Severity Of Coronary Lesions Research Articles

Expression and clinical significance of circRNA cSMARCA5 in patients with acute myocardial infarction

Objective: To investigate the expression level and clinical significance of cSMARCA5 in the patients with acute myocardial infarction (AMI). Methods: This study was a case-control study. A total of 100 patients with AMI and 100 patients without coronary heart disease who received treatment in the Department of Cardiology, Peking University Third Hospital from September to December 2021 were included in the study according to the principle of 1∶1 frequency matching. The expression levels of cSMARCA5 in the peripheral blood of AMI patients and control groups were measured by real-time quantitative polymerase chain reaction (RT-qPCR). The receiver operating characteristic (ROC) curve was used to calculate the diagnostic ability of cSMARCA5 for AMI. Spearman or Pearson correlation analysis was used to explore the correlation between cSMARCA5 and the degree of myocardial necrosis, coronary lesion severity and GRACE risk stratification score. Bioinformatics analysis was used to predict the possible mechanism of cSMARCA5 in pathological changes of AMI. Results: The age [M (Q1,Q3)] of AMI patients and control group was 63.0 (56.0, 71.5) and 63.0 (53.0, 75.5) (P=0.622), and the proportion of males was 75.0% (75 cases) and 46.0% (46 cases) (P<0.001), respectively. The expression level [M (Q1,Q3)] of cSMARCA5 was significantly lower in AMI patients compared with the control group [0.37 (0.22, 0.73) vs 1.03(0.71, 1.75), P<0.001]. ROC analysis showed that the area under the curve of cSMARCA5 in diagnosing AMI was 0.83 (95%CI: 0.77-0.89, P<0.001), with a sensitivity of 89.0% and specificity of 67.7%. cSMARCA5 was negatively correlated with creatine kinase isoenzyme MB (r=-0.203, P=0.041), troponin T (r=-0.230, P=0.023) and N-terminal brain natriuretic peptide precursor (r=-0.250, P=0.012), and positively correlated with left ventricular ejection fraction (r=0.201, P=0.042). In addition, the expression level of cSMARCA5 was negatively correlated with SYNTAX score (r=-0.196, P=0.048) and GRACE risk score (r=-0.321, P=0.001). Bioinformatic analysis suggested that cSMARCA5 might be involved in the process of AMI through regulating the gene expression of tumor necrosis factor. Conclusions: The expression of cSMARCA5 is significantly decreased in peripheral blood of AMI patients compared with control group, and its expression level is negatively correlated with the severity of myocardial infarction. cSMARCA5 is expected to be a potential biomarker of AMI.

Rotational atherectomy treatment before drug-eluting stent implantation in severe calcific coronary lesion

Rotational atherectomy can effectively destroy calcified plaques and facilitate stent insertion and expansion in many cases. In this article, we present a successful application of rotational atherectomy with rotablator and drug-eluting stent implantation treatment in a 43-year-old male patient with severe calcific stenosis in the right coronary artery that could not be dilated with a high-pressure balloon. During the follow-up, the patient did not have any complaints as long as he was hospitalized, and no recent adverse events, such as acute stent thrombosis and bleeding, were observed.

Neutrophil-lymphocyte ratio in patients with coronary heart disease

Introduction. Despite significant advances in the diagnosis and treatment of patients with cardiovascular pathology, it is diseases associated with atherosclerosis that are still the main cause of mortality and disability. Atherosclerosis is based on local inflammation of the vascular wall and disruption of the lipid profile. Neutrophillymphocyte ratio is an indicator that can serve as a new diagnostic criterion of atherosclerotic changes. Materials and methods. The study enrolled 240 patients with coronary heart disease (150 men and 90 women). The subjects gave voluntary informed consent to participate in the study. All patients with CHD underwent coronary angiography, echocardiography and general blood analysis. Statistical processing of the results was performed using "Microsoft Office Excel" for Windows and "Statistica 10.0" software. Mann-Whitney test was used to assess the statistical significance of differences between the two groups for any parameters in the distribution of features other than normal. The Spearman rank correlation coefficient and its significance were used to assess the relationship between the two traits. Results. An increase in NLS values with progression of atherosclerotic coronary lesion severity was found; an inverse correlation between NLS value and LV ejection fraction (EF) was detected. Discussion. Our results, demonstrating an increase in this index with increasing severity of atherosclerotic lesions of the coronary arteries, are consistent with the literature data. Conclusion. Taking into account the fundamental role of inflammation in atherogenesis, as well as the difficulties of routine determination of expensive markers in everyday practice, the inclusion of an uncomplicated and economically affordable index of LVEF to assess the severity of coronary atherosclerosis and stratify the risk of adverse outcomes in patients with CHD is of undoubted scientific and practical interest and dictates the need for further study of its use in various patient cohorts.

