Normal Coronary Arteries Group Research Articles

NSTEMI'da Erken Evrede HALP Skorunun Öngörü Değeri

Introduction: Several inflammatory markers are associated with coronary artery disease severity and worse cardiovascular outcomes. The haemoglobin, albumin, lymphocyte, and platelet (HALP) score is an indicator of inflammation and nutritional status. We aimed to evaluate the practicity of HALP score in non-ST elevation myocardial infarction (NSTEMI) patients. Materials and Methods: This study was designed as a retrospective cohort study. Patients over the age of 18 who have been diagnosed with acute coronary syndrome were retrospectively searched from hospital records. The study groups were formed according to the results of the coronary angiography. Demographic data such as age, gender, total blood count, albümin levels, troponin levels and HALP scores of the patients were analyzed and comparisons between the groups were made decisively. Results: 201 patients were enrolled in the study and the data was obtained from hospital records retrospectively. 79 patients were excluded from the study due to ST segment elevation myocardial infarction (STEMI). The study population was collected under two groups; the NSTEMI group (n=66) and normal coronary arteries (NCA) group (n=56). The mean age of NSTEMI group was 62.3 ± 11.8 and 71.2% (n=47) was male. The mean age of NCA group was 51.8 ± 9.2 and 30.3% (n=17) was male. There were statistically significant difference between NSTEMI and NCA groups in term of age and gender (p<0.05). The HALP score was statistically higher in NSTEMI group compared to NCA group (p<0.001). Age and HALP score have explanatory powers on NSTEMI patients (p=0.001 and p=0.022, in order of). Conclusion: HALP score may be used as an easily applicable and inexpensive method in clinical practice that can contribute to the early diagnosis of NSTEMI patients.

MRI Diagnosis of Coronary Artery Lesions in Children With Kawasaki Disease and Their Correlation With Inflammatory Factors.

Ultrasonography (US), as a routine examination for evaluating coronary artery lesions (CAL) in children with Kawasaki disease (KD), has strong subjectivity and limitations. Non-contrast enhanced coronary magnetic resonance angiography (NCE-CMRA) is sensitive and reliable in displaying the segments of coronary arteries (CA). To evaluate the CA using NCE-CMRA, to compare NCE-CMRA with US, and to assess the correlation between KD-related inflammatory factors and the occurrence of CAL. Retrospective. 61 children with KD who had undergone NCE-CMRA. Ultimately, 52 cases were included (32 males and 20 females), with an average of 5.9 ± 0.3 years old. 3-T, 3D balanced turbo field echo sequence. NCE-CMRA and US coronary visualization rates were compared in 41 children who were imaged with both techniques. Inflammatory factors were compared between CAL and normal coronary artery (NCA) subgroups. In the CAL group, correlations of these inflammatory factors with CAL parameters were investigated. Comparison between groups was performed by the two independent samples t-test; the comparison of enumeration data between groups was performed by chi-square test. Receiver operating characteristic (ROC) curve analysis was performed to determine the sensitivity of inflammatory factors for detecting CAL. The correlation between CAL and inflammatory indexes was analyzed by multiple linear regression. A P value <0.05 was considered statistically significant. NCE-CMRA visualized significantly more segments than US (76% vs. 46%). There were significant differences in PLT, CRP, ESR, and D-dimer between the CAL and NCA groups. ROC curve analysis showed that the sensitivities of these four indicators in diagnosing CAL were 39%, 44%, 72%, and 61%, respectively, at cut-off points of 562.5 × 109 /L, 48.93 mg/L, 45.5 mm/h, and 0.5 mg/L, respectively. The combination of NCE-CMRA and inflammatory factors is helpful for the early diagnosis and disease severity of CAL in children with KD. 3 TECHNICAL EFFICACY: Stage 2.

Association Between Ratio of White Blood Cells to Mean Platelet Volume and Coronary Artery Ectasia.

