Multislice Computed Tomography Coronary Angiography Research Articles

Assessment of the Level of Matrix Metalloproteinases, VEGF and MicroRNA-34a in Patients With Non-obstructive and Obstructive Lesions of the Coronary Arteries.

To assess the levels of matrix metalloproteinases (MMP), vascular endothelial growth factor (VEGF), and miRNA-34a expression in patients with ischemic heart disease (IHD) and obstructive and nonobstructive coronary artery (CA) disease. This cross-sectional observational study included 64 patients with IHD (diagnosis verified by coronary angiography or multislice computed tomography coronary angiography), of which 33 (51.6%) were men aged 64.9±8.1 years. 20 patients had nonobstructive CA disease (stenosis <50%), and 44 had hemodynamically significant stenoses. The control group consisted of 30 healthy volunteers. MMP-1, -9, -13, and -14, miRNA-34a, and VEGF were measured in all patients. The concentration of MMP-1 was significantly higher in patients with ischemia and nonobstructive CA disease (INOCAD) (p=0.016), and the concentration of MMP-9 was the highest in the group with obstructive CA disease (p<0.001). The concentrations of MMP-13 and MMP-14 did not differ significantly between the groups. The highest VEGF concentrations were observed in the INOCAD group (p<0.001). The expression of miRNA-34a significantly differed between the IHD groups with different types of CA disease and controls (p <0.001). Patients with hemodynamically significant stenosis showed moderate relationships between the concentrations of MMP-14 and VEGF (ρ=0.418; p=0.024), as well as between VEGF and miRNA-34a (ρ=0.425; p=0.022). Patients with INOCAD had a significant negative correlation between the concentrations of MMP-13 and VEGF (ρ= -0.659; p=0.003). Correlation analysis showed in all IHD patients a moderate relationship of the concentrations of MMP-1 and MMP-14 with VEGF (ρ=0.449; p=0.002 and p=0.341; p=0.019, respectively). According to ROC analysis, a MMP-9 concentration above 4.83 ng/ml can be a predictor for the presence of hemodynamically significant CA obstruction in IHD patients; a VEGF concentration higher than 27.23 pg/ml suggests the absence of hemodynamically significant CA stenosis. IHD patients with INOCAD had the greatest increase in MMP-1, whereas patients with obstructive CA disease had the highest level of MMP-9. According to our data, concentrations of MMP-9 and VEGF can be used to predict the degree of CA obstruction. The expression of miRNA-34a was significantly higher in IHD patients with INOCAD and CA obstruction than in the control group, which suggested a miRNA-34a contribution to the development and progression of coronary atherosclerosis. In the future, it may be possible to use this miRNA as a diagnostic marker for IHD.

High calcium score in an 83-year-old patient with non-ST elevation acute coronary syndrome and nonobstructive coronary artery disease: a case report

Currently, multi-slice computed tomography (MSCT) coronary angiography is a leader in the diagnosis of coronary artery disease in patients with non-ST elevation acute coronary syndrome of low or moderate risk. High coronary calcium score (CCS) obtained by MSCT indicate a high probability of obstructive coronary artery disease. In the presented case of an 83-year-old patient with unstable angina, the CCS was 1394, and hemodynamically significant stenoses were detected. However, according to selective coronary angiography, no hemodynamically significant coronary lesions were found. High CCS suggests poor image quality in MSCT coronary angiography. High CCS is detected in most people over 70 years of age. Obviously, in this patient, a high CCS is mainly determined by age. Most studies on CCS did not include patients over 80 years of age. When deciding whether to perform MSCT coronary angiography, it is necessary to take into account the individual characteristics of a particular patient, which may affect the interpretation of results.

