Significant Obstructive Coronary Artery Disease Research Articles

Broken Heart! Surprised to Know Why!

A 70-year-old female attended the emergency department with cardiac sounding chest pain, cough, new concerning ECG changes and recent history of long flight. Her cardiac enzymes were elevated raising the suspicion of Acute Coronary syndrome. She was taken for urgent percutaneous coronary intervention which did not reveal any significant obstructive coronary artery disease however, ventriculogram revealed severe left ventricular systolic dysfunction (LVSD) with typical apical akinesis resembling takatsubo. A transthoracic echocardiogram confirmed severely reduced left ventricular ejection fraction. In addition, she was also treated for pneumonia which was the possible trigger of the event.

Coronary Artery and Peripheral Vascular Disease in a Patient with Poorly Differentiated Thyroid Cancer Treated with the Tyrosine Kinase Inhibitor Lenvatinib

A subset of patients with differentiated thyroid carcinoma develop radioiodine refractory (RAIR) incurable disease, which typically has a poor prognosis. The multitargeted tyrosine kinase inhibitor lenvatinib has demonstrated significant improvements in progression-free survival in RAIR thyroid cancers compared to placebos. However, in the phase III SELECT trial of the drug in thyroid cancer, 5.4% of patients on lenvatinib experienced arterial thromboembolic events, with 2.7% experiencing severe grade ≥3 toxicities associated with arterial vascular events. This case study reports a patient with metastatic poorly differentiated follicular thyroid cancer who developed significant obstructive coronary artery disease following initiation of lenvatinib treatment, despite no predisposing cardiovascular risk factors apart from a remote smoking history. The possibility of developing coronary or peripheral artery disease should be considered in patients who are on targeted therapies, such as lenvatinib, even in the absence of traditional cardiovascular risk factors. In addition, baseline cardiac risk assessment and early treatment should be pursued to minimize interruptions to potentially lifesaving cancer therapy.

Clinical and Angiographic Profile in Non-ST Elevation Acute Coronary Syndrome (NSTE-ACS) and Chronic Stable Angina: A Tertiary Care Centre-Based Cohort Study From Southern Indian Population.

Purpose This study aimed to assess the clinico-demographic profile, risk factors, and pattern of coronary involvement in non-ST elevation acute coronary syndrome (NSTE-ACS) and chronic stable angina (CSA). Methods This was a retrospective study conducted in a tertiary care hospital catering mainly to the rural population in Southern India from January 2020 to July 2022. Data from 333 patients with NSTE-ACS and CSA were analyzed during the study period for the clinico-demographic profile, risk factors, and pattern of coronary involvement in angiography. Results The mean age at presentation was 56.05±9.31. Significant obstructive coronary artery disease was present in 234 (70.3%) patients. Overall, single, double, and triple vessel disease occurred in 26%, 20%, and 32.4% of patients with NSTE-ACS and chronic stable angina. Sixty percent of the diabetic and hypertensive patients (n=92/153) had multivessel involvement. Left main coronary artery disease was present in 40 patients (12%). Conclusion Unstable angina was the most common clinical presentation. Left anterior descending (LAD) was the most common coronary vessel to be involved with occurrence of triple vessel disease in 32% of the study population. Multivessel involvement was more common in the diabetic and hypertensive groups.

TCTAP A-066 Agreement Between Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience

TCTAP A-066 Agreement Between Different Angiography-Derived Modalities With Wire-Based Fractional Flow Reserve Systems and 30 Month Clinical Outcomes in Evaluation of Non-Hemodynamically Significant Obstructive Coronary Artery Disease, a Single Centre Experience

Practical Approach for Angina and Non-Obstructive Coronary Arteries: A State-of-the-Art Review.

Anginal symptoms are frequently encountered in patients without the presence of significant obstructive coronary artery disease (CAD). It is increasingly recognized that vasomotor disorders, such as an abnormal vasodilatory capacity of the coronary microcirculation or coronary vasospasm, are the dominant pathophysiological substrate in these patients. Although the evidence with respect to angina in patients with non-obstructive coronary arteries is accumulating, the diagnosis and treatment of these patients remains challenging. In this review, we aimed to provide a comprehensive overview regarding the pathophysiological origins of angina with non-obstructive coronary arteries disorders and its diagnostic and therapeutic considerations. Hereby, we provide a practical approach for the management of patents with angina and non-obstructive CAD.

