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The article examines the findings of the FAVOR III Europe trial, which compared angiography-based quantitative flow ratio (QFR) with pressure wire-based fractional flow reserve (FFR) for guiding coronary revascularization. Topics discussed include the higher incidence of major adverse cardiac events with QFR at one year, the increased stent use in the QFR group, and the potential limitations of QFR when FFR is available as a treatment strategy.

Aims The diagnostic performance of quantitative perfusion cardiac magnetic resonance (QP-CMR) imaging has scarcely been evaluated in patients with a history of coronary artery disease (CAD) and new onset chest pain. The present study compared the diagnostic performance of automated QP-CMR for the detection of fractional flow reserve (FFR) defined hemodynamically significant CAD with visual assessment of first-pass stress perfusion CMR (v-CMR) and quantitative [15O]H2O positron emission tomography (PET) imaging in a true head-to-head fashion in patients with prior CAD. Methods and results This PACIFIC-2 substudy included 145 symptomatic chronic coronary symptom patients with prior myocardial infarction and/or percutaneous coronary intervention. All patients underwent dual-sequence, single-bolus perfusion CMR, and [15O]H2O PET perfusion imaging followed by invasive coronary angiography with three-vessel FFR. Hemodynamically significant CAD was defined as an FFR ≤ 0.80. QP-CMR, v-CMR, and PET exhibited a sensitivity of 66, 67, and 80%, respectively, whereas specificity was 60, 62, and 63%. Sensitivity of QP-CMR was lower than that of PET (P = 0.015), whereas the specificity of QP-CMR and PET was comparable. Diagnostic accuracy and area under the curve of QP-CMR (64% and 0.66) was comparable to both v-CMR [66% (P = not significant [NS]) and 0.67 (P = NS)] and PET [74% (P = NS) and 0.78 (P = NS)]. Conclusion In patients with prior myocardial infarction and/or percutaneous coronary intervention, the diagnostic performance of QP-CMR was comparable to visual assessment of first-pass stress perfusion CMR and quantitative [15O]H2O PET for the detection of hemodynamically significant CAD as defined by FFR. [ABSTRACT FROM AUTHOR]

Some of the millions of patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have developed new sequelae after recovering from the initial disease, termed post-acute sequelae of coronavirus disease 2019 (PASC). One symptom is anxiety, which is likely due to three etiologies: brain structural changes, neuroendocrine disruption, and neurotransmitter alterations. This review provides an overview of the current literature on the pathophysiological pathways linking coronavirus disease 2019 to anxiety, as well as the possible mechanisms of action in which an increasingly scrutinized treatment method, enhanced external counter-pulsation (EECP), is able to alleviate anxiety. SARS-CoV-2 triggers increased inflammatory cytokine production, as well as oxidative stress; these processes contribute to the aforementioned three etiologies. The potential treatment approach of EECP, involving sequenced inflation and deflation of specifically-placed airbags, has become of increasing interest, as it has been found to alleviate PASC-associated anxiety by improving patient cardiovascular function. These functional improvements were achieved by EECP stimulating anti-inflammatory and pro-angiogenic processes, as well as improving endothelial cell function and coronary blood flow, partially via counteracting against the negative effects of SARS-CoV-2 infection on the renin–angiotensin–aldosterone system. Therefore, EECP could promote both psychosomatic and cardiac rehabilitation. Further research, though, is still needed to fully determine its benefits and mechanism of action. [ABSTRACT FROM AUTHOR]

To investigate the relationships between inflammatory parameters, including neutrophil‐to‐lymphocyte ratio (NLR), platelet‐to‐lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR) and systemic immune-inflammation index (SII), and quantitative flow ratio (QFR) in stable coronary artery disease (CAD) patients (n = 450) enrolled in this cross-sectional study. Logistic regression was performed to evaluate the associations of NLR, PLR, MLR, and SII evaluated as continuous and binary variables with QFR ≤0.80. When treated as continuous variables, lnNLR was associated with QFR ≤0.80 with borderline significance in univariable (odds ratio (OR) = 1.60, p =.05) and multivariable analysis (OR = 1.72, p =.05), while lnMLR was associated with QFR ≤0.80 significantly in univariable analysis (OR = 1.87, p =.03) and with borderline significance in multivariable analysis (OR = 1.91, p =.05). When treated as binary variables, high levels of MLR and SII were significantly associated with QFR ≤0.80 in univariable (MLR: OR = 1.91, p =.02; SII: OR = 2.42, p =.006) and multivariable analysis (MLR: OR = 1.83, p =.04; SII: OR = 2.19, p =.02). NLR, MLR, and SII, but not PLR, were significantly associated with the severity of coronary physiology in stable CAD patients. [ABSTRACT FROM AUTHOR]

The article explores coronary blood flow in patients with Hypoplastic Left Heart Syndrome (HLHS) after Total Cavopulmonary Anastomosis (TCPC). The study found that while mean coronary blood flow in HLHS patients is slightly reduced compared to normal values, there is an increase in coronary blood flow during exercise for most patients. Additionally, the cross-sectional area of the native aorta showed a weak positive correlation with the increase in coronary blood flow during stress. This research sheds light on the long-term complications faced by HLHS patients surviving into early adulthood. [Extracted from the article]

Copyright of Folia Cardiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Folia Cardiologica is the property of VM Medica-VM Group (Via Medica) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aims There is a paucity of data on the performance of angiography-derived vessel fractional flow reserve (vFFR) in coronary artery lesions of patients presenting with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Optical coherence tomography (OCT) allows for visualization of lumen dimensions and plaque integrity with high resolution. The aim of this study was to define the association between vFFR and OCT findings in intermediate coronary artery lesions in patients presenting with NSTE-ACS. Methods and results The FAST OCT study was a prospective, multicenter, single-arm study. Patients presenting with NSTE-ACS with intermediate to severe coronary artery stenosis in one or multiple vessels with TIMI 3 flow suitable for OCT imaging were eligible. Complete pre-procedural vFFR and OCT data were available in 226 vessels (in 188 patients). A significant association between vFFR and minimal lumen area (MLA) was observed, showing an average decrease of 20.4% (95% CI −23.9% to −16.7%) in MLA per 0.10 decrease in vFFR (adjusted P < 0.001). vFFR ≤ 0.80 showed a sensitivity of 56.7% and specificity of 92.5% to detect MLA ≤ 2.5 mm2. Conversely, vFFR had a poor to moderate discriminative ability to detect plaque instability (sensitivity, 46.9%; specificity, 71.6%). Conclusion In patients with NSTE-ACS, vFFR is significantly associated with OCT-detected MLA, and vFFR ≤ 0.80 is highly predictive of the presence of significant disease based on OCT. Conversely, the sensitivity of vFFR ≤ 0.80 to detect OCT-assessed significant disease was low, indicating that the presence of significant OCT findings cannot be ruled out based on a negative vFFR. [ABSTRACT FROM AUTHOR]

This paper addresses the development of computational methods for the needs of interventional cardiology to evaluate coronary hemodynamics in patients with ischemic heart disease (IHD). In particular, the study focuses on the role of hemorheology in determining blood flow in stenotic coronary arteries. An algorithm to quantify the contribution of blood viscosity to vascular resistance (pressure drop - Δ P ) is proposed. The algorithm based on the idea of the contribution of three components to Δ P : anatomical features, stenosis-induced vortex formation, and normal viscous flow in the healthy segment. Data obtained from IHD patient's angiography with catheterization were used for 3D artery reconstruction and boundary conditions set. The analysis was performed considering three plausible blood viscosities in the range of 3.5 - 5.5 mPa s. The Carreau model was used to account for the non-Newtonian blood properties. It was found that the contribution of blood viscosity to Δ P , not related to stenosis anatomy and vessel curvature, can reach up to 45%. Besides, the change of blood can significantly (1.5–2 times) increase the blood viscosity factor to the vessel resistance. The obtained results were interpreted in terms of the invasive fractional flow reserve (FFR) method, one of the most common clinical methods for determining the hemodynamic significance of stenosis. Changes in blood viscosity led to a correction of FFR within 2%. Obtained results are consistent with the results of known clinical observations. A correlation between patient blood viscosity and FFR accuracy is demonstrated. [ABSTRACT FROM AUTHOR]

