Severity Of Coronary Artery Disease Research Articles

Gender-related impact of vitamin D status on severity of coronary artery disease

Abstract Funding Acknowledgements None. Background Vitamin D has cardioprotective properties. A status of hypovitaminosis D, defined as vitamin D ≤ 20 ng/ml, was found to have a comparable effect to diabetes mellitus (DM) in terms of adverse outcomes in patients with acute myocardial infarction (AMI). To date, it is known that hypovitaminosis D is more frequent in women than men but there is still a paucity of data on how gender differences in vitamin D levels are associated with the extent of coronary heart disease (CAD). Purpose To evaluate the relationship between vitamin D status on CAD incidence and severity in patients with AMI. Methods Blood samples were obtained from 1484 patients with AMI on hospital admission. Levels of vitamin D ≤ 10 ng/ml were considered as severe hypovitaminosis D. CAD was defined as the presence of at least one coronary vessel stenosis greater than 50%, while severe CAD was defined as left main disease and/or three-vessel disease. The endpoint was all-cause mortality. Results The cohort's mean age was 66.25 (11.47) years, the majority were male (71.8%) and 24.3% of patients had DM. Overall, 86.2% of patients had CAD and 32.9% severe CAD. The median vitamin D concentration was 17.25 [10.3 - 24.7] ng/ml, and 23.6% of patients had severe hypovitaminosis D. In female patients, hypovitaminosis D was significantly more common in whom with severe CAD (74.1% vs 58.1%, p=0.002), but not in men (61.3% vs 57.1%, p=0.193). On the other hand, severe hypovitaminosis D was significantly more frequent in patients with severe CAD in both genders (male and female respectively 26.6% vs 17.9%, p=0.005; 40.5% vs 26.4%, p=0.001). In female patients, severe CAD was predicted by hypovitaminosis D (OR: 1.85 [1.14 – 3.03], p=0.013) along with DM and older age after correction for confounders as GFR<60 mL/min/1.73 m2, higher cholesterol levels and body mass index. However, hypovitaminosis D was not an independent predictor of severe CAD in men. Moreover, a composite of hypovitaminosis D and DM was identified as a predictor of severe CAD when compared to patients with neither hypovitaminosis D nor DM (OR: 3.56 [1.8 – 7.03], p=0.021) only in female patients. Conclusions The identification of an association between hypovitaminosis D and severe CAD in women but not in men is a novelty in this field. Furthermore, we found that the presence of both hypovitaminosis D and DM has a greater contribution to severe CAD in female patients with AMI.

Left ventricular systolic function in patients with acute coronary syndrome-risk profile

Abstract Funding Acknowledgements None. Introductions and objectives Left ventricular (LV) systolic dysfunction is one of the most important determinants of long-term outcome in acute coronary syndrome (ACS). Aim To determine the impact of the patient’s risk profile on the LV systolic function. Methods A single-center cross-sectional cohort study that included 3093 patients with ACS without pre-existing LV dysfunction. The comparison was performed between patients who did or did not develop a reduction in LV systolic function during the index event (<50%/≥50%), analyzing patients’ demographic, clinical, biochemical data, LV functional data, and anatomical distribution of the coronary artery disease (CAD). Result 1369 patients out of 3093 developed LV systolic dysfunction (44.3%). They were predominantly males 75.1% (1028), p=0.002; older (63.39±11.04 vs 61.21±11.12, p<0.00000); had higher level of cardiac troponin (p=0.00002), higher stress glycemia (9.2±5.3; p=0.0000001), HbA1c (6.9±1.8, p=0.000003), WBC (11.7±4.1, p=0.00001), blood urea nitrogen (BUN) (6.8±3.7, p=0.000003), and creatinine (93.2±45.1 p=0.000167), and had anemia (OR 0.35 (CI 0.29–41, p=0.000012). They had more severe CAD (SINTAX score 16.8±8.4 p=0.000012). Patients with preserved LV systolic function were predominantly females (29.7%, OR 1.1 95% CI 1.0-1.2), p = 0.002), younger (p<0.00000), and severely metabolically burdened (hypothyreosis (2.7%, OR 1.28 95% CI 0.93-1.76, p=0.052), higher levels of triglycerides (2.2±1.7 vs 1.9±1.5, p = 0.001), cholesterol (5.3±1.4 vs 5.2±1.4, p = 0.002), non-HDL-C (4.1±1.5 vs 3.9±1.3, p=0.006), however less likely to have pre-existing DM (OR 0.8 (CI 0.78–0.92), p=0.000094). They were more often NSTEMI [851 (49.4%), p = 0.000012]. Independent variables associated with a reduction in LV function were: advanced age, male gender, previous DM and anemia, stress glycemia, WBC, creatinine, and BUN. Conclusion Patients who developed reduced LV function had a very specific risk profile with bigger neuro-hormonal activation and inflammation, higher degree of myocardial damage, and worse renal function, whereas those with preserved LV systolic function after ACS were younger, predominantly females, more severely metabolically burdened, more often with NSTEMI and without LAD involvement.

