Significant Coronary Artery Stenosis Research Articles

Effect of blood viscosity on the hemodynamic significance of coronary artery stenosis

Effect of blood viscosity on the hemodynamic significance of coronary artery stenosis

The Impact of Neutrophil-to-High-Density Lipoprotein Ratio and Serum 25-Hydroxyvitamin D on Ischemic Heart Disease

Background: This study describes the complex association between the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), 25-hydroxyvitamin D (25(OH)D) levels, and cardiovascular disease (CVD), such as stable ischemic heart disease (IHD), ST elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). Methods: The serum 25(OH)D concentration and NHR values were analyzed in groups of patients with chronic coronary syndrome (CCS) and acute coronary syndrome (ACS). The severity of coronary artery atherosclerosis was determined using the Coronary Artery Surgery Study (CASS) scale. Results: Significant differences in 25(OH)D and NHR concentrations were observed between CCS and (ACS)/STEMI patients (p < 0.01). Higher 25(OH)D concentrations were associated with the diagnosis of CCS, and higher NHR values with the diagnosis of ACS/STEMI. The NHR threshold for ACS was set at 0.10 (p < 0.001). Patients without significant coronary artery stenosis showed significantly higher 25(OH)D levels and lower NHR values (p < 0.01). Conclusions: The significant correlation between 25(OH)D, HDL, and the NHR suggests that vitamin D, through its influence on inflammatory processes and lipid metabolism, may play a role in the pathogenesis of chronic and acute coronary syndromes. The suggested bidirectional relationship between the NHR and 25(OH)D and the role of the NHR as a predictor of vitamin D levels require further well-designed studies.

The Importance of Blood Inflammatory Parameters in the Assessment of Hemodynamically Significant Coronary Artery Stenosis

The Importance of Blood Inflammatory Parameters in the Assessment of Hemodynamically Significant Coronary Artery Stenosis

Prognostic implications of microvascular resistance reserve in symptomatic patients with intermediate coronary stenosis

Abstract Background Microvascular resistance reserve (MRR) is a novel index reflecting coronary microcirculatory function, irrespective of epicardial coronary artery stenosis. There is limited evidence regarding whether MRR can be an independent prognostic tool in patients with stable ischemic heart disease (IHD). Objective To evaluate clinical outcomes according to MRR in patients with stable IHD accompanied with or without significant epicardial coronary artery stenosis. Methods The current study included 547 consecutive patients undergoing systematic echocardiographic and invasive physiologic assessment for suspected stable IHD. Significant epicardial coronary artery stenosis was defined as fractional flow reserve (FFR)≤0.80. Coronary microvascular dysfunction (CMD) was defined as MRR≤3.0. Primary outcome was major adverse cardiovascular event (MACE), a composite of cardiovascular death, myocardial infarction, repeat revascularization, and admission for heart failure. Results Among the total patients, 172 patients (31.4%) had FFR≤0.80 and 200 patients (36.6%) had CMD defined by MRR≤3.0. MRR showed no significant correlation with FFR (R=-0.031, P=0.469), however, it was significantly correlated with index of microcirculatory resistance (R=-0.353, P<0.001), NT-proBNP (R=-0.296, P<0.001), left ventricular filling pressure (E/e’) (R=-0.224, P<0.001), and diastolic dysfunction grade (P<0.001). During median follow-up of 3.3 years (interquartile range from 2.0 to 4.5 years), MRR was significantly associated with MACE risk (HR 1.23 per-1 decrease, 95% CI 1.12-1.36, P<0.001). CMD defined by MRR≤3.0 was associated with an increased MACE risk in both FFR>0.80 (41.0% vs. 26.0%; HRadj 1.59, 95% CI 1.07-2.35, P=0.021) and FFR≤0.80 (34.7% vs. 14.8%; HRadj 2.32, 95% CI 1.12-4.82, P=0.024) groups. Conclusion Decreased MRR was associated with the presence of cardiac diastolic dysfunction as well as with increased left ventricular filling pressure. The presence of CMD defined by MRR was independently associated with the risk of a composite of cardiovascular death, myocardial infarction, repeat revascularization, and admission for heart failure in patients with stable IHD, irrespective of significant epicardial coronary artery stenosis.

