Significant Atherosclerotic Disease Research Articles

Feasibility and Intermediate Results of Transcarotid Revascularization with a Prosthetic Conduit

IntroductionTranscarotid artery revascularization (TCAR) is a hybrid technique with excellent initial outcomes. The technical success and safety of TCAR is heavily dependent on an anatomically suitable common carotid artery (CCA). Many patients do not meet anatomic criteria and therefore are not eligible for this therapy. We sought to extend the eligibility of TCAR to patients with unfavorable CCA anatomy via the adoption of a prosthetic arterial conduit. MethodsA single center retrospective study of patients with critical carotid artery stenosis who underwent TCAR via a prosthetic conduit between June 2019 and October 2021 was performed. All patients in the study were considered high-risk for carotid endarterectomy (CEA) based on anatomic features, such as restenosis post-CEA and neck radiation. Unfavorable CCA anatomy was defined as a clavicle to carotid bifurcation distance < 5 cm, a CCA diameter < 6 mm, and/or significant atherosclerotic disease at the intended arterial access site. The primary outcome of interest was technical success. Secondary outcomes included perioperative complications, intermediate and long-term patency, intermediate and long-term stroke and/or mortality and in-hospital length of stay. Follow-up ranged from 1-29 months. ResultsEight patients underwent ten TCAR procedures via a prosthetic conduit. A total of two procedures (20%) were performed on female patients and eight procedures (75%) were performed on male patients. The mean age was 65 years old (standard deviation (SD) 11 years). Technical success was 100%. The 30-day ipsilateral stroke rate was 0%. The 30-day patency was 90%. There was no re-exploration for hemorrhage and 30 day mortality was 0%. ConclusionsTCAR is an excellent option for carotid artery revascularization. Unfavorable CCA anatomy has limited its applicability. TCAR via a prosthetic conduit has the potential to expand eligibility for this promising therapy.

Investigating the place of sodium-glucose cotransporter-2 inhibitors and dual sodium-glucose cotransporter-1 and dual sodium-glucose cotransporter-2 inhibitors in heart failure therapy: a systematic review of the literature.

Sodium-glucose cotransporter-2 inhibitors have been shown to have significant metabolic, renal, and atherosclerotic cardiovascular disease benefits. Recent randomized controlled trials have extended these benefits to patients with heart failure. In fact, the robust findings from these studies in patients with any type of heart failure have led to the incorporation of this drug class in currently updated evidence-based guidelines for this condition. However, given the novelty in utilizing these agents in heart failure, there is uncertainty regarding place in therapy and sequencing in treatment. As such, this review aims to summarize existing literature to guide practitioners regarding the use of these agents in the management of heart failure.

Distal Target Vessel Quality and Outcomes of Chronic Total Occlusion Percutaneous Coronary Intervention

BackgroundDistal vessel quality is a key parameter in the global chronic total occlusion (CTO) crossing algorithm. ObjectivesThe study sought to evaluate the association of distal vessel quality with the outcomes of CTO percutaneous coronary intervention. MethodsWe examined the clinical and angiographic characteristics and procedural outcomes of 10,028 CTO percutaneous coronary interventions performed at 39 U.S. and non-U.S. centers between 2012 and 2022. A poor-quality distal vessel was defined as <2 mm diameter or with significant diffuse atherosclerotic disease. In-hospital major adverse cardiac events (MACE) included death, myocardial infarction, urgent repeat target vessel revascularization, tamponade requiring pericardiocentesis or surgery, and stroke. ResultsA total of 33% of all CTO lesions had poor-quality distal vessel. When compared with good-quality distal vessels, CTO lesions with a poor-quality distal vessel had higher J-CTO (Japanese chronic total occlusion) scores (2.7 ± 1.1 vs 2.2 ± 1.3; P < 0.01), lower technical (79.9% vs 86.9%; P < 0.01) and procedural (78.0% vs 86.8%; P < 0.01) success, and higher incidence of MACE (2.5% vs 1.7%; P < 0.01) and perforation (6.4% vs 3.7%; P < 0.01). A poor-quality distal vessel was independently associated with technical failure and MACE. Poor-quality distal vessels were associated with higher use of the retrograde approach (25.2% vs 14.9%; P < 0.01) and higher air kerma radiation dose (2.4 [IQR: 1.3-4.0] Gy vs 2.0 [IQR: 1.1-3.5] Gy; P < 0.01). ConclusionsA poor-quality distal vessel in CTO lesions is associated with higher lesion complexity, higher need for retrograde crossing, lower technical and procedural success, higher incidence of MACE and coronary perforation, and higher radiation dose.

