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Background: Multivessel disease(MVD) is linked to a poorer prognosis, increased complications, longer hospital stays, and higher in-hospital mortality when compared to single-vessel disease(SVD).The purpose of this study is to explore the clinically relevant predictors of acute cornary syndrome (ACS) combined with MVD. Methods: This multicenter retrospective study included 68,378 ACS patients from 240 hospitals.The clinical data were retrospectively analyzed with univariate and multivariate analyses to identify the predictive factors for MVD. Results: When compared to SVD group, the MVD group showed a higher incidence of Major Adverse Cardiovascular Events(MACCEs), including all-cause death, myocardial infarction, stent thrombosis, and ischemic stroke during hospitalization, These differences were found to be statistically significant (P < 0.05).The multivariate analysis revealed that age over 75 years (OR: 1.246, 95% CI: 1.176, 1.319), LDL/HDL ratio > 1.98 (OR: 1.245, 95% CI: 1.192, 1.302), history of heart failure (OR: 1.446, 95% CI: 1.143, 1.829), hypertension (OR: 1.274, 95% CI: 1.225, 1.325), diabetes (OR: 1.341, 95% CI: 1.278, 1.406), eGFRs < 60 ml/min·1.73m2 (OR: 1.179, 95% CI: 1.112, 1.249), family history of CAD (OR: 1.236, 95% CI: 1.108, 1.379), and high homocysteine levels (OR: 1.209, 95% CI: 1.029, 1.420) are independent predictors of MVD. The incidence of multivessel disease increased from 37.7 to 58.6% with an increase in the number of predictive factors, while the incidence of single vessel disease decreased from 62.3 to 41.4%. This trend was statistically significant (P trend < 0.001). Conclusions: MVD is strongly correlated with a range of risk factors including diabetes, hypertension, LDL/HDL ratio greater than 1.98, hyperhomocysteinemia, family history of CAD, reduced glomerular filtration rate (< 60 ml/(min·1.73m2), age over 75 years, and a history of heart failure. Furthermore, as the number of predictive factors increases, the odds ratio (OR) for patients with MVD also increases, reaching 2.344 times the OR for patients without any predictive factors. [ABSTRACT FROM AUTHOR]

Abstract Background Multivessel disease(MVD) is linked to a poorer prognosis, increased complications, longer hospital stays, and higher in-hospital mortality when compared to single-vessel disease(SVD).The purpose of this study is to explore the clinically relevant predictors of acute cornary syndrome (ACS) combined with MVD. Methods This multicenter retrospective study included 68,378 ACS patients from 240 hospitals.The clinical data were retrospectively analyzed with univariate and multivariate analyses to identify the predictive factors for MVD. Results When compared to SVD group, the MVD group showed a higher incidence of Major Adverse Cardiovascular Events(MACCEs), including all-cause death, myocardial infarction, stent thrombosis, and ischemic stroke during hospitalization, These differences were found to be statistically significant (P 1.98 (OR: 1.245, 95% CI: 1.192, 1.302), history of heart failure (OR: 1.446, 95% CI: 1.143, 1.829), hypertension (OR: 1.274, 95% CI: 1.225, 1.325), diabetes (OR: 1.341, 95% CI: 1.278, 1.406), eGFRs

Background: Chronic coronary syndrome (CCS) has a high mortality rate worldwide, especially in developing countries. The degree of vessel stenosis and the number of stenotic vessels impact the mortality rate in coronary artery disease (CAD) patients. Additionally, multivessel disease (MVD) significantly influences clinical outcomes more than single-vessel disease (SVD). Objective: To examine if gut microbial communities could be used as biomarkers to discriminate patients with varying numbers of coronary stenotic vessels. Materials and Methods: Patients between 35 and 70 years old hospitalized at Chulabhorn Hospital were recruited between February 25 and July 15, 2023. Participants were divided into three groups, CCS patients with SVD, CCS patients with MVD, and healthy participants. On the day of the assessment, blood was drawn from each patient. The day before an appointment, the feces of every patient were collected. The present study was cross-sectional. Results: Forty-nine patients were included, and were divided into 11 SVD patients, 19 MVD patients, and 19 healthy participants. The patients were 38.78% female, with a mean age of 59.38±7.66 years, and 48.98% had hypertension. Based on sequencing of the V3-V4 regions of the 16S rRNA gene, it was revealed that the relative abundance of the Prevotella and Veillonella genera was significantly higher in MVD than in SVD patients. In the present study, MVD patients had differences in the diversity and composition of the gut microbiome compared to SVD patients and healthy participants. Conclusion: The development of SVD and MVD is correlated with changes in the gut microbiome, which may create a diagnostic marker of CAD to distinguish MVD patients from SVD patients and may be useful for further therapy and prevention. [ABSTRACT FROM AUTHOR]

