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Anomalous aortic origin of a coronary artery is a rare congenital heart defect. The detection of anomalous coronary arteries is likely to increase with increased availability and application of cardiac computed tomography and magnetic resonance imaging. Once detected, the recommendation for surgical intervention on anomalous coronary arteries depends upon patient symptoms, the presence or absence of inducible ischemia on stress imaging, and high‐risk anatomic features. A 77‐year‐old man with a history of hypertension, hyperlipidemia, chronic kidney disease Stage III, and moderate aortic stenosis presented with a non‐ST‐elevation myocardial infarction and was found to have an anomalous aortic origin of the right coronary artery on cross‐sectional imaging. His aortic stenosis had also progressed from moderate to severe, and it was not clear whether his myocardial infarction could be exclusively attributed to a supply–demand disparity within the context of profound aortic stenosis or if his aberrant coronary anatomy could be implicated as the culprit for his presentation. A multidisciplinary heart team decided to proceed with a transcatheter aortic valve replacement and then readdress surgical intervention on his anomalous right coronary artery if his anginal symptoms persisted following valve replacement. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) is a widespread health issue globally, linked to significant morbidity and mortality. While oxidative stress, dysregulated lipid metabolism, and unhealthy lifestyle choices contribute to CAD, recent research highlights the role of immune responses and inflammation. Malnutrition, a modifiable risk factor, notably impacts CAD prognosis. The prognostic nutritional index (PNI), derived from serum albumin and lymphocyte count, predicts outcomes in various diseases. This study aims to elucidate the relationship between malnutrition, as assessed by the PNI score, and the functional significance of coronary artery stenosis, evaluated by fractional flow reserve (FFR) measurements. Methods: A retrospective analysis involved 232 patients with single intermediate-grade coronary stenosis who underwent FFR measurement between January 2022 and January 2024. Prognostic nutritional index values were calculated from serum albumin and lymphocyte counts. Patients were divided into 2 groups based on FFR values. Results: Patients with hemodynamically significant coronary stenosis (FFR = 0.80) exhibited higher inflammatory markers and triglycerides, while those with FFR > 0.80 showed elevated albumin and PNI levels. Triglycerides and PNI emerged as independent predictors of significant coronary stenosis. Conclusions: This study demonstrates that PNI is independently associated with the functional significance of coronary artery stenosis as determined by FFR. Since lymphocytes, total protein and albumin values, which are readily available from routine blood tests, form the basis for PNI, this index can be easily used in clinical settings to predict hemodynamically significant coronary artery stenosis. However, the results of this study should be further expanded and validated through studies involving larger samples and prospective designs. [ABSTRACT FROM AUTHOR]

Coronary heart disease (CHD) has been recognized as a chronic progressive inflammatory disorder, and Diabetes mellitus (DM) is an independent risk factor for the pathogenesis of CHD. Recent research has underscored the systemic immune-inflammation index (SII) as a potent prognostic indicator for individuals suffering from acute coronary syndrome (ACS). This study aimed to delve into the relationship between SII and the degree of coronary atherosclerotic stenosis in non-acute myocardial infarction patients with or without DM. We enrolled a total of 2760 patients with cardiovascular disease between November 2023 and May 2024. All eligible participants were divided into the CHD group and the DM & CHD group according to the existence of comorbid DM. Our study revealed that the SII values were significantly higher in diabetic patients with CHD compared to those with CHD alone (P < 0.05). Furthermore, among patients with both CHD and DM, higher SII values were associated with a greater likelihood of developing complex, triple-branch coronary artery lesions, while the opposite trend was observed in CHD populations (P < 0.05). In the regression model completely adjusted for potential confounders, the correlation between high SII levels and co-existing DM status in CHD patients persisted as statistically significant even after attaining guideline-recommended LDL-C and TG goals (P < 0.05). Moreover, our findings demonstrated a significant link between SII levels and the severity of coronary artery stenosis as assessed by coronary angiography, particularly in the DM and CHD patient cohorts (P < 0.05). Further stratified analysis revealed a novel finding that SII levels in DM and CHD patients maintained a positive linear relationship with coronary plaque burden even under stringent glycemic control (P < 0.01, r = 0.37), whereas this correlation was absent in CHD patients who had FBG of 7 mmol/L or lower upon admission (P < 0.01, r < 0.30). These important findings underscore the SII as an independent predictor of the severity of coronary plaque burden in diabetic patients with CHD, offering valuable insights that can aid clinicians in refining risk stratification and implementing personalized management strategies for those at elevated risk. [ABSTRACT FROM AUTHOR]

Patients with severe aortic stenosis present frequently (∼50%) with concomitant obstructive coronary artery disease. Current guidelines recommend combined surgical aortic valve replacement (SAVR) and coronary artery bypass grafting (CABG) as the preferred treatment. Transcatheter aortic valve implantation (TAVI) and fractional flow reserve (FFR)-guided percutaneous coronary intervention (PCI) represent a valid treatment alternative. We aimed to test the non-inferiority of FFR-guided PCI plus TAVI versus SAVR plus CABG in patients with severe aortic stenosis and complex coronary artery disease. This international, multicentre, prospective, open-label, non-inferiority, randomised controlled trial was conducted at 18 tertiary medical centres across Europe. Patients (aged ≥70 years) with severe aortic stenosis and complex coronary artery disease, deemed feasible for percutaneous or surgical treatment according to the on-site Heart Team, were randomly assigned (1:1) to FFR-guided PCI plus TAVI or SAVR plus CABG according to a computer-generated sequence with random permuted blocks sizes stratified by site. The primary endpoint was a composite of all-cause mortality, myocardial infarction, disabling stroke, clinically driven target-vessel revascularisation, valve reintervention, and life-threatening or disabling bleeding at 1 year post-treatment. The trial was powered for non-inferiority (with a margin of 15%) and if met, for superiority. The primary and safety analyses were done per an intention-to-treat principle. This trial is registered with ClinicalTrials.gov (NCT03424941) and is closed. Between May 31, 2018, and June 30, 2023, 172 patients were enrolled, of whom 91 were assigned to the FFR-guided PCI plus TAVI group and 81 to the SAVR plus CABG group. The mean age of patients was 76·5 years (SD 3·9). 118 (69%) of 172 patients were male and 54 (31%) patients were female. FFR-guided PCI plus TAVI resulted in favourable outcomes for the primary endpoint (four [4%] of 91 patients) versus SAVR plus CABG (17 [23%] of 77 patients; risk difference –18·5 [90% CI –27·8 to –9·7]), which was below the 15% prespecified non-inferiority margin (p non-inferiority <0·001). FFR-guided PCI plus TAVI was superior to SAVR plus CABG (hazard ratio 0·17 [95% CI 0·06–0·51]; p superiority <0·001), which was driven mainly by all-cause mortality (none [0%] of 91 patients vs seven (10%) of 77 patients; p=0·0025) and life-threatening bleeding (two [2%] vs nine [12%]; p=0·010). The TCW trial is the first trial to compare percutaneous treatment versus surgical treatment in patients with severe aortic stenosis and complex coronary artery disease, showing favourable primary endpoint and mortality outcomes with percutaneous treatment. Isala Heart Centre and Medtronic. [ABSTRACT FROM AUTHOR]

Background: Unlike on-pump beating coronary artery bypass grafting, off-pump coronary artery bypass grafting (OPCAB) rarely causes intracardiac air embolisms. However, there have been several reports of air embolisms that occurred during OPCAB using a CO2 blower, which is commonly used to facilitate visualization of the anastomotic site. Herein, we describe a rare case of air bubbles detected only in the left ventricle during OPCAB. Case presentation: A 72-year-old man visited our hospital due to a myocardial infarction. Because of diffuse tight stenosis of the coronary artery, urgent OPCAB was performed under median sternotomy. After successful grafting, a significant number of air bubbles were detected in the left ventricle but not in the right side of the heart. To prevent air embolism, the patient was maintained in the Trendelenburg position. The surgery was completed, and no neurological abnormalities were observed during hospitalization. Conclusions: Air bubbles entered the left ventricle through a specific route. The use of an excessive flow rate of CO2 blower should be avoided during anastomosis. This case and other similar incidents encourage maintaining vigilant monitoring for air bubbles using transoesophageal echocardiography, even during OPCAB. [ABSTRACT FROM AUTHOR]

Coronary artery stenosis detection remains a challenging task due to the complex vascular structure, poor quality of imaging pictures, poor vessel contouring caused by breathing artifacts and stenotic lesions that often appear in a small region of the image. In order to improve the accuracy and efficiency of detection, a new deep-learning technique based on a coronary artery stenosis detection framework (DCA-YOLOv8) is proposed in this paper. The framework consists of a histogram equalization and canny edge detection preprocessing (HEC) enhancement module, a double coordinate attention (DCA) feature extraction module and an output module that combines a newly designed loss function, named adaptive inner-CIoU (AICI). This new framework is called DCA-YOLOv8. The experimental results show that the DCA-YOLOv8 framework performs better than existing object detection algorithms in coronary artery stenosis detection, with precision, recall, F1-score and mean average precision (mAP) at 96.62%, 95.06%, 95.83% and 97.6%, respectively. In addition, the framework performs better in the classification task, with accuracy at 93.2%, precision at 92.94%, recall at 93.5% and F1-score at 93.22%. Despite the limitations of data volume and labeled data, the proposed framework is valuable in applications for assisting the cardiac team in making decisions by using coronary angiography results. [ABSTRACT FROM AUTHOR]

