Correlation of neutrophil to lymphocyte ratio to severity of coronary artery disease and in-hospital clinical outcomes in patients with acute coronary syndrome: A prospective observational study

Objective:To explore correlation of neutrophil-to-lymphocyte ratio(NLR)to severity of coronary artery disease(CAD)and in-hospital clinical outcomes in patients with acute coronary syndrome(ACS).Methods:In this prospective and observational study,we recruited 500 patients with ACS.For all the eligible patients,demographic details were collected,and laboratory parameters were evaluated.The CAD severity was evaluated in terms of the number of involved vessels.The NLR was calculated based on neutrophils and lymphocytes and the correlation of various risk factors and severity and outcome of CAD was performed.Results:77.2%of Patients was male,and 52%of the patients aged between 55-70 years.Based on the type of ACS,396 out of 500 patients had ST-elevation myocardial infarction.An ascending trend in the white blood cell levels and NLR value was noted as the severity of the ACS increased and the highest white blood cell levels and NLR was noted among classⅣpatients.The mean NLR value among the non-survivors were higher compared to the survivors(9.52±5.72 vs.4.76±2.36;P<0.01).Receiver operating curve showed that the cut-off NLR value was 5.76 with a sensitivity of 75.0%and a specificity of 77.3%.Conclusions:The NLR can be used as an independent prognostic marker in ACS.An elevated NLR value serves as a reliable predictor for short-term complications,notably in-hospital mortality.

Coronary artery disease and heart failure:Late-breaking trials presented at American Heart Association scientific session 2023

The late-breaking science presented at the 2023 scientific session of the American Heart Association paves the way for future pragmatic trials and provides meaningful information to guide management strategies in coronary artery disease and heart failure(HF).The dapagliflozin in patient with acute myocardial infarction(DAPA-MI)trial showed that dapagliflozin use among patients with acute MI without a history of diabetes mellitus or chronic HF has better cardiometabolic outcomes compared with placebo,with no difference in cardiovascular outcomes.The MINT trial showed that in patients with acute MI and anemia(Hgb<10 g/dL),a liberal transfusion goal(Hgb≥10 g/dL)was not superior to a restrictive strategy(Hgb 7-8 g/dL)with respect to 30-day all-cause death and recurrent MI.The ORBITA-2 trial showed that among patients with stable angina and coronary stenoses causing ischemia on little or no antianginal therapy,percutaneous coronary intervention results in greater improvements in anginal frequency and exercise times compared with a sham procedure.The ARIES-HM3 trial showed that in patients with advanced HF who received a HeartMate 3 levitated left ventricular assist device and were anticoagulated with a vitamin K antagonist,placebo was noninferior to daily aspirin with respect to the composite endpoint of bleeding and thrombotic events at 1 year.The TEAMMATE trial showed that everolimus with low-dose tacrolimus is safe in children and young adults when given≥6 months after cardiac transplantation.Providing patients being treated for HF with reduced ejection fraction(HFrEF)with specific out-of-pocket(OOP)costs for multiple medication options at the time of the clinical encounter may reduce‘contingency planning’and increase the extent to which patients are taking the medications decided upon.The primary outcome,which was cost-informed decisionmaking,defined as the clinician or patient mentioning costs of HFrEF medication,occurred in 49%of encounters with the checklist only control group compared with 68%of encounters in the OOP cost group.

Nε-carboxymethyl-lysine and inflammatory cytokines,markers and mediators of coronary artery disease progression in diabetes

