Predictor Of Significant Coronary Artery Disease Research Articles

Lipoprotein (a), coronary artery disease risk, and MACE in individuals without standard modifiable risk factors in the UK Biobank

Abstract Background A significant proportion of patients with coronary artery disease (CAD) lack standard modifiable risk factors (SMuRFs; smoking, hypercholesterolaemia, diabetes and hypertension), for example with recent analyses demonstrating that around 25% of patients with ST-elevation myocardial infarction are SMuRF-less(1). With continued focus on primary prevention in cardiovascular disease, the SMuRF-less subset is likely to increase over time. A body of evidence has implicated lipoprotein (a) in CAD, but no such studies have investigated this association in a purely SMuRF-less population. Purpose To investigate the role of lipoprotein (a) in predicting CAD risk and major adverse cardiovascular events (MACE) in a large, SMuRF-less cohort. Methods The UK Biobank is a large prospective multicentre study which recruited over 500,000 participants in the UK aged 37-73 years at entry between 2006-2010. SMuRFs were defined as 1) smoking (current or historical), 2) hypercholesterolaemia – lipid lowering medication on enrolment or total cholesterol >5.5mmol/L or LDL-C >3.5mmol/L, 3) previous diagnosis of diabetes mellitus, or HbA1c >48mmol/mol, 4) previous diagnosis of hypertension. MACE was defined as a composite of coronary artery disease – previous myocardial infarction, percutaneous coronary intervention or coronary artery bypass graft surgery –, stroke, or all-cause mortality. Results Of the total UK Biobank cohort, 46,139 participants were identified as SMuRF-less together with a valid lipoprotein (a) level. Median follow-up duration was 12yrs. In univariate analyses (Table 1), there was no significant difference in lipoprotein (a) concentrations between individuals with and without MACE (16.9 vs. 17.1nmol/L respectively, p = 0.913). The overall event rate was low, with just 3% MACE (1381 events) overall. Older age, male gender, apolipoprotein A, apolipoprotein B, HbA1c level, HDL cholesterol level and body mass index were all associated with MACE. In regard to all-cause mortality alone, there was no association with lipoprotein (a) level, although the other aforementioned parameters were all significantly associated with this outcome. Similarly, lipoprotein (a) was not a significant predictor of stroke. However, there was a large difference in lipoprotein (a) levels between patients with and without CAD (27.2 vs. 17.1nmol/L respectively, p = 0.004). In Kaplan-Meier analysis, lipoprotein (a) level above the 77th percentile (60.3nmol/L) was significantly associated with CAD (p=0.032). In Cox regression models, despite the low event rate, lipoprotein (a) was a significant predictor of CAD (HR 1.00-1.01, p=0.01), and importantly the only potentially modifiable parameter (N = 39,433, 111 events, Table 2). Conclusion Lipoprotein (a) independently predicts CAD in those without SMuRFs, highlighting the importance of checking this parameter in such patients, particularly given the novel antisense technologies in development which may lower lipoprotein (a)(2).Univariate analysesCox regression for CAD

Impact of Smoking on Hematologic and Biochemical Predictors of Coronary Artery Disease in Iraqi Male Population

Background: Smoking is a well-known risk factor for coronary artery disease (CAD) and other cardiovascular conditions, including coronary heart disease (CHD). Blood cell components and biomarkers such as white blood cells (WBCs), haemoglobin (Hb), fibrinogen, high-sensitivity C-reactive protein (hs-CRP), D-dimer, and ferritin have been implicated in the pathogenesis of CAD. This study aimed to identify key predictors of CAD in smokers by assessing these hematologic and biochemical parameters. Methods: This study included male smokers with hypertension, excluding those with diabetes or dyslipidaemia, and compared them to a control group of healthy nonsmokers. Parameters assessed included complete blood count (CBC) and blood-based biomarkers (hs-CRP, D-dimer, fibrinogen, and ferritin). The predictive value of the fibrinogen-to-D-dimer ratio was also analyzed. Statistical analysis was conducted using GraphPad Prism 9.5.0 with a 95% confidence level. Results: Significant differences were observed between smokers and nonsmokers in WBC count, Hb level, and packed cell volume (PCV). Smokers exhibited higher levels of hs-CRP, fibrinogen, D-dimer, and ferritin. However, the fibrinogen-to-D-dimer ratio was not a significant predictor of CAD. Conclusion: The study found that elevated WBC count, Hb level, PCV, and biomarkers (hs-CRP, D-dimer, fibrinogen, ferritin) are strong predictors of CAD in smokers. These findings suggest the potential for developing a predictive panel for CAD risk in smokers, though the study's small sample size is a limitation.

