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Advances in Coronary Heart Disease
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Advances in Coronary Heart Disease

A topical collection in Life (ISSN 2075-1729). This collection belongs to the section "Medical Research".

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Editor

Dr. Hiroki Teragawa

E-Mail Website
Collection Editor
Department of Cardiovascular Medicine, JR Hiroshima Hospital, Hiroshima 732-0057, Japan
Interests: acute coronary syndrome; coronary microvascular dysfunction; chronic coronary syndrome; microvascular spasm; percutaneous coronary intervention; vasospastic angina

Topical Collection Information

Dear Colleagues,

As you know, guidelines and other preventive measures for coronary heart disease (CHD) have been reworked and made more practical. Nonetheless, CHD remains an essential component of cardiovascular disease and can cause acute and chronic coronary syndromes, heart failure, fatal arrhythmias and sudden cardiac death.

In acute coronary syndrome (ACS), there is no disagreement with the policy of considering early revascularisation for ST-elevation myocardial infarction (STEMI) and coronary angiography and revascularisation for non-ST elevation ACS risk assessment. However, many items remain unresolved, including the need for the re-evaluation of aspiration thrombectomy in STEMI patients and the usefulness of recent heart failure drugs for ACS.

Some impactful studies have recently shown that revascularisation does not have the same predictive value as optimal medical therapy in stable chronic coronary syndrome (CCS), indicating the need to reconsider CCS treatment. The incidence of procedure-related myocardial infarction has been identified as a substantial complication. Preventing such an occurrence is becoming increasingly crucial in revascularisation, with an emphasis on ischemia diagnosis and safe revascularisation. Current diagnostic methods for myocardial ischemia include imaging and functional diagnosis, which can be non-invasive or invasive. In addition, artificial intelligence is being used in some imaging diagnostics.

Furthermore, ischemic heart disease without organic stenosis is known as myocardial infarction with nonobstructive coronary arteries (MINOCA) or ischemia with nonobstructive coronary arteries (INOCA). Coronary artery dysfunctions, including vasospastic angina, microvascular spasm and coronary microvascular dysfunction (CMD), are now widely considered the primary pathophysiology of such diseases, and guidelines directly address them. The invasive and non-invasive diagnoses of coronary artery dysfunction have been the subject of much debate. Presently, there is no clear consensus on which methods and protocols are superior and better. Moreover, despite recent guidelines, describing the treatment of these coronary artery dysfunctions, particularly those resulting in abnormal resistance vessels, the actual clinical situation is still chaotic, and many patients appear to be changing drugs manually.

In this Topical Collection of ‘Advances in Coronary Heart Disease’, we have compiled the latest information on ACS and CCS diagnoses, treatment and prognosis, including clinical studies and reviews, to provide the current knowledge on these diseases.

Dr. Hiroki Teragawa
Collection Editor

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Keywords

  • acute coronary syndrome
  • chronic coronary syndrome
  • ischemia with no obstructive coronary arteries
  • vasospastic angina
  • microvascular spasm
  • coronary microvascular dysfunction

Published Papers (17 papers)

