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The development of different phenotypes of coronary artery (CA) lesions is regulated via many various factors, such as pro-inflammatory agents, zinc-dependent endopeptidases, growth factors and circulating microRNAs (miRs). To evaluate the expression levels of miR-34a, miR-145 and miR-222, tumor necrosis factor α (TNF-α), matrix metalloproteinases (MMP-1, -9, -13 and -14) and vascular endothelial growth factor (VEGF) in patients with different phenotypes of coronary artery disease (CAD): ischemia/angina with non-obstructive coronary arteries (INOCA/ANOCA) and obstructive CAD (oCAD) compared with a control group. This cross-sectional observational study included 157 subjects with a verified CAD diagnosis (51 patients with INOCA, 76 patients with oCAD and 30 healthy volunteers). The expression of miR-34a, miR-145 and miR-222 (RT-PCR) and the levels of VEGF, TNF-α, MMP-1, MMP-9, MMP-13 and MMP-14 (ELISA) were estimated in plasma samples. A higher concentration of MMP-9 was found in oCAD-group samples compared to the INOCA/ANOCA group. The INOCA/ANOCA group was characterized by higher levels of TNF-α. Based on multivariate regression analysis, a mathematical model predicting the type of CA lesion was constructed. MiR-145 was the independent predictor of INOCA/ANOCA (p = 0.006). Changes in concentrations of MMP-9 and MMP-14 were found in both investigated CAD groups, with MMP-9 levels being significantly higher in obstructive CAD samples than in INOCA/ANOCA, which confirms the role of inflammation in the development of atherosclerosis. A multivariate regression analysis allowed us to achieve a model that can predict the phenotype of stable CAD, and MiR-145 can be assumed as an independent predictor of INOCA/ANOCA. [ABSTRACT FROM AUTHOR]

Acute chest pain (ACP) is a frequent cause of Emergency Department (ED) admissions, with millions of cases reported globally each year. Timely and accurate diagnosis is crucial due to the wide range of underlying causes, such as acute coronary syndrome (ACS), pulmonary embolism (PE), aortic dissection, and others. Misdiagnosis can lead to missed life-saving interventions or, alternatively, unnecessary hospitalizations, escalating healthcare costs. While risk stratification tools like the HEART, GRACE, and TIMI scores are useful, additional imaging is often required to achieve diagnostic precision. Coronary computed tomography angiography (CCTA) has shown significant potential in enhancing diagnostic accuracy and improving patient outcomes. In this review, we explore the challenges physicians encounter when evaluating ACP in the ED, emphasizing the utility of CCTA as a key diagnostic tool. Additionally, we present a clinical case that illustrates how CT scan effectively aids in diagnosing patients with ambiguous symptoms, with CT imaging playing a pivotal role in identifying the underlying pathology. [ABSTRACT FROM AUTHOR]

Purpose of Review: Elevated lipoprotein(a) (Lp[a]) is a genetically determined cardiovascular risk factor, causally linked to both atherosclerotic coronary artery disease and aortic stenosis. Elevated Lp(a) is widely prevalent, and several cardiovascular societies now recommend performing Lp(a) screening at least once in all adults. However, there are currently no approved drugs aimed specifically at lowering Lp(a). In this review, we describe several promising Lp(a)-lowering therapies in the drug development pipeline and outline what role these may have in future clinical practice. Recent Findings: Pelacarsen and olpasiran are two novel RNA-based injectable therapies which are being studied in ongoing phase 3 clinical trials, with the earliest of these to be concluded in 2025. These drugs act by degrading transcribed LPA mRNA, which would normally yield the apolipoprotein(a) constituent of Lp(a). Other candidate drugs, such as Lepodisiran, Zerlasiran, and Muvalaplin, are also in early-stage development. Summary: While there are presently no Lp(a)-lowering drugs available for routine clinical use, several promising candidates are currently under investigation. If these prove to be effective in randomized clinical trials, they will expand the cardiovascular care armamentarium and will allow clinicians to treat a presently unmitigated cardiovascular risk factor. [ABSTRACT FROM AUTHOR]

Introduction: Coronary artery disease (CAD) remains a major global health concern, with left main coronary artery (LMCA) disease posing high risks due to the large myocardial area it supplies. Despite coronary artery bypass grafting (CABG) being the preferred revascularization strategy for unprotected left main coronary artery (ULMCA) disease, percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has emerged as a viable alternative. However, data on ULMCA PCI outcomes in the Indian subcontinent are scarce. Materials and Methods: This single-center, retrospective study evaluated 253 patients who underwent ULMCA PCI using DES between January 2018 and June 2023 in Central India. Clinical, angiographic, and procedural data were analyzed with a median follow-up of 753.5 days. Comparative analyses were conducted based on SYNTAX scores and imagingguided versus non-imaging-guided interventions. Results: The cohort's mean age was 61.3 years, with a predominantly male population (77.5%). Imaging guidance was employed in 30.4% of cases. The composite outcome (cardiovascular death, myocardial infarction, stroke) occurred in 11.6% of patients. Higher age and hypertension were identified as significant predictors of adverse outcomes. Conclusion: In this study, PCI for unprotected left main coronary artery (ULMCA) disease using drug-eluting stents (DES) demonstrated favorable short- and mid-term outcomes in an Indian cohort, even in a resource-limited setting. While procedural success was high, factors such as SYNTAX score and patient comorbidities such as age >60 yrs, hypertension significantly influenced outcomes. Imaging-guided interventions, though not altering mortality rates, appeared to enhance procedural safety. These findings support the feasibility of PCI as an alternative to surgery in select high-risk patients, emphasizing the need for further research to refine risk stratification and optimize intervention strategies. [ABSTRACT FROM AUTHOR]

Introduction: Acute Coronary Syndrome (ACS) is a significant cause of morbidity and mortality worldwide, characterized by a spectrum of conditions ranging from unstable angina to myocardial infarction. Traditionally perceived as a disease predominantly affecting older adults, ACS is increasingly being recognized in younger populations, raising concerns about its etiology, presentation, and management in this age group. Aims: The findings will highlight the distinctive characteristics and needs of the very young CAD patients, underlining the necessity for targeted interventions in this emerging subset. This study is especially essential for India, given its significant and growing young population vulnerable to CVD. Materials and Methods: his study was an investigator-initiated, single-center, retrospective observational study aimed at examining the clinico-demographic, risk factors, and angiographic profiles of Acute Coronary Syndrome (ACS) in young adults at a tertiary Cardiology Institute in Central India. Approved by the local ethical committee and conducted according to ICH Harmonized Guidelines for Good Clinical Practice, the study involved a review of medical records from 550 young adults (aged 18 to = 45 years) diagnosed with ACS between January 2018 and July 2023. Result: The comparative analysis of coronary angiographic profiles by age group. Among the cases with single-vessel disease, 22 (8.9%) were under 30 years, while 226 (91.1%) were over 30 years. In cases of double-vessel disease, 1 (0.7%) was under 30 years, and 140 (99.3%) were over 30 years. Notably, no patients under 30 years had triple-vessel disease, whereas all 92 (100%) cases of triple-vessel disease occurred in patients over 30 years. Conclusion: Our study provides valuable insights into the clinicodemographic characteristics, risk factors, and angiographic profiles of ACS in young adults. Young ACS patients exhibit a strong male predominance. Although Obesity and hypertension emerged as the most common risk factor, affecting around 40% of participants, conventional risk factors, such as diabetes and hypertension, are significantly less prevalent in patients younger than 30 years compare to older young patients. [ABSTRACT FROM AUTHOR]

