Presence Of Significant Coronary Artery Disease Research Articles

Relación entre las situaciones clínicas que llevan al tratamiento exclusivamente farmacológico del SCASEST y su pronóstico

Introduction and objectivesA large proportion of patients with non—ST-segment elevation acute coronary syndrome (NSTEACS) are initially selected for medical management (MM) and do not undergo coronary revascularization during or immediately after the index event. The aim of this study was to explore the clinical pathways leading to MM in NSTEACS patients and their influence on prognosis. MethodsPatient characteristics, pathways leading to MM, and 2-year outcomes were recorded in a prospective cohort of 5591 NSTEACS patients enrolled in 555 hospitals in 20 countries across Europe and Latin America. Cox models were used to assess the impact of hospital management on postdischarge mortality. ResultsMedical management was the selected strategy in 2306 (41.2%) patients, of whom 669 (29%) had significant coronary artery disease (CAD), 451 (19.6%) had nonsignificant disease, and 1186 (51.4%) did not undergo coronary angiography. Medically managed patients were older and had higher risk features than revascularized patients. Two-year mortality was higher in medically managed patients than in revascularized patients (11.0% vs 4.4%; P<.001), with higher mortality rates in patients who did not undergo angiography (14.6%) and in those with significant CAD (9.3%). Risk-adjusted mortality was highest for patients who did not undergo angiography (HR=1.81; 95%CI, 1.23-2.65), or were not revascularized in the presence of significant CAD (HR=1.90; 95%CI, 1.23-2.95) compared with revascularized patients. ConclusionsMedically managed NSTEACS patients represent a heterogeneous population with distinct risk profiles and outcomes. These differences should be considered when designing future studies in this population.Full English text available from:www.revespcardiol.org/en

Association Between Clinical Pathways Leading to Medical Management and Prognosis in Patients With NSTEACS

Introduction and objectivesA large proportion of patients with non—ST-segment elevation acute coronary syndrome (NSTEACS) are initially selected for medical management (MM) and do not undergo coronary revascularization during or immediately after the index event. The aim of this study was to explore the clinical pathways leading to MM in NSTEACS patients and their influence on prognosis. MethodsPatient characteristics, pathways leading to MM, and 2-year outcomes were recorded in a prospective cohort of 5591 NSTEACS patients enrolled in 555 hospitals in 20 countries across Europe and Latin America. Cox models were used to assess the impact of hospital management on postdischarge mortality. ResultsMedical management was the selected strategy in 2306 (41.2%) patients, of whom 669 (29%) had significant coronary artery disease (CAD), 451 (19.6%) had nonsignificant disease, and 1186 (51.4%) did not undergo coronary angiography. Medically managed patients were older and had higher risk features than revascularized patients. Two-year mortality was higher in medically managed patients than in revascularized patients (11.0% vs 4.4%; P < .001), with higher mortality rates in patients who did not undergo angiography (14.6%) and in those with significant CAD (9.3%). Risk-adjusted mortality was highest for patients who did not undergo angiography (HR = 1.81; 95%CI, 1.23-2.65), or were not revascularized in the presence of significant CAD (HR = 1.90; 95%CI, 1.23-2.95) compared with revascularized patients. ConclusionsMedically managed NSTEACS patients represent a heterogeneous population with distinct risk profiles and outcomes. These differences should be considered when designing future studies in this population.

Abdominal aortic calcification on a plain X-ray and the relation with significant coronary artery disease in asymptomatic chronic dialysis patients

BackgroundCoronary artery disease (CAD) is common in asymptomatic chronic dialysis patients and plays an important role in their poor survival. Early identification of these high-risk patients could improve treatment and reduce mortality. Abdominal aortic calcification (AAC) has previously been associated with CAD in autopsy studies. Since the AAC can be quantified easily using a lateral lumbar X-ray we hypothesized that the extent of AAC as assessed on a lateral lumbar X-ray might be predictive of the presence of significant CAD in dialysis patients.MethodsAll patients currently enrolled in the ICD2 trial without a history of CABG or a PCI with stent implantation were included in this study. All patients underwent CT-angiography (CTA) and a lateral X-ray of the abdomen. AAC on X-ray was quantified using a previously validated scoring system whereupon the association between AAC and the presence of significant CAD was assessed.ResultsA total of 90 patients were included in this study (71% male, 67 ± 7 years old). Forty-six patients were found to have significant CAD. AAC-score was significantly higher in patients with CAD (10.1 ± 4.9 vs 6.3 ± 4.6 (p < 0.05). Multivariate regression analysis revealed that AAC score is an independent predictor for the presence of CAD with a 1,2 fold higher risk per point increase (p < 0.01). The AAC score has a sensitivity of 85% and a specificity of 57% for the presence of significant CAD.ConclusionThis study shows that abdominal aortic calcification as assessed on a lateral lumbar X-ray is predictive for the presence of significant coronary artery disease in asymptomatic dialysis patients. This simple, non-invasive and cheap screening method could contribute to early identification of patients eligible for further screening of CAD.Trial registrationNTR948, registered 10-4-2007 ; ISRCTN20479861, registered 2-5-2007

Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity

IntroductionFragmented QRS complexes (fQRS) are a sign of myocardial scar and are associated with adverse outcomes and mortality in patients with coronary artery disease (CAD). However, little is known about the significance of fQRS or of their localization on electrocardiography (ECG) in patients without known CAD. We aimed to investigate the association between localization of fQRS on ECG and CAD severity in patients undergoing a first diagnostic coronary angiography. MethodsWe enrolled 135 consecutive patients who had a narrow fQRS on ECG and underwent a first diagnostic coronary angiography. Patients were divided into two groups based on localization of fQRS on ECG (group 1: fQRS in the inferior leads, group 2: fQRS in the anterior leads). The groups were compared regarding the presence of significant CAD, multivessel disease (MVD) and SYNTAX score (SXscore). ResultsEighty-six (63.7%) patients had fQRS in the inferior leads and 49 (36.3%) had fQRS in the anterior leads. There was no statistically significant difference between the groups regarding presence of significant CAD (47.7% vs. 51%, p=0.708). However, the incidence of MVD was significantly higher in group 2 compared to group 1 (10.5% vs. 28.6%, p=0.007). The median SXscore (6 [3,12] vs. 8 [4,24], p=0.047), and incidence of patients with SXscore >22 were significantly higher in group 2 compared to group 1 (3.5% vs. 20.4%, p=0.009). ConclusionThe presence of fQRS in the anterior leads may indicate more severe CAD compared to fQRS in the inferior leads in patients undergoing a first diagnostic coronary angiography.

Comparison of the presence of fragmented QRS complexes in the inferior versus the anterior leads for predicting coronary artery disease severity

IntroductionFragmented QRS complexes (fQRS) are a sign of myocardial scar and are associated with adverse outcomes and mortality in patients with coronary artery disease (CAD). However, little is known about the significance of fQRS or of their localization on electrocardiography (ECG) in patients without known CAD. We aimed to investigate the association between localization of fQRS on ECG and CAD severity in patients undergoing a first diagnostic coronary angiography. MethodsWe enrolled 135 consecutive patients who had a narrow fQRS on ECG and underwent a first diagnostic coronary angiography. Patients were divided into two groups based on localization of fQRS on ECG (group 1: fQRS in the inferior leads, group 2: fQRS in the anterior leads). The groups were compared regarding the presence of significant CAD, multivessel disease (MVD) and SYNTAX score (SXscore). ResultsEighty-six (63.7%) patients had fQRS in the inferior leads and 49 (36.3%) had fQRS in the anterior leads. There was no statistically significant difference between the groups regarding presence of significant CAD (47.7% vs. 51%, p=0.708). However, the incidence of MVD was significantly higher in group 2 compared to group 1 (10.5% vs. 28.6%, p=0.007). The median SXscore (6 [3,12] vs. 8 [4,24], p=0.047), and incidence of patients with SXscore >22 were significantly higher in group 2 compared to group 1 (3.5% vs. 20.4%, p=0.009). ConclusionThe presence of fQRS in the anterior leads may indicate more severe CAD compared to fQRS in the inferior leads in patients undergoing a first diagnostic coronary angiography.

Inter-ethnic marriages and severity of coronary artery disease: A multicenter study of Arabian Gulf States.

