Significant Coronary Artery Disease Research Articles

Presence of coronary artery disease in adults with newly detected diabetes mellitus

PurposeWe aimed to analyze the presence and extent of coronary artery disease in patients with newly detected diabetes mellitus.MethodsClinical health examinations of asymptomatic community-dwelling adults between 2008 and 2018 at a medical center in Taiwan were reviewed. Coronary computed tomography angiography was performed in 444 participants, of which 338, 54, and 52 were categorized as ‘without diabetes mellitus’, ‘newly detected diabetes mellitus’, and ‘known diabetes mellitus’, respectively.ResultsPrevalence of significant coronary artery disease (≥ 50% stenosis) was higher in participants with newly detected diabetes mellitus than in participants without diabetes mellitus (40.7% vs. 20.1%, p < 0.0001). Among those with coronary artery stenosis, the number of coronary vessels with significant obstruction (0.72 vs. 0.42, p = 0.0147) was also higher in participants with newly detected diabetes mellitus. Using multiple logistic regression analysis, new detection of diabetes mellitus was identified as an independent risk factor for significant coronary artery disease (odds ratio: 2.153, 95% confidence interval: 1.112–4.166).ConclusionAsymptomatic patients with newly detected diabetes mellitus had higher prevalence and greater extent of coronary artery disease than those without diabetes mellitus. More attention should thus be paid to the assessment of coronary artery disease in patients with newly detected diabetes mellitus.

Sex Differences in Computed Tomography Coronary Stenosis Severity Versus Flow Impairment and Impact on Revascularization, Clinical Events and Health Care Costs: A FORECAST Substudy.

The impact of sex-related differences in coronary atheroma and flow impairment severity on clinical events and costs remains unclear. This is a secondary analysis of patients with stable coronary artery disease who underwent both coronary computed tomography angiography and fractional flow reserve derived from computed tomography as part of the FORECAST (Fractional Flow Reserve Derived From Computed Tomography Coronary Angiography in the Assessment and Management of Stable Chest Pain) trial, investigating (1) the relationship between coronary stenosis severity on coronary computed tomography angiography and fractional flow reserve derived from computed tomography FFRCTby sex and (2) the association with revascularization, resource usage, and adverse clinical events. A total of 212 patients (64 female participants [32.1%]) and 1245 vessels were included. There was no significant sex difference in the frequencies of significant coronary artery disease (38.2% of women versus 51.3% of men; P=0.073), but female participants had significantly less coronary flow impairment, according to the presence of at least 1 fractional flow reserve derived from computed tomography≤0.8 (47.0% versus 71.5%; P=0.008). Female subjects underwent fewer revascularization procedures (23.5% versus 42.3%; P=0.014), less coronary artery bypass graft surgery (2.9% versus 13.1%; P=0.025) and were less likely to be on statin treatment (72.0% versus 84.7%; P=0.022) by 9-month follow-up. This resulted in lower overall health care costs for female participants compared with male counterparts (median total cost, £1276 versus £2051; P=0.014). In multivariable Cox analysis the presence of significant coronary artery disease (hazard ratio [HR], 2.91; 95% CI, 1.30-6.51) and having a positive fractional flow reserve derived from computed tomography (HR, 4.11; 95% CI, 1.15-14.69) were independent predictors of major adverse cardiovascular events at 9 months, whereas sex was not statistically significant (p=0.13). There are significant sex differences in the anatomico-functional assessment of coronary artery disease leading to differences in clinical management, costs, and adverse events.

Functional myocardial assessment in cine cardiac computerized tomographic angiography using echocardiographic feature-tracking software in patients with and without significant coronary disease.