Aortic stenosis (AS) and coronary artery disease (CAD) frequently coexist and share pathophysiological mechanisms. The proportion of patients with AS and CAD requiring revascularization varies widely because of uncertainty about best clinical practices. Although combined surgical aortic valve replacement and coronary artery bypass grafting has been the standard of care, management options in patients with AS and CAD requiring revascularization have expanded with the advent of transcatheter aortic valve replacement (TAVR). Potential alternative treatment pathways include revascularization before TAVR, concomitant TAVR and percutaneous coronary intervention, percutaneous coronary intervention after TAVR and deferred percutaneous coronary intervention or hybrid procedures. Selection depends on underlying disease severity, antithrombotic treatment strategies, clinical presentation, and symptom evolution after TAVR. In patients undergoing surgical aortic valve replacement, the addition of coronary artery bypass grafting has been associated with improved long-term mortality, especially if CAD is complex. although it is associated with higher periprocedural risk. The therapeutic impact of percutaneous coronary intervention in patients with TAVR is less well-established. The multitude of clinical permutations and remaining uncertainties do not support a uniform treatment strategy for patients with AS and CAD. Therefore, to provide the best possible care for each individual patient, heart teams need to be familiar with the available data on AS and CAD. Herein, we provide an in-depth review of the evidence supporting the decision-making process between transcatheter and surgical approaches and the key elements of treatment selection in patients with AS and CAD. [ABSTRACT FROM AUTHOR]

Background: Among patients with multivessel disease and ST-elevation myocardial infarction (MVD-STEMI), complete revascularization (CR) has been shown with improved outcomes. However, it is controversial whether diabetes mellitus (DM) status affects the outcomes. Quantitative flow ratio (QFR), as a newer non-invasive tool for identifying functional coronary stenosis and determining the presence of functional CR (FCR), may open up a new perspective for studying the above issues. The aim of this retrospective study was to investigate an association between QFR-based FCR and clinical outcomes in MVD-STEMI patients under DM status. Methods: A total of 623 patients were included in the final analysis. The patients were divided into nonDM cohort and DM cohort. Within each cohort, patients were further stratified into functional CR (FCR) layer and functional incomplete revascularization (FIR) layer based on QFR assessment. The primary outcomes were 3-year major adverse cardiovascular events (MACEs), encompassing cardiac death, ischemia-driven revascularization (target vessel and non-target vessel), rehospitalization due to unstable angina pectoris, and non-fatal myocardial infarction. Results: The incidence of MACEs was significantly lower in the FCR layer than in the FIR layer (12.6% vs 24.0%, log-rank P<0.001). In the nonDM cohort, the incidence of MACEs was also lower in the FCR layer than in the FIR layer (9.8% vs 18.5%, log-rank P = 0.032). Similar situations occurred in the DM cohort (16.1% vs 27.9%, log-rank P = 0.017). In addition, the multivariate Cox analysis showed that rSSQFR (QFR-derived residual SYNTAX score) was significantly associated with the increased risk of MACEs in the nonDM cohort (HR (95% CI) = 1.18 (1.10–1.26), P<0.001) and DM cohort (HR (95% CI) = 1.13 (1.09–1.18), P<0.001). ROC analysis showed adding rSSQFR into the model of clinical risk factors yielded a significant improvement in prediction of MACEs, especially in the DM cohort (AUC (95% CI) = 0.747 (0.675–0.819), P = 0.001) than in the nonDM cohort (AUC (95% CI) = 0.697 (0.602–0.791), P = 0.033). Furthermore, additional multivariate Cox analysis showed that rSSQFR was associated with the increased risk of MACEs in patients with moderate lesions (DS of 50%-89%) after procedure (HR (95% CI) = 1.16 (0.11–1.22), P<0.001). Conclusions: In patients with MVD-STEMI, the incidence of MACEs was lower in FCR than in FIR, and the decrease was particularly significant in the DM cohort. The association between QFR-derived rSSQFR and MACEs was independent of baseline characteristic differences, and rSSQFR provided higher prognostic predictive ability in DM cohort than in nonDM cohort. Additionally, QFR had the additional utility of identifying moderate residual lesions that require revascularization. [ABSTRACT FROM AUTHOR]

Kawasaki disease (KD), an acute self-limited febrile illness that primarily affects children <5 years old, is the leading cause of acquired heart disease in developed countries, with the potential of leading to coronary artery dilation and coronary artery aneurysms in 25% of untreated patients. This update summarizes relevant clinical data published since the 2017 American Heart Association scientific statement on KD related to diagnosis, cardiac imaging in acute KD treatment, and long-term management. Criteria defining North American patients at high risk for developing coronary artery aneurysms who may benefit from more intensive initial treatment have been published. Advances in cardiovascular imaging have improved the ability to identify coronary artery stenosis in patients with KD, yet knowledge gaps remain regarding optimal frequency of serial imaging and the best imaging modality to identify those at risk for inducible myocardial ischemia. Recent data have advanced the understanding of safety and dosing for several anti-inflammatory therapies in KD. New anticoagulation medication, myocardial infarction management, transition of health care for patients with KD, and future directions in research are discussed. [ABSTRACT FROM AUTHOR]

Objectives: The diagnostic performance of fractional flow reserve with computed tomography (FFR-CT) is affected by the presence of calcified plaque. Subtraction can remove the influence of calcification in coronary computed tomography angiography (CCTA) to increase confidence in the diagnosis of coronary artery stenosis. Our purpose is to investigate the accuracy of post-subtraction FFR-CT in predicting early revascularization. Design: Based on CCTA data of 237 vessels from 79 patients with coronary artery disease, subtraction CCTA images were obtained at a local post-processing workstation, and the conventional and post-subtraction FFR-CT measurements and the difference in proximal and distal FFR-CT values of the narrowest segment of the vessel (ΔFFR-CT) were analyzed for their accuracy in predicting early coronary artery hemodynamic reconstruction. Results: With FFR-CT ≤ 0.8 as the criterion, the accuracy of conventional and post-subtraction FFR-CT measurements in predicting early revascularization was 73.4% and 77.2% at the patient level, and 64.6% and 72.2% at the vessel level, respectively. The specificity of post-subtraction FFR-CT measurements was significantly higher than that of conventional FFR-CT at both the patient and vessel levels (P of 0.013 and 0.015, respectively). At the vessel level, the area under the curve of receiver operating characteristic was 0.712 and 0.797 for conventional and post-subtraction ΔFFR-CT, respectively, showing a difference (P = 0.047), with optimal cutoff values of 0.07 and 0.11, respectively. Conclusion: The post-subtraction FFR-CT measurements enhance the specificity in predicting early revascularization. The post-subtraction ΔFFR-CT value of the stenosis segment > 0.11 may be an important indicator for early revascularization. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to examine the relationship between the morphological parameters of retinal arteriolar bifurcations and coronary artery disease (CAD). Methods: In this cross-sectional observational study, fundus photography was conducted on 444 participants to capture retinal arteriolar bifurcations. A total of 731 fundus photographs yielded 9625 measurable bifurcations. Analyzed bifurcation parameters included the diameters of the parent vessel (d0), the larger branch (d1), and the smaller branch (d2), as well as the angles (θ1) and (θ2) representing the orientation of each branch in relation to the parent vessel, respectively. Additionally, theoretical optimal angles ( θ 1 ′ ) and ( θ 2 ′ ), calculated from the measured parameters, provided a benchmark for ideal bifurcation geometry. The study assessed the variation in these parameters across different levels of coronary atherosclerosis severity. Results: After adjusting for anatomical characteristics including the asymmetry ratio, area ratio, and distance to the optic disc, we observed that patients with severe coronary artery stenosis had significant deviations from the theoretical optimal bifurcation angles, with a decrease in ( θ 1 ′ ) and an increase in ( θ 2 ′ ) compared to those with moderate stenosis. Conclusion: The findings suggest a clear alteration in retinal arteriolar bifurcation morphology among patients with severe CAD, which could potentially serve as an indicator of disease severity. [ABSTRACT FROM AUTHOR]

Insulin resistance (IR) plays an important role in the occurrence and development of cardiovascular disease (CVD) in patients with chronic kidney disease (CKD). The triglyceride-glucose (TyG) index is a simple and effective tool to evaluate IR. This study aimed to evaluate the association of the TyG index with coronary artery disease (CAD) and the severity of coronary artery stenosis (CAS) in nondialysis patients with stages 3–5 CKD. Nondialysis patients with stages 3–5 CKD who underwent the first coronary angiography at Zhongda Hospital affiliated with Southeast University from August 2015 to January 2017 were retrospectively analyzed. CAS was measured by coronary angiography, and the CAS score was calculated as the Gensini score. Logistic regression analysis was used to determine the related factors of CAD and severe CAS. A total of 943 patients were enrolled in this cross-sectional study and 720 (76.4%) of these patients were diagnosed with CAD. The TyG index in the CAD group (7.29 ± 0.63) was significantly higher than that in the non-CAD group (7.11 ± 0.61) (p < 0.001). Multivariate logistic regression analysis showed that a higher TyG index was an independent risk factor for CAD in CKD patients after adjusting for related confounding factors (OR = 2.865, 95% CI 1.681–4.885, p < 0.001). Patients in the CAD group were divided into three groups according to the Gensini integral quantile level. Multivariate logistic regression analysis showed that the TyG index was an independent related factor for severe CAS after adjusting for relevant confounding factors (p < 0.001). The TyG index is associated with CAD and the severity of CAS in patients with nondialysis stages 3–5 CKD. A higher TyG index is an independent factor for CAD and severe CAS. [ABSTRACT FROM AUTHOR]