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2023

Jump to: 2022

12 pages, 1013 KiB  
Article
Which Coronary Artery Should Be Preferred for Starting the Coronary Spasm Provocation Test?
by Hiroki Teragawa, Yuko Uchimura, Chikage Oshita, Yu Hashimoto and Shuichi Nomura
Life 2023, 13(10), 2072; https://doi.org/10.3390/life13102072 - 17 Oct 2023
Viewed by 985
Abstract
Background: The spasm provocation test (SPT) is a critical test for diagnosing vasospastic angina (VSA). However, the choice of vessel to be preferred for initiating the SPT—the right coronary artery (RCA) or the left coronary artery (LCA)—is unclear. This study aimed to assess [...] Read more.
Background: The spasm provocation test (SPT) is a critical test for diagnosing vasospastic angina (VSA). However, the choice of vessel to be preferred for initiating the SPT—the right coronary artery (RCA) or the left coronary artery (LCA)—is unclear. This study aimed to assess SPT results including SPT-related complications while initiating the SPT in the RCA and LCA. Methods: We enrolled 225 patients who underwent coronary angiography and SPTs. The SPT was first performed in the RCA in 133 patients (RCA group) and the LCA in 92 patients (LCA group). We defined VSA as >90% narrowing of the coronary artery during the SPT, accompanied by chest pain and/or ST–T changes on the electrocardiogram. When coronary spasm occurs in two or more major coronary arteries, it is referred to as a multivessel spasm (MVS). SPT-related complications comprised atrial fibrillation, ventricular fibrillation, and unstable hemodynamics following catecholamine use. Analyses using propensity score matching (PSM) were performed in 120 patients. Results: No significant differences in the frequencies of VSA and complications were observed between the two groups (RCA: 79% and 19%, respectively; LCA: 85% and 22%, respectively). In both groups, spasms were most frequently provoked in the left anterior descending coronary artery (both p < 0.001) whereas spasms in the left circumflex coronary artery (LCX) were higher in the LCA group than in the RCA group (p = 0.015). Furthermore, no significant difference in the frequency of MVS was observed between both groups (RCA: 50%, LCA: 62%; p = 0.122). After PSM, no significant difference in the frequencies of VSA and complications were observed between the two groups (RCA: 82% and 15%, respectively; LCA: 88% and 18%, respectively). The frequencies of LCX spasms (RCA: 8%, LCA: 23%; p = 0.022) and MVS (RCA: 40%, LCA: 62%; p = 0.020) were higher in the LCA group than in the RCA group. Conclusions: Although the diagnostic rate of VSA and frequency of SPT-related complications were similar in the two groups, the frequency of MVS was higher in the LCA group than in the RCA group because of the increase in the number of LCX spasms. A routine SPT may be started from the LCA. Full article
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27 pages, 438 KiB  
Review
Evolving Diagnostic and Management Advances in Coronary Heart Disease
by Matheus de Oliveira Laterza Ribeiro, Vinícius Machado Correia, Lucas Lentini Herling de Oliveira, Paulo Rogério Soares and Thiago Luis Scudeler
Life 2023, 13(4), 951; https://doi.org/10.3390/life13040951 - 05 Apr 2023
Cited by 5 | Viewed by 3549
Abstract
Despite considerable improvement in diagnostic modalities and therapeutic options over the last few decades, the global burden of ischemic heart disease is steadily rising, remaining a major cause of death worldwide. Thus, new strategies are needed to lessen cardiovascular events. Researchers in different [...] Read more.
Despite considerable improvement in diagnostic modalities and therapeutic options over the last few decades, the global burden of ischemic heart disease is steadily rising, remaining a major cause of death worldwide. Thus, new strategies are needed to lessen cardiovascular events. Researchers in different areas such as biotechnology and tissue engineering have developed novel therapeutic strategies such as stem cells, nanotechnology, and robotic surgery, among others (3D printing and drugs). In addition, advances in bioengineering have led to the emergence of new diagnostic and prognostic techniques, such as quantitative flow ratio (QFR), and biomarkers for atherosclerosis. In this review, we explore novel diagnostic invasive and noninvasive modalities that allow a more detailed characterization of coronary disease. We delve into new technological revascularization procedures and pharmacological agents that target several residual cardiovascular risks, including inflammatory, thrombotic, and metabolic pathways. Full article
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Graphical abstract