Cardiovascular Risks in Testicular Cancer: Assessment, Prevention, and Treatment.

Testicular cancer (TC) is the leading cancer in men between 18 and 39years of age. Current treatment involves tumor resection followed by surveillance and/or one or more lines of cisplatin-based chemotherapy (CBCT) and/or bone marrow transplant (BMT). Ten years after treatment, CBCT has been associated with significant atherosclerotic cardiovascular disease (CVD) including myocardial infarction (MI), stroke, and heightened rates of hypertension, dyslipidemia, diabetes mellitus, and metabolic syndrome (MetS). Additionally, low testosterone levels and hypogonadism contribute to MetS and may further drive CVD. CVD in TCS has been associated with worse physical functioning accompanied by role limitations, decreased energy, and decreased overall health. Exercise may play a role in ameliorating these effects. Systematic CVD screening practices are needed at TC diagnosis and in survivorship. We encourage a multidisciplinary partnership between primary care physicians, cardiologists, cardio-oncologists, medical oncologists, and survivorship providers to address these needs.

Impact of smoking on the outcomes of minimally invasive direct coronary artery bypass

BackgroundTobacco smoking has been associated with an increased risk of complications after conventional coronary surgery. However, the impact of smoking on the risk of postoperative complications in minimally invasive coronary surgery is yet to be studied. We aimed to analyze the impact of the preoperative smoking status on the short- and long-term outcomes of minimally invasive direct coronary artery bypass grafting (MIDCAB) in the context of isolated surgical revascularization or in association with percutaneous coronary intervention.MethodsThis was a retrospective observational study of all patients undergoing MIDCAB at our institution between 2006 and 2020. Patients were divided into three groups: active smokers, ex-smokers who have quit smoking for at least 1 month before surgery, and non-smokers. The groups were compared using conventional statistical methods. Multivariate analysis was then performed where significant differences were found to eliminate bias.ResultsThroughout the study period, 541 patients underwent MIDCAB, of which 135 (25%) were active smokers, 183 (34%) were ex-smokers, and 223 (41%) were non-smokers. Smokers presented for surgery at a younger age (p < 0.0001), more frequently with a history of myocardial infarction (p < 0.001), peripheral artery disease (p < 0.001) and chronic obstructive pulmonary disease (p < 0.0001). Using multivariate analysis, active smoking was determined to be a significant risk factor for the need of urgent revascularization (odds ratio 2.36 [1.00–5.56], p = 0.049) and the composite of pulmonary complications (including pneumothorax, respiratory infection, respiratory dysfunction, subcutaneous emphysema and exacerbation of chronic obstructive pulmonary disease; odds ratio 2.84 [1.64–4.94], p < 0.001). Preoperative smoking status did not influence the long-term survival (p = 0.83).ConclusionsIn our study, active smokers presented for MIDCAB at a younger age and more often with signs of atherosclerotic disease (history of myocardial infarction and peripheral artery disease). Active smoking was found to be the most significant risk factor for postoperative pulmonary complications, and is also associated with a more frequent need for urgent surgery at diagnosis. Long-term postoperative survival is not affected by the preoperative smoking status.