Coronary artery ectasia (CAE) is a rare vascular phenotype characterized by abnormal dilation of blood vessels and disruption of coronary artery blood flow, which may promote thrombosis and an inflammatory response. We performed a cross-sectional study to investigate the association of white blood cells to mean platelet volume ratio (WMR) with CAE. Consecutive eligible patients (n = 492) were divided into two groups: including 238 patients with CAE and 254 patients in the normal coronary artery (NCA) group. WMR, the systemic immune-inflammation index (SII), and neutrophil-to-lymphocyte ratio (NLR) were found to be significantly associated with CAE in both univariate and multivariate logistic regression analyses. In multivariate analysis, the presence of WMR was associated with CAE (the odds ratios (OR) = 1.002, 95% CI: 1.001-1.003, P < .001). In the ROC analysis, the statistics (Z-values) of WMR vs SII and WMR vs NLR were 2.427 and 2.670 and were statistically significant (P = .015 and P = .008), indicating that WMR was superior to SII and NLR in distinguishing WMR. The optimal cut-off value was calculated from the point of maximal sensitivity and specificity by using Youden's index, which was determined to be 635.50. WMR has the potential to be a cost-effective tool to monitor CAE.

Plasma A2AR Measurement Can Help Physicians Identify Patients Suspected of Coronary Chronic Syndrome: A Pilot Study.

The evaluation of suspected coronary artery disease (CAD) in the medical community is challenging. Patients with suspected coronary chronic syndrome (CCS) are referred by the medical community to be assessed by specialists for the performance of noninvasive tests that have high rates of false positives and false negatives. While troponins are the gold standard for evaluate myocardial injuries, there is no biomarker to assess myocardial ischemia in patient populations with negative electrocardiography or without an increase in troponin level. A2A adenosine receptors control the coronary blood flow through its vasodilating properties. It has been shown that patients with CAD have a lower A2AR expression on peripheral blood mononuclear cells, suggesting a link between A2AR production and the severity of CAD. Herein, we present a new and innovative method of inhibition ELISA for A2AR in the plasma of patients who permit the evaluation of the amount of soluble A2AR. For this analysis, the total study sample was 54, including 31 patients with CAD with stenosis > 50% and a significant fractional flow reserve (FFR < 0.8) (Group 1) and 23 patients with normal or non-obstructive coronary arteries (stenosis < 50% and nonsignificant FFR > 0.8) (Group 2). The % inhibition (which is linked to the presence of soluble receptors) with the plasma of patients with FFR < 0.8 was significantly lower than that of patients with FFR > 0.8 (median [range]: 68% [20.7–86.9] vs. 83% [67–88.4]; p < 0.001). The ROC curve indicated a good sensitivity/specificity ratio with a cut off of 72.5% and an area under the curve of 0.87. In conclusion, a rapid ELISA to assess soluble A2AR in the plasma shows promise to screen patients suspected of having CAD.

Enhanced platelet NLRP3 inflammasome expression in patients with acute coronary syndrome and stable coronary artery disease: A prospective observational study

Background and purpose: Nucleotide-binding domain leucine-rich repeat containing protein (NLRP3) inflammasome contributes to the development and progression of atherosclerosis and cardiovascular diseases. Enhanced expression of NLRP3 in monocytes has been reported in patients with coronary artery disease (CAD). However, NLRP3 expression in platelets, an important link between inflammation and atherosclerosis/thrombosis in CAD patients has not been evaluated. The purpose of this study was to explore the expression of NLRP3 in platelets with acute coronary syndrome (ACS) and stable CAD. Methods: This prospective observational study included 60 treatment-naïve patients with newly diagnosed ACS, 60 patients with stable CAD, and 60 age- and sex-matched healthy individuals with normal coronary arteries (NCA). Platelet NLRP3 expression was evaluated by flow cytometry in venous blood samples, and compared among the 3 groups. Multivariate regression analysis was conducted to identify the risk of ACS. Results: Platelet NLRP3 expression was highest in the ACS group, followed by the stable CAD, and lowest in the NCA group (P &lt; 0.001 for ACS vs. stable CAD, 44.7 ± 21.3 vs. 25.9 ± 15.9, as well as for stable CAD, vs. NCA, 25.9 ± 15.9 vs. 12.4 ± 7.2). Higher platelet NLRP3 correlated with higher plasma interleukin-1β and interleukin-18 (r = 0.662 and 0.324, respectively; P &lt; 0.001 for both). In multivariate regression analysis, higher platelet NLRP3 was independently associated with ACS (odds ratio 1.06, 95% CI: 1.02–1.10 vs. stable CAD; odds ratio 1.23, 95% CI: 1.06–1.42 vs. NCA). Conclusion: Platelet NLRP3 expression was highest in the ACS group, followed by the stable CAD group, and lowest in the NCA group. Also, higher platelet NLRP3 expression was independently associated the ACS.