Usefulness of mean attenuation of pericoronary adipose tissue as a predictor of coronary microvascular dysfunction

Abstract Background/Introduction Coronary microvascular dysfunction (CMD) is a condition in which the distal microvasculature is compromised, resulting in inadequate blood flow to the subsequent arteries and myocardial ischemia. Index of microvascular resistance (IMR), which can quantify CMD, is becoming the standard for the diagnosis of CMD. Patients with CMD have a 4 to 5 times greater risk of cardiovascular death and myocardial infarction than patients without heart disease and similar cardiovascular risk. Early diagnosis of CMD may reduce cardiovascular risk and improve quality of life with therapeutic intervention. Pericoronary adipose tissue mean attenuation (PCATMA) is an indirect measure of adipocyte size and lipid content around coronary artery, reflecting inflammation status. Previous studies have shown that both PCATMA and CMD are associated with the functional severity of coronary artery disease, but no study has yet examined the relationship between PCATMA and CMD. Purpose We conducted a study comparing PCATMA in patients with and without CMD. Methods Between September 2022 and October 2023, 25 patients without significant stenosis (<50% stenosis) who underwent IMR measurement on invasive coronary angiography and coronary CT angiography (CCTA) were included. CMD was diagnosed when the IMR exceeded 25 as measured by a pressure wire inserted into the left anterior descending artery after invasive coronary angiography had excluded significant stenosis. PCATMA was measured on CCTA using the average of the values of right coronary artery, left anterior descending artery, and left circumflex artery. Multivariable logistic regression analysis with stepwise forward selection was used to assess predictors for patients with abnormal IMR. The following variables were included for adjustment: PCATMA, age, sex, diabetes, dyslipidemia, hypertension. Results The mean age of 25 patients in this study was 63 years, 48.0% were female, 29.2% had diabetes, 62.5% had dyslipidemia and 66.7% had hypertension. PCATMA was significantly higher in patients with abnormal IMR (IMR>25) (-79.6 [IQR: -82.1, -74.6] HU vs -86.3 [IQR: -89.8, -78.9] HU, p = 0.043). Multivariate logistic regression analysis demonstrated that PCATMA remained an independent predictor of patients with abnormal IMR (OR 1.27 [95% CI: 1.05–1.65], p = 0.039). Optimal cut-off value of PCATMA for predicting patients with abnormal IMR by Youden index was -82.1 HU (AUC = 0.75 [95% CI: 0.55-0.95]). Conclusions In patients without significant coronary artery stenosis, PCATMA on CCTA may be used to predict the patients with CMD, noninvasively.

Coexistence of coronary microvascular dysfunction and left ventricular hypertrophy can predict prognosis of patients with nonobstructive coronary arteries

Abstract Background Previous studies have reported that coronary microvascular dysfunction (CMD) and left ventricular hypertrophy (LVH) were associated with adverse cardiovascular events. The aim of this study was to determine the prognostic impact of coexistence of abnormal coronary flow reserve (CFR) and left ventricular mass index (LVMI). Methods and results This study included 297 patients who underwent intracoronary physiological assessment including CFR for suspected myocardial ischemia without significant stenosis in the epicardial coronary artery at our hospital from December 2019 to March 2023. Of 297 patients (female: n=89 [30%], age: 70±11 years), 93 (31%) had CMD (CFR<2.5) and 133 (45%) had LVH (LVMI>95 g/m2 for female and >115 g/m2 for male). We excluded patients with history of heart failure (HF). Patients were classified into 4 groups based on the cut-off values of CFR and LVMI: group 1 (no CMD nor LVH, n=109); group 2 (only LVH, n=95); group 3 (only CMD, n=55) and group 4 (both CMD and LVH, n=38). Patients of group 4 had a larger proportion of female (female 19%, 34%, 24% and 61% in group 1 to 4 respectively). There was no significant difference in left ventricular ejection fraction between patients of each groups. Clinical follow-up was performed for major adverse cardiovascular events (MACE) including cardiovascular death, myocardial infarction and hospitalization for new-onset HF. During a median follow-up of 753 days, the cumulative MACE-free survival rate at 2 year were 99.0%, 98.9%, 95.6% and 90.0% in groups 1 to 4. Group 4 showed significantly higher risk of MACE at 2 year compared with group 1 (hazard ratio [HR] 2.6; 95% confidence interval [CI] 1.3-5.3; p=0.009). Notably, Group 4 showed the highest incidence of hospitalization for new-onset HF than any other groups. Conclusion Patients with both CMD and LVH showed significantly higher risk for MACE and new onset of HF. The combined classification based on CFR and LVMI would identify the high-risk patients for MACE as well as new-onset HF.

