranial atherosclerosis and were maintained with statin treatment. Conclusions This study illustrates diverse stroke mechanism among stroke patients with FH. Further research is required to disclose exact incidence of FH among stroke population and effective treatment strategy. Key Words: Familial hypercholesterolemia, Stroke, Atherosclerosis

Generation of VCCRIi001-A, a human induced pluripotent stem cell line, from a patient with spontaneous coronary artery dissection.

Spontaneous coronary artery dissection (SCAD) is a non-atherosclerotic form of coronary artery disease of unknown cause that predominantly affects women (>90%; mean age 44-55 years) and can be fatal. The finding of familial clustering, including the concordant involvement of monozygotic twins, and its association with the PHACTR1/EDN1 genetic locus, indicate a genetic predisposition to its pathophysiology. A human induced pluripotent stem cell line (hiPSC) was generated from a patient who had survived an episode of SCAD. This disease-specific hiPSC line will be useful for the study of SCAD after differentiation into blood vessel-forming cells.

Comparability of scintigraphy data with coronary angiography after surgical myocardial revascularization

Introduction. Radionuclide imaging is included in diagnostic methods after PCI and CABG in patients with symptoms, but the recommendations caution against routine testing in all asymptomatic patients after revascularization. The paper shows the results of single-photon emission computed tomography after hybrid coronary myocardial revascularization; an analysis of the sensitivity and specificity of three methods of surgical myocardial revascularization was carried out in 12 months.Aim of the study was to determine the sensitivity and specificity of SPECT in determining coronary artery stenosis ≥ 50 % after performing three methods of surgical myocardial revascularization: CABG, PCI, and hybrid myocardial revascularization in patients with coronary artery disease and multi-vascular coronary lesion.Material and methods. A retrospective analysis of 82 patients with stable forms of coronary artery disease who underwent myocardial revascularization for the presence of the multivascular coronary lesion was carried out. The patients were divided into three groups: the first group consisted of 40 patients who underwent CABG, the second – 29 patients after PCI, and the third – 23 patients who underwent hybrid myocardial revascularization.Results. All patients after myocardial revascularization, on average, after 21.8±8.6 months, were hospitalized, where singlephoton emission computed tomography of the myocardium with 99mTc-technetril (SPECT) and control coronarography/ shuntography were performed. The frequency of the presence of significant stenosis during coronary angiography with a perfusion defect of ≥5 % on SPECT during exercise was 50, 50 and 33 % in the CABG, PCI, and hybrid revascularization, respectively (p=0.894). The least sensitivity of SPECT was after hybrid myocardial revascularization (20 %), while in the CABG group, the sensitivity was 71.4 % (p = 0.190). The SPECT specificity indices were much higher: in the GABG, PCI, and hybrid revascularization groups, respectively, 75.8, 79 and 88.9 % (p=0.530).Conclusion. There is no significant relationship between the size of the defect on SPECT and coronary angiography data, regardless of the type of surgical myocardial revascularization in patients after myocardial revascularization. Detection of a perfusion defect with a load of more than 10% in SPECT after surgical myocardial revascularization is the basis for coronary angiography in order to exclude stent restenosis or shunt dysfunction, as well as progression of coronary atherosclerosis.

256Heart transplant recipients with cardiac allograft vasculopathy have increased platelet aggregation before and after low-dose aspirin therapy