AKUT KORONER SENDROM OLMAYAN TİP 2 DİYABETİK HASTALARDA KORONER ARTER HASTALIĞI YAYGINLIĞI İLE MPV İLİŞKİSİNİN ARAŞTIRILMASI

Objective&#x0D; Since many studies focused on the relationship&#x0D; between mean platelet volume (MPV) and severity of&#x0D; type 2 diabetes mellitus (T2DM) or investigated MPV&#x0D; and coronary artery disease (CAD) mostly on acute&#x0D; coronary syndrome (ACS), this study primarily focused&#x0D; to investigate if MPV values have any relation with&#x0D; different levels of CAD specifically in T2DM patients,&#x0D; who had no previous coronary artery disease, and no&#x0D; ACS history.&#x0D; Materials And Methods&#x0D; T2DM patients who had first coronary angiography&#x0D; (CAG) between November 2019 and February&#x0D; 2020, and whose after night fasting blood tests&#x0D; were performed before CAG were included. Two&#x0D; cardiologists, blinded to the patients, evaluated&#x0D; angiographies. Patients have divided into groups&#x0D; accordingly; normal coronary artery (Group 1),&#x0D; non-critic stenosis (Group II), and severe CAD&#x0D; (Group III) according to the Gensini score. Patients’&#x0D; demographics, heart rate, risk factors of CAD, and&#x0D; blood test including MPV were also collected.&#x0D; Results&#x0D; A total of 180 patients (88 female, 92 male) were&#x0D; involved in the study. There was no significant relation&#x0D; between MPV and the severity of CAD in T2DM&#x0D; patients (p=0.228). The mean age of the Group I group&#x0D; was significantly lower than in other groups (p=0.228),&#x0D; and there were significantly lower males in Group I&#x0D; than other groups (p=0.0001). The triglycerides levels&#x0D; were significantly low in Group I than in other groups&#x0D; (p=0.021 and p=0.006).&#x0D; Conclusion&#x0D; MPV values were not associated with the severity&#x0D; of CAD in stable patients. Older age, male gender,&#x0D; higher levels of triglycerides, and initial glucose levels&#x0D; were significantly related to the severity of CAD in&#x0D; T2DM patients.

Serum Lp-PLA2 Level Predicting Coronary Artery Lesions in Children with Kawasaki Disease.

Kawasaki disease (KD) is an inflammatory disease associated with coronary vasculitis in children. In this study, we explored the correlation between Lipoprotein associated phospholipase A2 (Lp-PLA2) and coronary artery lesions (CAL) in children with KD. Ninety-three children with KD were divided into a normal coronary artery (NCA, 54 cases) group and coronary artery lesions (CAL, 39 cases) group, according to the results of echocardiography. Another 42 healthy children were selected as the control group. The serumal levels of Lp-PLA2, Interferon-γ(IFN-γ) and Interleukin-6 (IL-6) were determined by using an enzyme-linked immunosorbent assay. In addition, erythrocyte sedimentation rate (ESR) and serum C-reactive protein (CRP) level were analyzed. The left main coronary artery (LMCA), diameters of left anterior descending coronary artery (LADC), right proximal coronary artery (PRCA), and carotid intima-media thickness (IMT) were obtained by color Doppler ultrasound. The correlation between the above indexes and KD was analyzed. The levels of white blood cell counts (WBC), ESR, CRP, IFN-γ, IL-6 and Lp-PLA2 as well as IMT were significantly increased in KD children (P < 0.05), and the levels of CRP, IFN-γ, IL-6 and Lp-PLA2 as well as IMT in the CAL group increased more significantly (P < 0.05). An increasing trend also has been described in the diameters of LMCA, LADC and PRCA for KD children with CAL compared with with NCA. The results of logistic regression analysis showed that the elevated levels of CRP, IFN-γ, IL-6 and Lp-PLA2 were independent risk factors for KD with CAL. Correlation analysis showed that Lp-PLA2 level was positively correlated with the levels of IFN-γ, IL-6 and CRP in CAL group and NCA group (respectively, all P < 0.01). In addition, a similar correlation was also described between Lp-PLA2 level and the diameters of LMCA, LADC and PRCA in CAL group (respectively, all P < 0.01). Lp-PLA2 may participate in the pathological mechanism of KD. Detection of the serum Lp-PLA2 level can be used in the diagnosis of KD disease and the assessment of coronary artery lesions in KD children.

