Moderate Coronary Artery Disease Research Articles

Calcium Scoring on CT Coronary Angiography in Hypertensive Patients as a Criterion for the Prediction of Coronary Artery Disease

Introduction: Hypertension is the strongest independent predictor of Coronary Artery Disease (CAD) identified by Computed tomography of coronary arteries (CTCA). In this study, CTCA-assessed Coronary Calcium Scoring (CCS) was studied in hypertensive subjects referred for CTCA. Methods: After excluding TAVI and graft assessment patients, the individual electronic health records of 410 consecutive patients who underwent CTCA between July and November 2020, were reviewed with a mean age of 58.7 years. Risk factors were recorded including smoking (38%), hyperlipidaemia (33%), positive family history (22%), systemic hypertension (48%), diabetes mellitus (30%), and male gender (46%). Referral criteria, ethnicity, cardiac, and past medical history were recorded. Patients were stratified into four groups according to CAD severity: absent, mild, moderate, and severe disease, as seen on CTCA. The mean CCS for each CAD category was compared between hypertensive and non-hypertensive patients. Mean CCS were further compared according to the number of coronary arteries affected and the severity of CAD in each artery. Results: Out of all CTCA reports, 200 (48.8%) CCS were interpreted in the very low-risk category, 80 (19.5%) low risk, 58 (14.1%) moderate risk, 23 (5.6%) moderately high risk and 49 (12.0%) high risk. A significant difference in mean CCS and CAD severity was observed between mild, moderate, and severe CAD (p = 0.015 and p < 0.001). Comparison of CCS between hypertensives and non-hypertensives, across the four CAD severity categories, revealed a significant difference in mean CCS in the severe CAD category (p = 0.03). There was no significant difference in the CCS between hypertensives with chest pain and hypertensives without chest pain. A higher number of affected coronary arteries was associated with a higher mean CCS and a significant difference in CCS was observed between hypertensive and non-hypertensive subjects for the number of arteries affected. Similar results were observed when comparing mean CCS in moderate-severely affected coronary arteries. Conclusion: Hypertensive patients with a high CCS were associated with a higher incidence of severe CAD independent of the presence of chest pain. These results suggest that the incorporation of CCS in the investigation of CAD on CT angiography may pose a powerful adjunct in proposing an alternative paradigm for the assessment of patients with hypertension, in the progress of coronary artery disease.

Triglyceride-glucose Index as a Valuable Marker to Predict Severity of Coronary Artery Disease: A Retrospective Cohort Study.

The diagnostic standard of coronary artery disease (CAD) is coronary angiography (CAG). Since CAG is an invasive procedure underscores the need for identifying non-invasive, effective, and innovative biomarkers. Our study aimed to retrospectively analyze hematological markers for predicting the severity of CAD. Case data were collected from 195 CAD patients admitted to the hospital for CAG. According to Gensini score, patients were divided into mild, moderate, and severe CAD groups. Blood indexes and predictive efficacy of the triglyceride-glucose (TyG) index were retrospectively analyzed. Among 195 CAD patients, 81 had mild CAD, 60 had moderate CAD, and 54 had severe CAD. Sex, fast blood glucose (FBG), TyG index, and high-sensitivity C-reactive protein (hs-CRP) significantly differed among the three groups. The TyG index demonstrated higher values in patients with moderate (9.07[8.62-9.44]) and severe (8.98[8.46-9.45]) CAD compared to those with mild CAD (8.75[8.49-9.14]). The AUC of the TyG index was 0.615 (95% confidence interval (CI): 0.536-0.694, P =.004), with a cut-off value of 8.997, specificity of 0.704, and sensitivity of 0.535. Logistics analysis showed the risk of moderate and severe CAD with an odds ratio (OR) value of 2.595 (95% CI: 1.199-5.619, adjusted P = .016) following regrouping by the TyG index optimal cut-off value of 8.997. The TyG index combined with FBG and hs-CRP had an elevated AUC value, significantly higher than other combinations (P = .011 and 0.02, respectively). The severity of CAD is positively correlated with an increased TyG index value. A combination of TyG, FBG, and hs-CRP has demonstrated improved diagnostic efficiency, suggesting its potential as a novel indicator for predicting and diagnosing CAD progression.

