Proximal Coronary Artery Research Articles

Interventional Applications for an Ostial Protection Guidewire-The WALPO Technique.

Coronary atherosclerotic lesions at the ostium and proximal coronary arteries pose significant challenges in percutaneous coronary interventions (PCI), especially in the left main coronary artery (LMCA). Guide catheter-induced damage can lead to severe complications such as vessel dissection or myocardial infarction. Ostial stent placement with drug-eluting stents offers mechanical support and reduces restenosis but is technically challenging due to the anatomical complexity of the ostium. Complications like longitudinal stent deformation and hydraulic dissection from contrast media are specific concerns. The aortic free-floating wire technique, expanded in this article to Wire in Aorta for Localization and Protection of the Ostium (WALPO), provides a method for safely locating and protecting the ostium during PCI, aiming to improve the safety and efficacy of PCI at this location.

Intracoronary ECG ST-segment shift remission time during reactive myocardial hyperemia: a new method to assess hemodynamic coronary stenosis severity.

Fractional flow reserve (FFR) measurements are recommended for assessing hemodynamic coronary stenosis severity. Intracoronary ECG (icECG) is easily obtainable and highly sensitive in detecting myocardial ischemia due to its close vicinity to the myocardium. We hypothesized that the remission time of myocardial ischemia on icECG after a controlled coronary occlusion accurately detects hemodynamically relevant coronary stenosis. This retrospective, observational study included patients with chronic coronary syndrome undergoing hemodynamic coronary stenosis assessment immediately following a strictly 1-min proximal coronary artery balloon occlusion with simultaneous icECG recording. icECG was used for a beat-to-beat analysis of the ST-segment shift during reactive hyperemia immediately following balloon deflation. The time from coronary balloon deflation until the ST-segment shift reached 37% of its maximum level, i.e., icECG ST-segment shift remission time (τ-icECG in seconds), was obtained by an automatic algorithm. τ-icECG was tested against the simultaneously obtained reactive hyperemia FFR at a threshold of 0.80 as a reference parameter. From 120 patients, 139 icECGs (age, 68 ± 10 yr old) were analyzed. Receiver operating characteristic (ROC) analysis of τ-icECG for the detection of hemodynamically relevant coronary stenosis at an FFR of ≤0.80 was performed. The area under the ROC curve was equal to 0.621 (P = 0.0363) at an optimal τ-icECG threshold of 8 s (sensitivity, 61%; specificity, 67%). τ-icECG correlated inversely and linearly with FFR (P = 0.0327). This first proof-of-concept study demonstrates that τ-icECG, a measure of icECG ST segment-shift remission after a 1-min coronary artery balloon occlusion accurately detects hemodynamically relevant coronary artery stenosis according to FFR at a threshold of ≥8 s.NEW & NOTEWORTHY Invasive hemodynamic measurements are recommended by the current cardiology guidelines to guide percutaneous coronary interventions in the setting of chronic coronary syndrome. However, those pressure-derived indices demonstrate several theoretical and practical limitations. Thus, this study demonstrates the accuracy of a novel, pathophysiology-driven approach using intracoronary ECG for the identification of hemodynamically relevant coronary lesions by quantitatively assessing myocardial ischemia remission.

THE EFFECTIVENESS OF STEM CELL THERAPY IN MYOCARDIAL INFARCTION REVIEWED FROM UREUM, CREATININE AND KIDNEY HISTOPATHOLOGY LEVELS

This study aims to study the effectiveness of single placental stem cell therapy or cardiomyocyte combination in pigs experiencing myocardial infarction in terms of urea, creatinine and kidney organ histopathology values. A total of 9 pigs were divided int o three groups: without therapy (K1), single placental stem cell therapy (K2), and cardiomyocyte coculture combination therapy (K3). All pigs underwent circumflex artery ligation of the proximal coronary artery branch to stimulate cardiac ischemia and therapy was given after myocardial infarction and ST-elevation were formed. The pigs were then treated for eight weeks, euthanized and necropsied for kidney organ removal. The re sults showed a significant decrease in urea and creatinine values (P0.05) in K2 and K3 as compared to K1. Histopathology results showed a decrease in glomerular atrophy values (K2: 10.26±0.93 and K3: 12.44±1.21), tubular necrosis (K2: 13.67±3.76 and K3: 17.23±0.55), and tubular dilation (K2: 16.36±1.26 and K3: 18.03±1.76) and these values were significantly different than those observed in K1. It was concluded that the administration of placental stem cell therapy or combined with cardiomyocyte coculture could reduce urea, creatinine values, and improve kidney tissue histopathologically.