Objectives: Patients with unstable angina and non-ST-elevated myocardial infarction (NSTEMI) present with a spectrum of cardiac events and death. Hence, early accurate management should be initiated. This can be achieved by risk stratifying the patients as early as possible on hospital admission. Thrombolysis in myocardial infarction (TIMI) risk score assessment is used widely for this purpose. It helps to standardize the approach of management and compare the extent and number of vessels involved in the coronary angiogram. This research aims to assess coronary artery disease (CAD) in individuals with NSTEMI by examining the extent of vessel involvement and the complexity of coronary artery blockages, using the SYNTAX score about the TIMI risk score. Materials and Methods: This cross-sectional observational study involved 60 participants who were selected based on specific inclusion and exclusion criteria. The TIMI risk score was computed for each individual, categorized as either <4 or =4, and the results of their coronary angiogram were analyzed to assess the degree of vessel involvement, categorizing it as either single-vessel disease (SVD) or multi-vessel disease (MVD). The Syntax score was computed for all angiograms and divided into two groups based on whether it was =22 or >22. Results: The average age of the participants in our study was 56 ± 10.64, with an age range of 34. Gender distribution revealed a higher proportion of males, constituting 68.3% (41 individuals), while females accounted for 31.7% (19 individuals). The angiogram results demonstrated that among the patients with TIMI score <4, 70% (14 individuals) had SVD, 30% (6 individuals) had MVD, and among those with score =4, 15% (6 individuals) had SVD while 75% (34 individuals) had MVD. In the subgroup analysis of TIMI <4, a Syntax score <22 was observed in 15 cases of SVD and a score >22 was observed in cases of MVD. Likewise, in the TIMI >4 group, a Syntax score <22 was observed in 12 cases of SVD and a score >22 was observed in 28 cases of MVD. Conclusion: This study noted that patients with non-ST-segment elevation acute coronary syndrome who underwent coronary angiogram and had a TIMI score of =4 were observed to have a 13-fold increased likelihood of having multi-vessel Coronary artery disease (CAD) compared to those with a TIMI score of <4. TIMI score of =4 had a 7 times higher chance of getting a SYNTAX score >22. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) is a major cause of morbidity and mortality worldwide. It occurs due to blockage of blood vessels supplying the area of the heart. Increased age, diabetes, hypertension, dyslipidemia, and significant alcohol history are some of the major risk factors for acute coronary syndrome (ACS). After coronary angiography, (CAG) angioplasty is the mainstay of treatment. Objectives: The objectives were: (1) To assess the clinical profile of patients with ACS. (2) To study the angiographic profile of patients with ACS. Materials and Methods: A cross-sectional study of 110 patients who underwent CAG at a tertiary care teaching hospital, Amritsar, from April 2021 to July 2022 was studied. Detailed history and echocardiographic findings were obtained. Angiographic findings were studied with management. Data were analyzed using SPSS (version 22) and Chi-square test. Results: Double-vessel disease was the most common angiographic abnormality in unstable angina and ST-elevation myocardial infarction (STEMI); whereas in non-STEMI, triple-vessel disease was the most common. The left anterior descending artery was the most common artery involved. Patients with the age of 51-60 years were the most commonly involved patients, and males had a more severe form of CAD. Smoking did not affect the severity of the disease. Conclusions: Increased age, male sex, and patients with diabetes mellitus, hypertension, and dyslipidemia were predisposed to develop ACS. Smoking did not affect the severity or pattern of artery involvement. [ABSTRACT FROM AUTHOR]

