Severity Of Coronary Artery Lesions Research Articles

Alterations of gut microbiome profiles as potential markers in patients developing acute coronary syndrome

Abstract Background Imbalanced gut microbiota or gut dysbiosis leads to systemic inflammation, one of key contributors to the development and progression of atherosclerosis. A recent study revealed the association of the gut microbiota and the severity of coronary artery lesions in patients with acute coronary syndrome (ACS). However, the gut microbiota profile in ACS patients in comparison with patients with high-risk cardiovascular disease (CVD) has not been thoroughly investigated. Purpose We aimed to compare the profiles of gut microbiome between patients with ACS and patients with high-risk CVD, as well as to determine the association between gut microbiota and CVD risk factors. Methods This cross-sectional study enrolled 24 stabilized ACS patients within 24 hrs of hospitalization and 59 outpatients in CVD clinics, as a control group. Echocardiography was done in those patients. Blood was collected for biochemical analysis, and fecal samples were collected for gut microbiome analysis via 16S RNA sequencing. Results The demographic data showed no significant differences between groups in CVD risk factors (age, levels of systolic and diastolic blood pressure, fasting glucose, high- and low-density cholesterol, and triglycerides). However, patients with ACS had greater cigarette use and alcohol consumption than the control group. For gut microbiome, both alpha and beta diversity levels of ACS group were significantly higher than those in a control group (Figure 1A-B). Differential abundance analysis by ANCOM-BC revealed significantly increased level of bacteria in the Atopobiaceae family in ACS patients, compared to controls (Figure 1C). Since Atopobiaceae was reported to be positively associated with percent atheroma volume (PAV), a marker of plaque deposit in the arteries, we found an increased number of Atopobiaceae which was positively associated with serum Troponin T level (Figure 1D), systemic inflammation (Figure 1E), and a trend to negatively correlated with LV ejection fraction. Conclusion Our findings suggested that alterations of gut microbiota occurred in ACS patients, and an increase in gut Atopobiaceae level could potentially be the predictive marker of the development of ACS in CVD patients.Figure 1

Prevalence of genetically diagnosed familial hypercholesterolemia in Vietnamese patients with premature acute myocardial infarction.

Familial hypercholesterolemia (FH) is a genetic disorder that results in elevated low-density lipoprotein cholesterol (LDL-C) levels, which manifest early in the first decades of life. It is a major cause of premature coronary artery disease worldwide, leading to significant public health challenges. The prevalence of genetically determined FH in patients with premature coronary artery disease remains underestimated, particularly in developing countries. This study aimed to assess the prevalence of genetically defined FH in Vietnamese patients with premature acute myocardial infarction (AMI) in the Vietnamese population. This cross-sectional study enrolled 218 consecutive patients diagnosed with premature AMI who underwent coronary angiography. The low-density lipoprotein receptor (LDLR), apolipoprotein B, and proprotein convertase subtilisin-kexin type 9 genes were analyzed by next-generation sequencing. FH was diagnosed according to Dutch Lipid Clinic Network criteria. Among the patients with premature AMI who underwent coronary angiography, the mean age was 46.9 ± 6.1 years, with a predominance of males (83.9%). The prevalence of potential FH diagnosed using Dutch Lipid Clinic Network criteria was 14.7% (definite FH, 6.0%; probable FH, 8.7%). Pathogenic or likely pathogenic variants in LDLR, apolipoprotein B, and proprotein convertase subtilisin-kexin type 9 were found in 9 of 218 patients (4.1%), all of which were causative mutations in LDLR. Patients with premature AMI and FH had significantly greater LDL-C levels (217.6 vs 125.7 mg/dL) and more severe coronary artery lesions, as assessed by the Gensini score (100.3 vs 60.5), than did those in the No FH group. The prevalence of genetically determined FH among Vietnamese patients with premature AMI is relatively high. Screening and diagnosis of hereditary conditions in patients with premature AMI are essential to improve early detection and management and reduce the burden of coronary artery disease in this population.

Smartphone addiction habit is positively associated with coronary artery disease and its severity in Chinese adults: a case-control study.

