Presence Of Coronary Artery Stenosis Research Articles

Abstract 16552: Coronary Vasomotor Response to Intracoronary Ergonovine Provocation Test According to the Severity of an Insignificant Coronary Artery Fixed Stenosis

BACKGROUND: Coronary artery spasm (CAS) is a major cause of variant angina in patients with chest pain without significant coronary stenosis. However, whether there are differences in the incidence of CAS according to the severity of underlying coronary artery fixed stenosis is limited. Methods: A total of 608 patients without significant coronary artery disease (CAD) who underwent the ergonovine (ERG) provocation test between January 2018 and December 2021 were enrolled. Significant CAS was defined as having≥70% of temporary narrowing by ERG test. Patients were divided into three groups, based on the presence of coronary artery stenosis: None group (n=456), mild group (30-49%,n=114) and moderate group (50-69%,n=38). Results: In patients with chest pain without significant coronary artery stenosis, mild stenosis was 18.8%, and moderate stenosis was 6.3% in the population. The baseline characteristics of the patients were worse in the mild and moderate group than in the None group, including age, hypertension, diabetes, and smoking habit. In the ERG test, CAS occurred in 44.4% (270/608) of the overall population. The incidence of CAS of the mild (55.3%) and moderate (52.6%) groups were higher than the None group (41.0%). Also, in the case of CAS occurrence, focal CAS (Length<20mm) was more frequent in the mild (14.3%) and moderate (30%) groups than in the no group (8.6%). CONCLUSIONS: In patients with resting chest pain without severe coronary artery stenosis, CAS was observed in a high proportion of nearly half by ergonovine provocation test. Moreover, the mild to moderate coronary artery fixed stenosis showed higher incidence of CAS and focal CAS than patients without fixed stenosis.

Deep learning-based prediction for significant coronary artery stenosis on coronary computed tomography angiography in asymptomatic populations.

Although coronary computed tomography angiography (CCTA) is currently utilized as the frontline test to accurately diagnose coronary artery disease (CAD) in clinical practice, there are still debates regarding its use as a screening tool for the asymptomatic population. Using deep learning (DL), we sought to develop a prediction model for significant coronary artery stenosis on CCTA and identify the individuals who would benefit from undergoing CCTA among apparently healthy asymptomatic adults. We retrospectively reviewed 11,180 individuals who underwent CCTA as part of routine health check-ups between 2012 and 2019. The main outcome was the presence of coronary artery stenosis of ≥70% on CCTA. We developed a prediction model using machine learning (ML), including DL. Its performance was compared with pretest probabilities, including the pooled cohort equation (PCE), CAD consortium, and updated Diamond-Forrester (UDF) scores. In the cohort of 11,180 apparently healthy asymptomatic individuals (mean age 56.1 years; men 69.8%), 516 (4.6%) presented with significant coronary artery stenosis on CCTA. Among the ML methods employed, a neural network with multi-task learning (19 selected features), one of the DL methods, was selected due to its superior performance, with an area under the curve (AUC) of 0.782 and a high diagnostic accuracy of 71.6%. Our DL-based model demonstrated a better prediction than the PCE (AUC, 0.719), CAD consortium score (AUC, 0.696), and UDF score (AUC, 0.705). Age, sex, HbA1c, and HDL cholesterol were highly ranked features. Personal education and monthly income levels were also included as important features of the model. We successfully developed the neural network with multi-task learning for the detection of CCTA-derived stenosis of ≥70% in asymptomatic populations. Our findings suggest that this model may provide more precise indications for the use of CCTA as a screening tool to identify individuals at a higher risk, even in asymptomatic populations, in clinical practice.

Analysis of Characteristics of Coronary Artery Stenosis Based on the Comorbidities in Coronary Heart Disease Patients Undergoing Coronary Angiography

Background: Comorbid diseases are a risk factor for atherosclerosis in coronary heart disease (CHD). Atherosclerosis causes the narrowing of the coronary arteries so that the heart muscles lack blood supply. Diagnostic coronary angiography is an invasive medical examination performed to determine the presence of coronary artery stenosis and to show the location and the number of coronary artery stenosis. Objective: This study aimed to analyze the characteristics of coronary artery stenosis based on comorbidities of patients with CHD undergoing coronary angiography. Methods: This analytical study was conducted using a cross-sectional design of 105 patients with CHD undergoing coronary angiographyat the catheterization laboratory at Bahteramas Hospital, Southeast Sulawesi, from January 1 to December 31, 2021.Statistical testing used Chi-squaretests with 95% confidence interval and significance set as p<0.05. Results: Most of the respondents were over 45 years old as many as 87 (82.9%), and most are male as many as 72 (68.6%). The category of the highest number of stenosis was less than two stenosis, namely 70 patients (66.7%) with the most common location as the Left Anterior Descending. The comorbidities category included a history of dyslipidemia in 41 people (39.0%), history of diabetes mellitus (DM) in 28 people (26.7%), and history of hypertension in 75 people (71.4%).The bivariate analysis showed a history of DM was associated with coronary artery stenosis (p-value = 0.007) with an Odds Ratio of 3.111. Conclusions: Patients with DM have 3.111 times greater possibility of developing stenosis of the coronary arteries.WC:246

