Presence Of Severe Coronary Artery Disease Research Articles

Frank's sign associated with the severity of ischemic heart disease in patients under 65 years old

Background and objectiveFrank's sign is the diagonal ear fold which has been associated with ischemic heart disease. The objective of this work was to evaluate the relationship of Frank's sign with severity of ischemic heart disease in adults ≤ 65 years old in the northeast of Mexico. Patients and methodsA cross-sectional study was conducted in patients ≤ 65 years old who underwent coronary angiography consecutively over a period of 5 months in 2022. Severe coronary artery disease (CAD) was associated with Frank's sign and other common cardiovascular risks. To determine the association, bivariate and multivariate analysis was performed using logistic regression that included variables with a value of p<0.05. Statistical analysis was performed with SPSS version 22. ResultsWe included 311 patients ≤ 65 years, of whom 80% were men. The median age was 57 years (range 28–65). Frank's sign was positive in 62% of the population. The main clinical characteristics in patients with Frank's sign were type 2 diabetes mellitus (55%), p=0.003, dyslipidemia (53%), p=0.026 and smoking (68%), p=0.002.In the multivariate analysis, the independent variables associated with severe CAD were Frank's Sign OR 3.26; 95% CI (1.98–5.38), p≤0.001, male gender OR 2.28; 95% CI (1.20–4.35), p=0.012, and dyslipidemia OR 1.81; 95% CI (1.11–2.97), p=0.017. ConclusionsThere is an independent association between Frank's sign with the presence of severe CAD in patients ≤ 65 years old, which may be useful for screening and prevention.

Frank's sign associated with the severity of ischemic heart disease in patients under 65 years old

Background and objectiveFrank's sign is the diagonal ear fold which has been associated with ischemic heart disease. The objective of this work was to evaluate the relationship of Frank's sign with severity of ischemic heart disease in adults ≤ 65 years old in the northeast of Mexico. Patients and methodsA cross-sectional study was conducted in patients ≤ 65 years old who underwent coronary angiography consecutively over a period of 5 months in 2022. Severe coronary artery disease (CAD) was associated with Frank's sign and other common cardiovascular risks. To determine the association, bivariate and multivariate analysis was performed using logistic regression that included variables with a value of p<0.05. Statistical analysis was performed with SPSS version 22. ResultsWe included 311 patients ≤ 65 years, of whom 80% were men. The median age was 57 years (range 28–65). Frank's sign was positive in 62% of the population. The main clinical characteristics in patients with Frank's sign were type 2 diabetes mellitus (55%), p=0.003, dyslipidemia (53%), p=0.026 and smoking (68%), p=0.002.In the multivariate analysis, the independent variables associated with severe CAD were Frank's Sign OR 3.26; 95% CI (1.98–5.38), p≤0.001, male gender OR 2.28; 95% CI (1.20–4.35), p=0.012, and dyslipidemia OR 1.81; 95% CI (1.11–2.97), p=0.017. ConclusionsThere is an independent association between Frank's sign with the presence of severe CAD in patients ≤ 65 years old, which may be useful for screening and prevention.

Utilidad del pliegue diagonal del lóbulo de la oreja en enfermedad coronaria, un signo simple y eficaz

Different publications have pointed out the predictive value of the presence of the diagonal earlobe crease (DELC) for coronary artery disease (CAD) irrespective of gender, although its usefulness in patients over 60 years has been discussed. Despite the simplicity of its evaluation, it is not commonly used in clinical/forensic practice. METHODS: Systematic evaluation of the presence of DELC in forensic autopsies. RESULTS: 247 cases with 177 men (72%), mean age 64±16.3 years, violent death in 85 cases (34%), natural in 158 cases (64%) and undetermined in 4 cases (2%), 17% DM, 33% hypertension, 41% severe CAD, 51% sudden cardiovascular death (SCD-CV) and 26% sudden death due to ischemic heart disease (SCD-I). The presence of severe CAD was significantly associated with men, age ≥60 years, hypertension, increased heart weight and DELC; in multivariate analyses, only DELC and increased heart weight maintained their association with severe CAD. The same multivariate analyses were performed to predict SCD-CV and SCD-I. In the first case, only the male sex, increased heart weight and DELC, and in the second case only the male sex, hypertension and increased heart weight maintained statistical significance. Finally, we separately analyzed the age groups &lt;60 years (N=91) and ≥60 years (N=156), estimating the utility of the DELC with Sensitivity=39 and 56%, Specificity=88 and 75%, Positive predictive value= 53 and 70%, Negative predictive value=81 and 62% respectively. CONCLUSIONS: Checking for the presence of PDL is easy, fast and cheap. Its strong and consistent independent association with severe CAD and CV death should position this trait as an important finding in the physical examination of patients with suspected CAD. In our series, this association was repeated in the group &gt;60 years, although with less weight than in young people.

