Abstract 14829: Semi-quantitative Assessment of OCT-macrophage Predicts Future Development of Thin-cap Fibroatheroma in Non-culprit Lipid Plaques: A Serial Optical Coherence Tomography Study

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Yoshiyasu Minami ◽  
Daniel S. Ong ◽  
Shiro Uemura ◽  
Zhao Wang ◽  
Aaron D. Aguirre ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Future Development ◽  
Area Under The Curve ◽  
Coronary Syndrome ◽  
Fibrous Cap ◽  
Artery Disease ◽  
The Impact

Introduction: Previous pathological studies have demonstrated that macrophages play an important role for the deterioration of fibrous cap and the onset of acute coronary syndrome. However, the significance of macrophage on the development of thin-cap fibroatheroma (TCFA) had not been fully evaluated in vivo. Aim: To explore the impact of OCT detected macrophage on the development of TCFA in patients with coronary artery disease using serial OCT images. Methods: A total of 152 non-culprit plaques from 90 patients who had serial OCT imaging at baseline and follow-up (median 6.38 [6.07-12.5] months) were included. TCFA was defined as the plaque with the fibrous cap thickness <65μm.OCT detected macrophage was semi-quantitatively assessed in every 1mm along the entire target plaque using a previously introduced grading system; Grade 0: no macrophage, Grade 1: localized macrophage accumulation, Grade 2: clustered accumulation<1 quadrant, Grade 3: clustered accumulation≥1 quadrant but <3 quadrants, Grade 4: clustered accumulation≥3 quadrants. The summation of 0 to 4 grades was evaluated. Results: Among 45 TCFA at baseline, 19 remain as TCFA [persistent TCFA] and 26 changed to non-TCFA [resolved TCFA] at follow-up (Figure). The macrophage grade in persistent TCFA was significantly greater than that in resolved TCFA (13.0 [8.00-17.0] vs. 4.00 [2.00-8.25] (P<0.001)) at baseline. On the other hand, 11 among 107 non-TCFA at baseline changed to TCFA [acquired TCFA] at follow-up. The macrophage grade in acquired TCFA was significantly greater than that in non-TCFA (14.0 [11.0-19.0] vs. 2.0 [0.00-6.75] (P<0.001)) at baseline. The macrophage grade>7.5 at baseline had good performance in discriminating TCFA from non-TCFA at follow-up (area under the curve [AUC] = 0.884, P<0.001) (Figure). Conclusions: The semi-quantitative evaluation of OCT detected macrophage at baseline had the potential to predict the future development of TCFA in patients with coronary artery disease.

scholarly journals Impact of Coronary Artery Disease and Diabetes Mellitus on the Long-Term Follow-Up in Patients after Retrograde Recanalization of the Femoropopliteal Arterial Region

2019 ◽  
Vol 2019 ◽  
pp. 1-6 ◽  
Author(s):  
Joanna Wojtasik-Bakalarz ◽  
Zoltan Ruzsa ◽  
Tomasz Rakowski ◽  
Andreas Nyerges ◽  
Krzysztof Bartuś ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Risk Of Death ◽  
Significant Difference ◽  
Long Term Follow Up ◽  
Artery Disease ◽  
The Impact

The most relevant comorbidities in patients with peripheral artery disease (PAD) are coronary artery disease (CAD) and diabetes mellitus (DM). However, data of long-term follow-up of patients with chronic total occlusion (CTO) are scarce. The aim of the study was to assess the impact of CAD and DM on long-term follow-up patients after superficial femoral artery (SFA) CTO retrograde recanalization. In this study, eighty-six patients with PAD with diagnosed CTO in the femoropopliteal region and at least one unsuccessful attempt of antegrade recanalization were enrolled in 2 clinical centers. Mean time of follow-up in all patients was 47.5 months (±40 months). Patients were divided into two groups depending on the presence of CAD (CAD group: n=45 vs. non-CAD group: n=41) and DM (DM group: n=50 vs. non-DM group: n=36). In long-term follow-up, major adverse peripheral events (MAPE) occurred in 66.6% of patients with CAD vs. 36.5% of patients without CAD and in 50% of patients with DM vs. 55% of non-DM subjects. There were no statistical differences in peripheral endpoints in both groups. However, there was a statistically significant difference in all-cause mortality: in the DM group, there were 6 deaths (12%) (P value = 0.038). To conclude, patients after retrograde recanalization, with coexisting CTO and DM, are at higher risk of death in long-term follow-up.

