Coronary endarterectomy in myocardial revascularization

Aim. To compare the immediate outcomes of combined coronary artery bypass grafting (CABG) with coronary endarterectomy (CE) and isolated CABG.Material and methods. This retrospective study included 192 patients with stable angina who underwent myocardial revascularization in the period from January 2016 to August 2018. The patients were divided into 2 groups. Group 1 included patients who underwent combined CABG and CE, while group 2 — patients who underwent isolated CABG. Patients in both groups did not differ in the main preoperative characteristics, with the exception of the incidence of obesity and right coronary artery disease.Results. In-hospital mortality in group 1 was 2,2% (n=2), in group 2 — 2% (n=2). The incidence of perioperative myocardial infarction in group 1 was 1% (n=1) and in group 2 — 0%. There were no significant differences between groups in the following postoperative parameters: in-hospital mortality, perioperative myocardial infarction, need and duration of inotropic support, duration of mechanical ventilation (MV) and need for long-term mechanical ventilation, stroke, arrhythmias, resternotomy for bleeding. In group 1, encephalopathy (11,8%) and respiratory failure (12,9%) were significantly more common.Conclusion. Combined CABG and CE is a safe technique for achieving complete myocardial revascularization in diffuse coronary artery disease, since, in comparison with isolated CABG, there is no increase in the incidence of death and perioperative myocardial infarction. However, in this category of patients, an increase in the incidence of non-lethal, non-disabling cerebral and pulmonary complications should be expected.

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Association between the severity of coronary artery disease and ST2 expression in patients with heart failure

Russian Medical Inquiry ◽

10.32364/2587-6821-2020-4-7-399-405 ◽

2020 ◽

Vol 4 (7) ◽

pp. 399-405

Author(s):

E.V. Grakova ◽

◽

K.V. Kopieva ◽

A.T. Teplyakov ◽

M.V. Soldatenko ◽

...

Keyword(s):

Heart Failure ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Myocardial Revascularization ◽

Patients With Heart Failure ◽

Lv Remodeling ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim: to study the association between ST2 (sST2) and severity of coronary artery lesion in patients with chronic heart failure (CHF), and to analyze changes in sST2 levels and left ventricle (LV) remodeling indicators depending on complete or incomplete myocardial revascularization (MR) after the 12-month follow-up period.Patients and Methods: a total of 118 patients (16.1% women, mean age of 62.5 [57; 68] years) with stable coronary heart disease (CHD) with LV ejection fraction 60% [46; 64] and CHF of NYHA functional class I–III were enrolled in the study. All patients underwent MR. Depending on the completeness of the performed MR, all patients were retrospectively divided into 2 groups: group 1 (n=75) consisted of patients with complete MR, group 2 (n=43) — with incomplete MR. Serum levels of sST2 were measured using an enzyme immunoassay before MR and after the 12-month follow-up period.Results: the sST2 level in patients with single vessel coronary artery disease was 29.92 [22.43; 32.68] ng/ml and was 21% lower (p=0.002) than in patients with two or more coronary arteries (CA) — 37.87 [37.87; 51.82] ng/ml. During 12-month follow-up, the incidence of adverse cardiovascular events (CVE) in group 1 was 18.7%, in group 2–46.5% (p=0.001). After 12-month follow-up, the level of sST2 in group 1 decreased by 33.6% (p=0.0001) (from 30.51 [26.38; 37.06] to 20.27 [16.56; 27.11] ng/ml), while in group 2 there was only a tendency to decrease in the level of this biomarker, which was 6.9%. In group 2, after 12-month follow-up, there was a tendency to increase in the LV EF, which increased by only 2.4%, as well as a tendency to increase in the end-systolic dimension (ESD), which increased by 5.4%. In the group of patients with complete MR, the increase in the LV EF was significant (p=0.001) — by 13.6% (from 54.0 [42.0; 63.0] to 62.5 [49.0; 64.0]%), and the ESD decreased by 3%, the final ESV — by 4.6%.Conclusion: the sST2 level can be used as a diagnostic marker for assessing the severity of atherosclerotic CA lesion in patients with CHF. Performing complete MR in patients with stable CHD with CHF has a predominance over incomplete MR, leading to reversed LV remodeling, a decrease in sST2 levels and, as a result, the incidence of adverse CVE during the 12-month follow-up. KEYWORDS: coronary atherosclerosis, soluble ST2, myocardial revascularization, heart failure, prognosis, left ventricular remodeling.FOR CITATION: Grakova E.V., Kopieva K.V., Teplyakov A.T., Soldatenko M.V. Association between the severity of coronary artery disease and ST expression in patients with heart failure. Russian Medical Inquiry. 2020;4(7):399–405. DOI: 10.32364/2587-6821-2020-4-7-399-405.