Unveiling the Effects of Diabetes on Coronary Artery Disease Through Angiography

Background: Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, particularly among patients with Type 2 Diabetes Mellitus (T2DM). Diabetic patients are at a higher risk of developing CAD due to factors such as poor glycemic control, lipid metabolism abnormalities, and endothelial dysfunction. Prior studies have demonstrated that diabetic patients tend to present with more extensive coronary artery involvement and worse outcomes following cardiovascular interventions. Objective: This study aimed to assess the impact of T2DM on coronary angiography outcomes, specifically focusing on the incidence of multi-vessel disease and the severity of coronary artery stenosis. Methods: This observational cohort study was conducted at Lady Reding Hospital, a tertiary care center specializing in cardiovascular diseases. Participants were recruited from the outpatient cardiology clinic between January 2020 and January 2022. Inclusion criteria included patients aged 40 to 80 years undergoing coronary angiography for the first time due to suspected CAD. Exclusion criteria were previous coronary artery interventions, congenital heart disease, active infections, and renal insufficiency (creatinine > 2.0 mg/dL). Baseline characteristics such as age, gender, BMI, hypertension status, and smoking history were collected. Diabetes status was confirmed via HbA1c levels (≥6.5%). Coronary angiography was performed using standard techniques, with angiograms analyzed by two blinded cardiologists. Primary outcomes included the presence of multi-vessel disease (≥70% stenosis in two or more major coronary arteries) and the severity of stenosis (>70% blockage). Additional assessments using Intravascular Ultrasound (IVUS) and Optical Coherence Tomography (OCT) evaluated plaque characteristics and vessel sizes in a subset of patients. Statistical analysis was performed using SPSS version 25.0, employing Chi-square tests for categorical variables, independent t-tests for continuous variables, and multivariable logistic regression to adjust for confounders. Results: The study included 300 participants, with 150 diabetic and 150 non-diabetic patients. Diabetic patients had a mean age of 62.3 ± 10.4 years, while non-diabetic patients had a mean age of 58.2 ± 9.8 years. The prevalence of hypertension was higher among diabetic patients (60%) compared to non-diabetic patients (40%). The incidence of multi-vessel disease was significantly higher in diabetic patients (70%) compared to non-diabetic patients (50%) (p < 0.05). Severe stenosis was observed in 65% of diabetic patients versus 45% of non-diabetic patients (p < 0.01). IVUS and OCT analyses showed a higher prevalence of lipid-rich plaques in diabetic patients (55% vs. 30%) and a smaller mean luminal diameter (2.8 ± 0.6 mm vs. 3.4 ± 0.5 mm). Conclusion: Diabetes significantly impacts the severity and extent of coronary artery disease, with diabetic patients exhibiting higher rates of multi-vessel disease and severe stenosis. Advanced imaging techniques highlighted distinct plaque characteristics in diabetic patients, underscoring the need for aggressive and personalized management strategies. These findings emphasize the importance of integrating advanced imaging and comprehensive management to mitigate cardiovascular risks in diabetic patients.