Left atrial functional assessment a prime clue in solving the puzzle of stable angina symptoms in suspected coronary artery disease patients

Abstract Background Assessing clinically for significant coronary artery disease (CAD) in stable angina patients presents a formidable task. Routinely performed echocardiography is limited in diagnosing CAD with provision for the regional wall motion abnormality (RWMA) for left ventricle (LV) systolic dysfunction and altered mitral inflow velocities for LV diastolic dysfunction. However, the advent of two-dimensional (2D) speckle-tracking technique has established the era of strain imaging, opening new possibilities in echocardiography. It is now possible to have a detailed functional assessment of left atrium (LA). We utilised speckle tracking imaging to obtain strain parameters for LA function. Combining these strain parameters with the doppler myocardial velocities and mitral inflow velocities, may prove useful mode of imaging to diagnose significant CAD in stable angina patients. Purpose To study the parameters of left atrial functions utilising echocardiographic strain imaging and evaluate their correlation with the syntax score-II in patients with symptoms of stable angina. Methods 103 patients with symptoms of stable angina undergoing coronary angiography for suspected coronary artery disease(CAD), were considered for LA function assessment and compared with their syntax-II score. Results The LA reservoir function parameters, peak atrial longitudinal strain (PALS) and peak global systolic strain rate (LAsSR), decreased with increasing syntax-II score (p values 0.011 and 0.001 respectively) and the parameter of LA conduit function, peak global early diastolic strain rate (LAeSR) increased (p value <0.001). The LA filling pressures reflected by E/e`, also increased with more severe syntax-II score (p value <0.001). We, further, configured cut off values of < 23.56 for PALS, < 1.15 for LAsSR, > -1.09 for LAeSR, and E/e` ratio > 10.39 as predictors of significant CAD, with good sensitivity and specificity. Therefore, stable angina patients who had significant CAD on coronary angiogram represented by severe syntax score-II, had higher LA filling pressures and deranged LA function with transition from more of reservoir chamber to merely a conduit. Conclusion Our study shows a significant association between LA strain parameters (PALS, LAsSR, and LAeSR) and LA filling pressures (E/e`), with the presence of significant CAD in these patients. The stable angina patients with more severe CAD as quantified by their severe syntax score-II, have an impaired LA reservoir and LA functions more as a conduit, with elevated filling pressures. This study establishes a significant association between LA deformation strain variables and severity of CAD and hence LA strain imaging can be a useful tool to diagnose significant CAD in stable angina patients.

Abstract 17580: "Healthy Smile for a Healthy Heart": A National Study on the Correlation Between Periodontal Diseases and Coronary Artery Disease

Introduction: Chronic inflammatory periodontal disease (CIPD) is a common disease of the supporting tissues of the teeth that manifest as swelling, bleeding, pain, and clinical attachment loss (CAL) upon periodontal examination. CIPD has been associated with a chronic inflammatory state, also a known risk factor for coronary artery disease (CAD). Hypothesis: There is a possible correlation between CIPD and CAD. Methods: We utilized the 2013-2014 National Health and Nutrition Examination Survey database. We included participants aged 30 years and above who reported having gum disease and had undergone a periodontal examination. CAL measured in millimeters, was reported at six different locations around 28 teeth. To obtain national estimates, we conducted complex survey sample analyses, accounting for weights, clustering, and strata. Furthermore, we adjusted for well-known CAD risk factors in multivariate analyses. Results: Our study included 184,010,722 participants; 7.3% had CAD (n=13,461,796), and 17.1% reported CIPD (n=31,425,382). Baseline Characteristics are presented in Table 1. The unadjusted rate of CAD was higher in patients with CIPD than those without CIPD [10.3% (n=3,238,995) vs 6.7% (n=10,222,801), p=0.018]. Similarly, average CAL was higher in patients with CAD (2.04 vs 1.62 mm, p<0.001). After adjusting for confounders listed in Table 1, CIPD was a significant predictor of CAD (OR 1.744, 95% CI 1.088-2.796, p=0.012). The average CAL of all the teeth also predicted CAD (OR 1.195, 95% CI 1.025-1.394, p=0.026). Conclusions: Our data suggest that patients with reported CIPD had a 1.7 times higher risk of developing CAD. Similarly, each 1 mm increase in CAL leads to a 20% increased CAD risk (OR 1.2). Further prospective studies are needed to confirm these findings and to explore whether treatment of CIPD mitigates the increased CAD risk. These findings underscore the significance of optimizing dental health in patients with CAD.

Liver Fibrosis Scores and Coronary Artery Disease: Novel Findings in Patients with Metabolic Dysfunction-Associated Fatty Liver Disease.