Artificial Intelligence Prediction of Cardiovascular Events Using Opportunistic Epicardial Adipose Tissue Assessments From Computed Tomography Calcium Score

BackgroundRecent studies have used basic epicardial adipose tissue (EAT) assessments (eg, volume and mean Hounsfield unit [HU]) to predict risk of atherosclerosis-related, major adverse cardiovascular events (MACEs). ObjectivesThe purpose of this study was to create novel, hand-crafted EAT features, “fat-omics,” to capture the pathophysiology of EAT and improve MACE prediction. MethodsWe studied a cohort of 400 patients with low-dose cardiac computed tomography calcium score examinations. We purposefully used a MACE-enriched cohort (56% event rate) for feature engineering purposes. We divided the cohort into training/testing sets (80%/20%). We segmented EAT using a previously validated, deep-learning method with optional manual correction. We extracted 148 initial EAT features (eg, morphologic, spatial, and HU), dubbed fat-omics, and used Cox elastic-net for feature reduction and prediction of MACE. Bootstrap validation gave CIs. ResultsTraditional EAT features gave marginal prediction (EAT-volume/EAT-mean-HU/BMI gave C-indices 0.53/0.55/0.57, respectively). Significant improvement was obtained with the 15-feature fat-omics model (C-index = 0.69, test set). High-risk features included the volume-of-voxels-having-elevated-HU-[-50,-30-HU] and HU-negative-skewness, both of which assess high HU values in EAT, a property implicated in fat inflammation. Other high-risk features include kurtosis-of-EAT-thickness, reflecting the heterogeneity of thicknesses, and EAT-volume-in-the-top-25%-of-the-heart, emphasizing adipose near the proximal coronary arteries. Kaplan-Meyer plots of Cox-identified, high- and low-risk patients were well separated with the median of the fat-omics risk, with the high-risk group having an HR 2.4 times that of the low-risk group (P < 0.001). ConclusionsPreliminary findings indicate an opportunity to use finely tuned, explainable assessments on EAT for improved cardiovascular risk prediction.

Combined Computed Coronary Tomography Angiography and Transcatheter Aortic Valve Implantation (TAVI) Planning Computed Tomography Reliably Detects Relevant Coronary Artery Disease Pre-TAVI.

Background: Before surgical or transcatheter aortic valve implantation (TAVI), coronary status evaluation is required. The role of combined computed coronary tomography angiography (cCTA) and TAVI planning CT in this context is not yet well elucidated. This study assessed whether relevant proximal coronary disease requiring coronary revascularization can be safely detected by combined cCTA and TAVI planning CT, including CT-derived fractional flow reserve (FFR) calculation in patients with severe aortic stenosis. Methods: This study analyzed patients with successful cCTA combined with TAVI planning CT using a 128-slice dual-source scanner. The detection via cCTA of relevant left main stem stenosis (>50%) or proximal coronary artery stenosis (>70%) was compared to invasive coronary angiography (ICA). Results: This study comprised 101 consecutive TAVI patients with a median age of 83 [77-86] years, a median STS score of 3.7 [2.4-6.1] and 54% of whom had known coronary artery disease. Of 15 patients with relevant coronary stenoses, 14 (93.3%) were detected with cCTA, while false positive results were found in 25 patients. Only in patients with previous percutaneous coronary stent implantation (PCI) were false positive rates (11/29) increased. In the subgroup without previous PCI, an improved classification performance of 87.5%, being mainly due to 11.1% false positive classifications, led to a negative predictive value of 98.5%. Conclusions: Combined cCTA and CT-FFR with TAVI planning CT via state-of-the-art scanners and protocols as a one-stop shop can replace routine ICA in patients prior to TAVI due to its safe detection of relevant coronary artery stenosis, although diagnostic performance of cCTA is only reduced in patients with coronary stents.