Background: Complex coronary atherosclerotic lesions often lead to coronary occlusion, clinically represented as a single-vessel disease (SVD) and multivessel disease (MVD). These occlusions could hinder the blood flow in coronary arteries that affects appropriate management of the CVD. The current study intended to genotype interleukin (IL)-18 promoter's hotspots (rs187238, rs1946518, and rs1946519) and their possible association with coronary artery stenosis. Material and methods: The IL-18 promoter genotyping was performed by the Sanger method along with the examination of biochemical parameters in 125 study subjects categorized into three groups, viz. controls, SVD and MVD. Results: The current study observed a significant association of diabetes, hypertension, and dyslipidemia between the studied group's viz. healthy controls, SVD, and MVD. Fasting blood sugar and glycosylated hemoglobin (HBA1C) were also significantly enhanced from 4.82 vs. 8.01 and 4.33 vs. 8.27, in SVD, and MVD respectively. Despite the visible differences in the pattern of genotypic and allelic expressions, the current study did not show any statistically significant correlation with IL-18 promoter polymorphism at its hotspots with controls, SVD, and MVD subjects. The only exception of the above results was the distribution of allelic frequency at the rs1946519 hotspot, where a significant change (P < 0.05) was observed. Conclusion: This study is of additional value to our previous reports, revealing the pattern of genotypes and allelic frequency of IL-18 promoters in a small cohort of Saudi ethnicity. Further investigations on larger sample size are recommended to envisage the presence of functional mutations in the IL-18 gene that could establish or rule out the possible association of IL-18 polymorphism with SVD and MVD. [ABSTRACT FROM AUTHOR]

Objectives: Premature coronary artery disease (CAD) is on the rise in our population, and multivessel disease (MVD) is no longer an uncommon finding in young patients. Therefore, aim of this study was to determine the predictors of MVD in young patients who presented with ST-Segment Elevation Myocardial Infarction (STEMI). Methodology: For this study, we enrolled 294 young adult (18-40 years) patients with STEMI. MVD was diagnosed based on angiography. Demographic characteristics and baseline risk profiles were considered for the univariate and multivariate analyses to determine the predictors of MVD. Results: Out of 294 patients, 90.5% (266) were males, and the mean age was 35.45 ± 4.07 years. Our 24.1% (71) patients were hypertensive (HTN), and 36.1% (106) were smokers. A total of 94 patients had MVD. Patients with MVD were older and more likely to have diabetes (DM) and HTN than their counterparts. Only age and DM were found to be significant independent predictors of MVD. The risk of developing MVD was higher in diabetics, with adjusted odds ratios (ORs) [95% CI] of 2.47 [1.23-4.97; p=0.011]. Conclusion: In conclusion, we showed that age and DM are independent predictors of MVD in a young Pakistani adult population presenting with STEMI. However, none of the other risk factors, such as obesity, male gender or smoking, were found to be significantly associated with MVD in Pakistani adults with premature CAD. Although significantly associated, HTN does not prove to be an independent predictor of multivessel CAD in young adults . [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) is a potentially life-threatening condition which is more common in elderly people, and young are relatively protected. Currently, the protective effect on young from coronary artery disease (CAD) is taken away by several risk factors. The aim of this study is to determine the conventional risk factors and angiographic correlation of CAD in young age (40 years). Materials and Methods: This study was a hospital-based retrospective cross-sectional analytical study involving 1151 patients of ACS admitted in the cardiac ICU from May 2016 to May 2018. Among these patients, coronary risk factors such as smoking, diabetes, hypertension, dyslipidemia, and family history were studied. Patients were divided into two groups, Group A: 40 years. Patients were evaluated angiographically. The significance of each risk factor between the groups was calculated by employing the Chi-square test and P < 0.05 was taken as statistically significant. Results: A total of 1151 cases were included in the study, of which 120 cases were

