P3596The role of MSCT and SPECT in patients with acute coronary syndromes and non-obstructive coronary artery disease

Abstract Background Approximately 1–14% of patients with ACS not have obstructive changes in the coronary arteries according to the data of invasive coronary angiography (ICA) is myocardial infarction (AMI) with non-obstructive coronary artery- MINOCA. MSCT has the ability to assess the lumen of the vessel, visualize the artery wall, the structure of the atherosclerotic plaque. SPECT is used to detect myocardial ischemia, determine the functional significance of atherosclerotic plaques, and evaluate regional tissue perfusion. There are no data on a research of a structurally functional condition of a coronary blood-groove by means of MSCT, SPECT.Aim. To study the role of MSCT and SPECT in patients with MINOCA, to compare MSCT with invasive coronarography. Material and methods The study is registered on ClinicalTrials.gov. Inclusion criteria are listed on the site. All patients underwent CT, SPECT, on the 6th day from the beginning of the index event. All MSCT and SPECT studies were performed on a 64-section combined single-photon-emission and X-ray computer tomograph GE Discovery NM/CT 570C. Endpoint: Frequency of occurrence of atherosclerosis, frequency of occurrence of unstable plaques according to MSCT, the magnitude of a transient defect in myocardial perfusion according to SPECT. Results The study included 14 patients with MINOCA, women predominate – 11 (78.6%), the average age was 61.1±14 years. The risk of GRACE was moderate in 8 (57%) pts. 12 (85.7%) pts were hospitalized within the first 6 hours of the onset of the disease.Thrombolytic therapy was performed in 3 (21.4%) pts, 2 of them were effective (14%). 57% of patients at admission were troponin-positive.According to the results of ICA, intact coronary arteries were detected in 9 (64.3%) pts, 5 (35%) had stenosis up to 50%. Coronary slow flow (TIMI 2) was determined in 11 (78.6%) pts, of which 8 (57%) pts have coronary slow flow and intact coronary arteries. Coronary spasm was in 1 (7.1%) patient. According to MSCT, the proportion of pts with intact coronary arteries decreased (9 (64.3%) → 5 (35.7%)) and the proportion with non-obstructive atherosclerosis increased (5 (35%) → 9 (64.3%)). All pts had a positive remodeling index, soft-tissue, predominantly calcified stenoses and eccentric plaques. The average Segment Involvement Score was 2.1 (0; 5), the Segment Stenosis Score was −2.4 (1; 3). 12 pts (85%) had transitory perfusion defects. The median SSS values were 7.5 (4; 13), SRS 4.7 (1.0; 9.0), SDS 4.7 (3.0; 8.0). Conclusion In 78% of pts had a slowing of the coronary blood flow and intact coronary arteries according to ICAG. However, according to MSCT, only 36% of the patients did not have plaques. MSCT allows to identify eccentric soft tissue atherosclerotic plaques that have a high risk of rupture/erosion, and, accordingly, the high risk of the development of AMI in this group. Using SPECT revealed a statistically significant transient perfusion defect.

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ACUTE CORONARY SYNDROME WITH NONOBSTRUCTIVE CORONARY ARTERIES: THE SEVERITY OF CORONARY ATHEROSCLEROSIS AND MYOCARDIAL PERFUSION DISORDERS (PILOT STUDY)

Siberian Medical Journal ◽

10.29001/2073-8552-2019-34-2-71-78 ◽

2019 ◽

Vol 34 (2) ◽

pp. 71-78

Author(s):