Metabolic dysfunction-associated fatty liver disease (MAFLD) is a recently proposed term as a more appropriate definition for nonalcoholic fatty liver disease (NAFLD). Previous studies have shown an association between liver fibrosis scores and cardiovascular disease (CVD) in patients with NAFLD. In this study, we aimed to investigate the relationship between liver fibrosis scores and coronary artery disease (CAD) severity in patients with MAFLD. This study was conducted on 1346 patients with MAFLD at the Second Hospital of Dalian Medical University between January 2018 and December 2021. We calculated the liver fibrosis scores, including the fibrosis 4 (FIB-4) score, nonalcoholic fatty liver disease fibrosis score (NFS), and aspartate aminotransferase-to-platelet ratio index (APRI). We divided the participants into three groups based on the degree of coronary artery stenosis assessed using coronary computed tomography angiography (CCTA): CAD (≥50%), non-obstructive (1-49%), and normal (no stenosis). An increased FIB-4 score and NFS were significantly associated with CAD severity in patients with MAFLD. The percentage of patients with a high FIB-4 score was higher in the CAD group than in the other two groups (5.80%, 4.31%, and 2.24%, respectively; p<0.001), as was the percentage of patients with NFS (11.12%, 5.19%, and 0.93%, respectively; p<0.001). Carotid atherosclerosis, creatinine levels, and CAC scores were significant predictors of CAD. The FIB-4 score and NFS were independently associated with CAD even after adjusting for sex and well-known cardiovascular risk factors. The APRI was not a significant factor for CAD in any model. In the bivariate correlation analysis, the FIB-4 score and NFS were directly correlated with CAC scores. Non-invasive liver fibrosis scores (FIB-4 and NFS) were significantly associated with the CAD severity and CAC scores in patients with MAFLD. Screening for CAD may be beneficial for subjects with high liver fibrosis risk MAFLD.

Lipoprotein(a) as predictor of coronary artery disease and myocardial infarction in a multi-ethnic Asian population

Background and aimsThe role of Lp(a) in multi-ethnic Asian populations with coronary artery disease (CAD) has not been well established. The aims of this study were (i) to investigate whether Lp(a) is a predictor of CAD, and (ii) amongst patients with CAD, to ascertain whether Lp(a) is a predictor of acute myocardial infarction (AMI) and severity of CAD. MethodsWe compared three cardiovascular phenotypes from patients recruited at coronary angiography. CAD was defined as ≥50% coronary artery stenosis and subdivided into a group with AMI history (CAD+AMI+) and a group without (CAD+AMI-). Minimal CAD group (CAD-) was defined as normal or <30% coronary artery stenosis and no AMI. The severity of CAD was defined using the modified Gensini score. ResultsWe studied 2025 patients comprising 94.5% men and 61.4% of Chinese ethnicity. The median Lp(a) level was highest in CAD+AMI+, followed by CAD+AMI- and CAD- (26.2, 20.1, and 15.8 nmol/L respectively). Similarly, the frequency of patients with Lp(a) ≥120 nmol/L were in the same order (11.8%, 9.1% and 2.4%). Lp(a) levels were highest among Asian Indians, followed by Malays and Chinese patients (p < 0.001). Lp(a) levels and Lp(a) ≥120 nmol/L were significant predictors of CAD (Odds ratio (OR) = 1.12 per 10 nmol/L increment, p < 0.001, and OR = 5.41 p = 0.004 respectively). Among patients with CAD, higher Lp(a) levels were associated with increased AMI risk (OR = 1.02 per 10 nmol/L increment, p = 0.024). Lp(a) ≥120 nmol/L was positively associated with CAD severity (p = 0.020). ConclusionsPlasma Lp(a) concentration is a positive predictor of CAD and AMI in a mostly male South East Asian population.

Increase of serum cyclophilin C levels in the follow-up of coronary artery disease: A biomarker and possible clinical predictor.

Objective:This study is aimed at investigating the changes in serum CypC levels and their relationship with cardiovascular events at 12 months of follow-up in coronary artery disease (CAD) patients.Methods:The study included a total of 125 subjects (40 patients with acute CAD, 40 patients with chronic CAD, and 45 control volunteers) and we analyzed plasma CypC levels from baseline to 6 and 12 months for a better understanding of its behavior in atherosclerosis.Results:Serum CypC levels were shown to be gradually increased in CAD patients (30.63 pg/mL ± 3.77 at baseline, 38.70 pg/mL ± 6.41 at 6 months [p = 0.25], and 47.27 pg/mL ± 5.65 at 12 months [p = 0.007]). In addition, serum CypC levels during the follow-up were a significant predictor of CAD (c-statistic 0.76 at 6 months and 0.89 at 12 months; p < 0.001). Despite it, there was no significant association between CypC and cardiovascular events, but serum CypC levels tended to be higher in patients suffering cardiovascular events during the follow-up (29.02 pg/mL ± 6.39 vs. 79.96 pg/mL ± 22.18; p = 0.029). In this regard, plasma levels of high-sensitivity C-reactive protein (hsCRP) > 2.3 mg/L plus NT-proBNP > 300 pg/mL together were significant predictors of cardiovascular events during the follow-up in CAD patients with CypC levels >17.5 pg/mL (p = 0.048).Conclusions:Taken together, our results suggest that serum CypC levels increase during the follow-up in CAD patients and could be a novel biomarker with a possible prognostic value in combination with hsCRP and NT-proBNP.

