Prevalence Of Significant Stenosis Research Articles

Prevalence and Prognostic Value of Mesenteric Artery Stenosis in Patients Undergoing Transcatheter Aortic Valve Implantation.

IntroductionData regarding the prevalence of mesenteric artery stenosis in patients undergoing transcatheter aortic valve implantation (TAVI) are scarce. Whether patients with high-risk features for acute mesenteric ischemia (AMesI) have a worse prognosis compared with those without high-risk features is unknown. We aimed to address these questions.MethodsWe included 361 patients who underwent TAVI between 2015 and 2019. Using pre-TAVI computed tomography exams, the number of stenosed arteries in each patient and the degree of stenosis for the coeliac trunk (CTr), SMA and inferior mesenteric artery (IMA) were analyzed. High-risk features for AMesI were defined as the presence of ≥2 arteries presenting with ≥50% stenosis. Patient demographic and echocardiographic data were collected. Endpoints included 30-day all-cause mortality, mortality and morbidity related to mesenteric ischemia.Results22.7% of patients had no arterial stenosis, while 59.3% had 1 or 2 stenosed arteries, and 18.0% presented stenoses in 3 arteries. Prevalence of significant stenosis (≥50%) in CTr, SMA, and IMA were respectively 11.9, 5.5, 10.8%. Twenty patients at high-risk for AMesI were identified: they had significantly higher all-cause mortality (15.0 vs. 1.2%, p < 0.001) and higher mortality related to AMesI (5.0 vs. 0.3%, p = 0.004), compared with non-high-risk patients.ConclusionsPatients at high-risk for AMesI presented with significantly higher 30-day all-cause mortality and mortality related to AMesI following TAVI. Mesenteric revascularization before TAVI interventions may be beneficial in these patients. Prospective studies are needed to clarify these questions.

Triglyceride to HDL-cholesterol ratio is a predictor of future coronary events: a possible role of high-risk coronary plaques detected by coronary CT angiography

Abstract Background For the prevention of future cardiovascular events, control of residual risks such as triglyceride rich lipoproteins and HDL-cholesterol is an emerging problem beyond LDL-cholesterol. Triglyceride to HDL-cholesterol ratio (TG/HDL ratio) has been reported to be useful for risk classification of cardiovascular diseases. Meanwhile, several studies showed that high-risk plaque characteristics evaluated with coronary CT angiography (cCTA) was associated with the incidence of acute coronary syndrome. However, the relationship of TG/HDL ratio with coronary plaque characteristics and its impact of this association on future coronary events have not been fully elucidated. Purpose The aim of this study was to evaluate the association between TG/HDL ratio and high-risk plaque detected by cCTA and its impact on future coronary events. Methods A total of 944 patients suspected stable coronary artery disease who underwent cCTA at our institution were analyzed (mean 64-year-old, 55% male). Patients were divided into two groups by the median value of TG/HDL ratio (higher TG/HDL: TG/HDL ratio ≥2.0, lower TG/HDL: TG/HDL ratio &amp;lt;2.0). Coronary high-risk plaques were defined as a plaque with all three components; low attenuation plaque (&amp;lt;50H.U.), positive remodeling (remodeling index &amp;gt;1.1) and spotty calcification. Cardiovascular event was defined as cardiovascular death, acute coronary syndrome, and late coronary revascularization after 30 days of CT acquisition. Results The higher TG/HDL ratio was significantly associated with male gender (63% vs. 48%, P&amp;lt;0.001), body mass index (24.8±3.8 vs. 22.9±4.0, p&amp;lt;0.001), the prevalence of hypertension (65% vs. 54%, P&amp;lt;0.001), dyslipidemia (60% vs. 42%, P&amp;lt;0.001), diabetes mellitus (38% vs. 27%, P=0.001) and current smoking (26% vs. 10%, p&amp;lt;0.001). Regarding cCTA findings, the prevalence of significant stenosis, calcified plaque, non-calcified plaque, coronary plaques with low attenuation plaque, positive remodeling and spotty calcification in the higher TG/HDL group were greater than those in the lower group (Figure 1A). Of note, the difference in high-risk plaque between two groups was significant. (18% vs. 11%, p=0.004). Multivariate logistic analysis revealed that the TG/HDL ratio was an independent risk factor for high-risk plaque even after adjustment (OR, 1.35; 95% CI, 1.01–1.81; p=0.049). Regarding coronary events (median follow-up duration; 48 months), Kaplan-Meier curve showed poor event-free rate in the higher TG/HDL group (Figure 1B). At Cox proportional hazard analysis, higher TG/HDL ratio (HR, 1.94; 95% CI, 1.01–3.70; p=0.046) and CT-verified high-risk plaque (HR, 2.36; 95% CI, 1.27–4.38; p=0.006) were independent predictive factors for coronary events even after adjustment. Conclusion TG/HDL ratio is involved in the vulnerability of CT-verified coronary plaque characteristics. This association may play an important role in the prognostic impact of TG/HDL ratio on future cardiovascular events. Funding Acknowledgement Type of funding source: None

Four Different Carotid Atherosclerotic Behaviors Based on Luminal Stenosis and Plaque Characteristics in Symptomatic Patients: An in Vivo Study.

