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Journal articles on the topic 'Coronary artery desease'

Author: Grafiati
Published: 9 March 2023
Last updated: 10 March 2023

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1

Stavenchuk, T. V., E. D. Kosmachova, I. A. Shelestova, K. O. Barbuhatty, M. V. Kolodina, and V. A. Porhanov. "Analysis of survival and risk factors in recipients with coronary artery disease of a heart transplant." South Russian Journal of Therapeutic Practice 2, no. 2 (July 7, 2021): 34–43. http://dx.doi.org/10.21886/2712-8156-2021-2-2-34-43.

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Objective: to conduct a comparative analysis of survival rate and development of heart transplant coronary artery disease risk factors during early and late post-transplantation periods. Materials and methods: a retrospective analysis of 58 patients with was conducted in S.V. Ochapovsky Region Clinical Hospital № 1, Krasnodar. Inclusion criteria were patients with vasculopathy; group № 1 — recipients with heart transplant coronary artery disease up until 3 years after heart transplantation; group № 1 — recipients with heart transplant coronary artery desease 3 years after heart transplantation. Endomyocardial biopsy, coronary angiography and immunological examination were used for monitoring heart recipients. Results: survival rate in group № 1 — 51,9%; in group № 2 — 64,5%. During studying the influence of age category on survival rate it was discovered that belonging to the age category influences on the survival rate in group № 1, p – 0,023. Death risk in group №1 is 1,7 (0,59 – 4,85) times higher in comparison with group № 2. When combined heart transplant coronary artery desease with cellular and humoral rejection in group №1 death risk is reliably 2,75 (1,58 – 4,78) times higher (p = 0,010). The frequency of heart transplant coronary artery desease recurrence does not have a meaningful impact on the survival rate of the recipients with heart transplant coronary artery desease n both groups. One of the meaningful risk factors in two groups, which affects heart transplant coronary artery desease development is cytomegalovirus infection. Cellular rejection is also a fact which influences lethal outcome.
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Neskovic, Vojislava, Predrag Milojevic, and Nada Dimkovic. "Kombinacija opste anestezije i visoke torakalne epiduralne analgezije u revaskularizaciji miokarda na kucajucem srcu u bolesnika na hemodijalizi." Acta chirurgica Iugoslavica 50, no. 4 (2003): 139–41. http://dx.doi.org/10.2298/aci0304139n.

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Terminal renal failure is often associated with severe coronary artery desease that should be treated with surgical myocardial revascularization. Since perioperative morbidity and mortality rates in these patients are high, the best way and the time for surgical intervention are still uncertain. We present the patient with end-stage renal disease, on chronic program of hemodyalisis, who had underwent off-pump coronary artery bypass grafting and high thoracic epidural anaesthesia, followed by early extubation. To our knowledge, off-pump surgical myocardial revascularization in patients on hemodyalisis using this anaesthetic technique has not yet been presented in our literature.
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3

Fischer, A., D. E. Gutstein, Z. A. Fayad, and V. Fuster. "Predicting plaque rupture: enhancing diagnosis and clinical decision-making in coronary artery desease." Vascular Medicine 5, no. 3 (August 1, 2000): 163–72. http://dx.doi.org/10.1191/135886300701568397.

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4

Khokhlov, A., A. Miroshnikov, N. Pozdnyakov, D. Komarov, and I. Dryagencova. "The Prevalence of Enos and Agtr2 Gene Polymorphism In Patient With Coronary Artery Desease." Clinical Therapeutics 37, no. 8 (August 2015): e69. http://dx.doi.org/10.1016/j.clinthera.2015.05.206.

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5

Marniati, Soekidjo Notoatmodjo, Sutomo Kasiman, and R. kintoko Rohadi. "Patient’s Behaviour with Coronary heart desease Viewed from Socio-Cultural aspect of Aceh Society in Zainoel Abidin Hospital." MATEC Web of Conferences 150 (2018): 05065. http://dx.doi.org/10.1051/matecconf/201815005065.

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Coronary heart disease (CHD) is a chronic inability of heart to draw an adequate blood on myocardium due to specific problem in coronary artery. When the artery that supplies myocardium is interrupted, thus the heart is unable pumping the blood effectively to fill up an adequate blood perfusion to vital organs and other peripheral tissues. If the perfusion is impaired in time of oxygenation, the patient will threatened by a sudden death. This is a quantitative, analytical and observational research with a design of case study control, in which the subject is CHD patients and the control is non-CHD patients. The research populations were 2318 outpatients with CHD who visited Heart Polyclinic at Zainoel Abidin Hospital Banda Aceh. The sample studied were 92 patients with CHD and 92 patients with non-CHD (control). We used primary and secondary data that processed through editing, coding, entry, cleaning and tabulating. The data was analyzed using univariate, bivariate and multivariate analysis. The results showed that the CHD occurrences are significantly influenced by eating behavior (p = 0,000), smoking habit (p = 0,000) and sporting habit (p = 0,000). Therefore, health workers are expected to increase health promotion in order to improve the quality of life of people, especially in elderly people, by adopting a healthy lifestyle and avoiding CHD risk factors. Moreover, people are also suggested to take regular lipid profile check up and keep off smoking habit in order to do early prevention of CHD.
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6

Suherni, Suherni, and Heni Triana. "PENGARUH DISCHARGE PLANNING TERHADAP KECEMASAN PASIEN CORONARY ARTERY DESEASE (CAD) YANG DIRENCANAKAN AKAN MENJALANI TINDAKAN DIAGNOSTIK ANGIOGRAPHY KORONER DI INSTALASI RAWAT JALAN POLY JANTUNG RS. USU MEDAN." JURNAL ONLINE KEPERAWATAN INDONESIA 3, no. 2 (December 21, 2020): 93–103. http://dx.doi.org/10.51544/keperawatan.v3i2.1350.

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Coronary Angiography is an invasive examination to describe the condition of the coronary arteries of the heart by inserting a blood vessel catheter into the body and injecting contrast fluid to give a picture of coronary arteries on X-ray imaging immediately after contrast is injected. One of the things that nurses can do to reduce patient anxiety before undergoing a Coronary Angiography procedure is to application Discharge Planning . The purpose of this study was to determine whether there is an effect of application Discharge Planning on the anxiety of patients with coronary artery disease (CAD) who are planned to undergo diagnostic procedure by coronary angiography performed at an outpatient installation of cardiac polyclinic of the University of North Sumatra Hospital Medan. The present study was carried out with a quasi-experimental design by One The Group Test. The sample in this study was determined by consecutive sampling technique that produced 32 subjects as sample. The results of the study indicated by the statistical analysis of paired t-test that the average anxiety value of pre-test and post-test was 12,348% and the value of p was 0,000. This is also in accordance with the significance test (hypothesis) of the two groups where the value of t-counted of 12.50 is obtained compared to the value of t-table of 2.04. Thus it can be concluded that there are differences in anxiety before and after the intervention is given, in this case the intervention in question is the application Discharge Planning. It is recommended to nurses at the Outpatient Installation of Cardiac Polyclinic of the University of North Sumatra Hospital Medan to continue to application Discharge Planning related to the diagnostic procedures for coronary angiography that will be undertaken by the patient, as well as provide physiological and psychological support so that patients can undergo diagnostic procedures with optimistic, more relaxed, and without anxiety. Keywords: Coronary Angiography, Discharge Planning, Anxiety ABSTRAK Angiography Coronary adalah salah satu pemeriksaan invasif untuk menggambarkan keadaan arteri koroner jantung dengan cara memasukkan kateter pembuluh darah ke dalam tubuh dan menginjeksikan cairan kontras untuk memberikan gambaran pembuluh darah koroner pada pencitraan sinar-X segera setelah kontras diinjeksikan.. Salah satu hal yang dapat dilakukan perawat dalam mengurangi kecemasan pasien sebelum menjalani prosedur Angiography Coronary yaitu penerapan Discharge Planning. Tujuan penelitian ini adalah untuk mengetahui adanya pengaruh penerapan Discharge Planning terhadap kecemasan pasien Coroner Artery Desease (CAD) yang direncanakan akan menjalani tindakan diagnostic Angiografi Koroner yang dilaksanakan di Instalasi Rawat Jalan Poli Jantung Rumah Sakit Universitas Sumatera Utara Medan. Desain penelitian adalah desain Quasi Eksperimental dengan One The Group Test. Pengambilan sampel pada penelitian ini menggunakan Tehnik Consecutive Sampling yang berjumlah 32 orang. Hasil penelitian menunjukkan bahwa analisis dengan uji Statistik Paired T-Test diperoleh nilai rata-rata antara kecemasan pre dan post test adalah 12.438% dan p (value) adalah 0.000. Hal ini juga sesuai dengan nilai pengujian signifikan (hipotesis) dua kelompok diperoleh nilai t (hitung) adalah 11.50 dan t (table) adalah 2.04. Dengan demikian dapat disimpulkan bahwa terdapat perbedaan kecemasan sebelum dan sesudah diberikan intervensi, dalam hal ini intervensi yang dimaksud adalah penerapan Discharge Planning. Disarankan kepada perawat di Instalasi Rawat Jalan Poli Jantung RS. USU Medan untuk selalu tetap mempertahankan penerapan Discharge Planning terkait tindakan diagnostic Angiografi Koroner yang akan dijalani oleh pasien serta memberikan dukungan fisiologis maupun dukungan psikologis agar pasien dapat menjalani tindakan dengan optimis, lebih rileks, serta tanpa perasaan cemas
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7