AIMTo assess the association of inter-ethnic vs intra-ethnic marriage with severity of coronary artery disease (CAD) in men undergoing angiography.METHODSWe conducted a prospective multicenter, multi-ethnic, cross sectional observational study at five hospitals in Saudi Arabia and the United Arab Emirates, in which we used logistic regression analysis with and without adjustment for baseline differences.RESULTSData were collected for 1068 enrolled patients undergoing coronary angiography for clinical indications during the period of April 1st, 2013 to March 30th, 2014. Ethnicities of spouses were available only for male patients. Of those enrolled, 687 were married men and constituted the cohort for the present analysis. Intra-ethnic marriages were reported in 70% and inter-ethnic marriages in 30%. After adjusting for baseline differences, inter-ethnic marriage was associated with lower odds of having significant CAD [adjusted odds ratio 0.52 (95%CI: 0.33, 0.81)] or multi-vessel disease (MVD) [adjusted odds ratio 0.57 (95%CI: 0.37, 0.86)]. The adjusted association with left main disease showed a similar trend, but was not statistically significant [adjusted odds ratio 0.74 (95%CI: 0.41, 1.32)]. The association between inter-ethnic marriage and the presence of significant CAD and MVD was not modified by number of concurrent wives (P interaction > 0.05 for both).CONCLUSIONAmong married men undergoing coronary angiography, inter-ethnic, as compared to intra-ethnic, marriage is associated with lower odds of significant CAD and MVD.

Polygamy and Risk of Coronary Artery Disease in Men Undergoing Angiography: An Observational Study.

Epidemiologic evidence suggests a link between psychosocial risk factors such as marital status and coronary artery disease (CAD). Polygamy (multiple concurrent wives) is a distinct marital status practiced in many countries in Asia and the Middle East, but its association with CAD is not well defined. We conducted a multicenter, observational study of consecutive patients undergoing coronary angiography during the period from April 1, 2013, to March 30, 2014. Of 1,068 enrolled patients, 687 were married men. Polygamy was reported in 32% of married men (1 wife: 68%, 2 wives: 19%, 3 wives: 10%, and 4 wives: 3%). When stratified by number of wives, significant baseline differences were observed in age, type of community (rural versus urban), prior coronary artery bypass grafting (CABG), and household income. After adjusting for baseline differences, there was a significant association between polygamy and CAD (adjusted OR 4.6 [95% CI 2.5, 8.3]), multivessel disease (MVD) (adjusted OR 2.6 [95% CI 1.8, 3.7]), and left main disease (LMD) (adjusted OR 3.5 [95% CI 2.1, 5.9]). Findings were consistent when the number of wives was analyzed as a continuous variable. In conclusion, among married men undergoing coronary angiography for clinical indications, polygamy is associated with the presence of significant CAD, MVD, and LMD.

Longitudinal Strain at Rest does not Predict Stress Echo Results

Background: Stress echo shows ischemia as a transient regional motility disorder. The subjective visual analysis which is dependenton the operator’s experience has prompted the search for a semiautomatic method to mitigate this limitation and improve thereliability and reproducibility of the test. This has generated a growing interest in the introduction of two-dimensional longitudinalstrain before, during and after stress echo. If useful, its assessment during the different stress stages would attenuate other limitations,such as the inability to achieve submaximal heart rate, difficult visualization of more subtle disorders and delay in imageacquisition, which increases false negative results.Objectives: The aim of this study was to assess whether longitudinal strain analysis at rest is able to predict the outcome of stressecho when there is no visual evidence of contractile disorders, and whether baseline longitudinal strain is different in patients withsignificant coronary artery disease compared with patients not presenting this disease (in their previous evaluation before the test).Methods: The study compared longitudinal strain results at rest in 62 patients with positive stress echo consecutively recruitedduring a 12-month period, half of whom underwent coronary angiography(Group A) and the other half did not undertake this study(Group B) versus a control group (Group C) with negative test and without coronary angiography.Results: Longitudinal strain showed no significant difference between groups A and B (-21.8%±2.4% vs. -21.5% ±2.5%) and neitherbetween patients with positive test (Group A+B) versus Group C (-21.67 % ±2.4% vs. -21.9 %±2.8%).Conclusions: Two-dimensional longitudinal strain did not predict stress echo results or the presence of significant coronary arterydisease in the group of patients undergoing invasive coronary angiography.

Does the Post-Systolic Shortening of the Left Ventricle by Tissue Doppler Imaging Predict Coronary Artery Disease?

