Stable Angina Patients Research Articles

Estimating the role of single-nucleotide polymorphism (rs1800629)-308 G/A of TNF-alpha gene as genetic marker associated with angina pectoris in a sample of Iraqi patients

BackgroundAngina pectoris (AP) occurs when oxygen and other nutrients are insufficient to meet the metabolic needs of the heart muscle. Stable angina is the most common, while the unstable angina is less frequent. Tumor necrosis factor alpha (TNF-alpha) is a pleiotropic cytokine plays a vital function in the immune response regulation. TNF gene cluster contains many polymorphisms; the most commonly investigated polymorphism is the rs1800629 SNP. This SNP, located at − 308 position with regard to the TNF promoter region, replaces guanine (G) with adenine (A), with the allelic types − 308 G/A, and has been linked to a variety of inflammatory condition and autoimmune diseases. The − 308 G/A SNP was investigated in AP and interconnected to the TNF level to figure out the responsibilities of TNF-alpha gene polymorphism in the pathogenesis of AP. MethodThe current work design as a case–control study that involves 300 participant divided to 200 patients evaluated as (stable angina n = 100 and unstable angina n = 100) compared with 100 apparently healthy control subjects. The serum level of TNF-alpha was assessed via enzyme-linked immunosorbent assay (ELISA)/sandwich method. The genotype and allele frequency distribution of TNF-alpha rs1800629 gene polymorphism were investigated by TaqMan probe of allelic discrimination method. ResultsThe levels of TNF-alpha were significantly higher in patients with stable and unstable angina pectoris in comparison with controls. The deviation from Hardy–Weinberg equilibrium (HWE) of TNF-alpha genotypes was obvious in control and unstable angina pectoris groups. Moreover, the significant differences between patients with AP and controls under the five genetic models consider the association between TNF-alpha (rs1800629) − 308 G/A and AP with OR > 1. However, data analysis of allelic and genotypic of (rs1800629) − 308 G/A revealed higher significantly differences of GG homozygous and GA heterozygous proportions between stable angina patients and control. The A allele was more represented as etiological allele, and G allele was represented as protective allele. The serum levels of TNF-alpha were significantly higher in subjects with genetically mutated AA genotypes than in subjects with wild GG genotypes in the study groups. ROC curve analysis found the best cutoff value of TNF-alpha level was 77.25 pg/ml. ConclusionAs the results, our data observed a linked of TNF-alpha (rs1800629) − 308 G/A genetic variant with angina pectoris patients, and the A allele has been linked to the production or expression of TNF-alpha serum level and represented an etiological factor of angina pectoris.

Blood urea nitrogen to left ventricular ejection fraction ratio is associated with long-term mortality in the stable angina pectoris patients.

Left ventricle (LV) dysfunction remains a significant cause of morbidity and mortality in patients with stable angina pectoris (SAP) and has prognostic significance. However, new prognostic indicators may be more useful in clinical practice. There is a growing interest in the role of blood urea nitrogen (BUN) in cardiovascular diseases. Blood urea nitrogen is an indicator of cardiac dysfunction and neurohormonal activation. We aimed to determine the relationship of BUN/LV ejection fraction ratio (BUNLVEFr) with long-term mortality and de novo decompensated heart failure (HF) in SAP patients. The study comprised 603 consecutive SAP patients who underwent coronary angiography. The median duration of the follow-up period was 112.6±17.8 months. All-cause mortality and de novo decompensated HF were determined as the endpoints. Adverse cardiac events were observed in 141 patients (23.3%), including mortality in 103 (17.1%) and decompensated HF in 38 (6.3%) of them during the follow-up period. Age (p=0.027), BUNLVEFr (p=0.001), glucose (p=0.043), hemoglobin (p=0.035), and Gensini score (p=0.012) were found as independent predictors of mortality and decompensated HF. BUNLVEFr was superior to BUN alone (BUNLVEFr vs. BUN: Z=5.715, p<0.001) and LVEF alone (BUNLVEFr vs. LVEF: Z=4.075, p<0.001) in predicting endpoints. In addition, BUNLVEFr >29 predicted all-cause mortality/decompensated HF with high sensitivity (78%) and low specificity (68%). BUNLVEFr may provide better prognostic information than either BUN or EF can give alone in determining therapeutic strategies for SAP patients.

