Multi-vessel Group Research Articles

Visfatin Related to the Severity of Non-ST-Segment Elevation Acute Coronary Syndrome: A Retrospective Study of 164 Patients at a Tertiary Chest Pain Center

Acute coronary syndrome (ACS) poses a pervasive threat to individuals grappling with cardiovascular afflictions, manifesting as unstable angina, non-ST-segment elevation myocardial infarction (NSTEMI), ST-segment elevation myocardial infarction (STEMI), or sudden cardiac death, depending on vascular obstruction’s extent and location. NSTEMI, closely linked to substantial morbidity and mortality, has become the primary cause of hospitalization in ischemic heart disease patients. Swift prognostication of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is crucial, necessitating the identification of precise markers. This study, conducted from January 2020 to March 2021, explored the correlation between serum visfatin levels and NSTE-ACS severity. A total of 164 patients undergoing coronary angiography were enrolled, with a control group (n = 55) exhibiting less than 50% coronary stenosis. NSTE-ACS patients were categorized based on angiography outcomes into single-vessel (n = 41), double-vessel (n = 28), and multivessel (n = 40) groups. Serum visfatin levels, meticulously quantified, showed significant elevation in NSTE-ACS patients (n = 109) compared to the control group (n = 55) (P<0.01). Visfatin correlated positively with the GRACE score (r = 0.397, P<0.01). In the multivessel disease group, visfatin levels were notably higher (P<0.01). After adjusting for cardiovascular risk factors, visfatin emerged as an independent predictor of affected coronary arteries (OR 0.205; 95% CI 0.032–0.378; P=0.02). Receiver-operating characteristic (ROC) curves demonstrated enhanced prognostic ability when combining visfatin with age, hypertension, and diabetes for multivessel disease (AUC: 0.839, sensitivity: 65.0%, specificity: 89.7%, P<0.001). Elevated serum visfatin in NSTE-ACS patients suggests its role as an independent harbinger for the number of affected coronary arteries, potentially indicating severity in NSTE-ACS patients.

The Difference of Low Density Lipoprotein Cholesterol Levels on Different Severity of Coronary Artery Disease Patients in Siloam Hospital Lippo Village

<p><strong>Background:</strong> Coronary artery disease (CAD) is one of the highest causes of death in the world. Hypercholesterolemia, especially low-density lipoprotein (LDL) levels, is a major risk factor, because it is the main precursor of atherosclerosis. Previous studies showed the relationship between LDL level and the number of vessel disease is still inconsistent, therefore it needs to be observed further. The objective of this study was to know the effect of LDL levels on the number of vessel disease in CAD patients who underwent coronary angiography.</p><p><strong>Methods:</strong> It was a cross-sectional and retrospective study, where data were taken from medical records of CAD patients who underwent coronary angiography at Siloam Hospital Lippo Village between January to June 2018. Patients with at least one vessel disease were included. The number of vessel disease was categorized into 3 groups: one-vessel, two-vessels, and multi-vessel. The relationship between LDL levels and the number of vessel disease was analyzed using one way ANOVA.</p><p><strong>Result:</strong> The data includes 90 patients; 70 (77.8%) were male with average age of 56±9 years. There were 32 (35.6%) patients in one-vessel group; 27 (30%) in two-vessel group; and 31 (34.4%) in multi-vessel group with an average LDL levels of 106.43±40.51 mg/dl; 111.15±39.43 mg/dl; and 114.52±32.55 mg/dl respectively. Although it seemed that the increase in LDL cholesterol levels was in line with the number of vessel disease, there was no statistically significant relationship between the two variables (<em>p</em>=0.694).</p><p><strong>Conclusions:</strong> LDL cholesterol level does not affect the number of vessel disease in CAD patients.</p>

Multivessel spontaneous coronary artery dissection: clinical features, angiographic findings, management, and outcomes