Comparison of Post PCI TIMI Flow Between Diabetic and Non-Diabetic Individuals

Background: Cardiovascular diseases remain the leading cause of morbidity and mortality globally, with diabetes significantly exacerbating the incidence and severity of coronary artery disease. Diabetic patients experience altered coronary blood flow dynamics, which can impact the efficacy of therapeutic interventions like percutaneous coronary intervention (PCI). Objective: This study aims to compare the post-PCI Thrombolysis in Myocardial Infarction (TIMI) flow grades between diabetic and non-diabetic patients to assess the impact of diabetes on the short-term outcomes of coronary revascularization. Methods: A retrospective observational study was conducted at the National Institute of Cardiovascular Diseases in Karachi, involving 3,000 patients who underwent primary PCI between January 2018 and December 2020. Patients were categorized into diabetic (1,500) and non-diabetic (1,500) groups. Data collected included demographics, coronary artery risk factors, TIMI flow grades before and after PCI, and the use of GPIIb/IIIa inhibitors. Statistical analysis was performed using SPSS version 25, employing chi-square tests, t-tests, and Mann-Whitney U tests for comparative analysis, with a p-value of <0.05 considered statistically significant. Results: The study found significant differences in postoperative TIMI3 flow rates, with non-diabetic patients achieving a higher rate of TIMI3 (59.4%) compared to diabetic patients (58.1%). The use of GPIIb/IIIa inhibitors was higher in diabetic patients (34.7%) than in non-diabetic patients (1.8%). Additionally, diabetic patients showed a higher incidence of multi-vessel disease and more severe lesion profiles, including higher rates of triple branch lesions (45.9% vs. 39.9%) and left main lesions (53% vs. 43.9%). Conclusion: Diabetic patients exhibit worse post-PCI TIMI flow grades and more complex coronary lesions compared to non-diabetic patients, suggesting that diabetes adversely affects the outcomes of coronary revascularization. These findings underscore the need for tailored therapeutic approaches to improve PCI outcomes in diabetic patients.

Histological Changes in the Popliteal Artery Wall in Patients with Critical Limb Ischemia

Introduction: This prospective study aims to illustrate the histopathological arterial changes in the popliteal artery in peripheral arterial disease of the lower limbs. Material and method: A total of 60 popliteal artery segments taken from patients who had undergone lower limb amputation were examined between April and June 2023. The degree of arterial stenosis, medial calcinosis, and the vasa vasorum changes in the arterial adventitia were quantified. The presence of risk factors for atherosclerosis was also observed. Results: Atherosclerotic plaque was found in all of the examined segments. Medial calcinosis was observed in 40 (66.6%) of the arterial segments. A positive association between the degree of arterial stenosis and the vasa vasorum changes in the arterial adventitia was also found (p = 0.025). The level of blood sugar and cholesterol were predictive factors for the severity of atherosclerosis. Conclusions: Atherosclerosis and medial calcinosis are significant in patients who underwent lower limb amputation. Medial calcinosis causes damage to the arterial wall and leads to a reduction in responsiveness to dilator stimuli.

Association of testosterone with myocardial infarction and severity of coronary artery disease among male patients

BackgroundCoronary heart disease (CHD) remains a leading cause of morbidity and mortality, particularly in aging populations. Men typically exhibit higher rates of CHD compared to women, with testosterone levels inversely associated with cardiovascular risk. This study investigates the relationship between testosterone levels and angiographically confirmed CHD, disease severity, and myocardial infarction (MI) among CHD cases. MethodsA cohort of 1724 male patients undergoing diagnostic or interventional coronary angiography was examined. Demographic, clinical, and biochemical data were collected, including serum total testosterone levels. The severity of CHD was assessed using the Gensini score, and MI cases were diagnosed according to World Health Organization criteria. ResultsResults revealed significant differences in testosterone levels among CHD subtypes, particularly between MI and unstable angina/stable angina groups (p < 0.001). Testosterone levels were inversely correlated with CHD severity, as evidenced by the Gensini score (Pearson coefficient = −0.062, P = 0.004). Cross-validation random forest analysis demonstrated the significant contribution of testosterone to CHD severity discrimination (p < 0.05). ConclusionsThere is an association between testosterone and a predisposition to severe CAD indicated by Gensini score and myocardial infarction.

A Noninvasive Arterial Stiffness Index to Estimate the Severity of Coronary Atherosclerosis in Patients Undergoing Coronary Angiography

The early diagnosis and appropriate treatment of subclinical atherosclerosis before the onset of life-threatening cardiovascular (CV) diseases are major unmet medical needs in current clinical practice. Noninvasive arterial stiffness indices, the arterial velocity–pulse index (AVI) and the arterial pressure–volume index (API) have been associated with CV risks, conventional arterial stiffness indices, and the severity of coronary atherosclerosis. However, few studies have examined the relationship between these indices and the occurrence of CV events. We measured the AVI and API in 113 consecutive patients admitted to Yokohama City University Hospital for cardiac catheterization between June 2015 and March 2016. Patients were followed until September 2022, and the occurrence of CV events was assessed. The mean age was 71.2 ± 10.7 years, and 83 patients (73.5%) were male. In total, 80 patients (70.8%) had hypertension, 87 (77.0%) had dyslipidemia, and 91 (80.5%) had a history of ischemic heart disease (IHD). The mean follow-up duration was 1752 ± 819 days. Patients who received elective percutaneous coronary intervention (PCI) based on the results of coronary angiography (CAG) at the time of enrollment had significantly higher API than those who did not (38.5 ± 12.6, n = 17 vs. 31.3 ± 7.4, n = 96, p = 0.001). The API was independently associated with the risk of elective PCI in multiple logistic regression analysis. In conclusion, the API could be a useful indicator for estimating the need for coronary interventional treatment in patients with a high CV risk.