Involvement of Multivessel Coronary Artery in Chronic Stable Angina Patients

Introduction: Globally, an annual estimate of over 7 million deaths occurs due to Coronary Artery Disease (CAD) - the leading cause of Cardiovascular (CV) morbidity and mortality. Multivessel coronary artery disease (MVD) is defined as luminal stenosis of at least 70% in at least two major coronary arteries or in one coronary artery in addition to a 50% or greater stenosis of the left main trunk. Methods: A prospective observational study was carried out at Department Of Vascular Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from January to December 2021. Out of 286 individuals younger than 60 years old admitted to the outpatient clinic with chest pain and referred for coronary angiography were included in the study. All clinical and biochemical parameters were documented in the hospital records. Coronary angiography of patients was monitored from records. The individuals were divided into two groups. The patient group consisted of 182 individuals with at least one-vessel stenosis of ≥70%, and the control group consisted of 104 individuals with normal coronary angiography. We compared the traditional and nontraditional risk factors of these two groups in terms of the presence of CAD. Results: Prevalence of male sex and smoking were higher in the patient group, and the prevalence of hypertension and diabetes were similar in the two groups. In the patient group, mean age, blood cholesterols, serum gamma-glutamyl transferase, hemoglobin, and white blood cell and lymphocyte levels were higher, while estimated glomerular filtration rate (eGFR), high-density lipoprotein cholesterol (HDL-C), platelets, and neutrophil/lymphocyte and platelet/lymphocyte ratios were lower. Low eGFR and HDL-C levels, older age, male sex, smoking, and high levels of low-density lipoprotein cholesterol and lymphocytes were independent risk factors for the presence of CAD in young patients. Conclusion: In conclusion, contrary to studies done in the patients, ............

The results of inspiratory muscle training on cardiac, respiratory, musculoskeletal, and psychological status in patients with stable angina: a randomized controlled trial

Purpose To determine the effect of inspiratory muscle training (IMT) on respiratory and peripheral muscle strength, functional exercise capacity, health-related quality of life (HRQoL), fatigue, depression, and cardiac functions in patients with stable angina. Methods A randomized, controlled, single-blinded study. Twenty patients (59.95 ± 7.35 y, LVEF = 58.77 ± 7.49) with stable angina received IMT at the lowest load (10 cmH2O), and 20 patients (55.85 ± 7.60 y, LVEF = 62.26 ± 7.75) received training at 30% of maximal inspiratory pressure (MIP) seven days/8 weeks. Respiratory muscle strength (MIP; maximal expiratory pressure, MEP), peripheral muscle strength, pulmonary functions, functional exercise capacity (6-min walking test; exercise test), fatigue, HRQoL, depression, and cardiac functions were evaluated before and after. Results A statistical difference was found between groups in terms of respiratory and peripheral muscle strength, pulmonary functions, functional exercise capacity (p < 0.05). The results of fatigue, depression, HRQoL, and cardiac functions were similar between the groups (p > 0.05). Conclusions This study is the first to demonstrate the positive effects of IMT in patients with stable angina. IMT is a safe and effective method and is recommended to be added to cardiopulmonary rehabilitation programs and guidelines, as it results in increased peripheral muscle strength and functional exercise capacity in stable angina patients. Implications for rehabilitation Inspiratory muscle training (IMT) is a safe and effective method for coronary artery disease (CAD) patients with stable angina. IMT improved respiratory and peripheral muscle strength, functional exercise capacity, pulmonary functions, and health-related quality of life in CAD patients with stable angina. Perception of depression and fatigue were decreased with IMT in CAD patients with stable angina.

Abstract 10314: Clinical Impact of C-Reactive Protein to Albumin Ratio on Prognosis in Patients With Stable Coronary Artery Disease After Percutaneous Coronary Intervention