Anemia increases long-term mortality in patients undergoing conventional coronary angiography – the ECAT registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
B Balcer ◽  
I Dykun ◽  
S Hendricks ◽  
F Al-Rashid ◽  
M Totzeck ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Regression Analysis ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Conventional Coronary Angiography ◽  
Term Survival ◽  
Coronary Syndrome ◽  
Artery Disease

Abstract Background Anemia is a frequent comorbidity in patients with coronary artery disease (CAD). Besides a complemental effect on myocardial oxygen undersupply of CAD and anemia, available data suggests that it may independently impact the prognosis in CAD patients. We aimed to determine the association of anemia with long-term survival in a longitudinal registry of patients undergoing conventional coronary angiography. Methods The present analysis is based on the ECAD registry of patients undergoing conventional coronary angiography at the Department of Cardiology and Vascular Medicine at the University Clinic Essen between 2004 and 2019. For this analysis, we excluded all patients with missing hemoglobin levels at baseline admission or missing follow-up information. Anemia was defined as a hemoglobin level of &lt;13.0g/dl for male and &lt;12.0g/dl for female patients according to the world health organization's definition. Cox regression analysis was used to determine the association of anemia with morality, stratifying by clinical presentation of patients. Hazard ratio and 95% confidence interval are depicted for presence vs. absence of anemia. Results Overall, data from 28,917 patient admissions (mean age: 65.3±13.2 years, 69% male) were included in our analysis (22,570 patients without and 6,347 patients with anemia). Prevalence of anemia increased by age group (age &lt;50 years: 16.0%, age ≥80 years: 27.7%). During a mean follow-up of 3.2±3.4 years, 4,792 deaths of any cause occurred (16.6%). In patients with anemia, mortality was relevantly higher as compared to patients without anemia (13.4% vs. 28.0% for patients without and with anemia, respectively, p&lt;0.0001, figure 1). In univariate regression analysis, anemia was associated with 2.4-fold increased mortality risk (2.27–2.55, p&lt;0.0001). Effect sizes remained stable upon adjustment for traditional risk factors (2.38 [2.18–2.61], p&lt;0.0001). Mortality risk accountable to anemia was significantly higher for patients receiving coronary interventions (2.62 [2.35–2.92], p&lt;0.0001) as compared to purely diagnostic coronary angiography examinations (2.31 [2.15–2.47], p&lt;0.0001). Likewise, survival probability was slightly worse for patients with anemia in acute coronary syndrome (2.70 [2.29–3.12], p&lt;0.0001) compared to chronic coronary syndrome (2.60 [2.17–3.12], p&lt;0.0001). Interestingly, within the ACS entity, association of anemia with mortality was relevantly lower in STEMI patients (1.64 [1.10–2.44], p=0.014) as compared to NSTEMI and IAP (NSTEMI: 2.68 [2.09–3.44], p&lt;0.0001; IAP: 2.67 [2.06–3.47], p&lt;0.0001). Conclusion In this large registry of patients undergoing conventional coronary angiography, anemia was a frequent comorbidity. Anemia relevantly influences log-term survival, especially in patients receiving percutaneous coronary interventions. Our results confirm the important role of anemia for prognosis in patients with coronary artery disease, demonstrating the need for specific treatment options. Figure 1. Kaplan Meier analysis Funding Acknowledgement Type of funding source: None

P2245Sex differences in the in-vivo markers of platelet activation among patients with ischemic heart disease: insights from the EVA study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Raparelli ◽  
G F Romiti ◽  
N Sperduti ◽  
G F Santangelo ◽  
M Vano ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Acute Coronary Syndrome ◽  
Sex Differences ◽  
Coronary Artery ◽  
Coronary Stenosis ◽  
Clinical Presentation ◽  
Coronary Syndrome ◽  
Chronic Angina ◽  
Artery Disease

