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 Patterns in Diabetic Patients Undergoing Diagnostic Coronary Angiography-Data from a Major Cardiac Center in Yemen

Background: Diabetes mellitus (DM) is independently associated with an increased risk of cardiovascular mortality and morbidity, including coronary artery disease (CAD). CAD is a shared burden disease and the leading cause of death in developed and developing countries. We aimed to assess the angiographic patterns of coronary arteries in patients with DM in a developing country (Yemen) as the first study. Methods: This study is a cross-sectional, prospective, observational study that includes a total of 250 patients who were admitted for elective diagnostic coronary angiography. Results: 96 (38.4%) patients were diabetics;68% were male;mean age was 57 ± 11 years. The incidence of three-vessel disease was 31.2% of patients. Considering the severity of lumen occlusion, (11.2%) of patients had non-significant lesions, (37.6%) of patients had significant lesions, and (32%) had total occlusive lesions. Lesions were of LAD in 76%, RCA in 60%, and LCX in 52% of the population. Among diabetics, two and 3-vessel diseases (33.3% vs. 20.8% & 50% vs. 19.5%, P = 0.001), left main lesion (10.4% vs. 2.6%, P = 0.012), significant stenosis (41.7% vs. 35.1%, P = 0.032), total occlusion of coronary arteries (43.8% vs. 19.5%, P = 0.032) and type C lesion (66.7% vs. 35.1%, P = 0.010) were more frequent than non-DM patients. Conclusion: The burden of significant and severe coronary lesions is more common among DM, which may be the major cause of morbidity and mortality of DM in developing countries.

Diagnostic Accuracy of Three-Dimensional Whole-Heart Magnetic Resonance Angiography to Detect Coronary Artery Disease with Invasive Coronary Angiography as a Reference:A Meta-Analysis

Objective:We aimed to evaluate the diagnostic performance of three-dimensional whole-heart magnetic resonance coronary angiography(MRCA)in detecting coronary artery disease(CAD)with invasive coronary angiography as the reference standard.Methods:We searched PubMed and Embase for studies evaluating the diagnostic performance of three-dimensional whole-heart MRCA for the diagnosis of CAD with invasive coronary angiography as the reference standard.The bivariate mixed-effects regression model was applied to synthesize available data.The clinical utility of whole-heart MRCA was calculated by the posttest probability based on Bayes’s theorem.Results:Eighteen studies were included,of which 16 provided data at the artery level.Patient-based analysis revealed a pooled sensitivity of 0.90(95%confi dence interval[CI]0.87–0.93)and specifi city of 0.79(95%CI 0.73–0.84),while the pooled estimates were 0.86(95%CI 0.82–0.89)and 0.89(95%CI 0.84–0.92),respectively,at the artery level.The areas under the summary receiver operating characteristic curve were 0.93(95%CI 0.90–0.95)and 0.92(95%CI 0.90–0.94)at the patient and artery levels,respectively.With a pretest probability of 50%,the patients’posttest probabilities of CAD were 81%for positive results and 11%for negative results.Conclusions:Whole-heart MRCA can be an alternative noninvasive method for diagnosis and assessment of CAD.

Interleukin-17A gene variants and risk of coronary artery disease:a large angiography-based study

Background Recent studies have also revealed that interleukin(IL)-17A plays a key role in atherosclerosis and its complication,but the relationship of its common variants with coronary artery disease(CAD) has not been extensively studied.Methods We systematically screened sequence variations in the IL17A gene and designed an angiog-raphy -based case-controlled study consisting of 1031 CAD patients and 935 control subjects to investigate the association between the selected polymorphisms of IL-17A gene and CAD risk in Chinese Han population.Results Frequencies of IL17A rs8193037 GG homozygote and G allele were significantly higher in the patient group than those in the control group(P【0.001;OR=0.68;95%CI=0.54-0.85).Stratification analysis showed that the IL17A rs8193037 G allele significantly increased the risk of CAD only among male subjects (P=0.001;OR=0.63;95%CI=0.47-0.83).After adjustment for conventional risk factors,binary logistic regression analysis showed that the G allele carriers(GG +AG) had significantly increased CAD risk compared with the AA homozygotes (adjusted P【0.001;OR 0.43;95%CI,0.33- 0.58).ELISA showed augmented IL17A production in plasma of the AMI patients.Conclusions Based on our data,we speculated that the SNP rs8193037 of IL17A gene is significantly associated with CAD risk in Chinese Han population and the rs8193037 G allele which is associated with increased expression of IL17A in AMI patients may be an independent predictive factor for CAD.