Abstract Background Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome. The rate of SCAD patients with multivessel (MV) involvement varies between series (6–13%)1,2. MV SCAD might be potentially associated to a worse prognosis due to a higher ischemic burden compared with patients with single-vessel (SV) involvement. However, comparative data between patients with MV versus SV SCAD is lacking. Methods The Spanish multicentre nationwide SCAD registry prospectively included 389 consecutive patients from 34 university hospitals. Patients were classified according to the number of affected vessels in two groups: SV or MV SCAD. In-hospital major adverse event (MAE) was defined as a composite of death, myocardial reinfarction, unplanned revascularization, cardiogenic shock, ventricular arrhythmia or stroke. A major cardiac or cerebrovascular adverse event (MACCE) was defined as a composite of death, myocardial reinfarction, unplanned revascularization, SCAD recurrence or stroke. Results A total of 41 patients (10.5%) presented MV SCAD (Table 1). There were no significant differences between groups regarding age, sex and distribution of most cardiovascular risk factors, with a non-significant trend towards more hypertension in the MV group (49% vs 34%, p=0.06). MV SCAD patients had more often previous history of hypothyroidism (22% vs 11%, p=0.04) and anxiety disorder (32% vs 16%, p=0.01), with a trend towards more fibromuscular dysplasia (50% vs 29%, p=0.12) among those patients screened. MV SCAD patients presented more often with NSTEMI (73% vs 52%, p=0.01). Regarding angiographic findings, MV SCAD patients presented more frequently focal type 3 lesions (19% vs 6%, p<0.01) and fewer type 1 double-lumen lesions (12% vs 21%, p=0.04). The rate of lesions with an impaired initial Thrombolysis In Myocardial Infarction (TIMI) flow 0–1 was lower (14% vs 29%, p<0.01) in MV SCAD. In both groups, most patients were treated conservatively (71% vs 79%, p=NS). We found no significant differences between groups in MAE during admission. At long-term follow-up (median 29 months), there were no significant differences in MACCE between groups (18% vs 12%, p=0.28). However, the rate of stroke was higher in patients with MV SCAD, both in-hospital (2.4% vs 0%, p<0.01) and at follow-up (5.1% vs 0.6%, p=0.01). This finding could be explained by the basal differences found in hypertension and fibromuscular dysplasia between MV and SV SCAD patients. Conclusions Patients with MV SCAD have some distinctive clinical and angiographic features. We found no significant differences in our primary composite outcomes, both in-hospital and at long-term follow-up, between patients with SV and MV SCAD. Rate of stroke was significantly higher in patients with MV SCAD. Funding Acknowledgement Type of funding sources: None.

The relationship between the number of stenotic coronary arteries and the gut microbiome in coronary heart disease patients.

An increasing number of studies have shown that the gut microbiome plays an important role in the development of coronary heart disease (CHD). However, there are no clear studies on the relationship between the gut microbiome and the number of stenotic coronary arteries. To clarify whether the gut microbiome is associated with the number of stenotic coronary arteries in CHD, we performed the 16S rRNA gene sequencing for the V3-V4 region in the gut microbiota from 9 healthy controls (C) and 36 CHD patients, which including 25 CHD patients with multivessel (MV) lesion and 11 CHD patients with single-vessel (SV) lesion. It showed that the abundance of the genus Escherichia-Shigella was significantly increased in the MV and SV groups compared with C group, while the abundance of the genera Subdoligranulum and Collinsella was significantly decreased. Biomarkers based on three gut microbiotas (Escherichia-Shigella, Subdoligranulum, and Collinsella) and three plasma metabolites(left atrial diameter (LA), low density lipoprotein (LDL), and total bile acids (TBA)) were able to distinguish CHD patients with different numbers of stenotic coronary arteries. Functional prediction of the gut microbiome was performed based on the Kyoto Encyclopedia of Genes and Genomes (KEGG) database. The results showed that the gut microbial function of MV and SV group patients was richer than C group in betaine biosynthesis and unsaturated fatty acid biosynthesis, in the contrast less than C group in sphingolipid metabolism and primary bile acid biosynthesis. In summary, our study showed that the composition and function of the gut microbiome changed significantly from healthy controls to CHD patients with different numbers of coronary lesions.

Clinical Utility of a Slow 201Tl Washout Rate in the Detection of Multi-Vessel Coronary Artery Disease Using a Simultaneous Acquisition Rest 99 mTc/Stress 201Tl Protocol and a Semiconducting Gamma Camera.

The diagnostic accuracy of stress myocardial perfusion single-photon emission computed tomography (SPECT) to detect coronary artery disease (CAD) is reduced by the balanced reduction of myocardial perfusion in patients with multi-vessel or left main trunk CAD (multi-vessel group). This study investigated the diagnostic performance of a simultaneous acquisition rest 99 mTc/stress 201Tl dual-isotope protocol for myocardial perfusion SPECT (MPS) in a multi-vessel group by examining the assessment of a slow 201Tl washout rate (WR) finding in comparison to the accuracy of perfusion assessments.Methods and Results: This study enrolled 91 patients who had undergone angiography within 3 months after MPS. The diagnostic performances of perfusion assessments and a slow 201Tl WR parameter were compared using the area under the curve (AUC) in a multi-vessel group of patients with mild ischemia (2≤summed difference score [SDS]≤7). The AUC of a slow WR parameter was significantly larger compared with that for perfusion assessments, in patients with mild ischemia, (AUC, 0.736 vs. 0.504-0.558, P value: <0.01-0.05). Among patients with mild ischemia, a slow 201Tl WR parameter improved the detection of CAD in a multi-vessel group.