Serum Vitamin D Level in Patients Undergoing Coronary Artery Catheterization

Background: Vitamin D deficiency may be a risk factor for coronary artery disease (CAD). We aimed to measure the prevalence of vitamin D deficiency in CAD and its association with severity of angiographic proven CAD.&#x0D; Methods: This prospective, cross-sectional study included 106 consecutive patients who were admitted for typical angina and had signs of myocardial injury (ECG findings and/ or elevated troponin I or CK-MB) and who underwent coronary angiography at the university hospital of BPKIHS from August 2020 to April 2021. Patients were categorized into angiographic proven CAD group and angiographic normal coronary artery group. Serum vitamin D level was classified as normal (≥ 30 ng/ml) and deficiency (&lt; 30 ng/ml).&#x0D; Results: Out of 106 patients, 78 patients (73.6%) had vitamin D deficiency and 28 (26.4%) had normal vitamin D level (p = 0.39). Vitamin D level (mean ± SD) in patients with angiographic normal coronary artery and angiographic proven CAD were 25.94 ± 11.63 ng/ml and 26.07 ± 12.90 ng/ml respectively (p = 0.97). Prevalence of vitamin D deficiency was 75.0% and 64.3% in significant CAD group and normal coronary artery group respectively (p = 0.39). Similarly, frequency of vitamin D deficiency were 68.6%, 78.3% and 88.90% in single, double, and triple vessel disease respectively (p = 0.21). The vitamin D level (mean ± SD) in single, double and triple vessel disease were 27.31 ± 14.02 ng/ml, 25.69 ± 12.72 ng/ml, 23.08 ± 9.45 ng/ml respectively.&#x0D; Conclusion: The prevalence of vitamin D deficiency in both angiographic normal coronary artery and angiographic proven CAD were high but comparable. There was no association of vitamin D deficiency with severity of angiographic proven CAD.

Prognostic Implication of Non-Obstructive Coronary Lesions: A New Classification in Different Settings.

The clinical significance of non-obstructive coronary artery disease is the subject of debate. Our objective was to evaluate the long-term cardiovascular prognosis associated with non-obstructive coronary artery disease in patients undergoing coronary angiography, and to conduct a stratification by sex, diabetes, and clinical indication. We designed a multi-centre retrospective longitudinal observational study of 3265 patients that were classified into three groups: normal coronary arteries (lesion <20%, 1426 patients), non-obstructive coronary artery disease (20–50%, 643 patients), and obstructive coronary artery disease (>70%, 1196 patients). During a mean follow-up of 43 months, we evaluated a combined cardiovascular event: acute myocardial infarction, stroke, hospitalization for heart failure, or cardiovascular death. Multivariable-adjusted Cox proportional hazard models showed a worse prognosis in patients with non-obstructive coronary artery disease, in comparison with patients of normal coronary arteries group, in the total population (hazard ratio 1.72, 95% confidence interval 1.23–2.39; p for trend <0.001), in non-diabetics (hazard ratio 2.12, 95% confidence interval: 1.40–3.22), in women (hazard ratio 1.75, 95% confidence interval 1.10–2.77), and after acute coronary syndrome (hazard ratio 2.07, 95% confidence interval 1.25–3.44). In conclusion, non-obstructive coronary artery disease is associated with an impaired long-term cardiovascular prognosis. This association held for non-diabetics, women, and after acute coronary syndrome.

The Association between Tp-e interval, Tp-e/QT , and Tp-e/QTc Ratios and Coronary Artery Disease Spectrum and Syntax Score

Background Coronary artery disease (CAD) causes electrical heterogeneity on ventricular myocardium and ventricular arrhythmia due to myocardial ischemia linked to ventricular repolarization abnormalities. Objective Our aim is to investigate the impact of increased level of CAD spectrum and severity on ventricular repolarization via Tp-e interval, Tp-e/QT and Tp-e/QTc ratios. Methods 127 patients with normal coronary artery (group 1), 129 patients with stable CAD (group 2) and 121 patients with acute coronary syndrome (group 3) were enrolled. Tp-e interval, Tp-e/QT [...]

