Tool For Coronary Artery Disease Research Articles

A Review of Factors Affecting Radiation Dose and Image Quality in Coronary CTA Performed with Wide-Detector CT

Compared with traditional invasive coronary angiography (ICA), coronary CT angiography (CCTA) has the advantages of being rapid, economical, and minimally invasive. The wide-detector CT, with its superior temporal resolution and robust three-dimensional reconstruction technology, thus enables CCTA in patients with high heart rates and arrhythmias, leading to a high potential for clinical application. This paper systematically summarizes wide-detector CT hardware configurations of various vendors routinely used for CCTA examinations and reviews the effects of patient heart rate and heart rate variability, scanning modality, reconstruction algorithms, tube voltage, and scanning field of view on image quality and radiation dose. In addition, novel technologies in the field of CT applied to CCTA examinations are also presented. Since this examination has a diagnostic accuracy that is highly consistent with ICA, it can be further used as a routine examination tool for coronary artery disease in clinical practice.

How to predict myocardial injury in patients with large ischaemic burden identified during stress echocardiography?

Abstract Background/Introduction Stress echocardiography (SE) is well established diagnostic tool in coronary artery disease (CAD) with broadly agreed consensus for the indications and protocols. There is, however, no clear non-invasive SE parameter in identifying high risk features in patients with large burden of inducible regional wall motion abnormalities (RWMA) that would require prompt treatment or urgent admission. Purpose To identify high risk features during SE associated with myocardial injury following a positive SE with large amount of RWMA. Methods All consecutive patients referred for SE from June 2019 to November 2022 to diagnose coronary artery disease were assessed for inducible RWMAs using a hybrid protocol (low dose Dobutamine and exercise on supine bike with 3 min increments of workload of 25W). Those with ≥4/17 segments of inducible RWMAs underwent measurement of Troponin level 1 hour after the test termination. Somatometric characteristics, risks factors, symptoms, haemodynamic pre- and during SE and results of subsequent coronary angiography were recorded. Results 631 patients were referred for assessment of CAD. 87 patients had ≥4/17 inducible RWMAs out of 152 patients with positive SE. 61/87 who had Troponin measurements were included in the analysis. Mean age was 65 ± 13 yo, 61% were male. There was high prevalence of known CAD (77%) and cardiovascular risks factors as hypertension (59%) and hyperlipidaemia (61%). The median exercise time was 9 minutes, 46% developed chest pain (CP), 49% - ECG changes, 39% - left ventricular (LV) dilatation and 74% - reduction in LVEF. Troponin was positive in 25/61 patients. Invasive coronary angiography confirmed clinical CAD in 51/61 patients. 5 patients had either normal angiogram or non-obstructive CAD, 5 patients were awaiting diagnostic test. The severity of CAD appears to be associated with magnitude of Troponin release (1 vessel disease - 16.5 ng/L, 2 vessels disease - 39.9 ng/L, 3 vessels disease – 58.2 ng/L). All patients (6/61) with higher troponin values (>90ng/L) had multivessel disease involving the left anterior descending (LAD) artery. Interestingly, 2/5 patients without CAD had elevated Troponin suggesting possible ongoing myopathic process. The only non-invasive SE parameters that were significantly related to troponin increase were recovery time (P=0.001) and exercise time (P<0.05) whereas symptoms, BP response and LVEF reduction showed a trend which did not achieve significance. Conclusions In patient with positive SE with large burden of inducible RWMAs prolonged recovery time and low threshold for ischaemia appear to be the most reliable characteristic to identify patients with potential myocardial injury and should be used as a triaging tool for admission or early invasive assessment.

The association between mammographic breast density, epicardial adipose tissue volume and coronary artery disease