Cardiac computerized tomographic angiography (CCTA) is perceived as a non-invasive tool for assessment of coronary vessel anatomy. Feature tracking echocardiography has recently emerged as a tool for assessment of regional and global left ventricular function. We aimed to explore the applicability of echocardiographic strain on CCTA cine clips and assess whether global and regional strain parameters are associated with the extent of coronary stenosis. CCTA studies of 61 consecutive patients were reconstructed to yield cine images in classic echocardiographic long and short views. Siemens Velocity Vector Imaging (VVI) software was applied to generate strain and displacement results. Volumetric and mechanics parameters were compared among patients with no or non-significant coronary artery disease (CAD) and patients with significant CAD. Finally, a comparison of the degree of coronary stenosis to regional segmental strain was performed. Myocardial mechanics parameters could be generated in 60 cases. Ejection fraction (EF) and left ventricular end diastolic volume (LVEDV) were within the normal range in both groups. VVI values were lower in the CAD group (VVI LVEF 59±6 vs. 50±11, p=0.0002). Global longitudinal and global circumferential strain both were significantly lower in this group. Regional segmental strain was lower in segments affected by coronary stenosis in comparison to unaffected segments. While CT segmentation derived LVEF did not differ among groups, patients with significant coronary stenosis had reduced longitudinal and circumferential contraction. This suggests that application of VVI to CCTA cine clips tracking may help to differentiate significant and non-significant coronary stenosis, adding functional value to anatomic findings in CCTA.

Global longitudinal strain as a prognostic index of significant coronary artery disease

Abstract Introduction Speckle tracking Echocardiography (STE) has recently gained significant value in echocardiography practice. Its role in stable coronary artery disease, however, remains controversial. Purpose The purpose of this study is to assess the diagnostic value of Global Longitudinal Strain (GLS) in predicting significant Coronary Artery Disease (CAD). Methods This is a prospective study of 103 symptomatic patients who were referred to our hospital for invasive coronary angiography to exclude CAD. An initial echocardiogram including GLS was performed in all. Patients with acute coronary syndrome, history of CAD, heart failure, left ventricle wall motion abnormalities or significant valve disease were excluded. Patients were diagnosed as having significant CAD if the angiogram confirmed ≥50% stenosis in one or more of the coronary branches. The sensitivity and specificity of GLS in predicting the presence of CAD was assessed. Results The study included 103 patients (with a mean age of 63.8 ± 9.3 years), 78.6% were males. A history of arterial hypertension was present in 63.1% of the patients, dyslipidemia in 77.7%, diabetes in 22.3% and peripheral arterial disease in 11.7%. 71.9% of the subjects smoked and 24.3% had family history of premature CAD. Finally, 8.7% had atrial fibrillation and 5.8% had chronic kidney disease. Among the 103 patients, 47 (45.6%) were found to have significant CAD, while the remaining 56 (54.3%) had either non-significant CAD or normal coronary arteries. Patients with significant CAD had lower GLS values than those with non-significant CAD (-15.73 ± 2.64% vs. -17.6 ± 1.85%, p=0.001). GLS values ranging from -16.25 to -14.45 can predict significant CAD. Sensitivity and specificity values ranged from 56%-75% and 69%-83% respectively, considering the type of the coronary lesion, as it is demonstrated in Table 1. Conclusions Resting myocardial GLS can be considered a predictive index of significant CAD in symptomatic patients, for better stratification. These findings need to be confirmed in larger multicenter setting.

Apical rocking and septal flash revealed by an electrocardiographic parameter in the left bundle branch block