180 LONG TERM FOLLOW UP OF A NON-PROGRESSIVE LEFT MAIN CORONARY ARTERY FISTULA TO RIGHT ATRIUM

Abstract A 63 years old man, with multiple cardiovascular risk factor, presented at the emergency department with a transient ischemic attack during an hypertensive crisis. Electrocardiogram revealed a sinus rhythm and no sign of ischemia. No critical stenosis were detected at ultrasonography of the supra-aortic trunks. Brain CT showed an arachnoid cyst in right posterior cerebellar site. Transthoracic echocardiographic showed normal wall motion with a left ventricular ejection fraction of 66%. The transesophageal echocardiography, performed for searching possible emboligenic heart disease, revealed a fistulous aneurysmal formation arising from the left main coronary artery. Angio-CT confirmed a CAF between distal left main coronary artery and right atrium, with a retro-aortic serpiginous course and an ectasic vascular structure (above 8.35 mm), this pathological vessel also had an aneurismatic formation of maximum diameter of 1 cm. CT scan detected also a 50% soft eccentric plaque in mid circumflex coronary artery and a less than 50% soft eccentric plaque in the right coronary artery. An elective hospitalization was performed in order to better assess the CAF. Coronary angiography revealed no significant coronary atherosclerotic disease and confirmed the CAF with its convoluted course. No left to right shunt was found either in cardiac magnetic resonance (Qp/Qs close to 1) or in right heart catheterization. Maximal stress test with cycloergometer was negative for clinical and electrocardiographic inducible ischemia (120W). CAF is a rare vascular abnormality, occurring in only 0.002% of the general population. The majority of CAFs have a congenital origin, but occasionally they may be acquired after cardiac surgery or repeated myocardial biopsies in cardiac transplantation. The CAFs may increase in size over time, although this does not occur invariably, and complications include: myocardial ischemia (due to myocardial ‘steal’), thrombosis and embolism, heart failure, atrial fibrillation, rupture, endocarditis/endarteritis, arrhythmias and also spontaneous rupture of the CAF causing hemopericardium. Current treatment options for CAF include surgery or transcatheter closure. Considered the age of the patient, the absence of clinical symptoms and the absence of left to right shunt, a conservative strategy was chosen. The patient had strict follow up, with clinical and echocardiographic assessment every 6 months, and with annually CT scan and stress test. During these 9 years of follow up the CAF remained stable, and the patients clinically asymptomatic.

Abstract 14626: Dissecting Out Risk Factors: A Case of Spontaneous Coronary Artery Dissection Without Traditional Risk Factors, in the Presence of Methamphetamine Use

Introduction: Methamphetamine use is not a traditional risk factor for spontaneous coronary artery dissection (SCAD). There have been several case reports suggesting an association between methamphetamine use and SCAD. Case: We present a case of a 50-year-old female with a history of hypertension, hyperlipidemia, stroke, and active tobacco use who presented with substernal chest pain radiating to the back and abdomen with associated dyspnea and diaphoresis. The patient was also taking warfarin for a prior history of deep venous thrombosis. Her serum 5 th generation troponin level was elevated to a peak of 1135 ng/L, and a 12-lead EKG showed ST-elevations not meeting STEMI criteria (1mm in V3, 2mm in V4, and 0.5mm in V5). Coronary angiography showed a short section of SCAD type 1 involving the mid portion of the LAD with TIMI 3 flow. There was no significant atherosclerotic disease throughout any of the vessels. The patient was managed conservatively with medical therapy and had resolution of her pain. CT-angiography of the chest, abdomen and pelvis was performed to rule out dissection involving the aorta and its branches and was unrevealing. Urine toxicology screening returned positive for methamphetamine. Given a lack of other traditional risk factors aside from gender, the patient was diagnosed with SCAD secondary to methamphetamine use. Discussion: Traditional risk factors for SCAD include female sex, fibromuscular dysplasia, connective tissue disease, multiparity (our patient was parity 1), and exogenous hormone use. Methamphetamine use as well as prescription amphetamines have been associated with SCAD in several case reports. SCAD tends to occur in women with an absence of risk factors for coronary artery disease. However, even in patients with multiple risk factors for atherosclerosis and an absence of risk factors for SCAD, SCAD should not be excluded in the differential when a history of amphetamine use is elicited.

