Severity Of Coronary Artery Disease Research Articles

Cardiac computed tomography-derived coronary artery volume to myocardial mass in patients with severe coronary artery disease

BackgroundCoronary artery lumen volume (V) to myocardial mass (M) ratio (V/M) can show the mismatch between epicardial coronary arteries and the underlying myocardium. MethodsThe V, M and V/M were obtained from the coronary computed tomography angiography (CCTA) of patients in the FAST-TRACK CABG study, the first-in-human trial of coronary artery bypass grafting (CABG) guided solely by CCTA and fractional flow reserve derived from CCTA (FFRCT) in patients with complex coronary artery disease (CAD). The correlations between V/M ratios and baseline characteristics were determined and compared with those from the ADVANCE registry, an unselected cohort of historical controls with chronic CAD. ResultsThe V/M ratio was obtained in 106 of the 114 pre-CABG CCTAs. Mean age was 65.6 years and 87% of them were male. The anatomical SYNTAX score from CCTA was significantly higher than the functional SYNTAX score derived using FFRCT [43.1 (15.2) vs 41.1 (16.5), p ​< ​0.001]. Mean V, M, and V/M were 2204 ​mm3, 137 ​g, and 16.5 ​mm3/g, respectively. There were weak negative correlations between V and anatomical and functional SYNTAX scores (Pearson's r ​= ​−0.26 and −0.34). V and V/M had a strong correlation (r ​= ​0.82). The V/M ratio in the current study was significantly lower than that in the ADVANCE registry (median 16.1 vs. 24.8 [1st quartile 20.1]). ConclusionSystematically smaller V/M ratios were found in this population with severe CAD requiring CABG compared to an unselected cohort with chronic CAD. The V/M ratio could provide additional non-invasive assessment of CAD especially when combined with FFRCT.

Determination of Correlation between Diabetes Duration and Coronary Artery Disease Severity in Patients Undergoing Coronary Angiography

Background. Coronary artery disease (CAD) is caused by atherosclerotic process in coronary arteries. Due to extraordinary risk for atherosclerosis in diabetic patients, it is also counted as a vascular disease. Diabetes mellitus (DM) is a direct major associated risk factor in the development of cardiovascular disease with some studies from high income countries reporting correlation between duration of DM and severity of CAD. However, data from Pakistan is scarce. The aim. To determine the correlation between duration of DM and severity of CAD in patients undergoing coronary angiography at the tertiary care cardiac center. Materials and methods. This cross-sectional study was conducted in the Department of Cardiology, Civil Hospital Karachi, among 160 patients who were scheduled for coronary angiography with comorbid DM. Correlation between duration of DM and severity of CAD (as assessed by the modified Gensini score) was statistically measured and reported employing Pearson’s correlation coefficient (r). Results. Significant correlation between DM duration and total Gensini score was shown with r = 0.759 and p = 0.000001. With the increase in the duration of DM, the severity of CAD also increased. Conclusion. DM duration is positively associated with the modified Gensini score and the significant determinants of CAD severity tend to be relevant.

Sex differences in coronary atherosclerotic plaque activity using 18F-sodium fluoride positron emission tomography.

