PECAM1, COL4A2, PHACTR1, and LMOD1 Gene Polymorphisms in Patients with Unstable Angina

Coronary artery disease (CAD) is a syndrome resulting from myocardial ischaemia of heterogeneous pathomechanism. Environmental and genetic factors contribute to its development. Atherosclerotic plaques that significantly narrow the lumen of coronary arteries cause symptoms of myocardial ischaemia. Acute coronary incidents are most often associated with plaque rupture or erosion accompanied by local activation of the coagulation system with thrombus formation. Plaque formation and stability are influenced by endothelial function and vascular smooth muscle cell function. In this study, we investigated the association between polymorphisms in genes affecting endothelial and vascular smooth muscle cell (VSMC) function and the occurrence of unstable angina pectoris. The aim of this study was to evaluate the association between the PECAM1 (rs1867624), COL4A2 (rs4773144), PHACTR1 (rs9349379) and LMOD1 (rs2820315) gene polymorphisms and the risk of unstable angina. The study included 232 patients with unstable angina diagnosed on the basis of clinical symptoms and coronary angiography and 144 healthy subjects with no significant coronary lumen stenosis at coronary angiography. There were no statistically significant differences in the distribution of COL4A2 rs4773144 and PECAM1 rs1867624 gene polymorphisms between patients with unstable angina and control subjects. In patients with unstable angina, there was an increased frequency of PHACTR1 rs9349379 G allele carriers (GG and AG genotypes) (GG+AG vs. AA, OR 1.71; 95% CI 1.10–2.66, p = 0.017) and carriers of the LMOD1 rs2820315 T allele (TT and CT genotypes) (TT+CT vs. CC, OR 1.65; 95% CI 1.09–2.51, p = 0.019) compared to the control group. The association between these alleles and unstable angina was confirmed by multivariate logistic regression analysis, in which the number of G (PHACTR1 rs9349379) and T (LMOD1 rs2820315) alleles was an independent risk factor for unstable angina. The results suggest an association between PHACTR1 rs9349379 and LMOD1 rs2820315 polymorphisms and the risk of unstable angina.

The utility of SYNTAX score predictability by electrocardiogram parameters in patients with unstable angina

Background SYNTAX score is one of the risk assessment systems to predict cardiac events in acute coronary syndrome patients. Despite the large number of SYNTAX score benefits, invasive methods such as coronary angiography are necessary to perform the scoring. We hypothesized that ECG parameters could predict the SYNTAX score in unstable angina patients. Methods During the retrospective cohort study, a total number of 876 patients were diagnosed with unstable angina. After applying the exclusion criteria, 600 patients were divided into tertiles based on the SYNTAX scores as low (0–22), intermediate (23–32), and high (≥ 33). The association between ECG parameters and SYNTAX score was investigated. Results The study included 65% men and 35% women with a mean age of 62.4 ± 9.97 years. The delayed transition zone of QRS complex, ST-depression in inferior-lateral territories or/and in all three territories, and T-wave inversion in lateral territory were significant (p < 0.05) independent predictors of intermediate SYNTAX score. High SYNTAX score was predicted by the presence of prolonged P wave duration, ST-depression in lateral territory or/and anterior-lateral territories, ST-elevation in aVR–III leads or/and aVR–III–V1 leads. Among those, all three territories ST-depression (AUC: 0.611, sensitivity: 75%, specificity: 51%) and aVR + III ST-elevation (AUC: 0.672, sensitivity: 50.12%, specificity: 80.50%) were the most accurate parameters to predict intermediate and high SYNTAX scores, respectively. Conclusion The present study demonstrates that accompanying the STE in the right side leads (aVR, III, V1) with ST-depression in other leads indicates the patients with high SYNTAX score; meanwhile, diffuse ST-depression without ST-elevation is a marker for intermediate SYNTAX score in unstable angina patients and can be applied for early risk stratification and intervention.