Koroner anjiyografide yavaş akım tespit edilen kararlı anjina pektorisli hastalarda CHA2DS2-VASc skorunun kullanımı

Purpose: Coronary slow flow (CSF) phenomenon is the slow movement of contrast to distal vascular structures during coronary angiography. Eventhough It has a high morbidity due to recurrent chest pain and different ischemic presentations, it is linked to coronary artery diseases (myocardial ischemia symptoms, life-threatening arrhythmias, recurrent acute coronary syndromes and sudden cardiac death). CHA2DS2-VASc score is a total of several risk factors for thromboembolism. Impaired renal function was shown to be a predictor of stroke and systemic embolism. We aimed to evaluate the CHA2DS2-VASc score to predict coronary slow flow.Materials and Methods: Of the 3772 patients who applied to Tokat State Hospital with the diagnosis of stable angina pectoris (SAP) were screened retrospectively. A total of 71 patients with angiographically proven CSF and to meet the age characteristics of the CSF group, 84 patients who were completely normal coronary arteries (NCA) in the control group (n = 84) were screened and total of 155 patients were included in the study.Results: Patients were classified into two groups: the CSF group (n=71) and the NCA group (n=84). When the characteristics of the CSF and control groups were compared, age, body mass index, systolic blood pressure, diastolic blood pressure, gender were similar. According to the results of the multivariate regression analysis, CHA2DS2-VASc score was an independent predictor (odds ratio: 1.872, 95 % CI: 0.849-1.981, p&amp;lt;0.001)Conclusion: CHA2DS2-VASc score can be very useful in this regard as an easily applicable instrument. CHA2DS2-VASc score is independent indicators of CSF and can be used to predict CSF risk.

Down-regulation and Clinical Implication of Galectin-9 Levels in Patients with Acute Coronary Syndrome and Chronic Kidney Disease.

In various autoimmune diseases, Galecin-9 (Gal-9) has been shown to regulate the T-cell balance by decreasing Th1 and Th17, while increasing the number of regulatory T cells (Tregs). However, the role of Gal-9 in the patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) remains unclear. This study aims to measure the Gal-9 levels in serum and peripheral blood mononuclear cells (PBMCs) in patients with ACS plus CKD and examine their clinical implication. The serum levels of Gal-9 were determined by enzyme-linked immunosorbent assay (ELISA), the expression levels of Gal-9, Tim-3, and Foxp3 mRNA in PBMCs were detected by real-time reverse transcription-polymerase chain reaction (RT-PCR), and the expression of Gal-9 on the surface of PBMCs and in PBMCs was analyzed by flow cytometry. Furthermore, the correlation of serum Gal-9 levels with anthropometric and biochemical variables in patients with ACS plus CKD was analyzed. The lowest levels of Gal-9 in serum and PBMCs were found in the only ACS group, followed by the ACS+CKD group, and the normal coronary artery (NCA) group, respectively. Serum Gal-9 levels were increased along with the progression of glomerular filtration rate (GFR) categories of G1 to G4. Additionally, serum Gal-9 levels were negatively correlated with high-sensitivity C-reactive protein (hs-CRP), estimated GFR (eGFR), and lipoprotein(a), but positively with creatinine, age, osmotic pressure, and blood urea nitrogen (BUN). Notably, serum Gal-9 was independently associated with hs-CRP, osmotic pressure, and lipoprotein(a). Furthermore, serum Gal-9 levels were elevated in patients with type 2 diabetes (T2DM) and impaired glucose tolerance (IGT) in ACS group. It was suggested that the levels of Gal-9 in serum and PBMCs were decreased in patients with simple ACS and those with ACS plus CKD, and hs-CRP, eGFR, osmotic pressure and T2DM may have an influence on serum Gal-9 levels.

Elevated Levels of Pentraxin 3 Correlate With Neutrophilia and Coronary Artery Dilation During Acute Kawasaki Disease.

Kawasaki disease (KD) is the leading cause of acquired pediatric heart disease in the developed world as 25–30% of untreated patients and at least 5% of treated patients will develop irreversible coronary artery lesions (CAL). Pentraxin-3 (PTX-3) has been well-studied in inflammatory diseases, particularly in cardiovascular diseases associated with vascular endothelial dysfunction. We hypothesized that PTX-3 plays an important role in the development of KD-associated CAL and investigated the circulating levels of PTX-3 in the serum of KD patients. Children with acute KD were followed from diagnosis through normalization of the clinical parameters of inflammation (convalescent phase). Serum samples were obtained and echocardiograms were conducted at several phases of the illness: acute [prior to intravenous immunoglobulin (IVIG) treatment], sub-acute (5–10 days after IVIG treatment), and convalescent (1–4 months after KD diagnosis). Seventy children were included in the final cohort of the study, of whom 26 (37%) presented with CAL and 18 (26%) developed IVIG resistance. The patients included in this study came from diverse ethnic backgrounds, mostly with mixed ancestry/ ethnicity. Significantly increased PTX-3 levels were observed during the acute phase of KD compared to the sub-acute and the convalescent phases. The PTX-3 levels during acute KD were significantly higher among KD patients with CAL compared to patients with normal coronary arteries (NCA). Also, the PTX-3 levels were significantly higher in patients with IVIG resistance. Furthermore, the PTX-3 levels were significantly higher in IVIG-resistant KD patients with CAL as compared to the NCA group. Moreover, the PTX-3 levels were significantly correlated to coronary artery z-score during acute KD and to neutrophil counts throughout KD progression regardless of coronary artery z-score. Elevated PTX-3 levels correlated to elevated neutrophil counts, a known source of PTX-3 in acute inflammation and an important player in the development of KD vasculitis. We, therefore, suggest PTX-3 as a novel factor in the development of KD-associated CAL and propose neutrophil-derived PTX-3 as contributing to KD vascular dysfunction.

