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Background Methods Results Conclusion New antithrombotic medications and improved stent designs have reduced branch occlusion, although the sino‐atrial nodal artery (SANA) may still be occluded after a percutaneous coronary intervention (PCI), causing sinus node dysfunction (SND). Ischemic sinus nodes are usually asymptomatic but can cause sinus arrest sometimes requiring pacemaker placement. In rare cases, junctional escape rhythms, a manifestation of sinus exit blocks after PCI, can predict cardiogenic shock.We present a case study of a patient who underwent bifurcation PCI to the LMCA to the LCX but subsequently developed cardiogenic shock as a result of SND, a junctional escape rhythm required substantial inotropic support. This case offers an exemplification of a sparsely documented, yet infrequent manifestation of iatrogenic ischemic SND at an unorthodox site, the confluence of the LMCA‐LCX. In addition, we conducted a comprehensive analysis of 22 scholarly works pertaining to the subject of sinus node dysfunction (SND) subsequent to PCI resulting from ischemia caused by stenosis or occlusion of the SANA.RCA was responsible for 96.1% of SND cases, whereas LCX was responsible for 3.9%. SND was asymptomatic in 49.3% of cases and junctional escape rhythm in 37.6% of symptomatic cases. 28% needed a temporary transvenous pacemaker, while 7.8% needed a permanent one. Interventional management recanalized the SANA in 5.2% of patients, restoring flow.Transient sino‐atrial node ischemia after PCI can cause acute SND. Before stent implantation, doctors should consider SND. Complete plaque evaluation around the SANA is needed before choosing the best PCI procedure. [ABSTRACT FROM AUTHOR]

Background Purpose Methods Results Conclusions Retrospective studies indicate that radiation damage to left anterior descending coronary artery (LAD) may be critical for late‐stage radiation‐induced cardiac morbidity. Developing a method that accurately depicts LAD motion and perform dose assessment is crucial.To construct a generalized cardiac surface motion model for LAD dose assessment in left breast cancer radiotherapy.Cine MRI of 25 cases were divided into training and testing sets for model construction, and five external cases were gathered for generalization validation. Motion prediction from average intensity projection images (AIP) surface point cloud to that of each phase was realized by mapping the relationship between datum points and corresponding points with statistical shape modeling (SSM). Root mean square error (RMSE) for predicted corresponding points and Euclidean distance (ED) for predicted surface point cloud were used to assess model's accuracy. LAD dose assessment for 10 left breast cancer radiotherapy cases was perform by model application.The RMSE in testing cases and external cases were 0.209 ± 0.020 mm to 0.841 ± 0.074 mm and 0.895 ± 0.093 mm to 1.912 ± 0.138 mm, respectively; while the ED were 1.399 ± 0.029 mm to 1.658 ± 0.100 mm, 1.571 ± 0.080 mm to 1.779 ± 0.104 mm, respectively, proving the generalized model's high accuracy. The volume of LAD characterizing motion range (WPLAD) (2.392 ± 0.639 cm3) was approximately twice that of LAD from superimposed images (SPLAD) (0.927 ± 0.326 cm3) with p < 0.05, and the former's Dmax (3582.06 ± 575.92 cGy) was significantly larger than latter's (3222.71 ± 665.37 cGy) (p < 0.05). While WPLAD's Dmean (1408.06 ± 413.06 cGy) was slightly smaller than that of SPLAD (1504.15 ± 448.03 cGy), the difference did not reach statistical significance (p > 0.05). WPLAD's V20 (23.42% ± 16.62%) was less than SPLAD's (29.18% ± 21.07%) with p < 0.05, but their comparison in V30 and V40 did not yield statistically significant results. It implies the conventional LAD dose assessment ignores motion impact and may not be justified.The generalized cardiac surface motion model informs LAD dose accurate assessment in left breast cancer radiotherapy. [ABSTRACT FROM AUTHOR]

Background: Prenatal hypoxia, a common pregnancy complication, leads to impaired cardiovascular outcomes in the adult offspring. It results in impaired vasodilation in coronary and mesenteric arteries of the adult offspring, due to reduced nitric oxide (NO). Thromboxane A2 (TxA2) is a potent vasoconstrictor increased in cardiovascular diseases, but its role in the impact of prenatal hypoxia is unknown. To prevent the risk of cardiovascular disease by prenatal hypoxia, we have tested a maternal treatment using a nanoparticle-encapsulated mitochondrial antioxidant (nMitoQ). We hypothesized that prenatal hypoxia enhances vascular TxA2 responses in the adult offspring, due to decreased NO modulation, and that this might be prevented by maternal nMitoQ treatment. Methods: Pregnant Sprague–Dawley rats received a single intravenous injection (100 µL) of vehicle (saline) or nMitoQ (125 µmol/L) on gestational day (GD)15 and were exposed to normoxia (21% O2) or hypoxia (11% O2) from GD15 to GD21 (term = 22 days). Coronary and mesenteric arteries were isolated from the 4-month-old female and male offspring, and vasoconstriction responses to U46619 (TxA2 analog) were evaluated using wire myography. In mesenteric arteries, L-NAME (pan-NO synthase (NOS) inhibitor) was used to assess NO modulation. Mesenteric artery endothelial (e)NOS, and TxA2 receptor expression, superoxide, and 3-nitrotyrosine levels were assessed by immunofluorescence. Results: Prenatal hypoxia resulted in increased U46619 responsiveness in coronary and mesenteric arteries of the female offspring, and to a lesser extent in the male offspring, which was prevented by nMitoQ. In females, there was a reduced impact of L-NAME in mesenteric arteries of the prenatal hypoxia saline-treated females, and reduced 3-nitrotyrosine levels. In males, L-NAME increased U46619 responses in mesenteric artery to a similar extent, but TxA2 receptor expression was increased by prenatal hypoxia. There were no changes in eNOS or superoxide levels. Conclusions: Prenatal hypoxia increased TxA2 vasoconstrictor capacity in the adult offspring in a sex-specific manner, via reduced NO modulation in females and increased TP expression in males. Maternal placental antioxidant treatment prevented the impact of prenatal hypoxia. These findings increase our understanding of how complicated pregnancies can lead to a sex difference in the programming of cardiovascular disease in the adult offspring. Highlights: Prenatal hypoxia increases thromboxane-mediated vasoconstrictor responses in both coronary and mesenteric arteries from the adult female and male offspring. This was more pronounced in females, and was prevented by maternal placental antioxidant treatment in pregnancy. The mechanisms for the increased thromboxane-mediated vasoconstrictor responses by prenatal hypoxia exposure were sex-specific, where females had reduced nitric oxide modulation of vasoconstriction, while males had increased thromboxane receptor expression. There are sex-specific differences on how prenatal hypoxia impairs vascular function in the adult offspring. Placenta-targeted therapies in pregnancy should be considered to improve cardiovascular outcomes in the offspring later life but should take the sex of the fetus into consideration. Plain language summary: Prenatal hypoxia, when the fetus does not receive enough oxygen, is a common problem during pregnancy that impacts the developing fetus. It is associated with an increased risk of cardiovascular disease in the offspring in adulthood. While the mechanisms are not fully understood, the blood vessel function in the offspring may be impacted by prenatal hypoxia. We hypothesize that prenatal hypoxia increases the constriction of the blood vessels in the offspring. The placenta, an essential organ for fetal development, supplies oxygen and nutrients to the fetus. In prenatal hypoxia pregnancies, the placenta does not work properly. We have been studying a placental treatment (called nMitoQ) to improve placenta function and thereby the blood vessel function of the offspring. We used a rat model of prenatal hypoxia, where pregnant rats (dams) were placed in a low oxygen environment (hypoxia) during the last trimester of pregnancy. Control rats were kept in normal oxygen conditions. The dams were treated with nMitoQ, or with saline (control). Next, we studied the blood vessels of the offspring in adulthood. We found that prenatal hypoxia increases the constriction of the blood vessels, which was prevented by treating the dams with nMitoQ. Interestingly, this impact was more severe in females compared to males, and the mechanisms were different between the sexes. This study helps in the understanding of how complicated pregnancies can impair cardiovascular health in the offspring, and in a potential development of targeted and sex-specific therapies for those offspring at high risk for future cardiovascular disease. [ABSTRACT FROM AUTHOR]

This article, published in the Journal of Cardiovascular Imaging, presents a case report of a 48-year-old woman who developed mucoid vasculopathy and multiple giant pseudoaneurysms following a Bentall procedure. The patient had previously undergone surgery for an ascending aortic aneurysm and severe aortic regurgitation. The article describes the diagnostic process, including echocardiogram and computed tomography (CT) scans, and the subsequent surgical repair of the pseudoaneurysms. The authors note that mucoid vasculopathy is a rare form of vasculopathy and that this case is the first reported instance of multiple huge pseudoaneurysms associated with this condition. [Extracted from the article]