D. A. Vorobeva ◽

A. V. Mochula ◽

A. E. Baev ◽

V. V. Ryabov

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Angiography ◽

Coronary Arteries ◽

Invasive Coronary Angiography ◽

Atherosclerotic Plaques ◽

Slow Flow ◽

Flow Phenomenon ◽

Coronary Syndrome ◽

Coronary Slow Flow ◽

Coronary Slow Flow Phenomenon

Aim. To study the structural and functional status of coronary blood flow in patients with acute coronary syndrome with nonobstructive coronary arteries using multispiral computed tomography (MSCT) and single photon emission tomography (SPECT) and to compare data of MSCT and invasive coronary angiography (ICA).Material and Methods. This study is a non-randomized, open-label, controlled clinical trial. The study is registered on ClinicalTrials.gov. The inclusion criteria are listed on the site. All patients underwent CT and SPECT.Results. The study included 14 patients with MINOCA; the group comprised predominantly women (n=11, 78.6%); the average age was 61.1±14 years. The risk according to GRACE (Global Registry of Acute Coronary Events) risk score was moderate in 8 patients (57%) and high in 5 patients (35.7%). 85.7% of patients were admitted to hospital within the first six hours from onset of diseases. Three patients (21.4%) received thrombolytic therapy and it was effective in two of them (14%). Risk factors included hypertension (64.2%), dyslipidemia (50%), and burdened history (71.4). According to the results of invasive coronary angiography, intact coronary arteries were detected in 9 patients (64.3%); 5 patients (35.7%) had stenosis up to 50%. Coronary slow-flow phenomenon (TIMI 2) was detected in 11 patients (78.6%) including 8 patients (57.1%) who had coronary slow-flow phenomenon and intact coronary arteries. Severe coronary spasm was registered in 1 patient (7.1%) in the group with ST segment elevation acute coronary syndrome (STE ACS). According to MSCT data, the proportion of patients with intact coronary arteries decreased from 7 (50%) to 5 patients (35.7%) whereas the proportion of patients with nonstenosing atherosclerosis increased from 7 (50%) to 9 patients (64.3%). Twenty six atherosclerotic plaques were detected including eccentric (76%), circular (11.5%), and semi-circular plaques (11.5%). In regard to morphological structure, the atherosclerotic plaques were calcified (59.5%), mostly calcified (7.7%), and soft (29%). Normal myocardial perfusion (Summed Stress Score (SSS) and Summed Rest Score (SRS) <4) was detected in two patients (14.3%); 12 patients (85%) had transitory perfusion defects. The median score values were 7.5 (4; 13) for SSS, 4.7 (1.0; 9.0) for SRS, and 4.7 (3.0; 8.0) for SDS.Conclusion. The introduction of MCTA and SPECT into the algorithm of the examination of patients with acute myocardial infarction and non-obstructive atherosclerosis of the coronary arteries was safe when additionally used during index hospitalization. These approaches provided new information about the structure and function of the coronary arteries. These data provide rationale for further study using a larger group of patients to determine a prognostic significance of detecting the atherosclerotic plaques with the signs of instability in this patient category.

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A Pilot Study on Correlation Between Serum Selenium and Copper Concentrations and Coronary Slow Flow Phenomenon

ACTA MEDICA IRANICA ◽

10.18502/acta.v57i6.1883 ◽

2019 ◽

Author(s):

Mostafa Dastani ◽

Soheila Moshiri ◽

Ramin Khameneh Bagheri ◽

Maryam Bahramizadeh ◽

Ladan Hassanzadeh Khayyat ◽

...

Keyword(s):

Coronary Arteries ◽

Serum Copper ◽

Serum Selenium ◽

Slow Flow ◽

Serum Concentrations ◽

Entry And Exit ◽

Flow Phenomenon ◽

Coronary Slow Flow ◽

Coronary Slow Flow Phenomenon

Abstract- The pathophysiology of coronary arteries slow flow phenomenon is related to the microvascular and endothelial disorder. The role of copper and selenium in the development of microvascular and endothelial disorders, as well as atherosclerosis, has been proven in previous studies. The aim of this study was to evaluate the serum copper and selenium concentrations in patient with coronary slow flow phenomenon to find a probable relationship between them. In this study, 125 patients who referred to Ghaem Hospital in Mashhad for angiography were selected based on entry and exit criteria. Patients were divided into 5 groups according to the results of angiography. Blood samples of these patients were evaluated about the levels of copper and selenium. Finally the correlation between these levels and the intensity of coronary arteries slow flow (based on TIMI scores) was evaluated. In the present study, serum selenium and copper concentrations did not show a significant correlation with the intensity of coronary arteries slow flow (P>0.05). In the present study, no significant correlation was found between copper and selenium serum concentrations and coronary arteries slow flow based on TIMI. Further studies are recommended to investigate this association.