Background: Intermediate lesions (ILs) present challenges in making therapeutic decisions. This study aimed to determine the practical coronary angiographic predictors for revascularization in patients with ILs who underwent repeated angiograms. Methods: This study was a retrospective single-center study. The study subjects were divided into two groups according to their target lesion revascularization (TLR) during the follow-up period: the TLR (+) group (n = 135, 30.9%) and the TLR (−) group (n = 302, 69.1%). We evaluated the angiographic characteristics of ILs such as the presence of branches, luminal irregularity, tortuosity, ulcer/erosion, haziness, and calcification in the ILs, with an average follow-up of 34.2 ± 32.0 months. Results: The TLR (+) group had higher percentage of diameter stenoses (47.3 ± 13.5% vs. 44.2 ± 12.2%, p = 0.006) than the TLR (−) group, whereas the lesion length of the ILs showed no significant differences between the two groups. The prevalence of branches (79.0% vs. 69.1%, p = 0.018) and haziness (4.3% vs. 2.6%, p < 0.001) was higher in the ILs of the TLR (+) group than those of the TLR (−) group. Therefore, the angiographic predictors for the TLR of ILs were haziness (hazard ratio = 2.126, 95% confidence interval = 1.240–3.644, p = 0.006) and % diameter stenosis (DS) ≥ 60% (hazard ratio = 1.025, 95% confidence interval = 1.013–1.037, p < 0.001). Conclusions: Angiographic haziness and % DS > 60% were the independent angiographic predictors for TLR in patients with ILs. Our study is the first to present the angiographic findings of vulnerable plaques of ILs. Further studies such as intravascular imaging or physiologic studies should be strongly considered before making treatment decisions in ILs when such angiographic features are observed. [ABSTRACT FROM AUTHOR]

Background: Our recently developed Coronary Artery Tree description and Lesion EvaluaTion (CatLet) angiographic scoring system is unique in its description of the variability in the coronary anatomy, the degree of stenosis of a diseased coronary artery, and its subtended myocardial territory, and can be utilized to predict clinical outcomes for patients with acute myocardial infarction (AMI) presenting ≤12 h after symptom onset. The current study aimed to assess whether the Clinical CatLet score (CCS), as compared with CatLet score (CS), better predicted clinical outcomes for AMI patients presenting >12 h after symptom onset. Methods: CS was calculated in 1018 consecutive AMI patients enrolled in a retrospective registry. CCS was calculated by multiplying CS by the ACE F I score (age, creatinine, and left ventricular ejection fraction). Primary endpoint was major adverse cardiac events (MACE s) at 4-year-follow-up, a composite of cardiac death, myocardial infarction, and ischemia-driven revascularization. Results: Over a 4-year follow-up period, both scores were independent predictors of clinical outcomes after adjustment for a broad spectrum of risk factors. Areas-under-the-curve (AUCs) for CS and CCS were 0.72(0.68-0.75) and 0.75(0.71-0.78) for MACE s; 0.68(0.63-0.73) and 0.78(0.74-0.83) for all-cause death; 0.73(0.68-0.79) and 0.83(0.79-0.88) for cardiac death; and 0.69(0.64-0.73) and 0.75(0.7-0.79) for myocardial infarction; and 0.66(0.61-0.7) and 0.63(0.58-0.68) for revascularization, respectively. CCS performed better than CS in terms of the above-mentioned outcome predictions, as confirmed by the net reclassification and integrated discrimination indices. Conclusions: CCS was better than CS to be able to risk-stratify long-term outcomes in AMI patients presenting >12 h after symptom onset. These findings have indicated that both anatomic and clinical variables should be considered in decision-making on management of patients with AMI presenting later. [ABSTRACT FROM AUTHOR]

Aims: Despite the tremendous improvement in therapeutic medication and intervention for coronary atherosclerotic disease (CAD), residual risks remain. Exome sequencing enables identification of rare variants and susceptibility genes for residual risks of early‐onset coronary atherosclerotic disease (EOCAD) with well‐controlled conventional risk factors. Methods: We performed whole‐exome sequencing of subjects who had no conventional risk factors, defined as higher body mass index, smoking, hypertension and dyslipidemia, screened from 1950 patients with EOCAD (age ≤ 45 years, at least 50% stenosis of coronary artery by angiography), and selected control subjects from 1006 elder (age ≥ 65 years) with < 30% coronary stenosis. Gene‐based association analysis and clinical phenotypic comparison were conducted. Results: Subjects without defined conventional risk factors accounted for 4.72% of young patients. Totally, 6 genes might be associated with residual risk of EOCAD, namely CABP1 (OR = 22.19, p = 0.02), HLA‐E (OR = 22.19, p = 0.02), TOE1 (OR = 33.6, p = 0.002), HPSE2 (OR = 11.1, p = 0.04), CHST14 (OR = 22.19, p = 0.02) as well as KLHL8 (OR = 22.19, p = 0.02). Phenotypic analysis displayed the levels of low‐density lipoprotein cholesterol in carriers of mutations from CABP1, HLA‐E, TOE1, and HPSE2 were significantly elevated compared to noncarriers. Notably, extracellular matrix‐associated CHST14 and fibrinogen‐associated KLHL8 both displayed possible correlation with increased neutrophil proportion and decreased monocyte percentage (both p < 0.05), exerting potential effects on the residual inflammatory risks of EOCAD. Conclusion: The study identified six genes related to dyslipidemia and inflammation pathways with potential association with residual risk of EOCAD, which will contribute to precision‐based prevention in these patients. Trial Registration: The GRAND study was registered at www.clinicaltrials.gov on July 14, 2015, and the registry number is NCT 02496858. [ABSTRACT FROM AUTHOR]

Background Initially conceptualized as a bridge to heart transplantation, the left ventricular assist device (LVAD) has become an important option for improving survival in patients with severe heart failure and poor prognosis. Case summary We report the case of a patient suffering from severe chronic heart failure, complicated by ST-elevation myocardial infarction due to left main coronary artery stenosis (NYHA IV, INTERMACS profile 1). Despite support with veno-arterial extracorporeal membrane oxygenation, inotropes, and catecholamine therapy, the patient's cardiac function did not recover sufficiently. Consequently, the decision was made to proceed with LVAD implantation as destination therapy. The initial LVAD implantation was uneventful, and the patient received anticoagulant therapy according to standard operating procedure. However, pump thrombosis occurred on the first post-operative day, necessitating an LVAD exchange. Following an extended stay in the cardiac surgery intensive care unit, the patient was eventually discharged. Approximately 15 months later, the patient developed a driveline infection, involving most of the intrapericardial components of the LVAD. A second LVAD exchange was required, and the patient received a third LVAD. To mitigate the risk of recurrent infection, suppressive antibiotic therapy with ampicillin/sulbactam was initiated. Discussion This is the first reported case of a patient surviving three LVAD implantations and highlights an instance of off-label use of lifelong antibiotic therapy following a driveline infection. [ABSTRACT FROM AUTHOR]

Background Congenital coronary artery anomalies are a rare but reversible cause of dilated cardiomyopathy in infants and children. Optimal imaging strategies to efficiently identify and confirm the diagnosis in the setting of extracorporeal membrane oxygenation (ECMO) are crucial to timely surgery. Case summary A 2-month-old boy presented with dilated cardiomyopathy and severe left ventricular dysfunction requiring ECMO support. During an unsuccessful ECMO wean, turbulent flow was noted at the origin of the left coronary artery on echocardiography with subsequent computed tomography (CT) angiogram and cardiac angiogram via catheter confirming the very rare diagnosis of left main coronary artery ostial stenosis. He underwent emergency left coronary artery augmentation with excellent outcome. Discussion A high index of suspicion for coronary artery anomalies is required for infants presenting with suspected dilated cardiomyopathy. While CT is a potential diagnostic tool for investigating coronary abnormalities in children, image optimization on ECMO is challenging, with further imaging often required. The superior spatial and temporal resolution of cardiac angiography via catheterization allows definitive diagnosis of coronary artery abnormalities in this situation and facilitates timely surgical intervention. [ABSTRACT FROM AUTHOR]

Balloon valvuloplasty is the treatment of choice for dogs with severe type A pulmonic stenosis (PS), but less successful for dogs with other types of stenosis i.e. annular hypoplasia, supravalvular stenosis or cases with a coronary arteries malformation. We report transvalvular pulmonic stent angioplasty procedures performed in dog with unusual supravalvular stenosis as an alternative to balloon valvuloplasty. [ABSTRACT FROM AUTHOR]

