Suspicion Of Coronary Artery Disease Research Articles

The relationship between epicardial fat volume and myocardial perfusion scintigraphy findings

Objectives: We investigated the epicardial fat volume (EFV) between patients with normal perfusion and reversible perfusion abnormalities in the myocardial perfusion scintigraphy (MPS) in patients with suspected coronary artery disease (CAD). In addition, we aimed to investigate the relationship of automated analysis parameters obtained in the MPS SPECT examination with EFV. Methods: A total of 295 patients (182 F, 113 M) who underwent MPS in our unit with the suspicion of CAD in the last 1 year and who had a recent thorax CT examination were included. EFV measurement in CT scans was done with Invesalius software. MPS was performed in all patients with a one-day stress and rest imaging protocol. In the stress study, imaging was performed approximately 30-45 minutes after intravenous injection of ~12 mCi Tc99m Sestamibi. Rest study imaging was performed approximately 30-60 minutes after intravenous injection of ~25 mCi Tc99m Sestamibi. Results: Median EFV was 53.00 ml (interquartile range: 23 ml, range 17-238 ml) in patients with normal MPS, and 62.00 ml in patients with myocardial ischemia on scintigraphy (interquartile range: 53 ml, range: 25-207 ml). The EFV value was statistically significantly higher in patients with reversible ischemia on MPS compared to patients with normal scintigraphy findings (p < 0.001). There was a statistically significant, low, and positive correlation between EFV and summed difference score (SDS) values (p = 0.002, r = 0.178). Conclusions: The EFV value was significantly higher in patients with reversible ischemia on MPS compared to patients with normal scintigraphy findings. Also there was a statistically low and positive correlation between EFV and SDS values. The automatic calculation of the EFV value during this examination may be a good additional parameter to detect the presence of ischemia.

Undiagnosed chronic respiratory disorders in symptomatic patients with initially suspected and excluded coronary artery disease: insights from a prospective pilot study.

Chronic respiratory diseases represent the third-leading cause of death on a global scale. Due to mutual symptoms with cardiovascular diseases and potential inappropriate attribution of symptoms, pulmonary diseases often remain undiagnosed. Therefore, we aimed to evaluate the prevalence of chronic respiratory disorders among symptomatic patients in whom suspected coronary artery disease (CAD) was ruled out. After CAD was excluded by invasive coronary angiography (ICA), 50 patients with chest pain or dyspnea were prospectively enrolled in this study. All patients underwent lung function testing, including spirometry and diffusion measurements. At baseline and the 3-month follow-up, standardized assessments of symptoms (CCS chest pain, mMRC score, CAT score) were performed. Chronic respiratory disease was diagnosed in 14% of patients, with a prevalence of 6% for chronic obstructive ventilation disorders. At 3-month follow-up, patients with normal lung function tests revealed a substantial improvement in symptoms (mean mMRC 0.70 to 0.33, p = 0.06; median CAT 8 to 2, p = 0.01), while those with pulmonary findings showed non-significant alterations or unchanged symptoms (mean mMRC 1.14 to 0.71, p = 0.53; median CAT 6 to 6, p = 0.52). A substantial proportion of patients with an initial suspicion of coronary artery disease was diagnosed with underlying chronic respiratory diseases and exhibited persistent symptoms.