Abstract 10363: Mitochondrial DNA Copy Number is Associated with Severe Coronary Artery Disease and Risk of Subsequent Long-Term Major Adverse Cardiovascular Events

Introduction: Mitochondrial DNA copy number (mtDNA-CN) is associated with cardiovascular disease (CVD) and mortality. Here we examine, in a high-risk CVD population, the association with prevalent coronary artery disease (CAD) and subsequent major adverse events (MACE) at 1-,5- and 10-year follow-up of mtDNA-CN. Methods: Consecutive subjects (n=2267) consenting to a blood sample drawn for the Intermountain INSPIRE biorepository at the time of a coronary angiogram from July 1994 to Sept 2003 were included. The mtDNA-CN was determined by multiplexed real-time polymerase chain reaction coamplifying a stable site of mt D- Loop and a region of a single copy genomic β-2-microglobulin gene(β2M). MtDNA-CN is given as the ratio of Mt to β2M DNA. The presence of severe CAD (&gt;70% stenosis) was analyzed using multivariate logistic regression. The subsequent MACE (including all-cause mortality and non-fatal MI) outcomes were studied using multivariate Cox proportional hazard regression. Results: The average age of subjects was 62.3 ± 13.8, 35% were female, and 50% had prior CAD. Over half (55%) had severe CAD at the angiogram. As the mtDNA-CN increased, severe CAD decreased (58% for 1 st quartile vs. 51% for 4 th quartile). After adjustment for baseline differences, subjects with mtDNA-CN in the 1 st quartile were 1.31 times more likely to have severe CAD than subjects with mtDNA-CN in the 4 th quartile (95% CI: 1.01, 1.71; p=0.04). A total of 902(39.8%) had a subsequent MACE event within 10-years (193[8.5%] in 1-year and 548[24.2%] in 5-years). There was no association between mtDNA-CN and 1-year MACE. However, mtDNA-CN was associated with 5-year (p=0.006) and 10-year (p=0.003) MACE. After adjustment, subjects with mtDNA-CN in the 1 st quartile were at 1.29 increased risk of 10-year MACE than subjects with mtDNA-CN in the 4 th quartile (95% CI: 1.07, 1.56; p=0.008). Conclusions: In a coronary angiographic population, mtDNA-CN was associated with severe CAD and the risk of subsequent long-term MACE. These findings suggest that mtDNA-CN could be used as a clinical biomarker for risk. Moreover, understanding the factors impacting mtDNA-CN may also help in the prevention of secondary CVD outcomes.

Serum Biomarkers are Associated With Atherosclerotic Cardiovascular Disease Among Patients With Nonalcoholic Fatty Liver Disease Undergoing Elective Angiography