Khvysiuk, M. O. "Changing levels of inflammation biomarkers in plasma of patients with coronary artery desease and diabetes mellitus type 2 due to coronary angiography results." Problems of Uninterrupted Medical Training and Science 2018, no. 1 (April 2018): 68–71. http://dx.doi.org/10.31071/promedosvity2018.01.068.

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8

Khvysiuk, M. O., O. V. Bilchenko, and S. B. Pavlov. "Influence of the level of p-selectine on the development of adverse reasons in patients with stable coronary artery desease." Problems of Uninterrupted Medical Training and Science 2018, no. 2 (June 2018): 33–36. http://dx.doi.org/10.31071/promedosvity2018.02.033.

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9

Kobayashi, Kensuke, Masahiro Endo, Hiroshi Nishida, Yasuko Tomizawa, Hiroaki Satoh, and Hitoshi Koyanagi. "A case of coronary artery bypass grafting for effort angina in a patient with post skin grafting for an extramammary Paget’s desease." Japanese Journal of Thoracic and Cardiovascular Surgery 46, no. 9 (September 1998): 878–81. http://dx.doi.org/10.1007/bf03217837.

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10

Hung, Ming-Yow, and Ming-Jui Hung. "Relationship between Inflammation and Vasospastic Angina." Medicina 59, no. 2 (February 9, 2023): 318. http://dx.doi.org/10.3390/medicina59020318.

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Coronary artery spasm (CAS) is a dynamic coronary stenosis causing vasospastic angina (VSA). However, VSA is a potentially lethal medical condition with multiple presentations, including sudden cardiac death. Despite investigations to explore its pathogenesis, no single mechanism has been found to explain the entire process of VSA occurrence. The roles of elevated local and systemic inflammation have been increasingly recognized in VSA. Treatment strategies to decrease local and systemic inflammation deserve further investigation.
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Lu, Tzu-Pin, Nai-Chen Chuang, Chin-Yu Cheng, Cheng-An Hsu, Yi-Chih Wang, Yen-Hong Lin, Jen-Kuang Lee, et al. "Genome-wide methylation profiles in coronary artery ectasia." Clinical Science 131, no. 7 (March 17, 2017): 583–94. http://dx.doi.org/10.1042/cs20160821.

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Coronary artery ectasia (CAE) is a disease characterized by abnormally dilated coronary arteries. The mechanism of CAE remains unclear, and its treatment is limited. Previous studies have shown that risk factors for CAE were related to changes in DNA methylation. However, no systematic investigation of methylation profiles has been performed. Therefore, we compared methylation profiles between 12 CAE patients and 12 propensity-matched individuals with normal coronary arteries using microarrays. Wilcoxon's rank sum tests revealed 89 genes with significantly different methylation levels (P<0.05 and Δβ > |0.1|). Functional characterization using the DAVID database and gene set enrichment analysis indicated that these genes were involved in immune and inflammatory responses. Of these genes 6 were validated in 29 CAE patients and 87 matched individuals with CAE, using pyro-sequencing. TLR6 and NOTCH4 showed significant differences in methylation between the two groups, and lower protein levels of toll-like receptor 6 (TLR6) were detected in CAE patients. In conclusion, this genome-wide analysis of methylation profiles in CAE patients showed that significant changes in both methylation and expression of TLR6 deserve further study to elucidate their roles in CAE.
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12

Palmer, Barry R., Melinda A. Paterson, Chris M. Frampton, Anna P. Pilbrow, Lorraine Skelton, Chris J. Pemberton, Robert N. Doughty, et al. "Vascular endothelial growth factor-A promoter polymorphisms, circulating VEGF-A and survival in acute coronary syndromes." PLOS ONE 16, no. 7 (July 14, 2021): e0254206. http://dx.doi.org/10.1371/journal.pone.0254206.

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Background Development of a competent collateral circulation in established coronary artery disease is cardio-protective. The vascular endothelial growth factor (VEGF) system plays a key role in this process. We investigated the prognostic performance of circulating VEGF-A and three genetic variants in the VEGFA gene in a clinical coronary cohort. Methods and results The Coronary Disease Cohort Study (CDCS) recruited 2,140 patients, with a diagnosis of acute coronary syndrome (ACS), after admission to Christchurch or Auckland City Hospitals between July 2002 and January 2009. We present data for 1927 patients from the cohort genotyped for three SNPs in the VEGF-A gene, rs699947 (C-2578A), rs2010963 (C405G) and rs3025039 (C936T). Plasma VEGF-A concentrations were assayed in a subgroup (n = 550) of CDCS patients (geometric mean 36.6 [34.7–38.5] pg/ml). VEGF-A levels correlated with patient heart rate at baseline (p = 0.034). None of rs699947, rs3025039, nor rs2010963 genotypes were significantly associated with VEGF-A levels, but rs3025039 genotype was positively associated with collateral vessels perfusion according to the Rentrop classification (p = 0.01) and baseline natriuretic peptide levels (p<0.05). Survival in the CDCS cohort was independently associated with baseline VEGF-A levels and (in males) with rs699947 genotype. Conclusions This study is strongly suggestive that VEGF-A levels have value as a prognostic biomarker in coronary heart disease patients and SNPs in VEGF-A deserve further investigation as prognostic markers and indicators of angiogenic potential influencing the formation of collateral circulation.
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Žáček, Pavel, Jan Dominik, Jan Harrer, Vladimír Lonský, Jiří Manďák, Pavel Kuneš, and Miroslav Solař. "Morbidity and Mortality in Patients 70 Years of Age and Over Undergoing Isolated Coronary Artery Bypass Surgery." Acta Medica (Hradec Kralove, Czech Republic) 44, no. 3 (2001): 109–14. http://dx.doi.org/10.14712/18059694.2019.95.

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Background and aim: Due to the constantly improving results of surgical revascularization for coronary heart disease even the elderly patients are offered more frequently this type of treatment. Since older age is a harbinger of reduced vital capacity and increased morbidity the results of coronary artery bypass grafting (CABG) in elderly as well as long-term benefit deserve a careful examination. Materials and methods: 1475 isolated CABG procedures performed between 1995 and 1997 in a university hospital cardiac surgery unit, divided in group I (age below 70, n = 1324) and group II (age 70 and over, n=151). A retrospective analysis of pre-operative, peri-operative and post-operative data. Results: Significant differences (lower BMI and BSA, advanced NYHA and CCS stage, higher prevalence of diabetes, renal dysfunction and extracardial atherosclerotic lesions) were found in elderly. CABG was performed in both groups with no differences in technique of procedure (only slightly longer duration of CPB in group II). However, there was markedly higher mortality (2.3 vs. 7.3 %, p < 0.005), incidence of NearMiss+ (18.4 vs. 36.4 %, p < 0.005) and post-operative morbidity (34.6 vs. 56.3 %, p < 0.005) in the older group, which was also expressed in a longer ICU stay and postoperative hospitalization. Conclusion: Coronary revascularization can be performed in elderly with higher but still acceptable risk. Higher mortality and associated morbidity is caused by higher preoperative prevalence of known risk factors as well as generally reduced vital capacity. Surgical procedure should not be denied to elderly population because of the age alone but a careful evaluation of an individual patient is required.
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Emelina, E. I., A. A. Ibragimova, P. A. Dreval, Gennady E. Gendlin, I. G. Nikitin, I. E. Byalik, and E. A. Antuch. "CONSEQUENCES OF RADIATION THERAPY OF ONCOLOGICAL DISEASES: FOCUS ON PERICARDITIS." Medical Journal of the Russian Federation 25, no. 2 (April 15, 2019): 120–26. http://dx.doi.org/10.18821/0869-2106-2019-25-2-120-126.