Abstract Background Dysfunctional adipose tissue is strongly linked to cardiometabolic disease. Epicardial adipose tissue (EAT) which is measurable on cardiac computed tomography (CT) is well correlated with cardiovascular disease (CVD), however it is not reported clinically. Breast mammography mandates reporting of breast density (BD), which is also a marker of breast adipose tissue quantity with less dense breasts indicating greater adipose tissue volume. Given the widespread use of screening mammography, this presents an opportunity to employ BD as a possible surrogate for CVD risk. Purpose To evaluate the correlation between BD, EAT and coronary artery disease (CAD). Methods Single-centre, retrospective, cross-sectional study, including women who had both clinically indicated coronary computed tomography angiogram (CCTA) and mammography. Epicardial adipose tissue volume (EATv) was quantified using semi-automated software (QFAT 2.0). BD was visually assessed by standard 4-level Breast Imaging-Reporting and Data System (BI-RADS) grade with grade A-B representing low density, and C-D representing high density. CAD was categorised as presence/absence of any coronary artery plaque, and CAD severity was quantified using the Coronary Artery Disease Reporting and Data Systems (CAD-RADS) score, with CAD-RADS 1-2 representing mild disease, CAD-RADS 3 moderate disease and CAD-RADS 4 severe disease. CAD analyses were adjusted for modifiable (hypertension, dyslipidaemia, diabetes, body mass index) and non-modifiable (age, past smoking, family history, breast cancer) risk factors. Logistic regression was performed with results presented as Odds Ratio (OR) and [95% Confidence Intervals]. Results Among 153 patients (mean age 62±10), 103 (67.3%) had low BD (high breast adiposity). Compared with high BD, low BD patients were older, had greater rates of hypertension, had significantly higher mean EAT (106.6 ± 43.0 vs 81.0 ± 31.6ml, p<0.001) (Figure 1), and body mass index (30.5 ± 6.3 vs 26.4 ± 5.4kg/m², p<0.001). Adjusted for age and hypertension, EATv remained independently predictive of low BD (OR:1.02 [1.01-1.03], p=0.006). Low BD made up a higher proportion of mild (76.5%), moderate (73.9%) and severe (80.0%) disease. Low BD was strongly associated with presence of CAD (prevalence 75% vs 48%, OR 3.21 [1.58-6.53], p=0.001) independent of EATv (p=0.25), and independent of modifiable (OR: 2.69 [1.24-5.92], p=0.012) and non-modifiable (OR: 2.42 [1.04-5.85], p=0.047) risk factors (Figure 2). Conclusions Low breast density is associated with higher EATv and independently associated with CAD presence beyond EATv and other risk factors. Consequently, mammographic breast density may act as an early risk identification tool for CAD in women.

Severity Stratification of Coronary Artery Disease Using Novel Inner Ellipse-Based Foveal Avascular Zone Biomarkers.

Given the similarities between the retinal and coronary microvasculature, the retina holds promising potential to serve as a non-invasive screening tool for coronary artery disease (CAD). We aimed to develop novel inner ellipse-based metrics and discern whether foveal avascular zone (FAZ) alterations can serve as indicators for CAD presence and severity. Patients admitted to the Department of Cardiology who underwent coronary angiography were included. This resulted in an inclusion of 212 patients, of which 73 had no CAD. During the same visit, 6 × 6-mm (nominal size) fovea-centered optical coherence tomography angiography images of both eyes were acquired. The Gensini score (GS) was utilized to quantify CAD severity. Six known FAZ shape metrics were assessed and three novel biomarkers based on the inner ellipse were defined: absolute inner ellipse difference, Hausdorff distance, and Chamfer distance. Eight out of nine metrics showed significant associations with the GS in the left eye. However, significant differences across three CAD severity groups were only demonstrated by the novel metrics. Utilizing the Chamfer distance, age, and sex, patients with and without CAD could be distinguished with an average area under the curve (AUC) of 0.89 (95% confidence interval [CI], 0.84-0.95). Moreover, three CAD severity groups could be discerned with a macro average AUC of 0.77 (95% CI, 0.72-0.84). A comprehensive assessment of FAZ shape descriptors was performed, and a strong association with CAD was found. The inner ellipse-based biomarkers especially demonstrated high predictive abilities for CAD presence and severity.