Background: Abnormalities in the velocity and pattern of myocardial shortening on tissue Doppler imaging (TDI) have been pro- posed to aid in the noninvasive diagnosis of coronary artery disease (CAD). Objectives: We investigated the diagnostic value of post-systolic shortening (PSS), a delayed ejection velocity of the myocardium after the closure of the aortic valve, on TDI in the diagnosis of CAD among patients with chest pain and normal resting wall motion on standard 2D echocardiography. Methods: Eighty consecutive patients (49% female) with typical ischemic chest pain but without prior myocardial infarction, coro- nary revascularization, arrhythmia, or heart failure, who had no regional wall motion abnormalities on resting echocardiography and who were scheduled to undergo coronary angiography, were selected. TDI was performed in each patient before coronary an- giography at 2 levels (basal and mid left ventricle (LV)) in each of the 4 LV walls (i.e., septal, anterior, inferior, and lateral). Coronary angiography was performed and interpreted per standard clinical protocols. Results: Compared to the patients with normal coronaries, those with angiographic CAD showed significantly increased myocar- dial isovolumic relaxation time (IVRT) velocity (P 4.0 m/sec, a positive PSS velocity had about 65% sensitivity and 85% specificity with a positive predictive value > 90% in predicting angiographic CAD. Conclusions: Among patients with chest pain and normal LV wall motion on 2D echocardiography, a prominent and prolonged IVRT on TDI may help predict the presence of significant CAD.

ABSENCE OF SEPTAL Q WAVES: An Important Predictor of Significant Coronary Artery Disease and Mainly Proximal Stenosis of the Left Anterior Descending Artery.

Data concerning the correlation between the absence of septal q waves and significant stenosis of proximal left anterior descending (LAD) artery shows conflicting results. This retrospective study was conducted to show that absence of septal q waves in leads V5-V6 could be of value in predicting significant coronary artery disease (CAD) and mainly significant proximal LAD coronary artery stenosis. Our study included 500 consecutive patients who had coronary angiography, retrospectively chosen, excluding patients with acute coronary syndromes, and patients with abnormal ECGs (abnormal QRS duration, pathological q waves and hemiblocks). ECG and angiography films were reviewed. For the 2x2 tables analysis, a chi-square test was used. Of the 500 patients, 386 had significant CAD defined as 70% luminal stenosis, and 260 had no septal q wave. Of the 386 patients with significant CAD, 233 (60%) did not have septal q waves. Of 260 who did not have septal q wave, 192 (73%) had significant stenosis of proximal LAD. Statistical analysis shows that significant CAD correlates with the absence of septal q waves, with a sensitivity of 60% and a specificity of 76%, and that stenosis of proximal LAD could be predicted by absence of septal q waves in leads V5-V6 with a sensitivity of 83% and a specificity of 74%. The absence of septal q waves in leads V5-V6 on the ECG correlates with the presence of significant CAD and is of highly predictive value in those with significant stenosis of proximal LAD (p < 0.0001).

35 Comparison of the heart and grace risk stratification tools in predicting significant coronary artery disease in patients presenting with non acs chest pain to the emergency department: Abstract 35 Table 1

Introduction Chest pain is one of the most common presenting complaints in the Emergency Department (ED) accounting for approximately 10% of total ED visits. Clinicians are often challenged in differentiating chest pain associated with significant coronary artery disease (CAD) from non-significant. Both HEART score and GRACE score are often used to risk stratify patients with chest pain in ED. No study has previously compared the two scores in prediction of the presence of significant CAD in a non ACS (Acute Coronary Syndrome) population. Objective To compare the HEART score with the GRACE score amongst non ACS chest pain patients discharged from ED to chest pain clinic follow up with a confirmed diagnosis of CAD. Method Retrospective analysis of data collected by the specialist cardiology nurse on non ACS chest pain patients who attended the chest pain clinic from April 2014 to December 2014. Age, gender, detailed history, risk factors, ECG, and high sensitivity troponin were collected. Both HEART score and GRACE scores were calculated on each patient and stratified into low, intermediate and high risk of MACE in both indexes. Presence of CAD was confirmed or excluded by either visual coronary angiography or CT coronary angiography. Primary end point is the evidence of significant coronary artery disease needing medical treatment or angioplasty. Result A total of 177 out of 403 patients had CT coronary angiography or coronary angiography performed, results available on 111 patients. Mean age was 58.79 ± 10.98 years. 40.54% (n = 45) male and female 59.45% (n = 66). A total of 69.36% (n = 77) patients had coronary angiogram while 30.63% (n = 34) had CT coronary angiogram. Heart score was found to be more sensitive and specific than GRACE; High risk 100% vs 50% (p Conclusion In this study the HEART score has shown to be a statistically significant predictor for the diagnosis or exclusion of CAD when compared to the GRACE score. As a result it is the preferred risk stratification tool for the everyday evaluation of patients who present to Tallaght Hospital ED with chest pain.

