Severity Of Coronary Artery Disease Research Articles

Exploring the Utility of the Reynolds and Framingham Risk Stratification Models in Predicting the Presence and Severity of Coronary Artery Disease in Chinese Patients.

Coronary artery disease (CAD) is one of the leading causes of mortality and morbidity worldwide. Thus, a simple and practical method to identify it is urgently needed. This study aims to explore the correlation between the Reynolds and Framingham risk scores and the Gensini score (GS), along with their utility in predicting the presence and severity of CAD.This research represents a single-center retrospective study. A total of 13,824 Chinese patients were enrolled in our study. GS was used to assess and group the presence and severity of CAD. The Spearman rank test and the logistic regression analysis were then performed to explore the correlation between the Reynolds/Framingham risk scores and the GS. The receiver-operating characteristic curve analysis was used to evaluate the performance of the Reynolds and Framingham risk stratification models.Both the Reynolds and Framingham risk scores showed statistically significant positive correlations with the presence (r (Reynolds): 0.179; r (Framingham): 0.182) and severity (r (Reynolds): 0.232; r (Framingham): 0.259) of CAD. Both scores had statistically significant powers of predicting the presence (cut-off value [Reynolds]: 4.20%; cut-off value [Framingham]: 12.33%) and severity (cut-off value [Reynolds]: 8.94%; cut-off value [Framingham]: 20.59%) of CAD. The Reynolds risk score showed a better performance compared to the Framingham risk score for both the presence (Reynolds area under the curve (AUC): 0.649 versus Framingham AUC: 0.637 P < 0.05) and severity (Reynolds AUC: 0.656 versus Framingham AUC: 0.645 P < 0.05) of CAD.Our study suggests that the Reynolds and Framingham risk scores can be used to predict the presence and severity of CAD in the Chinese population. The Reynolds risk score showed great superiority in the women's group, while the Framingham risk score had a better performance in predicting severity as a whole.

DIEN: A dual-factor iterative enhancement network with the global Re-calibration feature for coronary artery segmentation

ObjectiveCoronary artery segmentation is a prerequisite for assessing the severity of coronary artery disease (CAD), which has a high prevalence and mortality rate. However, segmentation of the coronary arteries is challenging due to their complex anatomy diverse morphology, and small target size. MethodsThis study proposes a dual-factor iterative enhancement network (DIEN) for automatic coronary artery segmentation in coronary computed tomography angiographic (CCTA) images. The DIEN includes a dual-factor layer-by-layer iterative convolution (DLIC) module and a global recalibration feature selection (GRFS) module. The DLIC in the encoding part aims to capture diverse semantic information from coronary arteries with different morphologies based on extracting multiple features under different receptive fields. The GRFS bridges the semantic gap between the encoding and decoding parts by exploiting the global information of the slices to improve the feature representation of the coronary artery. ResultsExperiments show that the DIEN outperforms seven state-of-the-art algorithms on a variety of metrics on two datasets. On a self-collected dataset, the DIEN achieved a 1.01 %, 0.69 %, 1.91 %, and 0.63 % improvement over U-Net in IoU, dice, recall, and precision, respectively. In comparison to U-Net, the IoU, dice, recall, and precision obtained by the DIEN on the public dataset were improved by 1.03 %, 0.73 %, 0.12 %, and 0.23 %, respectively. ConclusionCompared with state-of-the-art approaches, the proposed model achieves good performance in segmenting coronary arteries both on our dataset and a publicly available dataset. Significance: Our method can accurately segment coronary arteries, and can contribute to improved diagnosis and assessment of CAD.

Circulating YKL-40 levels but not CHI3L1 or TRIB1 gene variants predict long-term outcomes in patients with angiographically confirmed multivessel coronary artery disease

YKL-40 is significantly associated with the prevalence and severity of coronary artery disease (CAD). YKL-40 levels are significantly associated with variations in the CHI3L1 and TRIB1 genes. We investigated candidate genes for YKL-40 levels and evaluated the prognostic value of this biomarker and corresponding variants for long-term outcomes in patients with CAD. We included 4664 and 521 participants from the Taiwan Biobank (TWB) and CAD cohorts, respectively. Candidate variants for circulating YKL-40 levels were investigated using genome-wide association study (GWAS) data from the TWB cohort, and the results were validated in the CAD cohort. The primary endpoint was all-cause mortality. The secondary endpoint was major adverse cardiac events (MACEs), which included the composite endpoints of all-cause mortality, nonfatal acute coronary syndrome, hospitalization for heart failure, and nonfatal stroke. According to the GWAS data from the TWB cohort, three CHI3L1 variants (rs4950928, rs10399931, and rs872129) and one TRIB1 variant (rs6982502) were independently associated with YKL-40 levels. These findings were validated in the CAD cohort. The combined CHI3L1 and TRIB1 weighted genetic risk scores (WGRSs) were not associated with the long-term outcomes (median follow-up period of 3.7 years) in patients with CAD. Conversely, patients with YKL-40 levels in the upper tertile had the highest rates of all-cause mortality and MACEs (log-rank p = 9.58 × 10−8 for all-cause mortality and 1.34 × 10−7 for MACEs). Furthermore, YKL-40 levels predicted poor clinical outcomes only in patients with multivessel CAD (log-rank p = 3.0 × 10−6 for all-cause mortality and 1.10 × 10−5 for MACEs) and not in patients with single-vessel CAD. This study revealed that YKL-40 levels but not the combined CHI3L1 and TRIB1 WGRSs were found to be independent predictors of poor clinical outcomes in patients with multivessel CAD.

