Prevalence Of Severe Coronary Artery Disease Research Articles

Association between sleep apnea-specific hypoxic burden and severity of coronary artery disease.

Sleep apnea-specific hypoxic burden (SASHB) is a polysomnographic metric that comprehensively measures the degree of nocturnal desaturation caused by obstructive sleep apnea. This research was conducted to elucidate the relationship between SASHB and coronary artery disease (CAD) severity. We carried out a prospective study of hospitalized patients with CAD of unstable angina who were expected to undergo invasive coronary angiography at Beijing Anzhen Hospital from February to September 2023. SASHB values were calculated using a self-programmed C + + program. Multivariable logistic regression analysis was applied to identify the association between SASHB and the prevalence of severe CAD, documented by the Gensini Score, and the SYNTAX (Synergy between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery) Score. This study enrolled 137 patients with a median age of 59years, 96 (70.1%) of whom were male. A total of 125 (91.2%) patients had coronary stenosis of ≥ 50% in at least one location. Patients with a high SASHB of ≥ 18% min/h had a significantly higher Gensini Score (32.0 vs. 18.5, P = 0.002) and SYNTAX Score (14.0 vs. 7.0, P = 0.002) than those with a low SASHB. After adjusting for multiple covariates, a high SASHB was significantly associated with the prevalence of severe CAD, determined by a Gensini Score ≥ 21 (OR 2.67, P = 0.008) or a SYNTAX Score > 22 (OR 4.03, P = 0.016). Our findings revealed a robust and independent association between SASHB and CAD severity in patients with unstable angina, highlighting the potential value of SASHB as a predictor of risk and a target for interventions aimed at preventing cardiovascular diseases. Chinese Clinical Trial Registry No. ChiCTR2300067991 on February 2, 2023.

Relationship among Insulin Therapy, Insulin Resistance, and Severe Coronary Artery Disease in Type 2 Diabetes Mellitus.

ObjectivesThe effect of insulin therapy on coronary artery disease (CAD) remains controversial. This study aimed to analyze the association between insulin resistance and the morbidity of severe CAD in type 2 diabetes mellitus (T2DM). Methods A total of 2044 T2DM patients aged ≥40 years were included in this cross-sectional observational study. Clinical information and laboratory results were collected from the medical records. Those who underwent percutaneous coronary intervention (PCI) were classified as severe CAD, while those who did not have a history of and were not suffering from CAD were classified as patients without CAD. Results T2DM patients with severe CAD and without CAD had no significant differences in glycosylated hemoglobin A1c (8.55% ± 2.10% vs. 8.39% ± 1.77%, P=0.234). The proportion of insulin treatment was also similar between the two groups (56.85% vs. 53.65%, odds ratio = 1.138, P=0.310). In the patients without insulin treatment, the levels of fasting C peptide (FCP) correlated with severe CAD prevalence. FCP was categorized into 3 tertiles (<1.5 ng/mL, 1.5 ng/mL- 3 ng/mL, and ≥3 ng/mL), and the prevalence rates of severe CAD were 7.88%, 14.31%, and 18.28%, respectively (P < 0.05). In the patients with insulin treatment, the body mass index (BMI) was the significant risk factor of severe CAD. The prevalence of severe CAD according to BMI tertiles (<24 kg/m2, 24 kg/m2–28 kg/m2, and ≥28 kg/m2) was 11.22%, 14.61%, and 24.62%, respectively (P < 0.01). Conclusions Our results showed that insulin resistance, rather than insulin therapy, increases the risk of severe CAD in T2DM patients with inadequate glycemic control. Non-insulin treated patients with high FCP and insulin-treated patients with high BMI are at higher risk of severe CAD.

Left Atrium Volume Index and Aortic Stiffness as Predicting Factors for Severity of Coronary Artery Disease

AbstractBackground: Recently, it has been demonstrated that left atrial distension and aortic stiffness have a predictive value for cardiovascular outcomes especially in high-risk, elderly, and hypertensive adults.Aim of Study: Evaluation of predictive value of Left Atrium Volume Index (LAVI) and aortic stiffness for severity of angiographic pattern of Coronary Artery Disease (CAD).Methods: A prospective observational cohort single-center study conducted from May 2016 to May 2017, at Cardiovas-cular Medicine Department, Tanta University Hospitals in Gharbia Governorate, Egypt. The study enrolled 100 consec-utive adult patients of both genders who were diagnosed with chronic stable coronary artery disease and were candidates for invasive coronary angiography. Each patient was subjected to echocardiographic assessment for Left Atrium Volume Index (LAVI) and Aortic Stiffness Index (ASI) followed by invasive coronary angiography for assessment of severity of coronary artery disease by Gensini score. Patients were classified into 3 groups by Gensini score: Group I (gensini score equal zero), Group II (Gensini score more than 0 and less than 20) and Group III (Gensini score equal or more than 20).Results: The prevalence of severe CAD was higher among patients with high LAVI (p-value 0.002) and ASI (p-value 0.05). The significant positive relation between LAVI and Gensini score was mainly between Groups II, III (non-severe and severe coronary artery disease). ASI was more sensitive than LAVI for detection of the severity of CAD as ASI showed statistically significant positive strong correlation with the coronary angiographic score (p=0.001) while LAVI showed no significant correlation with the coronary angiographic score (p=0.061). The LAVI carried sensitivity of 67% and specificity of 49.5% in predicting CAD with cutoff value >19.5. While The ASI carried sensitivity of 66.7% and spe-cificity of 21% in predicting CAD with cutoff value >2.88.Conclusion: It was demonstrated that there is significant elevation at aortic stiffness index and left atrium volume index within the group of patient with the higher Gensini score. So ASI and LAVI could be used as promising factors for evalu-ation of the severity of coronary artery disease.