Cross sectional study of the relationship between the presence / severity of coronary artery disease evaluated by computed tomography coronary angiography and the presence/ degree of non-alcoholic fatty liver disease evaluated by trans-abdominal ultrasonography

Abstract Background Coronary artery disease is one of the common causes of mortality worldwide. Studies have shown a prevalence of 24.5% in Egypt. Therefore, early accurate diagnosis, risk factors and associations of coronary artery disease are of utmost importance. Objectives The aim of the current study is to investigate the relationship between the presence / severity of coronary artery disease and presence extent of nonalcoholic fatty liver disease. Patients and Methods Cross-sectional study on total 52 patients performed multi-slice computed tomography coronary angiography, and liver evaluation by abdominal ultrasonography at Dar Shefaa hospital. Results We found that there is a positive significant relationship between the number of coronary arteries affected and the coronary lesion degree of stenosis (proven by P value= 0.909). Also, a positive significant relationship between the number of affected vessels and the degree of non-alcoholic fatty liver disease (proven by P value =-0.783). Also, a positive significance between coronary lesion stenosis degree and the degree of non-alcoholic fatty liver disease (proven by P value= 0.785). Conclusion The existence of non-alcoholic fatty liver disease is independently associated with the presence and existence of coronary artery disease. it is not still clear whether the non-alcoholic fatty liver disease causes coronary artery disease or whether this relationship is seem because of the common mechanisms causing both diseases, yet the relationship between the existence of hepatosteatosis and the extent of coronary artery disease has been strongly documented.

Coronary atherosclerotic plaque extent in hypertensive patients detected by computed tomographic angiography

Objective To evaluate the extent of coronary artery calcium in hypertensive patients using multislice computed tomography. Background Uncontrolled hypertension is one of the most common determinants for hospital admissions owing to acute coronary events. Computed tomographic (CT) coronary calcium scoring has been established as the best noninvasive predictor of atherosclerotic cardiovascular risk available today. Patients and methods The present study was conducted on 90 patients with recurrent chest pain referred for coronary multislice computed tomography angiography at Kobry El-Kobba Military Hospital. Patients comprised 69 hypertensive patients and 21 normotensive patients. Full history taking, laboratory investigation, coronary CT angiography, coronary plaque distribution, and coronary artery calcium scoring (CACS) were done. Results There was no statistically significant difference between the studied groups regarding mid left anterior descending (LAD) obstruction, distal LAD obstruction, proximal left circumflex (LCX) obstruction and distal LCX obstruction, proximal right coronary artery (RCA) obstruction, mid RCA obstruction, and distal RCA obstruction. However, hypertensive patients had significantly higher rate of 1–49% proximal LAD obstruction (P = 0.015) and mid LCX 1–49% and more than or equal to 50% obstruction (P = 0.034). Moreover, nonhypertensive patients had significantly higher number of patients with nonaffected vessels. Hypertensive patients had significantly higher rate of two-vessel affection. Moreover, hypertensive patients had significantly higher CACS, atheroma burden obstructive score, segment involvement score, and segment stenosis scored syntax I score compared with nonhypertensive patients. Conclusion Hypertension is associated with higher rate of coronary artery stenosis as shown by CT angiography. Hypertension is associated with increasing CACS.

Clinical and biochemical markers of coronary artery calcification progression after elective coronary artery bypass grafting

