High Risk For Coronary Artery Disease Research Articles

Correlation between plasma homocysteine and first myocardial infarction in young patients: Case-control study in Constanta County, Romania.

An elevated level of total plasma homocysteine has been associated with a higher risk of atherosclerosis and coronary heart disease. The aim of our research was to study the relation between homocysteine and myocardial infarction (MI) in young patients. We conducted a case-control study in Constanţa County, Romania including 61 patients, divided in two groups. The first group, the MI group, consisted of 28 patients, male (67.9%) and female (32.1%) aged less than 45 years who were consecutively admitted to the Intensive Coronary Care Unit of the Emergency County Hospital of Constanţa from September 1, 2017 to August 31, 2018 (12 months), with an established diagnosis of first acute MI. The second group, the control group, included 33 patients, male (75.8%) and female (24.2%) aged less than 45 years, with cardiovascular risk factors and/or stable angina pectoris that were consecutively addressed for ambulatory cardiac evaluation at the Outpatient Clinic of Emergency County Hospital of Constanţa during the same period. Fasting plasma homocysteine was determined in both groups, within 24 h after MI onset, respectively after first cardiac exam in the controls. High homocysteine was statistically confirmed to be a risk factor in the study group, especially in association with smoking, chronic kidney disease (CKD), and to a lesser extent with diabetes mellitus (DM) and hypertension. Data analysis was performed using IBM SPSS Statistics 23. The procedures used included descriptive statistics, parametric statistical tests (Independent sample t-test), non-parametric statistical tests [Chi-square test of the association, with the evaluation of odds ratio (OR)]; the significance level used in the analysis (P-value) was 0.05. After adjusting for variables, our study results pointed out a strong association between plasma homocysteine and first acute MI among young patients, emphasising plasma homocysteine as a possible risk factor for myocardial infarction.

Abstract 15844: Predicting the Risk of Significant Coronary Artery Disease in Liver Transplant Patients: The CAD-LT Score

Background: Patients with significant coronary artery disease (CAD) are more likely to develop post-liver transplant (LT) cardiac events. We developed the CAD-LT screening score and testing algorithm to predict the risk of significant CAD in LT candidates. Methods: Patients who underwent pre-LT evaluation at Indiana University (2010-2017) were studied retrospectively (n=1814). Stress tests (ST) (n=1677) and cardiac catheterization (CATH) reports (n=1300) were reviewed. CATH was performed in patients with predefined CAD risk factors. Significant CAD was defined as disease requiring percutaneous or surgical intervention. Multivariable estimates (Adjusted Odds Ratio i.e. AOR [95%CI]) with assessment of model performance using Receiver Operating Curve analysis were used to compute a point-based risk score and stratify patients. A 10-fold internal cross-validation (CV) model was done. Results: There were 950 LT and 864 no-LT patients. The risk-adjusted predictors of significant CAD were older age (AOR 1.06 [95%CI 1.03-1.09]), male gender (1.69 [1.13-2.50]), diabetes (1.44 [1.01-2.06]), hypertension (1.50 [1.05-2.15]), current smoking history (1.81 [1.16-2.82]), family history of CAD (1.76 [1.24-2.50]), and personal history of CAD (5.41 [3.48-8.43]). The CAD-LT score is shown in Table 1. Figure 1 is an algorithm for its use. The mean CV Area Under the Curve [95% CI] was 0.75 [0.71-0.79]. The algorithm detected 97% of the patients with significant CAD and would decrease the number of ST by 718 (43%; 671 in high-risk group and 47 in low-risk group) and CATH by 409 (30%). Conclusion: The CAD-LT score identifies LT candidates at high risk for significant CAD and guides pre-LT testing.

Endocrine therapy use and cardiovascular risk in postmenopausal breast cancer survivors

ObjectiveExamine the effect of tamoxifen and aromatase inhibitors (AIs) on the risk of 12 clinically relevant cardiovascular outcomes in postmenopausal female breast cancer survivors.MethodsWe carried out two prospective cohort studies...

Numbers and phenotype of non-classical CD14dimCD16+ monocytes are predictors of adverse clinical outcome in patients with coronary artery disease and severe SARS-CoV-2 infection.