P170 WHICH DIAGNOSTIC PROCEDURE IN CANCER SURVIVORS WITH CHEST PAIN? DESCRIPTION OF A CLINICAL CASE

Abstract Introduction Cancer and CVD often share common risk factors and pathophysiological mechanisms, the relationship can be amplified by oncological treatment. In the case of aromatase inhibitors (AIs), used for a long time in breast cancer (BC) expressing the estrogen receptor there is a significant association with dyslipidemia, metabolic syndrome, ischemic heart disease and heart failure. For this reason the ESC guidelines on Cardio–oncology (LG–CO) recommend the evaluation of the baseline CV risk using SCORE2 or SCORE2–OP and aggressive control of CV risk factors (RF) to be integrated with the management of cancer. In case of suspicion of coronary artery disease (CAD), ESC LG–CO recommended the adoption of ESC 2019 guidelines for CAD. We present a case of atypical chest pain (LG 2019 ESC CAD pre–test probability < 15%) in a woman at very high CV risk and in adjuvant therapy with AI for BC Clinical case August 2022: 63–year–old female with multiple RF (premature family history of CAD, smoke, hypertension and dyslipidemia) in adjuvant treatment with Exemestane (Letrozole not tolerated) for BC (2020: T2N0M0 ER 99%, PGr– HER2– Ki67 20%) presents in ER for chest pain typical for site, character and irradiation (constricting – burdening, retrosternal radiating to the neck and shoulders) mainly at rest, in the evening, very rarely induced by rapid efforts. Statin therapy was discontinued after initiation of letrozole therapy for arthralgias – myalgias. At the most recent evaluation of blood chemistry: LDL cholesterol 185 mg/dl, Hb, glycemia and thyroid hormones were normal. ECG and rest, troponin, echocardiogram and exercise ECG were normal. Non–synchronized CT with ECG, performed for tumor staging, showed the presence of multiple calcifications on DA, CX and CD (Figure 1). The CGF confirmed the presence of a critical stenosis on the right coronary artery (Figure 2) and a non–critical stenosis on the DA (Figure 3). Successfully performed PTCA with DES implant and started DAPT + high intensity statin with Ezetimibe in addition to antihypertensive therapy obtaining asymptomaticity and optimal control of CV risk factors (FR) Conclusions Aggressive control of CV RF is mandatory in women with BC on AI therapy and high CV risk; the onset of symptoms suggestive of CAD must not be overlooked and in this context coronary CT can be a valid tool for estimating the atherosclerotic burden and to establish the diagnosis.

Can prediabetes diagnosed using HemoglobinA1c or oral glucose tolerance test predict presence and severity of coronary artery disease in symptomatic patients?

We investigated whether prediabetes diagnosed by hemoglobinA1c (HbA1c) or oral glucose tolerance test (OGTT) could predict presence and severity of coronary artery disease (CAD) in symptomatic patients. The presence of plaque, stenosis, plaque characteristics, and coronary artery calcium (CAC) were evaluated by coronary CT angiography in 702 patients with suspicion of CAD. Patients were classified by glycemic status using the American Diabetes Association criteria for HbA1c and OGTT, and compared to their respective normal ranges. Prediabetes was observed in 24% by HbA1c and 72% by OGTT. Both prediabetes classifications were associated with increased presence of plaque, stenosis, calcified plaques, CAC >400, and a lower frequency of zero CAC compared to their respective normal range (all, p < 0.05). After adjusting for potential confounders, patients with HbA1c-prediabetes had an odds ratio of 2.1 (95% CI: 1.3-3.5) for CAC >400 and 1.5 (95% CI: 1.0-2.4) for plaque presence, while none of the associations for OGTT-prediabetes were significant. The receiver operating characteristic-curve for HbA1c-prediabetes showed an area under the curve of 0.81 for CAC >400 and 0.77 for plaque presence. Prediabetes defined by HbA1c predicts presence and severity of CAD. Although OGTT identified more patients with prediabetes, their risk of CAD were not explained by prediabetes using these diagnostic-criteria.

Incidental Coronary Artery Disease on Routine CT Coronary Angiography –An evidence-based approach

Atherosclerotic coronary artery disease is the leading cause of high morbidity and mortality across the globe [1]. Coronary CT angiography has emerged as a highly accurate non-invasive diagnostic modality for the diagnosis of atherosclerotic coronary artery disease [2]. Coronary CT angiography should be considered as an alternative to stress imaging technique for ruling out atherosclerotic coronary artery disease in patients with the lower range of intermediate pre-test probability for atherosclerotic stable coronary artery disease. However, coronary CT angiography is not recommended as a screening test in asymptomatic individuals without clinical suspicion of coronary artery disease. CT Coronary angiography has been performed routinely before many of the cardiac and non-cardiac procedures like TAVI, atrial fibrillation ablation prior to the organ transplantation. Many a times, advised by Family Physician or patients themselves for a routine screening for atherosclerotic coronary artery disease undergo CT coronary angiography. When incidental atherosclerotic coronary artery disease is found in such patients who do not have any typical or atypical symptom suggestive of coronary artery disease then question arises how to approach this patient as far as the risk estimation for future adverse cardiovascular event and prognostication is concerned. It also becomes imperative to decide the line of management for this patient. To answer these two pertinent questions, we need to understand the behavior and natural history of atherosclerosis &amp; performance of CT coronary angiography in diagnosis and in predicting the prognosis of atherosclerotic disease.