Impact of DM on clinical outcomes in patients with CAD diagnosed by CCTA

Abstract Background/Introduction Diabetes mellitus (DM) is the most important risk factor for coronary artery disease (CAD) progression and prognosis. The DM patients with normal coronary artery on coronary CT angiography had good prognosis, however the prognosis of mild and moderate CAD was not fully elucidated. Purpose The aim of this study was to investigate the impact of DM on clinical outcomes in patients with mild and moderate CAD diagnosed by coronary CT angiography. Methods A total of 6014 patients underwent CCTA were prospectively enrolled and the 1126 patients with minimal and intermediate CAD were analyzed. Patients were categorized according to maximal severity of coronary artery stenosis: minimal CAD (31 to 50%) and intermediate CAD (51 to 70%). The primary outcome was major adverse cardiac events (MACE) including all-cause death, non-fatal myocardial infarction, coronary revascularization, or cardiac hospitalization. Results Nine hundred eighty-five patients had minimal CAD and 141 patients had intermediate CAD. The DM patients were 307 (31.2%) in the minimal CAD group and 52 (36.9%) in the intermediate CAD group. During the follow-up period (median 18.9 months [interquartile range: 7.8 to 34.6 months]), there is no significant difference of the risk of MACE between the non-DM and DM patients in the minimal CAD group (26.9% vs. 32.8%; adjusted hazard ratio [HR], 1.05; 95% confidence interval [CI], 0.74-1.49; p=0.79). However, compared with the non-DM patients, the DM patients significantly increased the risk of MACE in the intermediate CAD group (36.5% vs. 63.2%; adjusted HR, 2.37; 95% CI, 1.18-4.77; p=0.02). Conclusion The prognosis of the DM patients was similar with the non-DM patients in the minimal CAD group. However, the DM patients had worse clinical outcomes compared with the non-DM patients in the intermediate CAD group.Study design and clinical outcomeKaplan-Meier curves of event rate for MA

A long-term prognostic factor for cardiovascular risk in patients with chest pain without diabetes mellitus and significant coronary stenosis

Abstract Background Chest pain is the most common symptom of coronary artery disease (CAD); diabetes mellitus (DM) is a well-known single largest risk factor for cardiovascular diseases and survival worldwide. So, the impact of CAD and DM on long-term clinical effects is reported widely. This study aimed to evaluate the long-term prognostic factor for major adverse cardiac and clinical events (MACCE) in patients with chest pain without DM and CAD who underwent coronary angiography (CAG) and acetylcholine (ACH) provocation test. Methods A total of 1,046 patients with chest pain without DM and significant CAD who underwent CAG and ACH tests were finally enrolled. Propensity score matching and multivariate Cox-proportional hazard ratio analysis were performed to adjust for baseline potential confounders. All subjects were followed clinically for up to 5 years. Results Coronary spasm (CAS) seems the most common cause of chest pain. However, long-term MACCE of CAS is not worse than those of patients with chest pain without CAS when patients with CAS had subsequent optimal anti-anginal medication therapy. However, a repeated chest pain remains a problem even with continuous anti-anginal medication therapy. Up to 5-year follows, MACCE has occurred 7.3%, including recurrent angina of 6.9%. Dyslipidemia, mild to moderate CAD, and the use of aspirin/nitrates are associated with long-term MACCE. Conclusions Among the patients with chest pain without DM and significant CAD, the occurring major adverse cardiac events, including death, MI, and de novo CAD, are rare, but recurrent angina is still a challenging problem who had the treatment by anti-anginal medications.

The Potential of Magnesium Sulfate to Change Serum Lysyl Oxidase and Nitrite Levels in Patients with Atherosclerosis: A Double-Blind Clinical Trial Study