AimsTo elucidate the prognostic role of monocytes in the immune response of patients with coronary artery disease (CAD) at risk for life-threatening heart and lung injury as major complications of SARS-CoV-2 infection.Methods and ResultsFrom February to April 2020, we prospectively studied a cohort of 96 participants comprising 47 consecutive patients with CAD and acute SARS-CoV-2 infection (CAD+SARS-CoV-2), 19 CAD patients without infections, and 30 healthy controls. Clinical assessment included blood sampling, echocardiography, and electrocardiography within 12 hours of admission. Respiratory failure was stratified by the Horovitz Index (HI) as moderately/severely impaired when HI ≤ 200 mmHg. The clinical endpoint (EP) was defined as HI ≤ 200 mmHg with subsequent mechanical ventilation within a follow-up of 30 days.The numbers of CD14dimCD16+ non-classical monocytes in peripheral blood were remarkably low in CAD+SARS-CoV-2 compared to CAD patients without infection and healthy controls (p < 0.0001). Moreover, these CD14dimCD16 monocytes showed decreased expression of established markers of adhesion, migration, and T cell activation (CD54, CD62L, CX3CR1, CD80, HLA-DR). Decreased numbers of CD14dimCD16+ monocytes were associated with the occurrence of EP. Kaplan-Meier curves illustrate that CAD+SARS-CoV-2 patients with numbers below the median of CD14dimCD16+ monocytes (median 1443 cells/mL) reached EP significantly more often compared to patients with numbers above the median (log-rank 5.03, p = 0.025).ConclusionDecreased numbers of CD14dimCD16+ monocytes are associated with rapidly progressive respiratory failure in CAD+SARS-CoV-2 patients. Intensified risk assessments comprising monocyte sub- and phenotypes may help to identify patients at risk for respiratory failure.Translational PerspectivePatients with coronary artery disease (CAD) are at risk of life-threatening heart and lung injury accelerated by the pro-inflammatory and pro-thrombotic immune response during SARS-CoV-2 infection. We found substantially low numbers of CD14dimCD16+ non-classical monocytes with an altered phenotype suggesting impaired migration behaviour and T cell activation capacity in peripheral blood of SARS-CoV-2 patients with CAD, compared to CAD patients without infection or healthy controls. Decreased numbers of CD14dimCD16+ monocytes predicted rapidly progressive respiratory failure (Horovitz index ≤ 200 mmHg) with subsequent mechanical ventilation. Therefore, early sub- and phenotyping of CD14dimCD16+ monocytes using simple flow cytometry might predict worsening of respiratory failure at an early stage of SARS-CoV-2 infection in high-risk CAD patients, who require an extensive heart failure and anti-thrombotic therapy to improve their clinical outcome.

About 1/3rd of north Indian patients less than 50 years of age with type 2 diabetes have high pulse wave velocity indicating high risk of atherosclerosis

Background and aimsAsian Indian patients with type 2 diabetes mellitus (T2DM) have a high cardiovascular risk even at young age. There is a need to assess this increased risk and identify atherosclerosis early so that appropriate measures for risk reduction can be taken. We aimed to study carotid-femoral pulse wave velocity (Cf-PWV), a non-invasive indicator of atherosclerosis, in patients with diabetes below 50 years of age and its correlation with markers of obesity and other cardiovascular risk factors. MethodsPatients (n, 299) with T2DM below 50 years of age underwent measurement of Cf-PWV by applanation tonometry. Anthropometric parameters, blood pressure, liver span, glycosylated hemoglobin, serum lipid profile, urinary microalbumin, ankle brachial index and carotid intima media thickness were measured. ResultsData show that 32.4% of patients had high Cf-PWV, with mean values higher in males than females. On stepwise multiple linear regression analysis, the significant independent determinants of PWV were age, systolic blood pressure, waist circumference, microalbumin and liver span. ConclusionAbout one third patients with T2DM less than 50 years of age, in north India have increased arterial stiffness which correlates with blood pressure, abdominal obesity, liver size and microalbumin, indicating increased risk for coronary artery disease.