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Radiation exposure of the chest is associated with a significant risk of subsequent development of cardiovascular diseases. Associated cardiovascular injuries include pericardial disease, coronary artery disease, valvular disease, conduction disease, cardiomyopathy, and vasculopathy. This article presents the development of different variants of pericardial radiation damage, methods of diagnosis and treatment of these complications. Radiation damage to the pericardium can manifest as acute pericarditis, effusion with tamponade or without cardiac tamponade, effusion-constrictive or classic constrictive pericarditis. Algorithms for the diagnosis and treatment of patients with radiation pericarditis in connection with a long asymptomatic course in a number of patients deserve special attention. Careful history taking and identifying prior radiotherapy is important in this category of patients. Untimely diagnosis and late treatment of these complications leads to a decrease in the quality of life of patients and increases the risk of cardiovascular mortality.
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Jakob, André, Sheila Unger, Raoul Arnold, Jochen Grohmann, Cornelia Kraus, Christian Schlensak, and Brigitte Stiller. "A family with a newelastingene mutation: broad clinical spectrum, including sudden cardiac death." Cardiology in the Young 21, no. 1 (November 16, 2010): 62–65. http://dx.doi.org/10.1017/s1047951110001563.

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AbstractSupravalvular aortic stenosis is associated with the Williams–Beuren syndrome, but it also occurs in a non-syndromatic congenital form. Anelastingene mutation of chromosome 7q11.23 is responsible in both cases. The vascular features are identical. These patients have a higher risk of sudden death, particularly when undergoing diagnostic or surgical procedures. We report the account of a family with a new mutation in theelastingene. Screening over three generations revealed eight affected individuals. The cardiac and vascular malformations ranged from mild asymptomatic supravalvular aortic stenosis and isolated dysplastic atrioventricular valves to diffuse arterial hypoplasia. Two infants presented arteries affected at multiple locations, including the left coronary artery. Both died of sudden cardiac death and myocardial ischaemia, one while under general anaesthesia for cardiac catheterisation, and the other perioperatively. We discuss the pathophysiological aspects in these patients that deserve consideration before any general anaesthesia is administered.
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Sorbets, Emmanuel, Kim M. Fox, Yedid Elbez, Nicolas Danchin, Paul Dorian, Roberto Ferrari, Ian Ford, et al. "Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry." European Heart Journal 41, no. 3 (September 3, 2019): 347–56. http://dx.doi.org/10.1093/eurheartj/ehz660.

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Abstract Aims Over the last decades, the profile of chronic coronary syndrome has changed substantially. We aimed to determine characteristics and management of patients with chronic coronary syndrome in the contemporary era, as well as outcomes and their determinants. Methods and results Data from 32 703 patients (45 countries) with chronic coronary syndrome enrolled in the prospective observational CLARIFY registry (November 2009 to June 2010) with a 5-year follow-up, were analysed. The primary outcome [cardiovascular death or non-fatal myocardial infarction (MI)] 5-year rate was 8.0% [95% confidence interval (CI) 7.7–8.3] overall [male 8.1% (7.8–8.5); female 7.6% (7.0–8.3)]. A cox proportional hazards model showed that the main independent predictors of the primary outcome were prior hospitalization for heart failure, current smoking, atrial fibrillation, living in Central/South America, prior MI, prior stroke, diabetes, current angina, and peripheral artery disease. There was an interaction between angina and prior MI (P = 0.0016); among patients with prior MI, angina was associated with a higher primary event rate [11.8% (95% CI 10.9–12.9) vs. 8.2% (95% CI 7.8–8.7) in patients with no angina, P &lt; 0.001], whereas among patients without prior MI, event rates were similar for patients with [6.3% (95% CI 5.4–7.3)] or without angina [6.4% (95% CI 5.9–7.0)], P &gt; 0.99. Prescription rates of evidence-based secondary prevention therapies were high. Conclusion This description of the spectrum of chronic coronary syndrome patients shows that, despite high rates of prescription of evidence-based therapies, patients with both angina and prior MI are an easily identifiable high-risk group who may deserve intensive treatment. Clinical registry ISRCTN43070564
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Israfil, Israfil, and Maria Agustina Making. "Blood Glucose Level, Blood Pressure, and Medication Behavior are related to Cardiovascular Complication in Hypertension Patient at Sikumana Public Health Center." Unnes Journal of Public Health 9, no. 1 (January 31, 2020): 50–55. http://dx.doi.org/10.15294/ujph.v9i1.28051.

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Hypertension tends to be incurable and can only be controlled, including to prevent cardiovascular complications. The purpose of this study was to look at the relationship of age, gender, blood glucose level, blood cholesterol level, blood pressure, and medication behavior (consumption of drugs and health control) with the incidence of cardiovascular complications in patients with hypertension at the Public Health Center in Sikumana-Kupang City. This study used a cross sectional design with a sample of 87 hypertension patients. Data analysis used Rank Spearman's Test (α = 0.01). There were 50 respondents who had cardiovascular complications in the form of non- hemorrhagic stroke complications (NHS), complications of coronary artery deseases (CAD), NHS and CAD complications, and complications of anggina pectoris. Analysis of Rank Spearman indicated age had p = 0.404 and r = 0.091, gender had p = 0.161 and r = -0,152, blood glucose level had p = 0.000 and r = -0.390, blood cholesterol level had p = 0.272 and r = -0.119, blood pressure had p = 0.000 and r = +0.417, drug consumption had p = 0.000 and r = +0.439, and health control had p = 0.000 and r = +0.490. It was concluded that there were significant relationships between blood glucose levels, blood pressure, and medication behavior (which consists of the consumption of hypertension drugs and health control) with the incidence of cardiovascular complications in patients with hypertension at the Sikumana Public Health Center in Kupang City.
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Lamblin, Nicolas, Sandro Ninni, Olivier Tricot, Thibaud Meurice, Gilles Lemesle, and Christophe Bauters. "Secondary prevention and outcomes in outpatients with coronary artery disease, atrial fibrillation or heart failure: a focus on disease overlap." Open Heart 7, no. 1 (April 2020): e001165. http://dx.doi.org/10.1136/openhrt-2019-001165.

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ObjectiveTo assess secondary prevention and outcomes in patients with chronic coronary artery disease (CAD), atrial fibrillation (AF) and heart failure (HF), focusing on disease overlap.MethodsWe analysed the data of 10 517 outpatients with a diagnosis of CAD, AF and/or HF included in a prospective cohort study. Follow-up (median 3.2 years) was achieved in 10 478 (99.6%) patients. Seven mutually exclusive patient groups were formed: CAD alone (n=4303), AF alone (n=2604), CAD+AF (n=700), HF alone (n=513), HF+CAD (n=728), HF+AF (n=1087) and HF+CAD+AF (n=582).ResultsPatients with disease overlaps represented 29.4% of the total population. The level of secondary prevention was high in all subgroups and in accordance with European class I – level A guidelines. Among patients with CAD, 99% received an antithrombotic and 91% received a statin. Among patients with AF, 81.7% were treated with an anticoagulant if indicated. Among HF patients with left ventricular ejection fraction <40%, 90.9% received a renin-angiotensin system antagonist and 91% a beta-blocker. Three-year all cause/cardiovascular mortality rates were: 6.4%/2%, 9.7%/3.3%, 15.6%/6.7%, 19.2%/9.4%, 24.3%/13.6%, 28%/15.7% and 35.4%/24.8%, for patients with CAD alone, AF alone, CAD+AF, HF alone, HF+CAD, HF+AF and HF+CAD+AF, respectively. In all groups with HF, observed all-cause mortality was higher (p<0.0001) than expected mortality for age-matched, gender-matched and geography-matched persons. In contrast, observed mortality was lower than expected for patients with CAD alone and AF alone (p<0.0001).ConclusionsIn a context of adequate secondary prevention, overlap between diseases is a frequent and high-risk situation with incremental increases in mortality. These patients deserve specific attention.
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Hlaing, Su M., Leah A. Garcia, Jaime R. Contreras, Keith C. Norris, Monica G. Ferrini, and Jorge N. Artaza. "1,25-Vitamin D3 promotes cardiac differentiation through modulation of the WNT signaling pathway." Journal of Molecular Endocrinology 53, no. 3 (August 19, 2014): 303–17. http://dx.doi.org/10.1530/jme-14-0168.