Diagnostic performance of computational fluid dynamics (CFD)-based fractional flow reserve (FFR) derived from coronary computed tomographic angiography (CCTA) for assessing functional severity of coronary lesions.

Fractional flow reserve (FFR) is the gatekeeper for lesion-specific revascularization decision-making in patients with stable coronary artery disease (CAD). The potential of noninvasive calculation of FFR from coronary computed tomographic angiography (CCTA) to identify ischemia-causing lesions has not been sufficiently assessed. The objective of this study was to evaluate the feasibility and diagnostic accuracy of a novel computational fluid dynamics (CFD)-based technology, termed as AccuFFRct, for the diagnosis of functionally significant lesions from CCTA, using wire-based FFR as a reference standard. A total of 191 consecutive patients who underwent CCTA and FFR measurement for suspected or known CAD were retrospectively enrolled at 2 medical centers. Three-dimensional anatomic model of coronary tree was extracted from CCTA data, CFD was applied subsequently with a novel strategy for the computation of FFR in a blinded fashion by professionals. Results were compared to invasive FFR, a threshold of ≤0.80 was used to indicate the hemodynamically relevant stenosis. On a per-patient basis, the overall accuracy, sensitivity, specificity of AccuFFRct for detecting ischemia were 91.78% (95% CI: 86.08% to 95.68%), 92.31% (95% CI: 81.46% to 97.86%) and 91.49% (95% CI: 83.92% to 96.25%), respectively; those for per-vessel basis were 91.05% (95% CI: 86.06% to 94.70%), 92.73% (95% CI: 82.41% to 97.98%) and 90.37% (95% CI: 84.10% to 94.77%), respectively. The AccuFFRct and FFR was well correlated on per-patient (r=0.709, P<0.001) and per-vessel basis (r=0.655, P<0.001). The AUC of AccuFFRct determination was 0.935 (95% CI: 0.881 to 0.969) and 0.927 (95% CI: 0.880 to 0.960) on per-patient and per-vessel basis. This novel CFD-based CCTA-derived FFR shows good diagnostic performance for detecting hemodynamic significance of coronary stenoses and may potentially become a new gatekeeper for invasive coronary angiography (ICA).

Abstract P596: Familiar Hypercholesterolemia is Associated With Lower All-Cause Mortality Despite Higher Complexity of Coronary Lesions and Interventions Among Patients Admitted With Acute Myocardial Infarction

Background: Familiar hypercholesterolemia is a genetic disorder affecting lipoprotein metabolism which is strongly associated with early atherosclerosis. Our resolve in this study is to evaluate the severity of coronary lesions ,complexity of acute interventions and clinical outcomes. Hypothesis: Patients with familiar hypercholesterolemia are relatively younger, have high coronary atheroma burden with less comorbidities, thus likely to have complex atherosclerosis but with paradoxical better prognosis. Method: A retrospective cohort study with data from the 2016 to 2018 combined National Inpatient Sample (NIS) database was employed. ICD-10 codes were used to sample all admissions for acute myocardial infarction who were then dichotomized based secondary diagnosis of familiar hypercholesterolemia. Procedure codes of ICD-10 were used to identify patients undergoing coronary revascularizations. We determined relative frequencies of various ischemic injury patterns and complexity of revascularization procedures among the two cohorts. Primary clinical outcome of mortality rate, and secondary outcomes including length of stay and total hospital charge were then assessed. Multivariate linear and logistic regressions were used to adjust for confounders. Results: We identified a total of 4,300,389 adult hospitalizations for acute myocardial infarction including 0.033% with familiar hypercholesterolemia. Patients with familiar hypercholesterolemia were younger (55.8 years vs 58.2 years, adjusted mean difference: -7.87 years, 95%CI: -9.49 years to -6.0 years). Table 1 below shows details of outcomes of our study. Conclusion: Among patients hospitalized with acute myocardial infarction, comorbid familiar hypercholesterolemia was associated with a 62% reduction in odds of in-hospital all-cause mortality despite a 2.25-fold increased odds of STEMI and higher odds for having multivessel percutaneous. revascularization.