Background: Aberrant left coronary artery from pulmonary artery (ALCAPA) is a very rare congenital heart defect. Its coexistence with patent ductus arteriosus (PDA) is extremely rare. The high pressures created by the left-to-right shunt in the pulmonary arteries can delay symptoms and create a real challenge in diagnosing ALCAPA. Missing this diagnosis can have severe results, including extensive ischemia and sudden death. Case presentation: We present a case of an infant born with a large PDA. Initially treated conservatively, however, due to congestive heart failure and lack of weight gain, she underwent surgical ligation of the PDA at the age of four and a half months. Following surgery, she developed pulmonary edema. Echocardiography revealed decreased ventricular function. ECG revealed ST elevations on lateral leads, and serum troponin was significantly increased. The patient underwent cardiac magnetic resonance imaging (MRI), which revealed signs of wall ischemia and decreased function of the left ventricle (LV) with unclear coronary anatomy. Diagnostic catheterization revealed an ALCAPA. She underwent surgical intervention, and the left coronary artery was re-implanted in the aortic sinus. Follow-up revealed slow improvement of cardiac function. Discussion and literature review: The coexistence of PDA and ALCAPA is a very rare occurrence. We found at least 10 reported cases in the literature. Delayed diagnosis might be detrimental. The prognosis of these patients is variable. Conclusion: An unusual post-surgical course following PDA repair requires a high index of suspicion and appropriate evaluation for ALCAPA, preferably with angiography. [ABSTRACT FROM AUTHOR]

Background: Globally, myocardial infarction (AMI) is a leading cause of mortality and disability. Early detection of ischemic myocardium has consequences for prognosis and treatment. It is still challenging to evaluate right heart function in spite of rapid advances in technologies. Objective: This study aimed to evaluate the improving right ventricle function (RV) in patients with AMI. Patients and methods: This prospective study included 50 patients who were admitted with inferior wall myocardial infarction (IWMI). Patients were subjected to resting 12-lead standard surface electrocardiogram, transthoracic echocardiography (TTE), coronary angiography and primary percutaneous coronary intervention (PCI). Results: 74% of studied cases were males with mean age of 62.1 years, 42% of them had positive family history. Risk factor found among studied cases was diabetes mellitus (60%), 54% had hypertension, 52% with dyslipidemia and 50% were obese. Only one stent used for 90% of studied cases during PCI, while 10% of them had two stents. There was a high significant improvement in RV function parameters (RVDD, PASP, TAPSE, RVFAC and TR), myocardial performance index and S wave post PCI. There was a high statistically significant improvement in RV diastolic function grading, as 50% of studied cases had impaired function preoperative changed to 8% only and 74% of the cases become normal after PCI. Also, 62% of studied lesions were proximal, 24% proximal to mid and 8% proximal para-osteal. Conclusion: Primary PCI of proximal right coronary artery can improve right ventricular systolic and diastolic dysfunction in patients with acute inferior wall myocardial infarction. [ABSTRACT FROM AUTHOR]

Total coronary atherosclerotic plaque activity across the entire coronary arterial tree is associated with patient-level clinical outcomes. We aimed to investigate whether vessel-level coronary atherosclerotic plaque activity is associated with vessel-level myocardial infarction. In this secondary analysis of an international multicenter study of patients with recent myocardial infarction and multivessel coronary artery disease, we assessed vessel-level coronary atherosclerotic plaque activity using coronary 18F-sodium fluoride positron emission tomography to identify vessel-level myocardial infarction. Increased 18F-sodium fluoride uptake was found in 679 of 2,094 coronary arteries and 414 of 691 patients. Myocardial infarction occurred in 24 (4%) vessels with increased coronary atherosclerotic plaque activity and in 25 (2%) vessels without increased coronary atherosclerotic plaque activity (HR: 2.08; 95% CI: 1.16-3.72; P = 0.013). This association was not demonstrable in those treated with coronary revascularization (HR: 1.02; 95% CI: 0.47-2.25) but was notable in untreated vessels (HR: 3.86; 95% CI: 1.63-9.10; P interaction = 0.024). Increased coronary atherosclerotic plaque activity in multiple coronary arteries was associated with heightened patient-level risk of cardiac death or myocardial infarction (HR: 2.43; 95% CI: 1.37-4.30; P = 0.002) as well as first (HR: 2.19; 95% CI: 1.18-4.06; P = 0.013) and total (HR: 2.50; 95% CI: 1.42-4.39; P = 0.002) myocardial infarctions. In patients with recent myocardial infarction and multivessel coronary artery disease, coronary atherosclerotic plaque activity prognosticates individual coronary arteries and patients at risk for myocardial infarction. [Display omitted] [ABSTRACT FROM AUTHOR]

Central to the clinical adoption of patient-specific modeling strategies is demonstrating that simulation results are reliable and safe. Indeed, simulation frameworks must be robust to uncertainty in model input(s), and levels of confidence should accompany results. In this study, we applied a coupled uncertainty quantification–finite element (FE) framework to understand the impact of uncertainty in vascular material properties on variability in predicted stresses. Univariate probability distributions were fit to material parameters derived from layer-specific mechanical behavior testing of human coronary tissue. Parameters were assumed to be probabilistically independent, allowing for efficient parameter ensemble sampling. In an idealized coronary artery geometry, a forward FE model for each parameter ensemble was created to predict tissue stresses under physiologic loading. An emulator was constructed within the UncertainSCI software using polynomial chaos techniques, and statistics and sensitivities were directly computed. Results demonstrated that material parameter uncertainty propagates to variability in predicted stresses across the vessel wall, with the largest dispersions in stress within the adventitial layer. Variability in stress was most sensitive to uncertainties in the anisotropic component of the strain energy function. Moreover, unary and binary interactions within the adventitial layer were the main contributors to stress variance, and the leading factor in stress variability was uncertainty in the stress-like material parameter that describes the contribution of the embedded fibers to the overall artery stiffness. Results from a patient-specific coronary model confirmed many of these findings. Collectively, these data highlight the impact of material property variation on uncertainty in predicted artery stresses and present a pipeline to explore and characterize forward model uncertainty in computational biomechanics. [ABSTRACT FROM AUTHOR]

Background: Coronary arteries originate from the first portion of the aorta, emerging from the right and left aortic sinuses. They traverse through the subepicardium and coronary sulcus to supply the myocardium during diastolic function. The objective of this review was to understand how the hypoplasia and agenesis of the coronary arteries are associated with cardiac pathologies. Methods: The databases Medline, Scopus, Web of Science, Google Scholar, CINAHL, and LILACS were researched until January 2024. An assurance tool for anatomical studies (AQUA) was used to evaluate methodological quality. The pooled prevalence was estimated using a random effects model. Results: A total of three studies met the established selection criteria for inclusion in this meta-analysis. The prevalence of coronary artery variants was 3% (CI = 2% to 8%), with a heterogeneity of 77%. The other studies were analyzed descriptively, along with their respective clinical considerations in the presence of the variant. Conclusions: Hypoplasia and the congenital absence of the coronary arteries are often incidental findings and understanding these variants is crucial to prevent misdiagnosis. Additionally, it is essential to exercise caution when considering surgical management for hearts with these variants. [ABSTRACT FROM AUTHOR]

Hypertension induces cardiac fibrotic remodelling characterised by the phenotypic switching of cardiac fibroblasts (CFs) and collagen deposition. We tested the hypothesis that Wnt1-inducible signalling pathway protein-1 (WISP-1) promotes CFs' phenotypic switch, type I collagen synthesis, and in vivo fibrotic remodelling. The treatment of human CFs (HCFs, n = 16) with WISP-1 (500 ng/mL) induced a phenotypic switch (α-smooth muscle actin-positive) and type I procollagen cleavage to an intermediate form of collagen (pC-collagen) in conditioned media after 24h, facilitating collagen maturation. WISP-1-induced collagen processing was mediated by Akt phosphorylation via integrin β1, and disintegrin and metalloproteinase with thrombospondin motifs 2 (ADAMTS-2). WISP-1 wild-type (WISP-1+/+) mice and WISP-1 knockout (WISP-1−/−) mice (n = 5–7) were subcutaneously infused with angiotensin II (AngII, 1000 ng/kg/min) for 28 days. Immunohistochemistry revealed the deletion of WISP-1 attenuated type I collagen deposition in the coronary artery perivascular area compared to WISP-1+/+ mice after a 28-day AngII infusion, and therefore, the deletion of WISP-1 attenuated AngII-induced cardiac fibrosis in vivo. Collectively, our findings demonstrated WISP-1 is a critical mediator in cardiac fibrotic remodelling, by promoting CFs' activation via the integrin β1-Akt signalling pathway, and induced collagen processing and maturation via ADAMTS-2. Thereby, the modulation of WISP-1 levels could provide potential therapeutic targets in clinical treatment. [ABSTRACT FROM AUTHOR]

Introduction: Catheter ablation of ectopy originating from the vicinity of the His bundle can be challenging. Methods and Results: We report a case of a 33‐year‐old man with narrow QRS ectopy with preferential conduction from a para‐Hisian origin to the proximal left fascicles, which was successfully eliminated by radiofrequency ablation in the right coronary cusp, guided by ultrahigh‐resolution mapping of the His bundle, bundle branch, and fascicular electrograms. Conclusion: Some narrow QRS ectopy may originate from the vicinity of the conduction system, instead of the "true" conduction system, and have concealed connections from its origin to the conduction system. [ABSTRACT FROM AUTHOR]