Background: Lysyl oxidase (LOX) and magnesium contribute to vascular development and stability. This research describes how magnesium sulfate (MgSO4 ) regulates the serum levels of LOX and nitric oxide in patients with moderate coronary artery disease (CAD). Methods: This was a randomized double-blind placebo-controlled clinical trial with 76 patients with moderate CAD divided into four groups. The subjects were randomly assigned to groups that took either capsules containing placebo or MgSO4 (300 mg) daily for 6 months. Thus, the experiment included Mg-treated groups with one and two vessels with atherosclerotic plaque (MgVR1 and Mg-VR2) and placebo-treated groups with one and two vessels with atherosclerotic plaque (placebo-VR1 and placeboVR2). Every 3 months, LOX, homocysteine, nitrite, and lipid profile levels were measured. Women and men with moderate CAD who were more than 55 and 50 years old, respectively, were included. Results: Total cholesterol and triglyceride (TG) levels significantly decreased 6 months after intervention (P<0. 01). Decrease of serum homocysteine levels was seen in all groups during the study, but the reduction in the placebo groups was greater than the Mg-treated groups (P<0.001). Three months after treatment with MgSO4 , LOX had stayed at high levels, and it then returned to baseline in the 6-month follow up (P<0.001). The rise in nitrite levels in the placebo-VR2 group was significantly greater than in the Mgso4 -VR2 group (P<0.001). Conclusion: magnesium sulfate may prevent the progression of arteriosclerosis through modulating LOX and homocysteine levels and preventing the increase of nitrite levels. Trial Registration: Identifier: IRCT20151028024756N3; https://www.irct.ir/trial/29097.

Association between hyperuricemia and coronary artery disease severity among patients undergoing coronary angiography

Aim: To determine the association between hyperuricemia and coronary artery disease severity among patients undergoing coronary angiography. Methods: This study was conducted at multi centers including Al- Aleem Medical College (Gulab Devi Teaching Hospital) Lahore and Fatima Memorial Hospital Lahore in the duration from December, 2022 to May, 2023. Total 180 patients were presented with Coronary Artery Disease, Coronary angiography was performed to determine the presence of coronary artery disease, with patients having luminal stenosis of greater than 50% in at least one of the coronary arteries. Relation between hyperuricemia and coronary artery disease was assessed using Chi Square test keeping P < 0.05 as significant. Results: The mean age was 49.59±6.11 years. The frequency of hyperuricemia was 120 (66.7%), around 32.3% patients had mild CAD, about 37.2% patients had moderate CAD while 30.6% patients had severe CAD. We found a significant association between hyperuricemia and severity of CAD. Conclusion: We conclude that hyperuricemia is significantly associated with the severity of coronary artery disease (CAD).

Non-destructive detection of CAD stenosis severity using ECG-PCG coupling analysis

Background and ObjectiveEffectively assessing the coronary stenosis degree is vital for the diagnosis of coronary artery disease (CAD). Electrocardiogram (ECG) and phonocardiogram (PCG) are simple, affordable, and non-invasive approaches, containing large cardiovascular physio-pathology information. This study aims to develop a non-destructive technique for CAD stenosis severity assessment. MethodsBy extracting the time series data from ECG and PCG signals, three coupling feature types, namely, cross-entropy (XEntropy), non-entropy (NEntropy), and multivariate-entropy features (MEntropy), are constructed. Then, a statistical analysis is conducted. Combing recursive feature elimination and support vector machines, coronary artery stenosis severity is identified. Experiments are performed on 237 simultaneously obtained ECG and PCG signals from the severe CAD (sCAD), mild to moderate CAD (mCAD), suspected CAD (CPNCA), and healthy (Health) subject groups. ResultsStatistical analysis results show that numerous features are statistically different. Regarding single-class coupling features, MEntropy has the strongest detection ability, followed by XEntropy, while that of NEntropy is relatively poor. Combining these three types of coupling features further improved the accuracy; the accuracies of sCAD-mCAD, sCAD-CPNCA, mCAD-CPNCA, sCAD-Health, mCAD-Health, and CPNCA-Health were 91.17%, 96.64%, 93.33%, 99.39%, 98.89%, and 97.78%, respectively. ConclusionsOur study confirms the great potential of MEntropy in characterizing cardiovascular status and provides a feasible solution for non-destructively assessing coronary artery stenosis.