Correlation of Epicardial Fat Thickness with Angiographic Severity and LDL Cholesterol Level in CAD

Background: Epicardial fat is independently related to coronary artery disease (CAD). Clinical imaging research has established a robust direct correlation between epicardial fat and abdominal visceral adiposity. This study aimed to assess the association of epicardial fat thickness (EFT) with CAD in patients. Objective: To find the association between EFT, Low-density lipoprotein (LDL) cholesterol levels, and angiographic severity by SYNTAX score. Methods: This prospective observational study involved 321 patients with suspected CAD patients undergoing catheter coronary angiography. Epicardial fat thickness was measured by means of transthoracic echocardiography within 90 days after coronary angiography. The severity of coronary atherosclerotic lesions become evaluated from at least 3 projections in all of the sufferers. The angiographic characteristics of the coronary atherosclerotic lesion have been defined using the SYNTAX score. Results: 321 patients took part in this study; the sex distribution has 259 male subjects (80.7%) and 62 female subjects (19.3%). LDL cholesterol levels &lt;100 mg/dl are present in 75.1% (241 subjects) of the study population. The categories and variables were analyzed, and they show a significant correlation between epicardial fat thickness and SYNTAX score with a p-value of &lt;0.0001. A significant correlation has been observed between LDL cholesterol levels and the angiographic severity of CAD by the SYNTAX score. Conclusion: This study suggests that there is a significant correlation between LDL cholesterol levels, EFT and angiographic severity, and complexity of the coronary lesions by the SYNTAX score. Keywords: Body Fat; Coronary Artery Disease; Epicardial Fat Thickness; CAD

Optical coherence tomography factors for adverse events in patients with severe coronary calcification

BackgroundSevere coronary calcification is a factor for worse outcomes after percutaneous coronary intervention. AimsTo identify factors of pre- and post-stent optical coherence tomography (OCT) for device-oriented clinical endpoints (DoCE) in patients with severely calcified lesions requiring drug-eluting stent (DES) implantation. MethodsA total of 237 consecutive patients with stable coronary disease who underwent OCT imaging of severe coronary lesions were included. Lesions with a maximum calcium angle >180°, maximum calcium thickness > 0.5 mm, and calcium length > 5 mm were defined as having severe calcification. ResultsThe prevalence of eruptive calcified nodules (41% vs. 18%, p = 0.002) and medial dissection with calcified flaps (59% vs. 26%, p < 0.001) was significantly higher in patients with DoCE (n = 34) than those without DoCE (n = 203). Multivariate analyses demonstrated that the presence of a medial dissection with calcified flap within the DES-implanted segment was independently associated with a higher incidence of DoCE (odds ratio, 3.367; 95% confidence interval, 1.503–7.543; p = 0.003). The combined presence of eruptive calcified nodules and medial dissection with calcified flaps was associated with a higher incidence of DoCE (p < 0.001) during a median of 756 days after DES implantation. ConclusionsOCT-defined severely calcified lesions with eruptive calcified nodules and medial dissection with calcified flaps were associated with a higher incidence of DoCE after DES implantation.

Alterations of NMR-Based Lipoprotein Profile Distinguish Unstable Angina Patients with Different Severity of Coronary Lesions.