Abstract Background Assessing the relationship between electrical and mechanical dyssynchrony in patients with left bundle branch block (LBBB) remains a significant challenge for clinicians. Visual echocardiographic parameters, apical rocking (ApR), and septal flash (SF) are accurate markers of the contraction-and-stretch pattern in the septal and lateral wall in LBBB patients. Electrical activity of the LV apical septum and the LV lateral wall is ECG recorded by the aVL and aVF leads. An ECG parameter that integrates the electrical activation of these two contralateral LV walls could reveal subtle electrical features related to the uncoordinated contraction pattern in LBBB. To the best of our knowledge, no studies have examined the relationship between electrical and mechanical uncoordinated activation of the apical septum and lateral LV wall. Purpose This study aimed to assess the relationship between visual echocardiographic parameters of mechanical uncoordinated contraction pattern (ApR and SF) and ECG parameters of electrical intraventricular asynchrony in patients with LBBB. Methods We retrospectively included 157 consecutive patients with LBBB, in sinus rhythm, without significant coronary artery disease, and no more than mild organic valvular heart disease. The ApR and SF were echocardiographic visually assessed as a typical sequence of the septal-to-lateral apex motion for the ApR and the short leftward movement of the septum in early systole for the SF. We measured the following ECG parameters: LV activation times (LVAT), RR1 interval (as the longest interval from the first R wave to the last R1 wave) in lateral leads, intrinsicoid deflection (ID) in lateral and aVF leads, and a newly defined marker – the difference (Diff) between aVL and aVF ID’s (Diff_IDaVL_aVF). Based on the presence and absence of both ApR and SF (ApR_SF), the patients were divided into two groups: patients with (68.2%) and without (31.8%) ApR_SF. Results In the group of patients with ApR_SF, the LVAT, ID, and RR1 measured in lateral leads, and the Diff_IDaVL_aVF were significantly longer, but IDaVF was significantly shorter compared to the group of patients without ApR_SF (p&amp;lt;0.05) (Table 1). In multivariable analysis, the Diff_IDaVL_aVF (p &amp;lt; 0.001) was the only parameter independently correlated with the presence of ApR_SF (Table 2). On ROC analysis, the best cut-off of DIFF_IDaVL_IDaVF for predicting the presence of ApR_SF in LBBB patients was 46 ms (AUC of 0.92, sensitivity 86%, and specificity 80%) (Figure 2). Conclusions In LBBB, a simple ECG parameter incorporating the electrical activation of contralateral LV myocardial segments can provide insights into the myocardial contraction pattern in LBBB patients. A Diff_IDaVL_aVF longer than 46 msec identified LBBB patients with specific contraction patterns (ApR_SF). Considering ECG is the screening tool for LBBB diagnosis, these patients might benefit from early treatment to avoid a worse prognosis.

Real-life data and the utility of echocardiography in young patients under 45 years with ischemic heart disease- a single-centered retrospective analysis

Abstract Background In the last decade there is an increased incidence of coronary artery disease occurring in young adults ≤45-year-old who were referred for selective coronary angiography (SCAG). The traditional risk factors and approach are not informative and effective enough for adequate stratification and interventional referral. Purpose This study aims to measure the predictive value of the echocardiographic data added to the conventional approach for selection of invasive diagnostic procedures (symptoms, ECG, laboratory markers- hs-troponin and lipid profile, risk factors- sex, diabetes, smoking, etc.). Reduction of the overuse of angiography in young patients without added risk for their health is a priority. Methods We did a single-centered retrospective cohort study from January 1, 2019 to June 1, 2024 of young patients under 45 years-old who underwent coronary angiography. During this 5 years period, of the 5933 SCAGs performed in our center, 225 (225/5933; 3.8%) were patients ≤45 years who presented with symptoms of angina, had elevated hs-troponin T (over 0.014 ng/ml), ischemic ECG findings or had several risk factors such as sex, diabetes, LDL&amp;gt; 3.0 mmol/l, smoking. Of all the young patients only 82 (82/225- 36.4%) were diagnosed with significant coronary artery disease (including unstable angina, STEMI, NSTEMI) and the data from this patient cohort was analyzed. Death, sex stratification, smoking, diabetes, number of diseased vessels were studied. The added value of echocardiographic evaluation with simple markers such as left-ventricular ejection fraction (LVEF), mitral (MR) and tricuspid regurgitation (TR) as a potential discriminator for significant CAD was evaluated. Results We identified 82 patients under age 45 with CAD diagnosed by coronary angiography. The sex stratification showed clear predominancy for male (n= 74, p=90.2%), death (n=4, p=4.9%), number of diseased vessels (one- n=28, p=34.1%; two- n=24, p=29.3%, three- n=30, p=36.6%) and the most common cardiovascular risk factors for significant CAD were dyslipidemia with LDL&amp;gt; 3 (n=22, p=26.8%), diabetes (all n=35, p=42.7%), smoking (n=58, p=70.7%). To better recognize the full diagnostic capability of echocardiography, we performed thorough analysis of the selected sub-population with positive echo signs represented by LVEF, MR and TR. Overall, 29.3% had reduction in EF (n=24 with EF below 49%), 92.6% had MR I stage (n=76), 7.4%- MR II stage (n=6), 95.1%- TR I stage (n=78), 4.9%- TR II stage. The sub-population of 82 young patients with CAD were divided in two groups- patients with reduced and preserved EF. Only left-ventricular EF of the investigated echo markers showed statistical significance in the single-variable analysis (r = 0.20, P &amp;lt; .0001) between the groups. Conclusion(s) When the predictive values of LVEF and risk factors- sex, diabetes, smoking and LDL are combined, the discrimination for the need of SCAG in young patients is more precise and clearer. Flow chart 1

Does ischemic stress echocardiography study in subjects with non-obstructive coronary artery disease predicts worse cardiovascular prognosis?