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Screening for coronary artery disease in early surgical treatment of acute aortic valve infective endocarditis

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivaa313 ◽

2020 ◽

Author(s):

Wiebe G Knol ◽

Ali R Wahadat ◽

Jolien W Roos-Hesselink ◽

Nicolas M Van Mieghem ◽

Wilco Tanis ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Infective Endocarditis ◽

Perioperative Complications ◽

Invasive Coronary Angiography ◽

Perioperative Myocardial Infarction ◽

Non Invasive ◽

Estimated Risk ◽

Artery Disease

Abstract OBJECTIVES In patients with unknown coronary status undergoing surgery for acute infective endocarditis (IE), the need to screen for coronary artery disease (CAD) and the risk of embolization during invasive coronary angiography (ICA) are debated. Coronary computed tomography angiography (CCTA) is a non-invasive alternative in these patients. We aimed to evaluate the safety and feasibility of ICA and CCTA to diagnose CAD, and the necessity to treat CAD to prevent CAD-related postoperative complications. METHODS In this single-centre retrospective cohort study, all patients with acute aortic IE between 2009 and 2019 undergoing surgery were selected. Outcomes were any clinically evident embolization after preoperative ICA, in-hospital mortality, perioperative myocardial infarction or unplanned revascularization and postoperative renal function. RESULTS Of the 159 included patients, CAD status was already known in 14. No preoperative diagnostics for CAD was done in 46/145, a CCTA was performed in 54/145 patients and an ICA in 52/145 patients. Significant CAD was found after CCTA in 22% and after ICA in 21% of patients. In 1 of the 52 (2%) patients undergoing preoperative ICA, a cerebral embolism occurred. The rate of perioperative myocardial infarction or unplanned revascularization in patients not screened for CAD was 2% (1 out of 46 patients). CONCLUSIONS Although the risk of embolism after preoperative ICA is low, it should be carefully weighed against the estimated risk of CAD-related perioperative complications. CCTA can serve as a gatekeeper for ICA in most patients with acute aortic IE.

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Comparison of the ATRIA, CHA2DS2-VASc, and Modified Scores ATRIA-HSV, CHA2DS2-VASc-HS, for the Prediction of Coronary Artery Disease Severity

Angiology ◽

10.1177/0003319721991410 ◽

2021 ◽

pp. 000331972199141

Author(s):

Arafat Yildirim ◽

Mehmet Kucukosmanoglu ◽

Fethi Yavuz ◽

Nermin Yildiz Koyunsever ◽

Yusuf Cekici ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Vascular Disease ◽

Operating Characteristics ◽

Coronary Artery Disease Severity ◽

Group 3 ◽

The Mean ◽

Group 2 ◽

Artery Disease ◽

Group 1

Many parameters included in the Anticoagulation and Risk Factors in Atrial Fibrillation (ATRIA) and CHA2DS2-VASc (congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke, vascular disease, age 65-74 years, sex category) scores also predict coronary artery disease (CAD). We modified the ATRIA score (ATRIA-HSV) by adding hyperlipidemia, smoking, and vascular disease and also male sex instead of female. We evaluated whether the CHA2DS2-VASc, CHA2DS2-VASc-HS, ATRIA, and ATRIA-HSV scores predict severe CAD. Consecutive patients with coronary angiography were prospectively included. A ≥50% stenosis in ≥1epicardial coronary artery (CA) was defined as severe CAD. Patient with normal CA (n = 210) were defined as group 1, with <50% CA stenosis (n = 178) as group 2, and with ≥50% stenosis (n = 297) as group 3. The mean ATRIA, ATRIA-HSV, CHA2DS2-VASc, and CHA2DS2VASc-HS scores increased from group 1 to group 3. A correlation was found between the Synergy between PCI with Taxus and Cardiac Surgery score and ATRIA ( r = 0.570), ATRIA-HSV ( r = 0.614), CHA2DS2-VASc ( r = 0.428), and CHA2DS2-VASc-HS ( r = 0.500) scores ( Ps < .005). Pairwise comparisons of receiver operating characteristics curves showed that ATRIA-HSV (>3 area under curve [AUC]: 0.874) and ATRIA (>3, AUC: 0.854) have a better performance than CHA2DS2-VASc (>1, AUC: 0.746) and CHA2DS2-VASc-HS (>2, AUC: 0.769). In conclusion, the ATRIA and ATRIA-HSV scores are simple and may be useful to predict severe CAD.