There are sex differences in the extent, severity, and outcomes of coronary artery disease. We aimed to assess the influence of sex on coronary atherosclerotic plaque activity measured using coronary 18F-sodium fluoride (18F-NaF) positron emission tomography (PET), and to determine whether 18F-NaF PET has prognostic value in both women and men. In a post-hoc analysis of observational cohort studies of patients with coronary atherosclerosis who had undergone 18F-NaF PET CT angiography, we compared the coronary microcalcification activity (CMA) in women and men. Baseline 18F-NaF PET CT angiography was available in 999 participants (151 (15%) women) with 4282 patient-years of follow-up. Compared to men, women had lower coronary calcium scores (116 [interquartile range, 27-434] versus 205 [51-571] Agatston units; p = 0.002) and CMA values (0.0 [0.0-1.12] versus 0.53 [0.0-2.54], p = 0.01). Following matching for plaque burden by coronary calcium scores and clinical comorbidities, there was no sex-related difference in CMA values (0.0 [0.0-1.12] versus 0.0 [0.0-1.23], p = 0.21) and similar proportions of women and men had no 18F-NaF uptake (53.0% (n = 80) and 48.3% (n = 73); p = 0.42), or CMA values > 1.56 (21.8% (n = 33) and 21.8% (n = 33); p = 1.00). Over a median follow-up of 4.5 [4.0-6.0] years, myocardial infarction occurred in 6.6% of women (n = 10) and 7.8% of men (n = 66). Coronary microcalcification activity greater than 0 was associated with a similarly increased risk of myocardial infarction in both women (HR: 3.83; 95% CI:1.10-18.49; p = 0.04) and men (HR: 5.29; 95% CI:2.28-12.28; p < 0.001). Although men present with more coronary atherosclerotic plaque than women, increased plaque activity is a strong predictor of future myocardial infarction regardless of sex.

Influence of apolipoprotein E gene polymorphisms on coronary artery disease in patients undergoing coronary angiography

ObjectivePrevious studies have shown that apolipoprotein E (ApoE) gene polymorphisms have an impact on coronary artery disease(CAD). However, many studies have small sample sizes and different conclusions. The purpose was to retrospectively study the influence of ApoE gene polymorphisms on CAD. MethodsThis study assessed the influence of different ApoE genotypes on coronary heart disease in patients who received coronary angiography and used multivariate logistic regression to assess the influence of different ApoE genotypes on CAD. ResultsPatients with different ApoE genotypes had no obvious differences in the incidence of hypertension, diabetes or obesity（P > 0.05). Patients with ε2/ε2 had higher incidence of hypertriglyceridemia than patients with other ApoE genotypes, while patients with ε3/ε3 had a lower incidence of hypertriglyceridemia than those with ε3/ε4,ε4/ε4, ε2/ε3 and ε2/ε2（P < 0.05）. Patients with ε3/ε4, ε4/ε4, ε3/ε3 and ε2/ε2 had no significant differences in the severity or incidence of CAD （P > 0.05). ε2/ε4 and ε2/ε3 reduced the risk of high LDL-C, and reduced the severity and incidence of coronary heart（P < 0.05). ε2/ε3 reduced risk of premature coronary artery disease（PCAD）（P < 0.05). ε2/ε3 reduced risk of CAD in patients age <45,age at 60–74 and age ≥74, while ε2/ε4 reduced risk of CAD in patients age ≥74（P < 0.05). ConclusionPatients with ε3/ε4, ε4/ε4,ε3/ε3 and ε2/ε2 had no significant differences in the severity and occurrence of CAD. Compared to the isoform ε3 (ε3/ε3), isoform ε4 did not increased the severity and occurrence of CAD. Compared with ApoE other genotypes, ε2/ε3 and ε2/ε4 reduced the risk of high LDL-C and the severity and occurrence of CAD.

Association of the stress hyperglycemia ratio with coronary artery disease complexity as assessed by the SYNTAX score in patients with acute coronary syndrome