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Cardiovascular disease (CVD) remains the leading cause of death worldwide. Low levels of vitamin D are associated with high risk of myocardial infarction, even after controlling for factors associated with coronary artery disease. A growing body of evidence indicates that vitamin D plays an important role in CVD-related signaling pathways. However, little is known about the molecular mechanism by which vitamin D modulates heart development. The WNT signaling pathway plays a pivotal role in tissue development by controlling stem cell renewal, lineage selection and, even more importantly, heart development. In this study, we examined the role of 1,25-D3(the active form of vitamin D) on cardiomyocyte proliferation, apoptosis, cell phenotype, cell cycle progression and differentiation into cardiomyotubes. We determined that the addition of 1,25-D3to cardiomyocytes cells: i) inhibits cell proliferation without promoting apoptosis; ii) decreases expression of genes related to the regulation of the cell cycle; iii) promotes formation of cardiomyotubes; iv) induces the expression of casein kinase-1-α1, a negative regulator of the canonical WNT signaling pathway; and v) increases the expression of the noncanonicalWNT11, which it has been demonstrated to induce cardiac differentiation during embryonic development and in adult cells. In conclusion, we postulate that vitamin D promotes cardiac differentiation through a negative modulation of the canonical WNT signaling pathway and by upregulating the expression ofWNT11. These results indicate that vitamin D repletion to prevent and/or improve cardiovascular disorders that are linked with abnormal cardiac differentiation, such as post infarction cardiac remodeling, deserve further study.
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Basu, Arpita, Amy C. Alman, and Janet K. Snell-Bergeon. "Associations of Dietary Antioxidants with Glycated Hemoglobin and Insulin Sensitivity in Adults with and without Type 1 Diabetes." Journal of Diabetes Research 2022 (June 25, 2022): 1–8. http://dx.doi.org/10.1155/2022/4747573.

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Type 1 diabetes (T1D) has been associated with increased risks of atherosclerotic cardiovascular disease, and poor glycemic control and oxidative stress play a major role in its pathology. There is a lack of data on the role of dietary antioxidant micronutrients, including vitamins and trace elements, in glycemic control in T1D. The aim of this study is to examine associations of dietary intakes of micronutrients with glycemic status. We report data from a cross-sectional analysis from the coronary artery calcification in type 1 diabetes (CACTI) study ( n = 1257 ; T1D: n = 568 ; nondiabetic controls: n = 689 ) collected between the years 2000 and 2002. Participants completed a validated food frequency questionnaire, a physical examination, and biochemical analyses. Linear regression was used to examine the associations of dietary antioxidant micronutrients with HbA1c and estimated insulin sensitivity (eIS) in models adjusted for relevant covariates and stratified by diabetes status. In adults with T1D, we observed higher dietary manganese intake associated with higher eIS in the model adjusted for age, sex, diabetes duration, and total calories. In nondiabetic controls, higher intake of manganese associated with lower HbA1c and higher eIS values that persisted in models adjusted for all relevant covariates. On the other hand, dietary copper revealed a positive association with HbA1c in models adjusted for all covariates, except BMI and plasma lipids. No associations were noted for vitamins C and E and dietary carotenoids in either group. These findings reveal dietary antioxidant micronutrients, especially trace elements such as copper and manganese deserve special attention in glycemic control in adults with T1D as well as in nondiabetic controls.This trial is register with NCT00005754.
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Madani, Rana, Kalypso Karastergiou, Nicola C. Ogston, Nazar Miheisi, Rahul Bhome, Nora Haloob, Garry D. Tan, et al. "RANTES release by human adipose tissue in vivo and evidence for depot-specific differences." American Journal of Physiology-Endocrinology and Metabolism 296, no. 6 (June 2009): E1262—E1268. http://dx.doi.org/10.1152/ajpendo.90511.2008.

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Obesity is associated with elevated inflammatory signals from various adipose tissue depots. This study aimed to evaluate release of regulated on activation, normal T cell expressed and secreted (RANTES) by human adipose tissue in vivo and ex vivo, in reference to monocyte chemoattractant protein-1 (MCP-1) and interleukin-6 (IL-6) release. Arteriovenous differences of RANTES, MCP-1, and IL-6 were studied in vivo across the abdominal subcutaneous adipose tissue in healthy Caucasian subjects with a wide range of adiposity. Systemic levels and ex vivo RANTES release were studied in abdominal subcutaneous, gastric fat pad, and omental adipose tissue from morbidly obese bariatric surgery patients and in thoracic subcutaneous and epicardial adipose tissue from cardiac surgery patients without coronary artery disease. Arteriovenous studies confirmed in vivo RANTES and IL-6 release in adipose tissue of lean and obese subjects and release of MCP-1 in obesity. However, in vivo release of MCP-1 and RANTES, but not IL-6, was lower than circulating levels. Ex vivo release of RANTES was greater from the gastric fat pad compared with omental ( P = 0.01) and subcutaneous ( P = 0.001) tissue. Epicardial adipose tissue released less RANTES than thoracic subcutaneous adipose tissue in lean ( P = 0.04) but not obese subjects. Indexes of obesity correlated with epicardial RANTES but not with systemic RANTES or its release from other depots. In conclusion, RANTES is released by human subcutaneous adipose tissue in vivo and in varying amounts by other depots ex vivo. While it appears unlikely that the adipose organ contributes significantly to circulating levels, local implications of this chemokine deserve further investigation.
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Brassard, Didier, Benoît J. Arsenault, Marjorie Boyer, Daniela Bernic, Maude Tessier-Grenier, Denis Talbot, Angelo Tremblay, et al. "Saturated Fats from Butter but Not from Cheese Increase HDL-Mediated Cholesterol Efflux Capacity from J774 Macrophages in Men and Women with Abdominal Obesity." Journal of Nutrition 148, no. 4 (April 1, 2018): 573–80. http://dx.doi.org/10.1093/jn/nxy014.

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Abstract Background Recent evidence suggests that the association between dietary saturated fatty acids (SFAs) and coronary artery disease risk varies according to food sources. How SFAs from butter and cheese influence HDL-mediated cholesterol efflux capacity (CEC), a key process in reverse cholesterol transport, is currently unknown. Objective In a predefined secondary analysis of a previously published trial, we have examined how diets rich in SFAs from either cheese or butter influence HDL-mediated CEC, compared with diets rich in either monounsaturated fatty acids (MUFAs) or polyunsaturated fatty acids (PUFAs). Methods In a randomized crossover controlled consumption trial, 46 men and women with abdominal obesity consumed 5 isocaloric diets, each for 4 wk. Two diets were rich in SFAs either from cheese (CHEESE) or butter (BUTTER) [12.4–12.6% of energy (%E) as SFAs, 32%E as fat, 52%E as carbohydrates]. In 2 other diets, SFAs (5.8%E) were replaced with either MUFAs from refined olive oil (MUFA) or PUFAs from corn oil (PUFA). Finally, a lower fat and carbohydrate diet was used as a control (5.8%E as SFAs, 25.0%E as fat, 59%E as carbohydrates; CHO). Post-diet HDL-mediated CEC was determined ex vivo using radiolabelled J774 macrophages incubated with apolipoprotein B–depleted serum from the participants. Results Mean (±SD) age was 41.4 ± 14.2 y, and waist circumference was 107.6 ± 11.5 cm in men and 94.3 ± 12.4 cm in women. BUTTER and MUFA increased HDL-mediated CEC compared with CHEESE (+4.3%, P = 0.026 and +4.7%, P = 0.031, respectively). Exploring the significant diet × sex interaction (P = 0.044) revealed that the increase in HDL-mediated CEC after BUTTER compared with CHEESE was significant among men (+6.0%, P = 0.047) but not women (+2.9%, P = 0.19), whereas the increase after MUFA compared with CHEESE was significant among women (+9.1%, P = 0.008) but not men (–0.6%, P = 0.99). Conclusion These results provide evidence of a food matrix effect modulating the impact of dairy SFAs on HDL-mediated CEC with potential sex-related differences that deserve further investigation. This trial was registered at clinicaltrials.gov as NCT02106208.
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Kanar, B., RM Hamdy, A. Lindholm, L. Puga, A. Zaroui, L. Groenningsaeter, R. Sorrentino, et al. "P1113Relationship between left atrium and hypertensive retinopathy in patients with systemic hypertension: a real-time three-dimensional echocardiography-based studyP1114Detection of early left ventricular systolic dysfunction in hypertensive patients with preserved ejection fraction using deformation imagingP1115Left ventricular strain in systemic sclerosis with and without pulmonary hypertension; a cardiac magnetic resonance studyP1116End-stage chronic kidney disease and routine annual transthoracic echocardiograpyP1117arrhythmogenic right ventricular cardiomyopathy or athlete's heart adaptations ?P1118Reduced left ventricular function in long term follow-up in women with previous severe preeclampsiaP1119Preload dependent changes of left ventricular twisting and torsion during pregnancy: a three-dimensional strain studyP1120Pre-procedural renal resistive index predicts contrast-induced acute kidney injury following coronary angiographyP1121Simplified 10 point ultrasound in diagnosis of pulmonary congestion in heart failureP1122Pulmonary and systemic vascular resistance during graded exercise in patients with ventricular septal defect repair versus healthy controlsP1123Effect of percutaneous stent implantation on arterial hypertension and aortic flow dynamics in patients with aortic coarctation: identification of responders and non respondersP1124The use of vitamin k antagonists is associated with increased levels of vascular calcification in low-risk patients with atrial fibrillationP1125Stress echo positivity predicts cancer deathP1126Assessment of the agreement between instantaneous wave-free ratio (iFR) and dobutamine stress echo in real world stable angina patientsP1127Impact of AVAproj on severity reclassification of LFLG AS with persistent area - gradient discordanceP1128 The prognostic value of rest and exercise- induced B-lines in heart failure patientsP1129Stress-induced worsening of left ventricular diastolic function as a new marker of myocardial ischemia: a retrospective observational studyP1130Prediction and management of stable angina in senior populationP1131Risk assessment of coronary heart desease in men before revascularization of non-coronary arteriesP1132Relation of elevated C - reactive protien level to left atrial size and left atrial thrombus in patients with valvular and non-valvular atrial fibrillationP1133Transesophageal echocardiographic assessment of left atrial appendage function as a cardioembolic source in atrial fibrillationP1134Correlations of three-dimensional mitral valve geometry with chronic ischemic mitral regurgitation severity in compliance with tethering phenotypesP1135Aortic root physiology in patients with aortic valvulopathyP1136Comparison of layer-specific strain to other contemporary deformation parameters for coronary artery disease prediction in patients with non-ST-segment elevation acute coronary syndromeP1137Machine-learning based diagnosis of heart failure with preserved ejection fraction: how much do we agree with the guidelines?" European Heart Journal – Cardiovascular Imaging 17, suppl 2 (December 2016): ii234—ii241. http://dx.doi.org/10.1093/ehjci/jew262.002.

