6.9Identifying cardiac risk of diabetic patients with no typical chest pain and no previous coronary artery disease

Background: An age, sex, and blood gene expression score (ASGES) has been previously validated to detect obstructive coronary artery disease (CAD) in non-diabetic patients presenting with stable chest pain in the outpatient setting. However, the diagnostic performance of this test in ruling out obstructive CAD in patients presenting with acute chest pain (ACP) to the emergency department (ED) is unknown. Methods: In an ongoing study, 371 low-intermediate risk patients with ACP and no prior history of CAD (TIMI risk score ≤ 2, negative troponins and normal/non-diagnostic ECG) underwent coronary CT angiography (CCTA) using institutional protocols. Patients were classified based on severity of stenosis (obstructive CAD, >50%; high grade stenosis, >70%) and ASGES. The ASGES blood test sample was drawn before ED discharge and analyzed in a commercial reference laboratory (Redwood City, CA). We excluded 23 (6%) patients with unreportable ASGES and 47 (13%) diabetics from this primary analysis. Results: 301 (53±10 years, 45% males, 78% Hispanics) non-diabetic ACP patients undergoing CCTA in an ED setting were included in this analysis. No plaque was detected in 183 (60%) patients, and 22 (7%) patients had obstructive CAD. In this population, 51% of patients had scores below the previously defined threshold of ASGES≤ 15. This threshold yielded sensitivity, specificity, NPV, and PPV of 71% (52-86%), 53% (47-59%), 97% (93-98%), and 12% (9-14%) for obstructive CAD. Furthermore, ASGES≤15 yielded a 100% sensitivity and NPV for patients with high grade stenosis (n=7, 2%). In a multivariable analysis including patient demographics and clinical covariates, ASGES ≤15 was significantly associated with obstructive CAD (OR: 0.15, 95% CI: 0.04-0.62). As a continuous variable, increasing ASGES was positively correlated with the presence of obstructive CAD and CCTA-defined plaque burden (p<0.0001). Conclusions: This is the first study validating the use of this blood-based precision medicine test to rule out obstructive CAD among low-intermediate risk non-diabetic patients presenting with ACP in ED setting. 30-day follow-up is underway to evaluate the prognostic implications of these findings.

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PCI is a long-lasting solution for abolishing angina. Or maybe not?

Heart and Metabolism - Heart Failure in patients with Diabetes ◽

10.31887/hm.2020.81/ldeluca ◽

2020 ◽

pp. 27-31

Keyword(s):

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Cardiovascular Diseases ◽

Coronary Angiography ◽

Previous History ◽

History Of ◽

Artery Disease ◽

Vessel Coronary Artery ◽

Typical Chest Pain

We describe a case of a 62-year-old man with no previous history of cardiovascular diseases presenting with typical chest pain. The patient was referred for coronary angiography, which revealed the presence of single-vessel coronary artery disease. After intracoronary stent implantation, the patient experienced recurrent episodes of angina followed by further revascularizations that did not clear up his symptoms.

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Epicardial adipose tissue volume as a predictor for coronary artery disease in diabetic, impaired fasting glucose, and non-diabetic patients presenting with chest pain

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jes024 ◽

2012 ◽

Vol 13 (6) ◽

pp. 517-523 ◽

Cited By ~ 20

Author(s):

M. O. Versteylen ◽

R. A. P. Takx ◽

I. A. P. G. Joosen ◽

P. J. Nelemans ◽

M. Das ◽

...

Keyword(s):

Coronary Artery Disease ◽

Adipose Tissue ◽

Chest Pain ◽

Coronary Artery ◽

Impaired Fasting Glucose ◽

Epicardial Adipose Tissue ◽

Fasting Glucose ◽

Diabetic Patients ◽

Adipose Tissue Volume ◽

Artery Disease

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Can short-term heart rate variability predict coronary artery disease in patients undergoing elective coronary angiography because of typical chest pain?

Journal of Clinical and Translational Research ◽

10.18053/jctres.06.202002.005 ◽

2020 ◽

Keyword(s):

Coronary Artery Disease ◽

Heart Rate ◽

Heart Rate Variability ◽

Chest Pain ◽

Coronary Artery ◽

Coronary Angiography ◽

Short Term ◽

Artery Disease ◽

Typical Chest Pain

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Different pathologies without coronary artery disease may induce typical chest pain

Journal of Integrative Cardiology ◽

10.15761/jic.1000187 ◽

2016 ◽

Vol 2 (6) ◽

Author(s):

Giuseppe Cocco ◽

Philipp Amiet ◽

Paul Jerie

Keyword(s):

Coronary Artery Disease ◽

Chest Pain ◽

Coronary Artery ◽

Artery Disease ◽

Typical Chest Pain

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Poor outcome of diabetic patients with coronary artery disease and coexisting heart failure

European Journal of Heart Failure Supplements ◽

10.1016/s1567-4215(08)60052-1 ◽

2008 ◽

Vol 7 ◽

pp. 19-19

Author(s):