BackgroundMounting evidence supports a significant correlation between the stress hyperglycemia ratio (SHR) and both short- and long-term prognoses in patients with acute coronary syndrome (ACS). Nevertheless, research examining the association between the SHR and the complexity of coronary artery disease (CAD) is scarce. Therefore, this study aimed to explore the association between the SHR and CAD complexity, as assessed by the SYNTAX score, in patients with ACS.MethodsA total of 4715 patients diagnosed with ACS were enrolled and divided into five groups according to the quintiles of the SHR. CAD complexity was assessed using the SYNTAX score and categorized as low (≤ 22) or mid/high (> 22) levels. Logistic regression was utilized to examine the association between the SHR and CAD severity (mid-/high SYNTAX score). Restricted cubic spline (RCS) curves were generated to assess the association between the SHR and CAD severity. Subgroup analyses were conducted to stratify outcomes based on age, sex, diabetes mellitus (DM) status, and clinical presentation.ResultsAmong the total ACS population, 503 (10.7%) patients had mid/high SYNTAX scores. Logistic regression analysis revealed that the SHR was an independent risk factor for mid/high SYNTAX scores in a U-shaped pattern. After adjusting for confounding variables, Q1 and Q5 demonstrated elevated odds ratios (ORs) relative to the reference category Q3, with ORs of 1.61 (95% CI: 1.19 ∼ 2.19) and 1.68 (95% CI: 1.24 ∼ 2.29), respectively. Moreover, the ORs for Q2 (1.02, 95% CI: 0.73 ∼ 1.42) and Q4 (1.18, 95% CI: 0.85 ∼ 1.63) resembled that of Q3. Compared with the merged Q2-4 group, the ORs were 1.52 (95% CI: 1.21 ∼ 1.92) for Q1 group and 1.58 (95% CI: 1.25 ∼ 2) for the Q5 group. Subgroup analysis revealed that the U-shaped association between the SHR and mid/high SYNTAX score was attenuated in DM patients (P for interaction = 0.045).ConclusionsThere were U-shaped associations between the SHR and CAD complexity in ACS patients, with an SHR ranging from 0.68 to 0.875 indicating a relatively lower OR for mid/high SYNTAX scores. Further studies are necessary to both evaluate the predictive value of the SHR in ACS patients and explore the underlying mechanisms of the observed U-shaped associations.

A comprehensive investigation of atherosclerosis in the 10-25 age group through medico-legal autopsies

Introduction: Atherosclerosis, a leading cause of coronary heart disease (CHD), remains a global health concern with a rising prevalence in young populations, particularly in regions like Kerala, India. Despite advancements in social indicators, Kerala faces an alarming surge in CHD cases among its youth. This study aimed to assess the prevalence and severity of atherosclerosis in coronary arteries and the aorta among individuals aged 10–25 years, shedding light on etiological factors influencing CHD.Methods: A cross-sectional study was conducted at the Department of Forensic Medicine, Government Medical College, Thiruvananthapuram, India, involving medico-legal post-mortem examinations. Sixty-four cases aged 10-25 years were included, with data collected on personal, physical, and lifestyle parameters. Autopsy-based examinations focused on atherosclerosis in coronary arteries and the aorta, utilizing a detailed histopathological classification system.Results: The study revealed a high prevalence of atherosclerosis, with 60.9% of cases exhibiting aortic lesions, and varying percentages observed in coronary arteries. Associations were found between atherosclerosis and age, family history of heart disease leading to death, cigarette smoking, recreational drug use, and personal history of heart disease.Conclusion: This study underscores the concerning prevalence of atherosclerosis among young individuals and emphasizes the need for antiatherogenic preventive measures and targeted awareness programs against cigarette smoking and recreational drug abuse. It calls for novel therapeutic approaches and public health campaigns to promote lifestyle modifications and mitigate atherosclerosis-related early mortality and morbidity. Policy implications include recognizing atherosclerosis as a condition affecting young populations and advocating for comprehensive research approaches with larger sample sizes and genetic studies to identify potential genetic contributions to atherosclerosis development. Limitations include challenges in obtaining accurate lifestyle histories during autopsies and the need for larger, multicenter studies to provide deeper insights into risk factors and age-related trends.

Opportunistic Detection of Phytosterolaemia during Genetic Testing for FH: Case Series and Contextual Review.