Background : The C-reactive protein/albumin (CRP/Alb) ratio is known to be a novel marker of inflammation and is associated with outcome in septic patients. However, the effect of CRP/Alb ratio for clinical outcomes in patients with stable coronary artery disease (CAD) after percutaneous coronary intervention (PCI) has not been well evaluated. Methods : The subject comprised 500 consecutive stable angina patients who underwent successfully elective PCI using second-generation drug-eluting stents and intravascular ultrasound. We investigated between the clinical factors including CRP/Alb ratio and the incidences of both all-cause death and major cardiovascular and cerebrovascular events (MACCE). Results: Median of age was 69 years (62-76) and 356 cases (71%) were male. Thirty-seven patients (7%) died after PCI, and the incidence of MACCE including all-cause death was 47 cases (9%). Age, dyslipidemia, hemodialysis, statin use , estimated glomerular filtration rate and CRP/Alb ratio correlated significantly with all-cause death and MACCEin the univariate cox proportional hazards analysis. A multivariate Cox proportional hazards regression analysis modeling relevant factors from univariate analysis showed CRP/Alb ratio was significantly associated with both all-cause death (HR: 1.24, 95%CI: 1.11-1.35, p&lt;0.001) and MACCE (HR: 1.21, 95%CI: 1.09-1.32, p&lt;0.001). The optimal cut-off on the receiver-operating characteristic curve of CRP/Alb ratio for predicting for all-cause death and MACCE were both 0.30 [all-cause death; the area under the curve (AUC) = 0.75, Sensitivity = 57%, Specificity = 87%, p&lt;0.001 and MACCE; AUC = 0.73, Sensitivity = 49%, Specificity = 87%, p&lt;0.001). Kaplan-Meier analysis showed a significantly lower survival rate after PCI in low CRP/Alb ratio (&lt; 0.30) group than high CRP/Alb ratio (≥ 0.30) group (p&lt;0.001). Similarly, cumulative incidence of MACCE was significantly higher in the high CRP/Alb ratio group than in the low CRP/Alb ratio group (p&lt;0.001). Conclusion: The CRP/Alb ratio may have a potential for predicting the all-cause death and MACCE in patients with stable CAD after PCI.

Lessons Learned from the ISCHEMIA Trial for the Management of Patients with Stable Ischemic Heart Disease.

The recent landmark International Study of Comparative Health Effectiveness With Medical and Invasive Approaches (ISCHEMIA) trial was undertaken to assess whether stable angina patients with moderate to severe baseline ischemia would benefit from an invasive approach with revascularization versus a conservative approach of intensive lifestyle intervention and pharmacologic secondary prevention. This trial addressed the hypothesis that treating ischemia with an invasive approach would reduce major adverse cardiac events more than a noninvasive pharmacologic and lifestyle approach. ISCHEMIA is discussed in detail, along with current implications for contemporary management of this very common cardiac disorder afflicting millions of patients worldwide.

The place of diltiazem in the treatment of patients with stable angina in concomitant bronchial asthma

Introduction. In the treatment of stable angina in patients with concomitant bronchial asthma (BA), the bronchopulmonary system may be adversely affected by a number of drugs. Diltiazem may be the drug of choice when antianginal therapy with a pulseslowing effect is required, but β-blockers are contraindicated.Aim of the study. To compare the antianginal, pulse-slowing and vasoprotective effects of the calcium antagonist (CA) diltiazem, the calcium antagonist verapamil and the cardioselective beta-adrenoblocker (BAB) bisoprolol in the treatment of stable angina (SA) patients with concomitant BA.Materials and methods. The study included 60 patients with stable angina II-III FC with concomitant mild or moderate persistent BA. The patients were divided into three groups of 20 patients depending on antianginal drugs: Group 1 received betaadrenoblocker bisoprolol, Group 2 – calcium antagonist verapamil, Group 3 – calcium antagonist diltiazem. All patients underwent cardiography (Doppler EchoCG), external respiration function (ERF), endothelium-dependent vasodilation (EDVD) study at baseline and after 2, 4, 6 weeks of treatment.Results. No negative dynamics of FEV1 was found in patients of all groups during the study of ERF after 6 weeks of treatment. There was a statistically significant increase in FEV1 after 6 weeks of treatment in group 3 patients receiving diltiazem (p = 0.032). There was a statistically significant decrease in HR in all three groups during treatment, but in group 2 the dynamics were significantly lower when treated with verapamil. Analysis of mPAP of patients showed that it decreased in all groups after 6 weeks of treatment, but significant dynamics was noted only in Group 3. EDVD test after 6 weeks of treatment revealed positive dynamics, with a statistically significant increase in the index registered in patients of groups 1 and 3.Conclusions. In treatment of patients with stable angina with mild and intermediate persistent disease without exacerbation, antianginal therapy with the calcium antagonist diltiazem has marked antianginal, pulse-slowing action, has vasoprotective effect on the small and large circulatory vessels, improves the parameters of bronchial permeability.