This editorial refers to the article“Comparative analysis of Nε-carboxymethyllysine and inflammatory markers in diabetic and non-diabetic coronary artery disease patients”,published in the recent issue of the World Journal of Diabetes 2023 is based on glucose metabolism,advanced glycation end products(AGEs),inflammation and adiposity on diabetes and coronary artery disease(CAD).This study has included CAD patients who were stratified according to glycosylated hemoglobin higher than 6.5 and sex-matched.A higher prevalence of hypertension,dyslipidemia,and non-vegetarian diet were found in the diabetic group.These risk factors might influence body weight and adiposity and explain the increment of the left atrium.Although this data was not supported by the study.The diet can also explain the non-enzymatic reactions on lipids,proteins,or nucleic acids and consequently an increment of AGEs.These molecules can emit fluorescence.However,one of the non-fluorescent and most abundant AGEs is Nε-carboxymethyl-lysine(CML).Its association with coronary artery stenosis and severity in the diabetic group might suggest its role as a player in CAD progression.Thus,CML,after binding with its receptor(RAGE),can induce calcification cascade through reactive oxygen species and mitogen-activated protein kinase.Moreover,this interaction AGE-RAGE can cause activation of the transcription nuclear factor-kb and induce inflammatory cytokines.It might explain the relationship between CML and pro-inflammatory cytokines in diabetic and CAD patients.Although this is a population from one center,the determination of CML and inflammatory cytokines might improve the diagnosis of severe and progressive CAD.Future and comparative studies among glycosylated hemoglobin,CML,and other AGE levels according to diagnosis and prognosis value might modify the clinical practice.Although these molecules are irreversible,they can act through a specific receptor inducing a signal transduction that might be modulated by inhibitors,antibodies,or siRNA.Further mechanistic studies might improve the development of future preventive therapies for diabetic patients.

Employing a random forest model to forecast the likelihood of coronary artery lesions in Kawasaki disease: a study centered on four biomarkers

Background:Kawasaki disease is an acute immune vasculitis,which is more common in children under 5 years old.Kawasaki disease mainly affects the cardiovascular system,especially the coronary arteries.Once coronary artery damage occurs,it can significantly impact the patient’s prognosis.Therefore,in some countries and regions,Kawasaki disease has become a common acquired heart disease.Methods:First,univariate analysis was conducted on each predictive factor.Then,Least Absolute Shrinkage and Selection Operator and random forest algorithms were used to screen all predictive factors,and the prediction model was evaluated using receiver operating characteristic curve,calibration curve,and Decision Curve Analysis.Results:This study,based on data from 228 Kawasaki disease patients,utilized a random forest model to identify four predictive factors:white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count.These factors were used to construct a prediction model,which achieved an area under the curve of 0.743.Conclusions:We developed a forest plot based on white blood cell count,creatine kinase isoenzyme MB,albumin,and neutrophil count to effectively predict the occurrence of coronary artery lesions in Kawasaki disease.

Application Effect of Blended Education Strategy Based on the Learning Pass Platform in Phase III Cardiac Rehabilitation of Patients with Coronary Artery Disease

Objective:To explore the application effect of the blended education strategy based on the Learning Pass platform in the phase III cardiac rehabilitation of patients with coronary artery disease.Methods:90 patients diagnosed with coronary artery disease in the Department of Cardiology of our hospital from January 2019 to January 2021 were selected and divided into the control group and the experimental group according to the method of randomized numerical table,with 45 cases in each group.Both the experimental group and the control group received pre-discharge cardiac rehabilitation education by conventional means.The control group received education and supervision information via WeChat after discharge,while the experimental group joined the Learning Pass platform to receive online and offline hybrid education and supervision,with online as the mainstay and offline as a supplement.The disease cognitive level,self-management skills,quality of life,medication adherence,and emotional status of the two groups were compared.Results:The disease cognitive levels in the experimental group were significantly higher than those of the control group(P<0.05);the scores of the experimental group in terms of quality of life,self-management skills,and medication adherence were significantly higher than those of the control group(P<0.05);and the scores of anxiety and depression in the experimental group were significantly lower than those of the control group(P<0.05).Conclusion:The blended education strategy based on the Learning Pass platform has a significant application effect in phase III cardiac rehabilitation of patients with coronary artery disease.It can improve patients’disease cognitive level,self-management skills,and quality of life,and provide a basis for improving patients’prognosis.