Depth Of Myocardial Bridging At Left Anterior Descending Artery On Coronary Computed Tomography Angiography Associated With High-risk Plaque Of Proximal Coronary Artery Segment

Depth Of Myocardial Bridging At Left Anterior Descending Artery On Coronary Computed Tomography Angiography Associated With High-risk Plaque Of Proximal Coronary Artery Segment

Role of NOD1 in atrial myopathy associated with heart failure

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Funding: Spanish Ministry of Economy and Competitiveness and the European Regional Development Fund (ISCIII [PI17/01344 and PI20/01482]), Ministry of Education (FPU19/01973), SEC, Proyecto Traslacional 2019, FEDER, FSE, CIBER-CV, a network funded by ISCIII Introduction Heart failure (HF) is a complex syndrome that constitutes one of the leading causes of cardiovascular death worldwide. Although multifactorial mechanisms appear to be responsible of atrial and ventricular HF-myopathy, the innate immune system and the derived inflammatory response have gained much attention in the last years. Previous studies from our group have demonstrated that the nucleotide-binding oligomerization domain 1 (NOD1), a receptor of the innate immune system, plays a role in HF left ventricular (LV) dysfunction. However, its role in HF-atrial myopathy remains completely unknown. The main purpose of our study is to determine the role of NOD1 in human and experimental HF-atrial myopathy. Methods and Results The study was performed in two cohorts of individuals who underwent heart valve repair surgery, 51 non-failing individuals (NF) with LV ejection fraction (LVEF)&amp;gt;50% and NT-ProBNP levels&amp;lt;200pg/mL and 41 subjects with medium to severe reduced EF (HF)&amp;lt;50% and NT-ProBNP levels&amp;gt;200pg/mL. An informed consent was signed by all patients. Atrial myocardial tissue was excised from the atrial appendage and prepared for biochemical and histological studies. Echocardiography analysis showed that left and right atrial areas (LA and RA) were significantly increased in the HF group compared to NF, while LA and RA reservoir functions were significantly decreased in HF. Immunostaining demonstrated NOD1 location in atrial cardiomyocytes, being the protein levels of NOD1 and its specific adaptor RIP2 significantly increased in atrial tissue obtained from HF vs. NF. Although the prevalence of atrial fibrillation (AF) was significantly higher in the HF group compared to NF, the upregulation of NOD1 was not conditioned by the presence of AF. Similarly, pigs that underwent transverse aortic constriction (TAC) or proximal left circumflex coronary artery occlusion involving the LA branch (LAI), showed an upregulation of NOD1 pathway in atrial tissue, compared with the sham operated animals. Interestingly, an atrial upregulation of NOD1 axis was also observed in wild-type TAC mice, whereas Nod1-/- knockout mice showed a prevention in both structural and functional atrial remodelling induced by TAC, mainly by a prevention of intracellular calcium mishandling in isolated atrial cardiomyocytes. Finally, wild-type mice injected i.p. for 3 days with 3.3 mg/kg with a selective activator of NOD1, showed increased structural atrial remodelling and intracellular calcium mishandling compared to the vehicle-treated group. Conclusions Our results demonstrate that NOD1 axis is upregulated in human, swine and murine atrial failing myocardium. Genetic deletion of NOD1 prevented HF-atrial structural and functional remodelling, mainly by avoiding intracellular calcium mishandling, whereas its pharmacological activation induced atrial dilation and intracellular Ca2+ mishandling. All these data uncover NOD1 as a new player in atrial HF-remodelling.

DISCONTINUING DAPT: NOT JUST A MATTER OF SCORES BUT OF INTEGRATED EVALUATION? A KEY ROLE OF IMAGING IN A COMPLEX SCENARIO

Abstract The duration of the dual antiplatelet therapy (DAPT) is a widely debated topic within the scientific community. The latest guidelines on acute coronary syndromes have supported the possibility of different therapeutic approaches tailored to patient characteristics. However, the clinical cardiologist‘s decisions are not always based on certain principles. The following case report is a practical example. Discussion: A 31–years–old man came to our attention after a resuscitated cardiac arrest due to ventricular fibrillation during a motorcycle race. His history was characterized by a previous acute myocardial infarction at the age of thirteen due to a traumatic dissection of the proximal left anterior descending (LAD) coronary artery and ascending aorta treated conservatively, with residual transmural necrosis of the mid and subendocardial anterior wall on cardiac MRI. At the admission, ECG showed ST–segment elevation in the anterior leads. Coronary angiography revealed occlusion of the proximal LAD coronary artery, treated with drug–eluting stent (ONYX 5.0 mm), with evidence of dissection and aneurysmal wall of that segment. The patient started a DAPT with aspirin and prasugrel. At discharge, echocardiogram evidenced a moderate left ventricular dysfunction (ejection fraction 34%) with signs of anterior and apical necrosis. Later, the patient was admitted for a subcutaneous defibrillator implantation, due to persistent moderate ventricular dysfunction. One year after revascularization, a lifelong DAPT strategy with downgrading to clopidogrel was considered the best choice for the following considerations: the young age of the patient, the low bleeding risk (PRECISE DAPT score 8), a not elevated DAPT score (value 2), the revascularization in the aneurysmal segment without an appropriate stent apposition (due to absence of a right sizing) and the previous dissection with sign of partial thrombosis at coronary CT. Conclusions: The anatomical complexity of angioplasty procedures and the delicate balance between ischemic and thrombotic risks have led to continuously evolving therapeutic strategies. The clinical scores currently available cannot often account for complex coronary anatomy. Thus, it‘s essential to consider a personalized approach, individualized on clinical and imaging characteristics, that encompasses ischemic and bleeding risk and procedural data for the appropriate treatment for each patient.