B PONIKOWSKA ◽

E JANKOWSKA ◽

K WEGRZYNOWSKATEODORCZYK ◽

S POWIERZA ◽

L BORODULINNADZIEJA ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Diabetic Patients ◽

Poor Outcome ◽

Artery Disease

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Evaluation of aortic arch calcification in type 2 diabetic patients

VASA ◽

10.1024/0301-1526.34.2.113 ◽

2005 ◽

Vol 34 (2) ◽

pp. 113-117 ◽

Cited By ~ 4

Author(s):

Papanas ◽

Symeonidis ◽

Maltezos ◽

Giannakis ◽

Mavridis ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Aortic Arch ◽

Diabetic Patients ◽

Type 2 Diabetic Patients ◽

Insulin Dependence ◽

Artery Disease ◽

Type 2 Diabetic ◽

Aortic Arch Calcification

Background: The purpose of this study is to evaluate the severity of aortic arch calcification among type 2 diabetic patients in association with diabetes duration, diabetic complications, coronary artery disease and presence of cardiovascular risk factors. Patients and methods: This study included 207 type 2 diabetic patients (101 men) with a mean age of 61.5 ± 8.1 years and a mean diabetes duration of 13.9 ± 6.4 years. Aortic arch calcification was assessed by means of posteroanterior chest X-rays. Severity of calcification was graded as follows: grade 0 (no visible calcification), grade 1 (small spots of calcification or single thin calcification of the aortic knob), grade 2 (one or more areas of thick calcification), grade 3 (circular calcification of the aortic knob). Results: Severity of calcification was grade 0 in 84 patients (40.58%), grade 1 in 64 patients (30.92%), grade 2 in 43 patients (20.77%) and grade 3 in 16 patients (7.73%). In simple regression analysis severity of aortic arch calcification was associated with age (p = 0.032), duration of diabetes (p = 0.026), insulin dependence (p = 0.042) and presence of coronary artery disease (p = 0.039), hypertension (p = 0.019), dyslipidaemia (p = 0.029), retinopathy (p = 0.012) and microalbuminuria (p = 0.01). In multiple regression analysis severity of aortic arch calcification was associated with age (p = 0.04), duration of diabetes (p = 0.032) and presence of hypertension (p = 0.024), dyslipidaemia (p = 0.031) and coronary artery disease (p = 0.04), while the association with retinopathy, microalbuminuria and insulin dependence was no longer significant. Conclusions: Severity of aortic arch calcification is associated with age, diabetes duration, diabetic complications (retinopathy, microalbuminuria), coronary artery disease, insulin dependence, and presence of hypertension and dyslipidaemia.

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Coronary Artery Disease Screening Using CT Coronary Angiography

Aerospace Medicine and Human Performance ◽

10.3357/amhp.5522.2020 ◽

2020 ◽

Vol 91 (10) ◽

pp. 812-817

Author(s):

Randy Wang Long Cheong ◽

Brian See ◽

Benjamin Boon Chuan Tan ◽

Choong Hou Koh

Keyword(s):

Systematic Review ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Cardiac Risk ◽

Disease Screening ◽

Ct Coronary Angiography ◽

Major Adverse Cardiovascular Events ◽

Cardiac Events ◽

Artery Disease

BACKGROUND: The increased utility of CT coronary angiography (CTCA) in cardiovascular screenings of aircrew has led to the increased detection of asymptomatic coronary artery disease (CAD). A systematic review of studies relevant to the interpretation of CTCA for the occupational fitness assessment of high-risk vocations was performed, with findings used to describe the development of a pathway for the aeromedical disposition of military aviators with asymptomatic CAD.METHODS: Medline was searched using the terms CT coronary angiogram and screening and prognosis. The inclusion criteria were restricted to study populations ages > 18 yr, were asymptomatic, were not known to have CAD, had undergone CTCA, and with their associations with major adverse cardiovascular events (MACE) and other relevant cardiac outcomes reported.RESULTS: Included in this systematic review were 10 studies. When compared to subjects with no or nonobstructive CAD, those with obstructive CAD on CTCA had hazard ratios (HR) for cardiac events ranging from 1.42 to 105.48. Comparing subjects with nonobstructive CAD and those without CAD on CTCA, a lower HR of 1.19 for cardiac events was found. The annual event rates of subjects with no CAD on CTCA were extremely low, ranging from 0 to 0.5%.CONCLUSIONS: Based on the findings, we suggest that CTCA should only be performed in aircrew with higher cardiac risk profiles. Those found to have no CAD or minimal CAD (i.e., 25% stenosis) in a non-left main coronary artery on CTCA can be returned to flying duties. All other results should be further evaluated with an invasive angiogram.Cheong RWL, See B, Tan BBC, Koh CH. Coronary artery disease screening using CT coronary angiography. Aerosp Med Hum Perform. 2020; 91(10):812817.

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