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ABSTRACTβ-sitosterol is waxy substance, white in color distributed in a variety of natural plant sources cereals, pulses, legumes, vegetables, fruits, and herbs. Several clinical and preclinical investigations indicate that β-sitosterol has a wide range of important health advantages. It prevents many types of malignancies, lowers levels of low density lipoprotein (LDL), lowers the risk of coronary artery disease, heart attacks, and atherosclerosis, and supports the body’s natural healing process. It is found to have cancer-protective properties and has the potency to be beneficial against breast, prostate, colon, lung, stomach, and leukemia. The present review provides a complete analysis and examines the literature on β-sitosterol from different dietary sources, with a focus on its toxicological characteristics and nutraceutical qualities. It lays down the theoretical basis and justification for directing the future planning and execution of clinical studies intended to confirm the importance and possible toxicity of β-sitosterol.

ABSTRACT Introduction and objectives: The role of inflammation in the pathogenesis of coronary artery disease, and that resulting from percutaneous coronary intervention (PCI) is increasingly recognized, yet the effect of colchicine in attenuating peri-PCI inflammation remains unknown. This meta-analysis investigated the efficacy of colchicine in patients undergoing PCI for secondary prevention of coronary artery disease. Methods: The Web of Science, PubMed, Ovid MEDLINE, Embase, Cochrane Central Register of Controlled Trials and ClinicalTrials.gov databases were searched. Data on studies assessing the efficacy profile of colchicine in patients undergoing PCI were pooled using a random-effects model. Results: In 13 studies of 7414 patients, no differences were observed between patients treated with colchicine compared to those without for all-cause mortality (OR, 1.1; 95%CI, 0.72-1.56; I2 = 0%), cardiovascular mortality (OR, 0.98; 95%CI, 0.42-2.28; I2 = 14.2%), myocardial infarction (OR, 0.84; 95%CI, 0.65-1.08; I2 = 1.4%) or coronary revascularization (OR, 0.64; 95%CI, 0.28-1.42; I2 = 49.3%). However, patients treated with colchicine had a lower risk of stroke (OR, 0.33; 95%CI, 0.15-0.72; I2 = 0%). Conclusions: Adding colchicine to standard medical therapy in patients undergoing PCI did not decrease all-cause mortality, cardiovascular mortality or urgent revascularization. However, it showed a trend towards a lower risk of myocardial infarction and a significantly lower risk of stroke.

RESUMEN El estudio de la fisiología coronaria ha pasado de ser una técnica de investigación hace algunos años a convertirse en una herramienta necesaria para el abordaje óptimo de los pacientes con enfermedad coronaria epicárdica y para evaluar la microcirculación. La realización de estas técnicas requiere el uso de una guía de presión para la que hacen falta medios técnicos, tiempo y práctica en su ejecución, y es en parte por ello que su utilización es baja. Existe la necesidad de conocer la evidencia actualizada, las técnicas disponibles y la forma idónea de aplicarlas para ofrecer el mayor beneficio a los pacientes. Esta revisión ofrece un resumen práctico sobre el estado actual de los estudios de fisiología coronaria, con el fin de facilitar el mejor uso posible de esta herramienta diagnóstica esencial.

Resumen: Introducción: Los ensayos clínicos aleatorizados que compararon la cirugía de revascularización miocárdica (CRM) contra la angioplastia transluminal coronaria (ATC) incluyeron todo tipo de técnicas quirúrgicas, con y sin circulación extracorpórea (CEC), como también diversos conductos (arteriales y venosos). ¿Es razonable suponer que todas las técnicas quirúrgicas son iguales en términos de sobrevida alejada? Objetivo: Evaluar si la CRM sin CEC y utilizando ambas arterias mamarias (BITA por sus siglas en inglés) tiene un beneficio adicional a la revascularización convencional utilizando una sola mamaria (SITA por sus siglas en inglés) en términos de sobrevida a largo plazo para la enfermedad del tronco de la coronaria izquierda (TCI). Material y Métodos: Estudio observacional retrospectivo comparativo (n = 723) ajustado por riesgo. Se estratificaron según el uso de una arteria mamaria interna (SITA, n = 144) o ambas arterias mamarias internas (BITA, n = 579). Se analizó la sobrevida a los 10 años de la intervención. Resultados: La supervivencia a los 10 años fue significativamente mayor en el grupo BITA versus el grupo SITA (79,0% ± 3,4% vs 67,0% ± 4,9%, p log-rank

ABSTRACT Introduction and objectives: Coronary artery disease and mental health disorders are often coexistent. Selective serotonin reuptake inhibitors (SSRIs) are often used in this context but have been associated with an increased risk of bleeding due to platelet dysfunction. Previous studies have assessed this risk in patients treated with clopidogrel-based dual antiplatelet therapy (DAPT) with contradictory results. However, there is no data regarding the use of SSRIs and potent P2Y12 inhibitors or triple antithrombotic therapy after percutaneous coronary intervention (PCI). The purpose of this study was to assess the impact of SSRIs on bleeding outcomes after PCI in patients treated with clopidogrel, prasugrel or ticagrelor-based DAPT or triple antithrombotic therapy. Methods: Retrospective study including all patients undergoing PCI at a high-volume center during 2018. Patients on SSRIs were propensity-score-matched on a 1:1 ratio with patients naive to SSRIs adjusting for the baseline differences. The primary endpoint was major bleeding (BARC type 3 or 5 bleeding) at the 1-year follow-up. Secondary endpoints were a composite of major/non-major clinically relevant bleeding (BARC type 2, 3 or 5 bleeding), and a composite of major adverse cardiovascular events. Results: Out of a total of 1063 patients treated with PCI during the study period, 1002 met the selection criteria, and 139 (13.9%) were on SSRIs. The latter had a higher bleeding risk before matching [PRECISE-DAPT, 16 [10-24] vs 13 [9-21]; P = .040]. No differences were reported in major bleeding (2.9% vs 2.9%, P = .991), major/non-major clinically relevant bleeding (2.9% vs 7.2%, P = .120) or in major adverse cardiovascular events (7.9% vs 7.9%, P = .979) in patients treated with SSRIs. Conclusions: The use of SSRIs was frequent in patients treated with PCI, and although it was a marker of a higher bleeding risk at baseline, this was not associated with an additional bleeding liability.

ABSTRACT Objectives: to develop and analyze content validity evidence of a website for patients with coronary artery disease. Methods: a methodological study, carried out in the phases: Definition - determined contents for inclusion in the website, architecture and design; Implementation - subjects included in the website; Assessment - website submitted to analysis by 13 experts and eight laypersons regarding organization, content and design, on a scale of 1 (no agreement) to 4 (complete agreement). Items that reached Content Validity Ratio (CVR) higher than the established critical values and Content Validity Index greater than 0.80 were considered valid. Results: eight domains related to secondary prevention in coronary heart disease were included on the website. Critical CVR and adequate CVI were obtained according to professional and lay experts. Conclusions: the website was developed, achieving adequate content validity evidence, and can be used as an educational tool for this population.