Purpose: The tensor fasciae latae (TFL) muscle is supplied by the lateral femoral circumflex artery (LCFA), arising from the deep femoral artery. However, it has been noted that there is also a consistent vascular anastomotic network. The aim of this study was to describe the accessory vascularization of the TFL muscle through a descriptive anatomical study, in order to hypothesize the feasibility of harvesting a TFL flap in the event of an injury to the main pedicle. In addition, we illustrate this hypothesis with a successful clinical case of Scarpa freconstruction following ligature of the deep femoral artery. Methods: The description of the accessory vascularization was obtained by injecting dye into seven lateral femoral circumflex arteries (LCFA), six superficial circumflex iliac arteries (SCIA), and three inferior gluteal arteries (IGA). Results: The TFL muscle was vascularized primarily by the LCFA. A vascular anastomotic network with the SCIA and the IGA was observed. After selective injection to the SCIAs and IGAs, the subsequent injection to the LCFA showed a diffusion of the TFL skin paddle with a perforasome overlapping between the different vascular territories. Conclusion: The ascending branch of the lateral femoral circumflex plays a dominant role in the vascularization of the TFL muscle. As a result of a periarticular anastomotic network of the hip, this artery establishes several connections with the proximal arteries. Consequently, in cases where blood flow through the LCFA is interrupted, it should be equally possible to harvest the TFL flap through its accessory vascularization. [ABSTRACT FROM AUTHOR]

The article thoroughly examines the dynamics of coronary circulation, shedding light on its functionality in healthy individuals and those with various health conditions. It delves into the effects of anaesthesia, the intricacies of cardiac surgical procedures, and the complexities surrounding coronary vessels, offering valuable insights into these critical aspects of cardiovascular health.

Limited data exist regarding drug-coated balloon (DCB) treatment in de novo large coronary arteries. We sought to demonstrate procedural characteristics, residual stenosis, and clinical outcomes following DCB angioplasty for de novo lesions in large versus small coronary arteries. The study included 184 consecutive patients with 223 de novo coronary lesions undergoing paclitaxel DCB angioplasty between January 2019 and August 2020, who were divided according to whether the DCB diameter was ≥ 3.0 mm (large group, n = 58) or < 3.0 mm (small group, n = 125). The large group had a higher proportion of acute coronary syndrome more commonly with ostial, bifurcation, and calcified lesions in large vessels and received lesion preparation with more frequent use of scoring or cutting balloons and atherectomy devices compared to the small group. Postprocedural angiographic diameter stenosis was smaller in the large group compared to the small group (31% [22–37] vs. 35% [26–42], p = 0.032), and intravascular ultrasound revealed no significant difference in postprocedural area stenosis between the groups (66.2 ± 7.7% vs. 67.9 ± 7.8%; p = 0.26). The median follow-up duration was 995 days. The incidence of a composite of all-cause death, myocardial infarction, stroke, or target lesion revascularization was similar between the groups (log-rank p = 0.41) and was influenced by the presence of acute coronary syndrome and anemia but not by DCB diameter. The rate of cardiovascular outcomes after DCB treatment was comparable in de novo large and small coronary arteries. Notably, well-planned lesion preparation with intravascular imaging guidance was prevalent in large vessels. [ABSTRACT FROM AUTHOR]

Background: Drug-eluting stents (DESs) have been shown to reduce the risk of restenosis and other adverse cardiac events after percutaneous coronary intervention (PCI) as compared with bare-metal stents (BMSs). However, the superiority of DES over BMS has been questioned in large vessels. We evaluated the risks and benefits of the use of DES versus BMS in patients who undergo stenting of large coronary arteries (=3.5 mm) up to 8 year follow-up. Materials and Methods: This was a prospective study carried out in all-comer patients enrolled between January 2015 and December 2015. The patients with the variable indication for PCI, multi vessel involvement, prior revascularization, and adjuvant drugs such as GP IIb-IIIa inhibitors were included in the study. However, patients who did not provide written informed consent and received both DES and BMS were excluded from the study. The clinical outcomes were evaluated at 1year. We now report clinical outcomes of the patients wh o were followe dupfo reiig ht years. Results: A total of 266 lesions (240 patients) in the large coronary arteries were stented, of which 130 lesions were treated with BMS and 136 lesions were treated with DES. At 8-year follow-up, there were 2% patients lost to follow up. Target lesion revascularization/target vessel revascularization (TLR/TVR) (P = 0.7685) and all-cause death (P = 0.8790) did not differ significantly between the two groups. In addition, no significant difference was found in patients with effort angina as well as number of asymptomatic patients.. Conclusion: At 8-year follow-up, BMSs and DESs showed similar clinical outcomes in large coronary arteries. Hence, the use of BMS in large coronary arteries (=3.5 mm) should not be discouraged unless clinically indicated. [ABSTRACT FROM AUTHOR]

A knowledge graph can effectively showcase the essential characteristics of data and is increasingly emerging as a significant means of integrating information in the field of artificial intelligence. Coronary artery plaque represents a significant etiology of cardiovascular events, posing a diagnostic challenge for clinicians who are confronted with a multitude of nonspecific symptoms. To visualize the hierarchical relationship network graph of the molecular mechanisms underlying plaque properties and symptom phenotypes, patient symptomatology was extracted from electronic health record data from real-world clinical settings. Phenotypic networks were constructed utilizing clinical data and protein‒protein interaction networks. Machine learning techniques, including convolutional neural networks, Dijkstra's algorithm, and gene ontology semantic similarity, were employed to quantify clinical and biological features within the network. The resulting features were then utilized to train a K-nearest neighbor model, yielding 23 symptoms, 41 association rules, and 61 hub genes across the three types of plaques studied, achieving an area under the curve of 92.5%. Weighted correlation network analysis and pathway enrichment were subsequently utilized to identify lipid status-related genes and inflammation-associated pathways that could help explain the differences in plaque properties. To confirm the validity of the network graph model, we conducted coexpression analysis of the hub genes to evaluate their potential diagnostic value. Additionally, we investigated immune cell infiltration, examined the correlations between hub genes and immune cells, and validated the reliability of the identified biological pathways. By integrating clinical data and molecular network information, this biomedical knowledge graph model effectively elucidated the potential molecular mechanisms that collude symptoms, diseases, and molecules. [ABSTRACT FROM AUTHOR]

Background: Coronary microvascular dysfunction (CMD) refers to structural and functional abnormalities of the coronary microcirculation, which may be diagnosed using invasive coronary physiology. CMD is responsible for impaired diastolic cardiac function. It has recently been suggested that left atrial strain (LASr) represents a highly sensitive tool for detecting cardiac diastolic function abnormalities. Accordingly, the aim of this study was to investigate the relationship between CMD and LASr. Methods: Consecutively enrolled patients with non-obstructed coronary arteries (NOCA) underwent CMD and LASr evaluation by invasive thermodilution and noninvasive echocardiography, respectively. Results: Forty-two (42) patients were included, out of which 26 presented with CMD. There were no significant differences between CMD-positive and negative patients in terms of clinical and echocardiographic characteristics. LASr was significantly reduced in patients with CMD (24.6% ± 6.1 vs. 30.3 ± 7.8%, p = 0.01). A moderate correlation was observed between coronary flow reserve and LAsr (r = 0.47, p = 0.002). A multivariate logistic regression analysis demonstrated that CMD was independently associated with LASr (OR = 0.88, 95%CI 0.78–0.99.135, p = 0.04). A LASr cut-off of 25.5% enabled an optimal classification of patients with or without CMD. Conclusion: Patients with NOCA and CMD had a significantly reduced LASr compared with patients without CMD, suggesting the early impairment of diastolic function in these patients. [ABSTRACT FROM AUTHOR]

This study used the roto-evaporation technique to engineer a 6 mm three-layer polyurethane vascular graft (TVG) that mimics the architecture of human coronary artery native vessels. Two segmented polyurethanes were synthesized using lysine (SPUUK) and ascorbic acid (SPUAA), and the resulting materials were used to create the intima and adventitia layers, respectively. In contrast, the media layer of the TVG was composed of a commercially available polyurethane, Pearlbond 703 EXP. For comparison purposes, single-layer vascular grafts (SVGs) from individual polyurethanes and a polyurethane blend (MVG) were made and tested similarly and evaluated according to the ISO 7198 standard. The TVG exhibited the highest circumferential tensile strength and longitudinal forces compared to single-layer vascular grafts of lower thicknesses made from the same polyurethanes. The TVG also showed higher suture and burst strength values than native vessels. The TVG withstood up to 2087 ± 139 mmHg and exhibited a compliance of 0.15 ± 0.1%/100 mmHg, while SPUUK SVGs showed a compliance of 5.21 ± 1.29%/100 mmHg, akin to coronary arteries but superior to the saphenous vein. An indirect cytocompatibility test using the MDA-MB-231 cell line showed 90 to 100% viability for all polyurethanes, surpassing the minimum 70% threshold needed for biomaterials deemed cytocompatibility. Despite the non-cytotoxic nature of the polyurethane extracts when grown directly on the surface, they displayed poor fibroblast adhesion, except for SPUUK. All vascular grafts showed hemolysis values under the permissible limit of 5% and longer coagulation times. [ABSTRACT FROM AUTHOR]