Defining the prognostic value of [15O]H2O positron emission tomography derived myocardial ischemic burden

Abstract Background A myocardial ischemic burden (IB) of 10% is used to denote high-risk patients with coronary artery disease (CAD). This threshold has primarily been assessed by single-photon emission computed tomography. Differences in the pharmacokinetics of the utilized traces, higher resolution of positron emission tomography (PET), and lastly differences in assessment of IB might lead to a higher prognostic threshold for quantitative PET. Purpose To determine a [15O]H2O PET derived IB to identify low (annualized event rate (AER) &amp;lt;1.0%) and high (AER ≥3%) risk CAD patients. Methods 623 patients who underwent [15O]H2O PET because of suspected CAD and in whom follow-up was obtained were included. The IB was defined as the percentage of myocardium with a hyperemic blood flow (hMBF) ≤2.3 ml/min/g and by a coronary flow reserve (CFR) of ≤2.5. The endpoint was a composite of death and non-fatal myocardial infarction (MI). Time-dependent ROC curves were constructed for the prediction of the endpoint within the first 5-years, based on these curves thresholds were selected for which specificity was maximized and sensitivity was at least 80%. Patients were classified as having a high IB if their respective IBs were above the prognostic thresholds and as having a low IB if not. Results During a median follow-up of 6.7 years, 34 (6%) patients died and 28 (4%) experienced a MI resulting in 62 (10%) endpoints. An IB of 24% and 28% for hMBF and CFR, respectively, was found to be the optimal threshold to define prognosis. Patients with a high hMBF or high CFR IB had worse outcome compared to patients with a low IB (log-rank p&amp;lt;0.001 for both), with AERs of 0.6% vs. 2.8%, and 0.6% vs. 2.4% (p&amp;lt;0.001 for both), respectively. Patients with a concordantly high hMBF and CFR derived IB had the worst outcome (AER: 3.1%), whereas patients with a concordantly low or discordant IB result had a similarly low event rate of 0.5% and 0.9% (p=0.953), respectively (log-rank p=0.445). A concordantly high hMBF and CFR IB was an independent predictor of adverse outcome beyond clinical characteristics (adjusted hazard ratio: 3.52, p&amp;lt;0.001). Conclusion An IB of 24% and 28% for hMBF and CFR was found to be the optimal prognostic threshold. Both measurements can be used to determine patients outcome. However combining hMBF and CFR IB results leads to a further refinement of risk-stratification allowing for the identification of low (concordant low or discordant IB result) and high (concordant high IB result) risk CAD patients. Funding Acknowledgement Type of funding source: None

A cost effectiveness study into the detection of functionally significant coronary artery disease in patients with chronic coronary syndrome: a decision-analytic modelling approach

Abstract Background ESC guidelines recommend functional or anatomical imaging for stable coronary artery disease (CAD) diagnosis. We investigated cost-effective diagnostic strategies for CAD detection with invasive coronary angiography (ICA) and fractional flow reserve (FFR) as reference standard [1,2], using NHS reference costs. Methods Deterministic and probabilistic decision-analytic models for diagnostic strategies in low (25%), intermediate (50%) and high (75%) risk CAD were devised. Strategies: standalone or combined testing with computed tomographic coronary angiography (CTCA), stress echocardiography (SE), CT-FFR, single-photon emission computed tomography (SPECT), cardiac magnetic resonance (CMR), positron emission tomography (PET), ICA, and ICA-FFR. Proportion of correct diagnosis served as measure of clinical effectiveness. Incremental cost-effectiveness ratios were calculated for dominant strategies. Cost-effectiveness acceptability curves (CEAC) tested variation of cost-effectiveness threshold (CET). Results Base case (Table 1) consistent with probabilistic analysis (Figure 1 left). CEACs (Figure 1 right). Conclusions Direct ICA is not cost-effective. Functional testing has significant role in low/intermediate risk. CMR is cost-effective in all risk and most likely cost-effective in CETs &amp;lt;£10,000. ICA-FFR yields highest correct diagnoses in all at highest cost. Future long-term follow-up studies with quality of life measures are needed.

Prognostic durability of coronary computed tomography angiography.

