Favorable Vasomotor Function after Drug-Coated Balloon-Only Angioplasty of De Novo Native Coronary Artery Lesions

Balloon-injured coronary segments are known to harbor abnormal vasomotion. We evaluated whether de novo coronary lesions treated using drug-coated balloon (DCB) are prone to vasospasm and how they respond to ergonovine and nitrate. Among 132 DCB angioplasty recipients followed, 89 patients underwent ergonovine provocation test at 6–9 months follow-up. Within-subject ergonovine- and nitrate-induced diameter changes were compared among three different sites: DCB-treated vs. angiographically normal vs. segment showing prominent vasoreactivity (spastic). No patient experienced clinically refractory vasospastic angina or symptom-driven revascularization during follow-up. Ergonovine induced vasospasm in seven patients; all were multifocal spasm either involving (n = 2) or rather sparing DCB-treated segments (n = 5). None showed focal spasm that exclusively involved DCB-treated lesions. Among 27 patients with vasospastic features, DCB-treated segments showed less vasoconstriction than spastic counterparts (p < 0.001). A total of 110 DCB-treated lesions were analyzed to assess vasomotor function. Vasomotor function, defined as a combined constrictor and dilator response, was comparable between DCB-treated and angiographically normal segments (p = 0.173), while significant differences were observed against spastic counterparts (p < 0.001). In our study, DCB-treated lesions were not particularly vulnerable to vasospasm and were found to have vasomotor function similar to angiographically normal segments, supporting safety of DCB-only strategy in treating de novo native coronary lesions.

Study on the characteristics of coronary calcification by Intravascular Ultrasound (IVUS)

Background: Percutaneous coronary angiography is considered the "gold standard" for the diagnosis of coronary artery disease and provides the necessary anatomical information to provide appropriate treatment. The limitation of coronary angiography is the accurate assessment of calcified coronary lesions. Intravascular ultrasonography has many advantages in the assessment of calcified coronary lesions. Methods: The descriptive clinical study. Evaluation of calcified coronary artery lesions by intravascular ultrasound Results: From January 2019 to December 2019, at the Hanoi Heart Institute, 64 patients had 64 coronary artery lesions surveyed by intravascular ultrasound. There were 42 (65,6%) calcified lesions assessed by IVUS and 25 (39,1%) calcified lesions were detected by coronary angiography. In addition, the location of calcified were revealed more in the LAD compared to other: LAD 60%, LCx 24%, RCA 12% and LM 4%. Conclusion: IVUS calcification detection rate is higher than coronary angiography. The most common site of calcification in the LAD.

Identifying Coronary Artery Lesions by Feature Analysis of Radial Pulse Wave: A Case-Control Study

Background. Cardiovascular diseases have been always the most common cause of morbidity and mortality worldwide. Health monitoring of high-risk and suspected patients is essential. Currently, invasive coronary angiography is still the most direct and accurate method of determining the severity of coronary artery lesions, but it may not be the optimal clinical choice for suspected patients who had clinical symptoms of coronary heart disease (CHD) such as chest pain but no coronary artery lesion. Modern medical research indicates that radial pulse waves contain substantial pathophysiologic information about the cardiovascular and circulation systems; therefore, analysis of these waves could be a noninvasive technique for assessing cardiovascular disease. Objective. The objective of this study was to analyze the radial pulse wave to construct models for assessing the extent of coronary artery lesions based on pulse features and investigate the latent value of noninvasive detection technology based on pulse wave in the evaluation of cardiovascular disease, so as to promote the development of wearable devices and mobile medicine. Method. This study included 529 patients suspected of CHD who had undergone coronary angiography. Patients were sorted into a control group with no lesions, a 1 or 2 lesion group, and a multiple (3 or more) lesion group as determined by coronary angiography. The linear time-domain features and the nonlinear multiscale entropy features of their radial pulse wave signals were compared, and these features were used to construct models for identifying the range of coronary artery lesions using the k -nearest neighbor (KNN), decision tree (DT), and random forest (RF) machine learning algorithms. The average precision of these algorithms was then compared. Results. (1) Compared with the control group, the group with 1 or 2 lesions had increases in their radial pulse wave time-domain features H2/H1, H3/H1, and W2 ( P < 0.05 ), whereas the group with multiple lesions had decreases in MSE1, MSE2, MSE3, MSE4, and MSE5 ( P < 0.05 ). (2) Compared with the 1 or 2 lesion group, the multiple lesion group had increases in T1/T ( P < 0.05 ) and decreases in T and W1 ( P < 0.05 ). (3) The RF model for identifying numbers of coronary artery lesions had a higher average precision than the models built with KNN or DT. Furthermore, average precision of the model was highest (80.98%) if both time-domain features and multiscale entropy features of radial pulse signals were used to construct the model. Conclusion. Pulse wave signal can identify the range of coronary artery lesions with acceptable accuracy; this result is promising valuable for assessing the severity of coronary artery lesions. The technique could be used to development of mobile medical treatments or remote home monitoring systems for patients suspected or those at high risk of coronary atherosclerotic heart disease.

