Mild Luminal Stenosis of Parent Artery and Neurologic Deterioration After Acute Lacunar Stroke

BACKGROUND Early neurologic deterioration (END) occurs in a quarter of acute lacunar infarcts, but the underlying pathophysiological features are poorly understood. We sought to determine the association between luminal stenosis (<50%) of the parent artery and END. METHODS This observational study included consecutive patients with lacunar stroke from the ischemic stroke registries of New York University Langone Health and Brown University. All included patients were admitted for acute lacunar stroke, which was defined as a subcortical infarct <1.5 cm on computed tomography or <2 cm on diffusion‐weighted imaging without significant stenosis (>50%) in the parent vessel and no cardioembolic source. We defined END as any neurologic deterioration referable to the acute lacunar stroke and not related to a medical or noncerebrovascular neurological complication. We used univariate and logistic regression analyses to determine associations between luminal stenosis (<50%) and the odds of END. Furthermore, we attempted to validate findings using the Columbia University Medical Center stroke registry and perform a meta‐analysis combining the derivation and validation groups because of the expected small samples and event rates. RESULTS The New York University Langone Health and Brown University sample included 205 patients, of whom 41 (20%) had END. In adjusted models, we found no definite association between luminal stenosis (<50%) and END (adjusted odds ratio [OR], 1.74; 95% CI, 0.73–4.14). From Columbia University Medical Center, 361 total patients were included, of whom 59 (16%) had END. In adjusted models, we found an association between luminal stenosis (<50%) and END (adjusted OR, 2.28; 95% CI, 1.15–4.50). Meta‐analysis of both cohorts found luminal stenosis (<50%) associated with END (relative risk, 1.69; 95% CI, 1.17–2.43). CONCLUSIONS In this multicenter study, luminal stenosis (<50%) may be associated with END following an acute lacunar infarct. Larger studies using vessel wall imaging are needed to validate our findings.

Automatic Evaluation of Histological Prognostic Factors Using Two Consecutive Convolutional Neural Networks on Kidney Samples

Background and Objectives: The prognosis of patients undergoing kidney tumor resection or kidney donation is linked to many histological criteria. These criteria notably include glomerular density, glomerular volume, vascular luminal stenosis, and severity of interstitial fibrosis/tubular atrophy. Automated measurements through a Deep Learning approach could save time and provide more precise data. This work aimed to develop a free tool to automatically obtain kidney histological prognostic features. Design, setting, participants, and measurements: Two hundred and forty one samples of healthy kidney tissue were split into 3 independent cohorts. The "Training" cohort (n=65) was used to train two Convolutional Neural Networks: one to detect the cortex and a second one to segment the kidney structures. The "Test" cohort (n=50) assessed their performances by comparing manually outlined regions of interest to predicted ones. The "Application" cohort (n=126) compared prognostic histological data obtained manually or through the algorithm based on the combination of the two Convolutional Neural Networks. Results: In the Test cohort, the networks isolated the cortex and segmented the elements of interest with good performances (more than 90% of the cortex, healthy tubules, glomeruli, and even globally sclerotic glomeruli were detected). In the Application cohort, the expected and predicted prognostic data were significantly correlated. The correlation coefficients r were respectively 0.85 for glomerular volume, 0.51 for glomerular density, 0.75 for interstitial fibrosis, 0.71 for tubular atrophy, and 0.73 for vascular intimal thickness. The algorithm had a good ability to predict significant (> 25%) tubular atrophy and interstitial fibrosis level (ROC curve with an area under the curve 0.92 and 0.91, respectively) or a significant vascular luminal stenosis (> 50%) (area under the curve 0.85). Conclusion: This freely available tool enables the automated segmentation of kidney tissue to obtain prognostic histological data in a fast, objective, reliable and reproducible way.

A STUDY OF HYPERURICACIDEMIA AND THE PRESENCE AND SEVERITY OF ACUTE CORONARY SYNDROME IN INDEX MEDICAL COLLEGE, HOSPITAL AND RESEARCH CENTER, INDORE ( M.P.)