Lipoprotein (a) is a risk factor of aortic valve calcification in patients with a risk of atherosclerosis.

Aortic valve calcification (AVC), which causes aortic stenosis (AS), is more common in elderly persons. Controlling for conventional risk variables did not, however, reduce the incidence of AS. Thus, residual risk factors of AS should be identified. We enrolled 513 patients who underwent coronary angiography with computed tomography because of suspicion of coronary artery disease (CAD) or ruling out of CAD before aortic valve replacement. Calcium volume was calculated with a commercially available application. Conventional and lipid-related risk factors including serum levels of Lp(a) were evaluated for all patients. Calcium volume and Lp(a) levels were significantly higher in patients who underwent aortic valve replacement than in those who did not. A single regression analysis showed that the calcium volume was positively associated with age and the Lp(a) levels and negatively associated with the estimated glomerular filtration rate. No statistical significance was observed for other risk factors, including oxidized low-density lipoprotein, omega-3 fatty acids levels. The multiple regression analysis revealed that age (P<0.001), female sex (P<0.05), Lp(a) (P<0.01), and hemoglobin A1c (P<0.01) were determinants of the calcium volume. The area under the curve in receiver operating characteristic analysis of Lp(a) for implementation of AVR was 0.65 at an Lp(a) cut-off level of 16 mg/dL. In conclusion, the serum Lp(a) level is a potent risk factor of AVC in patients with high risk of atherosclerosis. J. Med. Invest. 70 : 450-456, August, 2023.

Chronic ischemia in Left anterior descending artery territory presenting as intractable hiccups: An unusual symptom of coronary artery disease.

Classical symptoms of ischemic heart disease include exertional chest pain associated diaphoresis, palpitations or shortness of breath. Yet, it can also present unusually with symptoms ranging from epigastric discomfort, fatigue and vomiting. A 48 years old male presented to the hospital with severe retrosternal chest pain for 6 hours duration. ECG showed acute anterior wall STEMI. Primary PCI to LAD was performed successfully. He had been complaining of intractable hiccups for the past one year for which he had been seen in gastroenterology clinics multiple times with no relief in hiccups. After we performed primary PCI to LAD, he had complete resolution of hiccups. He is still under regular follow up with us for the past 4 months with no active complaints of hiccups. This case conclude that Intractable hiccups can be the only symptomatic manifestation of coronary artery disease (CAD) in some patients. Therefore, a high suspicion of CAD should be kept in mind especially in patients with risk factors for CAD.&#x0D;

Correlation between Left main artery diameter derived by Finet’s Law and direct angiographic quantitative coronary dimension analysis

Background and Aims: In the era of left main angioplasty, the aim of this study is to evaluate the applicability of Finet’s law in left main diameter calculation and establish this as a useful feasible alternative tool to intravascular ultrasound in the left main intervention.&#x0D; Methods: A total of 164 patients who underwent coronary angiography at PAHS due to suspicion of coronary artery disease between 1st January 2017 and April 2020 were included. The left main diameter(do-QCA) was calculated using the Quantitative coronary angiographic (QCA) method and correlated with the Left main diameter (do-finets) derived from Finet’s law which takes into account the diameter (d1) of the proximal left anterior descending artery (LAD) and left circumflex (LCX) diameter (d2) derived from QCA, added together and multiplied by the factor of 0.678 i.e do-finets=0.678(d1+d2).&#x0D; Results: Using the Bivariate Pearson correlation method, do-QCA was found to have a positive correlation with do-finets with a correlation coefficient of (r=0.721) significant at the level of P value 0.01 (2-tailed).&#x0D; Conclusion: The application of Finet’s Law using the QCA method has been found to be a handy feasible alternative tool to intravascular ultrasound in calculating the left main diameter for the left main intervention where intravascular ultrasound is not available or economic constraint prevails.

