Stages Of Coronary Artery Disease Research Articles

The effect of miR-223-3p on endothelial cells in coronary artery disease.

Endothelial cell damage and dysfunction are crucial factors in the development and early stages of coronary artery disease (CAD) and apoptosis plays a significant role in this process. In this study, We aimed to simulate the CAD vascular microenvironment by treating endothelial cells with tumor necrosis factor alpha (TNF-α) to construct an endothelial cell apoptosis model. Our findings revealed that the TNF-α model resulted in increased micro-RNA 223-3p (miR-223-3p) mRNA and Bax protein expression, decreased kruppel-like factor 15 (KLF15) and Bcl-2 protein expression, and decreased cell viability. More importantly, in the TNF-α-induced endothelial cell apoptosis model, transfection with the miR-223-3p inhibitor reversed the effects of TNF-α on Bcl-2, Bax expression. We transfected miRNA-223-3p mimics or inhibitors into endothelial cells and assessed miR-223-3p levels using RT-PCR. Cell viability was detected using CCK8. Western blot technology was used to detect the expression of Bcl-2, Bax, and KLF15. In summary, this study demonstrates the role and possible mechanism of miR-223-3p in endothelial cells during CAD, suggesting that miR-223-3p may serve as a promising therapeutic target in CAD by regulating KLF15.

Jujubes and Rosuvastatin: Comparison of Two Hypolipidemic Agents in Primary and Secondary Hyperlipidemic and Hypertensive Patients

Biotransformation in human body results accumulation of free radicals (reactive oxygen species or ROS). If patients LDL particles are more than normal in systemic circulation, get interacted with free radicals and form foamy cells; initial stage of coronary artery disease (CAD). Hyperlipidemia may be primary (genetic reason) or secondary which is acquired type of dyslipidemia. Free radicle formation in human body is very much normal phenomenon. Just reducing LDL or raising HDL may prevent interaction of LDL with reactive oxygen species (free radicals), escaping patient to develop CAD. Commonly used drugs in prophylaxis or treatment of dyslipidemia include statins (HMGCo-A reductase inhibitors), niacin, bile resins and fibric acids. There are alternative therapies for dyslipidemia including use of fibers, fruits, and vegetables. In Pakistan there are huge number of fruits and herbs which are getting popularity as hypolipidemic agents. One of the important fruit in Pakistan having hypolipidemic potential is JUJUBES (in urdu called Bair). In this study we have compared hypolipidemic effects of Bair with statin in hyperlipidemic patients. This study was conducted at Begum Jan hospital, Islamabad-Pakistan. Sixty hyperlipidemic patients were selected and divided in two groups. Their lipid profile (LP) was determined in the hospital and blood pressure (BP) was recorded at start of treatment. Group-1 was advised to take 10 mg tablet Rosuvastatin in divided doses, and group-2 was advised to use 500 mg Bair (JUJUBES) in divided times per day for the period of 2 months. RESULTS: after two months therapy their lipid profile and BP was re-determined and analyzed statistically by using SPSS version 22.00.01. It was observed that Rosuvastatin decreased systolic BP and LDL-c highly significantly (p-value < 0.001), while diastolic BP was reduced significantly (p-value <0.01) and HLD-c was increased significantly with p-value <0.01. In group-2 JUJUBES (Bair) reduced systolic BP and LDL-c significantly (p-value <0.01) but no significant changes were observed in diastolic BP and HDL-c in this group. CONCLUSION: It was concluded from the research study that Jujubes reduce LDL-c and systolic BP in hyperlipidemic patients, but lesser than statin group of antihyperlipidemic agents.