Background: Inflammation plays a key role in the pathogenesis of atherosclerosis and coronary artery disease (CAD). Aim and Objectives: The aim of this study was to assess the relation of serum high-sensitivity C-reactive protein (hs-CRP) with the presence and severity of CAD. Study Design: This was a cross-sectional, observational study done on patients with diagnosis of acute coronary syndrome (ACS) undergoing coronary angiogram (CAG). Materials and Methods: A total of 100 patients were included in this study satisfying the inclusion criteria. The inclusion criteria were patients with the diagnosis of ACS undergoing CAG. All enrolled patients underwent hs-CRP, hemoglobin, serum creatinine, fasting lipid profile, blood sugar level, resting 12-lead electrocardiogram, creatine kinase–myocardial band, troponin -I, and CAG. Statistical Analysis: Data were analyzed for mean, percentage, standard deviation and Chi-square test for quantitative data using SPSS software version 21 (trial version), and P < 0.05 was considered statistically significant. Results: A total of 63% of male and 37% of female patients underwent CAG. The mean level of hs-CRP was 2.73 (±0.73) mg/L. The level of hs-CRP, severity of coronary artery involvement, and CAD risk factors was significantly more with an hs-CRP level of 1–3 mg/L followed by >3 mg/L. The significant number of patients with double-vessel disease (DVD) and triple-vessel disease (TVD) had an hs-CRP level between 1 and 3 mg/L compared to single-vessel disease (SVD) with P < 0.03. About 67.57% of females and 44.44% of males had an hs-CRP level of 1–3 mg/L, respectively (P < 0.02). A total of 53% of population had an hs-CRP level between 1 and 3 mg/L, 23% had <1 mg/L, and 24% had >3 mg/L (P < 0.02). The hs-CRP was positively correlated with severity of CAD by angiogram (+0.21). Conclusions: A significant number of patients had an hs-CRP level of 1–3 mg/L. The severity of CAD was positively correlated with a level of hs-CRP in incremental fashion. Patients with DVD and TVD had a high hs-CRP level compared to SVD. The hs-CRP can be considered as novel CAD risk factors to be screened in the patients with CAD where it cannot be forecasted by traditional risk factors. [ABSTRACT FROM AUTHOR]

Objective An isolated stenosis of the celiac artery (CA) or the superior mesenteric artery (SMA) is frequently detected in patients with abdominal complaints. The dilemma is whether these patients suffer from chronic mesenteric ischemia (CMI) and whether they will benefit from revascularization. We evaluated the long-term clinical success rates for single CA or SMA revascularization in patients with gastrointestinal symptoms and confirmed mucosal ischemia. Methods This was a retrospective cohort analysis of 59 consecutive patients with gastrointestinal symptoms and a single atherosclerotic mesenteric artery stenosis who were referred to our tertiary care institution between 2006 and 2010 for standardized diagnostic workup of CMI, including measurement of mucosal ischemia with visible light spectroscopy or gastric-jejunal tonometry. Patients with multidisciplinary consensus diagnosis of CMI underwent surgical or endovascular revascularization. The primary outcome was clinical response to revascularization, defined as relief of presenting symptoms as experienced by the patient. Results Consensus diagnosis of CMI was obtained in 37 of 59 patients. Isolated CA stenosis was present in 30 of 37 patients (81%) and isolated SMA stenosis in seven patients. After a mean follow-up of 5.0 ± 3.0 years, 27 of 37 patients (73%) experienced sustained symptom relief after revascularization. Response was not related to lesion localization (CA, 73%; SMA, 71%; P = .919). Conclusions Revascularization of the CA or SMA provides persistent symptom relief in 73% of patients diagnosed with CMI due to single atherosclerotic mesenteric artery stenosis. [ABSTRACT FROM AUTHOR]

Background: Successful chronic total occlusion (CTO) revascularization has been associated with prognostic benefits. Whether the extent of coronary artery disease interferes with these benefits has not been investigated yet. Aims: We sought to compare the survival after percutaneous coronary intervention (PCI) for CTO between patients with multi- (MVD) and single-vessel disease (SVD). Methods: A total of 2002 consecutive patients undergoing CTO PCI between 01/2005 and 12/2013 were identified and stratified according to the presence/absence of MVD. The primary endpoint was all-cause mortality. Median follow-up was 2.6 (interquartile range 1.1-3.1) years. Results: A total of 1634 (81.6%) patients had MVD. Procedural success rates were 81.5 and 89.7% in the MVD and SVD groups ( p < 0.001). All-cause mortality during entire follow-up was higher in MVD as compared to SVD patients (13.5 versus 5.7%, p < 0.001), and differences were attenuated after multivariable adjustment for baseline characteristics [adjusted hazard ratio (HR) 1.51, 95% CI 0.98-2.33, p = 0.06]. The effect of successful CTO PCI on all-cause mortality was consistent among patients with MVD [11.0 versus 24.5%; adjusted HR 0.60, 95% CI 0.45-0.80, p < 0.001] and SVD [5.2 versus 10.5%; adjusted HR 0.74, 95% CI 0.24-2.26, p = 0.59, P = 0.65]. However, due to the greater baseline risk in the former group, the absolute survival benefit after successful CTO PCI was higher. Conclusions: Successful recanalization of a CTO is a strong independent predictor for reduced long-term mortality. Due a higher baseline risk, the absolute benefit in patients with MVD is substantially larger than in patients with SVD. [ABSTRACT FROM AUTHOR]

