scholarly journals Sex differences in patients with ischemia and no obstructive coronary disease subjected to intracoronary acetylcholine test in a multicenter registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Grigorian ◽  
E Gutierrez ◽  
J.F Oteo ◽  
O Abdul-Jawad ◽  
I Amat Santos ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Angiography ◽  
Medical Treatment ◽  
Coronary Disease ◽  
Coronary Atherosclerosis ◽  
Coronary Revascularization ◽  
Coronary Spasm ◽  
Pathophysiological Mechanisms ◽  
Major Cardiovascular Events ◽  
Associated Risk Factors

Abstract Background Ischemia with no obstructive coronary disease (INOCA) is increasingly diagnosed because of wide performance of coronary angiography. Prevalence of INOCA is higher in women than in men, however the exact pathophysiological mechanisms which may explain this phenomenon are still not very well understood. Objective To evaluate differences in clinical and procedural characteristics between men and women with INOCA subjected to intracoronary acetylcholine test (Ach). Methods A total of 210 women and 148 men with INOCA diagnosed with coronary angiography, were prospectively enrolled in a multicenter, observational registry. Ach test was performed according to clinical indications in all included patients. After 1-year patients were re-evaluated for major cardiovascular events, angina symptoms and prescribed medical treatment. Results Mean age of 60.6±13.6 years old was similar in both populations, but differences were observed in the prevalence of risk factors: active smoking was more frequent among men (43% vs. 17%, p<0.001), who had also a higher number of associated risk factors (≥3 risk factors were present in 31.2% of men vs. 20.2% of women, p<0.01) and more frequent history of percutaneous coronary revascularization (14.2% vs. 6.7%, p=0.03). Women were more prone to have dyspnea than men (35.5% vs. 20.8%, p=0.01). Men had more coronary atherosclerosis in angiography (57.9% vs. 43.7%, p=0.01) and more slow flow in the left anterior descending artery (21.6% vs. 9.0%, p=0.001). Ach was positive in 36.5% of patients, similar in both sexes, with no differences in the type of induced coronary spasm. Among those with a positive Ach test, at one-year, 36% of women vs. 43.6% of men were on optimal medical treatment for vasospasm although the difference was not statistically significant. Importantly, 41.5% of women and 38.1% of men experienced severe symptoms of angina during follow-up. Conclusions Although men with INOCA have a higher risk profile than women and more coronary atherosclerosis, one third of patients present endothelial dysfunction, similar in both groups, indicating that probably other pathophysiological mechanisms are responsible for it in females. Treatment in these patients remains suboptimal and associated with highly impaired quality of life. Funding Acknowledgement Type of funding source: None

Critical limb ischemia patients clinically improving with medical treatment have lower neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios

Vascular ◽  
2021 ◽  
pp. 170853812098629
Author(s):  
Sevinç B Erdoğan ◽  
Ümmühan N Selçuk ◽  
Murat Baştopçu ◽  
Gökhan Arslanhan ◽  
Arif Y Çakmak ◽  
...  
Keyword(s):  
Risk Factors ◽  
Medical Treatment ◽  
Critical Limb Ischemia ◽  
Limb Ischemia ◽  
Response To Treatment ◽  
Standard Regimen ◽  
Markers Of Inflammation ◽  
Endovascular Revascularization ◽  
Cardiovascular Center ◽  
Associated Risk Factors

Objectives Inflammation is a component in the pathogenesis of critical limb ischemia. We aimed to assess how inflammation affects response to treatment in patients treated for critical limb ischemia using neutrophil-to-lymphocyte (NLR) and platelet-to-lymphocytes ratios (PLR) as markers of inflammation. Methods Patients in a single tertiary cardiovascular center with critical limb ischemia unsuitable for surgical or interventional revascularization were retrospectively identified. Data were collected on medical history for risk factors, previous surgical or endovascular revascularization, and outcome. A standard regimen of low molecular weight heparin, aspirin, statins, iloprost infusions, and a standard pain medication protocol were applied to each patient per hospital protocol. Patients with improvement in ischemic pain and healed ulcers made up the responders group and cases with no worsening pain or ulcer size or progression to minor or major amputations made up the non-responders group. Responders and Non-responders were compared for risk factors including pretreatment NLR and PLR. Results 268 included patients who were not candidates for surgical or endovascular revascularization were identified. Responders had significantly lower pretreatment NLR (4.48 vs 8.47, p < 0.001) and PLR (162.19 vs 225.43, p = 0.001) values. After controlling for associated risk factors NLR ≥ 4.63 (p < 0.001) and PLR ≥ 151.24 (p = 0.016) were independently associated with no response to treatment. Conclusions Neutrophil-to-lymphocyte ratio and platelet-to-lymphocytes ratio are markers of inflammation that are reduced in patients improving with medical treatment suggesting a decreased state of inflammation before treatment in responding patients.