Background- Atherosclerotic vascular diseases, major global health burden which comprises cerebrovascular disease and coronary heart disease. For coronary artery disease and cerebrovascular disease, diabetes is considered as an independent risk factor. Since more than 80% of diabetes cases occurs in developing countries so they pose the highest economic burden. HDL levels are low in diabetics then non diabetics. This Low level of HDL is strongly associated with elevated increase risk for CAD in diabetics. Hence it is very important to study the clinical way of presentation of the disease and in which pattern coronary arteries are involved in both patients with diabetes and without -diabetes. Methodology: The present study is a cross-sectional study. This study was conducted on 335 patients with ACS who subsequently underwent coronary angiogram admitted in Department of Cardiology. Patients who matched the inclusion and exclusion criteria were selected randomly during period of approximately one year formed the study group. The severity of involvement of coronary artery is quantitatively assessed by GENSINI score [Angiographic severity score].So in this study we analysed the comparison of coronary artery disease and its influence by change in glycaemic status quantitively. Result- CAD severity was higher in patients with diabetes with mean gensini score of 40.9 followed by pre-diabetics 33.7and non diabetics with 23.8 (p value .001). The severity of CAD was higher in patients with diabetes for more than 6 years. There was Statistically significant correlation between duration of diabetes and severity of CAD in diabetes. Conclusions: The severity and extent of CAD in diabetics was more compared to non-diabetics. Involvement and occlusion of vessels were more commonly seen in diabetic patients. The incidence of triple vessel or multi-vessel disease was significantly higher in diabetics. Patients with poor glycemic control with elevated levels of HbA1c had diffuse pattern of atherosclerotic disease and high levels of HbA1c mildly correlated with gensini score. [ABSTRACT FROM AUTHOR]

Coronary artery calcification (CAC) is a hallmark of atherosclerosis and a critical factor in the development and progression of coronary artery disease (CAD). This review aims to address the complex pathophysiological mechanisms underlying CAC and its relationship with CAD. We examine the cellular and molecular processes that drive the formation of calcified plaques, highlighting the roles of inflammation, lipid accumulation, and smooth muscle cell proliferation. Additionally, we explore the genetic and environmental factors that contribute to the heterogeneity in CAC and CAD presentation among individuals. Understanding these intricate mechanisms is essential for developing targeted therapeutic strategies and improving diagnostic accuracy. By integrating current research findings, this review provides a comprehensive overview of the pathways linking CAC to CAD, offering insights into potential interventions to mitigate the burden of these interrelated conditions. [ABSTRACT FROM AUTHOR]

Background/Objectives: The identification of coronary artery disease (CAD) high-risk individuals is a major clinical need for timely diagnosis and intervention. Many different polygenic scores (PGSs) for CAD risk are available today to estimate the genetic risk. It is necessary to carefully choose the score to use, in particular for studies on populations, which are not adequately represented in the large datasets of European biobanks, such as the Italian one. This work aimed to analyze which PGS had the best performance within the Italian population. Methods: We used two Italian independent cohorts: the EPICOR case–control study (576 individuals) and the Atherosclerosis, Thrombosis, and Vascular Biology (ATVB) Italian study (3359 individuals). We evaluated 266 PGS for cardiovascular disease risk from the PGS Catalog, selecting 51 for CAD. Results: Distributions between patients and controls were significantly different for 49 scores (p-value < 0.01). Only five PGS have been trained and tested for the European population specifically. PGS003727 demonstrated to be the most accurate when evaluated independently (EPICOR AUC = 0.68; ATVB AUC = 0.80). Taking into account the conventional CAD risk factors further enhanced the performance of the model, particularly in the ATVB study (p-value = 0.0003). Conclusions: European CAD PGS could have different risk estimates in peculiar populations, such as the Italian one, as well as in various geographical macro areas. Therefore, further evaluation is recommended for clinical applicability. [ABSTRACT FROM AUTHOR]

Background: Exosomes are membrane vesicles that are actively secreted in response to microenvironmental stimuli. In this study, we quantified the amount of exosomes in patients with significant coronary artery disease (CAD) and evaluated its relationship with myocardial perfusion imaging (MPI) results. Methods: Patients who underwent both MPI and coronary angiography were recruited. Plasma was collected during angiography, and exosomes were extracted via the precipitation method. The summed stress scores (SSS), summed difference scores, and ventricular functional parameters were calculated from the MPI and compared with the amounts of exosomes and extracted miRNAs. Results: In total, 115 patients were enrolled (males: 78 %; mean age: 66.6 ± 10.6 years). Those with abnormal SSS according to the MPI had significantly fewer exosomes (p = 0.032). After multivariate analysis, the SSS remained significantly related to the amount of exosomes (p = 0.035). In forty randomly selected samples, miRNA-432–5p and miRNA-382–3p were upregulated in patients with abnormal SSS. Conclusion: Patients with compromised poststress myocardial perfusion on MPI tended to have fewer exosomes in association with CAD-related miRNAs. This is the first study to clarify the fundamental and pathophysiological causes of CAD using radiographic examinations.

Background: Coronary artery disease (CAD) is increasing at an alarming rate worldwide, and psychological risk factors are also involved in the morbidity and spread of the disease. The present study aimed to determine the effectiveness of emotionally focused couple therapy (EFCT) on affective temperaments in patients with CAD. Methods: This semi-experimental study was conducted with two groups using a pre-test, post-test, and follow-up design involving 34 couples, where one partner had CAD, in Mashhad, Iran, in 2022. The couples were selected via two-stage cluster sampling and allocated into two groups: The intervention group (16 couples) and the control group (18 couples) through permuted block randomization. An EFCT based on the healing hearts together (HHT) educational program was performed in the intervention group during eight weekly 2-hour sessions. The control group received only routine care. Data were collected using a demographic questionnaire and the temperament evaluation of the Memphis, Pisa, Paris, and San Diego auto questionnaire (TEMPS-A) before, after, and two months following the intervention. Data were analyzed using the chi-square test, independent t-test, and repeated measures ANOVA by SPSS software, version 26. Results: The EFCT significantly decreased the mean score of irritable, anxious, and depressed temperaments but significantly increased the mean score of hyperthymic temperament in the post-test and follow–up. However, the changes observed at the follow-up stage were less pronounced than those at the post-test stage (P0.05). Conclusion: Using EFCT in couples can improve affective temperaments in patients with CAD. EFCT in couples, where one partner has CAD, can be effective in health maintenance and promotion, as well as in enhancing the quality of life (QoL) for patients with CAD.

