Presence Of Coronary Stenosis Research Articles

The Belgian registry on coronary function testing (BELmicro registry): study population and prevalence of coronary vascular dysfunction

Abstract Background Coronary function tests (CFT) play a pivotal role in the diagnosis of coronary vascular dysfunction and in providing patients with tailored therapy. Aims To describe baseline characteristics and prevalence of coronary microvascular dysfunction (CMD) and coronary vasospasm in a real-world population of patients undergoing CFT. Methods The Belgian registry on coronary function testing (BELmicro registry) is a prospective, observational registry that includes 14 centers in Belgium. All patients undergoing clinically indicated CFT were included. Baseline characteristics, CFT data, and clinical outcomes were collected. Results Between October 2021 and September 2023, 449 patients were enrolled. The mean age was 65 ± 10 years, and 47.4% of patients were male. Fifty-nine percent of patients had hypertension, 18.7% diabetes, 69.5% hypercholesterolemia, and 40.1% smoking habit. On coronary angiography, the presence of coronary stenosis ≥ 50% was detected in 20.3% of patients. A microvascular physiology assessment was performed in 95.5% of patients, a vasoreactivity test in 28.5%, and both in 24.0%. CMD was diagnosed in 23.6% of patients. Definite epicardial vasospasm was diagnosed in 27.3% of patients, and microvascular spasm in 14.1%. The rates of severe complications were 0.7% for the microvascular physiology assessment and 0% for the vasoreactivity test. Conclusion Participants in the BELmicro registry represent a real-world population of patients, characterized by a high burden of cardiovascular risk factors. Both CMD and coronary vasospasm were frequent. CFT in daily clinical practice was feasible with a low rate of complications.Visual summaryScatter plot of measurements

Predictive value of coronary artery calcium score on radiological and autoptic findings in cases of sudden death

Calcium Artery Coronary Score (CACS) is a noninvasive examination of the coronary arteries in which the amount of calcium is calculated using cardiac Computed Tomography. The role of postmortem imaging in sudden death has been the subject of increasing interest in recent years, and previous studies have proposed a possible correlation between CACS and autopsy findings.The present study aims to establish a correlation between CACS, the presence of coronary artery opacification defects on Multi-Phase Post-Mortem Computed Tomography Angiography (MPMCTA), and the presence of coronary stenosis at autopsy, in order to verify whether CACS confirms its predictive value in terms of cardiac risk and can guide the decision to perform or not to perform MPMCTA.A cohort of 24 subjects who died suddenly was examined. Firstly, MPMCTA was performed, then autopsy was carried out. CACS was calculated, the detection of opacification defects on MPMCTA was investigated and the presence of coronary stenoses on autopsy was described.24 deceased individuals (53 years ± 11.7; 20 men) were evaluated. CACS has a positive predictive value of 0.78 and a negative predictive value of 0.73 in assessing the presence of radiological coronary artery opacification defects. The positive predictive value on stenosis relief is 0.88, while the negative predictive value on the same relief is 0.73.CACS is an appropriate additional tool in the evaluation of sudden death cases. Our results provided an encouraging contribution to the systematic application of CACS in cases of sudden death.

Coronary computed tomographic angiography-derived anatomic and hemodynamic plaque characteristics in prediction of cardiovascular events.