Atrial fibrillation and coronary artery disease:An integrative review focusing on therapeutic implications of this relationship

The incidence of both atrial fibrillation(AF)and coronary artery disease(CAD)increases with advancing age.They share common risk factors and very often coexist.Evidence points to an intricate relationship between atrial tissue excitability and neuronal remodeling with ischemia at the microcirculatory level.In this review,we delineated this complex relationship,identified a common theme between the two,and discussed how the knowledge of this relationship translates into a positive and meaningful impact in patient management.Recent research indicates a high prevalence of CAD among AF patients undergoing coronary angiography.Further,the incidence of AF is much higher in those suffering from CAD compared to age-matched adults without CAD underlying this reciprocal relationship.CAD adversely affects AF by promoting progression via re-entry and increasing excitability of atrial tissue as a result of ischemia and electrical inhomogeneity.AF in turn accelerates atherosclerosis via endothelial dysfunctional and inflammation and together with enhanced thrombogenicity and hypercoagulability contribute to micro and macrothrombi throughout cardiovascular system.In a nutshell,the two form a vicious cycle wherein one disease promotes the other.Most AF recommendations focuses on rate/rhythm control and prevention of thromboembolism.Very few studies have discussed the importance of unmasking coexistent CAD and how the treatment of underlying ischemia will impact the burden of AF in these patients.Inflammation and endothelial dysfunction remain central to both disease processes and form a handsome therapeutic target in the management of the two diseases.The relationship between AF and CAD is complex and much more than mere coincidence.The two diseases share common risk factor and pathophysiology.Hence,it is impractical to treat them in isolation.Accordingly,we share the implications of managing underlying ischemia and inflammation to positively impact and improve quality of life among AF patients.

Comparative analysis of Nε-carboxymethyl-lysine and inflammatory markers in diabetic and non-diabetic coronary artery disease patients

BACKGROUND Coronary artery disease(CAD)is a major cause of death worldwide,and India contributes to about one-fifth of total CAD deaths.The development of CAD has been linked to the accumulation of Nε-carboxymethyl-lysine(CML)in heart muscle,which correlates with fibrosis.AIM To assess the impact of CML and inflammatory markers on the biochemical and cardiovascular characteristics of CAD patients with and without diabetes.METHODS We enrolled 200 consecutive CAD patients who were undergoing coronary angiography and categorized them into two groups based on their serum glycosylated hemoglobin(HbA1c)levels(group I:HbA1c≥6.5;group II:HbA1c<6.5).We analyzed the levels of lipoproteins,plasma HbA1c levels,CML,interleukin-6(IL-6),tumor necrosis factor alpha(TNF-α),and nitric oxide.RESULTS Group I (81 males and 19 females) patients had a mean age of 54.2 ± 10.2 years, with a mean diabetes duration of4.9 ± 2.2 years. Group II (89 males and 11 females) patients had a mean age of 53.2 ± 10.3 years. Group I had moresevere CAD, with a higher percentage of patients with single vessel disease and greater stenosis severity in the leftanterior descending coronary artery compared to group II. Group I also exhibited a larger left atrium diameter.Group I patients exhibited significantly higher levels of CML, TNF-α, and IL-6 and lower levels of nitric oxide ascompared with group II patients. Additionally, CML showed a significant positive correlation with IL-6 (r = 0.596,P = 0.001) and TNF-α (r = 0.337, P = 0.001) and a negative correlation with nitric oxide (r=-4.16, P = 0.001). Oddsratio analysis revealed that patients with CML in the third quartile (264.43-364.31 ng/mL) were significantlyassociated with diabetic CAD at unadjusted and adjusted levels with covariates.

Real-world five-year outcomes of FlexyRap®cobalt-chromium rapamycin-eluting stents with biodegradable polymer in patients with de-novo coronary artery disease