14 pages, 1646 KiB  
Systematic Review
Thirty-Days versus Longer Duration of Dual Antiplatelet Treatment after Percutaneous Coronary Interventions with Newer Drug-Eluting Stents: A Systematic Review and Meta-Analysis
by Grigorios Tsigkas, Anastasios Apostolos, David-Dimitrios Chlorogiannis, Elena Bousoula, Georgios Vasilagkos, Sotirios Tsalamandris, Ioannis Tsiafoutis, Konstantinos Katsanos, Konstantinos Toutouzas, Adel Aminian, Dimitrios Alexopoulos and Periklis Davlouros
Life 2023, 13(3), 666; https://doi.org/10.3390/life13030666 - 28 Feb 2023
Cited by 3 | Viewed by 1465
Abstract
Abbreviation of the duration of dual antiplatelet therapy (DAPT) (one or three months) has been recently proposed, especially for high bleeding risk patients, after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Three databases were screened for eligible randomized control trials. The primary [...] Read more.
Abbreviation of the duration of dual antiplatelet therapy (DAPT) (one or three months) has been recently proposed, especially for high bleeding risk patients, after percutaneous coronary intervention (PCI) with drug-eluting stent (DES). Three databases were screened for eligible randomized control trials. The primary endpoint was the incidence of net adverse clinical events (NACE). Secondary endpoints consisted of major adverse cardiovascular events (MACE), all-cause and cardiovascular mortality, myocardial infarction, stroke, stent-thrombosis, repeat revascularization and major bleeding. We included four RCTs with a total of 26,576 patients; 13,282 patients were grouped in 30-days DAPT, while the remaining 13,294 were allocated in a longer period of DAPT. One month of DAPT did not significantly reduce NACE (odds ratio [OR]: 0.87, 95% confidence intervals [Cl]: 0.74–1.03); however, major bleedings were significantly reduced by 22% (OR: 0.78, 95% Cl: 0.65–0.94). Mortality or ischemic events (stroke, myocardial infarction, revascularization and stent thrombosis) were not affected. Thus, 30-days DAPT could be considered as safe and feasible after PCI with DES in selected patients, especially those with high bleeding risk. Forthcoming RCTs could shed light on the optimal duration of DAPT. Full article
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14 pages, 2072 KiB  
Article
Relation of GRACE Risk Score to Coronary Lipid Core Plaques in Patients with Acute Coronary Syndrome
by Takanori Sato, Yuichi Saito, Hideki Kitahara and Yoshio Kobayashi
Life 2023, 13(3), 630; https://doi.org/10.3390/life13030630 - 24 Feb 2023
Viewed by 1195
Abstract
The GRACE risk score is established to predict thrombotic events in patients with acute coronary syndrome (ACS). Although thrombotic events including myocardial infarction after ACS are mainly attributable to vulnerable plaque formation, whether the GRACE score correlates with coronary lipid-rich plaque is unclear. [...] Read more.
The GRACE risk score is established to predict thrombotic events in patients with acute coronary syndrome (ACS). Although thrombotic events including myocardial infarction after ACS are mainly attributable to vulnerable plaque formation, whether the GRACE score correlates with coronary lipid-rich plaque is unclear. A total of 54 patients with ACS undergoing primary percutaneous coronary intervention under near-infrared spectroscopy intravascular ultrasound (NIRS-IVUS) guidance were included in a prospective manner. Patients were divided into two groups according to the median of the GRACE risk score. Coronary lipid plaques in the target vessel were assessed by NIRS-IVUS with lipid core burden index (LCBI) and a maximum LCBI in 4 mm (maxLCBI4mm). The receiver operating characteristics (ROC) curve analysis was performed based on the major adverse cardiovascular events as an exploratory analysis. The GRACE risk score was significantly and positively correlated with LCBI (r = 0.31, p = 0.03) and maxLCBI4mm (r = 0.38, p = 0.006). LCBI (111.7 ± 85.7 vs. 169.0 ± 83.5, p = 0.02) and maxLCBI4mm (428.5 ± 227.1 vs. 600.6 ± 227.7, p = 0.009) in the target vessel were significantly higher in the high GRACE risk score group than their counterpart. In the ROC curve analysis, LCBI and maxLCBI4mm were predictive for clinical events. In conclusion, the higher GRACE risk score may serve as a discriminator of risk comprising more lipid-rich plaques as an underlying mechanism of an increased risk of thrombotic events after ACS. In patients with ACS, the higher GRACE risk score was significantly and modestly associated with greater coronary lipid plaques in the target vessel. Full article
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2022