Association of galectin-3 and significant atherosclerotic epicardial artery disease in patients with chronic coronary syndrome

Association of galectin-3 and significant atherosclerotic epicardial artery disease in patients with chronic coronary syndrome

Uno scompenso per due, col terzo incomodo

The importance of differentiating between primary cardiovascular prevention and secondary prevention in diabetes will be discussed in light of the results obtained by the cardiovascular outcome trials (CVOTs). In patients with diabetes, the distinction between primary and secondary cardiovascular prevention could be artificial. The main criteria for enrollment in cardiovascular outcome trials that define the so-called patient in secondary prevention are, typically: i) the history of heart attack or unstable angina; ii) the history of ischemic or hemorrhagic stroke, iii) subclinical conditions, i.e., multivessel coronary ar¬tery disease, occlusive peripheral vascular disease with stenosis greater than 50%, or with a Winsor index less than 0.9. However, in patients with diabetes, a significant coronary atherosclerotic disease can be asymptomatic: this has important clinical implications, i.e., i. patients with diabetes are frequently undertreated, ii: it is unclear whether all asymptomatic patients should be screened for coronary artery disease for implementing optimal medical therapy. The conclusion is that placing the outpatient in the so-called primary or secondary prevention without a clinical event is impossible.

MRA-detected intracranial atherosclerotic disease in patients with TIA and minor stroke

ObjectivesPatients with TIA and minor stroke commonly undergo CT and CTA in the emergency department with subsequent MRI with MRA for further workup. The purpose of this study was to review outpatient MRIs for TIA/stroke patients to assess the additional benefit, if any, of the MRA sequence in the detection of intracranial atherosclerotic disease in patients for whom CTA had already been performed.MethodsThe radiology reports of outpatient MRIs of the brain for TIA/minor stroke patients were retrospectively reviewed via the hospital PACS system. Following this, the imaging report from the patient’s initial presentation to the emergency department was reviewed. This index imaging and subsequent MRI were compared to assess the incidence of new vascular findings detected on the MRA sequence in patients for whom CTA had already been performed. Where new lesions had been identified at follow-up, the imaging was retroactively reviewed to assess if they were present on the index imaging.ResultsTwo hundred seven consecutive patients were reviewed. Significant (> 50%) intracranial atherosclerotic disease was present on MRA in 18 patients (8.7%). This was a new finding in 11 patients. Five had initial CTA where the atherosclerosis was not detected. All 5 of these cases were located in the posterior cerebral arteries. Incidental aneurysms were seen in 14 (6.7%); 12 were a new finding at time of MRI.ConclusionThe MRA sequence provides additional value by increasing the detection of clinically important intracranial atherosclerotic disease which may inform management in patients with minor stroke and TIA.

Single direct right axillary artery cannulation using a modified Seldinger technique in minimally invasive cardiac surgery.

Single direct right axillary artery cannulation is uncommon in minimally invasive cardiac surgery; however, the risk of cerebral infarction due to retrograde perfusion using the femoral artery remains high in patients with thoracoabdominal aortic atheroma. In our institution, we perform right axillary artery cannulation using a modified Seldinger technique in patients with atherosclerotic disease. This study aimed to evaluate the safety and effectiveness of this technique in minimally invasive cardiac surgery. Data of all peripheral cannulation cases in patients who underwent minimally invasive cardiac surgery between March 2014 and December 2019 were obtained from our institutional database. Right axillary artery cannulation was successfully performed in 175 patients, 112 of whom underwent magnetic resonance imaging. Procedures comprised single-valve 86.3% (n = 151, 86.3%), double-valve (n = 21, 12%), and triple-valve (n = 3, 1.7%) surgeries. In-hospital mortality rate was 1.7% (n = 3). Stroke rate was 1.1% (n = 2); these 2 patients developed stroke at 3 and 5days postoperatively. Forty-one (36.9%) patients were diagnosed with silent brain infarction on postoperative magnetic resonance imaging. There were no instances of intraoperative local axillary arterial injury, dissection, rupture, or surgical wound infection. Two patients had axillary wound hematoma and 2 had temporary right limb neuropathy, which resolved before discharge. No cases of pseudoaneurysm were found at the cannulation site. Limb ischemia and compartment syndrome were not reported. There were no complications of postoperative symptomatic cerebral infarction following minimally invasive cardiac surgery with single direct right axillary artery cannulation using a modified Seldinger technique, even though patients had significant atherosclerotic vascular disease.