Comparison of Body Mass Index, Waist-to-hip Ratio and Waist-to- height Ratio as Predictor of the Severity of Coronary Artery Disease Based on Gensini Scoring System on Coronary Angiography

OBJECTIVE: This study aimed to determine the correlation of body mass index (BMI), waist-to-hip ratio (WHR) and waist-to-height ratio (WHtR) with the severity of coronary artery disease (CAD) based on the Gensini scoring system on coronary angiography among Filipinos. METHODOLOGY: This was a cross-sectional, analytical study conducted at Perpetual Succour Hospital–Cebu Heart Institute. It included all admitted Filipino patients who were suspected to have CAD with indications to undergo coronary angiography from March 1, 2014 to September 30, 2014. RESULTS: A total of 101 patients were included in the study. The mean BMI was 26.83 kg/m2, with most patients (45.5%) having normal BMI. Forty percent were overweight, 7.9% were obese and 6% were very obese. The mean WHR was 0.98 and 97% of patients had a high ratio. The mean WHtR was 0.59 and 96% had a high ratio. Fifty-six percent had significant CAD. The mean Gensini Score was 41.14 and 50.5% of patients had a score of &gt;20. BMI showed no correlation with the severity of CAD by Gensini score (p=0.355). There was a trend towards a weak positive correlation between WHR and Gensini score (r=0.194; p=0.052). WHtR did not show a significant relationship with severity of CAD based on Gensini score (p=0.801). CONCLUSION: BMI, WHR and WHtR did not show significant correlations with the presence of significant CAD. However, there was a trend towards a weak positive correlation between WHR and CAD severity by Gensini score; hence, it may still be useful as a predictor for CAD severity among Filipinos. KEYWORDS: Anthropometric indices, body mass index, waist-to-hip ratio, waist-to-height ratio, coronary artery disease, Gensini score.

Lack of an Association between a Functional Polymorphism in the Neuropeptide Y Gene Promoter and the Presence of Coronary Artery Disease in an Iranian Population

Background/Aims: Several genetic factors have been identified that may contribute to the risk of coronary artery disease (CAD). Variants of the neuropeptide Y (NPY) gene, whose products play an important role in regulating several physiological functions, have been associated with the risk of CAD in some populations. The purpose of this study was to investigate the relationship between the NPY gene rs16147 polymorphism and the presence of CAD in an Iranian population. Methods: DNA samples of 922 subjects, including 433 with angiographically defined CAD (CAD+), 196 without angiographically defined significant CAD (CAD-) and 293 controls, were genotyped using polymerase chain reaction based on the amplification-refractory mutation system. Logistic regression analyses were performed to assess the association of rs16147 genotypes with the presence of significant CAD. Results: Although logistic regression analysis indicated that the NPY polymorphism rs16147 was nominally associated with an increased risk of CAD (p < 0.05), after adjustment for confounding factors, there was no evidence for any significantly increased or decreased risk of CAD with this polymorphism. However, in stratified analyses, the C allele was significantly associated with a reduced risk of CAD in males and subjects who were <50 years of age. Conclusions: This study suggests that the rs16147 polymorphism in the NPY gene may not be a potential contributor to the risk of CAD in an Iranian population.

Abstract 13196: The Prevalence and Prediction of Significant Coronary Artery Disease in Patients Referred for Valvular Heart Surgery