Background: Patient outcomes after percutaneous coronary intervention (PCI) have improved over the last 30 years due to better techniques, therapies, and care processes. This study evaluated contemporary predictors of post-PCI major adverse cardiovascular events (MACE) and summarized risk in a parsimonious risk prediction model. Methods: The Cardiovascular Patient-Level Analytical Platform (CLiPPeR) is an observational dataset of baseline variables and longitudinal outcomes from the American College of Cardiology's CathPCI Registry® and national claims data. Cox regression was used to evaluate 2–6 years of patient follow-up (mean: 2.56 years), ending in December 2017, after index PCI between 2012 and 2015 (N = 1,450,787), to examine clinical and procedural predictors of MACE (first myocardial infarction, stroke, repeat PCI, coronary artery bypass grafting, and mortality). Cox analyses of post-PCI MACE were landmarked 28 days after index PCI. Results: Overall, 12.4% (n = 179,849) experienced MACE. All variables predicted MACE, with cardiogenic shock, cardiac arrest, four diseased coronary vessels, and chronic kidney disease having hazard ratios (HRs) ≥ 1.50. Other major predictors of MACE were in-hospital stroke, three-vessel disease, anemia, heart failure, and STEMI presentation. The index revascularization and discharge prescription of aspirin, P2Y12 inhibitor, and lipid-lowering medication had HR ≤ 0.67. The primary Cox model had c-statistic c = 0.761 for MACE versus c = 0.701 for the parsimonious model and c = 0.752 for the parsimonious model plus treatment variables. Conclusions: In a nationally representative US sample of post-PCI patients, predictors of longitudinal MACE risk were identified, and a parsimonious model efficiently encapsulated them. These findings may aid in assessing care processes to further improve care post-PCI outcomes. [ABSTRACT FROM AUTHOR]

Background: Although coronary artery nomograms in children have been published, data on Caucasian children are lacking. The aim of this study is to provide: (i) a full dataset of coronary artery diameters in healthy children and (ii) a comparison among major previous nomograms. Materials and Methods: We prospectively evaluated 606 healthy subjects (age range, 1 days–<18 years; median age 8.7 years; 62.5% male). Coronary artery measurements in a short-axis view were performed. Age, heart rate, and body surface area (BSA) were used as independent variables in different analyses to predict the mean values of each measurement. To assess the accuracy of the predictive models of different studies, a Z-score calculator was created using Lopez's nomograms for comparison. Results: The association with BSA was found to be stronger, and was used for normalization of our data. The best-fit models, satisfying the assumption of homoscedasticity and normality of residuals and showing the highest R2 scores, were logarithmic (ln[y] = a + b*ln[x]). Predicted values and Z-score boundaries by BSA are provided. Our ranges of normality are slightly lower than those, diverging from −0.22 to −0.59 Z-scores for the left main coronary artery and from −0.23 to −0.3 Z-scores for the right coronary artery. Conclusions: We report a complete dataset of normal echocardiography coronary artery diameter (including new measures of the proximal origin) values in a large population of healthy children. Our data were statistically like those of north American nomograms. [ABSTRACT FROM AUTHOR]

We examined the technique and early outcomes of coronary artery bypass graft surgery (CABG) with endarterectomy. In 2023, the single-center database identified 24 severe coronary disease patients undergoing CABG with coronary artery endarterectomy. The patients were in a selected cohort with a minimum of three grafts for the three main vessels. Patients' mean age was 63.8 years. The mean number of grafts was 4.3. A coronary endarterectomy (CE) was performed on the right coronary artery in 45.8% of patients, the left anterior descending artery in 29.1%, the circumflex artery in 16.6%, and the diagonal artery in 29.1%. Aortic cross-clamp took 147.2 minutes, perfusion 180.9 minutes, mechanical ventilation 18.9 hours, and intensive care unit stay 4.8 days. Our in-hospital mortality rate was 8.3% with no technical complications. To achieve complete revascularization in patients with extensive coronary artery disease, CE should be considered an acceptable adjunct to CABG. [ABSTRACT FROM AUTHOR]

Background: The frequency of coronary artery disease is increasing nowadays. A detailed idea about the normal and variant anatomy of coronary arteries is essential in the management of various heart diseases, especially coronary bypass surgeries. Aims and Objectives: The aims and objectives of the study are to study the branching pattern of the right coronary artery (RCA). Materials and Methods: One hundred adult heart specimens were collected from the Department of Anatomy, Government Medical College, Kottayam. The specimens were fixed in formalin and the RCA was traced from origin to termination. Emphasis was given to the variations in branching patterns. Results: The incidence of a third coronary artery was 20%. The origin of the sinoatrial (SA) nodal artery from both the RCA and the left circumflex artery was 7%. The incidence of the double posterior descending artery was 9%. Short RCA terminating near the right margin was 4%. Long RCA reaching up to left margin was 4%. Conclusion: The SA nodal artery arose from RCA in the majority of cases. The posterior descending artery was single in most of the cases and its most common site of termination was up to three-quarters of the way down the posterior interventricular sulcus. In about half of the cases, the Atrioventricular nodal artery took origin from RCA. There was no statistically significant association between origin of the conus artery and gender. A statistically significant association was not observed between the origin of SA Nodal artery and gender. [ABSTRACT FROM AUTHOR]

Introduction: Left atrial appendage (LAA) closure (LAAC) is considered a viable alternative to anticoagulation therapy for stroke prevention in nonvalvular atrial fibrillation, we report a case with a less common shunt resulting from a device‐ related coronary artery‐appendage fistula (CAAF) following LAAC. Methods and Results: A 67‐year‐old male with a history of LAAC was referred to our emergency room with recurrent chest pain and palpitations and was diagnosed with ischemic angina pectoris. Subsequent coronary angiography (CAG) revealed 70% in‐stent restenosis and an abnormal shunt of contrast originating from the left circumflex artery (LCA) to the LAA tip which did not exist before. The restenosis was successfully dilated using a drug‐coated balloon, the procedure was safely completed without pericardial effusion. The patient had been implanted with a LAmbre occluder (Lifetech Scientific Corp.) in the previous LAAC procedure. This occluder had a lobe‐disk design, and the distal umbrella was not fully opened after release, particularly in the lower portion. This could make the hooks embedded on the umbrella contact the LAA wall more tightly, possibly resulting in microperforation and coincidental impingement of the LCA. The epicardial adipose and hyperplastic tissue then chronically wrapped the perforated site, prevented blood outflow into the epicardium, and ultimately formed a CAAF. Conclusion: CAAF is a rare complication after LAAC but may be underestimated, especially for lobe‐disk designed occluders. Therefore, CAG is perhaps necessary to detect this complication. [ABSTRACT FROM AUTHOR]

Purpose: To quantitatively investigate the effect of myocardial bridge (MB) in the left anterior descending artery (LAD) on the fractional flow reserve (FFR). Materials and Methods: Three‐hundred patients with LAD MB who had undergone coronary artery CT angiography (CCTA) were retrospectively enroled, and 104 normal patients were enroled as the control. The CCTA‐derived fractional flow reserve (FFRCT) was measured at the LAD 10 mm proximal (FFR1) and 20–40 mm distal (FFR3) to the MB and at the MB location (FFR2). Results: FFR2 and FFR3 of the MB (with BM only) and MBLA (with both MB and atherosclerosis) groups were significantly (p < 0.01) lower than those of the control. The FFR3 distal to the MB was significantly lower (p < 0.01) than that of the control. The FFRCT of the whole LAD in the MBLA group was significantly (p < 0.05) lower than that of the MB and control group (p < 0.05). MB length (OR 1.061) and MB muscle index (odds ratio or OR 1.007) were two risk factors for abnormal FFRCT, and MB length was a significant independent risk factor for abnormal FFRCT (OR = 1.077). LAD stenosis degree was a risk factor for abnormal FFRCT values (OR 3.301, 95% confidence interval [CI] 1.441–7.562, p = 0.005) and was also a significant independent risk factor (OR = 3.369, 95% CI: 1.392–8.152; p = 0.007) for abnormal FFRCT. Conclusion: MB significantly affects the FFRCT of distal coronary artery. For patients with MB without atherosclerosis, the MB length is a risk factor significantly affecting FFRCT, and for patients with MB accompanied by atherosclerosis, LAD stenotic severity is an independent risk factor for FFRCT. [ABSTRACT FROM AUTHOR]