OBJETIVO: Estudar um grupo de pacientes com lesão significativa em apenas uma artéria coronária e demonstrar se a ecocardiografia de estresse com dobutamina (EED) tem boa sensibilidade e especificidade na avaliação de viabilidade miocárdica nesse grupo de pacientes. MÉTODOS: Foram estudados 20 pacientes submetidos a angioplastia coronariana transluminal percutânea (ATC). Esse grupo foi avaliado 2 a 7 (3,65 ± 1,69) dias antes do procedimento, e 2 a 5 (4 ± 0,80) dias depois, realizando-se EED. Para a determinação de viabilidade miocárdica foi utilizado ecocardiograma bidimensional três meses após o procedimento. Doze pacientes foram submetidos a ATC de artéria descendente anterior (DA), 7 de artéria coronária direita (CD) e 1 de circunflexa (CX). Apenas um procedimento (CD) não obteve pleno êxito. RESULTADOS: Dos 340 segmentos estudados, 99 (29,18%) demonstraram alterações contráteis, sendo 63 hipocinéticos (63,4%), 28 acinéticos (28,28%) e 8 discinéticos (8,08%). Quanto aos segmentos envolvidos, obtivemos sensibilidade de 92,59%, especificidade de 84,45%, acurácia de 88,88% para o exame EED. O único caso de ATC de CX demonstrou sensibilidade de 100%; para DA, sensibilidade de 88,58%, especificidade de 95% e acurácia de 90,91%. Para segmentos da CD, sensibilidade de 91,30%, especificidade de 83,33% e acurácia de 88,71%. Todos os segmentos discinéticos eram inviáveis. Dos 63 hipocinéticos, a EED previu recuperação em 91,48%. CONCLUSÃO: A EED é útil na avaliação de viabilidade miocárdica em pacientes com lesão significativa de apenas uma artéria.OBJECTIVE: To investigate a group of patients that have a significant lesion in a single-vessel and to demonstrate whether or not the sensitivity and specificity of a dobutamine stress echocardiography (DSE) was valuable in the evaluation of myocardial viability for these patients. METHODS: Twenty patients who had undergone percutaneous transluminal coronary angioplasty (PTCA) were studied. This group was evaluated 2 to 7 days (3.65 ± 1.69) before the procedure and 2 to 5 days (4 ± 0.80) after the procedure with a DSE. Myocardial viability was assessed three months after the procedure using a two dimensional echocardiogram. Twelve patients underwent PTCA on the left anterior descending artery (LAD), 7 on the right coronary artery (RC) and 1 on the circumflex artery (CX). Only one right coronary artery procedure was not 100% successful. RESULTS: From the 340 segments that were studied, 99 (29.18%) demonstrated contractile alterations of which 63 were hypokinetic (63.4%), 28 akinetic (28.28%) and 8 dyskinetic (8.08%). In reference to the segments involved, we obtained a sensitivity of 92.59%, specificity of 84.45%, and accuracy of 88.88% for the DSE. The solitary case of PTCA for the circumflex artery demonstrated 100% sensitivity. The LAD demonstrated a sensitivity of 88.58%, specificity of 95% and accuracy of 90.91%. For the RC segments, sensitivity was 91.30%, specificity 83.33% and accuracy 88.71%. All dyskinetic segments were unviable. The DSE predicted a 91.48% recovery rate for the 63 hypokinetic segments. CONCLUSION: The DSE is an effective test for evaluating myocardial viability in patients with a significant single-vessel disease.