Abstract Background Many patients with signs of ischemia in stress echocardiography (SE) do not have obstructive coronary artery disease (CAD). There is concern that subjects with abnormal SE results without significant CAD have a worse prognosis than patients with normal SE. Purpose The aim of this study was to examine the cardiovascular prognosis and mortality of patients with ischemic SE test and normal or non-obstructive CAD. Methods A retrospective cohort study of patients with ischemic SE test who demonstrated a normal coronary arteries or non-significant CAD by coronary catheterization or computerized tomography angiography were compared to patients with normal SE study, matched by distribution of age, gender, and by the year that the test was performed for the rate of all-cause mortality and mayor adverse cardiac events (MACE). Results There were 55 out of 168 patients with ischemic SE that had normal or non-significant CAD (64 ± 9 years, 54% females). During a mean follow up of 7.9 ± 2.6 years, MACE was higher in ischemic SE group than the non–ischemic group (15% and 7%, respectively). The most common MACE component in the ischemic SE subjects was heart failure (11% and 2% for ischemic SE group and non-ischemic SE group, respectively) (HR 2.854). The rate of all-cause mortality was also higher in the ischemic SE group than the non-ischemic SE group (3.1% and 2.1%, respectively) By multivariate analysis the most powerful parameter that predicted all-cause mortality was hypertension (HR 1.195) and diabetes mellitus (HR 1.548). Conclusions The outcome of patients with ischemic SE and normal coronary arteries or non-obstructive CAD is worse for patients with normal SE. According to these findings patients with ischemic SE results and normal coronary arteries or non-obstructive CAD may benefit from different management that should include frequent medical follow up and tight control of risk factors.

Prognostic role of con-/discordant coronary flow reserve and microvascular resistance in coronary microvascular disease: a systematic review and network meta-analysis

BackgroundCoronary microvascular disease (CMD) is defined as impaired coronary flow reserve (CFR) and/or increased microvascular resistance (MR) without significant epicardial coronary stenosis. This definition allows for discordant CFR and MR...

Combined single-photon emission computed tomography-myocardial perfusion imaging with coronary calcium score for assessing coronary disease.

Coronary artery disease (CAD) underestimation represents a major pitfall of single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI). Coronary artery calcium score (CACS) has emerged as a sensitive tool for the assessment of suspect CAD; however, the integration of SPECT-MPI with CACS has been seldom evaluated, so far, and was therefore the aim of the present study. Patients undergoing SPECT-MPI with CACS and subsequent coronary angiography were included. ROC curves were used to identify the CACS values best predictive for CAD. In SPECT-MPI negative patients, the formula: defined the optimal CACS cut-points. The Systematic Coronary Risk Evaluation 2 was applied for 10-year cardiovascular risk estimation. Significant CAD was defined for an epicardial coronary stenosis >70 or 50% for the left main. Among 124 patients, 61 (49.19%) displayed positive SPECT-MPI, whereas 69 (56%) had significant CAD at angiography. Sensitivity, specificity, and positive predictive value (PPV) for SPECT-MPI were, respectively, 74, 82, and 84%. Considering 63 SPECT-MPI negative cases, the index values for CACS at the optimal cutoff value of 1949 were: sensitivity 28%, specificity 89%, and PPV 50%, allowing to further detect five (8%) of the patients with significant CAD. The increased discriminative power of the combined SPECT-MPI with CACS was not conditioned by the pretest cardiovascular risk. Among patients with suspect CAD undergoing SPECT-MPI, the addition of CACS in negative cases allows to detect a consistent further 8% of patients with significant CAD, thus limiting the risk of disease underestimation and offering potential prognostic benefits.