Synergic interaction between coronary flow reserve and left atrial diameter as a risk factor for major adverse cardiovascular events in patients with nonobstructive coronary artery disease

Abstract Background Left atrial diameter (LAD) is one of the parameters which indicate left ventricular diastolic disorders (DD) and associated with poor prognosis. Previous studies have reported the relationship between DD and coronary microvascular dysfunction (CMD) but the impact of coexisting DD and CMD on prognosis is unknown. Methods and results This study included 330 patients who underwent intracoronary physiological assessment including CFR for suspected myocardial ischemia without significant stenosis in the epicardial coronary artery from December 2019 to March 2023. Of 330 patients (female: n=96 [29%], age: 70±11 years), 109 (33%) had CMD (CFR<2.5) and 93 (28%) had DD (LAD>40 mm). Patients were classified into 4 groups based on the cut-off values of CFR and LVMI: group 1 (no CMD nor DD n=160); group 2 (only DD, n=61); group 3 (only CMD, n=77) and group 4 (both CMD and DD, n=32). Clinical follow-up was performed for major adverse cardiovascular events (MACE) including cardiovascular death, acute coronary syndrome and hospitalization for heart failure. During a median follow-up of 715 days, the cumulative MACE-free survival rate at 2 year were 97.9%, 100.0%, 95.5% and 75.1% in groups 1 to 4. Group 4 showed significantly higher MACE rate compared with other 3 groups (hazard ratio [HR] 14.3; 95% confidence interval [CI] 3.8-53.9; p<0.001, HR 14.25; 95% CI 1.8-114.4; p=0.01 and HR 4.7; 95% CI 1.4-15.8; p=0.01 respectively). Notably, Bonferroni's multiple comparison showed that Group 4 had the highest incidence of heart failure hospitalization compared with other 3 groups (p=<0.001, p=0.002, p=0.01 respectively). Cox proportional hazards model revealed that CMD and DD had synergic interaction as a risk factor for MACE (HR 9.1; 95% CI 3.4-24.4; p<0.001). Conclusion Patients with both CMD and DD showed significantly higher risk for MACE, especially for heart failure hospitalization. The combined classification based on CFR and LAD would identify the high-risk patients for MACE.MACE-free survival curveheart failure-free survival curve

Significant impact of a novel whole heart motion correction algorithm on cardiac computed tomography and aortic valve calcium scores