Analysis of the Risk Factors in Prognosis of Kawasaki Disease With Coronary Artery Lesions

Kawasaki disease (KD) is one of the most common forms of systemic vasculitis in children. Pathological features include extensive inflammation of small and medium blood vessels throughout the body. The primary complication of KD is coronary artery lesions (CALs). A total of 640 children with KD were admitted to the Department of Pediatric Cardiology at Shengjing Hospital of China Medical University from January 2017 to December 2019. These patients comprised 52 coronary artery aneurysm (CAA) cases and 47 coronary artery dilation (CAD) cases. Echocardiography was performed during the acute KD phase and then at 1, 3, 6, 12, and 24 months after KD onset. Patients were divided into a poor prognosis group (n = 30) and a normal group (n = 69) based on CALs prognosis. Differences in laboratory data, clinical manifestations and coronary artery damage rates were compared between the two groups. Univariate analysis was performed on these data, and an ROC curve was used to analyze the efficacy of each risk factor. Univariate analysis revealed that age (months), number of coronary arteries involved (NACI), IgM, IgA and brain natriuretic peptide (ProBNP) levels were higher in the poor prognosis group compared with the normal group, procalcitonin (PCT) levels in the poor prognosis group were lower than in the normal group (P &lt; 0.05).Conclusion: Age ≥ 18 months, IgM ≥ 1.07g/L, IgA ≥ 0.728g/L and NCAI ≥ 3 were poor prognostic factors of KD children with CALs. These parameters can be used as a reference indicator of early prediction where combined detection might improve the accuracy and sensitivity of prediction. Follow-up should be maintained to monitor changes in the coronary artery by echocardiography.

Effects of immunoglobulin plus prednisolone in reducing coronary artery lesions in patients with Kawasaki disease: study protocol for a phase III multicenter, open-label, blinded-endpoints randomized controlled trial

Background Kawasaki disease (KD) is an acute systemic vasculitis of unclear etiology that mainly affects infants and young children. Strategies to reduce the incidence and severity of coronary artery lesions (CALs), the determinant factor in the long-term prognosis of KD, are currently a focus of studies on KD. Corticosteroids, preferred in the treatment of the majority of vasculitides, are controversial in the treatment of acute KD. In this trial, we will evaluate whether the addition of prednisolone to standard intravenous immunoglobulin (IVIG) plus aspirin therapy can reduce the occurrence of CAL in Chinese patients with KD. Methods This is a multicenter, prospective, open-label, randomized controlled trial, which is expected to be conducted in more than 20 hospitals in China and aims to assess the efficacy and safety of IVIG + prednisolone treatment versus standard treatment. Patients with KD who fulfill the inclusion and exclusion criteria will be recruited and randomized (1:1) to receive either a large dose of IVIG (2 g/kg over 12–24 h with a maximum dose of 60 g) + aspirin 30 mg/kg/d or IVIG (2 g/kg over 12–24 h) + aspirin 30 mg/kg/d + prednisolone (2 mg/kg/d with a maximum dose of 60 mg tapered over 15 days after normalization of C-reactive protein concentration). The primary outcome will be the occurrence of CAL at 1 month of illness. The follow-up duration for each participant will be set as 1 year. Patients and treating physicians will be unmasked to group allocation. Discussion This will be the first multicenter randomized controlled trial to evaluate the efficacy of IVIG + aspirin + prednisolone in Chinese pediatric patients with KD, which may provide high-level evidence for improving the initial treatment for acute KD. Trial registration ClinicalTrials.govNCT04078568. Registered on 16 August 2018.