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Possibilities of cardioselective beta - blocker bisoprolol therapy in patients having coronary artery disease and bronchial asthma

Terapevticheskii arkhiv ◽

10.26442/00403660.2019.09.000268 ◽

2019 ◽

Vol 91 (9) ◽

pp. 26-31

Author(s):

N Y Grigorieva ◽

T P Ilyushina ◽

E M Yashina

Keyword(s):

Coronary Artery Disease ◽

Heart Rate ◽

Coronary Artery ◽

Calcium Antagonist ◽

Beta Blocker ◽

Ventricular Extrasystoles ◽

Group 3 ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim: to compare the antianginal and pulse slowing effects, the impact on the ectopic myocardial activity as well as the safety of the treatment with beta - adrenoblocker bisoprolol, calcium antagonist verapamil and the combination of bisoprolol with amlodipine in patients with stable angina (SA) and bronchial asthma (BA). Materials and methods. The study included 90 patients with SA II-III functional class (FC) having concomitant persistent asthma of moderate severity, controlled, without exacerbation. The patients were divided into three groups with 30 individuals in each one depending on the main antianginal drug prescribed. Group 1 patients received a cardio - selective beta - adrenergic blocker bisoprolol (Concor) at the dose of 5 mg/day, patients of group 2 were treated by a calcium antagonist verapamil at the dose of 240 mg/day, patients of group 3 received combined therapy with bisoprolol at the dose of 5 mg/day and amlodipine at the dose of 5 mg/day given as a fixed combination (Concor AM 5/5). All the patients were investigated by the methods of daily ECG monitoring and respiratory function study (RFS) in addition to physical examination at baseline and after 4 weeks of treatment. Results. After 4 weeks of treatment, patients of group 1 and group 3 did not complain of angina attacks and did not use nitroglycerin unlike patients of group 2. The achieved heart rate (HR) in group 1 patients was 68.6±8.5 beats/min, in group 2 - 74.3±5.6 beats/min, in group 3 - 67.3±4.8 beats/min. A significant decrease in the number of supraventricular and ventricular extrasystoles occurred in patients of group 1 and group 3 only. Thus, the pulse slowing, antianginal, antiischemic and antiarrhythmic effect of the calcium antagonist verapamil, even at the dose of 240 mg/day, is not always sufficient for the patients with SA II-III FC and concomitant BA, unlike therapy with the inclusion of beta - blocker bisoprolol. During the study there was no registered deterioration in the indices of bronchial patency according to the RFS data in the patients of all three groups. Conclusion. In patients with coronary artery disease and concomitant asthma, all three types of pulse slowing therapy do not have any negative effects on bronchial patency. Therapy with the inclusion of beta - blockers (bisoprolol or its combination with amlodipine), in contrast to verapamil, reliably reduces heart rate and the number of supraventricular and ventricular extrasystoles in addition to a good antianginal effect.

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Natriuretic Peptide and High-Sensitive Troponin T Concentrations Correlate with Effectiveness of Short-Term CPAP in Patients with Obstructive Sleep Apnea and Coronary Artery Disease

Clinical Medicine Insights Circulatory Respiratory and Pulmonary Medicine ◽

10.4137/ccrpm.s40939 ◽

2016 ◽

Vol 10 ◽

pp. CCRPM.S40939 ◽

Cited By ~ 4

Author(s):

Ralf Strehmel ◽

Misa Valo ◽

Claudius Teupe

Keyword(s):