Coronary artery disease (CAD) has a high incidence and poor prognosis worldwide. It has been confirmed that smartphone addiction (SA) habit can increase the incidence of hypertension and obesity in adolescents. However, the association of SA with CAD and its severity in Chinese adults remains largely unknown. A total of 700 Chinese adults (aged 18-70 years) including 350 CAD patients and 350 control subjects were enrolled. The Smartphone Addiction Scale Short Version (SAS-SV) was used to measure SA habit, and the Pittsburgh sleep quality index (PSQI) was used to assess sleep quality. Multiple logistic regression was employed to analyze the relationship between SA habit and CAD. After adjusting for age, smoking, hypertension, type 2 diabetes mellitus, and other risk factors, there was a significant association between SA habit and CAD in adults (p < 0.001). Subgroup analysis showed that there were statistical differences in the correlation between SA habit and CAD in the hypertension, ≤55 years age old, and female subgroups. Moreover, we performed a subgroup analysis based on the number of coronary artery lesions. The result showed that the rate of SA habit in the three-vessel disease group was the highest (p < 0.001). We applied Gensini score to evaluate the severity of coronary artery lesions (median Gensini score, 34) and divided all CAD patients into high Gensini score group (>34) and low Gensini score group (≤34), respectively. Compared with low Gensini score group, patients in high Gensini score group were more likely to have SA habit (p = 0.049). There is a positive association of SA habit with CAD and its severity in Chinese adults.

Association between Triglyceride - High Density Lipoprotein Ratio with Angiographic Severity of Coronary Artery Disease in Patients with Non-ST Segment Elevated Myocardial Infarction

Background: Non-ST Segment Elevated Myocardial infarction (NSTEMI) is a potentially life-threatening condition. Dyslipidaemia is a major contributor of coronary artery disease (CAD) and TG/HDL-C ratio can be an important marker for the prediction of the extent of CAD. This study was aimed to find out the relation between TG/HDL-C ratio with severity of coronary artery lesion in NSTEMI patients. Methods: A total of 200 NSTEMI patients were included and classified into two groups on the basis of TG/HDL-C ratio: Group-A (TG/HDL-C ratio ≤4, n=100) and Group-B (TG/HDL-C ratio &gt;4, n=100). Angiographic severity was measured by Gensini score in all the patients during the same hospital stay period. Relation between TG/HDL-C ratio and angiographic severity was evaluated. Results: Mean age of the study populations was 55.13±8.49 (years) with male predominance (75%). Hypertension, diabetes mellitus, dyslipidaemia and obesity were significantly higher in Group-B (p&lt;0.05). Gensini score in Group-B were significantly higher than Group-A (71±23 vs 30±12, p&lt;0.001). A strong positive linear relationship was found between TG/HDL-C ratio and Gensini score (r=+0.803). Multivariate logistic regression found TG/HDL-C ratio &gt;4 as the powerful independent predictor of Gensini score &gt;36 (AOR=7.98, 95% CI=4.0-15.91, p&lt;0.001). Conclusion: There is a significant positive correlation between TG/HDL-C ratio with Gensini score indicating increased severity of coronary disease in patients with NSTEMI. So early risk stratification and intensive management of NSTEMI can be done by using this cheap and easily available marker on admission. Cardiovasc j 2024; 16(2): 63-69

The evaluation value of atherogenic index of plasma and high-sensitivity C-reactive protein for the degree of coronary artery lesion in premature coronary artery disease

BackgroundPremature coronary artery disease (PCAD) is prevailing. We aimed to investigate the evaluation value of atherogenic index of plasma (AIP) and high-sensitivity C-reactive protein (hs-CRP) for the occurrence and severity of coronary artery lesion in PCAD patients.MethodsPCAD (PACD group)/non-PCAD (control group) patients were enrolled. The coronary artery lesion degree was evaluated using Gensini score (GS). PCAD patients were allocated into the low/medium/high GS groups, with general clinical baseline data analyzed. Plasma hs-CRP/AIP levels were compared in PCAD patients with different disease degree. Correlations between plasma hs-CRP/AIP with Gensini score, independent risk factors affecting the occurrence of PCAD, and the predictive value of hs-CRP/AIP/their combination for the occurrence and degree of PCAD were evaluated by Spearman correlation analysis/Logistic multivariate regression/receiver operating characteristic (ROC) curve. The differences in the area under the curve (AUC) were compared using MedCalc-Comparison of ROC curves.ResultsPlasma hs-CRP/AIP levels in the PCAD group were increased. Plasma hs-CRP/AIP levels varied significantly among PCAD patients with different disease degree. Plasma hs-CRP/AIP levels were markedly positively correlated with the Gensini score. Smoking history/homocysteine/fasting blood-glucose/hs-CRP/AIP were all independent risk factors affecting PCAD occurrence. The AUC of hs-CRP and AIP combination predicting the occurrence of PCAD was 0.950 (90.80% sensitivity/93.33% specificity). hs-CRP/AIP combination assisted in predicting the disease degree in PCAD patients.ConclusionsAIP and hs-CRP are independent risk factors for the occurrence of PCAD, and their combination has high predictive value for PCAD occurrence and disease degree, which are both positively correlated with coronary artery lesion degree.

Analysis of the correlation between the Systemic Inflammatory Response Index and the severity of coronary vasculopathy.