Cardiologists Do Advise Hyperlipidemic Patients to Maintain or Follow Prophylactic Measures in Scenario of Genetic Susceptibility of Hyperlipidemic Patients

Biotransformation in human body results accumulation of free radicals (reactive oxygen species or ROS). If patients LDL particles are more than normal in systemic circulation, get interacted with free radicals and form foamy cells; initial stage of coronary artery disease (CAD). Hyperlipidemia may be primary (genetic reason) or secondary which is acquired type of dyslipidemia. Free radicle formation in human body is very much normal phenomenon. Just reducing LDL or raising HDL may prevent interaction of LDL with reactive oxygen species (free radicals), escaping patient to develop CAD. Commonly used drugs in prophylaxis or treatment of dyslipidemia include statins (HMGCo-A reductase inhibitors), niacin, bile resins and fibric acids. There are alternative therapies for dyslipidemia including use of fibers, fruits, and vegetables. In Pakistan there are huge number of fruits and herbs which are getting popularity as hypolipidemic agents. One of the important fruit in Pakistan having hypolipidemic potential is JUJUBES (in urdu called Bair). In this study we have compared hypolipidemic effects of Bair with statin in hyperlipidemic patients. This study was conducted at Begum Jan hospital, Islamabad-Pakistan. Sixty hyperlipidemic patients were selected and divided in two groups. Their lipid profile (LP) was determined in the hospital and blood pressure (BP) was recorded at start of treatment. Group-1 was advised to take 10 mg tablet Rosuvastatin in divided doses, and group-2 was advised to use 500 mg Bair (JUJUBES) in divided times per day for the period of 2 months. RESULTS: after two months therapy their lipid profile and BP was re-determined and analyzed statistically by using SPSS version 22.00.01. It was observed that Rosuvastatin decreased systolic BP and LDL-c highly significantly (p-value < 0.001), while diastolic BP was reduced significantly (p-value <0.01) and HLD-c was increased significantly with p-value <0.01. In group-2 JUJUBES (Bair) reduced systolic BP and LDL-c significantly (p-value <0.01) but no significant changes were observed in diastolic BP and HDL-c in this group. CONCLUSION: It was concluded from the research study that Jujubes reduce LDL-c and systolic BP in hyperlipidemic patients, but lesser than statin group of antihyperlipidemic agents.

Extracorporeal Membrane Oxygenation in Cardiogenic shock – A Review

Extracorporeal membrane oxygenation has been used in adult in cardiogenic shock due to myocardial infarction, myocardiopathy, myocarditis, or inability to come off cardiopulmonary bypass (CPB) after cardiac surgery.3 ECMO can provide partial or total support, but it is temporary. It is not a definitive treatment but a life support system that allows time for evaluation, diagnosis and treatment of the condition that causes heart failure. With high incidence of late stage coronary artery disease and infective myocarditis in India, the usage of ECMO for refractory cardiogenic shock is going to be a promising approach for effective management of refractory heat failure .ECMO has proven to be an effective therapeutic modality in managing cardiovascular collapse as a bridge to recovery or more definitive treatment options.

The role of epicardial and pericoronary adipose tissue in cardiometabolic disease

Epicardial adipose tissue (EAT) is a metabolically active fat depot which modulates coronary arterial function. The measurement of EAT volume and attenuation from non-contrast cardiac computed tomography (CT) provides valuable information on cardiometabolic risk. Pericoronary adipose tissue (PCAT), a subset of EAT which directly surrounds the coronary vessels, may function as a sensor of coronary inflammation. PCAT attenuation on coronary CT angiography associates with coronary plaque morphology, stages of coronary artery disease, and risk of future cardiac events. Quantification of EAT and PCAT has incremental and complementary prognostic value over and above current risk assessment tools. This review covers the biological role of EAT in healthy and dysfunctional states, and CT-based assessment of EAT and PCAT towards the development of clinically meaningful imaging biomarkers.

Early Results of Percutaneous Myocardial Revascularization with Three Dimensional Non-fluoroscopic Electromechanical Mapping - A Novel Revascularization Therapy in Patients with End Stage Coronary Artery Disease

On three months follow up, three of four patients had angina class improved from class III to II. One patient had remained in class III angina. The average number of additional nitrate tablets use decreased from 4 to 1.75 per week. Hence, DMR with non-fluoroscopic electromechanical mapping is a safe and feasible revascularization option for patients with end stage coronary artery disease.

Numerical Analysis on Effect of Coronary Supply-Demand Equilibrium on Varying Coronary Blockage and Stress Conditions.

