Three-dimensional speckle tracking echocardiography in evaluating left ventricular function in patients with triple vessel coronary artery disease without myocardial infarction

Purpose Using three-dimensional speckle tracking echocardiography (3D-STE) to evaluate left ventricular (LV) function in patients with triple vessel coronary artery disease(TVD) without myocardial infarction. Methods Sixty patients with TVD without myocardial infarction were divided into two groups according to the results of coronary angiography. Group B (n=31)：50%≤the stenosis rates of all triple vessel coronary artery＜75%; Group C (n=29)：the stenosis rates of all triple vessel coronary artery≥75%. Thirty healthy subjects were recruited as the group A. We measured LV end-diastolic and end-systolic volume (LVEDV, LVESV) and LV ejection fraction (LVEF) using real-time three-dimensional echocardiography. The 3D-STE parameters of LV included global longitudinal strain (GLS), global area strain (GAS), global radial strain (GRS) and global circumferential strain (GCS). Results In group C, LVEDV and LVESV were significantly increased (all P＜0.05), while LVEF, GLS, GRS, GCS and GAS were significantly decreased compared with groups A and B (all P＜0.05). In groups A and B, there were no statistical differences in LVEDV, LVESV and LVEF. However, GLS, GCS and GAS were lower in group B than in group A (all P＜0.05). Conclusion Our study shows that 3D-STE can evaluate the LV function in patients with triple vessel coronary artery disease without myocardial infarction through multiple strain parameters.

Endovascular recanalization of chronic infrarenal aortic occlusion in a patient with two-vessel coronary artery disease: a case report

A case report on endovascular treatment of occlusion of the infrarenal aorta and iliac arteries in a patient with hemodynamically significant two-vessel coronary artery disease is presented. After a thorough examination and assessment of surgical risks, a multidisciplinary team meeting chose a staged revascularization strategy: stage 1 — percutaneous coronary intervention in the left anterior descending artery and right coronary artery; stage 2 — endovascular recanalization of aorto-iliac segment occlusion using the kissing stents technique. There were no perioperative complications and the patient was discharged on the 4th day after surgery in a satisfactory condition. The choice in favor of these types of reconstruction and staged revascularization strategy was substantiated. A conclusion was made about the effectiveness and safety of implemented measures.

Insulin resistance genetic risk score and burden of coronary artery disease in patients referred for coronary angiography

Aims Insulin resistance associates with development of metabolic syndrome and risk of cardiovascular disease. The link between insulin resistance and cardiovascular disease is complex and multifactorial. Confirming the genetic link between insulin resistance, type 2 diabetes, and coronary artery disease, as well as the extent of coronary artery disease, is important and may provide better risk stratification for patients at risk. We investigated whether a genetic risk score of 53 single nucleotide polymorphisms known to be associated with insulin resistance phenotypes was associated with diabetes and burden of coronary artery disease. Methods and results We genotyped patients with a coronary angiography performed in the capital region of Denmark from 2010–2014 and constructed a genetic risk score of the 53 single nucleotide polymorphisms. Logistic regression using quartiles of the genetic risk score was performed to determine associations with diabetes and coronary artery disease. Associations with the extent of coronary artery disease, defined as one-, two- or three-vessel coronary artery disease, was determined by multinomial logistic regression. We identified 4,963 patients, of which 17% had diabetes and 55% had significant coronary artery disease. Of the latter, 27%, 14% and 14% had one, two or three-vessel coronary artery disease, respectively. No significant increased risk of diabetes was identified comparing the highest genetic risk score quartile with the lowest. An increased risk of coronary artery disease was found for patients with the highest genetic risk score quartile in both unadjusted and adjusted analyses, OR 1.21 (95% CI: 1.03, 1.42, p = 0.02) and 1.25 (95% CI 1.06, 1.48, p<0.01), respectively. In the adjusted multinomial logistic regression, patients in the highest genetic risk score quartile were more likely to develop three-vessel coronary artery disease compared with patients in the lowest genetic risk score quartile, OR 1.41 (95% CI: 1.10, 1.82, p<0.01). Conclusions Among patients referred for coronary angiography, only a strong genetic predisposition to insulin resistance was associated with risk of coronary artery disease and with a greater disease burden.