Introduction: This study was designed to test the hypothesis that coronary artery adaptations during the postpartum period are related to underlying reductions in endothelium-dependent relaxation and/or augmented smooth muscle vasoconstrictor responsiveness. Methods: In vivo experiments were performed in control (nonpregnant) and postpartum swine 35–45 days of postdelivery, with isometric tension experiments performed in isolated coronary arteries from those animals. Results: Coronary artery rings demonstrated increases in active tension generation following incremental increases in passive stretch with no differences between groups. Endothelium-dependent relaxation to bradykinin was attenuated in arteries from postpartum swine versus control (p < 0.005). Concentration-dependent contractions to the thromboxane A2 mimetic U46619 (0.1 nm–1 µm) were shifted rightward (EC50 27 ± 10 nm vs. 238 ± 66 nm; p < 0.01) in arteries from postpartum swine, with no changes in maximum contractile responses (p = 0.68). Intracoronary administration of U46619 (1 nm–1 µm) in open-chest swine decreased coronary blood flow ∼45 ± 3% in nonpregnant controls but had no effect on coronary blood flow in postpartum swine. Concentration-dependent contractions to KCl (5–90 mm) showed a rightward shift in arteries from postpartum swine (15.6 ± 1.4 mm vs. 21.8 ± 1.9 mm; p = 0.03), with no change in maximum response. Taken together, the postpartum period is associated with reduced endothelium-dependent relaxation and responsiveness to receptor-dependent and -independent vasoconstrictor stimuli. Conclusion: These findings indicate that chronic exposure of the coronary circulation to the pregnancy/postpartum milieu results in functional adaptations in sensitivity to paracrine/hormonal compounds that should be further explored. [ABSTRACT FROM AUTHOR]

Timely restoration of blood supply after myocardial infarction is crucial for saving the infarcted myocardium. So far, the most effective method is to restore myocardial oxygenation and coronary blood flow through coronary interventional therapy. However, reperfusion may also lead to greater heart damage due to the reintroduction of molecular oxygen. New treatments are needed to protect the heart from myocardial ischemia-reperfusion injury (MIRI) to improve clinical outcomes in patients with acute myocardial infarction and heart failure (HF). A deeper understanding of the mechanisms of MIRI and the search for new treatments could provide key evidence to mitigate myocardial damage and improve patient survival. At present, it has been found that copper, as a trace element in human body, can have a significant protective effect on MIRI. Copper can reduce apoptosis in cardiomyocytes, that is, control the self-destruction process of cell, so as to reduce the degree of myocardial injury. However, the potential relationship between abnormal copper ion metabolism as well as cuproptosis and MIRI as well as HF has not been explored. In this review, we focus on potential therapeutic strategies for MIRI and understand the metabolic pathways of copper in the human body, so as to provide more options and hope for the treatment of cardiovascular diseases. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to clarify whether Protein kinase B (PKB)/AKT is nitrated in myocardial ischemia and reperfusion injury (MIRI) resveratrol (RSV)'s protective effect during this process. Methods: We blocked blood flow of the left coronary artery (LAD) of mice and used H9c2 cells under an oxygen-glucose deprivation (OGD) environment as animal and cell models of MIRI. N-methyl-D-aspartic acid receptor (NMDAR) inhibitor MK801, neuronal nitric oxide synthase (nNOS) inhibitor 7-NI and RSV were used as interventions. Nitration of proteins, infarction area, cardiomyocyte apoptosis and AKT nitration sites were detected during this study. Results: During in-vivo study, AKT nitration was induced through the NMDAR/nNOS/peroxynitrite (ONOO–) pathway, leading to decreased phosphorylation of AKT and increased cardiomyocyte apoptosis. AKT nitration was decreased and phosphorylation was elevated when administrated with RSV, MK801 and 7-NI. In in-vitro study, AKT nitration and TUNEL positive cells was elevated when administrated with NO donor H9c2 cells after OGD/R, when administrated with RSV, MK801 and 7-NI, AKT nitration and apoptosis was deceased in H9c2 cells. Mass spectrometry revealed that nitration sites of AKT included 14 Tyrosine residues. Discussion: RSV could inhibit AKT nitration and elevated phosphorylation through suppressing NMDAR/nNOS/ONOO– pathway and further reduce the apoptosis of cardiomyocytes in of myocardial I/R. [ABSTRACT FROM AUTHOR]

In the last decade, artificial intelligence (AI) has influenced the field of cardiac computed tomography (CT), with its scope further enhanced by advanced methodologies such as machine learning (ML) and deep learning (DL). The AI‐driven techniques leverage large datasets to develop and train algorithms capable of making precise evaluations and predictions. The realm of cardiac CT is expanding day by day and multiple tools are offered to answer different questions. Coronary artery calcium score (CACS) and CT angiography (CTA) provide high‐resolution images that facilitate the detailed anatomical evaluation of coronary plaque burden. New tools such as myocardial CT perfusion (CTP) and fractional flow reserve (FFRCT) have been developed to add a functional evaluation of the stenosis. Moreover, epicardial adipose tissue (EAT) is gaining interest as its role in coronary artery plaque development has been deepened. Seen the great added value of these tools, the demand for new exams has increased such as the burden on imagers. Due to its ability to fast compute multiple data, AI can be helpful in both the acquisition and post‐processing phases. AI can possibly reduce radiation dose, increase image quality, and shorten image analysis time. Moreover, different types of data can be used for risk assessment and patient risk stratification. Recently, the focus of the scientific community on AI has led to numerous studies, especially on CACS and CTA. This narrative review concentrates on AI's role in the post‐processing of CACS, CTA, FFRCT, CTP, and EAT, discussing both current capabilities and future directions in the field of cardiac imaging. [ABSTRACT FROM AUTHOR]

Accurate modeling of blood dynamics in the coronary microcirculation is a crucial step toward the clinical application of in silico methods for the diagnosis of coronary artery disease. In this work, we present a new mathematical model of microcirculatory hemodynamics accounting for microvasculature compliance and cardiac contraction; we also present its application to a full simulation of hyperemic coronary blood flow and 3D myocardial perfusion in real clinical cases. Microvasculature hemodynamics is modeled with a compliant multi-compartment Darcy formulation, with the new compliance terms depending on the local intramyocardial pressure generated by cardiac contraction. Nonlinear analytical relationships for vessels distensibility are included based on experimental data, and all the parameters of the model are reformulated based on histologically relevant quantities, allowing a deeper model personalization. Phasic flow patterns of high arterial inflow in diastole and venous outflow in systole are obtained, with flow waveforms morphology and pressure distribution along the microcirculation reproduced in accordance with experimental and in vivo measures. Phasic diameter change for arterioles and capillaries is also obtained with relevant differences depending on the depth location. Coronary blood dynamics exhibits a disturbed flow at the systolic onset, while the obtained 3D perfusion maps reproduce the systolic impediment effect and show relevant regional and transmural heterogeneities in myocardial blood flow (MBF). The proposed model successfully reproduces microvasculature hemodynamics over the whole heartbeat and along the entire intramural vessels. Quantification of phasic flow patterns, diameter changes, regional and transmural heterogeneities in MBF represent key steps ahead in the direction of the predictive simulation of cardiac perfusion. [ABSTRACT FROM AUTHOR]