Altered blood gas tensions of oxygen and carbon dioxide confound coronary reactivity to apnea

PurposeArterial blood gases change frequently during anesthesia and intensive care. Apnea can occur during diagnostic exams and airway and surgical interventions. While the impact of blood gas levels on coronary blood flow is established, their confounding effect on coronary vasoreactivity in response to an apneic stimulus, especially in coronary artery disease, is not known.MethodsSix anesthetized control swine and eleven swine with coronary artery stenosis were examined. Nine different blood gas levels from a combination of arterial partial pressure of oxygen (70, 100, and 300 mmHg) and carbon dioxide (30, 40, and 50 mmHg) were targeted. Apnea was induced by halting controlled positive pressure ventilation for 3–30s, while the left descending coronary artery flow was measured and reported relative to apnea duration, and at the adjusted mean (12s).ResultsAt normoxemic-normocapnic blood gas levels, apnea increased coronary blood flow in proportion to the duration of apnea in the control (r = 0.533, p < 0.001) and stenosed groups (r = 0.566, p < 0.001). This culminated in a 42% (95% CI: 27–58) increase in controls (p < 0.001) and, to a lesser extent, 27% (15–40) in the presence of coronary artery stenosis (p < 0.001). Vasoreactivity was augmented by mild-hypoxemic levels [81% (65–97), and 66% (53–79) increase in flow respectively, p < 0.001 vs. normoxemia], but markedly reduced during hyperoxia (7.5% (−8.2–23) and 0.3% (−12–13), respectively, p < 0.001 vs. normoxemia).ConclusionAlterations of blood oxygen and carbon dioxide affect coronary vascular reactivity induced by apnea in swine, which was attenuated further in the presence of coronary stenosis. Especially hyperoxia significantly reduces coronary blood flow and blunts coronary vascular reactivity.

Clonal Hematopoiesis Is More Common in People Living with HIV and May be Associated with Increased Prevalence of Cardiovascular Disease

Background: Cardiovascular disease (CVD) is more common in people living with HIV (PLWH) and may be related to abnormal immune activation. With aging, the expansion of mutated hematopoietic clones or clonal hematopoiesis (CH) has been associated with CVD events in the general population and is hypothesized to be driven by systemic inflammation. We investigated whether CH was more common in PLWH compared to those without HIV, whether the distribution of CH mutations differed by HIV status, and whether CH was associated with subclinical coronary atherosclerosis in PLWH.Methods: Study participants were selected from men in the Baltimore -Washington DC center of the Multicenter AIDS Cohort Study (MACS) who had had coronary CT angiography (CTA) as part of the MACS Cardiovascular Study 2. The MACS is a prospective study of the natural history of HIV infection in men who have sex with men, and includes both PLWH and HIV-uninfected men. Since the prevalence of CH increases with age, the oldest participants were preferentially included in this study. To detect CH, DNA extracted from viably frozen peripheral blood mononuclear cells or cell pellets was subjected to targeted, error-corrected, ultra-deep next generation sequencing (NGS) which included 70 genes frequently mutated in hematologic malignancies. CTA results and inflammatory biomarker levels were already available from MACS data.Results: The current analysis was a cross-sectional study involving 118 participants: 86 (72.9%) PLWH and 32 (27.1%) HIV-uninfected men (HIV-). The groups were well-balanced in terms of known major risk factors for CH such as age and smoking. The median age was 53 and 54 years for PLWH and HIV- men, respectively (p=0.147). Caucasians represented 37 (43.0%) of PLWH and 21 (65.6%) of HIV- men. Out of 86 PLWH, 72 (83.7%) were on antiretroviral therapy (ART) at the time of the assessment; 41 (47.7%) on a PI-containing regimen and 31 (36.0%) on an NNRTI-containing regimen. The HIV viral load was under 400 copies/mL in 77 (89.5%) of PLWH, and the median (IQR) CD4+ count was 585 (397, 745)/mL. The prevalence of coronary artery stenosis of 50% or more was 12 (14.3%) in PLWH and 5 (16.1%) in HIV- men (p = 0.774).Since the minimum size of the biologically relevant CH is unknown, we applied variant allele frequency (VAF) cut-offs of > 0.5% and > 1%. For both cutoffs, CH was significantly more frequent in PLWH than in HIV- men (p=0.012 and p=0.036, respectively) (Figure 1A). Mutations in epigenetic modifiers (DNMT3A, TET2) were the most common mutations among both PLWH and HIV- men. Interestingly, DNMT3A mutations were more frequent in PLWH (Figure 1B). For both VAF cut-offs, PLWH had significantly more somatic mutations than HIV-uninfected men (p = 0.043 and 0.033, respectively) (Figure 1C).Since inflammation-mediated complications of CH become more apparent in people with larger clones, we focused on CH with VAF > 1% in order to determine the clinical consequences of CH in PLWH. As CH is known to be a risk factor for accelerated CVD in the general population, we asked whether CH was also associated with subclinical atherosclerosis in PLWH. Coronary artery stenosis > 50% (moderate/severe) was significantly more frequent in PLWH with CH compared to PLWH without CH (p = 0.032) (Figure 1 D). This difference remained significant in multivariable logistic regression models that adjusted for the Framingham coronary heart disease 10-year risk (p=0.017) and for the Framingham hard coronary heart disease 10-year risk (p<0.01).Additionally, we examined the association of serum concentrations of several inflammatory markers such as CRP, IL-1b, IL-6, as well as white blood cell count, with the presence of CH in PLWH, but we found no significant associations.Conclusions: CH was more common in PLWH compared to HIV-uninfected men, and PLWH had more somatic mutations. Moreover, the presence of CH was significantly associated with the presence of coronary artery stenosis > 50% (moderate/severe) in PLWH, even after adjusting for known CVD risk factors. The results from our exploratory analysis may provide a potential explanation for increased CVD in PLWH. Larger studies are warranted to further delineate the etiology of increased CH in PLWH and its impact on accelerated CVD. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Cervicocephalic Spotty Calcium for the Prediction of Coronary Atherosclerosis in Patients With Acute Ischemic Stroke.