Emerging role of computed tomography coronary angiography in evaluation of children with Kawasaki disease

Coronary artery abnormalities are the most important complications in children with Kawasaki disease(KD).Two-dimensional transthoracic echocardiography currently is the standard of care for initial evaluation and follow-up of children with KD.However,it has inherent limitations with regard to evaluation of mid and distal coronary arteries and,left circumflex artery and the poor acoustic window in older children often makes evaluation difficult in this age group.Catheter angiography(CA)is invasive,has high radiation exposure and fails to demonstrate abnormalities beyond lumen.The limitations of echocardiography and CA necessitate the use of an imaging modality that overcomes these problems.In recent years advances in computed tomography technology have enabled explicit evaluation of coronary arteries along their entire course including major branches with optimal and acceptable radiation exposure in children.Computed tomography coronary angiography(CTCA)can be performed during acute as well as convalescent phases of KD.It is likely that CTCA may soon be considered the reference standard imaging modality for evaluation of coronary arteries in children with KD.

Multislice CT angiography in coronary artery disease: Technical developments, radiation dose and diagnostic value

Multislice computed tomography (CT) angiography has been increasingly used in the detection and diagnosis of coronary artery disease because of its rapid technical evolution from the early generation of 4-slice CT scanners to the latest models such as 64-slice, 256-slice and 320-slice CT scanners. Technical developments of multislice CT imaging enable improved diagnostic value in the detection of coronary artery disease, and this indicates that multislice CT can be used as a reliable lessinvasive alternative to invasive coronary angiography in selected patients. In addition, multislice CT angiography has played a significant role in the prediction of disease progression and cardiac events. Despite promising results reported in the literature, multislice CT has the disadvantage of having a high radiation dose which could contribute to the radiation-induced malignancy. A variety of strategies have been currently undertaken to reduce the radiation dose associated with multislice CT coronary angiography while in the meantime acquiring diagnostic images. In this article, the author will review the technical developments, radiation dose associated with multislice CT coronary angiography, and strategies to reduce radiation dose. The diagnostic and prognostic value of multislice CT angiography in coronary artery disease is briefly discussed, and future directions of multislice CT angiography in the diagnosis of coronary artery disease will also be highlighted.

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.

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.

Coronary computed tomography angiography in coronary artery disease

AIM: To investigate the research directions of coronary computed tomography (CT) angiography in the diagnosis of coronary artery disease (CAD) based on a systematic review of the literature.METHODS: A search of articles on coronary CT angiography in the diagnosis of CAD was performed during a 6-year-period between 2005 and 2010 from f ive main radiology journals namely, Radiology, American Journal of Roentgenology, European Radiology, European Journal of Radiology and British Journal of Radiology. Analysis of the references was focused on the research directions of coronary CT angiography with regard to the type of studies in terms of diagnostic value, application of dose-reduction strategies and resultant effective radiation doses with use of these techniques.RESULTS: One hundred and forty two studies were identified which met the selection criteria and were included in the analysis. 64-slice CT (single source anddual-source CT) dominated 78% of the coronary CT angiography studies. Prior to 2007, research was focused on the diagnostic value of coronary CT angiography, but since 2008 more attention has been paid to radiation dose reduction. Radiation dose was reported in 64 studies, representing 45% of total studies published in the f ive radiology journals. Various dose-saving strategies have been implemented and prospective electrocardiography-triggering and high pitch techniques were found to be the most effective approaches for radiation dose reduction, with the corresponding mean effective dose being 3.5 ± 1.9 mSv and 1.7 ± 0.6 mSv, respectively.CONCLUSION: This review shows that the current research in coronary CT angiography has shifted from the previous focus on diagnostic accuracy in CAD to more emphasis on radiation dose reduction.