Rapid eye movement sleep apnea and carotid intima thickness in men and women: a SHE-MUSTACHE cohort study.

Rapid eye movement (REM) obstructive sleep apnea might be particularly harmful to the cardiovascular system. We aimed to investigate the association between sleep apnea during REM sleep and signs of atherosclerotic disease in the form of carotid intima thickness in a community-based sample of men and women and possible sex differences in this association. The association between sleep apnea during REM sleep and intima thickness was analysed cross-sectionally in women from the community-based "Sleep and Health in Women" (SHE) study (n=253) and age- and body mass index (BMI)-matched men from the "Men in Uppsala; a Study of sleep, Apnea and Cardiometabolic Health" (MUSTACHE) study (n=338). Confounders adjusted for were age, BMI, gender, alcohol, and smoking. All participants underwent a full-night polysomnography, high-resolution ultrasonography of the common carotid artery, anthropometric measurements, blood pressure measurements, and answered questionnaires. There was an association between sleep apnea during REM sleep and thicker carotid intima that remained after adjustment for confounding (adjusted β=0.008, p=0.032). The intima was increased by 9.9% in the group with severe sleep apnea during REM sleep, and this association between severe sleep apnea during REM sleep and increased intima thickness remained after adjustment for confounders (adjusted β=0.043, p=0.021). More women than men had severe sleep apnea during REM sleep; moreover, in sex-stratified analyses, the association between sleep apnea during REM sleep and intima thickness was found in women but not in men. We conclude that severe REM sleep apnea is independently associated with signs of atherosclerosis. When stratified by sex, the association is seen in women but not in men.

Management of significant atherosclerotic carotid artery disease: review of literature

Stroke is the third leading cause of death and disability in the world. Carotid artery stenosis due to atherosclerosis accounts for 20 to 30% of all strokes. The patients can be asymptomatic or present with a transient ischemic attack or stroke. Diagnosis is based primarily on imaging modalities like carotid Doppler, CT (Computed tomography) angiogram, MR (Magnetic resonance) angiogram or DSA (Digital subtraction angiogram). Treatment options include optimal medical therapy, carotid endarterectomy-touted as the gold standard for treating significant carotid stenosis; and carotid artery stenting, whose safety and efficacy have undergone significant improvements due to technological advances in the field. We presented a review of the literature outlining the various aspects of atherosclerotic carotid stenosis and the findings of several randomized controlled trials conducted to settle the debate between endarterectomy and stenting for carotid stenosis.

Abstract 12521: Atherosclerotic Cardiovascular Disease Risk and Small Dense Low-Density Lipoprotein Cholesterol in Men, Women, African Americans and Non-African Americans

Introduction: Increased small dense low-density lipoprotein cholesterol (sdLDL-C) has been reported to be a significant atherosclerotic cardiovascular disease (ASCVD) risk factor Hypothesis: SdLDL-C is an independent ASCVD risk factor in men, women, African Americans, and non-African Americans. Methods: A total of 15,933 participants (median age 62 years, 56.7% female, 19.7% African-American, free of inclusive ASCVD at baseline) pooled from three studies (Atherosclerosis Risk in Communities Study, Framingham Offspring Study, and Multi-Ethnic Study of Atherosclerosis) were followed for 10 years for incident hard ASCVD and inclusive ASCVD (includes angioplasty and/or coronary artery bypass). These endpoints occurred in 6.1% and 9.7% of subjects, respectively. Information on all standard risk factors was obtained, and serum sdLDL-C levels were measured at baseline using automated analysis. The utility of traditional cardiovascular risk factors and sdLDL-C in 10-year hard and inclusive ASCVD risk was assessed-using univariate and multivariable regression analyses. Results: All standard risk factors were significant for hard and inclusive ASCVD in men, women, African-Americans and non-African-Americans on univariate statistical analysis. SdLDL-C was a significant risk factor when added to the pooled cohort equation for hard and inclusive ASCVD in all subjects, and for inclusive ASCVD in all subgroups, and significantly improved the C-Statistic and affected the net reclassification index for all subjects (p&lt;0.0001). When subjects with elevated sdLDL-C levels of &gt; 50 mg/dL were compared to those with optimal levels of &lt;25 mg/dL after adjustment for all standard risk factors, the hazard ratios (HR) and confidence intervals (CI) for incident inclusive ASCVD were all significant at p&lt;0.01: all subjects (HR 1.54, CI 1.30-1.83), men (HR 1.59, CI 1.27-1.99), women (HR 1.51, CI 1.05-1.27), non-African-Americans (HR 1.49, CI 1.24-1.80[CLA3] ), and African-Americans (HR 1.88, CI 1.23-2.89). Conclusions: An elevated sdLDL-C value &gt; 50 mg/dL was independently associated with a 50% increased 10-year inclusive ASCVD risk in all subjects regardless of sex or race[MD1] , and therefore is an important ASCVD risk enhancer.