Abstract Background Following heart transplantation (HTx), long-term survival is reduced mainly due to development of a specific form of coronary artery disease, coronary allograft vasculopathy (CAV). Using optical coherence tomography to visualize the coronary artery wall, we have recently shown that layered fibrotic plaques resembling organized clots are the dominant plaque component in CAV. Thus, thrombosis is suggested as a possible mechanism contributing to development and progression of CAV. Aspirin is widely used after HTx despite limited evidence and lack of specific guidelines. The antiplatelet effect of aspirin has not been thoroughly examined in HTx-patients. Purpose To investigate baseline platelet aggregation and the antiplatelet effect of aspirin in HTx-patients with and without CAV. Methods We included 68 HTx-patients (median 8.6 years from HTx). In 66 patients taking 75 mg aspirin for a minimum of 7 days, platelet aggregation was measured in whole blood using impedance aggregometry with the following agonists: Adenosine diphosphate (ADP) stimulating ADP-receptors and arachidonic acid (AA) for monitoring of aspirin treatment. Aspirin compliance was confirmed by measuring serum-thromboxane B2. Platelet aggregation prior to aspirin therapy was measured in 59 patients as it was not considered clinically safe to interrupt ongoing aspirin treatment for one week prior to blood sampling in 9 patients mainly due to previous coronary stenting. CAV burden was determined by coronary angiography and echocardiography based on international classification. Patients were divided into two groups; no CAV (n=37) and CAV (n=29). Results In HTx-patients not treated with aspirin, we found significantly increased ADP-induced platelet aggregation in patients with CAV vs. patients without CAV (904 (95% CI 813–995) vs. 786 (95% CI 728–843) AU*min, P=0.02). Baseline AA-induced aggregation was also higher in patients with CAV vs. patients without CAV, though non-significant (994 (95% CI 907–1081) vs. 905 (95% CI 839–972) AU*min, P=0.10). Even though aspirin reduced AA-induced platelet aggregation in both groups, patients with CAV had significantly increased AA-induced platelet aggregation compared with patients without CAV on aspirin treatment (380 (95% CI 295–465) vs. 286 (95% CI 239–334) AU*min, P=0.04) (Fig. 1). Conclusions HTx-patients with CAV have increased platelet aggregation before and after aspirin treatment compared with HTx-patients without CAV. Aspirin monotherapy may not provide sufficient platelet inhibition in HTx-patients with CAV. Acknowledgement/Funding Aarhus University (PhD-salary)

L’angor spastique : une pathologie sous-diagnostiquée

The clinical and physiopathological clinical entity known as spastic angina or variant angina has been long documented. It remains, however, an under-estimated condition, which is insufficiently diagnosed and explored. This pathology is associated with severe complications such as heart rhythm disorders, which may potentially result in ventricular fibrillation and cause sudden death. In Japan, this condition occurs more frequently and is better documented. Stimulation tests are also carried out more often and have a higher positivity rate than in France where vasospastic angina is less frequently reported and where provocation tests are associated with negative results and are, consequently, performed less often. In order to improve the detection of this pathology, its potential presence should be explored in patients with rest angina who experience chest pain in the second half of the night and also in instances of acute coronary syndrome with sudden death and no angiographically visible coronary artery disease. The diagnosis should be confirmed by means of ergonovine provocation tests. In order to enhance the sensitivity of these tests without increasing the risk of complications, injection of ergonovine should be preferably carried out via the intracoronary route. By increasing the frequency and sensitivity of these tests, this pathology, which responds well to medical treatment in many cases, could be amenable to therapeutic management as any other form of coronary artery disease.

Nicorandil in the prevention of cardiac damage and type 4A myocardial infarction with planned percutaneous coronary intervention in patients with atherosclerosis of coronary arteries

Aim. To study the possibility of reducing the risk of intraoperative cardiac damage and 4a type myocardial infarction (MI) by administering the oral nicorandil in patients with a stable form of coronary artery disease (CAD) before planned percutaneous coronary intervention (PCI). Material and methods . The study included 182 patients with stable CAD who were randomized to the nicorandil treatment group (n=90) and the control group with a standard treatment (n=92). Nicorandil was prescribed 2 days before PCI (30 mg/day); on the day of PCI — 2 hours before surgery (20 mg orally), 6-12 hours after PCI — 10 mg, later — 30 mg/day within 30 days. The analysis of highly sensitive troponin I (hs-troponin) and creatine kinase-MB (CK-MB) was carried out before PCI and 24, 72 hours after the procedure, the type 4a diagnosis of MI was established according to fourth universal definition. Results . The rate of hs-troponin after 24 hours exceeded the 99th percentile from the upper limit of normal in 146 patients (80%). In the control group, there was a statistically significant more frequent increase in hs-troponin by more than 2000 ng/ml (10% of patients in the control group versus 1% of the patient in the nicorandil group, p=0,038). Type 4a MI was detected in 12% of patients in the control group, and it decreased to 3% of patients in the nicorandil group (p=0,05), and in women it was observed in 21% in the control group and in 3% in the nicorandil group. Among women (n=61), the increment of hs-troponin 24 hours after PCI was statistically significantly lower (287 versus 1135 pg/ml, p=0,04) in the nicorandil group compared to the control group. Conclusion. Reducing the risk of cardiac damage and 4a type MI by nicorandil using before PCI, compared with standard antianginal therapy, is an effective tool in cardioprotection of patients with stable CAD before planned PCI.