Percutaneous coronary intervention (PCI) and minimally invasive direct coronary artery bypass (MIDCAB) grafting are both established therapeutic options for single-vessel disease of the left anterior descending artery (LAD). The present systematic review with meta-analysis aims to determine the current strength of evidence for or against PCI and MIDCAB for revascularization of the LAD. Therefore, we performed a meta-analysis of randomized, controlled trials (RCTs) and observational trials (OTs) that reported clinical outcome after isolated LAD revascularization. Analysed postoperative outcomes included major adverse cardiac and cerebrovascular events (MACCEs), all-cause mortality, myocardial infarction and stroke. Pooled treatment effects [odds ratio (OR) or weighted mean difference (WMD), 95% confidence intervals (95% CI)] were assessed using a fixed- or random-effects model. A total of 2885 patients from 12 studies (6 RCTs, 6 OTs) were identified after a literature search of major databases using a predefined list of keywords. PCI of the LAD was performed in 60.7% (n = 1751) and MIDCAB in 39.3% of patients (n = 1126). Pooled-effect estimates revealed an increased incidence for MACCEs after PCI (OR 1.98; 95% CI 1.45–2.69; P < 0.0001) 6 months after the procedure. Especially, PCI was particularly associated with an increased odds for target vessel revascularization (OR 2.11; 95% CI 1.00–4.47; P = 0.0295). No differences with regard to stroke, myocardial infarction and all-cause mortality were observed between both revascularization strategies. Patients after PCI had a shorter length of hospital stay (WMD −3.37 days; 95% CI (−)4.92 to (−)1.81; P < 0.0001). In conclusion, the present systematic review underscores the superiority of MIDCAB over PCI for treatment of single-vessel disease of the LAD. [ABSTRACT FROM PUBLISHER]

Purpose: Skin injury in patients due to radiation exposure has been a complication in percutaneous coronary intervention (PCI) for a long time. To the best of our knowledge, there have been no reports comparing radiation dose by treatment area with diagnostic reference levels (DRLs) 2020, although the radiation dose varies by treatment area in PCI., Methods: In this study, the treatment areas were classified into four segments (i.e., AHA #1-3, AHA #4, AHA #5-10, and AHA #11-15), and each segment was compared with DRLs 2020. This retrospective study included 984 consecutive patients with single-vessel disease and non-chronic total occlusion. PCI was performed on a single device., Results: The median radiation dose was 1640.8 mGy, and the radiation dose for AHA #4 was 2732.0 mGy, which was significantly higher than the other treatment areas (p<0.001). In AHA #4, the radiation dose increased due to the heavy use of the left cranial view, and the patient background contributed to the increased lesion complexity. Therefore, it was challenging to evaluate AHA #4 and the other treatment areas with a uniform DRL value., Conclusion: Establishing a subdivided index for each treatment area is crucial if DRLs are used as a reference during procedures and as a guide for dose optimization.

Abstract: Background: Despite procedural advances, recanalization of chronic total occlusions (CTOs) with percutaneous coronary intervention (PCI) remains controversial, particularly given that its long-term benefits are unclear. We assessed the association between successful PCI and symptom improvement as well as outcomes in patients with CTO and stable angina. Methods: We performed a retrospective study of 386 consecutive patients undergoing attempted PCI of an isolated CTO (i.e., no other angiographically-significant disease was present). We analyzed prospectively the change in Canadian Cardiovascular Society (CCS) classification system and occurrence of major adverse cardiovascular events (death, myocardial infarction or target vessel revascularization), after stratifying patients by procedural success. To understand which patients might benefit most from attempted PCI, multivariable models were constructed to predict: likelihood of successful PCI and symptom improvement, defined as resolution of angina or improvement of ≥2 CCS classes. Results: A total of 247 (64%) patients had successful PCI. Greater symptom improvement was noted after successful PCI at both 6months (79.8% versus 34.5% with resolution of angina or improvement of ≥2 CCS classes, p<0.01) and 24months (71.7% and 20.9%, respectively, p<0.01). No differences were noted in MACE (11.3% vs. 10.0% at 6months, p=0.70; and 18.6% vs. 19.4% at 24months, p=0.84). Multivariable analysis identified several factors associated with successful PCI, but not predictive of symptom improvement. In conclusion, successful PCI of an isolated CTO improves symptom burden, but is not associated with MACE at 6 or 24months. Conclusions: Several factors are associated with successful PCI, but identifying those most likely to have symptom improvement remains challenging. [Copyright &y& Elsevier]