Abstract 14822: Lipoprotein (a) is a Residual Risk Factor of Aortic Valve Calcification in Patients With High Risk of Atherosclerotic Disease

Introduction: The number of patients with aortic valve stenosis which results from aortic valve calcification (AVC), has been increasing in the elderly population. The risk factors of AVC include diabetes, dyslipidemia, and hypertension. However, control of these risk factors has not resulted in a decreased incidence of AVC. Increased Lipoprotein (LP) (a) and oxidized low-density lipoprotein (LDL), or decreased omega 3-fatty acids, are the candidates for serum biomarkers of residual risk factors. However, the most contributable risk factors for AVC has not been identified. Methods: We enrolled a total of 618 patients who underwent coronary angiography by computed tomography because of suspicion of coronary artery disease (CAD). Calcium scores were calculated using imaging software (3mensio Medical Imaging) and existence of coronary stenosis was evaluated. Patients who were suspected of having significant coronary stenosis underwent coronary angiography to confirm the existence of ischemic heart disease. Patients were evaluated for residual risk factors including Lp(a), oxidized LDL, omega 3- and 6-fatty acids, and C-reactive protein in addition to markers of conventional risk factors. Result: The calcium score in patients who received aortic valve replacement was significantly higher than that in patients who did not undergo AVR. There were no difference between the calcium scores in patients with CAD and those without CAD. Univariate analysis showed that the calcium score was associated with levels of Lp(a) (P&lt;0.01) but not with omega 3- and 6-fatty acids, oxidative LDL, hemoglobin A1c, LDL- and HDL-cholesterol, triglycerides, and C-reactive protein. Multivariate analysis showed that increased Lp(a) and age were independently correlated with the calcium score (P&lt;0.01), but sex and the existence of other conventional risk factors including hypertension, dyslipidemia, and chronic kidney disease were not. Conclusion: Serum Lp(a) is a potent risk factor for AVC in patients with high risk of atherosclerosis. Lowering Lp(a) may be a potential strategy for prevention of AVC. Intervention studies involving methods of lowering Lp(a) are needed to confirm the results.

Association of propionate with coronary artery disease in a large cross-sectional study

Abstract Background Microbiome has been linked to the pathogenesis of coronary artery disease (CAD) but data providing direct evidence for an association of short-chain fatty acids (SCFA) like propionate with CAD are lacking. Purpose To study the association of propionate in blood samples with the presence of CAD Methods This was a cross-sectional study enrolling patients admitted to invasive coronary angiography in a university hospital in Germany. Patients were prospectively recruited between from March 2017 to January 2020. Patients with known or suspected CAD and risk factors for cardiovascular diseases were screened for eligibility to participate in the trial. Main exclusion criteria were inflammatory/rheumatic disease, active cancer disease and acute infection. Blood sampling was performed after overnight fasting and before invasive procedures. Measurement of propionate was performed though liquid chromatography. Results The study included 691 patients (median n [IQR] age, 69 [60–78] years; 406 men [59%]). A total of 368 had invasively confirmed CAD with at least one coronary artery stenosis ≥50% and 323 had non CAD and 194 had invasively excluded CAD. 129 additional patients without suspicion for CAD and without diabetes/smoking were also recruited in the no CAD group. CAD patients had significant lower levels of propionate (median) 6.08 μM (IQR, 4.31–7.65) compared to the no CAD groups 6.92 μM (4.89–9.25, &amp;lt;0.05). Linear regression multivariate analysis adjusted for age, gender, body mass index, hypertension, smoking, diabetes and hyperlipidemia revealed an odds ratio of 0.92 (CI 0.89–0,96, p&amp;lt;0.001) for propionate as predictor of CAD. Conclusions The study provides large-scale data for a protective role of propionate in the development of CAD, independent of the presence of other known cardiovascular risk factors. Funding Acknowledgement Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Internal Grant, Medical School of Brandenburg

Obstructive coronary artery disease in symptomatic diabetics with zero coronary calcium score: are we missing something?