The predictive value of preprocedural laboratory data in patients with coronary artery restenosis in various types of stents

Aim.To identify the effect of preprocedural laboratory parameters on the occurrence of in-stent restenosis in various types of stents, to assess the significance of gender, age and various forms of coronary artery disease (CAD) as risk factors for coronary artery restenosis after stenting.Material and methods.The study included 436 patients with CAD, which were divided into 2 groups. The study group included 218 patients with in-stent restenosis. The control group consisted of 218 patients with CAD without in-stent restenosis. Inclusion criteria were acute or chronic form of CAD, age 45-74 years, CAG and percutaneous coronary intervention (PCI) with emergency or planned stenting of the native coronary artery, repeated CAG in history due to signs/symptoms of myocardial ischemia. Exclusion criteria: age younger than 45 years and over 74 years, coronary artery bypass surgery (CABG), cancer, autoimmune disease, anemia, liver failure, chronic kidney disease S4-S5, recent blood transfusion, hypo-or hyperthyroidism.Results.According to the study, the risk in-stent restenosis is 5,2 times higher in patients in the 65-69 years age group and 9,9 times higher in the 70-74 years age group compared with the group of young patients (45-49 years). In-stent restenosis is 2,7 times more common in men than in women. Predictors of restenosis were red cell distribution width, mean platelet volume, Gensini score with OR 1,5; 1,4; 1,1; 1,5, respectively.Conclusion.Risk factors for coronary artery restenosis after stenting are markers of chronic inflammation, such as the red cell distribution width, mean platelet volume. The risk of restenosis is higher in the male population. In old age, the risk of restenosis increases, however, young people and middle-aged people do not differ in risk of in-stent restenosis.

Intensity of Statin Therapy Affects Progression of Coronary Artery Vasculopathy

Purpose Statin therapy offers long-term morbidity and mortality benefits after orthotopic heart transplant (OHT), regardless of lipid levels. Multiple statins have been specifically studied in post-OHT patients, showing decrease in dyslipidemia and development of cardiac allograft vasculopathy (CAV). CAV is an accelerated form of coronary artery disease characterized by concentric fibrous intimal hyperplasia along the length of coronary vessels. CAV is detectable by angiography in 43% of survivors in the first 8 years after OHT. Treatment with statins significantly reduces the incidence of transplant CAV and shows mortality benefit at ten years. This retrospective study examines the relationship between certain variables and the risk of developing CAV in a cohort of OHT patients at a single center. Methods Retrospective data points from 212 OHT patients at a single center were collected from the electronic medical record. For all patients, statin dosage was recorded as low, moderate, and high intensity based on the 2013 ACC/ AHA guidelines. Patient's yearly catheterization reports were reviewed for diagnosis of CAV. Time from OHT to CAV diagnosis was calculated from the date of the diagnosing catheterization. If a patient was diagnosed with CAV, data points including degree of CAV, systolic blood pressure, lipid levels, and HbA1c at the time of CAV diagnosis were recorded. Results Statin intensity was the only significant variable in the Cox Proportional Hazards model (p= 0.0025; HR = 1.49 (95% CI: 1.15-1.93). Similar models to predict rejection were considered, and no variables were found to be significant. A binary logistic regression model was run to predict the presence of any malignancy, and no variables were found to be significant at the 0.05 level. Elevated systolic blood pressure and HbA1c were also significant findings in the CAV group as compared to the non-CAV group of OHT patients (p=0.003 and p=0.035 respectively). Conclusion The intensity of statin therapy significantly affects the progression of CAV. OHT programs should be vigilant in prescribing their OHT patients statins and encouraging compliance due to the risk of life threatening complications. As well, as prescribing statins, patients should be monitored closely for hypertension and diabetes as these disease processes are more often found in patients with CAV, than those would do not have a CAV diagnosis.