In this paper, we present a computational fluid dynamic (CFD) analysis to capture the effect of physical stress and stenosis severity in coronary arteries leading to changes in coronary supply demand oxygen equilibrium. We propose a coupled Od-3d coronary vessel model to predict the variation in flow dynamics of coronary as well as arterial system, modeled using an in-silico model replicating cardiovascular hemodynamics. CFD simulation were solved using subject specific CT scan for coronary and arterial flow and pressure along with metrics related to arterial wall shear stress. Simulations were performed for three heart rates (75, 90 and 120 bpm) and four stenosis states representing different stages of Coronary artery disease (CAD) namely healthy, 50%, 75%, 90% blockage in left anterior descending artery (LAD). Myocardial oxygen supply demand equilibrium were calculated for each cases using hemodynamic surrogate markers naming Diastolic pressure time index for supply and Tension time index for demand. The proposed 0d-3d coupled hemodynamic model of the coronary vessel bed along with supply-demand equilibrium estimated for different stress level and stenosis severity may provide useful insights on the dynamics of CAD manifestation and predict vulnerable regions in coronary bed for early screening and interventions.

Association of epicardial adipose tissue with different stages of coronary artery disease: A cross-sectional UK Biobank cardiovascular magnetic resonance imaging substudy.

ObjectiveIncreased epicardial adipose tissue (EAT) has been identified as a risk factor for the development of coronary artery disease (CAD). However, the exact role of EAT in the development of CAD is unclear. This study aims to compare EAT volumes between healthy controls and individuals with stable CAD and a history of myocardial infarction (MI). Furthermore, associations between clinical and biochemical parameters with EAT volumes are examined.MethodsThis retrospective cross-sectional study included 171 participants from the United Kingdom Biobank (56 healthy controls; 60 stable CAD; 55 post MI), whom were balanced for age, sex and body mass index (BMI). EAT volumes were quantified on end-diastolic cardiac magnetic resonance (CMR) imaging short-axis slices along the left and right ventricle and indexed for body surface area (iEAT) and iEAT volumes were compared between groups.ResultsiEAT volumes were comparable between control, CAD and MI cases (median [IQR]: 66.1[54.4–77.0] vs. 70.9[55.8–85.5] vs. 67.6[58.6–82.3] mL/m2, respectively (p > 0.005 for all). Increased HDL-cholesterol was associated with decreased iEAT volume (β = -14.8, CI = -24.6 to −4.97, p = 0.003) and suggestive associations (P-value < 0.05 and ≥ 0.005) were observed between iEAT and triglycerides (β = 3.26, CI = 0.42 to 6.09, p = 0.02), Apo-lipoprotein A (β = -16.3, CI = -30.3 to −2.24, p = 0.02) and LDL-cholesterol (β = 3.99, CI = -7.15 to −0.84, p = 0.01).ConclusionsNo significant differences in iEAT volumes were observed between patients with CAD, MI and healthy controls. Our results indicate the importance of correcting for confounding by CVD risk factors, including circulating lipid levels, when studying the relationship between EAT volume and CAD. Further mechanistic studies on causal pathways and the role of EAT composition are warranted.

Small Differences in Vitamin D Levels between Male Cardiac Patients in Different Stages of Coronary Artery Disease.

Cardiovascular diseases are the main cause of mortality in males older than 65 years of age. The prevalent vitamin D deficiency in the worldwide population may have multiple effects on the cardiovascular system. This study sought to determine the association between serum levels of 25-hydroxyvitamin D (25(OH)D) and the stage of coronary artery disease (CAD) in Polish male subjects. Additionally, subjects with a history of myocardial infarction (MI) were analyzed for potential differences in 25(OH)D levels in comparison with those diagnosed with stable CAD. The study was conducted prospectively in a group of 669 male patients subjected to coronarography examination. CAD stage was defined using the Coronary Artery Surgery Study Score. Patients without significant coronary lesions had significantly higher 25(OH)D levels than patients with single-, double-, or triple-vessel disease (median, 17 vs. 15 ng/mL; p < 0.01). Significantly lower levels of 25(OH)D were apparent when MI was identified as the cause of the then-current hospitalization in comparison with stable CAD, as well as in patients with a history of MI; all of these cases had lower levels of 25(OH)D in comparison with patients with no such history. Male patients with single-, double-, or triple-vessel CAD, acute coronary syndrome, or a history of MI presented lower serum 25(OH)D.

Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease

Abstract Background FFRCT gradually decreases from the proximal to the distal part of a vessel and reach the pathological threshold for significant ischemia even in the absence of obstructive coronary artery disease (CAD). The exact mechanisms of such gradual FFRCT decline remain unknown. Purpose The aims of this study are (1) to clarify the mechanisms of the gradual decline of computed tomography (CT) derived fractional flow reserve (FFRCT); and (2) to identify the predictive factors of an FFRCT decline below the pathological value of 0.80 in no apparent CAD vessels. Methods A total of 1058 outpatients with suspected CAD and who underwent CT angiography (CTA) with FFRCT analysis between January 2017 and December 2019 were evaluated. Among them, 150 consecutive patients who had both a CTA coupled to an FFRCT analysis and an invasive angiogram showing &amp;lt;25% coronary stenosis were included for analysis. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT &amp;gt;0.80 (n=317) and FFRCT ≤0.80 (n=114). ΔFFRCT was defined as the magnitude of the change in FFRCT from the proximal to the distal vessel. Plaque characterization and vessel morphology measurements were performed semi-automatically. Vessel constituents were characterized based on Hounsfield units (HU) into lumen volume (&amp;lt;−50 HU), non-calcified plaque (NCP) (−50–150 HU), and calcified plaque (&amp;gt;150 HU). Results FFRCT decreased continuously from the proximal to distal across the three major vessels in both FFRCT&amp;gt;0.80 and FFRCT ≤0.80 groups (Figure 1). Compared to FFRCT&amp;gt;0.80 group, NCP volume was significantly higher in all three major vessels in FFRCT ≤0.80 group (210.2±83.6 mm3 vs. 140.9±139.3 mm3 for the RCA, p=0.01; 177.5±150.2 mm3 vs. 133.2±112.2 mm3 for the LAD, p=0.04; 127.6±91.5 mm3 vs. 58.7±57.7 mm3 for the LCX, p&amp;lt;0.01). Next, we investigated the vessel parameters that correlated with ΔFFRCT. ΔFFRCT was correlated with lumen volume in FFRCT&amp;gt;0.80 group (r=−0.24, p&amp;lt;0.0001), whereas ΔFFRCT was correlated with NCP volume in FFRCT ≤0.80 group (r=0.42, p&amp;lt;0.001) (Figure 2). An NCP volume above 44.8 mm3 was the strongest predictor of distal FFRCT of ≤0.80 (area under the curve 0.69, p&amp;lt;0.0001, sensitivity 95%, specificity 39%). Conclusions FFRCT is affected by vascular morphology and plaque characteristics even in the early stage of coronary artery disease. Our study highlights that subclinical coronary artery disease strongly influences FFRCT by effects unrelated to coronary stenosis. The presence of NCP is a major predictor of the gradual decrease of FFRCT toward pathological values. Anatomical findings as vessel morphology and plaque characteristics should be taken into consideration when interpreting numerical values of FFRCT to avoid unnecessary referrals for invasive coronary angiography or percutaneous coronary intervention. Funding Acknowledgement Type of funding sources: None. Figure 1Figure 2

Impact of vascular morphology and plaque characteristics on computed tomography derived fractional flow reserve in early stage coronary artery disease