ROLE OF STRESS CARDIAC MRI IN THE EVALUATION OF SUSPECTED CORONARY ARTERY DISEASE.

Background: Cardiovascular magnetic resonance (CMR) has emerged in recent years as an essential tool in the imaging of coronary artery disease(CAD) and its preclinical detection. Our study aims at describing CMR imaging features of CAD, including CINE and perfusion imaging. We performed Stress perfusion CMR with Methods: pharmacologic stress(Adenosine) in 26patients of suspected CAD with intermediate cardiac chest pain. Results: All patients showed maintained wall thickness.The mean wall thickness of LV was 7.3mm ± 0.6 SD. 5 (6.4%) coronary territories showed regional wall motion abnormality on CINE imaging. No patient had hyperintensity on T2/STIR images. 9 patients (34.6%)showed subendocardial perfusion defect in coronary distribution on stress imaging, without matched defect on rest perfusion or LGE on delayed imaging (reversible inducible ischemia). 17 patients (73.4%) showed no perfusion defect on stress imaging. Out of 26, only 15 patients underwent catheter coronary angiography (CCA). This included all the 9 patients with stress inducible perfusion defect, of which 7(78%) showed significant CAD (>70% stenosis) in the corresponding artery and 2(22%) showed no significant CAD and 6 patients without stress inducible perfusion defect of which 5(83%) patients showed no significant CAD and 1(17%) showed significant CAD. Using CCA as a gold standard, the sensitivity of stress perfusion CMR in our study was 87.5%, specificity was 71.4% and accuracy was 80%. Stress Perfusion CMR is a noninvasive technique capable of detecting obstructive C Conclusion: AD with excellent diagnostic accuracy. It has high sensitivity and moderate specificity for diagnosing significant obstructive CAD compared with CCA.

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Reverse Takotsubo Stress Cardiomyopathy During Liver Transplantation

Sex-differences in prevalence and outcomes of the different endotypes of chronic coronary syndrome – analysis from the multi-center international ILIAS Registry

Abstract Introduction Guideline-directed management of chronic coronary syndrome (CCS) remains focused on obstructive causes of angina, and is based on established therapies derived from studies predominantly including men. This occurs despite documented higher mortality from cardiovascular causes in women compared to men, which is hypothesized to be related to a higher prevalence of coronary microvascular dysfunction (CMD) in women. However, data on the relationship between sex, the different endotypes of CCS, and related sex-specific clinical outcomes are limited. Purpose This study aimed to investigate the relationship between sex and the different endotypes of CCS, as well as sex-specific clinical outcomes of CCS endotypes. Method In patients with stable angina undergoing coronary angiography, the following invasive coronary hemodynamics were characterized: fractional flow reserve (FFR; <0.80 considered abnormal), coronary flow reserve (CFR; <2.0 considered abnormal) and microcirculatory resistance (MR) (hyperemic microvascular resistance; >2.5mmHg/cm/sec or index of microvascular resistance >25 considered abnormal). Patients were stratified into three groups: 1) hemodynamically significant obstructive coronary artery disease (oCAD) (FFR abnormal or a severe coronary stenosis requiring revascularization), 2) no-obstructive coronary artery disease but with CMD (FFR normal, but abnormal CFR and/or MR), or 3) no-obstructive coronary artery disease and no CMD (FFR normal, and normal CFR and MR). We assessed the prevalence of the CCS endotypes across sex, and sex-specific cardiovascular outcomes over a follow-up of 7 years defined as the composite endpoint of death or acute myocardial infarction. Results Amongst a total of 1987 included patients, 1435 (72.2%) were men and 552 (27.8%) were women. oCAD occurred in 904 (45.5%) patients, which was significantly more prevalent in men (48.9% (701/1435) of men vs. 36.8% (203/552) of women, p<0.001). In contrast, CMD was significantly more prevalent in women (19.6% (281/1435) of men vs. 24.1% (133/552) of women, p=0.031). Across the population, either oCAD or CMD occurred in 68.4% of men versus 60.9% of women (p=0.002). There were no sex-specific differences in cardiovascular outcomes across CCS entities (Figure 1). Conclusion In patients evaluated for CCS who underwent clinically indicated coronary angiography and physiological assessment, men were more likely to have oCAD and women were more likely to be classified as CMD. There were no sex-related differences in the prognosis associated with the individual CCS endotypes. Therefore, pathophysiological changes in the coronary circulation potentially underlying angina pectoris are similarly prevalent in men and women, but the high incidence of CMD in women makes women prone to underdiagnosis if no additional physiological measurements are assessed. Funding Acknowledgement Type of funding sources: None.