This large prospective cohort study sought to confirm the incremental prognostic value of coronary computed tomographic angiography (CCTA) measured over a prolonged follow-up duration. CCTA has diagnostic and prognostic value but data supporting its long-term prognostic value in a large prospectively recruited cohort with suspected coronary artery disease (CAD) has been limited. Consecutive patients (without history of myocardial infarction, revascularization, cardiac transplantation, and congenital heart disease) were prospectively enrolled. CCTA was evaluated for CAD severity, total plaque score (TPS), and left ventricular ejection fraction. Patients were followed for major adverse events (MAE) and major adverse cardiac events (MACE).Over a total of 99 months, 8667 consecutive CCTA patients (mean age = 57.1 ± 11.1 years, 52.9% men) were prospectively enrolled and followed for a mean duration of 7.0 ± 2.6 years. At follow-up, there were a total of 723 MAE, 278 MACE, 547 all-cause deaths, 110 cardiac deaths, and 104 non-fatal myocardial infarction. Patients without coronary atherosclerosis at the time of CCTA had a very low annual event rate for both MAE and MACE (0.45%/year and 0.19%/year, respectively). Both MAE and MACE increased with increasing TPS and severity of CAD. In patients with non-obstructive CAD and who were statin-naive, TPS ≥5 had MACE rates >0.75%/year. Patients with high-risk CAD had an annual MAE and MACE rates of 3.52%/year and 2.58%/year, respectively. Adjusted hazard ratio of the severity of CAD based on multivariable analyses indicated that the prognostic values were incremental. CCTA has independent and incremental prognostic value that is durable over time. The absence of coronary atherosclerosis portends an excellent prognosis. Patients with increasing non-obstructive plaque burden have worse prognosis and a TPS threshold ≥5 may identify a population that may benefit from statin therapy.

Parametry morfologiczne tętnic obwodowych w ocenie ryzyka sercowo-naczyniowego

Introduction. The aim of the study was to test the hypothesis that ultrasound measurements of common carotid artery (CCAd) and brachial artery (BAd) diameters represent markers of higher coronary artery disease risk (CAD, defined as ≥ 50% reduction in diameter of at least one large coronary artery segment). Materials and methods. Seventy-one patients (pts) evaluated for suspected stable CAD (23.9% women, age 61.5 ± 7.5) underwent ultrasound measurements of averaged diameters of both common carotid arteries and the brachial artery diameter of dominant arm. Clinical protocol included also: standard medical examination, assessment of biochemical parameters, resting electrocardiography, treadmill exercise test and transthoracic echocardiography. Diagnosis was established using quantitative coronary angiography measurements and calculation of Gensini Score (GS). Results. Angiographic CAD was present in 43 (60.5%) patients. Average CCAd was larger in CAD group (7.97 ± 0.96 mm vs. 7.37 ± 0.67 mm, p = 0.0052), similar to BAd (5.06 ± 0.65 vs. 4.68 ± 0.75, p = 0.03), respectively. The peripheral arterial diameters correlated with values of GS index, more pronounced for CCAd ( ρ = 0.35, p = 0.0023) than for BAd ( ρ = 0.24, p = 0.0368). CCAd significantly more positively correlated with the distal coronary artery segments values of the GS index ( ρ = 0.35, p = 0.0024), whereas the diameter of BA with the proximal segments values of GS index ( ρ = 0.239, p = 0.045). CCA and BD diameters indexed to body surface area (BSA) showed a strong trend toward larger average diameters in CAD patients: CCAd/BSA index: 4.06 ± 0.46 mm/m 2 vs. 3.85 ± 0.56 mm/m 2 , p = 0.087, BAd/BSA index: 2.57 ± 0.29 mm/m 2 vs. 2.42 ± 0.35 mm/m 2 , p = 0.057. Gensini score significantly correlated with CCAd/BSA index ( ρ = 0.24, p = 0.043) with a strong trend of positive correlation between GS index and BAd/BSA index ( ρ = 0.21, p = 0.076). Conclusions. The diameters of common carotid arteries and the brachial artery of dominant arm are greater in CAD pts. Peripheral arteries ultrasound may complement classic diagnostic pathway of stable coronary artery disease.

Effects of normoxic versus hyperoxic hyperventilation followed by apnea on right ventricular strain in patients with multi-vessel coronary artery disease