Increase of serum cyclophilin C levels in the follow-up of coronary artery disease: a biomarker and possible clinical predictor

Abstract Background Traditional cardiovascular risk factors and a large number of biomarkers are well known in their association with the diagnosis and prognosis of coronary artery disease (CAD). Cyclophilin C (CypC) is a subfamily of immunophilins that modulates macrophage activation and redox homeostasis. Purpose This study is aimed at investigating the changes in serum CypC levels and their relationship with cardiovascular events at 12 months of follow-up in CAD patients. Methods The study included a total of 125 subjects (40 patients with acute CAD, 40 patients with chronic CAD and 45 control volunteers). We analyzed plasma CypC levels from baseline to 6 and 12 months for a better understanding of its behaviour in atherosclerosis. Results Serum CypC levels were shown to be gradually increased in CAD patients [(30.63 pg/mL ± 3.77 at baseline, 38.70 pg/mL ± 6.41 at 6 months (p=0.25) and 47.27 pg/mL ± 5.65 at 12 months (p=0.007)]. In addition, serum CypC levels during the follow-up were a significant predictor of CAD (c- statistic 0.76 at 6 months and 0.89 at 12 months; p&amp;lt;0.001). Despite it, there was no significant association between CypC and cardiovascular events, but serum CypC levels tended to be higher in patients suffering cardiovascular events during the follow-up (29.02 pg/mL ± 6.39 vs 79.96 pg/mL ± 22.18; p=0.029). In this regard, plasma levels of hsCRP &amp;gt;2.3 mg/L plus NT-proBNP &amp;gt;300pg/mL together were significant predictors of cardiovascular events during the follow-up in CAD patients with CypC levels &amp;gt;17.5 pg/mL (p=0.048). Conclusions Taken together, our results suggest that serum CypC levels increase during the follow-up in CAD patients and could be a novel biomarker with a possible prognostic value in combination with hsCRP and NT-proBNP. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Instituto de Salud Carlos III. Spain

Atherosclerosis associated pathways are upregulated in stenotic aortic valves from patients with severe concomitant coronary artery disease

Abstract Aortic valve stenosis (AVS) share pathobiology and risk factors with atherosclerosis. However, medical treatment effective against atherosclerosis lack ability to halt the progression of AVS. The aims of this study were to (i) determine the prevalence of coronary artery disease (CAD) in surgical AVS patients and (ii) to establish predictors of CAD in AVS patients and (iii) to identify differential aortic valve transcriptomic profiles depending on concomitant CAD. The study cohort consisted of 256 consecutive AVS patients with surgically verified tricuspid aortic valves, of which 74 aortic valves were collected. CAD defined as coronary artery stenosis requiring concomitant bypass surgery or previous acute coronary syndrome or percutaneous coronary intervention Transcriptomic data were obtained from microarray analysis of tissues from three different stages of AVS process (healthy, intermediate, and calcified tissue). All comparisons were sex and tissue adjusted. Non-coding probes were removed and a variance filter was applied prior to analysis which yielded 5121 genes. The prevalence of CAD in AVS was 49%. A logistic regression model revealed male sex, claudication, diabetes and current smoking as significant predictors of CAD when age, sex, peak transaortic velocity, hsCRP, eGFR and BMI were held constant. 28 genes were significantly (q&amp;lt;0.05) differentially expressed when aortic valves from patients with (n=43) and without (n=31) CAD were compared. A comparison of patients with concomitant multi vessel disease (2–3 affected vessel territories, n=20) and patients without CAD or single vessel disease (n=54) revealed 189 significantly expressed genes and an optimal visual separation on heatmap (Figure 2). Active-subnetwork-oriented-enrichment analysis identified upregulated aortic valve atherosclerosis associated pathways in multi vessel disease patients related to reactive oxygen species and cytokine signaling. This study provides a novel observation of differential aortic valve gene expression profile depending on concomitant severe CAD. The results revealed that patients with concomitant severe CAD exhibited underlying atherosclerosis-related mechanisms to their aortic valve disease. Therefore, future precision medicine against AVS may be facilitated by assessing concomitant CAD. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Karolinska Institute - Clinical Science Training ProgrammeSwedish Heart Lung Foundation Predictors of concomitant CADDEGs in AVs stratified on severe CAD

Alternative sites of echocardiographic epicardial fat assessment and coronary artery disease.