The utility of a fully automated cardiac magnetic resonance post-processing tool and radiomics algorithm to non-invasively classify patients with or without significant coronary artery stenosis

Abstract Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Research Institute of the McGill University Health Centre. Background Oxygenation-Sensitive Cardiac Magnetic Resonance (OS-CMR) has emerged as a powerful tool to investigate the underlying physiology of a number of disease states through the assessment of tissue oxygenation status with myocardial oxygenation reserve and functional kinetics of the myocardium with strain. Recently, the analysis of CMR scans with radiomics algorithms has demonstrated to have superior diagnostic accuracy over standard analysis and reporting methods. As up to half of patients undergoing coronary angiography are found to have ischemia with no significant coronary artery obstruction, a non-invasive diagnostic test that can help to more accurately stratify patients presenting with symptoms of ischemia as having significant or no significant coronary artery disease (CAD) would be of great clinical use. Methods We analyzed 49 patients (38 with significant and 15 without significant obstructive CAD) with a positive stress test and coronary angiography. All participants underwent a non-contrast CMR exam on a clinical 3T MRI system (Magnetom Skyra™, Siemens Healthineers, Erlangen, Germany) within one week of the coronary angiography. Long axis cine CMR for ventricular morphology, volumes, function including strain, and short axis OS-CMR images were acquired (total image acquisition time less than 15min). The images were imported and analyzed with a fully automated analysis package including an advanced machine learning algorithm (cvi42™ Cardiom prototype (Circle Cardiovascular Imaging, Alberta, Canada). Per participant, 602 discrete data points per participant are extracted. A 75% or higher degree of coronary artery stenosis on Quantitative Coronary Angiography (QCA) was used as the ground truth and classified as either 1 vessel disease (VD), 2VD, 3VD, or no significant coronary artery obstruction. Results Fig. 1 shows the top discriminative features as identified by the algorithm: OS-CMR derived marker: 1) myocardial oxygen saturation (LV SVO2), 2) myocardial oxygenation in response to hyperventilation stress (MORS), and 3) epicardial myocardial oxygenation reserve (MORE). Other predictive markers were: Peak Systolic Radial Strain, treatment with calcium channel blockers, presence of cerebrovascular disease, and hypertension. The algorithm showed a 73% classification accuracy of identifying patients with or without obstructive coronary artery stenosis. Conclusion In this proof-of-concept analysis, a fully automated post-processing tool and radiomics algorithm has demonstrated the potential to accurately predict clinical classification in patients with and without significant CAD with a non-invasive, contrast-free CMR protocol. Further training and refinement of analysis algorithms are likely to further enhance the predictive value.

Visual patterns of breast attenuation artifacts in women and men with an upright and supine cadmiun-zinc-telluride camera

BackgroundBreast attenuation artifacts occurring with upright cadmium-zinc-telluride (CZT) cardiac imaging systems have not been well characterized. Methods216 consecutive patients with Single Photon Emission Computerized Tomography myocardial perfusion imaging and no angiographically significant obstructive coronary artery disease were identified. All upright and supine SPECT images as well as coronary angiograms were reviewed and analyzed in blinded fashion. ResultsIn women imaged upright, more visual false positive defects were noted in the inferior wall compared to the anterior wall (26 vs. 10 at rest, p = 0.006, and 33 vs. 13 at stress, p < 0.001). Visual inferior wall defects were more common in the upright than supine position at stress (33 vs. 23, p = 0.018) and rest (26 vs. 14, p = 0.011), and most apparent in non-obese women (13 vs. 8, at stress, p = 0.059 and 11 vs. 5, at rest, p = 0.014). ConclusionsWith upright CZT myocardial perfusion imaging, women often have visible inferior wall attenuation artifact defects, likely from pendant breast tissue. These inferior wall attenuation artifacts may be seen in non-obese female patients.