Homozygous phytosterolaemia, is a rare autosomal recessive disorder which lead to severely elevated plasma levels of plant phytosterols causing an increased risk of coronary artery disease (CAD) and mimics the clinical presentation of familial hypercholesterolaemia(FH). Integration of the genetic variants for homozygous phytosterolaemia into the genetic panel for FH in clinical practice likely increases the detection of milder genetic forms of phytosterolaemia, of which the implications to clinical practice including cascade testing remain unclear. We report three families with pathogenic loss-of-function variants in ABCG5 and/or ABCG8, in which probands were identified incidentally when genetically testing them for FH. The proband of the first family was a 35-year-old man with a homozygous ABCG5 loss-of-function variant (c.1336C > T, p.Arg446*) causing severe phytosterolaemia and premature CAD on cardiac imaging; his younger brother was heterozygous for the same variant with mildly elevated phytosterol levels. The second family included 2 sisters (31 and 29-year-old) with digenic variants in ABCG5 (c.1336C > T, p.Arg446*) and ABCG8 (c.1269G > T, p.Glu423Asp with uncertain significance) with moderately elevated plasma phytosterol levels and premature CAD on cardiac imaging. The third family referred to a 68-year-old man and his 44-year-old daughter who were both heterozygous for a pathogenic ABCG5 variant (c.1166G > A, p.Arg389His), had mild phytosterolaemia and CAD on cardiac imaging. Treatment with ezetimibe alone or in combination with colesevelam reduced elevated plasma sitosterol and campesterol concentrations by 30 to 80%. Phytosterolaemia is specific genetic disorder that can mimic FH, cause premature atherosclerosis, and require specific pharmacotherapy. Cascade testing for pathogenic ABCG5/G8 variants can lead to earlier detection and treatment of affected family members.

Low Levels of IgM Recognizing 4-Hydroxy-2-Nonenal-Modified Apolipoprotein A-I Peptide and Its Association with the Severity of Coronary Artery Disease in Taiwanese Patients.

Autoantibodies against apolipoprotein A-I (ApoA-I) are associated with cardiovascular disease risks. We aimed to examine the 4-hydroxy-2-nonenal (HNE) modification of ApoA-I in coronary artery disease (CAD) and evaluate the potential risk of autoantibodies against their unmodified and HNE-modified peptides. We assessed plasma levels of ApoA-I, HNE-protein adducts, and autoantibodies against unmodified and HNE-peptide adducts, and significant correlations and odds ratios (ORs) were examined. Two novel CAD-specific HNE-peptide adducts, ApoA-I251-262 and ApoA-I70-83, were identified. Notably, immunoglobulin G (IgG) anti-ApoA-I251-262 HNE, IgM anti-ApoA-I70-83 HNE, IgG anti-ApoA-I251-262, IgG anti-ApoA-I70-83, and HNE-protein adducts were significantly correlated with triglycerides, creatinine, or high-density lipoprotein in CAD with various degrees of stenosis (<30% or >70%). The HNE-protein adduct (OR = 2.208-fold, p = 0.020) and IgM anti-ApoA-I251-262 HNE (2.046-fold, p = 0.035) showed an increased risk of progression from >30% stenosis in CAD. HNE-protein adducts and IgM anti-ApoA-I251-262 HNE may increase the severity of CAD at high and low levels, respectively.

Prevalence of Carotid Artery Stenosis in Patients with Acute Myocardial Infarction Admitted to a Coronary Care Unit and its Relationship with Coronary Angiographic Findings