Purpose: To investigate the characteristics of cervicocephalic spotty calcium (SC) and coronary atherosclerosis in patients with acute ischemic stroke (AIS) and to assess the predictive value of SC for coronary atherosclerosis using combined coronary and cervicocephalic CTA.Materials and Methods: Patients with AIS (n = 70) confirmed by brain MRI or CT and patients with asymptomatic carotid atherosclerosis (n = 58) confirmed by carotid ultrasonography were enrolled in our study. Subjects in both groups underwent combined coronary and cervicocephalic CTA. SC was used to evaluate cervicocephalic atherosclerosis. Coronary artery stenosis (CAS) ≥ 50% by segment and coronary artery calcium score (CACS) were used to evaluate coronary atherosclerosis. The SC frequency and the difference in coronary atherosclerosis between the two groups were compared, and the correlation between SC and coronary atherosclerosis was analyzed. Independent factors for CAS ≥ 50% were assessed via logistic regression analysis. Receiver operating characteristic curve analysis was performed to evaluate the added value of SC for predicting CAS ≥ 50%.Results: Both SC and the CACS were significantly higher in the Stroke group than in the Control group (total SC count: 6.83 ± 4.34 vs. 2.98 ± 2.87, P < 0.05; CACS: 477.04 ± 798.01 vs. 136.31 ± 205.65, P < 0.05). There were significant differences in the presence of CAS ≥ 50% (61.4 vs. 27.6%, P < 0.001). SC and coronary atherosclerosis were significantly correlated for both the CACS and CAS ≥ 50% (r = 0.746 and 0.715, respectively; P < 0.001). SC was an independent predictor for CAS ≥ 50%.Conclusion: SC correlates significantly with the CACS and could serve as an independent predictor of CAS ≥ 50% in patients with AIS, which suggests that combined cerebrovascular and cardiovascular assessments are of importance for such patients.