Acute Circulatory Collapse and Advanced Therapies in Patients with COVID-19 Infection

IntroductionIn the current COVID era, ICU-level patients typically develop respiratory failure and acute respiratory distress syndrome (ARDS). While less frequent, the management of concomitant acute circulatory collapse has its own challenges and nuances. Early identification of acute circulatory collapse requires appropriate imaging and precise diagnosis of cardiogenic shock. Escalation to mechanical circulatory support such as intra-aortic balloon pump (IABP), Impella and extracorporeal membrane oxygenation (ECMO) have been useful in patients with circulatory collapse from COVID.Case Report42-year-old obese female presented with COVID bronchopneumonia 6 days after a positive outpatient COVID swab. In the ED, she was given 3L of fluid bolus for severe sepsis and developed flash pulmonary edema requiring emergent intubation. She also developed hemodynamic collapse, requiring inotrope and pressor support and a TTE demonstrated severely depressed left ventricular ejection fraction (LVEF) of < 10%. Peripheral VA ECMO was placed, and the patient was transferred to our tertiary care center for further management of fulminant COVID-myocarditis with cardiogenic shock. Patient did not have any significant obstructive coronary artery disease on catheterization. An Impella CP was placed for hemodynamic support. She was started on a high-dose steroid, one dose of tocilizumab for severe LV dysfunction, two rounds of IVIG, and CRRT for volume removal. On Day 11 she had improved hemodynamics and there were signs of LV recovery, after which she was decannulated. Impella support was continued until there was complete recovery. Patient was extubated on Day 17 and continues to recover at a long-term acute care facility.SummaryAcute circulatory collapse in COVID-19 infection is a serious complication with high morbidity and mortality. Early recognition of depressed LV function and cardiogenic shock by echocardiography, cardiac MRI, and/or Swan-Ganz catheter assessment is critical. ICU management of hemodynamic function, fluid status, and blood pressure management remains standardized, but prompt medical management with inotropes and mechanical support maximizes patient outcomes. IABP, Impella, and ECMO all play a key role in managing acute circulatory collapse.

Measurement uncertainty quantification for myocardial perfusion using cardiac positron emission tomography imaging

Perfusion, the flow of blood, and hence oxygen, is essential to the functioning of the heart. Reduced perfusion (or ischemia), is a reliable indicator of the presence of significant obstructive coronary artery disease (CAD), which is one of the biggest causes of death in Europe. Myocardial perfusion imaging is a non-invasive technique used in the diagnosis, management and prognosis of CAD and is a key component in the triage of patients into treatment and non-treatment groups. Cardiac positron emission tomography (PET) is an imaging technique with high sensitivity and specificity to CAD, however perfusion measurements are difficult to calibrate against a common reference standard, and confidence in them is generally not quantified in terms of measurement uncertainty. There are a number of steps involved in measuring perfusion using cardiac PET—from patient preparation to data analysis—each associated with potential sources of uncertainty. The absence of measurement uncertainty quantification can lead to inaccuracies in measurement results, a lack of comparability between devices or scanning facilities, and is likely to be detrimental to a decision-making process. In this paper, we identify some of the sources of measurement uncertainty in the cardiac PET perfusion measurement pipeline. We assess their relative contribution by performing a sensitivity analysis using experimental data of a flow phantom acquired on a PET scanner. The results of this analysis will inform users of how parameter choices in their imaging pipeline affect the output of their measurements, and serves as a starting point to develop an uncertainty quantification method.

Effects of left ventricular mass on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease

BackgroundIn significant obstructive coronary artery disease (SOCAD), a mismatch in assessment of severity of coronary artery stenosis may occur between invasive coronary angiography (ICA) and computed tomography (CT) derived fractional flow reserve (FFRCT). The present study aimed to identify the factors giving an FFRCT > 0.80 and leading to an underestimation of coronary artery severity in SOCAD vessels. MethodsA total of 141 consecutive patients who underwent both CT angiography including FFRCT and ICA, the latter showing >75% coronary artery stenosis were evaluated. Vessels were divided into two groups according to FFRCT at the distal aspect of the vessel: FFRCT > 0.80 (n = 12) and FFRCT ≤ 0.80 (n = 153). Vessel morphology, plaque characteristics, left-ventricular (LV) wall thickness at each site of the myocardium, and LV mass were also assessed. ResultsLV myocardium-related parameters including LV wall thickness (base, middle, apex, average, and maximal), LV mass, and LV mass index were higher in FFRCT > 0.80, whereas vessel-related parameters including, vessel morphology and plaque characteristics were not significantly different between >0.80 and < 0.80. Vessel morphology and plaque characteristics had no effect on FFRCT, whereas maximum LV wall thickness, LV mass, and LV mass index influenced FFRCT. LV mass index was the strongest predictor of distal FFRCT > 0.80 with an area under the curve of 0.81, and an optimal cut-off value of 66.5 g/m2 (sensitivity 77.8%, specificity 89.6%). ConclusionsThe presence of a high LV mass is a major cause for underestimation of coronary artery severity on FFRCT in SOCAD vessels. LV myocardium-related parameters should be considered when interpreting numerical values of FFRCT.