Direct and accumulative DNA damage level in patients underwent coronary CT angiography

Background and objectiveCoronary Computed Tomography Angiography (CCTA) is a highly accurate non-invasive diagnostic tool for coronary artery disease, and concerns exist about the potential DNA damage caused by the ionizing radiation it employs. This study aimed to investigate the impact of CCTA radiation on DNA damage. Materials and methodsFor each 45 participating patients, both pre-and post-radiation, blood samples were collected at two different time points: (first group = 25) blood samples were collected 1 h after exposure CT, and (second group = 20) blood samples were collected 24 h of post-exposure. Before radiation exposure, baseline blood samples were collected from all participants to establish a reference point representing their normal biological parameters. Various factors were documented, including patient characteristics like age, gender, weight, and height, as well as exposure factors kV, mA, DLP, and CTDIvol. The study's practical aspect encompassed applying three specific methods: measurement of peripheral DNA damage level by alkaline comet assay, 8-Hydroxy-deoxyguanosine, and total antioxidant status. The statistical analysis was carried out using JMP Pro 14.3.0. ResultsThe results showed a non-significant increase in 8-OHdG levels for two sample groups. The mean levels for TAOS before exposure were 0.62 ± 0.13 U/ml and 0.53 ± 0.18 U/ml, respectively. After exposure, there was a non-significant decrease in the first sample (p-value 0.4416), but a significant decrease in the second sample (p-value 0.0104). An increase in DNA damage was observed in patients after CCTA radiation compared to the non-exposed group. There was a statistically significant difference in the frequency of DNA damage level (% Tail DNA) in lymphocytes between both groups. ConclusionOptimizing CCTA dose parameters and utilizing prospective techniques are considered the best approaches for reducing radiation exposure effectively. These strategies contribute to patient safety and align with the overarching goal of maintaining the highest diagnostic accuracy.

Is dobutamine stress echocardiography a good screening tool for coronary artery disease in breast cancer patients that underwent treatment with radiotherapy?

Abstract INTRODUCTION Accelerated atherosclerosis has been described in breast cancer patients receiving cardiac exposure from adjuvant radiotherapy (RT). As a result of multidisciplinary care, breast cancer cure rates have improved in recent decades. Therefore, evaluating radiation-induced heart disease (RIHD), especially coronary artery disease (CAD), is essential. The 2022 cardio-oncology European Society of Cardiology (ESC) guidelines recommend screening patients 5 to 10 years after RT for CAD according to cardiovascular risk factors. This screening is generally recommended with exercise stress echocardiography since it can assess the physiological functional performance. Until now, it is unknown if dobutamine stress echocardiography (DSE) is an equal screening tool and if it can predict major adverse cardiovascular events (MACE) (myocardial infarction, stroke, cardiac death, revascularization). PURPOSE Evaluate if DSE is an adequate tool to stratify and predict MACE in post-radiotherapy patients. Methods A retrospective, descriptive cohort study was conducted. Patients who had chest RT for breast cancer and underwent DSE from 2000 to 2022 were included. A bivariate analysis, including Kruskal Wallis and Pearson Chi-Squared test, was done to identify variables associated with a positive DSE. A multivariable Cox Model for MACE and a time-to-event curve for MACE were also performed. Results We identified 163 patients that underwent DSE after a median time of 5.8 years from the end of RT. The median age was 74 years, 98.2% were female, 50% had left and 45% right breast cancer, 81% had hypertension, 41% diabetes mellitus, 71% dyslipidemia, 34% were smokers, and 19% had a prior myocardial infarction. The average dose of photon RT to the chest was 55Gy in the cohort, and 40% received chemotherapy before RT. Patients were divided into two groups: positive and negative DSE. A positive DSE was seen in 19.6%. The median (Q1, Q3) regional wall motion abnormalities (RWMA) of patients with a positive DSE was 1 (1, 1.015) at baseline and 1.280 (1.190, 1.520) at peak stress, and for a negative DSE, was 1 (1, 1) at baseline and peak stress. 88.2% of negative DSE and 87.5% of positive DSE achieved the target heart rate of 85%. HTN, dyslipidemia, and prior MI were significantly associated with a positive DSE (p <0.023). The cumulative incidence of MACE was higher in the group of positive DSE (p<0.001), even after adjusting for hypertension, diabetes mellitus, dyslipidemia, smoking, and prior myocardial infarction, with a hazard ratio of 2.500 (1.51 – 4.13) and a p< 0.001. Similar results were observed regardless of RT laterality. Conclusions In breast cancer survivors that received adjuvant radiotherapy as part of multidisciplinary care, a positive DSE was an independent predictor of MACE compared to a negative result. These results support the usefulness of dobutamine stress echocardiography as a screening tool in breast cancer survivors.Kaplan-Meier Curve for MACE

Abstract 16044: Coronary Artery Calcium Score, a Superior Predictor of Cardiac Revascularization Risk Than Framingham