Introduction and Objectives: Several studies have investigated the effectiveness of fractional flow reserve (FFR) guidance in improving clinical outcomes after myocardial revascularization, yielding conflicting results. The aim of this study was to compare clinical outcomes in patients with coronary artery disease following FFR-guided or angiography-guided revascularization., Methods: Both randomized controlled trials (RCTs) and nonrandomized intervention studies were included. Coprimary endpoints were all-cause death, myocardial infarction, and major adverse cardiovascular events (MACE). The study is registered with PROSPERO (CRD42022344765)., Results: A total of 30 studies enrolling 393 588 patients were included. FFR-guided revascularization was associated with significantly lower rates of all-cause death (OR, 0.63; 95%CI, 0.53-0.73), myocardial infarction (OR, 0.70; 95%CI, 0.59-0.84), and MACE (OR, 0.77; 95%CI, 0.70-0.85). When only RCTs were considered, no significant difference between the 2 strategies was observed for any endpoints. However, the use of FFR was associated with reduced rates of revascularizations and treated lesions. Metaregression suggested that the higher the rate of revascularized patients the lower the benefit of FFR guidance on MACE reduction compared with angiography guidance (P=.012). Similarly, higher rates of patients with acute coronary syndromes were associated with a lower benefit of FFR-guided revascularization (P=.039)., Conclusions: FFR-guided revascularization was associated with lower rates of all-cause death, myocardial infarction and MACE compared with angiographic guidance, with RCTs and nonrandomized intervention studies yielding conflicting data. The benefits of FFR-guidance seem to be less evident in studies with high revascularization rates and with a high prevalence of patients with acute coronary syndrome., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The current study aimed to evaluate the causal association between hemodynamically significant stenosis and the occurrence of ischemic myocardium using an experimental animal model of coronary artery stenosis., Methods: In Yorkshire swine (n = 10), coronary stenosis in the left anterior descending artery was induced using a customized vascular occluder to create varying degrees of occlusion severity (40%-99%). Serial changes in coronary pressure and flow velocity were measured in the left anterior descending artery before and after the implantation of the vascular occluder. At 1 month, 13N-ammonia positron emission tomography (PET) was performed, followed by the collection of isolated hearts for 2,3,5-Triphenyltetrazolium chloride (TTC) staining to quantify the percent area of necrotic myocardium. Three animals in the control group were evaluated using the same protocols, but without the implantation of a vascular occluder Results: The median diameter stenosis after vascular occluder implantation was 61.3% (Q1-Q3: 55.9%-72.3%). Significant differences were observed in hyperemic stenosis resistance, fractional flow reserve (FFR), stress perfusion defect and reversibility in PET, as well as in necrotic myocardium in TTC staining based on stenosis severity (control group: < 50%, 50%-70%, 70%-90%, and > 90%) (all P < .010). Animals with FFR < 0.75 at 1 month exhibited a significantly higher area of stress perfusion defect (30.7 ± 3.1% vs 6.0 ± 4.2%, P < .001), reversibility in PET (11.0 ± 4.0% vs 0.0 ± 0.0%, P = .006), and necrotic myocardium in TTC staining (15.8 ± 6.4% vs 0.0 ± 0.0%, P < .001) than those with FFR ≥ 0.75., Conclusions: In a porcine model, the induction of hemodynamically significant stenosis with FFR < 0.75 was associated with the development of stress perfusion defects and reversibility in PET, as well as necrotic myocardium identified by pathology., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Introduction and Objectives: Although visceral adiposity increases cardiovascular risk in the general population, the obesity paradox has been reported in critically ill patients. However, evidence for its prognostic role in patients undergoing coronary artery bypass grafting (CABG) is limited. This study evaluated the prognostic implications of visceral adiposity in patients who underwent CABG using computed tomography-based measurement of visceral fat., Methods: A total of 2810 patients who underwent CABG from 2007 to 2017 were analyzed. The study population was classified into 3 groups according to visceral fat area index (VFAI) tertiles. VFAI was calculated as visceral fat area (cm 2 )/height 2 (m 2 ) at the L3 level. The primary outcome was all-cause mortality during follow-up., Results: Patients in the low VFAI group (lowest tertile) were younger and had a lower body mass index and less subcutaneous fat than those in the high VFAI group (highest tertile). During a median 8.7-year follow-up, VFAI was significantly associated with the risk of mortality in restricted cubic spline curve analysis (HR, 0.94 per 10 increases; 95%CI, 0.91-0.97; P<.001). Patients in the low VFAI group had a higher incidence of long-term mortality than those in the intermediate and high VFAI groups (T1 36.1%, T2 27.2%, and T3 29.1%; T1 vs T2; adjusted HR, 1.36; 95%CI, 1.15-1.61; P<.001; T1 vs T3; adjusted HR, 1.37; 95%CI, 1.16-1.62; P<.001). Similar results were obtained after inverse probability treatment-weighting analysis., Conclusions: Low visceral adiposity was associated with an increased risk of long-term mortality in patients who underwent CABG., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Objectives: To examine the relationship between inflammatory biomarkers and the occurrence of cardiovascular events in patients with type 2 diabetes mellitus (DM2) and stable coronary artery disease., Methods: A total of 964 patients with stable coronary artery disease were included. Plasma levels of inflammatory markers, including tumour necrosis factor receptors 1 and 2 (TNF-R1 and TNF-R2), growth differentiation factor-15 (GDF-15), soluble suppression of tumorigenicity 2 (sST2), and high-sensitivity C-reactive protein (hsCRP) were measured. The primary endpoint was the development of acute ischaemic events (any type of acute coronary syndrome, stroke, or transient ischaemic attack)., Results: There were 232 diabetic patients and 732 non-diabetic patients. Patients with coronary artery disease and DM2 (232, 24%) had higher levels of TNF-R1, TNF-R2, GDF-15, sST2 (P<.001), and hsCRP compared to patients without DM2, indicating a higher inflammatory state. After a median follow-up of 5.39 (2.81-6.92) years, patients with DM2 more frequently developed the primary endpoint (15.9% vs 10.8%; P=.035). Plasma levels of TNF-R1 were independent predictors of the primary endpoint in patients with DM2, along with male gender, triglyceride levels, and the absence of treatment with angiotensin-converting enzyme inhibitors. None of these inflammatory markers predicted the development of this event in non-diabetic patients., Conclusions: Patients with stable coronary artery disease and DM2 exhibit elevated levels of the proinflammatory markers TNF-R1, TNF-R2, GDF-15, and sST2. Moreover, TNF-R1 is an independent predictor of acute ischaemic events only in diabetic patients., (Copyright © 2024 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The association between apolipoprotein B (apoB) and residual cardiovascular (CV) risk in patients with chronic coronary syndrome (CCS) remains unclear. We aimed to investigate the association between apoB levels and CV outcomes in statin-treated CCS patients., Methods: We enrolled 8641 statin-treated CCS patients at Fuwai Hospital. The patients were divided into 5 groups based on to apoB quintiles (Q1 to Q5). The primary endpoint was 3-year CV events, including CV death, nonfatal myocardial infarction, and nonfatal stroke., Results: During a median follow-up of 3.17 years, there were 232 (2.7%) CV events. After multivariable adjustment, a restricted cubic spline illustrated a J-shaped relationship between apoB levels and 3-year CV events, with the risk remaining flat until apoB levels exceeded 0.73g/L, after which the risk increased (nonlinear P <.05). Kaplan-Meier curves showed the lowest CV event rate in the Q3 group (0.68-0.78g/L). Compared with the Q3 group, multivariable Cox regression models revealed that both low (Q1, ≤0.57g/L) and high (Q5, >0.93g/L) apoB levels were associated with an increased risk of major adverse cardiac events (all P <.05). Notably, patients with low apoB levels (Q1) had the highest risk of CV death (HR, 2.44; 95%CI, 1.17-5.08)., Conclusions: Our analysis indicates that both low and high levels of apoB are associated with elevated CV risk, with the risk being particularly pronounced at higher levels (> 0.73g/L)., (Copyright © 2024. Published by Elsevier España, S.L.U.)

Introduction and Objectives: Lipoprotein (a) [Lp(a)] concentration influences serum low-density lipoprotein cholesterol (LDL-C) levels. How it influences the achievement of LDL-C targets established in the guidelines is not well studied. Our aim was to know the prevalence of elevated Lp(a) levels in patients with coronary artery disease, and to assess its influence on the achievement of LDL-C targets., Method: We conducted a cross-sectional study in a cardiology department in Spain. A total of 870 patients with stable coronary artery disease had their lipid profile determined, including Lp(a). Patients were stratified into 2 groups according to Lp(a)>50mg/dL and Lp(a)≤50mg/dL. The association of Lp(a)>50mg/dL with achievement of LDL-C targets was assessed by logistic regression analysis., Results: The prevalence of Lp(a)>50mg/dL was 30.8%. Patients with Lp(a)>50mg/dL had higher baseline (142.30±47.54 vs. 130.47±40.75mg/dL; p=0.0001) and current (72.91±26.44 vs. 64.72±25.30mg/dL; p=0.0001), despite the fact that they were treated with more high-potency statins (77.2 vs. 70.9%; p=0.058) and more combination lipid-lowering therapy (37.7 vs. 25.7%; p=0.001). The proportion of patients achieving target LDL-C was lower in those with Lp(a)>50mg/dL. Independent predictors of having elevated Lp(a) levels>50mg/dL were the use of high-potency statins (OR 1.5; 95% CI 1.08-2.14), combination lipid-lowering therapy with ezetimibe (OR 2.0; 95% CI 1.45-2.73) and failure to achieve a LDL-C ≤55mg/dL (OR 2.3; 95% CI 1.63-3.23)., Conclusions: Elevated Lp(a) levels influence LDL-C levels and hinder the achievement of targets in patients at very high cardiovascular risk. New drugs that act directly on Lp(a) are needed in these patients., (Copyright © 2024 Sociedad Española de Arteriosclerosis. Publicado por Elsevier España, S.L.U. All rights reserved.)