Increasing evidence points towards the use of epicardial fat (EF) as a reliable biomarker of coronary artery disease extent and severity. We aim to assess the different locations of echocardiographic EF thickness measurement and their relation with the presence, extent, and severity of coronary artery disease (CAD) in patients admitted with acute coronary syndromes (ACS). Prospective cohort study including patients admitted for ACS. EF was assessed by transthoracic echocardiography and compared with coronary angiography findings. Spearmen correlation analysis was used to search for EF correlations. Receiver-operating characteristic curve analysis was performed to assess the predictive value of the different sites of measurement of EF thickness for the presence of CAD. To evaluate other potential variables independently associated with CAD, we performed multivariate analysis employing logistic regression. 196 patients were included. Significant CAD was diagnosed in 83.7% of patients. In all views, EF thickness was greater in patients with CAD (p < 0.001). We found a moderate correlation between EF thickness and CAD extent and severity. EF thickness measured at RV basal level showed a good performance in predicting significant CAD in patients with ACS (AUC = 0.885, 95% CI 0.80-0.97, p < 0.001). For a value of mean RV basal region EF thickness ≥ 12.57mm, sensitivity was 85% and specificity was 80.8%. In patients admitted with ACS, echocardiographic EF thickness predicted the presence of CAD, as well as its extent and severity. We found EF thickness measured at the RV basal region to be the best predictor of significant CAD.

Rapid atrial fibrillation increases cardiac biomarkers: decision to perform coronary angiography based on novel high-sensitivity Troponin I peak

Abstract Funding Acknowledgements Type of funding sources: None. Background Since January 2018 the availability of high sensitivity Troponin I (hsTnI) has improved ischemia diagnosis. In patients with rapid atrial fibrillation (AF), the decision to undergo coronary angiography is usually due to elevated cardiac biomarkers. However, evidence to support the rentability of this approach is sparse. Purpose Evaluate if hsTnI in patients with rapid AF and elevated cardiac biomarkers has a good discriminative power to predict a positive coronary angiography. Methods We retrospectively studied consecutive patients admitted to the emergency department (ED) between January 2018 and December 2019 with rapid AF that underwent coronary angiography and had multiple hsTnI values obtained. We analysed risk factors, initial and peak hsTnI, time from ED admission to peak hsTnI and ST-T segment abnormalities (ST depression and/or T wave inversion). We evaluated the presence of significant coronary artery stenosis with the need of revascularization at coronary angiography. Univariable and multivariable analysis was performed to obtain the Odds Ratio (OR, 95% CI, p-value) for significant coronary artery disease (CAD). Receiver operator characteristics (ROC) curve and area under the curve (AUC) were obtained to determine the discriminative power of peak hsTnI as predictor of a positive coronary angiography. Optimal cut-point value was obtained (Youden index) and patients were divided according to this value. Results From 1407 patients admitted to the ED with rapid AF, 30 patients, 60% male, median age 74 (IQR 61.25-80.75) years, were submitted to coronary angiography. Significant coronary artery stenosis was present in 17 (57%) patients. Age, ST-T segment abnormalities and peak hsTnI were predictors of significant CAD, respectively 1.203, 1.064-1.361, 0.003; 25.00, 3.522-177.477, 0.001; and 1.000, 1.000-1.001, 0.015. Optimal cut-point value for predicting the presence of significant coronary artery stenosis at coronary angiography was a peak hsTnI of 359 pg/mL (AUC 0.869, p-value 0.001, 95% CI 0.742-0.995). The two groups with hsTnI &amp;lt; 359 and hsTnI &amp;gt;359 differed in age and ST-T segment abnormalities (see Table). After adjustment, peak hsTnI &amp;gt;359 pg/mL was the only independent predictor of significant CAD (23.894, 1.310-435.669, 0.032). Conclusion In this group of patients with rapid AF, peak hsTnI &amp;gt;359 pg/mL was the only independent predictor of significant coronary artery disease. Therefore, those patients should undergo coronary angiography. Abstract Figure.

Abstract 15844: Predicting the Risk of Significant Coronary Artery Disease in Liver Transplant Patients: The CAD-LT Score

Background: Patients with significant coronary artery disease (CAD) are more likely to develop post-liver transplant (LT) cardiac events. We developed the CAD-LT screening score and testing algorithm to predict the risk of significant CAD in LT candidates. Methods: Patients who underwent pre-LT evaluation at Indiana University (2010-2017) were studied retrospectively (n=1814). Stress tests (ST) (n=1677) and cardiac catheterization (CATH) reports (n=1300) were reviewed. CATH was performed in patients with predefined CAD risk factors. Significant CAD was defined as disease requiring percutaneous or surgical intervention. Multivariable estimates (Adjusted Odds Ratio i.e. AOR [95%CI]) with assessment of model performance using Receiver Operating Curve analysis were used to compute a point-based risk score and stratify patients. A 10-fold internal cross-validation (CV) model was done. Results: There were 950 LT and 864 no-LT patients. The risk-adjusted predictors of significant CAD were older age (AOR 1.06 [95%CI 1.03-1.09]), male gender (1.69 [1.13-2.50]), diabetes (1.44 [1.01-2.06]), hypertension (1.50 [1.05-2.15]), current smoking history (1.81 [1.16-2.82]), family history of CAD (1.76 [1.24-2.50]), and personal history of CAD (5.41 [3.48-8.43]). The CAD-LT score is shown in Table 1. Figure 1 is an algorithm for its use. The mean CV Area Under the Curve [95% CI] was 0.75 [0.71-0.79]. The algorithm detected 97% of the patients with significant CAD and would decrease the number of ST by 718 (43%; 671 in high-risk group and 47 in low-risk group) and CATH by 409 (30%). Conclusion: The CAD-LT score identifies LT candidates at high risk for significant CAD and guides pre-LT testing.