Diagnosis of adult ALCAPA with computed tomography coronary artery

Background Anomalous left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly where the left main coronary artery arises from the pulmonary artery, instead of the coronary sinus of the ascending aorta. ALCAPA is divided into infant and adult types. Life-threatening complications such as malignant arrhythmia and sudden death could ensue in adult type of ALCAPA. Imaging is the current preferred modality for ALCAPA. It is indeed a challenge to diagnose ALCAPA due to its non-specific clinical presentation and laboratory findings. We report a case of adult type ALCAPA presented with unstable angina surprisingly surviving into adulthood with no symptoms prior to presentation, which is extremely rare. Case presentation A 53-year-old lady presented with sudden onset of chest pain and worsening shortness of breath. She was initially treated as unstable angina. Physical examination revealed normal heart sound. Computed tomography coronary angiography (CTCA) showed an anomalous origin of the left coronary artery from the posterior wall of the proximal pulmonary artery, compatible with ALCAPA. The anomalous left coronary artery bifurcates into left anterior descending and left circumflex arteries. Cardiothoracic surgeon planned for occlusion of ALCAPA via the pulmonary artery, owing to the fact that unfeasible rerouting in the presence of well-established collateral supply. Conclusions ALCAPA is a rare and life-threatening condition in adults which may lead to myocardial infarction and sudden death in untreated cases. CTCA is one of the preferred modern imaging modality in ALCAPA owing to its superior ability for direct visualization of the anomaly. Hence, early identification and surgical intervention of the anomaly are paramount to reduce the morbidity and mortality.

Disorders of lipid metabolism and lipid transport system in women with unstable angina in the dependence on smoking: pathogenetic connections and development risks

The aim of the study. To study the effect of smoking on lipid metabolism, lipid transport system and systemic inflammation, to find out their correlations and the risks of unstable angina in women, depending on the habit of smoking.Material and methods. 225 women were examined: 150 women - patients with unstable angina and 75 healthy women. The level of total cholesterol, low and high-density lipoprotein cholesterol, triglycerides, apolipoproteins A1 (ApoA1) and B (ApoB), C-reactive protein, fibrinogen were determined in all subjects. Multifactor correlation-regression analysis was performed using Fisher's test. Statistical processing of the results was performed using the applications "Microsoft Office Excel 2016" and "Statistics ver. 10.Results. The relative risk of developing unstable angina in patients with a smoking habit is most often associated with atherogenic dyslipidemia (total cholesterol > 4 mmol, OR = 12.02, SI = 8.12-16.32; low-density lipoprotein cholesterol > 1.8 mmol / l, OR = 9,32, SI = 6,13-12,56, high-density lipoprotein cholesterol <1,2 mmol / l, OR = 3,91, SI = 2,12-5,45, the ratio of apolipoproteins ApoV / ApoA1> 0.85, OR = 2.69, SI = 1.15-4.21) and the highest activity of systemic inflammation (C-reactive protein >3 mg / l, OR = 3.62, SI = 2.15- 4.56). The risk of developing unstable angina associated with these indicators is 1.5-2 times higher in women with a smoking habit than in women who have never smoked. Significant direct correlations of high and medium strength between the severity of systemic inflammation, disorders of the lipid transport system (increase in the ratio of ApoB / ApoA1 and decrease in the level of ApoA1), in patients with unstable angina in women smokers.Conclusions. Smoking is one of the most aggressive factors of unstable angina in women, which contributes to the emergence and progression of other important risk factors and leads to disorders of lipid metabolism, lipid transport system, systemic inflammation and increased chances of unstable angina.