Predictors of rhythm disorders following cardiac surgery

Abstract Funding Acknowledgements Type of funding sources: None. Background. Identification of high-risk patients and predictors for cardiac arrhythmias allows the development of preventive measures that will improve the postoperative period and rehabilitation of patients following cardiac surgery. Purpose. To determine probable predictors of arrhythmias in patients following cardiac surgery in the early postoperative period (up to 7 days). Methods. 56 patients were examined, including 19 (33.9%) men (p = 0.02). The average age of the patients was 60.86 ± 8.87 years. Cardiac surgery was performed for coronary heart disease in 37 (66.1%) and valvular heart defects in 19 (33.9%) patients (p = 0.02). The average duration of the operations was 371.94 ± 102.04 minutes. In 25 (44.6%) cases, the operations were performed in conditions of bypass, the average duration of which did not differ from operations without bypass (389.44 vs. 355.47, p = 0.34). Assessment of arrhythmias was performed during the first 7 days after cardiac surgery. Results. 27 (48.2%) patients have developed arrhythmias within first 7 days, among them in 12 (63.2%) women and 15 (40.5%) men (p = 0.24). Predictors of arrhythmias in early postoperative period are: operation with bypass r = 0,332 [1,06-3,03], p = 0,01; the size of left atrium (LA)&amp;gt; 40 mm r =0,296 [1,01-3,31], p = 0,03; presence of coronary artery (CA) stenosis r = 0,139 [1,11-2,69], p = 0,04; atrial fibrillation (AF) in the history r = 0,607 [1,99-5,58], p = 0,001. AF dominates in the structure of arrhythmias – in 17 (30.4%) patients, among them – in 11 (64.7%) was paroxysmal, 6 (35.3%) patients - persistent form. The mean score of CHA2DS2VASc scale - 2.56 ± 0.89. The predictors of AF are: operation with bypass r = 0.451 [1.63-9.76], p= 0.0001; the size of the LA&amp;gt; 40 mm r = 0.303 [1.04-7.58], p = 0.02; left ventricle (LV) ejection fraction (EF) &amp;lt;40% r = -0.207 [1.23-1.82], p = 0.05; mitral regurgitation r = 0.314 [1.05-10.04], p = 0.02. Also registered ventricular ventricular prematute beats (VPB) – in 12 (21.4%) patients, among them VPB 1st Laun class - in 8 (66.7%), 2nd Laun class – in 2 (16.7%), 3rd Laun class – in 1 (8.3%), 4A Laun class – in 1 (8.3%) patient, respectively. Predictors of VPB are: chronic heart failure (CHF) 4 functional class (FC) r = 0.258 [2.94-8.48,], p = 0.05; CA stenosis r = 0,282 [1,04-40,54], p = 0,04; LV EF &amp;lt;50% r = -0.344 [1,3-9,42], p = 0,009, stroke in the anamnesis r = 0,262 [1,33-9,37], p = 0,05. Conclusions The prevalence of arrhythmias in the early postoperative period (up to 7 days) following cardiac surgery is 48.2%. The predictors of arrhythmias are: operation with bypass, the size of LA&amp;gt; 40 mm, presence of CA stenosis and any form of AF in the history. AF dominates in the structure of heart arrhythmias (30.4%). The predictors of AF are: operation with bypass, the size of the LA&amp;gt; 40 mm, LV EF &amp;lt;40%, mitral regurgitation according to echocardiography; predictors of VPB are: CHF 4 FC, CA stenosis, LV EF &amp;lt;50%, stroke in the history.

Computed tomography coronary angiogram in left main stem disease: how does it fare against invasive coronary angiography?

Abstract Funding Acknowledgements Type of funding sources: None. Background Computed Tomography Coronary Angiography (CTCA) is increasingly being used to detect and exclude the presence of coronary artery stenosis. Published studies to date comparing CTCA to invasive coronary angiography (ICA) have focused on epicardial vessels other than the left main stem (LMS) (1 - 4). Despite the diagnostic accuracy of CTCA specifically for LMS disease being unknown, it has been used in a recent multi-centre trial (5). Purpose To evaluate the diagnostic performance of CTCA compared with ICA for the detection and visual grading of native Left Main Stem lesions. Methods Retrospective study of patients who underwent CTCA and ICA within 12 months as part of a Quality Improvement project, with no prior coronary intervention. CTCA LMS lesions were graded by consensus of 3 independent blinded reviewers using the Coronary Artery Disease - Reporting and Data System (CAD-RADS) (none, minimal, mild, moderate and severe) and ICAs were similarly evaluated by consensus of 2 independent, blinded reviewers. Moderate and severe LMS lesions were considered clinically significant. Results A total of 53 subjects underwent both CTCA and ICA (70% male, mean age: 62). 66% of LMS lesions were found to be significant on ICA. Compared to ICA, CT angiography has a sensitivity of 83% and a specificity of 89% for detecting a significant LMS stenosis of 50% or more, with a positive predictive value of and a negative predictive value of 94% and 73% respectively. CTCA for detecting a significant LMS stenosis has a AUC of 0.88. In stenosis grading, CTCA correlated with ICA at the same CAD-RADS level in 53% of cases, with over-estimation in 19% and under-estimation in 28% of cases. Conclusion In this retrospective single centre study of patients with native coronary vessels, CTCA is shown to be accurate in identifying significant LMS lesions detected on ICA. However, at a level of stenosis grading, there is significant inter-modality discrepancy with CTCA associated with over- and under-estimation of LMS lesion severities compared with ICA. Diagnostic Performance of CTCA vs ICA Significant LMS lesion ICA positive ICA negative CTCA positive 29 2 CTCA negative 6 16 Diagnostic Performance of CTCA vs ICA in significant LMS lesions Abstract Figure. Significant LMS lesions:CTCA performance

Is two-dimensional echocardiography better than electrocardiography for predicting patient outcomes after cardiac arrest?