Evaluation of Platelet Indices in Diabetic Patients with Myocardial Bridges

Objectives: Myocardial bridges (MB) are a congenital anomaly in which part of the epicardial coronary artery is intramuscular, known as the presence of myocardium, which causes narrowing of the artery during heart contraction. We aimed to evaluate hemogram parameters (especially platelet indices) in diabetic patients with myocardial bridges. Methods: We reviewed angiograms performed between May 2017 and August 2019 at Bolu Abant Izzet Baysal University Medical Faculty Hospital. After appropriate exclusions, diabetic patients were divided into groups with myocardial bridges and normal coronary artery groups. A total of 124 patients were included in the study and hemogram parameters of these two groups were compared. Kolmogorov Smirnov test was used to examine the normality of variables. Data were compared using univariate tests including independent samples t-test, Mann–Whitney U-test and chi-square test. Results: Compared to control group PDW (17.7 (15.9-19.5) vs.17.4 (16.2-18.9) % p=0.047), MPV (8.3 (6.6-11.4) vs. 7.5 (6.6-8.7) Fl p<0.001), PCT (0.2 (0.16-0.25) vs. 0.18 (0.13-0.24) p=0.004), and Neutrophil-Lymphocyte Ratio (NLR) (1.71 (0.82-9.14) vs. 1.43 (0.78-5.75) p=0.036) were significantly higher in MB patients. There was no significant difference between the two groups in terms of other biochemical and hemogram values. Conclusion: Common, simple and inexpensive platelet indices were found to be increased in myocardial bridge diabetic patients

Predictive Value of Pancreatic Steatosis for Severity of Coronary Atherosclerosis in Patients with Type 2 Diabetes Mellitus

Objective To investigate the association of pancreatic steatosis with coronary atherosclerosis in patients with type 2 diabetes mellitus (T2DM). Methods Patients with T2DM who underwent coronary computed tomography angiography(CCTA)in our center due to chest pain were enrolled from January 2016 to February 2019. According to the CCTA findings,patients were divided into normal group,mild-to-moderate coronary atherosclerosis group and severe coronary atherosclerosis group. CT attenuation of pancreas and spleen was measured on abdominal non-enhanced CT,and the CT attenuation indexes including the difference between pancreatic and splenic attenuation (P-S) and the ratio of pancreas-to-spleen attenuation (P/S) were calculated. Analysis of variance or Kruskal-Wallis rank test were used to assess differences among each group. Logistic regression analysis was used to analyze the risk factors of severe coronary stenosis. The accuracy of P/S in predicting severe coronary artery stenosis was assessed by receiver operator characteristic (ROC) curve analysis. Results A total of 173 consecutive T2DM patients were enrolled. These patients included 27 patients with normal coronary artery (15.6%),124 patients with mild to moderate stenosis (71.7%),and 22 patients with severe stenosis (12.7%). There were significant differences in CT attenuation of pancreas (Z=11.543,P=0.003),P-S (Z=11.152,P=0.004) and P/S (Z=11.327,P=0.004) among normal coronary artery group,mild and moderate stenosis group,and severe stenosis group. The CT attenuation of pancreatic head,body,and tail significantly differed in patients with coronary artery stenosis (Z=14.737,P=0.001). After adjusting for confounding factors,multiple Logistic regression showed that P/S (OR=0.062,95%CI=0.008-0.487,P=0.008) was still significantly associated with the severe coronary artery stenosis. The area under the ROC curve of P/S for the diagnosis of severe coronary artery stenosis was 0.701,and the optimal cutoff point was 0.660. Conclusion CT attenuation of pancreas and CT attenuation indexes are associated with the severity of coronary stenosis in T2DM patients,suggesting that pancreatic steatosis may be used as one of the indicators for predicting severe coronary artery stenosis.