Post myocardial infarction left ventricular intramural dissecting hematoma: a case report describing a very rare complication

BackgroundDissecting intramural hematoma is a rare complication of acute myocardial infarction (AMI) and has been associated with increased mortality. There has been paucity of literature to establish protocols and guidelines for management in such cases.Case presentationWe hereby report the case of a 45-year-old male patient with left ventricular intramural dissecting hematoma (LV-IDH) who presented with chest pain and breathlessness and diagnosed as non-ST-elevation myocardial infarction (NSTEMI). Transthoracic echocardiography (TTE) was performed showing LV-IDH, confirmed with cardiac magnetic resonant imaging (cMRI). Selective coronary arteriography (CAG) was performed showing significant obstructive coronary artery disease (CAD). Further management with conservative approach involved discussion with patient, cardiothoracic surgeon and cardiology team including heart failure specialist and interventional cardiology.ConclusionsThis case describes a rare complication of AMI and also focuses on utility of TTE and cMRI in the diagnosis of this rare complication. Both diagnosis and management are challenging and have to be individualized in similar cases. Multidisciplinary care coordination is important in management of patients with this diagnosis.

Takotsubo Syndrome: Translational Implications and Pathomechanisms.

Takotsubo syndrome (TTS) is identified as an acute severe ventricular systolic dysfunction, which is usually characterized by reversible and transient akinesia of walls of the ventricle in the absence of a significant obstructive coronary artery disease (CAD). Patients present with chest pain, ST-segment elevation or ischemia signs on ECG and increased troponin, similar to myocardial infarction. Currently, the known mechanisms associated with the development of TTS include elevated levels of circulating plasma catecholamines and their metabolites, coronary microvascular dysfunction, sympathetic hyperexcitability, inflammation, estrogen deficiency, spasm of the epicardial coronary vessels, genetic predisposition and thyroidal dysfunction. However, the real etiologic link remains unclear and seems to be multifactorial. Currently, the elusive pathogenesis of TTS and the lack of optimal treatment leads to the necessity of the application of experimental models or platforms for studying TTS. Excessive catecholamines can cause weakened ventricular wall motion at the apex and increased basal motion due to the apicobasal adrenoceptor gradient. The use of beta-blockers does not seem to impact the outcome of TTS patients, suggesting that signaling other than the beta-adrenoceptor-associated pathway is also involved and that the pathogenesis may be more complex than it was expected. Herein, we review the pathophysiological mechanisms related to TTS; preclinical TTS models and platforms such as animal models, human-induced pluripotent stem cell-derived cardiomyocyte (hiPSC-CM) models and their usefulness for TTS studies, including exploring and improving the understanding of the pathomechanism of the disease. This might be helpful to provide novel insights on the exact pathophysiological mechanisms and may offer more information for experimental and clinical research on TTS.

Coronary Cameral Fistula

Coronary Cameral Fistulas (CCFs) are rare arteriovenous malformations, defined as a connection between a coronary artery and a cardiac chamber or any segment of the systemic or pulmonary circulation. These may be congenital or acquired, and show a low incidence in both angiographic studies, and the general population. The presentation of CCFs varies depending upon their size and location. These can be majorly asymptomatic or show symptoms and complications like congestive heart failure, myocardial infarction, and bacterial endocarditis. Although percutaneous closure with embolisation can be done, surgical closure of CCF is a gold standard of treatment. The authors reported a case of a 57-year-old male who presented with exertional chest pain and dyspnea. Coronary angiography revealed the presence of dilated tortuous Left Main Coronary Artery (LMCA), Left Anterior Descending artery (LAD), Left Circumflex artery (LCX) and CCF between LAD to Right Ventricle (RV), Obtuse Marginal (OM) to RV and Posterior Left ventricular Branch (PLB) to RV. No significant obstructive coronary artery disease was present. Coronary artery calcium score was 15. The patient was managed conservatively with antiplatelets, statin, and heparin and responded well to the treatment.