BackgroundComputed-tomography (CT) derived fractional-flow-reserve (FFRCT) gradually may decrease from proximal to distal vessels even without apparent coronary artery disease (CAD). It may be unclear whether the decrease in FFRCT at the distal coronal artery is physiological or due to stenosis. We decided to study predictive factors of an FFRCT decline below the pathological value of 0.80 in no-apparent CAD. MethodsA total of 150 consecutive patients who had both CT angiography coupled to FFRCT analysis and invasive angiogram showing < 20% coronary stenosis were included. Vessels were divided into two groups according to FFRCT at the distal vessel: FFRCT > 0.80 (n = 317) and FFRCT ≤ 0.80 (n = 114). ΔFFRCT was defined as the change in FFRCT from proximal to distal vessel. Vessel morphology (vessel length and lumen volume) and plaque characteristics [low-attenuation plaque volume, intermediate-attenuation (IAP) plaque volume, and calcified plaque volume] were evaluated. ResultsFFRCT decreased from proximal to distal for the three major vessels in both FFRCT > 0.80 and FFRCT ≤ 0.80. Compared to FFRCT > 0.80, IAP volume was significantly higher in all three major vessels in FFRCT ≤ 0.80. ΔFFRCT was correlated with vessel length and lumen volume in FFRCT > 0.80, whereas ΔFFRCT was correlated with IAP volume in FFRCT ≤ 0.80. IAP volume above 44.8 mm3 was the strongest predictor of distal FFRCT of ≤ 0.80. ConclusionsThe presence of IAP is a major predictor of gradual decrease of FFRCT below 0.80 in no-apparent CAD vessels. Vessel morphology and plaque characteristics should be considered when interpreting FFRCT.

Aging Effects on Epicardial Adipose Tissue.

Epicardial fat is the visceral fat of the heart. Epicardial fat is a white adipose tissue, but it displays also brown-fat like or beige fat features. Under physiological conditions, epicardial fat has cardioprotective functions such as free fatty acids supply and thermoregulation of the adjacent myocardium. Epicardial adipose tissue encounters changes in the transition from embryological to childhood and then to adult life. Aging can affect the function and morphology of epicardial fat, more likely in women than in men. The effect of aging on the brown fat properties of the epicardial fat is the most prominent and with the greatest clinical implications. It is promising to know that epicardial fat responds to newer pharmaceutical drugs modulating the adipose tissue and potentially restoring its browning effects. Epicardial fat pro-inflammatory secretome is down-regulated in end-stage coronary artery disease. Chronic ischemia and adverse hemodynamic conditions can also affect the regulatory component of the epicardial fat. Epicardial fat may incur in apoptotic and fibrotic changes that alter its transcriptome and proteasome. In conclusion, aging and advanced stage of chronic diseases are likely to influence and affect epicardial fat genes and function. Whether the downregulation of the epicardial fat tissue is due more to aging than advancing stages of coronary artery disease, or more likely to the combination of both, would be object of future investigations.

The prognostic value of neutrophil-to-lymphocyte ratio across all stages of coronary artery disease.

The natural history of coronary heart disease (CAD) commonly begins with atherosclerosis, progressing to chronic coronary syndrome (CCS), acute coronary syndrome (ACS), and eventually, heart failure. Despite advancements in preventive and therapeutic strategies, there is room for further cardiovascular risk reduction. Recently, inflammation has emerged as a potential therapeutic target. The neutrophil-to-lymphocyte ratio (NLR) is a novel inflammatory biomarker which predicts poor prognosis in several conditions such as metabolic syndrome, sepsis, malignancy and CAD. In atherosclerosis, a high NLR predicts plaque vulnerability and severe stenosis. This is consistent with observations in CCS, where an elevated NLR predicts long-term major adverse cardiac events (MACEs). In ACS patients, high NLR levels are associated with larger infarct sizes and poor long-term outcomes. Possible reasons for this include failure of fibrinolysis, ischemia-reperfusion injury and in-stent restenosis, all of which are associated with raised NLR levels. Following myocardial infarction, an elevated NLR correlates with pathological cardiac remodeling which propagates chronic heart failure. Finally, in heart failure patients, an elevated NLR predicts long-term MACEs, mortality, and poor left ventricular assist device and transplant outcomes. Further studies must evaluate whether the addition of NLR to current risk-stratification models can better identify high-risk CAD patients.

Gene Expression Analysis Suggests Immunological Changes of Peripheral Blood Monocytes in the Progression of Patients With Coronary Artery Disease.