Objective: Body surface potential mapping (BSPM) is essentially recommended for detecting and evaluating abnormalities of cardiac electric field specific for various stages of ischemic state of myocardium caused by coronary artery disease (CAD). In this regard, a goal of the present paper was to summarize the BSPM results, which were gathered in our laboratory for several years from the patients with CAD. Methods: In a group of 110 patients (mean age: 48.4±6.2 years) with angiographically documented critical single-vessel (SVD) coronary artery disease among them 52 patients with left anterior descending artery (LAD) involvement, 40 patients with right coronary artery (RCA) and 18 patients with left circumflex artery (Cx) lesions, without any specific ischemic changes on standard resting 12-lead electrocardiogram (ECG), isointegral and departure ST-T maps were recorded using Fukuda Denshi (Tokyo, Japan) 87-electrode system for BSPM. Results: Significant decrease of the minimum values of ST-T maps was found only in patients with LAD involvement. Typical distribution of the negative potential was found on ST-T map for each of LAD, RCA and Cx stenosis. Overall sensitivity of abnormal distribution of ST-T maps was 55.5% for the SVD group. In 21/96 of the SVD patients in whom exercise test was performed, the result was negative. Generally, in 12 of these 21 patients, the abnormal ST-T maps were observed (57.1%). The RCA lesion group had abnormal ST-T maps in 75% of the patients with negative exercise test. The corresponding ratios were 71.4% for LAD, and only 16.7% for Cx patients. Conclusion: ST-T resting maps are of some value in diagnosing stable ischemic heart disease. [ABSTRACT FROM AUTHOR]

: ObjectivesThe objective of this study was to evaluate the effect of estrogen compared to estrogen plus progesterone on the stress electrocardiogram (ECG) in relationship to stress-gated myocardial perfusion imaging (MPI) in postmenopausal women.: BackgroundIt is generally recognized that estrogen may cause false positive ST depressions on the stress ECG. The effects of estrogen plus progesterone are not known. This study was performed to define the effects of these agents on the stress ECG correlated with results from MPI.: MethodsWe evaluated 140 postmenopausal women—31 not taking any hormone replacement therapy (HRT); 75 taking estrogen alone; and 34 taking estrogen plus progesterone. Women with a history of coronary artery disease (CAD), cardiomyopathy, or an abnormal resting ECG were excluded. All women underwent a symptom-limited treadmill test and MPI.: ResultsThe overall sensitivity and specificity of the stress ECG compared to MPI in women not taking HRT was 54% and 78%, respectively. In women taking estrogen or estrogen plus progesterone, the sensitivity was unchanged. The power to detect clinically meaningful sensitivity difference (10%) was poor (p = 0.09). The specificity was reduced to 46% (p < 0.01) in women on estrogen therapy. In women taking estrogen plus progesterone, specificity was 80%.: ConclusionsOur results suggest that estrogen increases the false positive rate of the stress ECG. This decreased specificity is countered by co-administration of progesterone. Nonetheless, because the sensitivity of the stress ECG is only 50% to 57% in postmenopausal women, women at risk should have imaging in conjunction with stress for the optimal detection of CAD. [Copyright &y& Elsevier]

Aims: Revascularization procedures are increasingly applied in patients with single-vessel coronary artery disease in spite of the fact that a prognostic benefit has been proved only for soft end-points. This review summarizes the results of stress echocardiography in the diagnostic and prognostic assessment of these patients.Methods and Results: The diagnostic and prognostic assessment of patients with single-vessel disease using stress (exercise, dobutamine, adenosine and dipyridamole) echocardiography are focused upon in the light of pathophysiological considerations and the results of clinical studies. Factors affecting test accuracy are individually addressed and comparisons made with different stress testing modalities, including exercise electrocardiography and nuclear techniques. Finally, therapeutic options are discussed and the superior accuracy of the physiological assessment of coronary stenosis as compared to the simple anatomic evaluation emphasized.Conclusions: Patients with single-vessel disease represent an anatomically heterogeneous group. Although the suboptimal performance of any technique in their evaluation has to be acknowledged, stress echocardiography can effectively contribute to selection of the management strategy. [ABSTRACT FROM AUTHOR]