Circulating RBP4 and FABP4 concentrations in patients with chronic schizophrenia are associated with increased epicardial adipose tissue volume and metabolic syndrome.

Schizophrenia has been linked to an elevated cardiovascular risk profile and premature onset of cardiovascular disease. Quantifying epicardial adipose tissue (EAT) volume provides insight into its correlation with coronary artery disease (CAD) severity and associated risk factors. Previous research indicates higher pericardial adipose tissue in individuals with schizophrenia compared to non-schizophrenic counterparts. RBP4, FABP3, and FABP4 have been implicated in CAD pathogenesis. In this study, we examined the potential increase in EAT volume in individuals with chronic schizophrenia and aimed to elucidate the relationship between circulating levels of RBP4, FABP3, and FABP4 with EAT volume and coronary artery calcium score within this cohort. We recruited 186 consecutive patients with chronic schizophrenia and utilized enzyme-linked immunosorbent assay to assess plasma concentrations of RBP4, FABP3, and FABP4. Cardiac multislice computed tomography measured EAT volume and coronary artery calcium scores. Significantly higher EAT volume in patients with chronic schizophrenia compared to controls. RBP4 associated positively with metabolic factors and EAT volumes, while FABP3 associated positively with creatinine and coronary atherosclerosis markers. FABP4 showed positive associations with metabolic factors, hypertension, and EAT volumes, but negative associations with HDL-C and eGFR. Logistic regression identified RBP4 and FABP4 as independent factors associated with increased EAT volumes, even after adjusting for known biomarkers. Both RBP4 and FABP4 were significantly associated with metabolic syndrome components and EAT volume. This study elucidates the association between chronic schizophrenia and augmented EAT volume, suggesting plausible correlations with CAD-related health complications through RBP4 and FABP4 pathways.

Sublingual glyceryl trinitrate given during adenosine sestamibi myocardial perfusion imaging causes apparent transient ischaemic dilation in a propensity-matched analysis.

Administration of sublingual glyceryl trinitrate (GTN) prior to resting radiotracer injection during myocardial perfusion imaging (MPI) has been advocated to aid detection of viable myocardium and increase the extent of reversible perfusion defects. However, GTN is also known to reduce resting left ventricular volume and could thus increase the transient ischaemic dilation (TID) ratio, independently of severe or extensive coronary artery disease. We aimed to determine if GTN administration causes an increase in the TID ratio. Causal inference using propensity score matched analysis was used to assess the effect of GTN on TID ratios in subjects undergoing adenosine sestamibi MPI. From 597 consecutive patients undergoing MPI, we selected a treatment group of 51 who received 400 μg of sublingual GTN before resting sestamibi injection and 51 propensity score matched controls. Mean TID ratios were 1.24 in treated subjects and 1.10 in controls (mean difference 0.15; 95% CI, 0.05-0.25; P = 0.0018). The mean difference in TID ratio fell progressively in each quartile of time elapsed between GTN administration and image acquisition. The proportion with TID ratios equal and greater than an abnormal threshold of 1.39 was 17.6% among the treated and 0% in controls (P = 0.0010). The effect on TID ratio was not restricted to those with moderate-to-severe stress perfusion defects or accompanied by greater reversible perfusion defects. There is evidence of a cause-and-effect relationship between administering GTN before resting sestamibi injection and increased TID ratio on MPI. This may be a source of misleading false positive TID findings.

Healthy Dietary Patterns and Lower Atherosclerosis in High-Risk Individuals.