Exercise induced reduction in myocardial work predicts significant coronary artery disease in patients with false negative stress echocardiography

Abstract Stress echocardiography (SE) is a reliable technique for the diagnosis of coronary artery disease (CAD) with high sensitivity and specificity. However in patients with small left ventricular (LV) cavity caused by marked concentric hypertrophy the sensitivity of SE is low. We assumed that in patients with false negative SE evaluation of global myocardial work (GW) might detect significant CAD. Methods 238 patents with chest pain (98 female, mean age 61±5 years) without history of CAD were referred to SE for CAD confirmation. 94 (39.5%) patients had negative SE and were enrolled in our study for re-examination. Age and gender matched 50 healthy subjects served as controls. GW index (GWI) was obtained from pressure-strain loops composed from speckle tracking analysis indexed to brachial systolic blood pressure. Global constructive work (GCW) as the sum of positive work due to myocardial shortening during systole and negative work due to lengthening during isovolumic relaxation, global wasted work (GWW) as energy loss by myocardial lengthening in systole and shortening in isovolumic relaxation, and GW efficiency (GWE) as the percentage ratio of constructive work to the sum of constructive work and wasted work were measured after submaximal treadmill SE at the heart rate of 100–110 beats per minute (109±11 s after SE) using EchoPac software by blinded experienced echocardiographer. All patients were referred to coronary angiography after re-examination. Results 42 (44.7%) patients had lower GWI values than the lowest limit of GWI value in controls. These patients had significant reduction in GWI, compared with remaining 52 patients in whom GWI did not differ from those of controls (GWI 1897±112 mmHg% vs 2518±243 mmHg%, p&amp;lt;0.01). GCW, GWE and GWW were comparable between patients with or without reduced GWI (GCW 2283±107mmHg% vs 2321±110 mmHg%, p=NS; GWE 96.9±1.1% vs 97.4±1.2%, p=NS; GWW 57±3 mmHg% vs 53±4 mmHg%, p=NS). 28 (66.7%) of 42 patients with GWI reduction and 8 (15.0%) of 52 patients without GWI reduction had at least one vessel significant CAD. GWI had sensitivity, specificity, and accuracy in detection of CAD 78%, 76%, 77% respectively with 67% positive predictive value, and 85% negative predictive value. 29 (80.5%) patients out of 36 with significant CAD had concentric increase in LVMi compared with true negative SE patients (83±6 g/m2 vs 71±4 g/m2, p&amp;lt;0.01). GWI was the predictor of significant CAD (area under the curve 0.793). Conclusion GWI extends diagnostic power of conventional SE in detection of CAD, especially in patients with smaller LV cavity due to concentric hypertrophy when sensitivity of conventional SE is low. Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): Committee of Sience at Ministry of Education of Republic of Armenia

Predicting the presence of coronary artery disease by transesophageal echocardiography.

SummaryBackgroundThe accuracy of ultrasound signs as predictors for the presence of coronary artery disease (CAD) has been evaluated extensively in the 1990s and 2000s. Imaging quality has improved tremendously over the last decades.HypothesisHigh-end ultrasound systems allow for accurate prediction of the presence or absence of CAD.MethodsAll patients who underwent a transesophageal echocardiography examination (TEE) between 2007 and 2016 and who had coronary angiography within 24 months before or after the TEE were retrospectively evaluated.ResultsA total of 242 patients fulfilled the inclusion criteria, 60% were male. Mean age was 70 years (SD ± 13 years). In multivariate regression analysis, plaque in the ascending aorta (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.18–5.32, p = 0.017), plaque in at least one of the thoracic aortic segments (OR 2.07, 95% CI 1.02–4.22, p = 0.045), and the presence of mitral annular calcification (MAC, OR 1.84, 95% CI 1.01–3.36, p = 0.046) were predictors of significant CAD. The isolated finding of aortic stenosis (AS) (OR 2.53, 95%CI 1.23–5.21, p = 0.012) was a significant predictor for the absence of normal coronary arteries.ConclusionWith an negative predictive value (NPV) of 80%, the absence of MAC, AS, and aortic plaque makes the presence of significant CAD unlikely. If at least mild AS is present, normal coronary arteries are improbable.

