Triglyceride to High-Density Lipoprotein Ratio can predict coronary artery calcification

Objectives: We assessed the TG/HDL-C ratio as a predictor for the presence of coronary artery calcifications (CACs). Methods: We collected demographic characteristics (age and gender), physical examination (height, weight, BMI, SBP, DBP), comorbidities, medication use, and laboratory variables Triglyceride to High-Density Lipoprotein (TG, HDL-C, TG/HDL-C, UA, TBG, 25-OH-VitD3); and we used coronary angiography to determine the presence of CACs. We performed univariate and multivariate analyses to evaluate the correlation between the TG/HDL-C ratio and CACs and established a predictive model. Results: CAC was present in 121 patients (25.80%). The levels of TG and TG/HDL-C ratio in the CAC group were higher than those in the non-CAC group, while the level of HDL-C in the CAC group was lower than that in the non-CAC group. The univariate analysis showed that the TG/HDL-C ratio was associated with CAC (OR, 0.021; 95% CI, 0.008 to 0.052; P<0.001), and the multivariate analysis indicated that the ratio was an independent risk factor for CAC (OR, 4.088; 95% CI, 2.787-5.996; P<0.001). Using the ratio to establish a prediction model, the area under the ROC curve was 0.814 (95% CI, 0.775-0.853; P<0.001), suggesting that the TG/HDL-C ratio has a high diagnostic efficiency. The diagnostic threshold was 1.037, and the corresponding sensitivity and specificity were 89.3% and 60.5%, respectively. Conclusion: The Triglyceride to High-Density Lipoprotein TG/HDL-C ratio is an independent risk factor for CAC with good diagnostic efficacy. Abbreviations: TG: Triglycerides, HDL-C: High-Density Lipoprotein, CAC: Coronary Artery Calcifications, BMI: Body Mass Index, SBP: Systolic Blood Pressure, DBP: Diastolic Blood Pressure, UA: Uric Acid, FBG: Fasting Blood Glucose, 25-OH-VitD3: 25-Hydroxyvitamin D3, ACEI: Angiotensin-Converting Enzyme Inhibitors, ARB: Angiotensin Receptor Blockers, CCB: Calcium Channel Blockers, ARNI: Angiotensin Receptor-Neprilysin Inhibitor, CAG: Coronary Angiography, AUCROC: Area Under the Receiver Operating Curve. doi: https://doi.org/10.12669/pjms.38.3.5290 How to cite this:Wang B, Hua J, Ma L. Triglyceride to High-Density Lipoprotein Ratio can predict coronary artery calcification. Pak J Med Sci. 2022;38(3):---------. doi: https://doi.org/10.12669/pjms.38.3.5290 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Trans-coronary Pacing via Rota Wire Prevents Bradycardia During Rotational Atherectomy: A Case Report

Back ground Rotational atherectomy (RA) is used for plaque modification in patients with heavily calcified coronary lesions. RA can induce significant bradycardia or atrioventricular block requiring for temporary pacemaker insertion. In this report, we present a case of trans-coronary pacing via a Rota wire to prevent bradycardia during RA in the proximal right coronary artery (RCA). Case summary A 72-year-old woman with a one month history of worsening effort angina was admitted to our hospital. Computed tomography coronary angiography disclosed significant coronary stenosis with severe calcification in proximal RCA. Coronary angiography revealed significant coronary stenosis with severe calcification in the proximal RCA. Subsequently, percutaneous coronary artery intervention was performed under the guidance of intravascular ultrasound(IVUS). The pull-back IVUS showed a circumferential calcified lesion in the proximal RCA, that was treated using RA, which induced significant bradycardia requiring temporary pacemaker insertion. Immediately, trans-coronary pacing was provided via a Rota wire placed in the far distal RCA; this was used for back-up pacing during RA. RA was completed by safely modifying the calcified lesion. After successful debulking of the calcified lesion, we dilated with a balloon, and a drug-eluting stent was implanted at the proximal RCA. Final IVUS and angiography showed good stent apposition and expansion. we did not observe any serious intraprocedural complications. Discussion RA is used for plaque modification in patients with heavily calcified coronary lesions. RA can induce significant bradycardia or atrioventricular block requiring for temporary pacemaker insertion via the transvenous route. This method could be an effective method to prevent bradycardia during RA.

PECAM1, COL4A2, PHACTR1, and LMOD1 Gene Polymorphisms in Patients with Unstable Angina

Coronary artery disease (CAD) is a syndrome resulting from myocardial ischaemia of heterogeneous pathomechanism. Environmental and genetic factors contribute to its development. Atherosclerotic plaques that significantly narrow the lumen of coronary arteries cause symptoms of myocardial ischaemia. Acute coronary incidents are most often associated with plaque rupture or erosion accompanied by local activation of the coagulation system with thrombus formation. Plaque formation and stability are influenced by endothelial function and vascular smooth muscle cell function. In this study, we investigated the association between polymorphisms in genes affecting endothelial and vascular smooth muscle cell (VSMC) function and the occurrence of unstable angina pectoris. The aim of this study was to evaluate the association between the PECAM1 (rs1867624), COL4A2 (rs4773144), PHACTR1 (rs9349379) and LMOD1 (rs2820315) gene polymorphisms and the risk of unstable angina. The study included 232 patients with unstable angina diagnosed on the basis of clinical symptoms and coronary angiography and 144 healthy subjects with no significant coronary lumen stenosis at coronary angiography. There were no statistically significant differences in the distribution of COL4A2 rs4773144 and PECAM1 rs1867624 gene polymorphisms between patients with unstable angina and control subjects. In patients with unstable angina, there was an increased frequency of PHACTR1 rs9349379 G allele carriers (GG and AG genotypes) (GG+AG vs. AA, OR 1.71; 95% CI 1.10–2.66, p = 0.017) and carriers of the LMOD1 rs2820315 T allele (TT and CT genotypes) (TT+CT vs. CC, OR 1.65; 95% CI 1.09–2.51, p = 0.019) compared to the control group. The association between these alleles and unstable angina was confirmed by multivariate logistic regression analysis, in which the number of G (PHACTR1 rs9349379) and T (LMOD1 rs2820315) alleles was an independent risk factor for unstable angina. The results suggest an association between PHACTR1 rs9349379 and LMOD1 rs2820315 polymorphisms and the risk of unstable angina.