Relationship between coronary and renal artery disease and associated risk factors in hypertensive and diabetic patients undergoing coronary angiography

2008 ◽  
Vol 4 (3) ◽  
pp. 373-377 ◽  
Author(s):  
Seyed Danesh Sani ◽  
Mehdi Hasanzadeh ◽  
Arash Gholoobi ◽  
Hedieh Alimi ◽  
Habib allah Esmaily ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Angiography ◽  
Renal Artery ◽  
Diabetic Patients ◽  
Artery Disease ◽  
Associated Risk Factors ◽  
Renal Artery Disease

Accidental button battery ingestion presenting as croup

2014 ◽  
Vol 128 (3) ◽  
pp. 292-295 ◽  
Author(s):  
R Gohil ◽  
J Culshaw ◽  
P Jackson ◽  
S Singh
Keyword(s):  
Risk Factors ◽  
Case Report ◽  
Medical Treatment ◽  
Foreign Bodies ◽  
Button Battery ◽  
Associated Risk Factors ◽  
Contrast Swallow ◽  
Button Batteries

AbstractObjectives:To report a case of misdiagnosis of an impacted oesophageal button battery in a child, and to describe the associated risk factors for impaction and the management of such cases.Case report:An 18-month-old, otherwise fit and well child with stridulous respiration was initially treated for croup. Medical treatment over the course of three months failed, and appropriate imaging subsequently demonstrated an impacted button battery in the upper oesophagus. This was promptly removed. There were no signs of damage on direct visualisation, or on a follow-up contrast swallow image.Conclusion:This case highlights the difficulty of diagnosing oesophageal foreign bodies. We also discuss the characteristics of button batteries which confer a greater risk of impaction, and the associated sequelae and complications.

scholarly journals Quantification of epicardial fat with cardiac CT and association with cardiovascular risk factors and obstructive coronary disease

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Mano ◽  
J Viegas ◽  
J Reis ◽  
A Castelo ◽  
P Bras ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Disease ◽  
Cardiovascular Risk ◽  
Cardiovascular Risk Factors ◽  
Coronary Disease ◽  
Coronary Atherosclerosis ◽  
Calcium Score ◽  
Coronary Calcium Score ◽  
Epicardial Fat ◽  
Patients With Diabetes

Abstract Introduction Recent studies advocate epicardial fat (EF) as a biologically active organ that influence coronary atherosclerosis development through endocrine and paracrine pathways. We aim to study the relations between EF, thoracic adipose tissue (TAT), cardiovascular risk factors (CRF) and obstructive coronary disease (OCD). Methods Retrospective analysis of patients (pts) referred to 64-multislice cardiac computed tomography (CT) in one center. The authors underwent a standardized protocol for quantification of EAT, TAT (subcutaneous and visceral), abdominal visceral fat, coronary calcium score and angiography. Results Total of 178 pts: male 99 (56%), mean age 65.9±12.9 years. Indications for performing CT were coronary disease (76%), valvular heart disease (15%), atrial fibrillation (6%) and congenital heart disease (2%). Regarding CRF, EF was only significant higher in patients with diabetes (115±60 vs 95±47, p=0.018), in male gender (114±60 vs 91±42, p=0.04) and was linear correlated with age (p=0.004). The authors also found that EF volume is significant higher in patients with typical angina (p=0.02) and with coronary atherosclerosis: non-obstructive (p=0.0049) and OCD (p=0.001) – Graphic 1. ROC analysis of EF (AUC 0.659, p=0.0039) and EF/TAT relation (AUC 0.704, p=0.003) allowed to estimate that EF&gt;100 ml and EF/TAT &gt;0.06 had a sensibility to predict OCD of 53% and 58%, respectively, and specificity of 66% and 60%. We did not find a correlation between EF, EF/TAT or TAT and coronary calcium score. Conclusion EF is higher in patients with diabetes and coronary atherosclerosis. EF and EF/TAT relation had moderate sensibility and specificity to predict OCD, irrespective of calcium score. EF and EF/TAT are promising atherosclerotic markers that could be routinely use in the near future. FUNDunding Acknowledgement Type of funding sources: None.