BackgroundCoronary artery stenosis increases hospital mortality and leads to poor neurological recovery in cardiac arrest (CA) patients. However, electrocardiography (ECG) cannot fully predict the presence of coronary artery stenosis in CA patients. Hence, we aimed to determine whether regional wall motion abnormality (RWMA), as observed by two-dimensional echocardiography (2DE), predicted patient survival outcomes with greater accuracy than did ST segment elevation (STE) on ECG in CA patients who underwent coronary angiography (CAG) after return of spontaneous circulation.MethodsThis was a retrospective observational study of adult patients with CA of presumed cardiac etiology who underwent CAG at a single tertiary care hospital. We investigated whether RWMA observed on 2DE predicted patient outcomes more accurately than did STE observed on ECG. The primary outcome was incidence of hospital mortality. The secondary outcomes were Glasgow-Pittsburgh Cerebral Performance Category scores measured 6 months after discharge and significant coronary artery stenosis on CAG.ResultsAmong the 145 patients, 36 (24.8%) experienced in-hospital death. In multivariable analysis of survival outcomes, only total arrest time (P=0.011) and STE (P=0.035) were significant. The odds ratio (OR) and 95% confidence interval (CI), which were obtained by adjusting the total arrest time for survival outcomes, were significant only for STE (OR, 0.40; 95% CI, 0.17–0.94). The presence of RWMA was not a significant factor.ConclusionsWhile STE predicted survival outcomes in adult CA patients, RWMA did not. The decision to perform CAG after CA should include ECG under existing guidelines. The use of RWMA has limited benefits in treatment of this population.

The predictive value of speckle tracking during dobutamine stress echocardiography in patients with chronic stable angina

ObjectiveEvaluation of the diagnostic value of speckle tracking echocardiography (STE) at rest and during dobutamine stress in predicting the presence and severity of coronary artery disease (CAD) in patients with chronic stable angina. MethodsA total of 100 patients with chronic stable angina were evaluated using STE at rest and during dobutamine stress to detect the presence, severity, and number of affected coronary arteries. Then, the correlation with the SYNTAX score (SS) was analyzed. ResultsSTE at stress showed better agreement with coronary angiography (CA) than dobutamine stress echocardiography (DSE) in detecting the presence of coronary artery stenosis (Kappa = 0.819, p < 0.001). STE at stress suggested involvement of the left anterior descending artery (LAD) with excellent agreement with CA (Kappa = 0.816, p < 0.001). For right coronary artery, STE at rest and stress showed good agreement with the CA results (Kappa = 0.775 and 0.858, respectively, p < 0.001), whereas for left circumflex artery, STE at rest and stress showed a fair agreement with the CA results (Kappa = 0.556 and 0.583, respectively, p < 0.001). Resting global longitudinal peak systolic strain (GLPSS) ≥ −15.2% had the best diagnostic accuracy (sensitivity = 61.8%; specificity = 93.5%) in predicting SS > 22. Stress GLPSS ≥ −12.5% had the best diagnostic accuracy (sensitivity = 82.4%; specificity = 78.3%) in predicting SS > 22. ConclusionSpeckle tracking during DSE has high sensitivity and specificity for predicting the presence of CAD. It provides quantitative diagnostic information that decreases the false positive and false negative results of DSE.

Prevalence of Asymptomatic Coronary Artery Stenosis Based on Coronary Computed Tomography Angiography in Adults with Erectile Dysfunction: A Cross-Sectional Study

Objectives: To investigate the prevalence of asymptomatic coronary artery stenosis (CAS) using coronary computed tomography angiography (CCTA) in Korean men with erectile dysfunction (ED). Subjects and Methods: A cross-sectional study was conducted on 108 men who underwent CCTA at a health promotion center in Pusan National University Yangsan Hospital. Each subject who was evaluated for ED using the International Index of Erectile Dysfunction (IIEF) questionnaire did not have a past history or symptoms of coronary artery disease (CAD). We assessed the association between ED and CCTA-based CAS. Results: The overall prevalence of ED was 57.4%; furthermore, age (p = 0.001) and fasting blood glucose (p =0.035) were the metabolic risk factors that were most significantly associated with the presence of ED. The overall frequency of CAS was 31.5%, and ED (p = 0.022), age (p < 0.001), fasting blood glucose (p = 0.021), and total cholesterol/high-density lipoprotein cholesterol (p = 0.029) were significantly associated with the presence of CAS. The prevalence of CAS was 40.3 and 19.6% in the ED and non-ED groups, respectively. Men with ED were 2.778 times more likely to present with CAS than those without ED (OR 2.778, 95% CI 1.143–6.749, p = 0.024); however multivariate logistic regression analysis, while controlling for age, total cholesterol/high-density lipoprotein cholesterol, and fasting blood glucose, suggested the absence of a significant association between ED and CCTA-based CAS. Conclusion: This study shows that CCTA-based CAS is a common phenomenon in men who have ED. Furthermore, ED patients without cardiac symptoms need to be investigated for the possibility of hidden CAD.