Coronary collateral circulation is a common finding in patients with chronic total occlusions (CTOs) resulting from chronic coronary artery disease (CAD). Regional wall motion abnormalities (RWMA) on transthoracic echocardiography (TTE) can be used for the diagnosis of CAD. However, little work has been done to investigate the impact of collateral vessels on the diagnostic accuracy of resting TTE for CAD. A retrospective chart review was conducted of adults who received a resting TTE and cardiac catheterization within 30 days over a 4-year period at the Temple Baylor Scott & White echocardiography laboratory. Exclusion criteria included catheterization without coronary angiography and prior history of CAD, percutaneous coronary intervention (PCI), or coronary artery bypass graft (CABG). We analyzed RWMA on TTE in patients with CAD and coronary collateral circulation on cardiac catheterization to assess for correlation. Of the 753 patients were included in this study, 453 had CAD, 272 had both CAD and RWMA, 111 had collateral circulation, and 73 had collateral circulation and RWMA. There was no significant difference in RWMA in patients with CAD with and without collateral circulation. There was no significant difference in the sensitivity (60.0 % vs 59.2 %) and specificity (78.4 % vs 73.9 %) after collateral-adjusted interpretation of RWMA and CAD (p = 0.3). Our results suggest the average coronary collateral system is of insufficient clinical significance to prevent the development of RWMA on resting TTE. • Current guidelines support the use of resting TTE in suspected occlusive coronary artery disease when data are insufficient to warrant cardiac catheterization. • However, do regional wall motion abnormalities (RWMA) on resting echocardiography (TTE) correlate with obstructive coronary disease (CAD) via angiography? • The sensitivity and specificity of RWMA on TTE for detecting CAD in adults was 49.5 % and 78.8 %, respectively. • There was no difference in patients with CAD or chronic total occlusions (CTOs) with collateral circulation in protecting from RWMAs. • Collateral circulation for CTOs might be insufficient to provide adequate blood flow to prevent against myocardial damage and revascularization should be considered. [ABSTRACT FROM AUTHOR]

Background: Coronary microvascular disease is associated with adverse prognosis in a range of cardiovascular diseases, but its prognostic role in patients with aortic stenosis (AS) is unclear. The aim of this systematic review and meta-analysis is to determine the prognostic role of myocardial perfusion and coronary flow reserve, assessed using non-invasive imaging modalities, in patients with AS. Methods: We conducted a systematic review and meta-analysis of all studies assessing myocardial perfusion reserve (MPR) or coronary flow reserve (CFR) in patients with AS and reporting clinical outcomes, from inception to January 2024. The definition of abnormal MPR/CFR and major adverse cardiovascular events (MACE) was that used in each study. Estimates of effect were calculated from hazard ratios (HRs) and 95% confidence intervals (CIs) using a random-effects model. Results: Four studies comprising 384 participants met the inclusion criteria. Myocardial/coronary blood flow was assessed using Doppler echocardiography (n = 2), PET (n = 1), or cardiac magnetic resonance (n = 1). The median optimal cutoff for MPR/CFR across all studies was 2.01 (range 1.85–2.13), with 109 events. Impaired MPR/CFR was associated with a higher incidence of MACE (HR 3.67, 95% CI: 1.66, 8.09, I2 = 63%) in the overall population. Conclusions: Reduced MPR/CFR is associated with increased risk of MACE in patients with AS, although significant heterogeneity exists in published studies. Further studies are required to establish its role in the risk stratification of asymptomatic patients with AS. [ABSTRACT FROM AUTHOR]

Chronic kidney disease (CKD) predisposes to cardiac remodeling and coronary microvascular dysfunction. Studies in swine identified changes in microvascular structure and function, as well as changes in mitochondrial structure and oxidative stress. However, CKD was combined with metabolic derangement, thereby obscuring the contribution of CKD alone. Therefore, we studied the impact of CKD on the heart and combined proteome studies with measurement of cardiac function and perfusion to identify processes involved in cardiac remodeling in CKD. CKD was induced in swine at 10–12 weeks of age while sham-operated swine served as controls. 5–6 months later, left ventricular (LV) function and coronary flow reserve were measured. LC–MS–MS-based proteomic analysis of LV tissue was performed. LV myocardium and kidneys were histologically examined for interstitial fibrosis and oxidative stress. Renal embolization resulted in mild chronic kidney injury (increased fibrosis and urinary NGAL). PV loops showed LV dilation and increased wall stress, while preload recruitable stroke work was impaired in CKD. Quantitative proteomic analysis of LV myocardium and STRING pre-ranked functional analysis showed enrichments in pathways related to contractile function, reactive oxygen species, and extracellular matrix (ECM) remodeling, which were confirmed histologically and associated with impaired total anti-oxidant capacity. H2O2 exposure of myocardial slices from CKD, but not normal swine, impaired contractile function. Furthermore, in CKD, mitochondrial proteins were downregulated suggesting mitochondrial dysfunction which was associated with higher basal coronary blood flow. Thus, mild CKD induces alterations in mitochondrial proteins along with contractile proteins, oxidative stress and ECM remodeling, that were associated with changes in cardiac function and perfusion. [ABSTRACT FROM AUTHOR]

Blood flow through the coronary vasculature is essential to maintain myocardial function. As the metabolic demand of the heart increases, so does blood flow through the coronary arteries in a dynamic and adaptive manner. Several mechanisms, including local metabolic factors, mechanical forces and autonomic neural control, regulate coronary artery blood flow. To date, neural control has predominantly focused on the classical neurotransmitters of noradrenaline and acetylcholine. However, autonomic nerves, sympathetic, parasympathetic and sensory, release a variety of neurotransmitters that can directly affect the coronary vasculature. Reduced or altered coronary blood flow and autonomic imbalance are hallmarks of most cardiovascular diseases. Understanding the role of autonomic non‐adrenergic, non‐cholinergic cotransmitters in coronary blood flow regulation is fundamental to furthering our understanding of this vital system and developing novel targeted therapies. What is the topic of this review?How non‐adrenergic, non‐cholinergic neural mechanisms regulate coronary artery blood flow.What advances does it highlight?The main coronary arteries dynamically adapt to maintain adequate blood flow to the working myocardium. There is growing evidence for an important role of non‐classic neurotransmitters in regulating coronary blood flow. This review highlights current evidence for non‐adrenergic, non‐cholinergic control of coronary artery blood flow and our understanding of the dynamics of this system. [ABSTRACT FROM AUTHOR]

Aims Dynamic stress computed tomography (CT) perfusion is a non-invasive method for quantifying myocardial ischaemia by assessing myocardial blood flow (MBF). In this meta-analysis, we evaluated the diagnostic accuracy of dynamic CT perfusion for the detection of significant coronary artery disease (CAD) across various CT scanners, obese patients, and its prognostic value. Methods and results We systematically searched PubMed, Embase, Web of Science, and Cochrane library for published studies evaluating the accuracy of CT myocardial perfusion in diagnosing functional significant ischaemia by invasive fractional flow reserve. The diagnostic performance of dynamic CT perfusion in detecting ischaemia was evaluated using a summary receiver operating characteristic (sROC) curve. A total of 23 studies underwent meta-analysis. In myocardial region without ischaemia, MBF was measured at 1.39 mL/min/g [95% confidence interval (CI) 1.25–1.54], while in region with ischaemia, it was 0.92 mL/min/g (95% CI 0.83–1.01) (P < 0.001). On the patient-based analysis, the area under the sROC curve of CT-MBF was 0.92, with a sensitivity of 0.82 and specificity of 0.86. Differences in CT type (dual source vs. single source), and body mass index did not significantly affect the diagnostic performance. The pooled hazard ratio of dynamic CT perfusion for predicting adverse events was 4.98 (95% CI 2.08–11.93, P ≤ 0.001, I 2 = 61%, P for heterogeneity = 0.07). Conclusion Dynamic CT perfusion has high diagnostic performance in the quantitative assessment of ischaemia and detection of functional myocardial ischaemia as defined by invasive FFR and may be useful in risk stratification of CAD patients. [ABSTRACT FROM AUTHOR]