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Tsujita, Yuki, Yoichi Kawamura, Takashi Kanai, Seiichiro Takeshita, and Shigeaki Nonoyama. "Abstract 70: Trial of Ulinastatin treatment for murine model of Kawasaki Desease." Circulation 131, suppl_2 (April 28, 2015). http://dx.doi.org/10.1161/circ.131.suppl_2.70.

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Recently, we reported that the initial Ulinastatin (UTI) therapy combined with intravenous immunoglobulin (IVIG) reduced the proportion of patients with Kawasaki disease requiring additional rescue treatment and the occurrence of coronary artery lesions as compared with IVIG alone (Circulation. 2011;124(25):2822-2828.). However, there have been no reports that histologically examined the therapeutic effects of UTI., In the present study, to investigate the histological efficacy of UTI, we administered UTI in a vasculitis murine model, resembling Kawasaki disease Four-week-old male mice DBA/2 were intraperitoneally administered Candida albicans water soluble extract (CAWS) for 5 days and were treated either with UTI, IVIG, or a combination of UTI and IVIG. Further, we examined the plasma levels of neutrophil elastase andcytokinesandevaluated histopathological features.. Neutrophil elastase, TNF-α, IL-6, IP-10, and MIG significantly increased in the CAWS-treated mice. Large amount of elastase-positive neutrophils infiltrated in the coronary tissue. In addition, the infiltration of elastase-positive neutrophils was reduced in the pathological tissue of the UTI treatment group. Neutrophil elastase is strongly involved in the destruction of the elastic plate and smooth muscle layer. There is a possibility that destruction of the vascular structures can be suppressed by decreasing the elastase-positive neutrophils infiltration in the UTI treatment group.
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Sturzu, A., A. M. Balahura, S. Dumitrascu, L. Calmac, A. Alexandrescu, R. Vatasescu, E. Badila, and D. Bartos. "P888 How many diagnoses can one heart gather?" European Heart Journal - Cardiovascular Imaging 21, Supplement_1 (January 1, 2020). http://dx.doi.org/10.1093/ehjci/jez319.528.

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Abstract Background Apical hyperthrophic cardiomyopathy (AHCM) is an uncommon form of hyperthrophic cardiomyopathy (HCM) with less prevalent detection of gene mutations and sudden cardiac death compared with other types of HCM. Purpose We present the case of a 76 years old patient with multiple cardiovascular risk factors (hypertension, dyslipidemia, obesity, former smoker) with history of unprovoked pulmonary embolism - PE (2018), without evidence of deep venous thrombosis, in treatment with rivaroxaban, who presented with worsening severe dyspnea at effort and peripheral edemas, symptoms started a few days before admission. He denied angina or palpitations. Methods On clinical examination we identified obesity grade II and bilateral leg edema and routine laboratory tests revealed controlled dyslipidemia. The electrocardiogram (ECG) showed atrial flutter (AF) with block 5:1, heart rate 50/min, with negative T waves in DI, aVL and V2-V6. Transthoracic echocardiography with contrast was performed showing no wall motion abnormalities otherwise with a mild concentric left ventricle hypertrophy (LVH) except for the apex where there was severe LVH suggestive for AHCM; there was an increased aortic velocity with an aortic valve with degenerative changes. We thought that the changes on the ECG were most likely due to AHCM. A thoracic tomography scan with contrast was also performed because of associated dyspnea which excluded an acute recurrence of PE. The next day the T waves on ECG normalized, putting forward for consideration an acute coronary syndrome. We performed a coronarography which confirmed a 80% stenosis of proximal left anterior descending (LAD) artery with subsequent placement of a drug eluting stent. We also did a transesophageal echocardiography (noncompliant patient) for exclusion of intracardiac thrombi (which also showed bicuspid aortic valve) and then we performed radiofrequency ablation of the cavotricuspid isthmus followed by atrial overdrive pacing for typical AF, but unsuccessful, with degeneration into atrial fibrillation. Results Sometimes heart failure might occur due to multiple etiological factors and mechanisms of decompensation. We had a patient with AHCM with an ECG that could be interpreted as typical for this pathology but with concomitent severely affected LAD coronary artery, with AF and high grade atrioventricular block plus mild aortic stenosis with a bicuspid aortic valve with indication for strict follow up. Conclusions AHCM was first described in Japan where has the highest prevalence, but is also documented in other countries (rare in Caucasian population). Note that AHCM often mimic acute coronary syndromes through clinical manifestations and electrocardiographic aspects. Our case report showed a Caucasian patient with AHCM with concomitent severe atherosclerotic desease and aortic stenosis on a bicuspid valve.
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Money, Joel E., Joseph B. Muhlestein, Steve M. Mason, Tami L. Bair, Kirk U. Knowlton, and Jeffrey L. Anderson. "Abstract 13551: Identifying Left Main Coronary Artery Disease Using Coronary Artery Calcium Scans." Circulation 142, Suppl_3 (November 17, 2020). http://dx.doi.org/10.1161/circ.142.suppl_3.13551.