.special th, .special td { vertical-align: text-top; } ABSTRACT For many years, left main coronary artery disease has remained as the last frontier resisting percutaneous coronary intervention. Until recently, the most relevant clinical studies in this regard as well as clinical practice guidelines favored surgical revascularization almost as the only treatment pathway for the management of this condition. The changes that have occurred over the last 10 to 15 years since the appearance of drug-eluting stents and their technological advances have been extraordinary. This, added to the publication of randomized clinical trials that compared both revascularization modalities, has placed percutaneous coronary interventions at a similar level to surgery in a large number of patients. The anatomical, technical, and strategic aspects are essential for the percutaneous management of left main coronary artery lesions given their tremendous clinical variability. In this article we will be reviewing their anatomy, angiography, intracoronary diagnostic techniques, and different percutaneous revascularization strategies. As long as future clinical studies do not definitively favor percutaneous over surgical revascularization or vice versa, individual discussions on each particular case by the heart team and our patients’ preferences should guide our clinical decision-making process.

ABSTRACT Introduction and objectives: Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause for acute coronary syndrome. The optimal management and treatment of SCAD is still unknown. Methods: Data analysis of a prospective protocol including centralized care management of a consecutive series of patients with SCAD diagnosed between January 2010 and December 2018. Major adverse cardiovascular events included all-cause mortality, new myocardial infarction, coronary revascularization, ventricular arrhythmia, heart failure or stroke. Results: A total of 33 consecutive patients were included (41 lesions). Intravascular imaging modalities were used to confirm the diagnosis in 42% patients. None of the patient showed images of thrombus formation in the true lumen. Conservative treatment was the initial approach in most of the cases (82%). No deaths were reported during the index admission, but 15% experienced major adverse cardiovascular events. The coronary computed tomography angiography performed in 58% of patients during the admission identified SCADs in 79% of the patients. Most of the patients managed with conservative treatment received only 1 antiplatelet agent for a limited period of time (17 months [9-35]). During a median clinical follow-up of 33 months [13-49], 82% of patients did not have any adverse events. The angiographic surveillance obtained in 48% of patients at the 6-month follow-up confirmed the complete healing of the SCAD image in 86% of the patients. The screening for extracoronary vascular findings (97% of patients) resulted in a high prevalence of abnormalities (59%). Conclusions: The unrestricted use of intravascular imaging modalities showed no thrombus in the true lumen of patients with SCAD. In patients managed with conservative treatment, a limited course of antiplatelet monotherapy is safe and provides good clinical outcomes. Performing a coronary computed tomography angiography in the acute phase of SCAD is useful at the follow-up. The screening for extracoronary vascular findings confirmed a high prevalence of abnormalities.

Resumen: La enfermedad aneurismática coronaria se define como la dilatación de un segmento arterial coronario más 1,5 veces el diámetro de las arterias adyacentes de tamaño normal. Puede ser difusa, y afectar todo el trayecto de la arteria, o localizada y afectar sólo un segmento arterial específico. Puede encontrarse entre un 3 a un 8% de los estudios angiográficos y entre un 0,22% a un 1,4% de las necropsias clínicas. Se presenta 3 reportes de casos, donde la presentación clínica, los hallazgos angiográficos y el manejo farmacológico es diverso como corresponde a esta entidad. Abstract: Coronary aneurysm disease is defined as the dilation of a coronary artery segment more than 1.5 times the diameter of the adjacent arteries of normal size. It may be diffuse, and affect the whole trajectory of the artery, or localised and only affect a specific arterial segment. It can be found in between 3% and 8% of angiograph studies, with between 0.22% and 1.4% in clinical post-mortems. Three case reports are presented in which the clinical presentation, the angiographic findings, and the pharmacological management are shown to be as diverse as this condition itself.

Aim of the study: Determination of quantitative radiological indicators of myocardial revascularization effectiveness in patients with coronary artery disease in the early postoperative period. Materials and methods of research: For the implementation of the clinical objectives, 62 patients with coronary artery disease, heart failure, with preserved systolic function and systolic dysfunction were examined in the early postoperative period (up to 7 days). The patients' age ranged from 40 to 79 years, the average age of the examined was 59.6 ± 8.2 years. 35 (56%) patients had HF with LV systolic dysfunction with EF of 49% or less. 27 (44%) patients had preserved systolic function - ejection fraction greater than or equal to 50%. Results: In the group before treatment, the average value ​​of MV was 69.4% CI 95% [65.3%; 73.5%], and after treatment the value of MV was 75.0% CI 95% (70.8%; 79.3%], p = 0.0000. Percentage of RFP inclusion in the anterior wall was 69.5% CI [66.2%; 72.8%] before treatment and significantly improved to 72.3% CI [69.1%; 75.4%] after treatment (p = 0.023). Lateral wall had a parameter value of 73.9% CI [70.7%; 77.1%] before treatment and improved perfusion up to 77.2% CI [74.3%; 80.2%] (p = 0.018). Parameter values for the intraventricular septum were 64.5% CI [60.7%; 68.3%] before treatment and 69% CI [65.2%; 72.8%] after treatment (p = 0.000034) and for the inferior wall those were 54.0% CI (49.7%; 58.3%] and 61.7% CI (57.9%); 65.6%] before and after treatment respectively (p = 0.000032). Conclusion: The determination of quantitative radiological parameters proposed as a result of this study is extremely important for the early postoperative period (7-10 days) for determination of stunned myocardial reserve and late stage of patients` management (1-1.5 years) for determination of hibernation reserve and final assessment of CABG effectiveness.

Introduction and Objectives: Multivessel percutaneous coronary intervention (MV-PCI) is recommended in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (CAD) without cardiogenic shock. The present network meta-analysis investigated the optimal timing of MV-PCI in this context., Methods: We pooled the aggregated data from randomized trials investigating stable STEMI patients with multivessel CAD treated with a strategy of either MV-PCI or culprit vessel-only PCI. The primary outcome was all-cause death. The main secondary outcomes were cardiovascular death, myocardial infarction, and unplanned ischemia-driven revascularization., Results: Among 11 trials, a total of 10 507 patients were randomly assigned to MV-PCI (same sitting, n=1683; staged during the index hospitalization, n=3460; staged during a subsequent hospitalization within 45 days, n=3275) or to culprit vessel-only PCI (n=2089). The median follow-up was 18.6 months. In comparison with culprit vessel-only PCI, MV-PCI staged during the index hospitalization significantly reduced all-cause death (risk ratio, 0.73; 95%CI, 0.56-0.92; P=.008) and ranked as possibly the best treatment option for this outcome compared with all other strategies. In comparison with culprit vessel-only PCI, a MV-PCI reduced cardiovascular mortality without differences dependent on the timing of revascularization. MV-PCI within the index hospitalization, either in a single procedure or staged, significantly reduced myocardial infarction and unplanned ischemia-driven revascularization, with no significant difference between each other., Conclusions: In patients with STEMI and multivessel CAD without cardiogenic shock, multivessel PCI within the index hospitalization, either in a single procedure or staged, represents the safest and most efficacious approach. The different timings of multivessel PCI did not result in any significant differences in all-cause death. This study is registered at PROSPERO (CRD42023457794)., (Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

ABSTRACT Objective: to carry out translation, cross-cultural adaptation to Portuguese and assess the reliability of the four versions of the Coronary Revascularization Outcome Questionnaire - adapted. Methods: a methodological study of translation and cross-cultural adaptation into Portuguese, as proposed by Beaton et al., and reliability analysis, by calculating Cronbach's alpha coefficient and item-total correlation of the four versions of the Coronary Revascularization Outcome Questionnaire - adapted. Results: the adaptations made facilitated the understanding of the items. All domains had Cronbach's alpha above 0.70, except two in the post-percutaneous coronary intervention version and two in the post-myocardial surgical revascularization version. All items had item-total correlation values greater than 0.20, except two in the post-percutaneous coronary intervention version, one in the pre-coronary intervention version and six in the post-myocardial surgical revascularization version. Conclusion: the cross-cultural adaptation to Portuguese was considered satisfactory. Pre-procedure versions were considered reliable, while the post-procedures require other psychometric analyses.