Microvascular Angina : A Diagnosis Hidden in Plain Sight

2021 ◽  
Author(s):  
Curtis D. Samuels
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Cardiovascular Diseases ◽  
Endothelial Dysfunction ◽  
Coronary Angiography ◽  
Coronary Disease ◽  
Microvascular Dysfunction ◽  
African Caribbean ◽  
Caribbean Population ◽  
Risk Factor Burden

Background: Patients who are initially suspected of having ischemic heart disease, but in whom normal coronaries are discovered at angiography, are frequently believed to have pain of a non-cardiac aetiology. Micro vascular angina is hardly ever diagnosed save in peri-menopausal women. Physicians traditionally tend to view coronary microvascular disease and obstructive coronary artery disease as two separate entities. Notwithstanding, recent studies have begun to focus on endothelial dysfunction as being a key component in all cardiovascular diseases, with or without obstructive coronary lesions. Hypothesis: Patients suspected of having obstructive coronary disease associated with a significant risk factor burden, but in whom normal coronaries are found at angiography, in reality possess microvascular dysfunction. Objectives: • To determine the prevalence of normal coronaries at elective angiography compared to subjects with significant obstructive lesions. • To examine the influence of risk factor burden in patients who present normal coronaries in comparison with those who demonstrate obstructive lesions at angiography. • To suggest endothelial dysfunction as the common nexus underlying the disparities in cardiovascular morbidity observed among population samples. Methods: A group of 90 patients were randomly selected from clinical files of those who underwent elective coronary angiography between January, 2013 and May, 2017. The study cohort was comprised of 55 males and 35 females between the ages of 43 to 84 years. All subjects presented chest pain suspected of being coronary in origin. Coronary risk factors were recorded for each patient and the results were compared with findings at coronary angiography and then correlated with those encountered in medical literature. Results: Normal coronary angiograms were more prevalent in the African-Caribbean population (54.16%), than within the Mestizo-Mayan population (37.5%) Conversely, the finding of an obstructive lesion was more common in the Mestizo-Mayan population (56.25%), than within the African-Caribbean group (31.25%). The African-Caribbean group generally possessed a greater risk factor burden than their Mestizo-Mayan counterparts. Mayan counterparts. The percentage of women with normal coronaries (52.94%) showed a slight increase over that of men (47.05%). Males possessed a prevalence for obstructive disease of almost 4 times greater (79.48% vs. 20.5%) than females, yet females demonstrated a greater risk factor burden than males in most risk parameters. Hypertension was the most prevalent risk factor followed by dyslipidaemia and diabetes mellitus but these factors were more commonly encountered in patients with “normal” coronaries, than in those with obstructive lesions. Conclusion: Our study reported a significant number (56.66%) of “normal” coronaries at angiography. The majority (54.16%) of this figure pertained to the African-Caribbean sub-group, which in other studies also appeared to have a lesser coronary disease morbidity and mortality than their white counterparts despite having a greater risk factor burden. This is particularly true in the female African-Caribbean population. Several research papers have made reference to racial, ethnic and gender disparities in the manifestation of cardiovascular diseases. Paradoxically in some cases risk factor burden may be higher in the non-obstructive group rather than in the obstructive population. Convincing research has led us to believe that the vascular endothelium in its state of dysfunction plays a key role in explaining these disparities. Wherever cardiovascular risk factors exert their damage, endothelial injury and dysfunction ensues. Therefore, having an established risk factor burden portends microvascular dysfunction independently of any angiographic result.

P188 Aboriginal and Torres Strait Australians have significantly worse coronary disease, risk factors and 4 year outcomes compared with non-indigenous Australians

2020 ◽  
Vol 41 (Supplement_1) ◽  
Author(s):  
A Helms ◽  
R Gilhotra ◽  
S Preston ◽  
R Saireddy ◽  
G Starmer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Coronary Disease ◽  
Cardiac Risk ◽  
Indigenous Group ◽  
Significant Difference ◽  
Torres Strait ◽  
Artery Disease

Abstract Introduction The Aboriginal and Torres Strait Islander (ATSI) population in Australia appear to present with coronary disease more frequently, have worse risk factors, worse coronary disease and poorer outcomes, however there is limited data available on this population.  The ATSI population represent 8% of the Cairns total population. We undertook to compare these findings and four-year outcomes in ATSI versus non-indigenous patients aged &lt; 50 years old undergoing coronary angiography. Methods   We collected data on all patients aged &lt; 50 years old, who underwent coronary angiography at Cairns Hospital over a two-year period (2014-2016), from the Queensland Coronary Outcomes Registry. Data of patient risk factors and 4 year outcomes were collected using electronic hospital medical records and electronic discharge summaries available on all Queensland patients. Patients residing outside Queensland were excluded. Results From 2014-2016, a total of 555 patients &lt; 50 years old underwent coronary angiography. The average age was 43. 322 (58.0%) patients were male and 233 (42.0%) were female. 271 patients (48.8%) identified as ATSI.  Coronary risk factors - 42.4% of ATSI patients had diabetes vs 13.7 in the non-indigenous group, 58.7% of ATSI patients vs 43.7% had hyperlipidaemia, 61.3% of ATSI patients vs 39.8% were current smokers, 65.3% of ATSI patients vs 42.3% were hypertensive, and 64.2% of ATSI patients vs 50.4% had a family history of premature coronary artery disease. This demonstrates significantly higher incidence of cardiac risk factors in ATSI patients (combined risk factors P = 0.00086).   When comparing coronary artery disease, as demonstrated by coronary angiography, the ATSI group had significantly more abnormal coronary angiograms - 74.5% compared to the non-indigenous group 42.3% (P = 0.000006). There was not a statistically significant difference between the severity of coronary artery disease between the two populations who had coronary disease, however, the ATSI population demonstrated a higher incidence of triple vessel disease. ATSI patients were more likely to have repeat coronary angiography 11% vs 4%. In the four-year follow up period, 18.5% of the ATSI population had at least one major adverse cardiac event (MACE), whereas in the non-indigenous group 7.0% had at least one MACE.  There was not a statistically significant difference between all cause mortality between the two populations. Conclusion   We have shown that Aboriginal and Torres Strait Islanders Australians are more likely to have coronary angiography at a younger age. That Aboriginal and Torres Strait Islanders Australians have a significantly higher incidence of cardiac risk factors, higher incidence of coronary artery disease, and more major cardiac events after undergoing coronary angiography compared to non-indigenous patients. The all cause mortality in this young population was not significantly different.