Introduction Hypocapnia and hyperoxia are coronary vasoconstrictors, whereas hypercapnia acts as a coronary vasodilator. Prior to anaesthetic induction, patients receive a FiO2 of 1.0 and are asked to take deep breaths. Resulting hyperoxic hypocapnia may be aggravated by excessive manual ventilation. Subsequent apnea during intubation increases paCO2. So far it remains unclear whether and how such rapid blood gas alterations impact right ventricular (RV) function, especially so in the presence of coronary artery disease (CAD). Cardiovascular magnetic resonance (CMR) imaging is useful to assess subtle changes of myocardial function and constitutes the gold standard for RV imaging. The objective of this CMR study is to compare RV function of healthy persons and patients with CAD during a typical hyperventilation-apnea maneuver. Methods Ten healthy participants and 25 patients with stable, well-defined multi-vessel CAD underwent a CMR study. After baseline imaging at room air, subjects hyperventilated for 60 seconds (HV) and then maintained apnea for 30s. Cine images of two ventricular short axis slices were acquired at baseline and from the end of HV throughout the breath-hold. After reequilibration, participants breathed oxygen (10L/min) for 5 minutes via a non-rebreathing mask and repeated the same respiratory maneuver under oxygen inhalation. CMR cine images were analyzed for RV global peak circumferential strain (RVGCS) for each group and condition. Results Healthy participants showed no significant RVGCS changes within or between normoxic or hyperoxic respiratory maneuvres, although HV enhanced strain numerically. CAD patients showed significant attenuation of RVGCS at the end of the hyperoxic HV-apnea sequence (baseline, -13.5±4.7 % vs. hyperoxic apnea, -11.8±4.9 %; p= 0.047), but not after the respective sequence at room air (-13.8±4.1%, p=0.611). In 20% of the CAD patients the hyperoxic HV-apnea sequence attenuated RVGCS by more than 5% from normoxic baseline. The figure shows RVGCS of both groups during the maneuver (more negative numbers representing better systolic contractile function, i.e., circumferential shortening). Discussion At the conclusion of an induced respiratory maneuver, which resembles a hyperoxic anaesthesia induction sequence, awake CAD patients exhibit significant attenuation of RV peak circumferential strain. This response could be haemodynamically relevant during anaesthesia induction in high-risk CAD patients and needs to be investigated further in a scenario of general anaesthesia.

Comparison of the EuroSCORE I, EuroSCORE II and STS Scales in Cardiac Surgery of High-Risk Patients with Complicated Forms of CAD

Before performing cardiac surgery, risk stratification is necessary in order to predict the outcome of the operation. Today, there are European risk calculators EuroSCORE I, EuroSCORE II and the scale of the American Society of Thoracic Surgeons – STS.&#x0D; The aim. To compare prognostic scales for high-risk patients with complicated forms of coronary artery disease (CAD).&#x0D; Materials and methods. Post-hoc analysis of the data obtained from 100 random high-risk patients with complicated forms of CAD who were operated and discharged from Amosov National Institute in the period from 2009 to 2019. For all patients, risk factors were analyzed and calculated using three risk scales.&#x0D; Results. In addition to the initial severity of cardiovascular disease, the patients of the study group had comor-bidities like diabetes mellitus (23%), obesity (33%), and chronic kidney disease (34%), atherosclerosis of brachio-cephalic arteries (57%), chronic obstructive pulmonary disease (78%), a history of cerebrovascular accident (9%) etc. The predicted operative mortality was 19.2% according to the ES I scale, 8.6% according to the ES II, and 2.6% according to the STS scale, while mortality in the study group was 0%. An analysis of the ten-year experience of National Amosov Institute in the surgical treatment of CAD in more than 15,000 patients showed 0.9% mortality in complicated forms of high-risk CAD, which is significantly less than the forecast according to all the three scales. The ES I scale is characterized by a significant overestimation of mortality rates, the STS scale is cumbersome, time consuming, predicts 9 indicators that are not statistically significant in comparison with real practice. The most modern and convenient to use, but though not 100% reliable, is the ES II scale. The scales are necessary to stratify the risk and to understand the severity of the patient’s condition. It should be kept in mind that, in addition to comorbidities as well as cardiac and non-cardiac factors, the result of surgical intervention is influenced by the coordinated work of the Heart Team consisting of a cardiologist, interventional cardiologist, functional diagnostics doctor, cardiac surgeon, anesthesiologist and resuscitator.

Increased Rates of Coronary Artery Calcium Score in Patients with Non - Functioning Adrenal Incidentaloma.

We evaluated cardiovascular (CV) risk stratification for nonfunctioning adrenal incidentalomas (NFAIs) via the coronary-artery-calcium (CAC) score. The participants were patients with NFAI (n = 55). They were compared to patients with chest pain, a low-intermediate Framingham-risk score, and a non-diagnostic treadmill- exercise test, which served as the control group (n = 49). Subsequently, the NFAI group was subdivided according to a CAC score of <100 Agatston units - mild coronary-artery calcification (n = 40) - and ≥100 Agatston units - moderate-to-severe calcification (n = 15). Similar rates of traditional risk factors were observed between the NFAI and control groups, and lower low-density lipoprotein cholesterol rates were observed in the NFAI group. The CAC score was significantly higher for the NFAI group than the control group. Glucose, potassium, adrenocorticotropic-hormone, and basal-cortisol levels were higher in those with a CAC score of ≥100. High-density-lipoprotein cholesterol estimated glomerular filtration rate and ejection fraction (EF) were higher in those with a CAC score of <100. Adenoma size and location were similar between the groups. Age, EF, and glucose were the most significant variables related to CAC score in patients with NFAI, at ≥100 Agatston units. Patients with a low-intermediate CV risk profile and NFAI have a higher risk of atherosclerosis when compared to patients with a low-intermediate CV risk profile, but no NFAI. In patients with NFAI, CAC score evaluation may be used to predict increased atherosclerosis, especially in patients of an older age with higher glucose and decreased EF.