Transient Ischemic Dilation Ratio in Regadenoson, Single Isotope Gated Single-photon Emission Computed Tomography Myocardial Perfusion Imaging.

Single isotope 99mTc single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) is the most commonly used protocol for nuclear stress testing. Transient ischemic dilation of the left ventricle (TID) has been considered a specific marker of severe coronary artery disease (CAD). Recent publications have questioned the clinical utility of TID, specifically with regadenoson as a stressor and 4DM-SPECT software for TID analysis. These findings have not been demonstrated using other imaging packages. The goal of our study was to establish the TID threshold in the identification of Multi-vessel CAD using Quantitative Perfusion SPECT (QPS) software. Included in this study are 190 patients that had undergone regadenoson-stress, same day, single-isotope 99mTc MPI and had a coronary angiography within a designated 3-month period. QPS (Cedars-Sinai, LA, CA) automated image analysis software was used to calculate TID ratios which were compared across different CAD categories. Coronary angiograms were reviewed to identify both obstructive and nonobstructive CAD. The mean TID for patients with nonobstructive CAD (n = 91) was 1.02 ± 0.11, and the threshold for TID was 1.24. A receiver operating characteristic curve showed that TID had a poor discriminatory capacity to identify MVD (area under the curve 0.58) with a sensitivity of 3% and a specificity of 97%. In our study with regadenoson MPI in a predominantly African-American population, TID was found to be a poor predictor of MVD using QPS software. The reason is unclear but possibly related to the significant decline in the prevalence of severe CAD in the area where our study took place.

Abstract 14637: Effects of Dietary Patterns in the Severity of Coronary Artery Disease

Introduction: The impact of diet on atherosclerosis progression is well established. However, the independent predictive value of unhealthy diet in the prognosis and severity of coronary artery disease (CAD) has not been definitely confirmed and clinicians often ignore how to incorporate it in clinical practice. Hypothesis: Dietary patterns may impact CAD severity. Methods: In this cohort study we included 188 consecutive symptomatic stable CAD patients. The diagnosis of CAD was based on coronary angiography and patients were categorized as having severe CAD and non-severe CAD. The diagnosis of severe CAD was based on the presence of either left main coronary artery disease (stenosis≥50%), or three-vessel coronary artery disease, or two-vessel coronary artery disease marked by stenosis of the proximal left anterior descending artery ≥70%. Among several demographics and clinical characteristics all subjects were tested with a validated semi quantitative food frequency questionnaire. Results: Concerning baseline demographic characteristics there was no difference between subjects with severe CAD and non-severe CAD while, the prevalence of severe CAD was higher in current smokers compared to non-smokers. Principal component analysis revealed 8 distinct dietary patterns. The first component-western dietary pattern (increased intake of fat, red meat and carbohydrates and minimal consumption of fruits vegetables and green leafy)- was predictive of severe CAD (AUC:0.73, 95% CIs:0.64-0.83, p&lt;0.001) and more interestingly, can increase the discriminative ability of a multivariate model based on all major risk factors. Conclusion: The unhealthy western type of diet is associated with the severity and extent of coronary artery lesions in patients with stable CAD. These findings highlight the importance of accessing dietary patterns when calculating cardiovascular risk and to take into consideration dietary habits in the management of cardiovascular patients.