Introduction: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease with still growing incidence among adults and young people worldwide. Patients with T2DM are more susceptible to develop coronary artery disease (CAD) than non-diabetic individuals. Several pre-clinical and clinical studies suggested that adiponectin, a pleiotropic hormone with anti-atherogenic, anti-inflammatory, and insulin-sensitizing properties, may be a molecular link between metabolic and cardiovascular diseases. Aim of the study: This article summarizes the current knowledge on single nucleotide polymorphisms (SNPs) within the adiponectin and its receptors’ genes on the risk of CAD in patients with T2DM. Description of knowledge: Adiponectin, the most abundant circulating adipocytokine, is encoded by the Acrp30/adiponectin gene on chromosome 3q27, which constitutes a region specific for obesity-related metabolic syndrome. A genetic deficit of this adipokine may be responsible for the increased risk of CAD both in the general population and T2DM subjects. The results of recent years’ studies highlight that SNPs at the adiponectin locus, +45 T>G and +276 G>T as well within its two receptors, are determinants of early onset atherosclerosis in individuals with T2DM. Conclusions: SNPs in ADIPOQ, ADIPOR1 and ADIPOR2 may modify the risk of CAD in the group of patients with T2DM. SNP +45 and SNP +276 seem to be attractive, molecular markers for identification of diabetic individuals at especially high risk of CAD. The discovering of their exact mechanisms may result in novel screening options as well as diagnostic process and treatment scheme. Therefore, further research is required to determine the effects of adiponectin and its receptors’ polymorphisms and their roles in the pathogenesis of obesity-related metabolic diseases.

Introducción: El estudio SYNTAX dotó a la comunidad cardiológica de dos grandes herramientas: el puntaje SYNTAX y el papel del “Heart team”. Objetivo: Determinar la utilidad pronóstica de la puntuación SYNTAX en pacientes con diagnóstico de enfermedad coronaria triarterial o del tronco coronario izquierdo revascularizados en el CIMEQ durante el año 2016. Método: Estudio observacional analítico prospectivo de cohorte. La población de estudio estuvo constituida por 41 pacientes con diagnóstico de novo enfermedad coronaria multiarterial durante el 2016 llevados a cirugía de revascularización miocárdica o intervencionismo coronario percutáneo, a los cuales se les realizó el cálculo de la puntuación SYNTAX previa intervención. Se siguieron los eventos cardiovasculares mayores durante 48 meses. Se estudiaron variables clínicas y angiográficas. Resultados: Las variables insuficiencia cardíaca (p=0.046), modalidades de revascularización por separadas (p=0.000), el número de lesiones (p=0.042), la extensión de la enfermedad coronaria que involucra TCI más tres vasos (p=0.040), la presencia de oclusiones totales (p=0.010), lesiones que involucraron bifurcaciones/trifurcaciones (p=0.044), la presencia de calcificación severa (p=0.014) y la tortuosidad (p=0.001) mostraron asociación estadística con los tertiles de la puntuación SYNTAX. La media de seguimiento fue de 28,5 meses. En el tertil alto la cirugía de revascularización mostró un 58,3% de los pacientes libres de eventos adversos al final del seguimiento. El intervencionismo coronario presentó 50,0% y un 42,9% de pacientes libres de eventos en los tertiles medio y bajo respectivamente y cero por ciento de supervivencia en el estrato alto. Conclusiones: El puntaje SYNTAX resultó de valor predictivo de eventos adversos en el intervencionismo coronario percutáneo en los tertiles moderado y alto. El puntaje SYNTAX es adecuado para estratificar a los pacientes a intervencionismo coronario percutáneo o cirugía de revascularización.

ABSTRACT Objective: To analyze the planning and implementation of the care offered by nurses to elders with coronary disease during the hospital-house transition. Methods: Qualitative research that used the Transitions Theory as a theoretical reference. The participants were 12 nurses who work in a hospital that specializes in cardiology, in the city of Salvador-BA. A semistructured interview was carried out from January to February 2018, and the data was analyzed using the Content Analysis technique. Results: Transition care takes place on the day of discharge. The presence of the family was found to be a facilitator; low adherence, poor financial situations, the low educational levels inhibited its implementation. The rehospitalization is an indicator of the results of the transition of care. Final considerations: The planning and implementation of transition care is not effective. It must provide safety in the management of self-care in the home of elders with coronary disease and their families.

ABSTRACT The management of chronic total coronary occlusions (CTO) is still today one of the greatest challenges of cardiology. The complexity of the angioplasty procedure of a CTO added to its controversial clinical benefits has generated certain skepticism in the community of cardiologists when developing coronary deocclusion programs at the catheterization laboratory. However, the evidence from observational studies indicates that if the intervention is successful it can significantly increase the patient’s quality of life, improve the left ventricular function, reduce the need for a subsequent CABG, and possibly improve survival. Several factors must be taken into consideration in the selection of patients elective for an intervention, including the extent of ischemia surrounding the occlusion, the myocardial viability, the coronary location of the CTO, and the chances of being successful with the procedure. This review provides a general description of the anatomy and histopathology of the CTOs, the evidence surrounding the clinical benefit of these procedures, the use of useful scoring systems to assess more objectively the probability of success, and a summary of the latest techniques available today to perform this procedure.

ABSTRACT Introduction and objectives: The PSP (pre-dilation, sizing and post-dilation) score, derived from the GHOST-EU registry, has evaluated the relationship between the implantation technique of bioresorbable scaffolds and the clinical outcomes. The objective was to perform an external validation of the PSP technique and to determine its effect on adverse cardiac events in various clinical and anatomical scenarios. Methods: Data from the REPARA registry (2230 patients) were used for external validation, whereas a common database combining REPARA and GHOST-EU (3250 patients) data was used to evaluate the effect of PSP technique in various clinical and anatomical scenarios. PSP-1 and PSP-3 were used to score the appropriateness of pre-dilation, scaffold sizing, and post-dilation. The primary endpoint was 1-year device-oriented composite endpoint of cardiac death, target-vessel myocardial infarction, and target-lesion revascularization. The definite/probable scaffold thrombosis according to the Academic Research Consortium criteria was also evaluated. Results: A total of 303 (18.2%) patients were treated with an optimal PSP-1, and 182 (8.2%) with an optimal PSP-3. The external validation showed that PSP has a very high negative predictive value for device-oriented composite endpoint and scaffold thrombosis (91.8% and 89.1% for PSP-1; 98.4% and 97.3% for PSP-3, respectively). Patients with an optimal PSP-3 had a numerically lower rate of device-oriented composite endpoint and scaffold thrombosis compared to those without it (0.5% vs 2.9%; P = .085 and 0.5% vs 1.8%; P = .248, respectively). In the merged database, PSP benefits were seen on many scenarios, except in the ST-segment elevation myocardial infarction where a trend towards no benefit of an optimal PSP technique was present (Pinteraction = .100). Conclusions: In the REPARA registry, at 1-year follow-up, an optimal PSP technique was not associated with a lower rate of device-oriented composite endpoint. Further research is necessary to assess the impact of the PSP technique in longer follow-ups.

ABSTRACT Objectives: to identify and discuss the main risk factors for coronary artery disease, observed in nursing students. Methods: an observational and cross-sectional study conducted with nursing students at a public college in Niterói, RJ. Data collection involved instruments validated for use in Brazil. PROCAM Quick Check score was used to estimate cardiovascular risk. Results: of the 110 students, 88 (80%) were female, with a mean age of 22.03±3.63 years. The most relevant cardiovascular risk factors were alcohol consumption 62 (56.4%), family history of coronary artery disease 35 (31.8%), poor eating habits (49.5%) and stress, whose domain “Professional training” received the highest mean, with 11.62 ± 3.42 points. Conclusions: the most frequent risk factors in nursing students are stress, inadequate nutrition and risky consumption of alcoholic beverages. These present a low risk for coronary artery disease through PROCAM Quick Check score.