Copyright of Kufa Medical Journal is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: Our goal was to evaluate the associations between postoperative coronary perfusion pressure (CPP) values and in-hospital outcomes in infants after congenital cardiac surgery. Our goal was to assess the relationship between postoperative coronary perfusion pressure (CPP) values and in-hospital outcomes in infants following congenital cardiac surgery. Methods: In this study, we conducted a retrospective analysis on a cohort of 296 consecutive infant patients (aged 31–120 days) who underwent congenital cardiac surgery between 1 January 2019 and 30 April 2019. A total of 208 patients undergoing congenital cardiac surgery were included. The primary poor in-hospital outcome was prolonged recovery. The association between CPP level and in-hospital outcomes was determined using logistic regression analysis. We also used restricted cubic splines (RCSs) to evaluate the nonlinear relationship. Results: Our study included 208 participants, among whom the mortality rate was 1%. Prolonged hospital length of stay (LOS) was defined as more than 15 days, prolonged mechanical ventilation (MV) stay as more than 96 h, and prolonged intensive care unit (ICU) LOS as more than 403 h. In univariate analyses, we found that prolonged recovery was associated with both low CPP levels (p < 0.001, OR 4.28, 95% CI 1.94–9.46) and high CPP levels (p = 0.003, OR 3.39, 95% CI 1.52–7.58). In multivariable logistic regression analysis, after full adjustment, low CPP levels and high CPP levels were significantly associated with prolonged recovery (p = 0.005, OR = 3.72, 95% CI 1.48–9.35 and p < 0.001, OR = 6.04, 95% CI 2.32–15.72, respectively). We observed that the relationship between CPP level and poor in-hospital outcomes was U-shaped in a two-piecewise linear regression analysis. We found that the inflection point of CPP level for prolonged recovery was 47 mm Hg. Conclusion: The CPP levels exhibited a nonlinear relationship with poor in-hospital outcomes. [ABSTRACT FROM AUTHOR]

Coronary flow capacity (CFC) integrates quantitative assessment of hyperemic myocardial blood flow and coronary flow reserve. We aimed to evaluate the effect of elective percutaneous coronary revascularization (PCI) on CFC using serial stress transthoracic Doppler echocardiography (STDE). Overall, 148 stable patients underwent STDE of the left anterior descending arteries (LAD), before and after elective PCI. Coronary flow velocity reserve (CFVR) was measured using basal and hyperemic diastolic peak velocity (hDPV). Vessels were classified into four CFC categories: severely, moderately, or mildly reduced CFC, and normal flow. Changes in hDPV and CFC status post-PCI, as well as predictors of hDPV increase, were assessed. Despite improvements in fractional flow reserve (FFR) in all cases, 31 cases (20.9%) showed a decrease in hDPV following PCI. Vessels with ischemic CFC, defined as moderately or severely reduced CFC, decreased from 46.6% (69/148) to 19.6% (29/148) post-PCI. Conversely, CFC worsened in 15.5% of patients. Multivariable analysis showed lower pre-PCI hDPV and ischemic CFC were independently predictive of higher-level (> 50%) hDPV increase after PCI. Approximately 20% of FFR-guided LAD PCI resulted in decreased hDPV. CFC deterioration was not uncommon despite FFR improvement. Preprocedural non-invasive STDE may help identify lesions that benefit from revascularization. [ABSTRACT FROM AUTHOR]

The article discusses the prevalence of heart failure (HF) as a major disease burden in Europe, exacerbated by comorbidities such as chronic kidney disease, anaemia, obesity, and diabetes. It highlights the systemic nature of HF, requiring an interdisciplinary approach for prevention and treatment. The new COST Action EU-METAHEART aims to address metabolic alterations in HF through research areas focusing on cardiomyocyte metabolism, coronary vascular dysfunction, immunometabolism, and mitochondrial redox alterations. The Action seeks to improve understanding, identify treatment targets, and train the next generation of scientists in this field. [Extracted from the article]

Objectives: Residual dissection is a concern in endovascular treatment with a DCB, and there is limited knowledge of hemodynamics at a dissection lesion. Therefore, the objective of this study is to evaluate the mean pressure gradient (MPG) and fractional flow reserve (FFR) at a residual dissection after DCB angioplasty for the superficial femoral artery (SFA). Methods: A total of 59 cases with residual SFA dissection treated with DCB angioplasty at a single center were analyzed retrospectively. The dissection was classified into 6 types (A-F). The primary endpoints were MPG and FFR at a residual dissection lesion after DCB angioplasty, using evaluation with a pressure wire. Results: The median lesion length was 70 (40-130) mm with 24% popliteal involvement, and 11 cases (18%) had chronic total occlusion. A completion angiogram revealed dissection of types A (n = 33, 56%), B (n = 18, 31%), C (n = 7, 12%), and D (n = 1, 2%). The median MPGs in type A, B, and C cases were 0 (0-2), 0 (0-4), and 3 (0-6) mmHg, with a significant lower in type C cases than in type A cases (A vs C, P =.021). The median FFRs in type A, B, and C cases of 1.0 (.98-1.00), 1.0 (.96-1.00), and.98 (.95-1.00) did not differ significantly among dissection types (A vs B, P =.86; A vs C, P =.055; B vs C, P =.15). Conclusions: This is the first report of hemodynamics at a SFA dissection. The results suggest that low-grade dissection (types A or B) does not affect MPG and FFR at a SFA lesion. This indicates that a bailout stent may be unnecessary for patients with dissection of types A or B. A further investigation is needed to determine whether a scaffold is required for a SFA lesion with type C dissection. [ABSTRACT FROM AUTHOR]

Hypoxia, or the lack of oxygen, has multiple impacts on the vascular system. The major molecular sensors for hypoxia at the cellular level are hypoxia inducible factor and heme oxygenase. Hypoxia also acts on the vasculature directly conveying its damaging effects through disruption of the control of vascular tone, particularly in the coronary circulation, enhancement of inflammatory responses and activation of coagulation pathways. These effects could be particularly detrimental under pathological conditions such as obstructive sleep apnea and other breathing disorders. Introduction: The effect of conjugate 2-(3,4-Dihydroxyphenyl)-6-{[1-(2'-bromo-3',4'-dimethoxyphenyl)-6,7-dimethoxy-3,4-dihydroisoquinolin-2(1H)-yl]methyl}-3,5,7-trihydroxychroman-4-one (DHQ-11) on hypoxia-induced vasorelaxation was investigated in rat aortic rings using standard organ bath techniques. Materials and methods: Hypoxia was stimulated by a superfusion of aortic rings with a glucose-free Krebs solution bubbled with 95% N2/5% CO2. The effect of conjugate DHQ-11 was assessed after a 60-min period of hypoxia on aortic rings precontracted with 50 mM KCl or 1µM phenylephrine (PE). The conjugate DHQ-11 significantly attenuated hypoxia-induced vasorelaxation in the endothelium-intact aortic rings precontracted with KCl or PE in a concentration-dependent manner. Results and discussion: This effect of conjugate DHQ-11 was more potent in aortic rings precontracted with PE than those with KCl where it maximally reduced hypoxia-induced vasorelaxation from 44.7 ± 3.7 to 5.4 ± 3.7 and 33.9 ± 3.4 to 10.8 ± 4.2%, respectively. The removal of the endothelium attenuated the effect of conjugate DHQ-11 on hypoxia-induced vasorelaxation. Similarly, pretreatment of endothelium-intact aortic rings with L-NAME and methylene blue also attenuated the effect of conjugate DHQ-11 on hypoxia-induced vasorelaxation. Furthermore, the blockade of the ATP-sensitive KATP channel with glibenclamide and the calcium-activated large conductance BKCa channel with TEA also significantly attenuated the effect of conjugate DHQ-11 on hypoxia-induced vasorelaxation. Collectively, these results indicated that conjugate DHQ-11 attenuated the hypoxia-induced vasorelaxation suggesting that it alleviated the oxidative damage of vasculature. Conclusions: This effect of conjugate DHQ-11 possible is mediated through several mechanisms including the blockage of the extracellular Ca2+ entry via the voltage-dependent and receptor-operative Ca2+ channels, as well as inhibition of sarcoplasmic reticulum Ca2+ release via the inositol triphosphate pathway. In addition, endothelium and NO/sGC/cGMP/PKG pathway, as well as KATP and BKCa channels most likely participate in protection by conjugate DHQ-11 against hypoxia-induced vasorelaxation. [ABSTRACT FROM AUTHOR]

Coronary microvascular dysfunction is a clinical condition very diffuse in many different settings. Often the diagnosis can be very tricky, and choosing the proper diagnostic strategy can be fundamental for reaching the goal. The aim of this review is to evaluate the properties and the feasibility of our tests in specific scenarios by looking at the performances of each methodology reported in the literature. [ABSTRACT FROM AUTHOR]