Cytokine profile in patients with obstructive coronary artery disease

Background. Studies of the role of cytokines in the pathogenesis of coronary artery disease (CAD) are quite relevant. Significant cytokine imbalance is mostly observed in patients with acute coronary syndrome. However, there are limited reports of serum cytokine levels in patients with chronic stable CAD. The problem of relationship between cytokines to the severity of coronary atherosclerosis is still urgent.Aim: To investigate the relationship between serum levels of cytokines and the severity of CAD.Material and Methods. Serum levels of IL-2, IL-4, IL-6, IL-10, TNF-a was analyzed in 24 healthy control patients and 70 patients with stable CAD who underwent coronary angiography. Coronary atherosclerosis was assessed with Gensini scoring system. Depending on the median of GS (38.0), the patients were divided into moderate CAD group (GS = 8–37) and severe CAD group (GS ≥ 38). The data were analyzed using Statistical Package for the Social Sciences (SPSS) software 26.0.Results. Patients with obstructive CAD presented higher TNF-α levels and lower IL-4. Patients with severe CAD increased IL-6 and reduced IL-2 levels. Logistic regression analysis showed that the IL-6 was independently related to the presence of obstructive CAD (OR = 3.836; 95% CI= 1.8–8.177). ROC analysis of the IL-6 logistic regression model showed that a cut-off of 5.19 pg/mL had 75.0 % sensitivity and 70.0 % specificity to predict severe atherosclerosis.Conclusion. Pro-inflammatory TNF-α and IL-6 cytokines increased, while regulatory IL-2 and anti-inflammatory IL-4 decreased in patients with stable CAD. Cytokine imbalance contributes to CAD progression. Elevated IL-6 levels and the pro-inflammatory potential of the blood increases in case of severe coronary atherosclerosis. It has been shown that with an increase in IL-6 levels, the odds of detecting severe CAD increases 3.5-folds.

Clinical outcomes and health care costs of transferring rural Western Australians for invasive coronary angiography, and a cost-effective alternative care model: a retrospective cross-sectional study.

To examine the severity of coronary artery disease (CAD) in people from rural or remote Western Australia referred for invasive coronary angiography (ICA) in Perth and their subsequent management; to estimate the cost savings were computed tomography coronary angiography (CTCA) offered in rural centres as a first line investigation for people with suspected CAD. Retrospective cohort study. Adults with stable symptoms in rural and remote WA referred to Perth public tertiary hospitals for ICA evaluation during the 2019 calendar year. Severity and management of CAD (medical management or revascularisation); health care costs by care model (standard care or a proposed alternative model with local CTCA assessment). The mean age of the 1017 people from rural and remote WA who underwent ICA in Perth was 62 years (standard deviation, 13 years); 680 were men (66.9%), 245 were Indigenous people (24.1%). Indications for referral were non-ST elevation myocardial infarction (438, 43.1%), chest pain with normal troponin level (394, 38.7%), and other (185, 18.2%). After ICA assessment, 619 people were medically managed (60.9%) and 398 underwent revascularisation (39.1%). None of the 365 patients (35.9%) without obstructed coronaries (< 50% stenosis) underwent revascularisation; nine patients with moderate CAD (50-69% stenosis; 7%) and 389 with severe CAD (≥ 70% stenosis or occluded vessel; 75.5%) underwent revascularisation. Were CTCA used locally to determine the need for referral, 527 referrals could have been averted (53%), the ICA:revascularisation ratio would have improved from 2.6 to 1.6, and 1757 metropolitan hospital bed-days (43% reduction) and $7.3 million in health care costs (36% reduction) would have been saved. Many rural and remote Western Australians transferred for ICA in Perth have non-obstructive CAD and are medically managed. Providing CTCA as a first line investigation in rural centres could avert half of these transfers and be a cost-effective strategy for risk stratification of people with suspected CAD.

The Association of Coronary Fat Attenuation Index Quantified by Automated Software on Coronary Computed Tomography Angiography with Adverse Events in Patients with Less than Moderate Coronary Artery Stenosis.

This study analyzed the relationship between the coronary FAI on CCTA and coronary adverse events in patients with moderate coronary artery disease based on machine learning. A total of 172 patients with coronary artery disease with moderate or lower coronary artery stenosis were included. According to whether the patients had coronary adverse events, the patients were divided into an adverse group and a non-adverse group. The coronary FAI of patients was quantified via machine learning, and significant differences between the two groups were analyzed via t-test. The age difference between the two groups was statistically significant (p < 0.001). The group that had adverse reactions was older, and there was no statistically significant difference between the two groups in terms of sex and smoking status. There was no statistical significance in the blood biochemical indexes between the two groups (p > 0.05). There was a significant difference in the FAIs between the two groups (p < 0.05), with the FAI of the defective group being greater than that of the nonperforming group. Taking the age of patients as a covariate, an analysis of covariance showed that after excluding the influence of age, the FAIs between the two groups were still significantly different (p < 0.001).