Procedure and Effectiveness of Extracorporeal Membrane Oxygenation in Percutaneous Coronary Intervention for High-risk Complex Coronary Disease

Objective: It has been demonstrated that performing percutaneous coronary intervention (PCI) in the absence of mechanical circulation support (MCS) for patients with complex high-risk coronary artery disease bears a high risk. Alternatively, to figure out the procedure effectiveness and the mid-term prognosis of PCI for complex high-risk coronary artery disease, we accomplished the whole process by the assistance of extracorporeal membrane oxygenation (ECMO). Methods: Between July 2016 and October 2017, 6 consecutive complex and high-risk coronary disease patients underwent routine ECMO-supported PCI. Results: The average age of the patients was 70.5±11.98, and half of them (50%) were male. The mean creatinine (Cr) was 188.67±151.68 µmol/L. The average scores for SYNTAX, SYNTAX II, and LVEF pre the procedure was 41.33±12.14, 47.87±9.45 / 31.55±8.82, and 44.40±12.58%, respectively. The mean supporting duration of ECMO was 10.50±7.79 h. Regarding the postoperative complication, one case observed lower limp venous thrombosis and another reported infection at the access site. Two patients (33.3%) died for refractory heart failure during the follow-up course of 17.00±9.51 months, and the average net improvement index (NII) was 28.30±25.11% for this period. Conclusion: With the support of ECMO, the prognosis of complex high-risk coronary disease has shown to be improved by intervention in our study.

Predictors of abnormality in thallium myocardial perfusion scans for type 2 diabetes.

Type 2 diabetes mellitus (T2DM) increases coronary artery disease (CAD) risk. In this study, we used T2DM clinical variables to predict abnormality in thallium-201 myocardial perfusion scans (Th-201 scans). These clinical variables were summed stress score (SSS), summed rest score, and summed difference score (SDS), with data obtained from 368 male and 428 female participants with T2DM. Multiple linear regression results were as follows. In male participants, body mass index (BMI) and creatinine (Cr) were associated with SSS (β = 0.224, p < 0.001; β = 0.140, p = 0.022, respectively), and only BMI was associated with SDS (β = 0.174, p = 0.004). In female participants, BMI and high-density lipoprotein cholesterol level were associated with SSS (β = 0.240, p < 0.001; β = - 0.120, p = 0.048, respectively), and only BMI was correlated with SDS (β = 0.123, p = 0.031). Our multivariate logistic regression indicated that in male and female participants, BMI was the only independent indicator of high SSS (SSS ≥ 9). In this study, we demonstrated that male patients have a higher SSS and SDS than female patients do in Th-201 scans for T2DM in a Chinese population. For male and female patients, BMI was the strongest predictor of abnormality in Th-201 scans. Our results can help clinicians identify patients with T2DM at high risk of CAD.

Preoperative prediction of Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS): an international prospective cohort study

BackgroundDiagnostic criteria for Bleeding Independently associated with Mortality after noncardiac Surgery (BIMS) have been defined as bleeding that leads to a postoperative haemoglobin <70 g L−1, leads to blood transfusion, or is judged to be the direct cause of death. Preoperative prediction guides for BIMS can facilitate informed consent and planning of perioperative care. MethodsIn a prospective cohort study of 16 079 participants aged ≥45 yr having inpatient noncardiac surgery at 12 academic hospitals in eight countries between 2007 and 2011, 17.3% (2782) experienced BIMS. An electronic risk calculator for BIMS was developed and internally validated by logistic regression with bootstrapping, and further simplified to a risk index. Decision curve analysis assessed the potential utility of each prediction guide compared with a strategy of identifying risk of BIMS based on preoperative haemoglobin <120 g L−1. ResultsWith information about the type of surgery, preoperative haemoglobin, age, sex, functional status, kidney function, history of high-risk coronary artery disease, and active cancer, the risk calculator accurately predicted BIMS (bias-corrected C-statistic, 0.84; 95% confidence interval, 0.837–0.852). A simplified index based on preoperative haemoglobin <120 g L−1, open surgery, and high-risk surgery also predicted BIMS, but less accurately (C-statistic, 0.787; 95% confidence interval, 0.779–0.796). Both prediction guides could improve decision making compared with knowledge of haemoglobin <120 g L−1 alone. ConclusionsBIMS, defined as bleeding that leads to a postoperative haemoglobin <70 g L−1, leads to blood transfusion, or that is judged to be the direct cause of death, can be predicted by a simple risk index before surgery. Clinical trial registrationNCT00512109.