Objectives: The prevalence and clinical significance of carotid artery stenosis (CAS) in acute myocardial infarction (AMI) patients remain uncertain. This study aims to evaluate CAS prevalence and its association with coronary artery disease (CAD) severity in AMI patients admitted to a coronary care unit (CCU). Methodology: In this cross-sectional study, 100 consecutively selected AMI patients underwent ultrasound Doppler carotid artery assessments, including measurements of carotid intima-media thickness (cIMT), identification of plaque (stenosis &gt;0%), and calculation of internal carotid artery/common carotid artery (ICA/CCA) peak systolic velocity ratio. Angiographic findings, including the number of diseased vessels and Syntax score (SS), were also recorded. Results: Among the study cohort (mean age 55.1±11.2 years, 78 males), 32 patients exhibited CAS, with 8 having cIMT&gt;1.2mm, 3 showing ICA/CCA PSV ratio&gt;2, and 25 presenting plaque. CAS prevalence did not significantly correlate with CAD severity, regardless of the number of diseased vessels or SS. Similarly, CAS rates did not significantly differ based on SS categories (low, intermediate, high). While CAS prevalence trended higher in patients with conventional atherosclerotic risk factors (diabetes, hypertension, smoking, obesity), these associations were not statistically significant. Conclusion: CAS was prevalent in approximately one-third of AMI patients, yet it did not demonstrate a significant association with CAD severity or SS. However, CAS rates tended to increase with the presence of conventional atherosclerotic risk factors. Further research is warranted to elucidate the clinical implications of CAS in AMI patients and its relationship with CAD severity.

Is the prevalence of risk factors, clinical presentations and severity of coronary artery diseases (CAD) in patients with very early and premature CAD are different from mature CAD patients?: A registry- based cross-sectional study

IntroductionThe present study aims to compare the risk factors, clinical presentation, and severity of coronary artery involvement in young compared to elderly CAD patients to assess the cardiovascular health status for better disease management and control of these specific patients. MethodsThis registry-based cross-sectional study was conducted using Coronary Angiography and Angioplasty Registry (CAAR) patients in east of Tehran, Iran. The data were extracted from 330 patients with confirmed CAD recorded by the CAAR during July 2021 to August 2023. ResultsThe majority of patients in MCAD (68.2%) and VECAD (80%) were male, while the majority of PCAD patients were female (51.8%). Among PCAD patients, the prevalence of diabetes (38.1%) was higher than in other groups. The presence of IHD history in the father (38.1%) and mother (26.3%) was higher in the VECAD group. The mean total cholesterol, LDL, and LDL/HDL ratio were higher in the VECAD group. Among MCAD group (75.4%) compared to PCAD (58.1%) and VECAD (47.2%) groups, the multi-vessel disease was more common.MCAD patients had the highest median Gensini score compared to PCAD and VECAD patients. Also, in male compared to female the mean Gensini score was higher by 8 units (ß = 8.26, 95%CI = 0.24, 16.28). ConclusionModifiable risk factors in young CAD patients are common. High LDL-C levels and smoking were the common modifiable CVD risk factors in young patients, indicating the significant role of these traditional risk factors in early atherosclerosis development alongside inheritable risk-factors such as positive family history that were more common in young CAD patients. While, the severity of coronary artery involvement in individuals with MCAD was higher, but the priority of involvement based on the type of vessel was almost the same in all CAD groups.

The Value of 2D Global Longitudinal Strain in Predicting the Severity of Coronary Artery Disease in Patients with NSTEMI and Unstable Angina and Regional Strain Value for Predicting the Culprit Artery

Background: Our study aimed to evaluate the predictive ability of resting strain to determine the severity of CAD in the absence of impaired LVEF in patients with NSTEMI and unstable angina. Additionally, the study sought to predict culprit and infracted related artery (IRA) using regional strain (SLR). Methods: The study was conducted between January 2023 and May 2023 at the cardiology department of Ibn Rochd Hospital, Morocco. We conducted a comparative analysis involving 30 patients, comprising 23 individuals with NSTEMI and 7 with unstable angina. In all cases, we assessed both GLS and RLS before proceeding to coronary angiography. Subsequently, we categorized the patients into two groups: one consisted of 18 individuals with severe coronary lesions, including left main trunk (LM) and three vessels lesions, while the other group, comprising 12 patients, served as the control group and had non-severe coronary lesions Results: At resting GLS threshold below -16,3 %, despite its subnormal nature, should raise suspicion and suggest severe coronary artery disease. RLS in the "Single-vessel" group was significantly lower in the culprit artery territories, suggesting that RLS may be a better marker for identifying the culprit artery. Both GLS and the visual analysis of segmental kinetics by WMSI (Wall Motion Score Index) at rest, were statistically significant for detecting severe coronary lesions. Conclusion: GLR and SLR are sensitive markers for early detection of myocardial ischemia and predicting its severity. A resting GLR threshold of less than -16.13% could indicate severe CAD with severe tri-truncular or LMT damage, especially when combined with abnormal WMSI scores. These 2D strain parameter changes precede subjective abnormalities in segmental kinetics, which are often considered normal at rest.