Characteristics of the phenotype of mixed cardiomyopathy in patients with implantable cardioverter-defibrillators

Background or PurposeThe prognosis of mixed cardiomyopathy (CMP) in patients with implanted cardioverter-defibrillators (ICDs) has not been investigated. We aim to study the demographic, clinical, device therapies and survival characteristics of mixed CMP in a cohort of patients implanted with a defibrillator.MethodsThe term mixed CMP was used to categorise patients with impaired left ventricular ejection fraction attributed to documented non-ischemic triggers with concomitant moderate coronary artery disease. This is a single center observational cohort of 526 patients with a mean follow-up of 8.7 ± 3.5 years.ResultsThere were 42.5% patients with ischemic cardiomyopathy (ICM), 26.9% with non-ischemic cardiomyopathy (NICM) and 30.6% with mixed CMP. Mixed CMP, compared to NICM, was associated with higher mean age (69.1 ± 9.6 years), atrial fibrillation (55.3%) and greater incidence of comorbidities. The proportion of patients with mixed CMP receiving device shocks was 23.6%, compared to 18.4% in NICM and 27% in ICM. The VT cycle length recorded in mixed CMP (281.6 ± 43.1 ms) was comparable with ICM (282.5 ± 44 ms; p = 0.9) and lesser than NICM (297.7 ± 48.7 ms; p = 0.1). All-cause mortality in mixed CMP (21.1%) was similar to ICM (20.1%; p = 0.8) and higher than NICM (15.6%; p = 0.2). The Kaplan–Meier curves revealed hazards of 1.57 (95% CI: 0.91, 2.68) for mixed CMP compared to NICM.ConclusionIn a cohort of patients with ICD, the group with mixed CMP represents a phenotype predominantly comprised of the elderly with a higher incidence of comorbidities. Mixed CMP resembles ICM in terms of number of device shocks and VT cycle length. Trends of long-term prognosis of patients with mixed CMP are worse than NICM and similar to ICM.

Coronary Artery Stenosis Severity in Patients With Different Coronary Artery Calcium Scores on Coronary Computed Tomography Angiography.

Background In this study, we aimed to determine coronary artery stenosis severity in patients with different coronary artery calcium (CAC) scores. Methodology A total of 145 patients were included in the study. All patients were given beta-blockers 12 hours and two hours before the test to keep their heart rate between 55 and 65 beats per minute. Computed tomography angiography was done from the pulmonary hilum up to the base of the heart and the patients were asked to hold their breath. The CAC score and stenosis were assessed. Results The mean age of the patients was 41.35 ± 4.95 years. In total, 112 (77.24%) patients were male and 33 (22.76%) were female. Regarding the frequency of the CAC score, a score of 0-9 was observed in 43 (29.66%) patients, 10-99 was observed in 55 (37.93%) patients, and 100-400 was observed in 47 (32.41%) patients. The CAC score was 0-9 in 86.4% of patients having normal coronary arteries. Two (5.2%) patients with a CAC score of 100-400 had mild coronary artery stenosis, 11 (32.3%) patients had moderate coronary artery disease, and 33 (66.0%) patients had severe coronary artery disease (p < 0.00001). Conclusions There is a strong association between CAC scores and the severity of coronary artery stenosis. A CAC score of zero is associated with a very low risk of having coronary artery stenosis.

The value of calcium scoring in hypertensive patients as a referral criterion for the prediction of coronary artery disease detected on computed tomography coronary angiography