Prevalence and severity of coronary artery disease (CAD) in symptomatic patients with zero coronary artery calcium score (CACS) are unclear, particularly in regard to the diabetic population, which represents, per se, a subgroup at increased cardiovascular risk. The aim of this study was to investigate the prevalence and severity of CAD by coronary computed tomography angiography (CCTA) in a symptomatic diabetic cohort with zero CACS. All consecutive symptomatic diabetics referred for CAD suspicion were included in this study. All subjects underwent a noncontrast coronary artery calcium scan followed by CCTA. CACS was quantified using the Agatston method. CAD was defined as a total plaque score (TPS) greater than zero. Obstructive and severe obstructive CAD were defined respectively as luminal stenosis >50% and >70% in at least one coronary segment. We identified 1722 symptomatic diabetics (mean age 62.5 ± 12.9 years, 62% men). One hundred and eleven subjects had zero CACS and TPS >0 (mean age was 49.5 ± 14.8, 58% women, 56% Hispanics). Sixty-five patients (58.5%) had one-vessel disease, followed by 30 (27%) with two-vessel disease and 14 (12.6%) with ≥ three-vessel disease. Obstructive CAD was found in 11 subjects and, among these, three were categorized as severe obstructive CAD. In symptomatic diabetic patients with zero CACS, CAD, including obstructive disease, can still occur and is predominant in middle-aged adults, women and Hispanics. In symptomatic diabetics CCTA is a critical step for accurate risk stratification even when CACS would have placed some of these individuals in a lower-risk category.

Coronary Artery Dissection and Myocardial Infarction Due to Blunt Chest Trauma

Introduction: Coronary artery dissection and myocardial infarction happen rarely after BCT (3). In the following, a rare case of acute myocardial infarction (AMI) caused by the dissection of left anterior descending (LAD) artery following BCT due to suffering a blow in boxing is presented. Case presentation: A 22-year-old professional boxing athlete presented with chest pain and dyspnea from a week ago to our center. A week before the visit, the patient referred to the general hospital complaining from chest pain and nausea after suffering a blow during boxing. According to the ECG and normal cardiac troponin, the patient was discharged with diagnosis of Prinzmetal Angina (without coronary angiography). When referring our center, lead electrocardiogram (ECG) was done and showed ST segment elevation on V1-V4 leads and T inversion on aVL and I leads. According to wchocardiography, (LVEF) was calculated to be 45%. Angiography was performed due to the lack of definitive diagnosis and suspicion of coronary artery disease. Results of angiography showed coronary artery dissection on LAD. Finally, the patient was diagnosed with AMI due to LAD dissection and was subjected to angioplasty intervention Discussion: In our case, BCT resulted in LAD dissection after a less common cause of trauma. Not having a serious risk factor, the presence of atypical symptoms of the disease, as well as evidence of ST segment elevation without increasing the cardiac enzyme led to dilemma and delayed diagnosis, and the diagnosis of Prinzmetal angina was mistaken for the patient. So due to failure of improvement and further investigation, the diagnosis of AMI due to LAD dissection after BCT reached certainty

Evaluation of Prevalence and Features of Coronary Artery Anomalies using Multidetector-row Computed Tomography

Aim: To evaluate the course, origin and termination of coronary artery anomalies in subjects demonstrating various symptoms and undergoing multidetector CT coronary angiography for evaluation of coronary disease. Study Design: Retrospective study Place and duration: Ch.Pervaiz Elahi Institute of Cardiology Multan from January 2021 to January 2022. Methodology: The study included patients who were referred to the radiology department because of suspicion of coronary artery disease. The data of these patients were reviewed for the course and origin of coronary artery anomalies. A 64-slice scanner was used for MDCT coronary angiography. At the start of acquisition contrast arriving coronary arteries were synchronised using the bolus tracking technique. The whole heart was imaged during apnea using 80-90ml iodinated contrast material administered intravenously. Coronary arteries were evaluated using 3-D and multiplanar reformatted images Results: Total of 600 patients who were referred for MDCT coronary angiography. The subjects underwent screening because of various risk factors, chest pain, or similar symptoms. Coronary artery anomalies were diagnosed in 21 out of 600 (3.5%) patients, whose mean age was 52.6±10.8 years and 504 (84%) were male. 3(14%) patients had high take-off of RCA (right coronary right) and 4(19%) of LMCA (left main coronary artery). In 5(24%) patients left circumflex artery (LCx) and left anterior descending artery (LAD) originated separately from the left sinus of Valsalva (LSV). In 3(14%) patients RCA originated from the opposite sinus of Valsalva.RCA anomaly in 1 patient had a malignant course. Conclusion: The study shows that evaluation of coronary artery anomalies can viably be done using CT. Right diagnosis and treatment planning are based upon an understanding of the clinical significance and CT characteristics of different CAAs. Keywords: Coronary artery angiography, MDCT, prevalence

Coronary Sinus Diameter as a Potential Marker of Right Ventricle Impairment.

