Traditional CAD Risk Factors Research Articles

Value of Platelet-to-Lymphocyte Ratio in Acute Coronary Syndrome for Predicting In-Hospital Complications and Mortality

Background: Acute coronary syndrome (ACS) refers to a spectrum of urgent heart conditions caused by a sudden decrease in blood flow to the heart. This condition demands immediate medical attention as it can lead to severe complications, including heart attack and death. The platelet-to-lymphocyte ratio (PLR) has recently gained attention as a potential biomarker for assessing the inflammatory status in ACS patients. Inflammation plays a crucial role in the pathophysiology of ACS, and biomarkers like PLR can offer insights into the severity and prognosis of the disease. Methods: This study was a prospective cross-sectional analysis conducted in Sulaymaniyah city, spanning from December 2021 to December 2022. The study included 100 patients who were diagnosed with ACS and subsequently hospitalized. Data collection involved comprehensive clinical histories, physical examinations, and laboratory analyses. Among the laboratory tests, complete blood counts were performed to calculate the PLR for each patient. Based on their PLR levels, patients were categorized into two primary groups for comparative analysis. Results: In a study of 100 ACS patients (mean age 61.54 years, 69% male), elevated PLR correlated with lower oxygen saturation, more frequent STE-ACS (70.6%), and higher in-hospital complications, including mortality (11.8%). No significant links were found between PLR and traditional CAD risk factors. Conclusion: The findings of this study underscore the potential prognostic value of PLR in ACS patients. Elevated PLR was significantly associated with worse oxygen saturation, a higher prevalence of STE-ACS, and an increased occurrence of in-hospital complications and mortality.

Effect of LPA gene on CAD risk among diabetic patients

Abstract Introduction Previous research reported that the LPA gene is a strong and independent predictor of CAD in non-diabetic patients but not in patients with type 2 diabetes mellitus (T2DM). These results suggest that the LPA gene might contribute less to CAD risk in patients with T2DM than in the general population. Objective Investigate, in our population, the association between the LPA gene variant rs3798220 T>C and CAD risk among the total, diabetic and non-diabetic populations. Methods 3161 individuals (1724 coronary patients and 1437 controls) were genotyped for LPA rs3798220 T>C. This variant has a MAF <2%; hence the risk homozygous CC is a rare genotype, and we used the heterozygous CT in our analysis. Bivariate and multivariate logistic regression evaluated LPA heterozygous genotype (CT) and CAD risk in the whole population, in the group with T2DM (n=782) and without T2DM (n=2379). The multivariate model was adjusted to the main traditional risk factors for CAD. Results After multivariate analysis, LPA CT remained a strong and independent predictor of CAD risk in the whole and non-diabetic populations (OR=2.12; 95%CI: 1.43-3.14; p<0.0001 and OR=2.56; 95%CI: 1.64-4.00; p<0.0001, respectively). However, this association was less pronounced in the diabetic population (OR= 1.12; 95%CI: 0.47-2.65; p=0.799). Conclusions Our results show that the effect of the homozygous LPA genotype on CAD risk among the diabetic population might differ from that in non-diabetics, with less impact on diabetic patients. Many aspects of the genetic regulation of Lp(a) in diabetics are not fully understood, and other genetic and environmental factors may be crucial to CAD risk in diabetes, such as those linked to insulin resistance and hyperglycemia.

Incidence of acute myocardial infarction and hurricane Katrina: Fourteen years after the storm

IntroductionHistorically, natural disasters have been known to have an effect on humankind including physical and mental health. Studies dating from the early nineteen hundreds have shown repeated associations between different catastrophic natural disasters and its effects on cardiovascular (CV)health, including increased morbidity and mortality. Knowing that these effects on CV health last sometimes up to a decade, we sought to study the effects of hurricane Katrina on incidence of acute myocardial infarctions (AMI) to see if the effects perpetuated and continued or mitigated after the first decade. MethodsOurs is a single center, retrospective observational study at TUHSC to compare the incidence of AMI, chronobiology and other demographic characteristics between the 2-year pre-Katrina and 14-year post-Katrina group. After IRB approval, patients were identified using specific ICD 9 and 10 codes. Data was collected by chart review and stored in secure password protected files. Descriptive statistics including mean, standard deviation and percentages were calculated. Statistical analysis comparing mean and standard deviations were performed using Chi-square test and t-test. ResultsThe pre-Katrina cohort saw a 0.7% incidence of AMI, whereas the post-Katrina cohort saw 3.0% incidence of AMI (p < 0.001). The post- Katrina group was also noted to have significantly higher comorbidities including diabetes, hypertension, polysubstance abuse and coronary artery disease. ConclusionsEven 14 years after the storm, there was a four-fold increase in the incidence of AMI. Additionally, psychosocial, behavioral and traditional risk factors for CAD were significantly higher more than a decade after the natural disaster as well.