Background and aim: The present study aimed to analyze the correlation between carotid atherosclerotic plaque (CAP) and/or subclavian atherosclerotic plaque (SAP) and coronary atherosclerosis disease (CASD). Methods: A total of 1343 patients hospitalized for chest pain or tightness due to coronary atherosclerotic disease and underwent initial coronary angiography (CAG) were evaluated by color Doppler flow imaging (CDFI) for CAP and SAP. The patients were divided into four groups: non-CAP & non-SAP, only-SAP, only-CAP, or CAP & SAP. Finally, 1,242 patients were included in this study. Results: The incidence of CASD and main coronary artery disease in the CAP & SAP group was higher than that in the CAP-only group. Moreover, the detection rate of three-vessel disease (3-VD) in the CAP & SAP group was significantly higher than that in the CAP group (p < 0.05). The incidence of main coronary artery branch lesions in patients with CAP & SAP was approximately 1.5 times higher than in those with only CAP. Male gender, hypertension, and diabetes were independent risk factors for main coronary artery branch lesions. If the patient had CAP & SAP lesions and more than three cardiovascular disease risk factors, coronary artery main artery disease incidence was about 81.7% Conclusion: Based on the CDFI screening and combined with cardiovascular disease risk factors, the combined evaluation of CAP and SAP showed higher CASD prediction values than the CAP group alone. Early detection of coronary atherosclerotic stenosis and timely clinical intervention is expected to reduce the incidence of ischemic heart disease events caused by coronary atherosclerotic stenosis [ABSTRACT FROM AUTHOR]

Background: Patients with severe coronary arterystenosis may present with apparently normal electrocardiograms (ECGs), making it difficult to detect adverse health conditions during routine screenings or physical examinations. Consequently, these patients might miss the optimal window for treatment. Methods: We aimed to develop an effective model to distinguish severe coronary stenosis from no or mild coronary stenosis in patients with apparently normal ECGs. A total of 392 patients, including 138 with severe stenosis, were selected for the study. Deep learning (DL) models were trained from scratch and using pre-trained parameters via transfer learning. These models were evaluated based on ECG data alone and in combination with clinical information, including age, sex, hypertension, diabetes, dyslipidemia and smoking status. Results: We found that DL models trained from scratch using ECG data alone achieved a specificity of 74.6% but exhibited low sensitivity (54.5%), comparable to the performance of logistic regression using clinical data. Adding clinical information to the ECG DL model trained from scratch improved sensitivity (90.9%) but reduced specificity (42.3%). The best performance was achieved by combining clinical information with the ECG transfer learning model, resulting in an area under the receiver operating characteristic curve (AUC) of 0.847, with 84.8% sensitivity and 70.4% specificity. Conclusions: The findings demonstrate the effectiveness of DL models in identifying severe coronary stenosis in patients with apparently normal ECGs and validate an efficient approach utilizing existing ECG models. By employing transfer learning techniques, we can extract "deep features" that summarize the inherent information of ECGs with relatively low computational expense. [ABSTRACT FROM AUTHOR]

Background: Individuals with type 1 diabetes are at increased risk of accelerated atherosclerosis, causing coronary artery disease (CAD). The underlying mechanisms remain unclear, but new theories proposed are damage of gut mucosa causing leakage and translocation of gut microbiota products into the circulation, leading to inflammatory responses and atherosclerosis. We therefore aimed to study the associations between gut related inflammatory biomarkers and coronary atherosclerosis in individuals with long-term type 1 diabetes. Methods: In this cross-sectional, controlled study of 102 participants with type 1 diabetes and 63 control subjects, we measured circulating levels of intestinal fatty acid binding protein (I-FABP), soluble cluster of differentiation 14 (sCD14), lipopolysaccharide binding protein (LBP) and interleukin 18 (IL-18) by enzyme-linked immunosorbent assay (ELISA), and further gene expression of CD14 and toll-like receptor 4 (TLR4) by real time PCR in circulating leukocytes and peripheral blood mononuclear cells (PBMCs). The participants had either established coronary heart disease (CHD) or underwent computed tomography coronary angiography (CTCA) to assess for coronary atherosclerosis, including total, calcified and soft/mixed plaque volumes. Results: In the diabetes group, the levels of I-FABP were significantly higher in participants with established CHD or significant stenosis on CTCA compared to the participants with normal arteries or non-significant stenosis, with median 1.67 ng/ml (interquartile range [IQR] 1.02–2.32) vs. median 1.09 ng/ml (IQR 0.82–1.58), p = 0.003. I-FABP was associated with significant coronary artery stenosis by CTCA (> 50%) or previously established CHD in the adjusted analysis (odds ratio [OR] = 2.32, 95% confidence interval [CI]: 1.09–4.95; p = 0.029). The levels of I-FABP correlated also to total coronary plaque volume (r = 0.22, p < 0.05). This association remained significant after adjusting for age, sex, persistent albuminuria, eGFR, statin treatment, diabetes duration and mean time-weighted variables; HbA1c, LDL-cholesterol and systolic blood pressure (OR = 1.97, 95% CI: 1.28–3.01; p = 0.002). Conclusions: In this cohort of individuals with long-term type 1 diabetes I-FABP associated significantly with coronary artery stenosis, suggesting a potential role of gut mucosa damage in the process of atherosclerosis in type 1 diabetes. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome (MetS) and coronary artery stenosis (CAS) independently increase the risk of cardiovascular events, while the impact of CAS on left ventricular (LV) function and deformation in MetS patients remains unclear. This study investigates how varying degrees of CAS exacerbate LV function and myocardial deformation in MetS patients. Methods: One hundred thirty-one MetS patients who underwent CMR examinations were divided into two groups: the MetS(CAS−) group (n = 47) and the MetS(CAS+) group (n = 84). The MetS(CAS+) group was divided into MetS with non-obstructive CAS(NOCAS+) (n = 30) and MetS with obstructive CAS(OCAS+) group (n = 54). Additionally, 48 age- and sex-matched subjects were included as a control group. LV functional and deformation parameters were measured and compared among subgroups. The determinants of decreased LV global peak strains in all MetS patients were identified using linear regression. The receiver operating characteristic (ROC) curve and logistic regression model (LRM) evaluated the diagnostic accuracy of the degree of CAS for identifying impaired LV strain. Results: Compared to MetS(CAS−), MetS(NOCAS+) showed a significantly increased LV mass index (p < 0.05). Global longitudinal peak strain was decreased gradually from MetS(CAS−) through MetS(NOCAS+) to MetS(OCAS+) (− 13.02 ± 2.32% vs. − 10.34 ± 4.05% vs. − 7.55 ± 4.48%, p < 0.05). MetS(OCAS+) groups showed significantly decreased LV global peak strain (GPS), PSSR and PDSR in radial and circumferential directions compared with MetS(NOCAS+) (all p < 0.05). The degree of CAS was independently associated with impaired global radial peak strain (GRPS) (β = − 0.289, p < 0.001) and global longitudinal peak strain (GLPS) (β = 0.254, p = 0.004) in MetS patients. The ROC analysis showed that the degree of CAS can predict impaired GRPS (AUC = 0.730) and impaired GLPS (AUC = 0.685). Conclusion: Besides traditional biochemical indicators, incorporating CAS assessment and CMR assessment of the LV into routine evaluations ensures a more holistic approach to managing MetS patients. Timely intervention of CAS is crucial for improving cardiovascular outcomes in this high-risk population. [ABSTRACT FROM AUTHOR]

Background and Aims: Hypovitaminosis D is involved in the development and progression of atherosclerosis, and it is more prevalent in women. The differential impact of hypovitaminosis D on the severity of coronary artery disease (CAD) between genders remains poorly understood. This study aims to address this literature gap. Methods: A total of 1484 consecutive patients with acute myocardial infarction (AMI) were enrolled in the study. Hypovitaminosis D was defined as vitamin D ≤ 20 ng/mL. CAD was defined as the presence of at least one coronary vessel stenosis > 50%, while severe CAD was defined as left main disease and/or three-vessel disease > 50%. Results: The mean age of the cohort was 66.3 (11.5) years, with a predominance of the male gender (71.8%). Vitamin D values were significantly lower in women than in men (15.7 [8.4–25.4] ng/mL vs. 17.9 [11–24.3] ng/mL, p = 0.01). A higher prevalence of severe CAD was observed in female patients with hypovitaminosis D compared to those without (33% vs. 19%, p < 0.01). This finding was not observed in men. Among women, hypovitaminosis D significantly increased the risk of severe CAD (OR: 1.85, p = 0.01), together with diabetes mellitus (DM) and older age, adjusted for GFR < 60 mL/min/1.73 m2, cholesterol and body mass index. Furthermore, women with both hypovitaminosis D and DM had more than three times the risk of severe CAD compared with women who lacked both (OR: 3.56, p = 0.02). Conclusions: In women, hypovitaminosis D increases the risk of severe CAD, and the co-existence of hypovitaminosis D and DM triples the incidence of severe CAD. [ABSTRACT FROM AUTHOR]