Strain Analysis Using Speckle Tracking Echocardiography for Detection of Coronary Artery Disease in Stable Angina Patients with No Regional Wall Motion Abnormality at Rest

Background: Speckle-tracking imaging is a novel method for assessing left ventricular (LV) function and ischemic changes. The aim of this study was to predict the presence of coronary artery disease by longitudinal 2D strain analysis using speckle tracking echocardiography in patients with stable or unstable angina with no regional wall motion abnormality at rest. Objectives: Objective of this study is to predict the presence of significant CAD in a patient with no regional wall motion abnormality by longitudinal 2D strain analysis using speckle tracking echocardiography. Methods: This cross-sectional study included a total 66 patients (mean age, 51.92±8.9 years) with suspected CAD without RWMA on resting echocardiography who underwent coronary angiography. Longitudinal 2D strain analysis by STE was performed in all patients before coronary angiography. Global and segmental peak systolic longitudinal strain (PSLS) were recorded &amp; computed by offline dedicated software semi-automatically on bull’s-eye report. The patients were divided into two groups according to the coronary angiographic findings; group- I: significant CAD on coronary angiogram (n=35), group-II: normal coronaries on CAG (n=31).All the baseline characteristics and outcome were then compared between the two groups. Results: PSLSs of all left ventricular segments were obtained successfully in 66 patients. PSLS (both global and segmental) was significantly decreased in patients with significant CAD on CAG group. Receiver operating characteristic (ROC) curve analysis demonstrated that global PSLSs could effectively detect patients with CAD (area under ROC curve = 0.877, 95% CI=0.749–0.960). According to ROC curve analysis, -18.77% appeared to be a good cutoff value for predicting those with significant CAD (specificity 77.4% and sensitivity 82.9%). Conclusion: Global and segmental PSLS using speckle tracking echocardiography at rest was significantly lower in patients with CAD without RWMA, and might be useful for identifying patients with a significant CAD with good degree of sensitivity and specificity.

Level of vascular inflammation is higher in acute coronary syndromes compared to chronic coronary disease

Abstract Background Vascular inflammation has been recognized as one of the key factors in the pathogenesis of acute coronary syndromes (ACS). Peri-coronary adipose tissue (PCAT) attenuation by computed tomography angiography (CTA) has emerged as a marker specific for coronary artery inflammation. We examined the relationship between clinical presentation and coronary artery inflammation assessed by PCAT attenuation and coronary plaque characteristics. Methods Patients with ACS or stable angina pectoris (SAP) who underwent pre-intervention coronary CTA and optical coherence tomography (OCT) were enrolled. PCAT attenuation was measured around the culprit lesion and in the proximal 40 mm of all coronary arteries. PCAT attenuation and OCT findings were compared between patients with ACS versus SAP. Results Among 471 patients (ACS: 198, SAP: 273), PCAT attenuation was higher in ACS patients than in SAP patients both at the culprit plaque level (−67.5±9.6 Hounsfield unit [HU] vs. −71.5±11.0 HU, p&amp;lt;0.001) and the culprit vessel level (−68.3±7.7 HU vs. −71.1±7.9 HU, p&amp;lt;0.001). The mean PCAT attenuation of all 3 coronary arteries was also significantly higher in ACS patients than in SAP patients (−68.8±6.3 HU vs. −70.5±7.1 HU, p=0.007). After adjusting patient characteristics, not only thin-cap fibroatheroma (OR: 2.44; 95% CI: 1.63–3.65) and macrophages (OR: 2.07; 95% CI: 1.34–3.21) but also PCAT attenuation in the culprit plaque (OR: 1.04; 95% CI: 1.02–1.06) was associated with the clinical presentation of ACS. Conclusions PCAT attenuation at culprit plaque, culprit vessel, and pan-coronary levels was higher in ACS patients than in SAP patients. Vascular inflammation appears to play a crucial role in the development of ACS. Funding Acknowledgement Type of funding sources: None.