Association of Waist and Hip Ratio with the Angiographic Severity of Coronary Artery Disease in Patients with Non ST Segment Elevation Myocardial Infarction

Background: Obesity is a proven independent risk factor for coronary artery disease. There are different Methods for evaluation of obesity. The aim of this study is to evaluate the association between waist hip ratio and the severity of CAD in non-ST-segment elevation myocardial infarction patients. Methods: This cross-sectional observational study was done at the National Institute of Cardiovascular Diseases (NICVD), Dhaka. A total of 100 patients with NSTEMI who underwent coronary angiogram during the indexed hospitalization period were included in this study. On the basis of WHR, study patients were divided into two groups 50 patients of NSTEMI with normal WHR (Male &lt;0.90, Female &lt;0.80) were assigned as group I and 50 patients of NSTEMI with increased WHR (Male ³0.90, Female ³0.80) were assigned as group II. Results: The mean age of patients was 49.6±7.9 years and 52.3±8.7 years in Group I and Group II respectively with a male predominance in both the groups. No significant difference was found in between two groups in terms of demographic characteristics and traditional risk factors for CAD. Different parameters of angiographic severity of CAD were significantly higher in patients with increased WHR. Patients with non critical CAD (14% vs 0%, P = 0.02) and single vessel disease (58% vs 24%, P = 0.005) were more frequent in Group I, on the contrary double vessel disease (24% vs. 56%, P = 0.001) and triple vessel disease (4% vs. 20%, P = 0.03) were significantly more frequent in patients of Group II. Patients with moderate to severe CAD (Gensini score ³36) were found more in Group II than that of in Group I (24% vs. 76%, P &lt;0.001) and there was statistically significant higher Gensini score was found in Group II (21.96±19.72 vs. 44.18±28.91, P &lt;0.001). Significant positive correlation was found in between WHR and coronary artery disease severity measured by vessel score (r = 0.41, P &lt; 0.001) and Gensini score (r = 0.31, P&lt; 0.001). Multivariate regression analysis yielded that the risk of having significant CAD are 3.45 times more in patients with increased WHR than those of normal WHR (95% CI: 1.229-12.979, P = 0.01). Conclusion: Abdominal obesity, as evidenced by increased WHR, may be considered as a predictor of the severity of CAD in patients with acute NSTEMI. Bangladesh Heart Journal 2022; 37(2): 122-129

Nonalcoholic fatty liver disease is associated with myocardial ischemia by CT myocardial perfusion imaging, independent of clinical and coronary CT angiography characteristics.

The aim of this study was to evaluate whether patients with nonalcoholic fatty liver disease (NAFLD) have more myocardial malperfusion on CT myocardial perfusion imaging (CT-MPI), as well as to further assess if NAFLD is a predictor of myocardial ischemia independently. A total of 310 consecutive patients were included for analysis. All patients were divided into two groups according to the presence or absence of NAFLD, which was diagnosed by noncontrast cardiac CT partially covered liver and spleen. Clinical characteristics as well as imaging features including coronary artery calcium score, CCTA, and CT-MPI findings were analyzed. Univariable and multivariable logistic regression analyses were used to find out the relationship between NAFLD and myocardial ischemia. NAFLD (unadjusted hazard ratio [HR]: 2.4, 95% confidence interval [CI]: 1.2 to 4.4, p = 0.008), male (HR: 2.6, 95% CI: 1.5 to 4.5, p = 0.001), obstructive CAD (HR: 2.3, 95% CI: 1.3 to 4.2, p = 0.004), and FAI ≥ -70.1 HU (HR: 3.1, 95% CI: 1.8 to 5.5, p < 0.001) were associated with myocardial ischemia in univariable analysis. After adjusting for traditional CAD risk factors and CT characteristics in the multivariable regression analysis, NAFLD (HR: 2.3, 95% CI: 1.2 to 4.4, p = 0.016) was an independent predictor of myocardial ischemia. Our data suggest that myocardial ischemia was more prevalent in patients with NAFLD, and NAFLD is a predictor of myocardial ischemia independent of traditional cardiovascular risk factors and CCTA characteristics. • NAFLD patients had higher calcium score, incidence of obstructive coronary artery disease, grade of CAD-RADS, quantitative plaque characteristics, and incidence of fat attenuation index ≥ -70.1 HU. • NAFLD patients had a higher incidence of myocardial ischemia, myocardial hypoperfusion, and hypoperfusion myocardial segments ratio. • NAFLD was a predictor of myocardial ischemia, independent of traditional cardiovascular risk factors, and CCTA characteristics.