Background: Management of non-ST elevation myocardial infarction acute coronary syndrome (NSTEMI ACS) patients is not well defined as that of ST elevation myocardial infarction. The accuracy of results of conventional echocardiography is significantly compromised when imaging is suboptimal, myocardial damage is in small areas, and compensatory hyperkinesias of healthy segment. Aims and Objectives: Duration of early systolic lengthening (DESL) may be employed to identify early myocardial ischemia and thus, may help to prepare treatment strategies for NSTEMI patients. Materials and Methods: A total of 57 patients with NSTEMI ACS attending the cardiology department were included in the study group. Results: More than 80% of patients of NSTEMI have normal or near normal ejection fraction and wall motion score index. In our study, the DESL is prolonged in a significant number of non-ST-elevation acute coronary syndrome patients. Conclusion: As DESL is afterload independent, it is superior to global longitudinal strain in assessing myocardial damage. Several studies including ourselves show that DESL of

Exosomes are membrane vesicles that are actively secreted in response to microenvironmental stimuli. In this study, we quantified the amount of exosomes in patients with significant coronary artery disease (CAD) and evaluated its relationship with myocardial perfusion imaging (MPI) results. Patients who underwent both MPI and coronary angiography were recruited. Plasma was collected during angiography, and exosomes were extracted via the precipitation method. The summed stress scores (SSS), summed difference scores, and ventricular functional parameters were calculated from the MPI and compared with the amounts of exosomes and extracted miRNAs. In total, 115 patients were enrolled (males: 78 %; mean age: 66.6 ± 10.6 years). Those with abnormal SSS according to the MPI had significantly fewer exosomes (p = 0.032). After multivariate analysis, the SSS remained significantly related to the amount of exosomes (p = 0.035). In forty randomly selected samples, miRNA-432–5p and miRNA-382–3p were upregulated in patients with abnormal SSS. Patients with compromised poststress myocardial perfusion on MPI tended to have fewer exosomes in association with CAD-related miRNAs. This is the first study to clarify the fundamental and pathophysiological causes of CAD using radiographic examinations. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) is increasing at an alarming rate worldwide, and psychological risk factors are also involved in the morbidity and spread of the disease. The present study aimed to determine the effectiveness of emotionally focused couple therapy (EFCT) on affective temperaments in patients with CAD. Methods: This semi-experimental study was conducted with two groups using a pre-test, posttest, and follow-up design involving 34 couples, where one partner had CAD, in Mashhad, Iran, in 2022. The couples were selected via two-stage cluster sampling and allocated into two groups: The intervention group (16 couples) and the control group (18 couples) through permuted block randomization. An EFCT based on the healing hearts together (HHT) educational program was performed in the intervention group during eight weekly 2-hour sessions. The control group received only routine care. Data were collected using a demographic questionnaire and the temperament evaluation of the Memphis, Pisa, Paris, and San Diego auto questionnaire (TEMPS-A) before, after, and two months following the intervention. Data were analyzed using the chi-square test, independent t-test, and repeated measures ANOVA by SPSS software, version 26. Results: The EFCT significantly decreased the mean score of irritable, anxious, and depressed temperaments but significantly increased the mean score of hyperthymic temperament in the post-test and follow–up. However, the changes observed at the follow-up stage were less pronounced than those at the post-test stage (P<0.05). There was no significant difference in the mean score of the cyclothymic temperament dimension between the intervention and control groups in the post-test and follow-up (P>0.05). Conclusion: Using EFCT in couples can improve affective temperaments in patients with CAD. EFCT in couples, where one partner has CAD, can be effective in health maintenance and promotion, as well as in enhancing the quality of life (QoL) for patients with CAD. [ABSTRACT FROM AUTHOR]

Background: Despite continuous improvements in revascularization techniques, refractory angina without potential revascularization options remains a relevant clinical issue with significant impact on the patient's quality of life. Recently, a novel device, the Coronary Sinus Reducer (CSR), has been introduced into clinical practice as a therapeutic option for patients with disabling angina pectoris. In this single-center, observational study, we evaluated the mid-term (3-month) safety and efficacy of the CSR in a real-world cohort. Methods: The study population consisted of 55 patients with refractory angina without potential revascularization options, who were predominantly men (87.3%) with a high cardiovascular risk factor burden and advanced angina (baseline CCS angina class 3.15 ± 0.6). In terms of procedure safety, all patients underwent successful device deployment with only one periprocedural complication. Results: At the 3-month follow-up, we observed a statistically significant improvement in angina control measured CCS class and SAQ-7 total questionnaire along with increased abolition of physical limitation—6-MWT (233.3 ± 107.1 vs. 305.2 ± 126.8; p < 0.0001). Additionally, we observed significant improvement in terms of quality of life measurements SF-36, the EQ-5D-5L questionnaire, and the EQ-VAS. Conclusions: Our real-world data suggest that CSR implantation is a relatively safe procedure and appears to be particularly effective in relieving angina symptoms and improving quality of life in subjects with refractory angina. [ABSTRACT FROM AUTHOR]

Olive oil is the main source of lipid energy in the Mediterranean diet and there is strong evidence of its health benefits. The effect of extra virgin olive oil (EVOO) in the form of a preparation of spreadable virgin olive oil (S-VO) on the progression of atheroma plaques was investigated in Apoe-deficient mice, a model of accelerated atherosclerosis. Methods: Two isocaloric Western purified diets containing 20% fat, either as S-VO or as dairy butter, were used to feed 28 males and 16 females of two-month-old Apoe-deficient mice for 12 weeks. S-VO was prepared by blending more than 75% virgin olive oil with other vegetal natural fat to obtain a solid fat. Plasma total cholesterol, triglycerides and HDL cholesterol were measured. Hepatic lipid droplets were analyzed. Areas of atherosclerotic aortic lesions were quantified in cross-sectional images of the proximal aorta and en face analysis of the whole aorta. Results: Total plasma cholesterol was increased in mice on the butter-supplemented diet in both female and male mice compared to S-VO, and the ratio of TC/HDL-cholesterol was significantly lower in S-VO than in the butter diet, although only in males, and no differences in plasma triglycerides were observed. No significant differences in hepatic lipid droplets were observed between diets in either sex. Aortic lesion areas were significantly higher in mice consuming the butter versus the S-VO diet in both sexes. Conclusion: Extra virgin olive oil prepared in spreadable form maintained the delay in atheroma plaque progression compared to butter. [ABSTRACT FROM AUTHOR]

During coronary artery bypass grafting (CABG), the surgical procedure, particularly the manipulation of the major arteries of the heart, induces a significant inflammatory state that may compromise platelet function to the extent that platelet transfusion is required. Given stored platelets as a major source of biological mediators, this study investigates the effects of platelet transfusion on the major pro‐aggregatory, pro‐inflammatory and immunomodulatory markers of platelets. Platelets from 20 patients, 10 who received platelet transfusion and 10 without, were subjected to flow cytometery where P‐selectin and CD40 ligand (CD40L) expressions and PAC‐1 binding (activation‐specific anti GPIIb/GPIIIa antibody) analysed at five‐time points of 24 h before surgery, immediately, 2 h, 24 h and 1 week after surgery. Analysis of intra‐platelet transforming growth factor‐beta‐1 (TGF‐β1) was also conducted using western blotting. Patients with platelet transfusion showed increased levels of P‐selectin, CD40L and intra‐platelet TGF‐β1 2‐h after surgery compared to those without transfusion (p < 0.05). PAC‐1 binding was increased 24 h after surgery in transfused patients (p < 0.05). Given the significant post‐transfusion elevation of platelet TGF‐β1, P‐sel/CD40L reduction in transfused patients a week after was of much interest. This study showed for the first time the significant effects of platelet transfusion on the pro‐inflammatory, pro‐aggeregatory and immunomodulatory state of platelets in CABG patients, which manifested with immediate, midterm and delayed consequences. While the increased pro‐inflammatory conditions manifested as an immediate effect of platelet transfusion, the pro‐aggregatory circumstances emerged 24 h post‐transfusion. A week after surgery, attenuations of pro‐inflammatory markers of platelets in transfused patients were shown, which might be due to the immunomodulatory effects of TGF‐β1. [ABSTRACT FROM AUTHOR]