Diagnostic and prognostic significance of ischemic electrocardiographic changes with regadenoson-stress myocardial perfusion imaging

BackgroundThe diagnostic and prognostic value of regadenoson-induced ST-segment depression (ST↓) is not defined. Due to the low incidence of ST↓ ≥1.0 mm with vasodilator stress, a lower threshold to define ischemic ECG response may provide improved clinical utility. MethodsWe conducted a retrospective cohort study of patients who underwent regadenoson-stress SPECT myocardial perfusion imaging (MPI) followed by coronary angiography within 6 months. Ischemic ST↓ was defined as ≥0.5 mm. The prevalence of angiographically severe coronary artery disease (CAD) and the rates of major adverse cardiac events (MACE) including cardiac death, myocardial infarction, and coronary revascularization were determined. ResultsIn a diagnostic cohort of 629 subjects, 117 (18.6%) had ST↓ ≥0.5 mm. Severe CAD was more prevalent in the ST↓ ≥0.5 vs ST <0.5 group (13.7% vs 5.3%, P = .001). Among patients with normal MPI (n = 229), the prevalence of severe CAD was higher in the ST↓ ≥0.5 group (8.2% vs 2.2%, P = .04). Adjusting for clinical and imaging covariates, ST↓ ≥0.5 mm was independently predictive of severe CAD [odds ratio = 3.37, 95% confidence interval (CI) = 1.67-6.83, P = .001], and provided incremental diagnostic value (Chi square increment = 10.3, P = .001). In an outcome cohort of 748 subjects, after adjusting for clinical and imaging covariates, ST↓ ≥0.5 mm was associated with increased MACE rate in the entire cohort [hazard ratio = 1.41, CI 1.01-1.96, P = .04] and in the subgroup of patients with normal MPI [hazard ratio = 2.2, CI 1.11-4.39, P = .02], and provided incremental prognostic value (Chi square increment = 3.9, P = .049). A diagnostic ST↓ threshold of 0.5 mm provided greater discriminatory capacity than a 1.0 mm cutoff (P = .03). ConclusionsAmong patients selected to undergo coronary angiography, regadenoson-induced ST↓ ≥0.5 mm was associated with higher rates of severe CAD and MACE, irrespective of MPI finding.

Serum Fetuin-A and Mitral Annular Calcification As a New Predictors For Significant Coronary Artery Disease

Mitral annular calcification has been shown to be associated with atherosclerosis,and is a predictor of cardiovascular events. Fetuin-A has recently been described as aserum-based inhibitor of calcification. The present study was designed to evaluate thepredictive value of serum fetuin-A and mitral annular calcification in patients withsuspected/ diagnosed coronary artery disease. We prospectively studied fifty fourpatients with suspected/diagnosed coronary artery disease without renal impairmentor rheumatic valvular disease. The patients divided into 3 groups according to fetuin-A values. Group 1 low fetuin-A (32 patients). Group 2 normal fetuin-A (12 patients),group 3 fetuin-A high fetuin-A (10 patients). Full clinical examination, transthoracicechocardiography, coronary angiography, biochemical investigations offered to allpatients and fetuin-A level measured using EDI human fetuin-A ELISA kit. The resultsof the current study showed a higher incidence of mitral annular calcification amonggroup 1 (59.4%) in comparison to other groups, on other hand the same group hadlower left ventricular ejection fraction percent and higher incidence of restingregional wall motion abnormalities. Angiography showed a higher prevalence ofsevere coronary artery disease in patients with mitral annular calcification than thosewithout. Group 1 had, also higher prevalence of left main stenosis (43.1%vs 0%)P<0.05, and triple vessels disease (43.6%vs 13%) P<0.05. While the predictiveability of Mitral annular calcification in detection of significant coronary arterydisease was highly significant P= 0.0001. There was significant negative correlationbetween fetuin-A and hsCRP p<0.01and LDL-c p<0.05. One of the main findings isthe inverse association of serum fetuin-A concentration with Mitral annularcalcification as well as strong predictive value of both to presence of significantcoronary artery disease after multilogestic regression analysis. Conclusion: insymptomatic patients with suspected coronary artery disease, the presence of lowfetuin-A level and mitral annular calcification, may be considered as independentpredictors for the presence of significant obstructive coronary artery disease.

Lysine‐binding species of lipoprotein(a) in coronary artery disease

Elevated levels of plasma lipoprotein(a) [Lp(a)] have frequently been associated with coronary artery disease (CAD). Recently Lp(a) was fractionated into two species with different affinities for Lysine-Sepharose. The influence of lysine-binding heterogeneity of Lp(a) on its cardiovascular pathogenicity has not previously been studied. The authors have determined plasma levels of total Lp(a), its lysine-binding [lys+] and unretained [lys-] species in 67 male CAD patients undergoing cardiac catheterization. Forty-three patients have severe CAD (two- or three-vessel disease) and 24 patients have less pronounced CAD (one-vessel disease or less than 50% narrowing of coronary vessels). All patients were ranked in order of their Lp(a) levels and then grouped into quartiles. The prevalence of severe CAD was significantly higher in the upper Lp(a) quartile as compared with the other three quartiles (odds ratio 10-5; chi-square 11.2; P = 0.0008). Similar results were obtained when the same analysis was carried out for [lys+] and [lys-] species of Lp(a) (odds ratio 11.52 and 3.3, respectively; chi-square 12.3 and 4.34, respectively; P = 0.0004 and 0.037, respectively). Thus, measurement of either species of Lp(a) does not provide any additional improvement in the prediction of CAD as compared to the estimation of total Lp(a) levels.