Abstract Introduction A new whole-heart motion-correction algorithm has been available in cardiac computed tomography (CT), and it has already revealed the higher diagnostic accuracy of significant coronary artery stenosis in cases with higher heart rate at the CT scan. Recently, aortic valve calcium scores (AVCS) are often measured for the decision-making of surgical treatment of aortic valve stenosis. However, the measurement of AVCS of the aortic valve has potential risks of motion artifact of the aortic valve. Therefore, we would like to know the clinical impact of a new whole-heart motion correction algorithm for accurately measuring aortic valve AVCS without motion artifacts. Purpose The purpose of this study is to evaluate the impact of a new whole-heart motion-correction algorithm on non-contrast cardiac CT images and the AVCS in trans-catheter aortic valve regurgitation (TAVR) candidates with severe aortic valve stenosis. Materials and methods Forty-two consecutive TAVR candidates (83 ± 7 years old, 21 males) who underwent ECG-gated CT using 256-row detector CT from November 2023 to February 2024 at our hospital were analyzed. The best phase non-contrast cardiac images were automatically selected, and they were reconstructed with both the standard (STD) algorithm and the new whole-heart motion-correction algorithm. AVCS was calculated using semi-automatic commercially available software. The aortic valve's image noise was also measured. Results Non-contrast best cardiac phase images were successfully reconstructed using the new motion correction algorithm in 36 patients (86%). The best cardiac phase was mainly the diastolic phase in 29 patients (81%). The overall Agatston score and calcified volume of the aortic valve in SSF2 were 1779 ± 896, and 1403 ± 689, respectively, and they were lower than 2195 ± 1132 and 1656 ± 851 of STD (all P < 0.01). Conclusion The new whole-heart motion-correction algorithm worked in almost all TAVR candidates, and revealed lower AVCS and shows a potential for increasing AVCS accuracy.

The prognostic value of contrast stress echocardiography in a real-world population of symptomatic patients without known coronary artery disease

Abstract Background Coronary artery disease (CAD) is the leading cause of mortality and morbidity worldwide. In addition to diagnosis, non-invasive tests may also provide prognostic information useful in the risk stratification and management of CAD patients. Stress echocardiography (SE) is an accurate, non-invasive method for the detection of obstructive CAD. However, in real-world clinical practice the test performance may vary among different centres, depending on availability, local protocols, and operator expertise. Purpose To evaluate the prognostic value of contrast SE in a real-world population of symptomatic patients without known CAD. Methods This was a cohort follow-up study of patients without known CAD and symptoms of atypical chest pain, unexplained dyspnoea or palpitations who were referred to the echocardiography lab of a tertiary hospital for SE between January 2020 and December 2021. Patients with resting regional wall motion abnormalities were excluded. All patients underwent treadmill exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE) if unable to exercise. Contrast agents were used in almost all patients (99%). The study population was followed-up for at least 2 years after SE by phone and/or electronic hospital records. Cardiac outcome was defined as anatomically or functionally significant stenosis on angiography, revascularization, acute coronary syndrome (ACS), or cardiac-related death. Results The study comprised 266 patients (mean age 58±12 years, 63% male) who underwent either ESE (58%) or DSE (42%). The patients' details are reported in Table 1. The most common indication for the exam was atypical chest pain, with a prevalence of 73%. SE exams were positive for inducible ischaemia in 14 (5%) patients. Symptoms during the exam were present in 3 (21%) patients with positive SE and 4 patients (2%) with negative SE (p=0.004). No serious complications (sustained ventricular tachycardia, myocardial infarction, or death) were recorded. During the follow-up (median 30, IQR 23–38 months), 264 patients (99%) were successfully contacted. Cardiac outcome occurred in 10 patients. Among 14 patients with positive SE, 8 underwent revascularization due to significant coronary artery stenosis. Among 250 patients with negative SE, 1 underwent revascularization due to significant coronary artery stenosis and 1 presented with ACS 13 months after the test (both patients underwent DSE). Negative predictive value was 99% over a median follow-up of 30 months, corresponding to an annualized event rate of 0.32% per year. A positive SE was significantly associated with cardiac outcome (log-rank test p<0.0001, Figure 1). Conclusion Contrast SE carries significant prognostic implications in symptomatic patients without known CAD. A positive test is strongly associated with the need for revascularization, while a normal test result has an excellent negative predictive value regarding cardiovascular morbidity and mortality.Figure 1

Functional and morphological improvement of significant non-culprit coronary artery stenosis by LDL-C reduction with a PCSK9 antibody: Rationale and design of the randomized FITTER trial