Multivessel versus Culprit-Only Revascularization Strategies in Cardiac Arrest Survivors.

Whether multivessel revascularization or culprit-only revascularization is more beneficial in cardiac arrest survivors with multivessel coronary artery disease remains unclear. We aimed to retrospectively evaluate whether multivessel or culprit-only revascularization following cardiac arrest was associated with a reduced incidence of in-hospital mortality. A total of 273 adult nontraumatic cardiac arrest survivors (aged ≥ 18 years) who underwent emergent coronary angiography (CAG) within 24 h following cardiac arrest were retrospectively recruited from three hospitals. Patients without definite coronary artery stenosis (n = 72), one-vessel stenosis (n = 74), or failed percutaneous coronary intervention (PCI; n = 37) were excluded. A total of 90 patients were enrolled for the final analysis and classified into multivessel (revascularization of more than one major vessel during the index CAG; n = 45) and culprit-only (revascularization of the infarct-related artery alone; n = 45) groups. Twenty-five patients (55.6%) in the culprit-only group and 17 patients (37.8%) in the multivessel group failed to survive to discharge [adjusted hazard ratio (HR) = 0.47, 95% confidence interval (CI) = 0.24-0.95, p = 0.035]. The benefit of multivessel revascularization on survival was obvious among those with a prolonged cardiopulmonary resuscitation duration (> 10 min) (47.82% vs. 76.92%, adjusted HR = 0.27, 95% CI = 0.08-0.93, p = 0.03). No difference in neurological outcomes (favorable = cerebral performance category scores 1-2; poor = 3-5) between groups was observed (60.0% vs. 55.6%, adjusted OR = 1.22, 95% CI = 0.35-4.26, p = 0.753). Compared with culprit-only revascularization, multivessel revascularization was associated with lower in-hospital mortality among cardiac arrest survivors with multivessel lesions. Owing to the retrospective design and small sample size, the current study should be interpreted as observational and exploratory.

Incremental value of early systolic lengthening and postsystolic shortening in detecting left anterior descending artery stenosis using nonstress speckle-tracking echocardiography

The diagnosis of coronary artery disease (CAD) with nonstress echocardiography remains challenging. Although the assessment of either early systolic lengthening (ESL) or postsystolic shortening (PSS) allows the sensitive detection of CAD, it is unclear whether the integrated analysis of ESL and PSS in addition to the peak systolic strain can improve the diagnostic accuracy. We investigated the incremental value of ESL and PSS in detecting left anterior descending artery (LAD) stenosis using nonstress speckle-tracking echocardiography. Fifty-nine patients with significant LAD stenosis but without visual wall motion abnormalities on echocardiography at rest (30 single-vessel stenosis, 29 multivessel stenosis) and 43 patients without significant stenosis of any vessel were enrolled. The peak systolic strain, the time to ESL (TESL), and the time to PSS (TPSS) were analyzed in all LAD segments, and the incremental values of the TESL and TPSS in detecting LAD stenosis and the diagnostic accuracy were evaluated. In the apical anterior segment, the peak systolic strain was significantly lower and TESL and TPSS were significantly longer in the single-vessel group than in the no stenosis group. In the single-vessel group, the addition of TESL and TPSS to the peak systolic strain significantly increased the model power in detecting stenosis, and the integrated analysis improved diagnostic accuracy compared with the peak systolic strain alone. In contrast, this incremental value was not demonstrated in the multivessel group. The integrated analysis of the peak systolic strain, ESL, and PSS may allow better screening of single-vessel LAD stenosis using nonstress speckle-tracking echocardiography.