Background: Few studies have assessed the relation of hyperuricacidemia with the acute coronary syndrome (ACS). This study investigated the association between high uric acid levels with the presence and severity of ACS. Methods: Three hundred and seventy patients having angiographic evidence of atherosclerosis (CAD + case group) compared to 170 patients with no luminal stenosis (n=110) or with <50% luminal stenosis (n=60) at coronary angiography (CAD – control group). Results: The mean age of the patients was 60 ± 10 years (317 men, 58.7%). Hyperuricacidemia was more likely associated with a trend toward higher vessel scores, indicating a more severe CAD (adjusted OR=1.51, 95% CI=1.09-2.09; P=0.005) in the whole population. A comparison of sex-specific values showed a significant association existed only in men. Conclusions: Asymptomatic hyperuricacidemia may be associated with the presence and severity of ACS. Keywords: Hyperuricacidemia, Severity & Acute Coronary Syndrome.

ASSOCIATION OF HYPERURICEMIA WITH THE PRESENCE AND SEVERITY OF CORONARY ARTERY DISEASE IN PATIENTS UNDERGOING CORONARY ANGIOGRAPHY

Objectives: To determine the association of hyperuricemia with the presence and severity of coronary artery disease in patients undergoing coronary angiography. Methodology: This case control study was carried out in the Department of Cardiology, Chaudhary Pervaiz Elahi Institute of Cardiology, Multan for six months. Total number of 292 patients (146 cases with coronary artery disease and 146 controls with normal coronary arteries) having age 40-60 years of both genders were included in this study. Coronary angiography was performed using standard angiographic techniques. After undergoing coronary angiography, patients with 50% luminal stenosis or more in any one of the coronary arteries were labeled case group. Patients with normal coronaries or less than 50% luminal stenosis in any one of the coronary vessels were taken as control group. Serum uric acid was advised and value was noted along with the basic demographic data and established risk factors of coronary artery disease. Results: Mean age was 50.79±6.08 years. Mean serum uric acid was 7.54±3.60 mg/dl. Hyperuricemia was diagnosed in 94 (64.40%) patients with significant CAD (case group) and in only 59 (40.40%) in control group. The odds ratio was 2.66 (95% CI 1.66 to 7.28) with p-value of <0.001. Triple vessel disease was diagnosed in 66.7% patients with hyperuricemia and in only 33.3% patients without hyperuricemia [OR 4.0 (2.09-7.64), p-value <0.001]. Conclusion: There is a significant association between the presence and severity of coronary artery disease with hyperuricemia.

Coronary artery disease in East and South Asians: differences observed on cardiac CT

Epidemiological studies have observed East Asians (EAs) are significantly less likely to develop or die from coronary artery disease (CAD) compared with Caucasians. Conversely South Asians (SAs) develop CAD at higher rate and earlier age. Recently, a range of features derived from cardiac CT have been identified which may further characterise ethnic differences in CAD. Emerging data suggest EAs exhibit less coronary calcification and high-risk, non-calcified plaque compared with Caucasians on CT, with no difference in luminal stenosis. In contrast, SAs exhibit similar to higher coronary calcification and luminal stenosis, smaller luminal dimensions and more high-risk, non-calcified plaque than Caucasians. Beyond demonstrating ethnic differences in CAD, cardiac CT may enhance and individualise cardiovascular risk stratification in EAs and SAs. While data thus far in EAs have demonstrated calcium score and CT-derived luminal stenosis may incrementally predict cardiovascular risk beyond traditional risk scores, there remains a paucity of data assessing its use in SAs. Future studies may clarify the prognostic value of cardiac CT in SAs and investigate how this modality may guide preventative therapy and coronary intervention of CAD in EAs and SAs.