This study aims to analyze the correlation between Systemic Inflammatory Response Index (SIRI) and the severity of coronary artery stenosis in patients with coronary heart disease (CHD). It also aims to assess the predictive value of SIRI for the severity of coronary artery stenosis. A total of 2990 patients who underwent coronary angiography were included in this study. The Gensini score was used to estimate the severity of coronary vascular lesions. The predictive ability of SIRI for CHD was evaluated using receiver operating characteristic (ROC) curves. Binary multivariate logistic regression analysis was used to predict the likelihood of CHD based on the SIRI index. The results showed that people with higher SIRI were more likely to have CHD (P < 0.001). After controlling for other risk factors, the highest quartile had a significantly higher incidence of coronary artery disease compared to the lowest quartile (odds ratio [OR] 2.25, 95% confidence interval [CI] 1.73-3.92, P < 0.001). Furthermore, the Gensini score was significantly higher in the fourth quartile group (T4) compared to the first (T1) and second (T2) quartile groups (P < 0.001). Additionally, the SIRI was significantly higher in the group with severe coronary artery lesions compared to the mild and moderate groups (P < 0.001). The SIRI also showed a higher predictive ability for the extent of coronary lesions under the ROC curve compared to other commonly used markers, including platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and neutrophil-to-lymphocyte ratio (NLR) (P < 0.001). Therefore, SIRI positively correlates with coronary artery stenosis in CHD patients, serving as an effective early screening marker for assessing stenosis severity.

Baseline coronary artery stenosis severity is an independent predictor of subsequent poor sleep quality in patients with acute coronary syndrome.

To investigate the relationship between coronary artery lesion severity determined using the baseline SYNTAX score and sleep problems that might occur after discharge determined using the Pittsburgh Sleep Quality Index (PSQI). This prospective study included patients with first acute coronary syndrome (ACS) who underwent percutaneous coronary angiography between February 2019 and August 2019. The severity of coronary artery stenosis was classified according to coronary angiography and SYNTAX scores. Patients were grouped as those with a SYNTAX score of ≤22 and >22. Sleep quality after discharge was classified according to the PSQI. PSQI ≤5 represented good sleep quality, and PSQI >5 represented poor sleep quality. Univariate and multivariate logistic regression was used to investigate the relationship between sleep quality and coronary artery stenosis severity. A total of 424 patients were included in the study. Of these, 294 (69.34%) had a SYNTAX score of ≤22 and 130 (30.66%) had a SYNTAX score of >22. The mean age of all patients was 60.37 ± 12.23 years, 59.69 ± 11.85 years in the SYNTAX ≤22 groups and 61.90 ± 12.98 years in the SYNTAX >22 group (P = 0.086). The majority (78.54%) of the patients were male and there was no significant difference between the SYNTAX ≤22 group and the SYNTAX >22 group in terms of sex distribution (P = 0.383). According to the univariate logistic regression analysis, age (P = 0.014), diabetes (P = 0.027), left ventricular ejection fraction (P = 0.001), estimated glomerular filtration rate (P = 0.039), creatine kinase MB (P = 0.040) and SYNTAX scores (P < 0.001) were significantly associated with high PSQI global scores (>5). However, according to the multivariate logistic regression analysis results, high (>22) SYNTAX scores were the only factor independently associated with the high (>5) PSQI global scores [odds ratio, 3.477; 95% confidence interval (CI), (2.190-5.522); P < 0.001]. Complete revascularization group had significantly higher sleep latency and sleep duration time, sleep efficiency and the percentage of patients with PSQI global score of ≤5 than the incomplete revascularization group (P < 0.001 for all). Among patients with ACS, those with high SYNTAX scores should be monitored more carefully for sleep disorders that may occur later.

Effect of statins on severity of coronary artery lesion and clinical prognosis in patients with coronary heart disease