P1377 Predicting the presence of coronary artery disease by transesophageal echocardiography

Abstract Introduction The accuracy of ultrasound signs as predictors for the presence of coronary artery disease (CAD) has been evaluated extensively in the 1990s and 2000s. Imaging quality has improved tremendously over the last decades. Hypothesis High-end ultrasound systems allow for accurate prediction of presence or absence of CAD. Methods We retrospectively evaluated all patients who received transesophageal echocardiography examination (TEE) between 2007 and 2016 and who had coronary angiography within 24 months before or after the TEE. Results A total of 242 patients fulfilled the inclusion criteria, 60% were male. Mean age was 70 (SD ±13) years. In multivariate regression analysis, plaque in the aortic arch (OR 2.53, 95%CI 1.01-6.35, p = 0.048), plaque in at least one of the thoracic aortic segments (OR 2.44, 95%CI 1.21-4.9, p = 0.012), the presence of mitral annular calcification (MAC) (OR 1.87, 95%CI 1.03-3.39, p = 0.038), and any two of the three (aortic stenosis (AS), MAC, aortic plaque) in combination (OR 2.05, 95%CI 1.08-3.88, p = 0.028) were predictors of significant CAD. The isolated findings MAC (OR 1.91, 95%CI 1.00-3.65, p = 0.049) and AS (OR 2.45, 95%CI 1.22-4.92, p = 0.012) were significant predictors for the absence of normal coronary arteries. Conclusion With a negative predictive value of 80%, the absence of MAC, AS, and aortic plaque makes the presence of significant CAD unlikely. If CAD must be excluded and MAC or AS are present, there is high likelihood for at least mild CAD. Coronary angiography rather than coronary CT angiography should be applied in these patients.

Periodontal disease, smoking, cardiovascular complications and mortality in type 1 diabetes

AimTo assess the role of periodontal disease (PD) as a predictor of coronary artery disease (CAD) and mortality in a prospective type 1 diabetes (T1D) cohort and to evaluate the role of smoking in this relationship. MethodsData were based on 320 participants of the Pittsburgh Epidemiology of Diabetes Complications study of T1D who, during 1992–94, received a partial mouth periodontal exam, and who were followed for up to 19 years to ascertain complication incidence. PD was defined as clinical attachment loss of ≥4 mm for at least 10% of the examined sites. Predictors of all-cause mortality; Hard CAD (CAD death, myocardial infarction or revascularization), and Total CAD (Hard CAD, angina, ischemic ECG) were assessed using Cox models. ResultsDuring 19 years of follow-up, 33.7% (97/288) developed CAD, 27.3% (83/304) developed Hard CAD, and 16.9% (54/320) died. Among current smokers, 46.4% (26/56) developed CAD, 42.7% (24/56) developed Hard CAD and 29.5% (18/61) died. PD was not associated with all-cause mortality, although it was a significant predictor of both CAD (HR = 1.12, CI = 1.01–1.23) and Hard CAD (HR = 1.30, CI = 1.11–1.51). As smoking modified the PD-CAD and PD-Hard CAD associations, analyses were stratified by smoking status. PD was associated with an increased risk of CAD (HR = 1.25, CI = 1.03–1.50) and Hard CAD (HR = 1.85, CI = 1.17–2.93) only among smokers. ConclusionPD was a significant predictor of CAD and Hard CAD among current smokers with T1D.

Genetic and Environmental Dispositions for Cardiovascular Variability: A Pilot Study

Background: The aim of our study was to evaluate the degree of genetic homozygosity in the group of patients with coronary artery disease (CAD), as well as to evaluate morphogenetic variability in CAD patients regarding the presence of investigated risk factors (RF) compared to a control sample of individuals. Additionally, we aimed to evaluate the distribution of ABO blood type frequencies between tested samples of individuals. Methods: This study analyzed individual phenotype and morphogenetic variability of 17 homozygously-recessive characteristics (HRC), by using HRC test in a sample of 148 individuals in CAD patients group and 156 individuals in the control group. The following RF were analyzed: hypertension, diabetes mellitus, hyperlipidemia, and smoking. Results: The mean value of HRC in CAD patients is significantly higher, while variability decreases compared to the control sample (CAD patients: 4.24 ± 1.59, control sample: 3.75 ± 1.69; VCAD-patients = 37.50%, VC = 45.07%). There is a significant difference in individual variations of 17 HRC between control sample and CAD patients (χ2 = 169.144; p < 0.01), which points out to different variability for tested genes. Mean values of HRC significantly differed in CAD patients in regard to the number of RF present. A blood type (OR = 1.75) is significant predictor for CAD, while O blood type (OR = 0.43) was significantly associated with controls. Conclusion: There is a higher degree of recessive homozygosity in CAD patients versus individuals in the control sample, and the presence of significant variations in the degree of recessive homozygosity as the number of tested RF increases.

Elevated fasting blood glucose, but not obesity, is associated with coronary artery disease in patients undergoing elective coronary angiography in a referral hospital in Jordan.