Calcium Distribution Patterns of the Aorta as Predictors of Significant Coronary Artery Disease in Patients with Moderate to Severe Aortic Stenosis

OBJECTIVE Computed tomography (CT) of the aortic valve and aorta has gained a greater role in planning for aortic valve replacement (AVR). However, when AVR is planned, invasive coronary angiography remains the standard investigation. Whether the calcium distribution pattern in the aorta predicts the significant presence of coronary artery disease (CAD) in patients undergoing AVR remains unclear. This study evaluated the correlation between the calcium distribution pattern from the CT aorta to predict significant CAD in patients with symptomatic moderate to severe aortic stenosis undergoing AVR. METHODS This retrospective study included candidates for AVR either with transcatheter replacement (TAVR) or surgical replacement (SAVR) at a single tertiary-care center between 2017 and 2022. The calcium distribution patterns from the left ventricular outflow tract up to the descending aorta were analyzed from the non-contrast CT of the aorta. Significant CAD was identified from invasive coronary angiography and was defined as 50% diameter stenosis (DS) of the left main and 70% DS of the proximal left anterior descending artery. Multivariate logistic regression analysis was performed to identify the calcification pattern associated with the significant CAD. RESULTS In total, 110 patients were included in the analysis. Among them, 40 patients (36.4%) were candidates for TAVR, while 70 patients (63.6%) were candidates for SAVR. The prevalence of significant CAD was 12.7%. Baseline characteristics were similar between patients with and without CAD, with the exception of a higher prevalence of chronic kidney disease in the CAD group (42.9% vs. 19.8%, p = 0.01). The presence of calcium at the ostium of the coronary artery and descending aorta was an independent predictor of significant CAD (OR 3.44, 95% CI1.30-9.10, p = 0.01 and OR 12.03, 95% CI 1.14-126.84, p = 0.04). CONCLUSIONS This pilot study showed that calcium at the ostium of the coronary artery and descending aorta from non-contrast CT aorta was associated with significant CAD in patients with moderate to severe AS. Further study with more subjects be needed to confirm the findings. KEYWORDS calcium distributions; aortic stenosis; coronary artery disease; computed coronary angiography

Accelerated and efficient CMR perfusion assessment for the detection of functionally significant coronary artery disease: A prospective randomized diagnostic accuracy study

Accelerated and efficient CMR perfusion assessment for the detection of functionally significant coronary artery disease: A prospective randomized diagnostic accuracy study

Artificial intelligence-enhanced electrocardiography improves the detection of coronary artery disease.

An AI-assisted algorithm has been developed to improve the detection of significant coronary artery disease (CAD) in high-risk individuals who have normal electrocardiograms (ECGs). This retrospective study analyzed ECGs from patients aged ≥ 18 years who were undergoing coronary angiography to obtain a clinical diagnosis at Chang Gung Memorial Hospital in Taiwan. Utilizing 12-lead ECG datasets, the algorithm integrated features like time intervals, amplitudes, and slope between peaks, a total of 561 features, with the XGBoost model yielding the best performance. The AI-enhanced ECG algorithm demonstrated high sensitivity (0.82-0.84) when detecting CAD in patients with normal ECGs and gave remarkably high prediction rates among those with abnormal ECGs, both with and without ischemia (92 %-95 % and 80 %-83 %, respectively). Notably, the algorithm's top features, mostly related to slope and amplitude differences, are challenging for clinicians to discern manually. Additionally, the study highlights significant sex differences regarding feature prediction and ranking. Comparatively, the AI-enhanced ECG's detection capability matched that of myocardial perfusion scintigraphy, which is a costly nuclear medicine test, and offers a more accessible alternative for identifying significant CAD, especially among patients with atypical ECG readings.

Diagnostic accuracy of low-dose myocardial perfusion imaging in a real-world setting.