Background: Recently, a new inflammatory and prognostic marker called glucose/lymphocyte ratio (GLR) has been used in patients with coronary artery disease. In this study, we analyzed the correlation between GLR and coronary artery disease (CAD) severity in patients with chronic coronary syndrome (CCS). Methods: The study included 341 patients with CCS who underwent coronary angiography and documented coronary stenosis of 50% or more in at least one major coronary artery and 437 individuals with coronary atherosclerosis between 1% and 50% or no coronary atherosclerosis (control group). Blood samples for GLR and other laboratory parameters were obtained from all patients on admission. GLR was obtained by dividing the glucose level by the lymphocyte count. Results: There were more patients with diabetes mellitus (DM) in the critical CAD group, and glucose levels (p < 0.001), neutrophil counts (p < 0.001), C-reactive protein (CRP) levels (p < 0.001), neutrophil/lymphocyte ratio (NLR) (p < 0.001), platelet/lymphocyte ratio (PLR) (p < 0.001), and GLR (p < 0.001) were higher. In contrast, lymphocyte counts were lower (p < 0.034). Multivariate logistic regression analysis showed that DM and high CRP were independent predictors of critical CAD (p = 0.004 and p = 0.048, respectively). However, high GLR was found to be an independent predictor of critical CAD (p < 0.001). Conclusions: GLR, a simple and easily measured marker, has shown strong predictive value for CAD severity in CCS patients. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the diagnostic performance of combined dynamic stress CT myocardial perfusion imaging (CTP) and coronary CT angiography (CTA) alongside CT-derived fractional flow reserve (CT-FFR) in detecting hemodynamically significant coronary artery disease (CAD). A total of 33 patients (86 vessels) who underwent coronary CTA, dynamic stress CTP, and coronary angiography were included. Vessels exhibiting 30–90% stenosis were subjected to FFR analysis based on coronary angiography (Angio-FFR). Hemodynamic significance, determined by Angio-FFR ≤ 0.80, and imaging findings were evaluated. The evaluation involved a comparison between the combined use of coronary CTA, CTP and CT-FFR, versus the sole use of coronary CTA. Out of 86 coronary vessels, 17 (19.8%) exhibited hemodynamically significant stenosis. The sensitivity, specificity, and accuracy of coronary CTA for detecting ischemia were 94.12%, 34.78%, and 46.51%, respectively. Adding CTP to CTA improved specificity to 88.41%, and accuracy to 87.21%, respectively. The area under the curve (AUC) for the discrimination of functional significant stenosis was 0.798 when using CTA alone, and for CTA plus CTP, it reached 0.910. Furthermore, the combination of CTA, CTP and CT-FFR, showed accuracy of 88.37%, sensitivity of 88.24% and specificity of 88.41% with the AUC of 0.946. The integration of dynamic CTP with CTA significantly enhances the diagnostic accuracy for identifying patients with hemodynamically significant CAD, compared to the use of CTA alone. This study underscores the value of combining CTP, CT-FFR, and CTA in improving diagnostic precision for CAD. The combination of CTP, CT-FFR and CTA offers a multifaceted assessment for patients with CAD by simultaneously providing anatomical detail, functional analysis, and physiological quantification, which facilitating rapid, accurate, and optimal clinical decision-making and significantly enhances patient management. [ABSTRACT FROM AUTHOR]

AbstractCisgender women living with HIV experience elevated cardiovascular disease (CVD) risk that increases with age, a concern given extended life expectancies for people living with HIV. The CVD risk disparity among cisgender women aging with HIV is understudied and remains unclear. Taking a psychoneuroimmunology approach, given this group’s intersecting marginalized identities, one potential driver of the disparity is intersectional stigma. Yet not all women living with HIV have coronary artery disease (CAD). Resilience to stigma may serve as a protective factor to CAD, as observed in other health issues. This study aimed to explore the relationship between intersectional stigma, resilience, “traditional” CVD risk factors, and objective indicators of CAD among women aging with HIV. A diverse sample of cisgender women aging with HIV (aged ≥ 35, N = 48) completed a cross-sectional survey, clinical health interview, blood sample, blood pressure, anthropometric measurements, and computed tomography angiography (CTA). CART-based machine learning models assessed the statistical importance of traditional CVD risk factors, intersectional stigma, and resilience for classifying individuals with coronary artery stenosis, calcification, and inflammatory markers associated with CAD. Of the n = 31 who completed CTA, 74% had detectable calcification and 39% stenosis. Intersectional stigma was identified as an important variable for explaining calcification, but not stenosis, and for explaining sCD163, an inflammatory biomarker associated with CAD. Results show a potential psychoneuroimmunology pathway to the CAD disparity among this group. Future longitudinal research should investigate the mechanisms of this pathway and consider stigma as target for intervention to improve cardiovascular health among women aging with HIV. [ABSTRACT FROM AUTHOR]

Objective To explore the predictive value of novel anthropometric indicators for the long-term prognosis in patients with acute myocardial infarction (AMI). Methods A total of 712 patients diagnosed with AMI in the People's Hospital of Xinjiang Uygur Autonomous Region from January 2018 to December 2019 were selected as research subjects, and divided into an event group and a non-event group according to whether major cardiovascular adverse events (MACEs) occurred during the period of follow-up. Gensini score was used to quantitatively assess the degree of coronary artery stenosis. Spearman correlation analysis was used to explore the correlation between the new anthropometric indicators and Gensini score. Receiver operating characteristic (ROC) curve was used to evaluate the ability of new anthropometric indicators to predict MACEs, and the patients were grouped according to the optimal cut-off value. Kaplan-Meier curve was used to analyze the survival difference between the groups. Multivariate Cox regression was used to analyze the independent risk factors of MACEs. Results During a median follow-up of 27 (20, 39 ) months, a total of 125 patients developed MACEs. As compared with those in the non-event group, the patients in the event group had a higher proportion of hypertension, diabetes and abdominal obesity, higher HbA1c and FBG levels, and longer body weight and waist circumference. The LAP index, CMI index, BRI index and Gensini score were significantly increased, and the differences were statistically significant (P < 0.05). Spearman correlation analysis showed that LAP index, CMI index and BRI index were positively correlated with Gensini score (r = 0.233, 0.126, 0.272, P < 0.001). ROC curve analysis showed that the AUC of LAP index, CMI index, VAI index, BRI index and ABSI index were 0.745, 0.640, 0.490, 0.874 and 0.506 respectively ; Kaplan-Meier curve analysis showed that the cumulative incidence of MACEs in LAP index, CMI index and BRI index was significantly increased in the high-value group (Log-rank test, P < 0.05). The results of multivariate Cox regression analysis after adjusting confounding showed that CMI index (HR = 1.430, 95%CI: 1.049 ~ 1.952, P = 0.024) and BRI index (HR = 1.332, 95%CI: 1.234 ~ 1.439, P < 0.001)were independent risk factors for MACEs. Conclusions CMI index and BRI index of new anthropometric indicators are independent risk factors for long-term prognosis in patients with AMI. [ABSTRACT FROM AUTHOR]

Background: Progranulin is a secreted glycoprotein that regulates inflammation and wound healing. However, plasma progranulin levels in the acute phase and their clinical significance in patients with acute myocardial infarction (AMI) remain to be elucidated. Objective: We aimed to investigate the relationship between the increase in plasma progranulin levels in the acute phase and the recovery of left ventricular function in the chronic phase in AMI patients. Method and result: Eighteen AMI patients were followed up for 6 months. Blood samples were collected from the antecubital vein on day 0 (on admission) and day 7 in the acute phase. The control group consisted of patients without significant coronary artery stenosis, as assessed by cardiac catheterization (n = 16). Plasma progranulin levels were measured by enzyme-linked immunosorbent assay. Echocardiography was performed in the acute (within 7 days) and chronic (6 months) phases of AMI to evaluate left ventricular ejection fraction using the modified Simpson's method. Plasma progranulin levels in the AMI group on day 0 (69.5 ± 24.6 ng/mL) were similar to those in the control group (84.2 ± 47.1 ng/mL). There was a significant increase in progranulin levels in the AMI group on day 7 (104.2 ± 52.0 ng/mL) compared with day 0. The increase in plasma progranulin levels in the acute phase was positively correlated with the increase in left ventricular ejection fraction between the acute and chronic phases. Among various factors, only plasma progranulin levels were favorably correlated with left ventricular functional recovery in the chronic phase. Conclusion: The increase in plasma progranulin levels in the acute phase may serve as a predictive biomarker and a contributer for the recovery of left ventricular function in the chronic phase in patients with AMI. [ABSTRACT FROM AUTHOR]