Aim. To assess the relationship of various clinical and biological markers of bone metabolism with the progression of coronary artery calcification (CAC) in patients with stable coronary artery disease (CAD) within 5 years after coronary artery bypass grafting (CABG).Material and methods. This single-center prospective observational study included 111 men with CAD who were hospitalized for elective CABG. In the preoperative period, all patients underwent duplex ultrasound of extracranial arteries (ECA) and multislice computed tomography (MSCT) to assess CAC severity using the Agatston score, as well as densitometry with determination of bone mineral density in the femoral neck, lumbar spine and T-score for them, In all participants, the following bone metabolism biomarkers were studied: calcium, phosphorus, calcitonin, osteopontin, osteocalcin, osteoprotegerin (OPG), alkaline phosphatase, parathyroid hormone. Five years after CABG, ECA duplex ultrasound, MSCT coronary angiography and bone metabolism tests were repeated. Depending on CAC progression (>100 Agatston units (AU)), patients were divided into two groups to identify significant biomarkers and clinical risk factors associated with CAC progression.Results. For 5 years after CABG, contact with 16 (14,4%) patients was not possible; however, their vital status was assessed (they were alive). Death was recorded in 4 (3,6%) cases (3 — due to myocardial infarction, 1 — due to stroke). In 18 (19,7%) cases, non-fatal endpoints were revealed: angina recurrence after CABG — 16 patients, myocardial infarction — 1 patient, emergency stenting for unstable angina — 1 patient. There were no differences in the incidence of events between the groups with and without CAC progression. According to MSCT 5 years after CABG (n=91 (81,9%)), CAC progression was detected in 60 (65,9%) patients. Multivariate analysis allowed to create a model for predicting the risk of CAC progression, which included following parameters: cathepsin K <16,75 pmol/L (p=0,003) and bone mineral density <0,95 g/cm3 according to femoral neck densitometry before CABG (p=0,016); OPG <3,58 pg/ml (p=0,016) in the postoperative period 5 years after CABG.Conclusion. Within 5 years after CABG, 65,9% of male patients with stable coronary artery disease have CAC progression, the main predictors of which are low preoperative cathepsin K level (<16,75 pmol/L) and low bone mineral density (<0,95 g/cm3) according to femoral neck densitometry, as well as a low OPG level (<3,58 pg/ml) 5 years after CABG. 

Minimally invasive coronary artery bypass grafting via a lower ministernotomy for left anterior descending artery myocardial bridging: mid-term results.

Coronary artery bypass grafting or supra-arterial myotomy is now suggested as a better therapeutic option in myocardial bridging (MB) when medical treatment fails to control symptoms. For left anterior descending (LAD) MB, minimally invasive coronary artery bypass via a lower ministernotomy can be offered. Forty-four consecutive patients who underwent elective minimally invasive coronary artery bypass surgery from 2005 to 2014 via an inferior sternotomy using the left internal mammary artery as a bypass graft for LAD MB were evaluated retrospectively. The mean age was 59.1 ± 13.1 years with 26 (59%) men and 18 (41%) women. The mean body mass index was 27.2 ± 3.9 and the mean EuroSCORE II was 1.6 ± 1.8. Routine coronary multislice computed tomography angiography on the 6th postoperative day revealed 97.7% graft patency. During the initial hospital stay, 1 patient (2.3%) underwent a reoperation for early graft failure. Forty patients (91%) could be followed up for a mean period of 64.4 ± 24.5 months after the procedure, during which 2 patients (4.5%) died of non-cardiac causes and 9 patients (20.5%) underwent postoperative coronary angiography with confirmed graft occlusion in only 1 case (2.3%). The improvement in the distribution of patients in the Canadian Cardiovascular Society class 0 was from 4 patients (9%) preoperatively to 37 patients (84%) at the end of the follow-up period (P-value 0.001). Minimally invasive coronary artery bypass surgery via a lower ministernotomy may be safe and efficient for treating LAD artery MB with acceptable complication rates, cosmetic benefits and patency rates.

Identification of Risk Factors Affecting Graft Patency after bypass surgery Assessed by Multi-slice Computedtomography coronary Angiography

Ischemic heart disease is the top cause of death globally. Percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) are options for patients requiring revascularisation. European guidelines advise discussing these patients in a multidisciplinary Heart Team In recent years, 64 slice multi-detector computed tomography (MDCT) has emerged as an alternative to ICA in evaluating the graft and native coronary arteries for its diagnostic potentials, low cost and safety. There need aid a number elements that influence graft patency which incorporate hypercholesterolemia, danger variable modification, for example, such that diet Also smoking auto cessation, and release therapies (counting antiplatelets Furthermore lipid-lowering agents) Purpose: to distinguish danger figures influencing Graft patency after sidestep surgery by utilizing MSCT coronary angiography. It may be single, center, cross sectional, observational investigation that held once Kobry-ElKobba military healing facility –Cardiology Branch Throughout the time from september 2018 should september 2019. There might have been statistically noteworthy the middle of number about grafts What's more patency from claiming grafts. Increment number about grafts reasons higher danger to blocked grafts.