Non-culprit coronary artery lesions are commonly present in patients presenting with an acute coronary syndrome (ACS). Additional stenting of non-culprit lesions in addition to the culprit lesion intends to prevent secondary events caused by these lesions. At the same time, multiple trials have demonstrated the potential of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in reducing plaque size and changing plaque composition of non-culprit lesions. Whether intensive low-density lipoprotein cholesterol (LDL-C) reduction with PCSK9 inhibitor evolocumab improves non-culprit vessel hemodynamics, reduces the risk of plaque rupture of important non-culprit lesions, and might obviate the need for additional stenting has not been investigated. The “Functional Improvement of non‐infarcT related coronary artery stenosis by Extensive LDL‐C Reduction with a PCSK9 Antibody” (FITTER) trial is a multi-center, randomized, double-blind, placebo-controlled clinical trial for patients presenting with ACS and multivessel disease (MVD). After treatment of the culprit lesion, fractional flow reserve (FFR) is performed in non-culprit vessels amenable for percutaneous coronary intervention (PCI). Coronary intervention in patients with hemodynamically important non-critical lesions (FFR: 0.67–0.85) is staged after baseline imaging using near-infrared spectroscopy (NIRS) and intravascular ultrasound (IVUS). Eligible patients are randomized and treated for 12 weeks with either evolocumab or placebo, in addition to high-intensity statin therapy. Follow-up angiography with repeat FFR and IVUS-NIRS is scheduled at 12 weeks. Staged PCI is performed at the operator's discretion.The FITTER trial is the first study to evaluate the effect of maximal LDL-C reduction by the PCSK9 inhibitor evolocumab on invasively measured FFR, plaque size, and plaque composition in hemodynamically important non-culprit lesions, during a treatment period of just 12 weeks after an ACS. Currently, all patients have been included (August 2023) and data analysis is ongoing. Trial registration numberclinicaltrials.gov NCT04141579.

Role of computed tomographic dynamic myocardial perfusion in the diagnosis of functional significance of coronary artery stenosis

Role of computed tomographic dynamic myocardial perfusion in the diagnosis of functional significance of coronary artery stenosis

Discrepancies between Coronary Artery Calcium Score and Coronary Artery Disease Severity in Computed Tomography Angiography Studies.

The aim of this paper is to demonstrate the difference in usefulness of the coronary artery calcium score (CACS) and the full assessment of the severity of coronary artery disease in coronary computed tomography angiography (CCTA) studies. The difference between the population risk of coronary artery disease (CAD) assessed by the CACS and the severity of CAD was demonstrated in images from two CCTA studies. The first image is from a patient with a CACS of 0 and significant coronary artery stenosis. In the native phase of CCTA examination, no calcified changes were detected in the topography of the coronary arteries. In the middle section of the left descending artery (LAD), at the level of the second diagonal branch (Dg2), a large non-calcified atherosclerotic plaque was visible. Mid-LAD stenosis was estimated to be approximately 70%. The second image features a patient with a high CACS but no significant coronary artery stenosis. The calcium score of individual coronary arteries calculated using the Agatston method was as follows: left main (LM) 0, LAD 403, left circumflex (LCx) 207.7, right coronary artery (RCA) 12. CACS was 622.7, representing a significant population risk of significant CAD. In the proximal and middle sections of the LAD, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visible, causing stenosis of 25-50%. Similarly, in the proximal and middle sections of the LCx, numerous calcified and mixed atherosclerotic plaques with positive remodeling were visualized, causing stenoses of 25-50%. Calcified atherosclerotic plaques were found in the RCA, causing stenosis <25%. The entire CCTA image met CAD-RADS 2 (coronary artery disease reporting and data system) criteria. In summary, CACS may be applicable in population-based studies to assess the risk of significant CAD. In the evaluation of individual patients, a comprehensive assessment of CAD severity based on the angiographic phase of the CCTA examination should be used.