Background: The most frequent cause of coronary artery aneurysm in children is Kawasaki disease (KD). Recently, limited studies on procalcitonin (PCT) were performed to find a biomarker for the diagnosis or prognosis of children with KD. Objectives: This study aimed to compare serum PCT levels between complete and incomplete KD and testify to the predictive validity of PCT for intravenous immunoglobulin (IVIG) resistance and predicting coronary artery lesions (CALs). Methods: This cross-sectional study was conducted at Namazi hospital in Shiraz, Iran, in 2019. All KD patients admitted to the hospital were included, with parental consent obtained. Kawasaki disease patients were categorized as complete KD (cKD) or incomplete KD (iKD). Two-dimensional echocardiography was performed, and peripheral venous blood was examined for PCT levels and other markers. All patients received IVIG and aspirin as standard treatment. The presence of coronary artery abnormalities (CAAs) was determined based on coronary artery size and morphology. We used Stata software version 14.0 for data analysis. Logistic regression models identified predictive factors for coronary complications. This study determined the optimal PCT cut-off point for predicted coronary complications using receiver operating characteristic (ROC) curve analysis. Approval was obtained from the Research Ethics Committees of Shiraz University of Medical Sciences. Results: Procalcitonin values in 38 children hospitalized with acute KD ranged from 0.2 ng/mL to 10 ng/mL, with a mean of 2.65 ng/m. There was no correlation of PCT with patients' age or gender, incomplete KD, or IVIG resistance. The serum PCT concentration was higher in patients with CAL (P = 0.009). The best PCT cut-off value for CAL prediction was 2.5 ng/mL (corresponding sensitivity = 81.8% and specificity = 68.7%), considering CAL prevalence as the studied group. Conclusions: Supplementary research is needed to determine the sensitivity and specificity of PCT for the diagnosis and prognosis of KD. Procalcitonin might be of value in predicting which children are at increased risk for CALs to intensify therapy. [ABSTRACT FROM AUTHOR]

Key Clinical Message: A woman with a single coronary artery underwent aortic valve replacement due to aortic stenosis. Two years later, she developed an aortic annular abscess around the right coronary cusp and non‐coronary cusp. Significant adhesions to the right coronary artery (RCA) resulted from the abscess, making artery separation challenging, and raising concerns about potential future RCA stenosis. The patient subsequently underwent aortic root replacement and coronary artery bypass grafting. Utilizing a freestyle valve and a saphenous vein graft for the RCA. Following the procedure, the patient was discharged and has remained symptom‐free without any recurrence of infection for 2 years. [ABSTRACT FROM AUTHOR]

Background and Objectives: Coronary artery anomalies (CAAs) represent a group of rare cardiac abnormalities with an incidence of up to 1.2%. The aim of this retrospective study was to conduct a comprehensive epidemiological assessment of the prevalence of hypoplastic coronary arteries using coronary computed tomography angiography (CCTA) in patients with diagnosed CAAs and individuals presenting with cardiovascular manifestations in the north-eastern region of Romania. This study was motivated by the limited investigation of the CAAs conducted in this area. Methods: We analyzed data collected from 12,758 coronary computed tomography angiography (CCTA) records available at the "Prof. Dr. George I.M. Georgescu" Cardiovascular Diseases Institute, spanning the years 2012 to 2022. Results: Among 350 individuals with CAAs (2.7% of the total cohort), 71 patients (20.3% of the anomaly presenting group and 0.5% of the entire CCTA cohort) exhibited at least one hypoplastic coronary artery. The mean age of individuals diagnosed with hypoplastic coronary artery disease (HCAD) was 61 years, while the age distribution among them ranged from 22 to 84 years. Nearly equal cases of right and left dominance (33 and 31, respectively) were observed, with only 7 cases of co-dominance. Conclusions: HCAD may be considered underexplored in current published research, despite its potentially significant implications ranging to an increased risk of sudden cardiac arrest. The specific prevalence of HCAD among CAAs might be higher than previously reported, possibly reflecting better diagnostic accuracy of CCTA over classic coronary imaging. The absence of standard diagnostic and therapeutic protocols for HCAD underscores the necessity of a personalized approach for such cases. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide. Calcification of the coronary artery wall is a definite indicator of coronary atherosclerosis. Calcium scores in coronary arteries (CAC) can be detected by multidetector computed tomography (MDCT) before any cardiac event occurs. Gamma-glutamyl transferase (GGT) is a biomarker for oxidative stress and a proatherogenic marker for its indirect contribution to the biochemical process resulting in low-density lipoprotein cholesterol oxidation. Studies have shown that serum inorganic phosphorus levels are an independent risk factor for cardiovascular mortality. In our study, we evaluated the correlation between MDCT, CAC score, and the risk of coronary events predicted by evaluating this score according to age, gender, and serum GGT, calcium, and phosphorus levels. Methods: In this retrospective study, 190 patients with a prediagnosis of CAD, laboratory investigations and MDCT were included. Patients were divided into three groups as low, intermediate, and high based on the risk of coronary events determined by the evaluation of CAC scores according to age and gender. Results: In our study, a statistically significant result was found between high serum phosphorus and GGT levels and CAC and coronary event high risk groups classified according to this score (p<0.05). No significant result was found with high calcium level (p>0.05). Conclusion: The correlation of phosphorus and GGT levels, which are considered independent risk factors for CAD, with CAC, which is an indicator of atherosclerosis in coronary arteries, was significant. [ABSTRACT FROM AUTHOR]

Background: CAD is the most common heart disease. It can describe asymptomatic atherosclerosis, stable angina, and acute coronary syndrome (unstable angina, NSTEMI, STEMI). Multifactorial CAD. Modifiable and non-modifiable etiologic factors exist. Gender, age, family history, and genetics are unchangeable. Smoking, obesity, cholesterol levels, and psychosocial factors are modifiable. Methods: Institutional Ethics Committee approved the prospective observational case-control study (Regd. No. ECR/84/Inst/OR/2013/RR-20). The Department of Cardiology at S.C.B Medical College and Hospital, Cuttack, comprised 80 CAD outpatients or inpatients between 2020 and 2022. Controls were age- and sex-matched. Patients with acute or chronic kidney illness, traumatic heart disease, head injury, morbidity, or refusal were eliminated. Results: FBS, cholesterol, HDL, LDL, total and direct bilirubin, SGOT, SGPT, and alkaline phosphatase differed between groups (P<0.05). 56.25 percent had severe CAD and 30 percent mild. Cases have greater copeptin than controls (P<0.0001). ROC curve analysis found a cut-off value of 0.98 and sensitivity and specificity of 83.8% and 76.2%. Conclusion: In contrast to healthy controls, CAD patients had greater copeptin levels, according to our study. In these cases, copeptin levels can be employed as a biomarker. [ABSTRACT FROM AUTHOR]

Background: Patients presenting with typical cardiac chest pain often undergo coronary angiography, but a significant proportion is found to have non-obstructive epicardial coronary arteries. This study aimed to determine the frequency of non-obstructive coronary arteries in patients with typical cardiac chest pain and explore associated risk factors and clinical outcomes. Methods: This retrospective, observational study included patients who presented with typical cardiac chest pain and underwent coronary angiography at S.S. Narayana Heart Centre, Davanagere, Karnataka, between January 2018 and December 2022. Non-obstructive epicardial coronary arteries were defined as the absence of =50% luminal narrowing in any major coronary artery. Baseline characteristics, angiographic findings, and clinical outcomes were analyzed. Results: Of the 1,257 patients included, 287 (22.8%) had non-obstructive epicardial coronary arteries. The frequency was higher in women (28.1%) compared to men (17.6%, p < 0.001). Logistic regression analysis identified female sex (odds ratio [OR] 1.84, 95% confidence interval [CI] 1.39-2.44, p < 0.001) and the absence of traditional cardiovascular risk factors (OR 1.62, 95% CI 1.22-2.16, p = 0.001) as significant predictors of non-obstructive coronary arteries. During a median follow-up of 24 months, patients with non-obstructive coronary arteries had a lower rate of major adverse cardiovascular events (MACE) (5.6% vs. 14.3%, p < 0.001), cardiovascular death (0.7% vs. 2.9%, p = 0.032), non-fatal myocardial infarction (2.1% vs. 5.3%, p = 0.017), and revascularization (2.8% vs. 6.2%, p = 0.018) compared to those with obstructive disease. Conclusion: Non-obstructive epicardial coronary arteries were present in nearly one-quarter of patients with typical cardiac chest pain, with a higher frequency in women. Patients with non-obstructive coronary arteries had a more favorable prognosis but may still benefit from tailored diagnostic and management approaches. [ABSTRACT FROM AUTHOR]

Coronary artery three‐dimensional reconstruction is essential for preventing, diagnosing, and treating coronary heart disease. This study introduces SegUnet, a lightweight hybrid CNN‐Transformer network for pixel‐level segmentation of coronary artery computed tomography angiography (CTA) slices to enhance the precision of coronary artery reconstruction. The overall SegUnet adopts a U‐shaped encoder‐decoder structure, with a hierarchical Transformer structure serving as the encoder to extract global contextual information; the decoder is enhanced with spatial attention mechanism (SAM) and residual structure to improve its perception and adaptive adjustment abilities for coronary artery vessels. In contrast to other methods, we propose an interpolation‐based multi‐feature fusion bridge to integrate multi‐scale features between encoder levels, capturing their semantic dependencies. Experimental results show that SegUnet achieves a prediction accuracy of 97.23% on the test set of coronary arteries 2D slices. Moreover, the network exhibits excellent performance on Synapse Multi‐Organ Segmentation, highlighting the superiority, effectiveness, and robustness of our proposed method. The outstanding performance of SegUnet in coronary artery segmentation has elevated the quality of three‐dimensional reconstruction of the coronary arteries, exerting a positive impact on the enhancement of diagnosis and treatment of coronary artery diseases. [ABSTRACT FROM AUTHOR]