Gemfibrozil Induces Anemia, Leukopenia and Reduces Hematopoietic Stem Cells via PPAR-α in Mice.

Hypercholesterolemia, also called high cholesterol, is a form of hyperlipidemia, which may be a consequence of diet, obesity or diabetes. In addition, increased levels of low-density lipoprotein (LDL) and reduced levels of high-density lipoprotein (HDL) cholesterol are associated with a higher risk of atherosclerosis and coronary heart disease. Thus, controlling cholesterol levels is commonly necessary, and fibrates have been used as lipid-lowering drugs. Gemfibrozil is a fibrate that acts via peroxisome proliferator-activated receptor alpha to promote changes in lipid metabolism and decrease serum triglyceride levels. However, anemia and leukopenia are known side effects of gemfibrozil. Considering that gemfibrozil may lead to anemia and that gemfibrozil acts via peroxisome proliferator-activated receptor alpha, we treated wild-type and peroxisome proliferator-activated receptor alpha-knockout mice with gemfibrozil for four consecutive days. Gemfibrozil treatment led to anemia seven days after the first administration of the drug; we found reduced levels of hemoglobin, as well as red blood cells, white blood cells and a reduced percentage of hematocrits. PPAR-alpha-knockout mice were capable of reversing all of those reduced parameters induced by gemfibrozil treatment. Erythropoietin levels were increased in the serum of gemfibrozil-treated animals, and we also observed an increased expression of hypoxia-inducible factor-2 alpha (HIF-2α) and erythropoietin in renal tissue, while PPAR-alpha knockout mice treated with gemfibrozil did not present increased levels of serum erythropoietin or tissue HIF-2α and erythropoietin mRNA levels in the kidneys. We analyzed bone marrow and found that gemfibrozil reduced erythrocytes and hematopoietic stem cells in wild-type mice but not in PPAR-alpha-knockout mice, while increased colony-forming units were observed only in wild-type mice treated with gemfibrozil. Here, we show for the first time that gemfibrozil treatment leads to anemia and leukopenia via peroxisome proliferator-activated receptor alpha in mice.

The associations between neutrophil-to-lymphocyte ratio and the Chinese Visceral Adiposity Index, and carotid atherosclerosis and atherosclerotic cardiovascular disease risk.

Inflammation and obesity are the main risk factors for the development of carotid atherosclerosis and atherosclerotic cardiovascular disease (ASCVD). The neutrophil-to-lymphocyte ratio (NLR) is a recently developed indicator of inflammation that can be easily calculated from blood cell counts. The Chinese Visceral Adiposity Index (CVAI) was used to assess visceral obesity in the Chinese population. To explore the associations between both NLR and CVAI, and carotid atherosclerosis and ASCVD risk in elderly Chinese. A total of 4437 participants aged ≥55years and with no history of cardiovascular disease, were enrolled in this retrospective study. Anthropometric measurements, laboratory results, and carotid ultrasonography results were extracted from a database. We used established formulas to calculate NLR and CVAI, and the Pooled Cohort Equations to generate the 10-year ASCVD risk score. Participants were divided into two groups according to their 10-year ASCVD scores: <7.5% and ≥7.5%. NLR and CVAI were significantly higher in patients with carotid atherosclerosis. Regression analysis showed that NLR (OR 1.23, 95% CI 1.05-1.43, p=0.01) and CVAI (OR 1.39, 95% CI 1.21-1.61, p=0.001) were independent risk factors for carotid atherosclerosis. A combination of NLR and CVAI improved the goodness-of-fit (p<0.001) and discriminability of the model (p=0.0013). NLR, CVAI and carotid plaques showed positive associations with the 10-year ASCVD risk score (all p<0.001). NLR and CVAI are positively associated with the prevalence of carotid atherosclerosis and high risk of ASCVD in elderly adults and could be useful in the identification of a high risk of atherosclerosis.