APOLIPOPROTEIN E GENE POLYMORPHISMS AND RISK FOR CORONARY ARTERY DISEASE IN CHINESE XINJIANGUYGUR AND HAN POPULATION

Objective To examine the relationship between apolipoprotein E (Apo E) gene polymorphism and risk of coronary artery disease (CAD), analyzing association of polymorphism with classical risk factors. Methods A total of 124 patients (including 84 Han population and 40 Uygur population) with angiographically verified CAD or myocardial infarction were prospectively evaluated. Data referring to hypertension, diabetes, and tobacco consump-tion were recorded. The levels of total cholesterol (TC), high density lipoprotein (HDL) cholesterol, Apo A1 and B, and triglycerides (TG) were determined. DNA was obtained from 124 patients and 70 controls. In order to determine Apo E genotypes, DNA was PCR amplified and digested with HhaI. The genetic polymorphism of Apo E is due to three common alleles, epsilon(ε) 2, ε3, ε4, at a single autosomal gene locus. These alleles determine the six phenotypes E2/2, E3/3, E4/4, E4/2, E4/3, and E3/2. Results In Uygur population, the frequency of the ε2, ε3, and ε4 was 0.155, 0.648, and 0.197 respectively. In Han po-pulation, the frequency of the ε2, ε3, and ε4 was 0.081, 0.772, and 0.146 respectively. In the patient group, the frequency of the ε2, ε3, and ε4was 0.060, 0.758, and 0.182 respectively. In the control group, the frequency of the ε2, ε3, and ε4 was 0.193, 0.671, and 0.136 respectively. ε2 frequency of Uygur’ patients and controls was 0.050 and 0.290 respectively. Serum low density lipoprotein (LDL) cholesterol, TC, and TG values tended to decrease from the Apo E-4 phenotypes to Apo E-2 phenotypes. When deletion polymorphism of ε2 was compared with the common risk factors for CAD, its risk ratio (RR) is 4.38. Conclusions These studies confirm and find that Apo E phenotype distribution in Uygur population differs significantly from that in Han population in Xinjiang. CAD patients have significantly lower ε2 allele and slightly higher ε3 or ε4 allele frequency than controls, especially in Uygur population. It shows protective effects of ε2 on CAD.

Multislice computed tomography angiography in the diagnosis of coronary artery disease

Multislice CT angiography 表示在心脏的成像和它的最令人激动的工艺的革命之一逐渐地在冠的动脉疾病的诊断被使用了。在在最后十年的 multislice CT 扫描仪的快速的改进允许这种技术与怀疑的冠的动脉疾病在病人成为一种潜在地有效的选择到侵略冠的 angiography。高诊断的价值与 64- 和更多的片 CT 扫描仪的使用与 multislice CT angiography 被完成了。另外， multislice CT angiography 显示出冠的钙，冠的匾的描述，以及疾病前进和主要心脏的事件的预言的精确察觉和分析。因此，当避免不必要的侵略冠的 angiography 过程时，病人们能得益于提供快速、精确的诊断的 multislice CT angiography。这篇文章的目的是在场的在有冠的动脉疾病的诊断精确性的一个焦点的冠的动脉疾病的 multislice CT angiography 的临床的应用的概述；关于主要心脏的事件的预言的冠的动脉疾病的预示的价值；冠的匾的冠的钙和描述的察觉和 quantification。在冠的动脉疾病的 multislice CT angiography 的限制简短也被讨论，并且未来方向被加亮。

Severity of Coronary Artery Disease by Coronary CT Angiography in Relation to Left Ventricular Diastolic Function

Objectives:?The aim of this study is to evaluate the relationship between severity of CAD by coronary mutlislice computed tomography scan and the degree of diastolic function Methods:?The study consisted of 80 patients who underwent both coronary CTA and TTE within 1 year with no identifiable intervening cardiovascular event in National?Heart?Institute and Menoufia?University?Hospitals. All patients were subjected to detailed medical history, physical examination, full electrocardiography study including tissue Doppler imaging on mitral annulus, MSCT coronary angiography and different laboratory investigation as CBC, creatinine, lipid profile. Results:?From 80 patients who have done both echocardiography examination and MSCT coronary angiography, the CT scan results were 38 patients with non-obstructive coronary artery disease and 42 patients with obstructive CAD, higher number of patients with diastolic dysfunction with higher values of E/E’, medial e’, lateral e’, LAVI (left atrial volume index) and TRV (tricuspid regurge velocity) were found in the group with obstructive coronary artery disease.?Conclusion:?Our study showed that diastolic dysfunction is more prevalent in patients with obstructive coronary artery disease with higher grade of diastolic dysfunction.