Coronary Artery Disease ◽

Obstructive Sleep Apnea ◽

Coronary Artery ◽

Troponin T ◽

Oxygen Desaturation ◽

Obstructive Sleep ◽

Group 2 ◽

Artery Disease ◽

High Sensitive Troponin ◽

Group 1

The risk of cardiovascular complications is increased in patients with obstructive sleep apnea (OSA). Continuous positive airway pressure (CPAP) is the most effective way to treat clinically significant OSA. We hypothesized that the concentrations of the cardiac risk markers N-terminal brain natriuretic peptide (NT-proBNP) and high-sensitive troponin T (hs-TropT) correlate with the effectiveness of CPAP therapy in patients with OSA and coexisting coronary artery disease (CAD). Twenty-one patients with severe OSA and coexisting CAD (group 1) and 20 control patients with severe OSA alone (group 2) were treated with CPAP and monitored by laboratory-based polysomnography. NT-proBNP and hs-TropT levels were measured before and after CPAP. Apnea-hypopnea index (AHI) and oxygen desaturation were similar in both groups. In group 1, hs-TropT levels correlated with AHI and oxygen desaturation upon CPAP. Elevated NT-proBNP levels in group 1 were significantly reduced by CPAP. NT-proBNP levels correlated with AHI and showed negative correlation with ST-segment depression. No such correlations were found in group 2. CPAP has the potential to normalize elevated NT-proBNP serum levels in patients with severe OSA and coexisting CAD. Levels of NT-proBNP and hs-TropT correlated with AHI and oxygen desaturation.

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P657 Deterioration of left ventricular performance in response to pulmonary hypertension, in patients with scleroderma versus patients with coronary artery disease

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.337 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

E Marton ◽

R Hodas ◽

C Blendea ◽

R Cucuruzac ◽

M Pirvu ◽

...

Keyword(s):

Coronary Artery Disease ◽

Pulmonary Hypertension ◽

Systemic Sclerosis ◽

Coronary Artery ◽

Left Ventricular ◽

Left Ventricular Performance ◽

Ventricular Performance ◽

Group 2 ◽

Artery Disease ◽

Group 1

Abstract Funding Acknowledgements PlaqueImage Background The relationship between the degree of pulmonary hypertension (PH) and left ventricular performance in patients with systemic sclerosis is still a controversial issue in the literature. We aimed to conduct a comparative analysis of indexes characterizing left ventricular systolic and diastolic function, in two etiological types of pulmonary hypertension involving different pathophysiological mechanisms: PH caused by systemic sclerosis and PH caused by myocardial ischemia. Material and method We performed a prospective study on 83 patients (36 patients with documented PAH with a systolic pulmonary arterial pressure – sPAP of >35 mmHg and 47 subjects with normal sPAP), out of which group 1 – with systemic sclerosis (n = 48); group 2 – significant coronary artery disease - CAD (n = 35). Patients of each group were divided in two subgroups based on the diagnosis of PH: group 1A - subjects with scleroderma and associated PH (n = 20), group 1B - subjects with scleroderma without PH (n = 28), group 2A - ischemic patients with associated PH (n = 16) and subgroup 2B - patients with ischemic disease without PH (n = 19). Results Patients in group 1 presented a significantly higher number of female subjects (p = 0.001) and a higher mean age (p = 0.009) compared to group 2. Patients with associated PH presented a significantly lower left ventricular ejection fraction (LVEF) compared to those without PH within the ischemic group (p = 0.023). There was a significant inverse correlation between the sPAP and LVEF in ischemic patients (r=-0.52, p = 0.001) as well as for scleroderma patients without PH (r=-0.51, p = 0.04). Tissue Doppler analysis of the left ventricular function indicated a significant negative correlation between the septal E’ value versus the sPAP and lateral E’ value versus the sPAP (r=-0.49, p = 0.002; r=-0.43, p = 0,008). Conclusions Intrinsic myocardial damage plays an important role in left ventricular systolic function even in the absence of PAH. Scleroderma patients present a less pronounced deterioration of the LVEF in response to pulmonary hypertension, indicating that in this group, additional compensatory mechanisms could be involved in the complex response of myocardium to elevated pulmonary pressures.

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Left ventricular concentric remodelling and functional impairment in women with ischaemia with no obstructive coronary artery disease and intermediate coronary flow reserve: a report from the WISE-CVD study

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez044 ◽

2019 ◽

Vol 20 (8) ◽

pp. 875-882 ◽

Cited By ~ 3

Author(s):

Seong-Mi Park ◽

Janet Wei ◽

Galen Cook-Wiens ◽

Michael D Nelson ◽

Louise Thomson ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Coronary Flow Reserve ◽