BACKGROUND The use of biodegradable polymer drug-eluting stents(BP-DES)has been proven to minimize restenosis and stent thrombosis.The current post-marketing monitoring was observed at the 5-year clinical outcomes of individuals who had been treated with FlexyRap®DES in the real world.AIM To assess the safety and effectiveness of FlexyRap®DES at the 5-year follow-up in real-world settings.METHODS Findings from a retrospective,multi-center,observational,post-market clinical follow-up study of patients treated with FlexyRap®DES for de novo coronary artery disease(CAD)were reported.During the 12-mo follow-up,the primary endpoint was target lesion failure,which was defined as the composite of cardiovascular death, target vessel myocardial infarction(TV-MI), and clinically driven target lesion revascularization.RESULTS The data of 500 patients received with FlexyRap®DES was obtained at the completion of the surveillance timeline of 5-year.After the implantation of FlexyRap®DES,the device success rate was 100%.Adverse events that led to major bleeding,permanent disability,or death were not experienced in the patients.The major adverse cardiac event rate at 12-mo,3-year,and 5-year follow-up was 1(0.2%),0(0%),and 1(0.2%)respectively with 0(0%)cardiovascular death,2(0.4%)TV-MI,and 0(0%)TLR compositely.Furthermore,late stent thrombosis was found in 2(0.4%)patients at the follow-up of 12-mo,very late stent thrombosis was observed in 2 patients(0.4%)at 3-year follow-up.CONCLUSION FlexyRap®DES was proved to be safe and efficacious in real-world patients with de novo CAD,indicating a lowered rate of cardiac events and stent thrombosis at 5-year follow-up.

A Robust Tuned Random Forest Classifier Using Randomized Grid Search to Predict Coronary Artery Diseases

Coronary artery disease(CAD)is one of themost authentic cardiovascular afflictions because it is an uncommonly overwhelming heart issue.The breakdown of coronary cardiovascular disease is one of the principal sources of death all over theworld.Cardiovascular deterioration is a challenge,especially in youthful and rural countries where there is an absence of humantrained professionals.Since heart diseases happen without apparent signs,high-level detection is desirable.This paper proposed a robust and tuned random forest model using the randomized grid search technique to predictCAD.The proposed framework increases the ability of CADpredictions by tracking down risk pointers and learning the confusing joint efforts between them.Nowadays,the healthcare industry has a lot of data but needs to gain more knowledge.Our proposed framework is used for extracting knowledge from data stores and using that knowledge to help doctors accurately and effectively diagnose heart disease(HD).We evaluated the proposed framework over two public databases,Cleveland and Framingham datasets.The datasets were preprocessed by using a cleaning technique,a normalization technique,and an outlier detection technique.Secondly,the principal component analysis(PCA)algorithm was utilized to lessen the feature dimensionality of the two datasets.Finally,we used a hyperparameter tuning technique,randomized grid search,to tune a random forest(RF)machine learning(ML)model.The randomized grid search selected the best parameters and got the ideal CAD analysis.The proposed framework was evaluated and compared with traditional classifiers.Our proposed framework’s accuracy,sensitivity,precision,specificity,and f1-score were 100%.The evaluation of the proposed framework showed that it is an unrivaled perceptive outcome with tuning as opposed to other ongoing existing frameworks.

Role of ADAMTS-5 Expression in the Prognosis of Patients with Coronary Artery Disease: A Single Retrospective Analysis

This study explores the predictive value of plasma a disintegrin and metalloproteinase with thrombospondin motifs 5 (ADAMTS-5) levels for major adverse cardiovascular events (MACE) in patients with coronary artery disease (CAD). 595 patients admitted to our hospital were selected. Initially, the serum ADAMTS-5 levels of subjects were analyzed. Subsequently, a receiver operating characteristic (ROC) curve was constructed. Furthermore, the serum levels of ADAMTS-5 were assessed in patients, and based on CAD severity, they were categorized into stable angina pectoris (SAP), unstable angina (UA), non-ST-segment elevation myocardial infarction (NSTEMI), and ST-segment elevation myocardial infarction (STEMI) groups, with the aim of examining the relationship between ADAMTS-5 levels and CAD severity. Differences in clinical outcomes between patients with high and low levels of ADAMTS-5 were analyzed during the follow-up period. The study found that the serum levels of ADAMTS-5 were significantly higher in the group of patients with coronary artery disease (CAD) compared to the group without CAD, indicating its potential as a diagnostic marker for CAD. The ADAMTS-5 levels in the serum of STEMI patients were higher than those with SAP, while NSTEMI patients showed higher levels of ADAMTS-5 than the UA group. There was a positive correlation between serum ADAMTS-5 levels and the syntax score in CAD patients, suggesting a potential association with adverse clinical outcomes in patients with acute myocardial infarction (AMI). This study indicates that ADAMTS-5 shows promise as a biomarker for CAD and highlights the need for further research and validation.