People are exposed to low-dose radiation in medical diagnosis, occupational, or life circumstances, but the effect of low-dose radiation on human health is still controversial. The biological effects of radiation below 100 mGy are still unproven. In this study, we observed the effects of low-dose radiation (100 mGy) on gene expression in human coronary artery endothelial cells (HCAECs) and its effect on molecular signaling. HCAECs were exposed to 100 mGy ionizing radiation at 6 mGy/h (low-dose-rate) or 288 mGy/h (high-dose-rate). After 72 h, total RNA was extracted from sham or irradiated cells for Quant-Seq 3'mRNA-Seq, and bioinformatic analyses were performed using Metascape. Gene profiling was validated using qPCR. Compared to the non-irradiated control group, 100 mGy of ionizing radiation at 6 mGy/h altered the expression of 194 genes involved in signaling pathways related to heart contraction, blood circulation, and cardiac myofibril assembly differentially. However, 100 mGy at 288 mGy/h altered expression of 450 genes involved in cell cycle-related signaling pathways, including cell division, nuclear division, and mitosis differentially. Additionally, gene signatures responding to low-dose radiation, including radiation dose-specific gene profiles (HIST1H2AI, RAVER1, and POTEI) and dose-rate-specific gene profiles (MYL2 for the low-dose-rate and DHRS9 and CA14 for the high-dose-rate) were also identified. We demonstrated that 100 mGy low-dose radiation could alter gene expression and molecular signaling pathways at the low-dose-rate and the high-dose-rate differently. Our findings provide evidence for further research on the potential impact of low-dose radiation on cardiovascular function. [ABSTRACT FROM AUTHOR]

Coronary artery fistulas draining into the left ventricle is a rare finding. They can be associated with other congenital cardiac anomalies like ventricular septal defect or tetralogy of Fallot. While most of them are asymptomatic, they can lead to severe cardiac complications like infective endocarditis, heart failure, or myocardial ischemia. Symptomatic coronary artery fistulas can be managed surgically or percutaneously. We present a case of a 61-year-old male patient with both left anterior descending artery and right coronary artery fistulas draining into the left ventricle associated with ascending aorta and root aneurysm. Preoperative assessment for myocardial ischemia and the size and location of the fistulas was performed. The echocardiography stress test was negative. Surgery consisted of replacement of the ascending aorta and reconstruction of the noncoronary sinus with a Dacron patch with aortic valve preservation and no intervention for the coronary artery fistulas. The surgical strategy was adapted for cardioplegia administration to compensate for the volume of coronary blood drained into the left ventricle and for better protection of the distal myocardium. [ABSTRACT FROM AUTHOR]

Background: Intracoronary acetylcholine testing may induce epicardial coronary artery spasm (CAS) or coronary microvascular spasm (CMVS) in patients with angina syndromes but non-obstructive coronary artery disease, but their causal role in individual patients is not always clear. In this prospective, observational single-center study, we aimed to assess whether (1) the induction of myocardial ischemia/angina by electrocardiogram (ECG) exercise stress test (EST) differs between patients showing different results in response to acetylcholine testing (i.e., CAS, CMVS, or no spasm); (2) the preventive administration of short-acting nitrates has any different effects on the EST of those patients who showed a positive basal EST. We expected that if exercise-induced angina and/or ischemic ECG changes are related to CAS, they should improve after nitrates administration, whereas they should not significantly improve if they are caused by CMVS. Methods: We enrolled 81 patients with angina syndromes and non-obstructive coronary artery disease, who were divided into three groups according to acetylcholine testing: 40 patients with CAS (CAS-group), 14 with CMVS (CMVS-groups), and 27 with a negative test (NEG-group). All patients underwent a basal EST (B-EST). Patients with a positive B-EST repeated the test 24–48 h later, 5 min after the administration of short-acting nitrates (N-EST). Results: There were no significant differences among the groups in terms of the B-EST results. B-EST was positive in eight (20%) patients in the CAS-group, seven (50%) in the CMVS-group, and six (22%) in the NEG-group (p = 0.076). N-EST, performed in eight, six, and five of these patients, also showed similar results in the three groups. Furthermore, the N-EST results also did not significantly differ compared to B-EST in any group, remaining positive in seven (87.5%), four (66.7%), and four (80%) patients in the CAS-group, CMVS-group, and NEG-group, respectively (p = 0.78). Conclusions: Our data show that patients with angina and non-obstructive coronary artery disease show largely comparable results of the ECG exercise stress test and similar poor effects of short-acting nitrates on abnormal ECG exercise stress test results. On the whole, our findings suggest caution in attributing to the results of Ach testing a definite causal role for the clinical syndrome in individual patients. [ABSTRACT FROM AUTHOR]

This study aimed to reduce the risk of graft occlusion by evaluating the two-phase flow of blood and LDL nanoparticles in coronary artery grafts. The study considered blood as an incompressible Newtonian fluid, with the addition of LDL nanoparticles, and the artery wall as a porous medium. Two scenarios were compared, with constant inlet velocity (CIV) and other with pulsatile inlet velocity (PIV), with LDL nanoparticles experiencing drag, wall-induced lift, and induced Saffman lift forces, or drag force only. The study also evaluated the concentration polarization of LDLs (CP of LDLs) near the walls, by considering the artery wall with and without permeation. To model LDL nanoparticles, the study randomly injected 100, 500, and 1000 nanoparticles in three release states at each time step, using different geometries. Numerical simulations were performed using COMSOL software, and the results were presented as relative collision of nanoparticles to the walls in tables, diagrams, and shear stress contours. The study found that a graft implantation angle of 15° had the most desirable conditions compared to larger angles, in terms of nanoparticle collision with surfaces and occlusion. The nanoparticle release modes behaved similarly in terms of collision with the surfaces. A difference was observed between CIV and PIV. Saffman lift and wall-induced lift forces having no effect, possibly due to the assumption of a porous artery wall and perpendicular outlet flow. In case of permeable artery walls, relative collision of particles with the graft wall was larger, suggesting the effect of CP of LDLs. [ABSTRACT FROM AUTHOR]

The structural morphology of coronary stents and the local hemodynamic environment following stent deployment in coronary arteries are crucial determinants of procedural success and subsequent clinical outcomes. High-resolution intracoronary imaging has the potential to facilitate geometrically accurate three-dimensional (3D) reconstruction of coronary stents. This work presents an innovative algorithm for the 3D reconstruction of coronary artery stents, leveraging intravascular ultrasound (IVUS) and angiography. The accuracy and reproducibility of our method were tested in stented patient-specific silicone models, with micro-computed tomography serving as a reference standard. We also evaluated the clinical feasibility and ability to perform computational fluid dynamics (CFD) studies in a clinically stented coronary bifurcation. Our experimental and clinical studies demonstrated that our proposed algorithm could reproduce the complex 3D stent configuration with a high degree of precision and reproducibility. Moreover, the algorithm was proved clinically feasible in cases with stents deployed in a diseased coronary artery bifurcation, enabling CFD studies to assess the hemodynamic environment. In combination with patient-specific CFD studies, our method can be applied to stenting optimization, training in stenting techniques, and advancements in stent research and development. [ABSTRACT FROM AUTHOR]

Atherosclerotic plaques are commonly observed at low shear regions, in particular, the left main coronary artery (LMCA) bifurcation. Low shear regions at bifurcations promote endothelial dysfunction, a key factor initiating atherogenesis, however, mechanisms underlying this process are poorly understood. Dynamic in vitro models are critical to investigate endothelial dysfunction, but current static and vessels‐on‐chip systems typically lack physiologically complex geometries and local shear changes. Here, a bifurcating coronary artery‐on‐a‐chip is developed, mimicking the human LMCA, displaying reduced shear near the bifurcation, verified using computational fluid dynamics simulations. Over 7 days of dynamic culture, human coronary artery endothelial cells aligned with the flow and expressed more Endothelial nitric oxide synthase (eNOS) and intercellular cell adheison molecule‐1 (ICAM‐1) at high shear regions (12.7 dyn cm−2) adjacent to, but not at the bifurcation (0–3 dyn cm−2). After tumor necrosis factor‐alpha (TNFα) stimulation to induce endothelial dysfunction, spatially mapping cellular changes and shear gradients revealed cell alignment is disrupted over a larger area surrounding the bifurcation at a higher shear, and ICAM‐1 expression is increased closer to the bifurcation at a lower shear. This coronary artery‐on‐a‐chip establishes a system to spatially map endothelial cell behavior in response to differential shear and vessel geometry, enabling future studies into plaque initiation events, treatment targets, and drug screening. [ABSTRACT FROM AUTHOR]