Coronary artery morphometrics in Indians – An optical coherence tomography perspective

Abstract BACKGROUND: The diameter of the coronary artery is an important predictor of prognosis and long-term outcome after percutaneous coronary interventions. There are very limited data available about coronary artery dimensions in an Indian population. AIMS: The aim is to study the normal dimensions of the coronary artery segments in Indians without coronary artery disease using optical coherence tomography and to compare the dimensions in Indians with Western. METHODS: Two hundred patients who have undergone coronary angiography with an entirely normal coronary angiogram were included in our study. RESULTS: This study showed the diameter of vessels in males and females when taken together, the left main was larger in size, followed by the proximal left anterior descending, proximal right coronary artery, and proximal left circumflex, respectively. When the vessel diameter was indexed to body surface area (BSA), there was no statistical difference between males and females (P &gt; 0.05). The computed value of proximal coronary artery diameter unadjusted for individual BSA, when compared to Caucasians, showed that Caucasians have larger coronary artery dimensions than Indians. However, when the proximal vessel diameter was indexed to BSA, there was no statistically significant difference between Indians and Caucasians (P &gt; 0.05). CONCLUSIONS: We found that coronary artery size when indexed to BSA is not statistically different in Indian males and females and compared to Caucasians. However, with a smaller body habitus, Indians have smaller coronary arteries.

Effects of Coronary Stenosis on Coronary Vascular Impedance

Introduction: The impedance analysis for circulation system is a powerful tool to comprehensively measure the afterload of the entire circulation system. The spectrum of vascular mechanical parameters derived from the impedance analysis can reveal the compliance and resistance changes in proximal and distal vessels, as well as the wave reflections. However, the similar investigation in the opposition of the coronary circulation is limited, and it is unknown how coronary stenosis affects the vascular impedance of the coronary circulation. In this study, we aimed to quantify and compare the changes in the vascular impedance of coronary circulation from the dynamic pressure and flow relations in healthy and patients with stenosis. Method: The pressure and flow rate waveforms from the main coronary artery were obtained from a lumped-parameter computational model that coupled the systemic circulation with the coronary perfusion within a closed system. Both healthy and diseased (coronary stenosis) pressure-flow relations were examined. A Fourier transform was performed to analyze the pressure and flow data, and the resistance (Z0), characteristic impedance (ZC), wave reflections (RW), total arterial compliance (C), and other hemodynamic parameters were derived. Results: Compared to the healthy subject, the diseased subject presented an increased resistance (Z0 was elevated from 0.44 mmHg ▪ min/ml to 0.59 mmHg ▪ min/ml), increased characteristic impedance (ZC was elevated from 0.07 mmHg ▪ min/ml to 0.14 mmHg ▪ min/ml), and reduced wave reflection (RW was decreased from 0.72 to 0.6). These changes indicate elevated distal arteries and arterioles narrowing and proximal artery stiffening in the entire coronary vasculature. Moreover, the coronary flow and the total arterial compliance (stroke volume divided by pulse pressure) were reduced with the disease progression. These data suggest a reduced coronary perfusion and stiffening of the artery in the coronary circulation. Discussion: The impedance analysis has been widely used for systemic and pulmonary circulations previously to quantify the total afterload of the left and right ventricles, respectively. The distribution of the impedance in different frequencies reflects the anatomical and mechanical properties of the vasculature in the circulation system. This study originally found that the coronary artery impedance is altered by coronary stenosis. The key characteristics include the narrowing of distal coronary arteries and stiffening of proximal coronary arteries. However, since both proximal and distal arteries are altered, the wave reflection was reduced, and this may explain a reduced pulse pressure observed in the diseased subject. The reduction in overall coronary perfusion indicates an impaired blood supply to the ventricle and may be responsible for the dysfunction of the heart. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