Cardiovascular disease is the most common cause of death among patients with nonalcoholic fatty liver disease (NAFLD). We assessed select cardiac biomarker associations for existing or future coronary artery disease (CAD) risk in patients with NAFLD. Patients with/without NAFLD undergoing elective cardiac angiography were prospectively enrolled. Severe CAD was defined as presence of at least 1 proximal artery >70% stenosis; risk of severe CAD as either existing severe CAD or atherosclerotic cardiovascular disease score ≥20; NAFLD was defined as hepatic fat in the absence of other liver diseases. Cardiac biomarkers (high-sensitivity C-reactive protein, N-terminal pro-brain natriuretic peptide, and high-sensitivity cardiac troponin I [hs-cTnI]) were measured using Atellica Solution assays (Siemens Healthineers). A total of 619 patients were enrolled (mean age, 63 ± 10 years; 80% male; 31% type 2 diabetes; 65% NAFLD); 42% had severe CAD, and 57% had risk of severe CAD. NAFLD prevalence was similar between patients with and without severe CAD (68% vs 62%; P > .05). Patients with NAFLD with severe CAD (44%) or with risk of severe CAD (58%) had higher levels of hs-cTnI than NAFLD controls (both P < .001). Presence of severe CAD or risk of severe CAD in all patients was associated with older age, male, aspects of metabolic syndrome, and elevated hs-cTnI: odds ratio 2.0 (95% confidence interval [CI],1.4-2.9) and 1.8 (95% CI, 1.1-3.0), respectively; 2.3 (95% CI, 1.4-3.8) and 2.2 (95% CI, 1.2-4.2), respectively, in patients with NAFLD (all P < .02). CAD is common in patients with NAFLD. High hs-cTnI was associated with an increased risk of CAD. Pending validation, hs-cTnI may be a useful marker for CAD risk prediction in patients with NAFLD.

The Relationship Between the Severity of Coronary Artery Disease and Erythrocyte Morphology Parameters Measured by New-Generation Hematology Analyzer.

There is a possible relation between red blood cell distribution width (RDW) and various clinical conditions. These conditions can render RDW disadvantageous in its relation with cardiovascular disease. There may be a relation between the severity of acute coronary syndrome (ACS) and the percentage of hypochromia (hypo%), percentage of hyperchromia (hyper%), percentage of macrocytosis (MAC%), and percentage of microcytosis (MIC%) values measured using new-generation hematological devices. We aimed to examine the relation between the SYNTAX score and the hypo%, hyper%, MAC%, and MIC% values in patients admitted with ACS. A group of 55 patients who underwent coronary angiography with diagnosis of ACS (STEMI and NSTEMI) and a control group of 48 patients with normal coronary arteries were included in the study. Venous blood samples were collected in the morning after a fasting of at least 8 h and analyzed using standard laboratory methods. Hemogram parameters were studied using Alinity HQ (Abbott, USA) a completely automated hemogram autoanalyzer. Biochemical parameters were studied using Architect c16000 (Abbott, USA) a completely automated biochemistry autoanalyzer. Significant difference was observed in erythrocyte morphology-related tests (mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, RDW, hypo%, hyper%, MIC%, and MAC%) between the groups. Correlation analysis showed a positive correlation between the SYNTAX score and MAC% (r = 0.315, p = 0.019). Multivariate logistic regression analysis was performed for MAC% to identify the independent predictors of the SYNTAX score (β = 0.315, p = 0.019). Changes in MAC% test can be measured in emergencies with new-generation hematological devices and used as independent predictors of the presence of severe coronary artery disease.

Epicardial adipose tissue volume as a marker of coronary artery disease severity in patients with diabetes independent of coronary artery calcium: Findings from the CTRAD study

AimsThe association between epicardial adipose tissue (EAT) volume and coronary artery disease (CAD) severity was evaluated, independent of traditional risk factors and coronary artery calcium (CAC) scores, in patients with diabetes type 2 (DM-2) using cardiac computed tomography angiography (CTA). MethodsA multivariate analysis was utilized to assess for an independent association after calculating EAT volume, CAD severity, and calcium scores in 92 patients with DM-II from the CTRAD study. We graded CAD severity as none (normal coronaries), mild-moderate (<70% stenosis), and severe (70% or greater stenosis). ResultsA total of 39 (42.3%) asymptomatic patients with diabetes did not have CAD; 30.4% had mild/moderate CAD; and 27.1% had severe CAD. Mean EAT volume was highest in patients with severe CAD (143.14cm3) as compared to mild/moderate CAD (112.7cm3), and no CAD (107.5cm3) (p=0.003). After adjustment of clinical risk factors, notably, CAC score, multivariate regression analysis showed EAT volume was an independent predictor of CAD severity in this sample (odds ratio 11.2, 95% confidence interval 1.7–73.8, p=0.01). ConclusionsIncreasing EAT volume in asymptomatic patients with DM-II is associated with presence of severe CAD, independent of BMI and CAC, as well as traditional risk factors.

