Predictor Of Coronary Artery Disease In Patients Research Articles

Assesmen of atherosclerotic lesions of the carotid artery and risk factors for rheumatoi arthritis patients

Aim . To study and evaluate risk factors and analyze carotid artery intima-media thickness parameters as an early predictor of atherosclerosis in patients with rheumatoid arthritis. Materials and methods . The study involved 86 patients (women - 67, men - 19) observed in the State Institution “City Medical Center №2”, Dushanbe, aged from 37 to 67 years (mean age - 56.5±2.9 years). The diagnosis of rheumatoid arthritis was established according to the American College of Rheumatologists/EULAR 2010 criteria. The examination program included general clinical and instrumental methods (examination of common and accessible parts of internal and external carotid arteries), estimation of lumen size, the thickness of intima-media complex (TCIM), straightness of its course, atherosclerotic plaques of carotid arteries (ABS), echocardiography (ECHO-KG). Results and discussion . Thus, in the absence of significant gender differences in the frequency of arterial hypertension and increased intima-media thickness (the earliest manifestation of atherosclerotic vascular lesions), hypercholesterolemia and long-term glucocorticoid intake were more frequently recorded in women. Undoubtedly, each of the considered risk factors makes a definite contribution to the development of vascular atherosclerosis and the instability of their organic changes. However, the significance of these risk factors in the thickening of the intima-media complex of vessels may differ. Conclusion . Data correlated with intima-media thickness show sex differences, the significance of risk factors, and an increase in intima-media thickness despite the duration of glucocorticoid therapy. The factors mentioned are more significant in men, while in women, intima-media thickness is closely related to the duration of rheumatoid arthritis, total cholesterol levels, and blood pressure.

Comparison of Framingham risk score and atherogenic indices as a predictor of atherosclerosis in patients with myocardial bridge in left anterior descending artery

Background Myocardial bridge (MB) is generally considered as a benign condition, but it may trigger atherosclerosis, especially in the adjacent proximal coronary artery segment. In this study, we aimed to investigate whether the Framingham risk score (FRS) or atherogenic indices are risk factors for coronary atherosclerosis in patients with MB in the left anterior descending coronary artery (LAD). Methods We performed a retrospective study evaluating 155 patients who have MB in LAD. The patients were evaluated in two groups according to the presence of atherosclerosis (74 patients in atherosclerotic group vs. 81 patients in non-atherosclerotic group). Baseline characteristics, FRS and atherogenic indices were reviewed between groups. Significant independent risk factors for coronary atherosclerosis were investigated by logistic regression analysis. Results Patients in atherosclerotic group were significantly older (58.15 ± 10.04 vs. 50.22 ± 9.27 years, p < .001) and 74.3% of the patients were male. While the mean FRS in the atherosclerotic group was 21.20 ± 8.81, it was 12.79 ± 8.61 in the non-atherosclerotic group (p < .001). Among the atherogenic indices, only LDL-c/HDL-c ratio was significantly higher in the atherosclerotic group (3.49 ± 1.2 vs. 3.11 ± 0.98, p:.033). Multivariable analysis showed that age (OR: 1.08, 95% CI 1.03–1.13, p < .001) and FRS (OR: 1.06, 95% CI 1.01–1.11, p:.012) were independently associated with the presence of atherosclerotic lesion. Conclusions FRS is an easily applicable predictor in clinical practice that indicates the presence of coronary atherosclerosis in patients with MB in LAD.

Epicardial adipose tissue thickness as a possible predictor of carotid atherosclerosis in patients with abdominal obesity