Multislice computed tomography in the evaluation of coronary atherosclerosis dynamics: data three-year observation in patients with myocardial infarction-segment elevation ST and stenting of coronary arteries

The aim – to use multislice computed tomography (MSCT)-coronary angiography data to determine the presence of atherosclerotic process progression in coronary vessels in the dynamics of the three-year follow-up period in patients after STEMI and coronary artery stenting.Materials and methods. 66 MSCT-coronary angiography studies were performed in 19 men after primary myocardial infarction with ST-segment elevation (STEMI) and coronary artery stenting. All patients were male, ranging in age from 38 to 66 years, with a mean (Me 55.6; (Q1–Q3 (49–64)) years, and 18 of 19 (94.0 %) patients developed Q-MI. 1 patient (6 %) had non-Q-MI. A month after acute MI, patients underwent MSCT of the heart with coronary vascular contrast. Re-examination was performed one, two and three years after the development of STEMI. According to the results of MSCT coronary angiography determined the functional status of stents, as well as the presence or exclusion of signs of restenosis (about 50 % or more) or thrombosis 100 % – occlusion) in the stent coronary artery and in non-infarction-causing arteries. With the progression of atherosclerotic plaque, an increase in atherosclerotic plaque of more than 20 % was taken into account compared to the previous study.Results and discussion. By the end of the first year after MI in 11 of 19 (57.9 %) patients according to MSCT-coronary angiography, no progression of atherosclerotic lesions of the coronary arteries was observed. 1 patient (5.6 %) had stent restenosis, which was confirmed by CAG data. Progression of atherosclerotic lesions was observed in 7 patients (36.8 %), 3 of them (16.6 %) in the stent artery, and in 4 patients in the non-infarction-causing artery. In the second year after myocardial infarction, compared with the annual examination, in 6 of 14 (42.9 %) no progression of atherosclerosis was observed, and in 7 of 14 (50 %) progression of atherosclerotic lesions not in the stent artery, and only in 1 of 14 – progression of atherosclerosis in the stent artery. In the third year after the development of MI, 10 of 14 (71.4 %) had no progression of atherosclerosis, and 4 patients showed progression in both IOA and other arteries.Conclusions. MSCT coronary angiography is an informative method in assessing the functional status of stents and determining the progression of coronary atherosclerosis in the infarct-causing artery and other coronary arteries in patients after MI and coronary artery stenting in the dynamics of three-year follow-up. The lack of progression of atherosclerosis was accompanied by slightly lower levels of low-density lipoprotein cholesterol, compared with patients with progression of atherosclerosis.

Role of smoking on body fat distribution and coronary artery disease

Abstract Introduction Smoking and obesity are recognized as important modifiable risk factors for coronary artery disease (CAD). However, the general perception that smoking protects against obesity is a common reason for starting, and/or not quitting smoking. Purpose To detect the quantity, quality and relative distribution of subcutaneous adipose tissue (SAT) and visceral adipose tissue (VAT) estimated by abdominal computed tomography in smokers versus non- smokers. Methods The abdominal muscular wall was traced manually to calculate SAT and VAT areas (cm2) (outside and inside abdominal muscular wall respectively) as well as SAT density [Hounsfield units (HU)] at L4-L5 in 409 consecutive patients referred for evaluation of chest pain by multi-slice computed tomography coronary angiography (MSCT-CA). Results 26% of the studied patients (n=107) were current smokers, while the remaining 74% (n=302) never smoked. Coronary artery atherosclerosis was more prevalent in smokers compared to non-smokers (64.5% vs 55.0%; p=0.09). Smokers had statistically significantly lower body mass index (BMI) (31.2±4.3 vs. 32.5±4.7 kg/m2; p=0.015), hip circumference (HC) (98.6±22.5 vs. 103.9±20.9 cm; p=0.031), total fat area (441.62±166.34 vs. 517.95±169.51cm2; p<0.001), and SAT area (313.07±125.54 vs. 390.93±143.28 cm2; p<0.001) as compared to non-smokers. However, smokers had statistically significantly greater waist-to-hip ratio (0.98±0.08 vs. 0.96±0.08; p=0.010), VAT/SAT area ratio (0.41±0.23 vs. 0.35±0.20; p=0.013), and denser SAT depot (−98.91±7.71 vs. −102.08±6.44 HU; p<0.001). Conclusion Smoking contributes to CAD and to the pathogenic redistribution of body fat towards VAT, through limiting SAT potential to expand. Funding Acknowledgement Type of funding source: None