Plant-based diet and its effect on coronary artery disease:A narrative review

Coronary artery disease(CAD),a primary component of cardiovascular diseases,is one of the top contributors to mortality rates worldwide.In 2021,dietary risk was estimated to be attributed to 6.58 million cardiovascular deaths.Plant-based diets(PBDs),which encourage higher consumption of plant foods and lower intake of animal-based foods,have been shown to reduce the risk of CAD by up to 29% when compared to non-vegetarian diets in a meta-analysis.This article aims to summarize the array of PBDs and compare them with conventional Western diets that include meat.We review the various proposed mechanisms for how the bioactive nutrients of PBDs aid in preventing atherosclerosis and CAD events,as well as other cardiac diseases.We conducted a detailed search of PubMed using our exclusive search strategy using the keywords plant-based diet,vegan diet,phytosterols,CAD,myocardial ischemia,and atherosclerosis.A total of 162 pertinent articles published within the past decade were identified for qualitative synthesis.To ensure the accuracy and reliability of our review,we included a total of 55 full-text,peer-reviewed articles that demonstrated the effects of plant-based diets on CAD and were written in English.We excluded animal studies,in vitro or molecular studies,and non-original data like editorials,letters,protocols,and conference abstracts.In this article,we emphasize the importance of dietary interventions,such as PBDs,to prevent CAD and their benefits on environmental sustainability.Integrating plant foods and whole grains into one's daily eating habits leads to an increase in the intake of nutrient-rich foods while reducing the consumption of processed food could not only prevent millions of premature deaths but also provide prevention against many chronic gastrointestinal and metabolic diseases.

Application Effect of Blended Education Strategy Based on the Learning Pass Platform in Phase III Cardiac Rehabilitation of Patients with Coronary Artery Disease

Objective:To explore the application effect of the blended education strategy based on the Learning Pass platform in the phase III cardiac rehabilitation of patients with coronary artery disease.Methods:90 patients diagnosed with coronary artery disease in the Department of Cardiology of our hospital from January 2019 to January 2021 were selected and divided into the control group and the experimental group according to the method of randomized numerical table,with 45 cases in each group.Both the experimental group and the control group received pre-discharge cardiac rehabilitation education by conventional means.The control group received education and supervision information via WeChat after discharge,while the experimental group joined the Learning Pass platform to receive online and offline hybrid education and supervision,with online as the mainstay and offline as a supplement.The disease cognitive level,self-management skills,quality of life,medication adherence,and emotional status of the two groups were compared.Results:The disease cognitive levels in the experimental group were significantly higher than those of the control group(P<0.05);the scores of the experimental group in terms of quality of life,self-management skills,and medication adherence were significantly higher than those of the control group(P<0.05);and the scores of anxiety and depression in the experimental group were significantly lower than those of the control group(P<0.05).Conclusion:The blended education strategy based on the Learning Pass platform has a significant application effect in phase III cardiac rehabilitation of patients with coronary artery disease.It can improve patients’disease cognitive level,self-management skills,and quality of life,and provide a basis for improving patients’prognosis.

Characteristic analysis of clinical coronary heart disease and coronary artery disease concerning young and middle-aged male patients

BACKGROUND Coronary heart disease(CHD)is a type of coronary atherosclerotic heart disease.In recent years,the incidence of CHD has been increasing annually,with an increasing number of young patients.Severe CHD may cause severe myocardial ischemia or myocardial necrosis,which in turn may cause myocardial infarction and related complications that seriously affect the life and health of the patient.AIM To examine the coronary arteries and clinical features of young and middle-aged male patients with CHD.METHODS From February 2019 to January 2020,110 male CHD patients admitted to our hospital were selected as research subjects and were divided into two groups by age:middle-aged group(n=55)and young group(n=55).The coronary arteries and clinical features of the patients were compared.RESULTS There were no significant differences in dyslipidemia,stroke history,high-density lipoprotein cholesterol,or triacylglycerol(P>0.05)between the two groups.In the young group,age,diabetes,hypertension,smoking history,body mass index,family history of CHD,drinking history,fibrinogen,low-density lipoprotein cholesterol,total cholesterol,and single-vessel disease were higher than those in the middle-aged group.Correspondingly,serum uric acid,hyperuricemia,myocardial infarction,Gensini score>50,collateral circulation,multivessel disease,double vessel disease,involvement of the right coronary artery,and involvement of the left main coronary artery were lower in the young group than in the middle-aged group.The middle-aged group mainly suffered from a high Gensini score,implicating multiple arteries,whereas the young group was mainly affected by single-vessel disease.The between-group difference was significant(P<0.05).CONCLUSION In CHD attacks,multiple coronary arteries are implicated in middle-aged male patients and single-vessel disease in young male patients.