Introduction: The coronary artery calcium (CAC) score is a powerful independent screening tool for coronary artery disease (CAD). Elevated CAC score has been significantly associated with increased rates of revascularization, however the Framingham Risk Score remains the most used method of predicting patients’ risk for future revascularization. Hypothesis: The CAC score is a superior predictor of adverse cardiac events than the traditionally accepted Framingham Risk Score. Methods: Data was analyzed retrospectively of patients who underwent calcium score scans between August 2011 and April 2021 as part of the Sanford Cardiovascular Prevention Program and were categorized into low (<100), moderate (100-399), or high (≥400) CAC groups. The accuracy of revascularization prediction between subjects with CAC score and those without CAC score were evaluated by a ROC curve. Results: A total of 28,187 patients were screened for CAC score. 46% were females and the mean age was 61.4 ± 9.9 years. ROC predictive accuracy of patients with CAC scores (0.76) compared against those with no CAC score (0.71) was found to be statistically significant (Z = -6.27, P<0.01). Furthermore, total CAC was found to a significant predictor (b=.001, p<0.01) of revascularization above and beyond the additional risk factors with the pseudo R2 increasing from .08 for starting risk factors to .15 when total CAC was added for a pseudo R2 change of .07 Conclusions: In our study, CAC scoring was not only able to better predict the need for future revascularization compared to Framingham components but also able to improve the specificity of revascularization prediction when added to the Framingham components.

Effectiveness of Pre-TAVR CTA as a Screening Tool for Significant CAD Before TAVR

BackgroundComputed tomography angiography (CTA) and invasive coronary angiography (ICA) are routinely performed before transcatheter aortic valve replacement (TAVR) to assess aortic root anatomy and screen for coronary artery disease (CAD), respectively. ObjectivesThis study explored the efficacy of CTA as a screening tool for significant proximal CAD before TAVR. MethodsWith proper ethical oversight, patients undergoing TAVR at Cleveland Clinic with a preprocedural CTA and invasive coronary angiography (ICA), and no prior percutaneous intervention, were identified from 2015 to 2021. Blinded to ICA results, the authors reviewed the left main, proximal left anterior descending coronary artery, proximal left circumflex coronary artery, and proximal right coronary artery by CTA coronary reconstruction to assess for nonsignificant stenosis (0% to 49%), moderate stenosis (50% to 69%), and severe stenosis (≥70%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen Kappa statistic were analyzed. Results2,217 patients (53.4% male, age 79.2 ± 8.5 years) met inclusion criteria. CTA evaluation revealed a sensitivity of 90%, specificity of 92%, PPV of 74%, and NPV of 97% for detecting ≥50% stenosis. Using a ≥70% stenosis cutoff, evaluation revealed a sensitivity of 91%, specificity of 97%, PPV of 83%, and NPV of 99%. Assessment of bypass graft patency revealed a sensitivity of 86%, specificity of 97%, PPV of 84%, and NPV of 98%. Cohen Kappa analysis indicated substantial to near perfect agreement between pre-TAVR CTA and ICA. ConclusionsPre-TAVR CTA has a high NPV for high-grade proximal stenosis of each coronary artery. As a result, CTA can be used as a screening tool to rule out significant proximal CAD in patients undergoing TAVR.

Non-invasive Coronary Artery Disease Screening Based on Electrocardiogram Characteristics and Clinical Risk Factors.

Coronary artery disease (CAD), an acute and life-threatening cardiovascular disease, is a leading cause of mortality and morbidity worldwide. Coronary angiography, the principal diagnostic tool for CAD, is invasive, expensive, and requires a lot of skilled effort. The current study aims to develop an automated and non-invasive CAD detection model and improve its performance as closely as possible to clinically acceptable diagnostic sensitivity. Electrocardiogram (ECG) characteristics are observed to be altered due to CAD and can be studied to develop a screening tool for its detection. The subject's clinical information can help broadly identify the high-cardiac-risk population and serve as a primary step in diagnosing CAD. This paper presents an approach to automatically detect CAD based on clinical data, morphological ECG features, and heart rate variability (HRV) features extracted from short-duration Lead-II ECG recordings. A few popular machine-learning classifiers, including support vector machine (SVM), random forest (RF), K-nearest neighbours (KNN), Gaussian Naïve Bayes (GNB), and multi-layer perceptron (MLP), are trained on the extracted feature space, and their performance is evaluated. Classifiers built by integrating clinical data and features extracted from ECG recordings demonstrated better performance than those built on each feature set separately, and the RF classifier outperforms other considered machine learners and reports an average testing accuracy of 94% and a G-mean score of 92% with a 5-fold cross-validation training accuracy of 95(± 0.04)%.Clinical relevance- The proposed method uses a brief, single-lead ECG recording and performs similarly to current clinical practices in an explainable manner. This makes it suitable for deployment via wearable technology (like smart watch gadgets) and telemonitoring, which may facilitate an earlier and more widespread CAD diagnosis.