BACKGROUNDObesity and its metabolic complications are endemic in the Middle East, but the cardiovascular consequences are not well defined in local studies.OBJECTIVETo assess the association between fasting blood glucose (FBG), obesity and coronary artery disease (CAD) in Jordan.DESIGNA cross-sectional, hospital-based study.SETTINGA referral hospital in Amman, Jordan.PATIENTS AND METHODSPatients with complete anthropomorphic data who were referred for elective coronary angiography were included in the analysis. Associations between CAD, FBG and obesity were assessed in multivariate logistic regression models, adjusting for known risk factors.MAIN OUTCOME MEASUREThe presence of CAD.SAMPLE SIZE434 subjects.RESULTSOnly those who underwent coronary angiography and had complete anthropometric data were included in the study: 291 (67.1%) had CAD and 143 (32.9%) had a normal coronary angiogram.The mean body mass index, waist circumference and FBG of the study participants was 30.0 kg/m2, 106.0 cm and 8.8 mmol/L, respectively. The mean FBG was significantly higher in patients with CAD compared to those without CAD (9.5 vs. 7.3 mmol/L, P<.001). Waist circumference was significantly higher in women with CAD compared to women without CAD (111.0 vs. 105.9 cm, P=.036), but no significant difference was observed in men. In a multivariate analysis, FBG was a strong and significant predictor of CAD; however, none of the measures of obesity were significantly associated with CAD. The findings were robust in a sensitivity analysis that excluded patients with known diabetes mellitus.CONCLUSIONSElevated FBG, but not obesity, predicted CAD in a Middle Eastern population. Improved prevention, detection and management of type 2 diabetes should be a priority in this setting.LIMITATIONSThe cross-sectional design cannot control for temporal changes in risk factors and/or reverse causation.

Equivocal tests after contrast stress-echocardiography compared with invasive coronary angiography or with CT angiography: CT calcium score in mildly positive tests may spare unnecessary coronary angiograms

BackgroundImaging stress tests are not ideally accurate to predict anatomically obstructive CAD, leading to a non-trivial rate of unnecessary iCA. This may depend on the threshold used to indicate iCA, and maybe CTA or, one step earlier, CT calcium score could spare most unnecessary iCA in only mildly positive cSE. We assessed the diagnostic accuracy of contrast stress-echocardiography (cSE) in comparison with invasive coronary angiography (iCA), and CT angiography (CTA) only in case of equivocal tests, to find hints helping reduce falsely positive cSE in the suspicion of coronary artery disease (CAD).MethodsPatients who were indicated cSE for suspected CAD between 2012 and 2016, who also underwent iCA were selected and diagnostic results compared. A second group, specifically with equivocal cSE who underwent CTA was also analyzed.Results137 subjects with equivocal cSE and CTA and 314 with cSE (any result) and iCA were selected. In the CTA-equivocal cSE group, an Agatston score < 105 and a coronary flow reserve (CFR-LAD) <1.7 had very high negative predictive value (99%, 92% respectively) to exclude obstructive CAD. The Agatston score was the most significant incremental predictor of CAD beyond clinical variables (chi square 31 to 47, p < 0.001). In the iCA group a more-than-mild reversible wall motion abnormality (WMA) demonstrated high positive predictive value for CAD (89%), while CFR-LAD appeared less useful. More-than-mild reversible WMA was the most significant predictor of CAD beyond clinical variables (chi square 37.5 to 56, p < 0.001).ConclusionsOur data suggest iCA should be indicated only for more-than-mild reversible WMA at cSE, due to the very high positive predictive value for CAD of this finding, while mildly positive tests should be shifted to non-invasive CT, with CTA performed only for coronary calcium Agatston score > 100, since lower scores demonstrated very high negative predictive value for CAD, not justifying proceeding to CTA and even less to iCA.

Myeloperoxidase, protein carbonyls and oxidative stress in coronary artery disease

ObjectiveOxidative stress and inflammation play important roles in the pathogenesis of coronary artery disease (CAD). Myeloperoxidase (MPO) produced by circulating neutrophils plays an important role in both processes of inflammation and oxidative stress. MPO generates reactive oxygen species which cause oxidative damage to cellular lipids and proteins. Generation and accumulation of oxidative damage plays an proatherogenic role initiating a cascade of damaging cellular changes. This study was designed to evaluate the association of MPO with oxidative stress and to assess MPO as a predictor of CAD. Methods and resultsThirty patients diagnosed with CAD following angiography along with thirty age matched healthy controls were taken into the study. CAD cases had significantly higher triglyceride (p=0.012), lower HDL cholesterol, higher oxidative stress markers malondialdehyde (MDA), protein carbonyl content (PCO), and MPO levels and lower antioxidant ferric reducing ability of plasma (FRAP) levels in CAD patients when compared to controls (p<0.001). The oxidant markers were found to have good sensitivity and specificity at cut off values of MPO 106.25IU/L, PCO 0.250nmol/mg of protein and MDA 1.8μmol/L. MPO was found to be a significant predictor of CAD. ConclusionOur study shows that an increase in MPO levels is associated with oxidative stress and MPO is also observed to be a significant predictor of CAD.