Secondary rotational atherectomy strategy may reduce the occurrence of prolonged ST-segment elevation following ablation

Abstract Background Rotational atherectomy (RA) has been widely used for severely calcified lesions in performing percutaneous coronary intervention (PCI). The slow flow phenomenon is the most frequently observed complication of RA and leads to prolonged ST-segment elevation. The incidence of the slow flow phenomenon was reported as approximately 5–20%. Several methods have been recommended to treat the slow flow phenomenon; however, the elevation of ST-segment may often persist after disappearance of slow flow phenomenon on angiography. Purpose The aim of the present study was to investigate the clinical factors on the incidence of prolonged ST-segment elevation following ablation of RA. Methods The subject comprised 140 consecutive stable angina patients with severe calcified lesions. All patients had undergone successfully elective PCI using RA and intravascular ultrasound, and had been prescribed strong statins more than 2 week before PCI regardless dyslipidemia. We investigated the occurrence of prolonged ST-segment elevation following ablation of RA with resistance to use of nitroprusside as intra-coronary vasodilators, and the clinical factors including of primary or secondary RA strategy for calcification lesions. Secondary RA strategy was defined as RA performed after pre-dilatation with small balloon (balloon/artery ratio = 0.6). Results Median of age was 71 years (66–80) and 98 cases (70%) were male. Of 140 target lesions, 82 (59%) were LAD (RCA; 24%, LCX; 16%, and LMT; 1%, respectively). The rates of hemodialysis and diabetes mellitus were 31% and 61%. The incidence of prolonged ST-segment elevation with resistance to use of nitroprusside as intra-coronary vasodilators was 8 cases (6%). Major complications of RA including coronary perforation, coronary rupture, burr entrapment and cardiogenic shock requiring the mechanical support were none. Univariate logistic regression analysis showed that age [Odds ratio (OR); 1.07, 95% confidence interval (CI) 0.99–1.17, p=0.103], hemodialysis (OR; 0.71, 95% CI: 0.10–3.25, p=0.688), diabetes mellitus (OR; 1.08, 95% CI: 0.25–5.46, p=0.915), use of β-blocker (OR; 0.70, 95% CI: 0.14–2.96, p=0.633), left ventricular ejection fraction (OR; 0.99, 95% CI: 0.94–1.05, p=0.781), lesion length ≥20mm (OR; 1.04, 95% CI: 0.23–7.33, p=0.962), and burr size (OR; 2.42, 95% CI: 0.53–16.95, p=0.289) were not associated with the incidence of prolonged ST-segment elevation. Multivariate logistic regression analysis for the incidence of prolonged ST-segment elevation revealed that secondary RA strategy and levels of low-density lipoprotein cholesterol (LDL-C) were independent factors of the incidence of prolonged ST-segment elevation following ablation of RA (OR; 0.05, 95% CI: 0.01–0.39, p=0.017 and LDL-C: OR 0.91, 95% CI 0.83–0.96, p=0.010, respectively). Conclusion Secondary RA strategy may be useful to reduce the occurrence of prolonged ST-segment elevation following ablation of RA. Funding Acknowledgement Type of funding sources: None.

Outcomes of drug coated balloon only angioplasty for stable angina in routine clinical practice

Abstract Introduction The recent BASKETSMALL2 trial demonstrated safety and efficacy of drug coated balloon (DCB) angioplasty for de novo small vessel disease. Registry data have demonstrated that DCB angioplasty is safe; however, the majority of these studies are limited due to long recruitment time and small number of patients with DCB compared to drug eluting stents (DES). Our aim was to investigate if DCB-only strategy is safe to incorporate in routine clinical practice. Methods We identified all patients treated for stable angina and de novo disease in our institution from January 2015 till November 2019. During that period an equivalent number of patients were treated with DCB-only or DES-only strategy on a yearly basis. The primary endpoint was all cause mortality. The secondary endpoints were cardiovascular mortality, acute coronary syndrome (ACS), ischaemic stroke, major bleeding and target lesion revascularisation (TLR). Data were obtained from the hospital episodes statistics from NHS digital. Clinical and angiographic data were collected from our prospectively collated database and supplemented from electronic records as required. All angiograms were reviewed to confirm accuracy of angiographic data and determine TLR. On multivariable COX regression analysis (Table 1) age, frailty and hypercholesterolaemia were the only independent predictors of all cause mortality. Results A total of 1302 patients were identified. HES data were not obtained for 65 patients who had opted-out, therefore 1237 were included in the analysis; 544 were treated with DCB and 693 with DES. The average age for the DCB-group was 67.9±10.2 years old (79% male); while for the DES group it was 67.9±9.7 years old (78.1% male). The average follow up was 1339±514 days and 1354±527 days for the DCB and DES group respectively. Table 1 shows the differences between the groups in terms of clinical and angiographic characteristics. The DES group had more patients with history of COPD (6.3% vs 3%; p=0.01) and larger average vessel diameter (3.46±0.58 vs 3.09±0.53mm; p&amp;lt;0.001). The DCB group had more patients with true bifurcation disease and TIMI 0 or 1 pre-PCI (11.6% vs 8.1%; p=0.04) and TIMI 0 or 1 pre-PCI (11.7% vs 6.6%; p=0.001). Furthermore, more than 70% of patients in the DCB group had vessel diameter ≥3mm indicating that large vessels were treated. The all cause mortality was 35 (6.4%) and 59 (8.5%) for the DCB and DES group respectively. Kaplan Meier estimator plot did not show a significant difference between the groups. There was no difference between the groups in any of the secondary endpoints (cardiovascular mortality, ACS, stroke, major bleeding and TLR). Conclusion Our real world data from a large, contemporary cohort of stable angina patients, including predominantly large vessels, demonstrate that DCB only angioplasty is safe compared to DES in terms of all major cardiovascular endpoints including TLR. Funding Acknowledgement Type of funding sources: Private company. Main funding source(s): B Braun - investigator initiated research