Aims: To assess the incidence of Chronic Total Occlusions (CTOs) in patients with coronary artery disease and to study the symptom complex of patients with Chronic Total Occlusions (CTOs). Materials and methods: This is a prospective observational study conducted in 40 adult patients aged between 18-75 years of age, of any gender, undergoing coronary artery bypass grafting for coronary artery disease with chronic total occlusion of one or more coronary vessels and analyzed the surgical outcomes. Results: CAD was most frequently seen in males in their sixth decade of life, with smoking being a definite possible risk factor. Chest discomfort was the most common presenting complaint of the patients with CTOs of the coronaries. CTOs were frequently associated with triple vessel disease of the coronary vessels. Surgical management of CTOs by CABG seems to be more appropriate as it can provide revascularization of all major coronary territories. CTOs have been more commonly found in the Right coronary artery, with single vessel CTO being more common than multi-vessel CTOs. Peri-operative low cardiac output, requirement of endarterectomy and IABP support were associated with eventful outcomes and were indicators of a poorer prognosis. Majority of the CTOs were bypassed successfully and significant improvement in the left ventricular ejection fraction was noted in most of the patients post-operatively. Conclusions: Despite their variable complex anatomy, most of the CTOs were amenable to revascularization by CABG reiterating the fact that surgery still remains a definitive mode of treatment for complex CAD. [ABSTRACT FROM AUTHOR]

Background: Management of non-ST elevation myocardial infarction acute coronary syndrome (NSTEMI ACS) patients is not well defined as that of ST elevation myocardial infarction. The accuracy of results of conventional echocardiography is significantly compromised when imaging is suboptimal, myocardial damage is in small areas, and compensatory hyperkinesias of healthy segment. Aims and Objectives: Duration of early systolic lengthening (DESL) may be employed to identify early myocardial ischemia and thus, may help to prepare treatment strategies for NSTEMI patients. Materials and Methods: A total of 57 patients with NSTEMI ACS attending the cardiology department were included in the study group. Results: More than 80% of patients of NSTEMI have normal or near normal ejection fraction and wall motion score index. In our study, the DESL is prolonged in a significant number of non-ST-elevation acute coronary syndrome patients. Conclusion: As DESL is afterload independent, it is superior to global longitudinal strain in assessing myocardial damage. Several studies including ourselves show that DESL of <50 ms may be the cutoff value to reveal minimal myocardial damage. [ABSTRACT FROM AUTHOR]

Aims: Recently, interventional techniques and material to treat chronic total occlusion (CTO) with percutaneous coronary intervention (PCI) have evolved significantly. Nevertheless, it is still unknown whether this progress improved treatment success and patients' outcome. In a nationwide sample, we sought to analyze trends of patients' characteristics, complications and in-hospital case-fatality of patients undergoing CTO revascularization in Germany. Methods and Results: We analyzed data on characteristics, treatments, and in-hospital outcomes for all coronary artery disease (CAD) patients (ICD-code I25) undergoing dual-injection CTO recanalization (OPS procedural code: 8–839.9) in Germany from 2009 to 2020. Overall, 4,998,457 inpatients aged ≥ 18 years with diagnosis of CAD were treated in German hospitals in this period. Among these, 52,879 patients (1.1%) underwent CTO recanalization. Annual number of CTO PCIs increased from 1263 in 2009 to 6435 in 2020 (β 3.48 [95% CI 3.44–3.52]; p < 0.001) in parallel with a significant decrease of case-fatality (2.2% in 2009 to 1.4% in 2020; β – 0.60 [95% CI – 0.82 to – 0.39]; p < 0.001). Overall, 754 (1.4%) patients with CTO recanalization died during the in-hospital stay and in-hospital case-fatality grew exponentially with age (β 0.82 [95% CI 0.73–0.90]; p < 0.001). Significant predictors of in-hospital case fatality with an OR > 3 were cancer, stroke, hemopericardium, acute renal failure, pulmonary embolism and shock. Conclusion: Annual number of CTO procedures performed in Germany increased from 2009 to 2020 with a concomitant anti-proportional decrease in the case-fatality. Our findings may help to draw more attention to predictors of in-hospital case fatality in patients hospitalized for CTO recanalization. [ABSTRACT FROM AUTHOR]

Background: Osteoprotegerin (OPG) is a secretory glycoprotein known for its involvement in bone metabolism and immune regulation. Research has extended OPG's significance in cardiovascular diseases (CVDs). Elevated OPG levels have been associated with increased cardiovascular risks, prompting interest in its role as a potential biomarker. Main Body: This study summarizes several studies that investigated the relationship between OPG levels and the incidence of CVD. The studies indicate that higher plasma levels of OPG are associated with an increased incidence of all‐cause death, cardiovascular death, and heart failure, even after adjusting for clinical confounders. Moreover, the findings suggest that OPG has the potential to serve as a predictive biomarker for adverse cardiovascular events in the patient population studied. The findings suggest that OPG could aid in risk stratification, allowing clinicians to identify high‐risk patients who might benefit from intensified preventive measures or tailored therapeutic interventions. Therefore, early identification of individuals at risk for adverse cardiovascular events could lead to improved patient outcomes and reduced disease burden. Conclusions: OPG's role in bone health and immune regulation has expanded to potential use as a biomarker for adverse cardiovascular events in stable coronary artery disease (CAD) patients. Despite limitations, its association with cardiovascular risks highlights its importance in risk assessment and personalized interventions. [ABSTRACT FROM AUTHOR]

IntroductionPericoronary adipose tissue (PCAT) plays a significant role in the occurrence and progression of coronary artery disease (CAD). This study investigates the relationship between PCAT and CAD, focusing on the occurrence of the disease, the severity of vascular narrowing, and the characteristics of arterial plaques.MethodsWe analyzed a cohort of 152 individuals with CAD and 55 individuals with non-coronary artery disease (N-CAD). Participants underwent both coronary computed tomography angiography (CCTA) and digital subtraction angiography (DSA). Utilizing United Imaging software for artificial intelligence delineation, we measured the fat attenuation index (FAI) and volume of PCAT in the left anterior descending (LAD), left circumflex (LCX), and right coronary arteries (RCA).ResultsOur findings demonstrate that while CCTA is effective in diagnosing CAD compared to DSA, its diagnostic power for individual coronary arteries remains limited. Further analysis revealed that the FAI of the RCA and the overall PCAT volume independently influenced CAD (OR: 1.057, 95% CI: 1.002 to 1.116; OR: 0.967, 95% CI: 0.936 to 0.999). FAI showed a significant independent effect on RCA stenosis (OR: 1.041, 95% CI: 1.003 to 1.081), while the fat volume of the LAD had a significant independent effect on LAD stenosis (OR: 0.884, 95% CI: 0.809 to 0.965). A higher FAI and a lower fat volume were significantly correlated with more severe vascular stenosis percentages in all three arteries (p