ELECTROCARDIOGRAPHY PATTERNS IN PATIENTS WITH PROXIMAL LEFT ANTERIOR DESCENDING CORONARY ARTERY STENOSIS

Background: Stenosis of proximal left anterior descending coronary artery presents with diverse electrocardiographic patterns. This study aimed to determine different types of ECG changes and their frequency in patients with proximal left anterior descending coronary artery stenosis. Methods: This descriptive cross-sectional study was conducted at the Department of Cardiology, College of Medical Sciences, Bharatpur from Ist June 2023 to 30 October 2023. Patients who underwent coronary angiography and had proximal left coronary artery stenosis were included in the study. Total 80 such patients were evaluated. Electrocardiographic changes in these patients was noted. Proximal left anterior descending coronary artery stenosis was independent variable and ECG changes were dependent variables. The ECG changes were ST elevations in leads I, aVL and precordial leads V1-V6, ST elevations in V1-V6, De Winter’s T-wave pattern, acute LBBB and Wellen’s Syndrome. Frequency of varying electrocardiographic changes in proximal left anterior descending coronary artery stenosis was evaluated. Results: Electrocardiographic analysis of proximal left anterior descending artery revealed diverse patterns. 37.5% (n=25) had ST elevations in leads I, aVL and V1-V6. 25% (n=20) had ST elevations in V1-V6. De Winter’s T-wave pattern was seen in 16.25% (n=13) patients. Left bundle branch block was present in 15% (n=12). A Wellen’s Syndrome was present in 12.5% (n=10). Conclusions: Proximal LAD artery stenosis reveals significant diversity in ECG patterns.

Evaluation of post-dilatation on longitudinal stent deformation and postprocedural stent malapposition in the left main artery by optical coherence tomography (OCT): an in vitro study

BackgroundThe diameter of the ostial and proximal left main coronary artery can be greater than 5.0 mm. However, the diameters of the mostly available coronary drug-eluting stents (DESs) are ≤ 4.0 mm. Whether high-pressure dilatation can increase the diameter of stents from 4.0 to 5.0 mm and whether post-dilatation leads to longitudinal stent deformation (LSD) of 4.0-mm-diameter stents have rarely been studied. Therefore, this study aims to evaluate LSD and stent malapposition of six types of commercially available 4.0-mm-diameter stents in China in a 5.0-mm-diameter artificial blood vessel model by optical coherence tomography (OCT) in vitro.MethodsThe left main coronary artery was simulated by a truncated cone-shaped silicone tube. The internal diameters were 4.0 mm at one end of the silicone tube and 5.0 mm at the other end. Six different types of coronary stents widely used in China were selected for this study. Each stent was respectively implanted into the simulated blood vessel and dilated to a diameter of 4.2 mm according to the stent-balloon pressure compliance table. The stents were subjected to post-dilatation with a 5.0 × 15-mm noncompliant balloon. The LSD ratio of the longitudinal axis of each stent and stent malapposition were measured through OCT, and any fractures of the stents were determined.ResultsNone of the six types of stents fractured following post-dilatation. The longitudinal axes of the BuMA and Excrossal stents were slightly shortened, while the other stents were elongated after high-pressure post-dilatation. All stents expanded to a diameter of 5.0 mm without incomplete stent apposition, except for the Nano Plus stent, which remained malapposed after high-pressure post-dilatation.ConclusionAll 4.0-mm-diameter stents can be expanded to a diameter of 5.0 mm by noncompliant balloon post-dilatation without stent strut fracture. Most stents were found to be well apposed after high-pressure post-dilatation. However, LSD was observed after post-balloon dilatation. Stent malapposition might be positively correlated with the percentage change in stent length.

Effects of guiding catheter on franctional flow reserve and non-hyperemic pressure ratios for the assessment of coronary artery stenoses