Impact of Early Treatment with High-Dose Intravenous Immunoglobulin on Incidence of Kawasaki Disease Complications in Iranian Children

Objective: Kawasaki disease (KD) occurs in five-year-old or younger children. This study aimed to evaluate the impact of high-dose intravenous immunoglobulin plus acetylsalicylic acid therapy on the prevention and treatment of coronary artery lesions and to evaluate the impact of high-dose acetylsalicylic acid (ASA) on the hearing of the patients. Materials and methods: In this retrospective cohort study, 31 patients with KD were followed from January 2012 to December 2015. The clinical, para-clinical, color Doppler echocardiogram and audiometry results were evaluated. Results: Overall, seven cases (22.6%) developed coronary artery aneurysm (CAA) in the acute phase of the disease, of whom only two still had CAA at the end of the treatment (6%). One of the five children with CAA recovery had a delay in the onset of treatment and one of two patients with persistent CAA at the end of treatment was admitted within the first 10 days. There was no evidence-based abnormal liver biochemical test. None of the patients developed sensorineural hearing loss (SNHL) on audiometry tests conducted before and after treatment. Conclusion: Recovery of coronary artery lesions was 71.43% after 28 days of the onset of treatment. The distribution of coronary artery aneurysm was not different in terms of the time of the treatment initiation (P-Value = 0.371). None of the children had a sensorineural hearing loss (SNHL) 48 hours and 4 weeks after treatment.

Characteristics of coronary flow velocity reserve on transthoracic Doppler echocardiography in patients with a history of Kawasaki disease

Whether the acute inflammation caused by Kawasaki disease will have an effect on the endothelial function of coronary arteries in the future is unknown. Methods: The coronary flow velocity reserve of the left anterior descending artery was examined by transthoracic Doppler echocardiography in 189 patients (male 125, female 64) with a history of Kawasaki disease and 10 volunteers (control). Their ages ranged from 6 to 40 years (median 22 years). The patients were divided into nine groups based on the left anterior descending artery lesions. The coronary flow velocity reserve was measured by intravenous administration of adenosine triphosphate (0.15 mg/kg/minute) while fasting. The coronary flow velocity reserve was calculated as the ratio of hyperaemic to basal mean diastolic flow velocities. The respective groups were as follows: control, no coronary artery lesions (n = 39), no coronary artery lesions in the right coronary artery (n = 29), regression (n = 11), aneurysm at the bifurcation of the left coronary artery (n = 26), aneurysm of the left anterior descending artery (n = 15), localised stenosis <75% (n = 12), localised stenosis ≥75% (n = 17), segmental stenosis (n = 5) and coronary artery bypass grafting (n = 36). One-factor ANOVA followed by Tukey’s test was used to compare the coronary flow velocity reserve among the groups. Results: The coronary flow velocity reserve was significantly lower in the localised stenosis ≥75%, segmental stenosis and coronary artery grafting groups than in the other groups (p < 0.05). Conclusions: The endothelial function in the epicoronary artery was preserved in patients with a history of Kawasaki disease and dilated coronary artery lesions.