Low ambient temperature and air pollution are associated with hospitalization incidence of coronary artery disease:Insights from a cross-sectional study in Northeast China

Background:Previous studies have established a link between fluctuations in climate and increased mortality due to coronary artery disease(CAD).However,there remains a need to explore and clarify the evidence for associations between meteorological changes and hospitalization incidences related to CAD and its subtypes,especially in cold regions.This study aimed to systematically investigate the relationship between exposure to meteorological changes,air pollutants,and hospitalization for CAD in cold regions.Methods:We conducted a cross-sectional study using hospitalization records of 86,483 CAD patients between January 1,2009,and December 31,2019.Poisson regression analysis,based on generalized additive models,was applied to estimating the influence of hospitalization for CAD.Results:Significant associations were found between low ambient temperature[-10℃,RR=1.65;95%CI:(1.28-2.13)]and the incidence of hospitalization for CAD within a lag of 0-14 days.Furthermore,O_(3)[95.50μg/m^(3),RR=12;95%CI:(1.03-1.21)]and NO_(2)[48.70μg/m^(3),RR=1.0895%CI:(1.01-1.15)]levels were identified as primary air pollutants affecting the incidence of CAD,ST-segment-elevation myocardial infarction(STEMI),and non-STEMI(NSTEMI)within the same lag period.Furthermore,O_(3)[95.50μg/m^(3),RR=1.12;95%CI:(1.03-1.21)]and NO_(2)[48.70μg/m^(3),RR=1.0895%CI:(1.01-1.15)]levels were identified as primary air pollutants affecting the incidence of CAD,ST-segment-elevation myocardial infarction(STEMI),and non-STEMI(NSTEMI)within the same lag period.The effect curve of CAD hospitalization incidence significantly increased at lag days 2 and 4 when NO_(2)and O_(3)concentrations were higher,with a pronounced effect at 7 days,dissipating by lag 14 days.No significant associations were observed between exposure to PM,SO_(2),air pressure,humidity,or wind speed and hospitalization incidences due to CAD and its subtypes.Conclusion:Our findings suggest a positive correlation between short-term exposure to low ambient temperatures or air pollutants(O_(3)and NO_(2))and hospitalizations for CAD,STEMI,and NSTEMI.These results could aid the development of effective preparedness strategies for frequent extreme weather events and support clinical and public health practices aimed at reducing the disease burden associated with current and future abnormal weather events.

Real-time Three-dimensional Echocardiographic Assessment of Left Ventricular Remodeling Index in Patients with Hypertensive Heart Disease and Coronary Artery Disease

Left ventricular remodeling index （LVRI） was assessed in patients with hypertensive heart disease （HHD） and coronary artery disease （CAD） by real-time three-dimensional echocardiography （RT3DE）. RT3DE data of 18 patients with HHD, 20 patients with CAD and 22 normal controis （NC） were acquired. Left ventricular end-diastolic volume （EDV） and left ventricular end-diastolic epicardial volume （EDVepi） were detected by RT3DE and two-dimensional echocardiography Simpson biplane method （2DE）. LVRI （left ventricular mass/EDV） was calculated and compared. The results showed that LVRI measurements detected by RT3DE and 2DE showed significant differences inter-groups （P〈0.01）. There was no significant difference in NC group （P〉0.05）, but significant difference in HHD and CAD intra-group （P〈0.05）. There was good positive correlations between LVRI detected by RT3DE and 2DE in NC and HHD groups （t=0.69, P〈0.01; r=0.68, P〈0.01）, but no significant correlation in CAD group （r=0.30, P〉0.05）. It was concluded that LVRI derived from RT3DE as a new index for evaluating left ventricular remodeling can provide more superiority to LVRI derived from 2DE.