This study investigated the association of anatomic and hemodynamic plaque characteristics based on deep learning coronary computed tomography angiography (CCTA) with high-risk plaques that caused subsequent major adverse cardiovascular events (MACE). A retrospective analysis was conducted on patients who underwent CCTA between 1month and 3years prior to the occurrence of a MACE. Deep learning and computational fluid dynamics algorithms based on CCTA were applied to extract adverse plaque characteristics (low-attenuation plaque, positive remodeling, napkin-ring sign, and spotty calcification), and hemodynamic parameters (fractional flow reserve derived by coronary computed tomographic angiography [FFRCT], change in FFRCT across the lesion [△FFRCT], wall shear stress [WSS], and axial plaque stress [APS]). Correlation analysis, logistic regression, and Cox proportional risk analysis were conducted to understand the relationship between these measures and the occurrence of MACE and assess the value of hemodynamic parameters in predicting the incidence of MACE events and their prognosis. Our study included 86 patients with a total of 134 vessels exhibiting plaque formation and 83 culprit vessels with a subsequent coronary event. Culprit vessels had percent diameter stenosis [%DS] (0.54 ± 0.16 vs. 0.62 ± 0.13, P = 0.003), larger non-calcified plaque volume (45.8 vs. 101.7, P < 0.001), larger low-attenuation plaque volume (3.6 vs. 14.5, P < 0.001), more lesions with ≥ 3 adverse plaque characteristics (APC) (4 vs.26, P = 0.002), and worse hemodynamic features of adverse plaque. FFRCT demonstrated better visualization of maximum achievable flow in the presence of coronary stenosis and better correlation with the stenosis severity, while maximum of wall shear stress (WSSmax) was highly correlated with low-attenuation plaques and APC. The inclusion of hemodynamic parameters improved the efficacy of the predictive model, and a high WSS suggested a higher probability of MACE. Hemodynamic parameters based on CCTA are significantly correlated with plaque morphology. Importantly, integrating CCTA-derived parameters can refine the predictive performance of MACE occurrence.

Frequency of Coronary Anomalies and Association with Atherosclerotic Coronary Stenoses in the Coronary Angiography Candidates

Introduction: Due to the importance of atherosclerotic changes in the patients with coronary anomalies, it was aimed to evaluate the prevalence of atherosclerotic changes in patients with coronary anomalies who underwent coronary angiography at Tehran Heart Center within two years.&#x0D; Methods: In this cross-sectional study, all the patients who underwent coronary angiography and were diagnosed with coronary artery anomalies were included in this study (2018-2020). The frequency and frequency percentage of the detected anomalies, cardiovascular risk factors and also the presence of coronary stenosis among the patients were then determined and reported.&#x0D; Results: Among 79 patients with coronary artery anomaly evaluated in this study, 43 (54.4%) and 36 (45.6) were male and female, respectively. Of these, 39.2% were smokers and 10.1% had an addiction to opioids. The most frequent baseline disease in these patients was dyslipidemia, hypertension, and diabetes mellitus with 63%, 49%, and 46%, respectively. Moreover, hypertension was more frequent in women (p=0.005). A total of 81.6% of the patients (all of them had abnormal coronary arteries) had atherosclerotic stenosis in their coronary arteries. The highest frequency of coronary abnormality was left circumflex from right coronary sinus with 29.1%; the others included absent left main, coronary fistula, and right coronary artery from left coronary sinus, which were 12.7%.&#x0D; Conclusion: In the patients with coronary artery anomalies, atherosclerotic changes were frequent prevalence, which can be an important cause of sudden cardiac death in these patients.

Feasibility of the Anchor‐Free Deep Learning Method in Coronary Stenosis Automatic Detection

