Predictor Of CAD Research Articles

A study of 10 years risk prediction of CAD – applying “Framingham risk scores” among the coal mine employees of the Singareni Collieries company ltd, Telangana state, India

Background: Cardiovascular Disease (CVD) has become the leading cause of death. Many tools for CVD risk assessment have been devised. While it is relatively easy to identify those who are obviously at high risk, the health expenditure can be predicted and necessary high risk based preventive care programmes can be introduced. The study has been taken up with an objective of assessing “10 years risk prediction of CAD, Among the Coal Mine Employees by applying “Framingham Risk Scores.”.Methods: Study population: coal mine employees (30-60 years of age). Study area: Singareni Collieries Company Limited (SCCL), Telangana State, India. Study design: cross-sectional observational study. Sample size: 53367coal mine workers. Sampling methods: All coal mine employees (30-60 years) working atleast of 10 years duration and those who have given consent for the study have been included. Data collection: collected from the periodic medical examination records from 2008 to 2012. Analysis: By using Micro soft Excel 2007 and SPSS version 19.Results: Majority of the workers were in the age group of 51-60 years of age, followed by 41-50 years (31.5%). 11.9% has mild risk, 3.2% has moderate risk and 0.6% has severe risk of CAD. Mining Surface labourers has marginally higher risk of CAD than “Mining Supervisory and Managerial Staff’, Opencast mining staff were found to at higher risk of CAD.Conclusions: Mining Surface labourers and opencast mining staff were found to at higher risk of CAD.

“Correlation of red blood cell distribution width with the severity of coronary artery disease—A single center study”

ObjectiveCoronary Artery Disease (CAD) is the leading cause of morbidity and mortality all around the world. We evaluated the correlation of Red blood cell Distribution Width (RDW) with the severity of lesion on coronary angiography as assessed by Modified Gensini score (MGS) in CAD patients. MethodsA total of 576 consecutive patients admitted in Department of Cardiology over a period of one year, who underwent coronary angiography after diagnosis of CAD or presence of angina like chest pain and/or positive treadmill test were enrolled in the study (August 2014–May 2015). Patients were divided into two groups, with CAD (Group A) and without CAD (Group B). The RDW Cofficience of variance (RDW CV) and RDW standard deviatiton (RDW SD) of each patient, and their correlation with severity of CAD was assessed. ResultsOf the total 576 patients enrolled, 438 were in Group A and 138 were in Group B. The mean age of presentation in Group A and Group B was (53.64±10.36 vs 49.4±9.73)years (p<0.0001). The Male and Female ratio overall was 2.42:1. Patients in Group A had significantly elevated RDW CV and RDW SD levels compared with those in Group B [(14.59±1.04)% vs (13.6±0.68)%, p<0.0001], [(45.78±4.76) vs (40.77±3.01), p<0.0001 respectively]. A significant positive correlation between RDW CV, RDW SD and MGS was noted (r=0.33, p<0.0001) (r=0.43, p<0.0001) respectively. On multivariate logistic regression analysis, RDW was demonstrated to be an independent predictor for angiographic CAD (OR=4.17, 95% CI 3.05–5.69, p<0.0001). On receiver operating characteristic curve (ROC) analysis, an RDW value of 14.3% was identified as an effective cut off point in diagnosing CAD with a sensitivity of 58.9% and specificity of 84.8%. ConclusionsRDW is an independent predictor of CAD and severity of coronary stenosis, suggesting that it can be a readily available marker for prediction and severity of CAD.

PS 05-42 THE USEFULNESS OF HEART RATE AND BLOOD PRESSURE RECOVERY IN DIAGNOSIS OF CORONARY ARTERY DISEASE IN HYPERTENSIVE WOMEN WITH SUSPECTED CORONARY ARTERY DISEASE