To investigate the effect of statins on the severity of coronary artery lesion in patients with coronary heart disease, and to analyze the risk factors of clinical prognosis. A retrospective cohort study was conducted. The clinical data of 156 patients with coronary heart disease and completed the second re-examination of coronary CT angiography (CCTA) who were admitted to the department of cardiovascular medicine of Peking University People's Hospital from January 2017 to December 2021 were collected. According to whether they took statins regularly according to the doctor's instructions after being diagnosed with coronary heart disease based on the first CCTA examination, the patients were divided into statin group and non-statin group, and the clinical characteristics of the two groups and the results of the second re-examination of CCTA were compared and analyzed. According to whether the patients had major adverse cardiovascular and cerebrovascular events (MACCE) within 3-5 years after diagnosis of coronary heart disease, the patients were divided into MACCE group and non-MACCE group, and the clinical characteristics of the two groups were compared and analyzed. Multivariate Logistic regression analysis was used to screen the risk factors related to the adverse prognosis (occurrence of MACCE) of patients with coronary heart disease. (1) A total of 156 patients with coronary heart disease were enrolled, including 113 patients (72.44%) in the statin group and 43 patients (27.56%) in the non-statin group. Except for low density lipoprotein (LDL) and serum creatinine (SCr), there was no significant difference in gender, age, body mass index (BMI), basic diseases, smoking history, the first CCTA display of coronary artery lesions and plaque characteristics, the interval between the two CCTA and other laboratory indicators between the two groups. Compared with the non-statin group, the statin group had a significant reduction in the overall increase rate of coronary artery stenosis score (Gensini score) in the CCTA re-examination and the incidence of MACCE [Gensini score increase rate: 25.66% (29/113) vs. 46.51% (20/43), incidence of MACCE: 9.73% (11/113) vs. 30.23% (13/43), both P < 0.05]. (2) Among 156 patients with coronary heart disease, 24 cases (15.38%) experienced MACCE within 3-5 years after diagnosis, while 132 cases (84.62%) did not experience MACCE. The proportion of patients in the MACCE group who regularly took statins after diagnosis was significantly lower than that in the non-MACCE group [45.83% (11/24) vs. 77.27% (102/132), P < 0.01], and D-dimer and glycosylated hemoglobin (HbA1c) were significantly higher than those in the non-MACCE group [D-dimer (μg/L): 148.50 (101.25, 314.75) vs. 88.10 (59.03, 132.12), HbA1c: 6.45% (6.20%, 7.93%) vs. 6.10% (5.81%, 6.92%), both P < 0.05]. Compared with the non-MACCE group, in the first CCTA examination of patients in the MACCE group, the total percentage of atheroma volume (PAV), fibrous-fat PAV, necrotic core PAV and Gensini score were significantly increased [total PAV: 43.05% (29.19%, 60.60%) vs. 24.57% (16.94%, 39.09%), fibrous-fat PAV: 18.61% (8.48%, 26.44%) vs. 6.81% (4.16%, 12.57%), necrotic core PAV: 5.96% (2.98%, 8.71%) vs. 2.29% (1.47%, 4.36%), Gensini score: 30.25 (23.50, 38.30) vs. 19.50 (13.20, 31.10), all P < 0.05]. Multivariate Logistic regression analysis showed that regular use of statins [odds ratio (OR) = 0.282, 95% confidence interval (95%CI) was 0.110-0.727, P = 0.008], D-dimer (OR = 1.011, 95%CI was 1.005-1.017, P < 0.001), necrotic core PAV (OR = 1.323, 95%CI was 1.120-1.563, P = 0.001) and Gensini score (OR = 1.038, 95%CI was 1.004-1.073, P = 0.028) were independent risk factors for MACCE within 3-5 years after diagnosis in patients with coronary heart disease. For patients with coronary heart disease, D-dimer, necrotic core PAV, and Gensini scores should be closely monitored. Statins can effectively alleviate the severity of coronary artery disease and reduce the occurrence of MACCE in patients with coronary artery disease.

An innovative approach for assessing coronary artery lesions: Fusion of wrist pulse and photoplethysmography using a multi-sensor pulse diagnostic device

Coronary heart disease (CHD) is a leading cause of mortality globally and poses a significant threat to public health. Coronary angiography (CAG) is a gold standard for the clinical diagnosis of CHD, but its invasiveness restricts its widespread application. In this study, we utilized a pulse diagnostic device equipped with pressure and photoelectric sensors to synchronously and non-invasively capture wrist pressure pulse waves and fingertip photoplethysmography (FPPG) of patients undergoing CAG. The extracted features were utilized in constructing random forest-based models to assessing the severity of coronary artery lesions. Notably, Model 3, incorporating both wrist pulse and FPPG features, surpassed Model 1 (solely utilizing wrist pulse features) and Model 2 (solely utilizing FPPG features). Model3 achieved an Accuracy, Precision, Recall, and F1-score of 78.79%, 78.69%, 78.79%, and 78.70%, respectively. Compared to Model1 and Model2, Model 3 exhibited improvements by 4.55%, 5.25%, 4.55%, and 5.12%, and 6.06%, 6.58%, 6.06%, and 6.54% respectively. This fusion of wrist pulse and FPPG features in Model 3 highlights the advantages of multi-source information fusion for model optimization. Additionally, this research provides invaluable insights into the novel development of diagnostic devices imbued with TCM principles and their potential in managing cardiovascular diseases.

Diagnostic Accuracy of Pre-Transcatheter Aortic Valve Replacement Nitroglycerin-Free Fractional Flow Reserve-Computed Tomography-Based Physiological Assessment in Patients With Severe Aortic Stenosis for Predicting Post-Transcatheter Aortic Valve Replacement Ischemia.