Background: The guidelines recommend preoperative diagnostic coronary angiography (DCA) prior to valvular heart surgery (VHS) in men ≥35 years, premenopausal women with CAD risk factors ≥35 years, and postmenopausal women. Objectives: To determine the prevalence and risk factors for significant CAD in patients, without a prior history, undergoing DCA as a part of a preoperative evaluation for VHS. To create a risk prediction model to identify very-low risk patients. Methods: Patients undergoing DCA between 2/1/2004 and 10/1/2013 as a part of a preoperative evaluation for VHS were included. Significant CAD was defined as either ≥50% stenosis on DCA or the use of bypass grafting at the time of VHS. Multivariate analyses were used to determine risk factors for CAD. Patients were randomly split into derivation and validation cohorts. A nomogram was created to predict the risk of significant CAD, and the performance was assessed using a ROC curve. Results: We identified 5,360 patients (age 63±14 years, male 57%, diabetic 16%, hypertension 50%, hyperlipidemia 39%), of which 1,035 (19.3%) were found to have significant CAD. In multivariate analysis, age, gender, diabetes, renal dysfunction, hyperlipidemia and a family history of CAD were related to the presence of CAD (p&lt;0.001 for all). After multivariate adjustment, the specific dysfunctional valve was not associated with the presence of significant CAD. The risk prediction nomogram (Figure) performed well in predicting the presence of significant CAD in the validation group (AUC 75.7%). Conclusions: In patients undergoing DCA prior to VHS, the prevalence of significant CAD is associated with demographics and traditional risk-factors, but not the specific dysfunctional valve. This data suggests there is a group with sufficiently low risk of significant CAD to merit non-invasive testing instead of DCA. The risk prediction nomogram created in this study can be used to identify patients with a very-low risk of significant CAD.

Comparison of Epicardial Adipose Tissue Volume and Coronary Artery Disease Severity in Asymptomatic Adults With Versus Without Diabetes Mellitus

Epicardial adipose tissue (EAT) has been shown to have important effects on the development of coronary artery disease (CAD) through local paracrine influences on the vascular bed. We compared a cohort of asymptomatic patients with type II diabetes mellitus (DM) without known CAD to an age- and gender-matched group of asymptomatic patients without DM from the CTRAD (Cardiac CT's Role in Asymptomatic Patients with DM-II) study in which patients underwent a cardiac computed tomography angiogram, for early detection of CAD. Mean EAT volumes of 118.6 ± 43.0 and 70.0 ± 44.0cm(3) were found in the DM and non-DM groups, respectively. When stratified by the presence and severity of CAD, it was found that in the DM (p= 0.003) and non-DM groups (p <0.001), there was a statistically significant increase in EAT volume as the patients were found to have increasingly severe CAD. After adjusting for age, race, gender, DM, hypertension, insulin use, body mass index, and coronary artery calcium (CAC) score, the presence of >120cm(3) of EAT was found to be highly correlated with the presence of significant CAD (adjusted odds ratio 4.47, 95% confidence interval 1.35 to 14.82). We found that not only is EAT volume an independent predictor of CAD but that an increasing volume of EAT predicted increasing severity of CAD even after adjustment for CAC score.

Atherosclerotic coronary plaque in subjects with diabetic neuropathy: the prognostic cardiovascular role of Charcot neuroarthropathy—a case–control study

The aim of this study was to investigate the severity of coronary artery disease (CAD) and the plaque composition in neuropathic type 2 diabetic subjects with and without Charcot neuroarthropathy (CN) undergoing multidetector computed tomography coronary angiography (MDCT-CA). The study was a single-center, observational, with unmatched case-control design. We selected 17 CN patients and 18 patients with diabetic neuropathy (DN) without CN. In all the patients, multidetector computed tomography was performed to assess the coronary artery calcium score (CACS) and degree of coronary artery stenosis. Patients were classified as positive in the presence of significant CAD if there was at least one stenosis >50% on MDCT-CA. The invasive coronary angiography was performed in case of significant stenosis detected with MDCT-CA, both as reference to standard and eventually as treatment. Groups were matched for age, sex, and traditional CAD risk factors. As compared to DN individuals, CN exhibited higher rates of significant coronary stenoses (p=0.027; OR 7.7 [1.3-43.5]). However, no significant differences were observed in the CACS, which reflects plaque burden, in the two groups (p=0.759). No significant differences were observed comparing CACS distribution in all subjects for stenosis higher/equal or lower than 50% (p=0.320). Finally, no significant differences were observed comparing CACS distribution in CN and DN subjects for coronary stenoses higher/equal or lower than 50%. Our results suggest that CN patients have a higher prevalence of severe coronary plaques compared to DN patients. Nevertheless, coronary plaques in CN patients did not exhibit an increased degree of calcification.