Abstract 13686: HEART Score Predicts Coronary Artery Disease on Coronary Computed Tomography Angiography in the Emergency Department Only in Patients With Three or Greater Risk Factors

Introduction: HEART (History, Electrocardiogram, Age, Risk factors, Troponin) Score (HS) predicts MACE in patients presenting to the ED with chest pain. It was validated clinically but not radiologically. Coronary computed tomography angiography (CCTA) in the ED allows for rapid triaging of patients and carries prognostic value. Objective: study relationship between HS and the presence and severity of CAD on CCTA. Methods: In this retrospective cohort, we included patients undergoing CCTA in the ED for acute chest pain between January 2014 to July 2016. HS was calculated and classified as low-risk (score &lt;=3) or high-risk (score &gt;3). A certified specialist reviewed all CCTA studies and determined the presence and severity of CAD. Anatomic CAD was defined by coronary artery calcium score (CACS) &gt;0 or the presence of any stenosis. Obstructive CAD was defined by CACS&gt;100 or coronary stenosis &gt;=50%. Multivariate regression analysis was performed to determine predictors of anatomic and obstructive CAD. We performed interaction analysis between HS and the presence of &gt;=3 traditional CAD risk factors. Results: Of the 927 CCTA performed, 315 (34%) had anatomic CAD, 128 (14%) had obstructive CAD. Mean age was 51 years, 49% were males, mean HS was 2.6, and 71% of the cohort had a low-risk HS. High HS was associated with higher proportions of CAD only in patients who had &gt;=3 traditional CAD risk factors [Fig 1]. Regression and interaction analyses showed that HS was an independent predictor of anatomic and obstructive CAD only in patient with &gt;=3 traditional CAD risk factors [Fig 2]. Conclusion: HS is a predictor of radiographic CAD on CCTA when performed in patients with &gt;=3 traditional risk factors.

Coronary Artery Disease-Associated and Longevity-Associated Polygenic Risk Scores for Prediction of Coronary Artery Disease Events in Persons Living With Human Immunodeficiency Virus: The Swiss HIV Cohort Study.

Coronary artery disease (CAD) is in part genetically determined. Aging is accentuated in people with human immunodeficiency virus (HIV) (PLWH). It is unknown whether genetic CAD event prediction in PLWH is improved by applying individual polygenic risk scores (PRSs) and by considering genetic variants associated with successful aging and longevity. In the Swiss HIV Cohort Study participants of self-reported European descent, we determined univariable and multivariable odds ratios (ORs) for CAD events, based on traditional CAD risk factors, adverse antiretroviral exposures, and different validated genome-wide PRSs. PRSs were built from CAD-associated single-nucleotide polymorphisms (SNPs), longevity-associated SNPs, or both. We included 269 patients with CAD events between 2000 and 2017 (median age, 54 years; 87% male; 82% with suppressed HIV RNA) and 567 event-free controls. Clinical (ie, traditional and HIV-related) risk factors and PRSs, built from CAD-associated SNPs, longevity-associated SNPs, or both, each contributed independently to CAD events (P < .001). Participants with the most unfavorable clinical risk factor profile (top quintile) had an adjusted CAD-OR of 17.82 (95% confidence interval [CI], 8.19-38.76), compared with participants in the bottom quintile. Participants with the most unfavorable CAD-PRSs (top quintile) had an adjusted CAD-OR of 3.17 (95% CI, 1.74-5.79), compared with the bottom quintile. After adding longevity-associated SNPs to the CAD-PRS, participants with the most unfavorable genetic background (top quintile) had an adjusted CAD-OR of 3.67 (95% CI, 2.00-6.73), compared with the bottom quintile. In Swiss PLWH, CAD prediction based on traditional and HIV-related risk factors was superior to genetic CAD prediction based on longevity- and CAD-associated PRS. Combining traditional, HIV-related, and genetic risk factors provided the most powerful CAD prediction.

Gender Disparities on Access to Care and Coronary Disease Management.