Aim. To assess epicardial adipose tissue (EAT) thickness using echocardiography as one of the possible predictors of subclinical carotid atherosclerosis in patients with abdominal obesity in prospective follow-up.Material and methods. The study included 224 men (mean age, 49,1±2,4 years), without hypertension, carotid atherosclerosis, type 2 diabetes and symptoms of cardiovascular diseases, with abdominal obesity and SCORE risk &lt;5%. The levels of albuminuria, lipid and glucose profiles, C-reactive protein, uric acid, blood creatinine, EAT thickness, ultrasound parameters of abdominal obesity and perivascular adipose tissue (PVAT) were assessed. At the follow-up end (mean duration, 48,2±4,8 months), repeated triplex ultrasound of the brachiocephalic arteries was performed.Results. Patients with developed carotid atherosclerosis (n=70) had higher baseline values of blood pressure, fasting glycemia, C-reactive protein, as well as a higher incidence of prediabetes, hyperuricemia, and high-grade albuminuria. They were also distinguished by high values of EAT thickness (6,1±0,6 mm vs 5,0±1,0 mm, p &lt;0,001), abdominal visceral to subcutaneous fat ratio (3,1±0,5 vs 2,7±0,6, p &lt;0,05) and carotid extra-media thickness (0,64±0,08 mm vs 0,50±0,11 mm, p &lt;0,01). According to multivariate logistic regression, EAT thickness was characterized by the maximum standardized regression coefficient (0,443, p &lt;0,001), and the total percentage of correct mathematical model classifications was 88,2%. According to the ROC-analysis, the area under the curve was 0,86. With a cut-off value of EAT thickness of 5,9 mm, the sensitivity and specificity of the predictive model were 71,5% and 92,3%, respectively.Conclusion. EAT thickness assessed by echocardiography, as a marker of the severity of visceral EAT, can serve as a predictor of subclinical carotid atherosclerosis in persons with abdominal obesity and initially low cardiovascular risk according to the SCORE calculator. Patients with verified epicardial visceral obesity require more active preventive measures.

Serum Paraoxonase with HDL-C as a predictor of atherosclerosis in patients of Chronic Kidney Disease

Introduction and Aim: CKD (Chronic Kidney Disease) is a problem in health care spread all over the world with adverse consequences. CKD is associated with premature atherosclerosis and increased morbidity and mortality due to cardiovascular complications. Hypertriglyceridemia is a commonly seen lipid abnormality in CKD patients. PON-1 (Paraoxanase-1) is a glycoprotein synthesized in the liver and is released into the blood, where it links with HDL. This study was undertaken to find out the relation between PON-1 and HDL-C and its effect on atherosclerosis. &#x0D; Materials and Methods: A total number of 123 subjects participated in the study. Serum was used for estimating the parameters such as serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein (VLDL) by calculation, creatinine, urea in a fully automated analyzer BS300. Serum paraoxonase-1(PON) was estimated by spectrophotometric method.&#x0D; Results: The metabolic derangement was very evident in the CKD group with significantly higher creatinine, urea, and dyslipidemia, and abnormal paraoxonase activity being observed in the cases compared to controls. &#x0D; Conclusion: This study suggests the need for assessing PON-1 activity, a measure of the antioxidant capacity of HDL-C which improves the predictive accuracy of atherosclerosis in CKD.

Utility of mean platelet volume to predict the prevalence of coronary artery disease on coronary angiography in patients with stable angina

Approximately 50% of patients with stable angina have coronary artery disease (CAD) on coronary angiography. The mean platelet volume (MPV) has been proposed as a marker that reflects platelet size and reactivity. This study investigated the predictive value of high MPV in patients with stable angina for diagnosing stable CAD. A total of 491 patients with chest pain who underwent selective coronary angiography for suspected CAD were enrolled. The patients were divided into the CAD group and non-CAD group according to angiography. All demographic, laboratory, and angiographic data were collected. Patients with MPV in the highest tertile were more likely to have CAD (66.9 vs. 51.0 vs. 35.7% for the highest, middle, and lowest tertiles; P = 0.001), had lower platelet counts (186 ± 48 vs. 199 ± 52 vs. 223 ± 63; P < 0.001), and had higher hemoglobin A1c levels (6.8 ± 1.5 vs. 6.5 ± 1.5 vs. 6.2 ± 1.1; P < 0.001). MPV had a positive correlation with hemoglobin A1c (r = 0.16; P < 0.001). Patients with CAD (n = 248) had higher MPV than those without CAD (n = 243) (11.0 ± 1.0 vs. 10.5 ± 0.9; P < 0.001). MPV was an independent predictor of CAD in patients with stable angina, with an adjusted odds ratio of 1.820 (95% confidence interval: 1.453-2.279; P < 0.001). The presence of high MPV predicts the prevalence of CAD on coronary angiography in patients with stable angina, and this result may ultimately reduce unnecessary invasive coronary angiography.