Objective: In women, the evaluation for cardiac autonomic dysfunction may improve the diagnostic accuracy of exercise treadmill test (ETT). But cardiac autonomic dysfunction is frequently impaired in hypertension and the diagnostic usefulness in hypertension has not been evaluated. We investigate whether the additional assessment of autonomic functional parameters to ischemic EKG changes on ETT would improve the diagnostic accuracy for coronary artery stenosis (CAS) in female hypertensive patient with suspected CAS. Design and Method: 144 female hypertensive patients (mean age 62.2 ± 9.3) from a KoROSE registry were analyzed. The definition of significant CAS was >50% luminal narrowing of at least one coronary artery by coronary angiography. All patients underwent a symptom-limited treadmill exercise test. Ischemic ST changes were defined as > 1 mm of horizontal or down-sloping depression 80ms after the J point in 2 contiguous leads. Autonomic dysfunction was assessed by heart rate recovery (HRR) and blood pressure response (BPR) after exercise. Delayed HRR was defined as < 18 /min decrease at 1minute after exercise termination. Delayed BPR was defined as systolic blood pressure > 178 mmHg at 2 minute after exercise. Diagnostic accuracy was calculated. Results: Significant CAS was detected in 51 patients (35.4%). Sensitivity, specificity, PPV and NPV of ischemic EKG for prediction of CAD were 44%, 74%, 48% and 71% respectively. But after adding delayed HRR and BP to ischemic ST change, sensitivity and NPV was increased to 73% and 78%, respectively. But specificity and PPV was significantly decreased to 46% and 54%, respectively. And overall diagnostic accuracies were not different between 2 examinations (63.1% and 60.8%). Conclusions: The addition of delayed HRR and BPR after exercise improved the sensitivity but worsened specificity of ETT to detect CAS in hypertension. This findings suggests that impaired cardiac autonomic function was related with decreased myocardial perfusion caused by myocardial fibrosis or diastolic dysfunction, rather than fixed epicardial coronary stenosis

Value of global longitudinal strain by two dimensional speckle tracking echocardiography in predicting coronary artery disease severity.

BackgroundSignificant coronary artery stenosis might cause persistently impaired longitudinal left ventricle (LV) function at rest. LV global longitudinal strain (LVGLS) can be accurately assessed by 2D speckle-tracking strain echocardiography(2D-STE).ObjectiveWe aimed to evaluate the diagnostic accuracy of LV global longitudinal strain obtained by 2D-STE in prediction of severity of CAD.MethodsEighty patients with suspected stable angina pectoris were included. They underwent transthoracic echocardiography (TTE) to measure LV ejection fraction, 2-D-STE to measure GLS and coronary angiography (CA). The patients were divided into two groups: group 1 (58 patients) with significant (>70%) CAD, and group 2 (22 patients) with non-significant (<70%) CAD. Images were obtained in the apical long-axis, four-chamber, and two chamber views. Regional longitudinal systolic strain was measured in 17 myocardial segments and averaged to provide global longitudinal strain (LVGLS).ResultsThere was significant decrease in GLS in group 1 compared to group 2 (−11.86 ± 2.89% versus −18.65 ± 0.79%, P < 0.000). The optimal cutoff value of GLS for prediction of significant CAD was −15.6% [AUC 0.88, 95% CI 0.78–0.96 p < 0.000]. The sensitivity, specificity and accuracy of GLS for detecting significant CAD were 93.1%, 81.8%,and 90% respectively.There was a significant positive correlation between GLS and EF (r = 0.33; p = 0.036).There was incremental significant decrease in GLS with increasing number of coronary vessels involved.ConclusionMeasurement of global longitudinal strain using 2D speckle tracking echocardiography is sensitive and accurate tool in the prediction of severe CAD.

0051: Longitudinal 2D strain can efficiently diagnose CAD and localize the culprit lesion in patients with suspected non-ST-elevation acute coronary syndrome and presumed normal systolic function