Mortality decline in women to a lesser extent than in men with coronary artery disease (CAD) has provoked a bigger interest in some already existing dilemmas and questions. Many studies carried out in the past three decades did not provide us with precise conclusions. Moreover, various challenges in the prevention, diagnosis, treatment and outcome of CAD in women are still remaining. The meta-analysis and the systematic review conducted in the last years have offered novel approaches to understanding CAD gender disparities in access to care and coronary disease management in women, but women are more likely to experience less favorable short- and long-term outcomes than men do. The reasons for these findings should lie in several known segments in the CAD pathophysiological mechanisms different in women and ultimately leading to a lower quality of care. Clinical presentation in women, which is often characterized by atypical chest pain and a higher prevalence of non-obstructive CAD when evaluated invasively, places women to the false-negative diagnosis of CAD and influences inadequate access to care. Clinical presentation and diagnostic methods, as well as the appropriate treatment options insufficiently examined in women, need to be better defined. The traditional CAD risk factors have a greater impact on women than on men. Unique CAD risk factors only seen in women, have recently been recognized with more attention. However, it is important to note that even in women with obstructive CAD and typical clinical presentation, invasive therapy and pharmacologic therapy are not always implemented as recommended by guidelines as in men. Women are underrepresented in CAD trials, and in current guidelines, gender differences in CAD management have not yet been justified. The underestimation of the risk of CAD in women, followed by its underdiagnosis and undertreatment, might be one of the reasons for a worse prognosis in women in comparison with men.

Impact of coronary revascularization on regional artery-specific coronary flow capacity: a serial [15O]H2O positron emission tomography perfusion imaging study

Abstract Funding Acknowledgements Type of funding sources: None. Background. Coronary flow capacity (CFC) combines absolute hyperemic myocardial blood flow (hMBF) and coronary flow reserve (CFR) in a graphical representation of the severity of myocardial perfusion impairment. Studies evaluating the impact of coronary revascularization on CFC as assessed by [15O]H2O positron emission tomography (PET) are lacking. Purpose. The present study explored the impact of coronary revascularization on regional, artery-specific CFC as assessed by [15O]H2O PET. Methods. A total of 315 patients (mean age 62 ± 10 years) underwent absolute myocardial perfusion imaging at baseline and directly after either percutaneous or surgical coronary revascularization (at 110 ± 50 days). Revascularized perfusion regions were stratified in 3 CFC groups at baseline: severely reduced CFC (defined as myocardial ischemia), moderately reduced CFC and normal CFC. Results. Baseline CFC was severely reduced in 262 vessels (70%), moderately reduced in 95 vessels (25%) and normal in 17 vessels (5%). Regional, artery-specific CFC, hMBF and CFR improved after successful revascularization (P &amp;lt; 0.01). In 127/262 regions, CFC increased from severely reduced to moderately reduced and in 29/262 to normal flow after revascularization (p &amp;lt; 0.01 for both). Additionally, 28/95 revascularized regions increased from moderately reduced to normal flow (P = 0.18). Changes in hMBF (severe vs. moderate vs. normal: 0.84 ± 0.73; 0.41 ± 0.60 and 0.35 ± 0.84 mL·min-1·g-1 ) and CFR (0.92 ± 0.83; 0.49 ± 1.00 and -0.39 ± 1.15) were significantly different comparing baseline CFC groups (both p &amp;lt; 0.01). Furthermore, mixed-model analysis including traditional CAD risk factors revealed that baseline CFC and gender were independent predictors of changes in CFC, hMBF and CFR between baseline and follow-up. Conclusions. Successful revascularization demonstrated a significant and positive impact on regional, artery-specific CFC, hMBF and CFR. Improvements were largest among lower baseline CFC groups. Furthermore, baseline CFC was an independent predictor of change in CFC, hMBF and CFR. These results suggest that the assessment of flow capacity by [15O]H2O PET prior to revascularization may aid in the selection of regions in which absolute myocardial perfusion is most likely to improve. Abstract Figure 1.

Functional capacity and quality of life in the postural tachycardia syndrome: A retrospective cross-sectional study

BackgroundPostural tachycardia syndrome (POTS) is a complex syndrome of orthostatic intolerance that significantly affects quality of life. The relationship between functional capacity, quality of life, and age remains poorly understood in this patient population. The purpose of this cross-sectional study was to assess the clinical and exercise characteristics of patients with POTS who underwent exercise stress testing as part of cardiac rehabilitation, and to evaluate the relationships between functional capacity with age and sex, as well as the relationship between functional capacity and quality of life. MethodsWe included 255 consecutive adult patients with the diagnosis of POTS, by tilt table testing, who underwent exercise stress testing between 2012 and 2017. Clinical and stress test data were obtained from electronic medical records. ResultsOf the 255 patients, 232 (91%) were women, with median age 33.5 years. Prevalence of traditional CAD risk factors was low (2% diabetes, 13% hypertension, 7% hyperlipidemia, and 26% smoking history). Mean resting BP was 114 ± 13 mmHg systolic, resting HR was 76 ± 13 bpm, METs achieved 9.2 ± 2.2, and 1 min HR recovery 32 ± 17 bpm. 113 patients (44%) had abnormal functional capacity for age and sex. When analyzed by age groups, younger POTS patients had increasingly lower than expected functional capacity (compared to predicted normals) than did older patients (ANOVA P = 0.0017). The SF-36 physical component of patients with abnormal functional capacity was significantly lower than those with normal functional capacity. (p = 0.006). ConclusionsIn this large cohort, patients with POTS were predominantly female (91%) and relatively young. The novel findings are that younger patients with POTS were more likely to have lower-than-average functional capacity for their age and sex compared to older patients, and that abnormal functional capacity was associated with lower quality of life by SF-36 physical component.