Coronary Flow ◽

Obstructive Coronary Artery Disease ◽

Left Ventricular ◽

Flow Reserve ◽

Group 2 ◽

Artery Disease ◽

Group 1

Abstract Aims Women with evidence of ischaemia but no obstructive coronary artery disease (INOCA) often have coronary microvascular dysfunction (CMD). Although invasively measured coronary flow reserve (CFR) is useful for the diagnosis of CMD, intermediate CFR values are often found of uncertain significance. We investigated myocardial flow reserve and left ventricular (LV) structural and functional remodelling in women with suspected INOCA and intermediate CFR. Methods and results Women’s Ischemia Syndrome Evaluation-Coronary Vascular Dysfunction (WISE-CVD) study participants who had invasively measured intermediate CFR of 2.0≤ CFR ≤3.0 (n = 125) were included for this analysis. LV strain, peak filling rate (PFR) and myocardial perfusion reserve index (MPRI) were obtained by cardiac magnetic resonance imaging. Participants were divided: (i) Group 1 (n = 66) high MPRI ≥ 1.8, and (ii) Group 2 (n = 59) low MPRI < 1.8. The mean age was 54 ± 12 years and CFR was 2.46 ± 0.27. MPRI was significantly different but CFR did not differ between groups. LV relative wall thickness (RWT) trended higher in Group 2 and circumferential peak systolic strain and early diastolic strain rate were lower (P = 0.039 and P = 0.035, respectively), despite a similar LV ejection fraction and LV mass. PFR was higher in Group 1 and LV RWT was negatively related to PFR (r = −0.296, P = 0.001). Conclusions In women with suspected INOCA and intermediate CFR, those with lower MPRI had a trend towards more adverse remodelling and impaired diastolic LV function compared with those with higher MPRI. CFR was similar between the two groups. These findings provide evidence that both coronary microvessel vasomotion and structural and functional myocardial remodelling contribute to CMD.

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Relationship of Body Fat and Left ventricular hypertrophy with the Risk of All-cause Death in Patients with Coronary Artery Disease

10.21203/rs.3.rs-296999/v1 ◽

2021 ◽

Author(s):

Baotao Huang ◽

Lu Yang ◽

Bosen Yang ◽

Fangyang Huang ◽

Qianfeng Xiao ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Body Fat ◽

Ventricular Hypertrophy ◽

Left Ventricular ◽

Lower Body ◽

Group 3 ◽

Group 2 ◽

Artery Disease ◽

Group 1

Abstract Background and aimsLeft ventricular hypertrophy (LVH) is prevalent in obese individuals. Besides, both of LVH and obesity is associated with subclinical LV dysfunction. However, little is known about the interplay between body fat and LVH in relation to all-cause death in patients with coronary artery disease (CAD).MethodsIn this retrospective cohort study, a total of 2243 patients with angiographically proven CAD were included. Body fat and LV mass were calculated using formulas. Higher body fat was defined as the percentage of body fat was greater than 75th percentile. LVH was defined according to guidelines’ definition. Patients were divided into four groups: group 1, lower body fat and no LVH; group 2, lower body fat and LVH; group 3, higher body fat and no LVH; group 4, higher body fat and LVH. Cox-proportional hazard models were used to observe the interaction effect of body fat and LVH on all-cause death.ResultsOver 2.2 years, there were 120 deaths. Patients with higher body fat and no LVH (group 3) had similar risk of death (adjusted HR 1.83, 95%CI 1.00-3.38, P = 0.054) compared to the reference group (group 1), while patients with lower body fat and LVH (group 2) had the highest risk (adjusted HR 2.15, 95%CI 1.26–3.64, P = 0.005) of death. The results were robust after different degree of adjustment.ConclusionCertain amount of BF was not associated with increased risk of all-cause death in patients with CAD, even seems protective in those concomitant with LVH.

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Multi-Vessel Coronary Artery Disease: Choice of Myocardial Revascularization Strategy

Galician Medical Journal ◽

10.21802/gmj.2020.4.1 ◽

2020 ◽

Vol 27 (4) ◽

pp. E202041

Author(s):

Nestor Seredyuk ◽

Andrii Matlakh ◽

Yaroslava Vandzhura ◽

Mykyta Bielinskyi ◽

Oleksii Skakun ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Percutaneous Coronary Intervention ◽