the clinical work-up of patients presenting with chest pain is a diagnostic challenge. Conventional echocardiography is not informative in half of the cases. We investigated the diagnostic performance of global (GLS) and territorial (TLS) longitudinal strain to predict CAD in patients presenting with suspected non-ST-segment elevation acute coronary syndrome (NSTEACS) but presumed normal global and regional systolic function. 58 patients with suspected NSTE-ACS but normal LVEF (≥55%) and WMSI (=1) were prospectively enrolled. Echocardiography (with speckle-tracking analyses) was performed on admission and all the patients underwent angiocoronarography. CAD was defined as the presence of stenosis of >50%. CAD was present in 33 patients (57%). LVEF was 60.7±4.6% in group 1 (CAD) and 61.1±5.0% in group 2 (no CAD). Global longitudinal strain (GLS) was altered in group 1 (–16.7±3.4%) as compared to group 2 (–22.4±2.9%, p<0.001). ROC curve analysis showed a high diagnostic value of GLS for the prediction of CAD (AUC=0.92 [0.84 – 1.00], p=0.0001) with a sensitivity of 81% and a specificity of 88% at the optimal cut-off of –19.7%, Diagnostic values of Troponin Ic (AUC=0.66) and ECG (AUC=0.63) were significantly lower. Territorial longitudinal strain (TLS) was able to discriminate between coronary stenosis in the LAD, LCX or RCA. longitudinal 2D strain has a good diagnostic value in patients presenting with NSTE-ACS but pnormal global and regional systolic function.

DIAGNOSTIC AND PROGNOSTIC SIGNIFICANCE OF TRANSIENT LEFT VENTRICULAR DILATATION (TID) FOR DETECTION OF EXTENSIVE AND SEVERE CORONARY ARTERY DISEASE IN MYOCARDIAL PERFUSION IMAGING: A META-ANALYSIS

BackgroundTransient ischemic diltation (TID) in CAD predicts both high risk coronary artery anatomy and adverse prognosis. Currently no formal definition exists for TID. Aims of this study were to summarize the diagnostic and prognostic value of TID in detection of CAD severity & prediction of future cardiac outcomes.MethodsWe searched MEDLINE, EMBASE and COCHRANE databases for published studies to June 2014. Two reviewers assessed eligibility based on predetermined criteria. For all studies TID ratio, sensitivity (SENS), and specificity (SPEC) for diagnosis of severe CAD (angiographic gold standard) were recorded. Quality assessment of diagnostic accuracy was performed with QUADAS 2.ResultsWe reviewed 525 papers, 30 were included; total = 11,056 patients. TID ratios were 1.13 - 1.19 for Tc-based studies, 1.14 - 1.19 for Tl studies, and 1.22 - 1.38 for dual isotope studies. SENS was 21 - 62.5%, and specificity was 77% - 95.8%. Figure demonstrates: SENS 54% (CI 40%-67%), SPEC 83% (95% CI 77%-88%). SPEC was highest for dual isotope and Tl studies and lowest for Tc-based studies. Analysis of Tc studies showed SENS = 50% (95% CI, 31-68 %) and SPEC = 82% (95% CI, 73%-80%). Assessment the prognostic value of TID showed that it had and independent & incremental prognostic value, annual cardiac event rate (5.3%-7.2%). Similarly TID in normal perfusion (with history of CAD and/or diabetes) annual cardiac event rate was (1.8%-4.9%).Conclusion BackgroundTransient ischemic diltation (TID) in CAD predicts both high risk coronary artery anatomy and adverse prognosis. Currently no formal definition exists for TID. Aims of this study were to summarize the diagnostic and prognostic value of TID in detection of CAD severity & prediction of future cardiac outcomes. Transient ischemic diltation (TID) in CAD predicts both high risk coronary artery anatomy and adverse prognosis. Currently no formal definition exists for TID. Aims of this study were to summarize the diagnostic and prognostic value of TID in detection of CAD severity & prediction of future cardiac outcomes. MethodsWe searched MEDLINE, EMBASE and COCHRANE databases for published studies to June 2014. Two reviewers assessed eligibility based on predetermined criteria. For all studies TID ratio, sensitivity (SENS), and specificity (SPEC) for diagnosis of severe CAD (angiographic gold standard) were recorded. Quality assessment of diagnostic accuracy was performed with QUADAS 2. We searched MEDLINE, EMBASE and COCHRANE databases for published studies to June 2014. Two reviewers assessed eligibility based on predetermined criteria. For all studies TID ratio, sensitivity (SENS), and specificity (SPEC) for diagnosis of severe CAD (angiographic gold standard) were recorded. Quality assessment of diagnostic accuracy was performed with QUADAS 2. ResultsWe reviewed 525 papers, 30 were included; total = 11,056 patients. TID ratios were 1.13 - 1.19 for Tc-based studies, 1.14 - 1.19 for Tl studies, and 1.22 - 1.38 for dual isotope studies. SENS was 21 - 62.5%, and specificity was 77% - 95.8%. Figure demonstrates: SENS 54% (CI 40%-67%), SPEC 83% (95% CI 77%-88%). SPEC was highest for dual isotope and Tl studies and lowest for Tc-based studies. Analysis of Tc studies showed SENS = 50% (95% CI, 31-68 %) and SPEC = 82% (95% CI, 73%-80%). Assessment the prognostic value of TID showed that it had and independent & incremental prognostic value, annual cardiac event rate (5.3%-7.2%). Similarly TID in normal perfusion (with history of CAD and/or diabetes) annual cardiac event rate was (1.8%-4.9%). We reviewed 525 papers, 30 were included; total = 11,056 patients. TID ratios were 1.13 - 1.19 for Tc-based studies, 1.14 - 1.19 for Tl studies, and 1.22 - 1.38 for dual isotope studies. SENS was 21 - 62.5%, and specificity was 77% - 95.8%. Figure demonstrates: SENS 54% (CI 40%-67%), SPEC 83% (95% CI 77%-88%). SPEC was highest for dual isotope and Tl studies and lowest for Tc-based studies. Analysis of Tc studies showed SENS = 50% (95% CI, 31-68 %) and SPEC = 82% (95% CI, 73%-80%). Assessment the prognostic value of TID showed that it had and independent & incremental prognostic value, annual cardiac event rate (5.3%-7.2%). Similarly TID in normal perfusion (with history of CAD and/or diabetes) annual cardiac event rate was (1.8%-4.9%). Conclusion