The relationship between triglyceride/high-density lipoprotein cholesterol ratio and the severity of coronary artery disease in patients presenting with acute coronary syndrome.

The SYNTAX score is a score that grades the severity and complexity of coronary lesions. In this study, we aimed to investigate the relationship between triglyceride/high-density lipoprotein cholesterol (triglyceride/HDL-C) ratio and SYNTAX scores in patients presenting with non-ST elevation myocardial infarction (NSTEMI). This prospective study included 258 patients who presented at our center with STEMI, and underwent coronary angiography (CAG). The triglyceride/HDL-C ratio was calculated, and the relationship of this ratio with the SYNTAX score was determined with univariate and multivariate linear regression analyses. The patients were separated into two groups according to the triglyceride/HDL-C ratios as low (<3.88) and high (≥3.88). The SYNTAX scores of the group with a high triglyceride/HDL-C score were determined to be significantly high ( P < 0.001). When the SYNTAX scores were separated into two groups as low (≤22) and high (>23), a statistically significant correlation was determined between a high SYNTAX score and a high triglyceride/HDL-C ratio ( P < 0.001). Logistic regression analysis was performed for the SYNTAX score, and the BMI value [odds ratio (OR) = 0.91, 95% confidence interval (CI): 0.85-0.98] and the triglyceride/HDL-C ratio (OR = 6.86, 95% CI: 3.45-13.65) alone were determined to be independent determinants of the SYNTAX score. The most important result obtained from this study was that the triglyceride/HDL-C ratio, which is an index that has recently started to be frequently used, was a marker of greater coronary anatomic complexity (SYNTAX score >22), independently of other parameters in patients who presented with NSTEMI and underwent CAG.

Relationship between pericoronary fat attenuation values quantified by coronary computed tomography angiography and coronary artery disease severity

AimTo explore the relationship between pericoronary fat attenuation index (FAI) values and coronary artery disease (CAD) severity measured using coronary computed tomography angiography (CCTA). Materials And MethodsThis study retrospectively included 428 patients with CAD who were eligible and underwent CCTA at our hospital. CAD severity on CCTA images including obstructive stenosis and extensive lesions, and segment stenosis and involvement score (SSS, SIS), and CAD-RADS classification were assessed. FAI values for left anterior descending (LAD), left circumflex (LCX) branches, and right coronary artery (RCA) were quantified using fully automated software. The relationship between FAI values and CAD severity was assessed using univariate and multivariate regression models. ResultsUnivariate analyses showed that sex and current smoking were associated with elevated FAILAD and FAILCX values (all P<0.05), whereas CAD severity was not relevant (all P>0.05). Not only clinical factors such as gender, current smoking, and hypertension were associated with elevated FAIRCA, but also indicators to assess CAD severity including obstructive stenosis, SIS, and SSS were related to it (all P<0.05). Multivariate analysis demonstrated that after correcting for the effects of other conventional cardiovascular risk factors and CCTA imaging features, current smoking was an independent risk factor for elevated FAI values (odds ratio [OR] = 0.569, 0.458, and 0.517; all P<0.05), whereas that SSS (OR=1.041, P=0.027) for elevated FAIRCA values. ConclusionsFollowing correction for conventional cardiovascular risk factors and imaging characteristics, current smoking was an independent clinical risk factor for elevated FAI values, and SSS was an independent risk factor for elevated FAIRCA values.