Lipoprotein(a), Oxidized Phospholipids, and Progression to Symptomatic Heart Failure: The CASABLANCA Study.

Higher lipoprotein(a) and oxidized phospholipid concentrations are associated with increased risk for coronary artery disease and valvular heart disease. The role of lipoprotein(a) or oxidized phospholipid as a risk factor for incident heart failure (HF) or its complications remains uncertain. A total of 1251 individuals referred for coronary angiography in the Catheter Sampled Blood Archive in Cardiovascular Diseases (CASABLANCA) study were stratified on the basis of universal definition of HF stage; those in stage A/B (N=714) were followed up for an average 3.7 years for incident stage C/D HF or the composite of HF/cardiovascular death. During follow-up, 105 (14.7%) study participants in stage A/B progressed to symptomatic HF and 57 (8.0%) had cardiovascular death. In models adjusted for multiple HF risk factors, including severe coronary artery disease and aortic stenosis, individuals with lipoprotein(a) ≥150 nmol/L were at higher risk for progression to symptomatic HF (hazard ratio [HR], 1.90 [95% CI, 1.15-3.13]; P=0.01) or the composite of HF/cardiovascular death (HR, 1.71 [95% CI, 1.10-2.67]; P=0.02). These results remained significant after further adjustment of the model to include prior myocardial infarction (HF: HR, 1.89, P=0.01; HF/cardiovascular death: HR, 1.68, P=0.02). Elevated oxidized phospholipid concentrations were similarly associated with risk, particularly when added to higher lipoprotein(a). In Kaplan-Meier analyses, individuals with stage A/B HF and elevated lipoprotein(a) had shorter time to progression to stage C/D HF or HF/cardiovascular death (both log-rank P<0.001). Among individuals with stage A or B HF, higher lipoprotein(a) and oxidized phospholipid concentrations are independent risk factors for progression to symptomatic HF or cardiovascular death. URL: https://wwwclinicaltrials.gov; Unique identifier: NCT00842868.

Postmortem diagnosis of arterial atherosclerosis in autopsy, postmortem computed tomography and histopathological examinations in medico-legal aspect.

The aim of this study is to provide a retrospective assessment of the possibility of determining the severity of atherosclerosis based on postmortem computed tomography (PMCT), autopsy protocols and histopathological examination results. In the first stage of the study, 200 cases were evaluated of persons over 40 years of age in whom postmortem computed tomography and autopsy were performed. In the second stage, the cases were divided into a study group (cardiovascular deaths) and a control group, as well as divided by age and, in addition to autopsy protocols and PMCT results, histopathological findings were evaluated. The results of stage I demonstrated that the best detection of atherosclerosis was in the advanced stage with a predominance of detection in PMCT. Atherosclerosis detection in autopsy was highest in the coronary arteries, aorta and cerebral arteries; while in PMCT it remained equal in all evaluated locations. Autopsy showed higher detection of advanced atherosclerotic lesions in the coronary arteries and aorta compared to PMCT. The results of stage II of the study revealed that attaching the results of the general histopathological examination to the retrospective evaluation does not provide an opportunity to increase the accuracy of the evaluation of atherosclerotic lesions. The results obtained indicate the need for prospective studies. Autopsy allows macroscopic evaluation of a very broad spectrum of atherosclerotic lesions, but often without precise determination of their nature, and with limited localization; PMCT allows accurate and reproducible evaluation of calcified atherosclerotic lesions in large and medium-sized vessels, but is unsuitable for the evaluation of non-calcified lesions and small vessels; targeted histopathological examinations allow very accurate, but local assessment of atherosclerotic lesions.