Diagnostic accuracy of left ventricular longitudinal function by speckle tracking echocardiography to predict significant coronary artery stenosis. A systematicreview.

BackgroundPatients evaluated for acute and chronic chest pain comprise a large, heterogeneous group that often provides diagnostic challenges. Although speckle tracking echocardiography (STE) has proved to have diagnostic value in acute coronary syndrome it is not commonly incorporated in everyday practice.The purpose of the present systematic review was to assess the diagnostic accuracy of left ventricular (LV) longitudinal function by STE to predict significant coronary artery stenosis (CAD+) or not (CAD-) verified by coronary angiography in patients with chest pain suspected to be of cardiac ischemic origin.Methods4 electronic databases; Embase, Medline, Cochrane and PubMed ahead-of print were searched for per 19.05.14. Only full-sized articles including > 40 patients were selected.ResultsA total of 166 citations were identified, 16 full-size articles were assessed of which 6 were found eligible for this review. Of 781 patients included 397 (60 %) had CAD+. The overall weighted mean global longitudinal strain (GLS) was −17.2 % (SD = 2.6) among CAD+ vs. -19.2 % (SD = 2.8) in CAD- patients. Mean area under curve in 4 studies for predicting CAD+ ranged from 0.68 to 0.80. The study cut-off levels for prediction of CAD+ in the ROC analysis varied between −17.4 % and −19.7 % with sensitivity from 51 % to 81 % and specificity between 58 % and 81 %. In 1 study GLS obtained during dobutamine stress echocardiography (DSE) had the best accuracy. Regional strain measurements were not uniform, but may have potential in detecting CAD.ConclusionsGLS measurements at rest only have modest diagnostic accuracy in predicting CAD+ among patients presenting with acute or chronic chest pain. The results from regional strain, layer specific strain and DSE need to be verified in larger studies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12880-015-0067-y) contains supplementary material, which is available to authorized users.

Metabolic syndrome and risk of major coronary events among the urban diabetic patients: North Indian Diabetes and Cardiovascular Disease Study—NIDCVD-2

