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Objectives This study investigated sex differences in coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) in patients with angina in the absence of obstructive coronary artery disease. Background Coronary microvascular dysfunction is associated with worse long-term outcomes, especially in women. Coronary flow reserve (CFR) and the index of microcirculatory resistance (IMR) are 2 methods of assessing the coronary microcirculation. Methods We prospectively enrolled 117 women and 40 men with angina in the absence of obstructive coronary artery disease. We performed CFR, IMR, fractional flow reserve, and quantitative coronary angiography in the left anterior descending artery. Coronary flow was assessed with a thermodilution method by obtaining mean transit time (T mn ) (an inverse correlate to absolute flow) at rest and hyperemia. Results All patients had minimal atherosclerosis by quantitative coronary angiography (% diameter stenosis: 23.2 ± 12.3%), and epicardial disease was milder in women (fractional flow reserve: 0.88 ± 0.04 vs. 0.87 ± 0.04; p = 0.04). IMR was similar between the sexes (20.7 ± 9.8 vs. 19.1 ± 8.0; p = 0.45), but CFR was lower in women (3.8 ± 1.6 vs. 4.8 ± 1.9; p = 0.004). This was primarily due to a shorter resting T mn in women (p = 0.005), suggesting increased resting coronary flow, whereas hyperemic T mn was identical (p = 0.79). In multivariable analysis, female sex was an independent predictor of lower CFR and shorter resting T mn . Conclusions Despite similar microvascular function in women and men by IMR, CFR is lower in women. This discrepancy appears to be due to differences in resting coronary flow between the sexes. The effect of sex differences should be considered in interpretation of physiological indexes using resting coronary flow. [ABSTRACT FROM AUTHOR]

In this study, a novel zeolite (K-type zeolite) was synthesized from coal fly ash (FA), and adsorption capacity on Pb2+ was assessed. Six types of zeolite (FA1, FA3, FA6, FA12, FA24, and FA48) were prepared, and their physicochemical properties, such as surface functional groups, cation exchange capacity, pHpzc, specific surface area, and pore volume, were evaluated. The quantity of Pb2+ adsorbed by the prepared zeolites followed the order FA < FA1 < FA3 < FA6 < FA12 < FA24 < FA48. Current results indicate that the level of Pb2+ adsorbed was strongly related to the surface characteristics of the adsorbent. Additionally, the correlation coefficient between the amounts of Pb2+ adsorbed and K+ released from FA48 was 0.958. Thus, ion exchange with K+ in the interlayer of FA48 is critical for the removal of Pb2+ from aqueous media. The new binding energies of Pb(4f) at 135 and 140 eV were detected after adsorption. Moreover, FA48 showed selectivity for Pb2+ adsorption in binary solution systems containing cations. The results revealed that FA48 could be useful for removing Pb2+ from aqueous media. [ABSTRACT FROM AUTHOR]

• FA24 has a zeolite P structure and highly specific surface area. • Adsorption of Hg2+ and Pb2+ were related to ion exchange with Na+ in FA24. • New Pb (4f) peaks at 136.6 and 141.5 eV were detected after adsorption. In this study, zeolites (FA6, FA12, and FA24) were prepared from JIS Type-II fly ash (FA) by alkaline hydrothermal treatment, and their physicochemical characteristics were investigated. In addition, their adsorption capability for heavy metals ions (Hg2+ and Pb2+) was evaluated. Zeolites have Hydrosodalite and/or Zeolite P structure, and the specific surface area of FA24 was greater than that of FA6 and FA12. A higher amount of heavy metals ions was adsorbed by FA24 than by FA6 and fA12. After adsorption using FA24, the binding energy of Pb2+ was detected, on the other hand, the binding energy of Hg2+ was not detected under our experimental conditions. These results suggest that FA24 surface properties shows a low adsorption capability of Hg2+. In addition, ion exchange with sodium ions in the adsorbent was also related to the adsorption capability of heavy metals ions (correlation coefficient: 0.965–0.973). A pH of approximately 5 was found to be optimal for the adsorption of heavy metals ions under our experimental conditions. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Background: Intracoronary acetylcholine (Ach) provocation testing is the gold standard for assessing coronary endothelial function. However, dosing regimens of Ach are quite varied in the literature, and there are limited data evaluating the optimal dose. We evaluated the dose-response relationship between Ach and minimal lumen diameter (MLD) by sex and studied whether incremental intracoronary Ach doses given during endothelial function testing improve its diagnostic utility. Methods: We evaluated 65 men and 212 women with angina and no obstructive coronary artery disease who underwent endothelial function testing using the highest tolerable dose of intracoronary Ach, up to 200 μg. Epicardial endothelial dysfunction was defined as a decrease in MLD >20% after intracoronary Ach by quantitative coronary angiography. We used a linear mixed effects model to evaluate the dose-response relationship. Deming regression analysis was done to compare the %MLD constriction after incremental doses of intracoronary Ach. Results: The mean age was 53.5 years. Endothelial dysfunction was present in 186 (68.1%). Among men with endothelial dysfunction, there was a significant decrease in MLD/10 µg of Ach at doses above 50 μg and 100 µg, while this decrease in MLD was not observed in women (P <0.001). The %MLD constriction at 20 μg versus 50 μg and 50 μg versus 100 μg were not equivalent while the %MLD constriction at 100 μg versus 200 μg were equivalent. Conclusions: Women and men appear to have different responses to Ach during endothelial function testing. In addition to having a greater response to intracoronary Ach at all doses, men also demonstrate an Ach-MLD dose-response relationship with doses up to 200 μg, while women have minimal change in MLD with doses above 50 µg. An incremental dosing regimen during endothelial function testing appears to improve the diagnostic utility of the test and should be adjusted based on the sex of the patient. [ABSTRACT FROM AUTHOR]