Abstract 243: Long-term Effects of ACC/AHA Cholesterol Control on Cardiac Function

Background: The impact of long term strict cholesterol control on reservoir function and outcome in heart failure is unclear. Methods: We retrospectively analyzed 2939 patients (31.9% female, mean age 65.1±11.8 years) whom strict application of ACC/AHA cholesterol management with an average length of 9.4 years of follow-up. We also evaluated the ventricular ejection fraction, mass, and Global sore (Framingham-CVD), as well as 10-year Atherosclerotic Cardiovascular Disease (ASCVD) risk score. Results: Overall, 64.3% of patients were identified as strictly cholesterol control (case group). As compared to age-gender-race matched control group, patients in cases group have higher LV mass (152.9±34.4g vs. 143.6±34.4 g, p=0.0005) as well as an LV mass index (90.5±18.1 vs. 85 ±17 g/m2 vs. g/m2, P=0.0002) and Framingham Global CVD Risk score (18.9±17.7 vs. 8.6±17.3, P&lt;0.001), but not for LVEF (68.5%±7.5% vs. 69.1%±6.6%, p=0.263). The average percentage decrease in LVEF in patients with mild coronary artery calcification (CAC score&lt;100) in cases is 6.2%, and when CAC score&gt;400, the LVEF decreased up to 15.3% regardless of the cholesterol control status. Major coronary arteries with severe calcification are associated with increasing the risk of abnormal ejection fraction (LVEF&lt;50%) 4.84 times after adjusting for traditional CAD risk factors. Long-term ACC/AHA cholesterol control can not prevent the ASCVD risk score increase (Table 1). Conclusions: The strict long-term application of ACC/AHA cholesterol control can effectively LV mass change. However, this strategy does not adequately prevent LV systolic function attenuation. The 10-Year ASCVD risk score is one of the robust indicators of cardiac function for long-term lipid control outcomes. Abbreviations: LAD: left anterior descending, LCX: circumflex coronary arteries, RCA: right coronary artery. CTA: coronary computed tomography angiogram. LVEF:Left Ventricular Ejection Fraction

TCTAP C-152 Simultaneous Embolic Events in Both Arterial Systems Causing Cardiogenic Shock

### Patient Initials or Identifier Number C.C.J. ### Relevant Clinical History and Physical Exam This was a 37-year-old man who received V-P shunt in his childhood for congenital hydrocephalus. He had no traditional CAD risk factors except smoking. He presented to the emergency department for

Determination of the Relationship Between Serum Uric Blood Levels and the Severity of Coronary Artery Disease in Angiography of Patients with Acute Coronary Syndrome

Background: Uric acid as an inflammatory marker has been hypothesized as a precursor of atherosclerosis and its role has been evaluated in recent studies. Objectives: In our study we wanted to assess its effect on the severity and extent of coronary artery disease in patients presenting to emergency department with acute coronary syndrome. Methods: In this cross-sectional descriptive study, we enrolled all patients with ACS who attended to Shahid Rajaie Emergency Department from May 2016 to May 2018. All patients were sampled for their laboratory evaluation of serum uric acid and routine other lab tests. Besides, their traditional risk factors and medications were recorded and all patients underwent coronary angiography while their SYNTAX score was measured. Results: Two-hundred and six patients were included in our study in which 153 were male (74.3%) and the rest were female (25.7%). The mean age of all patients was 58.37 ± 10.48. From all traditional CAD risk factors, only hyperlipidemia had a direct relation with hyperuricemia (P value < 0.001). Inverse relation was demonstrated between LVEF and serum uric acid level (correlation coefficient -0.126 and P value = 0.047). Analysis also proved a strong relationship between the number of vessels involved and serum uric acid level and the higher serum uric acid level, the more vessels were involved (in SVD 5.29 ± 1.42 mg/dL, 2VD 5.81 ± 162 mg/dL, 3VD 6.14 ± 1.06 mg/dL and 3VD + LM 6.63 ± 1.70 mg/dL and P value = 0.004). Consequently, there was a significant relation between serum uric acid level and SYNTAX score (hyperuricemia prevalence in patients with SYNTAX score less than 22 was 15.8%, in the group of 22 - 32 SYNTAX score 28.6% and in patients with more than 32 SYNTAX score was 41.4% with P value = 0.007). Conclusions: Serum uric acid level measurement in patients presenting with acute coronary syndrome is both sensitive and efficient and could help in determining the patients’ general probability of atherosclerotic disease.