Machine Learning to Predict Long-Term Cardiac-Relative Prognosis in Patients With Extra-Cardiac Vascular Disease

Aim: Patients with ischemic stroke (IS), transient ischemic attack (TIA), and/or peripheral artery disease (PAD) represent a population with an increased risk of coronary artery disease. Prognostic risk assessment to identify those with the highest risk that may benefit from more intensified treatment remains challenging. To explore the feasibility and capability of machine learning (ML) to predict long-term adverse cardiac-related prognosis in patients with IS, TIA, and/or PAD.Methods: We analyzed 636 consecutive patients with a history of IS, TIA, and/or PAD. All patients underwent a coronary CT angiography (CCTA) scan. Thirty-five clinical data and 34 CCTA metrics underwent automated feature selection for ML model boosting. The clinical outcome included all-cause mortality (ACM) and major adverse cardiac events (MACE) (ACM, unstable angina requiring hospitalization, non-fatal myocardial infarction (MI), and revascularization 90 days after the index CCTA).Results: During the follow-up of 3.9 ± 1.6 years, 21 patients had unstable angina requiring hospitalization, eight had a MI, 23 had revascularization and 13 deaths. ML demonstrated a significant higher area-under-curve compared with the modified Duke index (MDI), segment stenosis score (SSS), segment involvement score (SIS), and Framingham risk score (FRS) for the prediction of ACM (ML:0.92 vs. MDI:0.66, SSS:0.68, SIS:0.67, FRS:0.51, all P &lt; 0.001) and MACE (ML:0.84 vs. MDI:0.82, SSS:0.76, SIS:0.73, FRS:0.53, all P &lt; 0.05).Conclusion: Among the patients with IS, TIA, and/or PAD, ML demonstrated a better capability of predicting ACM and MCAE than clinical scores and CCTA metrics.

Xuesaitong Capsule For Patients After Percutaneous Coronary Intervention For Unstable Angina: Study Protocol For a Randomized Controlled Trial

• Background: This study was designed to investigate the effect of Xuesaitong (XST) capsule added to conventional treatment in patients after percutaneous coronary intervention (PCI) for unstable angina (UA).• Methods: This is a 12-week, randomized, multi-center, double-blinded, placebo-controlled clinical trial. A total of 120 patients with UA will be recruited and randomly allocated in a 1:1 ratio to receive XST or placebo (2 capsules twice per day) on the background of conventional treatment. The changed level of high-sensitivity C-reactive protein from baseline to week 12 is the primary outcome. Secondary outcomes include tumor necrosis factor-α, interleukin-6, platelet aggregation, blood lipid, angina symptoms and ST segment deviation in electrocardiogram. The safety of XST will be monitored during the trial.• Discussion: This study will provide an evidence regarding the efficacy and safety of XST on the background of conventional medical treatment in patients after PCI for UA.• Trial registration: Chinese Clinical Trial Registry, ChiCTR2000032152. Registered on 14 January 2020.

Flow reserve fraction: the optimal choice in lesion assessing and interventional guiding for patient with unstable angina pectoris and intermediate lesion wrapped with myocardial bridge: a case report

Background It is difficult to choose correctly interventional strategy for coronary intermediate lesions combined with myocardial bridge. Endovascular imaging is advocated to guide treatment, but flow reserve fraction (FFR) is not recommended to guide the interventional treatment of myocardial bridge disease because of the inaccurate judgment misled by myocardial bridge. Case presentation In this study, we reported a case of a 56-year-old male patient with unstable angina pectoris (UAP). From his coronary angiography, we found diffuse stenosis near the midsection of the left anterior descending (LAD) branch and the presence of a severe myocardial bridge in the lesion area. We were sure that the LAD was culprit vessel and this lesion was culprit lesion. Both FFR and intravenous ultrasound (IVUS) were performed and the conclusions of them are different. Although stent implantation is not usually recommended in the myocardial bridge area. However, after careful examination, a stent was finally implanted under the precise guidance of FFR. And the patient recovered well up-to now. Conclusions This case illustrates that FFR functional test was complimentary to intravascular imaging test for the coronary intermediate lesion, especially the lesion wrapped with myocardial bridges, both in assessing the lesion and in guiding treatment.