Correct stratification of ischemic stroke risk allows for the proper treatment of carotid atherosclerotic disease. We seek to differentiate plaque types based on stenosis level and plaque morphology. The Chinese Atherosclerosis Risk Evaluation (CARE–II) study is a cross-sectional, observational, multicenter study to assess carotid atherosclerotic plaques in symptomatic subjects using vessel wall magnetic resonance imaging. Plaque morphology and presence of plaque components were reviewed using multi-contrast magnetic resonance imaging. The carotid arteries were divided into four groups based on stenosis level and plaque components. Out of 1072 ischemic stroke subjects, 452 ipsilateral side carotid arteries were included. Significant stenosis (SS) (≥50% stenosis) with high-risk plaque (HRP) features was present in 37 arteries (8.2%), SS(+)/HRP(−) in 29 arteries (6.4%), SS(−)/HRP(+) in 57 arteries (12.6%), and SS(−)/HRP(−) in 329 arteries (72.8%). The prevalence of SS(−)/HRP(+) arteries in this cohort was substantial and had greater wall thickness than the SS(+)/HRP(−) group. These arteries may be misclassified for carotid revascularization by current guidelines based on the degree of luminal stenosis only. These findings have implications for further studies to assess stroke risk using vessel wall imaging.

Coronary Calcification and Male Gender Predict Significant Stenosis in Symptomatic Patients in Northern and Southern Europe and the USA: A Euro-CCAD Study

Background and Aims: Significant stenosis is the principal cause of stable angina but its predictors and their variation by geographical region are unclear.Methods and Results: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 5515 symptomatic patients from northern Europe (Denmark, France, Germany), southern Europe (Italy, Spain) and USA. All had conventional cardiovascular risk factor assessment, angiography and CT scanning for coronary artery calcium (CAC) scoring. There were differences in the patient characteristics between the groups, with the USA patients being younger and having more diet and lifestyle-related risk factors, although hypertension may have been better controlled than in Europe. USA patients had a two-fold increase in prevalence of significant stenosis and a three-fold increase in median CAC score. In all three groups, the log CAC score proved to be the strongest predictor of &gt;50% stenosis followed by male gender. In the USA group, there were no additional independently predictive risk factors, although in northern Europe obesity, hypertension, smoking and hypercholesterolaemia remained predictive, with all risk factors other than hypertension proving to be predictive in the southern Europe group. Without the CAC score as a variable, male gender followed by diabetes were the most important predictors in all three regions, with hypertension also proving predictive in northern Europe.Conclusion: In symptomatic patients, the CAC score and male gender were the two most important predictors of significant stenosis in symptomatic patients in northern and southern Europe and the USA.

Clinical impact of preoperative brain MR angiography and MR imaging in candidates for liver transplantation: a propensity score-matching study in a single institution.

To investigate the prevalence of cerebrovascular stenosis and white matter lesions on preoperative magnetic resonance angiography (MRA) and magnetic resonance imaging (MRI) in liver transplantation candidates. This retrospective study included 1,460 consecutive patients with liver cirrhosis (LC) who underwent MRA with/without brain MRI for pretransplantation evaluation. These patients were matched with 5,331 controls using propensity scores, and the prevalences of significant cerebrovascular stenosis and white matter lesions were compared. A matched analysis of 1,264 pairs demonstrated that the prevalence of significant stenosis was comparable between LC patients and controls (2.2% vs. 1.4%, P = 0.143). LC and most ofLC-related parameters were not associated with stenosis. Significant white matter lesions were more common in LC patients (2.8% vs. 1.3%, P = 0.036). A high Model for End-Stage Liver Disease (MELD) score (OR 1.11, CI 1.03-1.20, P = 0.008, for infarction; OR 1.1, CI 1.04-1.16, P = 0.001, for haemorrhage) and stroke history (OR 179.06, CI 45.19-709.45, P < 0.001) were predictors of perioperative stroke. LC patients and control subjects demonstrated similar cerebrovascular stenosis prevalences, whereas white matter lesions were more common in LC patients. A high MELD score and stroke history contribute as predictors of perioperative stroke. • Routine preoperative MR imaging in liver transplantation candidates may not be necessary. • Liver cirrhosis patients and control subjects had similar prevalences of significant cerebrovascular stenosis. • Liver cirrhosis and cirrhosis-related parameters were not correlated with significant cerebrovascular stenosis. • Significant white matter lesions were more frequent in liver cirrhosis patients.