Этиопатогенез и иммунный статус в развитии интра- и послеоперационных осложнений у пациентов с осложненными формами ишемической болезни сердца

&lt;p&gt;&lt;b&gt;Цель исследования&lt;/b&gt; – изучить особенности этиопатогенеза, иммунного статуса и возможности его коррекции в предоперационном периоде у больных с осложненными формами ишемической болезни сердца (ИБС). &lt;p&gt;&lt;b&gt;Материал и методы.&lt;/b&gt; В исследование включены данные 100 пациентов с тяжелыми формами ИБС, готовящихся к кардиохирургическим вмешательствам в условиях искусственного кровообращения. Изучены сочетания этиопатогенетических факторов и выявлены особенности иммунного статуса этих пациентов. &lt;p&gt;&lt;b&gt;Результаты.&lt;/b&gt; В предоперационном периоде 50 пациентам проведена персонифицированная иммунокоррекция, другим 50 больным иммунокоррекция не выполнялась. По результатам исследования у пациентов с иммунокоррекцией количество интра- и послеоперационных осложнений оказалось достоверно меньше, чем в контрольной группе. &lt;p&gt;&lt;b&gt;Заключение.&lt;/b&gt; Использование этиопатогенетических подходов в предоперационной диагностике и комплексное лечение кардиохирургических больных с осложненными формами ИБС, включая персонифицированную иммунокоррекцию, позволяют существенно снизить число интра- и послеоперационных осложнений. HTML

Prevalence and clinical profile of angiographic coronary artery ectasia among North Indian population

Background: Coronary artery ectasia (CAE) has been widely recognized as not so infrequent form of coronary artery disease. Few retrospective studies from the Indian subcontinent have reported its prevalence to be varying from 1.9% to 10%. No large-scale study has been done among North Indian population. Methods: A prospective analysis of all coronary angiograms performed at our catheterization laboratory, between June 2012 and February 2014, was done. CAE was defined and classified according to the Markis classification. For every patient included, epidemiological, clinical, and appropriate laboratory data were obtained. Results: One hundred and twenty-four out of 3,014 coronary angiograms (4.1%) showed CAE. Mean age of the study population was 55.5 years. About 86.3% were male, 50.8% were current smokers, 27.4% had hypertension, 16.1% had diabetes mellitus, and 32.3% had dyslipidemia. The most common clinical presentation was ST-segment elevation myocardial infarction, observed in 44.4% of cases. Right coronary artery (RCA) was the most frequent coronary artery to be involved. Markis Class 3 was the most frequent pattern of CAE observed. Conclusion: The prevalence of coronary ectasia among North Indian patients undergoing coronary angiography was 4.1%. Of them, 16.9% angiograms showed isolated CAE. RCA was the most common affected vessel (58.1%). Large-sized studies to delineate treatment for this common entity are needed.

Association between depression and anxiety scores and inflammation in patients with isolated coronary artery ectasia.

Depression and anxiety disorders are frequently found in combination with obstructive coronary artery disease. Coronary artery ectasia (CAE) is an atypical form of coronary artery disease, the etiology of which has not yet been clearly defined. The aim of this study was to assess the existence of a relationship between anxiety/depression and CAE. A CAE group (n=41; mean age: 58.9±9.0 years) and a control group (n=42; mean age: 58.0±9.6 years) were compared. The anxiety and depression status of patients was evaluated using the Hospital Anxiety and Depression Scale (HADS) questionnaire. Age, sex, ejection fraction, and cardiovascular risk factor data were similar in both groups. The serum Creactive protein (CRP) and uric acid levels as well as the leukocyte count were significantly higher in the CAE group (p<0.05). The HADS anxiety score was higher in the CAE group, but without statistical significance (p=0.23). The HADS depression score and total HADS score was significantly higher in the CAE group (p<0.001 and p<0.001). The total HADS score and the HADS depression score were correlated with the serum CRP level (r=0.489; p<0.001 and r=0.543; p<0.001, respectively), whereas the anxiety score was not correlated with CRP (r=0.85; p=0.23). The depression score, CRP, and uric acid levels were greater in patients with isolated CAE compared with those of patients with normal coronaries. The anxiety score did not demonstrate a relationship to CAE; however, there was an association between the depression score and CRP, which is an inflammatory marker.