Background/Objectives: Radial artery occlusion (RAO) is the most common complication of transradial coronary catheterization. In this study, we aimed to evaluate the incidence of RAO and identify the risk factors that predispose patients to it. Methods: We conducted an investigator-initiated, prospective, multicenter, open-label study involving 1357 patients who underwent cardiac catheterization via the transradial route for angiography and/or a percutaneous coronary intervention (PCI). Univariate and multivariate logistic regression analyses were performed to identify potential predictors of RAO occurrence. Additionally, a subgroup analysis only for patients undergoing PCIs was performed. Results: The incidence of RAO was 9.5% overall, 10.6% in the angiography-only group and 6.2% in the PCI group. Independent predictors of RAO were as follows: (i) the female gender (aOR = 1.72 (1.05–2.83)), (ii) access site cross-over (aOR = 4.33 (1.02–18.39)), (iii) increased total time of the sheath in the artery (aOR = 1.01 (1.00–1.02)), (iv) radial artery spasms (aOR = 2.47 (1.40–4.36)), (v) the presence of a hematoma (aOR = 2.28 (1.28–4.06)), (vi) post-catheterization dabigatran use (aOR = 5.15 (1.29–20.55)), (vii) manual hemostasis (aOR = 1.94 (1.01–3.72)) and (viii) numbness at radial artery ultrasound (aOR = 8.25 (1.70–40)). Contrariwise, two variables were independently associated with increased odds for radial artery patency (RAP): (i) PCI performance (aOR = 0.19 (0.06–0.63)), and (ii) a higher dosage of intravenous heparin per patient weight (aOR = 0.98 (0.96–0.99)), particularly, a dosage of >50 IU/kg (aOR = 0.56 (0.31–1.00)). In the PCI subgroup, independent predictors of RAO were as follows: (i) radial artery spasms (aOR = 4.48 (1.42–14.16)), (ii) the use of intra-arterial nitroglycerin as a vasodilator (aOR = 7.40 (1.67–32.79)) and (iii) the presence of symptoms at echo (aOR = 3.80 (1.46–9.87)), either pain (aOR = 2.93 (1.05–8.15)) or numbness (aOR = 4.66 (1.17–18.57)). On the other hand, the use of intra-arterial verapamil as a vasodilator (aOR = 0.17 (0.04–0.76)) was independently associated with a greater frequency of RAP. Conclusions: The incidence of RAO in an unselected, all-comers European population after transradial coronary catheterization for angiography and/or PCIs is similar to that reported in the international literature. Several RAO prognostic factors have been confirmed, and new ones are described. The female gender, radial artery trauma and manual hemostasis are the strongest predictors of RAO. Our results could help in the future identification of patients at higher risk of RAO, for whom less invasive diagnostic procedures maybe preferred, if possible. [ABSTRACT FROM AUTHOR]

Background: The most frequent lesion in the blood vessels feeding the myocardium is vascular stenosis, a condition that develops slowly but can prove to be deadly in a long run. Non-invasive biomarkers could play a significant role in timely diagnosis, detection and management for vascular stenosis events associated with cardiovascular disorders. Aims: The study aimed to investigate high sensitivity troponin I (hs-TnI), cardiac troponin I (c-TnI) and high sensitivity C-reactive protein (hs-CRP) that may be used solely or in combination in detecting the extent of vascular stenosis in CVD patients. Methodology: 274 patients with dyspnea/orthopnea complaints visiting the cardiologists were enrolled in this study. Angiographic study was conducted on the enrolled patients to examine the extent of stenosis in the five prominent vessels (LDA, LCX, PDA/PLV, RCA, and OM) connected to the myocardium. Samples from all the cases suspected to be having coronary artery stenosis were collected, and subjected to biochemical evaluation of certain cardiac inflammatory biomarkers (c-TnI, hsTn-I and hs-CRP) to check their sensitivity with the level of vascular stenosis. The extent of mild and culprit stenosis was detected during angiographic examination and the same was reported in the form significant (≥50% stenosis in the vessels) and non-significant (<50% stenosis in the vessels) Carotid Stenosis. Ethical Clearance for the study was provided by Dr. Ram Manohar Lohia Institute of Medical Sciences Institutional Ethical Committee. Informed consent was obtained from all the participants enrolled in the study. Results: We observed that 85% of the total population enrolled in this study was suffering from hypertension followed by 62.40% detected with sporadic episodes of chest pain. Most of the subjects (42% of the total population) had stenosis in their LAD followed by 38% who had stenosis in their RCA. Almost 23% patients were reported to have stenosis in their LCX followed by OM (18% patients), PDA/ PLV (13%) and only 10% patients had blockage problem in their diagonal. 24% of the subjects were found to have stenosis in a single vessel and hence were categorized in the Single Vessel Disease (SVD) group while 76% were having stenosis in two or more than two arteries (Multiple Vessel Disease). hs-TnI level was found to be correlated with the levels of stenosis and was higher in the MVD group as compared to the SVD group. Conclusion: hs-TnI could be used as a novel marker as it shows prominence in detecting the level of stenosis quite earlier as compared to c-TnI which gets detected only after a long duration in the CVD patients admitted for angiography. hs- CRP gets readily detected as inflammation marker in these patients and hence could be used in combination with hs-TnI to detect the risk of developing coronary artery disease. [ABSTRACT FROM AUTHOR]

Objectives: This retrospective observational study aimed to evaluate the correlation between visually estimated left ventricular ejection fraction (LVEF) via 2D echocardiography (ECHO) and quantitatively measured LVEF via cardiovascular magnetic resonance imaging (CMR). Methodology: The study was conducted at Aga Khan University Hospital, involving patients who underwent both 2D ECHO and CMR within a maximum interval of three months between the two studies. LVEF was visually estimated by experienced cardiologists on 2D ECHO and quantitatively calculated on CMR. Results: Among 127 patients meeting inclusion criteria, comparisons between visually estimated LVEF ranges on ECHO and LVEF on CMR consistently showed highly significant differences (p < 0.0001), with ECHO underestimating LVEF. The mean difference between visually estimated average LVEF by ECHO and calculated LVEF by CMR was 4.9 ± 7.0. Subgroup analysis revealed consistent findings across patients with coronary artery disease (CAD) and those with dilated or hypertrophic cardiomyopathy. Conclusion: Despite a significant difference, the observed discrepancy in LVEF values between visually estimated ECHO and quantitatively measured CMR remains small. Thus, visually estimated LVEF by experienced readers retains its reliability as a method for diagnosing and managing patients in routine clinical practice. [ABSTRACT FROM AUTHOR]

Background: Atherosclerotic cardiovascular disease is highly prevalent in patients with end-stage kidney disease (ESKD). Kidney transplant (KT) improves patient survival and cardiovascular outcomes. The impact of preexisting coronary artery disease (CAD) and peripheral artery disease (PAD) on posttransplant outcomes remains unclear. Methods: This is a retrospective study utilizing the United States Renal Data System. Adult diabetic dialysis patients who underwent first KT between 2006 and 2017 were included. The study population was divided into four cohorts based on presence of CAD/PAD: (1) polyvascular disease (CAD + PAD); (2) CAD without PAD; (3) PAD without CAD; (4) no CAD or PAD (reference cohort). The primary outcome was 3-year all-cause mortality. Secondary outcomes were incidence of posttransplant myocardial infarction (MI), cerebrovascular accidents (CVA), and graft failure. Results: The study population included 19,329 patients with 64.4% men, mean age 55.4 years, and median dialysis duration of 2.8 years. Atherosclerotic cardiovascular disease was present in 28% of patients. The median follow up was 3 years. All-cause mortality and incidence of posttransplant MI were higher with CAD and highest in patients with polyvascular disease. The cohort with polyvascular disease had twofold higher all-cause mortality (16.7%, adjusted hazard ratio (aHR) 1.5, p < 0.0001) and a fourfold higher incidence of MI (12.7%, aHR 3.3, p < 0.0001) compared to the reference cohort (8.0% and 3.1%, respectively). There was a higher incidence of posttransplant CVA in the cohort with PAD (3.4%, aHR 1.5, p = 0.01) compared to the reference cohort (2.0%). The cohorts had no difference in graft failure rates. Conclusions: Preexisting CAD and/or PAD result in worse posttransplant survival and cardiovascular outcomes in patients with diabetes mellitus and ESKD without a reduction in graft survival. [ABSTRACT FROM AUTHOR]