Background. Coronary artery disease (CAD) is a type of cardiovascular disease which is one of the leading causes of death around the world. The presence of coronary stenosis is considered a pivotal indicator in the diagnosis of various CADs. The main purpose of this paper was to investigate the feasibility of an anchor‐free deep learning (DL) method, fully convolutional one‐stage object detection (FCOS), in coronary artery stenosis automatic detection. Methods. First, 2786 invasive coronary angiography (ICA) images from 130 patients were randomly divided into training, validation, and testing datasets using the 10‐fold cross‐validation approach. Then, FCOS was compared with other three widely used anchor‐based DL models: single shot multibox detector (SSD), faster region‐based convolutional network (Faster R‐CNN), and you only look once (YOLOv3), in terms of precision, recall, F1 score, average precision (AP), and average recall (AR). Finally, the performances of different models in the detection of stenosis were compared in either single or multiple lesion scenarios using statistical tests. Results. FCOS achieved significantly superior precision (96.14% ± 0.53%), recall (94.36% ± 0.79%), F1 score (95.22% ± 0.56%), AP0.50 (93.36% ± 0.93%), AR0.50:0.95 (64.73% ± 1.46%), APsmall (55.04 ± 0.96%), APmedium (59.97 ± 1.13%), and APlarge (68.09 ± 5.18%) compared to Faster R‐CNN and YOLOv3. Moreover, FCOS demonstrated significantly higher AR0.50:0.95 and APsmall compared to SSD. Regardless of the presence of single or multiple coronary stenoses in ICA images, FCOS also outperformed Faster R‐CNN and YOLOv3. Furthermore, it showed significantly higher AR0.50:0.95 compared to SSD when in the multiple stenosis scenario. Conclusions. It is feasible to use the anchor‐free DL model FCOS in detecting coronary stenosis based on ICA images.

Relationship between Coronary Artery Calcium Score and Coronary Stenosis.

The coronary artery calcium score (CACS) is commonly employed to quantify the degree of calcification in coronary atherosclerosis. Indeed, increased coronary stenosis severity is associated with a progressive increase in CACS. This study sought to explore the association between CACS and coronary stenosis of ≥50% and ≥70%. We conducted a retrospective analysis of patient data collected between July 1, 2017, and March 3, 2022, at Jiangmen Central Hospital. A total of 208 patients, presenting with both symptomatic and asymptomatic manifestations and suspected coronary artery disease (CAD), were included. Statistical analyses included ROC curve assessments, subgroup analyses based on age, and comparisons of CACS values against the presence of coronary stenosis ≥50% and ≥70%. Ultimately, 208 patients were included, with a median age of 65.0 years and a median CACS of 115.7 (interquartile range: 13.7-369.4). A CACS threshold of ≥1300 demonstrated a specificity of 100% for coronary stenosis of ≥50%. Notably, the percentage of patients with obstructive CAD showing CACS = 0 was significantly higher in those under 65 years (15.1%) compared to patients over 65 years (3.8%) (P=0.005). The inflection point, at which the risk probability for coronary stenosis of ≥50% shifted from being a protective factor to a risk factor, was observed when CACS fell within the range of 63.3 to 66.0. CACS demonstrates good performance for the detection of coronary artery stenosis.

Coronary artery disease in a patient with Addison’s disease: a case report and literature review

BackgroundAddison’s disease which is due to dysfunction of the adrenal gland, with abnormal secretion of glucocorticoids and mineralocorticoids, is rare. By inducing inflammation and disorders of water and electrolyte metabolism, Addison’s disease may accelerate progression of co-existed cardiovascular diseases. Addison’s disease combined with cardiovascular disease is infrequent, only 10 cases in the literature.Case presentationWe reported a 51-year-old male patient with unstable angina pectoris and hypotension. Changes on coronary angiography within 2 years suggested rapid progression of coronary artery disease in a patient with low cardiovascular risk. An additional clue of skin hyperpigmentation, fatigue and further examination confirmed the diagnosis of Addison’s disease caused by adrenal tuberculosis. After hormone replacement treatment, the frequency and severity of the angina pectoris were alleviated significantly, as were hypotension, hyperpigmentation and fatigue.ConclusionsThe combination of Addison’s disease and coronary artery disease in one patient is rare. Addison’s disease can induce inflammation and disorders of water and electrolyte metabolism, which may further accelerate the course of coronary artery disease. Meanwhile, the hypotension in Addison’s disease may affect the coronary blood flow, which may result in an increased susceptibility to unstable angina in the presence of coronary stenosis. So, we should analyze comprehensively if the coronary artery disease progress rapidly.