ObjectivesTo analyze the gene expression profile of peripheral blood monocytes in different stages of coronary artery disease (CAD) by transcriptome sequencing, and to explore potential genes and pathway involved in CAD pathogenesis.MethodsAccording to the screening of coronary angiography and quality control of blood samples, eight intermediate coronary lesion patients were selected, then eight patients with acute myocardial infarction, and eight patients with normal coronary angiography were matched by age and gender. Transcriptomics sequencing was conducted for the peripheral blood monocytes of these 24 samples by using the Illumina HiSeq high-throughput platform. Then, differentially expressed genes (DEGs) were analyzed. Gene Ontology (GO) functional annotation, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation, and protein-protein interaction (PPI) network were applied to annotate the potential functions of DEGs.ResultsCompared with the normal coronary angiography group, we identified a total of 169 DEGs in the intermediate coronary lesion group, which were significantly enriched in 59 GO terms and 17 KEGG pathways. Compared with the normal coronary angiography group, we found a total of 2,028 DEGs, which were significantly enriched in 311 GO terms and 20 KEGG pathways in the acute myocardial infarction group. The cross-comparison between normal versus intermediate coronary lesion group, and normal versus acute myocardial infarction group included 98 differential genes with 65 up regulated and 33 down regulated genes, which were significantly enriched in 46 GO terms and 10 KEGG pathways. During the progression of CAD, there was a significant up-regulated expression of CSF3, IL-1A, CCR7, and IL-18, and down-regulated expression of MAPK14. Besides GO items such as inflammatory response was significantly enriched, KEGG analysis showed the most remarkable enrichments in IL-17 signaling pathway and cytokine-cytokine receptor interactions.ConclusionsTranscriptomics profiles vary in patients with different severity of CAD. CSF3, IL-1A, CCR7, IL-18, and MAPK14, as well as IL-17 signaling pathway and cytokine and cytokine receptor interaction signaling pathway related with inflammatory response might be the potential biomarker and targets for the treatment of coronary artery disease.

Computed tomography - indications and the course of the examination

AdmissionComputed tomography, abbreviated CT or CK (computed tomography) is an imaging diagnostic method that uses the action of X-rays. The test allows you to obtain sections of the examined organs, as well as their 3D visualization, which greatly improves the diagnostic process. A tomograph is used to perform a CT scan, and the image obtained with it is called a tomogram. Computed tomography was first performed for diagnostic purposes in the early 1970s in the United States.The computer tomograph consists of three basic elements: the table, the operator's console and the scanner. During the examination, the scanner performs rotations around the patient's body, making a series of x-rays. Then the obtained image is transferred to a computer equipped with specialized software. The image is visible in 2D or 3D technology.AimThe aim of the study is to analyze the indications and the course of computed tomography examination. Material and methodReview of the available literature on the subject.ResultsComputed tomography is always performed based on a medical referral. It is the specialist who determines whether computed tomography will be more suitable than other imaging tests. Usually, computed tomography of the head and sinuses, chest and abdominal cavity are performed. The most common indications for head tomography are recurring headaches and dizziness, previous craniocerebral and sinus injuries, cerebral ischemia and strokes, as well as suspected neoplastic changes in the head. CT is also performed on people who struggle with neurodegenerative diseases, such as Alzheimer's disease. We can receive a referral for this examination froma neurologistan oncologist ophthalmologist, whether ENT specialist. Chest tomography shows the structure of the heart, coronary vessels and the entire respiratory system. Usually it is recommended in the diagnosis of cancers of the respiratory and cardiovascular systems and in the assessment of the stage of coronary artery disease. He can refer us to this research cardiologist, pulmonologist or internal medicine doctor. Abdominal tomography is performed in order to detect possible inflammations (pancreas, large intestine, appendix, kidneys), gastrointestinal obstruction or bleeding, as well as kidney stones or thrombosis of the liver veins. In this case, a referral can be obtained from a gastroenterologist, urologist, whether gynecologist.ConclusionsComputed tomography examination is completely painless and completely non-invasive for patients. It does not last long and allows you to quickly detect changes taking place inside the body. If the test was performed with a contrast agent, the patient may or may not experience some side effects, such as dizziness, a metallic taste in the mouth, nausea and vomiting, and palpitations.