Alterations in the gut mycobiome with coronary artery disease severity

BackgroundCoronary artery disease (CAD) is a prevalent cardiovascular condition, and numerous studies have linked gut bacterial imbalance to CAD. However, the relationship of gut fungi, another essential component of the intestinal microbiota, with CAD remains poorly understood. MethodsIn this cross-sectional study, we analyzed fecal samples from 132 participants, split into 31 healthy controls and 101 CAD patients, further categorized into stable CAD (38), unstable angina (41), and acute myocardial infarction (22) groups. We conducted internal transcribed spacer 1 (ITS1) and 16S sequencing to examine gut fungal and bacterial communities. FindingsBased on ITS1 analyses, Ascomycota and Basidiomycota were the dominant fungal phyla in all the groups. The α diversity of gut mycobiome remained unaltered among the control group and CAD subgroups; however, the structure and composition of the mycobiota differed significantly with the progression of CAD. The abundances of 15 taxa gradually changed with the occurrence and progression of the disease and were significantly correlated with major CAD risk factor indicators. The mycobiome changes were closely linked to gut microbiome dysbiosis in patients with CAD. Furthermore, disease classifiers based on gut fungi effectively identified subgroups with different degrees of CAD. Finally, the FUNGuild analysis further categorized these fungi into distinct ecological guilds. InterpretationIn conclusion, the structure and composition of the gut fungal community differed from healthy controls to various subtypes of CAD, revealing key fungi taxa alterations linked to the onset and progression of CAD. Our study highlights the potential role of gut fungi in CAD and may facilitate the development of novel biomarkers and therapeutic targets for CAD. FundingThis work was supported by the grants from the National Natural Science Foundation of China (No. 82170302, 92168117, 82370432), National clinical key specialty construction project- Cardiovascular Surgery, 2024 Reform and Development Program of Beijing Institute of Respiratory Medicine, the Beijing Natural Science Foundation (No. 7222068); the Reform and Development Program of Beijing Institute of Respiratory Medicine (No. Ggyfz202308); and the Clinical Research Incubation Program of Beijing Chaoyang Hospital Affiliated to Capital Medical University (No. CYFH202209).

Side branch predilatation during percutaneous coronary bifurcation intervention: Long-term mortality analysis.

Side branch predilatation (SBPD) during coronary bifurcation interventions is a technique that is not recommended by the latest guidelines. However, the data about the clinical outcomes after SBPD are surprisingly few. The current study aimed to explore the association between SBPD and mortality in long-term follow-up. All patients with coronary bifurcation stenoses revascularized with percutaneous coronary intervention were included in a prospective registry. Patients with stable angina and a bifurcation lesion with ≥50% diameter stenosis were included in the current analysis. Patients were assigned to two groups - those with SBPD(+) and those without SBPD(-). Propensity score matching was performed to equalize the risk factors and severity of coronary artery disease between the groups. A Kaplan-Meier analysis with a log-rank test for between-group differences was also performed. From January 2013 to June 2021, 813 patients were included in the final study population. The mean age was 67 (10) years. After propensity score matching, 648 patients remained for analysis - 324 in each group. At a median follow-up of 57 months patients in the SBPD(+) group had a higher all-cause mortality (n = 107 (33%) vs. n = 98 [30.2%]; P = 0.045) and cardiovascular mortality (n = 82 [25.3%] vs. n = 70 [21.6%]; P = 0.03) when compared with SBPD(-) patients. SBPD was independently associated with all-cause and cardiovascular mortality. SBPD treatment of coronary bifurcation stenoses is associated with worse patient survival in the follow-up of up to 8 years. SBPD treatment gives better angiographic results, but this did not translate into better clinical outcomes.

Preoperative smoking status and long-term survival after coronary artery bypass grafting: a Competing-Risk analysis.

Patients with severe coronary artery disease who undergo coronary artery bypass grafting consistently demonstrate that continued smoking after surgery increases late mortality rates. Smoking may exert its harmful effects through the ongoing chronic process of atherosclerotic progression both in the grafts and the native system. However, it is not clear whether cardiac mortality is primary and solely responsible for the inferior late survival of current smokers. In this retrospective analysis, we included all consecutive patients undergoing primary isolated coronary artery bypass surgery from January 1, 2000, to September 30, 2015, in an Academic Hospital in Northern Portugal. The predictive or independent variable was the patients' smoking history status, a categorical variable with three levels: non-smoker (the comparator), ex-smoker for more than 1 year (exposure 1), and current smoker (exposure 2). The primary end-point was long-term all-cause mortality. Secondary outcomes were long-term cause-specific mortality (cardiovascular and noncardiovascular). We fitted overall and Fine and Gray subdistribution hazard models. We identified 5242 eligible patients. Follow-up was 99.7% complete (with seventeen patients lost to follow-up). The median follow-up time was 12.79 years (IQR, 9.51 to 16.60). Throughout the study, there were 2049 deaths (39.1%): 877 from cardiovascular causes (16.7%), 727 from noncardiovascular causes (13.9%), and 445 from unknown causes (8.5%). Ex-smokers had an identical long-term survival than non-smokers (HR 0.99; 95% CI 0.88, 1.12; p = 0.899). Conversely, current smokers had a 24% increase in late mortality risk (HR 1.24; 95% CI 1.07, 1.44; p = 0.004) as compared to non-smokers. While the current smoker status increased the relative incidence of noncardiac death by 61% (HR 1.61; 95% CI 1.27, 2.05, p < 0.001), it did confer a 25% reduction in the relative incidence of cardiac death (HR 0.75; 95% CI 0.59, 0.97; p = 0.025). Whereas ex-smokers have an identical long-term survival to non-smokers, current smokers exhibit an increase in late all-cause mortality risk at the expense of an increased relative incidence of noncardiac death. By subtracting the inciting risk factor, smoking cessation reduces the relative incidence of cardiac death.