Prognosis and Medical Cost of Measuring Fractional Flow Reserve in Percutaneous Coronary Intervention.

There are limited data regarding comparative prognosis and medical cost between fractional flow reserve (FFR)-based and angiography-based percutaneous coronary intervention (PCI) among revascularized patients. This study evaluates prognosis and medical cost of FFR use in revascularized patients by PCI. Using the National Health Insurance Service database, stable or unstable angina patients who underwent PCI from 2011 to 2017 were evaluated. Eligible patients were divided into 2 groups according to use of FFR in PCI. Primary outcome was a composite of all-cause death or spontaneous myocardial infarction (MI). Secondary outcomes included individual components of the primary outcome, unplanned revascularization, and medical costs. Among 134,613 eligible patients, PCI was performed based on angiography (n=129,497) and FFR (n=5,116). During the study period, both the annual number and proportion of use of FFR in PCI increased (all P for trend<0.001). The FFR group showed significantly lower risk of the primary outcome (7.0% vs 9.5%; P< 0.001), all-cause death (5.8% vs 7.7%; P = 0.001), and spontaneous MI (1.6% vs 2.2%; P = 0.022) than the angiography group. Although the FFRgroup showed higher medical cost during index admission than angiography group (median: $6,265.10 vs $5,385.60; P< 0.001), cumulative medical cost after index admission was significantly lower ($2,696.50 vs. $3,142.10; P< 0.001). Use of FFR in PCI in stable or unstable angina patients showed significantly lower risk of all-cause death and spontaneous MI compared to angiography-based PCI. Although the FFR group had higher initial medical cost than the angiography group, cumulative medical cost after index admission was significantly lower.

Fibroblast growth factor 21 is associated with widening QRS complex and prolonged corrected QT interval in patients with stable angina

BackgroundFibroblast growth factor 21 (FGF21) is produced by cardiac cells, may acts in an autocrine manner, and was suggested to has a cardioprotective role in atherosclerosis. Wide QRS complex and heart rate-corrected QT interval (QTc interval) prolongation are associated to dangerous ventricular arrhythmias and cardiovascular disease mortality. Yet, the role of FGF21 in cardiac arrhythmia has never been studied. The aim of the study was to investigate the relationship between plasma FGF21 and the QRS duration and QTc interval in patients with stable angina.MethodsThree hundred twenty-one consecutive stable angina patients were investigated. Plasma FGF21 was measured through ELISA, and each subject underwent 12-lead electrocardiography.ResultsFGF21 plasma levels were positively associated with the QRS duration (β = 0.190, P = 0.001) and QTc interval (β = 0.277, P < 0.0001). With increasing FGF21 tertiles, the patients had higher frequencies of wide QRS complex and prolonged QTc interval. After adjusting for patients’ anthropometric parameters, the corresponding odd ratios (ORs) for wide QRS complex of the medium and high of FGF21 versus the low of FGF21 were 1.39 (95% CI 0.51–3.90) and 4.41 (95% CI 1.84–11.59), respectively, and p for trend was 0.001. Furthermore, multiple logistic regression analysis also showed the corresponding odd ratios (ORs) for prolonged QTc interval of the medium and high of FGF21 versus the low of FGF21 were 1.02 (95% CI 0.53–1.78) and 1.93 (95% CI 1.04–3.60) respectively with the p for trend of 0.037. In addition, age- and sex-adjusted FGF21 levels were positively associated with fasting glucose, HbA1c, creatinine, and adiponectin, but negatively associated with albumin, and the estimated glomerular filtration rate.ConclusionsThis study indicates that plasma FGF21 is associated with wide QRS complex and prolonged corrected QT interval in stable angina patients, further study is required to investigate the role of plasma FGF21 for the underlying pathogenesis.

