Optical coherent tomography for the diagnostic of non-obstructive coronary artery myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process. The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST-elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non-ST-elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, the atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of the hypertensive crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatous, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, antiplatelets were prescribed, patients with spontaneous dissection of CA had the recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was an atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.

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Using of optical coherent tomography in the determination of the causes of non-obstructive coronary artery myocardial infarction

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.100 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

I Leonova ◽

V Feoktistova ◽

S Boldueva ◽

D Evdokimov

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Atherosclerotic Plaque ◽

St Elevation ◽

Spontaneous Dissection

Abstract Funding Acknowledgements Type of funding sources: None. The widespread use of coronary angiography (CAG) in patients with acute coronary syndrome led to the understanding that in some patients myocardial infarction (MI) occurs against angiographically unchanged or slightly modified coronary arteries (CA). In such cases, the so-called "type 2 IM" is diagnosed in some patients, however, to determine the true cause of MI, a modern method of investigation such as optical coherence tomography (OCT) is needed to visualize the intima of the CA and detect a minimal atherosclerotic process. The purpose of the study was to establish the etiology of MI without obstructive coronary artery disease (MINOCA) using OCT. Materials and methods 160 conclusions of the OCT were analyzed. In 9 (6%) cases, the study was conducted in patients who underwent proven MI (mean age 43,1 ± 13,2, 8 males, 1 female) who had no hemodynamically significant CA stenosis according to CAG data. Results in 2 cases (22%) patients had ST elevation MI, thrombotic occlusion of the CA (in one case, thrombaspiration was performed). In both patients, spontaneous dissection of the intima of the unmodified CA was detected in the OCT. The remaining 7 patients had non ST elevation MI, and in 2 cases, a diagnosis of type 2 MI was established: in both patients, atherosclerotic plaque was visualized, narrowing the lumen of the CA less than 50%, in one case MI developed against a background of hypertonic crisis, in another - against a background of spasm of CA. In the remaining 5 patients, OCT revealed subintimal atheromatosis, with elements of local dissection of the intima. Thus, in 78% of patients atherosclerosis of CA of different severity (from the subintimal deposition of lipids to the development of atherosclerotic plaque, narrowing the clearance of the SC by less than 50%) was diagnosed. In the analysis of risk factors for coronary heart disease (CHD), 57% of patients with atheromatous CA had more than 2 risk factors for CHD: 3 (42%) smoked, 5 (71%) - obesity, 4 (57% ) - had arterial hypertension, 3 (42%) had dyslipidemia, 1 (14%) had type 2 diabetes. In the group of patients with spontaneous intima dissection of the CA, 1 patient (woman) did not have CHD risk factors, the 2-nd suffered from obesity and hypertension. For all patients a lifestyle correction was recommended; statins, disaggregants were prescribed, patients with spontaneous dissection of CA had recommendation of examination in the medical-genetic center. Conclusion Based on the results of the study, in most cases, the cause of IMBOC development was atherosclerotic lesion of the coronary arteries, which is not always visualized with standard coronary angiography. Basically, the patients were young and middle-aged. Most patients had different risk factors for coronary heart disease.

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Coronary vasomotor and blood flow responses to isoflavone-intact soya protein in subjects with coronary heart disease or risk factors for coronary heart disease

Clinical Science ◽

10.1042/cs20070443 ◽

2008 ◽

Vol 115 (12) ◽

pp. 353-359 ◽

Cited By ~ 6

Author(s):

Carolyn M. Webb ◽

Christopher S. Hayward ◽

Mark J. Mason ◽

Charles D. Ilsley ◽

Peter Collins

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Blood Flow ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Coronary Circulation ◽