Non-invasive detection of unstable angina (UA) patients with different severity of coronary lesions remains challenging. This study aimed to identify plasma lipoproteins (LPs) that can be used as potential biomarkers for assessing the severity of coronary lesions, determined by the Gensini score (GS), in UA patients. We collected blood plasma from 67 inpatients with angiographically normal coronary arteries (NCA) and 230 UA patients, 155 of them with lowGS (GS ≤ 25.4) and 75 with highGS (GS > 25.4), and analyzed it using proton nuclear magnetic resonance spectroscopy to quantify 112 lipoprotein variables. In a logistic regression model adjusted for four well-known risk factors (age, sex, body mass index and use of lipid-lowering drugs), we tested the association between each lipoprotein and the risk of UA. Combined with the result of LASSO and PLS-DA models, ten of them were identified as important LPs. The discrimination with the addition of selected LPs was evaluated. Compared with the basic logistic model that includes four risk factors, the addition of these ten LPs concentrations did not significantly improve UA versus NCA discrimination. However, thirty-two selected LPs showed notable discrimination power in logistic regression modeling distinguishing highGS UA patients from NCA with a 14.9% increase of the area under the receiver operating characteristics curve. Among these LPs, plasma from highGS patients was enriched with LDL and VLDL subfractions, but lacked HDL subfractions. In summary, we conclude that blood plasma lipoproteins can be used as biomarkers to distinguish UA patients with severe coronary lesions from NCA patients.

Correlation Between GDF11 Serum Levels, Severity of Coronary Artery Lesions, and the Prognosis of Patients with ST-segment Elevation Myocardial Infarction.

We aimed to explore the correlation among serum GDF11, the severity of coronary artery lesions, and the prognosis of patients with ST-segment elevation myocardial infarction (STEMI). A total of 367 patients were enrolled and divided into control (n = 172) and STEMI (n = 195) groups. Serum GDF11 (P < 0.001) was an independent predictor of STEMI and was negatively correlated with SYNTAX score (P < 0.05). ROC curve analysis showed that serum GDF11 could screen patients for major adverse cardiovascular events (MACEs). KM curve analysis showed that patients with lower concentration of GDF11 had a higher incidence of MACEs, and Cox proportional hazards regression analysis showed that the serum GDF11 (P < 0.001) was an independent predictor of MACEs. Serum GDF11 was negatively correlated with the severity of coronary lesions and was also an independent prognostic indicator of MACEs in patients with STEMI.

The link between different infection forms of Porphyromonas gingivalis and acute myocardial infarction: a cross-sectional study

BackgroundPorphyromonas gingivalis (Pg) is one of the keystone pathogens involved in periodontitis. The present study aimed to observe the relationship among different infection forms of Pg, systemic inflammation, and acute myocardial infarction (AMI).MethodsA total of 382 patients diagnosed with AMI and 78 patients without coronary heart disease (CHD) were included in the study. DNA from exfoliated oral cells, circulating cell-free DNA (cfDNA), and genomic DNA (gDNA) from blood samples were extracted. The qPCR method was employed to detect Pg infection. Clinical characteristics, inflammatory parameters, and severity of coronary artery lesions of the patients were analyzed and compared.ResultsBoth the oral colonization and distant invasion of Pg correlated positively with systemic inflammation. Multivariate logistic regression analysis suggested that Pg positivity in gDNA was correlated with the risk of AMI [Model 1 (odds ratio (OR) = 1.917, 95% confidence interval (CI) 1.108–3.315), Model 2 (OR = 1.863, 95% CI 1.064–3.262), and Model 3 (OR = 1.853, 95% CI 1.042–3.295); p < 0.05]. Pg positivity in cfDNA and gDNA was related to the severity of coronary artery lesions (cfDNA-positive cases, adjusted OR = 1.577, p < 0.05; gDNA-positive cases, adjusted OR = 1.976, p < 0.01).ConclusionsThe distant invasion and colonization of Pg were the risk factors of AMI. They also affected the severity of CHD, indicating that periodontitis severity and distant invasion of periodontal pathogens were related to CHD. The presence of Pg was likely able to drive systemic inflammation, suggesting that there was an inflammatory relationship between periodontitis and AMI.