Background: Coronary anomalies are those conditions characterized by the abnormal origin or course of the epicardial arteries. This generates challenges at the time of diagnosis by catheterization, which is why it is important that the cardiologist is related to these variations. The origin of the left coronary artery in the right sinus of Valsalva has a low incidence. It is reported the case of a patient with myocardial infarction who presented this anomaly with total thrombotic occlusion., Clinical Case: 69-year-old man who presented myocardial infarction with ST segment elevation in the anteroseptal region. The catheterization reported left coronary artery with anterior origin and the right coronary sinus. The anterior descending artery presented thrombotic occlusion, which is why a stent was placed successfully. Subsequently, the tomography of the coronary arteries confirmed the anomalous origin of the left coronary artery from the right sinus of Valsalva, with a lateral and anterior course to the right ventricle., Conclusions: Patients with anomalous origin of the coronary arteries are exposed to greater events of ischemia and sudden death. However, some patients present with no previous history of acute coronary syndrome associated with thrombotic occlusion, which can represent a diagnostic challenge at the time of catheterization and coronary intervention due to the anatomic variability they may present., (Licencia CC 4.0 (BY-NC-ND) © 2024 Revista Médica del Instituto Mexicano del Seguro Social.)

In this new edition of the Clinical and Epidemiological Round, the reader will be able to find four articles that we consider of special interest for current clinical practice. Abuzaid A., et al, performed a systematic review and meta-analysis comparing the outcomes of oxygen therapy vs. no-oxygen therapy in post-acute myocardial infarction settings. Freund Y., et al, present a non-inferiority cluster clinical trial in which they seek to prospectively validate the safety of a strategy based on clinical criteria to rule out pulmonary embolism. Also, using a retrospective cohort with propensity score matching study, Pasternak et al intend to investigate whether the use of oral fluoroquinolone is associated with an increased risk of aortic aneurysm or dissection. Finally, the SMART investigators group assess, through a pragmatic randomized clinical trial in critically ill patients, the impact of balanced crystalloids versus saline in the risk of developing major renal events.

We present a case of acute coronary syndrome with ST-segment elevation (ACS-STEMI) and spontaneous dissection of the right coronary artery, as evidenced by coronary angiography in a male patient, previously submitted to primary angioplasty with a stent implantation 3 years ago.

Introduction and Objectives: A new computed tomography-derived fractional flow reserve (CT-FFR) technique with a "coarse-to-fine subpixel" algorithm has been developed to generate precise lumen contours. The aim of this study was to assess the diagnostic performance of this new CT-FFR algorithm for discriminating lesion-specific ischemia using wire-based FFR ≤ 0.80 as the reference standard in patients with coronary artery disease., Methods: This prospective, multicenter study screened 330 patients undergoing coronary CT angiography (CCTA) and invasive FFR (median interval 2 days) from 6 tertiary hospitals. CT-FFR was evaluated in a blinded fashion with a "coarse-to-fine subpixel" algorithm for lumen contour., Results: Between March 2019 and May 2020, we included 316 patients with 324 vessels. There was a good correlation between CT-FFR and invasive FFR (r=0.76, P<.001). The diagnostic sensitivity, specificity, and accuracy on a per-vessel level were 95.3%, 89.8%, and 92.0% for CT-FFR, and 96.4%, 26.4%, and 53.1% for CCTA>50% stenosis, respectively. CT-FFR showed improved discrimination of ischemia compared with CCTA alone overall (AUC, 0.95 vs 0.74, P<.001) and in intermediate (AUC, 0.96 vs 0.62, P<.001) and "gray zone" lesions (AUC, 0.88 vs 0.61, P<.001). The diagnostic specificity, accuracy, and AUC for CT-FFR (71.9%, 82.8%, and 0.84) outperformed CCTA (9.4%, 48.3%, and 0.66) in patients or in vessels with severe calcification (all P<.05)., Conclusions: CT-FFR with a new "coarse-to-fine subpixel" algorithm showed high performance in identifying hemodynamically significant stenosis. The diagnostic performance of CT-FFR was superior to that of CCTA in intermediate lesions, "gray zone" lesions, and severely calcified lesions. Clinical Trial Register: NCT04731285., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: To evaluate the prevalence, clinical characteristics, and outcomes of patients with angina undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis., Methods: A total of 1687 consecutive patients with severe aortic stenosis undergoing TAVR at our center were included and classified according to patient-reported angina symptoms prior to the TAVR procedure. Baseline, procedural and follow-up data were collected in a dedicated database., Results: A total of 497 patients (29%) had angina prior to the TAVR procedure. Patients with angina at baseline showed a worse New York Heart Association (NYHA) functional class (NYHA class> II: 69% vs 63%; P=.017), a higher rate of coronary artery disease (74% vs 56%; P <.001), and a lower rate of complete revascularization (70% vs 79%; P <.001). Angina at baseline had no impact on all-cause mortality (HR, 1.02; 95%CI, 0.71-1.48; P=.898) and cardiovascular mortality (HR, 1.2; 95%CI, 0.69-2.11; P=.517) at 1 year. However, persistent angina at 30 days post-TAVR was associated with increased all-cause mortality (HR, 4.86; 95%CI, 1.71-13.8; P=.003) and cardiovascular mortality (HR, 20.7; 95%CI, 3.50-122.6; P=.001) at 1-year follow-up., Conclusions: More than one-fourth of patients with severe aortic stenosis undergoing TAVR had angina prior to the procedure. Angina at baseline did not appear to be a sign of a more advanced valvular disease and had no prognostic impact; however, persistent angina at 30 days post-TAVR was associated with worse clinical outcomes., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: Patients with clinically evident coronary artery disease differ in their rate of progression, which impacts prognosis. We aimed to characterize serum and genetic markers in patients with rapid clinical progression (RCP) of coronary artery disease vs those with long standing stable (LSS) disease., Methods: Retrospective study of cases (RCP) and controls (LSS) (1:2). Patients requiring ≥ 2 revascularizations due to atherosclerotic progression in the 10 years after a first angioplasty were considered to be RCP and those without events during the same period after the first angioplasty were considered to have LSS disease. After patient selection, we analyzed serum values, mRNA expression and genetic polymorphisms of inflammatory markers, including interleukin-6, C-reactive protein, and tumor necrosis factor (TNF)-a, and atherogenic markers consisted of proprotein convertase subtilisin/kexin type 9 (PCSK9), low-density lipoprotein receptor, sterol regulatory element binding transcription factor 2, and apolipoprotein-B., Results: The study included 180 patients (58 RCP and 122 LSS). Demographic characteristics, classic risk factors and the extent of coronary disease were similar in the 2 groups. Patients with RCP showed higher serum levels of interleukin-6 and PCSK9 and higher TNF mRNA expression. Interleukin-6 rs180075C, TNF rs3093664 non-G and PCSK9 rs2483205 T alleles conferred a risk of RCP (P<.05 in all cases). Among patients with RCP, 51.7% had all 3 risk alleles vs 18% of those with LSS (P<.001)., Conclusions: We suggest the existence of specific phenotypic and genotypic markers associated with RCP of coronary artery disease that could help to individualize the type and intensity of treatment., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: This article presents the annual activity report of the Interventional Cardiology Association of the Spanish Society of Cardiology (ACI-SEC) for the year 2022., Methods: All Spanish centers with catheterization laboratories were invited to participate. Data were collected online and were analyzed by an external company in collaboration with the members of the board of the ACI-SEC., Results: A total of 111 centers participated. The number of diagnostic studies increased by 4.8% compared with 2021, while that of percutaneous coronary interventions (PCI) remained stable. PCIs on the left main coronary artery increased by 22%. The radial approach continued to be preferred for PCI (94.9%). There was an upsurge in the use of drug-eluting balloons, as well as in intracoronary imaging techniques, which were used in 14.7% of PCIs. The use of pressure wires also increased (6.3% vs 2021) as did plaque modification techniques. Primary PCI continued to grow and was the most frequent treatment (97%) in ST-segment elevation myocardial infarction. Most noncoronary procedures maintained their upward trend, particularly percutaneous aortic valve implantation, atrial appendage closure, mitral/tricuspid edge-to-edge therapy, renal denervation, and percutaneous treatment of pulmonary arterial disease., Conclusions: The Spanish cardiac catheterization and coronary intervention registry for 2022 reveals a rise in the complexity of coronary disease, along with a notable growth in procedures for valvular and nonvalvular structural heart disease., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction: The anterior interventricular artery originates from the left coronary artery and irrigates the anterior surface of the ventricles, apex, and interventricular septum, making it the second most relevant artery of the heart., Objective: To describe the anatomical and clinical aspects of the anterior interventricular artery through angiography., Materials and Methods: A descriptive study was conducted using 200 angiographic reports of Colombian individuals. The anterior interventricular artery's origin, course, patency, and coronary dominance were evaluated. Data related to chest pain, acute myocardial infarction, dyslipidemia, and electrocardiographic abnormalities were included. Statistical tests could not be performed due to this artery's low prevalence of anatomical variations., Results: One anterior interventricular artery was found to have originated from the left coronary sinus without a myocardial bridge, with no alteration in permeability, and with left dominance. The frequency of bridges was 2%, and the most frequent dominance was right in 86%; permeability alterations occurred in 43% mainly affecting S13. Twentyfive per cent presented chest pain; 40%, echocardiographic alterations; 5%, ischemic heart disease, and 59%, electrocardiographic alterations., Conclusions: Variations of origin of the anterior interventricular artery have a low prevalence according to reports from Chile, Colombia, and Spain. anterior interventricular artery myocardial bridges were scarce compared to other studies, suggesting better specificity of computed tomography angiography or direct dissection for these findings. The assessment of coronary permeability is graded with the thrombolysis in myocardial infarction scale; values 0 and 1 indicate occlusive lesion associated with ischemic heart disease. According to various techniques, the most frequent coronary dominance the right, followed by the left in men and balanced circulation in women.