Laboratory and Echocardiographic parameters as predictors of Coronary artery Calcium score detected by multislice computed tomography coronary angiography

Laboratory and Echocardiographic parameters as predictors of Coronary artery Calcium score detected by multislice computed tomography coronary angiography

The Association between the Relative Visceral to Subcutaneous Abdominal Fat Distribution and the Presence of Coronary Artery Atherosclerosis

Introduction: Distribution of abdominal fat is more detrimental in the pathogenesis of coronary artery atherosclerosis (CAA) than its amount. Purpose: To detect the value of the amount of visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT), and their distribution by abdominal computed tomography in the detection of CAA as assessed by multi-slice computed tomography coronary angiography (MSCT-CA). Methods: The abdominal muscular wall was traced manually to calculate SAT and VAT areas (cm²) (outside and inside abdominal muscular wall respectively) at L4-L5 in 63 consecutive patients with no risk factors for coronary artery disease (CAD) referred for evaluation of chest pain by MSCT-CA. Results: 40% of the studied patients (n=25) had CAA (Group 1), while the remaining 60%(n=38) had no CAA (Group 2). There was no statistically significant difference between both groups as regards weight, body mass index (BMI), waist circumference (WC), waist-to hip ratio (W/H ratio), VAT area, SAT area, and total fat area. Group 1 patients were predominantly males (53% vs 24%; p=0.023), with statistically significantly increased VAT/ SAT area ratio (0.40 ± 0.23 vs 0.29 ± 0.16; p=0.028), and increased age (55.7 ± 7.9 vs 44.0 ± 11.1; p<0.001) as compared to Group 2 patients. Conclusion: VAT/SAT area ratio can be used in the detection of CAA in patients with no CAD risk factors.

Detection of positively remodeled coronary artery lesions by multislice CT and its impact on cardiovascular future events

BackgroundPositive arterial remodeling may be a characteristic of early proliferative lesions. The study was done to identify the different morphological characteristics of the positively remodeled coronary lesions, and causing non-significant arterial stenosis, as detected by multislice computed tomography coronary angiography (MSCT CA) and its predictors of cardiovascular clinical events at 90-day follow-up. The study included 55 patients who were candidate for MSCT CA and found to have a single-vessel disease with less than 70% stenosis positively remodeled lesions. The most expansive or solitary lesion was selected for each patient. Positive remodeling defined as remodeling index (RI) > 1.05. We followed the patients clinically for 90 days.ResultsTwenty-four patients had a history of acute coronary syndrome at initial presentation with normal LV systolic function for all studied patients. Dyslipidemia was found in 37 patients (67.3%) while diabetes was found in 29 patients (52.7%). The majority of the lesions were found in the proximal LAD (43.6%). The mean calculated remodeling index was 1.41 ± 0.25. At the end of 90 days, 25 patients had clinical events in the form of unstable coronary syndromes, coronary interventions, or coronary angiography related to the index lesion. The predictors of clinical events were duration of DM, higher degree of luminal narrowing, calculated wall/lumen area percentage, plaque burden, plaque-specific calcification, and total calcium score at remodeling site as well as a lower percentage of low-attenuation plaque area. The mean calculated wall/lumen area percentage was 263.72 ± 122.71%. A cut-off value of > 226% was found a predictor for clinical events. The mean plaque burden percentage was 69.72 ± 9.71%, a value of > 69% was found a predictor for clinical events. Both values had a sensitivity of 68% and specificity of 86.6% and PPV of 81%. Positively remodeled lesions with a high RI > 1.4 were correlated with patients who had acute coronary syndrome on their initial presentation.ConclusionDifferent morphological characteristics of positively remodeled non-occlusive atherosclerotic plaques as detected by multislice CT coronary angiography may be good potential predictors of future cardiovascular events.