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Association of the lymphocyte-to-monocyte ratio, mean diameter of coronary arteries, and uric acid level with coronary slow flow in isolated coronary artery ectasia

BMC Cardiovascular Disorders ◽

10.1186/s12872-021-01952-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Zhuoxuan Yang ◽

Jiansong Yuan ◽

JinGang Cui ◽

Hao Guan ◽

Shubin Qiao

Keyword(s):

Uric Acid ◽

Coronary Artery ◽

Coronary Arteries ◽

Odds Ratio ◽

Left Ventricular ◽

Slow Flow ◽

Coronary Artery Ectasia ◽

Lymphocyte To Monocyte Ratio ◽

Mean Diameter ◽

Coronary Slow Flow

Abstract Background The pathophysiology of isolated coronary artery ectasia (CAE) with the coronary slow flow (CSF) phenomenon is still unclear. The purpose of this study was to investigate the risk factors for isolated CAE complicated with CSF. Methods A total of 126 patients with isolated CAE were selected retrospectively. The patients were grouped into the no CSF (NCSF) group (n = 55) and the CSF group (n = 71) according to the corrected thrombolysis in myocardial infarction (TIMI) frame count (CTFC). Data on demographics, laboratory measurements, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter (LVEDd), CTFC and diameters of three coronary arteries were collected. Results The proportions of males (84.5% vs. 61.8%, p = 0.004) and patients with a smoking history (63.4% vs. 43.6%, p = 0.021) were higher in the CSF group than in the NCSF group. The neutrophil-to-lymphocyte ratio (NLR) (2.08(1.68–3.21) vs. 1.89 ± 0.58, p = 0.001), mean diameter of coronary arteries (mean D) (5.50 ± 0.85 vs. 5.18 ± 0.91, p < 0.001), and uric acid (URIC) level (370.78 ± 109.79 vs. 329.15 ± 79.71, p = 0.019) were significantly higher in the CSF group, while the lymphocyte-to-monocyte ratio (LMR) (4.81 ± 1.66 vs. 5.96 ± 1.75, p < 0.001) and albumin (ALB) level (44.13 ± 4.10 vs. 45.69 ± 4.11, p = 0.036) were lower. Multivariable logistic analysis showed that the LMR (odds ratio: 0.614, 95% CI: 0.464–0.814, p = 0.001), mean D (odds ratio: 2.643, 95% CI: 1.54–4.51, p < 0.001) and URIC level (odds ratio: 1.006, 95% CI: 1.001–1.012, p = 0.018) were independent predictors of CSF in CAE. Conclusions The LMR was a negative independent predictor of CSF in isolated CAE, while URIC level and mean D were positive independent predictors.

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Heart failure in an elderly man: where is that coronary?

Cardiology in the Young ◽

10.1017/s104795112100007x ◽

2021 ◽

pp. 1-4

Author(s):

Charlie J. Sang ◽

Stephen A. Clarkson ◽

Elizabeth A. Jackson ◽

Firas Al Solaiman ◽

Marc G. Cribbs

Keyword(s):

Heart Failure ◽

Coronary Artery ◽

Pulmonary Artery ◽

Medical Therapy ◽

Coronary Arteries ◽

Right Coronary Artery ◽

Adult Population ◽

Anomalous Coronary ◽

Anomalous Coronary Arteries

Abstract Anomalous coronary arteries from the pulmonary artery are uncommon causes of heart failure in the adult population. This case demonstrates the unusual presentation in a patient with anomalous right coronary artery from the pulmonary artery and discusses the complex pathophysiology of this lesion and the role of guideline-directed medical therapy in the management of these patients.

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Abstract 12063: High-risk Plaque Co-localizes With Low Endothelial Shear Stress and Expansive Remodeling in Human Coronary Arteries: A 3D Optical Coherence Tomography Study

Circulation ◽

10.1161/circ.132.suppl_3.12063 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Yiannis S Chatzizisis ◽

Konstantinos Toutouzas ◽

Andreas A Giannopoulos ◽

Maria Riga ◽

Antonios P Antoniadis ◽

...