The reliability of endothelial progenitor cells (CD34+, KDR+, and CD34+/KDR+) in the diagnosis of coronary artery disease and its severity

Background Bone marrow-derived endothelial progenitor cells (EPCs) play an integral role in the regulation and protection of the endothelium, as well as new vessel formation. Changes in EPC number and function during coronary heart disease allow their use as a biomarker. However, so far, there is no suggested definite level at which we can diagnose coronary artery disease (CAD) or determine the severity of the disease. Aim of the work To assess the sensitivity, specificity, and accuracy of the circulating EPCs count to diagnose coronary heart disease and to predict the severity of the disease. Patients and methods The percentage and count of circulating EPCs (CD34+KDR+, CD34+, and KDR+) were measured by flow cytometry in 52 patients who underwent diagnostic angiography. The correlation between the level of the EPCs on the one hand and the presence or absence of CAD and the Gensini score calculated for each patient on the other was determined. Results Thirty-eight patients were found to have CAD and 14 had normal coronaries. For those with CAD, 22 had single-vessel disease and 16 had multiple vessel disease. It was found that EPCs (CD34+KDR+% and count and CD34+%) were significantly lower in patients with CAD compared with those with normal coronaries. CD34+KDR+% had an AUROC of 0.846 to diagnose CAD, with a sensitivity of 45.5%, a specificity of 100%, a positive predictive value (PPV) of 100%, a negative predictive value (NPV) of 64.3%, and an accuracy of 72.75%. CD34+% and count and CD34+KDR+ count were negatively correlated with the Gensini score. CD34+% has an AUROC of 0.802 to diagnose the Gensini score of more than 6, with a sensitivity of 100%, a specificity of 55.2%, a PPV of 69%, an NPV of 100%, and an accuracy of 77.6%. Conclusion EPCs decrease in patients with CAD compared with those without CAD. CD34+KDR+% can diagnose CAD with a sensitivity, specificity, PPV, NPV, and accuracy of 45.55, 100, 100, 64.3, and 72.75%. CD34% can help to exclude the presence of severe CAD with a sensitivity, specificity, PPV, NPV, and accuracy of 100, 55.2, 69, 100, and 77.6%, respectively.

Adverse prognosis of patients with hypertrophic cardiomyopathy who have epicardial coronary artery disease.

Adult patients with hypertrophic cardiomyopathy (HCM) may develop concomitant atherosclerotic coronary artery disease (CAD). There is a paucity of data on the clinical outcomes of HCM patients who have CAD. We examined the outcome of 433 adult patients with HCM according to the presence and severity of CAD. All patients were aged > or =21 years, had a left ventricular ejection fraction of > or =50%, and were without a history of prior surgical revascularization (mean age, 63 years; 212 men). Compared with HCM patients with mild-to-moderate or no CAD, those with severe CAD demonstrated markedly reduced survival. Ten-year overall survival was 46.1%, 70.5%, and 77.1% for patients with severe, mild-to-moderate, and no CAD, respectively (unadjusted P=0.0001; adjusted P=0.0006). For the end point of cardiac death, this survival was 62.3%, 81.0%, and 80.9% (unadjusted P=0.009; adjusted P=0.004). For the end point of sudden cardiac death, this survival was 77.4%, 93.2%, and 90.3% (unadjusted P=0.01; adjusted P=0.01). The presence of severe CAD also was highly predictive of these events (risk ratio for respective event: 2.31, 2.15, and 2.77) in multivariate models that additionally identified age, prior stroke, hyperlipidemia, and atrial fibrillation as significant covariates. Among adult patients with HCM who undergo coronary angiography, those who have concomitant severe CAD are at increased risk of death. This risk far exceeds historical death rates of CAD patients with normal left ventricular function.