This study investigates associations between diet patterns and the risk of intracranial atherosclerosis (ICAD) in individuals with preexisting hypertension (HTN) or myocardial infarction (MI). 676 autopsied participants (mean age at death =91.1±6.1, 71% women) of a longitudinal clinical neuropathological cohort study, with complete dietary and neuropathology data, were included. Diet scores were computed (median interval to death = 5.9 (3.0, 8.7 years). HTN and MI history was self-reported. Large vessel atherosclerosis was evaluated at the circle of Willis, and severity of intracranial atherosclerosis was assessed based on number of atherosclerotic plaques, extent of vessel involvement, and degree of vessel occlusion to create a 4-level grading system (0-3). All regression models were adjusted for age, sex, education, caloric intake, and APOE4. Of the 676 subjects, 361 (53%) had mild, 142 (21%) had moderate, and 29 (5%) had severe atherosclerosis. There was no direct relationship between diet and atherosclerosis. The relationship between ICAD and MI (OR = 1.38, 95% CI = 0.95, 2.00) showed a nonsignificant trend. HTN (OR = 1.598, 95% CI = 1.15, 2.18) was positively associated with intracranial atherosclerosis. The association of diet with intracranial atherosclerosis differed by history of MI (MIND (p=0.007), MedDiet (p=0.006)). The association between ICAD and the MIND diet also differed by whether HTN was reported (β=-0.212, SE= 0.111, p=0.055) as did the relationship between ICAD and the MedDiet (β = -0.077, SE= 0.035, p=0.029). In stratified analysis, among individuals with preexisting MI (N=130), those with a better diet had lower odds of intracranial atherosclerosis (MedDiet: OR = 0.88, 95% CI = 0.81, 0.96; MIND: OR = 0.69, 95% CI = 0.53, 0.90). A healthy dietary pattern is associated with lower odds of severe intracranial large vessel atherosclerosis in high-risk older adults. In-vivo studies of dietary habits and brain health, specifically in those at high vascular risk are needed.

Predictive value of triglyceride-glucose index for the evaluation of coronary artery disease severity and occurrence of major adverse cardiovascular events.

The triglyceride-glucose (TyG) index has been proposed as an independent predictor of coronary artery disease (CAD). In this retrospective study we further examine this association and its utility as a predictor for major adverse cardiovascular events (MACE). A total of 870 patients who underwent coronary angiography between May 2008 and June 2009 were included in this retrospective study. The TyG index was calculated using the formula Ln (fasting TG [mg/dL] × FBG [mg/dL]/2). The association of TyG index with the presence and severity of CAD, cardiovascular risk factors, and inflammatory markers was evaluated at baseline. In the longitudinal study, the multivariate adjusted Cox hazard model was used to investigate the associations of the TyG index with the occurrence of MACE during a 5-year follow-up, which was defined as endpoint. The TyG index was significantly associated with the presence and severity of CAD. Multiple linear regression analysis showed that a high TyG index, together with inflammatory markers and dyslipidemia, were independently associated with greater stenotic occlusion of coronary arteries (adjusted R2 = 0.031, p<0.001). Kaplan-Meier survival curve (free of MACE) by tertiles of the TyG index showed a higher incidence of MACE in the upper tertile (log-rank test, p = 0.02). Multivariate Cox analysis demonstrated that the risk of incident MACE during the follow-up was associated with higher levels of TyG index, even after adjusting for inflammatory parameters and cardiovascular risk factors: hazard ratio (HR), 1.54 (95% confidence interval 1.18-2.13; p<0.01). We conclude that elevated TyG index is independently associated with a higher risk of CAD and a poor prognosis for MACE.

Unveiling the Synergy of Serum Lipoprotein-Associated Phospholipase A2 and PLA2G7 Gene Polymorphism (rs1805017) as Key Determinants of Coronary Artery Disease Risk and Severity: Implications for Early Intervention

Unveiling the Synergy of Serum Lipoprotein-Associated Phospholipase A2 and PLA2G7 Gene Polymorphism (rs1805017) as Key Determinants of Coronary Artery Disease Risk and Severity: Implications for Early Intervention

Zdhhc1 deficiency mitigates foam cell formation and atherosclerosis by inhibiting PI3K-Akt-mTOR signaling pathway through facilitating the nuclear translocation of p110α

Monocyte-to-macrophage differentiation and subsequent foam cell formation are key processes that contribute to plaque build-up during the progression of atherosclerotic lesions. Palmitoylation enzymes are known to play pivotal roles in the development and progression of inflammatory diseases. However, their specific impact on atherosclerosis development remains unclear. In this study, we discovered that the knockout of zDHHC1 in THP-1 cells, as well as Zdhhc1 in mice, markedly reduces the uptake of oxidized low-density lipoprotein (ox-LDL) by macrophages, thereby inhibiting foam cell formation. Moreover, the absence of Zdhhc1 in ApoE−/− mice significantly suppresses atherosclerotic plaque formation. Mass spectrometry coupled with bioinformatic analysis revealed an enrichment of the PI3K-Akt-mTOR signaling pathway. Consistent with this, we observed that knockout of zDHHC1 significantly decreases the palmitoylation levels of p110α, a crucial subunit of PI3K. Notably, the deletion of Zdhhc1 facilitates the nuclear translocation of p110α in macrophages, leading to a significant reduction in the downstream phosphorylation of Akt at Ser473 and mTOR at Ser2448. This cascade results in a decreased number of macrophages within plaques and ultimately mitigates the severity of atherosclerosis. These findings unveil a novel role for zDHHC1 in regulating foam cell formation and the progression of atherosclerosis, suggesting it as a promising target for clinical intervention in atherosclerosis therapy.