Abstract Aims Non-hyperemic pressure-derived Indexes (NHPI) provide diagnostic efficacy equivalent to fractional flow reserve (FFR) to guide percutaneous coronary interventions. In the Disengage (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) registry, selective decannulation of the guiding catheter (GC) within the coronary ostium during FFR assessment was associated with a significant overall decrease in FFR, particularly when the stenosis was located in the proximal and middle coronary segments. So far it is unclear what influence the selective cannulation of the catheter in the coronary artery ostium has on the NHPI. This prospective registry aimed to evaluate the influence of GC engagement within the coronary ostium on FFR and NHPI values. Methods and results In the DISENGAGE@Rest (Determination of Fractional Flow Reserve in Intermediate Coronary Stenosis With Guiding Catheter Disengagement) 133 patients with 164 intermediate coronary artery stenoses (40-90%) were enrolled. We evaluated: 1) the impact of GC engagement within the coronary ostium on FFR and NHPI values; 2) implications for clinical decision making; 3) the relationship between coronary physiology indices and study site (proximal, middle and distal coronary segments). Disengagement of GC was associated with a significant decrease in FFR (FFReng, 0.85±0.07 vs. FFRdis, 0.83±0.07; p&amp;lt; .001), Pd/Pa (Pd/Paeng, 0.94±0.05 vs. Pd/Padis, 0.93±0.05; p&amp;lt; .001) and RFR values (RFReng, 0.91±0.07 vs. RFRdis, 0.90±0.07; p= .018). This significant decrease in invasive physiologic indexes was driven by a significant increase in mean Pa value (Pa eng, 93±15 mm Hg vs. Pa dis, 97±15 for FFR; P &amp;lt; .001; Pa eng, 94±15 mm Hg vs Pa dis, 96±15 for Pd/Pa; P &amp;lt; .001 Pa eng, 95±15 mm Hg vs Pa dis, 97±15 for RFR; P &amp;lt; .001), without changes in mean Pd value. In 24 (15%), 12 (7%) and 17 (10%) lesions, FFR, RFR and Pd/Pa values, respectively, shifted below the cut-off point after GC disengagement with changes in clinical decision-making. There was a significant FFR change, but no NHPI, across different segments (ΔFFReng–FFRdis proximal 0.04±0.03 vs. ΔFFReng–FFRdis middle 0.02±0.02 vs. ΔFFReng–FFRdis distal 0.03±0.04; p= .018). Conclusions The results confirm a significant overall decrease in FFR after GC disengagement and extend this to Pd/Pa and RFR. In case of proximal coronary artery disease, GC disengagement should be performed in order not to underestimate the hemodynamic significance of the lesion under examination.

Abstract 14730: The Effect of Electronic Cigarette Exposure With Nicotine on Expression of Inflammatory Genes and Blood Parameters in a Chronic Myocardial Infarction Model

Background: There are no data available regarding the effects of chronic electronic cigarette (eC) exposure on inflammatory gene expressions after myocardial infarction (MI) and whether eC could alter blood counts and chemistries in this setting. We determined the effect of eC on expression of genes for inflammatory cytokines and receptors and blood parameters during the healing phase of MI. Methods and Results: Sprague Dawley rats of either sex were subjected to a proximal left coronary artery occlusion to induce a large anterior wall MI. At 1 week, rats were randomized to exposure to air or E-cig with nicotine (eC Nic + ) for 12 weeks. After 12 weeks of exposure, rat inflammatory cytokine and receptor PCR array was performed (n=4 in each group). The data showed 70 out of 84 inflammatory-related genes were downregulated in the eC Nic+ group versus the air group and 11 downregulated genes reached a significant difference. Interleukin 6 (IL6), Tumor necrosis factor superfamily (TNF), Chemokine (C-C motif) ligand 12 (Ccl12), and C-X-C Motif Chemokine Receptor 3 (Cxcr3) gene expressions were significantly decreased by -6.49 fold, p=0.0048, -2.63 fold, p=0.0227, -2.71 fold, p=0.0146, and -2.28 fold, p=0.0067, respectively, in the eC Nic+ group vs air group. The rats in eC Nic+ group had significantly decreased white blood cell (WBC), lymphocyte and platelet count compared to the air group (Figure). Conclusions: Exposure to eC Nic+ alters the expression of inflammatory genes and decreases blood immune cells during the healing phase of MI. Our findings suggest that chronic inhalation of e-cigarette aerosols can suppress the immune and inflammatory response in the already compromised setting of MI.

Abstract 13361: The Effect of Electronic Cigarette Exposure on Flow Mediated Vasodilation and LV Remodeling in a Chronic Myocardial Infarction Model