BackgroundThe benefit of chronic total occlusion (CTO)-percutaneous coronary intervention (PCI) is controversial because of a lack of high-quality evidence. We aim to evaluate the impact of CTO-PCI on symptoms, quality of life and mortality.MethodsWe conducted a retrospective single center study of patients with CTO-PCI in a tertiary center in Austria. The study outcomes were Canadian Cardiovascular Society (CCS) angina score, quality of life measured by Seattle Angina Questionnaire (SAQ), and death at median follow up for patients with successful vs. failed CTO-PCI.ResultsA total of 300 patients underwent CTO-PCI for coronary artery disease, of which 252 (84%) were technically successful with median follow up of 3.4 years. There were no significant differences in in-hospital or all-cause mortality, major adverse cardiovascular event, or stent-related complications between the groups of failed and successful CTO-PCI. Among patients with successful CTO-PCI there was a significant improvement in CCS score, which was not found for the group with failed CTO-PCI. Successful reopening was associated with significant benefits of the SAQ domains of angina with stressful activity [3.7 ± 0.9 vs. 3.1 ± 0.5, p = 0.004, use of nitrates (4.7 ± 0.5 vs. 3.0 ± 1.0) p = 0.005] and satisfaction from angina relief (4.4 ± 1.1 vs. 3.6 ± 1.4 p

BackgroundDespite clinical suspicion, most non-invasive ischemia tests for coronary artery disease (CAD) reveal unremarkable results. Patients with a coronary artery calcium score (CACS) of zero rarely have an abnormal positron emission tomography (PET) and could be deferred from further testing. However, most patients have some extent of coronary calcification.ObjectivesCACS percentiles could be useful to exclude abnormal perfusion in patients with CACS >0, but data from patients with 82Rb PET are lacking. The aim of this study was to assess the diagnostic utility of CACS percentiles in comparison to zero calcium and absolute CACS classes.MethodsConsecutive patients with suspected CAD (n = 1,792) referred for 82Rb PET were included and analyzed for abnormal PET (SSS ≥4) and relevant ischemia (>10% myocardium). Test characteristics were calculated.ResultsThe mean age was 65 ± 11 years, 43% were female, and typical angina was reported in 21%. Abnormal PET/relevant ischemia (>10%) were observed in 19.8%/9.3%. Overall, the sensitivity/negative predictive value (NPV) of a 90.9% in all age groups.ConclusionIn patients >50 years, the 10%). They could be used to extend the scope of application of CACS 0 by 8%–10% to 32%–34% overall of patients who could be deferred from further testing.

IntroductionThe safety and efficacy of minimally invasive direct coronary artery bypass (MIDCAB) surgery has been confirmed in numerous reports. However, minimally invasive multi-vessel off-pump coronary artery bypass grafting (MICS CABG) has lower uptake and has not yet gained widespread adoption. The study aimed to investigate the non-inferiority of MICS CABG to MIDCAB in long-term follow-up for several clinical outcomes, including angina pectoris, major adverse cardiac and cerebrovascular events (MACCE) and overall survival.MethodsThis is an observational, retrospective, single center study of 1,149 patients who underwent either MIDCAB (n = 626) or MICS CABG (n = 523) at our institution between 2007 and 2018. The left internal thoracic artery and portions of the radial artery and saphenous vein were used for the patients’ single-, double-, or triple-vessel revascularization procedures. We used gradient boosted propensity-score estimation to account for possible interactions between variables. After propensity-score adjustment, the two groups were similar in terms of preoperative demographics and risk profile. Long-term follow-up (mean 5.87, median 5.6 years) was available for 1,089 patients (94.8%).ResultsA total of 626, 454 and 69 patients underwent single, double and triple coronary revascularization, respectively. The long-term outcomes of freedom from angina pectoris, acute myocardial infarction, and revascularization rate were similar between the two groups. During follow-up, there were 123 deaths in the MIDCAB group and 96 in the MICS CABG group. The 1-, 3-, 5-, and 10-year survival rates were 97%, 92%, 85%, and 69% for the MIDCAB group and 97%, 93%, 89%, and 74% for the MICS CABG group, respectively. The hazard ratio of overall survival for patients with two or more bypass grafts compared to those with one bypass graft was 1.190 (p-value = 0.234, 95% CI: 0.893–1.586). This indicates that there was no significant difference in survival between the two groups. Furthermore, if we consider a hazard ratio of 1.2 to be clinically non-relevant, surgery with two or more grafts was significantly non-inferior to surgery with just one graft (p-value = 0.0057).ConclusionIn experienced hands, MICS CABG is a safe and effective procedure. Survival and durability are comparable with MIDCAB.

Abstract Coronary Artery Disease (CAD) is a global health concern, with diagnostic modalities and risk factors that exhibit regional variations. This study, conducted at the Islamabad Diagnostic Center, Pakistan, aimed to provide a comprehensive assessment of CAD prevalence, severity, and associated risk factors, while also evaluating the diagnostic accuracy of Computed Tomography Coronary Test (CTT) and Exercise Treadmill Test (ETT) in a cohort of 2909 patients. Among the patients assessed via CT Coronary scans, CAD was universally observed, presenting with varying degrees of severity. Our findings indicated that 24.5% of patients had mild CAD, 28.6% exhibited mild to moderate CAD, 16.3% were diagnosed with moderate CAD, 18.4% demonstrated moderate to severe CAD, and 20.4% displayed severe CAD. This spectrum underscores the diverse nature of CAD within the study population. In addition to CTT, we conducted a detailed evaluation of ETT results in 49 patients. These results revealed that 55.1% of patients tested positive for ischemia during the exercise test, emphasizing the prevalence of cardiac stress and underlying CAD. Conversely, 32.7% of patients exhibited negative ETT results, indicating favorable cardiac tolerance during physical activity. A subset of patients yielded non-diagnostic or inconclusive results, necessitating further clinical assessment. Disease history analysis showed a dichotomy within the cohort, with 20.4% having a known medical history and 79.6% possessing an unknown disease history, highlighting the importance of comprehensive medical records in clinical practice. Hypertension, a critical cardiovascular risk factor, was identified in 87.8% of patients, underscoring its significance. Smoking history displayed notable variation, with 69.4% categorized as smokers, 14.3% as ex-smokers, and 10.2% as non-smokers. Lipid profile analysis indicated that 69.4% of patients had abnormal lipid levels. To assess the diagnostic accuracy of CTT and ETT, we calculated Positive Predictive Values (PPV) and Negative Predictive Values (NPV). CTT exhibited a PPV of approximately 5.99% and an NPV of approximately 4.40%, whereas ETT displayed a higher PPV of around 26.44% and a substantially higher NPV of about 49.24%. This study offers valuable insights into CAD prevalence, severity, and associated risk factors in a Pakistani cohort, emphasizing the importance of holistic risk assessment and tailored interventions in clinical practice. Our findings also highlight the diagnostic utility of ETT in CAD assessment.