Diagnosis of Coronary Artery Disease by Acoustic Analysis of Turbulent Murmur Caused by Coronary Artery Stenosis:A Single Center Study from China

Aim:Intracoronary murmur results from turbulent flow due to coronary artery narrowing.This study evaluated the diagnostic performance of a method for acoustic analysis of turbulent murmur caused by coronary artery stenosis in coronary artery disease(CAD)in Chinese populations.Method:Patients admitted to the cardiovascular department of the Sixth Medical Center of the Chinese People’s Liberation Army General Hospital between September 2021 and June 2022 for elective coronary angiography were prospectively enrolled.A digital electronic stethoscope was used to record heart sounds before angiography.Quantitative coronary angiography(QCA)served as the“gold standard”for CAD diagnosis to evaluate the diagnostic performance of the acoustic analysis method for CAD.Results:A total of 452 patients had complete QCA and heart sound data.The final interpretation results of the acoustic analysis method indicated 310 disease cases and 142 normal results.Increasing the cut-off values of coronary artery diameter stenosis from 30%to 50%,70%,and 90%increased the sensitivity and NPV of the acoustic analysis method;the sensitivity was 75.6%,81.9%,83.3%,and 85.7%,respectively;the NPV was 33.1%,57.0%,69.7%,and 88.0%,respectively;the specificity and PPV decreased(specificity of 75.8%,70.4%,51.0%,and 37.5%,respectively;PPV of 95.2%,89.0%,69.4%,and 32.9%,respectively);and the AUC values were 0.757,0.762,0.672,and 0.616,respectively.The sensitivity of the acoustic analysis method for one-vessel disease was 86.6%when the cut-off value was 50%.The sensitivity for identifying left anterior descending coronary artery lesions was best,at 90.7%.The sensitivity for identifying isolated coronary artery branch lesions was 66.7%,whereas the sensitivity for identifying three-vessel disease in multi-vessel coronary artery lesions was better,at 82.9%.Conclusion:Acoustic analysis of turbulent murmur caused by coronary artery stenosis for diagnosis of CAD may have favorable performance in the Chinese population.This method has good performance in CAD diagnosis with a cut-off coronary artery diameter for stenosis of 50%.

PCI compared with medical therapy in elderly patients with chronic symptomatic coronary artery disease

Objective The aim of this study was to assess quality of results of elderly patients with coronary disease after medical or revascularisation therapy. Methods In this study, we enrolled 103 patients aged 75 years or older with chronic angina in which 47 patients were assigned coronary angiography and revascularisation and 56 patients with optimised medical therapy. The primary endpoint was quality of life after 6 months, as assessed by questionnaire and the presence of major adverse cardiac events (death, non fatal myocardial infarction, or hospital admission for acute coronary syndrome with or without the need for revascularisation). Results After 6 months follow up, angina severity decreased and measures of quality of life increased in both treatment groups( P <0.05 ); however, these improvements were significantly greater after revascularisation( P <0.01 ). Major adverse cardiac events occurred in 30 ( 53.6% ) of patients in the medical group and 9 ( 19.1% ) in the invasive group ( P <0.01 ).Conclusions Patients aged 75 years or older with angina benefit more from revascularisation than from optimised medical therapy in terms of symptom relief and quality of life. Therefore, these patients should be offered invasive assessment despite their high risk profile followed by revascularisation if feasible.

Prediction of presence and severity of coronary artery disease using prediction for atherosclerotic cardiovascular disease risk in China scoring system

BACKGROUND Coronary artery disease(CAD)is one of the leading causes of death and disease burden in China and worldwide.A practical and reliable prediction scoring system for CAD risk and severity evaluation is urgently needed for primary prevention.AIM To examine whether the prediction for atherosclerotic cardiovascular disease risk in China(China-PAR)scoring system could be used for this purpose.METHODS A total of 6813 consecutive patients who underwent diagnostic coronary angiography were enrolled.The China-PAR score was calculated for each patient and CAD severity was assessed by the Gensini score(GS).RESULTS Correlation analysis demonstrated a significant relationship between China-PAR and GS(r=0.266,P<0.001).In receiver operating characteristic curve analysis,the cut-off values of China-PAR for predicting the presence and the severity of CAD were 7.55%with a sensitivity of 55.8%and specificity of 71.8%[area under the curve(AUC)=0.693,95%confidence interval:0.681 to 0.706,P<0.001],and 7.45%with a sensitivity of 58.8%and specificity of 67.2%(AUC=0.680,95%confidence interval:0.665 to 0.694,P<0.001),respectively.CONCLUSION The China-PAR scoring system may be useful in predicting the presence and severity of CAD.