Coronary artery fistula (CAF) is characterized as a congenital or acquired abnormal communication between a coronary artery and any of the four chambers of the heart (coronary–cameral fistula) or great vessels (coronary arteriovenous fistula) bypassing the capillaries within myocardium. CAF is a rare disease, challenging to diagnose and treat depending on the anatomical location and type of the fistula and accompanying diseases. This study aims to report a case with multiple coronary artery to coronary sinus (CS) fistulas with giant left circumflex artery and multivalvular infective endocarditis. [ABSTRACT FROM AUTHOR]

Background: The efficacy and safety of low-pressure balloon pre-dilatation before intracoronary pro-urokinase (pro-UK) in preventing no-reflow during percutaneous coronary intervention (PCI) remains unknown. This study aimed to evaluate the clinical outcomes of intracoronary pro-UK combined with low-pressure balloon pre-dilatation in patients with anterior ST-segment-elevation myocardial infarction (STEMI). Methods: This was a randomized, single-blind, investigator-initiated trial that included 179 patients diagnosed with acute anterior STEMI. All patients were eligible for PCI and were randomized into two groups: intracoronary pro-UK combined with (ICPpD group, n = 90) or without (ICP group, n = 89) low-pressure balloon pre-dilatation. The main efficacy endpoint was complete epicardial and myocardial reperfusion. The safety endpoints were major adverse cardiovascular events (MACEs), which were analyzed at 12 months follow-up. Results: Patients in the ICPpD group presented significantly higher TIMI myocardial perfusion grade 3 (TMPG3) compared to those in the ICP group (77.78% versus 68.54%, P = 0.013), and STR ≥ 70% after PCI 30 min (34.44% versus 26.97%, P = 0.047) or after PCI 90 min (40.0% versus 31.46%, P = 0.044). MACEs occurred in 23 patients (25.56%) in the ICPpD group and in 32 patients (35.96%) in the ICP group. There was no difference in hemorrhagic complications during hospitalization between the groups. Conclusion: Patients with acute anterior STEMI presented more complete epicardial and myocardial reperfusion with adjunctive low-pressure balloon pre-dilatation before intracoronary pro-UK during PCI. Trial registration: 2019xkj213. [ABSTRACT FROM AUTHOR]

This prospective study aimed to assess the accuracy of electrocardiography (ECG) and 2D echocardiography (2D-ECHO) in identifying the infarct vessel in acute myocardial infarction (AMI), correlating findings with coronary angiography (CAG). Seventy-five AMI cases were included, diagnosed by ECG and cardiac enzymes, and underwent 2D-ECHO and CAG. Statistical analysis was conducted using SPSS and R environment. Results showed significant correlations between ECG, 2D-ECHO, and CAG findings, aiding in accurate identification of infarct vessels. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ECG and 2D-ECHO in identifying coronary artery involvement were evaluated. Findings suggest ECG and 2D-ECHO as valuable tools in AMI diagnosis, with implications for patient management. [ABSTRACT FROM AUTHOR]

Objective To establish a differential model of phlegm and blood stasis pattern and qi deficiency and blood stasis pattern in stable angina pectoris using radiomics. Methods A total of 91 patients with stable angina pectoris who underwent coronary artery CT angiography in Affiliated Hospital of Liaoning University of Traditional Chinese Medicine from January 2021 to January 2022 were collected, including 47 cases of phlegm and blood stasis pattern and 44 cases of qi deficiency and blood stasis pattern. The patients were divided into train set(64 cases) and test set(27 cases) according to the ratio of 7:3 by stratified random sampling method. 3D-slicer software was used to extract the radiomics features of pericoronary adipose tissue(PCAT) images. Principal component analysis was used to visualize the distribution of radiomics features of pattern of phlegm and blood stasis and pattern of qi deficiency and blood stasis. The least absolute shrinkage and selection operator regression analysis and support vector machine decreasing feature elimination were used for feature selection. The multinomial logistics regression was used for model construction. The receiver operating characteristic (ROC) curve was used to verify the model in the train set and the test set to evaluate the effectiveness of the radiomics features in differentiating phlegm and blood stasis pattern and qi deficiency and blood stasis pattern. Finally, Spearman coefficient was used to analyze the correlation between the differential features and clinical physicochemical data. Results A total of 837 radiomics features were extracted from PCAT images by 3D-slicer software. In the principal component analysis, PC1 and PC2 explained 77.9% and 8.1% of the total variance, respectively, and there was a relatively obvious separation trend between the two pattern groups. After feature screening, 7 radiomics features were used to construct the differential model of phlegm and blood stasis pattern and qi deficiency and blood stasis pattern. The area under the ROC curve (AUC) of the differential model was 0.844 in the train set and 0.834 in the test set. Spearman correlation analysis showed that the differential features were significantly correlated with cTnI, neutrophil, triglyceride, total cholesterol, and leukocyte. Conclusion The CT radiomics model based on PCAT has a high discrimination efficiency for stable angina pectoris with phlegm and blood stasis pattern and qi deficiency and blood stasis pattern. [ABSTRACT FROM AUTHOR]

Kounis syndrome, an allergic hypersensitivity coronary disorder, is a rare but potentially lifethreatening condition triggered by various allergens, including medications. We present the case of a 41-year-old male with no prior cardiac history, who developed Kounis syndrome following vancomycin administration for suspected cellulitis. The patient initially presented with rash, fever, and malaise, which progressed to chest discomfort associated with diaphoresis and elevated troponin levels. Diagnostic evaluations, including electrocardiographic changes and coronary angiography, confirmed a diagnosis of type I Kounis syndrome. This case adds to the limited literature on vancomycin-induced Kounis syndrome, and underscores the importance of considering this diagnosis in patients with myocardial damage following exposure to potential allergens. [ABSTRACT FROM AUTHOR]

Objective To assess the potential values of radiomics signatures of pericoronary adipose tissue (PCAT) in identifying patients with acute coronary syndrome (ACS). Methods In total, 149, 227, and 244 patients were clinically diagnosed with ACS, chronic coronary syndrome (CCS), and without coronary artery disease (CAD), respectively, and were retrospectively analysed and randomly divided into training and testing cohorts at a 2:1 ratio. From the PCATs of the proximal left anterior descending branch, left circumflex branch, and right coronary artery (RCA), the pericoronary fat attenuation index (FAI) value and radiomics signatures were calculated, among which features closely related to ACS were screened out. The ACS differentiation models AC1, AC2, AC3, AN1, AN2, and AN3 were constructed based on the FAI value of RCA and the final screened out first-order and texture features, respectively. Results The FAI values were all higher in patients with ACS than in those with CCS and no CAD (all P  <  .05). For the identification of ACS and CCS, the area-under-the-curve (AUC) values of AC1, AC2, and AC3 were 0.92, 0.94, and 0.91 and 0.91, 0.86, and 0.88 in the training and testing cohorts, respectively. For the identification of ACS and no CAD, the AUC values of AN1, AN2, and AN3 were 0.95, 0.94, and 0.94 and 0.93, 0.87, and 0.89 in the training and testing cohorts, respectively. Conclusions Identification models constructed based on the radiomics signatures of PCAT are expected to be an effective tool for identifying patients with ACS. Advances in knowledge The radiomics signatures of PCAT and FAI values are expected to differentiate between patients with ACS, CCS and those without CAD on imaging. [ABSTRACT FROM AUTHOR]

Assay-specific increases in circulating cardiac troponin are observed in 20–40% of patients after noncardiac surgery, depending on patient age, type of surgery, and comorbidities. Increased cardiac troponin is consistently associated with excess morbidity and mortality after noncardiac surgery. Despite these findings, the underlying mechanisms are unclear. The majority of interventional trials have been designed on the premise that ischaemic cardiac disease drives elevated perioperative cardiac troponin concentrations. We consider data showing that elevated circulating cardiac troponin after surgery could be a nonspecific marker of cardiomyocyte stress. Elevated concentrations of circulating cardiac troponin could reflect coordinated pathological processes underpinning organ injury that are not necessarily caused by ischaemia. Laboratory studies suggest that matching of coronary artery autoregulation and myocardial perfusion–contraction coupling limit the impact of systemic haemodynamic changes in the myocardium, and that type 2 ischaemia might not be the likeliest explanation for cardiac troponin elevation in noncardiac surgery. The perioperative period triggers multiple pathological mechanisms that might cause cardiac troponin to cross the sarcolemma. A two-hit model involving two or more triggers including systemic inflammation, haemodynamic strain, adrenergic stress, and autonomic dysfunction might exacerbate or initiate acute myocardial injury directly in the absence of cell death. Consideration of these diverse mechanisms is pivotal for the design and interpretation of interventional perioperative trials. [ABSTRACT FROM AUTHOR]