Abstract Background Osteoprotegerin (OPG) is a secretory glycoprotein known for its involvement in bone metabolism and immune regulation. Research has extended OPG's significance in cardiovascular diseases (CVDs). Elevated OPG levels have been associated with increased cardiovascular risks, prompting interest in its role as a potential biomarker. Main Body This study summarizes several studies that investigated the relationship between OPG levels and the incidence of CVD. The studies indicate that higher plasma levels of OPG are associated with an increased incidence of all‐cause death, cardiovascular death, and heart failure, even after adjusting for clinical confounders. Moreover, the findings suggest that OPG has the potential to serve as a predictive biomarker for adverse cardiovascular events in the patient population studied. The findings suggest that OPG could aid in risk stratification, allowing clinicians to identify high‐risk patients who might benefit from intensified preventive measures or tailored therapeutic interventions. Therefore, early identification of individuals at risk for adverse cardiovascular events could lead to improved patient outcomes and reduced disease burden. Conclusions OPG's role in bone health and immune regulation has expanded to potential use as a biomarker for adverse cardiovascular events in stable coronary artery disease (CAD) patients. Despite limitations, its association with cardiovascular risks highlights its importance in risk assessment and personalized interventions.

Background: The impact of altitude on the prognosis of patients with coronary artery disease (CAD) after percutaneous coronary intervention (PCI) deserves further discussion and research. Methods: We conducted a post hoc analysis of a prospective observational study involving 5453 patients post-PCI, divided into medium-altitude and low-altitude groups. To control for confounding factors, propensity score matching was employed to pair patients with similar baseline characteristics between the two groups. The impact of altitude factors on patients’ prognosis post-PCI was examined through endpoint events over a 2-year follow-up period. Results: During the 2-year follow-up, patients at medium altitude exhibited a lower risk of MACE (including cardiovascular mortality, myocardial infarction, revascularization, and stroke) compared to those at low altitude (1196 versus 1196 patients [medium-altitude versus low-altitude, respectively]; hazard ratio [HR], 0.781 [95 % CI, 0.629–0.969]; P = 0.025) during 2-year follow-up. Even after excluding stroke, a significant difference in heart-related adverse events (HRAE) persisted between the two groups (HR, 0.794; 95 % CI, 0.636–0.991; P = 0.042). The incidences of individual MACE components were not significantly different between the two groups. Conclusions: Patients post-PCI residing at medium altitude exhibited a lower risk of 2-year MACE compared to those at low altitude. Further research is necessary to provide more robust evidence.

Introduction: Developing countries like India prevalence of coronary artery disease (CAD) is increasing day to day from 1.6 percent to 7.6 percent in rural areas and 1.0 percent to 13.6 percent in urban areas in last few decades and it is going to be a double burden near 2035. Indians are known to have the highest coronary artery disease (CAD) rates.Objective: To find out the socio-demographic characteristics and clinical profile of the patients suffering from coronary artery disease (CAD) attending a tertiary care hospital. This study also assessed the health-related quality of life (HRQOL) of patients.Method: A hospital based cross sectional study was done in Patients more than 18 years of age with coronary artery disease attending Cardiology OPD SSKM Hospital in Kolkata. The study was done from the year August 2020 to September 2022. The study was done on 220 patients by using a structured pretested Mac New HRQOL questionnaire. Results: The median age of coronary artery disease patients was 56 (50-62) years. Around one-third portion (34.1%) of the study participants achieved a primary level of education. The Median (IQR) of per capita income (Rs/month) of the study participants was 2000 (1250-3938). Nearly three fourth (71.4%) participants had various types of co-morbidities. Clinically, 88.2% had normal heart rates, 51.4% had normal blood pressure and 43.6% had low ejection fraction. MacNew HRQOL score among participants were 4.7,4.8,4.4 in social, emotional and physical domain, respectively. Conclusion: Male gender, lower socio-economic conditions, low level of education, inadequate dietary diversity patterns and substance user outnumbered their counterpart. The HRQOL was found satisfactory but lacking in physical domain.

Abstract Objective To evaluate the relationship between the ambulatory arterial stiffness index (AASI) and the degree of coronary stenosis, and assess its predictive value for the presence and severity of coronary artery disease (CAD). Materials and methods In total, 619 consecutive patients who presented with exertional anginal symptoms and/or acute coronary syndrome between January 2021 and December 2022 underwent elective non-urgent CAG with no emergency conditions and performed 24-h ambulatory blood pressure monitoring (ABPM) were included in this study and were divided into the control group (n = 68) and CAD group (n = 551) according to the angiography results. Ambulatory Arterial Stiffness Index (AASI) is obtained from the 24-h ABPM recordings, defined as 1 minus the regression slope of diastolic blood pressure on systolic blood pressure values. CAD complexity was determined by the Gensini score (GS). The patients with CAD were stratified according to the tertiles of the Gensini score (GS 48), and GS > 48 is considered severe coronary artery disease. To explore the relationship between AASI and the severity of CAD, Spearman correlation analysis was conducted. Logistic regression analysis was then performed to determine the influence of AASI on CAD as well as severe CAD. Moreover, a Receiver Operating Characteristic (ROC) curve was constructed to assess the predictive value of AASI for CAD and severe CAD. Results The CAD group had a substantially higher median AASI than the control group [0.47 (0.4, 0.58) vs.0.32 (0.24, 0.41), P

Abstract Background Coronary artery disease (CAD) is a complex medical condition characterized by atherosclerotic plaque accumulation in coronary arteries, leading to narrowed blood vessels and impaired blood flow. Endothelial dysfunction, smooth muscle cell proliferation, and various risk factors contribute to CAD development. Matricellular proteins, including thrombospondins (THBS), play crucial roles in vascular processes and cardiac function. Methods A case–control study was conducted among 296 participants from Era's Lucknow Medical College and Hospital, India, to investigate genetic variations in THBS1 (N700S) and THBS2 (3′ UTR T → G) in relation to CAD. Genomic DNA was isolated, and PCR–RFLP was employed for genotyping. Clinical and biochemical parameters were assessed, and statistical analyses were performed using SPSS software. Results The study revealed that age, serum cholesterol, HDL, VLDL, and LDL were significantly associated with CAD in the Indian population. However, no statistically significant associations were found between triglyceride and serum creatinine levels, as well as the studied THBS1 and THBS2 genetic polymorphisms, and CAD. The analysis of genotypic and allelic frequencies did not indicate significant associations with CAD risk. Conclusions This study suggests that specific genetic variations in THBS1 and THBS2 may not be strongly linked to the development or risk of CAD in the studied Indian population. The associations observed between age, lipid profiles, and CAD highlight the multifactorial nature of CAD susceptibility. Further research with larger sample sizes and diverse populations is warranted to validate these findings and explore additional genetic factors contributing to CAD in specific populations.

