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.

Early diagnostic value of carotid artery ultrasound parameters combined with epicardial adipose layer thickness in coronary heart disease

BACKGROUND Coronary heart disease is associated with coronary atherosclerosis indicated by carotid intima-media thickness(CIMT)thickening and altered vascular elasticity.The epicardial adipose layer can secrete proinflammatory factors that promote the formation of coronary atherosclerosis.Thus,the epicardial fat layer thickness(EAT)may also predict coronary heart disease.AIM To determine the role of common carotid artery ultrasound parameters and EAT in the early diagnosis of coronary artery disease.METHODS Based on coronary angiography,patients with newly suspected coronary heart disease were divided into case(n=107)and control(n=41)groups.The carotid ultrasound parameters,including vascular stiffness(β),elastic coefficient(EP),pulse wave conduction velocity(PWV-β),CIMT,and EAT were compared between the case and control groups and among patients with different lesion numbers in the case group.Pearson correlation was used to evaluate the early diagnostic value of EAT,common carotid artery elasticity,and CIMT for coronary heart disease.RESULTS EP,β,PWV-β,CIMT,and EAT were significantly higher in the case group compared with the levels in the control group(all P<0.001).In the case group,lesions were detected in one vessel in 34 patients,two vessels in 38 patients,and three vessels in 35 patients.Within the case group,β,EP,PWV-β,CIMT,and EAT levels significantly increased with an increased number of lesions(all P<0.001).EAT positively correlated withβ,EP,PWV-β,and CIMT(all P<0.01).The area under the curve for diagnosing coronary heart disease using EAT combined with CIMT and carotid elasticity was 0.893,and the sensitivity and specificity were 0.890 and 0.837.CONCLUSION EAT correlated well with changes in carotid artery elasticity and CIMT in patients with coronary heart disease.The combination of EAT,carotid artery elasticity,and CIMT facilitates the early diagnosis of coronary heart disease.

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.

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.

Correlation between Neutrophil Percentage-to-albumin Ratio and Coronary Heart Disease Complicated with Diabetes Mellitus

[Objectives]This study was conducted to explore the relationship between neutrophil percentage-to-albumin ratio(NPAR)and coronary heart disease complicated with diabetes.[Methods]A total of 603 patients with coronary heart disease who underwent coronary angiography in Pingquan County Hospital from January,2023 to December,2023 and met the inclusion criteria were included as the research object.All the patients were divided into a coronary heart disease complicated with diabetes group(CAD+T2DM group)(n=298 cases)and a control group(CAD group)(n=305 cases),according to patients medical history,heart color ultrasound and biochemical test results.The clinical data,biochemical test results and coronary artery imaging data of patients were recorded,and the Gensini score was calculated.The neutrophil percentage(NEUT%)and albumin count were determined to calculate NPAR.[Results]The NPAR value of the coronary heart disease complicated with diabetes mellitus group was(1.6±0.42),which was significantly higher than that of the control group(1.47±0.49),and the difference was statistically significant(P<0.05).The area under the ROC curve was 0.619(95%CI:0.591-0.675,P<0.05),and the prediction of coronary heart disease complicated with diabetes using NPAR showed a Youden index of 0.31,a sensitivity of 60.4%,a specificity of 40.3%,and a best cut-off score of 1.4506.[Conclusions]The neutrophil percentage-to-albumin ratio(NPAR)is closely related to coronary heart disease complicated with diabetes mellitus,and NPAR has clinical application value in the diagnosis of coronary heart disease complicated with diabetes mellitus.

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.

Multislice computed tomography angiography in the diagnosis of coronary artery disease

Multislice CT angiography represents one of the most exciting technological revolutions in cardiac imaging and it has been increasingly used in the diagnosis of coronary artery disease. Rapid improvements in multislice CT scanners over the last decade have allowed this technique to become a potentially effective alternative to invasive coronary angiography in patients with suspected coronary artery disease. High diagnostic value has been achieved with multislice CT angiography with use of 64- and more slice CT scanners. In addition, multislice CT angiography shows accurate detection and analysis of coronary calcium, characterization of coronary plaques, as well as prediction of the disease progression and major cardiac events. Thus, patients can benefit from multislice CT angiography that provides a rapid and accurate diagnosis while avoiding unnecessary invasive coronary angiography procedures. The aim of this article is present an overview of the clinical applications of multislice CT angiography in coronary artery disease with a focus on the diagnostic accuracy of coronary artery disease; prognostic value of coronary artery disease with regard to the prediction of major cardiac events; detection and quantification of coronary calcium and characterization of coronary plaques. Limitations of multislice CT angiography in coronary artery disease are also briefly discussed, and future directions are highlighted.