Lymphocyte-based inflammatory markers: Novel predictors of significant coronary artery disease✰,✰✰

BackgroundLymphocyte-based inflammatory indices such as monocyte-to-lymphocyte ratio (MLR) have long been recognized as reliable coronary artery disease (CAD) predictors. More recently, novel indices like the Systemic Inflammatory Index (SII), Systemic Inflammatory Response Index (SIRI), and Systemic Immune-Inflammation Index (SIIRI) have emerged. These newer markers offer a more comprehensive assessment of inflammation by integrating multiple immune cell types, potentially enhancing the prediction of cardiovascular outcomes. ObjectivesWe evaluated the predictive value of novel inflammatory markers in estimating the pretest probability of severe CAD in high-risk patients. MethodsWe enrolled consecutive patients undergoing diagnostic coronary angiography in a single tertiary care hospital. Inflammatory markers were calculated based on pre-procedural complete blood count laboratory measurements. Severe CAD was defined as critical (>70 %) and actionable narrowing of a primary coronary artery. Classification performance was assessed using multivariate logistic regression. ResultsThe study sample included 363 patients (age 58.9± 11 years, 44.9 % females, 30 % severe CAD). In univariate analysis, MLR, SIRI, and SIIRI were significant predictors of severe CAD, with age- and sex-adjusted OR of 1.98 [1.25–3.14], 1.79 [1.24–2.59], and 1.63 [1.11–2.38], respectively. In multivariate analysis, SIRI remained an independent predictor of severe CAD (OR = 1.98, 95 % CI 1.13–3.46, p = 0.02). ConclusionOur results suggest that novel inflammatory markers derived from routine blood tests are predictive of severe CAD in high-risk patients. Such simple, practical, and cost-effective inflammatory markers may enhance cardiac risk stratification and prediction of severe CAD.

Impact of Smoking on MicroRNAs in Significant Coronary Artery Disease.

Given the importance of coronary artery disease (CAD) and the range of cardiovascular disease phenotypes in smokers, as well as the potential genetic and epigenetic factors, we were motivated to explore the impact of smoking on some selected microRNAs associated with significant CAD. A total of 60 individuals were selected in four groups including non-smoker without significant CAD (S-A-), non-smokers with significant CAD (S-A+), smokers without significant CAD (S+A-) and smokers with significant CAD (S+A+). Micro-RNA expression was investigated using real-time PCR. General linear model was used to calculate fold change (FC) considering SA- as the reference group. For mir-34a, down-regulation was observed in S+A- (FC =0.13, P =0.007) and S+A+ (FC =0.23, P =0.036) groups. For mir-126-3p, down-regulation was observed in S-A+ group (FC =0.05, P =0.024). For mir-199, up-regulation was observed for S+A- group (FC =9.38, P =0.007). The only significant interaction between pack-years of smoking and number of significantly narrowed vessels (≥75% stenosis) was for mir-199 which was in favor of down-regulation (P =0.006), while the main effects were in favor of up-regulation (P <0.05). Mir-34a expression may be affected by smoking, whereas mir-126-3p expression may be affected by atherosclerosis, the most common reason of CAD. The significant down-regulation of mir-199 for the interaction of smoking dose and severity of CAD was a notable finding showing the harmful consequence of this interaction. Further studies are needed for this micro-RNA.

Association between platelet-to-high-density lipoprotein cholesterol ratio and future stroke risk: a national cohort study based on CHARLS.