Predictors of Atherosclerotic Change in Unruptured Intracranial Aneurysms and Parent Arteries During Clipping

To identify predictors of atherosclerotic change in aneurysms and parent arteries, and to retrospectively analyze outcomes from clipped aneurysms that showed atherosclerotic changes. Between May 2017 and April 2018, we collected a total of 151 clipping cases and reviewed records of operation videos to classify atherosclerosis by location (dome, neck of aneurysm, or parent artery). To identify predictors of atherosclerotic change in aneurysms, we analyzed baseline demographic characteristics, preoperative images, and Framingham Risk Scores (FRS). We also analyzed incomplete clipping cases according to atherosclerosis presence and location. This study cohort included 110 women (mean age, 59.3 ± 7.1 years) and 41 men (mean age, 55.9 ± 9.6 years). Atherosclerotic change was seen in 77 cases. FRS, diabetes mellitus, and aneurysm size were identified as independent risk factors for atherosclerotic change in multivariate logistic regression analysis. There were 11 incomplete clipping cases (7.2%). Among the 30 cases with atherosclerotic change in the neck were 10 cases of incomplete clipping (P < 0.001). FRS, diabetes mellitus, and aneurysm size as predictors of atherosclerosis in patients undergoing aneurysm surgery can help guide surgical decisions and performance.

Risk factor profile in patients who underwent coronary angiography at the Shisong Cardiac Centre, Cameroon

Background: Coronary artery disease (CAD) is the leading cause of death worldwide. Although there has been a drop in the prevalence and mortality from CAD in the western world, the reverse is happening in developing countries. In sub-Saharan Africa, there is a paucity of studies to support the rising burden of CAD, thus this information is needed to assist health care and policies planning in the region. The aim of this study was to find the predictors of CAD in patients who underwent coronary angiography (CA), the gold standard diagnostic test at the unique cardiac catheterization center in Cameroon. Methods: Medical files of all patients who underwent CA at Shisong Cardiac Centre (SCC) between March 2010 and February 2017 were analyzed for risk factors and CA results. Comparisons were made using the Chi-square and Fischer’s exact tests for frequencies and student t-test for means. The logistic regression model was used for multivariate analysis. Data was collected and analyzed using Epi Info 7.2.1.0. Results: Of 250 patients included in the study, 172 (68.80%) were males. Their mean age was 54.59±10.40 years. Most patients, 213 (85.20%) lived in an urban setting. The prevalence of CAD was 28.8%. The group of patients with CAD compared with those without CAD had a higher statistically significant proportion of males (86.11%, P Conclusions: In our study, CAD affects the generation of breadwinners, predominantly males living in urban areas. Diabetes, hypertension, male gender and dyslipidemia are strong predictors of CAD in Cameroon. With several studies showing a widespread prevalence of these risk factors in Cameroon, CAD might not be as rare as previously believed.

Predictive value of global and territorial longitudinal strain imaging in detecting significant coronary artery disease in patients with myocardial infarction without persistent ST-segment elevation.

Two-dimensional (2D) speckle-tracking echocardiographic (STE) imaging is frequently performed in the assessment of cardiovascular diseases. We aim to investigate the role of the global and territorial longitudinal strain (GLS and TLS) values assessed via 2D STE imaging to detect significant coronary artery disease (CAD) in non-ST-segment elevation myocardial infarction (NSTEMI) patients without wall-motion abnormalities. This study enrolled 150 patients with the diagnosis of NSTEMI. Patients who had typical chest pain with unstable angina characteristics within the last 24hours were 18-80years of age and had a typical rise and/or fall of cardiac biomarkers were included. Myocardial functions were assessed via myocardial deformation analyses of 2D STE images. The mean age of the CAD group was 52.91±9.11, vs 50.31±8.32 in the control group. In the CAD group, 56 patients were male (65%), whereas 21 were male (60%) in control group. GLS and TLS assessments demonstrated a statistically significant difference between CAD and control groups, with GLS values of -16.27±1.91 and -18.74±1.93 (P<0.001), TLS-LAD values of -15.67±1.83 and -18.54±1.97 (P<0.001), TLS-RCA values of -17.04±1.81 and -19.20±1.86 (P<0.001), and TLS-Cx values of -17.40±2.08 and -18.34±2.18 (P=0.028), respectively. Correlation analyses revealed that as high-sensitivity troponin (hsTnT) values increased, GLS decreased significantly, and further, an increase in severity of CAD resulted in decreased TLS-LAD, -CX and -RCA (TLS-LAD: P<0.001, r=-0.743; TLS-CX: P<0.001, r=-0.449; TLS-RCA: P<0.001, r=-0.737). Multivariate analyses indicated that GLS and GRACE ACS risk scores are independent predictors of CAD in patients with NSTEMI (GLS: OR=0.514, P<0.001; GRACE score: OR=0.938, P=0.007). Global longitudinal strain (GLS) assessed with 2D STE is a promising, easy to perform and quick imaging method to predict CAD in patients with NSTEMI.