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 &amp;lt; 0.001) and stenosed groups (r = 0.566, p &amp;lt; 0.001). This culminated in a 42% (95% CI: 27–58) increase in controls (p &amp;lt; 0.001) and, to a lesser extent, 27% (15–40) in the presence of coronary artery stenosis (p &amp;lt; 0.001). Vasoreactivity was augmented by mild-hypoxemic levels [81% (65–97), and 66% (53–79) increase in flow respectively, p &amp;lt; 0.001 vs. normoxemia], but markedly reduced during hyperoxia (7.5% (−8.2–23) and 0.3% (−12–13), respectively, p &amp;lt; 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.

Performance of Coronary Angiography in the Detection of Coronary Artery Disease in Patients with Systolic Left Ventricular Dysfunction and No Prior Ischemic Heart Disease.

The diagnosis of ischemic cardiomyopathy is not well established. Our objective is to determine predictive variables of coronary disease in unselected patients with ventricular dysfunction. This study is a retrospective cohort study of consecutive patients with left ventricular dysfunction and no known history of ischemic heart disease. We analyse the demographic variables, clinical data, electrocardiogram, and echocardiogram that are associated with the presence of coronary stenosis on coronary angiography. A total of 536 patients with left ventricular dysfunction were studied, with 135 (25.2%) of them having significant coronary lesions. In the multivariate logistic regression analysis, age ≤ 50 years, female gender, and the presence of atrial fibrillation on the electrocardiogram (ECG) were predictors of the absence of coronary lesions. Diabetes, hypercholesterolemia, the existence of Q waves in the ECG, and segmental alterations in contractility in the echocardiogram were predictors of coronary heart disease (C-Statistics 0.771, 95% CI 0.727 to 0.814). The information obtained from the clinical history, the ECG, and the echocardiogram of patients with ventricular dysfunction allows us to select subjects in whom coronary angiography has shown poor performance in diagnosing coronary disease.

Evaluation of coronary stenosis versus plaque burden for atherosclerotic cardiovascular disease risk assessment and management.

To provide a summary of recent literature on the relative impact of luminal stenosis versus atherosclerotic plaque burden in atherosclerotic cardiovascular disease (ASCVD) risk stratification and management. Recent results from both randomized controlled clinical trials as well as observational cohort studies have demonstrated that ASCVD risk is mediated mainly by the extent of atherosclerotic disease burden rather than by the presence of coronary stenosis or inducible ischemia. Although patients with obstructive CAD are generally at higher risk for ASCVD events than patients with nonobstructive CAD, this is driven by a higher plaque burden in those with obstructive CAD. Accordingly, the ASCVD risk for a given plaque burden is similar in patients with and without obstructive CAD. Accompanying these observations are randomized controlled trial data, which show that optimization of medical therapy instead of early revascularization is most important for improving prognosis in patients with stable obstructive CAD. Emerging evidence shows that atherosclerotic plaque burden, and not stenosis per se, is the main driver of ASCVD risk in patients with CAD. This information challenges the current paradigm of selecting patients for intensive secondary prevention measures based primarily on the presence of obstructive CAD.

Clinical Impact of High-Sensitivity Cardiac Troponin T on the Chronic Phase of Stable Angina after a Successful Initial Percutaneous Coronary Intervention.

