Modelling of hemodynamics in bifurcation lesions of coronary arteries before and after myocardial revascularization

Modelling of patient-specific hemodynamics for a clinical case of severe coronary artery disease with the bifurcation stenosis was carried out with allowance for standard angiographic data obtained before and after successfully performed myocardial revascularization by stenting of two arteries. Based on a non-Newtonian fluid model and an original algorithm for fluid dynamics computation operated with a limited amount of initial data, key characteristics of blood flow were determined to analyse the features of coronary disease and the consequences of its treatment. The results of hemodynamic modelling near bifurcation sites are presented with an emphasis on physical, physiological and clinical phenomena to demonstrate the feasibility of the proposed approach. The main limitations and ways to minimize them are the subjects of discussion as well. This article is part of the theme issue ‘Transport phenomena in complex systems (part 2)’.

Nonalcoholic Fatty Liver Disease-Associated Liver Fibrosis Is Linked with the Severity of Coronary Artery Disease Mediated by Systemic Inflammation

Background and Aim. Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular disease. Hepatic fibrosis is the most significant determinant of all-cause- and liver -related mortality in NAFLD. However, the relationship between NAFLD fibrosis and severe coronary artery disease (CAD) remains unclear. Methods and Results. We conducted a retrospective study of 531 patients with ultrasonogram-confirmed NAFLD who underwent percutaneous coronary intervention (PCI). Then, all patients were separated into four categories by Gensini score (0, 0-9, 9-48, and ≥48) for use in ordinal logistic regression analysis to determine whether NAFLD fibrosis was associated with increased Gensini scores. Mediation analysis was used to investigate whether systemic inflammation is a mediating factor in the association between NAFLD fibrosis and CAD severity. FIB − 4 > 2.67 ( OR = 5.67 , 95% CI 2.59-12.38) and APRI > 1.5 ( OR = 14.8 , 95% CI 3.24-67.60) remained to be independent risk factors for the severity of CAD after adjusting for conventional risk factors, whereas among the inflammation markers, only neutrophils and neutrophil-to-lymphocyte ratio (NLR) were independently associated with CAD. Multivariable ordinal regression analysis suggested that increasing Gensini score (0, 0-9, 9-48, and ≥48) was associated with advanced NAFLD fibrosis. ROC curve showed that either fibrosis markers or inflammation markers, integrating with traditional risk factors, could increase the predictive capacity for determining CAD. Inflammation markers, especially neutrophils and NLR, were mediators of the relationship between NAFLD fibrosis and CAD severity. Conclusions. NAFLD patients with advanced fibrosis are at a high risk of severe coronary artery stenosis, and inflammation might mediate the association between NAFLD fibrosis and CAD severity.

Homeopathic treatment of two patients with coronary artery disease: case-report

The homeopathic materia medica includes a number of remedies potentially useful in heart diseases and that could be an effective complementary tool in cardiology and cardiovascular surgery. As conventional doctors demand evidence on the efficacy and effectiveness of homeopathic treatment backed with independent laboratory evaluation by accredited specialists, this paper reports the outcome of two patients diagnosed with severe coronary artery disease treated with homeopathic remedies. Keywords: coronary artery disease; low dilutions remedies.  Tratamento de 2 pacientes com doenças na artéria coronária: relato de caso ResumoA Matéria Médica homeopática inclui uma série de medicamentos potencialmente úteis para doenças cardíacas, que poderiam ser efetivos como ferramenta complementar na cardiologia e cirurgia cardiovascular. A medicina tradicional exige a obtenção de evidéncias sobre a eficácia e efetividade de tratamentos homeopáticos, suportadas por resultados de laboratórios independentes e acreditados por especialistas. Este artigo relata o acompanhamento de 2 pacientes diagnosticados com doença severa da artéria coronária , tratados com medicamentos homeopáticos. Palavras-chave: doença da artéria coronariana, medicamentos dinamizados.  Tratamiento homeopático de dos pacientes con enfermedad arterial coronaria: informe de caso ResumenLa materia médica homeopática incluye una serie de recursos potencialmente útiles en las enfermedades del corazón y que podría ser una eficaz herramienta complementaria en cardiología y cirugía cardiovascular. Considerando la demanda por pruebas sobre la eficacia y la eficacia del tratamiento homeopático, con respaldo en laboratorios independiente y evaluación por especialistas acreditados, el presente documento informa de los resultados de dos pacientes con diagnóstico de grave enfermedad de la arteria coronaria tratada con remedios homeopáticos. Palabras-clave: enfermedad de las arterias coronarias; bajas diluciones recursos  Correspondence author: Pedro Bernardo Scala, [email protected] How to cite this article: Scala PB. Homeopathic treatment of two patients with coronary artery disease: case-report. Int J High Dilution Res [online]. 2009 [cited YYYY Month dd]; 8 (27): 45-49. Available from: http://journal.giri-society.org/index.php/ijhdr/article/view/337/391. ÂÂÂ