Relationships among Cortical Ischemia, Infarction, and Hemorrhage in Eclampsia

Neurosurgery ◽  
1988 ◽  
Vol 22 (2) ◽  
pp. 408-410 ◽  
Author(s):  
Anthony Salerni ◽  
Steven Wald ◽  
Martin Flanagan
Keyword(s):  
Risk Factors ◽  
Computed Tomography ◽  
Cerebral Infarction ◽  
Therapeutic Approach ◽  
Pathophysiological Mechanisms ◽  
Cerebrovascular Complications ◽  
Posterior Parietal ◽  
Cortical Ischemia ◽  
Associated Risk Factors

Abstract Cerebral infarction and hemorrhage are well-known cerebrovascular complications of eclampsia. A 30-year-old woman with eclampsia developed bilateral posterior parietal and occipital hemorrhages 4 hours after computed tomography demonstrated lucencies indicative of ischemia or infarction within the same regions. The association between infarction and hemorrhage has not been previously documented by computed tomography in eclampsia. Review of the pathophysiological mechanisms and associated risk factors has prompted a more aggressive prophylactic therapeutic approach. (Neurosurgery 22:408-410, 1988)

Abstract 14770: Reduction With Evolocumab in Complex Coronary Disease Requiring Revascularization: Insights From the FOURIER Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kazuma Oyama ◽  
Remo Furtado ◽  
Antonio Fagundes ◽  
Thomas A Zelniker ◽  
Minao Tang ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Coronary Disease ◽  
Coronary Atherosclerosis ◽  
Proportional Hazards ◽  
Thrombus Formation ◽  
Coronary Revascularization ◽  
Side Branch ◽  
Cox Proportional Hazards ◽  
Pcsk9 Inhibitors ◽  
Revascularization Procedures

Introduction: Although PCSK9 inhibitors induce plaque regression and reduce the risk of coronary revascularization overall, their ability to specifically reduce the risk of complex coronary atherosclerosis requiring revascularization has not been explored. Methods: FOURIER was a randomized trial of the PCSK9 inhibitor evolocumab vs. placebo in 27,564 patients with ASCVD on statin therapy (median achieved LDL-C 32 mg/dL vs. 89 mg/dL) followed for a median of 2.2 years. The study database was blindly reviewed to assess characteristics of coronary revascularization procedures. Complex revascularization was the composite of complex PCI (per GLOBAL LEADERS criteria, at least one of: multivessel PCI, 3 or more stents implanted, 3 or more lesions treated, bifurcation PCI with 2 or more stents, or total stent length >60 mm) or CABG. PCI complications included no-reflow, side branch loss, thrombus formation, major dissection, or perforation. The effects of evolocumab on types of revascularization and PCI complications were evaluated using Cox proportional hazards models. Results: 1724 patients underwent revascularization procedures during follow-up. Evolocumab reduced the risk of non-complex PCI by 22% (HR 0.78; 95%CI 0.70-0.88; P<0.001) and the risk of complex revascularization by 29% (HR 0.71; 95%CI 0.61-0.84; P<0.001), including complex PCI by 33% (HR 0.67; 95%CI 0.54-0.84; P<0.001) and CABG by 24% (HR 0.76; 95%CI 0.60-0.96; P=0.019; Figure). The incidence of reported PCI complications tended to be lower with evolocumab (HR 0.74; 95% CI 0.49-1.11). Conclusions: Adding evolocumab to statin therapy reduced the risk of developing complex coronary disease requiring revascularization, including complex PCI and CABG individually. Together with prior coronary imaging findings, these data suggest very aggressive LDL-C lowering to <1 mmol/L has beneficial effects on coronary atherosclerosis burden, anatomical complexity, and the need for intervention.

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