Abstract Background/Introduction Ischemic heart diseases (IHD) are not synonymous with obstructive flow-limiting coronary artery disease (CAD), especially in women. Platelet dysfunction is suggested as a potential mechanism favouring ischemia in non-obstructive CAD. However, it is unknown whether sex differences in platelet function of patients with non-obstructive CAD exist. Purpose We assessed for sex differences in in-vivo markers of platelet activation among patients with the acute coronary syndrome and chronic stable angina, with or without obstructive CAD Methods From the “Endocrine Vascular disease Approach” (EVA) study, we selected IHD patients undergoing urgent or elective coronary angiography with complete baseline clinical characteristics and angiographic data. Non-obstructive CAD was defined as the presence of coronary stenosis <50%. Thromboxane B2 (TxB2) and soluble P-selectin (sP-s) were measured at baseline. A sex-stratified analysis of platelet biomarkers was performed. Results Among two-hundred-seventy-seven patients (mean age 67±11, 37% women), non-obstructive CAD was documented in 25% of patients. Acute coronary syndrome (ACS) was the reason for angiography in 61% of cases. Women had more frequently ACS, as compared with men (54.8% vs 41.3%, p=0.001), with predominantly non-obstructive CAD. Median serum TxB2 (121.5 [92.7–174.0] vs 103.5 [83.0–140.2] pg/ml, p=0.005) and plasma sP-s (27.0 [18.7–35.0] vs 22.0 [16.0–30.0] ng/ml, p=0.006) levels were higher in patients with ACS as compared with the ones with stable chronic angina. The median concentration of TxB2 was significantly increased in women as compared with men, regardless of the clinical presentation and the coronary stenosis degree (all comparison, p<0.001). However, women with non-obstructive CAD were the group with the highest serum levels of TxB2 (140.0 [111.0–152.0] pg/ml). Sex differences in the plasma sP-s level were also observed among patients with stable chronic angina (women, 26 [20.0–34.0] vs men, 21 [16.6–27.7] ng/ml, p=0.002) and with non-obstructive CAD (women, 26 [20.5–34.5] vs men, 18.5 [16.6–26.0] ng/ml, p=0.003). Conclusion(s) Women with IHD and non-obstructive CAD had increased level of TxB2 and sP-s as compared with men, independently by the clinical presentation. Further investigations are warranted to verify the role of platelet hyperactivation in the pathogenesis of myocardial ischemia with non-obstructive coronary artery disease among women. Acknowledgement/Funding Scientific Independence of Young Researchers Program (RBSI14HNVT) - Ministry of Education, University and Research (MIUR)

scholarly journals Circulatory miR-133b and miR-21 as Novel Biomarkers in Early Prediction and Diagnosis of Coronary Artery Disease

Genes ◽  
2020 ◽  
Vol 11 (2) ◽  
pp. 164 ◽  
Author(s):  
Dinesh Kumar ◽  
Rajiv Narang ◽  
Vishnubhatla Sreenivas ◽  
Vandana Rastogi ◽  
Jagriti Bhatia ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Sensitivity And Specificity ◽  
Area Under The Curve ◽  
Early Prediction ◽  
Coronary Syndrome ◽  
Clinical Challenge ◽  
Novel Biomarkers ◽  
St Elevation ◽  
Artery Disease

While coronary artery disease (CAD) has become a major threat worldwide, the timely biomarker-based early diagnosis of CAD remains a major unmet clinical challenge. We aimed towards assessing the level of circulatory microRNAs as candidates of novel biomarkers in patients with CAD. A total of 147 subjects were recruited which includes 78 subjects with angiographically proven CAD, 15 pre-atherosclerotic normal coronary artery (NCA) subjects and 54 healthy individuals. Quantitative real-time PCR assays were performed. MiR-133b was downregulated by 4.6 fold (p < 0.0001) whereas miR-21 was upregulated by ~2 fold (p < 0.0001) in plasma samples of CAD patients. Importantly, both the miRNAs showed association with disease severity as miR-133b was downregulated by 8.45 fold in acute coronary syndrome (ACS), 3.38 fold in Stable angina (SA) and 2.08 fold in NCA. MiR-21 was upregulated by 2.46 fold in ACS, 1.90 fold in SA and 1.12 fold in NCA. Moreover, miR-133b could significantly differentiate subjects with ST-elevation myocardial infarction (STEMI) from Non-STEMI. Area under the curve (AUC) for miR-133b was 0.80 with >75.6% sensitivity and specificity, AUC for miR-21 was 0.79 with >69.4% sensitivity and specificity. Our results suggest that miR-133b and miR-21 could be possible candidates of novel biomarkers in early prediction of CAD.

scholarly journals Prospective cohort study of elderly patients with coronary artery disease: impact of frailty on quality of life and outcome

Open Heart ◽  
2020 ◽  
Vol 7 (2) ◽  
pp. e001314
Author(s):  
Shouaib Qayyum ◽  
Jennifer Ann Rossington ◽  
Raj Chelliah ◽  
Joseph John ◽  
Benjamin J Davidson ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Short Form ◽  
Composite Score ◽  
Coronary Syndrome ◽  
Mental Composite Score ◽  
Artery Disease