Relationship between neutrophils to HDL-C ratio and severity of coronary stenosis

Background Lipid and inflammatory molecules play a key role in the development of inflammation. Neutrophil counts are used as markers of inflammation duration, and HDL-C is used as an anti-atherosclerosis component. However, few studies have been found to integrate these two indicators to explore coronary stenosis. We suggested that neutrophil count as a marker of inflammation persistence and HDL-C as an anti-atherosclerotic component should be integrated into a single biomarker NHR to explore its correlation with CAD degree and predict the severity of coronary stenosis among CAD patients. Methods We examined 404 eligible patients who underwent coronary angiography. Based on the results of coronary angiography, patients in CAD+ group (n = 155) were defined as those having angiographic coronary stenosis of at least 50% lumen reduction in at least one major coronary artery (including left anterior descending artery, left circumflex artery, left main coronary artery, right coronary artery). Patients with luminal stenosis but no more than 50% were defined as CAD− group (n = 49), and patients without luminal stenosis (n = 200) were regarded as control group. The relationship between various serum markers and the severity of coronary stenosis was examined by Spearman correlation analysis. Logistic regression analysis was performed to identify the influencing factors of the severity of coronary artery disease. Results The modified Gensini score was positively correlated with neutrophil HDL-C ratio and negatively correlated with albumin and HDL-C. Multiple regression analysis showed that neutrophil HDL-C ratio were significantly associated with CAD. Neutrophil HDL-C ratio is an independent predictor of CAD. The ROC analysis provided a cut-off value of 1.51 for neutrophil HDL-C ratio to predict CAD with 94.8% sensitivity and 0.024 Yoden index, and area under the ROC curve of 0.617 (95% CI 0.560–0.675, P < 0.001). Conclusion Neutrophil HDL-C ratio is not only closely related to coronary artery stenosis, but also an independent predictor of severe coronary stenosis.

Smoking, ulcerated coronary plaques, and smoker’s paradox: A new hypothesis

Smoking accelerates the onset of acute coronary disease. Smoker’s paradox is the term applied to the observations that the short-term prognosis following an acute myocardial infarction is better in the smoker than in the nonsmoker. Efforts to explain these surprising observations have not been successful. The approach used in this study was to compare the pathologic findings in the coronary arteries following a complete histologic examination of the major branches of the epicardial coronary tree in smokers and nonsmokers. I found many ulcerated plaques in both smokers and nonsmokers, often without associated luminal stenosis or luminal thrombosis. These ulcerated plaques were discovered only on histologic examination and were consistently associated with dense foci of adventitial inflammatory cells. Based on these findings, the following hypothesis is proposed: Smoking injures the coronary artery endothelium, causing erosions, ulcerations, and a chronic inflammatory response in the arterial adventitia. These ulcerated plaques persist as chronically active, open ulcerations, constantly exposed to flowing blood, leading to increasing luminal stenosis as long as smoking continues. These ulcerated plaques eventually form the substrate for occlusive thrombosis and acute coronary events and are components of active, progressive, inflammatory, atherosclerotic disease. Premature acute coronary disease in the young smoker is due to accelerated plaque ulceration, luminal stenosis, and occlusive thrombosis. Smoker’s paradox can be explained by rapid resolution and healing of these potentially unstable ulcerated plaques when the patient is required to stop smoking during hospitalization for the acute myocardial infarction event.

Cardiomyopathy Associated With Coronary Arteriosclerosis in Free-Ranging Eurasian Lynx (Lynx lynx carpathicus)

The Eurasian lynx (subspecies Lynx lynx carpathicus) was reintroduced to Switzerland in the 1970's. Health monitoring of the reintroduced population started in the late 1980's. Since then, six lynx have been found affected by a myocardial disease. The earliest case was an animal that died after a field anesthesia. Two lynx were found dead, two were euthanized/culled because of disease signs, and one was hit by car. Two had a heart murmur at clinical examination. At necropsy, the first animal showed only lung edema but the other five had cardiomegaly associated with myocardial fibrosis. Three had multisystemic effusions. Histological examination of all six lynx showed mild to severe, multifocal, myocardial interstitial and perivascular fibrosis along with multifocal myocyte degeneration and loss, and replacement fibrosis. Moderate to severe multifocal arteriosclerosis with associated luminal stenosis of the small and medium-sized intramural coronary arteries and the presence of Anitschkow cells was also observed. The heart lesions may have led to sudden death in the first case and to a chronic right-sided heart failure in the remaining. None of the lynx showed lesions or signs suggestive of an acute or subacute infection. Given the common geographic origin of these animals and the severe loss of heterozygocity in this population, a genetic origin of the disease is hypothesized.