Interactive Effects of Nutrition Modification and Wet Cupping on Male Patients with Refractory Stable Angina.

ObjectivesRoutine therapies cannot control refractory stable angina, leading to a high economic burden and an impaired quality of life. Persian medicine incorporates exceptional attention to lifestyle and nutrition to prevent and treat various diseases. Previous studies have reported the analgesic and anti-inflammatory effects of wet cupping. The present study aims to determine the effects of nutrition and cupping on refractory stable angina patients.MethodsForty male patients with refractory stable angina were randomly allocated to four groups, including nutrition modification based on Persian medicine, wet cupping, nutrition modification along with wet cupping, and control. The primary outcomes were the changes in pain score using a visual analog scale and quality of life using the Seattle angina questionnaire. The secondary outcomes were changes in the exercise test and blood pressure.ResultsThe results of the present study revealed that 30 days of treatment with nutrition modification based on Persian medicine, cupping, and modified nutrition and cupping along with standard treatment for stable angina significantly increased the patient’s quality of life and exercise test results while reducing pain, and systolic and diastolic blood pressure.ConclusionApplying complementary Persian medicine methods such as nutrition modification and cupping along with the classical medical treatments may improve outcomes for refractory stable angina patients.

TCT-284 Long-Term Cost-Effectiveness of Fractional Flow Reserve in Stable and Unstable Angina Patients

TCT-284 Long-Term Cost-Effectiveness of Fractional Flow Reserve in Stable and Unstable Angina Patients

Turndown for coronary artery bypass surgery: Never say never to revascularization.

In this issue of Catheterization and Cardiovascular Interventions, Farag et al. reported their experience comparing patients with acute coronary syndrome versus stable angina patients who were turned down for bypass surgery and subsequently treated with coronary stenting (1).

Abstract P3083: Beta 1.3 1.6 D Glucan Immunomodulatory Activity Of Indonesian Ganoderma Lucidum Mycelium Extract In Repairing Heart Tissue And Function On Myocardial Infarction Patients

Introduction: Immune response plays a significant role in heart repair and regeneration after myocardial infarction and/or ischemia-reperfusion injury (MI/RI). Prolonged inflammation response contributes to adverse cardiac remodeling and reduction in pump function. In stable angina pectoris and patients with high-risk for heart disease, Beta 1.3 1.6 D Glucan has demonstrated reduced inflammation parameters including IL-6, TNF-α and CRP. Hypothesis: Beta 1.3 1.6 D Glucan modulates inflammation responses related to myocardial infarction or MI/RI, therefore preventing adverse heart remodeling measured by Left Ventricle Mass Index (LVMI) and Left Ventricle Ejection Fraction (LVEF). Method: In May - August 2018 a randomized double-blind placebo-controlled trial was conducted comprising of 50 STEMI/NSTEMI patients at the Saiful Anwar General Hospital, Malang, Indonesia. Next to standard therapy, 25 patients received Beta 1.3 1.6 D Glucan, 540 mg/day for 90 days, while the other 25 patients received placebo. Results: During the study duration, 5 patients dropped out. The mean value of pre-test LVMI for all patients is 114.07 ± 59.61 g/m 2 . After 90 days, there was a significant difference (p=0.012) in LVMI between the Beta 1.3 1.6 D Glucan and placebo group. The Beta 1.3 1.6 D Glucan group had a LVMI reduction of 4.55 ± 14.46 g/m 2 compared to the placebo group with an increase of 11.48 ± 23.94 g/m 2 in LVMI. The mean value of pre-test LVEF for all patients is 57.2 ± 11.39%. Post-test results demonstrated a significant difference (p=0.042) between both groups, with an increase in LVEF of 2.3 ± 9.77% for Beta 1.3 1.6 D Glucan group and a decrease in LVEF of 2.08 ± 3.35% for placebo group. Conclusion: Beta 1.3 1.6 D Glucan as an adjuvant therapy may have a beneficial effect to repair the vascular, heart tissues and function in myocardial infarction patients.