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.

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

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.

Left Radial Approach versus Right Radial Approach of Coronary Angiography in the Diagnosis of Coronary Heart Disease

Background: Transradial coronary angiography has established itself as safe alternative to transfemoral approach. Today, the artery of approach lies completely on the operator’s choice. The Right Radial Approach (RRA) has been a favorite for most of the interventional cardiologists due to the convenience in operating from the right side. The Left Radial Approach (LRA) has always been a neglected route. LRA does have many advantages over the right, the vascular anatomy being one of them. The aim of our study was to compare the right radial approach of diagnostic coronary angiography with left radial approach. Method: A total of 70 cases of Coronary Angiography (CAG) with normal Allen test and satisfying the inclusion criteria were prospectively observed and studied after randomly assigning them into two equal groups, LRA (Left Radial Approach) n = 35 and RRA (Right Radial Approach) n = 35. Multipurpose TIG (Tiger) catheter was used in both the approaches to catheterize the right as well as left coronary artery. Results: The access time, catheter manipulation time, procedure time, amount of contrast used, hospital stay, intensity of pain experienced, cost of the procedure and quality of coronary angiogram observed were statistically insignificant while the fluoroscopy time was slightly statistically significant which was independent to catheter manipulation time. Conclusions: The neglected Left Radial Approach to coronary angiography is as efficacious, safe and cost effective with reduction in arterial spasm complications when compared to the Right Radial Approach performed by multipurpose Tiger catheter.

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.

Analysis of coronary artery and clinical feature in patients with coronary heart disease coexisting with non--insulin dependent diabetes mellitus

Objective: To study the coronary artery lesions and clinical features in patients with coronary heart disease (CHD ) coexisting with non-insulin dependent diabetes mellitus (NIDDM ). Methods: 850 cases CHD patients were divided into 2 groups: patients with NIDDM and patients without NIDDM, the coronary lesions were compared between 2 groups by coronary artery angiography (CAG ) and the clinical characteristics were also studied between 2 groups. Results: More patients with NIDDM had hypertension, stroke, hyperlipemia and family history of NIDDM or CHD. More patients with NIDDM had painless chest pain, and the mortality rate in NIDDM group was higher than that of control group. More patients with NIDDM suffered from middle to serve stenosis of coronary artery and triple CHD and low ejection fraction than without (P<0. 01 ). Conclusion: NIDDM is an independent risk factor for CHD and heart function and the early diagnosis of NIDDM is very important for the prognosis of CHD.

Association between LDL, Apolipoprotein-B Apolipoprotein A-I and Lipoprotein(a) and Severity of Coronary Artery Disease Based on Coronary Angiography

Atherosclerosis is the most important contributor to increasing burden of coronary artery disease (CAD). Growing evidence suggests that the ratios of Apo B/Apo A-I and Lp(a) are better indexes for risk assessment of CAD. Elevated plasma levels of lipoprotein(a) in humans represent a major in-herited risk factor for atherosclerosis. Thus, a study was performed to determine the association betwwen serum Apo B, Apo A-I, and lipoprotein(a) levels, and severity of CAD in patients with CAD confirmed on coronary angiography findings. An analytical case control study was carried out with 85 patients (58 males and 27 females) 40 - 60 years of age confirmed as having CAD on coronary angiography and 85 age and sex matched healthy volunteers as controls. Serum samples were an-alyzed for Apo A-1 LDL, Apo B, Apo A-I, and lipoprotein(a) concentration and the severity of CAD was assessed using coronary angiography scoring method. Patients with CAD had significantly high serum LDL-C, Apo B and Lp(a) levels compared to control subjects. However, serum Apo A-I level did not show a significant difference between two groups. Subjects with a positive family history of CAD with increased serum Lp(a) ≥ 17.3 mg/dL have high risk for development of CAD. Present study suggests that serum Lp(a) cut-off value of 17.3 mg/dL may be an important predictor in ruling out major vessel disease and luminal narrowing by atheroma.