ObjectiveThe present study aimed at estimating the prevalence of metabolic syndrome (MetS) and prospectively, evaluating cardiovascular events among Asian Indians type 2 diabetic subjects. MethodsThe sample comprised 1522 type 2 diabetic mellitus (T2DM) subjects aged 25–91years, who participated in the North Indian Diabetes and Cardiovascular Disease Study (NIDCVD). The participants were screened for hypertension, dyslipidemia, obesity and cardiovascular events. Anthropometric, clinical and biochemical measurements were done in all subjects. The prevalence of MetS was estimated in all the subjects according to the harmonized criteria of 2009. ResultsThe prevalence of MetS among urban Indian diabetic subjects was 71.9% and was significantly higher in females (86%) as compared to males (57.9%). To determine the independent predictors of the MetS in diabetic sample, binary logistic regression analyses were performed using demographic and biochemical parameters. Significant differences in the indices of generalized and abdominal obesity and lipids (total cholesterol, high density lipoprotein) were observed (p<0.01) in male:female and MetS and non-MetS comparisons. Regression analysis for prediction of CAD showed that family history, age, body mass index (BMI), SBP, physical inactivity and hypertension independently and significantly predicted the disease outcome. Binary logistic regression analysis revealed that MetS may be an independent risk/predictor of CAD (odd ratio (OR)=3.44, CI 1.31–9.01, p=0.012) along with higher age groups, BMI and hypertension in Indian population. ConclusionThe study demonstrated that the high prevalence of MetS and its different components were positively associated with a higher risk of CAD in north Indian diabetic subjects. Nevertheless, MetS is a major health problem in India, comprehensive population studies are warranted for estimation of incidence and prevalence, and education should be provided on its prevention and control to reduce the diabetes-related morbidity and mortality.

Relative diagnostic, prognostic and economic value of stress echocardiography versus exercise electrocardiography as initial investigation for the detection of coronary artery disease in patients with new onset suspected angina

ObjectivesWe hypothesised that stress echocardiography (SE), may be superior to exercise ECG (ExECG), for predicting CAD and outcome, and cost-beneficial, when performed as initial investigation in newly suspected angina. MethodsAll patients seen in 2011, with suspected angina, no history of CAD, pre-test likelihood of CAD of >10% and who underwent SE or ExECG as first line were identified retrospectively. Cost to diagnosis was calculated by adding the cost of all tests, up to and including coronary angiography (CA), on an intention-to-treat basis. Follow-up data on cardiac death and myocardial infarction (MI) were collected, 26months after the presentation of the last study patient. ResultsA total of 456 patients underwent ExECG (224 (49%) negative, 93 (20%) positive, 139 (31%) inconclusive) and 241 underwent SE (200 (83%) negative, 35 (15%) positive, 6 (2%) inconclusive) as first line. In patients subsequently undergoing CA, CAD was present in 46% (37/80) of patients with positive ExECG vs. 72% (23/32) patients with positive SE (p=0.01). Mean cost to diagnosis was £456 for the ExECG vs. £360 for the SE group (p=0.002). Over a mean follow-up period of 31±5months, cardiac events were 2% each in negative SE vs. negative ExECG (p=0.9). ConclusionsSE is superior to ExECG for prediction of CAD and is cost-beneficial when used as initial test in patients with no history of CAD presenting with suspected angina.

Clinical characteristics, myocardial perfusion deficits, and clinical outcomes of patients with non-specific chest pain hospitalized for suspected acute coronary syndrome: A 4-year prospective cohort study

BackgroundAlthough the prognostic role of stress SPECT MPI is generally well established, its value in predicting non-fatal cardiac events in patients with acute, non-specific chest pain (NSCP) remains unclear. The aims of this study are 1) to describe the baseline clinical characteristics and prevalence of myocardial perfusion (MP) deficits, by use of an adenosine stress SPECT MPI, in NSCP patients without known CAD discharged after hospitalization for suspected ACS; and 2) to prospectively describe the 4-year clinical outcome in terms of all-cause and cardiac mortality; hospitalization and coronary revascularization procedures; and cardio-vascular events in patients with and without MP deficits. Methods and resultsWe evaluated a series of 272 consecutive patients with acute NSCP and aged 18–75years. ICD10-based registries were used to determine the primary outcome (a composite measure of incident CAD death, ACS, or revascularization) and two secondary outcomes (1. all-cause death; 2. a composite measure of cardiovascular death, ACS, revascularization, or stroke). Forty two (15%) participants had a MP deficit. During follow-up (median 1361days), 7 participants had a primary event, 4 died, and 20 had a secondary composite event. Annual event rates were 0.70, 0.39 and 2.07, respectively. MP deficits predicted both subsequent primary and composite secondary events (HR: 7.54; 95% CI=[1.69; 33.69] and 2.93 (95% CI=[1.10; 7.81], respectively). Usual clinical cardiac risk classification could not meaningfully differentiate between patients with and without MP deficits. ConclusionSPECT MPI substantially improved prediction of incident CAD beyond usual clinical procedures and risk classification systems among NSCP patients.