Method of thromboembolism prediction in advanced atherosclerosis

Aim. To develop a method for thromboembolism prediction in patients with ad­vanced atherosclerosis.Material and methods. The study involved 170 patients with advanced atheroscle­rosis and 110 patients with local atherosclerotic lesions. At the first stage, speciali­zed experts generated signs characterizing the severity of prothrombotic conditions. To determine whether patients belonged to the first or second group, the multivariate statistics method was used. Decision rules (DRs) was developed based on soft computing (SC), as well as the methodology for the synthesis of hybrid fuzzy DRs.Results. According to the discriminant function coefficient (DFC), the division into classes was made with the formation of an intersection area, which affected the diagnostic sensitivity of this method (=86%). Due to difficulties of separating more heterogeneous groups with a small sample, RP was synthesized according to the atherosclerosis severity classification using SC technology. Atherosclerosis severity classification was adopted according to fuzzy DRs: initiation stage (up to 20%); reverse stage (21-40%); progressive stage (41-65%); critical stage (more than 65%). As­ses­sment of thromboembolism risk in advanced atherosclerosis in the examined pati­ents showed the following trends: progressive stage — 55% of patients; critical stage — 21% of patients; reverse stage — 16% of patients; initiation stage — 7% of patients.Conclusion. DFC for DRs makes it possible to identify groups with high and low thromboembolism risk. The resulting final fuzzy DRs make it possible to differentiate the atherothrombotic condition in advanced atherosclerosis by severity, which can help to timely determine preventive and therapeutic measures.

Carotid Artery Doppler: A Possible Non-invasive Diagnostic Approach to Assessing the Severity of Coronary Artery Disease.

Carotid artery Doppler ultrasound is being explored for its potential as a non-invasive tool for evaluating coronary artery disease (CAD) severity and cardiovascular risk. This study aimed to investigate the association between carotid Doppler parameters and CAD severity, as determined by the Gensini score (GS) and multi-vessel disease presence. Ninety patients undergoing coronary angiography (CAG) and carotid ultrasound were retrospectively analysed. Carotid Doppler parameters and CAD severity were assessed through bivariate and multivariable analyses. Among the patients studied, 80% were male, with a mean age of 65.24 years (±9.91). Triple vessel disease (68.9%) and dominant vessel disease (73.3%) were prevalent coronary findings, with a mean GS of 139.2 (±76.6). Increased intima-media thickness (IMT) in the common carotid artery (CCA) and internal carotid artery (ICA) showed significant associations (CCA IMT: OR = 0.312, p = 0.037; ICA IMT: OR = 0.354, p = 0.017) with high GS (>125) and multi-vessel disease. Significant carotid stenosis (>50% diameter stenosis) emerged as an independent predictor of CAD severity. Fibrocalcific plaques, detected in 62.2% of cases, correlated significantly with elevated GS. Plaque burden, especially plaques in >3 locations, indicated a higher likelihood of triple vessel disease and a higher GS. Carotid Doppler parameters, particularly IMT and significant stenosis, are robust predictors of CAD severity, including high GS and multi-vessel disease. Integrating carotid artery assessment into clinical protocols can aid in timely interventions and preventive strategies for CAD management.

Left anterior descending coronary artery-left circumflex coronary artery bifurcation angle and severity of coronary artery disease; is there any correlation? A cross-sectional study.