Cardiac outcomes in severe acute respiratory syndrome coronavirus-2-associated multisystem inflammatory syndrome at a tertiary paediatric hospital

Introduction: We describe a cohort of children referred with multisystem inflammatory syndrome in children associated with severe acute respiratory syndrome coronavirus 2 and compare this cohort with a 2019 cohort of children with Kawasaki disease. Methods: We conducted a retrospective cohort study of 2019 and 2020 referrals to the inflammatory cardiology service at Great Ormond Street Hospital for Children. We compared cardiac and inflammatory parameters of a sub-section of the 2020 cohort who presented with reduced left ventricular ejection fraction with the remainder of the cohort. Results: Referrals significantly increased between February and June 2020 compared to 2019 (19.8/30 days versus 3.9/30 days). Frequency of coronary artery aneurysms (11/79 (13.9%) versus 7/47 (14.9%)) or severe coronary artery aneurysms (6/79 (7.6%) versus 3/47 (6.4%)) was similar between 2020 and 2019, respectively. The 2020 cohort was older (median age 9.07 years versus 2.38 years), more likely to be of Black, Asian, or other minority ethnic group (60/76 (78.9%) versus 25/42 (59.5%)), and more likely to require inotropic support (22 (27.5%) versus 0 (0%)). Even children with significantly reduced left ventricular ejection fraction demonstrated complete recovery of cardiac function within 10 days (mean 5.25 days ± 2.7). Discussion: We observed complete recovery of myocardial dysfunction and an overall low rate of permanent coronary sequelae, indicating that the majority of children with multisystem inflammatory syndrome in children are unlikely to encounter long-term cardiac morbidity. Although the frequency of myocardial dysfunction and inotropic support requirement is not consistent with a diagnosis of Kawasaki disease, the frequency of coronary artery abnormalities and severe coronary artery abnormalities suggests a degree of phenotypic overlap.

Impact of Arrhythmia on Myocardial Perfusion: A Computational Model-Based Study

(1) Background: Arrhythmia, which is an umbrella term for various types of abnormal rhythms of heartbeat, has a high prevalence in both the general population and patients with coronary artery disease. So far, it remains unclear how different types of arrhythmia would affect myocardial perfusion and the risk/severity of myocardial ischemia. (2) Methods: A computational model of the coronary circulation coupled to the global cardiovascular system was employed to quantify the impacts of arrhythmia and its combination with coronary artery disease on myocardial perfusion. Furthermore, a myocardial supply–demand balance index (MSDBx) was proposed to quantitatively evaluate the severity of myocardial ischemia under various arrhythmic conditions. (3) Results: Tachycardia and severe irregularity of heart rates (HRs) depressed myocardial perfusion and increased the risk of subendocardial ischemia (evaluated by MSDBx), whereas lowering HR improved myocardial perfusion. The presence of a moderate to severe coronary artery stenosis considerably augmented the sensitivity of MSDBx to arrhythmia. Further data analyses revealed that arrhythmia induced myocardial ischemia mainly via reducing the amount of coronary artery blood flow in each individual cardiac cycle rather than increasing the metabolic demand of the myocardium (measured by the left ventricular pressure-volume area). (4) Conclusions: Both tachycardia and irregular heartbeat tend to increase the risk of myocardial ischemia, especially in the subendocardium, and the effects can be further enhanced by concomitant existence of coronary artery disease. In contrast, properly lowering HR using drugs like β-blockers may improve myocardial perfusion, thereby preventing or relieving myocardial ischemia in patients with coronary artery disease.