According to recent research, there is a considerable correlation between the severity of coronary artery disease and the platelet-to-high-density lipoprotein cholesterol ratio (PHR), which suggests that PHR is a potentially valuable inflammatory biomarker. However, the body of current research offers insufficiently strong evidence to clarify the connection between PHR and the incidence of stroke. Therefore, this study aims to elucidate any potential associations between PHR and stroke risk. This study employed data from the China Health and Retirement Longitudinal Study (CHARLS) covering the period from 2011 to 2018. It included 5,872 participants who did not have a history of stroke in 2011. These patients were separated into four groups according to their baseline PHR quartiles. The main goal of the study was to focus on stroke outcomes. Stroke was defined as an occurrence of a cerebrovascular accident confirmed by a physician. We employed Cox proportional hazards regression models to investigate the association between PHR and the likelihood of experiencing a stroke. Furthermore, we conducted restricted cubic spline regression analysis and subgroup analysis. The average follow-up period was 77.5 months, during which 390 participants experienced a stroke. In comparison to the lowest quartile group, participants in the highest quartile of PHR had a 49% increased risk of stroke (HR 1.49, 95% CI 1.13-1.96, p = 0.004). The adjusted multivariable Cox regression analysis maintained the statistical significance of this association (aHR 1.42, 95% CI 1.06-1.90, p = 0.019). After adjustment, a positive linear relationship between stroke risk and PHR was identified through restricted cubic spline regression analysis (nonlinear p > 0.05). Additionally, the impact of stroke was consistent across a variety of subgroups, as evidenced by subgroup analysis. Our study indicates that higher PHR levels are significantly associated with an increased risk of stroke and that these levels can be used to identify groups that are at high risk of stroke.

Abstract 4138739: Insulin Resistance as a Marker of Multivessel Coronary Artery Diseases in Patients With Cardiovascular-Kidney-Metabolic Risk: Inshight From Invasive Coronary Angiography

Background: Cardiovascular-Kidney-Metabolic (CKM) syndrome is the concept of a combined diseases, including diabetes and chronic kidney disease (CKD), to stratify patients at cardiovascular risks. However, whether CKM components and insulin resistance differ in risk for coronary artery disease (CAD) severity is unknown. Purpose: This study aimed to investigate the association of distinct CKM risks and insulin resistance with CAD severity. Methods: In this study, we included 849 patients (74% male, 69±10 years of age) who underwent coronary angiography to assess chronic CAD. We assessed CKM risks using following components: (1) BMI ≥23 kg/m 2 , (2) diabetes, (3) hypertension and dyslipidemia, and (4) CKD. According to the number of CKM risk components, patients were categorized into four groups (Group A as having 0 or 1, Group B as 2, Group C as 3, and Group 4 as 4 risks). Insulin resistance was assessed by HOMA-IR and triglyceride-glucose index (TyG index) calculated as Ln (fasting plasma glucose × triglyceride/2). Coronary artery stenosis was categorized into single-vessel or multi-vessel CAD (MVD) per AHA classification. Gensini score was calculated to assess CAD extent. Logistic regression analysis was performed to determine independent predictors of MVD among CKM risk components. Results: MVD was diagnosed in 26.3% (n = 223) patients (mean Gensini score was 58±40 points). Among the four groups, there were significant differences in age, body mass index, hemoglobin A1c levels, TyG index, HOMA-IR, and Gensini score. Compared with Group A as reference, Group C (odds ratio [OR], 1.58; 95% confidence interval [CI] 1.03–2.42) or Group D (OR, 1.75; 95%CI, 1.06–2.89) but not Group B (OR, 1.09; 95%CI, 0.70–1.71) had higher risk for MVD (Figure). In a logistic regression model adjusting for age, male, smoker, and CRP ≥2 mg/dL, independent predictor of MVD was diabetes (OR, 2.15; 95%CI,1.55–2.99; p &lt; 0.001; model 1 in Table). In addition, when adjusting for age, male, smoker, and CRP ≥2 mg/dL, HOMA-IR&gt;2.5 was an independent predictor of MVD (model 2 in Table). Similarly, TyG index, an alternative marker of insulin resistance, remained as an independent predictor of MVD (model 3 in Table). Conclusions: In chronic CAD patients who underwent coronary angiography, subgroups stratified by the CKM risk components exhibit distinctly different insulin resistance, CAD severity and risk for MVD. Insulin resistance and diabetes were independent risks for MVD in this population.

Abstract 4136463: Novel Systemic Inflammatory Biomarkers Can Predict Significant Coronary Disease in High Risk Patients