Arterial Air Embolism Due to Blunt Chest Trauma: A Case Report

Trauma is the third leading cause of death in Brazil and has a huge impact on the potential years of life lost. Most of the lesions identified are mild and, when treated in time have an excellent prognosis. Air embolism (AE) is a rare but potentially fatal condition, especially after blunt chest trauma, when diagnosis is challenging. A 39-year-old male victim of a motorcycle fall at 60 km/h with moderate traumatic brain injury and chest trauma. There was no change in the primary assessment. In the secondary evaluation, he presented pain on palpation of the anterior chest, and pain in the epigastrium, without peritonitis. The computed tomography (CT) demonstrated the presence of a gaseous focus in the left ventricle (LV); small bilateral pneumothorax foci; areas of lung contusion bilaterally; left kidney and pancreas with signs of ischemia and gaseous foci inside. He was followed in the Intensive Care Unit (ICU) with acute renal failure and pancreatitis, treated conservatively. Then, he was undergone to a cardiac catheterization: absence of significant obstructive coronary artery disease and mild LV systolic dysfunction. He was maintained on 100% O2 until discharge from the ICU and discharged from hospital after 12 days of hospitalization. When the lung parenchyma is injured by a blunt trauma of high kinetics, the pulmonary vessels (PV) and the bronchial tree come into contact and air, under high pressure, enters the PV causing AE. AE is difficult to diagnose in the acute phase as the embolus disappears in about 0.5-30h. [1] Diagnosis is usually made with imaging tests. The treatment of air embolism is eminently supportive. 100% O2 therapy decreases bubble size by forcing nitrogen out of the plunger. The use of a hyperbaric chamber is described and, in more severe cases, it is possible to perform aspiration of the ventricle.

Effects of left ventricular mass index on computed tomography derived fractional flow reserve in significant obstructive coronary artery disease

Abstract Background In significant obstructive coronary artery disease (SOCAD), a mismatched assessment of the severity of coronary artery stenosis may occur between invasive coronary angiography and computed tomography (CT) derived fractional flow reserve (FFRCT). The exact mechanisms of unexpected underestimation of FFRCT remain unknown. Purpose The aims of this study are (1) to clarify the mechanisms of underestimation on FFRCT; and (2) to identify the predictive factors of FFRCT underestimation above the value of 0.80 in SOCAD vessels. Methods A total of 1160 outpatients who underwent CT angiography (CTA) with FFRCT analysis for suspected coronary artery disease (CAD) between January 2017 and June 2020 were evaluated. Among them, 141 consecutive patients who had both CTA coupled to FFRCT analysis and invasive angiogram showing &amp;gt;75% coronary stenosis were included for analysis. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT &amp;gt;0.80 (n=12) and FFRCT ≤0.80 (n=153). Vessel-related parameters, including vessel morphology (vessel length and lumen volume) and plaque components (non-calcified plaque volume and calcified plaque volume) and left ventricular (LV) myocardial-related parameters, including LV wall thickness at each site of the myocardium, and LV mass were evaluated semi-automatically. Results Vessel morphology and plaque components did not differ between FFRCT &amp;gt;0.80 and ≤0.80, whereas LV wall thickness (average; 10.7±2.7 vs. 8.4±1.6 mm, and maximal; 13.5±3.0 vs. 10.6±1.8 mm, all p value &amp;lt;0.001), LV mass (136.4±38.4 vs. 98.8±26.8 g, p&amp;lt;0.001), and LV mass index (73.8±22.6 vs. 51.8±12.2 g/m2, p&amp;lt;0.001) were significantly higher in FFRCT &amp;gt;0.80. Next, we investigated the parameters that correlated with FFRCT. Of all, vessel morphology and plaque components were not related to FFRCT, whereas maximal LV wall thickness, r=0.24, p=0.01; LV mass, r=0.19. p=0.04; and LV mass index, r=0.30, p=0.001) correlated with FFRCT. In the vessels showing FFRCT &amp;gt;0.80, only LV mass (r=0.84, p=0.005) and LV mass index (r=0.67, p=0.047) correlated with FFRCT. (Figure 1). LV mass index was the strongest predictor of a distal FFRCT of &amp;gt;0.80 with the area under curve (AUC) 0.81, 95% CI 0.62 – 1.00, P&amp;lt;0.0001 and an optimal cut-off value of 66.5 g/m2 sensitivity 77.8%, specificity 89.6% (Figure 2). Conclusions FFRCT is affected not by vessel-related parameters but LV myocardial-related parameters in SOCAD. The presence of an excessive LV mass is a major predictor of underestimation of FFRCT in SOCAD vessels. LV myocardial-related parameters should be considered when interpreting numerical values of FFRCT to avoid the possibility of overlooked SOCAD. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Association between coronary dominance pattern and left ventricular mass index: Is there a gender disparity?