Circulating vitamin D levels are associated with the presence and severity of coronary artery disease but not peripheral arterial disease in patients undergoing coronary angiography

Background and aimsTo investigate the association between vitamin D levels, angiographic severity of coronary artery disease, arterial stiffness and degree of peripheral arterial disease (PAD) as assessed by ankle brachial index (ABI). Methods and results375 patients undergoing coronary angiography from November 2012 to September 2013 were recruited. Serum 25-hydroxyvitamin D (25OHD) levels were measured as were ABI and pulse wave velocity (PWV). Based on the findings of the coronary angiogram, patients were divided into subgroups: Absent, Single, Double and Triple Vessel Disease (as defined by >50% stenosis in each major coronary artery) 0.275 patients not taking vitamin D supplements were included in the analysis. Mean age was 66.0 ± 11.2 (mean ± SD) years. Levels of 25(OH)D were significantly lower in patients with CAD when compared to patients without CAD (57.0 ± 1.73 versus 70.1 ± 2.46 nmol/L; p < 0.01). One way ANOVA revealed triple vessel disease patients had significantly lower 25(OH)D levels when compared to single vessel disease patients (50.6 ± 2.84 nmol/L versus 61.3 ± 3.16 p < 0.01) and trended to be lower when compared to double vessel disease patients (50.6 ± 2.84 versus 59.0 ± 2.99 nmol/L; p = 0.07). Stepwise regression revealed that age, gender (male), hypertension, hyperlipidemia and 25(OH)D were significant predictors of CAD (p < 0.05). Vitamin D was the most significant predictor for CAD (p < 0.001) There was no correlation between 25(OH)D levels, ABI and PWV. ConclusionAmong patients presenting for coronary angiography, low serum 25-hydroxyvitamin D levels are associated with the presence and extent of angiographic CAD but not arterial stiffness or PAD.

Impaired Renal Function is Associated with Severe Coronary Artery Disease in Chronic Stable Angina Patients

Background: Cardiovascular disease is the leading cause of morbidity and mortality in renal impaired patients. Many of the patients of chronic kidney disease die of cardiovascular disease before requiring dialysis. Cardiovascular disease in renal impaired patient is potentially preventable and treatable. The aim of this study was to evaluate the association between renal impairment and coronary artery disease severity in chronic stable angina patients. Methods: 110 patients with chronic stable angina who got admitted for coronary angiography were included in the study. They were divided into impaired renal function group (with estimated glomerular filtration rate [eGFR] &lt;90 ml/min/1.73m2) and normal renal function group (eGFR e” 90 ml/min/1.73m2) on the basis of eGFR. The severity of the CAD was assessed by angiographic Vessel score and Gensini score. Results: Mean Gensini score was significantly high in impaired renal function group (42.30±24.9 vs 25.65±17.9, p &lt;0.05). There was significant negative correlation between eGFR and vessel score (r=-0.30, p &lt;0.05) and between eGFR and Gensini score (r =-0.65, P &lt;0.05). In multivariate logistic regression analysis, after adjustment of factors eGFR remain independent predictors of severe CAD (P=0.002, OR -5.73). Conclusion: Impaired renal function, assessed by eGFR is associated with angiographic severe coronary artery disease in chronic stable angina patients and this association is independent of conventional cardiovascular risk factors. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20796 Cardiovasc. j. 2014; 7(1): 17-23

High risk Dukes score as predictor of multivessel CAD on coronary angiography

High risk Dukes score as predictor of multivessel CAD on coronary angiography

Risk Stratification of Hypertensive Patients Referred for Renal Transplant.