Fractional flow reserve-computed tomography (FFRCT) has not been validated in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) for coronary artery disease due to theoretical difficulties in using nitroglycerin for such patients.Methods and Results: In this single-center study, we prospectively enrolled 21 patients (34 vessels) and performed pre-TAVR FFRCTwithout nitroglycerin, pre-TAVR invasive instantaneous wave-free ratio (iFR) measurements, and post-TAVR FFR measurements using a pressure wire. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of pre-TAVR FFRCT≤0.80 to predict post-TAVR invasive FFR ≤0.80 were 82%, 83%, 82%, 71%, and 90%, respectively. A receiver operating characteristic analysis demonstrated an optimal cutoff of 0.78 for pre-TAVR FFRCTto indicate post-TAVR FFR ≤0.80, with an area under the curve (AUC) of 0.84, and the counterpart cutoff of pre-TAVR iFR was 0.89 with an AUC of 0.86. FFRCTwithout nitroglycerin could be a useful non-invasive imaging modality for assessing the severity of coronary artery lesions in patients with severe AS.

Correlation between serum growth differentiation factor 11 level and severity of coronary artery disease in patients with acute myocardial infarction

Objective: To investigate the correlation between serum growth differentiation factor 11 (GDF11) level and coronary artery lesions in patients with ST-segment elevation myocardial infarction (STEMI), and the predictive efficacy of nomogram risk prediction model based on GDF11 combined with traditional risk factors on the occurrence of STEMI. Methods: This study was a retrospective cross-sectional study. Patients hospitalized in the Department of Cardiology of the 904th Hospital of Joint Logistic Support Force of People's Liberation Army of China from 2016 to 2018 were selected and divided into control group and STEMI group. The demographic data, blood lipid level, laboratory indicators of blood and GDF11 level were collected. Logistic regression analysis screened out independent correlated factors for the occurrence of STEMI. Spearman correlation analysis clarified the correlation of each indicator with the SYNTAX or Gensini scores. A nomogram risk prediction model for the risk of STEMI occurrence and the receiver operating characteristic curve was used to compare the prediction efficiency of each model. Results: A total of 367 patients were enrolled, divided into control group (n=172) and STEMI group (n=195), age (66.5±11.8), male 222 (60.49%). The serum GDF11 level of STEMI group was significantly lower than that of the control group (36.20 (16.60, 70.75) μg/L vs. 85.00 (53.93, 117.10) μg/L, P<0.001). The results of multivariate logistic regression analysis showed serum GDF11(OR=0.98, 95%CI: 0.97-0.99) and traditional independent risk factors such as smoking, diabetes, C-reactive protein, homocysteine, lipoprotein (a) and apolipoprotein A1/B were independent correlate factors for the occurrence of STEMI (P<0.05). Spearman correlation analysis showed that serum GDF11 was negatively correlated with SYNTAX score and Gensini score (P<0.05). The nomogram model constructed by serum GDF11 combined with traditional independent risk factors (AUC=0.85, 95%CI: 0.81-0.89) had better predictive value for the occurrence of STEMI than the traditional nomogram model constructed by independent risk factors(AUC=0.80, 95%CI:0.75-0.84) or serum GDF11 (AUC=0.76, 95%CI: 0.72-0.81), all P<0.01. Conclusions: Serum GDF11 is an independent correlate factor in the occurrence of STEMI and is negatively correlated with the severity of coronary artery lesions in patients with STEMI. The nomogram model constructed based on GDF11 combined with traditional risk factors can be a good predictor for the occurrence of STEMI.

Procena odnosa između nivoa TWEAK-a u serumu i stepena vaskularne uključenosti kod pacijenata sa stabilnom anginom pektoris

Introduction: This study investigates the relationship between serum TWEAK levels and the degree of vascular involvement in patients with stable angina pectoris, offering insights beyond conventional cardiovascular risk factors. Materials and Methods: This study involved 88 patients (33 women, 55 men) diagnosed with stable angina pectoris. Patients were classified based on angiographic findings. Comprehensive demographic and medical history data were collected, and morning blood samples were analyzed, focusing on TWEAK and IL-6 levels. To assess the severity of coronary artery lesions, a modified version of the Gensini scoring system was employed. Results: Analyses revealed no significant correlation between TWEAK levels and the severity of coronary artery disease. Although some variations in biochemical markers were observed based on gender and diabetic status, these differences did not exhibit a statistically significant relationship with the degree of vascular involvement. Conclusion: The findings indicate that serum TWEAK levels do not have a significant association with the severity of vascular involvement in patients with stable angina pectoris. These results highlight the limited efficacy of TWEAK as a sole biomarker in assessing the severity of coronary artery disease, emphasizing the complexity of its role.

A risk predictive model for determining the severity of coronary artery lesions in older postmenopausal women with coronary heart disease.