The aim of this study is to evaluate the association of coronary computed tomography angiography derived (CCTA) plaque characteristics and the left anterior descending coronary artery (LAD) and left circumflex coronary artery (LCX) bifurcation angle with severity of coronary artery disease (CAD). All the stable patients with suspected CAD who underwent CCTA between January to December 2021 were included. Correlation between CCTA-derived aggregated plaque volume (APV), LAD-LCX angle, remodeling index (RI), coronary calcium score with Gensini score in conventional angiography were assessed. One hundred and twenty-two patients who underwent both CCTA and coronary angiography were analyzed. Our analysis showed that the median (percentile 25% to percentile 75%) of the APV, LAD-LCx angle, and calcium score were 31% (17%-47%), 58° (39°-89°), and 31 (0-186), respectively. Also, the mean ± SD of the RI was 1.05 ± 0.20. Significant correlation between LAD-LCx bifurcation angle (0.0001-0.684), APV (0.002-0.281), RI (0.0001-0.438), and calcium score (0.016-0.217) with Gensini score were detected. There was a linear correlation between the mean LAD-LCx bifurcation angle and the Gensini score. The sensitivity and specificity for the cut-off value of 47.5° for theLAD-LCX anglewere 86.7% and 82.1%, respectively. There is a direct correlation between theLAD-LCx angle and the Gensini score. In addition to plaque characteristics, anatomic-based CCTA-derived indices can be used to identify patients at higher risk for CAD.

Validity of the Triglyceride-Glucose Indices for Predicting the Severity of Coronary Artery Disease in Patients With Nondiabetic Chronic Coronary Syndrome.

The triglyceride-glucose (TyG) index was shown to be an independent predictor of coronary artery disease (CAD) progression and prognosis. However, whether the TyG index can predict the severity of CAD in nondiabetic patients with chronic coronary syndrome remains unclear. A total of 118 individuals who underwent elective coronary angiography were classified into group A (59 with coronary lesions) and group B (59 with normal coronary arteries; as a control group) after coronary angiography and laboratory tests for fasting and the postprandial (PP) TyG index. The complexity of CAD was determined by the Synergy Between Percutaneous Coronary Intervention (SYNTAX) score (SYNTAX score >22 indicated moderate-high risk), and patients diagnosed with diabetes or prediabetes were excluded. The TyG index was not related to the SYNTAX score in groups A and B; however, in the CAD group with an low-density lipoprotein (LDL) concentration <70 mg/dL (group A1), a fasting TyG index ≥8.25 and a PP TyG index ≥11 could predict moderate-high SYNTAX risk score; in addition, the odds ratio (OR) was 4.3× higher and the relative risk (RR) was 1.8× greater (OR = 4.3, RR = 1.8, 95% confidence interval = 1.4-13.5, P < 0.05) for individuals with a higher fasting TyG index ≥8.25 to have a moderate-high SYNTAX risk score. Individuals with a higher PP TyG index ≥11 had OR of 2.6× higher and a RR of 1.4× greater to have moderate-high SYNTAX risk score. Both fasting and PP TyG levels were associated with greater coronary anatomical complexity (SYNTAX score >22) in nondiabetic chronic coronary patients with LDL <70 mg/dL. Fasting and the PP TyG indices can serve as noninvasive predictors of CAD complexity in nondiabetic patients with LDL <70 mg/dL and could change the management and therapeutic approaches.

Myocardial Performance Index as a Predictor of Severity of Coronary Artery Disease in Patients with Non-ST- Elevation Myocardial Infarction

Myocardial Performance Index as a Predictor of Severity of Coronary Artery Disease in Patients with Non-ST- Elevation Myocardial Infarction

Correlation between impaired Aortic Distensibility and the severity of coronary artery disease and calcium scoring measured by cardiac CT

Correlation between impaired Aortic Distensibility and the severity of coronary artery disease and calcium scoring measured by cardiac CT

The impact of intensive glycemic control on prognosis in diabetes patients with severe coronary artery disease across different age groups

The impact of intensive glycemic control on prognosis in diabetes patients with severe coronary artery disease across different age groups