Colchicine as an Adjuvant Therapy for Coronary Artery Disease: A Systematic Review

Background:Inflammation plays a significant role in atherosclerosis at all phases. Colchicine is a pleiotropic anti-inflammatory agent that may be beneficial in various stages of coronary artery disease (CAD).&#x0D; Methods:We searched for literatures in PubMed, Cochrane Library, ScienceDirect, and Proquest regarding the use of colchicine on top of current optimal medical therapy for CAD.&#x0D; Results: Twelve studies were identified: three studies in stable CAD patients and the remaining nine assessed in acute coronary syndrome (ACS) and post-ACS patients. The majority of studies used a colchicine dose of 0.5 mg/day. Adjuvant colchicine of 0.5 mg daily reduced the risk of developing ACS, cardiac arrest, or ischemic stroke in stable CAD: HR (hazard risk) 0.33 (95% CI 0.18-0.59), p&lt;0.001. Patients admitted with ACS who received a 2 mg loading dose of colchicine pre-percutaneous coronary intervention (PCI) showed smaller infarct size than control: 18.3 (IQR 7.6-29.9) ml/1.73 m2vs 23.2 (18.5-33.4) ml/1.73 m2(p=0.019).In post-ACS patients, adjuvant colchicine of 0.5 mg daily significantly reduced the rate of ischemic cardiovascular events: HR 0.77 (95% CI 0.61-0.96), p=0.02.&#x0D; Conclusion: Stable CAD patients benefit from 0.5 mg daily dose of adjuvant colchicine to reduce the incidence of future cardiovascular events. For patients presenting with ACS, a loading dose of 2 mg of colchicine pre-PCI followed by a week of 0.5 mg colchicine twice daily on top of optimal medical care can reduce infarct size. This should be followed by consumption of 0.5 mg daily dose of adjuvant colchicine post-ACS for at least 20 months to prevent future reinfarctions.

Adverse effects of exposure to ambient air pollution on coronary calcification

Abstract Background The association of air pollution with cardiovascular morbidity and mortality has been attributed to acute events (atherothrombosis). It is unclear whether air pollution may influence the subclinical stage of coronary artery disease (CAD). This study investigated the relationship between particulate matter &amp;lt;2.5μm (PM2.5) and nitrogen dioxide (NO2) with coronary calcium score (CCS). Methods This study included 606 asymptomatic adults (49% men, aged 56±7 years) recruited from the community in two States of Australia (Victoria and Tasmania). Annual PM2.5 and NO2 concentrations were matched with residential address. CCS was measured using coronary CT scan. Medical history, physical measurements, biochemistry, and socioeconomic status were recorded for assessment of confounders. Results Average exposure to PM2.5 and NO2 were 6.7±1.5 (ppm) and 3.6±2.1 (μg/m3), respectively. Of the 606 participants, 17% had high CCS (≥100) and 4% had very high CCS (≥400). Exposure to higher annual PM2.5 was associated with greater odds of high CCS (OR=1.20 [95% CI: 1.02, 1.42]) and very high CCS (OR=1.47 [95% CI: 1.03, 2.11]). Similar adverse associations were also present for NO2 and high CCS (OR=1.13 [95% CI: 1.02, 1.25]) and very high CCS (OR=1.25 [95% CI: 1.06, 1.47]). These findings were independent of age, sex, body size, smoking, comorbidities and socio-economic status. Conclusions Ambient air pollution was associated with degree of coronary calcification, independent of standard risk factors. The link between air pollution and CAD is not limited to acute events but appears to include atherogenesis. Funding Acknowledgement Type of funding source: None

Pericoronary adipose tissue computed tomography attenuation distinguishes different stages of coronary artery disease: a cross-sectional study.

Vascular inflammation inhibits local adipogenesis in pericoronary adipose tissue (PCAT) and this can be detected on coronary computed tomography angiography (CCTA) as an increase in CT attenuation of PCAT surrounding the proximal right coronary artery (RCA). In this cross-sectional study, we assessed the utility of PCAT CT attenuation as an imaging biomarker of coronary inflammation in distinguishing different stages of coronary artery disease (CAD). Sixty patients with acute myocardial infarction (MI) were prospectively recruited to undergo CCTA within 48 h of admission, prior to invasive angiography. These participants were matched to patients with stable CAD (n = 60) and controls with no CAD (n = 60) by age, gender, BMI, risk factors, medications, and CT tube voltage. PCAT attenuation around the proximal RCA was quantified per-patient using semi-automated software. Patients with MI had a higher PCAT attenuation (-82.3 ± 5.5 HU) compared with patients with stable CAD (-90.6 ± 5.7 HU, P < 0.001) and controls (-95.8 ± 6.2 HU, P < 0.001). PCAT attenuation was significantly increased in stable CAD patients over controls (P = 0.01). The association of PCAT attenuation with stage of CAD was independent of age, gender, cardiovascular risk factors, epicardial adipose tissue volume, and CCTA-derived quantitative plaque burden. No interaction was observed for clinical presentation (MI vs. stable CAD) and plaque burden on PCAT attenuation. PCAT CT attenuation as a quantitative measure of global coronary inflammation independently distinguishes patients with MI vs. stable CAD vs. no CAD. Future studies should assess whether this imaging biomarker can track patient responses to therapies in different stages of CAD.