Is serum Klotho protective against atherosclerosis in patients with type 1 diabetes mellitus?

ObjectiveKlotho deficiency is associated with several metabolic disorders. Two dimensional (2D) longitudinal strain (LS) of left ventricle (LV), carotid artery intima–media thickness (CIMT), flow-mediated dilation (FMD) of brachial artery and epicardial fat thickness (EFT) have been reported to be early predictors of atherosclerosis. We aimed to investigate the relationship between serum Klotho levels and these early predictors of atherosclerosis in patients with type 1 diabetes mellitus (DM). MethodsThe study included 45 type 1 diabetic patients and 35 controls. Serum Klotho levels were determined by ELISA method. The patient group was also divided into two subgroups according to serum Klotho levels: high (HK) and low Klotho (LK) groups. EFT, CIMT and FMD were measured according to appropriate recommendations. Speckle tracking analysis was performed using the Echopac software. ResultsThe patient group had significantly lower serum Klotho (p=0.001), FMD (p<0.001) and LS of LV (p<0.001) values, but larger EFT (p<0.001) and CIMT (p<0.001) values than controls. LK subgroup had also significantly lower FMD (p<0.001) and LS of LV (p<0.001) but larger EFT (p=0.002) and CIMT (p<0.001) values than HK subgroup. ConclusionSerum Klotho may have a protective effect against atherosclerosis and endothelial dysfunction in type 1 DM.

Biochemical predictors of coronary atherosclerosis in patients with metabolic disorders

Metabolic syndrome represents a combination of different major risk factors of cardiovascular diseases and is mainly related to impaired insulin sensitivity in biological tissues. Common understanding of pathogenesis and relationship of different pathological conditions within metabolic syndrome is still missing. New data on endocrine function of adipose tissue suggests that development and progression of atherosclerosis in this situation may be related to adipokines dysbalance. This study investigates correlation of leptin and adiponectin with clinical and laboratory changes in patients with metabolic disorders.

221 Comparing Erectile Dysfunction with Traditional Vascular Risk Factors in the Prediction of Coronary Artery Disease in Patients Presenting with Chest Pain

<h3>Introduction</h3> Erectile dysfunction (ED) is the persistent inability to attain or maintain an erection and affects up to 52% of men between the ages of 40 and 70. ED is an independent predictor of clinically overt cardiovascular (CV) events, coronary artery disease (CAD), stroke and all-cause mortality, preceding these by 2–5 years. ED has not been evaluated in patients referred to a rapid access chest pain clinic (RACPC) for suspected CAD. <h3>Purpose</h3> To prospectively investigate ED in patients referred to the RACPC and to assess ED as an independent predictor of CAD in these patients. <h3>Methods</h3> All male patients attending RACPC between October 2012 and February 2014 were eligible. ED was measured using a well validated 5-item International Index of Erectile function (IIEF-5) questionnaire, with ED being defined as IIEF-5 of ≤21 out of 25. ED was further categorised into mild-moderate (IIEF-5: 11–21) and severe (IIEF-5: ≤10). All patients underwent an exercise tolerance test (ETT) according to Bruce protocol where appropriate as a first line investigation. When this was not possible, patients underwent a functional imaging (stress echocardiography [SE] or myocardial perfusion scintigraphy [MPS]). Patients with positive or inconclusive studies went on to have coronary angiography (CA). Patients were considered to have CAD if they had a positive ETT, SE, MPS or CA. Results were analysed using Chi-squared test for categorical data and one-way ANOVA for continuous data. Stepwise Binary logistic regression model was used to determine the contribution of traditional risk factors and the presence of ED to the prediction of CAD. P-value less than 0.05 was considered significant. <h3>Results</h3> Our study cohort constituted 181 patients. Of these, 26 (14%) could not complete IIEF-5. Of the remaining 155 participants, 53 (34%) had normal erectile function (IIEF-5: ≥22). Of 102 (66%) ED patients, 55 (36%) had mild-moderate ED and 47 (30%) had severe ED. Patients with ED reported more risk factors than patients without ED, including smoking (68% vs. 55%, p = 0.004), diabetes (9% vs. 23%, p = 0.029), and hypertension (30% vs. 56%, p = 0.002). More patients with ED had CAD (47% vs. 25%, p = 0.014). Using stepwise Binary logistic regression including hypertension, hypercholesterolemia, smoking, diabetes, family history and ED as covariates, hypercholesterolemia (p = 0.045) and ED (p = 0.007) were significant independent predictors of CAD (r2=0.135, p = 0.001). <h3>Conclusions</h3> ED may be a more powerful predictor of CAD in male patients with chest pain when compared to traditional vascular risk factors.