Supplemental Digital Content is available in the text. Background: The prognostic impact of coronary microvascular dysfunction after percutaneous coronary intervention (PCI) remains unclear in patients with stable coronary artery disease. This study sought to investigate the prognostic value of microvascular function measured immediately after PCI in patients with stable coronary artery disease. Methods: We enrolled 572 patients with stable coronary artery disease who underwent PCI and elective measurement of the index of microcirculatory resistance (IMR) immediately after PCI from 8 centers in 4 countries. Impaired microvascular function was defined as IMR≥25 (high IMR). Major adverse cardiac events, including death, myocardial infarction (MI) and target vessel revascularization, were evaluated. Results: During a median follow-up duration of 4.0 years, the cumulative major adverse cardiac events rate was significantly higher in the high IMR group (n=66/148) compared with the low IMR group (n=128/424; hazard ratio [HR], 1.56; 95% CI, 1.16−2.105; P =0.001), primarily due to a higher rate of periprocedural MI (HR, 1.59; 95% CI, 1.11−2.28; P =0.004) but also due to higher rates of mortality (HR, 1.59; 95% CI, 0.76−3.35; P =0.22), spontaneous MI (HR, 2.10; 95% CI, 0.67−6.63; P =0.20) and target vessel revascularization (HR, 1.40; 95% CI, 0.77−2.54; P =0.27). Cumulative risk for death, spontaneous MI, and target vessel revascularization was higher in the high IMR group (HR, 1.55; 95% CI, 0.99−2.43; P =0.056), as was death and spontaneous MI alone (HR, 1.79; 95% CI, 0.96−3.36; P =0.065). On multivariable analysis, high IMR post-PCI was an independent predictor of major adverse cardiac events. Conclusions: IMR measured immediately after PCI predicts adverse events in patients with stable coronary artery disease. [ABSTRACT FROM AUTHOR]

It is unclear whether coronary physiology or coronary angiography (CA)-guided strategy is the more preferable approach for deferring percutaneous coronary intervention (PCI). We sought to evaluate the clinical efficacy of various PCI strategies through a network meta-analysis of randomized controlled trials (RCTs). We searched multiple databases for RCTs investigating the impact of the following strategies for the purpose of determining whether or not to defer PCI: fractional flow reserve, instantaneous wave-free ratio, quantitative flow ratio (QFR), and CA. We conducted a network meta-analysis for trial-defined major adverse cardiovascular events (MACE), all-cause death, cardiovascular death, myocardial infarction (MI), target lesion revascularization (TLR), and stent thrombosis. We performed a subgroup analysis for those with acute coronary syndrome (ACS). Our search identified 12 eligible RCTs including a total of 13,177 patients. QFR-guided PCI was associated with reduced MACE, MI, and TLR compared with CA-guided PCI (relative risk (RR) 0.68; 95 % confidence interval (CI] [0.49 to 0.94], RR 0.58; 95 % CI [0.36 to 0.96], and RR 0.58; 95 % CI [0.38 to 0.91], respectively). There were no significant differences in any pairs for all-cause death, cardiovascular death, or stent thrombosis. QFR was ranked the best in most outcomes. In the subgroup analysis of the ACS cohort, there were no significant differences in MACE between any comparisons. QFR was associated with reduced MACE, MI, and TLR compared with CA, and ranked the best in most outcomes. However, this was not applied in the ACS cohort. • QFR was associated with reduced MACE, MI, and TLR compared with CA. • QFR was ranked the best in most outcomes among physiology-guided strategies. • The superiority of QFR was not observed in the ACS cohort. [ABSTRACT FROM AUTHOR]

The purpose of this study was to characterize Acute Coronary Syndrome (ACS)-associated inflammation by investigating correlates of the neutrophil-to-lymphocyte ratio (NLR), a surrogate marker of inflammation, and its relation to 1-year mortality in a cohort of patients undergoing percutaneous coronary intervention (PCI) for ACS at a single institution. We performed a single-institution, retrospective, observational study of all-comer ACS patients who underwent PCI and were discharged home before the COVID-19 pandemic between September 23, 2011 and July 31, 2017 for who outcomes data were available. NLR high group tended to be older, white patients, less likely to smoke, more likely to have a history of heart failure and cardiac arrest, higher creatinine values, lower LVEF, and higher CK-MB (a surrogate for infarct size). Linear regression model demonstrated a strong correlation between increasing NLR and white race (B = 1.103, p = 0.001, hemoglobin (B = −0.30, p < 0.001), peak CK-MB (B = 0.004, p = 0.02), LVEF (B = −0.048, p < 0.001), and serum creatinine (B = 0.47, p = 0.03). There were a total of 87 deaths at one year. NLR > 3.4 was associated with worse one-year survival post-PCI (91.4 % vs. 95.4 %, log-rank p < 0.004), which was confirmed on multivariate analysis. Our data confirm the independent prognostic significance of inflammation to mortality after ACS and may provide some insight into the putative benefits of inflammation modulation. • The NLR may be a cost-effective laboratory measurement to quantify the degree of ACS-associated inflammation • ACS-associated inflammation is correlated with hemoglobin, CK-MB, serum creatinine, and LVEF • NLR remained independently associated with worse all-cause mortality at one-year on multivariate analysis. [ABSTRACT FROM AUTHOR]