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Introduction: The ISCHEMIA trial tested an invasive vs. an initial medical strategy in patients (pts) with stable coronary disease and evidence of ischemia. No significant difference between strategies in cardiovascular events was found at 3.2 years. However, pts were screened before randomization by coronary CT angiography (CCTA) to exclude ≥50% left main coronary stenosis (LMCS). CCTA adds complexity to routine medical practice, including time delays, expense, and safety concerns. We tested whether a coronary artery calcium scan (CACS), a simpler, less expensive test, could replace CCTA to exclude significant LMCS. Methods: We hypothesized that pts with ≥50% LMCS would have a LM CACS score>0. As a corollary, we postulated that a LM CACS=0 would exclude pts with LMCS. To test this, we searched Intermountain Healthcare’s electronic medical records database for all adult pts who had undergone non-contrast cardiac CT for quantitative CACS scoring prior to selective coronary angiography (SCA) and were found to have a LMCS ≥50%. Pts aged <50 and those with a heart transplant were excluded. Cases with incomplete (qualitative) angiographic reports for LMCS and those with incomplete or discrepant LM CACS results were reviewed and reassessed blinded to CACS or SCA findings, respectively. Results: Among 674 candidate pts with CACS followed by SCA, 24 qualifying pts were identified who had a quantitative CACS score and LMCS ≥50%. Their age averaged 71 ± 11 years, and 83% were men. Angiographic LMCS averaged 77% (range 50%-99%). A heavy burden of both total CAC and LM CAC was typically present. Total CACS score averaged 2,545 Agatston Units (AU), range 571-6,636. LM CACS score averaged 214 AU, range 47-610. Importantly, no LMCS pt had a LM CACS score of 0 vs. 57% (368/650) of non-LMCS controls (p<0.00001). Conclusions: Our results support the hypothesis that an easily administered, inexpensive, low radiation CACS can identify a large subset of pts with a very low risk of LMCS without the need for routine CCTA. Using CACS to exclude LMCS may efficiently allow for safe implementation of an initial medical therapy strategy in clinical practice for ISCHEMIA trial-like pts with at least moderate ischemia on stress testing. These promising results deserve validation in larger data sets.
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Hamilos, Michalis, Thomas Cuisset, Jaydeep Sarma, Emanuele Barbato, Jozef Bartunek, Marc Vanderheyden, Guy Heyndrickx, William Wijns, Nico Pijls, and Bernard De Bruyne. "Abstract 4470: Long Term Follow Up After Fractional Flow Reserve-guided Treatment Of ‘Moderate’ Left Main Coronary Artery Stenosis." Circulation 118, suppl_18 (October 28, 2008). http://dx.doi.org/10.1161/circ.118.suppl_18.s_894-c.

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Introduction: We assesed the value, in terms of long-term clinical outcome, of a fractional flow reserve (FFR)-guided treatment strategy in patients with angiographically ‘intermediate’ left main coronary artery (LMCA) stenoses. Methods: In 215 consecutive patients with an angiographically ‘intermediate’ unprotected LMCA stenosis (between 30–70%, by visual estimate), FFR measurements and off line quantitative coronary angiography (QCA) were obtained. When FFR was ≥0.80, patients were treated medically (medical group); When FFR was <0.80 coronary artery bypass grafting (CABG) was advocated (surgical group). Incidence of death, myocardial infarction and any coronary revascularisation procedure were recorded. Results: 140 patients had an FFR≥0.80 and 75 patients had an FFR<0.80. Percent diameter stenosis at QCA correlated significantly with FFR (r = −0.38, p<0.001), but a very large scatter was observed (Figure 1B ). Mean follow up duration was 35 ± 25 months. The incidence of death was 7.9 % in the medical group and 9.3 % in the surgical group. (Figure 1A , p=0.73). Conclusions : Angiography alone does not allow appropriate decision making in patients with angiographically ‘intermediate’ stenosis of the LMCA. Given the favorable outcome of an FFR-guided strategy such patients deserve FFR assessment before blindly proceeding to revascularisation. Figure 1: A Kaplan-Meier mortality curves for the 2 study groups. B Scatterplots showing the distribution of % diameter stenosis and the corresponding FFR values (filled dots indicate FFR≥0.80 and circles indicate FFR<0.80).
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Gündüz, Yasemin, Huseyin Gunduz, Omer Faruk Ates, Mahmut Ciner, Ahmetcan Cakmak, Cagla Akcay., Ersin Ilguz., and Kahraman Cosansu. "Doppler ultrasonographic evaluation of radial and ulnar artery diameters and blood flow, before and after percutaneous coronary interventions." Medical Ultrasonography, July 1, 2021. http://dx.doi.org/10.11152/mu-2996.

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Aim: Although the transforearm approach is considered a safe and effective option for percutaneous coronary intervention, the different characteristics of the radial and ulnar arteries deserve attention. This study aimed to evaluate radial (RA) and ulnar artery (UA) diameter and blood flow parameters changes after catheterization. Material and method: A total of 328 patients were enrolled. Their artery (171 RA and 157 UA) diameter and flow parameters [peak systolic velocity (PSV), end-diastolic volume (EDV) and pulsatility index (PI)] were evaluated before and after catheterisation. Results: After RA catheterization, the diameters and PSV decreased in the RA (from 2.71±0.66 to 2.47±0.51, p=0.007; from 44.7±8.3 to 33.9±9.5, p=0.021) and increased in the UA (from 2.49±0.83 to 2.59±0.58, p=0.033; from 48.3±11.9 to 59.6±11.0, p
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Mureddu, Gian Francesco. "Secondary cardiovascular prevention in clinical practice: what do we need today?" Monaldi Archives for Chest Disease 89, no. 3 (September 30, 2019). http://dx.doi.org/10.4081/monaldi.2019.1160.

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In the last decades, the post-hospital mortality from coronary artery disease (CAD) has significantly increased. This new trend in the epidemiology of CAD has been largely attributed to the improvement of survival from acute coronary syndromes that generated increasing incidence of population at high risk of recurrences and rehospitalization for major adverse cardiovascular events (MACE) and heart failure (HF). Thus, much longer after the acute event than we had thought, we have now been facing with higher complexity of “chronic” CAD phenotypes which deserve high clinical attention and more and more intricate pharmacological management. Although the guidelines recommend implementing secondary prevention programs through cardiac rehabilitation (CR) facilities in order to achieve a better outcome, i.e. decreased morbidity, re-hospitalization and increased adherence to evidence-based interventions, the referral rate to CR is paradoxically scarce. The Italian Association of Clinical Preventive Cardiology and Rehabilitation (AICPR) has been launching a survey involving the Network of Italian CR centers, which will make possible to observe trends, implement guidelines recommendations and then verify the effectiveness of the interventions and outcomes in post-acute and chronic CAD.
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Cui, Charles Q., Bryon S. Cook, Matthew P. Cauchi, and Jason R. Foerst. "A case series: alternative access for refractory shock during cardiac arrest." European Heart Journal - Case Reports 3, no. 3 (July 4, 2019). http://dx.doi.org/10.1093/ehjcr/ytz101.

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Abstract Background In patients with iliofemoral arterial disease, transcaval and percutaneous axillary artery access are safe alternatives for delivery of transcatheter aortic valve replacement for severe aortic stenosis. In the setting of cardiac arrest, arterial access is crucial for delivery of mechanical circulatory support devices such as an Impella CP® or cannulation for extracorporeal cardiopulmonary resuscitation (ECMO). We report the use of transcaval and axillary artery access in three cases of cardiac arrest in which the emergent placement of an Impella CP® (Abiomed, Danvers, MA, USA) or cannulation for ECMO was instrumental in resuscitation from refractory cardiac arrest. Case summary The first patient is a 59-year-old woman who developed ventricular fibrillation arrest after percutaneous intervention with emergent placement of a transcaval Impella CP®. In the second case, a 67-year-old man with coronary vasospasm developed cardiac arrest with an axillary artery Impella CP® placed. The third case highlights a 67-year-old man who developed cardiac arrest 1 day after unsuccessful chronic total occlusion repair requiring ECMO cannulation to his axillary artery. All three patients achieved spontaneous circulation after placement of assist devices. Discussion To our knowledge, a case report of transcaval or percutaneous axillary artery access for Impella CP® during cardiac arrest has not been published. While the long-term prognosis following cardiac arrest is poor, younger patients deserve every chance for survival with rapid cardiopulmonary support by alternative access if necessary. Advanced large bore alternative access techniques should be learned by all interventional operators.
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Golino, Michele, Claudio Licciardello, Federica Matteo, Fulvio Lorenzo Francesco Giovenzana, Cinzia Franzosi, Federico Blasi, Paola Genoni, et al. "404 Acute coronary syndromes after healing from COVID-19: report of the initial observation." European Heart Journal Supplements 23, Supplement_G (December 1, 2021). http://dx.doi.org/10.1093/eurheartj/suab135.024.