This large-scale study analyzes factors affecting the diagnostic accuracy of low-dose myocardial perfusion imaging and correlation with coronary angiography in a real-world practice. We compared data extracted from routine reports of (i) low-dose [99mTc]sestamibi stress-MPI performed with no attenuation correction and predominantly exercise stress testing and (ii) the corresponding coronary angiography. We considered 1070 pairs of coronary angiography/stress-MPI results reported by 11 physicians. Mean MPI effective dose was 4.5±2.1mSv. The extent of MPI-ischemia was predictive of >70% but not 50%-70% coronary stenoses. A positive test was associated with a sensitivity of 74.7% (413/553) and a specificity of 53.2% (275/517) for >70% stenosis detection. Positive predictive values were lower in patients with left bundle branch block or pacemakers (LBBB/PM) (45.6% vs 64.7%, P=.006) and markedly higher for patients with MPI-ischemia ≥3 segments or associated with ST-segment depression (75.0% (165/220)) as compared to those with <3 segments MPI-ischemia, MPI-infarction or isolated ST-segment depression (57% (248.0/435), P<.001). Negative predictive values were lower for patients with previous coronary artery disease (CAD) history (58.3%), male (61.0%), and elderly patients (59.6%) (vs 72.1%, 79.2%, and 72.4%, respectively, all P<.05). Routine results from low-dose stress-MPI, predominantly associated with exercise stress testing and uncorrected for attenuation, correlate with real-world coronary angiography results. However, this correlation is lower than that achieved with conventional study designs and affected by the definition of significant CAD and context variables (LBBB/PM, CAD history, sex, and age). Better consideration of these interacting factors could improve patient monitoring.

Coronary artery profile on coronary angiography in TMT positive female patients presenting in BPKIHS, Nepal

BACKGROUND Diagnosis of Coronary artery disease by Coronary artery angiography is limited by its availability, cost and as an invasive procedure. Treadmill test is a noninvasive and easily available test for diagnosing as well as prognosis of coronary artery disease and is most commonly performed stress test for diagnosis of coronary artery disease. Women tend to have a greater release of catecholamines during exercise, which could potentiate coronary vasospasm and augment the incidence of abnormal exercise results. TMT in women have a relatively low diagnostic yield for CAD compared to men, especially when symptoms are atypical or non-specific. AIM AND OBJECTIVE To analyze the coronary artery profile on Coronary Angiography (CAG) in TMT positive female patients. METHODS This was a cross sectional observational study carried out over a period from 15th July 2024 to 15th October 2024 in Department of Cardiology. A total of 64 female patients with positive Treadmill test and underwent CAG after pre-test probability Results: A total of 64 patients were enrolled in the study. The mean age of the patient was 53.38±16.7 years. Hypertension was present in (43.8%) study female as must common risk factors. DM female patient was 35.9% study patients. Dyslipidemia was seen in 34.4% patients. CAD was seen in 29.7% of cases with significant CAD in 18.97% study patients. The most common coronary artery involved having significant disease during coronary angiogram was LAD in 38.89% of cases with CAD. Two third of patient who had CAD was at high pre-test probability categories. CONCLUSIONS TMT has a low predictive value of CAD in female patients except those female TMT positive patients with a high pre-test probability score.

Acute Anterior Wall Myocardial Infarction in a Gallbladder Cancer Patient: A Case of Sudden Coronary Thrombosis Post-normal Angiogram

Cancer patients face a heightened risk for thromboembolic events, including arterial thromboembolism such as myocardial infarction (MI). Thrombosis is a major cause of mortality in these patients due to the hypercoagulable state induced by malignancy and its treatments. Pro-inflammatory cytokines and pro-coagulants secreted by tumor cells lead to endothelial damage and an increased risk of thrombus formation. Despite extensive research on venous thromboembolism in cancer, arterial thromboembolism remains less studied. This case report highlights an acute anterior wall MI in a patient with metastatic gallbladder cancer, who developed a sudden thrombotic event despite having a normal coronary angiogram shortly before. A 52-year-old female with metastatic gallbladder cancer presented to the emergency department with acute chest pain. Her cancer, diagnosed 6 months earlier, had been managed with cholecystectomy and subsequent chemotherapy. Fifteen days before her current admission, she had undergone a coronary angiogram due to atypical chest pain, which showed no significant coronary artery disease. At presentation, the patient reported, sudden chest pain radiating to the left arm. She was hemodynamically stable with normal blood pressure and heart rate. The physical examination was unremarkable. Electrocardiogram segment elevation (ST)-segment elevation in anterior leads (V2-V6) and limb leads (II, II, and augmented vector foot [aVF]), indicative of an acute anterior wall MI. Elevated cardiac biomarkers confirmed myocardial injury. A two-dimensional echocardiogram showed mild hypokinesia of the distal interventricular septum and the apex. A repeat coronary angiogram identified a thrombus in the left anterior descending artery, which was not present in the previous angiogram. The rapid appearance of the thrombus pointed to an acute thrombotic event. This case illustrates the aggressive nature of thrombotic events in cancer patients. Despite a normal angiogram 2 weeks prior, the patient developed a sudden coronary thrombus, reflecting the hypercoagulable state associated with malignancy. The management involved thrombus aspiration and tirofiban, which effectively resolved the acute event. This aligns with existing literature, emphasizing the need for vigilant monitoring and proactive management in cancer patients to address the risk of rapid-onset thrombotic events. Cancer patients can experience sudden and severe thrombotic events, even with recent normal coronary evaluations. This case highlights the importance of ongoing cardiovascular assessment and tailored therapeutic strategies in managing cancer-associated thrombosis, underscoring the need for a collaborative approach between oncologists and cardiologists.