This study investigated the effect of ticagrelor combined with nicorandil on endothelial function and coronary blood flow after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). We retrospectively analyzed 300 STEMI patients who underwent emergency PCI, 150 in the observation group and 150 in the control group. The control group was given oral ticagrelor. The observation group received oral nicorandil along with the control group. A significant improvement in peak ejection rate (PER) and left ventricular (LV) ejection fraction (EF) occurred after the operation, while LV end-diastolic volume index (LVESVI), LV end-diastolic internal diameter (LVEDD), cardiac troponin I (cTnI), and creatine kinase myoglobin (CK-MB) were significantly reduced compared to the preoperative period. Improvements in cardiac function were significantly greater in the observation group than in the control group (p < 0.05). After the operation, both groups' serum nitric oxide (NO) and endothelin-1 (ET-1) levels were greatly higher and lower, respectively, during the preoperative period (p < 0.05). The observation group's serum NO level was significantly higher than the control group's, and its ET-1 level was substantially lower than the control group's (p < 0.05). There was a significant increase in thrombolysis in myocardial infarction (TIMI) flow grade 3 percentage and TIMI myocardial perfusion grade (TMPG) grade 3 percentage in the observation group in the immediate postoperative period compared to the control group, despite a significantly lower corrected TIMI Frame count (CTFC) (p < 0.05). 1 month postoperatively, major adverse cardiovascular events (MACE) incidence was significantly lower in the observation group than in the control group (χ2 = 3.914, p = 0.048). The preoperative combination of ticagrelor and nicorandil in STEMI patients undergoing PCI helped attenuate vascular endothelial function impairment, improved coronary blood flow, and promoted postoperative cardiac function recovery. [ABSTRACT FROM AUTHOR]

Background: This study examines the role of extracorporeal life support flow in the development of acute kidney injury in cardiogenic shock. Methods: We performed a retrospective analysis of 465 patients placed on extracorporeal life support at our institution between January 2015 and December 2020 for cardiogenic shock. Flow index was calculated by dividing mean flow by body surface. Stages of acute kidney injury were determined according to Kidney Disease: Improving Global Outcomes (KDIGO) organization guidelines. Results: There were 179 (38.5%) patients who developed acute kidney injury, 63.1% of which were classified as Stage 3--the only subgroup associated with 1-year mortality (hazard ratio = 2.03, p <.001). Risk of k idney injury increased up to a flow index of 1.6 L/min/m2, and kidney injury was more common among patients with flow index greater than 1.6 L/min/m2 (p =.034). Those with kidney injury had higher baseline lactate levels (4.4 vs 3.1, p =.04), and Stage 3 was associated wit higher baseline creatinine (p <.001). Conclusions: In our cohort, kidney injury was common and Stage 3 kidney injury was associated with worse outcomes compared to other stages. Low flow was not associated with increased risk of kidney injury. Elevated baseline lactate and creatinine among patients with acute kidney injury suggest underlying illness severity, rather than flow, may influence kidney injury risk. [ABSTRACT FROM AUTHOR]

Antegrade cardioplegia is routinely given during cardiac surgery. The delivery of antegrade cardioplegia from the cardiopulmonary bypass machine has many variables. Many perfusionists rely exclusively on cardioplegia system pressure to ensure safe antegrade delivery. Our group reviewed antegrade cardioplegia delivery in 50 patients undergoing coronary artery bypass graft. The data collected included the cardioplegia system pressure and the patient's direct aortic root pressure. The analysis of the data found weak correlation between the two pressures with a large mean difference and a wide standard deviation. The results suggest the direct measurement of aortic root pressure as guidance to antegrade cardioplegia instead of relying solely on cardioplegia system pressure. [ABSTRACT FROM AUTHOR]

The article offers a look at technological advancements in cardiac computed tomography (CT). Topics discussed include access to the cardiac catheterization laboratory, energy-integrating detectors, photon-counting detectors and spectral photon-counting CT, image reconstruction relative advances in artificial intelligence (AI) and deep learning, and CT-guided coronary risk stratification and cardiac preventative care.

The article published in the European Heart Journal Open in 2024 explores the association between antibodies against angiotensin II type 1 and endothelin-1 type A receptors with microvascular obstruction after revascularized ST-elevation myocardial infarction. The study conducted at the University of Padua Hospital involved 56 patients who underwent cardiac magnetic resonance imaging. Results indicated a higher prevalence of microvascular obstruction in patients with seropositivity for these antibodies, suggesting a potential cumulative effect on the risk of microvascular damage post-STEMI. Further research is needed to understand the molecular mechanisms underlying this association and develop new therapies for microvascular obstruction. [Extracted from the article]

Background The utilization of postdilatation in primary percutaneous coronary intervention (PCI) is feared to induce suboptimal coronary blood flow and compromise the outcome of the patients. This meta-analysis sought to verify whether postdilatation during primary PCI is associated with worse angiographic or long-term clinical outcomes. Methods Systematic literature searches were conducted on PubMed, The Cochrane Library, ClinicalTrials.gov , EBSCO, and Europe PMC on 10 March 2024. Eligible studies reporting the outcomes of postdilatation among ST-segment elevation myocardial infarction patients were included. The primary outcome was no-reflow condition during primary PCI based on angiographic finding. The secondary clinical outcome was major adverse cardiovascular events (MACEs) comprising all-cause death, myocardial infarction, target vessel revascularization (TVR), and stent thrombosis. Results Ten studies were finally included in this meta-analysis encompassing 3280 patients, which was predominantly male (76.6%). Postdilatation was performed in 40.7% cases. Postdilatation was associated with increased risk of no-reflow during primary PCI [Odd Ratio (OR) = 1.33, 95% Confidence Interval (CI): 1.12–1.58; P =.001)]. Conversely, postdilatation had a tendency to reduce MACE (OR = 0.70, 95% CI: 0.51–0.97; P =.03) specifically in terms of TVR (OR = 0.41, 95% CI: 0.22–0.74; P =.003). No significant differences between both groups in relation to mortality (OR = 0.58, 95% CI: 0.32–1.05; P =.07) and myocardial infarction (OR = 1.5, 95% CI: 0.78–2.89; P =.22). Conclusions Postdilatation after stent deployment during primary PCI appears to be associated with an increased risk of no-reflow phenomenon after the procedure. Nevertheless, postdilatation strategy has demonstrated a significant reduction in MACE over the course of long-term follow-up. Specifically, postdilatation significantly decreased the occurrence of TVR. Key messages: What is already known on this topic? Optimizing stent deployment by performing postdilatation during percutaneous coronary intervention (PCI) is essential for long-term clinical outcomes. However, its application during primary PCI is controversial due to the fact that it may provoke distal embolization and worsen coronary blood flow. What this study adds? In this systematic review and meta-analysis of 10 studies, we confirm that postdilatation during primary PCI is associated with worse coronary blood flow immediately following the procedure. On the contrary, this intervention proves advantageous in improving long-term clinical outcomes, particularly in reducing target vessel revascularization. How this study might affect research, practice, or policy? Given the mixed impact of postdilatation during primary PCI, this strategy should only be applied selectively. Future research should focus on identifying patients who may benefit from such strategy. [ABSTRACT FROM AUTHOR]

Background: Optimal medical therapy (OMT) is increasingly recognized as a cornerstone in managing chronic coronary syndrome (CCS), offering a non-invasive alternative to percutaneous coronary intervention (PCI). Case Presentation: A 38-year-old male with diabetes, dyslipidemia, and hypertension was treated with early and comprehensive OMT, including statins, ezetimibe, sodium-glucose cotransporter 2 inhibitors (SGLT2i), pioglitazone, and renin-angiotensin system inhibitors. Insulin was introduced during the acute phase to stabilize glycemic control. His HbA1c decreased to 6.3% within 4 months. Results: Over 8 months, the patient experienced a reduction in coronary plaque burden and an improvement in fractional flow reserve (FFR) from 0.75 to 0.90, indicating enhanced coronary blood flow. Plaque volume burden decreased from 85% to 52% in key coronary segments. Conclusions: This case highlights the effectiveness of OMT, including statins, ezetimibe, SGLT2i, and pioglitazone, in achieving outcomes comparable to PCI. FFR-computed tomography follow-up is critical in guiding treatment decisions. Continued OMT is recommended if plaque stabilization is observed. If no improvement is observed, OMT should be intensified, and PCI considered as appropriate. [ABSTRACT FROM AUTHOR]