Abstract Background Unraveling myeloperoxidase’s (MPO) correlation with coronary artery disease (CAD) and genetic variations, this study seeks to enhance diagnostic precision and therapeutic strategies. Results CAD patients were found to be older and more male than controls. Several clinical parameters, including glucose, total bilirubin, alkaline phosphatase, creatinine, and troponin levels, showed significant variations. Moreover, CAD patients had lower red cell distribution width (RDW%) and mean platelet volume (MPV) than controls. Serum MPO levels did not differ significantly between CAD patients and controls, and no correlation was found with other clinical parameters except for glucose, creatinine, and total bilirubin. Conclusions The data suggest that serum MPO levels are not substantially related to CAD patients, as indicated by lower MPO levels in CAD patients compared to controls. While highlighting the potential of MPV and RDW% as predictors of severe atherosclerosis in CAD. Further research is needed to validate the diagnostic and prognostic value of RDW%, MPV, and MPO levels in CAD. Trial registration: 15092021-9-12. Registered 15 September 2021.

Coronary Artery Disease (CAD) is a key factor in several serious heart conditions, such as ischemic heart disease, myocardial infarction, and heart failure. Detecting and treating CAD early is crucial for preventing further progression of the disease. Computer-aided techniques are needed to automate the characterization of CAD conditions. In this paper, a novel approach for the automated identification of CAD utilizing improved energy estimation of electrocardiogram (ECG) signals is developed. Due to the multi-component nature of ECG and the nonlinear characteristics of energy operators, estimating their instantaneous energy may lead to cross-component interactions complicating the interpretation. To overcome this issue, variational mode decomposition with a data-driven and adaptively initialized number of modes is suggested to estimate the accurate energy of ECG beat. In this process, the instantaneous energy of each decomposed component is computed for enhanced energy estimation of each ECG beat. Multiple statistical features calculated from the localized region of ECG beat could effectively classify CAD-affected ECG beats with more than 99.80 % accuracy with an optimized ensemble classifier and a 10-fold cross validation scheme. Moreover, experimental findings have revealed the effectiveness of the proposed methodology when compared to contemporary approaches employing identical datasets.

Monocytes are associated with human cardiovascular disease progression. Monocytes are segregated into three major subsets: classical (cMo), intermediate (iMo), and nonclassical (nMo). Recent studies have identified heterogeneity within each of these main monocyte classes, yet the extent to which these subsets contribute to heart disease progression is not known. Peripheral blood mononuclear cells (PBMC) were obtained from 61 human subjects within the Coronary Assessment of Virginia (CAVA) Cohort. Coronary atherosclerosis severity was quantified using the Gensini Score (GS). We employed high-dimensional single-cell transcriptome and protein methods to define how human monocytes differ in subjects with low to severe coronary artery disease. We analyzed 487 immune-related genes and 49 surface proteins at the single-cell level using Antibody-Seq (Ab-Seq). We identified six subsets of myeloid cells (cMo, iMo, nMo, plasmacytoid DC, classical DC, and DC3) at the single-cell level based on surface proteins, and we associated these subsets with coronary artery disease (CAD) incidence based on Gensini score (GS) in each subject. Only frequencies of iMo were associated with high CAD (GS > 32), adj.p = 0.024. Spearman correlation analysis with GS from each subject revealed a positive correlation with iMo frequencies (r = 0.314, p = 0.014) and further showed a robust sex-dependent positive correlation in female subjects (r = 0.663, p = 0.004). cMo frequencies did not correlate with CAD severity. Key gene pathways differed in iMo among low and high CAD subjects and between males and females. Further single-cell analysis of iMo revealed three iMo subsets in human PBMC, distinguished by the expression of HLA-DR, CXCR3, and CD206. We found that the frequency of immunoregulatory iMo_HLA-DR+CXCR3+CD206+ was associated with CAD severity (adj.p = 0.006). The immunoregulatory iMo subset positively correlated with GS in both females (r = 0.660, p = 0.004) and males (r = 0.315, p = 0.037). Cell interaction analyses identified strong interactions of iMo with CD4+ effector/memory T cells and Tregs from the same subjects. This study shows the importance of iMo in CAD progression and suggests that iMo may have important functional roles in modulating CAD risk, particularly among females. [ABSTRACT FROM AUTHOR]

(1) Background: The increase in cardiovascular risk related to air pollution has been a matter of interest in recent years. The role of particulate matter 2.5 (PM2.5) has been postulated as a possible factor for premature death, including cardiovascular death. The role of long-term exposure to PM10 is less known. The aim of the study was to assess the individual relationship between air pollution in habitation and the development of coronary artery disease. (2) Methods: Out of 227 patients who underwent coronary angiography, 63 (38 men and 25 women) with a mean age of 69 (63–74) years, with nonsignificant atherosclerotic changes at the initial examination, were included in the study. The baseline and repeated coronary angiography were compared to reveal patients with atherosclerotic progression and its relation to demographic and clinical factors and exposure to air pollution in the habitation place. (3) Results: In the performed analysis, we found a significant correlation between Syntax score in de novo lesions and BMI (Spearman's rho −0.334, p = 0.008). The significant and strong correlation between median annual PM10 values of 20 µg/m3 and at least 25 µg/m3 in air pollution and the risk of de novo coronary disease was noticed (Spearman's rho = 0.319, p = 0.011 and Spearman's rho = 0.809, p < 0.001, respectively). (4) Conclusions: There is a positive correlation between long-term exposure to PM10 air pollution and coronary artery disease progression, demonstrated by the increase in Syntax score. The presented analysis revealed increased morbidity at lower PM10 concentrations than generally recommended thresholds. Therefore, further investigations concerning air pollution's influence on cardiovascular risk should be accompanied by promoting lifestyle changes in the population and revisiting the needs for environmental guidelines. [ABSTRACT FROM AUTHOR]

Objective: To investigate the predictive ability of global longitudinal strain (GLS) and mechanical dispersion for coronary stenosis and provide a more reliable noninvasive method for diagnosis of obstructive coronary artery disease(OCAD). Methods: Sixty‐seven patients diagnosed with suspected CAD were included in the study. Patients with coronary stenosis greater than 50% were assigned as OCAD, while the others were assigned as non obstructive coronary artery disease(NOCAD). General information was collected and patients underwent speckle tracking echocardiogram(STE). Results: Spearman's correlation analysis showed that GLS and mechanical dispersion were positively correlated with the degree of coronary stenosis (r = 0.383, 0.342, p < 0.05), and there was also a positive correlation between GLS and mechanical dispersion (r = 0.327, p < 0.05). GLS, longitudinal strain (LS) of each chamber, and mechanical dispersion were higher in the OCAD group than in the NOCAD group (p < 0.05). Univariate regression analysis showed that GLS, each lumen LS and mechanical dispersion were statistically significant (p < 0.05). Multifactorial regression analysis showed that elevated GLS (p = 0.007) and elevated mechanical dispersion (p = 0.030) were independent risk factors for OCAD. The ROC curves showed that GLS predicted OCAD (AUC area 0.745, 95% CI 0.624 to 0.865) versus mechanical discrete prediction of OCAD (AUC area 0.702, 95% CI 0.569 to 0.834) were more diagnostic than conventional cardiac ultrasound observations of ventricular wall motion abnormalities (AUC area 0.566, 95% CI 0.463 to 0.669). Conclusions: Combining GLS with mechanical dispersion can rapidly assess OCAD in a very short period, which has strong promotion value and in‐depth research value. [ABSTRACT FROM AUTHOR]