Site specific prediction of PCI stenting based on imaging and biomechanics data using gradient boosting tree ensembles.

Cardiovascular diseases are nowadays considered as the main cause of morbidity and mortality worldwide. Coronary Artery Disease (CAD), the most typical form of cardiovascular disease is diagnosed by a variety of imaging modalities, both invasive and non-invasive, which involve either risk implications or high cost. Therefore, several attempts have been undertaken to early diagnose and predict either the high CAD risk patients or the cardiovascular events, implementing machine learning techniques. The purpose of this study is to present a classification scheme for the prediction of Percutaneous Coronary Intervention (PCI) stenting placement, using image-based data. The proposed classification model is a gradient boosting classifier, incorporated into a class imbalance handling technique, the Easy ensemble scheme and aims to classify coronary segments into high CAD risk and low CAD risk, based on their PCI placement. Through this study, we investigate the importance of image based features, concluding that the combination of the coronary degree of stenosis and the fractional flow reserve achieves accuracy 78%.

Association between apolipoprotein E gene polymorphism and the risk of coronary artery disease in Hakka postmenopausal women in southern China

BackgroundApolipoprotein E (APOE) is involved in the pathogenesis of atherosclerosis and conveys a higher risk of coronary artery disease (CAD). The aim of the present study was to investigate the possible association between APOE gene polymorphism and the risk of CAD in postmenopausal Hakka women in southern China.MethodsThe APOE genotypes of 653 CAD patients and 646 control participants were determined by the polymerase chain reaction (PCR) and hybridization to a Sinochip.ResultsThe prevalence of each APOE genotype differed between CAD patients and control participants (P = 0.011). The E3/E3 genotype was the most common and the E2/E2 genotype was the least common in the study sample. Moreover, the presence of ε4 allele was associated with higher serum concentrations of triglycerides (TG), total cholesterol (TC) and low-density lipoprotein-cholesterol (LDL-C), and lower concentration of high-density lipoprotein-cholesterol (HDL-C). Multiple logistic regression analysis revealed that participants with ε4 allele have a significantly higher risk of CAD after adjustment for the presence of diabetes mellitus and hypertension, and their serum uric acid, TC, and LDL-C concentrations (adjusted odds ratio (OR) 1.50, 95% confidence interval (CI) 1.10–2.05, P = 0.010).ConclusionsThe present results suggest that APOE polymorphism is associated with a higher risk of CAD in postmenopausal Hakka women in southern China.

Early Detection of Undiagnosed Abdominal Aortic Aneurysm and Sub-Aneurysmal Aortic Dilatations in Patients with High-Risk Coronary Artery Disease: The Value of Targetted Screening Programme.

IntroductionAbdominal aortic aneurysm (AAA) and coronary artery disease (CAD) share common risk factors. The objective of this study was to determine the prevalence of undiagnosed AAA in patients with angiographically diagnosed significant CAD.Patients and MethodsMale patients aged 50 years and above (including indigenous people) with angiographically diagnosed significant CAD in the recent one year were screened for AAA. Standard definition of abdominal aortic aneurysm and CAD was used. All new patients were followed up for six months for AAA events (ruptured AAA and AAA-related mortality).ResultsA total of 277 male patients were recruited into this study. The total prevalence of undiagnosed AAA in this study population was 1.1% (95% CI 0.2–3.1). In patients with high-risk CAD, the prevalence of undiagnosed AAA was 1.7% (95% CI 0.3–4.8). The detected aneurysms ranged in size from 35.0mm to 63.8mm. Obesity was a common factor in these patients. There were no AAA-related mortality or morbidity during the follow-up. Although the total prevalence of undiagnosed AAA is low in the studied population, the prevalence of sub-aneurysmal aortic dilatation in patients with significant CAD was high at 6.6% (95% CI 3.9–10.2), in which majority were within the younger age group than 65 years old.ConclusionThis was the first study on the prevalence of undiagnosed AAA in a significant CAD population involving indigenous people in the island of Borneo. Targeted screening of patients with high-risk CAD even though they are younger than 65 years old effectively discover potentially harmful asymptomatic AAA and sub-aneurysmal aortic dilatations.