Usefulness of an artificial neural network for a beginner to achieve similar interpretations to an expert when examining myocardial perfusion images

This study examined whether using an artificial neural network (ANN) helps beginners in diagnostic cardiac imaging to achieve similar results to experts when interpreting stress myocardial perfusion imaging (MPI). One hundred and thirty-eight patients underwent stress MPI with Tc-labeled agents. An expert and a beginner interpreted stress/rest MPI with or without the ANN and the results were compared. The myocardium was divided into 5 regions (the apex; septum; anterior; lateral, and inferior regions), and the defect score of myocardial blood flow was evaluated from 0 to 4, and SSS, SRS, and SDS were calculated. The ANN effect, defined as the difference in each of these scores between with and without the ANN, was calculated to investigate the influence of ANN on the interpreters' performance. We classified 2 groups (insignificant perfusion group and significant perfusion group) and compared them. In the same way, classified 2 groups (insignificant ischemia group and significant ischemia group) and compared them. Besides, we classified 2 groups (normal vessels group and multi-vessels group) and compared them. The ANN effect was smaller for the expert than for the beginner. Besides, the ANN effect for insignificant perfusion group, insignificant ischemia group and multi-vessels group were smaller for the expert than for the beginner. On the other hand, the ANN effect for significant perfusion group, significant ischemia group and normal vessels group were no significant. When interpreting MPI, beginners may achieve similar results to experts by using an ANN. Thus, interpreting MPI with ANN may be useful for beginners. Furthermore, when beginners interpret insignificant perfusion group, insignificant ischemia group and multi-vessel group, beginners may achieve similar results to experts by using an ANN.

The importance of circulating levels of salusin-α, salusin-β, and heregulin-β1 in atherosclerotic coronary arterial disease

ObjectiveThe relationship between the severity of atherosclerotic coronary artery disease (CAD) and circulating levels of salusin-α, salusin-β and heregulin-β1 has been investigated. In addition, the relationship with these peptides and high sensitive C-reactive protein (hsCRP) has been investigated. MethodsThe study was conducted on 55 volunteers who had normal coronary angiography (CAG) as the control group, 35 volunteers with the degree of coronary artery stenosis below 50% in CA as the non-critical stenosis group, 37 volunteers with narrowing of one coronary artery above 50% as single vessel group and 41 volunteers with narrowing of more than one coronary artery above 50% as multi-vessel group. One hundred and thirteen volunteers have been included to CAD group. ResultsThere was no statistically significant difference in serum salusin-α levels between groups. Serum salusin-β ve hsCRP levels were significantly lower in control group compared to other groups and CAD group. There was no statistically significant difference in salusin-β and salusin-α levels in reciprocal comparison of other groups other than heregulin-β1 levels. Heregulin-β1 levels were significantly lower in 'non-critical occlusion' and 'multiple artery occlusion' groups compared to control group. Heregulin-β1 levels in 'single artery occlusion' group were significantly higher than control, 'non-critical occlusion' and 'multiple artery occlusion' groups. ConclusionSalusin-α levels does not indicate any significant differences between any groups in our study however the relationship of salusin-α with salusin- β and heregulin-β1 levels drives to cogitate that these peptides can be used as biomarkers and therapeutic approaches in CAD. We think that these peptides will be used in laboratories routinely in future in addition to hsCRP for CAD.

P1719Sex-specific PCI strategies in patients with AMI and cardiogenic shock: a substudy of the culprit-shock trial

Abstract Background and purpose Women are more likely to suffer from a cardiogenic shock (CS) as the most severe complication of an acute myocardial infarction (AMI) and tend to have a higher mortality. Data concerning optimal management among women with CS are lacking. Aim of this study was therefore to better define characteristics of women suffering a CS and to investigate the influence of sex on different coronary revascularisation strategies Methods and results In the CULPRIT-SHOCK trial, patients with CS complicating AMI and multivessel coronary artery disease were randomly assigned to one of the following coronary revascularisation strategies: either percutaneous coronary intervention (PCI) of the culprit lesion only or immediate multivessel PCI. Primary end-point was a composite of death from any cause or severe renal failure leading to renal-replacement within 30 days after randomisation. We investigated sex-specific differences in general and according to the revascularisation strategies. Among all 706 randomised patients 26% were women. After 30 days, the primary end-point occurred in 55% women and 49% men (p=0.20), showing a relative risk of 1.14; 95% CI 0.94–1.38; p=0.17, women vs. men. Those women were older, more frequent diabetic and had more peripheral artery disease and less frequent smokers and less often family history of coronary artery disease. Regarding revascularisation strategy the composite end-point occurred in 55.8% women treated with the culprit-only strategy (vs. 42.4% men, p=0.04) and in 54.7% women in the multivessel group (vs. 55.6% men, p=0.99). This resulted in a no-significant difference among both groups (interaction p-value of 0.11). Conclusions In this large randomised trial among patients with multivessel coronary disease and CS complicating AMI, women had similar outcome for mortality and severe renal failure. Sex did not show to influence mortality and renal failure according to the different coronary revascularisation strategies. These data suggest that women and men presenting with CS should be treated equally.