Associations between coronary artery stenosis detected by coronary computed tomography angiography and the characteristics of health checkup examinees in the Republic of Korea

IntroductionThis study was conducted on healthy adults without a diagnosis related to cardiovascular disease to investigate the associations between asymptomatic coronary artery stenosis and the characteristics of health checkup examinees. MethodsThis study was performed on 601 people (320 males and 281 females), who underwent coronary computed tomography angiography (CCTA), among health checkup examinees from January 2, 2015 to December 31, 2016. Those with any prior history of cardiovascular diseases, underwent coronary artery bypass grafting or coronary artery stenting in the past, those with atrial fibrillation, those suspected of contrast agent side effects, and those whose creatinine levels deviated from the normal range were excluded. ResultsThe mean age was 58.7 ± 8.0 years. Coronary artery stenosis was detected in 173 people (28.8%), and the mean coronary artery stenosis rate was 25.8 ± 12.8%. Regression analysis showed that coronary artery stenosis was influenced significantly by age, gender, glycated hemoglobin (HbA1c), past smoking duration, current smoking duration, and number of glasses of alcohol consumed (p < 0.05). In terms of the relationship between the presence of coronary artery stenosis and lifestyle habits, amount of alcohol consumed per day (p = 0.03), and patients with a longer period of past (p < 0.001) and current smoking duration (p = 0.01) had a significant effect on coronary artery stenosis. ConclusionThese results suggest that men aged 60 years or older, who have consumed large amounts of alcohol and cigarettes for a long time, require continuous management through tests such as a health checkup, because of the high probability of coronary artery stenosis, even in those without specific symptoms.

Intraoperative Assessment of Coronary Artery Stenosis by 2D Speckle-Tracking Echocardiography: The Correlation Between Peak Strain Rate During Early Diastole and the Severity of Coronary Artery Stenosis in Patients Undergoing Coronary Artery Bypass Grafting

The effects of inhalation anesthetics on cardiac function and the low correlation between transthoracic and transesophageal echocardiographic measurements may alter the ability of transesophageal echocardiography-derived strain rate during early diastole to detect coronary artery stenosis in anesthetized patients. The authors assessed the correlation between coronary artery stenosis and strain-based parameters during early diastole in heart failure patients with preserved ejection fraction undergoing coronary artery bypass grafting. Retrospective clinical study. Single university hospital. Thirty-two adult patients with preserved ejection fraction undergoing coronary artery bypass grafting between December 2016 and December 2018. None. Transesophageal echocardiography images and coronary artery angiographies of the participants were studied. The correlation between the severity of coronary artery stenosis and strain-based indices measured in the corresponding left ventricular segments were assessed. Receiver operating characteristic curve analysis of strain rate during early diastole was used to predict the presence of coronary artery stenosis ≥70%. Regarding the severity of coronary artery stenosis, it demonstrated a strong and inverse correlation with strain rate during early diastole (r = -0.71, p < 0.001), but showed no significant correlation with time to peak strain rate during early diastole (r = 0.19, p = 0.18). Strain rate during early diastole ≤1.5 s-1 had a sensitivity of 77% and a specificity of 87% for predicting coronary artery stenosis ≥70% (area under the curve, 0.88). Strain rate during early diastole significantly correlates with the severity of coronary artery stenosis in anesthetized patients suffering from heart failure with preserved ejection fraction.

The relationship between epicardial adipose tissue and coronary artery stenosis by sex and menopausal status in patients with suspected angina

BackgroundEvidence suggests that epicardial adipose tissue (EAT) is closely related to coronary artery stenosis (CAS). However, sexual dimorphism may be present in adipose tissue, and its influence on CAS between men and women is controversial. We assessed the relationship between EAT and CAS by sex and menopausal status in patients with suspected angina.MethodsSix hundred twenty-eight consecutive patients (men/women n = 257/371; mean age = 59.9 ± 10.2 years) who had chest pain for angina and underwent coronary angiography were included. CAS was defined as > 50% luminal narrowing of at least one epicardial coronary artery. EAT thickness was measured by transthoracic echocardiography.ResultsOf the 628 patients, 52.1% (n = 134) of men and 35.3% (n = 131) of women had CAS. The mean EAT thickness was not different between men and women and was larger in patients with CAS (8.04 ± 2.39 vs 6.58 ± 1.88 mm, P < 0.001). EAT thickness was independently associated with CAS in both sexes (P < 0.001). The odds ratio (OR) of EAT for the presence of CAS was higher in men (OR = 1.43, 95% confidence interval [CI] 1.21–1.69) than in women (OR = 1.24, 95% CI 1.10–1.40). EAT thickness was larger in postmenopausal women than in premenopausal women (7.59 ± 2.25 vs 5.80 ± 1.57 mm, P < 0.001) and was independently related with CAS (OR = 1.24, 95% CI 1.09–1.41). This was not the case in premenopausal women.ConclusionIn patients with suspected angina, an increase in EAT thickness was independently related to the presence of CAS in both men and women, with it being stronger in men. According to menopausal status in women, EAT thickness is significantly associated with CAS only in postmenopausal women.