Successful percutaneous coronary intervention with extracorporeal membrane oxygenation in a patient with acute inferior wall myocardial infarction complicated by electrical storm, cardiogenic shock, and cardiac arrest: a case report

BackgroundHigh-risk patients with coronary heart disease who develop acute myocardial infarction (AMI) have severe coronary lesions. If severe complications occur, such as malignant ventricular arrhythmia, cardiogenic shock, and cardiac arrest, implementation of emergency percutaneous coronary intervention (PCI) may be hindered, leading to a higher perioperative mortality rate. Extracorporeal membrane oxygenation (ECMO) can pave the way for rapid myocardial reperfusion therapy. When cardiac arrest occurs, hemodynamic support with ECMO can facilitate revascularization with PCI, which can increase the time available for further salvage and treatment and reduce intraoperative risk during PCI.Case presentationHerein, we report a case of a 61-year-old man with AMI who suffered electrical storm of sustained malignant ventricular fibrillation, cardiogenic shock, and cardiac arrest and was successfully treated with PCI with ECMO support. During PCI, repeated aspiration and removal of the right coronary artery thrombus were performed, and blood flow was restored after right coronary artery balloon dilation. One episode of defibrillation was delivered to restore sinus rhythm. Then, stents were implanted in the distal and proximal right coronary artery lesions to achieve revascularization. After PCI with ECMO support, irreversible malignant arrhythmia returned to sinus rhythm through coronary perfusion, which prevented death following unsuccessful cardiopulmonary resuscitation. After applying active treatments, including anti-shock, mechanical ventilation, anti-inflammation, and organ support, the patient was discharged after his condition and vital signs stabilized. The patient was followed up once a week after hospital discharge, and his cardiopulmonary function recovered well.ConclusionsWith ECMO support, PCI should be performed immediately in patients with inferior wall AMI complicated by electrical storm of sustained ventricular fibrillation, cardiogenic shock, and cardiac arrest to facilitate stent placement, achieve complete revascularization, restore coronary perfusion, and avoid death

Value of glycosylated hemoglobin A1c and apolipoprotein A-1 ratio on predicting outcome of patients with acute coronary syndrome

Objective: To investigate the predictive value of glycosylated hemoglobin A1c/apolipoprotein A-1 (HbA1c/ApoA-1) ratio for major adverse cardiovascular events (MACEs) in patients with acute coronary syndrome (ACS). Methods: The present study is a retrospective cohort study. ACS patients who were hospitalized and underwent coronary angiography at Beijing Hospital from March 2017 to March 2019 were enrolled. Baseline information such as sex, age, previous history, Gensini score, HbA1c and ApoA-1 were analyzed. Patients were divided into two groups according to presence or absence of MACEs and the difference on HbA1c/ApoA-1 ratio was compared between the two groups. According to the tertiles of HbA1c/ApoA-1 levels, patients were divided into high (5.87-16.12), medium (4.50-5.83) and low (2.11-4.48) HbA1c/ApoA-1 groups. Cox proportional risk model was used to evaluate the differences in MACEs and all-cause mortality among the three groups. Kaplan-Meier survival analysis was used to compare the differences of MACEs between the various HbA1c/ApoA-1 groups. Results: A total of 366 ACS patients were included in this study. The mean age of the patients was (65.9±10.3) years. There were 59 MACEs and 10 all-cause deaths during the mean of (22.3±4.4) months follow-up. After adjusting for age, systolic blood pressure, history of diabetes and Gensini score, the incidence of MACEs was 2.45 times higher in the high HbA1c/ApoA-1 group than in the low HbA1c/ApoA-1 group (95%CI 1.16-5.18, P=0.019). There was no significant difference in all-cause mortality between the high and low HbA1c/ApoA-1 groups (P=1.000). Kaplan-Meier survival analysis showed that patients in the high HbA1c/ApoA-1 group had the highest risk of MACEs, while patients in the low HbA1c/ApoA-1 group had the lowest risk of MACEs (P<0.01). Spearman rank correlation analysis showed that HbA1/ApoA-1 ratio was positively correlated with Gensini score in ACS patients (r=0.274, P<0.01). Conclusion: High HbA1c/ApoA-1 ratio was an independent risk factor for MACEs in ACS patients. Patients with high HbA1c/ApoA-1 ratio had more severe coronary artery disease lesions. HbA1c/ApoA-1 ratio may be used as a potential risk stratification biomarker for ACS patients, it might be useful for the early identification of high-risk population and for predicting the incidence of MACEs among ACS patients.