The Utility of Coronary Revascularization to Reduce Ventricular Arrhythmias in Coronary Artery Disease Patients: A Systematic Review.

Ventricular arrhythmias (VA) are a major cause of morbidity and mortality in patients with coronary artery disease (CAD). Current guidelines recommend revascularization of significant CAD to improve survival in patients with ventricular fibrillation (VF), polymorphic ventricular tachycardia (VT), or those who are post-cardiac arrest. However, revascularization is not recommended for CAD patients with suspected scar-mediated monomorphic VT. There is a paucity of data detailing the utility of revascularization in reducing VA in CAD patients who do not present with acute coronary syndrome (ACS) and are not immediately post-cardiac arrest, which is the focus of this review. Medline, Scopus, and the Cochrane Central Register of Controlled Trials were systematically searched to identify relevant studies addressing this question. Studies that included patients presenting with ACS or those who were immediately post-cardiac arrest at the time of revascularization were excluded. In total, five studies comprising 2663 patients were reviewed.

Assessment of bystander coronary artery disease in transcatheter aortic valve replacement (TAVR) patients using noncoronary-dedicated planning computed tomography angiography (CTA): diagnostic accuracy in a retrospective real-world cohort.

To assess the diagnostic potential of a noncoronary-dedicated pre-TAVR CT angiography (CTA) conducted as a prospective ECG-gated scan without premedication and standard cardiac reconstructionsin evaluating bystander coronary artery disease (CAD) against invasive coronary angiography (ICA) as the gold standard. This retrospective study included 232 patients who underwent both CTA and ICA as part of their pre-TAVR evaluation. Exclusion criteria included prior stent, pacemaker, coronary artery bypass, or valve surgery. Coronary arteries were analysed solely through thin-slice axial reconstructions, with observers blinded to ICA results. Stenosis was categorised as mild (< 50%), moderate (50%-69%), or severe (≥70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy were calculated for 50% and 70% diameter stenosis (DS) thresholds. At the 50% DS threshold, CTA demonstrated 71% sensitivity, 74% specificity, 92% NPV, and 38% PPV. At the 70% DS threshold, results included 46% sensitivity, 91% specificity, 93% NPV, and 41% PPV. The highest vessel-specific NPV at 50% DS was for the left main (98%) and left anterior descending (LAD) (91%); at 70% DS, left main (LM) (98%) and left circumflex (LCX) (94%) showed the highest NPV. Image quality impacted NPV, with excellent or very good image quality linked to higher diagnostic performance. Noncoronary-dedicated pre-TAVR CTA shows promise for ruling out significant CAD effectively and may act as a gatekeeper for ICA, aligning with typical coronary CT angiography (CCTA) outcomes.

An observational study on global longitudinal strain in acute coronary syndrome and its correlation with coronary angiogram