To determine the risk factors affecting the severity of coronary artery disease (CAD) in older postmenopausal women with coronary heart disease (CHD) and to construct a personalized risk predictive model. In this cohort study, clinical records of 527 female patients aged ≥60 with CHD who were hospitalized in the First Affiliated Hospital of the University of Science and Technology of China from March 2018 to February 2019 were analyzed retrospectively. The severity of CAD was determined using the Gensini scores that are based on coronary angiography findings. Patients with Gensini scores ≥40 and <40 were divided into high-risk (n=277) and non-high-risk groups (n=250), respectively. Logistic regression analysis was used to assess independent predictors of CAD severity. The nomogram prediction model of CAD severity was plotted by the R software. The area under the receiver operating characteristic (ROC) and calibration curves were used to evaluate the predictive efficiency of the nomogram model, and the decision curve analysis (DCA) was used to assess the clinical applicability of the nomogram model. Multivariate analysis showed that high-sensitivity C-reactive protein, RBC count, WBC count, BMI, and diabetes mellitus were independent risk factors associated with CAD severity in older menopausal women (P<0.05); the area under the ROC curve of the nomogram constructed based on the independent risk factors was 0.846 (95% CI: 0.756-0.937). The area under the ROC curve after internal validation of the nomogram by the Bootstrap method after resampling 1000 times was 0.840 (95% CI: 0.741-0.923). The calibration curve suggested that the nomogram had an excellent predictive agreement, and the DCA curve indicated that the net benefit of applying the nomogram was significantly higher than that of the "no intervention" and "all intervention" methods when the risk probability of patients with high-risk CAD severity was 0.30-0.81. A personalized risk assessment model was constructed based on the risk factors of severe CAD in older menopausal women with CHD, which had good prediction efficiency based on discrimination, calibration, and clinical applicability evaluation indicators. This model could assist cardiology medical staff in screening older menopausal women with CHD who are at a high risk of severe CAD to implement targeted interventions.

Predictive Value of CFIm25 Expression in Peripheral Blood Monocytes for Coronary Atherosclerosis.

Background: Cleavage factor Im25 (CFIm25) regulates cell function by affecting mRNA editing processes and plays diverse roles in various diseases. Studies have found that peripheral blood monocytes are valuable in diagnosing and prognosing coronary atherosclerosis. However, no studies have examined the predictive value of CFIm25 expression in peripheral blood monocytes for coronary atherosclerosis. Methods and Results: We collected the coronary angiography results of 267 patients and calculated the Gensini score to evaluate their degree of coronary atherosclerosis. We isolated peripheral blood monocytes and detected CFIm25 RNA expression. Based on their Gensini score, we divided the patients into negative (0, n = 46), mild lesion (≤ 8, n = 71), moderate lesion (8-23, n = 76), and severe lesion (≥ 23, n = 74) groups. Results showed that CFIm25 expression correlated negatively with the Gensini score and the number of involved coronary vessels. Univariate and multivariate binary logistic regression analyses showed that CFIm25 expression in peripheral blood monocytes was a protective factor for severe lesions, ≥ 50% stenosis, and three-vessel lesions. The areas under the receiver operating characteristic curve of CFIm25 expression for predicting lesions, severe lesions, ≥50% stenosis, and three-vessel lesions were 0.743, 0.735, 0.791, and 0.736, respectively. Conclusions: CFIm25 expression in peripheral blood monocytes correlates negatively with the degree of coronary atherosclerosis and helps predict the severity and number of coronary artery lesions.

Correlation analysis of central arterial pressure parameters and the severity of atherosclerotic lesions in coronary arteries: A retrospective study.

To investigate the correlation between central arterial pressure (CAP) parameters and the severity of atherosclerotic lesions in the coronary arteries, understand the value of CAP in assessing the risk of coronary heart disease (CHD), and provide a theoretical basis for the prevention and treatment of CHD. Between January 2021 and January 2022, 224 patients admitted to our hospital for complete coronary angiography (CAG) were included in this retrospective study. CAP parameters, including central systolic pressure (CSP), diastolic pressure (CDP), and pulse pressure (CPP), and Gensini scores were collected; the association between CAP parameters and the severity of coronary lesions was analyzed using the Pearson correlation coefficient (r) and multivariate regression analysis. CPP was significantly higher in the coronary multi-branch lesion group than in the single-branch lesion group in patients with CHD (P < .05). CSP, CDP, and CPP were significantly higher in the high Gensini score group than in the low Gensini score group for coronary vascular lesions; furthermore, CSP and CPP were significantly higher in the high Gensini score group than in the medium Gensini score group (P < .05). Pearson correlation analysis showed that CSP and CPP were positively and CDP was negatively correlated with the severity of coronary artery lesions in patients with CHD (P < .05). Logistic regression analysis showed that a history of diabetes, CSP, CDP, and CPP were independent risk factors for severe atherosclerotic lesions in the coronary arteries (P < .05). noninvasive CAP-related indices, such as CSP, CDP, and CPP, are independently correlated with and can be used to predict the severity of coronary lesions in patients with CHD, which may be beneficial for guiding clinical diagnosis and treatment.