Expressions of miR-132, miR-145 and miR-208 in Patients with Acute Myocardial Infarction and Correlations with Gensini Score

The researchers aimed to investigate the correlations of miR-132, miR-145 and miR-208 with the Gensini score (GS) of patients with acute myocardial infarction (AMI). Totally 120 AMI patients and 80 healthy volunteers undergoing physical examination were included into AMI group and healthy group, respectively. The AMI patients were subdivided into low GS (LGS) group (&lt; 30 points) and high GS (HGS) group (&gt;30 points). Independent risk factors included troponin I (TnI), creatine kinase (CK) isoenzyme, uric acid (UA), C-reactive protein (CRP), miR-132, miR-145 and miR208, which affected the severity of coronary artery lesions (CALs) (P&lt;0.05). Compared with miR-132, miR-145, and miR208 alone, their combination had the highest diagnostic value, with the area under curve (95%CI) of 0.911 (0.869-0.978), sensitivity of 89.89 percent and specificity of 70.91 percent (P&lt;0.001). MiR-132, miR-145, and miR-208 are abnormally expressed in AMI patients. Their combination has higher diagnostic value for the severity of CALs in AMI patients.

Assessment of Diffusely Diseased Coronary Artery by Instantaneous Wave-Free Ratio Co-Registration versus Quantitative Coronary Angiography

Purpose: Coronary physiological assessment is now routinely applied in the catheter laboratory to guide percutaneous coronary intervention (PCI). Currently most physiological assessment is performed in a binary manner to determine whether a vessel requires intervention. Although studies have reported the high diagnostic efficiency of physiological assessment in minimizing the number of vessels requiring treatment, it is widely recognized that interrogation of individual stenosis in the presence of tandem lesions or diffuse disease under hyperemic conditions makes PCI planning complex and less practical. The aim of this study was to perform assessment of severity of coronary lesions of a pressure guide wire with continuous instantaneous wave-free ratio (iFR) co-registration measurement compared coronary angiography and quantitative coronary analysis (QCA) aiming to minimize the procedure, decrease number and length of stents used.&#x0D; Methodology: This non randomized controlled trial was conducted at Cardiology Department, Benha University, National Heart Institute (NHI) from February 2020 to September 2022. The study included a group of 30 patients presented with diffuse coronary artery disease and undergoing elective PCI.&#x0D; Findings: The study found out that the distribution of risk factors among studied groups was HTN representing 54%, regarding DM 60%, concerning dyslipidemia 64% and smokers represented 57%. The median of expected length of stent using QCA assessment was 40.2 mm with standard deviation (SD) (8mm) higher than detected actually deployed by iFR co-registration. The mean length of stents used by IFR co-registration was 20.2 mm stents (SD: 11.2 mm) and P-value was 0.0000. Also, all patients needed stent via QCA while only 86% actually need stent application via iFR co-registration assessment, leading to a fewer stents placed per patient. The difference was statistically significant p&lt;0.0022. This study demonstrates that iFR co-registration performed under resting conditions predicted the physiological outcome of PCI with a high degree of accuracy. Compared with QCA, iFR co-registration significantly decreased the number and length of hemodynamically significant lesions identified for revascularization. iFR co-registration should be performed under resting Recommendation: iFR co-registration should be performed under resting conditions to predict the physiological outcome of PCI with a high degree of accuracy.

Preliminary study of the significance of reverberation by IVUS detection for patients with severe calcified lesions.