Evaluation of hemogram parameters in diabetic patients with coronary artery ectasia

Aim: To compare the importance of hemogram parameters in predicting the disease in diabetic patients with coronary artery ectasia (CAE) and normal coronary artery. Methods: The records of 7287 patients who underwent coronary angiography between January 2017 and October 2019 were reviewed. After appropriate exclusions, diabetic patients were divided into coronary artery ectasia and normal coronary artery groups. A total of 248 patients were included in the study and hemogram parameters of these two groups were compared. Results: Compared to control group white blood count (WBC) [8 (4-13) vs. 7 (5-12) u/mm3, p=0.023], hemoglobin [13 (10-16) vs. 14 (10-20) gr/dL, p=0.015], red cell distribution width (RDW) [16 (14-20) vs. 15 (12-19) %, p=0.026], neutrophil [4.5 (2.1-11.4) vs. 4.0 (0.2-7.5) u/mm3, p=0.003], platelet counts (Plt) [266 (196-450) vs. 236 (163-362) k/mm3 p<0.001], platelet distribution width (PDW) (17.9 (16.2-20.4) vs. 17.7 (15.9-19.7) % p=0.011), mean platelet volume (MPV) [8.4 (6.4-11.2) vs. 7.9 (6.6-10.1) Fl, p=0.015], plateletcrit (PCT) [0.20 (0.14-0.32) vs. 0.19 (0.13-0.26), p<0.001], and neutrophil lymphocyte ratio (NLR) [2.1 (1.0-9.7) vs. 1.6 (0.2-5.7), p=0.002] were significantly higher in CAE patients. Conclusion: The results of this study suggest that the increased some hemogram parameters may be useful in predicting disease in diabetic patients with CAE.

Association Between Plasma Levels of Fibrinogen and the Presence and Severity of Coronary Artery Ectasia

Objective: The aim of this study was to investigate the plasma fibrinogen levels in patients with isolated coronary artery ectasia (CAE). Materials and Methods: The study population included 154 patients, of whom 52 had isolated CAE, 52 had stable coronary artery disease (CAD) and 50 had normal coronary arteries (NCA). The severity of isolated CAE was determined using the Markis classification. All the subjects underwent complete physical examinations, including a detailed medical history, complete blood count and biochemical parameters. Plasma fibrinogen levels also were measured in all subjects. Results: The baseline characteristics of the three groups were similar. Plasma fibrinogen levels were significantly higher in the CAE group and CAD group than in the NCA group (383.3 ± 53.0 mg/dl and 400.8 ± 50.6 mg/dl vs 324.0 ± 56.4 respectively, p < 0.001). No difference was found between the CAE and CAD groups. The fibrinogen level was significantly higher in the type 1 Markis subgroup than in the type 2 and type 3 subgroups (P <0.001). In multivariate logistic regression analyses, fibrinogen level was independently and significantly associated with isolated CAE. Receiver operating characteristic curve analysis revealed that fibrinogen levels > 325 mg/dl identified patients with isolated CAE. Conclusions: Plasma fibrinogen is an easily measurable systemic inflammatory biomarker that is independently associated with CAE presence and severity. This suggests that fibrinogen may be involved in the pathophysiology of CAE.

Targeted metabolomic analysis of plasma metabolites in patients with coronary heart disease in southern China.

Coronary heart disease (CHD), one of the leading causes of death in the world, is a complex metabolic disorder due to genetic and environmental interactions. The potential mechanisms and diagnostic biomarkers for different types of coronary heart disease remain unclear. Metabolomics is increasingly considered to be a promising technology with the potential to identify metabolomic features in an attempt to distinguish the different stages of CHD.We aimed to investigate serum metabolite profiling between CHD patients and normal coronary artery (NCA) subjects and identify metabolic biomarkers associated with CHD progression in an ethnic Hakka population in southern China.Using a novel targeted metabolomics approach, we explored the metabolic characteristics of CHD patients. Blood samples from 302 patients with CHD and 59 NCA subjects were collected that analyses using targeted liquid-chromatography coupled with tandem mass spectrometry (LC-MS).A total of 361 blood samples were determined using targeted LC-MS. Plasma concentrations for trimetlylamine oxide (TMAO), choline, creatinine, and carnitine were significantly higher in patients with CHD compared to the NCA cohort. Further, we observed that the concentration of the 4 metabolites were higher than that of the NCA group in any group of CHD, which including acute myocardial infarction (AMI), unstable angina (UA), and stable angina (SA). In addition, the diagnostic model was constructed based on the metabolites identified and the ROC curve of the NCA subjects and CHD patients were performed. For choline and creatinine, the AUCs ranged from 0.720 to 0.733. For TMAO and carnitine, the AUCs ranged from 0.568 to 0.600.In conclusion, the current study illustrates the distribution of 4 metabolites between CHD patients and NCA subjects. Metabolomics analysis may yield novel predictive biomarkers that will potentially provide value for clinical diagnosis of CHD.