Clonal hematopoiesis of indeterminate potential in persons with HIV.

Clonal hematopoiesis of indeterminate potential (CHIP) has been associated with older age, inflammation and with risk of coronary artery disease (CAD). We aimed to characterize the burden of CHIP, and to explore the association between CHIP, inflammatory markers, and CAD in older persons with HIV (PWH). From the Copenhagen Comorbidity in HIV Infection (COCOMO) study, we included 190 individuals older than 55 years of age. We defined CHIP as variant allele fraction at least 2%. CAD was categorized according to the most severe coronary artery lesion on coronary computed tomography (CT) angiography as no coronary atherosclerosis; any atherosclerosis defined as at least 1% stenosis and obstructive CAD defined as at least 50% stenosis. In the entire population (median age 66 years, 87% men), we identified a total of 62 mutations distributed among 49 (26%) participants. The three most mutated genes were DNMT3A , TET2 , and ASXL1 , accounting for 49, 25, and 16% of mutations, respectively. Age and sex were the only variables associated with CHIP. IL-1β, IL-1Ra, IL-2, IL-6, IL-10, soluble CD14, soluble CD163 and TNF-α were not associated with CHIP, and CHIP was not associated with any atherosclerosis or with obstructive CAD in adjusted analyses. In older, well treated, Scandinavian PWH, more than one in four had at least one CHIP mutation. We did not find evidence of an association between CHIP and inflammatory markers or between CHIP and CAD. CHIP is an unlikely underlying mechanism to explain the association between inflammation and CAD in treated HIV disease.

Association Between Interleukin-6 Gene Polymorphism and Severity of Coronary Artery Disease in Patients with Diabetes.

Previous studies have identified diabetes as a risk factor for coronary heart disease. This study determined the correlation between the IL-6 gene -572 G/C polymorphism and the incidence and severity of coronary heart disease in patients with diabetes. One hundred four patients with diabetes who were admitted to our hospital from January 2019 to December 2020 were retrospectively enrolled in the current study. These patients were divided into a diabetes only group (group A, 27 patients) and a diabetes complicated by coronary heart disease group (group B, 77 patients). Seventy patients in the latter group were further divided into low, medium, and high Syntax score groups based on coronary angiography results. A correlation analysis between IL-6, blood lipids, and the IL-6 -572 G/C gene levels was performed. The serum IL-6 level in patients with the IL-6-572G/C-GG genotype was higher than patients with the GC and CC genotypes. In patients with diabetes, the presence of the IL-6-572G/C-GG and GC genotypes was associated with a significantly increased risk of developing coronary heart disease. Patients with the IL-6-572G/C-GG genotype and diabetes were shown to have more severe coronary artery lesions compared to patients with the CC genotype. Moreover, the G allele of the IL-6-572G/C gene was linked to a higher risk of coronary heart disease and more severe coronary artery lesions in patients with diabetes compared to the C allele. The IL-6-572G/C gene polymorphism is associated with the incidence and severity of coronary heart disease in patients with diabetes.

Triglyceride-glucose index is associated with recurrent revascularization in patients with type 2 diabetes mellitus after percutaneous coronary intervention

BackgroundThe Triglyceride-glucose (TyG) index, as a surrogate marker of insulin resistance, is independently associated with the severity of coronary artery lesions and the prognosis of coronary heart disease. The investigation aimed to explore the relationship between the TyG index and recurrent revascularization in individuals with type 2 diabetes mellitus (T2DM) resulting from the progression of lesions or in-stent restenosis (ISR) after percutaneous coronary intervention (PCI).MethodA total of 633 patients who met the inclusion and exclusion criteria were enrolled and divided into three groups based on the tertiles of the TyG index. The primary endpoint was recurrent revascularization resulting from the progression of lesions or ISR. All-cause death was considered as the competing risk event. Competing risk analysis and Cox regression analysis for predicting recurrent revascularization after PCI were conducted stepwise. Variables were standardized to make the hazard ratio (HR), subdistribution hazard ratio (SHR) and corresponding 95% CI more consistent prior to being used for fitting the multivariate risk model. The predictive ability of the TyG index was evaluated using several measures, including the ROC curve, likelihood ratio test, Akaike’s information criteria, category-free continuous net reclassification improvement (cNRI > 0), and integrated discrimination improvement (IDI). Internal validation was conducted through bootstrapping with 1000 resamples.ResultsDuring a median follow-up period of 18.33 months, a total of 64 (10.11%) patients experienced recurrent revascularization, including 55 cases of lesion progression and 9 cases of in-stent restenosis. After controlling for competitive risk events, the TyG index was independently associated with a higher risk of recurrent revascularization [SHR:1.4345, (95% CI 1.1458–1.7959), P = 0.002]. The likelihood ratio test and Akaike’s information criteria showed that the TyG index significantly improves the prognostic ability. Additionally, adding the TyG index improved the ability of the established risk model in predicting recurrent revascularization, indicated by a C-index of 0.759 (95% CI 0.724–0.792, P < 0.01), with a cNRI > 0 of 0.170 (95% CI 0.023–0.287, P < 0.05), and an IDI of 0.024 (95% CI 0.009–0.039, P = 0.002). These results remained consistent when the models containing TyG index were confirmed using an internal bootstrap validation method.ConclusionThe findings highlight the potential of the TyG index as a predictor of recurrent revascularization. Lesion progression emerged as the primary contributor to recurrent revascularization instead of in-stent restenosis. The incorporation of the TyG index into risk prediction models is likely to be beneficial for accurate risk stratification in order to improve prognosis.