Background: Coronary angiography (CA) is crucial for diagnosing acute coronary syndrome (ACS) and assessing coronary artery disease (CAD), enabling healthcare providers to determine treatment options and assess the risk of cardiovascular events. Global longitudinal strain (GLS) is a sensitive marker of cardiac function. This study aimed to determine the correlation between GLS in ACS and CA findings. Methods: This prospective observational study was conducted at the cardiology department of the Salem government medical college. The study involved transthoracic echocardiography (TTE) to assess LV volumes, ejection fraction (EF), and LVGLS and strain analysis using 2D echocardiography to measure regional longitudinal peak systolic strain in different LV segments. CA was performed to visualise the coronary vessels and detect significant CAD. Results: The study population consisted predominantly of male patients (n=93, 62%), with notable smoking (n=48, 32%) and alcohol consumption (n=36, 24%). A significant majority of the patients (n=111, 74%) exhibited ECG abnormalities. Obstruction was present in 82% of the patients (n=123), with those showing impaired myocardial function compared to those without obstruction. GLS values below 13.95 were more common in patients with obstruction (n=8 out of 11), indicating reduced myocardial deformation. The GLS demonstrated excellent diagnostic performance for detecting significant coronary artery obstruction, with a high sensitivity of 88.89%, specificity of 90.63%, and overall accuracy of 90.24%. Conclusions: Our study revealed a strong correlation between reduced GLS and CAD, highlighting its importance in CAD assessment and risk stratification in ACS. GLS demonstrated excellent diagnostic performance for detecting significant CAD, showing high sensitivity and specificity.

Accuracy of 2-dimensional speckle tracking echocardiography in diagnosis of coronary artery stenosis in stable angina pectoris

Background It’s difficult to detect the severity of coronary artery disease in the patients who have stable angina pectoris. Echocardiography is a well-validated non-invasive diagnostic tool for detecting myocardial ischaemia, but judging wall motion abnormalities is subjective. Conventional echocardiography can assess radial mechanics only, so it cannot assess the sensitive longitudinal mechanics. 2-Dimensional strain echocardiography is a recent tool that has the ability to solve these drawbacks. Aim of study To detect the accuracy of 2D-STE in prediction of significant coronary artery stenosis in the patients with stable angina pectoris. Methods This study included 70 patients who have stable angina pectoris. Conventional and 2D speckle tracking echocardiography were done to all patients then compared with the coronary angiography results. Patients were classified into three groups according to their coronary arteries affection; patients with normal Coronaries, non-obstructed lesion and patients with significant lesion. Results Our study results show that the mean GLS was (-18.67 ± 0.93) in normal cases, and it was (-15.82 ± 1.11) in non-obstructed lesions but GLS was (-13.19 ± 1.7) in patients with significant CAD. And the best cut-off point of GLS was reported as (-17.35%) with a sensitivity of 97.6% and specificity of 93.3%. Also we found that SLS results in significant lesions of LAD, LCX, RCA territory was (-16.3%, −15.95%, −17.45%) with sensitivity and specificity (87.8%, 93.3%), (70.7%, 93.3%), (82.9%, 93.3%) respectively. Conclusion Global longitudinal strain has a good diagnostic significance over visual evaluation during conventional echocardiogram in predicting significant stenosis of the coronary arteries in patients with stable coronary artery disease. Segmental Longitudinal strain is also a sensitive tool to detect the affected Coronary Territory.

Accuracy of dynamic stress CT myocardial perfusion in patients with suspected non-ST elevation myocardial infarction

Coronary CT angiography (CCTA) and dynamic stress CT myocardial perfusion (CT-MPI) are established modalities in the analysis of patients with chronic coronary syndromes. Their role in patients with suspected non-ST elevation myocardial infarction (NSTEMI) is unknown. CCTA with CT-MPI might assist in the triage of NSTEMI patients to the Cath lab. We investigated the correlation of significant epicardial lesions by CT-MPI in addition to CCTA compared to invasive coronary angiography (ICA) with fractional flow reserve (FFR) in patients with NSTEMI. Twenty NSTEMI patients scheduled for ICA were enrolled in this study with planned ICA. CCTA and CT-MPI was performed pre-ICA. For each coronary artery, the presence or absence of significant lesions was interpreted by CCTA with CT-MPI, using an FFR of ≤ 0.8 or angiographic culprit (stenosis > 90%, suspected plaque rupture) as reference. The main outcome was the per-vessel correlation. Sixteen out of 20 patients had a culprit lesion that required immediate revascularization. CCTA with ≥ 50% stenosis demonstrated a per vessel sensitivity and specificity for the detection of significant stenosis of respectively 100% (95% CI: 86–100%) and 75% (95% CI: 58–88%). CCTA with CT-MPI showed a lower sensitivity 90% (95% CI: 70–99%) but higher specificity of 100% (95% CI: 90–100%). CCTA with CT-MPI exhibits a strong correlation for identifying significant CAD in patients with NSTEMI. Thereby, it might assist in the triage of ICA in NSTEMI patients.