The aim of this study was to assess the influence of the parameters of the coronary sinus (CS) on the parameters that describe the function of the right ventricle (RV), which were calculated using cardiac computed tomography. Methods: A CT scan of the heart was performed on 150 patients due to suspicion of coronary artery disease using a Siemens Somatom Force (2 × 192 × 0.6) and a syngo.via workstation. The “CT coronary” and in some cases the generic presets were used to measure the CS ostium in millimeters (mm). The functional measurements of right heart ventricles were examined using the “CT cardiac function” automatic function on a 256 × 256 matrix. Results: The average diameter of the CS ostium was 16.29 ± 4.37 mm. In the group with RV impairment, it was 16.56 ± 4.76, whereas in the group with normal values of the RV, it was 15.98 ± 3.88 mm, p = 0.4199. The average angle of the entrance of the CS into the right atrium was 107.25° ± 9.68°. In the group with an RV impairment, it was 105.91° ± 9.22°, while in the patients with normal values of the RV, it was 108.82° ± 10.04°; p = 0.0682. A multiple regression showed that end systolic volume (p = 0.0017) and stroke volume (p = 0.0144) are important predictors of the CS ostium. Conclusions: Some relationships were found between the CS and the selected parameters that describe the function of the RV. This may suggest a role for the CS as a right ventricular buffer, which could potentially be treated as a marker of an RV impairment.

Optimal fluoroscopic viewing angles for stenting of the coronary aorto-ostial lesions.

BackgroundLong-term results after stenting aorto-coronary ostial lesions (AOL) are worse than those achieved in non-ostial locations. AOL interventions still pose a substantial challenge for interventional cardiologists. The aim of the study was to determine the optimal fluoroscopic viewing angles of the left and right coronary ostia, based on multislice computed tomography (MSCT) data.MethodsCardiac MSCT exams of 30 patients with clinical suspicion of coronary artery disease were analyzed. En face angles of both coronary ostia, as well as their optimal projection curves, were determined by 2 independent observers in a standard Dicom viewer, without any additional, specialized software add-ons, using a systematic, step-by-step approach. Spatial relations between the ostial plane and the aorta were also assessed.ResultsThe average en face angle of the left coronary ostium was RAO 23°, CAU 45°; for the right coronary ostium RAO 18°, CRA 5°. The mean inter-observer differences for the en face angles of the left and right coronary arteries were 5° and 7°, respectively.ConclusionsMultislice computed tomography data provide precise spatial information on the orientation of the coronary ostia and their relation to the aortic root. Their utilization for determining the patient-specific viewing angle may substantially facilitate percutaneous coronary interventions in AOL.

Serum levels of Branched Chain Amino Acids and its Correlation with CA disease severity in diabetics and non-diabetics

Background: Branched chain amino acids are classified as essential amino acids, their role in metabolic disease has recently been established. The current research sort to identify the correlation of BCAAs with severity of coronary artery disease in diabetics and non-diabetics. Aim: To measure and compare blood levels of BCAAs in the following groups of subjects: Diabetics and Non diabetics undergoing angiography under the clinical suspicion of coronary artery disease. Secondly, to correlate serum BCAA levels with Coronary Artery Disease severity by using Gensini Score in each group. Methods: 119 patients who underwent angiography were recruited from cardiology department Mayo hospital, Lahore. They were allocated into two groups, diabetic and non-diabetic on the basis of HBA1c. 5 ml blood was collected, serum was separated and BCAA levels were measured by using internationally available calorimetric kit. Results were described as mean ± SD. Normality of continuous variables were assessed by using Shapiro Wilks test. Variables which were not normally distributed were log transformed. Results: Over all three factors affected BCAA levels; age (Beta= -0.32, p &lt;0.001), male gender (Beta=-0.32, p=&lt;0.001) and diabetic status (Beta=-0.20, p=0.03). Significant factors affecting severity of CAD as indicated by Gensini score were BMI (p=0.016, Beta=-0.22) and age (p=0.019, Beta=0.23). Factors determining the likely diabetes in CAD patients were male gender (p=0.013, Odds ratio 4.92s), BCAA levels (p=0.03, Odds ratio 1.05), age (p=0.01, odds ratio=1.08) and Gensini Score (p=0.05, odds ratio=1.013). Conclusions In CAD patient’s serum BCAA level are affected by age, male gender and diabetes status. Secondly the severity CAD is mainly affected by BMI and age. However the correlation between Gensini score and BCAA is not significant. Keywords: Coronary artery disease, branched chain amino acids, diabetic, serum level