Characteristics of Subclinical Coronary Artery Disease in Diabetic Patients without Known Coronary Artery Disease

Patients with diabetes have a high prevalence of subclinical coronary artery disease (CAD). Our purpose is to study the coronary artery characteristics in diabetic patients. We performed coronary computed tomographic angiography in 374 patients without known CAD. We divided these patients into those with diabetes (diabetes group, n=138) and those without diabetes (nondiabetes group, n=236). We compared coronary calcium score (CCS), prevalence of significant stenosis, coronary plaque, and high-risk plaque (positive remodeling and low attenuation plaque) between the two groups. Patient characteristics were not significantly different between the two groups. The CCS was significantly higher in diabetes group than in nondiabetes group (median with 95% confidence interval [CI] 202, 95% CI: 7.5-673 vs. 60, 95%CI: 0-291, p=0.0002). The prevalence of significant stenosis (17.4% vs. 6.8%, p=0.0014) and coronary plaques (4.3±4.3 vs. 3.1±4.4, p=0.0089) were significantly higher in diabetes group compared with nondiabetes group. The prevalence of high-risk plaque (9.4% vs. 9.7%, p=0.92) was not significantly different between the two groups. However, in a multiple logistic regression analysis adjusted for variables associated with a high-risk plaque, only diabetes were significantly associated with a high-risk plaque. Our results showed that diabetic patients had higher CCS, higher prevalence of significant stenosis, and coronary plaque compared with nondiabetic patients. Moreover, diabetes was significantly associated with the presence of high-risk plaque by multivariate analysis.

Renal artery stenosis in patients with established coronary artery disease: prevalence and predicting factors.

The association between renal artery stenosis (RAS) and other atherosclerotic diseases (particularly coronary artery diseases) is well known. In general, the risk factors for atherosclerosis have been clarified, but whether these risk factors operate equally in all forms of atherosclerotic diseases is not known. The aim of this study was to describe the prevalence of RAS in patients with established coronary artery diseases and then to define the most important risk factors that may help to predict the RAS in this population. In this cross-sectional study, 146 patients with established coronary artery stenosis by angiography simultaneously underwent renal angiography; RAS >50% was considered significant. We found that 25.3% of patients with coronary artery diseases had RAS. The prevalence of significant stenosis was 17.1%. Females were more vulnerable to this disorder than males (47.1% vs. 13.7%, P = 0.001). There was no relationship between the severity and number of stenosed coronary arteries and those of stenosed renal arteries (P = 0.716). Multi-variate logistic regression analysis revealed that among the risk factors for atherosclerosis, female sex (P = 0.001), duration of hypertension (P = 0.032), age (P = 0.046) and serum creatinine (P = 0.018) were strong predictors of the presence of RAS. We concluded that RAS is a common finding in patients with coronary artery disease. We suggest that all older females with deteriorating renal function and long-standing hypertension should be carefully evaluated for early detection of the RAS.

Troponin rise in patients with atrial fibrillation: A marker of adverse prognosis and increased thromboembolic risk