Lenard Rafał, Zielińska Urszula, Michalczak Magdalena, Sobieszczańska Anna, Smoleń Agata. Ocena przydatności parametrów przezklatkowego badania echokardiograficznego w diagnostyce choroby niedokrwiennej serca = The assessment of fitness parameters of transthoracic echocardiography in the diagnosis of coronary heart disease. Journal of Education, Health and Sport. 2015;5(12):701-716. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.45069 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%2812%29%3A701-716 https://pbn.nauka.gov.pl/works/701302 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014http://journal.rsw.edu.pl/index.php/JHS/issue/archive The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport (null) 2391-8306 7 © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 10.12.2015. Revised 25.12.2015. Accepted: 29.12.2015. Ocena przydatności parametrów przezklatkowego badania echokardiograficznego w diagnostyce choroby niedokrwiennej serca The assessment of fitness parameters of transthoracic echocardiography in the diagnosis of coronary heart disease Rafał Lenard1, Urszula Zielińska2, Magdalena Michalczak1, Anna Sobieszczańska3, Agata Smoleń1 1Katedra i Zakład Epidemiologii i Metodologii Badań Klinicznych, Uniwersytet Medyczny w Lublinie 2Klinika Neurochirurgii i Neurochirurgii Dziecięcej, Uniwersytet Medyczny w Lublinie 3Katedra i Zakład Ortopedii Szczękowej, Uniwersytet Medyczny w Lublinie Streszczenie Wprowadzenie Choroby układu krążenia stanowią główną przyczynę zgonów w Europie. Przezklatkowe badanie echokardiograficzne TTE wykonuje się celem oceny anatomii serca, oceny kurczliwości globalnej i odcinkowej lewej komory, oceny aorty piersiowej oraz naczyń płucnych. TTE należy do podstawowych badań w diagnostyce choroby niedokrwiennej serca. Cel pracy Celem pracy była ocena przydatności parametrów przezklatkowego badania echokardiograficznego w diagnostyce zmian w naczyniach wieńcowych. Materiał i metody Badaniem objęto 197 osób, w wieku od 43 do 88 lat, którzy byli hospitalizowani z powodu choroby niedokrwiennej serca (106 osób – 53,9% ze stabilną chorobą niedokrwienną serca, 91 osób – 46,1% z ostrym zespołem wieńcowym - OZW). Wyniki badań U pacjentów z OZW z obniżeniem frakcji wyrzutowej lewej komory częściej występowały istotne zmiany w tętnicach wieńcowych (p

Introduction: Epicardial fat has been shown to be related not only with clinical atherosclerosis, but also with subclinical atherosclerosis. Objective: To determine the significance of epicardial fat in the diagnosis of coronary atherosclerosis in patients with valvular heart disease. Method: The study included 62 patients scheduled for valve replacement surgery who had previously undergone invasive coronary angiography. Before surgery, epicardial fat measurement was performed by echocardiogram. Sensitivity, specificity, and positive and negative predictive values were determined, as well as the validity index andlikelihood ratios for positive and negative tests. Results: 88.7% of patients with heart valve disease had no lesions in the coronary arteries. The most relevant parameters obtained from the measurement of epicardial fat were 78% sensitivity and 93% negative predictive value, and a ratio of positive and negative likelihood of 2.23 and 0.34 respectively. Conclusions: The group of patients with significant coronary lesions showed higher levels of epicardial fat than the group without coronary lesions. It confirms the diagnostic validity of this test for the detection of coronary atherosclerosis in the study patients.

Lenard Rafał, Niedziela Magdalena, Sobieszczańska Anna, Smoleń Agata. Znaczenie przezklatkowej echokardiografii w diagnostyce choroby niedokrwiennej serca = The role of transthoracic echocardiography in the diagnosis of coronary artery disease. Journal of Education, Health and Sport. 2015;5(11):11-24. ISSN 2391-8306. DOIhttp://dx.doi.org/10.5281/zenodo.33160 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%2811%29%3A11-24 https://pbn.nauka.gov.pl/works/665723 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014http://journal.rsw.edu.pl/index.php/JHS/issue/archive Deklaracja. Specyfika i zawartość merytoryczna czasopisma nie ulega zmianie. Zgodnie z informacją MNiSW z dnia 2 czerwca 2014 r., że w roku 2014 nie będzie przeprowadzana ocena czasopism naukowych; czasopismo o zmienionym tytule otrzymuje tyle samo punktów co na wykazie czasopism naukowych z dnia 31 grudnia 2014 r. The journal has had 5 points in Ministry of Science and Higher Education of Poland parametric evaluation. Part B item 1089. (31.12.2014). © The Author (s) 2015; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland and Radom University in Radom, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 05.09.2015. Revised 05.10.2015. Accepted: 30.10.2015. Znaczenie przezklatkowej echokardiografii w diagnostyce choroby niedokrwiennej serca The role of transthoracic echocardiography in the diagnosis of coronary artery disease Rafał Lenard1, Magdalena Niedziela2, Anna Sobieszczańska3, Agata Smoleń4 1doktorant Katedry i Zakładu Epidemiologii, Uniwersytet Medyczny w Lublinie 2Studenckie Koło Naukowe przy Katedrze i Zakładzie Epidemiologii, Uniwersytet Medyczny w Lublinie 3Katedra i Zakład Ortopedii Szczękowej Uniwersytetu Medycznego w Lublinie 4Katedra i Zakład Epidemiologii, Uniwersytet Medyczny w Lublinie 1PhD student Deparment of Epidemiology, Medical University of Lublin, Lublin, Poland 2Students Research Circle at the Deparment of Epidemiology, Medical University of Lublin, Lublin, Poland 3Department of Jaw Orthopaedics, Medical University of Lublin, Lublin, Poland 4Deparment of Epidemiology, Medical University of Lublin, Lublin, Poland Abstrakt Wprowadzenie: Zapadalność na chorobę wieńcową serca należy do najwyższych wśród chorób układu krążenia w społeczeństwach krajów wysoko rozwiniętych. Choroba niedokrwienna serca jest to zespół objawów chorobowych, które są następstwem stanu niewystarczającego zaopatrzenia komórek mięśnia serca w tlen i w substancje odżywcze, a jej obraz kliniczny wykazuje duże zróżnicowania. Jednym z cennych badań diagnostycznych w tej chorobie jest przezklatkowe badanie echokardiograficzne. Wykonywane jest w celu oceny anatomii mięśnia serca, oceny kurczliwości globalnej i odcinkowej lewej komory, oceny aorty piersiowej oraz naczyń płucnych. Cel pracy: Celem pracy była ocena znaczenia przezklatkowej echokardiografii w diagnostyce choroby niedokrwiennej serca. Skrócony opis stanu wiedzy: Wśród wielu objawów i następstw w chorobie niedokrwiennej serca może występować upośledzenie funkcji skurczowej i rozkurczowej lewej komory, niedokrwienna niedomykalność zastawki mitralnej oraz powiększenie lewego przedsionka. U pacjentów po zawale mięśnia serca, objęty niedokrwieniem obszar ulega włóknieniu i zanikowi oraz przestaje pełnić swoje funkcje. W rozpoznawaniu choroby niedokrwiennej serca ważne znaczenie ma echokardiografia obciążeniowa, zwłaszcza w przypadku współistnienia dodatkowych czynników, utrudniających interpretację próby wysiłkowej EKG. Podsumowanie: Badanie echokardiograficzne powinno być wykonywane u każdego pacjenta z podejrzeniem choroby niedokrwiennej serca. Jest ono najważniejszym badaniem w diagnostyce różnicowej bólów w klatce piersiowej i należy do badań prognostycznych u pacjentów z chorobą niedokrwienną serca. Słowa kluczowe: echokardiografia, choroba niedokrwienna serca, diagnostyka. Abstract Introduction: The incidence of coronary artery disease (CAD) is the highest of cardiovascular disease in societies of highly developed countries. Coronary artery disease is complex of clinical syndrome based on inadequate supply of heart muscle cells with oxygen and nutrients. The clinical picure of CAD shows large variation. One of the valuable diagnostic studies for this disease is transthoracic echocardiography (TTE). TTE is performed to assess the anatomy of the heart, global and segmental left ventricular contractility and the structure of the thoracic aorta and pulmonary vessels. Aim of the study The aim of the study was to evaluate the importance of transthoracic echocardiography in the diagnosis of coronary heart disease. Short description of state of knowledge Among the many symptoms and consequences of coronary artery disease impaired systolic and diastolic left ventricular contractility, ischemic mitral regurgitation and left atrial enlargement may occur. In patients after myocardial infarction, atrophy and fibrosis of myocardium is leading to impairment of myocardial function. In the diagnosis of coronary artery disease stress echocardiography is important, especially in the case of co-existing additional factors causing difficulty in the interpretation of stress ECG. Conclusion. Echocardiography should be performed in all patients with suspected coronary artery disease. It is the most important test in the differential diagnosis of chest pain. Echocardiography has a predictive value in patients with ischemic heart disease. Keywords: echocardiography, coronary artery disease, diagnosis.