Prediction of coronary artery disease in patients with lower extremity peripheral artery disease.

Coronary artery disease (CAD) is a major determinant of long-term prognosis in patients with peripheral artery disease (PAD). We investigated the predictors of CAD in patients with lower extremity PAD.A total of 107 patients with PAD who underwent peripheral and simultaneous coronary angiography were reviewed. PAD was defined as (≥ 50%) stenosis associated with claudication or critical limb ischemia. PAD was divided into proximal and distal lesions. CAD was defined as angiographically significant (≥ 50%) stenosis of coronary arteries.The prevalence of CAD in patients with PAD was 62% (67/107), and of this 62%, only 13% (9/67) had angina and 72% (48/67) had multi-vessel disease. Diabetes significantly increased the risk of CAD in patients with PAD and the odds ratio of having multi-vessel CAD was 2.5 (1.1-5.9, P = 0.037) in multivariate regression analysis. The patients with multi-vessel CAD had more cardiovascular risk factors than those with normal, minimal and single CAD (P = 0.032). Interestingly, the prevalence of proximal PAD was higher in the normal or single CAD group than the multi-vessel CAD group, whereas both proximal and distal involvement of PAD was higher in the multi-vessel CAD group.Diabetes, multi-cardiovascular risk factors, and involvement of both proximal and distal lesions significantly increased the risk of multi-vessel CAD. Therefore, simultaneous CAD evaluation should be considered in patients with lower extremity PAD having diabetes, multi-cardiovascular risk factors, or multi-level disease.

Incidence of coronary artery disease before valvular surgery in isolated severe aortic stenosis

Background Angina pectoris has been recognized as one of the principal symptoms of aortic valve stenosis (AS), even in patients without significant coronary artery disease (CAD). However, the incidence of angina pectoris and related CAD in such patients is controversial. There is continuing debate as to whether coronary angiography is necessary before aortic valve replacement (AVR) in patients with severe AS. The purpose of this study was to evaluate the incidence and predictors of CAD in patients with severe AS in a Korean population. Methods Data from all consecutive patients with severe AS undergoing AVR at a major tertiary cardiac and vascular center in Korea were entered in a prospective registry beginning in 1995. Clinical and echocardiographic follow-up data were recorded into the database annually. Significant CAD was defined as one or more major coronary arteries having an estimated narrowing of ≥70% and left main coronary arteries having an estimated narrowing of ≥50% on coronary angiography. We excluded patients with multiple valve disease, significant aortic regurgitation, or prior CAD or valve surgery. Results Totally 574 patients with severe AS (mean age, (65.9±9.6) years) were enrolled in this study. Significant CAD was found in 61 patients (10.6%). Factors associated with increased likelihood of CAD were age, hypertension, diabetes mellitus, chronic renal failure, carotid disease, and aorta calcification. In Logistic regression analysis, the independent predictor of the presence of CAD was age (P=0.011). The incidence of CAD increased significantly at 69.2 years of age. Having two risk factors for cardiovascular disease was the most useful cutoff to predict whether a patient was going to have significant CAD. Conclusions There was a low incidence of significant CAD in a population of Korean patients with severe AS. Therefore, coronary angiography before AVR will be considered in patients with multiple risk factors for cardiovascular disease or in patients more than 69 years of age without risk factors for cardiovascular disease.