Keyword(s):

Optical Coherence Tomography ◽

Shear Stress ◽

High Risk ◽

Coronary Arteries ◽

Vascular Remodeling ◽

Pool Size ◽

Optical Coherence ◽

Fibrous Cap ◽

Endothelial Shear Stress

Background: High risk plaque accounts for the majority of acute coronary events. Low endothelial shear stress (ESS) is a key factor of the natural history of atherosclerosis. The role of ESS in high risk plaque formation is not well studied in man. Hypothesis: To explore the association of low ESS with high risk plaque and to identify the ESS milieu and vascular remodeling response in high risk vs. non high risk plaque. Methods: 35 coronary arteries from 30 patients were 3D reconstructed with fusion of coronary angiography and optical coherence tomography (Fig A-D) . ESS was calculated in the 3D reconstructed arteries using computational fluid dynamics (Fig E) and classified into low, moderate and high in 3 mm long segments. In each segment: i) fibroatheromas were classified into high risk and non high risk based on fibrous cap thickness and lipid pool size ii) vascular remodeling was classified into constrictive, compensatory and expansive. Results: Fibroatheromas in low ESS segments had significantly thinner fibrous cap compared to high ESS segments (89±84 vs.138±83 μm, p<0.05). Lipid pool size was comparable across all ESS categories. The majority of low ESS segments co-localized with high risk plaques (29 vs. 9%, p<0.05), whereas the majority of high ESS co-localized with non high risk plaques (24 vs. 9%, p<0.05, Fig F ). Compensatory and expansive remodeling was the predominant remodeling response in low ESS segments containing high risk plaques. In non-stenotic fibroatheromas (expansive or compensatory remodeling) low ESS was predominantly associated with high risk plaques (29 vs. 3%, p<0.05) whereas high ESS was associated with non high risk plaques (Fig F) . Conclusions: Novel combined anatomic and functional imaging with 3D OCT showed that low ESS and non-constrictive remodeling are associated with high risk plaque in man. Further studies are needed to assess the role of ESS and vascular remodeling in high risk plaque rupture and precipitation of clinical outcomes.

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High Plasma Levels of Soluble Talin-1 in Patients with Coronary Artery Disease

Disease Markers ◽

10.1155/2020/2479830 ◽

2020 ◽

Vol 2020 ◽

pp. 1-8

Author(s):

Masayuki Aoyama ◽

Yoshimi Kishimoto ◽

Emi Saita ◽

Yukinori Ikegami ◽

Reiko Ohmori ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Vessels ◽

Focal Adhesions ◽

High Plasma ◽

Blood Levels ◽

Atherosclerotic Plaques ◽

Vessel Disease ◽

Artery Disease

Aims. Talin-1 is a cytoskeletal protein that binds integrin, thereby leading to integrin activation and affecting focal adhesions. Recently, talin-1 expression was reported to be downregulated in human atherosclerotic plaques. However, blood levels of soluble talin-1 (sTalin-1) in patients with atherosclerotic disease, such as coronary artery disease (CAD), have not been elucidated. Methods. We measured plasma sTalin-1 levels in 349 patients undergoing elective coronary angiography. The severity of CAD was represented as the number of stenotic coronary vessels and segments. Results. Of the 349 study patients, CAD was found in 194 patients, of whom 88 had 1-vessel disease (1-VD), 60 had 2-vessel disease (2-VD), and 46 had 3-vessel disease (3-VD). Plasma sTalin-1 levels were higher in 194 patients with CAD than in 155 without CAD (CAD(-) group) (median 0.30 vs. 0.23 ng/mL, P<0.005). A stepwise increase in sTalin-1 levels was found depending on the number of >50% stenotic coronary vessels: 0.23 in CAD(-), 0.29 in 1-VD, 0.30 in 2-VD, and 0.32 ng/mL in 3-VD group, respectively, (P<0.05). High sTalin-1 level (>0.28 ng/mL) was found in 36% of CAD(-), 51% of 1-VD, 53% of 2-VD, and 59% of 3-VD group (P<0.025). sTalin-1 levels also correlated with the number of >50% stenotic segments (r=0.14, P<0.02). The multivariate analysis revealed that sTalin-1 levels were independently associated with CAD. The odds ratio for CAD was 1.83 (95%CI=1.14−2.93) for high sTalin-1 level (>0.28 ng/mL) (P<0.02). Conclusions. Plasma sTalin-1 levels in patients with CAD were found to be high and to be associated with the presence and severity of CAD, suggesting a role of sTalin-1 in the progression of coronary atherosclerosis.