Soya Protein ◽

Short Term ◽

Luminal Diameter

Results in animals suggest favourable coronary vasomotor actions of isoflavones; however, the effects of isoflavones on the human coronary circulation have not been determined. In the present study, we therefore investigated the effects of short-term isoflavone-intact soya protein ingestion on basal coronary arterial tone and stimulated vasoreactivity and blood flow in patients with CHD (coronary heart disease) or risk factors for CHD. Seventy-one subjects were randomized, double-blind, to isoflavone-intact soya protein [active; n=33, aged 58±8 years (mean±S.D.)] or isoflavone-free placebo (n=38, aged 61±8 years) for 5 days prior to coronary angiography. In 25 of these subjects, stimulated coronary blood flow was calculated from flow velocity, measured using intracoronary Doppler and coronary luminal diameter before and after intracoronary adenosine, ACh (acetylcholine) and ISDN (isosorbide dinitrate) infusions. Basal and stimulated coronary artery luminal diameters were measured using quantitative coronary angiography. Serum concentrations of the isoflavones genistein, daidzein and equol were increased by active treatment (P<0.001, P<0.001 and P=0.03 respectively). Basal mean luminal diameter was not significantly different between groups (active compared with placebo: 2.9±0.7 compared with 2.73±0.44 mm, P=0.31). There was no difference in luminal diameter, flow velocity and volume flow responses to adenosine, ACh or ISDN between groups. Active supplement had no effect on basal coronary artery tone or stimulated coronary vasoreactivity or blood flow compared with placebo. Our results suggest that short-term consumption of isoflavone-intact soya protein is neither harmful nor beneficial to the coronary circulation of humans with CHD or risk factors for CHD. These results are consistent with recent cautions placed on the purported health benefits of plant sterols.

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Acute Coronary Syndrome in an Intensive Care Unit of a Tertiary Referral Centre in Central Nepal: The Spectrum and Coronary Risk Factors.

Journal of Nepal Medical Association ◽

10.31729/jnma.1897 ◽

2013 ◽

Vol 52 (190) ◽

Author(s):

Mani Prasad Gautam ◽

Guruprasad Sogunuru ◽

Gangapatnam Subramanyam ◽

Lekhjung Thapa ◽

Raju Paudel ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Intensive Care Unit ◽

Coronary Heart Disease ◽

Acute Coronary Syndrome ◽

Intensive Care ◽

Heart Disease ◽

St Elevation Myocardial Infarction ◽

Coronary Syndrome ◽

St Elevation

Introduction: Acute coronary syndrome is the major leading cause for coronary care unit admission. Its spectrum comprises a variety of disorders including unstable angina, non ST elevation and ST elevation myocardial infarction.Methods: An observational study was designed to study the spectrum of acute coronary syndrome and associated coronary heart disease risk factors in subjects admitted in intensive care unit from August 2009 to September 2010. Details including coronary risk factors and the categories and outcomes of acute coronary syndrome were analyzed.Results: A total of 57 subjects were included in the study. The majority (63.1%) were males. The mean age was 64.54±13.8 years. Five (8.8%) patients were ≤45 years and 29 (50.88%) patients were ≥65 years. Majority of the patients were smokers (50.87%). The other major coronary heart disease risk factors were diabetes (43.85%), hypertension (36.87%), dyslipidemia (26.32%) and previous history of coronary heart disease (31.58%). Coronary heart disease figured prominently in the family history as well (26.32%). ST elevation myocardial infarction was the major category (42.11%) followed by non-ST elevation myocardial infarction and unstable angina (31.58% and 26.32% respectively). Myocardial infarction complicated with cardiogenic shock had very high mortality (83.33%). Conclusions: The ST elevation myocardial infarction was the major clinical form of acute coronary syndrome admitted in intensive care unit. Prevention should be targeted on modifiable risk factors such as the management of risk factors. In addition, the improvement in cardiology service with the establishment of CCU and cathlab might alter the mortality and morbidity in ACS management.Keywords: acute coronary syndrome; coronary risk factors; intensive care unit.

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Myocardial bridge and coronary artery fistulas in a patient with angina

Pediatrician (St Petersburg) ◽

10.17816/ped102137-141 ◽

2019 ◽

Vol 10 (2) ◽

pp. 137-141

Author(s):

Aleksandra A. Kholkina ◽

Yuriy R. Kovalev ◽

Vladimir A. Isakov ◽

Natal’ya O. Gonchar

Keyword(s):

Myocardial Infarction ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Surgical Treatment ◽