Myocardial ischemia in patients with hypertrophic cardiomyopathy

Authors present is comprehensive clinical and instrumental evaluation of patients with HCM with myocardial ischemia. 104 patients (38.4% of men) with HCM were examined, mean age 58.2±14.7. The examination included risk factors assessment for CAD, ECG, Echo, stress ECG test, 24-hour ECG monitoring. In the presence of myocardial ischemia, CAG (n=66) and MSCT of the coronary arteries (CA) (n=4) were performed. All patients were split up on 2 groups: I - 70 HCM patients with myocardial ischemia, 67.3%, and II (the control group) - 34 HCM patients without myocardial ischemia, 32.7%. The group I was divided on 2 subgroups: 1 - 29 patients with coronary atherosclerosis (41.4%), 2 - 41 patient without coronary atherosclerosis (58.6%). Age (p=0.046), family history (p=0.037), higher systolic and diastolic arterial pressure, long-term arterial hypertension (p<0.05) were determined as significant risk factors for CAD. Smaller diameter of LAD (p=0.008), higher LV mass index, greater LV diastolic function disorder (p<0.05) were detected in group 2 compared to group II. The decrease in myocardial perfusion (MBG scale) was associated with high LV mass index and cardiac arrhythmias. The frequency of concomitant coronary atherosclerosis among HCM patients with myocardial ischemia was determined as 41.4%. Analysis of traditional risk factors for CAD in patients with HCM revealed the strong relation to age, aggravated by a family history of CAD, blood pressure level and duration of hypertension. Smaller diameter of LAD, higher LV mass index, greater LV diastolic function disorder were observed in HCM patients with myocardial ischemia without CAD.

Abstract 024: Association of APOL1 Risk Alleles with Coronary Heart Disease in Million Veteran Program

Background: Approximately 13% of African-Americans carry 2 copies of the APOL1 risk alleles G1 or G2, which are associated with increased risk of CKD. There have been conflicting reports as to whether an association also exists between APOL1 and cardiovascular disease. Objective: Determine the association between APOL1 and CAD in African Americans genotyped in the Million Veteran Program (MVP) Methods and Results: APOL1 risk alleles were genotyped in 64,792 African American MVP participants. 7,987 (12%) of the participants carried the high-risk genotype comprised of 2 risk alleles. Of the high-risk carriers, 36% were G1 homozygotes, 49% were G1/G2 compound heterozygotes, and 15% were G2 homozygotes. We first confirmed the known association of the APOL1 risk genotype with end stage renal disease (OR 2.75, P=1.8 x 10 -66 ). We then considered the association between the high-risk APOL1 genotype and prevalent CAD. Based on electronic health record data, 11,902 (19.4%) of the participants had CAD. Individuals with 2 risk alleles trended toward increased rates of CAD compared to those with no risk alleles (OR 1.075, p=0.03). The strength of the association varied by the nature of composition of the high-risk genotype: G1/G1 carriers had increased rates of CAD (OR 1.19, p=0.002), G1/G2 carriers had a trend towards increased CAD (OR 1.08, p=0.1), and G2/G2 carriers had no differences in CAD rates (OR 0.99, p=0.9) than controls. Adjusting for traditional CAD risk factors and kidney disease in multivariable regression models attenuated the significance of the association between APOL1 and CAD. Conclusions: APOL1 variant contribution to CAD risk is genotype dependent and likely mediated by the known APOL1 association with CKD. The modest effect of APOL1 on CVD, the differential presence of CKD, and the relative proportion of G1 and G2 alleles may explain the conflicting findings in the published literature.

Abstract P201: Ischemia with Mental Stress is Associated with Greater Left Ventricular Dyssynchrony

