Relationship Between Immunoinflammation and Coronary Physiology Evaluated by Quantitative Flow Ratio in Patients With Coronary Artery Disease

Background: The association between coronary physiology and immunoinflammation has not been investigated. We performed a retrospective study using quantitative flow ratio (QFR) to evaluate the interaction between immunoinflammatory biomarkers and coronary physiology.Methods: A total of 172 patients with CAD who underwent coronary arteriography (CAG) and QFR were continuously enrolled from May 2020 to February 2021. As a quantitative indicator of coronary physiology, QFR can reflect the functional severity of coronary artery stenosis. The target vessel measured by QFR was defined as that with the most severe lesions. Significant coronary anatomical stenosis was defined as 70% stenosis in the target vessel.Results: Compared with the QFR > 0.8 group, interleukin (IL)-6, IL-10, tumor necrosis factor (TNF)-α, and interferon (IFN)-γ were increased and CD3+ and CD4+ T lymphocyte counts were decreased in the QFR ≤ 0.8 group. In addition, patients with DS ≤ 70% had higher IL-6, IL-10, and TNF-α levels and decreased CD3+ and CD4+ T lymphocyte counts than those with DS > 70%. Logistic regression analysis indicated IL-6 to be an independent predictor of significant coronary functional and anatomic stenosis (odds ratio, 1.125; 95% CI, 1.059–1.196; P < 0.001). Receiver operating characteristic (ROC) analyses showed that IL-6 > 6.36 was predictive of QFR ≤ 0.8 of the target vessel. The combination of IL-6, IL-10 and CD4 improved the value for predicting QFR ≤ 0.8 of the target vessel (AUC, 0.737; 95% CI, 0.661–0.810).Conclusion: Among immunoinflammatory biomarkers, IL-6 was independently associated with a higher risk of QFR ≤ 0.8 of the target vessel. The combination of immunoinflammatory biomarkers was highly predictive of significant coronary functional and anatomic stenosis.

Preoperative Fasting Blood Glucose Levels and the Risk of Contrast-induced Nephropathy in Patients With Diabetes and Pre-diabetes Receiving Coronary Arteriography or Percutaneous Coronary Intervention: a Cross-sectional Study

Background: Diabetes mellitus is an independent risk factor for contrast-induced nephropathy in patients undergoing coronary arteriography /percutaneous coronary intervention. In this study, we evaluated whether preoperative fasting blood glucose levels in diabetic and prediabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN.Methods: We reviewed the incidence of preoperative FBG and postoperative CIN in 3437 patients with CAG/PCI from January 1, 2019, to May 28, 2021 in Tianjin Chest Hospital. Patients were divided into 5 groups based on their preoperative FBG levels. Blood samples were collected at admission and at 48 h and 72 h after operation to determine the serum creatinine levels of patients. P for trend was used to analyze the trend between preoperative FBG levels and the increased risk of CIN. Univariable and multivariable logistic regression analysis were used to exclude the influence of the confounding factors, and some high-risk confounders were selected for subgroup analysis.Results: We found that patients with elevated preoperative FBG levels had higher body mass index (BMI), received PCI more often, and had higher basal SCr levels. The incidence of CIN in the 5 groups of patients was 6.7%, 10.5%, 17.5%, 18.4%, and 23.2%. The trend test was used to determine the odds ratio (OR) (1.000, 1.425, 2.489, 2.704, 3.234). Multivariate logistic regression analysis confirmed that in the main high-risk subgroups including BMI, PCI, hypertension, and age>65, patients with elevated preoperative FBG levels (≥150 mg/dL) had a higher risk of CIN. There was a significant relationship between higher preoperative FBG levels and greater risk for CIN in patients with HbA1c 6.5%-8.0% (P=0.007) and HbA1c 8.0%-9.5% (P=0.011). Conclusions: Results of our cross-sectional study shows that elevated preoperative FBG levels are independently associated with the risk of CIN in diabetic and prediabetic patients undergoing CAG/PCI, and that the incidence of CIN gradually increases with an increase in preoperative FBG levels. Therefore, patients with elevated preoperative FBG at admission should be carefully monitored and more active measures should be taken to prevent CIN.

Glycosylated hemoglobin levels and the risk for contrast-induced nephropathy in diabetic patients undergoing coronary arteriography/percutaneous coronary intervention

Backgrounds Diabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to assess whether preoperative HbA1c levels in diabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN. Methods We reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020 and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48 h and 72 h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Univariable and multivariable logistic regression analysis was used to exclude the influence of confounding factors, and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN. Results Patients with elevated HbA1c had higher BMI, FBG, and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 48 h and 72 h Scr. The incidence of CIN in the 5 groups of patients were: 9.8, 11.9, 15.2, 25.3, 48.1%. (p < 0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. Trend test showed the change of OR (1.000,1.248,1.553,2.625,5.829). Conclusions Studies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1c is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase. Therefore, we should attach great importance to patients with elevated HbA1c at admission and take more active measures to prevent CIN.