Assessment of Extent and Severity of Coronary Artery Stenosis Using CT Coronary Angiography Among Prediabetic Patients

Background and aims: Prediabetes is associated with an increased risk of developing diabetes and cardiovascular disease. Our objective was to assess the extent and severity of coronary artery diseases (CAD) among prediabetic patients using multi-slice computed tomography (MSCT) coronary angiography. Subjects and methods: Our population included 60 patients with mean age 56.2 ±10.5 years presented by typical chest pain with fasting blood glucose (FPG) < 126 mg/dL and HbA1c ≤ 6.4% and at least one CV risk factor. Any patients with prior history of CV disease or clinical evidence of advanced renal disease were excluded from this study. The extent and severity of coronary artery stenosis were assessed using MSCT coronary angiography. The patients were divided into two groups, prediabetic group (GI) and non-diabetic group (GII). Prediabetes was defined as an HbA1c value of 5.7-6.4%. Results: Prediabetic group had significantly higher number of diseased vessels with higher number of patients having MVD compared to non-diabetic group. HbA1C and FPG were found as independent predictors for both extent and severity of diseased coronary arteries. Conclusion: CAD was more advanced in prediabetic patients compared to non-diabetic patients. Moreover, non-diabetic levels of glucose metabolism evidenced by impaired FBG and increased levels of HbA1C were helpful to predict increased risk for the extent and severity of CAD among our study population.

TCT-208 Effectiveness of Multislice Computed Tomography Coronary Angiography Versus Invasive Coronary Angiography in Accurate Calculation of SYNTAX score

TCT-208 Effectiveness of Multislice Computed Tomography Coronary Angiography Versus Invasive Coronary Angiography in Accurate Calculation of SYNTAX score

Subclinical Atherosclerosis In Asymptomatic Patients With Metabolic Syndrome: The Role Of Multi-Slice Computed Tomography Coronary Angiography

Subclinical Atherosclerosis In Asymptomatic Patients With Metabolic Syndrome: The Role Of Multi-Slice Computed Tomography Coronary Angiography

Plaque morphology in diabetic vs. non diabetic patients assessed by Multi-Slice Computed Tomography coronary angiography

Plaque morphology in diabetic vs. non diabetic patients assessed by Multi-Slice Computed Tomography coronary angiography

Coronary Artery Atherosclerosis Assessment Using Multi Detector Computed Tomography and its Correlation with Framingham Risk Score Among Symptomatic Patients with Chest Pain

AbstractBackground: A non-invasive assessment of coronary atherosclerosis by means of Framingham risk scoring (FRS) and multi-slice computed tomography coronary angiography (MSCT) could improve patients' risk stratification. However, the data is still limited on the strong association between FRS and imaging modality in the form of MSCT coronary angiog-raphy.Aim of Work: To study the relationship between the extent of atherosclerotic affection among symptomatic patients with chest pain assessed by MDCT & the CAD risk as assessed by FRS.Patients and Methods: This prospective cross sectional study took place between September 2017 and September 2018, at Kobry El-Kobba Military Hospital, and enrolled 150 patients who presented with chest pain. All patients were subjected to clinical assessment with FRS, after which they had undergone MDCT coronary angiography to diagnose the type of vessels affected, number of stenotic segments, as well as the volume of plaques obstructing the vessels.Results: Most of our studied patients were males (70.7%) with mean±SD age 54.9±9.1 years. The mean ± SD FRS score was 15.6±11.3 with median value of 13.2. The majority of the patients were classified as low risk score. The patients with higher FRS showed more than 2 segments of stenosis and correlated strongly with the number of affected segments as well as the volume of detected plaques. Subjects who were in the higher risk group were significantly older, had disturbed lipid profile and showed the highest systolic blood pressure compared to the low and intermediate risk groups.Conclusion: Framingham risk score is a well validated clinical score being moderately correlated with number of affected segments and volume of plagues detected in MDCT coronary angiography. Higher group of FRS was significantly associated with male gender, older subjects and disturbed lipid profile.