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Abstract Aims Severe pulmonary complications are well described in the coronavirus disease 2019 (COVID-19) and cardiovascular diseases (CVDs) have been documented as well. Most patients (pts) recover quickly; nevertheless, the potential long-term cardiovascular sequalae of COVID-19 remain currently unknown. The aim was to report cases of acute coronary syndromes (ACS) after healing from COVID-19 and their features at coronary angiography; secondary purpose was to hypothesize the underlying mechanisms. Methods and results A retrospective study was performed by acquiring data from the electronic medical record. From January to June 2021, four hypertensive pts (64 ± 17 years old; three males) with no history of CVDs and previous symptomatic SARS-CoV-2 infection (mean interval from first positive molecular swab 47 ± 32 days; all recovered after 15 days with double negative swab) were admitted to the emergency department for ST-elevation myocardial infarction (3 anterior and one inferior). At admission, the SARS-CoV-2 molecular swab tested negative, left ventricle ejection fraction was 42 ± 12%, troponin T and Nt-proBNP values were 47 ± 24 ng/l and 1180 ± 978 ng/l, respectively. Emergency coronary angiography showed single-vessel acute thrombotic occlusion (in three cases of the anterior descending artery and in one case of the right coronary artery), with no evidence of atherosclerotic disease. Because of the high thrombotic burden, in all cases a mechanical thrombus aspiration system was used, tirofiban infusion started and no balloon angioplasty or drug-eluting stent implantation was necessary (Figures A–D). After 72 h, a second SARS-CoV-2 molecular swab tested also negative. In the following days, the pts gradually recovered and they were discharged home. Conclusions These cases deserve specific considerations both on the pathophysiologic mechanisms of the ACS possibly related to SARS-CoV-2 and on the subsequent long-term sequelae. Among various pathophysiologic mechanisms proposed, the high affinity of the spike protein for the angiotensin converting enzyme two receptor (expressed by both cardiac and endothelial cells) could explain direct cardiac viral infection and vasculitis with possible development of thrombosis. The latter could contribute both to acute and long-term cardiac sequelae, even months after the acute infection, configuring a sort of ‘cardiac post-Covid syndrome’. Whether and how long this status persists, making COVID-19 a risk factor for subsequent CVDs, is still an unresolved question. In this regard, continuous monitoring of these pts and larger future studies will be essential.
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Russo, G., D. Pedicino, F. Burzotta, M. Lodi Rizzini, L. Genuardi, R. Vinci, M. Bologna, et al. "Fluid-dynamics and biological features of unstable plaques: different shear stress for different plaques." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.1569.

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Abstract Background The use of Optical Coherence Tomography (OCT) in acute coronary syndromes (ACS) allows recognizing ruptured fibrous cap (RFC) and intact fibrous cap (IFC) culprit lesions. The biological differences between them, as recently pointed out in translation studies, highlight different mechanisms for a similar clinical manifestation that might deserve different therapeutic approaches. The relationship between endothelial wall shear stress (WSS) and ACS has been demonstrated, however the differences in WSS features between RFC and IFC have not been elucidated. Purpose The aim of this study is to provide a fluid-dynamic and biological description of unstable and stable (SA) plaques, according to OCT analysis. Methods We enrolled 10 SA and 20 Non-ST Elevation Myocardial Infarction (NSTEMI)-ACS patients, with IFC (n=10) and RFC (n=10) culprit lesions according to OCT analysis. We performed Real-time PCR primer array on pooled Peripheral Blood Mononuclear Cell (PBMC) for 30 different molecules whose expression is strictly dependent on WSS. High-fidelity 3D-coronary artery models were created for 3 patients per group, applying previously validated methodologies. Results Among the groups we found a broad difference in molecular expression (Fig. 1A), with RFC displaying higher levels of molecules involved in vasoconstriction/dilatation (EDN1, NOS3), cellular adhesion (ICAM1), and peptidase inhibition (PI16). A significantly higher WSS was observed in RFC group (p&lt;0.001, Fig 1B and C), with larger variability and larger areas exposed to both low and high WSS (Fig. 1D). Interestingly, the molecules overexpressed in RFC are known to be upregulated by high WSS. Conclusions Our data demonstrated that IFC and RFC unstable plaques are associated with different WSS conditions, alongside with the expression of different molecular patterns specifically related to altered WSS. In the era of precision medicine these findings may have relevant therapeutical implications. Funding Acknowledgement Type of funding source: None
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Goff, David C., David Jacobs, J. G. Terry, Stephen Sidney, and J. J. Carr. "Abstract P300: Major Risk Factors For Coronary And Aorto-iliac Calcium In Middle-aged Black And White Adults: Results From CARDIA." Circulation 125, suppl_10 (March 13, 2012). http://dx.doi.org/10.1161/circ.125.suppl_10.ap300.

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Background: Abdominal aorto-iliac atherosclerosis occurs earlier in the course of disease than coronary artery atherosclerosis and is often present in persons free of coronary atherosclerosis. Accounting for this early stage of disease might improve the ability to evaluate risk factors for atherosclerosis. Objective: We examined the associations of major risk factors with the presence of coronary artery calcium (CAC) and abdominal aorto-iliac calcium (AoIC) in the absence of CAC in 1994 black and white men and women participating in the CARDIA study at the year 25 exam in 2010–11. Methods: Multinomial logistic regression was used to examine the associations of risk factors measured at year 15 with the presence of CAC and AoIC (Agatston scores ≥1) at year 25. Ordinary logistic regression was used to examine the associations of risk factors with presence of CAC (ignoring AoIC) at year 25. Results: 457 (22.9%) had both CAC and AoIC, 139 (7.0%) had CAC only, 632 (31.7%) had AoIC only, and 766 (38.4%) had neither. The 596 with CAC (+/−AoIC) were analyzed as one group vs. AoIC only, both in comparison with no calcification. Most risk factors had similar association with CAC (+/−AoIC) and AoIC only, including total and HDL cholesterol, triglycerides, systolic and diastolic blood pressure, smoking status, waist circumference and education. When comparing odds ratios (OR) for CAC (+/−AoIC) and AoIC only, both vs. no calcification, substantial differences were seen for comparisons of blacks vs whites (0.52 for CAC, p<0.0001 and 0.88 for AoIC, p=0.34), women vs men (0.34 for CAC, p<0.0001 and 0.96 for AoIC, p=0.77), and use vs. nonuse of drugs for blood pressure lowering (2.24, p=0.0023 and 1.27, p=0.36) and lipid lowering drugs (2.39, p=0.07 and 0.98, p=0.97). Accounting for the presence of AoIC without CAC resulted in uniform strengthening of the associations of risk factors with CAC. The most impressive change was for current smoking. The OR for CAC was 2.01 (95% CI: 1.53, 2.65) when ignoring AoIC and 4.47 (3.15, 6.32) when accounting for AoIC. AoIC alone was also strongly associated with smoking with an OR of 3.84 (2.80, 5.28). Conclusions: AoIC, an early manifestation of subclinical atherosclerosis, is associated with the major risk factors for CAC. The race and sex differences shown here, including little race or sex difference in AoIC only, are consistent with previous autopsy studies and deserve further etiologic research. Accounting for the presence of AoIC without CAC results in stronger estimates of risk factor associations with CAC. Studies that have not accounted for the presence of atherosclerosis in other vascular beds may have under-estimated the associations of established and novel risk factors with CAC.
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Vitale, Carlo, Alessandro Parlato, Giovanni Mondello, Angelica Lossi, Eleonora Guarnieri, Lorenzo Ridolfi, Marco Favilli, et al. "598 PREVALANCE AND PREDICTORS OF LONG-TERM CARDIAC SYMPTOMS IN PATIENTS WITH TAKOTSUBO SYNDROME." European Heart Journal Supplements 24, Supplement_K (December 14, 2022). http://dx.doi.org/10.1093/eurheartjsupp/suac121.684.