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Echocardiographic diagnosis of congenital coronary artery abnormalities in a continuous series of adolescent football players

European Journal of Preventive Cardiology ◽

10.1177/2047487319825520 ◽

2019 ◽

Vol 26 (9) ◽

pp. 988-994 ◽

Cited By ~ 7

Author(s):

Stephan Gerling ◽

Oliver Loose ◽

Robert Zant ◽

Holger Michel ◽

Michael Melter ◽

...

Keyword(s):

Coronary Artery ◽

High Risk ◽

Coronary Arteries ◽

Left Coronary Artery ◽

Screening Tests ◽

Continuous Series ◽

Football Players ◽

Coronary Artery Abnormalities ◽

2D Echocardiography ◽

The Usa

Background Sudden cardiac death (SCD) in children and adolescents is rare. Several studies have reported a higher risk of SCD during athletic competition. High risk congenital coronary artery abnormalities are the second leading cause of SCD in young athletes in the USA. Echocardiographic assessment of coronary arteries has not been routinely used in screening programmes for junior athletes so far. Design Prospective cohort study in 1045 consecutive adolescent elite football players. Methods All athletes underwent a standardized cardiovascular screening protocol with a medical history, a physical examination, 12-lead resting electrocardiogram and a complete transthoracic 2D-echocardiography. Results Two athletes (0.19%) showed a high-risk coronary artery abnormality (CAA) with a right coronary artery originating abnormal from the aorta and coursing inter-arterial. Low-risk CAAs were found in 16 athletes (1.53%). There was an ectasia of the left coronary artery (+3.9z and +4.3z) and a fistula from the left coronary artery in two cases (0.19%), respectively. In 1.05% ( n = 11) we found a high take-off (2.3–6.8 mm) and in one case (0.096%) there was a tangential take-off of the right main coronary artery. Variants of coronary arterial anatomy were identified in 335 of 1045 athletes (32.06%). Conclusion Basic pre-participation screening tests including 12-lead or exercise electrocardiogram do not safely identify high-risk CAAs. In adolescent athletes an expert cardiologist is able to describe the origin and the proximal course of the coronary arteries and identify major abnormalities in most of the cases by transthoracic 2D-echocardiography.

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The Use of Intravascular Ultrasound in Patients with Coronary Atherosclerosis (Literature Review)

Journal of New Medical Technologies ◽

10.12737/17041 ◽

2015 ◽

Vol 22 (4) ◽

pp. 153-160

Author(s):

Меркулов ◽

E. Merkulov ◽

Миронов ◽

V. Mironov ◽

Терещенко ◽

...

Keyword(s):

Intravascular Ultrasound ◽

Coronary Arteries ◽

Ultrasonic Method ◽

Scientific Work ◽

Coronary Artery Occlusion ◽

Vascular Wall ◽

Artery Occlusion ◽

Atherosclerotic Plaques ◽

Optimal Method ◽

Risk Of Rupture

In recent years, along with radiopaque coronary angiography, the intravascular ultrasound of the coronary arteries is widely used. This method allows to image not only the lumen of the artery in real time, but also to evaluate the ultrasonic structure of the vascular wall in various areas. Spectral analysis of the radiofrequency characteristics of the reflected ultrasound signal allows to identifying the different types of plaques, including the structural unstable atherosclerotic plaques, among them the plaques with a high risk of rupture ‐ a thin‐cap fibroatheroma. Accurate quantification and detailed qualitative analysis of the state of the coronary arteries by the intravascular ultrasonic method assess the degree of atherosclerotic lesions and to choose the most optimal method of treatment. Stenting of coronary arteries under ultrasound control significantly reduces the risk of subacute thrombotic coronary artery occlusion in the stented segment and restenosis in the stent. The article discusses the role of the proposed method in clinical practice and in scientific work in the field of the evolution of atherosclerotic plaques, and assessing the effectiveness of new interventional and pharmacological therapies.

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