Angina Pectoris ◽

Coronary Angiography ◽

Coronary Arteries ◽

Myocardial Bridge

Cardiovascular diseases (CVDs) are the leading cause of mortality among the population. At the core of the progression of the coronary heart disease is the atherosclerosis of the coronary arteries, which is found in majority of patients suffering from angina and in patients with myocardial infarction. However, in some cases, coronary angiography reveals, that patients with the mentioned clinical manifestations have their coronary arteries unchanged. This is treated as syndrome X or microvascular angina. Along with that, development or aggravation of the coronary heart disease may be based on the congenital peculiarities in the coronary arteries location and structure, such as muscular bridges and fistulas of the coronary artery. This is confirmed by a number of studies, which indicate the role of the above mentioned pathologies in the occurrence of angina and myocardial infarction. Nevertheless, there is also the opposite view, which is supported by a number of specialists. According to them, the presence of the mentioned peculiarities in the structure of the coronary channel is deemed as the patient-specific norm. Hence, the issue of the surgical treatment of the patients with the aforementioned coronary arteries anomalies remains controversial. The clinical case report of the patient with the symptoms of angina pectoris, in which the coronary angiography did not reveal the stenosis of the coronaries arteries, but located the myocardial bridge and the coronary fistula. The role of the congenital coronary vessels pathology in the angina pectoris is analyzed. The diagnosis guidelines and the tactics of the conservative and surgical treatment of patients with the above mentioned syndromes are discussed.

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Analysis of Coronary Artery Lesion Degree and Related Risk Factors in Patients with Coronary Heart Disease Based on Computer-Aided Diagnosis of Coronary Angiography

Computational and Mathematical Methods in Medicine ◽

10.1155/2021/2370496 ◽

2021 ◽

Vol 2021 ◽

pp. 1-10

Author(s):

Xuan Wang ◽

Dehao Yu ◽

Junrui Wang ◽

Junjie Huang ◽

Wenqing Li

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Heart Disease ◽

Risk Factor ◽

Heart Disease ◽

Coronary Artery ◽

Coronary Angiography ◽

Computer Aided ◽

Hs Crp ◽

Artery Disease

A combination of various risk factors results in the development of coronary heart disease. The earlier that one identifies and deals with reversible risk factors for coronary heart disease, the greater the chance of recovery. The main goal of this research is to learn whether risk variables are associated with greater extent of coronary artery disease in people with coronary heart disease. This article selects 290 patients who had had coronary angiography in our hospital from September 2018 to March 2019 using a retrospective research and analytic methodology. Coronary angiography split the patients into two groups: those with coronary heart disease and those without. To determine the correlation between risk factors and a score related to heart disease, computer-aided statistical analysis of data about the differences in those risk factors was performed. The results were analyzed using the Spearman correlation and partial correlation, and the relationship between risk factors and Gensini score was analyzed by multiple linear regression. For the analysis, binary logistic regression was used to calculate the correlation between the risk factors of coronary heart disease and the probability of developing coronary heart disease. The findings concluded that increased age, smoking, elevated hs-CRP, HbA1c, hypertension, diabetes, and hyperuricemia are all contributors to coronary heart disease. Coronary heart disease is an independent risk factor for this condition. Many of the factors that play a role in the long-term development of the severity of coronary artery disease, such as hypertension, diabetes, smoking, elevated hs-CRP, decreased HDL-C, raised LDL-C, and TG, are commonly found in men. hs-CRP is the primary risk factor for the degree of coronary artery stenosis and could contribute to the progression of the condition by playing a major role in creating more stenosis.

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The PRIME study: classical risk factors do not explain the severalfold differences in risk of coronary heart disease between France and Northern Ireland. Prospective Epidemiological Study of Myocardial Infarction

QJM ◽

10.1093/qjmed/91.10.667 ◽

1998 ◽

Vol 91 (10) ◽

pp. 667-676 ◽

Cited By ~ 100

Author(s):

J. Yarnell

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Heart Disease ◽

Heart Disease ◽

Northern Ireland ◽

Epidemiological Study ◽

Prospective Epidemiological Study

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OBSTRUCTIVE SLEEP APNEA / HYPOPNEA SYNDROME IN RAILWAY WORKERS WITH RISK FACTORS FOR CORONARY HEART DISEASE

10.31089/978-5-6042929-2-1-2021-1-155-158 ◽

2021 ◽

Author(s):