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Abstract Background Takotsubo syndrome (TTS) is characterized by an acute and transient left ventricular dysfunction, usually involving the apical and midventricular segments, associated with troponin elevation and often triggered by either emotional or physical stressors. Once considered a benign condition, it is now clear that TTS patients have increased long-term mortality compared with the general population. Prevalence and the determinants of long-term cardiac symptoms in TTS patients have been scarcely investigated. Methods We enrolled consecutive patients admitted to our Centre with a diagnosis of TTS . All patients underwent invasive coronary angiography with left ventriculography at admission and only those fulfilling both the Mayo Clinic and Heart Failure Association criteria for a TTS diagnosis were selected for this study. Clinical, biochemical, and instrumental data were collected at admission and before discharge, and patients were followed-up for: symptoms recurrence (i.e., presence of effort angina and/or dyspnoea in the absence of other obvious causes) and all-cause mortality. The prevalence of long-term symptoms was further compared with a control group of unselected patients admitted for acute coronary syndromes (ACS) in the same period, matched for sex, age, and left ventricular ejection fraction (LVEF) at discharge. Results We eventually enrolled 118 patients (aged 73±10 years, 91% of whom were female). Acute chest pain was the most common presenting symptom (73%), followed by dyspnoea (32%), acute heart failure (16%), cardiogenic shock (9%), and syncope (8%). Most of cases (82%) were classified as having a typical (apical) LV dysfunction. Either a physical or an emotional stressor was identified in 37 (31%) and 31 (26%) of the patients, respectively. At admission, patients showed moderate systolic dysfunction (LVEF 40±9%), which was often improved at discharge (LVEF 52±8%). Over a median follow-up of 21 (interquartile interval 11-53) months, 35% of patients complained of some cardiac symptom: 32% of patients complained of effort dyspnoea and 7% (partially overlapping with the former) complained of effort angina. When compared with ACS patients (n=55, aged 71±10 years, 94% women, LVEF 53±9%), TTS patients featured a similar mortality rate, a lower (non-significant) prevalence of angina, and a significantly higher prevalence of dyspnoea (p=0.02). Notably, while a lower age at presentation (p=0.017) and a physical trigger (p=0.015) were significantly associated with the risk of recurrent angina, the absence of chest pain (p=0.044), a lower LVEF at admission (p=0.019), and a higher troponin T concentration at discharge (p=0.018) were associated with the presence of dyspnoea at follow-up. Finally, older age, male sex, renal dysfunction, cardiogenic shock, and concomitant coronary artery disease were all associated with a higher risk of death. Prescription of ACE-inhibitors and/or beta-blockers were associated with reduced risk (p&lt;0.05, for all), in line with previous reports. Conclusion TTS is associated with a high risk of recurrent cardiac symptoms, mostly dyspnoea, over time. Selected clinical, biochemical, and instrumental characteristics may help identify patients more at risk, who may deserve a closer follow-up and potentially tailored therapies, to be investigated in future studies.
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Turrini, Fabrizio, Roberto Messora, Paolo Giovanardi, Stefano Tondi, Paolo Magnavacchi, Rita Cavani, Giandomenico Tosoni, et al. "Screening asymptomatic patients with diabetes for unknown coronary artery disease: Does it reduce risk? An open-label randomized trial comparing a strategy based on exercise testing aimed at revascularization with management based on pharmacological/behavioural treatment of traditional risk factors. DADDY-D Trial (Does coronary Atherosclerosis Deserve to be Diagnosed and treated early in Diabetics?)." Trials 10, no. 1 (December 2009). http://dx.doi.org/10.1186/1745-6215-10-119.

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Lander, K., P. Thakeria, H. Andrew, and S. Nayyar. "Stroke prevention by Non-vitamin K Oral Anticoagulant (NOAC) agents in the absence of atrial fibrillation: meta-analysis of randomized control trials." European Heart Journal 41, Supplement_2 (November 1, 2020). http://dx.doi.org/10.1093/ehjci/ehaa946.2423.

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Abstract Background Anticoagulation to prevent stroke is a mainstay of atrial fibrillation (AF) management. Patients with established cardiovascular disease (CVD) may have conditions that fulfil Virchow's triad for thrombogenesis even in sinus rhythm. Previous investigation into the benefit of warfarin compared to placebo or antiplatelet drug in sinus rhythm found a reduction in stroke rates, but with an increase in bleeding. The efficacy and safety of non-vitamin K oral anticoagulant (NOAC) agents has not been studied. Purpose To assess the safety and efficacy of NOAC agents in patients without AF. Methods An electronic database search for randomized controlled trials that evaluated a NOAC and control drug (placebo or antiplatelet) in non-AF patients with CVD was conducted up until 1 September 2019. The primary efficacy and safety outcomes were ischemic stroke and major bleeding, respectively. The net clinical benefit (NCB) was calculated as a weighted sum of rate differences of ischemic stroke and major bleeding. Groups were stratified according to intensity of anticoagulation (full vs. low dose NOAC). Results Twelve randomized controlled trials were identified with a total of 83,008 patients (50,617 on NOAC, 32391 on control drug; mean age 66±2.7 years). CVD included coronary artery disease (78.3%), hypertension (73.7%), diabetes mellitus (34.7%), peripheral arterial disease (30.3%), previous stroke (21.7%), renal disease (22.9%) and heart failure (18.4%). Over a mean follow-up of 17.3 months, 1347 (1.6%) ischemic strokes occurred. Use of NOAC was associated with 28% reduction in ischemic stroke (odds-ratio [OR] 0.72, 95% confidence-interval [CI] 0.60 to 0.87; 1.1 vs. 1.8 events per 100-person years), with numbers needed to treat of 145 patients to prevent one stroke. Major bleeding was increased nearly 2-fold (OR 1.83, 95% CI 1.46 to 2.29; 2.1 vs. 1.0 events per 100-person years). The NCB demonstrated overall harm with the use of NOAC agents in this patient population (NCB = −0.28, 95% CI: −0.79 to 0.23). Use of full dose NOAC was widely unsafe (NCB = −0.35, 95% CI: −1.25 to 0.54) and low dose NOAC approached null therapeutic safety advantage (NCB = −0.06, 95% CI: −0.47 to 0.35). Conclusion Patients with CVD are at increased of ischemic stroke in the absence of AF. The use of NOAC agents in this non-AF population reduces rate of ischemic stroke however overall risk of bleeding exceeds antithrombotic benefit. Low-dose NOACs demonstrate a neutral NCB suggesting a point of clinical equipoise and deserve further scrutiny. Ischemic stroke vs major bleeding Funding Acknowledgement Type of funding source: None
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Gil Fernandez, J., G. Rojas Lavado, J. Candela Ferre, E. Gonzalez-Bartol, C. Aristizabal-Duque, I. Gomez-Salvador, T. Sevilla Ruiz, and JA San Roman. "Symptoms development overtime according to the imaging based cardiac damage staging classification in asymptomatic patients with moderate to severe aortic stenosis." European Heart Journal - Cardiovascular Imaging 23, Supplement_1 (February 1, 2022). http://dx.doi.org/10.1093/ehjci/jeab289.364.

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Abstract Funding Acknowledgements Type of funding sources: None. Background Recently, a new staging of patients with asymptomatic moderate to severe aortic stenosis (AS) based on extra-aortic valve cardiac damage has been described to stratify the prognostic of both, asymptomatic and symptomatic patients. Purpose To test the ability of this imaging based staging system to predict the development of symptoms in patients with moderate to severe asymptomatic AS. Methods We analyzed a retrospective cohort of 96 patients with at least moderate AS who were systematically studied with echocardiography and cardiac magnetic resonance imaging. Patients were classified according to the staging classification of extra-aortic valve damage: no cardiac damage (Stage 0), left ventricular (LV) damage: LV mass index &gt;95 g/m2 in women and &gt;115 g/m2 in men and or E/E´ratio &gt;14 and/or LV ejection fraction &lt;50% (Stage 1), mitral valve or left atrial (LA) damage: LA volume &gt;34 ml/m2, and/or atrial fibrillation and/or ≥ moderate mitral regurgitation (Stage 2), tricuspid valve or pulmonary vasculature damage: systolic pulmonary arterial pressure ≥60 mm Hg and/or moderate or greater tricuspid regurgitation (Stage 3), right ventricular damage: tricuspid annulus systolic velocity S´&lt; 9.5 cm/s, TAPSE &lt; 17 mm, and/or RV ejection fraction &lt; 50% (Stage 4). Given the small number of patients in Stages 3 and 4, patients were merged together in a single group. The primary endpoint was the development of symptoms during a follow-up of 5 years, regardless of whether the patient underwent aortic valve replacement. Kaplan-Meier curves and log-rank test of the time to development of symptoms data were used. Results At baseline patients had a mean age of 70.9 years old and 71.9% were male. Most of patients had hypertension (70.8%) and dyslipidemia (55.2%). 20.8% had diabetes mellitus and only 10.4% had previous coronary artery disease. The mean transvalvular gradient was 39 ± 14 mmHg and the mean aortic valve area was 1.04 ± 0.24 cm2. According to the staging scheme, 37 patients were classified in Stage 0 (38.5%), 32 in Stage 1 (33.3%), 23 in Stage 2 (24%) and 4 in the group of Stage 3-4 (4.2%). During 5 years of follow-up, 44 patients developed symptoms (33 dyspnea, 18 angina and 5 syncope), up to 40% of patients underwent aortic valve replacement and 20 patients died (20.8%), 7 of them due to cardiovascular causes. According to the staging scheme, the proportion of patients who remained asymptomatic at 5 years were: 50.3% in Stage 0, 45.8% in Stage 1, 27.3% in Stage 2, 0% in Stage 3-4 (p = 0.002). Every patient in stages 3 and 4 had developed symptoms by the third year while most patients in stage 0 remained asymptomatic within the first two years (figure 1). Conclusions Up to 45% of asymptomatic patients with moderate to severe AS will develop symptoms within a 5-year period. Symptoms are developed significantly earlier with incremental staging. This classification may be useful to identify patients that deserve a closer follow-up. Abstract Figure. Baseline Characteristics Abstract Figure. Symptoms development
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