Fractional flow reserve (FFR) or non-hyperaemic pressure ratios are recommended to assess functional relevance of intermediate coronary stenosis. Both diagnostic methods require the placement of a pressure wire in the coronary artery during invasive coronary angiography. Quantitative flow ratio (QFR) is an angiography-based computational method for the estimation of FFR that does not require the use of pressure wires. We aimed to investigate whether a QFR-based diagnostic strategy yields a non-inferior 12-month clinical outcome compared with an FFR-based strategy. FAVOR III Europe was a multicentre, randomised, open-label, non-inferiority trial comparing a QFR-based with an FFR-based diagnostic strategy for patients with intermediate coronary stenosis. Enrolment was performed in 34 centres across 11 European countries. Patients aged 18 years or older with either chronic coronary syndrome or stabilised acute coronary syndrome, and with at least one intermediate non-culprit stenosis (40–90% diameter stenosis by visual estimate; referred to here as a study lesion), were randomly assigned (1:1) to the QFR-guided or the FFR-guided group. Randomisation was done using a concealed web-based system and was stratified by diabetes and presence of a left anterior descending coronary artery study lesion. The primary endpoint was a composite of death, myocardial infarction, and unplanned revascularisation at 12 months. The predefined non-inferiority margin was 3·4% and the primary analysis was performed in the intention-to-treat population. The trial was registered with ClinicalTrials.gov (NCT03729739) and long-term follow-up is ongoing. Between Nov 6, 2018, and July 21, 2023, 2000 patients were enrolled and randomly assigned to the QFR-guided strategy (1008 patients) or the FFR-guided strategy (992 patients). The median age was 67·3 years (IQR 59·9–74·7); 1538 (76·9%) patients were male and 462 (23·1%) were female. Median follow-up time was 365 days (IQR 365–365). At 12 months, a primary endpoint event had occurred in 67 (6·7%) patients in the QFR group, and in 41 (4·2%) patients in the FFR group (hazard ratio 1·63 [95% CI 1·11–2·41]). The event proportion difference was 2·5% (90% two-sided CI 0·9–4·2). The upper limit of the 90% CI exceeded the prespecified non-inferiority margin of 3·4%. Therefore, QFR did not meet non-inferiority to FFR. A total of 18 (1·8%) patients in each group experienced an adverse procedural event, the most frequent being procedure-related myocardial infarction, which occurred in ten (1·0%) patients in the QFR group and seven (0·7%) in the FFR group. One patient in the QFR group died in relation to the index procedure. The results of the FAVOR III Europe trial do not support the use of QFR if FFR is available to guide revascularisation decisions in patients with intermediate coronary stenosis. This finding could have implications for current clinical guidelines recommending QFR for this purpose. Medis Medical Imaging Systems and Aarhus University. [ABSTRACT FROM AUTHOR]

Percutaneous coronary intervention (PCI) is currently the main method for treating coronary artery stenosis, but the incidence of restenosis after PCI is relatively high. Restenosis, the narrowing of blood vessels by more than 50% of the normal diameter after PCI, severely compromises the therapeutic efficacy. Therefore, preventing postinterventional restenosis is important. Vascular restenosis is mainly associated with endothelial injury, the inflammatory response, the proliferation and migration of vascular smooth muscle cells (VSMCs), excessive deposition of extracellular matrix (ECM) and intimal hyperplasia (IH) and is usually prevented by administering antiproliferative or anti-inflammatory drugs through drug-eluting stents (DESs); however, DESs can lead to uncontrolled drug release. In addition, as extracorporeal implants, they can cause inflammation and thrombosis, resulting in suboptimal treatment. Therefore, there is an urgent need for a drug carrier with controlled drug release and high biocompatibility for in vivo drug delivery to prevent restenosis. The development of nanotechnology has enabled the preparation of nanoparticle drug carriers with low toxicity, high drug loading, high biocompatibility, precise targeting, controlled drug release and excellent intracellular delivery ability. This review summarizes the advantages of nanoparticle drug carriers for treating vascular restenosis, as well as how nanoparticles have improved targeting, slowed the release of therapeutic agents, and prolonged circulation in vivo to prevent vascular restenosis more effectively. The overall purpose of this review is to present an overview of nanoparticle therapy for vascular restenosis. We expect these findings to provide insight into nanoparticle-based therapeutic approaches for vascular restenosis. [ABSTRACT FROM AUTHOR]

Objective To investigate the value of total cholesterol to high-density lipoprotein cholesterol ratio (THR), monocyte to high-density lipoprotein cholesterol ratio (MHR), and neutrophil to high-density lipoprotein cholesterol ratio(NHR)in predicting patients'coronary artery stenosis severity and percutaneous coronary intervention (PCI). Methods A total of 6 281 patients who underwent coronary angiography at our hospital between June 2021 and June 2023 were retrospectively included in this study. These patients were divided into two groups:PCI group and non-PCI group. The clinical data, laboratory findings, and interventional treatment data of all patients were collected and analyzed. Pearson correlation analysis was employed to evaluate the correlation of THR, MHR and NHR with the degree of coronary artery stenosis. Binary Logistic stepwise regression and receiver operating characteristic(ROC)curve were utilized to assess the influencing factors and predictive value of THR, MHR and NHR single and combined indexes for coronary artery disease patients undergoing PCI. Results The PCI group was observed to be older, with a higher proportion of males, individuals with diabetes mellitus, and those who had undergone THR, MHR, NHR, and a Gensini score than the non-PCI group. Conversely, the proportion of previous stent implantation was less than that of the non-PCI group (P＜0. 05). The results of Pearson correlation analysis showed a significant and positive correlation of the Gensini score with THR(r=0. 351, P＜0. 001), MHR(r=0. 192, P＜0. 001), and NHR(r=0. 236, P＜0. 001) levels, indicating that these variables had a significantly positive correlation with the degree of coronary artery stenosis. The results of multifactorial Logistic regression demonstrated that age＞50 years, male sex, diabetes mellitus, THR, MHR, and NHR were independent risk factors for PCI in patients with coronary artery disease. Conversely, a history of previous stent implantation was identified as a protective factor for PCI in patients with coronary artery disease. Furthermore, the results of ROC curves indicated that the combined area under the curve (AUC) was the largest for THR, MHR, and NHR(AUC=0. 809, 95％CI:0. 798-0. 820). Conclusion THR, MHR and NHR correlate with the degree of coronary stenosis and have strong clinical applications in the assessment of coronary artery disease for PCI. [ABSTRACT FROM AUTHOR]

Coronary arterial flow is affected by conditions such as atherosclerosis and stenosis resulting in coronary artery disease. Quantifying the flow fields across arteries is a key aspect in the functional assessment of occlusive arterial disease. An essential aspect of blood flow modeling is the mechanical interaction between the fluid flow and the arterial vessel wall. The present study focuses on the modeling of blood flow within the left anterior descending artery affected with stenosis. A one-dimensional (1D) model was developed to study the transient blood flow characteristics in the artery. The 1D model is coupled with the material tube law to account for the flexibility of the arterial wall. The loss coefficients that account for the local viscous and turbulent losses across the stenosis region are estimated accurately in terms of the varying local cross-sectional area, instead of empirical constants used in the literature. It was observed that the magnitude of viscous losses decreases with an increase in the severity of stenosis. For lower degree of stenosis (< 30 %), the local turbulent losses are insignificant compared to the viscous losses. The maximum deformation of the vessel wall is ∼ 0.12 m m at t = 0.45 s for s = 70 %. During the cardiac cycle (T = 0.9 s), the artery is observed to be experiencing dilation (Δ r > 0) in the upstream region, whereas contraction (Δ r < 0) in the downstream region for all the values of severity (s). A fractional flow reserve of 58.53% was noticed in a stenosed artery of 70% severity. [ABSTRACT FROM AUTHOR]

BACKGROUND: Fractional flow reserve (FFR) determined invasively has been globally accepted as the gold standard for determining the functional significance of coronary artery stenoses. However, despite its great importance, the invasive method has certain disadvantages, including the risk of vascular injuries, the need for vasodilation, and significant medical costs. That is why great attention was paid to the development of non-invasive methods that would enable reliable diagnosis without exposing patients to the risk of unwanted consequences. OBJECTIVE: This paper aimed to create and verify an alternative, less resource- and time-demanding, non-invasive solution. METHODS: The determination of FFR is based on the application of the fundamental laws of fluid dynamics. All energy losses in the coronary artery with stenosis were identified and analyzed in detail. A three-dimensional model of a coronary artery was generated using the corresponding angiographic images. Finally, the pressure due to stenosis was calculated and the FFR was determined. RESULTS: The results obtained using the proposed analytical method were compared with available experimental data for 40 patients who experienced the invasive coronary angiography. The coefficient of determination, mean difference and standard deviation values are determined to be 0.726, - 0.017 and 0.056, respectively. These values were slightly higher for FFR values above 0.80. CONCLUSION: The FFR calculated by the proposed analytical method has a relatively good correlation with clinical data, which leads to the conclusion that it can provide a reliable assessment of the functional significance of coronary stenosis. [ABSTRACT FROM AUTHOR]