Minimally invasive coronary artery bypass grafting using the skeletonized right gastroepiploic artery

ObjectiveTo evaluate the clinical outcomes of right gastroepiploic artery use in minimally invasive coronary artery bypass grafting. MethodsA total of 428 patients who underwent minimally invasive coronary artery bypass grafting from February 2012 to February 2024 were included into this retrospective cohort study. The selection criteria for right gastroepiploic artery use included satisfactory artery size and length, significant stenosis (99% to 100%) of the right coronary artery, and unsuitable ascending aorta for partial clamping. ResultsThe study cohort comprised 70 men and 8 women, with an average age of 63.6 ± 10.5 years. The right gastroepiploic artery was used in 18.2% (78 out of 428) of cases, without the aorta being touched in all these cases. Total arterial revascularization was achieved in 93.6% of cases and complete revascularization was achieved in 98.7%. Notable postoperative outcomes included zero in-hospital mortality, an incidence of new-onset atrial fibrillation of 9.0%, and a median intensive care unit stay of 2 days. Surgical site infections occurred in 7.5% of patients. ConclusionsThe use of the right gastroepiploic artery in minimally invasive coronary artery bypass grafting is a viable option for achieving total arterial revascularization without touching the ascending aorta, enhancing the rate of optimal clinical outcomes.

Angiographic evaluation of coronary artery disease in diabetic patients with and without end-stage kidney disease.

The objective of the present investigation was to compare the coronary angiography results in diabetic patients with and without end-stage kidney disease (ESKD). We included prolonged diabetic patients with ESKD (93 patients) and without ESKD (control group, 126 patients). Angiography of the coronary arteries was performed on all patients. Our results revealed that the ESKD patients tended to have a higher degree of coronary artery stenosis in all parts of LAD (p = 0.001, 0.024, and 0.005), proximal and distal RCA (p = 0.013, and 0.008), and proximal and distal LCX artery (p = 0.001, 0.008) than non-ESKD patients. Furthermore, we found that the ESKD group had higher significant coronary artery stenosis in the LAD artery (60.5% vs. 39.5%, p < 0.001), RCA (60.3% vs. 39.7%, p < 0.001), LCX artery (79.5% vs. 20.5%, p < 0.001), and LMCA (84.6% vs 15.4%, p = 0.002) compared to control group. There was a greater prevalence of multiple vessels coronary artery disease (≥ two) among ESKD patients (29%), compared with the non-ESKD group (16.8%, p < 0.001). Significant coronary artery stenosis was meaningfully higher in asymptomatic diabetic ESKD patients on hemodialysis than non-ESKD diabetic patients. Coronary angiography may be beneficial in diabetic patients with ESKD regardless of whether they have ischemic symptoms with low complication rate through radial access.

Incidence of Coronary Artery Spasm According to the Stratified 10-Year Atherosclerotic Cardiovascular Disease Risk Score in Patients With Chest Pain Without Significant Coronary Artery Stenosis

Incidence of Coronary Artery Spasm According to the Stratified 10-Year Atherosclerotic Cardiovascular Disease Risk Score in Patients With Chest Pain Without Significant Coronary Artery Stenosis

The association between cardiac T2*BOLD and quantitative flow ratio (QFR) in the diagnosis of stenotic coronary arteries in patients with multi-vessel coronary artery disease.