Study on correlation between property of coronary artery lesion and degree of coronary artery stenosis of elderly patients with coronary heart disease.

Objective:To discuss the influence of coronary artery lesion of elderly patients with coronary heart disease (CHD) on left ventricular remodeling.Methods:Retrospective selection method was used to choose 80 elderly CHD patients who received coronary angiogram examination in Baoding First Central Hospital from January 2014 to February 2018 as the objects of study. According to coronary artery lesion, the patients were classified into single vessel lesion group (single vessel group) and multi-vessel lesion group (multi-vessel group, the number of lesion vessels≧2). Single vessel group included 60 patients, and multi-vessel group includes 20 patients. Intravascular unltrasound was applied to record coronary plaque property of all patients and transthoracic echocardiography was used to record left ventricular remodeling. Later correlation analysis was carried out.Results:The proportion of calcified plaque and mixed plaque was higher than that of single vessel group, and the differences had statistical significance (P<0.05). Left ventricular end diastolic volume (LVEDV) and left ventricular end-systolic volume (LVESV) of multi-vessel group were higher than that of single vessel group, while left ventricular ejection fraction (LVEF) was lower than that of single vessel group. The differences had statistical significance (P<0.05). Linear correlation analysis showed coronary artery lesion was positively correlated with LVEF and calcified plaque (r=0.287, 0.371, P<0.05). Multiple linear regression analysis showed LVEF, calcified plaque and LDL-C were independent risk factors of multi-vessel coronary artery lesion of old CHD patients (P<0.05).Conclusion:The number of coronary artery lesions is significantly correlated with left ventricular remodeling, and can increase the proportion of calcified plaque and mixed plaque, thus leading to left ventricular remodeling abnormity.

The value of three-dimensional speckle tracking echocardiography in detecting severe multi-vessel coronary artery stenosis

Objective To evaluate the diagnosis value of three-dimensional speckle tracking echocardiography (3D-STE) in severe multi-vessel coronary stenosis at resting state. Methods Ninety-one patients with chest tightness, chest pain, other related clinical symptoms, and suspected coronary heart disease were enrolled and underwent coronary angiography (CAG), two and three-dimensional echocardiography(2D-STE, 3D-STE). According to CAG results, the patients were divided into 3 groups: severe multi-vessel stenosis group (n=38), severe single-vessel stenosis group (n=22), and control group (n=31). All patients underwent two and three-dimensional echocardiography.3D-STE was applied to obtain left ventricular global longitudinal strain (3D GLS), global circumferential strain (3D GCS), global area strain (3D GAS) and global radial strain(3D GRS). Receiver operating curve analysis was conduct to evaluate the diagnosis value of 3D-STE in severe multi-vessel coronary stenosis at resting state. Results 3D GLS, 3D GCS, 3D GAS and 3D GRS were decreased in the severe multi-vessel group and single-vessel stenosis group compared to those in the control group(P<0.05); and greater decreases was observed in the severe multi-vessel stenosis group(P<0.001). Furthermore, 3D GLS and 3D GAS in the severe multi-vessel stenosis group were lower than those in severe single-vessel stenosis group(P<0.05). ROC curve showed that the cutoff value for 3D GLS was ≤-11% with a measurement sensitivity of 84.2% and cutoff value for 3D GAS was ≤-20% with a measurement specificity of 79.3%. A joint diagnostic test showed that the sensitivity was increased when 3D GLS was combined with at least one other parameters. Conclusions 3D-STE shows a great diagnostic potential when applied to detect severe multi-vessel coronary stenosis. Moreover, GLS and GAS may act as more valuable indicators. Key words: Echocardiography; Coronary stenosis; Ventricular function, left; Global strain

Correlation analysis of stress indicators of blood growth differentiation factor-15, catecholamine, heat shock protein and acute coronary syndrome