Cardiovascular disease is the leading cause of morbidity and mortality in patients with end-stage renal disease. The 2012 AHA/ACCF guidelines gave only Class 2b recommendations for screening asymptomatic patients for renal transplant listing. In 2007, we adopted an invasive-only approach for assessment of coronary artery disease (CAD, ≥70% stenosis in a major epicardial vessel) in non-diabetics >50 years old on dialysis (n=159) referred for renal transplant. Prevalence of CAD and risk factors were identified. METHODS: Patients underwent coronary angiography after dialysis initiation and prior to transplant. Noninvasive stress testing was not performed routinely. Binary logistic regression was used to identify predictors of CAD. The initial model was fit and respecified by removal of nonsignificant interaction items. RESULTS: Patients were 50.3% male and 64.2% African-American. Mean age was 57 years. Smoking was present in 47.8%, hypertension (HTN) in 98.7%, hyperlipidemia in 47.2%. CAD was found in 20.1% (10.7% 1 vessel, 5.0% 2 vessel, 4.4% 3 vessel). Significant (p<0.05) bivariate predictors of CAD were history of CAD (Odds Ratio (OR)=18.303), history of MI (OR=7.067), hyperlipidemia (OR=3.109) and history of revascularization by PCI or bypass (OR=37.289). With each additional risk factor, odds of a finding CAD increased by 2.017 times (p<0.001). Patients with LVH were less likely to have CAD (OR=0.389). Patients without history of MI, CHF, stroke or CAD were 3.95 times more likely to have no CAD (p<0.001). Among traditional risk factors for CAD (HTN, hyperlipidemia, smoking), only hyperlipidemia was a significant predictor of CAD. Patients with hyperlipidemia were 3.101 times more likely to demonstrate CAD (p=0.008). The predicted probability of CAD in non-diabetics without risk factors other than HTN was 9%. Probability of CAD with one risk factor was 23%; 2 risk factors 47%; 3 risk factors 73% and all 4 risk factors 89%. CONCLUSIONS: In the absence of risk factors, the likelihood of identifying CAD at cardiac cath was very small. Routine cath in hypertensive patients >50 years old being considered for renal transplant without other risk factors for CAD is not warranted. Noninvasive testing should be adequate for most patients with HTN referred for renal transplant, including those > 50 years old.

Coronary artery disease in patients with atypical chest pain with and without diabetes mellitus assessed with coronary CT angiography

IntroductionCoronary artery disease (CAD) in diabetes mellitus (DM) is often widespread when diagnosed. Non-invasive coronary calcium scoring and coronary CT angiography (CAC-score/CCTA) are accurate in the detection of CAD. This...

Weight loss with or without exercise: effect on classic and novel biomarkers of cardiovascular risk (884.24)

We previously reported that novel metabolomics‐derived biomarkers (dicarboxyl/hydroxyl acylcarnitines (DC/OH‐ACs) and amino acid‐related metabolites (AAs)) are independent predictors of CAD, CV events, and death and add predictive value to classic CV risk factors in cardiac catheterization patients. Here, we evaluated associations between traditional CV risk factors (FRS; Framingham Risk Score) and DC/OH‐ACs and AAs in sedentary, overweight adults (N=46) randomized to 6 months of: AHA weight maintenance diet (CONTROL), 25% calorie restriction (CR), 12.5% CR + 12.5% increase in exercise energy expenditure (CR+EX), or 15% weight loss via low calorie diet (890 kcals/d; LCD). At baseline, serum DC/OH‐ACs and AAs predicted 97% of FRS. At 6 months, weight loss was greater in LCD (‐11±1 kg) than CR or CR+EX (‐8±1 kg) and in all groups relative to CONTROL (‐1±1 kg). Only in CR+EX did FRS change significantly (‐10±4%) or differ from the change in FRS in CONTROL (+7±4%). Across all groups, changes in serum DC/OH‐ACs and AAs predicted 97% of FRS change. Thus, CR+EX appears to be more effective than CR or LCD in reducing CV risk. Further, DC/OH‐ACs and AAs may have strong predictive value in overweight adults.Grant Funding Source: Supported by U01 AG20478 (ER) and F32 HL112575 (CRM). and

A relationship-based and object-oriented software for monitoring management during geotechnical excavation

The efficient management of monitoring data is necessary for large geotechnical engineering projects. The development of an information management, prediction and warning software system for geotechnical monitoring is presented in this study. Seven categories of property objects that describe the hierarchical relationships among the monitoring objects, as well as two objects that represent and manage the construction progress, are proposed based on the requirements of geotechnical monitoring, data flow and the monitoring objectives of the site. The corresponding data structure and database were established using the object-oriented method in the Visual C++ environment. The software integrated various types of information and document management schemes, including data input and processing, CAD drawing visualisation, data modelling and prediction, as well as an early warning function. The applied case studies indicate that the software system is highly flexible and reliable and can be widely applied to monitor the sites of various geotechnical construction projects, such as tunnels, underground caverns, slopes and foundation pits.