Feasibility of percutaneous coronary intervention via transulnar artery approachin selective patients with coronary heart disease

Objective To probe the clinic feasibility of percutaneous coronary intervention(PCI) via transulnar artery approach (PCI TRU).Methods Fourty patients with unstable ischemic manifestation(male 34,female 6;age 59.3 ±9.10 years)whose radial artery of right hand was thin with a weak pulse that was not suitable to transradial artery PCI while whose ulnar artery was thick with a strong pulse based on their larger diameter in ulnar artery as compared with those in radial artery ( 3.30 ±0.22mm vs 2.43 ±0.33 mm, P <0.05 ) by the investigation of vessel echography,but revesered Allen’s test for radial and ulnar artery was positive,were selected as the subjects for PCI TRU. The radio of ulnar artery versus radial artery was 1.35:1.00 and the time of Allen’s test in ulnar artery side was shorter than that in radial artery side ( 2.70 ±0.36 s vs 4.68 ±0.52s , P <0.05 ) before PCI. The efficiency of PCI TRU was evaluated. The time of manipulative duration for each procedure of PCI TRU was recorded. The time of Allen’s test, luminal diameter (mm) , cross area of vessel lumin (mm 2), blood velocity (Vs max), blood resistance (RI) in ulnar artery and radial artery and the level of blood oxygen in finger (PaO 2、SatO 2) were measured and recorded , respectively , as well were compared quantitatively before and after 1 month of procedure . Results Fourty eight lesion segments of 42 vessels in all patients were angioplasticized successfully via TRU by 6F guiding catheter including 23 segments of type B1 , 14 segments of type B2 and 11 segments of type C. PCI TRU in all of 40 patients was performed successfully. Fourty eight stents were implanted including 2 lesions of intrastent restenosis angioplasticized with cutting balloon technique before re stenting . The average time of manipulative duration of guiding catheters engaging in osicum of target coronary, crossing the vessel lesions of guidewire, dilatation and implantation of stents,and under X ray fluoroscopy were 4.30 ±0.59 min , 2.52 ±0.40min , 2.66 ±0.40 min ,and 25.9 ±0.49 min , respectively, and the total time of the whole procedure was 56.6 ±14.8 min . When the ulnar introducer was taken off, the access site in ulnar artery was suppressed by tourniquet with no bleeding in the access site and no limitation of physical activation under maintaining infusion of heparin immediately after procedure . There was no significant change in the diameter of ulnar artery and the time of Allen’s test after 1 month of PCI procedure as compared with those before procedure ( 3.22 ±0.48mm vs 3.26 ±0.22 mm , P >0.05 ; 2.96 ±0.98 s vs 2.72 ±0.47 s , P >0.05 ). No significant change was found in the parameters of blood velocity , cross area of vessel lumin, blood resistance and the level of blood oxygen in finger after 1 month of PCI procedure. The average total hospital stay was 5.21 ±0.43 days. Following up 1 month, no complications such as occlusion of ulnar artery, abnormal sensitivity and movement disability were found in right hands in all patients.Conclusions The ulnar artery might be selected as one approach of antebrachial artery for PCI in the patients with coronary heart disease whose radial artery was difficulty as access vessels of PCI, while reversed Allen’s test for radial and ulnar artery are positive and the luminal diameter of ulnar artery was larger than that of radial artery.

Correlation of CT coronary angiography plaque properties with platelet function and serum biochemical indexes in patients with coronary heart disease

Objective:To study the correlation of CT coronary angiography plaque properties with platelet function and serum biochemical indexes in patients with coronary heart disease.Methods:Patients who received CT coronary angiography examination and were diagnosed with coronary heart disease in Tianmen First People's Hospital between March 2015 and October 2017 were selected as the research subjects and divided into those with soft plaque, mixed plaque and calcified plaque according to the CT results;the serum levels of platelet function indexes as well as blood lipid and inflammation biochemical indexes were determined. Results: Serum PAF, CD62P, sTLT-1, LDL, Lp-a, PCSK9, TNF-α, IFN-γ, IL-17A, CD40L and sICAM1 levels as well as platelet surface EMMPRIN and GPVI fluorescence intensity of patients with soft plaque and mixed plaque were significantly higher than those of patients with calcified plaques whereas serum HDL levels were lower than that of patients with calcified plaque, and serum PAF, CD62P, sTLT-1, LDL, Lp-a, PCSK9, TNF-α, IFN-γ, IL-17A, CD40L and sICAM1 levels as well as platelet surface EMMPRIN and GPVI fluorescence intensity of patients with soft plaque were significantly higher than those of patients with mixed plaque whereas serum HDL level was lower than that of patients with mixed plaque. Conclusion: The changes of CT coronary angiography plaque properties in patients with coronary heart disease are closely related to platelet aggregation, lipid metabolism disorder and inflammatory response activation.