Associations between glycated albumin or hemoglobin A1c and the presence of coronary artery disease

ObjectiveWe investigated the associations between serum levels of glycated albumin (GA) or hemoglobin A1c (HbA1c) and the presence of coronary artery disease (CAD) in patients who underwent coronary computed tomography angiography (CTA). Methods and resultsThe study consisted of 244 consecutive patients who underwent CTA and in whom we could measure the levels of both GA and HbA1c. Any narrowing of the normal contrast-enhanced lumen to >50% that could be identified in multiplanar reconstructions or cross-sectional images by CTA was defined as significant stenosis in CAD. We divided the patients into two groups: CAD group (n=72) and non-CAD group (n=172), as assessed by CTA. The CAD group showed significantly higher GA and HbA1c than the non-CAD group. GA and HbA1c showed a positive correlation (r=0.551, p<0.0001). A multivariate logistic regression analysis was performed to examine the associations between the presence of CAD and age, gender, body mass index, and coronary risk factors (hypertension, dyslipidemia, and smoking), in addition to GA and HbA1c. Age [odds ratio (OR): 1.04, p=0.02], gender (OR: 2.84 p=0.01), hypertension (OR: 3.20, p=0.01), and GA (OR: 1.16, p=0.03) were identified as significant independent variables that predicted the presence of CAD. In particular, GA (OR: 1.30, p=0.02) was the only predictor of the presence of CAD in the diabetes mellitus group by a multivariate logistic regression analysis. We defined the cut-off value of GA for the prediction of CAD in patients with diabetes as 17.9% (sensitivity 0.639, specificity 0.639) by a receiver-operating characteristic curve analysis. ConclusionGA may be superior to HbA1c as a marker for evaluating the presence of CAD.

PREDICTION OF CORONARY ARTERY DISEASE BY DETECTION OF POSITIVE ISOVOLUMIC RELAXATION VELOCITY IN PATIENTS WITH NORMAL RESTING WALL MOTIONS "A Tissue Doppler Echocardiographic Study"

Background: Diagnosis of coronary artery disease (CAD) is of importance in the contemporary society of ever-increasing CAD (1,2). Isovolumic relaxation velocity (VIR), Postsystolic motion or postsystolic shortening (PSS) is a delayed ejection motion of the myocardium occurring after the aortic valve closure during a generally prolonged isovolumic relaxation time, which is related with myocardial ischemia in human(3,4) and in experimental studies(5). Spectral tissue Doppler imaging (TDI) is a simple echocardiographic technique that can provide velocity measurement of the myocardial segments(6). A positive myocardial velocity during isovolumic relaxation phase (VIR) detected by TDI, which corresponds to postsystolic motion or PSS, has been shown to indicate severely ischemic myocardium(8). So, detection of positive VIR by spectral TDI may be used as a noninvasive, nonprovocative method to predict possible CAD; specially for those with coexisting morbidities, such as peripheral artery disease in the lower limb, orthopedic diseases. Aim of the work: Diagnostic value of positive myocardial velocity during isovolumic relaxation phase (VIR) by spectral TDI in prediction of CAD in patients with typical ischemic chest pain and normal resting wall motions. Patients and methods: This study was done in Cardiology department, Zagazig University on 80 patients; 41 females (51%) & 39 males (49%)) with typical ischemic chest pain and no regional wall motion abnormalities detected by resting echocardiography. Patients were divided into 2 groups according to presence of significant coronary artery lesion by coronary angiography; group A (patients with CAD) and group B (patients without CAD). All the following parameters were measured by TDI; 5 peak velocities during; Isovolumic contraction phase (VIC), Systolic ejection phase (S'), Early diastolic relaxation phase (Em), Atrial contraction phase (Am) and Isovolumic relaxation phase (VIR) if present and VIR time. Then coronary angiography was done for all patients. Results: As regard to presence of VIR velocity, there was significant difference (<0.05) between group A and group B at mid septal and anterior walls, highly significant difference (<0.001) at basal septal and anterior walls. There was highly significant difference between group A and B at mid and basal lateral and inferior walls. There was highly significant correlation between coronary angiography and VIR velocity regarding detection of positive and negative cases and also there was highly significant correlation between previous 2 tests by Kappa test p value (<0.001). Conclusion: Positive VIR detected by spectral tissue Doppler imaging is a useful indicator of CAD in patients with apparently normal left ventricular contraction and chest pain. Key words: TDI, VIR velocity, coronary angiofraphy, coronary artery disease.