Comparison between Carotid Artery Doppler Ultrasound and Coronary Calcium Score as Predictors of Significant Coronary Artery Disease in Patients Undergoing Computed Tomography Coronary Angiography

Background: The association between carotid artery Doppler ultrasound (US) or coronary Calcium Score (CCS) and the presence of significant CAD has been suggested but not largely documented. The purpose of this study was to compare carotid artery Doppler US and CCS as predictors of significant CAD. Methods: 56 patients (47 males, mean age 62 ± 8 years) with no history of CAD, who had undergone computed tomography coronary angiography (CTCA), Calcium Score evaluation and US, entered the study. Distribution of main socio-demographic and health related characteristics were described. On the basis of the CTCA results patients were classified as with no/non-significant CAD or with significant CAD. The presence of carotid plaques and the intima-media thickness (IMT) value were assessed with US stratifying patients into 3 groups: IMT ≤ 0.5 mm (free from disease); IMT 0.6-1mm (non-significant disease); IMT >1 mm (significant disease). Volume, Mass and Agatston Score were calculated using computed tomography (CT). Considering Agatston Score absolute values patients were classified into 5 groups: Agatston Score 75° percentile. Association between Calcium Score and IMT with CAD at CTCA were assessed. Results: Age, gender, hypertension, diabetes, high blood cholesterol, familiar history of CAD and smoke habit were similar in patients with and without significant CAD, whilst chest pain was significantly (p=0.001) associated with CAD. At univariate analysis, IMT (p=0.001) and Calcium Score (p<0.001) were associated with significant CAD. However, after adjusting for potential confounders, multivariate analysis indicated Calcium Score as the only significant and independent predictor of significant CAD. Conclusion: Calcium Score is a more powerful marker of significant CAD compared to atherosclerotic burden of the carotid artery.

GW24-e2460 Diagnostic value of combined parameters derived from ambulatory electrocardiography for detecting coronary artery disease in the chest pain patients

ObjectivesThe present study tried to investigate the diagnostic value of ambulatory ECG in screening CAD referred for CAG when several parameters were combined.MethodsOne hundred and four inpatients with chest pain...

Predictive and prognostic values of transient ischemic dilatation of left ventricular cavity for coronary artery disease and impact of various managements on clinical outcome using technetium-99m sestamibi gated myocardial perfusion imaging

Transient ischemic dilatation (TID) of LV cavity during stress gated myocardial perfusion imaging (GMPI) is known as a predictor of severe CAD and signifies worse prognosis. To assess predictive and prognostic value of TID of LV cavity using GMPI and clinical outcome in patients treated conservatively or with revascularization. 189 patients out of 2689 were recruited (M:F 127/62, mean age 56 ± 9 years) whose same-day stress GMPI revealed TID ratio (> 1.22) with no (sum stress score, SSS < 2) or reversible perfusion defects (sum difference score, SDS > 2). Coronary angiography (CA) was performed within 3 months in 125/189 cases who were followed for mean period of 18 ± 4 months for fatal or non-fatal MI. CA was positive in 121/125 patients with TID for significant CAD (LAD = 11, multi vessel disease = 110 patients, positive predictive value 95%) and negative for obstructive disease in 4/125 (false-positive cases). 41/121 underwent revascularization within 2 months of CA (Intervention group), and remaining 80/121 were managed conservatively (Non-Intervention group). Overall event rate was 20% (4/16%: fatal/non-fatal MIs). Kaplan-Meier survival curves revealed event-free survival in Intervention and Non-Intervention groups for fatal MI 98/96% (P = 0.758), and for non-fatal MI, it was 97/58%, respectively (P = 0.042). We conclude that TID is a reliable predictor of multi vessel CAD and is associated with high incidence of non-fatal MIs than fatal MIs. Revascularization (PCI/CABG) rather than medical treatment should be considered in patients with TID for better clinical outcome.