Background Pulsed field ablation (PFA) is a novel ablation technology. A rare side-effect is the occurrence of mostly subclinical coronary spasms when PF energy is applied in proximity to coronary arteries. However, it has been described that prior application of nitroglycerin attenuates these effects. Case summary A 75-year-old female underwent catheter ablation with a penta-spline PFA catheter. After pulmonary vein isolation, the PFA catheter was positioned on the cavotricuspid isthmus (CTI). Before ablation, 2 mg of nitroglycerin was administered intravenously. After 10 PFA applications, the CTI was successfully blocked. After a timely delay of 95 s, a clinically apparent vasospasm with ST elevations in leads II, III, and aVF on the electrocardiogram was noticed. Shortly thereafter, the clinical course was aggravated by haemodynamically relevant non-sustained ventricular tachycardias (nsVTs) followed by asystole, requiring pacing and additional 4 mg of nitroglycerin. Twelve minutes later, a stable sinus rhythm with normalized ST segments was restored. The spasm resolved without any sequelae. Post-procedural coronary angiogram showed right dominant coronary circulation. Discussion This is the first report of a timely delayed, clinically apparent coronary spasm with a presentation of haemodynamically relevant nsVT and asystole despite the prophylactic application of high-dose intravenous nitroglycerin prior to PFA along the CTI. Subclinical vasospasm during PFA at the CTI has been described before. Severe spasms could be prevented by nitroglycerin. A word of caution needs to be raised as prophylactic nitroglycerin did not prevent the haemodynamically relevant coronary spasm in the here reported patient. Until now, it remains unclear how much later such effects may occur; therefore, patients should be monitored closely. [ABSTRACT FROM AUTHOR]

Objective: This study aims to assess the consistency of various CT-FFR software, to determine the reliability of current CT-FFR software, and to measure relevant influence factors. The goal is to build a solid foundation of enhanced workflow and technical principles that will ultimately improve the accuracy of measurements of coronary blood flow reserve fractions. This improvement is critical for assessing the level of ischemia in patients with coronary heart disease. Methods: 103 participants were chosen for a prospective research using coronary computed tomography angiography (CCTA) assessment. Heart rate, heart rate variability, subjective picture quality, objective image quality, vascular shifting length, and other factors were assessed. CT-FFR software including K software and S software are used for CT-FFR calculations. The consistency of the two software is assessed using paired-sample t-tests and Bland-Altman plots. The error classification effect is used to construct the receiver operating characteristic curve. Results: The CT-FFR measurements differed significantly between the K and S software, with a statistical significance of P < 0.05. In the Bland-Altman plot, 6% of the points (14 out of 216) fell outside the 95% consistency level. Single-factor analysis revealed that heart rate variability, vascular dislocation offset distance, subjective image quality, and lumen diameter significantly influenced the discrepancies in CT-FFR measurements between two software programs (P < 0.05). The ROC curve shows the highest AUC for the vessel shifting length, with an optimal cut-off of 0.85 mm. Conclusion: CT-FFR measurements vary among software from different manufacturers, leading to potential misclassification of qualitative diagnostics. Vessel shifting length, subjective image quality score, HRv, and lumen diameter impacted the measurement stability of various software. [ABSTRACT FROM AUTHOR]

Introduction and aim: External validations of the Good Outcome Following Attempted Resuscitation (GO-FAR) score have been in populations where Do Not Attempt Resuscitation (DNAR) is practised. We aim to externally validate the GO-FAR score in a population without a DNAR order. Methods: We studied patients ≥ 18 years old who had an In-hospital cardiac arrest (IHCA) with known outcomes at Al Ain Hospital from January 2017 to December 2019, excluding those who died in the emergency department. Studied variables included demography, location, response time, code duration, initial rhythm, primary diagnosis, admission vital signs, GO FAR score variables, discharge status, and functional outcomes as determined by the cerebral performance category score ranging from 1 (good cerebral performance) to 5 (brain death). Results: 366 patients were studied; 66.7% were males. The median (IQR) age was 70 (55–81) years. Cardiac and respiratory causes were the primary diagnoses in 89 (24.6%) and 67 (18.5%), respectively. IHCA occurred in critical areas such as the intensive care unit, high dependency unit and coronary care unit in 206 (80.8%) patients. The majority, 308 (91.8%), had a non-shockable rhythm, and a return of spontaneous circulation was achieved in 159 (43.4%) of the patients. Thirty-one (8.5%) patients survived to hospital discharge, and 20 (5.5%) patients had cerebral performance category scores of 1 and 2. The area under the curve of the ROC for survival to discharge with good functional outcome was 0.74 (95% CI 0.59–0.88). The best cut-off point for predicting survival with a good neurological outcome was a GO-FAR score of < 4, having a sensitivity of 0.81, a specificity of 0.7, a positive likelihood ratio of 2.7 and a negative likelihood ratio of 0.27. Conclusions: A GO-FAR score of less than 4 predicts survival with a good neurological outcome in a healthcare system with an all-inclusive patient population with no DNAR practice. [ABSTRACT FROM AUTHOR]

Background/Objectives: Truncus arteriosus communis (TAC) is a rare congenital heart defect characterized by a single arterial trunk that supplies systemic, pulmonary, and coronary circulations. This defect, constituting approximately 1–4% of congenital heart diseases, poses significant challenges in prenatal diagnosis, management, and postnatal outcomes. Methods: A retrospective analysis was conducted at the local tertiary referral center on cases of TAC diagnosed prenatally between 2019 and 2024. Additionally, a systematic literature review was performed to evaluate the accuracy of prenatal diagnostics and the presence of associated anomalies in fetuses with TAC and compare already published data with the local results. The review included studies that especially described the use of fetal echocardiography, the course and outcome of affected pregnancies, and subsequent management strategies. Results: The analysis of local prenatal diagnoses revealed 14 cases. Of the 11 neonates who survived to birth, the TAC diagnosis was confirmed in 7 instances. With all seven neonates undergoing surgery, the intention-to-treat survival rate was 86%, and the overall survival rate was 55%. By reviewing published case series, a total of 823 TAC cases were included in the analysis, of which 576 were diagnosed prenatally and 247 postnatally. The presence of associated cardiac and extracardiac manifestations as well as genetic anomalies was common, with a 22q11 microdeletion identified in 27% of tested cases. Conclusions: Advances in prenatal imaging and early diagnosis have enhanced the management of TAC, allowing for the detailed planning of delivery and immediate postnatal care in specialized centers. The frequent association with genetic syndromes underscores the importance of genetic counseling in managing TAC. An early surgical intervention remains crucial for improving long-term outcomes, although the condition is still associated with significant risks. Long-term follow-up studies are essential to monitor potential complications and guide future management strategies. Overall, a coordinated multidisciplinary approach from prenatal diagnosis to postnatal care is essential for improving outcomes for individuals with TAC. [ABSTRACT FROM AUTHOR]

This article provides information on various emergencies that can occur during the postpartum period. It discusses common causes of maternal death, such as infection, hemorrhage, cardiomyopathy, and mental health-related conditions. The article also addresses the increased risk of cardiovascular diseases during this time and provides information on the diagnosis and management of conditions like peripartum cardiomyopathy and pregnancy-associated myocardial infarction. Additionally, it covers specific medical conditions related to pregnancy and the postpartum period, including venous thromboembolism, stroke, and hypertensive disorders. The document emphasizes the importance of prompt recognition and management of these emergencies to prevent adverse outcomes and provides resources for further information and support. [Extracted from the article]