A retrospective analysis of the investigative practices of acute limb ischaemia presenting with an unknown aetiology.

Acute limb ischaemia (ALI) is a limb and life-threatening condition with significant morbidity. There are currently no consensus recommendations for the investigative practices to determine the aetiology of ALI presenting without a known aetiology. We undertook a detailed analysis of all investigations performed to identify an underlying precipitant in those with unexplained ALI and formulated a suggested diagnostic algorithm for the evaluation of unexplained ALI. ALI cases presenting to a tertiary referral centre over a 3-year period were reviewed, and known aetiologies, and investigations undertaken to determine the underlying aetiology of unexplained ALI were obtained. Unexplained ALI was found in 27 of 222 patients (12%), of which 21 (78%) had a cause for ALI established after further investigations. Six patients had no cause identified despite extensive work-up. Most patients with unexplained ALI had a cardioembolic source identified as the underlying cause (62%), and this included atrial fibrillation, infective endocarditis, cardiac myxoma and intra-cardiac thrombus. Other causes of unexplained ALI were detected by computed tomography (CT) imaging and included newly diagnosed significant atherosclerotic disease (19%), embolism from isolated proximal large vessel thrombus (10%) and metastatic malignancy (10%). There were no cases attributed to inherited thrombophilias, myeloproliferative neoplasms or anti-phospholipid syndrome. Among patients with unexplained ALI, the majority had a cardioembolic source highlighting the importance of comprehensive cardiac investigations. A subset of patients had alternative causes identified on CT imaging. These data support the use of a collaborative and integrative diagnostic algorithm in the evaluation of unexplained ALI.

Patients scheduled for TAVI tend to form abnormal fibrin clots more resistant to lysis: the impact of age.

Fibrin accumulation within the stenotic leaflets associated with impaired fibrinolysis was observed in severe aortic stenosis (AS). Little is known about fibrin clot properties in patients scheduled for transcatheter aortic valve implantation (TAVI). We investigated whether TAVI patients display a more prothrombotic state, including suppressed fibrinolytic capacity compared to those undergoing surgery. We enrolled patients with advanced AS without significant atherosclerotic vascular disease scheduled for TAVI (n = 45) or surgical aortic valve replacement (SAVR, n = 59). Plasma fibrin clot features, including clot permeability (Ks) reflecting an average pore size, and lysis potential (Lys50), along with thrombin generation were determined off anticoagulation within 12 hours before the procedure. TAVI patients compared to SAVR had prolonged Lys50 (median 420 [IQR, interquartile range, 337-480] seconds vs 379 [337-428] seconds; P = 0.045) and formed denser clots, reflected by lower Ks (3.66 [3.05-4.84] vs 4.36 [3.6-5.27] × 10-9 cm2; P = 0.02), but after adjustment for age the latter difference was no longer significant. Apart from age, concomitant diabetes mellitus, or chronic kidney disease, prolonged Lys50 was an independent predictor of indication for TAVI in AS patients on multivariate regression analysis. There was a delayed start of thrombin generation in TAVI patients (lag time, 4.5 [3.8-6.3] minutes vs 4.2 [3.3-4.7] minutes; P = 0.035), without other differences in thrombin generation parameters. This study is the first to show that patients scheduled for TAVI are characterized by prothrombotic fibrin clot properties including denser fibrin meshwork and more resistant to lysis compared with those undergoing SAVR, which might explain in part increased thromboembolic risk following TAVI.