The purpose of this study was to investigate the clinical significance of elevated plasma high-sensitivity troponin T (hs-TnT) in the chronic phase in patients with stable angina pectoris (SAP) who underwent a successful percutaneous coronary intervention (PCI). This study enrolled 158 consecutive SAP patients who underwent routine follow-up coronary angiography 9 months after a successful PCI with the implantation of a second-generation drug-eluting stent. Patients with previous coronary artery bypass graft and renal dysfunction were excluded. Patients were divided into two groups according to hs-TnT plasma level at follow-up: elevated hs-TnT (≥ 0.015 ng/ml) group and non-elevated hs-TnT group. Among the 158 subjects, 42 had an elevated hs-TnT level at follow-up. The elevated hs-TnT group had a significantly higher rate of any coronary lesion (in-stent restenosis and de novo lesions) in follow-up CAG (coronary angiography) than the non-elevated group (28.6% vs. 10.3%, p < 0.05). Multivariate analysis also showed that hs-TnT elevation was independently associated with the presence of significant coronary stenosis in the chronic phase (odds ratio: 3.99, 95% confidence interval: 1.38 to 11.53). The best cut-off value of the hs-TnT level at 9 months after a successful PCI to predict the presence of significant coronary stenosis was 0.016 ng/ml (sensitivity: 50.0%; specificity: 82.1%; area under the receiver operating characteristic curve: 0.67). hs-TnT elevation was independently associated with the presence of coronary stenosis in the chronic phase in SAP patients with successful PCI. Routine measurement of hs-TnT in the chronic phase may be useful to refine the risk of patients after PCI.

Epicardial adipose tissue volume and annexin A2/fetuin-A signalling are linked to coronary calcification in advanced coronary artery disease: Computed tomography and proteomic biomarkers from the EPICHEART study

Background & aimsThe role of epicardial adipose tissue (EAT) in the pathophysiology of late stage-coronary artery disease (CAD) has not been investigated. We explored the association of EAT volume and its proteome with advanced coronary atherosclerosis. MethodsThe EPICHEART Study prospectively enrolled 574 severe aortic stenosis patients referred to cardiac surgery. Before surgery, EAT volume was quantified by computed tomography (CT). During surgery, epicardial, mediastinal (MAT) and subcutaneous (SAT) adipose tissue samples were collected to explore fat phenotype by analyzing the proteomic profile using SWATH-mass spectrometry; pericardial fluid and peripheral venous blood were also collected. CAD presence was defined as coronary artery stenosis ≥50% in invasive angiography and by CT-derived Agatston coronary calcium score (CCS). ResultsEAT volume adjusted for body fat was associated with higher CCS, but not with the presence of coronary stenosis. In comparison with mediastinal and subcutaneous fat depots, EAT exhibited a pro-calcifying proteomic profile in patients with CAD characterized by upregulation of annexin-A2 and downregulation of fetuin-A; annexin-A2 protein levels in EAT samples were also positively correlated with CCS. We confirmed that the annexin-A2 gene was overexpressed in EAT samples of CAD patients and positively correlated with CCS. Fetuin-A gene was not detected in EAT samples, but systemic fetuin-A was higher in CAD than in non-CAD patients, suggesting that fetuin-A was locally downregulated. ConclusionsIn an elderly cohort of stable patients, CCS was associated with EAT volume and annexin-A2/fetuin-A signaling, suggesting that EAT might orchestrate pro-calcifying conditions in the late phases of CAD.

P2245Sex differences in the in-vivo markers of platelet activation among patients with ischemic heart disease: insights from the EVA study