T2*BOLD is based on myocardial deoxyhemoglobin content to reflect the state of myocardial oxygenation. Quantitative flow ratio is a tool for assessing coronary blood flow based on invasive coronary angiography. This study aimed to evaluate the correlation between T2*BOLD and QFR in the diagnosis of stenotic coronary arteries in patients with multi-vessel coronary artery disease. Fifty patients with MVCAD with at least 1 significant coronary artery stenosis (diameter stenosis > 50%) and 21 healthy control subjects underwent coronary angiography combined with QFR measurements and cardiovascular magnetic resonance (CMR). QFR ≤ 0.80 was considered to indicate the presence of hemodynamic obstruction. Totally 60 (54%) obstructive vessels had hemodynamic change. Between stenotic coronary arteries (QFR ≤ 0.8) and normal vessels, T2*BOLD showed AUCs of 0.97, 0.69, and 0.91 for left anterior descending (LAD), left circumflex (LCX) and right coronary (RCA) arteries and PI displayed AUCs of 0.89, 0.77 and 0.90 (all p > 0.05, except for LAD). The AUCs of T2*BOLD between stenotic coronary arteries (QFR > 0.8) and normal vessels were 0.86, 0.72, and 0.85 for LAD, LCX and RCA; while, PI showed AUCs of 0.93, 0.86, and 0.88, respectively (p > 0.05). Moreover, T2*BOLD displayed AUCs of 0.96, 0.74, and 0.91 for coronary arteries as before between coronary arteries with stenosis (QFR ≤ 0.8 and > 0.8), but the mean PI of LAD, LCX and RCA showed no significant differences between them. T2* BOLD and QFR have good correlation in diagnosing stenotic coronary arteries with hemodynamic changes in patients with stable multi-vessel CAD. T2* BOLD is superior to semi-quantitative perfusion imaging in analyzing myocardial ischemia without stress.

Accuracy of analytically determined fractional flow reserve derived from coronary angiography for non-invasive assessment of coronary artery stenosis.

Fractional flow reserve (FFR) determined invasively has been globally accepted as the gold standard for determining the functional significance of coronary artery stenoses. However, despite its great importance, the invasive method has certain disadvantages, including the risk of vascular injuries, the need for vasodilation, and significant medical costs. That is why great attention was paid to the development of non-invasive methods that would enable reliable diagnosis without exposing patients to the risk of unwanted consequences. This paper aimed to create and verify an alternative, less resource- and time-demanding, non-invasive solution. The determination of FFR is based on the application of the fundamental laws of fluid dynamics. All energy losses in the coronary artery with stenosis were identified and analyzed in detail. A three-dimensional model of a coronary artery was generated using the corresponding angiographic images. Finally, the pressure due to stenosis was calculated and the FFR was determined. The results obtained using the proposed analytical method were compared with available experimental data for 40 patients who experienced the invasive coronary angiography. The coefficient of determination, mean difference and standard deviation values are determined to be 0.726, -0.017 and 0.056, respectively. These values were slightly higher for FFR values above 0.80. The FFR calculated by the proposed analytical method has a relatively good correlation with clinical data, which leads to the conclusion that it can provide a reliable assessment of the functional significance of coronary stenosis.

Microcirculatory dysfunction in hypertrophic cardiomyopathy with chest pain assessed by angiography-derived microcirculatory resistance

Chest pain, a common initial symptom in hypertrophic cardiomyopathy (HCM) patients, is closely linked to myocardial ischemia, despite the absence of significant coronary artery stenosis. This study explored microvascular dysfunction in HCM patients by employing angiography-derived microcirculatory resistance (AMR) as a novel tool for comprehensive assessment. This retrospective analysis included HCM patients with chest pain as the primary symptom and control patients without cardiac hypertrophy during the same period. The AMR was computed through angiography, providing a wire-free and adenosine-free index for evaluating microcirculatory function. Propensity score matching ensured balanced demographics between groups. This study also investigated the correlation between the AMR and clinical outcomes by utilizing echocardiography and follow-up data. After matching, 76 HCM patients and 152 controls were analyzed. While there was no significant difference in the incidence of epicardial coronary stenosis, the AMR of three epicardial coronary arteries was markedly greater in HCM patients. The criterion of an AMR ≥ 250 mmHg*s/m was that 65.7% of HCM patients experienced coronary microvascular dysfunction (CMD). Independent risk factors for CMD included increased left ventricular (LV) wall thickness (OR = 1.209, 95% CI 1.013–1.443, p = 0.036). Furthermore, an AMR_LAD ≥ 250 mmHg*s/m had an increased cumulative risk of the endpoint (log-rank p = 0.023) and was an independent risk factor for the endpoint (HR = 11.64, 95% CI 1.13–120.03, p = 0.039), providing valuable prognostic insights.