Aortic propagation velocity in predicting coronary artery disease: A systematic review and meta-analysis.

Coronary artery disease (CAD) and its outcome, myocardial infarction, is yet a significant etiology of mortality and morbidity nowadays. The aortic propagation velocity (APV) can be a simple, straightforward and novel echocardiographic index for the risk stratification in the evaluation of CAD. In this meta-analysis, we evaluated the predictive role of APV in CAD. Relevant electronic bibliographies (PubMed, ScienceDirect, Scopus, EMbase, the Cochrane library) were explored. Related reports were selected according to the inclusion and exclusion criteria. Meta-analysis was performed using the Comprehensive Meta-analysis 2.0 software. Eventually, 5 articles met the inclusion criteria and included in the meta-analysis. Five studies with 490 patients reported the APV mean in CAD and non-CAD groups. A random-effect model was used and the pooled findings demonstrated a significant higher APV in non-CAD group compared to CAD group (SMD: 2.39, 95% CI: 1.70-3.07, P < .001, I2: 84%, Q: 19.03). The diagnostic value of APV in predicting CAD showed 86.3% sensitivity (95% CI: 74-91, P value < .001, I2: 65%, Q: 8.53, P value: .03) and 83.8% specificity (95% CI: 69-94, P value < .001, I2: 60%, Q: 9.89, P value: .01). There was a predictive role of APV in CAD with suitable specificity and sensitivity. Moreover, aortic distensibility and aortic strain were significantly different in CAD and non-CAD patients. APV could be used as a good noninvasive tool for screening CAD.

Peripheral atherosclerosis evaluation through ultrasound: A promising diagnostic tool for coronary artery disease.

Effective treatment, but also proper diagnosis of cardiovascular diseases, remains a major challenge in everyday practice. A quick, safe, and economically acceptable non-invasive procedure should play a leading role in cardiovascular risk assessment before invasive diagnostics is performed. The staging of subclinical atherosclerosis may help in further clinical decisions. Safe, widely available, and relatively inexpensive, ultrasonography is a promising examination that should find wider application in clinical practice. The latest ESC guidelines emphasize the usefulness of carotid ultrasound in the diagnosis of coronary artery disease (CAD) and subclinical assessment of atherosclerosis, which help to determine the level of cardiovascular risk. Ultrasound examination of peripheral arteries, especially superficial vessels such as the femoral arteries, is quite easy, quick, and accurate. Other vascular beds, such as iliac and renal, are more demanding to examine, but can also provide valuable information. This review summarizes important studies comparing the severity of atherosclerosis in ultrasound-visible vascular beds in patients with established CAD. We especially emphasize the benefits of the combined assessment of atherosclerosis features, which were characterized by high sensitivity and specificity in the diagnosis of CAD and other serious cardiovascular diseases.

Incidental Breast Arterial Calcifications and Assessment of Coronary Artery Disease Risk: A Review and Recommendation.

Coronary artery disease (CAD) continues to be the leading cause of morbidity and mortality in women, contributing to about 20%, or nearly 400,000, of female deaths annually in the United States. Despite their significant burden from CAD, women have been traditionally underrepresented in trials, and therefore, there is still much to be studied regarding the sex-based variations that have been reported regarding the pathophysiology, clinical presentation, efficacy of diagnostic workup, and response to therapy in CAD. Previous studies have reported that breast arterial calcifications, commonly found incidentally on screening mammography, may be associated with risk of CAD; however, there are currently no specific guidelines concerning reporting and quantification practices, as well as further workup recommendations for patients who are found to have vascular calcifications. Thus, the question remains whether breast arterial calcifications can serve as a sex-specific marker for CAD, and whether there is enough evidence to support the use of mammography as a screening tool for CAD in women. In this review, we will summarize the current understanding of cardiovascular disease in women, the existing literature regarding breast arterial calcifications and current reporting practices, and the association of vascular calcifications with CAD risk; based on the collected evidence, we will make a recommendation whether screening mammography and breast arterial calcifications should be used to assess CAD risk, and if so, what additional workup, if any, we recommend in women found to have breast arterial calcifications on imaging.