A comparative study of coronary angiography and optical coherence tomography findings in coronary artery disease patients with moderate stenosis

Objective To compare coronary angiography(CAG) and optical coherence tomography(OCT) findings in stenosis and culprit lesion morphology assessment in coronary artery disease patients with moderate stenosis(50%～70%).Methods 23 CAD patients with moderate stenosis(50%～70%) were enrolled in the study.These patients then underwent OCT analysis.CAG and OCT stenosis results were compared for conformity.OCT images of the culprit lesions were analyzed for more details about the morphological characteristics of the plaques in relation with the clinical diagnosis.Results Evaluation of stenosis of coronary lesions by Quantitative Coronary Angiography(QCA) corresponds approximately with OCT analysis estimation:CAG stenosis was 57.26% ±5.05,whereas the same OCT stenosis analysis reached a value of 61.17%±11.36,(P=0.032).From OCT image analysis,the vulnerable plaque was detected more in the culprit lesions of patients with a clinical diagnosis of unstable angina,than in stable angina pectoris patients(61.5%vs10%;P=0.012).

Clinical characteristics of different computed tomography coronary angiography plaque properties in patients with coronary artery disease

Objective: To study the clinical characteristics of different computed tomography coronary angiography (CTCA) plaque properties in patients with coronary artery disease. Methods:Patients who were diagnosed with coronary artery disease in Ankang Central Hospital between February 2015 and March 2017 were selected and divided into soft plaque group, mixed plaque group and calcified plaque group according to the plaque properties judged by CTCA examination, and healthy volunteers who received physical examination in Ankang Central Hospital during the same period were selected as control group. The serum levels of material metabolism indexes, cytokines as well as collagen synthesis and degradation indexes of the four groups were measured. Results: Serum UA, Hcy, PCSK9, LDL-C, GDF-15, CXCL5, hs-CRP, RANTES, IL-6, MMP1, ST2, CysC and I-CTP levels of soft plaque group, mixed plaque group and calcified plaque group were significantly higher than those of control group, serum UA, Hcy, PCSK9, LDL-C, GDF-15, CXCL5, hs-CRP, RANTES, IL-6, MMP1, ST2, CysC and I-CTP levels of soft plaque group and mixed plaque group were significantly higher than those of calcified plaque group, and serum UA, Hcy, PCSK9, LDL-C, GDF-15, CXCL5, hs-CRP, RANTES, IL-6, MMP1, ST2, CysC and I-CTP levels of soft plaque group were significantly higher than those of mixed plaque group. Conclusion: CTCA can accurately determine the plaque properties and evaluate the disorder of material metabolism, cytokine secretion as well as collagen synthesis and degradation during the change of plaque properties in patients with coronary artery disease.

Machine learning for diagnosis of coronary artery disease in computed tomography angiography:A survey

Coronary artery disease(CAD)has become a major illness endangering human health.It mainly manifests as atherosclerotic plaques,especially vulnerable plaques without obvious symptoms in the early stage.Once a rupture occurs,it will lead to severe coronary stenosis,which in turn may trigger a major adverse cardiovascular event.Computed tomography angiography(CTA)has become a standard diagnostic tool for early screening of coronary plaque and stenosis due to its advantages in high resolution,noninvasiveness,and three-dimensional imaging.However,manual examination of CTA images by radiologists has been proven to be tedious and time-consuming,which might also lead to intra-and interobserver errors.Nowadays,many machine learning algorithms have enabled the(semi-)automatic diagnosis of CAD by extracting quantitative features from CTA images.This paper provides a survey of these machine learning algorithms for the diagnosis of CAD in CTA images,including coronary artery extraction,coronary plaque detection,vulnerable plaque identification,and coronary stenosis assessment.Most included articles were published within this decade and are found in the Web of Science.We wish to give readers a glimpse of the current status,challenges,and perspectives of these machine learning-based analysis methods for automatic CAD diagnosis.