Effect of Low High-Density Lipoprotein Level on Endothelial Activation and Prothrombotic Processes in Coronary Artery Disease-A Pilot Study.

High-density lipoproteins (HDL) play an important role in the prevention of atherosclerosis. The aim of the study was to assess the relationship between serum HDL-C concentration and proinflammatory/prothrombic activation in coronary artery disease (CAD) patients. The study group included 27 acute myocardial infarction (AMI) patients and 30 stable angina pectoris (SA) patients. The control group consisted of 23 people without cardiac symptoms. In the AMI and SA groups, a lower HDL-C and a higher LDL-C/HDL-C index were observed. The SA patients had lower total cholesterol, LDL-C, sE-selectin ligand, as well as higher triglycerides and CD40 concentration in comparison with both the control and AMI groups. A higher von Willebrand Factor and intercellular adhesion molecule-1 were found in both study groups. Low HDL-C concentration in the CAD patients may intensify pro-inflammatory endothelial activation and prothrombotic processes. A low concentration of HDL-C and a high value of the LDL-C/HDL-C index seem to be better indices of atherogenic processes than the LDL-C concentration alone.

Fractional Flow Reserve (FFR) and Resting Index (dPR) Reproducibility With a Fiber-Optic Pressure Wire (Readi-Epic 14)

There are limited data regarding comparative prognosis and medical cost between fractional flow reserve (FFR)–based and angiography-based percutaneous coronary intervention (PCI) among revascularized patients.This study evaluates prognosis and medical cost of FFR use in revascularized patients by PCI.Using the National Health Insurance Service database, stable or unstable angina patients who underwent PCI from 2011 to 2017 were evaluated. Eligible patients were divided into 2 groups according to use of FFR in PCI. Primary outcome was a composite of all-cause death or spontaneous myocardial infarction (MI). Secondary outcomes included individual components of the primary outcome, unplanned revascularization, and medical costs.Among 134,613 eligible patients, PCI was performed based on angiography (n = 129,497) and FFR (n = 5,116). During the study period, both the annual number and proportion of use of FFR in PCI increased (all P for trend <0.001). The FFR group showed significantly lower risk of the primary outcome (7.0% vs 9.5%; P < 0.001), all-cause death (5.8% vs 7.7%; P = 0.001), and spontaneous MI (1.6% vs 2.2%; P = 0.022) than the angiography group. Although the FFR group showed higher medical cost during index admission than angiography group (median: $6,265.10 vs $5,385.60; P < 0.001), cumulative medical cost after index admission was significantly lower ($2,696.50 vs. $3,142.10; P < 0.001).Use of FFR in PCI in stable or unstable angina patients showed significantly lower risk of all-cause death and spontaneous MI compared to angiography-based PCI. Although the FFR group had higher initial medical cost than the angiography group, cumulative medical cost after index admission was significantly lower.

Chemerin Levels in Acute Coronary Syndrome: Systematic Review and Meta-Analysis.

We evaluated the relevant published studies exploring the association between chemerin concentrations and acute coronary syndromes (ACSs). A systematic search was performed in October 2021 using PubMed, Scopus, Embase, and Cochrane Library. We included full articles and assessed their quality using the Newcastle-Ottawa score. We found 6 studies in the systematic review and 5 of these were included in our meta-analysis. Mean difference (MD) of 41.69 ng/mL (95% CI, 10.07-73.30), 132.14 ng/mL (95% CI, -102.12-366.40), and 62.10 ng/mL (95% CI, 10.31-113.89) in chemerin levels was seen in ACS patients vs control subjects, ACS patients vs stable angina pectoris patients (SAP), and type 2 diabetes mellitus (T2DM) ACS patients vs nondiabetic ACS patients, respectively. Chemerin levels were significantly elevated in patients with ACS compared to controls, as well as in T2DM-ACS patients compared to nondiabetic ACS patients. However, no significant MD in chemerin levels was observed between SAP and ACS patients.