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The current national guidelines do not address the inequity between the increasing demand of Computed Tomography Coronary Angiography (CTCA) and the contrasting constrained imaging capacity. In a previous study we showed hypertension to be the strongest independent predictor of Coronary Artery Disease (CAD) detected on CTCA. In this study, the use of Coronary Calcium Scoring (CCS) for CTCA referrals is reviewed to identify the main parameters upon which CTCA referrals for the investigation of CAD, should be based. Methods After excluding TAVI and graft assessment patients, the individual electronic health records of 420 consecutive patients who underwent CTCA between July and November 2020, were reviewed with a mean age 59.1 years. Risk factors were recorded including smoking (23%), hyperlipidaemia (37%), positive family history (22%), systemic hypertension (51%), diabetes mellitus (30%) and male gender (50%). Referral criteria were also recorded for statistical analyses. Ethnicity, cardiac and past medical history were recorded. Patients were stratified into four groups according to CAD severity: absent, mild, moderate and severe disease, as seen on CTCA reports. The mean CCS for each CAD category was compared between hypertensive and non-hypertensive patients. Mean CCS were further compared in regard to the number of coronary arteries affected and the severity of CAD in each artery. Results Out of the total cohort, 247 (50.9%) patients were hypertensive. 249 (59.3%) CCS were interpreted in the very low risk category, 57 (13.6%) low risk, 58 (13.8%) moderate risk, 23 (5.48%) moderately high risk and 33 (7.86%) high risk. A significant difference in mean CCS and CAD severity was observed between mild, moderate and severe CAD (P = 0.015 and P &amp;lt; 0.001). Comparison of CCS between hypertensives and non-hypertensives, across the four CAD severity categories, revealed a significant difference in mean CCS in the severe CAD category (P = 0.013). Further comparison of CCS between hypertensives with chest pain and hypertensives without chest pain was non-significant. A higher number of affected coronary arteries was associated with a higher mean CCS and a significant difference in CCS was observed between hypertensives and non-hypertensives for the number of arteries affected. Similar results were observed when comparing mean CCS in moderate-severely affected coronary arteries. Conclusions Hypertensive patients with a high CCS were associated with higher incidence of severe CAD. Further, in those with hypertension, additional symptoms appear to have no effect on CCS. These results suggest that the incorporation of CCS in the investigation of CAD on CT angiography, may pose a powerful adjunct in proposing an alternative paradigm for the assessment of patients with hypertension and stable chest pain, in the progress of angiographic coronary disease.

Hypertensive patients are more likely to develop coronary artery disease on computed tomography coronary angiography

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Systemic hypertension (HTN) is the strongest cause for morbidity and mortality all over the world for its association with target organ damage including coronary artery disease (CAD). It creates a great challenge in medical field because it is often asymptomatic. CT coronary angiography (CTCA) being a non-invasive tool can be used to assess the presence of CAD successfully. In this study we aimed to identify the association between HTN and CAD. Methods The individual electronic health records of 566 consecutive patients who underwent CTCA between July and November 2020, were retrospectively reviewed. TAVI studies and graft assessment studies were excluded. A total of 485 patient (mean age 60.4) reports were analysed. All risk factors were recorded including smoking (23%), hyperlipidaemia (37%), positive family history (22%), systemic hypertension (51%), diabetes mellitus (30%) and male gender (50%). Referral criteria were also recorded for statistical analyses. Ethnicity, cardiac and past medical history were also recorded. Results Of the 170 patients with moderate-severe CAD, 127 (74.7%) had hypertension, and of the 100 patients with severe CAD, 78 (78%) had hypertension. Univariate analysis for comparison of patients with none (n = 222), mild (n = 93), moderate (n = 70) and severe (n = 100) CAD revealed that hypertension (P &amp;lt; 0.001), diabetes (P = 0.007), gender (P &amp;lt; 0.001), dyslipidaemia (P &amp;lt; 0.001) and smoking (P = 0.005), were all significantly associated with the presence of CAD on CTCA. However, multivariate analysis using a multiple logistic regression model, confirmed a significant association between hypertension and CAD (OR = 1.26, P &amp;lt; 0.001). SHAP-values for model interpretation revealed that hypertension has the strongest impact on CAD presence on CTCA. Conclusions Hypertension is the strongest independent predictor for the presence of CAD detected on CTCA, amongst diabetes, gender, dyslipidaemia, positive family history and smoking. These results suggest that hypertension and the other risk factors associated with CAD, should form the main parameters on consideration for CTCA referral. Further studies relating our results to the CTCA reports of same patients after a longer period of aggressive hypertension treatment, would prove essential in establishing the role of blood pressure management in the progress of angiographic coronary disease.