Changing Scenario in Management of Acute Coronary Syndromes in Females—Evidence from Recent Studies

AbstractCardiovascular diseases are the leading cause of morbidity and mortality worldwide. Acute coronary syndrome (ACS) represents the most severe form of coronary artery disease (CAD) warranting urgent admission and intervention. Conventional teaching dictates that women are free from cardiovascular diseases in their reproductive age group. There is also a high prevalence of microvascular disease and atypical presentations in the fairer sex. Because of these factors, CAD is often under diagnosed and undertreated in women. They are also unfortunately underrepresented in major studies. But it is noteworthy that CAD remains the leading cause of death in both men and women alike. Evidence-based medicine and protocols have led to drastic improvement of outcomes of CAD and ACS. With close to one hundred trials presented at major cardiology meetings, it is impossible for the clinician to keep track of all of them. The authors describe briefly the recent studies in management of STEMI /ACS which have the potential to impact their daily practice. Hence, they also try to assess the impact of female gender on cardiovascular outcomes in these studies.

Results of stenting the left main lesions in patients with stable coronary artery disease using biodegradable polymer and permanent polymer stents

Background. Routine coronary angiography reveals about 4–10% cases of the left main lesions in patients with different forms of coronary artery disease. With the advance of stenting technologies, percutaneous coronary intervention in this type of lesions might be an alternative to coronary artery bypass grafting in some patients. Despite a significant technical progress and current generations of drug-eluting stents, the issue of optimal dual antiplatelet therapy (DAAT) duration to minimize hemorrhagic complications in the long-term period is still an open question. The problem is especially acute in the case of left main lesions. Aim. To evaluate clinical outcomes of unprotected left main stenting using Synergy stents (Boston Scientific) followed by 4-month DAAT and Xience Prime stents (Abbott Vascular) followed by 12-month DAAT.Methods. Fifty patients with stable coronary artery disease were randomized into two groups depending on the stent type (Synergy and Xience). The subjects were evaluated in 12 months after the stenting procedure.Results. 100 % success was achieved in the study. At 3-month check-up, the indicators of endothelialization, strut overlapping and late lumen bore did not statistically differ in the groups under study. During 12-month follow-up 2 cases of restenosis were recorded, one in each group, which required revascularization. The remaining cases of repeated revascularization were associated with de novo lesions. The overall major cardiac events rate was 4% in the Xience group and 8% in the Synergy group. In one case, myocardial infarction in the Synergy group was associated with the right coronary artery.Conclusion. While treating patients with left main lesions, the use of Synergy stents followed by 4-month DAAT has no lesser clinical efficacy and safety than the Xience stents followed by 12-month DAAT. Received 28 August 2018. Revised 8 October 2017. Accepted 8 November 2018. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: R.U. Ibragimov, O.V. KrestyaninovData collection and analysis: R.U. Ibragimov, D.A. Khelimskiy, A.G. BadoyanStatistical analysis: R.U. Ibragimov, D.A. Khelimskiy, A.G. BadoyanDrafting the article: R.U. Ibragimov, D.A. Khelimskiy, A.G. BadoyanRevision of the article: R.U. Ibragimov, O.V. Krestyaninov, E.A. Pokushalov, A.B. RomanovFinal approval of the version to be published: R.U. Ibragimov, A.G. Badoyan, D.A. Khelimskiy, O.V. Krestyaninov, E.A. Pokushalov, A.B. Romanov ORCID IDE.A. Pokushalov, https://orcid.org/0000-0002-2560-5167