Background: This study describes the complex association between the neutrophil-to-high-density lipoprotein cholesterol ratio (NHR), 25-hydroxyvitamin D (25(OH)D) levels, and cardiovascular disease (CVD), such as stable ischemic heart disease (IHD), ST elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA). Methods: The serum 25(OH)D concentration and NHR values were analyzed in groups of patients with chronic coronary syndrome (CCS) and acute coronary syndrome (ACS). The severity of coronary artery atherosclerosis was determined using the Coronary Artery Surgery Study (CASS) scale. Results: Significant differences in 25(OH)D and NHR concentrations were observed between CCS and (ACS)/STEMI patients (p < 0.01). Higher 25(OH)D concentrations were associated with the diagnosis of CCS, and higher NHR values with the diagnosis of ACS/STEMI. The NHR threshold for ACS was set at 0.10 (p < 0.001). Patients without significant coronary artery stenosis showed significantly higher 25(OH)D levels and lower NHR values (p < 0.01). Conclusions: The significant correlation between 25(OH)D, HDL, and the NHR suggests that vitamin D, through its influence on inflammatory processes and lipid metabolism, may play a role in the pathogenesis of chronic and acute coronary syndromes. The suggested bidirectional relationship between the NHR and 25(OH)D and the role of the NHR as a predictor of vitamin D levels require further well-designed studies. [ABSTRACT FROM AUTHOR]

Background: Placental cadherin (CDH3) is an adhesion molecule expressed in many malignant tumors. The role of serum CDH3 in atherosclerosis is unclear. Methods: This 3-year follow-up study measured atherosclerosis and serum CDH3 in 218 angiography inpatients. Coronary stenosis was assessed as the Gensini score. The brachiocephalic and femoral plaques were quantified by ultrasound. Microarray serum profiling was conducted in selected samples. CDH3 in the serum was measured using an indirect ELISA. The odds ratio (OR), ROC analysis, and logistic regressions were used to evaluate the associations between CDH3 content, atherosclerotic lesions, and various serum biomarkers. Results: Serum CDH3 was associated with the severity of atherosclerosis and diastolic blood pressure. The levels of CDH3 were able to discriminate patients with total subclinical and hemodynamically significant atherosclerotic lesions in all circulation pools (coronary, brachiocephalic, and femoral). Elevated serum CDH3 appeared to be a risk factor for cardiovascular outcomes after 3-year follow up with OR = 1.81 (95% CI: 1.07–3.72; p = 0.022). Endothelin-1 and NOx were associated with the content of CDH3 in the serum, suggesting the involvement of certain signal transduction pathways that may participate in plaque formation. Conclusions: CDH3 was associated with cardiovascular outcomes adjusted for coronary plaque presence, indicating a role of CDH3 in plaque biology. [ABSTRACT FROM AUTHOR]

This study proposes a novel Hybrid Metaheuristic with explicit diversity control, aimed at finding an optimal feature subset by thoroughly exploring the search space to prevent premature convergence. Background/Objectives: Unlike traditional evolutionary computing techniques, which only consider the best individuals in a population, the proposed strategy also considers the worst individuals under certain conditions. In consequence, feature selection frequencies tend to be more uniform, decreasing the probability of premature convergent results and local-optima solutions. Methods: An image database containing 608 images, evenly balanced between positive and negative coronary stenosis cases, was used for experiments. A total of 473 features, including intensity, texture, and morphological types, were extracted from the image bank. A Support Vector Machine was employed to classify positive and negative stenosis cases, with Accuracy and the Jaccard Coefficient used as performance metrics. Results: The proposed strategy achieved a classification rate of 0.92 for Accuracy and 0.85 for the Jaccard Coefficient, obtaining a subset of 16 features, which represents a discrimination rate of 0.97 from the 473 initial features. Conclusions: The Hybrid Metaheuristic with explicit diversity control improved the classification performance of coronary stenosis cases compared to previous literature. Based on the achieved results, the identified feature subset demonstrates potential for use in clinical practice, particularly in decision-support information systems. [ABSTRACT FROM AUTHOR]

Background: Symptomatic intracranial atherosclerotic stenosis (ICAS) is a major cause of ischemic stroke worldwide. In patients undergoing endovascular treatment for ICAS, in-stent restenosis (ISR) is associated with ischemic stroke recurrence. Objective: Intracranial drug-eluting self-expanding stent systems (COMETIU; Sinomed Neurovita Technology Inc., CHN) are new devices for treating ICAS. This study evaluated the perioperative experience and medium-term outcomes of COMETIU in 16 patients. Methods: We prospectively analyzed 16 patients with ICAS (≥ 70% stenosis) who underwent intravascular therapy between September 4, 2022, and February 1, 2023. The primary outcome was the incidence of ISR at 6 months postoperatively. The secondary efficacy outcomes were device and technical success rates. The secondary safety outcomes included stroke or death within 30 days after the procedure and the cumulative annual rate of recurrent ischemic stroke in the target-vessel territory from 31 days to 6 months and 1 year. Results: A total of 16 patients with 16 intracranial atherosclerotic lesions were treated with 16 COMETIUs. All procedures were performed under general anesthesia with 100% device and technical success rates, with no cases of periprocedural stroke or death. The mean radiographic follow-up duration was at least 6 months postoperatively, and all patients presented for radiographic and clinical follow-up. There were no reported ischemic or hemorrhagic strokes. Angiographic follow-up for all patients revealed no cases of ISR. Conclusion: COMETIU is safe and effective for treating ICAS, with minimal risk during the procedure and a low rate of ISR during medium-term follow-up. [ABSTRACT FROM AUTHOR]

Background: Patients with stable chest pain suspected of coronary artery disease (CAD) usually undergo multiple diagnostic tests to confirm or rule out obstructive CAD. Some tests may not effectively assess the presence of CAD, precluding optimal treatment. A diagnostic strategy of upfront computed tomography coronary angiography (CTCA) combined with optimal medical therapy (OMT) tailored to the extent of CAD may be superior to standard care in preventing major adverse cardiac events. Study design: The CLEAR-CAD trial is a prospective, open-label, multicentre, randomised, superiority trial of an upfront CTCA-guided strategy in 6444 patients presenting in an outpatient setting with suspected CAD compared with standard care, in approximately 30 participating centres in the Netherlands. The upfront CTCA-guided strategy consists of an initial CTCA which is assessed using the Coronary Artery Disease-Reporting and Data System (CAD-RADS 2.0). In patients without CAD (CAD-RADS 0) no specific cardiac medication is mandated. Patients with non-obstructive CAD (CAD-RADS 1–2) are treated with preventive OMT. Patients with obstructive CAD (CAD-RADS ≥ 3) are treated with preventive and anti-anginal OMT; in the presence of pharmacologically refractory symptoms patients undergo selective revascularisation after non-invasive functional imaging for myocardial ischaemia (≥ 10%). Patients with significant left main or proximal left anterior descending coronary artery stenosis on CTCA undergo direct invasive coronary angiography and subsequent revascularisation. The primary endpoint is the composite of all-cause death and myocardial infarction. Conclusion: The CLEAR-CAD trial is the first randomised study to investigate the efficacy of a combined upfront CTCA-guided medical and selective revascularisation strategy in an outpatient setting with suspected CAD compared with standard care. [ABSTRACT FROM AUTHOR]

Coronary CT angiography (CCTA) offers an efficient and reliable tool for the non-invasive assessment of suspected coronary artery disease through the analysis of coronary artery plaque and stenosis. However, the detailed manual analysis of CCTA is a burdensome task requiring highly skilled experts. Recent advances in artificial intelligence (AI) have made significant progress toward a more comprehensive automated analysis of CCTA images, offering potential improvements in terms of speed, performance and scalability. This work offers an overview of the recent developments of AI in CCTA. We cover methodological advances for coronary artery tree and whole heart analysis, and provide an overview of AI techniques that have shown to be valuable for the analysis of cardiac anatomy and pathology in CCTA. Finally, we provide a general discussion regarding current challenges and limitations, and discuss prospects for future research. [ABSTRACT FROM AUTHOR]

The article discusses the challenges posed by complex coronary lesions in interventional cardiology and the potential of drug-coated balloons (DCBs) as an alternative to drug-eluting stents (DES) for treatment. Studies have shown the safety and efficacy of DCBs in various coronary artery conditions, including in-stent restenosis, bifurcation lesions, and small-sized vessels. The integration of nanoscale excipients and computational models has optimized the precision and efficacy of DCBs for complex coronary lesions, offering a transformative intervention strategy. Further research is needed to validate the utility of DCBs across different lesion types and patient demographics, while computational cardiology shows promise in driving precision medicine and improving patient outcomes. [Extracted from the article]

Percutaneous treatment of calcified coronary lesions is still a challenge in modern interventional cardiology practice. Coronary angiography is limited to the precise and quantitative assessment of calcium in coronary arteries. Intracoronary imaging (ICI) modalities, including optical coherence tomography (OCT) and intravascular ultrasound (IVUS), produce a very detailed image of calcifications and could help in proper percutaneous treatment. Intracoronary imaging indicates the need to use additional tools and improves the final effect of an intervention. Drawing on the already published literature, the authors focused on the qualification of patients to the procedure, conduct and result of interventional procedures involving calcified lesions supported by ICI. The article shows the advantages and disadvantages of both ICI methods in general and especially in calcified lesions. Currently available tools dedicated to dealing with coronary calcium and helping to meet optimal stent implantation criteria are also described. This article reviews the data on ICI implementation in daily clinical practice to improve the results of percutaneous interventions, and indicates further directions. [ABSTRACT FROM AUTHOR]