Effect of lipid-lowering therapy on carotid plaque burden in older adults

BackgroundLittle is known about the benefits of lipid-lowering medications in those age ≥ 75 years. We assessed the effect of lipid-lowering medications on progression to severe atherosclerosis in patients age > 75. MethodsData was retrospectively obtained from the Stroke Prevention & Atherosclerosis Research Centre, Canada. Atherosclerosis burden was measured as carotid total plaque area (TPA), a powerful predictor of cardiovascular risk. Survival time free of severe atherosclerosis (SFSA) was defined as the period when TPA remained <1.19 cm2. Kaplan–Meier, multiple Cox proportional hazard and hierarchical mixed-effect models were used to determine the effects of lipid-lowering medications on progression to severe atherosclerosis. ResultsIn total 1404 cases (mean age 81 ± 4 years; women 52%) were included. Those taking lipid-lowering medications were more likely to have a history of diabetes and a higher burden of atherosclerosis at baseline. In Kaplan–Meier analysis, the SFSA was significantly longer in those receiving lipid-lowering therapy. In multivariable-adjusted analyses, those not receiving lipid lowering therapy (irrespective of their vascular disease at baseline) were more likely to have TPA > 1.19 cm2 (hazard ratio (HR) = 1.37, 95% confidence interval (CI): 1.09,0.71). Similar findings were observed in mixed effects models when plaque progression was defined as any change >0.05 cm2 per year (odds ratio (OR):2.17, 95% CI:1.38,3.57). ConclusionLipid-lowering therapy is effective in controlling the burden of atherosclerosis among older adults with and without vascular disease. The measurement of plaque burden can guide selection and follow-up of those who may benefit from treatment.

Comparison of the outcomes of concurrent versus staged TAVR combined with PCI in patients with severe aortic stenosis and coronary artery disease: a systematic review and meta-analysis.

The optimal timing for percutaneous coronary intervention (PCI) in patients undergoing transcatheter aortic valve replacement (TAVR) remains uncertain. This research aims to evaluate the results of patients diagnosed with severe aortic valve stenosis and coronary artery disease who undergo either simultaneous or staged PCI therapy during TAVR procedures. We retrieved all relevant studies from our self-constructed databases up to January 2, 2024, encompassing databases such as Embase, Medline, Cochrane Library, and PubMed. A total of nine studies were included, and the results showed that both surgical modalities had good safety profiles in the early and long-term stages. For early endpoint events, the risk of all-cause mortality and major bleeding within 30 years was similar in the staged TAVR + PCI and the contemporaneous TAVR + PCI (P > 0.05). Additionally, the risk of myocardial infarction, stroke, acute kidney injury and pacemaker implantation within 30 days or perioperatively is similar (P > 0.05). For long-term endpoint events, the risk of all-cause mortality, myocardial infarction and stroke was similar in the two groups at ≥2 years (P > 0.05). In patients undergoing TAVR who required coronary revascularization, no significant differences were observed in the early and long-term outcomes between those receiving concurrent TAVR and PCI versus staged surgery.

Aortic thrombosis and acute kidney injury due to atherosclerosis in a dog.