Hypersensitive C-reactive Protein to HDL-C Ratio Predicts the Severity of Coronary Artery Disease

Background: Lipid and inflammatory molecules play a key role in the development of coronary atherosclerosis. Hypersensitive C-reactive proteins are used as markers of inflammation duration, and HDL-C is used as an anti-atherosclerosis component. However, few studies have combined the two indicators to explore coronary stenosis. We suggested that Hypersensitive C-reactive proteins as a marker of inflammation persistence and HDL-C as an anti-atherosclerosis component should be integrated into a single biomarker , so as to explore the correlation of Hypersensitive C-reactive protein HDL-C ratio with the severity of coronary stenosis and to predict the severity of coronary stenosis in CAD patients.Methods: We examined 360 eligible patients who underwent coronary angiography. Based on the results of coronary angiography, patients with any major coronary arteries (the left anterior descending artery, the left circumflex artery, the left main coronary artery, the right coronary artery) whose lumen diameter reduced by more than 50% were defined as CAD + group (n = 139) .Patients with luminal stenosis but no more than 50% were defined as CAD- group (n = 41), and patients without luminal stenosis (n = 180) were regarded as control group. The relationship between various serum markers and the severity of coronary stenosis was examined by Spearman correlation analysis. Logistic regression analysis was performed to identify the influencing factors of the severity of coronary artery disease.Results: The modified Gensini score was positively correlated with Hypersensitive C-reactive protein HDL-C ratio . Multiple regression analysis showed that Hypersensitive C-reactive protein HDL-C ratio were significantly associated with CAD. Hypersensitive C-reactive protein HDL-C ratio is an independent predictor of CAD. The ROC analysis provided a cut-off value of 1.17 for Hypersensitive C-reactive protein HDL-C ratio to predict CAD with 83.9% specificity and 0.242 Yoden index, and area under the ROC curve of 0.632 (95%CI 0.571-0.694, P <0.001).At the same time, the area under the ROC curve of Neutrophil HDL-C ratio was 0.620, indicating that Hypersensitive C-reactive protein HDL-C ratio as a predictor of CAD has better diagnostic performance than Neutrophil HDL-C ratio.Conclusion: Hypersensitive C-reactive protein HDL-C ratio is not only closely related to coronary artery stenosis, but also an independent predictor of severe coronary stenosis.

Studying the Factors of Human Carotid Atherosclerotic Plaque Rupture, by Calculating Stress/Strain in the Plaque, Based on CEUS Images: A Numerical Study

Carotid plaque neovascularization is one of the major factors for the classification of vulnerable plaque, but the axial force effects of the pulsatile blood flow on the plaque with neovessel and intraplaque hemorrhage was unclear. Together with the severity of stenosis, the fibrous cap thickness, large lipid core, and the neovascularization followed by intraplaque hemorrhage (IPH) have been regarded as high-risk features of plaque rupture. In this work, the effects of these factors were evaluated on the progression and rupture of the carotid atherosclerotic plaques. Five geometries of carotid artery plaque were developed based on contrast-enhanced ultrasound (CEUS) images, which contain two types of neovessel and IPH, and geometry without neovessel and IPH. A one-way fluid-structure interaction model was applied to compute the maximum principal stress and strain in the plaque. For that hyper-elastic and non-linear material, Yeoh 3rd Order strain energy density function was used for components of the plaque. The simulation results indicated that the maximum principal stress of plaque in the carotid artery was higher when the degree of the luminal stenosis increased and the thickness of the fibrous cap decreased. The neovessels within the plaque could introduce a 2.5% increments of deformation in the plaque under the pulsatile blood flow pressure. The IPH also contributed to the increased risk of plaque rupture that a gain of stress was 8.983, 14.526, and 34.47 kPa for the plaque with 50, 65, and 75%, respectively, when comparing stress in the plaque with IPH distributed at the middle to the shoulder of the plaque. In conclusion, neovascularization in the plaque could reduce the stability of the plaque by increasing the stress within the plaque. Also, the risk of plaque rupture increased when large luminal stenosis, thin fibrous cap, and IPH were observed.