Normal coronary diameters in coronary angiogram at Patan Hospital, Nepal

This study aims to assess the normal coronary diameters of patient who underwent coronary angiogram in Patan Hospital. Angiographic and demographic data of a total of 307 patients (155 males, 152 females; mean age 62.09±11.06 years) who underwent elective coronary angiography in Patan Hospital due to suspicion of coronary artery disease between 2017 and 2020 and in whom coronary angiography documented normal coronary arteries without any intra-luminal irregularity were analyzed retrospectively. Proximal diameters of the main epicardial coronary arteries were measured quantitatively using automated software analysis (Allura, Philips). The mean diameter of unadjusted/adjusted left main coronary artery, proximal left anterior descending artery, proximal left circumflex artery, proximal right coronary artery were 4.87±0.85mm/2.8±0.54, 3.8±0.7/2.19±0.439, 3.4±0.7/1.98±0.44, 3.6±0.85/2.07±0.53 respectively. Our study findings contradict the traditional belief that females have narrower coronary arteries than males. Our study showed the females have statistically significant larger unadjusted Right Coronary Artery diameter and adjusted Left Main Coronary Artery diameter. We believe that our findings may contribute to the global data pool of normal coronary diameters and can be utilized in future studies as a database.

Lean or obese, the epicardial fat thickness is increased in diabetics of south India – is it a south Indian paradox?

Abstract Type 2 Diabetes Mellitus (T2DM) is considered a Coronary Artery Disease (CAD) risk equivalent (1) Increased epicardial fat (EFT) thickness is one hypothesis contributing to the disproportionate CV morbidity and mortality in T2DM (2). Studies have shown, EFT was higher in patients T2DM and high BMI compared to the non diabetic group. (3). The aim of our study was to determine if T2DM patients had an increased EFT thickness even when their BMI was normal or low and whether there was a relation between the T2DM duration and the EFT thickness. Study cohort consisted of 260 patients, who underwent coronary angiography (CAG) for suspected CAD. All patients underwent detailed history, examination, routine biochemistry, HBA1c, Anthropometric measurements such as weight, height, waist circumference and BMI. Transthoracic ECHO assessment of EFT was done one day prior to CAG using the ECHO unit with a 3.6MHz transducer. The EFT thickness was measured as the echo-free space between the myocardium and visceral pericardium on the right ventricular free wall in end-systole in the parasternal long and short-axis views for 3 cardiac cycles. CAG was performed in the fasting state, using the Judkins' technique, by the femoral or radial artery approach. The severity of CAD was assessed by modified Gensini scoring system. The collected data were analysed with IBM.SPSS statistics software. Of the 260 patients 90 (73.1%) were males and 70 (26.9%) were females. In this study, the average value for normal EFT was 5.2mm in the control group (HBA1c &amp;lt;7) and anything more than 6 was taken as abnormal. Patients were divided into 4 groups based on their HbA1c levels viz Group A (HbA1c &amp;lt;7), Group B (HbA1c 7–9), Group C (HbA1c 9.1–12) and Group D (HbA1c &amp;gt;12). The EFT increased with increasing HbA1c levels and the correlation was statistically significant P value 0.0005. There was no gender differences in EFT in our study. EFT was higher when the T2DM duration was &amp;gt;5 yrs which was statistically significant. p value 0.0005 (Table 1). There have been no reports of the correlation between the duration of DM and EFT in literature to the best of our knowledge.There was a strong correlation between HbA1c and EFT and the severity of the coronary lesions which was statistically significant. There was no correlation between the BMI and EFT or CAD (Figure 1) and the EFT was increased even in non obese diabetics. This may be due to the fact that EFT is a part of visceral obesity whereas BMI is a measure of generalised obesity. Our study showed a linear correlation between EFT thickness, HBA1c, duration of T2DM irrespective of BMI values confirming the recent thinking that regional fat depots such as EFT are of greater importance as a CAD risk factor than overall adiposity as was previously considered. ECHO measured EFT can be used to raise the clinical suspicion of CAD in asymptomatic diabetics and being non invasive can also be used for followup. Funding Acknowledgement Type of funding sources: None. Table 1. Relation of T2DM duration with EFTFigure 1. Relation of BMI to EFT

Mean Platelet Volume is Associated with Pancreatic β-Cell Dysfunction in Nondiabetic Patients with Coronary Artery Disease.