Coronary Artery ◽

Right Coronary Artery ◽

Myocardial Revascularization ◽

Coronary Intervention ◽

Percutaneous Coronary ◽

Artery Disease ◽

The Right

Multi-vessel coronary artery disease is quite a common state, which is often diagnosed by coronary angiography in patients with both stable coronary artery disease and acute coronary syndromes. Major difficulties in percutaneous coronary intervention include stent thrombosis and the need for antiplatelet therapy (aspirin and a P2Y12 inhibitor). Stent thrombosis leads to the recurrence of myocardial infarction and may occur within the first few hours after percutaneous coronary intervention. The use of dual antiplatelet therapy, especially that combined with low-molecular-weight heparin in the first days after myocardial infarction, poses a risk of bleeding, which often occurs in real clinical practice. Among P2Y12 inhibitors, ticagrelor causes bleeding somewhat more frequently than clopidogrel. A case of multi-vessel coronary artery disease is described in this paper. Coronary angiography revealed right-dominant circulation; occlusion of the proximal and medial segments of the right coronary artery, thrombolysis in myocardial infarction flow grade 0; stenosis of the left main coronary artery (50-60%), thrombolysis in myocardial infarction flow grade 2; diffuse stenosis of the medial and distal segments of the left anterior descending artery, thrombolysis in myocardial infarction flow grade 1; stenosis of the proximal segment of the left circumflex artery (> 75%), thrombolysis in myocardial infarction flow grade 1. The patient underwent percutaneous coronary intervention; the stents were implanted in the infarct-dependent right coronary artery. The clinical course was complicated by early stent thrombosis with subsequent thrombus extraction; a day later melena developed. Bleeding was stopped, the intensity of antithrombotic therapy was reduced: the combination of aspirin and ticagrelor was replaced by the combination of aspirin and clopidogrel. Six weeks after stenting of the infarct-dependent coronary artery, complete myocardial revascularization (hybrid intervention) was performed: coronary artery bypass grafting [the left internal mammary artery → the left anterior descending artery], coronary autogenous bypass grafting [the aorta → the right coronary artery and the aorta → the left circumflex artery]. The role of fractional flow reserve or instantaneous wave-free ratio-controlled complete myocardial revascularization techniques is discussed. The following algorithm for myocardial revascularization was used: percutaneous coronary intervention for the right coronary artery + coronary artery bypass grafting-3: the left internal mammary artery → the left anterior descending artery, the aorta → the left circumflex artery, the aorta → the right coronary artery.

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Role of inflammation, autotaxin and lipoprotein (a) in degenerative aortic valve stenosis in patients with coronary artery disease

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2021-2598 ◽

2021 ◽

Vol 20 (2) ◽

Author(s):

A. L. Burdeynaya ◽

O. I. Afanasyeva ◽

E. A. Klesareva ◽

N. A. Tmoyan ◽

O. A. Razova ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Aortic Valve ◽

Aortic Valve Stenosis ◽

Control Group ◽

Lymphocyte Ratio ◽

Group 2 ◽

Artery Disease ◽

Group 1

Aim. To study the relationship between the concentration of lipoprotein (a) (Lp (a)) and autotaxin (ATX) in patients with and without degenerative aortic valve stenosis (AoS) in the presence of coronary artery disease (CAD).Material and methods. The study included 461 patients (mean age, 66±11 years, men, 323), 354 of whom had CAD with stenosis ≥50% in at least one coronary artery according to angiography. Degenerative AoS was diagnosed with ultrasound. The control group consisted of 107 patients without CAD and degenerative AoS. Concentrations of Lp (a), ATX, lipids and blood cells were measured for all patients.Results. CAD without degenerative AoS (group 1) was diagnosed in 307 patients, while 47 patients had CAD and degenerative AoS (group 2). Patients in both groups were older than patients in the control group (66±10, 74±8, and 61±13 years, respectively). The ATX level was lower in group 1 (median [25; 75%]: 495 [406; 583] ng/ml) than in the control group (545 [412; 654] ng/ml) or group 2 (545 [476; 605] ng/ml) (p<0,05 for all). Lp (a) was lower in the control group (14,5 [5,5; 36,0] mg/dl) than in group 1 (24,9 [9,7; 58,4] mg/dl) (p<0,005) and group 2 (23,8 [9,9; 75,7] mg/dL) (p<0,05). According to the logistic regression, an increased ATX level, regardless of age and other risk factors, was associated with degenerative AoS only in patients with CAD, while age and neutrophil to lymphocyte ratio were associated with the development of degenerative AoS both in patients with CAD and the general group.Conclusion. An elevated Lp (a) level is associated with CAD regardless of the aortic valve involvement, while an increased concentration of ATX and neutrophil to lymphocyte ratio in patients with CAD were associated with degenerative AoS regardless of age and other risk factors.

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