Introduction and Objectives: Data on the clinical profile and outcomes of younger patients with ST-elevation myocardial infarction (STEMI) is scarce. This study compared clinical characteristics and outcomes between patients aged<45 years and those aged ≥ 45 years with STEMI managed by the acute myocardial infarction code (AMI Code) network. Sex-based differences in the younger cohort were also analyzed., Methods: This multicenter study collected individual data from the Catalonian AMI Code network. Between 2015 and 2020, we enrolled patients with an admission diagnosis of STEMI. Primary endpoints were all-cause mortality within 30 days, 1 year, and 2 years., Results: Overall, 18 933 patients (23% female) were enrolled. Of them, 1403 participants (7.4%) were aged<45 years. Younger patients with STEMI were more frequently smokers (P<.001) and presented with cardiac arrest and TIMI flow 0 before pPCI (P<.05), but the time from first medical contact to wire crossing was shorter than in the older group (P<.05). All-cause mortality rates were lower in patients aged<45 years (P<.001). Among younger patients, cardiogenic shock was most prevalent in women than in their male counterparts (P=.002), with the time from symptom onset to reperfusion being longer (P<.05). Compared with men aged<45 years, younger women were less likely to undergo pPCI (P=.004)., Conclusions: Despite showing high-risk features on admission, young patients exhibit better outcomes than older patients. Differences in ischemia times and treatment were observed between men and women., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The United Kingdom Prospective Diabetes Study (UKPDS) risk score has limited value for predicting coronary artery disease (CAD) events. We investigated the additive value of coronary computed tomography angiography (CCTA) on top of the UKPDS risk score in predicting 10-year adverse cardiac events in asymptomatic patients with type 2 diabetes., Methods: We evaluated 589 asymptomatic diabetic patients without a history of CAD who underwent CCTA. The primary outcome was a composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, and revascularization. We estimated the discrimination and reclassification ability for the prediction models, which included combinations of the UKPDS category, severity of stenosis, and coronary artery calcium score by CCTA., Results: The incidence of the primary outcome was 12.4%. During 10 years of follow-up, patients without plaque by CCTA tended to have a low CAD event rate, while those with obstructive CAD tended to have a high event rate, irrespective of the baseline UKPDS risk category. The model that included only the UKPDS category had a Harrell's c-index of 0.658; adding the degree of stenosis to the model significantly increased the c-index by 0.066 (P=.004), while adding coronary artery calcium score increased the c-index by only 0.039 (P=.056). Overall, CCTA information in addition to the UKPDS risk category improved the reclassification rate for predicting the primary outcome., Conclusions: In asymptomatic patients with type 2 diabetes, CCTA information for CAD provided significant incremental discriminatory power beyond the UKPDS risk score category for predicting 10-year adverse coronary events., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

The article is dedicated to development of homeostatic criteria of efficacy and safety of drugs combinations “lisinopril, bisoprolol, indapamide, isosorbide dinitrate, acetylsalicylic acid”. These criteria are based on study of homeostatic shifts and their association with clinical and laboratory parameters on elder patients with arterial hypertension (AH) II, III stage combined with coronary artery disease (CAD). Complex clinical, biochemical, biophysical and instrumental investigation was performed in 67 patients with AH II, III stage combined with CAD. On the grounds of developed criteria was established that for patients with AH II and CAD is not recommended combination “lisinopril, acetylsalicylic acid” and for those ones with AH III and CAD prohibited combinations “lisinopril, bisoprolol, acetylsalicylic acid” and “lisinopril, bisoprolol, indapamide, isosorbide dinitrate, acetylsalicylic acid” in order to prevent development of drug induced renal dysfunction. It was also determined safety of combinations “lisinopril, bisoprolol, acetylsalicylic acid”; “lisinopril, bisoprolol, indapamide, acetylsalicylic acid” for patients with AH II and CAD and “lisinopril, bisoprolol, indapamide, acetylsalicylic acid” for those ones with AH III and CAD.

Introduction: Thanks to development of technology, new noninvasive techniques of coronary arteries evaluation, such as Multislice Computed Tomography (MSCT) were introduced. Nowadays tomographs are characterized by spatial and time resolution sufficient for reliable assessment of coronary arteries. Moreover, the dose of radiation taken by patient was substantially decreased. Two main methods of evaluation were introduced. Examination performed without contrast agent enables quantitive assessment of coronary arteries calcification by so called Agatston score. Another method performed after contrast injection is Computed Tomography Angiography (CTA) Goal: This studies purpose was to determine the role of Calcium Score in assessment of Coronary Arteries Disease (CAD) advancement Materials and methods: In this study the results of 100 consecutive patients (45% men, mean age 55 ± 8.9 years) were analyzed. All patients had a positive ECG stress test score. With a 64-row CT scan, coronary artery imaging of all patients was performed. The descriptive analysis of the group was based on information obtained from referrals issued by cardiologists to the MSCT. Analyzed parameters were: age, gender, indication for referral, Calcium Score and final diagnosis. Results: In most cases (84%) of patients with positive ECG stress test score, MSCT excluded significant changes in coronary arteries. Also, the correlation between Calcium Score and sex and diagnosis was proven. Conclusions: MSCT and Calcium Score enables to find patients without significant changes in coronary arteries and positive ECG stress test and to reduce the number of referrals to coronarography.