Prevalence and extent of atherosclerotic coronary artery disease and related outcome based on coronary computed tomographic angiography in asymptomatic elderly patients: retrospective cohort study

There is little data regarding coronary artery disease (CAD) and/or atherosclerotic plaques on coronary computed tomographic angiography (CCTA) among the elderly and its outcome, especially in asymptomatic patients. Using CCTA, we evaluated the prevalence and extent of CAD and/or atherosclerosis and related outcomes in asymptomatic elderly patients as compared with symptomatic elderly patients. The study included 1,196 consecutive patients aged 70 years or older who underwent CCTA over a 2-year period. Data were retrospectively evaluated for clinical cardiovascular risk factors with co-morbidities, and CCTA findings, including calcium scores, atherosclerotic plaques (number, plaque-segment score, plaque-extent score, and plaque-significant score) and presence of significant CAD. Follow-up data for active management and all-cause mortality after CCTA were collected for 2 years. Two-sided Student's t test for independent samples, Chi square contingency tables, and Kaplan-Meier survival curves were used for statistical analysis. Data for 454 asymptomatic and 742 symptomatic elderly patients were analyzed. The prevalence of significant CAD and the extent of atherosclerotic plaques did not differ between the two groups (all P > 0.05). Asymptomatic patients with significant CAD on CCTA, were less likely to receive active management (P < 0.001), which may be related to the higher death rate in this group (P = 0.012) than in the symptomatic patients with significant CAD. Overall, symptoms were not related to the presence of significant CAD or to the extent of atherosclerosis in these elderly patients. However, all-cause mortality was higher in the asymptomatic patients with significant CAD than in the symptomatic ones.

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

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

Aggravation of left ventricular diastolic dysfunction in hypertensives with coronary artery disease

We investigated the combined effects of hypertension and coronary artery disease (CAD) on left ventricular (LV) diastolic function. We examined 118 consecutive hypertensives who underwent diagnostic coronary angiography. All patients underwent a complete echocardiographic study within 24 h of catheterization by operators blind to their condition. The study participants were divided into two groups according to the presence of CAD: group A, with the disease (n=72); and group B, without (n=46). Patients with CAD exhibited lower LV fractional shortening and ejection fraction (P=0.002 and P=0.001). Hypertensives with CAD had significantly prolonged isovolumic relaxation time (IVRT) compared to those without CAD (P<0.001). Most interestingly, CAD patients had significantly worse Ema/Ama, Vp (flow propagation velocity), E/Vp and Vp/IVRT (all P<0.05). In addition, after adjusting for confounders, univariate and multivariate logistic regression analyses revealed that IVRT increases were associated with greater odds of CAD, whereas decreases in Vp or Vp/IVRT were associated with lower odds of CAD (all P ≤ 0.001). In hypertensives, the early recognition of LV diastolic performance alteration may be associated with the presence of significant CAD, indicating the need for more aggressive approaches both in terms of pharmacological treatment and interventional evaluation.

CT Coronary Angiography Is Feasible for the Assessment of Coronary Artery Disease in Chronic Dialysis Patients, Despite High Average Calcium Scores

PurposeSignificant obstructive coronary artery disease (CAD) is common in asymptomatic dialysis patients. Identifying these high risk patients is warranted and may improve the prognosis of this vulnerable patient group. Routine catheterization of incident dialysis patients has been proposed, but is considered too invasive. CT-angiography may therefore be more appropriate. However, extensive coronary calcification, often present in this patient group, might hamper adequate lumen evaluation. The objective of this study was to assess the feasibility of CT-angiography in this patient group.MethodsFor this analysis all patients currently participating in the ICD2 trial (ISRCTN20479861), with no history of PCI or CABG were included. The major epicardial vessels were evaluated on a segment basis (segment 1–3, 5–8, 11 and 13) by a team consisting of an interventional and an imaging specialist. Segments were scored as not significant, significant and not interpretable.ResultsA total of 70 dialysis patients, with a mean age of 66±8 yrs and predominantly male (70%) were included. The median calcium score was 623 [79, 1619].Over 90% of the analyzed segments were considered interpretable. The incidence of significant CAD on CT was 43% and was associated with cardiovascular events during follow-up. The incidence of cardiovascular events after 2-years follow-up: 36% vs. 0% in patients with no significant CAD (p<0.01).ConclusionDespite the high calcium scores CT-angiography is feasible for the evaluation of the extent of CAD in dialysis patients. Moreover the presence of significant CAD on CT was associated with events during follow-up.