Association of pentraxin in periodontitis patients with coronary artery disease.

Pentraxin 3 (PTX3) is a biomarker, associated with the pathogenesis of Periodontitis and coronary artery disease (CAD) individually, but their role in patients with both diseases remains unclear. The current study aims to evaluate the association of PTX in patients with concomitant periodontitis and CAD. In a case-control study, 240 participants were selected and divided into four groups. Nonperiodontitis + noncardiac = 60 patients, periodontitis + noncardiac (P + NC) = 60 patients, nonperiodontitis + cardiac (NP + C) = 60 patients, periodontitis + cardiac (P + C) = 60 patients. Demographic variables, cardiac and periodontal parameters were recorded. PTX was evaluated in the subgingival plaque and atheromatous plaque samples using real-time quantitative polymerase chain reaction and compared between the groups. The results were statistically analyzed. Among the demographic variables, age showed a significant difference between the groups. Systolic and diastolic blood pressure, low-density lipoprotein, and random blood sugar were significantly higher in NP + C and P + C groups (P ≤ 0.05). The plaque index, probing pocket depth, and clinical attachment loss were significantly higher in P + NC and P + C groups (P ≤ 0.05). PTX was significantly elevated in P + C group (P = 0.000). Pearson's correlation revealed a significant correlation between the periodontal parameters and PTX in both the cardiac and oral samples. PTX3 levels were elevated in CAD patients with periodontitis suggesting the influence of periodontal inflammation in the progression of CAD. PTX3 may serve as a diagnostic and prognostic tool for both periodontitis and CAD. This study could provide an understanding and awareness about the potential role of PTX3 in both periodontitis and CAD.

Angiographic Characteristics of Young Yemeni Patients Undergoing Diagnostic Coronary Angiography: Data from A Major Cardiac Center In Yemen

Background: Coronary artery disease (CAD) accounts for the greatest proportion of CVDs and is one of the most common causes of death in the developed countries. It is one of the main etiologies of disease burden in developing countries. There is increase in the number of patients with coronary artery disease in Yemen. The number of patients undergoing elective diagnostic coronary angiography is increasing among different age groups. This study was aimed to identify and compare the prevalence of the risk factors, clinical presentation, management, and angiographic characteristics of CAD between young patients (age ≤ 40 years) and older patients (age ≥ 40 years) presented with ischemic heart disease (IHD). Methods: A total of 555 patients were were enrolled between January 2013 and June 2013. Patient admitted in ward as one-day admission and discharged 6 hours after the procedure. Demographic data, clinical findings, and details of electrocardiographic and echocardiographic findings were recorded. The traditional cardiovascular risk factors (smoking, hypertension, Khat chewing, family history and diabetes mellitus, dyslipidemia) were noted. The patient included were patients with sable angina, post myocardial infarction and pre-operative coronary angiography before valve replacement. Results: The older group accounts for 90.3% while younger group accounts for 9.7% of the patients. The majority of patients in both groups were male (81.5% in the young and 74.5% in the older group). Most of the patients in the study were diagnosed as post MI angina. High incidence of diabetes and hypertension among the older group in comparison to the younger group (24.4% diabetes and 43.1% hypertensive Vs. 11.1% diabetes and 29.6% hypertensive). 50% of the younger group were smokers in comparison to 23.8% in older group with statistically significant difference (p=0.0001). Family history of IHD was higher in the younger age group (24.1%) than that in the older age group (16%) (p = 0.129). Dyslipidemia was not common risk factor among both groups. The percentage of Khat chewing did not differ between the two groups (70.4% and 62.5% in younger and older group respectively). Significant left main disease was more than double in younger group (3.7%) when compared older group (1.9%). About one-third (31.5%) of patients of younger group had significant LAD lesion while small number of older patients had significant LAD lesion (1.6%) (p = 0.037). The involvement of right coronary artery (RCA) was significantly higher in older group than in younger group (27.7% and 7.5% respectively; with p = 0.001). Although the incidence of left circumflex artery (LCX) disease was higher in older group (28.8% and 16.7% respectively) it did not reach statistical significance. The left anterior descending artery (LAD) was commonly involved vessel in the young group (31.5%) in comparison to older group (1.6%) while left circumflex artery and right coronary artery was common in in the older group. Conclusion: Coronary angiography is a useful diagnostic and therapeutic tool for CAD. Smoking, male gender as well as family history of cardiovascular diseases showed high prevalence in the in younger patients ≤ 40 years, while hypertension and diabetes were common in the older patients. Khat chewing was highly prevalent among both groups.