Introduction: Synchronized contraction of left ventricle (LV) is necessary for normal cardiac pump function. Delayed activation of LV segments, known as “dyssynchrony,” can result in systolic and diastolic function deterioration and clinical heart failure. The autonomic nervous system regulates LV conduction and is influenced by psychological stress. We used mental stress testing to examine the effects of psychological stress on LV dyssynchrony and assess whether patients who develop mental stress-induced myocardial ischemia (MSI), a condition associated with doubling of risk for mortality and cardiovascular events, have greater LV dyssynchrony at baseline and/or during stress as compared to MSI negative subjects. We compared results with a control condition of conventional physical (exercise/ pharmacological) stress. Methods: 660 patients with CAD underwent 99mTc[[Unable to Display Character: &amp;#8208;]]sestamibi myocardial perfusion imaging at rest and following both mental and physical stress. Dyssynchrony parameters, measured using the Emory Cardiac Toolbox software, included phase standard deviation (SD) and phase bandwidth; higher levels indicate higher desynchronized contraction. Ischemia with both conditions was blindly assessed by 2 independent readers, with consensus reading for any discordance. The Gensini score was calculated from angiographic data to assess CAD burden. Dyssynchrony data at baseline and during mental/physical stress were log-transformed for analyses. Results: Mean age was 63 years (SD: 9), 180 (27%) were females and 432 (66%) were whites. Overall, 108 (16%) subjects developed mental stress ischemia (MSI+), while 232 (35%) developed physical stress ischemia (PSI+). After adjusting for age, sex, race, traditional CAD risk factors, indicators of CAD burden, history of heart failure, and LV ejection fraction, at baseline MSI+ subjects compared with MSI- had 11% higher phase SD (95% CI: 1% to 19%), and 11% higher phase bandwidth (95% CI: 3% to 20%). PSI+ subjects compared with PSI- had a more modest and non-significant increase in phase SD (mean increase of 4%, 95% CI: -3% to 12%) and phase bandwidth (4%, 95% CI: -3% to 11%). The associations of MSI with baseline dyssynchrony was independent of PSI status. A similar association was noted between MSI and dyssyncrony during mental stress. Among the covariates, male sex (P=0.01), smoking (P=0.02), Gensini score (P=0.01), history of MI (P&lt;0.001), history of heart failure (P&lt;0.001), and LV ejection fraction (P&lt;0.001) were significantly associated with higher baseline dyssynchrony. Conclusion: MSI is associated with greater LV dyssynchrony at rest and during stress. Baseline LV dyssynchrony may be a marker of susceptibility to stress-induced ischemia possibly due to recurrent or chronic subclinical ischemia during daily life. LV dyssynchrony may be a potential mechanism for adverse cardiac events in patients with MSI.

Body Mass Index and Risk for Mental Stress Induced Ischemia in Coronary Artery Disease.

Acute emotionally reactive mental stress (MS) can provoke prognostically relevant deficits in cardiac function and myocardial perfusion, and chronic inflammation increases risk for this ischemic phenomenon. We have described parasympathetic withdrawal and generation of inflammatory factors in MS. Adiposity is also associated with elevated markers of chronic inflammation. High body mass index (BMI) is frequently used as a surrogate for assessment of excess adiposity, and associated with traditional CAD risk factors, and CAD mortality. BMI is also associated with autonomic dysregulation, adipose tissue derived proinflammatory cytokines, which are also attendant to emotion provoked myocardial ischemia. Thus, we sought to determine if body mass index (BMI) contributes to risk of developing myocardial ischemia provoked by mental stress. We performed a prospective interventional study in a cohort of 161 patients with stable CAD. They completed an assessment of myocardial blood flow with single photon emission computed tomography (SPECT) simultaneously during 2 conditions: laboratory mental stress and at rest. Multivariate logistic regression determined the independent contribution of BMI to the occurrence of mental-stress induced ischemia. Mean age was 65.6 ±9.0 years; 87.0% had a history of hypertension, and 28.6% had diabetes. Mean BMI was 30.4 ± 4.7. Prevalence of mental stress ischemia was 39.8%. BMI was an independent predictor of mental stress ischemia, OR=1.10, 95% CI [1.01-1.18] for one-point increase in BMI and OR=1.53, 95% CI [1.06-2.21] for a 4.7 point increase in BMI (one standard deviation beyond the cohort BMI mean), p=0.025 for all. These data suggest that BMI may serve as an independent risk marker for mental stress ischemia. The factors attendant with greater BMI, which include autonomic dysregulation and inflammation, may represent pathways by which high BMI contribute to this risk and serve as a conceptual construct to replicate these findings in larger CAD populations.

Abstract 12550: Persistent Relative Hypochromia is Associated With Adverse Outcomes in Non-anemic Patients With Heart Failure