Electrocardiography Predictive Value on Coronary Slow Flow Phenomenon

Coronary Slow Flow Phenomenon (CSFP) is characterized by the slow flow of contrast in one or more epicardial coronary vessels without evidence of coronary artery stenosis during coronary angiography procedures. CSFP is fairly common at the time of elective angiography with an incidence of around 7% and accounts for about 4% of hospitalized unstable angina cases. Coronary angiography is currently still the only effective way to detect CSFP, but this procedure is an invasive procedure with high costs, there is a risk of allergy to contrast. Electrocardiography (ECG), as a widely available, inexpensive, and simple modality is felt to be an attractive alternative in early detection of this abnormality. The ECG parameters on CSFP discussed in this study include; p-wave dispersion, QT interval dispersion, QRS intrinsic (Tpeak-Tenddeflection duration), and QRS fragmentation. Further studies are needed on the ECG image in CSFP so that in the future ECG can be a cheaper and non-invasive diagnostic modality for CSFP compared to coronary angiography.

Evaluation of Diagnostic Performance of MDCT Coronary Angiography in Comparison with Conventional Coronary Angiography

Background: Coronary artery disease is now becoming increasingly prevalent than before especially in younger age groups. We in the current study tried to evaluate the potential of 128 slice MDCT coronary angiography for the detection of stenotic coronary lesions by comparing the results of computed tomographic coronary angiography to a gold standard set by Conventional coronary angiography. Methods: A total of n=30 patients with clinically suspected Coronary artery disease. They were evaluated with 128 Slice CT Scanner (PHILIPS INGENUITY) and conventional coronary angiography. All patients were examined with a 128 slice MDCT scanner (Philips Ingenuity 128 slice Netherlands) using standard cardiac CT protocol. Gantry rotation time was 400 ms with a half sector acquisition protocol and multisector reconstruction permitting an effective temporal resolution between 50 and 200 ms depending on patient heart rate. Results: In the n=30 Patients included in the study with CCA, the n=450 coronary segments included in the study were found to contain a total number of n=138 stenoses among them non-significant stenoses. The accuracy of MDCT detection of coronary stenoses greater than 50% diameter of vessel lumen is about 94.78. When raising the threshold for stenosis from 50% to 70% of the vessel lumen, so that only hemodynamic relevant stenoses enter the evaluation, the sensitivity decreases from 88%. The MDCT detection in the patient group with heart rates below 60 beats per minute higher values for sensitivity 93% and specificity 97% were observed, compared to sensitivity 87% and specificity 93% of the patient group with heart rates above 60 beats per minute. Conclusion:The present study revealed that a high negative predictive value (98.08%)suggests that 128- Slice MDCT coronary angiography is a good screening modality for evaluation of patients with mild to intermediate-risk factors who might otherwise require invasive angiography.

Study on the characteristics of coronary calcification by Intravascular Ultrasound (IVUS)

Background: Percutaneous coronary angiography is considered the "gold standard" for the diagnosis of coronary artery disease and provides the necessary anatomical information to provide appropriate treatment. The limitation of coronary angiography is the accurate assessment of calcified coronary lesions. Intravascular ultrasonography has many advantages in the assessment of calcified coronary lesions. Methods: The descriptive clinical study. Evaluation of calcified coronary artery lesions by intravascular ultrasound Results: From January 2019 to December 2019, at the Hanoi Heart Institute, 64 patients had 64 coronary artery lesions surveyed by intravascular ultrasound. There were 42 (65,6%) calcified lesions assessed by IVUS and 25 (39,1%) calcified lesions were detected by coronary angiography. In addition, the location of calcified were revealed more in the LAD compared to other: LAD 60%, LCx 24%, RCA 12% and LM 4%. Conclusion: IVUS calcification detection rate is higher than coronary angiography. The most common site of calcification in the LAD.

Standardized Forearm Angiography Increases Procedural Success Rates of Coronary Angiography and PCI: A Retrospective Analysis of an All-Comers Patient Cohort

Background: There is a consensus, that transradial-access (TRA) for coronary procedures should be preferred over transfemoral-access (TFA). Previously, forearm-artery-angiography was mainly performed when difficulties during the advancement of the guidewire were encountered. We explored the implication of a standardized forearm-angiography (SFA) on procedural success rates of TRA.Methods: 1191 consecutive cases were assessed retrospectively. Primary TFA rates, crossover to TFA, reasons for forearm-artery-access (FAA) failure, the prevalence of kinking at the level of the forearm and the occurrence of vascular complications were analyzed.Results: Primary FAA access was attempted in 97.9%. Crossover to TFA after a primary or secondary FAA attempt was necessary in 2.8%. Severe kinking was the most frequent cause of FAA failure and occurred in 3.0%. A second or third FAA attempt to avoid TFA was successful in 81%. Severe kinking at the level of the forearm was reported in 1.8%.Conclusion:This is the first study to provide detailed success rates of a primary FAA strategy combined with SFA. While severe kinking proved to be a rare but relevant challenge for FAA success, the prevalence of arterial spasm was marginal. Multiple attempts of FAA to avoid TFA might be safe possibly due to collateral blood supply.