Atherosclerosis is a chronic lipid-driven inflammatory disease of the arterial wall. Due to its cardiovascular ischemic complications, it is one of the most common causes of death in people. However, atherosclerosis is seldomly reported in dogs. A 10-year-old male mixed-breed dog. Severe acute kidney injury associated with thrombosis of the abdominal aorta. Treatment included renal replacement therapy, antithrombotic therapy, and supportive care. However, the dog developed neurological and respiratory complications and was euthanized due to worsening kidney function and lack of improvement of the thrombosis. Postmortem examination confirmed the presence of aortic thromboembolism and renal infarcts. Histology revealed severe chronic-active atherosclerosis of the distal aorta and renal arteries. Aortic thrombosis is uncommon in dogs, and it is often associated with underlying conditions such as protein-losing nephropathy, endocrine disorders, cardiac disease, or hypercoagulability. In this case, no specific underlying cause was identified and atherosclerosis was considered the primary cause of the thrombosis.

No causal association between the volume of strenuous exercise and coronary atherosclerosis: a two-sample Mendelian randomization study.

Several observational studies have shown that high-volume and high-intensity exercise training increases the prevalence and severity of coronary atherosclerosis, but the causal effect still remains uncertain. This study aims to explore the causal relationship between the volume of strenuous exercise (SE) and coronary atherosclerosis (CA) using the Mendelian randomization (MR) method. The exposure factors were two basic parameters of the volume of strenuous exercise (duration and frequency of strenuous exercise), the outcome factor was coronary atherosclerosis, and the relevant genetic loci were extracted from the summary data of the genome-wide association study (GWAS) as the instrumental variables, and MR analyses were performed using the inverse variance weighting (IVW) method, the weighted median method, and the MR-egger method. Sensitivity analyses were performed using heterogeneity analysis, pleiotropy analysis, and the "leave-one-out" method. The original results were tested using other coronary atherosclerosis data sets. IVW results showed no causal association between duration of strenuous exercise (DOSE) [OR = 0.9937, 95% CI (0.9847, 1.0028), P = 0.1757] and frequency of strenuous exercise (FOSE) in the last 4 weeks [OR = 0.9930, 95% CI (0.9808, 1.0054), P = 0.2660] and coronary atherosclerosis. All of the above results were validated with other coronary atherosclerosis data sets. The present study supports that the causal association of duration and frequency of SE with CA was not found, and provides valuable insights into the choice of scientific and correct volume of SE to cardiac rehabilitation (CR).

Evaluation of Conventional and Novel Risk Factors in Young and Aged Patients, Undergoing Coronary Artery Bypass Grafting

ABSTRACT Aim: The aim of this study was to find out the relationship of conventional and/or novel cardiovascular risk factors with coronary artery disease severity in terms of SYNTAX scores in young (≤45 years) and aged (&gt;45 years) patients. Materials and Methods: The final number of patients included in the study was 132 and divided into 2 groups: Group A was young patients with age less than 45 years, and in group B, the age was more than 45 years. The SYNTAX score was determined for each case based on the preoperative coronary angiogram using the Online SYNTAX score calculator version 2.11. Results: It was seen that 33% of patients in group A had high SYNTAX scores, as compared to only 8% in group B. This definitely shows that the younger population has more COMPLEX coronary artery lesions than the elderly. Conclusion: YOUNG patients have significantly higher levels of homocysteine as compared to the elderly. Serum homocysteine correlates with SYNTAX scores in YOUNG patients, with a sensitivity of 83.33%, specificity 91.67%, and diagnostic accuracy 86.67%. Percentage of Low HDL in YOUNG is significantly higher than in the elderly.

Single-Cell Gene-Regulatory Networks of Advanced Symptomatic Atherosclerosis.

While our understanding of the single-cell gene expression patterns underlying the transformation of vascular cell types during the progression of atherosclerosis is rapidly improving, the clinical and pathophysiological relevance of these changes remains poorly understood. Single-cell RNA sequencing data generated with SmartSeq2 (≈8000 genes/cell) in nearly 19 000 single cells isolated during atherosclerosis progression in Ldlr-/-Apob100/100 mice with human-like plasma lipoproteins and from humans with asymptomatic and symptomatic carotid plaques was clustered into multiple subtypes. For clinical and pathophysiological context, the advanced-stage and symptomatic subtype clusters were integrated with 135 tissue-specific (atherosclerotic aortic wall, mammary artery, liver, skeletal muscle, and visceral and subcutaneous, fat) gene-regulatory networks (GRNs) inferred from 600 coronary artery disease patients in the STARNET (Stockholm-Tartu Atherosclerosis Reverse Network Engineering Task) study. Advanced stages of atherosclerosis progression and symptomatic carotid plaques were largely characterized by 3 smooth muscle cells (SMCs), and 3 macrophage subtype clusters with extracellular matrix organization/osteogenic (SMC), and M1-type proinflammatory/Trem2-high lipid-associated (macrophage) phenotypes. Integrative analysis of these 6 clusters with STARNET revealed significant enrichments of 3 arterial wall GRNs: GRN33 (macrophage), GRN39 (SMC), and GRN122 (macrophage) with major contributions to coronary artery disease heritability and strong associations with clinical scores of coronary atherosclerosis severity (SYNTAX/Duke scores). The presence and pathophysiological relevance of GRN39 were verified in 5 independent RNAseq data sets obtained from the human coronary and aortic artery, and primary SMCs and by targeting its top-key drivers, FRZB and ALCAM, in cultured human vascular SMCs. By identifying and integrating the most gene-rich single-cell subclusters of atherosclerosis to date with a coronary artery disease framework of GRNs, GRN39 was identified and independently validated as being critical for the transformation of contractile SMCs into an osteogenic phenotype promoting advanced-stage, symptomatic atherosclerosis.