BackgroundElderly, frail patients are often excluded from clinical trials so there is lack of data regarding optimal management when they present with symptomatic coronary artery disease (CAD).ObjectiveThe aim of this observational study was to evaluate an unselected elderly population with CAD for the occurrence of frailty, and its association with quality of life (QoL) and clinical outcomes.MethodsConsecutive patients aged ≥80 years presenting with CAD were prospectively assessed for frailty (Fried frailty phenotype (FFP), Edmonton frailty scale (EFS)), QoL (Short form survey (SF-12)) and comorbidity (Charlson Comorbidity Index (CCI)). Patients were re-assessed at 4 months to determine any change in frailty and QoL status as well as the clinical outcome.ResultsOne hundred fifty consecutive patients with symptomatic CAD were recruited in the study. The mean age was 83.7±3.2 years, 99 (66.0%) were men. The clinical presentation was stable angina in 68 (45.3%), the remainder admitted with an acute coronary syndrome including 21 (14.0%) with ST-elevation myocardial infarction. Frailty was present in 28% and 26% by FFP and EFS, respectively, and was associated with a significantly higher CCI (7.5±2.4 in frail, 6.2±2.2 in prefrail, 5.9±1.6 in those without frailty, p=0.005). FFP was significantly related to the physical composite score for QoL, while EFS was significantly related to the mental composite score for QoL (p=0.003). Treatment was determined by the cardiologist: percutaneous coronary intervention in 51 (34%), coronary artery bypass graft surgery in 15 (10%) and medical therapy in 84 (56%). At 4 months, 14 (9.3%) had died. Frail participants had the lowest survival. Cardiovascular symptom status and the mental composite score of QoL significantly improved (52.7±11.5 at baseline vs 55.1±10.6 at follow-up, p=0.04). However, overall frailty status did not significantly change, nor the physical health composite score of QoL (37.2±11.0 at baseline vs 38.5±11.3 at follow-up, p=0.27).ConclusionsIn patients referred to hospital with CAD, frailty is associated with impaired QoL and a high coexistence of comorbidities. Following cardiac treatment, patients had improvement in cardiovascular symptoms and mental component of QoL.

scholarly journals The effect of religiosity of patients with Coronary Artery Disease on in-hospital anxiety and depression

2020 ◽  
Vol 13 (3) ◽  
pp. 43-59
Author(s):  
Μaria Goudinoudi ◽  
Vasiliki Karra ◽  
Konstantinos Ekmetzoglou ◽  
Anna Korombeli ◽  
Evangelia Kouskouni
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Religious Faith ◽  
Anxiety And Depression ◽  
Family Status ◽  
Hospital Anxiety ◽  
Coronary Syndrome ◽  
Coronary Patients ◽  
Artery Disease ◽  
The Impact

Introduction: Religious faith and spirituality often seem to affect physical and psychological functioning of patients with chronic diseases. Aim: To investigate the relationship between religiosity/spirituality of coronary patients with anxiety and depression which may be experienced during their hospitalization. Methods: A cross-sectional study was conducted involving 172 patients (23 female and 149 male) with coronary artery disease, who were hospitalized in a general hospital of Attica region with an acute coronary syndrome diagnosis. HADS scale was used for the investigation of hospital anxiety and depression and the Belief and Values Scale was used to evaluate the patients’ religious faith and spirituality. Results: Moderate levels of religiosity/spirituality and no to moderate levels of anxiety and depression were found in coronary patients. No statistically significant correlations were found between the HADS subscales and the Beliefs and Values Scale (p> 0.001), although individuals who have experienced strong spiritual experiences, experienced less anxiety and depression in hospital. There were found statistically significant correlations (p <0.001) with gender, religious beliefs, patients’ age with Belief and Values Scale. There were also statistically significant correlations (p<0.001) of HADS subscales with family status, age, smoking habits, stress and medication. Conclusion: Highly religious coronary patients are less likely to experience anxiety and depression during hospitalization, though confounders seem to interfere and make it difficult to interpret this relationship. Further research is required in order to explore the impact of religiosity on psychological distress of hospitalized coronary patients.