Evaluation of long-term outcomes of percutaneous coronary intervention in patients with moderate to severe calcified coronary artery lesions.

Coronary artery calcification reduces elasticity and can cause hemodynamic disturbances, increasing the risk of cardiovascular complications. Furthermore, coronary calcifications make cardiovascular interventions difficult. The present study aimed to study the cardiovascular outcomes of the coronary intervention of calcified lesions in the Iranian population. The present cross-sectional study evaluated patients with moderate to severe calcified coronary artery lesions on angiography who were candidates for percutaneous coronary intervention (PCI). Demographic, echocardiographic, and angiographic data of the patients were recorded. In addition, clinical outcomes, including mortality, myocardial infarction, stroke, and stent thrombosis, were also measured 1 year after the procedure. A total of 125 participants (65% male and 35% female) with a median age of 69 (13.0) years old were enrolled. The most common calcification degree was 270° (43.5%), followed by 360° (35.5%) and 180° (21.0%). Most patients had thrombolysis in myocardial infarction (TIMI) score of 3 (47.6%). A more than 10% residual coronary minimum lumen diameter was seen in 25.8% of patients. Puncture site hemorrhage and contrast-induced nephropathy were observed in 2 (1.6%) and 1 (0.8%) patients, respectively. Following 1 year after PCI, no cases of mortality, cerebrovascular accident, myocardial infarction, and stent thrombosis were reported. Furthermore, we observed one case of heart failure (0.8%) and target lesion revascularization (0.8%). In addition, we revealed a significant relationship between calcification degree and TIMI (p < 0.001) and body mass index (p = 0.049). Percutaneous management of calcified lesions with noncompliant balloon and one or two guidewires was associated with a good success rate and few complications.

Effect of diabetes mellitus on young female patients with acute coronary syndrome

BackgroundDiabetes mellitus (DM) is one of the most important risk factors of acute coronary syndrome (ACS). There have been many studies on the relationship between DM and ACS. However, the effect of DM on young females with ACS is still unclear. ObjectiveTo explore the effect of DM on coronary arteries lesions in young females with ACS. Methods1278 young females (age ≤ 44 years) undergoing coronary angiography were divided into DM group (n = 197) and control group (n = 1081) according to whether they had diabetes. Based on whether the patient has ACS, each group was further divided into DM-ACS subgroup and Non-DM-ACS subgroup to compare the characteristics and severity of coronary artery lesions and follow-up outcomes. ResultsThe prevalence of diabetes was 15.41% (197/1278). Overweight (58.88%) and depression or anxiety (11.17%) in the DM group was significantly higher than those (32.22% and 6.20%) in the control group (P < 0.05). The prevalence of ACS (85.28%) in the DM group was significantly higher than that (25.35%) in the control group (P < 0.05). The proportion of type A lesions in the DM-ACS subgroup was lesser than that in the Non-DM-ACS subgroup (P < 0.05). The type C lesions in the DM-ACS subgroup were significantly higher than that in the Non-DM-ACS subgroup (P < 0.01). The number of stents implantation in the DM-ACS subgroup was no significant difference compared with the Non-DM-subgroup (P > 0.05). The length of stent implantation in the DM-ACS subgroup was significantly longer than that in the Non-DM-ACS subgroup (P < 0.05). The rate of MACE was not statistically significant between the two subgroups (P > 0.05), but the rate of all-cause death (2.98%) in the DM-ACS subgroup was significantly higher than that (0.36%) in the Non-DM-ACS subgroup (P < 0.05). ConclusionsDM is an important risk factor in young females with ACS. Young women with diabetes are prone to coronary heart disease. The coronary artery lesions in DM patients were more severe than those in Non-DM patients, despite the protective effect of estrogen on the cardiovascular system. Therefore, young women with DM should be treated to prevent ACS and future events activelyandpurposefully.