A cross-sectional study on coronary artery disease diagnosis in patients with peripheral artery disease

Purpose:Compared with healthy individuals,patients with peripheral artery disease(PAD)generally have a very high risk of subclinical Coronary artery disease(CAD)and cardiovascular events.To determine the correlation between CAD in PAD patients,thereby promoting the lifetime of PAD patients and reducing the serious impacts of CAD.Methods:This clinical-based cross-sectional study comprised 100 consecutive patients in India from 2014 to 2016.In this research,PAD patients were screened for CAD by treadmill stress test and cardiac colour Doppler examination.In addition,this study performed coronary angiography followed by peripheral angiography for patients who could not perform the treadmill test.Results:With the statistical results,the study observed a high prevalence of CAD in PAD patients that can be detected only with angiography.Further,30.93%of asymptomatic CAD prevalence was observed in PAD patients.The study strengthens the need for coronary angiography in all symptomatic lower limb PAD cases to detect early CAD,particularly in patients with diabetes and dyslipidemia.Conclusion:There exists a strong correlation between PAD and CAD.Hence,precise diagnosis followed by supervision of PAD patients is significant for avoiding local progression of cardiovascular risk.

Correlation between betatrophin/angiogenin-likeprotein3/lipoprotein lipase pathway and severity of coronary artery disease in Kazakh patients with coronary heart disease

BACKGROUND The results of previous animal experiments and clinical studies have shown that there is a correlation between expression of betatrophin and blood lipid levels.However,there are still differences studies on the correlation and interaction mechanism between betatrophin,angiogenin-likeprotein3(ANGPTL3)and lipoprotein lipase(LPL).In our previous studies,we found an increase in serum ANGPTL3 Levels in Chinese patients with coronary heart disease(CHD).Therefore,we retrospectively studied Kazakh CHD patients.AIM To explore the correlation between the betatrophin/ANGPTL3/LPL pathway and severity of coronary artery disease(CAD)in patients with CHD.METHODS Nondiabetic patients diagnosed with CHD were selected as the case group;79 were of Kazakh descent and 72 were of Han descent.The control groups comprised of 61 Kazakh and 65 Han individuals.The serum levels of betatrophin and LPL were detected by enzyme-linked immunosorbent assay(ELISA),and the double antibody sandwich ELISA was used to detect serum level of ANGPTL3.The levels of triglycerides,total cholesterol,and fasting blood glucose in each group were determined by an automatic biochemical analyzer.At the same time,the clinical baseline data of patients in each group were included.RESULTS Betatrophin,ANGPTL3 and LPL levels of Kazakh patients were significantly higher than those of Han patients(P=0.031,0.038,0.021 respectively).There was a positive correlation between the Gensini score and total cholesterol(TC),triglycerides(TG),low-density lipoprotein cholesterol(LDL-C),betatrophin,and LPL in Kazakh patients(r=0.204,0.453,0.352,0.471,and 0.382 respectively),(P=0.043,0.009,0.048,0.001,and P<0.001 respectively).A positive correlation was found between the Gensini score and body mass index(BMI),TC,TG,LDL-C,LPL,betatrophin in Han patients(r=0.438,0.195,0.296,0.357,0.328,and 0.446 respectively),(P=0.044,0.026,0.003,0.20,0.004,and P<0.001).TG and betatrophin were the risk factors of coronary artery disease in Kazakh patients,while BMI and betatrophin were the risk factors in Han patients.CONCLUSION There was a correlation between the betatrophin/ANGPTL3/LPL pathway and severity of CAD in patients with CHD.