To explore the potential significance of the reverberation of calcification by comparing both intravascular ultrasound (IVUS) and optical coherence tomography (OCT) measurement post manual coregistration. The reverberation phenomenon is often detected by IVUS for severe calcified lesions post rotational atherectomy (RA), which is thought to be due to the glassy and smooth inner surfaces of calcifications. Because of the poor penetration of IVUS, it is impossible to measure the thickness of calcifications, and the relationship between multiple reverberations and the thickness of calcification lesions has not been reported before. A total of forty-nine patients with severe calcified coronary lesions that were detected by IVUS and OCT simultaneously were enrolled in our retrospective study. If reverberation phenomena were detected by IVUS, intravascular imaging (IVI) data (including distance between the IVUS catheter center and the inner surface of the reverberation signal, the intervals between all adjacent reverberation signals, the number of layers of reverberation in IVUS, and the thickness of the calcification in OCT) were measured at the same position and same direction (each cross-section had 4 mutually perpendicular directions) at 1-mm intervals. The correlation between each reverberation observational value and OCT data was the primary target in this retrospective study, and the correlation between reverberation and calcium crack post predilatation was analyzed in other 15 patients. Four hundred twenty-eight valid observational points were analyzed simultaneously by IVUS and OCT; among them, 300 points had a single layer of reverberation, 83 had double layers of reverberation and 42 had multiple layers (≥ 3 layers) of reverberation by IVUS detection post-RA. Multivariate logistic regression analysis showed that the number of layers of reverberation by IVUS was significantly related to the thickness of calcifications by OCT at the same point and in the same direction (p < 0.001). Single, double, and multiple layers of reverberation in IVUS correspond to median calcification thicknesses (interquartile ranges (IQRs)) of 0.620mm (0.520-0.720), 0.950mm (0.840-1.040) and 1.185mm (1.068-1.373), respectively, by OCT detection. Another 100 points in other 15 patients with integrated IVUS data pre- and post-predilatation showed that only single layer of reverberation was related to calcium crack (p < 0.001). The number of layers of reverberation signal detected by IVUS is positively correlated with the thickness of calcifications measured by OCT post-RA and single layer of reverberation is correlated to calcium crack post-predilatation.

The association of glycated hemoglobin A1c with coronary artery disease, myocardial infarction, and severity of coronary lesions.

Glycated hemoglobin A1c (HbA1c) has been recognized as a predictor of cardiovascular events. However, the relationship between HbA1c and coronary artery disease (CAD) in the Chinese population has yet to be systematically explored. In addition, factors associated with HbA1c were generally analyzed linearly, thereby failing to appreciate more complex nonlinear associations. The study aimed to evaluate the relationship between the HbA1c value and the presence and severity of coronary artery stenosis. A total of 7192 consecutive patients who underwent coronary angiography were enrolled. Their biological parameters, including HbA1c, were measured. The severity of coronary stenosis was evaluated using Gensini score. After correcting for baseline confounding factors, a multivariate logistic regression analysis was used to evaluate the relationship between HbA1c and CAD severity. Restricted cubic splines were applied to explore the relation of HbA1c with the presence of CAD, myocardial infarction (MI), and the severity of coronary lesions. HbA1c was significantly associated with the presence and severity of CAD in patients without diagnosed diabetes (odds ratio: 1.306, 95% confidence interval: 1.053-1.619, p = 0.015). Spline analysis showed a U-shaped association of HbA1c with the presence of MI. Both HbA1c > 7.2% and HbA1c < 5.7% were associated with the presence of MI. In conclusion, HbA1c value was highly associated with the severity of coronary artery stenosis in the whole study population, and in CAD patients without diagnosed diabetes. Compared with patients with HbA1c levels between 6.0% and 7.0%, HbA1c < 5.7% and HbA1c > 7.2% were associated with higher presence of MI.

Effect of Low T3 Syndrome on Severity of Coronary Artery Disease in Patients with Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Low Triiodothyronine (T3) syndrome is a hormonal imbalance that significantly influences cardiovascular haemodynamics by altering the vascular endothelial function by influencing the Nitric Oxide (NO) production. In Acute Coronary Syndrome (ACS) inflammation disrupts plaque which stimulates thrombosis, coagulation, activation of sympathetic system and release of cytokines mainly Interleukin 6 (IL-6), which is a pleotropic and pro-inflammatory cytokine, which exerts inhibitory effect on thyroid axis function. Aim: To study the association of low T3 syndrome and severity of Coronary Artery Disease (CAD) in ACS. Materials and Methods: This cross-sectional study was conducted in the Intensive Critical Care Unit (ICCU)under the Department of Cardiology, Karnataka institute of Medical Sciences, Hubli, Karnataka, India, from July 2021 to August 2022. A total of 120 consecutive ACS patients were taken for the study and all underwent Coronary Angiography (CAG). Severity of CAD was assessed with the help of Gensini risk scoring system. The patients were divided based on thyroid function status. Low T3 syndrome was defined as &lt;0.846 ng/ mL with normal values of Thyroxine (T4) and Thyroid Stimulating Hormone (TSH). Receiver operating characteristic curves were generated to correlate low T3 syndrome and angiographic severity of CAD. Multinominal logistic regression analysis demonstrated LT3S is an independent risk factor for CAD. The Chi-square test was used for ordered categorical data with the severity of coronary artery lesions. Results: The severity of coronary artery lesions in the low T3 syndrome group (n=29, 24.16%) and hypothyroidism (n=20, 16.6%) group was significantly greater than that of euthyroid group (n=71, 59.1%), with all the groups’ (p-value=0.047). Multinominal logistic regression analysis demonstrated that low T3 syndrome was an independent risk factor of CAD for moderate (Odds ratio=2.34, 95%CI: 0.47-11.39, p&lt;0.02) and severe (Odds ratio=8.56, 95%CI: 1.52-47.9, p&lt;0.015) lesions. Conclusion: The patients with low T3 syndrome are associated with more severe and diffuse CAD and low T3 syndrome is an independent risk factor for ACS.