Coronary Arteries: Normal Anatomy With Historical Notes and Embryology of Main Stems

Anatomy of subepicardial coronary arteries became a topic of investigation at autopsy in Florence (Italy) by Banchi in the early twentieth century, with the discovery of dominant and balanced patterns. Thereafter, in the 60's of the same century Baroldi in Milan did post-mortem injection with spectacular three-dimensional casts. Later Sones at the Cleveland Clinic introduced selective coronary arteriography for in vivo visualization of coronary arteries. In the present chapter we show these patterns, as well as normal variants of origin and course with questionable risk of ischemia, like myocardial bridge as well as origin of the left circumflex coronary artery from the right sinus with retroaortic course. As far as embryology, the coronary arteries and veins are epicardial in origin and finally connect the former with the aorta, and the latter with the sinus venosus. At the time of spongy myocardium, intramural blood supply derives directly by the ventricular cavities, whereas later, at the time of myocardial compaction, vascularization originates from the subepicardial network. The connection of the subepicardial plexus with the aorta occurs with prongs of the peritruncal ring, which penetrate the facing aortic sinuses. Septation of truncus arteriosus is not responsible for the final position of the coronary orifices. Infact in transposition of the great arteries coronary ostia are regularly located within facing sinuses of the anterior aorta.

Imaging of cardiac fibroblast activation in a patient after acute myocardial infarction using 68Ga-FAPI-04

Our previous study has demonstrated the feasibility of noninvasive imaging of fibroblast activation protein (FAP)-expression after myocardial infarction (MI) in MI-territory in a rat model with 68Ga-FAPI-04-PET. In the current extended clinical case, we sought to delineate cardiac uptake of 68Ga-FAPI-04 in a patient after MI with clinical indication for the evidence of fibroblast activation. Carcinoma patients without cardiac disease underwent 68Ga-FAPI-04-PET/CT as control. The patient with one-vessel disease underwent dynamic 68Ga-FAPI-04-cardiac-PET/CMR for 60 minutes. Correlation of cardiac 68Ga-FAPI-04 uptake with clinical findings, ECG, echocardiography, coronary-arteriography and enhanced cardiac-MRI with T1 MOLLI and ECV mapping were performed. No uptake was found in normal myocardium and in mature scar. A focal intense 68Ga-FAPI-04 uptake with continuous wash-out in the infarct territory of coronary occlusion correlating with T1 and ECV mapping was observed. The uptake of 68Ga-FAPI-04 extends beyond the actual infarcted area and overestimates the infarct size as confirmed by follow-up CMR.

Heterozygous desmin gene (DES) mutation contributes to familial dilated cardiomyopathy

Familial dilated cardiomyopathy (FDCM) is characterized by high genetic heterogeneity and an increased risk of heart failure or sudden cardiac death in adults. We report the case of a 62-year-old man with a 2-month history of shortness of breath during activity, without paroxysmal nocturnal dyspnea. The patient underwent a series of examinations including transthoracic echocardiography, coronary arteriography, transesophageal echocardiography, and myocardial perfusion imaging. After excluding secondary cardiac enlargement, he was diagnosed with dilated cardiomyopathy (DCM). His sister had also been diagnosed with DCM several years before. Genetic sequencing analysis revealed that the patient, his sister, and his son all had the same mutation in the desmin gene ( DES) (chr2-220785662, c.1010C>T). Genetic testing confirmed a heterozygous DES mutation contributing to FDCM. In this case, the etiology of the patient’s whole-heart enlargement was determined as FDCM with DES gene mutation. This is the first report to describe DES c.1010C>T as a cause of FDCM.

Pre-Procedural Glucose Levels and the Risk for Contrast-Induced Nephropathy in Diabetic Patients Undergoing Coronary angiography or Percutaneous Coronary Intervention

Diabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). This study aimed to evaluate whether pre-procedural glucose levels in diabetic patients who received CAG/PCI had an impact on the occurrence of postoperative CIN. We reviewed the incidence of pre-procedural glucose and postoperative CIN in 532 patients with CAG/PCI from June 1, 2020 to January 31, 2021 in Tianjin Chest Hospital, and divided the preoperative pre-procedural glucose levels into 5 groups. Blood samples were collected at admission, 48h and 72h after operation to measure the serum creatinine (Scr) value of patients. We found Patients with elevated pre-procedural glucose had higher BMI, and they were more often on therapy with PCI. They also had higher basal, 24h and 48h Scr. (Table 1) The incidence of CIN in the 5 groups of patients were: 6.9%, 10.7%, 14.1%, 20.1%, 26.0%. (p = 0.030) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated pre-procedural glucose levels (≥ 158mg/dl) had a higher risk of CIN disease. (Fig. 2) Trend test showed the change of HR (1.000, 1.646, 2.285, 3.227, 4,788). (Table 2) We come to the conclusion that in diabetic patients undergoing CAG/PCI, elevated pre-procedural glucose is independently associated with the risk of CIN, and with the increase of pre-procedural glucose level, the incidence of CIN gradually increases.