Abstract Background/Introduction Ischemic heart diseases (IHD) are not synonymous with obstructive flow-limiting coronary artery disease (CAD), especially in women. Platelet dysfunction is suggested as a potential mechanism favouring ischemia in non-obstructive CAD. However, it is unknown whether sex differences in platelet function of patients with non-obstructive CAD exist. Purpose We assessed for sex differences in in-vivo markers of platelet activation among patients with the acute coronary syndrome and chronic stable angina, with or without obstructive CAD Methods From the “Endocrine Vascular disease Approach” (EVA) study, we selected IHD patients undergoing urgent or elective coronary angiography with complete baseline clinical characteristics and angiographic data. Non-obstructive CAD was defined as the presence of coronary stenosis &lt;50%. Thromboxane B2 (TxB2) and soluble P-selectin (sP-s) were measured at baseline. A sex-stratified analysis of platelet biomarkers was performed. Results Among two-hundred-seventy-seven patients (mean age 67±11, 37% women), non-obstructive CAD was documented in 25% of patients. Acute coronary syndrome (ACS) was the reason for angiography in 61% of cases. Women had more frequently ACS, as compared with men (54.8% vs 41.3%, p=0.001), with predominantly non-obstructive CAD. Median serum TxB2 (121.5 [92.7–174.0] vs 103.5 [83.0–140.2] pg/ml, p=0.005) and plasma sP-s (27.0 [18.7–35.0] vs 22.0 [16.0–30.0] ng/ml, p=0.006) levels were higher in patients with ACS as compared with the ones with stable chronic angina. The median concentration of TxB2 was significantly increased in women as compared with men, regardless of the clinical presentation and the coronary stenosis degree (all comparison, p&lt;0.001). However, women with non-obstructive CAD were the group with the highest serum levels of TxB2 (140.0 [111.0–152.0] pg/ml). Sex differences in the plasma sP-s level were also observed among patients with stable chronic angina (women, 26 [20.0–34.0] vs men, 21 [16.6–27.7] ng/ml, p=0.002) and with non-obstructive CAD (women, 26 [20.5–34.5] vs men, 18.5 [16.6–26.0] ng/ml, p=0.003). Conclusion(s) Women with IHD and non-obstructive CAD had increased level of TxB2 and sP-s as compared with men, independently by the clinical presentation. Further investigations are warranted to verify the role of platelet hyperactivation in the pathogenesis of myocardial ischemia with non-obstructive coronary artery disease among women. Acknowledgement/Funding Scientific Independence of Young Researchers Program (RBSI14HNVT) - Ministry of Education, University and Research (MIUR)

Relationship between Obesity and Coronary Artery Disease Defined by Coronary Computed Tomography Angiography

Abstract Background: Although associated with traditional cardiovascular risk factors, it is unclear whether obesity alone is associated with coronary artery disease (CAD). Objective: To investigate the role of obesity as a risk factor for CAD, defined by coronary computed tomography angiography (CCTA). Methods: This study retrospectively included 1,814 patients referred for CCTA in a hospital in Sao Paulo, from August 2010 to July 2012. CAD was identified by coronary calcium score and presence of coronary stenosis > 50%. Images were analyzed by two specialists, and the coronary findings were compared between obese and non-obese groups. A multivariate analysis model was used to assess obesity as an independent variable for the occurrence of obstructive CAD. Results: Among the study population, mean age was 58.5 +/- 11.5 years, 22.8% were obese (BMI = 30 kg/m2) and 66.3% were male. The prevalence of obstructive CAD was 18.4% in both groups. Obese patients had higher median calcium score compared to non-obese subjects (14.7 vs. 1.4, respectively, p = 0.019). In the multivariate analysis, obesity was not an independent factor for obstructive CAD (coefficient = -0.035, p = 0.102). Conclusion: Although no differences were observed in the prevalence of obstructive CAD between obese and non-obese individuals, coronary calcium scores were significantly in lower the latter group.

Longer diabetes duration reduces myocardial blood flow in remote myocardium assessed by dynamic myocardial CT perfusion

AimsTo investigate the relationship of type 2 diabetes duration and myocardial blood flow (MBF) assessed by myocardial CT perfusion. Materials and methodsWe prospectively included 140 patients with type 2 diabetes who underwent dynamic myocardial CT perfusion exam. MBF of the remote myocardium was calculated using the deconvolution technique and the Voronoi method. The relationships of MBF and diabetic duration, diabetic complications, conventional risk factors, coronary calcium, and coronary stenosis were assessed by logistic regression analysis. ResultsA weak but significantly negative relationship was present between diabetes duration and MBF (R2 = 0.05, p < 0.01). The average MBF of patients with a duration of >8 years was 13% lower than that of the remaining patients (1.11 ± 0.35 vs 1.28 ± 0.27 ml min−1 g−1, p < 0.01). Duration of one year was associated with a 6% increased risk for low MBF (<1.18 ml min−1 g−1) (odds ratio 1.06, 95% confidence interval 1.01–1.12, p < 0.05). Calcium score was also a significant factor for low MBF (odds ratio 1.08 (per 100 Agatston units), 95% confidence interval 1.01–1.17, p < 0.05). ConclusionLonger diabetes duration is associated with lower MBF independent of conventional cardiac risk factors or the presence of coronary stenosis.