Analysis of coronary artery lesion degree and related risk factors in patients with coronary heart disease

Background. The study of the association of risk factors and atherosclerotic burden assessed by coronary angiography is promising in terms of both understanding the pathogenesis of the disease and predicting its development. The aim of the study was to investigate the relationship between traditional risk factors and the severity of coronary atherosclerosis in patients with stable CHD.Materials and methods. Risk factors were studied in 100 patients who underwent angiography. Based on the Gensini (GS) score, participants were divided into groups: patients with moderate lesion of coronary arteries (GS = 8–39), with severe lesion (GS ≥ 40), and control group (GS = 0). To verify the association between the variables, Pearson’s chi-square test was used. The results were presented as relative risk (RR) and the confidence interval (95% CI).Results. It was found that in patients with GS score less than 40 points, statistically significant factors were hypertension (RR = 2.6; 95% CI: 1.023–10.09; р = 0.018), family history (RR = 2.94; 95% CI: 1.501–5.762; р &lt; 0.001), depression (RR = 1.81; 95% CI: 1.202–2.738; р = 0.028), In patients with GS ≥ 40, the most important factors were diabetes (RR = 1.72; 95% CI: 1.187–2.511; р = 0,017), family history (RR = 2.02; 95% CI: 1.233–3.315; р = 0.002), inactivity (RR = 1.85; 95% CI: 1.219–2.824; р = 0.005). The GS scores were significantly higher in smokers compared non-smokers (44.0 vs. 32.0; p = 0.043).Conclusion. The most significant influence on the development of coronary atherosclerosis is exerted by a family history and physical inactivity. Arterial hypertension and depression are associated with moderate coronary artery disease. Severe athero sclerosis is associated with diabetes mellitus, long smoking history, low levels of high-density lipoprotein cholesterol.

Can Significant Coronary Artery Disease Coexist With Transient Takotsubo Cardiomyopathy, and How Does Spasm Interrelate?

An 86-year-old woman being treated for metastatic breast cancer developed severe chest pain at rest during a follow-up visit at a hospital's outpatient oncology clinic. An electrocardiogram showed severe ST-segment elevation. The patient was given sublingual nitroglycerin and was transferred to the emergency department. Diagnostic coronary angiography revealed moderate coronary artery disease with calcific stenoses and transient spastic occlusion of the left anterior descending coronary artery. For this patient, sublingual nitroglycerin aborted the spastic event and apparent transient takotsubo cardiomyopathy. Chemotherapy can potentially cause endothelial dysfunction and increased coronary spasticity, which could result in takotsubo cardiomyopathy.

Instantaneous wave–free ratio (IFR) VS myocardial perfusion imaging by single photon emission tomography (MPI-SPECT) in assessment of significance of moderate coronary artery disease

Instantaneous wave–free ratio (IFR) VS myocardial perfusion imaging by single photon emission tomography (MPI-SPECT) in assessment of significance of moderate coronary artery disease

Abstract 11350: Arrhythmogenic Mitral Valve Prolaspe and Mitral Annular Disjunction

Background: Mitral valve prolapse (MVP) affects about 2-3% of the general population. A small proportion of persons may have arrhythmic symptoms, leading to ventricular arrhythmias and sudden cardiac death (SCD). Mitral annular disjunction is a recently described entity that may be present with MVP or independently. Case: A 55-year-old male patient presented to the hospital with cardiac arrest. He has a history of percutaneous coronary intervention with stenting to left anterior descending (LAD) and right coronary artery (RCA) in 2015. He had ventricular fibrillation (VF) and subsequently arrested and underwent resuscitation. Electrocardiogram (EKG) showed sinus rhythm with prolonged QTc 487msec with no ischemia; echocardiography showed mitral annular disjunction, severe left ventricular global hypokinesis with ejection fraction of 10%. Left heart catheterization revealed nonobstructive moderate coronary artery disease. Right heart catheterization showed a severely reduced cardiac index of 2.1, and he was placed on mechanical support (Impella) for cardiogenic shock. On day 5, repeat echocardiography revealed left ventricular ejection fraction of 60%. Subsequent cardiac magnetic resonance (CMR) showed no evidence of infiltrative diseases but revealed an inferolateral wall scar from previous myocardial infarction and MVP with MAD. An implantable cardiac defibrillator was placed for secondary prevention of SCD. Discussion: The potential etiology of our patient's ventricular fibrillation cardiac arrest may include a scar from previous myocardial infarction or arrhythmogenic MVP with MAD. Myocardial fibrosis arising from MAD may be an origin of ectopic activity and arrhythmia. EKG, echocardiographic, and cardiac magnetic resonance imaging (CMR) are essential in diagnosing arrhythmic MVP and MAD. Young patients with premature ventricular contractions without clear etiology should be evaluated for MAD, and incidental findings of MAD should warrant further investigations, given its arrhythmogenic potential. Conclusion: MVP with MAD is associated with life-threatening arrhythmias. Further studies are required to explore treatment options to reduce the incidence of malignant VAs and SCDs in patients with MVP.