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. Chronic inflammation is a known risk factor for atherosclerosis, plaque formation, disease progression, and plaque instability. Novel inflammatory biomarkers have been recently linked to excess risk of adverse cardiovascular events, including incident myocardial infarction. Elevated inflammatory biomarkers may help identify patients at higher risk for severe CAD. Aim: This study aimed to evaluate the use of novel systemic inflammatory markers in predicting the pretest probability of severe CAD in patients referred to diagnostic coronary angiography in a single tertiary care center. Methods: This was a prospective observational cohort study enrolling consecutive patients referred to diagnostic coronary angiography in a tertiary care center. Preprocedural laboratory results were obtained from medical charts, including complete blood counts with differentials. Three novel systemic inflammatory markers were computed using existing mathematical formulas: systemic immune-inflammation index (SII = neutrophil count*platelet/lymphocyte); systemic inflammation response index (SIRI = neutrophil*monocyte/lymphocyte); and systemic immune inflammatory response index (SIIRI = neutrophil*monocyte*platelet/lymphocyte). The primary study outcome was severe CAD defined as the presence of ≥70% stenosis in one of three main coronary arteries requiring percutaneous coronary intervention). The outcome was adjudicated by an independent reviewers blinded to computations of biomarkers. Result: The sample included 264 patients (age 59.3±10.8, 47% Females). Overall, 84 patients (32%) met the primary study outcomes. In univariate analysis, those with severe CAD had significantly higher SIRI (2.9±0.7 vs. 2.6±0.6, p = 0.001) and SIIRI (8.4±0.8 vs. 8.1±0.7, p = 0.015) compared to their counterparts. In multivariate analysis adjusted for age and sex, only SIRI was an independent predictor of severe CAD. Using SIRI &gt; 20.8 (upper quartile) was associated with nearly three-fold excess risk of severe CAD (OR = 2.72, 95% CI 1.45-5.09). Conclusion: Elevated SIRI, a marker of ongoing systemic inflammatory response, could be indicative of severe CAD. As an inexpensive biomarker based exclusively on complete blood count, SIRI can be used to prioritize patients referred for diagnostic angiography and potentially expedite treatments in those at higher risk for coronary events.

Abstract 4119869: Automatic assignment of CAD-RADS categories in coronary CTA reports using large language model

Background: The effectiveness of different large language models (LLM) in extracting important information from CT angiography (CTA) radiology reports is unknown. Purpose: The Coronary Artery Disease-Reporting and Data System (CAD-RADS) is a standardized reporting system for CTA that categorizes the severity of coronary artery disease to aid in clinical decision-making. To evaluate the agreement between human readers and LLMs in assigning CAD-RADS categories based on CTA reports. Materials and Methods: This retrospective study analyzed reports from patients who underwent coronary CTA for screening or diagnosis at Johns Hopkins Hospital. Reports with CAD-RADS 0–5 findings were collected from Jan. 2020 to Oct. 2023. Initially, 6,212 CTA reports were retrieved. After excluding non-organized reports and retaining only those with CAD-RADS scores, 590 reports remained. Board-certified radiologists and three large language models (GPT-3.5, GPT-4, and Llama3) assigned CAD-RADS categories based on the original radiologists' findings. Two radiologists reviewed the CAD scores, with only one discrepancy in the 590 reports, indicating high inter-agreement. Agreement between human readers and LLMs for CAD-RADS categories was assessed using the Gwet agreement coefficient (AC1 value). Frequencies of changes in CAD-RADS category assignments that could potentially affect clinical management (CAD-RADS 0-2 vs. 3-5) were calculated and compared. Typically, CAD-RADS 0-2 indicates mild disease leading to conservative management, while CAD-RADS 3-5 denotes further testing or disease requiring aggressive intervention to prevent adverse cardiovascular events. Results: Among 590 reports, agreement between original and reviewing radiologists was almost perfect (AC1 = 0.985). Good agreement was also found between original radiologists and Llama3, GPT-3.5, and GPT-4 (AC1 = 0.861, 0.907, 0.941, respectively). Differences in CAD-RADS category upgrades/downgrades potentially affecting clinical management were observed: 0 of 590 (0%) for human readers, 56 of 590 (9.4%) for Llama3, 33 of 590 (5.5%) for GPT-3.5, and 23 of 590 (3.9%) for GPT-4 upgrading CAD-RADs; 8 of 590 (1.4%) for human readers, 19 of 590 (3.2%) for Llama3, 22 of 590 (3.7%) for GPT-3.5, and 12 of 590 (2.0%) for GPT-4 downgrading RAD-CADs. Conclusion: LLMs showed good agreement with human readers in assigning CAD-RADS categories on CTA reports. However, they were more likely to upgrade CAD-RADS category when compared to radiologists.

Abstract 4143258: Sex Differences in Health Status Outcomes: Analysis of the ISCHEMIA Randomized Clinical Trial