PROBNP STRONGLY PREDICTS FUTURE VASCULAR EVENTS IN ANGIOGRAPHIED CORONARY PATIENTS WITH AS WELL AS IN THOSE WITHOUT THE METABOLIC SYNDROME

Introduction: Pro-B-type natriuretic peptide (proBNP) is a prognostic biomarker in various patient populations. Hypothesis: We aimed at testing the hypothesis that proBNP is a marker to predict cardiovascular events in metabolic syndrome (MetS) patients undergoing coronary angiography. Methods: We therefore measured serum proBNP in 752 patients who underwent coronary angiography for the evaluation of suspected or established coronary artery disease (CAD). Significant CAD was diagnosed in the presence of coronary stenoses with lumen narrowing ≥50%. Presence of the MetS was defined according to the current harmonized consensus definition. Prospectively, we recorded vascular events over 5.1±2.4 years. Results: ProBNP was significantly higher in patients with (n=591) than in subjects without significant CAD at baseline (715±1361 vs. 652±1842 pg/ml; p=0.003). Prospectively, we recorded 185 cardiovascular events. The incidence of vascular events significantly increased over tertiles of proBNP in patients with the MetS (15.8%, 24.2%, and 60.0% respectively; p=0.033) as well as in subjects without the MetS (13.3%, 22.2%, and 64.4%, respectively; p=0.004). Concordantly, serum proBNP significantly predicted the incidence of cardiovascular events after adjustment for age, gender, BMI, smoking, systolic and diastolic blood pressure, LDL cholesterol, HDL cholesterol and the eGFR both in patients with the MetS (standardized adjusted HR 1.34 [1.14-1.58]; p Conclusions: We conclude that serum proBNP predicts cardiovascular events independently of established cardiovascular risk factors and of the baseline CAD state both in patients with and in subjects without the MetS.

Coronary Artery Calcium Score Improves the Prediction of Occult Coronary Artery Stenosis in Ischemic Stroke Patients.

BackgroundCoronary heart disease is a significant cause of morbidity and mortality in stroke patients. The coronary artery calcium score (CACS) has emerged as a robust and noninvasive predictor of coronary events. We assessed the predictive ability of CACS to identify stroke patients with severe (≥50%) occult coronary artery stenosis in a stroke/transient ischemic attack population, in addition to the PRECORIS score, based on Framingham Risk Score and presence of cervicocephalic artery stenosis, which was derived and validated for that purpose.Methods and ResultsWe enrolled consecutive patients aged 45 to 75 years referred to our stroke unit with noncardioembolic ischemic stroke or transient ischemic attack, and no prior history of coronary disease. The presence of coronary stenosis was assessed with 64‐section computed tomography coronary angiography, and all patients had a detailed etiological work‐up. CACS was determined from computed tomography measurement using the Agatson score. The predictive value of CACS was assessed by logistic regression and reclassification method. Among 300 patients included in the study, 274 had computed tomography coronary angiography. Fifty patients (18%) had at least 1 coronary artery stenosis ≥50%. In multivariable analysis, after adjustment for the PRECORIS score, CACS was strongly associated with the presence of occult coronary artery stenosis (odds ratio=14.8 [1.8–120.3] for CACS [1–100] and 70.9 [8.9–562.0] for CACS >100). When CACS was added to the standard model, model fit was improved (P<0.001), Net Reclassification Improvement was 28.2% (P<0.001), and Integrated Discrimination Index was 18.2% (P<0.001).ConclusionsIn stroke/transient ischemic attack patients, CACS improves the prediction of occult coronary stenosis beyond classical risk factors.