Atherosclerotic Plaque Epigenetic Age Acceleration Predicts a Poor Prognosis and Is Associated With Endothelial-to-Mesenchymal Transition in Humans.

Epigenetic age estimators (clocks) are predictive of human mortality risk. However, it is not yet known whether the epigenetic age of atherosclerotic plaques is predictive for the risk of cardiovascular events. Whole-genome DNA methylation of human carotid atherosclerotic plaques (n=485) and of blood (n=93) from the Athero-Express endarterectomy cohort was used to calculate epigenetic age acceleration (EAA). EAA was linked to clinical characteristics, plaque histology, and future cardiovascular events (n=136). We studied whole-genome DNA methylation and bulk and single-cell transcriptomics to uncover molecular mechanisms of plaque EAA. We experimentally confirmed our in silico findings using in vitro experiments in primary human coronary endothelial cells. Male and female patients with severe atherosclerosis had a median chronological age of 69 years. The median epigenetic age was 65 years in females (median EAA, -2.2 [interquartile range, -4.3 to 2.2] years) and 68 years in males (median EAA, -0.3 [interquartile range, -2.9 to 3.8] years). Patients with diabetes and a high body mass index had higher plaque EAA. Increased EAA of plaque predicted future events in a 3-year follow-up in a Cox regression model (univariate hazard ratio, 1.7; P=0.0034) and adjusted multivariate model (hazard ratio, 1.56; P=0.02). Plaque EAA predicted outcome independent of blood EAA (hazard ratio, 1.3; P=0.018) and of plaque hemorrhage (hazard ratio, 1.7; P=0.02). Single-cell RNA sequencing in plaque samples from 46 patients in the same cohort revealed smooth muscle and endothelial cells as important cell types in plaque EAA. Endothelial-to-mesenchymal transition was associated with EAA, which was experimentally confirmed by TGFβ-triggered endothelial-to-mesenchymal transition inducing rapid epigenetic aging in coronary endothelial cells. Plaque EAA is a strong and independent marker of poor outcome in patients with severe atherosclerosis. Plaque EAA was linked to mesenchymal endothelial and smooth muscle cells. Endothelial-to-mesenchymal transition was associated with EAA, which was experimentally validated. Epigenetic aging mechanisms may provide new targets for treatments that reduce atherosclerosis complications.

Hybrid classification of XGBoost-based ADAM optimization for coronary artery disease diagnosis

A common cardiovascular illness with high fatality rates is coronary artery disease (CAD). Researchers have been exploring alternative methods to diagnose and assess the severity of CAD that are less invasive, cost-effective, and utilize noninvasive clinical data. Machine learning algorithms have shown promising and potential results. Accordingly, this study focuses on assisting medical practitioners with CAD detection by using a hybrid classification system combining XGBoost and Adam optimization. The primary approach incorporates One-Hot encoding to transform categorical attributes within the dataset, enhancing the precision of predictions. The secondary approach constitutes a hybrid classification model integrating XGBoost and employing Adam optimizations for CAD detections. The efficacy of the recommended method is assessed using the cleveland, Hungarian, and Statlog heart-disease data sets. The proposed system and the standard Grid and Random Search classifiers are compared. The experimental outcomes indicate that the suggested model achieves a notable prediction accuracy of 94.19%. This represents an improvement of 7 to 8% over the existing grid search algorithm and 2 to 3% improvement over the random search algorithm for the above all datasets. Hence, the proposed system can be a valuable tool for identifying CAD patients, offering enhanced prediction accuracy.