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.

MODIFIED CLASSIC RISK FACTORS FOR CORONARY ARTERY DISEASE IN CHINESE HAN POPULATION

Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independent cardiovascular centers.Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis <10% in every lesion.The classic risk factors including family history,body mass index,smoking habits,hypertension,diabetes mellitus,and serum lipid levels were surveyed according to established criteria.Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected,including 481 men and 281 women,aged from 17 to 81(mean 60±10) years.The patients with CAD accounted for 55.5% of all participants,and controls 44.5%,respectively.Compared with the pattern in published data,our study showed that mean serum high density lipoprotein cholesterol(HDL-C) level was significantly lower(P<0.001) and triglycerides was significantly higher(P<0.001),while total cholesterol(TC) and low density lipoprotein cholesterol levels were comparative(both P>0.05).The prevalence of low HDL-C(<40 g/L) and hypertriglyceridemia(>150 g/L) were 27.2% and 41.4%,respectively.Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male(P<0.001).Lower HDL-C functioned as an independent risk factor for CAD only in men(RR=2.8,95%CI:1.5-4.2,P<0.001),yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development ofCAD in women.Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects,while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.

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.

Anxiety, Depression and Coronary Artery Disease among Patients Undergoing Angiography in Ghaem Hospital, Mashhad, Iran

The prevalence of coronary artery disease (CAD) is increasing in Iran. Patients with depression who have a myocardial infarction are more likely to die and patients who have depressive symptoms during hospitalization may have increased cardiovascular events. This study aimed to determine the relationship between anxiety, depression and coronary artery disease among patients undergoing angiography in Ghaem Hospital, Mashhad. This was a case-control study conducted between September 2011 and August 2012 among patients undergoing coronary angiography in Ghaem Hospital, Mashhad, Iran. There were 486 cases that were found to have one or more coronary stenoses, with a stenosis of equal or more than 50% of the diameter of at least one major coronary artery. The other patient group consisted of the patients in whom the coronary artery stenosis was less than 50% in diameter which was classified as angiography negative, and a control group that consisted of 440 healthy adults aged 18 years old and above who were selected among people who attended for routine medical checkup and medical examination of employment. The dependent variables were Beck Anxiety and Depression Inventory scores and the independent factors were coronary artery disease, and socioeconomic profiles. Validated and reliability-tested questionnaires were used for data collection. The mean age of patients was 55.75 ± 10.64 years and in the healthy group was 55.83 ± 8.55 years;there was no significant difference in age between subject groups (p = 0.897) nor a significant difference in the gender frequency distribution of subjects (p = 0.610). There was a significant difference in anxiety score between the Angio positive and Angio negative patients and healthy control subjects

Radiation dose analysis of computed tomography coronary angiography in Children with Kawasaki disease

BACKGROUND There is evolving role of computed tomography coronary angiography(CTCA)in non-invasive evaluation of coronary artery abnormalities in children with Kawasaki disease(KD).Despite this,there is lack of data on radiation dose in this group of children undergoing CTCA.AIM To audit the radiation dose of CTCA in children with KD.METHODS Study(December 2013-February 2018)was performed on dual source CT scanner using adaptive prospective electrocardiography-triggering.The dose length product(DLP in milligray-centimeters-mGy.cm)was recorded.Effective radiation dose(millisieverts-mSv)was calculated by applying appropriate age adjusted conversion factors as per recommendations of International Commission on Radiological Protection.Radiation dose was compared across the groups(0-1,1-5,5-10,and>10 years).RESULTS Eighty-five children(71 boys,14 girls)with KD underwent CTCA.The median age was 5 years(range,2 mo-11 years).Median DLP and effective dose was 21 mGy.cm,interquartile ranges(IQR)=15(13,28)and 0.83 mSv,IQR=0.33(0.68,1.01)respectively.Mean DLP increased significantly across the age groups.Mean effective dose in infants(0.63 mSv)was significantly lower than the other age groups(1-5 years 0.85 mSv,5-10 years 1.04 mSv,and>10 years 1.38 mSv)(P<0.05).There was no significant difference in the effective dose between the other groups of children.All the CTCA studies were of diagnostic quality.No child required a repeat examination.CONCLUSION CTCA is feasible with submillisievert radiation dose in most children with KD.Thus,CTCA has the potential to be an important adjunctive imaging modality in children with KD.

