Application of the Truncated Zero-Inflated Double Poisson for Determining of the Effecting Factors on the Number of Coronary Artery Stenosis

Background. Risk factors of coronary heart disease have been discussed in the literature; however, conventional statistical models are not appropriate when the outcome of interest is number of vessels with obstructive coronary artery disease. In this paper, a novel statistical model is discussed to investigate the risk factors of number of vessels with obstructive coronary artery disease. Methods. This cross-sectional study was conducted on 633 elderly cardiovascular patients at Ghaem Hospital, Mashhad, Iran from September 2011 to May 2013. Clinical outcome is number of vessels with obstructive coronary artery disease (=0, 1, 2, 3), and predictor variables are baseline demographics and clinical features. A right-truncated zero-inflated double Poisson regression model is performed which can accommodate both underdispersion and excess zeros in the outcome. The goodness-of-fit of the proposed model is compared with conventional regression models. Results. Out of 633 cardiovascular patients, 327 were male (51.7%). Mean age was ~ 65 ± 7 years (for individuals with zero, one ,and two coronary artery stenosis) and ~ 66 ± 7 years (for individuals with three coronary artery stenosis). BMI ( 0.04 ± 0.01 , p = 0.011 ) and female gender ( 0.19 ± 0.09 , p = 0.032 ) were significant associated with the count part of the model, and only BMI ( − 0.47 ± 0.2 , p = 0.011 ) was significantly predictive of logit part of the model. The goodness-of-fit measurements indicate that the proposed model outperforms the conventional regression models. Conclusion. The proposal regression model shows a better fit compared to the standard regression analysis in modeling number of vessels with obstructive coronary artery disease. Hence, using truncated zero-inflated double Poisson regression model—as an alternative model—is advised to study the risk factors of number of involved vessels of coronary artery stenosis.

Role of Coronary Calcium Score as a Screening Tool for Excluding Significant Coronary Artery Disease in High Risk Asymptomatic Patients

OBJECTIVES: To determine correlation of zero coronary artery calcium score (CACS) with non-significant coronary artery stenosis by using computed tomography coronary angiography (CTCA). METHODOLOGY: 62 patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA from April 2018 to November 2020. Patients were examined with 160 slice multidetector CT and grouped according to their age, gender, CACS, and maximum coronary luminal stenosis. CACS was assessed using Agatston scoring and degree of stenosis was assessed by automatic software and severity was scored according to CAD-RADS. The correlation between these two main variables was calculated using Spearman rank correlation. RESULTS: The 62 patients were divided into four groups according to CACS, using the Agatston Unit (AU). Group 1; 0 AU (41 patients, 66.13%), Group 2; 1-100 AU (13 patients, 20.97%) Group 3; 101-400 AU (4 patients, 6.45%), Group 4; 401-1000 AU (4 patients, 6.45%). In 41 patients with zero calcium score (32 males and 9 females), 38 patients (92.68%) were found to have no coronary artery stenosis, 2 patients (4.87%) had mild coronary artery stenosis and 1 patient (2.43%) had moderate coronary artery stenosis. Total 35 patients presented for screening purpose out of which 25 (71%) had zero calcium score and no significant coronary artery disease. CONCLUSION: In high risk patients, zero calcium score excludes significant coronary artery stenosis (50%), hence coronary calcium score is a good screening tool before subjecting patients to coronary angiography.

Oxidative Stress and Inflammation Are Associated with Coexistent Severe Multivessel Coronary Artery Stenosis and Right Carotid Artery Severe Stenosis in Elderly Patients

Oxidative stress and inflammatory response are the main pathogenic pathways in atherosclerosis stenosis. This study is aimed at evaluating the roles of oxidative stress and inflammatory response in coexistent right carotid artery severe stenosis and severe multivessel coronary artery stenosis in elderly patients. Circulating levels of total oxidant status (TOS), lipid hydroperoxide (LHP), 8-isoprostane (8-IP), malondialdehyde (MDA), monocyte chemotactic protein-4 (MCP-4), amyloid A (AA), high-sensitivity C-reactive protein (hs-CRP), and tumor necrosis factor-α (TNF-α) were measured by standardised laboratory test methods. Markers of oxidative stress and inflammatory response: levels of TOS, LHP, 8-IP, MDA, MCP-4, AA, hs-CRP, and TNF-α, were increased ( P < 0.001 ) in elderly patient. These results suggested that oxidative stress and inflammatory response may be involved in carotid artery severe stenosis and severe multivessel coronary artery stenosis and measuring oxidative stress and inflammation biomarkers may also be a promising step in the development of an effective method for monitoring the severity of right carotid artery stenosis and multivessel coronary artery stenosis in elderly patients.