PurposeMean platelet volume (MPV) is an indicator of platelet activation. Pancreatic β-cell dysfunction is one of the fundamental defects contributing to the development of type 2 diabetes. The aim of this study was to assess the relationship between β-cell dysfunction and MPV in nondiabetic patients with coronary artery disease (CAD).Patients and MethodsA total of 1143 consecutive nondiabetic patients (874 males and 269 females; mean age 60.0±10.3 years) with CAD were recruited for this analysis. All patients were individuals who underwent coronary angiography with a suspicion of CAD. Homeostatic model assessment 2 (HOMA2) of β-cell function (HOMA2-β%) was performed, and β-cell dysfunction was defined by a HOMA2-β% in the lowest quartile.ResultsMPV was significantly higher in CAD patients with β-cell dysfunction than in controls [(10.6±1.0)fl vs (10.0±1.0)fl, P=0.011]. According to the multiple regression model, pancreatic β-cell dysfunction was independently associated with MPV (β=0.210, P=0.006) and age (β=0.008, P=0.028).ConclusionMPV was significantly elevated in nondiabetic CAD patients with β-cell dysfunction compared to patients with normal β-cell function.

How Can an Updated 320 Multi Detector Computed Tomography Low Dose Protocol Help in Assessment of Coronary Heart Disease

Abstract Background Coronary artery disease (CAD) is the single most common cause of death in the developed world, responsible for about I in every 5 deaths. The morbidity, mortality, and socioeconomic importance of this disease make timely accurate diagnosis and cost-effective management of CAD of the utmost importance. The recent years showed an overall increase in the use of CT for imaging of the heart and coronary arteries, coronary CT angiography is a rapidly growing technique that offers distinct advantages over traditional imaging techniques. However, because of rapid growth of this technique, radiation dose safety has been placed under the spotlight. Integration of dosesaving techniques will go a long way in maintaining diagnostic image quality and improving patient safety. Objectives The purpose of our study is the assessment of coronary artery disease by 320 MDCT and its capabilities of maintaining the quality of images and dose reduction improving patient safety. Patients and Methods This study was performed at New Cairo Police Hospital (Radiology department) and at Center in East Cairo, From October 2018 to October 2019, a total of 39 patients who had referred for CTCA for suspicion of coronary artery disease enrolled in our prospective study. Results In this study we used MDCT 64 with retrospective ECG-gating in 25.6% of patients (10 patients) and MDCT 320 with Retrospective ECG-gating was used in 25.6% (10 patients) and with Prospective ECG-gating in 48.8% (19 patients).we compared the radiation dose between prospective ECG-gating and retrospective ECG-gating acquisition techniques among all study population by the effective dose (ED) which is calculated from the DLP of the coronary scan. The effective radiation dose (ED) median was significantly lower in the prospective ECG-gating technique (7 msv) in comparison to retrospective ECG-gating technique (23 msv). We also compared the difference in radiation dose between MDCT 320 and 64 using retrospective ECG gating acquisition technique, the median (ED) was significantly lower in the 320 MI)CT technique (20 msv) in comparison to 64 MDCT (26 msv). The last comparison was the difference Of radiation dose between patients who underwent through MDCT 320 using two different techniques (prospective and retrospective), the median effective dose was lower in the prospective ECG-gating technique (7 msv) in comparison to retrospective ECG-gating technique (20 msv) this difference is also of high statistical significant value. Conclusion Prospective ECG-Gated CT coronary angiography protocol impressively reduces effective radiation doses in comparison to retrospective ECG-gated technique on 320 MDCT and is still sensitive for diagnosing significant coronary stenosis for patients with suspected CAD. Retrospective Coronary CT angiography can be performed with 320-MDCT with less radiation doses compared to 64-MDCT.