Utility of screening for silent myocardial ischaemia in diabetes with an annual electrocardiogram.

Asymptomatic coronary artery disease (CAD) is common in people with diabetes mellitus, but there is a lack of consensus regarding appropriate screening for the condition. We performed a 12-lead electrocardiogram (ECG) on 312 consecutive participants with diabetes mellitus attending for routine annual outpatient review in order to determine the effectiveness of a yearly ECG in screening people with diabetes for asymptomatic CAD. Three of 312 participants (0.96%, 95% CI 0.2%-2.78%) had a newly identified ECG abnormality. One person had newly discovered atrial fibrillation. Two people had abnormalities which prompted further investigation for asymptomatic CAD. One of these participants underwent percutaneous coronary intervention. Seventeen further participants had abnormalities on ECG which had been previously documented, the majority having been present since their diagnosis of diabetes. A low positive yield of routine annual ECG in our study does not support its use as a screening tool for asymptomatic CAD in diabetes. Our findings support advice to perform an ECG at diagnosis of diabetes and to repeat only if a person develops relevant symptoms.

Pengukuran Penyakit Arteri Koroner Dengan Menggunakan Ankle-Brachial Index (ABI)

Background: Coronary artery disease (CAD) is the main cause of death in the world. In this study we assessed the ankle-brachial index (ABI) as a screening tool for CAD. Methods: Between 2020 and 2023, a large population-based cross-sectional study was conducted on 4,207 new patients referred to Harapan Kita Hospital. The patients underwent selective coronary angiography via a radial artery approach. ABI was calculated for all patients. Researchers compared ABI with coronary angiography results to determine the specificity and sensitivity of ABI as a screening tool. Results: Abnormal ABI was significantly more common in patients with proven severe CAD (893, 54.8%) than in patients with proven mild CAD (33, 4.7%) or no CAD (94, 5.3% ). The specificity of the ABI was 95.3% and the sensitivity was 54.8%. ABI is associated with risk factors such as smoking, male gender, hypertension, diabetes mellitus and dyslipidemia. Conclusion: ABI can be used as a screening test to prevent CAD with a specificity of 95.3%. We need to consider risk factors other than ABI to improve screening sensitivity. Multidimensional scoring systems should consider risk factors and other noninvasive tests in addition to ABI to develop an ideal screening system for CAD

Evaluating the use of coronary artery calcium scoring as a tool for coronary artery disease (CAD) risk stratification and its association with coronary stenosis and CAD risk factors: a single-centre, retrospective, cross-sectional study at a tertiary centre in Pakistan

ObjectiveCoronary artery disease (CAD) risk stratification plays a fundamental role in the early detection and optimal management of CAD. The aim of our study is to investigate the use of...

Recent Advances in Coronary Computed Tomography Angiogram: The Ultimate Tool for Coronary Artery Disease.

The emerging technologies in multidetector computed tomography scanners gave the ability to image coronary arteries in a single heartbeat, at a higher quality, and low radiation dose. Furthermore, incorporating artificial intelligence and machine learning into image processing and interpretation have extended the use for coronary computed tomography angiogram (CCTA) and its applications. In this review, we will explore the recent evidence and advances supporting CCTA to become the ultimate tool for coronary artery disease. Results from the EVINCI, ISCHEMIA, SCOT-HEART, and PROMISE showed that CCTA is better in patients' risk stratification and in detecting subclinical atherosclerosis, resulting in earlier interventions and lesser events. Additionally, CCTA gave us a closer look on atherosclerotic disease by identifying different type of plaque and their clinical significance. Furthermore, FFRCT is a notable example of incorporating artificial intelligence into CCTA. This technology helped us to accurately and non-invasively identify flow limiting lesions, guiding revascularization. As a result of the recent evidence, CCTA have made its way into the chest pain guidelines all over the world. Moreover, CCTA have the potential to revolutionize our understanding and standards in screening, preventing, and managing heart disease.