Increased left ventricular mass index (LVMI) and left ventricular hypertrophy (LVH) are independent predictors of adverse cardiovascular events. However, little is known regarding the association between coronary circulation and LVMI. We aimed to investigate the association between coronary dominance and LVMI, and to demonstrate the impact of coronary dominance pattern on the emergence of LVH. In total, 367 consecutive patients without known cardiovascular disease and significant obstructive coronary artery disease who underwent diagnostic coronary angiography were prospectively included in the study. Patients were divided into three groups according to coronary dominance pattern. Patients with right dominance (RD), co-dominance (CD) and left dominance (LD) patterns were compared regarding echocardiographically detected LVMI. Additionally, the association between coronary dominance pattern and LVH was investigated. The frequency of RD, CD and LD patterns was 70.3%, 19.1% and 10.6%, respectively. LVMI was significantly higher in patients with CD pattern compared with those with RD and LD patterns (P<.001, for both comparisons). LVH was present in 71 (19.3%) patients. Importantly, the CD pattern was more frequent in patients with LVH compared with those without LVH (P<.001). No significant difference was found between women and men regarding the type of coronary dominance pattern. However, while the presence of CD pattern was found to be an independent predictor of LVH in women (OR:1.221, 95%CI:1.048-1.872, P<.001), no association was observed between coronary dominance pattern and LVH in men. Coronary dominance pattern may significantly affect the LVMI, and it may be useful in the further risk stratification of female patients.

Prognostic implications of left ventricular mass-geometry in patients with no or nonobstructive coronary artery disease

BackgroundCoronary computed tomography angiography (CCTA) is widely used as a first-line noninvasive modality that frequently exhibits no or nonobstructive coronary artery disease (CAD) in clinical practice, along with abnormal left ventricular (LV) geometry on echocardiography. However, the combined prognostic value of these findings has not been well elucidated. Therefore, we aimed to evaluate the prognostic implications of abnormal LV geometry in individuals with no or nonobstructive CAD.MethodsA total of 5806 subjects with no CAD or nonobstructive CAD (luminal narrowing < 50%) on CCTA were included in the study. The major exclusion criteria were structural heart disease and a history of myocardial infarction or coronary revascularization. Abnormal LV geometry on echocardiography was defined as LV mass index > 95 g/m2 in women and > 115 g/m2 in men, and/or relative wall thickness > 0.42. The primary outcome was all-cause mortality.ResultsA total of 5803 subjects without significant obstructive CAD (age, 56.6 ± 8.87 years; men, 3884 [66.9%]). Of them, 4045 (69.7%) subjects had normal LV geometry and 1758 (30.3%) had abnormal LV geometry respectively. During a mean follow-up of 6.2 ± 1.48 years, 84 (1.44%) subjects died in the study population. Of these, 56 subjects were from the normal LV geometry group (1.24%) and 28 were from the abnormal LV geometry group (2.32%). Subjects with abnormal LV geometry had significantly worse survival rates (log-rank, p < 0.001). After adjustment for confounding factors, abnormal LV geometry was an independent predictor of all-cause mortality (adjusted hazard ratio, 1.64; 95% confidence interval, 1.04–2.58; p = 0.034). Moreover, abnormal LV geometry was significantly worse in survival when classified as those with no CAD (log-rank, p = 0.024) and nonobstructive CAD (Log-rank, p < 0.001).ConclusionsAbnormal LV geometry portends a worse prognosis in subjects with no or nonobstructive CAD. These findings suggest that LV geometry assessment can help improve the stratification of individuals with these CCTA findings.