A multi-scale model of the coronary circulation applied to investigate transmural myocardial flow.

Distribution of blood flow in myocardium is a key determinant of the localization and severity of myocardial ischemia under impaired coronary perfusion conditions. Previous studies have extensively demonstrated the transmural difference of ischemic vulnerability. However, it remains incompletely understood how transmural myocardial flow is regulated under in vivo conditions. In the present study, a computational model of the coronary circulation was developed to quantitatively evaluate the sensitivity of transmural flow distribution to various cardiovascular and hemodynamic factors. The model was further incorporated with the flow autoregulatory mechanism to simulate the regulation of myocardial flow in the presence of coronary artery stenosis. Numerical tests demonstrated that heart rate (HR), intramyocardial tissue pressure (Pim ), and coronary perfusion pressure (Pper ) were the major determinant factors for transmural flow distribution (evaluated by the subendocardial-to-subepicardial (endo/epi) flow ratio) and that the flow autoregulatory mechanism played an important compensatory role in preserving subendocardial perfusion against reduced Pper . Further analysis for HR variation-induced hemodynamic changes revealed that the rise in endo/epi flow ratio accompanying HR decrease was attributable not only to the prolongation of cardiac diastole relative to systole, but more predominantly to the fall in Pim . Moreover, it was found that Pim and Pper interfered with each other with respect to their influence on transmural flow distribution. These results demonstrate the interactive effects of various cardiovascular and hemodynamic factors on transmural myocardial flow, highlighting the importance of taking into account patient-specific conditions in the explanation of clinical observations.

Accuracy of cardiac magnetic resonance imaging to rule out significant coronary artery disease in patients with systolic heart failure of unknown aetiology: Single-centre experience and comprehensive meta-analysis

Coronary artery disease (CAD) is the leading cause of systolic heart failure (HF). Cardiac magnetic resonance imaging (CMR) is a non-invasive technique that detects a myocardial infarction scar as subendocardial or transmural late gadolinium enhancement (st-LGE). We sought to evaluate whether a lack of st-LGE could rule out CAD in new-onset systolic HF of unknown aetiology. We included 232 consecutive patients with new-onset HF and left ventricular ejection fraction ≤35% who underwent both coronary angiography and CMR to assess HF aetiology. CAD was defined as the presence of coronary artery stenosis≥50% on a coronary angiogram. We assessed sensitivity, specificity, and positive and negative likelihood ratios (PLR and NLR) of the presence of st-LGE to detect underlying CAD. A complementary meta-analysis of 11 studies (including ours) was also performed. In our study, 49 (21.1%) patients had CAD. The sensitivity and specificity of the presence of st-LGE to detect CAD were 69 and 92%, respectively. PLR and NLR were 8.47 and 0.33, respectively. In the meta-analysis, 1227 patients were included, and the prevalence of CAD ranged from 19.2 to 68.3%. Sensitivity, specificity, PLR and NLR were 87% (95% confidence interval [CI] 0.80-0.92), 93% (95% CI 0.89-0.96), 12.91 (95% CI 7.70-21.64) and 0.14 (95% CI 0.09-0.22), respectively. Altogether, 55 patients presented CAD with no st-LGE; inversely, 75 patients presented st-LGE with no CAD. With a CMR specificity of 93%, the absence of st-LGE rules out significant underlying CAD in patients with systolic HF of unknown aetiology in most cases.

The interaction between a HSP-70 gene variant with dietary calories in determining serum markers of inflammation and cardiovascular risk

The high prevalence of cardiovascular disease (CVD) globally is attributable to an interaction between environmental and genetic factors. Gene×diet interaction studies aim to explore how a modifiable factor interacts with genetic predispositions. Here we have explored the interaction of a heat shock protein (HSP70) gene polymorphism (+1267A>G) with dietary intake and their possible association with serum C-reactive protein (CRP), an inflammatory marker, that is a major component of CVD risk. HSP70 genotype was determined using a TaqMan real time PCR based method.Dietary intake was assessed using a dietary questionnaire. Serum high sensitivity (Hs) CRP and other cardiovascular risk factors were assessed by routine methods. This included coronary angioplasty to determine the presence of coronary artery stenosis. There were significant differences between serum lipid profile and Hs-CRP across the genotypes for Hsp70. The carriers of G allele had higher serum hs-CRP concentrations, compared with the AA homozygotes, with the wild genotype. Interaction analysis showed the association was modulated by total energy intake; the interaction of high energy intake with GG genotype: RERI=0.77, AP=0.26, S=1.6. We have found a significant association between the +1267A>G variant of the HSP70 gene with cardiovascular risk factors and serum hs-CRP concentrations. It is possible that a low energy diet could ameliorate the unfavorable effects of G allele of HSP70.