Background: Despite a lesser extent and severity of coronary artery disease (CAD), women had a higher burden of angina than men in the ISCHEMIA trial, suggesting that other factors may explain symptom severity in women. We aim to describe demographic and clinical characteristics, as well as differences in care patterns, associated with health status differences in women, as compared with men, in the conservative and invasive treatment groups of the ISCHEMIA trial. Methods: The ISCHEMIA trial randomized participants with moderate or severe ischemia to a routine invasive strategy of cardiac catheterization with complete revascularization plus guideline-directed medical therapy (GDMT), or an initial conservative strategy of GDMT alone with catheterization reserved for GDMT failure. Health status was a key secondary outcome. Using linear regression models we compared raw and adjusted Seattle Angina Questionnaire (SAQ) scores in women and men at baseline and at 1 year, stratified by randomized treatment strategy. Within the invasive strategy, sex differences were adjusted for completeness of revascularization among those with ≥1 coronary stenosis ≥70%. Results: Of 4,617 ISCHEMIA participants with valid SAQ data, women had lower (worse) baseline SAQ summary scores (SS) throughout follow up (Figure) after adjustment for demographics and clinical characteristics, including severity of CAD (difference 5.4 points, 95% CI 4.0-6.7). Women had lower SAQ SS after adjustment for post-randomization treatment (i.e., medical therapy, achievement of risk factor goals and, in the invasive strategy, complete revascularization), 2.4 points lower (95% CI 0.7-4.1) in the conservative group (Figure), and 1.9 points lower than in men (95% CI 0.1-3.7) in the invasive group. Findings were similar for all SAQ subscales. Conclusions: Women with chronic coronary disease in ISCHEMIA had worse health status than men at baseline and 1 year later, which was not explained by demographic or clinical characteristics, intensity of medical therapy, or completeness of revascularization.

Abstract 4138602: Effect of Left Ventricular Ejection Fraction On Computed Tomography-Derived Fractional Flow Reserve Diagnostic Accuracy For Significant Coronary Artery Disease

Background: Coronary Computed Tomography Angiography (CCTA) and CT-derived fractional flow reserve (CT-FFR) accurately assess the severity of coronary artery disease. However, the diagnostic accuracy of CT-FFR in patients with low left ventricular ejection fraction (LVEF) is unknown. Goal: Describe the per-vessel diagnostic performance of CT-FFR to detect significant coronary disease in patients with normal and reduced LVEF by echocardiogram. Methods: This was a retrospective study of 441 patients who underwent CCTA and CT-FFR at the UMass Memorial Health System between 2020 and 2023. Those with echocardiogram and invasive coronary angiography were analyzed and divided in two groups based on two-dimensional LVEF: those with LVEF &lt; 55%, and with LVEF ≥ 55%. We excluded those with prior coronary stents, incomplete CCTA, CT-FFR data due to artifacts, or poor-quality echocardiographic images. CT-FFR ≤ 0.8 was considered abnormal. Significant coronary disease by invasive angiography (reference standard) was defined as lumen stenosis ≥ 70% (left main ≥ 50%), or abnormal physiologic characteristics by FFR, resting full-cycle ratio, or instantaneous wave-free ratio. Results: 222 coronary vessels (102 patients) were analyzed. Of 102 vessels (44%) with significant coronary artery disease, 55 (53.9%) were treated with percutaneous coronary intervention, and 25 (24.5%) with coronary artery bypass grafting. Overall, CT-FFR sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 86.7% (95%CI 78.3-92.7), 75.0% (95%CI 66.4-82.3), 73.2% (95%CI 66.6-78.9), 87.7% (95%CI 81.0-92.3), and 80.1% (95%CI 74.3-85.2), respectively. 37 vessels corresponded to patients with LVEF &lt; 55%, and 185 to those with LVEF ≥ 55%. Diagnostic accuracy in both groups is seen in table 1. Conclusions: Low-normal and reduced LVEF adversely affects the diagnostic performance of CT-FFR, by reducing sensitivity, and slightly increasing specificity.

Abstract 4135746: Assessing Coronary Artery Disease Severity: Leveraging Inflammatory Markers As a Prognostic Indicators

Introduction: Cardiovascular disease continues to be the leading cause of death and a significant cause of morbidity in the United States. In recent years, there has been increased interest in the role of inflammation in predicting and modifying the risk of coronary artery disease. Of the multitude of inflammatory markers studied subsequently, two of the most easily and widely obtained is the neutrophil to lymphocyte ratio (NLR) and the monocyte to lymphocyte ratio (MLR), which can be calculated from a complete blood count with differential. Multiple retrospective studies have demonstrated that the NLR and MLR have been used to diagnose ACS, predict mortality at a year after ACS, and risk stratify patients prior to percutaneous coronary intervention. Research Question: Are the NLR/MLR useful tools in predicting the severity of coronary artery disease (CAD) in patients admitted to a tertiary medical center in Southern Nevada for ACS between 2021 and 2023? Methods: A sample of n=344 patients was used to examine the potential significance of NLR/MLR to diagnose ACS and for predicting CAD severity. Traditional diagnostic test evaluation was used for determining CAD with a ratio of NLR=3.5 + MLR=0.35 (data medians) as the cut-off value. Patient risk group status (1:low risk to 4:high risk) was used as a binary outcome to test NLR/MLR between low and high risk groups using a nonparametric MWW test of medians. Additionally, ROC analysis was used to estimate an optimized cut-off for NLR/MLR as determined by AUC. Results: Results demonstrate for predicting ACS using the median NLR, sensitivity=88.07; specificity=14.88; PPV=52.01; NPV=54.35), LR(+)=1.03 and LR(-)= 0.80, using the median MLR results showed sensitivity=87.28; specificity=14.11; PPV=50.84; NPV=52.17, LR(+)=1.01 and LR(-)= 0.90. Subpopulation analysis demonstrated a statistically significant difference in NLR between “high risk ACS” vs “Low Risk ACS” (p&lt;0.001). Examination of the ROC curve for predicting the high-risk group suggested an optimized cutoff of NLR=3.7; however, AUC was only 0.617, and sensitivity and specificity were not improved compared to using the median NLR. Conclusion: Our findings suggest that an NLR greater than 3.7 may indicate multivessel involvement or proximal/left main disease in CAD patients. However, due to its low specificity and AUC, NLR alone cannot reliably distinguish between single-vessel and multivessel CAD.