Angiographic patterns of coronary artery disease in young patients presenting at a tertiary cardiac center.

To compare the patterns of coronary artery disease (CAD) between young adults ≤35 years of age and patients >35 years of age. The observational retrospective study was carried out in angiography department of emergency at Punjab Institute of Cardiology, Lahore between January 2020 and October 2020. Patients ≤35 years old were in Group-I whereas patients >35 years who served as controls were in Group-II. Patients with unstable angina, non-ST and ST elevation MI all were included. The patients with previous history of CAD (CABG/PCI) and angiography done for other purposes i.e., before valvular surgery or PPM implantation were excluded. Out of 1268 patients, 552 were in Group-I and 716 were in Group-II. The prevalence of normal coronaries/ mild CAD was higher in Group-I i.e., 224(40.6%) than in Group-II i.e., 64 (8.9%). Single vessel disease (SVD) was comparable in both the groups 185 (33.5%) vs. 216 (30.2%). Double vessel disease and triple vessel disease (TVD) was common in Group-II and left main stem (LMS) involvement was also significantly higher in Group-II i.e., 32 (4.5%) vs. 8 (1.4%). Clot in coronary arteries with or without underlying CAD was seen more frequently in Group-I, 61(11.1%) vs. 34 (4.7%). Presence of clot was seen mostly in those patients who had moderate coronary artery disease. Young patients have different coronary artery disease patterns, so the management strategy must be different in this population. Majority of the young patients have non severe disease. Clot formation is commonly seen in young adults with moderate CAD.

Cardiac risk factors limiting survival to liver transplantation in patients with nonalcoholic fatty liver disease.

BACKGROUNDNonalcoholic fatty liver disease (NAFLD) describes the hepatic manifestations of metabolic syndrome, which is estimated to affect 25% of adults, and currently represents the second most common indication for liver transplant in the United States. Studies have shown that patients with NAFLD are at an increased risk for heart failure, arrhythmia, and coronary artery disease (CAD), which may impact outcomes of liver transplantation. However, it remains unclear whether the presence of cardiac disease affects survival prior to liver transplant. If so, this would represent an important opportunity to optimize cardiac status and improve outcomes before liver transplant.AIMTo identify cardiac factors that impact survival to liver transplantation in patients with NAFLD and on the transplant waitlist.METHODSThe aim of this study was to identify cardiac risk factors that limit survival to transplant in patients with NAFLD. We performed a retrospective analysis of patients with NAFLD listed for liver transplant at a tertiary academic medical center in the United States from January 2015 to January 2021, identified through United Network of Organ Sharing registry. Exclusion criteria included a concurrent etiology of liver disease and removal from the transplant list due to chemical dependency, lack of social support, improvement in liver disease, or being lost to follow-up. We manually reviewed patient charts including electrocardiogram, echocardiogram, and cardiac catheterization reports as well as physician notes to identify cardiac disease states (i.e., heart failure, arrhythmia, valvular disease and CAD) and other related diagnoses. We performed a survival analysis by Cox proportional hazards regression model to analyze the association between cardiac factors at the time listed for transplant and death or clinical deterioration prior to transplant.RESULTSBetween January 2015 and January 2021, 265 patients with nonalcoholic fatty liver disease were listed for liver transplant at our institution. Our patient sample had a median age of 63 and an even distribution between sexes. The median Model for End-Stage Liver Disease (MELD) score was 17 and the median body mass index was 31.6. Of these 265 patients, 197 (74.3%) survived to transplant and 68 (25.7%) died or clinically deteriorated prior to transplant. The presence of mild or moderate CAD represented a hazard ratio of 2.013 (95%CI 1.078-3.759, P = 0.029) for death or clinical deterioration when compared to patients without CAD, after adjustment for age, sex, and MELD. MELD represented an adjusted hazard ratio of 1.188. CONCLUSIONMild or moderate CAD represents a hazard for waitlist mortality prior to liver transplant in patients with NAFLD. Aggressive management of CAD may be needed to improve patient outcomes.