Routine Coronary Angiography and Functional Cardiac Tests before Resection of Abdominal Aortic Aneurysm in Patients without Symptoms of Myocardial Infarction

INTRODUCTION: Cardiac complications are leaders in the structure of mortality of patients after resection of abdominal aortic aneurysms (AAA). In recent years more data have been obtained on the possibility of performing invasive coronary angiography (CAG) as a method of preoperative assessment of the condition of the coronary arteries. AIM: To assess the tactics of routine CAG and preventive revascularization of the myocardium in comparison with non-invasive functional tests in patients without clinical manifestations of coronary heart disease (CHD) from positions of the hospital outcomes of AAA resections. MATERIALS AND METHODS: A retrospective study included 205 patients without clinical and instrumental signs of CHD who underwent AAA resection at National Medical Research Center of Surgery named after A. Vishnevsky in 2001–2021. Patients of the first group (n = 55) underwent CAG before AAA resection and, if significant stenosis of coronary arteries was detected, revascularization of the myocardium was performed. In patients of the second group (n = 71), only functional cardiac tests were conducted before the operation. Patients of the third group were operated on without additional evaluation of cardiac status. RESULTS: In 30.9% of patients of the first group, significant coronary lesions were detected, in 29.5% of them with the involvement of the left main coronary artery. This required 10 percutaneous coronary interventions and 5 coronary artery bypass surgeries, which made 27.0% of patients in this group. No cases of myocardial infarction were recorded in this group. In the second and third groups, one case of myocardial infarction in each group was recorded (p = 0.688). There was no significant difference in the postoperative mortality in all the groups (1.8%; 4.2%; 2.5%, respectively; p = 0.704). To this end, maximally invasive diagnostic tactics increased the average waiting time for AAA resection: 52.2 ± 6.0 days in groups without coronary angiography and myocardial revascularization versus 99.2 ± 13.0 days in the first group. CONCLUSION: In a cohort of patients without anamnestic and clinical manifestations of coronary artery disease, the tactics of routine coronary angiography followed by prophylactic myocardial revascularization did not improve the short-term results of AAA resection, while the waiting period for intervention on the abdominal aorta increased. Preoperative tactics with functional cardiac tests also did not affect the treatment results.

The relationship between triglyceride/high-density lipoprotein cholesterol ratio and the functional significance of coronary lesions

Aims: Have shown that triglycerides (TG) are an independent risk factor for cardiovascular disease (CVD). Dyslipidemia characterized by low high-density lipoprotein cholesterol (HDL-C) has been shown to be associated with symptoms of coronary artery disease (CAD). In studies, the TG/HDL-C ratio has been found to be strongly associated with parameters indicative of the severity of coronary disease. In this study, we aimed to investigate whether the TG/HDL-C ratio is associated with the functional significance of moderate coronary artery lesions. Methods: A total of 102 consecutive patients, 72 male and 30 female, who underwent measurement of fractional flow reserve (FFR) due to moderate coronary stenosis (quantitative coronary analysis 40-70%) on angiography were included in the study. An FFR value ≤0.80 was accepted for hemodynamic significance. Results: Among the 102 patients included in the study, it was determined that 52 (50.9%) had significant functional stenosis. Left ventricular ejection fraction of Group II was lower than Group I (60 (55-62.5) vs. 55(50-60), p=0.006). The male patient ratio was higher in Group II, but the difference between the two groups was not significant (68% and 77%, respectively, p=0.072). Univariate and multivariate logistic regression analysis showed that TG/HDL-C (OR=1.278, 95% CI=1.078-1.514, p=0.005) was an independent determinant of significant functional stenosis. ROC analysis revealed that the TG/HDL-C value was 3.89 and provided 64% specificity and 61.5% sensitivity in predicting hemodynamically significant coronary artery stenosis. Conclusion: Elevated TG/HDL-C values are associated with the functional significance of angiographically moderate coronary artery stenosis.