Guidelines for the Prevention of Symptomatic Cardiovascular Disease, Based upon the Presence of Coronary Artery Calcified Plaque—Provided by the Society for the Prevention of Symptomatic Heart Disease

Introduction: The epidemic of atherosclerotic cardiovascular disease in the Western World accounts for the majority of morbidity and mortality in adults. This disease is on the increase, and previous recommendations using “risk equations” to prescribe preventive treatment have not been successful in reducing the prevalence of cardiovascular disease. Furthermore, compliance with statin medication has been limited, with approximately 50% of individuals being non-compliant within five years. This situation is unacceptable since atherosclerosis is both preventable and reversible. Methods: The guidelines presented in this article utilize coronary artery calcium scanning as the basis for preventative therapeutic decisions and identifying the presence of asymptomatic cardiovascular disease. This radiographic technique is superior to “risk equations” in predicting future cardiovascular events. It provides a comprehensive assessment of the lifelong insults to the coronary artery vascular endothelium and the resulting inflammation. Coronary artery calcium scanning is widely available, inexpensive, safe, and reproducible. It has the major advantage of increasing treatment compliance in patients with positive coronary artery calcium scores. Results: All suggested guidelines are supported by published scientific data. Citations are provided to allow the reader to obtain further information. The authors are available for further consultation. Each guideline provides specific recommendations that the primary caregiver can discuss with the patient. Patient involvement in decision-making is strongly recommended. Both treatment costs and adverse effects are minimal. Conclusion: It is anticipated that the early identification of asymptomatic cardiovascular disease and its aggressive treatment will result in regression of subclinical atherosclerosis. Adoption of these guidelines will stop the epidemic of symptomatic heart disease and result in healthier and more satisfied patients.

Risks and diagnosis of coronary artery disease in Hodgkin lymphoma survivors

Higher mortality rates are reported because of cardiovascular diseases in individuals living in industrialized areas of the World.In cancer patients,cardiotoxic chemotherapeutic agents and/or mediastinal radiotherapy are additional risk factors for the development of coronary artery disease.An improved survival rate for patients with Hodgkin lymphoma was reported in recent decades.Determining and handling the long-term effects of cancer treatment have become more important nowadays,parallel to the good results reached in survival rates.Mediastinal radiotherapy and cardiotoxic chemotherapeutic agents are routinely used to treat Hodgkin lymphoma but are commonly associated with a variety of cardiovascular complications.Drugs used in cancer treatment and radiotherapy may cause deleterious effects on contractile capacity and conduction system of the heart.Approximately ten years after the completion of all therapies,the cardiovascular disease risk peaks in patients who survived from Hodgkin lymphoma.The value of coronary computed tomography angiography as a diagnostic tool in determining coronary artery disease as early as possible is underlined in this review,in patients who are in remission and carry the risk of coronary artery disease probably because of chemo/radiotherapy used in their treatment.Survivors of Hodgkin lymphoma especially treated with combined chemoradiotherapy at younger ages are candidates for coronary computed tomography angiography.

Non-obstructive coronary artery disease and cardiovascular events in patients with angina-like chest pain detected by coronary angiography:a Chinese cohort study

Objective The utility of non-obstructive coronary artery diseases(NOCAD) in cardiovascular events (CVE) among Chinese patients has less been evaluated. Our objective was to investigate the prognostic value of NOCAD in patients with angina-like chest pain detected by coronary angiography (CAG) in a large Chinese cohort study.