HindIII polymorphism is the most common variant in the lipoprotein lipase gene, however, its association with cardiovascular disease is controversial. Objective: To establish the frequency of the HindIII polymorphism and its relationship with lipid profile and coronary arterial disease (CAD) in Colombian patients. Materials and Methods: The sample comprised patients attending a central hemodynamics of Quindio, by necessity of coronary angiography. HindIII polymorphism was evaluated by polymerase chain reaction and enzyme restriction. Results: 389 patients were divided into individuals with CAD ≥ 50% (60.4%) and individuals with EOC

Resumen Se analiza la utilidad de la ecocardiografía y nuevas técnicas de dianóstico cardiológico no invasivo en la valoración de la insuficiencia cardiaca. Se valora la utilidad de la coronariografía no invasiva por tomografía computarizada, así como las crecientes aplicaciones de la resonancia magnética en el estudio de la cardiopatía isquémica, miocardiopatías y displasia arritmogénica del ventrículo derecho. Para este propósito, se utilizan algunos casos clínicos. Se enfatiza la importancia del uso combinado de estas técnicas, especialmente en los pacientes con insuficiencia cardiaca cuya etiología sea la cardiopatía isquémica o alguna miocardiopatía.

Introduction and Objectives: Concomitant coronary artery disease (CAD) is prevalent among aortic stenosis patients; however the optimal therapeutic strategy remains debated. We investigated periprocedural outcomes among patients undergoing transcatheter aortic valve implantation with percutaneous coronary intervention (TAVI/PCI) vs surgical aortic valve replacement with coronary artery bypass grafting (SAVR/CABG) for aortic stenosis with CAD., Methods: Using discharge data from the Spanish National Health System, we identified 6194 patients (5217 SAVR/CABG and 977 TAVI/PCI) between 2016 and 2019. Propensity score matching was adjusted for baseline characteristics. The primary outcome was in-hospital all-cause mortality. Secondary outcomes were in-hospital complications and 30-day cardiovascular readmission., Results: Matching resulted in 774 pairs. In-hospital all-cause mortality was more common in the SAVR/CABG group (3.4% vs 9.4%, P <.001) as was periprocedural stroke (0.9% vs 2.2%; P=.004), acute kidney injury (4.3% vs 16.0%, P <.001), blood transfusion (9.6% vs 21.1%, P <.001), and hospital-acquired pneumonia (0.1% vs 1.7%, P=.001). Permanent pacemaker implantation was higher for matched TAVI/PCI (12.0% vs 5.7%, P <.001). Lower volume centers (< 130 procedures/y) had higher in-hospital all-cause mortality for both procedures: TAVI/PCI (3.6% vs 2.9%, P <.001) and SAVR/CABG (8.3 vs 6.8%, P <.001). Thirty-day cardiovascular readmission did not differ between groups., Conclusions: In this large contemporary nationwide study, percutaneous management of aortic stenosis and CAD with TAVI/PCI had lower in-hospital mortality and morbidity than surgical intervention. Higher volume centers had less in-hospital mortality in both groups. Dedicated national high-volume heart centers warrant further investigation., (Copyright © 2023 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Introduction and Objectives: The use of a pressure wire as a jailed wire to evaluate side branch results during provisional stenting seems feasible. However, safety concerns exist due to the mechanical damage of the wire and the lack of prospective data evaluating the prognosis of patients treated using this technique. This study sought to evaluate the structural damage of the pressure wire in patients treated using the jailed pressure wire technique and to assess mid-term clinical outcomes., Methods: We enrolled 99 patients with single bifurcation lesions and provisional stenting as the strategy of choice. A jailed pressure wire was used to guide side branch intervention according to the instantaneous wave-free ratio (iFR). A total of 114 patients and the respective nonpolymer-coated jailed wires were used as historical controls. Guidewire damage was evaluated by stereomicroscopy. The primary endpoint was significant microscopic damage. Major adverse cardiac events were evaluated at 2-year follow-up., Results: Significant microscopic damage was more frequent in pressure wires than in nonpolymer-coated wires (53.5% vs 22.8%, P<.001). There were no fractures in either group. There were fewer side branch interventions in the pressure wire group (postdilation/kissing balloon, 32.3% vs 56.1%, P=.001; stenting, 0.0% vs 2.6%, P=.104). The 2-year rate of major adverse cardiac events was similar between the 2 groups (HR adj , 0.42; 95%CI, 0.10-1.73; P=.229)., Conclusions: Pressure wires were less resistant to jailing than conventional nonpolymer-coated wires. Patients treated with iFR-guided provisional stenting required fewer side branch interventions but had similar 2-year clinical outcomes than patients treated with the angiography-guided technique., (Copyright © 2022 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.)

Resumen: El término síndrome X o angina microvascular se emplea habitualmente para definir a un grupo de pacientes que presentan dolor torácico característico, depresión del segmento ST durante el esfuerzo y arterias coronarias angiográficamente normales. Muchos datos apuntan a un posible origen isquémico de los síntomas. Es más frecuente en mujeres y en casi el 50 % de ellas, el dolor anginoso se atribuye específicamente a cambios en la microvasculatura coronaria. Debido a que el pronóstico no es tan benigno como se creía hace años, en pacientes con angina y coronarias epicárdicas normales, se impone una evaluación clínica (incluyendo un cuidadoso análisis de los factores de riesgo) e imagenológica, con el propósito de detectar isquemia funcionalmente significativa. La enfermedad coronaria microvascular es, por tanto, una enfermedad que requiere atención por parte del médico de asistencia. En este artículo se presenta una paciente con este diagnóstico, y se muestran las imágenes electrocardiográficas, ecocardiográfica, ergométricas y angiográficas. / Abstract: The term cardiac syndrome X or microvascular angina is commonly used to describe a group of patients who show a typical chest pain, ST segment depression during exercise and angiographically normal coronary arteries. Many data suggest the symptoms may have an ischemic origin. It is more common in women, and, in almost 50% of them, anginal pain is specifically attributed to changes in the coronary microvasculature. The prognosis is not as benign as it was believed for years; therefore, in patients with angina and a normal epicardial coronary, a clinical and imaging assessment is necessary (including a careful analysis of risk factors) in order to detect a functionally significant ischemia. Therefore, coronary microvascular disease is a condition that requires attention by the attending physician. A patient with this diagnosis is reported in this article, and electrocardiographic, echocardiographic, ergometric and angiographic images are shown.

Pastushyna Anna I. Peculiarities of platelet hemostasis changes in patients with arterial hypertension and coronary artery disease, depending on the presence of microalbuminuria. Journal of Education, Health and Sport. 2016;6(9):610-615. eISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.158164 http://ojs.ukw.edu.pl/index.php/johs/article/view/3887 The journal has had 7 points in Ministry of Science and Higher Education parametric evaluation. Part B item 755 (23.12.2015). 755 Journal of Education, Health and Sport eISSN 2391-8306 7 © The Author (s) 2016; This article is published with open access at Licensee Open Journal Systems of Kazimierz Wielki University in Bydgoszcz, Poland Open Access. This article is distributed under the terms of the Creative Commons Attribution Noncommercial License which permits any noncommercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. This is an open access article licensed under the terms of the Creative Commons Attribution Non Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted, non commercial use, distribution and reproduction in any medium, provided the work is properly cited. The authors declare that there is no conflict of interests regarding the publication of this paper. Received: 02.09.2016. Revised 24.09.2016. Accepted: 24.09.2016. Peculiarities of platelet hemostasis changes in patients with arterial hypertension and coronary artery disease, depending on the presence of microalbuminuria Anna I. Pastushyna Bogomolets national medical university, Department of propedeutics of internal medicine N1 Abstract The activity of platelets and microalbuminuria can be considered as a reflection of endothelial function both in arterial hypertension and in other cardiovascular diseases. To assess the platelet hemostasis we examined 98 people: 14 apparently healthy (Group 1, control), 34 patients with arterial hypertension, the 2-nd stage, in combination with coronary artery disease with concomitant MAU (group 2), 50 patients with arterial hypertension, the 2-nd stage, in combination with coronary artery disease without concomitant MAU (3 Group). Analysis of induced platelet aggregation revealed decrease in ADP and AA-induced aggregation in the study groups of patients, which may be due to the treatment of this category of patients with acetylsalicylic acid, which has a direct effect on the AA-stimulated aggregation. Decrease of expression of ADP aggregation in patients of surveyed groups may be due to a receiving clopidogrel by patients. It is noteworthy that despite treatment with antiplatelet drugs, collagen and epinephrine-induced aggregation were not significantly different from the control group. Key words: arterial hypertension, coronary artery disease, microalbuminuria, hemostasis, platelets aggregation.