Genetic variability in the extracellular matrix as a determinant of cardiovascular risk: association of type III collagen COL3A1 polymorphisms with coronary artery disease

Blood ◽  
2002 ◽  
Vol 100 (4) ◽  
pp. 1220-1223 ◽  
Author(s):  
Clare Muckian ◽  
Anthony Fitzgerald ◽  
Anne O'Neill ◽  
Anna O'Byrne ◽  
Desmond J. Fitzgerald ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Extracellular Matrix ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Stable Angina ◽  
Type Iii ◽  
Coronary Syndrome ◽  
Col3a1 Gene ◽  
Artery Disease ◽  
The Impact

Although common genetic variants in platelet collagen receptors influence platelet activation and thrombosis, the impact of polymorphisms in collagen genes on cardiovascular disease is unknown. To evaluate this, we genotyped a highly polymorphic intronic tandem repeat of the COL3A1 gene, encoding collagen type III, alpha 1. This revealed 4 common alleles (COL3A1-1, -2, -3, and -4). The 2 populations studied were as follows: (1) a cross-sectional study of 703 acute coronary syndrome (ACS) patients with myocardial infarction (MI) and unstable angina, and (2) a prospective study of 924 Caucasian patients from the OPUS (Orbofiban in Patients with Unstable coronary Syndromes)-TIMI-16 trial of the oral GPIIb/IIIa antagonist orbofiban. In addition, we studied 306 control subjects and 224 patients with stable angina. In the case-control population, COL3A1-4 carriers were protected against ACS (odds ratio [OR] = 0.57, 95% CI = 0.35-0.91, P = .02) and stable angina (OR = 0.35, 95% CI = 0.16-0.74, P = .006). In the OPUS population, allele 4 again appeared protective against composite end points (death, MI, stroke, recurrent ischemia, and urgent rehospitalization) (relative risk [RR] = 0.41, 95% CI = 0.17-1.00). There were significant interactions between COL3A1-1 and -3 variants and treatment. Allele COL3A1-3 was associated with an increased risk of the composite end point (RR = 1.65, 95% CI = 1.07-2.55) in patients randomized to orbofiban, but appeared protective in placebo patients (RR = 0.53, 95% CI = 0.28-0.98). We conclude that variants in the COL3A1 gene, the product of which is a vessel-wall protein and platelet ligand, modulate the risk of coronary artery disease and could also modulate the response to antithrombotic therapy. This is the first reported association between polymorphisms of extracellular matrix components and cardiovascular risk.

scholarly journals Predictors of adverse cardiovascular events in patients with coronary artery disease after percutaneous coronary intervention

2020 ◽  
Vol 25 (6) ◽  
pp. 3938
Author(s):  
A. V. Svarovskaya ◽  
E. A. Kuzheleva ◽  
A. A. Arzhanik ◽  
V. A. Fediunina ◽  
V. A. Aleksandrenko ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Percutaneous Coronary Intervention ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Coronary Intervention ◽  
Endothelin 1 ◽  
Coronary Syndrome ◽  
Percutaneous Coronary ◽  
Artery Disease

Aim. To identify predictors of major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI).Material and methods. This prospective single-center study included 225 patients with stable CAD requiring drug-eluting stent implantation. The average follow-up period for patients was 14,5 (6;23) months. Levels of glycated hemoglobin (HbA1c), insulin, tumor necrosis factor (TNF)-α, interleukin-6 (IL-6), interleukin-10 (IL-10), endothelin-1 (ET-1) and the serum lipid profile were evaluated. Insulin resistance was assessed by the HOMA-IR index. The patients were divided into 2 groups: group 1 (n=98) — patients with MACE, group 2 (n=127) — patients without MACE over the follow-up period.Results. During the follow-up period, MACE were recorded in 43,5% of patients, of which: fatal outcome in 3 (3,1%) patients, acute coronary syndrome (ACS) — 14 (14,3%), decompensated heart failure (HF) — 8 (8,2%), non-fatal myocardial infarc tion (MI) — 4 (4,1%), stroke — 3 (3,1%), in-stent restenosis — 18 (18,4%), target vessel revascularization due to progression of atherosclerosis — 25 (25,4%), lifethreatening arrhythmias — 18 (18,4%), implantation of a cardiac resynchronization therapy defibrillator — 5 (5%). To determine critical levels for quantitative predictors, ROC curves were created with threshold values that increase the likelihood of MACE.Conclusion. As a result of the study, we found that the waist-to-hip ratio >1,0495, the HOMA-IR index >3,13 and the endothelin-1 >0,75 mmol/L are independent predictors of unfavorable prognosis in patients with CAD after PCI.

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