The Co-Existence of Hypovitaminosis D and Diabetes Mellitus Triples the Incidence of Severe Coronary Artery Disease in Women.

Background and Aims: Hypovitaminosis D is involved in the development and progression of atherosclerosis, and it is more prevalent in women. The differential impact of hypovitaminosis D on the severity of coronary artery disease (CAD) between genders remains poorly understood. This study aims to address this literature gap. Methods: A total of 1484 consecutive patients with acute myocardial infarction (AMI) were enrolled in the study. Hypovitaminosis D was defined as vitamin D ≤ 20 ng/mL. CAD was defined as the presence of at least one coronary vessel stenosis > 50%, while severe CAD was defined as left main disease and/or three-vessel disease > 50%. Results: The mean age of the cohort was 66.3 (11.5) years, with a predominance of the male gender (71.8%). Vitamin D values were significantly lower in women than in men (15.7 [8.4-25.4] ng/mL vs. 17.9 [11-24.3] ng/mL, p = 0.01). A higher prevalence of severe CAD was observed in female patients with hypovitaminosis D compared to those without (33% vs. 19%, p < 0.01). This finding was not observed in men. Among women, hypovitaminosis D significantly increased the risk of severe CAD (OR: 1.85, p = 0.01), together with diabetes mellitus (DM) and older age, adjusted for GFR < 60 mL/min/1.73 m2, cholesterol and body mass index. Furthermore, women with both hypovitaminosis D and DM had more than three times the risk of severe CAD compared with women who lacked both (OR: 3.56, p = 0.02). Conclusions: In women, hypovitaminosis D increases the risk of severe CAD, and the co-existence of hypovitaminosis D and DM triples the incidence of severe CAD.

Abstract 4137058: Clinical Characteristics and Outcomes of South Asians Presenting with Acute Coronary Syndrome

Background: Patients of South Asian descent have a higher incidence of atherosclerotic cardiovascular disease and are affected by clinically significant coronary artery disease at an earlier age when compared to the general population. As a result, they have been shown to have a higher rate of cardiovascular events. This at-risk population has not been well studied as it pertains to acute coronary syndrome. Methods: Out of 1610 patients who presented to one of two tertiary care centers between 2021-2022 with a diagnosis of acute coronary syndrome and underwent coronary angiography, 240 patients were identified as being South Asian and were included in the study. 480 non-South Asian patients were randomly selected as controls. A retrospective analysis was conducted to study the demographics, risk factors, clinical presentation, diagnostic features, and outcomes of the two groups. Results: South Asian patients who were diagnosed with acute coronary syndrome and underwent coronary angiography were significantly younger than non-South Asian patients (61 vs 65 years, p &lt; 0.001). Though they were less likely to be smokers, they were significantly more likely to have other known risk factors including hypertension, dyslipidemia, and a history of prior myocardial infarction (p &lt; 0.001). South Asians had mean lower HDL (p = 0.02), higher triglycerides (0.006), and higher Hgb A1C (p &lt; 0.001). Surprisingly, rates of multivessel disease (defined as stenosis of 50% or greater in two or three vessels) were similar between the two groups. South Asians were more likely to be referred for CABG after initial coronary angiography most likely due to diffuse disease (p = 0.014). Clinical outcomes including pre-discharge LVEF, and 2-year mortality were similar between the groups. Conclusions: South Asians are a notoriously high-risk group when it comes to early-onset and more severe coronary artery disease. The pathophysiology behind this disproportionate manifestation of cardiovascular disease is not entirely understood, but several efforts to delineate this are ongoing. Our data demonstrate that this is at least in part, due to a higher prevalence of conventional modifiable and nonmodifiable risk factors in South Asian patients.