We have read with interest the article by Parwani and colleagues addressing the role of atrial fibrillation (AF) in induction of troponin release in patients presenting to the Emergency Department with AF and clinical symptoms suggestive of myocardial ischemia [1]. In face of their findings in 100 patients undergoing coronary angiography, of whom 23 had an elevated cardiac troponin I (N0.09 μg/L), the authors have suggested that troponin rise may be “falsely elevated” in this setting, since the prevalence of significant stenosis was similar irrespective of troponin rise: 26% in patients with positive troponin vs. 33% in patients with normal troponin (p = ns). However, we feel that, contrary to the author's opinion, troponin rise in this setting must be addressed with care in face of the recent evidence that we will shortly present. Conti and colleagues have recently shown that elevated cardiac troponin I is a predictor of poor outcome (a composite of stroke, acute coronary syndrome, revascularization, and global death) in patients presenting to the Emergency Department with AF lasting for less than 12 h [2]. The association of minor troponin elevations with an adverse prognosis in patients with AF has also been previously addressed by Van den Bos et al. in a prospective cohort study of 407 consecutive patients with AF admitted to the cardiology ward or intensive coronary unit (patients with ST elevation myocardial infarction were excluded) [3]. These authors have found that minor rises (N0.015 ng/ mL) were present in 20% of patients and associated with death, fatal myocardial infarction and major cardiovascular events (all-cause mortality, myocardial infarction and revascularization). As far as risk stratification of AF is concerned, minor rises in troponin seem also to have a major role in the prediction of thromboembolic events and may improve the discriminative capability of current risk classification schemes (CHADS2 and CHA2DS2-VASc), according to data from the “Randomised Evaluation of Long Term Anticoagulant Therapy” (RE-LY) trial biomarkers substudy [4]. Based on data from patients with AF undergoing transesophageal echocardiogram, this may be explained by the increased prevalence of markers of left atrial stasis (i.e., left atrial and left atrial appendage thrombi, dense spontaneous echocardiographic contrast and low flow velocities in the left atrial appendage), which are known to very strongly associate with embolism, and to increase in prevalence as troponin levels rise [5]. Therefore, we feel that minor elevations of troponin in patients with AF should be handled with care and not promptly assumed as false positives. In a first instance, ongoing myocardial ischemia should be ruled out if the clinical context is suggestive and the pretest probability is moderate or elevated. Then, even if the results are negative or the context is not suggestive of myocardial ischemia, an adequate prevention of thromboembolism should be considered, preferentially with anticoagulants, according to data of the RE-LY Biomarkers sub-analysis, if the bleeding risk of each particular patient is not prohibitive. The authors of this manuscript have verified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology and complies with the Statement on Matching Language to the Type of Evidence Used in Describing Outcomes Data [6].

Vitamin D deficiency is associated with significant coronary stenoses in asymptomatic African American chronic cocaine users

BackgroundChronic cocaine use may lead to premature atherosclerosis, however, the prevalence of and risk factors for coronary artery disease in asymptomatic cocaine users have not been reported. MethodsBetween August 2007 and June 2010, 385 African American chronic cocaine users aged 25 to 54years were consecutively enrolled in a study to investigate the prevalence of CT angiographically-defined significant (≥50%) coronary stenosis and related risk factors. Sociodemographic, drug-use behavior, medical history and medication data were obtained by interview and confirmed by medical chart review. Clinical examinations were performed as well as extensive laboratory tests including those for fasting lipid profiles, HIV, high sensitivity C-reactive protein, and vitamin D. Contrast-enhanced coronary CT angiography was performed. ResultsSignificant coronary stenosis was detected in 52 of 385 participants (13.5%). The prevalences were 12% and 30% in those with low risk and with middle–high risk Framingham score, respectively. In those with low risk scores, the prevalences of significant stenosis were 10% and 18% in those without and with vitamin D deficiency, defined as serum 25-(OH) vitamin D<10ng/mL (p=0.08). Multiple logistic regression analysis revealed that vitamin D deficiency (adjusted OR=2.18, 95% CI: 1.07–4.43) is independently associated with the presence of significant coronary stenosis after controlling for traditional risk factors. ConclusionsThe study indicates that the prevalence of significant coronary stenoses is high in asymptomatic young and middle-aged African American chronic cocaine users. These findings emphasize the importance of aggressive reduction of risk factors, including vitamin D deficiency in this population.

Long-Term Cocaine Use and Antiretroviral Therapy Are Associated with Silent Coronary Artery Disease in African Americans with HIV Infection Who Have No Cardiovascular Symptoms

Long-term use of cocaine (⩾15 years) and antiretroviral therapy (ART) have been implicated in cardiovascular complications. Nevertheless, the individual and combined effects of ART and cocaine use on silent coronary artery disease have not been fully investigated.Methods: Computed tomography coronary angiography was performed for 165 human immunodeficiency virus (HIV)– infected African American study participants aged 25–54 years in Baltimore, Maryland, with contrast-enhanced 64-slice multidetector computed tomography imaging.Result: Significant (⩾50%) coronary stenosis was detected in 24 (15%) of 165 participants. The prevalence of significant stenosis among those who had used cocaine for ⩾15 years and had received ART for ⩾6 months was 42%. Exact logistic regression analysis revealed that long-term cocaine use(adjusted odds ratio, 7.75; 95% confidence interval, 2.26–31.2) and exposure to ART for ⩾6 months(adjusted odds ratio, 4.35; 95% confidence interval, 1.30–16.4) were independently associated with the presence of significant coronary stenosis. In addition, after controlling for confounding factors,both stavudine use for ⩾6 months or combivir use for ⩾6 months were independently associated with the presence of significant coronary stenosis.Conclusions: Long-term exposure to ART may be associated with silent coronary artery disease;however, the magnitude of increased risk associated with ART was much lower than the risk associated with cocaine use or traditional risk factors. Cardiovascular monitoring and aggressive modification of cardiovascular risk factors are essential for reducing the risk of coronary artery disease in HIV-infected individuals. Extensive efforts should also be made to develop effective cocaine use cessation programs for HIV-infected cocaine users.