Coronary Computed Tomography Angiography in Patients with Stable Coronary Artery Disease

The guidelines on the management of stable coronary artery disease (SCAD) recommend the use of coronary computed tomography angiography (CTA) in the process of diagnosing coronary artery disease in patients with low intermediate pre-test probability for SCAD. Particularly in cases where stress electrocardiogram or stress imaging provides unclear results, a computed tomographic examination can be considered as a reliable alternative to invasive coronary angiography. Due to its high negative predictive value, coronary CTA can provide accurate information on the presence of coronary artery stenosis and thus coronary artery disease can be reliably excluded without the risks associated with invasive procedures. Similarly, patients with unstable angina or chest pain without typical alterations in the electrocardiogram and without an elevation of troponin can also benefit from a non-invasive coronary CTA-based diagnostics as first approach as it allows ruling out the presence of disease or planning an intervention without the risks associated with a potentially inappropriate invasive approach.

Head-to-head comparison of the diagnostic performance of coronary computed tomography angiography and dobutamine-stress echocardiography in the evaluation of acute chest pain with normal ECG findings and negative troponin tests: A prospective multicenter study

ObjectiveTo perform a head-to-head comparison of coronary CT angiography (CCTA) and dobutamine-stress echocardiography (DSE) in patients presenting recent chest pain when troponin and ECG are negative. MethodsTwo hundred seventeen patients with recent chest pain, normal ECG findings, and negative troponin were prospectively included in this multicenter study and were scheduled for CCTA and DSE. Invasive coronary angiography (ICA), was performed in patients when either DSE or CCTA was considered positive or when both were non-contributive or in case of recurrent chest pain during 6month follow-up. The presence of coronary artery stenosis was defined as a luminal obstruction >50% diameter in any coronary segment at ICA. ResultsICA was performed in 75 (34.6%) patients. Coronary artery stenosis was identified in 37 (17%) patients. For CCTA, the sensitivity was 96.9% (95% CI 83.4–99.9), specificity 48.3% (29.4–67.5), positive likelihood ratio 2.06 (95% CI 1.36–3.11), and negative likelihood ratio 0.07 (95% CI 0.01–0.52). The sensitivity of DSE was 51.6% (95% CI 33.1–69.9), specificity 46.7% (28.3–65.7), positive likelihood ratio 1.03 (95% CI 0.62–1.72), and negative likelihood ratio 1.10 (95% CI 0.63–1.93). The CCTA: DSE ratio of true-positive and false-positive rates was 1.70 (95% CI 1.65–1.75) and 1.00 (95% CI 0.91–1.09), respectively, when non-contributive CCTA and DSE were both considered positive. Only one missed acute coronary syndrome was observed at six months. ConclusionsCCTA has higher diagnostic performance than DSE in the evaluation of patients with recent chest pain, normal ECG findings, and negative troponine to exclude coronary artery disease.

Prognostic Value of Stress Dynamic Myocardial Perfusion CT in a Multicenter Population With Known or Suspected Coronary Artery Disease.

The purpose of this study was to determine the prognostic value of myocardial perfusion CT for major adverse cardiac events (MACE). Data from six centers in Asia, Europe, and North America on 144 patients with known or suspected coronary artery disease who had undergone coronary CT angiography (CCTA) and dynamic myocardial perfusion CT with a dual-source CT system were analyzed. CCTA studies were acquired at rest. Dynamic myocardial perfusion CT was performed under vasodilator stress. CCTA data were evaluated for the presence of coronary artery stenosis (≥ 50% luminal narrowing) on a per-vessel basis. Myocardial perfusion CT data were qualitatively evaluated for perfusion defects in each vessel territory. Patient follow-up was performed 6, 12, and 18 months after imaging. The prognostic value of CT findings was assessed with Kaplan-Meier statistics and the multivariate Cox proportional hazards regression model. According to the CCTA findings, 62 of 144 patients (43.1%) had at least one 50% or greater stenosis. According to the myocardial perfusion CT findings, 51 patients (35.4%) had one or more perfusion defects. Patients with at least one perfusion defect at myocardial perfusion CT were at increased risk of MACE (hazard ratio, 2.50; 95% CI, 1.34-4.65; p = 0.0040). This association remained significant after adjustment for age, sex, and clinical risk factors (hazard ratio, 2.41; 95% CI, 1.28-4.51; p = 0.0064) and after further adjustment for CCTA findings (hazard ratio, 2.03; 95% CI, 1.04-3.97; p = 0.0390). The number of territories with perfusion defects was strongly predictive of MACE with adjusted hazard ratios of 1.41, 3.44, and 4.76 for one, two, and three affected territories. In assessment for future MACE, myocardial perfusion CT has incremental predictive value over clinical risk factors and detection of coronary artery stenosis with CCTA.