Background: We previously reported that functional iron deficiency, assessed by low mean corpuscular hemoglobin concentration (MCHC), has been associated with adverse outcomes in non-anemic patients with HF. Yet, the effect of change in MCHC levels on outcomes has not been studied before. Methods: We prospectively enrolled 1,579 subjects with HF undergoing coronary angiography, with 5-year follow-up. Blood indices [hemoglobin (Hb), MCHC, MCV, RDW] were assessed on enrollment and after 6 months of follow up by reviewing medical records. Anemia was defined as Hb levels &lt;12 g/dL in males, and &lt;11 g/dL in females. Results: In our population (age 66 ± 10 years, male 65%, CAD 75%), most patients were non-anemic (n=1,161, 73.5%). In non-anemic patients, mean Hb and median (IQR) MCHC were 13.3±1.2 g/dL and 34.2 (33.43-34.9) g/dL, respectively. Non-anemic HF patients with lower MCHC had higher mortality risk [Q1 vs Q4 Hazard ratio (HR) (95%CI) of 2.5(1.9-3.2), p&lt;0.001]. Total of 552 (35%) had follow up Hb levels with a mean time between baseline and follow up levels of 169.3 ± 41.6 days. HF severity (EF, BNP), outcomes and blood indices were similar in patients with and without follow up levels, suggesting good representation of the total population. Changes in MCHC levels was studied in non-anemic patients on baseline and follow up (n=318). Most patient with low MCHC at baseline (&lt;Q1, n=79) continued to have low MCHC on follow up (n=61), while half of the patients with high baseline MCHC (≥Q1, n=239) developed low MCHC on follow up (n=120). In comparison to patient with persistently high MCHC, patients with persistently low MCHC had a significantly increased mortality risk [HR(95%CI) of 3.5(2.1-6.1), p&lt;0.001]. All models remained significant even after adjusting for traditional CAD risk factors, EF and baseline blood indices. Conclusion: Relative hypochromia is an independent predictor of increase mortality in patients with HF, even in the setting of normal hemoglobin levels.

MDCT assessment of CAD in type-2 diabetic subjects with diabetic neuropathy: the role of Charcot neuro-arthropathy.

To compare the CACS and CAD severity assessed by MDCT in neuropathic type-2 diabetic patients with and without Charcot-neuroarthropathy (CN). Thirty-four CN asymptomatic-patients and 36 asymptomatic-patients with diabetic-neuropathy (DN) without CN underwent MDCT to assess CACS and severity of CAD. Patients were classified as positive for significant CAD in presence of at least one stenosis >50 % on MDCT-coronary-angiography (MDCT-CA). Groups were matched for age, sex and traditional CAD risk-factors. The coronary-angiography (CA) was performed in all patients with at least a significant stenosis detected by MDCT-CA, both as reference and eventually as treatment. CN patients showed higher rates of significant CAD in comparison with DN subjects [p < 0.001], while non-significant differences were observed in CACS (p = 0.980). No significant differences were also observed in CACS distribution in all subjects for stenosis ≥/<50 % (p = 0.814), as well as in both groups (p = 0.661 and 0.559, respectively). The MDCT-CA showed an overall diagnostic-accuracy for significant CAD of 87%. These preliminary data suggest that CN-patients have a higher prevalence of severe CAD in comparison with DN-patients, while coronary plaques do not exhibit an increased amount of calcium. MDCT may be helpful to assess the CV risk in such asymptomatic type-2-diabetic patients with autonomic-neuropathy. Type 2-diabetic-patients with CN result having more severe coronary artery plaque-burden. MDCT-CA may stratify the CV risk in type 2-diabetic-patients with CN. Adequate diagnostic is mandatory for optimal management of type 2-diabetic-patients with CN.

Comparison of In-hospital Outcome of Acute Myocardial Infarction in Patients with vs without Diabetes Mellitus in Durres Population

Background: Diabetes mellitus (DM) is a worldwide epidemic and a major public health problem and the mortality of diabetic patients is twice higher than that of with non-diabetic patients. The inhospital outcomes in diabetic patients with acute myocardial infarction (AMI) are less known in Albania. Aim: To compare in-hospital outcomes of AMI in diabetic vs non-diabetic patients in Albania. Methods: A prospective, observational study. Patients with AMI between September 2012 and October 2014 were involved in the current study. Traditional risk factors for CAD, serum creatinine levels, and coronary angiographic results were recorded. In-hospital mortality of patients with and without DM was compared. P value of <0.05 was considered statistically significant. Results: From 420 enrolled patients with AMI, 281 (66.9%) were with DM, and 139 (33.1%) were non-diabetic. Baseline hypertension and cerebral vascular disease were more prevalent in diabetic than in non-diabetic patients. Diabetic patients also demonstrated a higher mean serum creatinine level than non-diabetic individuals (creatinine: 2.3±1.24 vs1.76±0.98 mg/dl P<0.05). Older age, Original Research Article Zera et al.; CA, 3(3): 130-136, 2015; Article no.CA.2015.011 131 multi-vessel diseases, poor renal function and higher killip class were associated with in-hospital mortality in patients with AMI. In-hospital mortality was higher in diabetic than non-diabetic patients (13.7% vs.7.9%, P<0.05). Conclusion: The present study suggests that in Albania, the in-hospital mortality rate in diabetic patients with AMI was higher than that in non-diabetic patients, which may be related to more comorbidies in diabetic patients. Hence, early aggressive treatment in the course of diabetic patients with acute AMI is important.