Objective To analyze the correlation between acute coronary syndrome (ACS) and stress differentiation factors (GDF-15), catecholamines, and heat shock proteins (HSP-70). Methods A total of 40 patients with ACS were selected from the Emergency Department of the PLA General Hospital from September 10, 2016 to October 10, 2016. 40 healthy volunteers were selected as the control group. The information of age, gender, history of smoking, drinking, hyperlipidemia, hypertension and diabetes. Inspection indicators of blood biochemistry (Creation kinase Isoenzyme, Total cholesterol, Triglyceride, High-density lipoprotein, Blood glucose, Total bilirubin, Direct bilirubin), serum level of GDF-15, catecholamine (Adrenaline,norepinephrine,dopamine)and HSP-70 were collected. Evaluation of Coronary Stenosis used with Coronary Artery Lesions and Gensini Score. Statistical analysis using SPSS 17.0 statistical software, measurement data are expressed as mean ± standard deviation (x±s), count data to the number of cases and percentage, measurement using t test, count data using chi-square test. Results Serum levels of GDF-15[(21.94±14.23) vs. (7.06±5.53), P=0.007],catecholamine[(46592.15±30931.27) vs. (5507.14±2083.28), P 40 compare with 40 group compare with <20 group significantly increased [(18.71 ± 7.32) vs. (18.6±46.1), P=0.017], GDF-15 levels were significantly higher in the multi-vessel stenosis group than in the double-vessel stenosis group[ (618.40±434.42) vs. (292.07±219.65), P=0.033]. Conclusions GDF-15, catecholamine and HSP-70 are correlated with ACS, as well as the severity of coronary artery lesions. Key words: Stress; Growth differentiation factor-15; Catecholamine; Heat shock protein-70; Acute coronary syndrome

N-terminal probrain natriuretic peptide in patients with acute coronary syndrome .

To observe the changes and evaluate the significance of serum N-terminal probrain natriuretic peptide (NT-proBNP) levels in patients with acute coronary syndrome and to discuss its clinical significance and relationship with the severity of disease. Serum NT-proBNP levels were determined rapidly by using the triage BNP test for 98 consecutive patients with coronary heart disease (CAD) admitted to the hospital from March 2013 to December 2013; the correlation between the concentration of NT-proBNP and the degree of severity of the disease was analyzed. The levels of NT-proBNP in the acute myocardial infarction (AMI) group were higher compared with unstable angina pectoris (UAP), stable angina pectoris (SAP), and control groups, and the levels of NT-proBNP in UAP were higher compared to the SAP and control groups. Levels of NT-proBNP in the extensive anterior wall infarction group were higher compared to that of the inferior or anteroseptal wall infarction groups: p<0.05; the levels of NT-proBNP in the inferior wall and posterior wall infarction group were higher compared with the inferior wall infarction group and anteroseptal wall infarction group: p<0.05; the levels of NT-proBNP in the multi-vessel group were higher than those in the single-vessel group: p<0.05. The BNP level was positively correlated with age, heart rate, creatinine kinase-myocardial band (CK-MB), cardiac troponin T (cTnT), and blood urea nitrogen (BUN), whereas it was negatively correlated with left ventricular ejection fraction (LVEF). NT-proBNP is related to the lowering of left ventricular ejection fraction and the severity of myocardial ischemia. .

Assessment for regional and global systolic function of left ventricle in patients with coronary arterial disease by longitudinal layer-specific strain

Objective To analyze longitudinal layer-specific strain in endocardial, midcardial and epicardial layers of left ventricle (LV) by two-dimensional speckle tracking imaging(2D-STI) in patients with coronary heart disease (CHD) and to evaluate the regional or global systolic function of LV. Methods Seventy-eight patients with suspected CHD were divided into CHD group (46 subjects) and control group (32 subjects) according to the results of selective coronary arteriography. According to the stenosis degree or number of coronary arteries, the CHD group was divided into mild stenosis group (corresponding blood-supply vessel stenosis 50%-75%), severe stenosis group(corresponding blood-supply vessel stenosis ≥75%) or single-vessel stenosis group, multi-vessel stenosis group. Two-dimensional images with high frame rate were recorded in apical four-chamber, long-axis, two-chamber of LV in all subjects. The strain parameters by EchoPAC analysis software included territorial longitudinal strain(TLS) of endocardial, midcardial and epicardial layers (TLSendo, TLSmid, TLSepi) and global longitudinal strain (GLS) of endocardial, midcardial and epicardial layers ( GLSendo, GLSmid, GLSepi). Results Regardless of with or without corresponding blood-supply coronary artery stenosis and range of coronary artery stenosis, TLSendo, TLSmid, TLSepi and GLSendo, GLSmid, GLSepi all showed a gradient decrease(P 0.05). Compared with the mild stenosis group, TLSendo, TLSepi of severe stenosis group decreased significantly(P 0.05). Moreover, compared with the control group, GLSendo, GLSmid, GLSepi of single-vessel stenosis group and multi-vessel stenosis group decreased significantly(P<0.05). Compared with the single-vessel stenosis group, GLSendo, GLSmid, GLSepi of multi-vessel stenosis group decreased significantly(P<0.05). For predicting corresponding blood-supply vessel stenosis ≥75%, the sensitivity and specificity were 55.6%, 72.6% and 57.8%, 76.4%, when the cut-off of TLSendo and TLSepi were 20.5% and 15.5% respectively. For predicting multi-vessel stenosis, the sensitivity and specificity were 54.5%, 71.4%; 50.0%, 87.5% and 63.6%, 87.5%; when the cut-off of GLSendo, GLSmid, GLSepi were 21.5%, 17.5% and 16.5% respectively. Conclusions Systolic dysfunction of LV happened through all layers in CHD patients. The longitudinal strain of layer-specific by 2D-STI can accurately evaluate the regional and global systolic function of LV in patients with CHD, which can also be used to predict the degree or range of coronary artery stenosis. Key words: Echocardiography; Coronary artery disease; Ventricular function, left; Two-dimensional speckle tracking imaging