Abstract Background Metabolic syndrome (MetS) and coronary artery stenosis (CAS) independently increase the risk of cardiovascular events, while the impact of CAS on left ventricular (LV) function and deformation in MetS patients remains unclear. This study investigates how varying degrees of CAS exacerbate LV function and myocardial deformation in MetS patients. Methods One hundred thirty-one MetS patients who underwent CMR examinations were divided into two groups: the MetS(CAS−) group (n = 47) and the MetS(CAS+) group (n = 84). The MetS(CAS+) group was divided into MetS with non-obstructive CAS(NOCAS+) (n = 30) and MetS with obstructive CAS(OCAS+) group (n = 54). Additionally, 48 age- and sex-matched subjects were included as a control group. LV functional and deformation parameters were measured and compared among subgroups. The determinants of decreased LV global peak strains in all MetS patients were identified using linear regression. The receiver operating characteristic (ROC) curve and logistic regression model (LRM) evaluated the diagnostic accuracy of the degree of CAS for identifying impaired LV strain. Results Compared to MetS(CAS−), MetS(NOCAS+) showed a significantly increased LV mass index (p

Huaqiong Wu,1,&ast; Guifen Yang,2,&ast; Shaohua Zhang,2 Jinxiang Luo,1 Pei Zhou,1 Yuhua Chen1 1Department of Radiodiagnosis, Central War Zone General Hospital of Wuhan, Wuhan, Hubei, People’s Republic of China; 2Department of Internal Medicine-Cardiovascular, Central War Zone General Hospital of Wuhan, Wuhan, Hubei, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Shaohua Zhang, Department of Internal Medicine-Cardiovascular, Central War Zone General Hospital of Wuhan, No. 627, Wuluo Road, Wuchang District, Wuhan, Hubei, 430070, People’s Republic of China, Tel +8618062579072, Email zhangshaohua1258@163.com Jinxiang Luo, Department of Radiodiagnosis, Central War Zone General Hospital of Wuhan, No. 627, Wuluo Road, Wuchang District, Wuhan, Hubei, 430070, People’s Republic of China, Tel +8602750773333, Email luojinxiang2020@21cn.comObjective: To investigate the correlation between risk factors for coronary stenosis and the degree of coronary artery stenosis based on coronary computed tomography angiography (CCTA).Methods: Two hundred seventy-eight patients with coronary artery disease who received treatment in our hospital between January 2020 and January 2021 were selected as the experimental group, and 100 healthy people who received physical examination in our hospital during the same period were selected as the control group (age and gender matched with the study group). The clinical data and CCTA data of the two groups of patients were collected and compared. Computed tomography fractional flow reserve (FFRCT) values were calculated based on the CCTA data of the patients in the study group, risk factors for coronary artery stenosis were analysed and the correlation between the risk factors and CT flow reserve fraction was explored.Results: The serum total bilirubin (BIL), apolipoprotein A (apoA), low-density lipoprotein cholesterol (LDL-C), uric acid, total cholesterol (TC) and mean platelet volume levels were higher in the experimental group than in the control group (P < 0.05). Unconditional logistic regression analysis showed that LDL-C, uric acid, TC, triglyceride, serum total BIL and apoA were independent risk factors for coronary heart disease (P < 0.05). Serum total BIL (r = 0.27), apoA (r = − 0.30), uric acid (r = − 0.48), TC (r = − 0.35), triglyceride (r = − 0.73) and LDL-C (r = − 0.65) showed a negative correlation with FFRCT values (P < 0.05). A positive correlation was detected between high-density lipoprotein cholesterol and FFRCT values (r = 0.37, P < 0.05).Conclusion: Triglycerides, LDL-C, uric acid, TC, serum total BIL and apoA are risk factors for coronary artery stenosis that should be closely monitored and receive active intervention in clinical practice.Keywords: coronary heart disease, coronary artery stenosis, computed tomography angiography, risk factors, computed tomography fractional flow reserve

Abstract Background In recent years, as deep learning has received widespread attention in the field of heart disease, some studies have explored the potential of deep learning based on coronary angiography (CAG) or coronary CT angiography (CCTA) images in detecting the extent of coronary artery stenosis. However, there is still a lack of a systematic understanding of its diagnostic accuracy, impeding the advancement of intelligent diagnosis of coronary artery stenosis. Therefore, we conducted this study to review the accuracy of image-based deep learning in detecting coronary artery stenosis. Methods We retrieved PubMed, Cochrane, Embase, and Web of Science until April 11, 2023. The risk of bias in the included studies was appraised using the QUADAS-2 tool. We extracted the accuracy of deep learning in the test set and performed subgroup analyses by binary and multiclass classification scenarios. We performed a subgroup analysis based on different degrees of stenosis and applied a double arcsine transformation to process the data. The analysis was done by using R. Results Our systematic review finally included 18 studies, involving 3568 patients and 13,362 images. In the included studies, deep learning models were constructed based on CAG and CCTA. In binary classification tasks, the accuracy for detecting > 25%, > 50% and > 70% degrees of stenosis at the vessel level were 0.81 (95% CI: 0.71–0.85), 0.73 (95% CI: 0.58–0.88) and 0.61 (95% CI: 0.56–0.65), respectively. In multiclass classification tasks, the accuracy for detecting 0–25%, 25–50%, 50–70%, and 70–100% degrees of stenosis at the vessel level were 0.78 (95% CI: 0.73–0.84), 0.86 (95% CI: 0.78–0.93), 0.83 (95% CI: 0.70–0.97), and 0.70 (95% CI: 0.42–0.98), respectively. Conclusions Our study shows that deep learning models based on CAG and CCTA appear to be relatively accurate in diagnosing different degrees of coronary artery stenosis. However, for various degrees of stenosis, their accuracy still needs to be further improved.

Objective: To explore the diagnostic value of intermittent changes in the nocturnal ST segment trend graph in a dynamic electrocardiogram (ECG) for coronary heart disease (CHD). Methods: A total of 205 patients who underwent coronary angiography were included in this retrospective study. The study sample was determined through a power analysis aimed at achieving power of 80% with a significance level of 0.05. The participants were divided into the CHD (n = 101) and the non-CHD (n = 104) group, based on the degree of coronary artery diameter stenosis. The morphological changes in the ST segment trend graph were observed and divided into two categories: 'wall-shaped' and 'peak-shaped' changes. Results: Among the 205 patients, 94 had nocturnal ST segment dynamic changes and 111 did not. The detection rate of CHD without nocturnal ST segment dynamic changes was 21.59%, significantly lower than the detection rate of 93.18% in those with nocturnal ST segment changes, reflecting a statistically significant difference (P < 0.05). The positive rate of ST segment in patients with single-vessel disease (71.88%) was lower than in patients with multi-vessel disease (78.57%), and both differences were statistically significant (P < 0.05). The duration of ST segment trend graph changes in 94 cases in the CHD group with intermittent changes in the nocturnal ST segment trend graph was higher than in the non-CHD group, but no significant difference was observed (P > 0.05). The detection rate of CHD in the peak-shaped dynamic change group of the nocturnal ST segment trend graph was significantly higher (76/82) than in the wall-shaped (6/82) dynamic change group (P < 0.05). Conclusion: Peak-shaped changes in the nocturnal ST segment trend graph indicate coronary artery lesions. Nocturnal ST segment changes observed through dynamic ECG monitoring can serve as a valuable non-invasive predictor for CHD, providing a feasible method for early diagnosis and intervention in clinical practice. [ABSTRACT FROM AUTHOR]

Homozygous familial hypercholesterolemia (HoFH), is a rare genetic disorder characterized by dual mutations in the low-density lipoprotein receptor (LDLR) gene, leading to dysfunctional or absent LDLRs, often accompanied by severe premature Atherosclerotic Cardiovascular Disease (ASCVD) and exhibiting refractoriness to aggressive pharmacological interventions. Double filtration plasmapheresis (DFPP), a form of lipoprotein apheresis (LA), has been effectively utilized as an adjunctive treatment modality to reduce serum LDL-C levels in refractory cases of HoFH. Here, we report a case of a 36-year-old female with HoFH who developed xanthomas on her limbs and waist at age 7. Despite maximum-tolerated doses of statins from age 32, combined with ezetimibe and evolocumab, her LDL-C levels remained critically elevated at 12–14 mmol/L. Her genetic testing confirmed a homozygous LDLR mutation. At 35 years old, she experienced exertional chest pain, and percutaneous coronary intervention revealed severe calcific left main stenosis, necessitating stent implantation. Subsequently, she initiated once every 1–2 months DFPP. Pre-DFPP, her LDL-C and total cholesterol (TC) levels were 13.82 ± 3.28 and 15.45 ± 0.78 mmol/L, respectively. Post-DFPP, her LDL-C and TC levels significantly decreased to 2.43 ± 0.33 mmol/L (81.76 ± 4.11% reduction) and 3.59 ± 0.41 mmol/L (76.76 ± 2.75% reduction), respectively. Lipoprotein (a) and triglycerides also decreased by 89.10 ± 1.39% and 42.29 ± 15.68%,respectively. Two years later, there was no progression of coronary artery disease, and her symptoms and xanthomas regressed significantly. Collectively, DFPP effectively reduces LDL-C levels in refractory cases of HoFH and contributes to delaying ASCVD progression, representing an efficacious adjunctive therapeutic modality. [ABSTRACT FROM AUTHOR]

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