OA28 Exploring the potential of polygenic risk scores for predicting coronary artery disease in patients with rheumatoid arthritis

Abstract Background/Aims Patients with rheumatoid arthritis (RA) have a higher prevalence of coronary artery disease (CAD) than the general population which contributes to early mortality. Current screening tools for CAD, which are developed in the general population, are less effective for estimating CAD risk in patients with RA. This reduced performance is mainly due to the differing contribution from traditional risk factors and the contribution from disease-specific factors. Our understanding of the genetic basis of CAD has improved over recent years and shows promise for improving risk prediction in the form of polygenic risk scores (PRS). We hypothesise that PRS can help us improve CAD risk prediction in patients with RA by providing more accurate models of risk. Methods Patients were recruited from the Norfolk Arthritis Register (NOAR), a detailed community-based longitudinal observational study focused on the cause and outcome of inflammatory polyarthritis, between 1990 and 2017. Analysis was restricted to patients who satisfied the 2010 ACR criteria cumulatively over five years and had detailed clinical history at baseline and follow-up. We developed a prediction model based on traditional risk factors and explored the inclusion of a PRS (49K SNPs) in a subset of patients with available genetic data. Cox proportional hazards models were used to derive risk equations for evaluation of 10-year risk of CAD. We applied multiple imputations with chained equations using the Random Forest algorithm to replace missing values. Measures of calibration and discrimination were determined in the validation cohort of 423 individuals. Results A total of 2123 patients were included in the analysis with 136 incident cases of self-reported CAD. The model using only traditional risk factors achieved an AUC of 0.72 (95% CI 0.71, 0.73), with a calibration slope of 1.03, and explained approximately 50% (95% CI 47, 52%) of the variance of the outcome. We found that being male reduces the risk by a factor of 0.82 (95% CI 0.68, 1.00). The hazard ratio for age was found to be 1.00 (95% CI 0.99, 1.01) indicating risk remains the same across all age groups. Inclusion of a CAD PRS increased the performance with an AUC of 0.76 (95% CI 0.75, 0.77), explained variance of 53% (95% CI 49, 56%) but with a slightly worse calibration slope of 0.91. Conclusion An integrated risk score, that combines traditional risk factors with a PRS, improves CAD prediction in patients with RA. Further research is required to better understand the role of heritable components contributing to CAD risk in RA patients. By refining the underlying PRS, we hope to further improve CAD risk prediction in RA patients, through this integrated approach. Disclosure M. Soomro: None. M. Stadler: None. S. Viatte: None. A. MacGregor: None. S. Verstappen: None. A. Barton: None. J. Bowes: None.

A novel algorithm for cardiovascular screening using conjunctival microcirculatory parameters and blood biomarkers

Microvascular haemodynamic alterations are associated with coronary artery disease (CAD). The conjunctival microcirculation can easily be assessed non-invasively. However, the microcirculation of the conjunctiva has not been previously explored in clinical algorithms aimed at identifying patients with CAD. This case–control study involved 66 patients with post-myocardial infarction and 66 gender-matched healthy controls. Haemodynamic properties of the conjunctival microcirculation were assessed with a validated iPhone and slit lamp-based imaging tool. Haemodynamic properties were extracted with semi-automated software and compared between groups. Biomarkers implicated in the development of CAD were assessed in combination with conjunctival microcirculatory parameters. The conjunctival blood vessel parameters and biomarkers were used to derive an algorithm to aid in the screening of patients for CAD. Conjunctival blood velocity measured in combination with the blood biomarkers (N-terminal pro-brain natriuretic peptide and adiponectin) had an area under receiver operator characteristic curve (AUROC) of 0.967, sensitivity 93.0%, specificity 91.5% for CAD. This study demonstrated that the novel algorithm which included a combination of conjunctival blood vessel haemodynamic properties, and blood-based biomarkers could be used as a potential screening tool for CAD and should be validated for potential utility in asymptomatic individuals.