Circulating microRNA expression profiling and bioinformatics analysis of dysregulated microRNAs of patients with coronary artery disease.

MicroRNs (miRNAs) are small non-coding RNAs that modulate the expression of protein-coding genes at the post-transcription level and their dysregulated expression has been implicated in cardiovascular diseases. Circulating miRNAs have been widely recommended as potential biomarkers for many diseases including coronary artery disease. In this study, the miRNA expression profiles of 6 normal coronary artery (NCA), 12 patients with coronary artery disease including 6 unstable angina (UA) patients and 6 ST-segment elevation myocardial infarction (STEMI) patients were determined by small RNA sequencing. The differential expression of miRNAs was verified via using quantitative reverse transcription polymerase chain reaction (qRT-PCR). We further performed bioinformatics analysis for the differentially expressed miRNAs. The results showed that 60 miRNAs were up-regulated and 26 miRNAs were down-regulated in the UA group and 49 miRNAs were up-regulated and 62 miRNAs were down-regulated in the UA group when compared with the NCA group. Among them, both of UA group and STEMI group shared 38 dysregulated miRNAs (28 up-regulated and 10 down-regulated) versus NCA group. ROC curves analysis showed that miR-142-3p and miR-17-5p might server as potential biomarkers for the detection and diagnosis of UA and STEMI. Bioinformatics functional predictions showed that the differential expressed miRNAs were closely related with the pathological process of coronary artery disease. We comprehensively analyzed profile expression of circulating miRNAs of patients with coronary artery disease. Our study suggested that miR-142-3p and miR-17-5p might be potential targets for follow-up research in evaluating biomarkers of coronary artery disease.

Correlation of epicardial adipose tissue thickness with severity of coronary atherosclerosis by SYNTAX score, carotid intima-media thickness and metabolic syndrome

PurposeMajor burden of cardiovascular disease (CVD) mortality around the globe is due to atherosclerosis and its complications. Hence its early detection and management with easily accessible and non-invasive methods is valuable.Epicardial adipose tissue thickness (EAT) through transthoracic two dimensional (2D) echocardiography determines highly active intrathoracic visceral adipose tissue burden which increases atherosclerosis.1 We did this study to find the utility of EAT in predicting coronary artery disease (CAD) burden and compare with carotid intima media thickness (CIMT) which is an established surrogate marker of atherosclerosis. MethodsIn this cross-sectional comparative study, we measured EAT by 2D echocardiography and CIMT by B-mode ultrasound in 161 patients, who underwent coronary angiogram (CAG) for various clinical indications. Coronary artery disease was considered significant if more than 70% diameter stenosis is present in any epicardial coronary artery and insignificant if otherwise. ResultsOn coronary aniography (CAG) 65.2% of patients had significant CAD, 24.3% had insignificant disease and 10.5% had normal coronaries. Epicardial adipose tissue was 0.59±0.26cm in normal coronary artery group, 0.61±0.20cm in insignificant CAD group and 0.72±0.19cm in significant CAD group (p<0.05) and CIMT was 0.54±0.15mm, 0.61±0.13mm and 0.65±0.15mm in normal coronaries group, insignificant CAD group and significant CAD group respectively (p<0.05). Pearson correlation analysis was conducted to examine the relationship between EAT and CIMT. Results showed a significant positive relationship between EAT and CIMT. (r=0.183, p=<0.01, N=161). The results also showed a significant positive relationship between EAT and SYNTAX score (r=0.290, p=<0.01, N=161) and a significant positive relationship between EAT and Gensini score (r=0.209, p=<0.01, N=161). ConclusionsEAT and CIMT can predict CAD burden in a robust way. EAT may emerge as an exquisite bedside tool to predict atherosclerotic burden and guide to implement preventive therapy for cardiovascular disease.