Introduction: AMI is the leading cause of death for both men and women all over the world. Acute myocardial infarction is myocardial necrosis resulting from acute obstruction of coronary artery. Calcium ions are involved in myocardial contraction, and during acute myocardial infarction. The disruption of blood flow to the heart muscle can lead to an imbalance in calcium levels. This disruption can cause calcium overload with myocardial cells, leading to cellular injury and dysfunction. Magnesium has properties of myocardial cryoprotection, the pathophysiological explanations of which in açute myocardial infarction include prevention of arrythmia, antiplatelet effect, prevention of reperfusion injury and coronary vasodilation. Increased serum uric acid (SUA) levels have been associated with various pathologic processes such as increased oxidative stress, inflammation and endothelial dysfunction. Troponin I is highly specific to cardiac muscle so its presence in the blood stream is a reliable indicator of heart muscle damage. The Elevation in troponin I levels is used as a diagnostic marker for AMI. Material and Methods:A comparative and cross-sectional study was conducted in the Department of Biochemistry in Rangaraya Medical College, Kakinada over a period of 4 months. Sampling Type: Casual sampling of newly diagnosed AMI patients attending the OPD. Controls are recruited from healthy individuals attending the OPD for health checkup. Sample Size: 50 newly diagnosed AMI patients constitute group 1, 50 age and sex matched healthy individuals in group 2. Results: The Group 1 has a higher mean age (54.36±6.70 years) compared to Group 2 (51.3±7.98 years), suggesting that on average, participants in Group 1 are older than those in Group 2. The higher mean calcium level in Group 2 (9.276±1.24 mg/dl) compared to Group 1 (8.548±1.73 mg/dl) suggests that, on average, participants in Group 2 have higher calcium levels than those in Group 1. Comparing the two groups:- Group 2 has a higher mean magnesium level (2.062 mg/dl) compared to Group 1 (1.892 mg/dl). The standard deviation for magnesium levels is smaller in Group 2 (0.41) compared to Group 1 (0.71), indicating that magnesium levels in Group 2 are less variable around the mean compared to Group 1. Group 1 has a mean uric acid level of 7.824 mg/dl with a standard deviation of 5.95 mg/dl. Group 2 has a mean uric acid level of 6.188 mg/dl with a standard deviation of 2.10 mg/dl. Group 1 has a mean Troponin I level of 4463 pg/ml with a standard deviation of 5226.92 pg/ml. Group 2 has a mean Troponin I level of 10.048 pg/ml with a standard deviation of 14.03 pg/ml. Conclusion: Acute MI is the 3rd largest cause of death in the population. If untreated it causes necrosis of the myocardium and finally death of the patient. Magnesium has cytoprotective properties, anti-platelet effect, prevents arrhythmias and reperfusion injury and coronary vasodilation. So it should be estimated. Calcium ions are involved in myocardial contraction. It plays a role in coagulation cascade. It forms blood clots that obstruct blood flow so medications targeting calcium channel to reduce myocardial oxygen load and improve coronary circulation. Uric acid may be a marker for increased cardiovascular risk. Troponin I is highly specific and diagnostic of acute MI. [ABSTRACT FROM AUTHOR]

Successful reperfusion of myocardial tissue is the goal of primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the association between the De Ritis ratio (AST/ALT) and myocardial reperfusion in patients with STEMI who underwent pPCI. We retrospectively investigated 1236 consecutive patients who were hospitalized for STEMI and underwent pPCI. ST-segment resolution (STR) was defined as the return of the deviated ST-segment to baseline; poor myocardial reperfusion was defined as <70% STR. Patients were divided into 2 groups according to the median De Ritis ratio (.921); 618 patients (50%) were assigned to the De Ritis low group while 618 patients (50%) were assigned to the De Ritis high group. Stent size, neutrophil-to lymphocyte ratio (NLR), and the De Ritis ratio found to be associated with poor myocardial reperfusion (Odds ratio (OR) 1.45, 95% CI 1.07–1.98, P =.01, OR 1.22, 95% CI 1.01–1.48, P =.03 and OR 10.9, 95% CI 7.9–15, P <.001, respectively). A high De Ritis ratio was associated with poor myocardial reperfusion in STEMI patients who underwent pPCI. As an easily obtainable test in clinical practice, the De Ritis ratio may help identify patients at major risk for impaired myocardial perfusion. [ABSTRACT FROM AUTHOR]

Dyslipidemia is an important risk factor for cardiovascular morbidity and mortality. Although low-density lipoprotein (LDL) is primarily responsible, the importance of triglyceride (TG) and high-density lipoprotein (HDL) has also been recognized. The present study investigated the effect of the atherogenic index of plasma (AIP), in which atherogenic and protective lipoproteins were evaluated together, on the initial flow in patients with ST elevation myocardial infarction. AIP was calculated as log(TG/HDL-cholesterol). Patients included in the study (n = 1535) were divided into Thrombolysis in Myocardial Infarction (TIMI) flow grade 0 and >0. AIP was found to be significantly different between 2 groups (.55 ±.23 vs.67 ±.21; P <.001). AIP was an independent predictor for pre-intervention TIMI flow (Odds Ratio: 2.778). A moderate correlation was found between TIMI frame count measurements, calculated in patients with TIMI 2–3, and AIP (Pearson correlation coefficient:.63, P <.001). In the receiver operating characteristic analysis, AIP showed the highest area under curve (AUC) compared with other lipid parameters for predicting vascular patency. The AUC of AIP was.634, the cut-off value was.59, and the sensitivity and specificity were 67.6% and 68.4%, respectively (P <.001). In conclusion, AIP was found to be an important marker affecting pre-percutaneous coronary intervention TIMI flow. [ABSTRACT FROM AUTHOR]

Coronary artery ectasia (CAE) is a rare vascular phenotype characterized by abnormal dilation of blood vessels and disruption of coronary artery blood flow, which may promote thrombosis and an inflammatory response. We performed a cross-sectional study to investigate the association of white blood cells to mean platelet volume ratio (WMR) with CAE. Consecutive eligible patients (n = 492) were divided into two groups: including 238 patients with CAE and 254 patients in the normal coronary artery (NCA) group. WMR, the systemic immune-inflammation index (SII), and neutrophil-to-lymphocyte ratio (NLR) were found to be significantly associated with CAE in both univariate and multivariate logistic regression analyses. In multivariate analysis, the presence of WMR was associated with CAE (the odds ratios (OR) = 1.002, 95% CI: 1.001–1.003, P <.001). In the ROC analysis, the statistics (Z-values) of WMR vs SII and WMR vs NLR were 2.427 and 2.670 and were statistically significant (P =.015 and P =.008), indicating that WMR was superior to SII and NLR in distinguishing WMR. The optimal cut-off value was calculated from the point of maximal sensitivity and specificity by using Youden's index, which was determined to be 635.50. WMR has the potential to be a cost-effective tool to monitor CAE. [ABSTRACT FROM AUTHOR]

Patients with unstable angina present clinical characteristics of atherosclerotic plaque vulnerability, contrary to chronic coronary syndrome patients. The process of athersclerotic plaque destabilization is also regulated by microRNA particles. In this study, the investigation on expression levels of microRNAs inhibiting the expression of proteins that protect from atherosclerotic plaque progression (miR-92a inhibiting KLF2, miR-10b inhibiting KLF4, miR-126 inhibiting MerTK, miR-98 inhibiting IL-10, miR-29b inhibiting TGFβ1) was undertaken. A number of 62 individuals were enrolled—unstable angina (UA, n = 14), chronic coronary syndrome (CCS, n = 38), and healthy volunteers (HV, n = 10). Plasma samples were taken, and microRNAs expression levels were assessed by qRT-PCR. As a result, the UA patients presented significantly increased miR-10b levels compared to CCS patients (0.097 vs. 0.058, p = 0.033). Moreover, in additional analysis when UA patients were grouped together with stable patients with significant plaque in left main or proximal left anterior descending ("UA and LM/proxLAD" group, n = 29 patients) and compared to CCS patients with atherosclerotic lesions in other regions of coronary circulation ("CCS other" group, n = 25 patients) the expression levels of both miR-10b (0.104 vs. 0.046; p = 0.0032) and miR-92a (92.64 vs. 54.74; p = 0.0129) were significantly elevated. In conclusion, the study revealed significantly increased expression levels of miR-10b and miR-92a, a regulator of endothelial protective KLF factors (KLF4 and KLF2, respectively) in patients with more vulnerable plaque phenotypes. [ABSTRACT FROM AUTHOR]

The article explores the impact of bifurcation angles on computed tomography (CT)-derived fractional flow reserve (FFRCT) decline in vessels with no apparent coronary artery disease (CAD). Topics include the correlation between bifurcation angles and FFRCT changes, the identification of optimal cut-off values for bifurcation angles in the left anterior descending (LAD) and left circumflex (LCX) arteries and the significance of vessel length as a predictor of distal FFRCT values.