Introduction: There is little information about the effect of electronic cigarette (e-C) exposure on the cardiovascular system in the setting of myocardial infarction (MI) and whether e-C’s could alter vascular or cardiac function during the healing phase of MI. We determine the effect of e-C on endothelial function, cardiac remodeling and function during the healing phase of MI. Methods: Sprague Dawley rats (both sexes) were anesthetized and subjected to a proximal left coronary artery occlusion to induce a large anterior wall MI. At one week, rats were randomized to receive either 12 weeks of exposure to purified air (n=37) or e-cig vapor plus 15 mg/ml of nicotine (e-Cn=32). At 12 weeks endothelial function was tested by assessing femoral artery diameter and blood flow following a 5- minute femoral artery occlusion and reperfusion (ultrasound and flow probe). Cardiac function was assessed by echocardiography; remodeling was also assessed by quantitative histologic analysis. Results: Baseline blood flow in the femoral artery did not differ between groups, but peak reperfusion blood flow was blunted in the e-Cn group (1.59 ± 0.15 ml/min) vs. the air group (2.11 ± 0.18 ml/min; p=0.034). Femoral artery diameter after reperfusion was narrower in the e-Cn group (0.54 ± 0.02mm) compared to the air group (0.60 ± 0.02mm; p=0.023). Postmortem left ventricular (LV) volumes were similar in the e-Cn (0.69 ± 0.04 ml) and air groups (0.73 ± 0.04 ml; p=NS); and myocardial infarct expansion index did not differ between groups (1.4 ± 0.1 in e-Cn group versus 1.3 ± 0.1 in air group; p=NS). Gross pathology LV wall thickness was greater in the e-Cn group (1.38 ± 0.12 mm) versus the air group (1.04 ± 0.10 mm) despite no increase in blood pressure at 12 weeks in the e-CN group. LV fractional shortening by echo did not differ between groups at 12 weeks (e-Cn at 29 ± 2% and air at 27 ± 1%; p=NS). Conclusion: Exposure to e-Cn during the healing phase of MI was associated with altered endothelial function with reduced femoral artery blood flow and diameter at reperfusion, but not with worsened LV dilation or worsened cardiac function. E-Cn did increase gross pathologic LV wall thickness. E-Cn exposure during the healing phase of MI has deleterious effects on the CV system but does not dilate the LV.

Super-resolution deep learning reconstruction at coronary computed tomography angiography to evaluate the coronary arteries and in-stent lumen: an initial experience

A super-resolution deep learning reconstruction (SR-DLR) algorithm trained using data acquired on the ultrahigh spatial resolution computed tomography (UHRCT) has the potential to provide better image quality of coronary arteries on the whole-heart, single-rotation cardiac coverage on a 320-detector row CT scanner. However, the advantages of SR-DLR at coronary computed tomography angiography (CCTA) have not been fully investigated. The present study aimed to compare the image quality of the coronary arteries and in-stent lumen between SR-DLR and model-based iterative reconstruction (MBIR). We prospectively enrolled 70 patients (median age, 69 years; interquartile range [IQR], 59–75 years; 50 men) who underwent CCTA using a 320-detector row CT scanner between January and August 2022. The image noise in the ascending aorta, left atrium, and septal wall of the ventricle was measured, and the signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) in the proximal coronary arteries were calculated. Of the twenty stents, stent strut thickness and luminal diameter were quantitatively evaluated. The image noise on SR-DLR was significantly lower than that on MBIR (median 22.1 HU; IQR, 19.3–24.9 HU vs. 27.4 HU; IQR, 24.2–31.2 HU, p < 0.01), whereas the SNR (median 16.3; IQR, 11.8–21.8 vs. 13.7; IQR, 9.9–18.4, p = 0.01) and CNR (median 24.4; IQR, 15.5–30.2 vs. 19.2; IQR, 14.1–23.2, p < 0.01) on SR-DLR were significantly higher than that on MBIR. Stent struts were significantly thinner (median, 0.68 mm; IQR, 0.61–0.78 mm vs. 0.81 mm; IQR, 0.72–0.96 mm, p < 0.01) and in-stent lumens were significantly larger (median, 1.84 mm; IQR, 1.65–2.26 mm vs. 1.52 mm; IQR, 1.28–2.25 mm, p < 0.01) on SR-DLR than on MBIR. Although further large-scale studies using invasive coronary angiography as the reference standard, comparative studies with UHRCT, and studies in more challenging population for CCTA are needed, this study’s initial experience with SR-DLR would improve the utility of CCTA in daily clinical practice due to the better image quality of the coronary arteries and in-stent lumen at CCTA compared with conventional MBIR.

Circumflex coronary artery revascularization at the proximal atrioventricular groove

Proximal circumflex coronary artery in the atrioventricular groove usually has large diameters. Arterial diameters in this region vary from 2.5 to 5 mm. Revascularization of this part of the circumflex artery allows good distal anastomosis configuration and better long-term patency rate.