Clinical implication of multi-slice computed tomography coronary angiography for symptomatic patients in clinical practice

Aim: Multi-slice computed tomography coronary angiography (MDCTA) has been reported as an effective alternative to invasive conventional coronary angiography (CCA) for the diagnosis of coronary artery disease (CAD). However, in previous reports, the diagnostic accuracy of MSCT has not been significant enough to be of benefit in symptomatic patients. The aim of this study was to identify the usefulness of multi-slice computed tomography coronary angiography for symptomatic patients in terms of the diagnostic accuracy of MDCTA and the prevalence of vasospastic angina pectoris (VSAP) within the study cohort.

Correlation between immunological-inflammatory markers and endothelial disfunction in the early stage of coronary heart disease

Classical risk factors for endothelial dysfunction (ED), such as age, gender, total cholesterol, high-density lipoprotein cholesterol, systolic blood pressure, and smoking history are utilised for the Framingham score and Systemic Coronary Risk Estimation (SCORE) for evaluation of the 10-year cardiovascular risk in routine practice. Nonetheless, pro-inflammatory mediators are deeply involved in the initiation and the progression of ED and coronary artery disease (CAD), and act additionally or independently of metabolic factors before clinical manifestations of the disease appear. C-reactive protein, a marker of intimal thickening of the myeloid-related protein 8/14 heterodimer, monocyte chemotactic protein 1, interleukin-15, the cytotoxic mediator, granulysin, and the matrix metalloproteinase 9 could be valuable, single, fast, and non-invasive laboratory tools for ED deterioration degree assessment. We propose to investigate the impact of pro-inflammatory biomarkers on ED, measured by previously established clinical methods in patients with yet undiagnosed CAD and at medium risk for an acute coronary event. It could be useful to measure and correlate the concentration of particular inflammatory markers in peripheral blood samples and the results of the Framingham and SCORE charts, multi-slice computed tomography coronary angiography, echocardiography, brachial artery flow-mediated dilatation, carotid-femoral pulse wave velocity, ankle-brachial index, carotid wall thickening, myocardial perfusion scintigraphy, and particularly, cardiac magnetic resonance imaging. The goal would be that the degree of correlation between particular inflammatory markers and the results of some methods for the assessment of ED or cardiac ischaemic imaging could be emphasised and pro-inflammatory markers positioned in the pathogenetic algorithm of CAD.

The diagnosis of coronary plaque stability by multi-slice computed tomography coronary angiography.

Coronary computed tomographic angiography is a robust non-invasive method to assess coronary artery disease (CAD) and analyze coronary plaque stability, especially for the non-calcified plaques. The aim of this study was to investigate the differential characteristics between the unstable coronary plaques and the stable coronary plaques using multi-slice computed tomography (MSCT). Sixty patients with coronary heart disease (37 unstable plaques and 31 stable plaques) were included. The napkin ring thickness, napkin-ring sign, plaque CT attenuation and degree of lumen stenosis were retrospectively analyzed. The diagnostic performances of MSCT were determined to predict the unstable plaques. The difference was statistically significant if P<0.05. The napkin ring thickness of the unstable plaques was thinner than that of the stable plaques (P<0.05). The napkin-ring sign was more frequently observed in the unstable group (89.2%) than the stable group (22.6%, P<0.05). The average CT value of the unstable plaques (26.8±17.8 HU) was lower than that of the stable plaques (68.5±25.5 HU, P<0.05). The unstable plaques had more severe lumen stenosis or occlusion (70.3%) than the stable plaques (41.9%, P<0.05). The measurable napkin ring thickness of the plaques with a cutoff value of 0.8 mm and an accuracy of 89.5% was one independent factor to predict unstable plaques. The optimal combined threshold of the napkin-ring sign and/or the plaque CT value of 53 HU with an accuracy of 80.9% was to predict unstable plaques. The optimal combined threshold of the napkin-ring sign and/or the plaque CT value ≤53 HU may be a good indicator to predict the unstable plaques in patients with CAD. The subgroup of measurable napkin ring thickness of the non-calcified plaques may also be an independent factor to predict the unstable plaques in patients with CAD.