Independent predictors of multivessel coronary artery disease: results from Angiocardio Registry

ABSTRACT Background The Angiocardio Registry, which comprises data from five different centers in the state of Sao Paulo, offers the opportunity to study the association between cardiovascular risk factors and coronary artery disease (CAD) extent, as assessed by coronary angiography. This study aimed to evaluate independent predictors of multivessel CAD in Brazil. Methods From August 2006 to January 2014, 16,320 patients with CAD were included and divided into the single- and multivessel groups. Results Patients with multivessel disease (n = 9,512, 58.3%) were on average 3 years older, with a higher prevalence of males (69.4% vs. 65.4%; p p p p p p p p = 0.02) and previous myocardial infarction (18.4% vs. 13.9%; p p 40 years (odds ratio - OR = 1.996; 95% CI: 1.52-2.63; p p p p p p p Conclusions Multivessel CAD in Brazil is associated with traditional risk factors for atherosclerosis, except for smoking. Age, diabetes, and chronic renal failure were the strongest predictors for multivessel CAD assessed by coronary angiography.

Multivessel Disease As A Prognostic Factor For Mortality In STEMI Patients

Summary The main objective of this analysis was to define the influence of multivessel disease involvement compared to single vessel disease on mortality rates in STEMI patients. The retrospective study included 549 patients, hospitalized with STEMI in St. Ekaterina University Hospital (age - 62.66±12.56; women - 31.3%) from 01.06.2008 to 30.06.2011. One-vessel disease was found in 232 patients (44%) as compared to two-vessel disease in 165 patients - 31% and multivessel disease in 130 patients - 25%. There was LM stenosis (&gt;30) in 11 patients (2%); ostial lesion in 33 patients (6.3%); presence of Ca in 37 patients (7%). A stent was implanted in 484 patients (91.8%), and GP IIb/IIIa was used in 400 patients (75.9%). There was significant increase in mortality rates in patients with multivessel disease: 15.6% - 46 patients, compared to one-vessel disease - 6.5% (15 patients) (p&lt;=0.01). Both early (30 days) and late mortality (one year) rates were higher in the multivessel group (6.8% vs. 2.6%, p&lt;=0.05 and 10.2% vs. 3.9% (p&lt;=0.0510), respectively. Multivessel disease is associated with higher mortality rates in STEMI patients, which may further alter clinical course and decision making.

3 Outcomes following Primary Percutaneous Coronary Intervention in Patients with multi-vessel Coronary Artery Disease in the Modern Era

Background The optimal timing of non-culprit lesion PCI in ST elevation myocardial infarction (STEMI) patients with multi-vessel coronary artery disease (MVD) treated primary percutaneous coronary intervention (PPCI) remains uncertain. Aim To assess early ( Methods After excluding patients with cardiogenic shock and those with previous CABG, a total of 3486 PPCI-treated STEMI at two tertiary centres were included in this study. Patients were divided into 3 groups according to their MVD status and the number of coronary arteries treated at time of PPCI: 1) single vessel disease (SVD, n = 2164); 2) culprit-only multi-vessel disease (CO-MVD, n = 790); and 3) multi-vessel PCI MVD disease (MVPCI-MVD, n = 193) group. Results Patients in SVG group were younger and were less likely to have previous history diabetes mellitus, hypertension, previous MI or CVA proportion of females compared to other groups. Overall one year emergency rePCI rate was 2.9%. One year emergency rePCI was significantly higher in CO-MVD group (7.5%) compared to SVD group (1.4%) and MVPCI-MVD group (2.1%). Overall 30-day and late mortality rates were 3.7% and 3.2%, respectively. Compared to SVG, both multi-vessel groups were associated with increased 30-day mortality; with adjusted odds ratios (95% confidence interval [CI]) of 1.69 (1.11–2.57) in CO-MVD and 1.78 (0.92–3.43) in MVPCI-MVD group, but not with late mortality; with hazard ratios (95% CI) of 1.01 (0.65–1.56) in CO-MVD and 0.88 (0.42–1.86) in MVPCI-MVD. Overall 30-day and late emergency PCI rates were 1.2% and 1.7%, respectively. Compared to SVD group, Conclusions In this large observational study of unselected PPCI-treated patients, MVD was associated with increased 30-day mortality but not with mortality beyond 30 days. Furthermore, rate of emergency repeat PCI was highest in CO-MVD compared to other groups.