Usefulness of metabolic syndrome score in the prediction of angiographic coronary artery disease severity according to the presence of diabetes mellitus: relation with inflammatory markers and adipokines

BackgroundIt is a matter of debate whether metabolic syndrome (MS) improves cardiovascular risk prediction beyond the risk associated with its individual components. The present study examined the association of MS score with high sensitivity C-reactive protein (hs-CRP), interleukin-6 (IL-6), resistin, adiponectin, and angiographic coronary artery disease (CAD) severity according to the presence of DM. In addition, the predictive value of various clinical and biochemical parameters were analyzed, including the MS score for angiographic CAD.MethodsThe study enrolled 363 consecutive patients (196 men, 62 ± 11 years of age) who underwent coronary angiography for evaluation of chest pain. Blood samples were taken prior to elective coronary angiography. MS was defined by the National Cholesterol Education Program criteria, with MS score defined as the numbers of MS components. CAD was defined as > 50% luminal diameter stenosis of at least one major epicardial coronary artery. CAD severity was assessed using the Gensini score.ResultsOf the 363 patients studied, 174 (48%) had CAD and 178 (49%) were diagnosed with MS. When the patients were divided into 4 subgroups according to MS score (0–1, 2, 3, 4–5), IL-6 levels and the CAD severity as assessed by the Gensini score increased as MS scores increased. In contrast, adiponectin levels decreased significantly as MS scores increased. When subjects were divided into two groups according to the presence of DM, the relationships between MS score and IL-6, adiponectin, and Gensini score were maintained only in patients without DM. Age, smoking, DM, MS score, and adiponectin independently predicted angiographic CAD in the whole population. However, age is the only predictor for angiographic CAD in patients with DM.ConclusionsIn the presence of DM, neither adipokines nor MS score predicted angiographic CAD. However, in non-diabetic patients, IL-6 and adiponectin showed progressive changes according to MS score, and MS score was an independent predictor of CAD in patients without DM.

Renal Artery Stenosis Predicts Coronary Artery Disease in Patients with Hypertension

In hypertensive patients with indication of renal arteriography to investigate renal artery stenosis (RAS) there are no recommendations regarding when to investigate coronary artery disease (CAD). Moreover, the predictors of CAD in patients with RAS are not clear. We aimed to evaluate the frequency and the determinants of CAD in hypertensive patients referred to renal angiography. Eighty-two consecutive patients with high clinical risk suggesting the presence of RAS systematically underwent renal angiography and coronary angiography during the same procedure. Significant arterial stenosis was defined by an obstruction≥70% to both renal and coronary territories. Significant CAD was present in 32/82 (39%) and significant RAS in 32/82 (39%) patients. Both CAD and RAS were present in 25.6% from the 82 patients. Patients with severe CAD were older (63±12 vs. 56±13 years; p = 0.03) and had more angina (41 vs. 16%; p = 0.013) compared to patients without severe CAD. Significant RAS was associated with an increased frequency of severe CAD compared to patients without significant RAS (66% vs. 22%, respectively; p<0.001). Myocardial scintigraphy showed ischemia in 21.8% of the patients with CAD. Binary logistic regression analysis showed that RAS≥70% was independently associated with CAD≥70% (OR: 11.48; 95% CI 3.2–40.2; p<0.001), even in patients without angina (OR: 13.48; 95%CI 2.6–12.1; p<0.001). Even considering a small number of patients with significant RAS, we conclude that in hypertensive patients referred to renal angiography, RAS≥70% may be a strong predictor of severe CAD, independently of angina, and dual investigation should be considered.