Relationship between admission random blood glucose, fasting blood glucose, with severity of coronary lesion and hospital outcomes in patients admitted with ST elevation myocardial infarction

Background: This research addressed the relationships between admission random blood glucose (RBG), fasting blood glucose (FBG), and severity of coronary artery disease (CAD) “assessed by Gensini score “and in hospital outcomes in patient admitted with ST elevated Myocardial Infarction (STEMI). Methods: The research was conducted on 100 cases who were recruited from Cardiology department in Tanta University presented with STEMI and underwent coronary angiography either primary PCI or Pharmaco-invasive, the cases were categorized firstly, according to RBG into two groups: Group 1: Non hyperglycemia group (200 mg/dl). Then after 8hours from admission FBG was tested "regarding FBG Patient is fasting but to be well hydrated" and accordingly the cases were further sub-divided into two groups: Group I: Non-FBG elevated (126 mg/dl). Results: It was shown that there was a significant difference between the hyperglycemic and FBG elevated groups in terms of severity of CAD and In-hospital mortality where both the hyperglycemic and the FBG elevated cases had more extensive CAD and higher Gensini score. Also, the occurrence of major adverse cardiovascular events was higher in these two groups in comparison to their non-hyperglycemic, non FBG elevated counterparts. There was statistically significant positive correlation between Gensini score and RBS and fasting blood glucose level (p

Association of Achilles Tendon Xanthoma Identified Based on New Guidelines from the Japan Atherosclerosis Society with Coronary Lesion Severity in Premature Coronary Artery Disease

Association of Achilles Tendon Xanthoma Identified Based on New Guidelines from the Japan Atherosclerosis Society with Coronary Lesion Severity in Premature Coronary Artery Disease

Elevated Lp(a) Levels Correlate with Severe and Multiple Coronary Artery Stenotic Lesions.

The role of Lipoprotein(a) (Lp(a)) in increasing the risk of cardiovascular diseases is reported in several populations. The aim of this study is to investigate the correlation of high Lp(a) levels with the degree of coronary artery stenosis. Two hundred and sixty-eight patients were enrolled for this study. Patients who underwent coronary artery angiography and who had Lp(a) measurements available were included in this study. Binomial logistic regressions were applied to investigate the association between Lp(a) and stenosis in the four major coronary arteries. The effect of LDL and HDL Cholesterol on modulating the association of Lp(a) with coronary artery disease (CAD) was also evaluated. Multinomial regression analysis was applied to assess the association of Lp(a) with the different degrees of stenosis in the four major coronary arteries. Our analyses showed that Lp(a) is a risk factor for CAD and this risk is significantly apparent in patients with HDL-cholesterol ≥35 mg/dL and in non-obese patients. A large proportion of the study patients with elevated Lp(a) levels had CAD even when exhibiting high HDL serum levels. Increased HDL with low Lp(a) serum levels were the least correlated with stenosis. A significantly higher levels of Lp(a) were found in patients with >50% stenosis in at least two major coronary vessels arguing for pronounced and multiple stenotic lesions. Finally, the derived variant (rs1084651) of the LPA gene was significantly associated with CAD. Our study highlights the importance of Lp(a) levels as an independent biological marker of severe and multiple coronary artery stenosis.