110 Infarct Burden Following Multivessel PCI Vs. Infarct-Only PCI in Patients with Acute Stemi: The Glasgow Prami CMR Sub-Study: Abstract 110 Table 1

Background In the Preventive Angioplasty in Myocardial Infarction trial (PRAMI; ISRCTN73028481), immediate multivessel PCI (MV-PCI) of non-IRA lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We assessed infarct distribution and size in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods In this single centre prospective sub-study, PRAMI participants were invited to undergo 1.5 Tesla CMR 1 week and 1 year after primary PCI. The CMR scans were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The presence and extent of infarction were assessed quantitatively with late gadolinium enhancement (LGE) imaging (Gadovist, 0.1 mmol/kg). The infarct was delineated as an area of myocardial enhancement (cm 2 ) using a signal intensity threshold of >5SDs above a remote region, and expressed as a% of total LV mass. The incidence of new LGE in non-infarct related artery territories at baseline and 1 year were assessed. Data were analysed by an independent statistician. Results Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Of these 80 patients underwent CMR 1 week post primary PCI of whom 41 (51%) were in the multi-vessel PCI group and 39 (49%) were in the IRA-only group. At 1 year, 69 (86%) patients had a follow up CMR scan. Infarct size and distribution are described in Table 1. Conclusion Infarct size and distribution were similar in patients treated by MV-PCI or IRA-only PCI. MV-PCI is not associated with additional MI acutely which supports the safety of this procedure in line with the benefits observed with preventive PCI in PRAMI. Funding Golden Jubilee National Hospital; PRAMI was funded by Barts and the London Charity.

109 Left Ventricular Outcomes Following Multivessel PCI Vs. Infarct -Only PCI in Patients with Acute Stemi: The Glasgow Prami CMR Sub-Study: Abstract 109 Table 1

Background In the Randomised Trial of Preventive Angioplasty in Myocardial Infarction (PRAMI; ISRCTN73028481), compared with infarct-related artery (IRA)-only PCI, additional immediate multivessel PCI (MV-PCI) of non-IRA lesions in patients with acute ST elevation myocardial infarction (STEMI) and multivessel coronary disease (MVD) improved long term prognosis. We studied left ventricular (LV) outcomes in a pre-specified cardiac magnetic resonance (CMR) sub-study. Methods In a single centre prospective sub-study, PRAMI participants were invited to undergo CMR at 1.5 Tesla 1 week and 1 year after primary PCI. LV volumes and function were analysed using semi-automated software by a clinician blinded to treatment group assignment and clinical outcomes. The statistical analyses were performed by an independent statistician. Results Of 465 randomised trial participants in 6 UK hospitals, 138 (30%) were enrolled in Glasgow. Eighty patients (17%) (mean age 60 years, 76% male) underwent CMR initially (n = 41 (51%) in the multi-vessel PCI group; n = 39 (49%) in the IRA-only group). 69 (86%) of these patients had a follow up CMR scan at 1 year (n = 7 lost to follow-up, n = 4 deceased). Mean (and SD) LVEF and volumes at 1 week post-MI and their change at 1 year from baseline were similar (Table 1). Conclusion The CMR sub-study participants represented the majority of all randomised participants in our hospital, which included one third of the PRAMI trial population. Random treatment group assignment in this CMR study was evenly balanced. LV function and volumes were similar at 1 week and 1 year post-intervention in survivors. The CMR sub-study suggests that the benefit of the preventive PCI strategy in PRAMI may not be mediated by any effects on LV function and remodelling. Funding Golden Jubilee National Hospital; PRAMI was funded by Barts and the London Charity.