BACKGROUND: "Slow flow" is one very important concept in modern fundamental and clinical biomedicine. Slow coronary flow is indicative of delayed filling of the terminal coronary artery vessels, occurring in the absence of significant coronary stenosis. This group patient of patients exhibits a high incidence of disability and represents a significant financial and material burden for the state and the healthcare system in general. OBJECTIVE: The primary objective of our study was to examine patients with slow coronary flow. METHODS: We studied the standard parameters recommended by the international health care system (electrocardiography (by Medica QRS-12, Germany), through the electrical activity of a patient's heart by the electrical impulses (beating) of the heart; HC1(Germany); coagulogramma by Coatron M1 (Germany), troponin by AQT 90 (Germany); general blood test we used automatic human counting device HC1(Germany). Also, we investigate the original parameters (non-standard parameters, which we use in this pilot study) that we were first studied for this diagnosis and non-standard parameters. RESULTS: A general blood test showed that patients with slow flow had a higher blood leukocyte count than the control group, but the amount of hemoglobin was normal, the hematocrit was much higher than in the control group, and the platelet count was close to the lower limit of clinical standards. We obtained details of blood flow by coagulation situation, such as prothrombin time, prothrombin index, international normalized ratio, activated partial thromboplastin time, thrombin time, fibrinogen, and rheological properties such as index of erythrocyte aggregability, index of erythrocyte deformability, plasma viscosity, in silico blood rheological index. CONCLUSSION: Blood flow can be considered as a superposition of vortices with similar frequencies and wave vectors that change after bifurcations or other obstacles in the vascular network. These factors together determine the conditions for structuring the flow of moving blood. Disruption or alteration of these factors results in slow flow. It has been found that the speed of blood flow in the coronary arteries depends on changes in the number and function of red blood cells. Slow flow is directly influenced by the aggregation and deformation of red blood cells, their number, and plasma viscosity. Consequently, the rheological status plays a crucial role in determining blood flow and its velocity. [ABSTRACT FROM AUTHOR]

Cinnamic acid (CA) possesses important cardiovascular effects such as cardioprotective, antiatherogenic, antihyperlipidemic and antioxidant, which predicts its potential role in the treatment of hypertension. The study was executed to investigate the antihypertensive potential of CA in Sprague Dawley (SD) rats followed by evaluation in diverse vascular preparations. Invasive blood pressure monitoring technique was used in normotensive and hypertensive rats, under anesthesia. Isolated aortic rings from rat and rabbit, Langendorrf's perfused isolated rabbit heart and guinea-pig right atria were used to probe the underlying mechanisms. The responses were recorded with pressure and force transducers connected to PowerLab Data Acquisition System. Intravenous administration of CA induced a respective 54% and 38% fall in mean arterial pressure (MAP) in the hypertensive and normotensive rats, respectively. In rat aortic rings, the CA exhibited muscarinic receptors-linked NO and indomethacin-sensitive endothelium-dependent (>50%) and calcium antagonistic and KATP-mediated endothelium-independent vasodilator effects. The CA showed negative inotropic and chronotropic effects in guinea-pig atrial strips. The CA suppressed force of ventricular contraction and heart rate while caused a 25% increase in coronary flow. This study supports the medicinal importance of CA as antihypertensive agent. [ABSTRACT FROM AUTHOR]

Coronary collateral circulation (CCC) comprises vascular pathways that activate in severe coronary stenosis to preserve perfusion. This study investigates the relationship between CCC development and male sex steroids. A retrospective analysis was performed on 149 male patients with ≥ 95% stenosis in epicardial coronary arteries and 29 with normal coronaries, identified via coronary angiography between January 2017 and December 2023. The cohort included 29 control patients, 99 with well collateral flow (WCF), and 50 with poor collateral flow (PCF). Serum leve ls of total testosterone, free testosterone, dehydroepiandrosterone sulfate (DHEA-S), and sex hormone-binding globulin (SHBG) were measured. Ordinal and logistic regression was used to analyze the relationship between sex steroid levels and collateral development. The PCF group exhibited higher rates of diabetes mellitus (p=0.001) and smoking (p<0.001). The WCF group had significantly higher levels of total testosterone (350.6 ± 78.5 vs. 273.8 ± 59.9 ng/dL, p<0.001), free testosterone (12.1 ± 3.3 vs. 7.2 ± 2.0 pg/mL, p<0.001), DHEA-S (180.5 ± 69.5 vs. 131.9 ± 87.9 μg/dL, p<0.001), and SHBG (35.3 ± 11.0 vs. 24.8 ± 6.9 nmol/L, p<0.001). Multiple logistic regression revealed that DM [OR = 1.923, 95% CI (1.041--4.092), p = 0.012] directly predicted PCF, whereas free testosterone [OR = 0.689, 95% CI (0.557--0.851), p < 0.001] and SHBG [OR = 0.903, 95% CI (0.849--0.960), p = 0.001] were inversely predictors. The study highlights the important role of sex steroids in coronary collateral development, with free testoster one and SHBG as key predictors of CCC levels in men with coronary occlusion. [ABSTRACT FROM AUTHOR]

Coronary microvascular dysfunction (CMD) involves functional or structural abnormalities of the coronary microvasculature resulting in dysregulation of coronary blood flow (CBF) in response to myocardial oxygen demand. This perfusion mismatch causes myocardial ischemia, which manifests in patients as microvascular angina (MVA). CMD can be diagnosed non-invasively via multiple imaging techniques or invasively using coronary function testing (CFT), which assists in determining the specific mechanisms involving endothelium-independent and dependent epicardial and microcirculation domains. Unlike traditional coronary artery disease (CAD), CMD can often occur in patients without obstructive atherosclerotic epicardial disease, which can make the diagnosis of CMD difficult. Moreover, MVA due to CMD is more prevalent in women and carries increased risk of future cardiovascular events. Successful treatment of symptomatic CMD is often patient-specific risk factor and endotype targeted. This article aims to review newly identified mechanisms and novel treatment strategies for managing CMD, and outline sex-specific differences in the presentation and pathophysiology of the disease. [ABSTRACT FROM AUTHOR]

Purpose: To determine the impact of time profile of tirofiban hydrochloride administration on short-term outcomes in patients with acute myocardial infarction (AMI) undergoing emergency percutaneous coronary intervention (PCI). Methods: A total of 112 patients with AMI who received PCI treatment in The First People's Hospital of Tianshui, Tianshui, China were randomly and equally assigned to study and control groups. The study group received intravenous tirofiban hydrochloride bolus (10 µg/kg) 1 - 2 h before PCI, followed by sustained infusion at 0.15 µg/kg/min for 36 h after the procedure. Control group received the same regimen immediately after PCI. Myocardial injury markers, cardiac functional parameters, ST-segment resolution, myocardial perfusion changes, bleeding complications, and adverse cardiovascular events over 6 months were evaluated. Results: When compared with control group, the study group exhibited significantly lower cardiac troponin T (cTnT) levels and lower serum creatine kinase-MB (CK-MB) levels at 7 days post-PCI (p < 0.05). Furthermore, the study group showed significantly reduced left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD), along with higher left ventricular ejection fraction (LVEF) after 7 days (p < 0.05). The study group also exhibited superior ST-segment resolution and significant improvement in myocardial perfusion 90 min post-treatment and significantly lower incidence of reperfusion arrhythmias (p < 0.05). Both groups had similar rates of minor bleeding events and no incidence of severe complications or fatalities. Conclusions: Administering tirofiban preoperatively enhances coronary blood flow, improves myocardial perfusion, and reduces the risk of distal embolic events without increasing severe bleeding complications. Larger-scale, multicenter studies with longer follow-up periods are required to confirm these findings and evaluate the safety and efficacy of different administration time for tirofiban infusion in patients with AMI undergoing PCI. [ABSTRACT FROM AUTHOR]