Clinicopathologic Appearance of Advanced Ketoacidosis With Basal Vacuolation in Renal Tubules

Context.— Basal vacuolization (BV) in renal tubules is a histopathologic hallmark of advanced ketoacidosis that enables us to retrospectively diagnose these cases. Objective.— To clarify the pathologic background and serologic findings of ketoacidosis with BV, and to reveal the pathologic findings by each pathologic background. Design.— We examined 664 serial autopsy cases. A systemic histopathologic examination and measurement of serum β-hydroxybutyrate concentration were performed for the cases with BV. The extent of steatosis and fibrosis in the organs and the degree of coronary artery stenosis were semiquantitatively investigated. Immunohistochemistry for adipophilin was also performed to analyze its usefulness for the pathologic diagnosis. Results.— Basal vacuolization was found in 16 cases, all of which showed a pathologic serum β-hydroxybutyrate concentration. The main background of ketoacidosis was considered as alcohol abuse in 6 cases, diabetes in 5, malnutrition in 3, and hypothermia and infection in 1 case each. Severe hepatic fibrosis was observed only in the alcohol-abuser group. Moreover, cardiac steatosis was more severe in patients with possible alcohol abuse than in those with other causes. Immunohistochemistry for adipophilin showed immunoreactivity consistent with BV in 13 of 16 cases. There was no correlation between β-hydroxybutyrate concentration and either the postmortem or storage interval. Conclusions.— Basal vacuolization may be a useful finding for detecting ketoacidosis cases in a postmortem investigation. Serum β-hydroxybutyrate was a stable and reliable compound for the definitive diagnosis of ketoacidosis in such cases. The present study showed that pathologic changes in some organs may vary by each pathologic background of ketoacidosis with BV.

Apolipoprotein B/A1 Ratio Is Associated with Severity of Coronary Artery Stenosis in CAD Patients but Not in Non-CAD Patients Undergoing Percutaneous Coronary Intervention

Background and Aims. Lipid metabolism plays important roles in atherosclerosis. Several studies have found that lipoprotein is associated with coronary artery disease (CAD) and hyperlipidemia. Although the roles of the apolipoprotein B/A1 ratio (ApoB/A1) were originally thought to be atherosclerotic, few studies have focused on the specific relationship between ApoB/A1 and severity of coronary artery stenosis with or without the presence of CAD. Methods. A total of 6956 consecutive patients aged 21–98 years with suspected CAD who had undergone coronary angiography were enrolled. The severity of coronary lesions was evaluated using the Gensini score (GS). The relationships between ApoB/A1 and severity of coronary artery stenosis were evaluated. Results. A total of 1795 non-CAD patients and 5161 CAD patients were included in the observational analysis. Patients with CAD had higher ApoB/A1 than individuals without CAD (0.67 (0.53-0.82) vs. 0.61 (0.49-0.75), p < 0.001 ). In CAD patients, the higher the ApoB/A1 was, the higher the proportion of patients with MI, triple-vessel lesions, and higher Gensini scores. ApoB/A1 was significantly positively correlated with HbA1c and Gensini scores in CAD patients but not in non-CAD patients (all p < 0.001 ). Logistic analyses showed that ApoB/A1 could be a risk factor for multivessel disease (OR: 2.768, 95% CI: 1.868-4.103, p < 0.001 ). ApoB/A1 was found to be significantly positively correlated with the Gensini score in CAD patients. Conclusions. ApoB/A1 is highly associated with the presence and severity of coronary artery stenosis in patients with CAD but not in non-CAD patients.

Non-mercaptalbumin is Significantly Associated with the Coronary Plaque Burden and the Severity of Coronary Artery Disease

Human non-mercaptalbumin (HNA), oxidized form of serum albumin, has been reported as a useful marker in oxidative stress-related diseases; however, few reports have examined the association between HNA and the severity of coronary artery disease (CAD). The present study evaluated whether the HNA fraction is correlated with coronary artery stenosis in 140 patients considered to have a high risk of CAD or who were suspected of having acute coronary syndrome. The severity of CAD was defined by the number of stenotic coronary vessels and a severity score system (the Gensini score). HNA measurements were performed using our newly established high-performance liquid chromatography methodology. The results had shown that HNA was significantly increased in patients with three-vessel disease, compared with those without CAD or with single-vessel disease (p=0.025), and was positively correlated with the Gensini score (ρ=0.421, p<0.001). A multivariate analysis showed that the number of stenotic vessels was an independent and significant factor associated with HNA (ρ=1.246, p=0.012). A logistic regression analysis showed that HNA was a strong predictor of multivessel CAD (odds ratio, 1.12; 95% confidence interval, 1.020-1.229; p=0.017). These findings indicate that the measurement of HNA could be clinically practical for predicting the severity of coronary artery stenosis.