Wellens syndrome: Prospective study of 40 observations

Wellens syndrome was first described in the early 1980s by Zwann, Wellens, and colleagues, who identified a subset of patients with unstable angina who had specific precordial T-wave changes and subsequently developed a large anterior wall myocardial infarction (MI). Wellens syndrome is also referred to as left anterior descending (LAD) coronary T-wave syndrome. Highlight the importance of recognizing wellens syndrome in the care of patients. We present a prospective study of 40 patients with Wellens syndome treated between june 2017 and december 2018 at The CNMS Hospital (Algiers). The following parameters were considered in this analysis: Age, gender, cardiovascular risk factors, characteristic of chest pain, Electrocardiographic aspects, Enzymatic profile, location of the coronary lesion, The delay between hospitalization and revascularization. There was a clear predominance of men with a sex ratio of 3 men for a woman, and we noticed that the prevalence increased after the age of 60, the main risk factors found in our patients were smoking, high blood pressure and diabetes mellitus, 3/4 of patients complained of typical anginal pain, the most common electrical aspect was Wellens syndrome type 1, the most frequent sites were the proximal and medium left anterior descending coronary artery (LAD), 50 per cent of the patients underwent revascularization within the first 24 hours of hospitalization with active stent placement, while 80 per cent had, within the first 48 hours. Wellens syndrome represents a critical LAD disease. Recognition of this ECG abnormality is very important because this syndrome represents a preinfarction stage of coronary artery disease (CAD) that often progresses to an extensive infarction.

Epicardial adipose tissue volume and annexin A2/fetuin-A signalling are linked to coronary calcification in advanced coronary artery disease: Computed tomography and proteomic biomarkers from the EPICHEART study

Background & aimsThe role of epicardial adipose tissue (EAT) in the pathophysiology of late stage-coronary artery disease (CAD) has not been investigated. We explored the association of EAT volume and its proteome with advanced coronary atherosclerosis. MethodsThe EPICHEART Study prospectively enrolled 574 severe aortic stenosis patients referred to cardiac surgery. Before surgery, EAT volume was quantified by computed tomography (CT). During surgery, epicardial, mediastinal (MAT) and subcutaneous (SAT) adipose tissue samples were collected to explore fat phenotype by analyzing the proteomic profile using SWATH-mass spectrometry; pericardial fluid and peripheral venous blood were also collected. CAD presence was defined as coronary artery stenosis ≥50% in invasive angiography and by CT-derived Agatston coronary calcium score (CCS). ResultsEAT volume adjusted for body fat was associated with higher CCS, but not with the presence of coronary stenosis. In comparison with mediastinal and subcutaneous fat depots, EAT exhibited a pro-calcifying proteomic profile in patients with CAD characterized by upregulation of annexin-A2 and downregulation of fetuin-A; annexin-A2 protein levels in EAT samples were also positively correlated with CCS. We confirmed that the annexin-A2 gene was overexpressed in EAT samples of CAD patients and positively correlated with CCS. Fetuin-A gene was not detected in EAT samples, but systemic fetuin-A was higher in CAD than in non-CAD patients, suggesting that fetuin-A was locally downregulated. ConclusionsIn an elderly cohort of stable patients, CCS was associated with EAT volume and annexin-A2/fetuin-A signaling, suggesting that EAT might orchestrate pro-calcifying conditions in the late phases of CAD.