S. Gorokhova ◽

◽

N. Belozerova ◽

M. Buniatyan ◽

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Heart Disease ◽

Heart Disease ◽

Coronary Artery ◽

Obstructive Sleep ◽

Railway Workers ◽

Artery Disease ◽

Step Algorithm ◽

Hypopnea Syndrome

Abstract: Obstructive sleep apnea/hypopnea syndrome (OSA) is a common condition that may lead to excessive daytime sleepiness, cognitive disturbance, and a decreased concentration that are associated with the risk of workplace accidents and injuries. It is difficult to diagnose OSA due to low severity and specificity of its symptoms and special requirements in respect of medical resources. We assumed that it would be more effective and cost-efficient to diagnose OSA in railway workers with such risk factors f coronary heart disease as arterial hypertension and metabolic disorders since this group receives comprehensive medical attention. However, no studies on the prevalence of OSA in railway workers specifically considered the risk factors for coronary artery disease. The aim of the study was to assess the prevalence of OSA in railway workers with confirmed cardiovascular and metabolic disorders that did not disqualify them from their job. Material and methods. The study included 967 railway workers (locomotive drivers and their assistants). On Stage 1, a group of participants suspected OSA was selected; and on Stage 2, a group of participants with confirmed OSA was formed. Polysomnography or cardiorespiratory monitoring were used to diagnose OSA. Results. We developed a two-step algorithm of OSA diagnosis that included a preliminary assessment of the probability of OSA. 236 (24.4%) participants with a probability of OSA were selected among the initial 967 persons with risk factors for coronary artery disease. Further assessment confirmed OSA in 141 (60%) participants in this group. The analysis of distribution of risk factors for coronary artery disease and OSA showed that 125 (53.0%) of patients with BMI ≥ 30 kg/m², 115 (48.7%) of patients with AH, and 26 (11.0%) of patients with type 2 diabetes had OSA; most of them had some combination of these risk factors. Conclusions: OSA is prevalent in the group of professionally active locomotive drivers and their assistants with risk factors for coronary heart disease; every second worker in a target group with BMI ≥ 30 kg/m², AH or with both risk factors was diagnosed with OSA. The proposed two-step algorithm with a pre-test assessment of OSA probability and subsequent instrumental examination (cardiorespiratory monitoring, polysomnography) allows to accurately diagnosis OSA and allocate medical resources in a cost-effective manner.

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Sex Differences in the Non-infarct-Related Artery-Based Quantitative Flow Ratio in Patients With ST-Elevation Myocardial Infarction: A Retrospective Study

Frontiers in Cardiovascular Medicine ◽

10.3389/fcvm.2021.726307 ◽

2021 ◽

Vol 8 ◽

Author(s):

Hongli Hou ◽

Qi Zhao ◽

Chao Qu ◽

Meng Sun ◽

Qi Liu ◽

...

Keyword(s):

Myocardial Infarction ◽

Sex Differences ◽

Coronary Artery ◽

Coronary Angiography ◽

Clinical Outcomes ◽

Flow Ratio ◽

Infarct Related Artery ◽

St Elevation ◽

Quantitative Flow Ratio ◽

Quantitative Flow

Introduction: It has been reported that sex has well-established relationships with the prevalence of coronary artery disease (CAD) and the major adverse cardiovascular events. Compared with men, the difference of coronary artery and myocardial characteristics in women has effects on anatomical and functional evaluations. Quantitative flow ratio (QFR) has been shown to be effective in assessing the hemodynamic relevance of lesions in stable coronary disease. However, its suitability in acute myocardial infarction patients is unknown. This study aimed to evaluate the sex differences in the non-infarct-related artery (NIRA)-based QFR in patients with ST-elevation myocardial infarction (STEMI).Methods: In this study, 353 patients with STEMI who underwent angiographic cQFR assessment and interventional therapy were included. According to contrast-flow QFR (cQFR) standard operating procedures: reliable software was used to modeling the hyperemic flow velocity derived from coronary angiography in the absence of pharmacologically induced hyperemia. 353 patients were divided into two groups according to sex. A cQFR ≤0.80 was considered hemodynamically significant, whereas invasive coronary angiography (ICA) luminal stenosis ≥50% was considered obstructive. Demographics, clinical data, NIRA-related anatomy, and functional cQFR values were recorded. Clinical outcomes included the NIRA reclassification rate between men and women, according to the ICA and cQFR assessments.Results: Women were older and had a higher body mass index (BMI) than men. The levels of diastolic blood pressure, troponin I, peak creatine kinase-MB, low-density lipoprotein cholesterol, N terminal pro B-type natriuretic peptide, stent diameter, and current smoking rate were found to be significantly lower in the female group than in the male group. Women had a lower likelihood of a positive cQFR ≤0.80 for the same degree of stenosis and a lower rate of NIRA revascularization. Independent predictors of positive cQFR included male sex and diameter stenosis (DS) >70%.Conclusions: cQFR values differ between the sexes, as women have a higher cQFR value for the same degree of stenosis. The findings suggest that QFR variations by sex require specific interpretation, as these differences may affect therapeutic decision-making and clinical outcomes.

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