The management of adult patients with anomalous aortic origin of the right coronary artery (ARCA) from the left aortic sinus poses important challenges. The presence of symptoms or documented ischaemia, the anatomical characteristics of the ostium, and the course of the coronary determine decision-making. A retrospective review was performed of all cases of surgical management of ARCA at a single centre. The primary endpoints were mortality and myocardial infarction at 30 days. Secondary endpoints included recurrence of symptoms, freedom from re-intervention, and mortality during long-term follow-up. From October 2019 to August 2023, 15 adult patients underwent surgery for ARCA; 13 patients were included in this study (mean age 53.9±11.1 years; 10 female). A slit-like orifice, a long intramural segment, and an interarterial course were found in all patients. Twelve (12) patients (92.3%) were symptomatic: nine with angina, combined with dyspnoea on exertion in seven. One (1) patient had history of pre-syncope. One (1) patient presented with out-of-hospital cardiac arrest. All patients underwent formal unroofing of the orifice and intramural portion of the ARCA; five patients had a concomitant procedure. No 30-day mortality nor myocardial infarction was recorded. At a mean follow-up of 20.1±12.8 months, all patients were alive. One (1) patient (7.6%) developed recurrent dyspnoea; investigations showed no ischaemia. No repeated interventions were required. Surgical unroofing of anomalous coronary artery in the adult is safe and effective; correction of both the slit-like orifice and intramural portion of the anomaly provides a durable result in patients with ARCA. [ABSTRACT FROM AUTHOR]

Background: Experimental coronary artery interventions are currently being performed on non-diseased blood vessels in healthy animals. To provide a more realistic pathoanatomical scenario for investigations on novel interventional and surgical therapies, we aimed to fabricate a stenotic lesion, mimicking the morphology and structure of a human atherosclerotic plaque. Methods: In an interdisciplinary setting, we engineered a casting mold to create an atherosclerotic plaque with the dimensions to fit in a porcine coronary artery. Oscillatory rheology experiments took place along with long-term stability tests assessed by microscopic examination and weight monitoring. For the implantability in future in vivo setups, we performed a cytotoxicity assessment, inserted the plaque in resected pig hearts, and performed diagnostic imaging to visualize the plaque in its final position. Results: The most promising composition consists of gelatin, cholesterol, phospholipids, hydroxyapatite, and fine-grained calcium carbonate. It can be inserted in the coronary artery of human-sized pig hearts, producing a local partial stenosis and interacting like the atherosclerotic plaque by stretching and shrinking with the vessel wall and surrounding tissue. Conclusion: This artificial atherosclerotic plaque model works as a simulating tool for future medical testing and could be crucial for further specified research on coronary artery disease and is going to help to provide information about the optimal interventional and surgical care of the disease. [ABSTRACT FROM AUTHOR]

Eptifibatide, a GPIIb/IIIa receptor inhibitor, has shown its efficacy and safety in patients with high clot burden in their coronary vessels. It is widely used in patients with this condition. However, this medication use is accompanied by complications in some cases. Thrombocytopenia which is a relatively common condition in patients admitted to the hospital, especially in the acute setting, can be caused by medications. This condition can occur as an antibody or non‐antibody‐mediated process, caused by medications, such as heparin, clopidogrel, and eptifibatide. In this case, we present a woman with acute coronary syndrome and a complex lesion with a clot in her coronary vessel who was treated with eptifibatide. It led to asymptomatic thrombocytopenia. Once detected in laboratory data, the infusion was held, and the platelet count recovered in less than 5 days without additional treatment for this adverse effect. Eptifibatide is a medication used to treat acute coronary syndrome patients with a large thrombus in their coronary vessels. The mechanism of inducing thrombocytopenia by eptifibatide has not been proven yet, but it might be related to IgG antibodies. The severity of the disease can vary significantly, and the treatment is based on this factor. However, the main pillar of the treatment is the cessation of eptifibatide as soon as possible. This case draws the attention of physicians to one of the infrequent adverse effects of a commonly used medication in cardiology patients. Thrombocytopenia and its manifestations should be investigated and considered in patients who receive eptifibatide. [ABSTRACT FROM AUTHOR]

Background: The increased amount of contrast media in frequency-domain optical coherence tomography (FD-OCT) imaging during percutaneous coronary intervention (PCI) has raised potential concerns regarding impairment of renal function. Objectives: This study aimed to evaluate the effectiveness of heparinized saline flush in FD-OCT-guided PCI and identify clinical factors contributing to optimal image quality. Methods: We retrospectively collected 100 lesions from 90 consecutive patients, and a total of 200 pullbacks were analyzed for the initial and final evaluation in which saline was used as the flushing medium. Results: The study population had a mean age of 73, with 52% having chronic kidney disease (CKD). The median amount of contrast used was 28 ml, and no complications were observed associated with saline flush OCT. Imaging quality was then categorized as excellent, good, or unacceptable. Among the total runs, 87% demonstrated clinically acceptable image quality, with 66.5% classified as excellent images and 20.5% classified as good images. Independent predictors of excellent images included lumen area stenosis ≥ 70% (adjusted odds ratio [OR] 2.37, 95% confidence interval [CI] 1.02–5.47, P = 0.044), and the use of intensive flushing (adjusted OR 2.06, 95% CI 1.11–3.86, P = 0.023) defined as a deep engagement of guiding catheter (GC) or a selective insertion of guide extension catheter (GE). Intensive flushing was performed in 60% of the total pullbacks, and it was particularly effective in improving image quality in the left coronary artery (LCA). Conclusion: The use of saline flush during FD-OCT imaging was safe and feasible, which had a benefit in renal protection with adequate imaging quality. [ABSTRACT FROM AUTHOR]

Objectives: Coronary artery calcification (CorCa) identifies high cardiovascular risk in the general population. In this setting, aortic valve calcification (AoCa) showed contradictory results. Our goal has been to assess the prognostic power of CorCa and AoCa in patients with chest pain who underwent an ECG-gated cardiac multidetector CT (cardiac-MDCT). Methods: A total of 528 patients without previous known coronary artery disease, with chest pain who underwent a cardiac-MDCT multidetector, were retrospectively recruited. The primary endpoint included death, acute coronary syndrome, stroke, and heart failure. Results: A total of 61 patients (11.6%) had an event during a mean follow-up of almost 6 years (5.95 ± 2.98). The most frequent event was acute coronary syndrome (6.4%). Total mortality was 4.5%. Patients with CorCa > 0 had more events than those without CorCa (17.3% versus 4.3%; p < 0.001). Likewise, when only patients without AoCa were considered (n = 118), clinical events were more frequent in those with CorCa (12.7% versus 3.6%; p = 0.004). After excluding patients with coronary artery disease, events were more frequent in those with CorCa (12.6% versus 4.3%; p = 0.004). The higher the Agatston score, the more frequent the events. Patients with AoCa > 0 had more events than those without (16.5% versus 7.3%; p < 0.001), but in patients without CorCa, no difference in events was seen (6.2% versus 3.6%; p = 0.471). A Cox regression analysis showed age, smoking, prior stroke, and CorCa but not AoCa to be independently related to events. Conclusions: In summary, CorCa, but not AoCa, is related to cardiovascular events in patients with chest pain who undergo a cardiac-MDCT. Clinical relevance statement: We show that coronary artery calcification, but not aortic valve calcification, detected in a coronary CT scan is tightly related to cardiovascular events. Although this is a message already shown by other groups in the general population, we do believe that this work is unique because it is restricted to patients with chest pain sent to coronary CT. In other words, our work deals with what we face in our routine everyday practice. Key Points: • The presence and the amount of coronary artery calcification are associated with cardiovascular events in patients with chest pain. • Aortic valve calcification is not associated with cardiovascular events in patients with chest pain. [ABSTRACT FROM AUTHOR]

Background: Our aim was to assess the relationship of the index of microvascular resistance (IMR) in left anterior descending (LAD) artery involved STEMI patients. Methods: Data of 316 STEMI patients who had undergone primary percutaneous coronary intervention (PCI) were collected from three cardiovascular centers from 2005 to 2015. In total, 246 patients with LAD STEMI were enrolled for IMR evaluation. Patients were divided into two groups respective of the cut-off IMR value of 30. All-cause mortality, left ventricular function, improvement of systolic function, and cardiac biomarkers were analyzed and compared. Results: A total of 246 patients were enrolled. The number of patients in the IMR above 30 group was 93 and below 30 was 153. The mean ages for each group were 57.91 ± 11.99 and 54 ± 10.63, respectively. The peak creatinine kinase (CK) (3936.85 ± 2827.32 IU/L vs. 2218.08 ± 2310.41 IU/L, p < 0.001) and CKmb (336.15 ± 195.08 mg/mL vs. 231.53 ± 179.53 mg/mL, p < 0.001) levels were higher for an IMR above the 30 group. The left ventricular ejection fraction (LVEF) (44.57 ± 6.685% vs. 47.35 ± 8.17%, p = 0.006) and improvement of LVEF (2.81 ± 7.135% vs. 5.88 ± 7.65%, p = 0.004) was lower in the IMR above 30 group. All-cause mortality (7.5% vs. 1.3%, p = 0.012) was higher in the IMR above 30 group, and a Cox regression analysis showed that an IMR above 30 was a poor prognostic factor regarding all-cause mortality (HR: 5.151, 95% CI 1.062–24.987, p = 0.042) even after adjusting for classical clinical risk factors. Conclusions: An elevated IMR value represented larger infarct size, more severe LV dysfunction, and higher mortality in LAD STEMI patients after successful PCI. [ABSTRACT FROM AUTHOR]