Arterial Stenosis Detected by Digital Subtraction Angiography and its Relationship with the Oxfordshire Community Stroke Project Classification

The aim of this study was to assess extra-and intracranial arterial stenosis in first-ever stroke patients and to analyse the relationship between arterial stenosis and the Oxfordshire Community Stroke Project (OCSP) classification. Chinese patients (n = 817) were classified according to OCSP criteria, and arterial abnormalities were evaluated in 342 of the patients by digital subtraction angiography. Prevalence of significant stenosis in the extracranial internal carotid artery was highest among total anterior circulation infarct patients and lowest among patients with lacunar infarct. There was no evidence that the frequency of patients with intracranial arterial significant stenosis was different among OCSP subtypes. The results suggest that extracranial internal carotid artery stenosis was significantly related to OCSP subtype and that patients with total anterior circulation infarct were more likely to have extracranial internal carotid artery stenosis than patients having partial anterior circulation infarct, posterior circulation infarct or lacunar infarct.

Detección de estenosis angiográfica de la arteria coronaria descendente anterior mediante ecocardiografía Doppler transtorácica: utilidad de la medida no invasiva de la reserva del flujo coronario

We evaluated the feasibility of detecting blood flow in the left anterior descending coronary artery and the usefulness of measuring coronary flow reserve to diagnose significant coronary artery disease, both by means of transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent. We studied 107 patients who were scheduled for coronary arteriography for known or suspected ischemic heart disease. A Doppler signal was recorded by a pulsed wave in the distal left anterior descending artery at baseline and after dipyridamole infusion. An echo-contrast agent was administered to all patients. A coronary flow reserve equal to or higher than 1.7 was considered normal. We recorded Doppler signals in the left anterior descending coronary artery of 83 patients (78%). Significant stenosis of the left anterior descending coronary artery was observed in 24 out of 83 patients (29%). The prevalence of significant stenosis was higher (62 vs 29%; p = 0.006) in patients in which no Doppler signal was detected. The sensitivity, specificity, and accuracy of abnormal coronary flow reserve in detecting significant stenosis of the left anterior descending coronary artery were 87, 74 and 78%, respectively. The measurement of coronary flow reserve by transthoracic Doppler echocardiography using a high-frequency transducer and echo-contrast agent is a feasible, widely available, and accurate method for detecting significant stenosis of the left anterior descending coronary artery.

Asymptomatic celiac and superior mesenteric artery stenoses are more prevalent among patients with unsuspected renal artery stenoses

The prevalence of unsuspected renal artery stenosis among patients with peripheral vascular disease has been reported to be as high as 40%, but the prevalence of asymptomatic celiac and superior mesenteric artery stenoses in these patients is not known. The biplane aortograms of 205 male patients who were military veterans and had aneurysms or occlusive disease were independently reviewed, and medical records were studied to determine associated coronary disease, risk factors, and patient outcome. Fifty-six patients (27%) had a 50% or greater stenosis in the celiac or superior mesenteric artery, and seven patients (3.4%) had significant stenoses in both mesenteric arteries. Patients with celiac or superior mesenteric artery stenoses were older (p = 0.002) and had a higher prevalence of hypertension (p = 0.029) than those without significant mesenteric stenoses. Fifty of the 205 patients had significant renal artery stenoses, and 20 had advanced (greater than 75% diameter loss) renal stenoses. Ten of the 20 patients (50%) with advanced renal stenoses had a concomitant celiac artery stenosis, compared to 40 of the 185 patients (22%) who did not have advanced renal stenoses (p = 0.011). In the present study asymptomatic celiac or superior mesenteric artery stenoses were common among male veterans evaluated for peripheral vascular disease, but the prevalence of significant stenoses in both the celiac and superior mesenteric arteries was low. The prevalence of significant celiac stenosis was higher in patients with advanced (greater than 75%) renal artery stenoses who might be considered for prophylactic renal revascularization. Lateral aortography with evaluation of the celiac artery is always appropriate in these patients.