Pre-test probability of obstructive coronary stenosis in patients undergoing coronary CT angiography: Comparative performance of the modified diamond-Forrester algorithm versus methods incorporating cardiovascular risk factors

BackgroundCurrent guidelines recommend the use of the Modified Diamond-Forrester (MDF) method to assess the pre-test likelihood of obstructive coronary artery disease (CAD). We aimed to compare the performance of the MDF method with two contemporary algorithms derived from multicenter trials that additionally incorporate cardiovascular risk factors: the calculator-based ‘CAD Consortium 2’ method, and the integer-based CONFIRM score. MethodsWe assessed 1069 consecutive patients without known CAD undergoing coronary CT angiography (CCTA) for stable chest pain. Obstructive CAD was defined as the presence of coronary stenosis ≥50% on 64-slice dual-source CT. The three methods were assessed for calibration, discrimination, net reclassification, and changes in proposed downstream testing based upon calculated pre-test likelihoods. ResultsThe observed prevalence of obstructive CAD was 13.8% (n=147). Overestimations of the likelihood of obstructive CAD were 140.1%, 9.8%, and 18.8%, respectively, for the MDF, CAD Consortium 2 and CONFIRM methods. The CAD Consortium 2 showed greater discriminative power than the MDF method, with a C-statistic of 0.73 vs. 0.70 (p<0.001), while the CONFIRM score did not (C-statistic 0.71, p=0.492).Reclassification of pre-test likelihood using the ‘CAD Consortium 2’ or CONFIRM scores resulted in a net reclassification improvement of 0.19 and 0.18, respectively, which would change the diagnostic strategy in approximately half of the patients. ConclusionsNewer risk factor-encompassing models allow for a more precise estimation of pre-test probabilities of obstructive CAD than the guideline-recommended MDF method. Adoption of these scores may improve disease prediction and change the diagnostic pathway in a significant proportion of patients.

Abstract 14063: Hand Grip Strength Significantly Predicts Cardiovascular Event Risk in Patients With Type 2 Diabetes

Introduction: Muscle fitness is an established indicator of overall health. The power of muscle strength to predict cardiovascular endpoints in patients with type 2 diabetes mellitus (T2DM) is unclear and is addressed in the present study. Methods: We studied a high-risk cohort of 209 patients with T2DM who underwent coronary angiography for the evaluation of stable coronary artery disease (CAD). Forearm muscle dynamometry was performed to determine hand grip strength in the dominant arm the day before angiography. Significant CAD was diagnosed in the presence of coronary stenoses with lumen narrowing ≥50%. T2DM was diagnosed according to the ADA criteria. Prospectively, we recorded vascular events over 5.5±2.2 years. Results: Grip strength, measured in kilograms, at baseline did not differ significantly between patients with significant CAD and those who did not have significant CAD (34±12 vs. 31±12 kg; p=0.140). Prospectively, hand grip strength significantly predicted the incidence of major cardiovascular events (n=65) after adjustment for age, gender, BMI, smoking, systolic and diastolic blood pressure, LDL cholesterol and HDL cholesterol (standardized adjusted HR 0.72 [0.52-0.99]; p=0.042). This result was not attenuated after further adjustment for the angiographically determined baseline CAD state (HR 0.72 [0.53-0.99]; p=0.046). Conclusions: We conclude that hand grip strength in patients with T2DM is inversely associated with vascular events independently both from well established cardiovascular risk factors and from the angiographically determined baseline CAD state.

TCTAP A-162 Relationships Between Epicardial Fat Volume, Agatston Score and Presence of Coronary Stenosis Measured on Computed Tomographic Coronary Angiography

TCTAP A-162 Relationships Between Epicardial Fat Volume, Agatston Score and Presence of Coronary Stenosis Measured on Computed Tomographic Coronary Angiography