Evaluation of intima-media thickness of carotid artery in patients with chronic graft-versus-host disease using ultrasound

Aim: We studied the use of ultrasound in the detection of intima-media thickness (IMT) as an early predictor of atherosclerosis in patients with and without chronic graft-versus-host disease (GVHD) after allogeneic bone marrow transplantation (BMT). Methods: We performed a cross-sectional study of 30 BMT patients without history of chronic GVHD, 30 BMT patients with chronic GVHD and 30 healthy controls. IMT was estimated at 3 points on the right and left sides – 1: within 10 mm of the distal common carotid artery; 2: within 10 mm of the carotid bulb; and 3: within 10 mm of the proximal internal carotid artery. Results: Patients with chronic GVHD had a significantly (p < 0.01) higher overall IMT and IMT in the right or left bulb of carotid compared with patients without chronic GVHD and controls. No differences were found in IMT at different points between controls and patients without GVHD. Conclusion: This study demonstrated a higher IMT in patients with chronic GVHD after BMT and no significant differen...

Accuracy of Stress Myocardial Perfusion Imaging to Diagnose Coronary Artery Disease in End Stage Liver Disease Patients

Patients with end-stage liver disease (ESLD) who also have underlying coronary artery disease (CAD) may be at increased risk for undergoing hemodynamically challenging orthotopic liver transplantation. Noninvasive single-photon emission computed tomographic (SPECT) imaging is often used to determine whether a patient with ESLD has unsuspected CAD. The objective of this study was to determine the accuracy of SPECT imaging for detection of CAD in patients with ESLD. Patients with ESLD who underwent coronary angiography and SPECT imaging before orthotopic liver transplantation were analyzed retrospectively. The predictive accuracy of clinical risk factors was calculated and compared to the results of SPECT imaging. There were 473 SPECT imaging studies. Adenosine SPECT imaging had a sensitivity of 62%, specificity of 82%, positive predictive value of 30%, and negative predictive value of 95% for diagnosing severe CAD. Regadenoson SPECT imaging had a sensitivity of 35%, specificity of 88%, positive predictive value of 23%, and negative predictive value of 93% for diagnosing severe CAD. The accuracy of a standard risk factor analysis showed no statistical difference in predicting CAD compared with adenosine (sensitivity McNemar's p = 0.48, specificity McNemar's p = 1.00) or regadenoson (sensitivity McNemar's p = 0.77, specificity McNemar's p = 1.00) SPECT studies. In conclusion, the 2 pharmaceutical agents had low sensitivity but high specificity for diagnosing CAD. However, because the sensitivity of the test is low, the chances of missing patients with ESLD with CAD is high, making SPECT imaging an inaccurate screening test. A standard risk factor analysis as a predictor for CAD in patients with ESLD is less expensive, has no radiation exposure, and is as accurate as SPECT imaging.

Epicardial adipose tissue volume as a predictor for coronary artery disease in diabetic, impaired fasting glucose, and non-diabetic patients presenting with chest pain

Epicardial adipose tissue (EAT) volume has been associated with coronary artery disease (CAD). As diabetes mellitus type 2 (DM2) patients have higher EAT volumes, it has been suggested that EAT may play a role in promoting CAD in these patients. The aim of this study was to examine the association between EAT and CAD in DM2, impaired fasting glucose (IFG) and control patients presenting with stable chest pain. A total of 410 stable chest pain patients underwent multidetector cardiac computed tomography angiography (CCTA) to assess the presence of CAD. The extent of CAD was expressed as the number of affected segments. The EAT volume was measured using three-dimensional volumetric quantification. The EAT was compared using ANOVA, logistic and linear regression models were used to assess its predictive value. Multivariable regression analysis corrected for traditional risk factors was performed. Eighty-three patients had DM2, 118 IFG and there were 209 controls. DM2 as well as IFG patients had higher EAT volumes compared with controls (98 ± 41, 92 ± 39, and 75 ± 34 cm(3), respectively; P < 0.001). EAT predicted the presence (OR: 1.01; P < 0.001) and the extent of CAD (B: 0.01; P < 0.001). The associations were equal in all subgroups. However, in a multivariable regression model corrected for traditional cardiovascular risk factors, EAT was not an independent predictor for the presence or extent of CAD (OR: 1.00; P = 0.88 and B: -0.11; P = 0.68, respectively). The EAT volume is associated with CAD in DM2, IFG, and control patients. However, EAT is not an independent predictor for CAD in patients presenting with stable chest pain.