Intraluminal carotid thrombosis and acute ischemic stroke associated with COVID-19.

COVID-19 (Coronavirus disease 2019) caused by SARS-CoV-2 has a diverse constellation of neurological manifestations that include encephalopathy, stroke, Guillain–Barré syndrome, myelitis, and encephalitis. Intraluminal carotid thrombi (ILT) are infrequent lesions seen in only 1.6% of patients with acute ischemic stroke. Underlying atherosclerosis is the most common lesion associated with ILT formation. However, with COVID-19, we have encountered ILT in patients without significant atherosclerotic disease. The endothelial inflammation and hypercoagulable state associated with COVID-19 pose a risk of arterial and venous thromboembolism and could have contributed to this presentation although the exact pathophysiology and optimal treatment of ILT in COVID-19 remain elusive. Herein, we present a series of ischemic stroke patients with carotid ILT in the setting of a recent SARS-CoV-2 infection.

Comparative methods for the quantification of post-IMA myocardial damage

This work aims to make a comparison between laboratory methods, especially by evaluating the role of troponin dosage and diagnostic imaging methods, specifically SPECT and cardiac magnetic resonance in the post-IMA evaluation. In both methods, we want to understand which one is able to be more predictive in terms of quantifying the extension of the infarcted area. Given the high sensitivity of troponin, even a very small damage can result from this examination, which SPECT or MRI cannot do. It must be said, however, that the initial high sensitivity troponin is not predictive of how much ischemic damage will be but is only useful for prognosis. The objective of the study was to determine the feasibility and diagnostic accuracy of an RMC stress protocol with the combined assessment of regional myocardial perfusion and contractility in the recognition of patients with significant coronary atherosclerotic disease leading to AMI, correlating the results with what would have been the study in SPECT.

COVID-19: The Heart of the Matter-Pathological Changes and a Proposed Mechanism.

The SARS-CoV-2 virus has resulted in over 88 million cases worldwide of COVID-19 as of January 2021. The heart is one of the most commonly affected organs in COVID-19, but the nature and extent of the cardiac pathology has remained controversial. It has been shown that patients infected with SARS-CoV-2 can sustain type 1 myocardial infarction in the absence of significant atherosclerotic coronary artery disease. However, many patients present with small elevations of troponin enzymes of unclear etiology which correlate with overall COVID-19 disease outcome. Early autopsy reports indicated variable levels of typical lymphocytic myocarditis, while radiology reports have indicated that myocarditis can be a persistent problem after recovery from acute illness, raising concern about participation in college athletics. In this communication, we review the literature to date regarding the gross and microscopic findings of COVID-19 cardiac involvement, present the findings from over 40 cases from our academic medical center, and propose mechanisms by which patients develop small elevations in troponin. .

Left anterior descending myocardial bridge: Angiographic prevalence and its association to atherosclerosis

ObjectiveLeft anterior descending Myocardial Bridge (LADMB) is considered a benign condition and actually becomes a forgotten cause of serious cardiac events. This study was conducted to estimate the prevalence of LADMB and its association to atherosclerosis. MethodsAn observational retrospective study was conducted on patients referred for coronary angiography between June 2012 and June 2020. Coronary angiography database was revisedand studied population was divided into 2 groups: LADMB group versus Non-LADMB group. ResultsLADMB was detected in 510 patients out of 35813 included in the study resulting in a prevalence at 1.42%. The mean age was 66.5 years. Male gender was more common than female (70vs30%). The prevalence of significant atherosclerotic LAD disease was more than two times higher in the non-LADMB group compared to the LADMB group. Statistical analysis revealed a significant negative association between LADMB and atherosclerosis (p < 0.001). A significant greater rate of MINOCA cases was observed in acute coronary syndrome LADMB patients. ConclusionsLADMB is an inborn anatomic variation associated to atherosclerotic risk reduction in LAD. Physicians must be aware about the potential complications and pay attention to those classified at high risk for cardiovascular events.