Diagnostic value of coronary flow acceleration measured by transesophageal echocardiography in coronary artery bypass graft surgery

Background: Transesophageal echocardiography as a method of intraoperative coronary flow assessment is largely unstudied.Objective: To evaluate the potential of intraoperative transesophageal echocardiography in diagnosing proximal coronary artery stenoses, to reveal the correlation between stenoses found on coronary angiography and coronary flow velocity in the corresponding area measured by intraoperative transesophageal echocardiography, and to study how coronary flow velocity changes before and after coronary artery bypass graft surgery and how it is related to postoperative myocardial injury.Methods: Our prospective cohort study included 186 patients scheduled for coronary artery bypass graft surgery. All the patients underwent intraoperative transesophageal echocardiography: coronary flow velocity was measured in the area of its acceleration (proximal parts of the left coronary artery) before and after the surgery. Troponin I was measured on the first postoperative day.Results: The areas of accelerated coronary flow before the procedure were detected in the left main coronary artery (88 patients, 47.3%), left anterior descending artery (146 patients, 78.5%), and left circumflex artery (28 patients, 15.1%). ROC analysis showed that coronary flow velocity of &gt;73 cm/s in the left main coronary artery and of &gt;91 cm/s in the left circumflex artery was associated with a stenosis of 50% and 70% in the respective arteries measured by coronary angiography. Furthermore, an increase in coronary flow velocity in the left anterior descending artery or its decrease by 4 cm/s after coronary artery bypass graft surgery are predictors of a 10-fold increase in troponin I concentration in the postoperative period.Conclusion: Coronary flow velocity assessment during intraoperative transesophageal echocardiography can offer added value in detecting clinically significant coronary artery stenoses, while assessment of changes in velocity may predict perioperative myocardial injury. Received 16 January 2023. Revised 16 May 2023. Accepted 31 August 2023. Funding: The study did not have sponsorship. Conflict of interest: The authors declare no conflict of interest. Contribution of the authorsConception and study design: S.M. Efremov, M.A. Novikov, A.V. ZagatinaData collection and analysis: S.M. Efremov, M.A. Novikov, A.A. Trofimov, A.V. ZagatinaStatistical analysis: S.M. Efremov, A.A. TrofimovDrafting the article: S.M. Efremov, A.A. TrofimovCritical revision of the article: S.M. Efremov, M.A. Novikov, A.A. Trofimov, D.V. Shmatov, M.S. Kamenskih, A.V. ZagatinaFinal approval of the version to be published: S.M. Efremov, M.A. Novikov, A.A. Trofimov, D.V. Shmatov, M.S. Kamenskih, A.V. Zagatina

Extrinsic Compression of the Whole Proximal Left Coronary Artery Presenting as Acute Coronary Syndrome

Extrinsic Compression of the Whole Proximal Left Coronary Artery Presenting as Acute Coronary Syndrome

Effectiveness of Pre-TAVR CTA as a Screening Tool for Significant CAD Before TAVR

BackgroundComputed tomography angiography (CTA) and invasive coronary angiography (ICA) are routinely performed before transcatheter aortic valve replacement (TAVR) to assess aortic root anatomy and screen for coronary artery disease (CAD), respectively. ObjectivesThis study explored the efficacy of CTA as a screening tool for significant proximal CAD before TAVR. MethodsWith proper ethical oversight, patients undergoing TAVR at Cleveland Clinic with a preprocedural CTA and invasive coronary angiography (ICA), and no prior percutaneous intervention, were identified from 2015 to 2021. Blinded to ICA results, the authors reviewed the left main, proximal left anterior descending coronary artery, proximal left circumflex coronary artery, and proximal right coronary artery by CTA coronary reconstruction to assess for nonsignificant stenosis (0% to 49%), moderate stenosis (50% to 69%), and severe stenosis (≥70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen Kappa statistic were analyzed. Results2,217 patients (53.4% male, age 79.2 ± 8.5 years) met inclusion criteria. CTA evaluation revealed a sensitivity of 90%, specificity of 92%, PPV of 74%, and NPV of 97% for detecting ≥50% stenosis. Using a ≥70% stenosis cutoff, evaluation revealed a sensitivity of 91%, specificity of 97%, PPV of 83%, and NPV of 99%. Assessment of bypass graft patency revealed a sensitivity of 86%, specificity of 97%, PPV of 84%, and NPV of 98%. Cohen Kappa analysis indicated substantial to near perfect agreement between pre-TAVR CTA and ICA. ConclusionsPre-TAVR CTA has a high NPV for high-grade proximal stenosis of each coronary artery. As a result, CTA can be used as a screening tool to rule out significant proximal CAD in patients undergoing TAVR.