Background: Even though percutaneous coronary intervention (PCI) improved the survival of patients with acute myocardial infarction, still multivessel coronary artery disease remains an important factor burdening prognosis and it is being associated with a worse prognosis compared to single-vessel disease (SVD)., Aim: To compare the clinical profile and outcomes after the primary PCI in young patients with SVD vs multivessel disease (MVD)., Methods: The retrospective cohort of patients were divided into two groups: SVD and MVD group. The study population consisted of both male and female young (≤ 45 years) patients presented with ST-elevation myocardial infarction (STEMI) at the National Institute of Cardiovascular Disease, Karachi, Pakistan and undergone primary PCI from 1 st July 2017 to 31 st March 2018. Pre and post-procedure management of the patients was as per the guidelines and institutional protocols., Results: A total of 571 patients with STEMI, ≤ 45 years were stratified into two groups by the number of vessels involved, 342 (59.9%) with SVD and 229 (40.1%) with MVD. The average age of these patients was 39.04 ± 4.86 years. A lower prevalence of hypertension and diabetes was observed in SVD as compare to MVD group (25.1% vs 38%, P < 0.01; 11.7% vs 27.5%, P < 0.001) respectively. While, smoking was more prevalent among the SVD group as compare to MVD group (36.3% vs 28.4%, P = 0.05). The high-C Lesion was observed in a significantly higher number of younger patients with MVD as compared to SVD group (48.8% vs 39.2%, P = 0.021). Post-procedure thrombolysis in myocardial infarction flow grade was found to be not associated with the number of diseased vessels with a P value of 0.426 and thrombolysis in myocardial infarction flow grade III was observed in 98% vs 96.5% of the patients is SVD vs MVD group., Conclusion: The MVD comprised of around 40% of the young patients presented with STEMI. Also, this study shows that diabetes and hypertension have a certain role in the pathogenesis of multivessel diseases, therefore, preventive measures for diabetes and hypertension can be effective strategies in reducing the burden of premature STEMI., Competing Interests: Conflict-of-interest statement: The authors have no conflicts of interest to declare., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Background: The effects of aggressive lipid-lowering therapy according to the number of diseased coronary arteries in acute coronary syndrome (ACS) are still controversial. This study investigated the efficacy of this therapy in ACS patients with multivessel disease (MVD) and single-vessel disease (SVD). Methods and Results: The subjects were derived from the HIJ-PROPER study, in which ACS patients with dyslipidemia were randomized to receive either pitavastatin+ezetimibe (targeting low-density lipoprotein cholesterol [LDL-C] <70 mg/dL) or pitavastatin monotherapy (targeting LDL-C <90 mg/dL). In this study, treatment efficacy was compared between patients with MVD and SVD. The primary endpoint was a composite of major advanced cardiovascular events (MACE; all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia-driven revascularization). We identified 1,702 eligible patients (MVD, n=869; SVD, n=833; mean age, 65.6 years; male, 75.6%; acute revascularization, 96.2%). MACE incidence was significantly higher in the MVD group than in the SVD group (43.7% vs. 25.9%, HR, 1.95; 95% CI: 1.65-2.31, P<0.001). In the SVD group, pitavastatin+ezetimibe had significantly fewer MACE than pitavastatin monotherapy (34.6% vs. 47.4%, HR, 0.72; 95% CI: 0.55-0.94, P=0.02). Conclusions: The benefits of aggressive lipid-lowering therapy, with the addition of ezetimibe to statins, were enhanced in ACS patients with SVD, but not with MVD, in the early invasive strategy era., Competing Interests: All members of the HIJ-PROPER study group have received research support to perform clinical trials through the Japan Research Promotion Society for Cardiovascular Diseases, which is sponsored by Abbott Vascular Japan, AstraZeneca, Bayer Yakuhin, Boston Scientific Corporation, Bristol-Myers, Daiichi Sankyo, Kowa Pharmaceutical, Mochida Pharmaceutical, MSD, Nippon Boehringer Ingelheim, Novartis Pharma, Pfizer Japan, Sanofi, and Takeda Pharmaceutical. N. Hagiwara has received honoraria from Bristol-Myers and Nippon Boehringer Ingelheim, and grants from Astellas Pharma, Daiichi Sankyo, Eisai, Mitsubishi Tanabe Pharma Corporation, Otsuka Pharmaceutical, Shionogi, and Takeda Pharmaceutical. J.Y. belongs to a division (Clinical Research division for Cardiovascular Catheter Intervention) financially maintained by donation from Abbott Vascular, Boston Scientific, Medtronic, and Terumo. All authors have no relationships relevant to the contents of this paper to disclose. The HIJ-PROPER Steering Committee had full access to all data in the study and had final responsibility for the decision to submit for publication. N.H. is a member of Circulation Reports’ Editorial Team., (Copyright © 2020, THE JAPANESE CIRCULATION SOCIETY.)