Jump to: 2023

8 pages, 818 KiB  
Article
Association of Glycosylated Hemoglobin with Long-Term Adverse Cardiac Events after Percutaneous Coronary Intervention in Non Diabetes and Controlled Diabetes Patients: An Observational Study from the Korean COACT Registry
by Ha-Wook Park, Sung-Ho Her, Jin Jung, Hyunji Chun and Wook-Sung Chung
Life 2022, 12(11), 1945; https://doi.org/10.3390/life12111945 - 21 Nov 2022
Viewed by 1130
Abstract
Glycosylated hemoglobin (HbA1c) is an established marker associated with cardiovascular risk, even if it is below the diagnostic threshold for diabetes mellitus (DM). However, whether or not prediabetic and controlled diabetic levels of HbA1c are associated with increased major adverse cardiovascular events (MACE) [...] Read more.
Glycosylated hemoglobin (HbA1c) is an established marker associated with cardiovascular risk, even if it is below the diagnostic threshold for diabetes mellitus (DM). However, whether or not prediabetic and controlled diabetic levels of HbA1c are associated with increased major adverse cardiovascular events (MACE) after percutaneous coronary intervention (PCI) remains unclear. This observational study included a total of 9128 patients who underwent PCI in the COACT registry from eight centers in Korea. A total of 2517 non-DM patients were divided into three groups (Groups I, II, III) according to their HbA1c levels and compared with 965 controlled DM patients (HbA1c < 7.0%, Group IV). During 22 months of median follow-up, there was no significant differences in MACE (p = 0.294) and cardiac death (p = 0.105) among the four groups. In addition, there were also no significant differences in MACE (p = 0.058) between Group III and Group IV. Although patients were diagnosed as DM, they had a similar prognosis in the same range of newly diagnosed DM patients in HbA1c, if they were treated well. The results of this study suggest that intensive treatment is required to reach the Hba1c target in diabetic patients with PCI in order to have a similar prognosis to patients not previously diagnosed with diabetes. Full article
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10 pages, 869 KiB  
Article
A Machine Learning Model for Detection of Coronary Artery Disease Using Noninvasive Clinical Parameters
by Mohammadjavad Sayadi, Vijayakumar Varadarajan, Farahnaz Sadoughi, Sara Chopannejad and Mostafa Langarizadeh
Life 2022, 12(11), 1933; https://doi.org/10.3390/life12111933 - 19 Nov 2022
Cited by 10 | Viewed by 2446
Abstract
Background and Objective: Coronary artery disease (CAD) is one of the most prevalent causes of death worldwide. The early diagnosis and timely medical care of cardiovascular patients can greatly prevent death and reduce the cost of treatments associated with CAD. In this study, [...] Read more.
Background and Objective: Coronary artery disease (CAD) is one of the most prevalent causes of death worldwide. The early diagnosis and timely medical care of cardiovascular patients can greatly prevent death and reduce the cost of treatments associated with CAD. In this study, we attempt to prepare a new model for early CAD diagnosis. The proposed model can diagnose CAD based on clinical data and without the use of an invasive procedure. Methods: In this paper, machine-learning (ML) techniques were used for the early detection of CAD, which were applied to a CAD dataset known as Z-Alizadeh Sani. Since this dataset has 54 features, the Pearson correlation feature selection method was conducted to identify the most effective features. Then, six machine learning techniques including decision tree, deep learning, logistic regression, random forest, support vector machine (SVM), and Xgboost were employed based on a semi-random-partitioning framework. Result: Applying Pearson feature selection to the dataset demonstrated that only eight features were the most effective for CAD diagnosis. The results of running the six machine-learning models on the selected features showed that logistic regression and SVM had the same performance with 95.45% accuracy, 95.91% sensitivity, 91.66% specificity, and a 96.90% F1 score. In addition, the ROC curve indicates a similar result regarding the AUC (0.98). Conclusions: Prediction is an important component of medical decision support systems. The results of the present study showed that feature selection has a high impact on machine-learning performance and, regardless of the evaluation metrics of the machine-learning models, determining the effective features is very important. However, SVM and Logistic Regression were designated as the best models according to our selected features. Full article
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16 pages, 1744 KiB  
Article
Diagnostic Performance of On-Site Computed Tomography Derived Fractional Flow Reserve on Non-Culprit Coronary Lesions in Patients with Acute Coronary Syndrome
by Abdelkrim Ahres, Judit Simon, Balazs Jablonkai, Bela Nagybaczoni, Tamas Baranyai, Astrid Apor, Marton Kolossvary, Bela Merkely, Pal Maurovich-Horvat, Balint Szilveszter and Peter Andrassy
Life 2022, 12(11), 1820; https://doi.org/10.3390/life12111820 - 08 Nov 2022
Cited by 2 | Viewed by 1660
Abstract
The role of coronary computed tomography angiography (CCTA) derived fractional flow reserve (CT-FFR) in the assessment of non-culprit lesions (NCL) in patients with acute coronary syndrome (ACS) is debated. In this prospective clinical study, a total of 68 ACS patients with 89 moderate [...] Read more.
The role of coronary computed tomography angiography (CCTA) derived fractional flow reserve (CT-FFR) in the assessment of non-culprit lesions (NCL) in patients with acute coronary syndrome (ACS) is debated. In this prospective clinical study, a total of 68 ACS patients with 89 moderate (30–70% diameter stenosis) NCLs were enrolled to evaluate the diagnostic accuracy of on-site CT-FFR compared to invasive fractional flow reserve (FFRi) and dobutamine stress echocardiography (DSE) as reference standards. CT-FFR and FFRi values ≤0.80, as well as new or worsening wall motion abnormality in ≥2 contiguous segments on the supplying area of an NCL on DSE, were considered positive for ischemia. Sensitivity, specificity, positive, and negative predictive value of CT-FFR relative to FFRi and DSE were 51%, 89%, 75%, and 74% and 37%, 77%, 42%, and 74%, respectively. CT-FFR value (β = 0.334, p < 0.001) and CT-FFR drop from proximal to distal measuring point [(CT-FFR drop), β = −0.289, p = 0.002)] were independent predictors of FFRi value in multivariate linear regression analysis. Based on comparing their receiver operating characteristics area under the curve (AUC) values, CT-FFR value and CT-FFR drop provided better discriminatory power than CCTA-based minimal lumen diameter stenosis to distinguish between an NCL with positive and negative FFRi [0.77 (95% Confidence Intervals, CI: 0.67–0.86) and 0.77 (CI: 0.67–0.86) vs. 0.63 (CI: 0.52–0.73), p = 0.029 and p = 0.043, respectively]. Neither CT-FFR value nor CT-FFR drop was predictive of regional wall motion score index at peak stress (β = −0.440, p = 0.441 and β = 0.403, p = 0.494) or was able to confirm ischemia on the territory of an NCL revealed by DSE (AUC = 0.54, CI: 0.43–0.64 and AUC = 0.55, CI: 0.44–0.65, respectively). In conclusion, on-site CT-FFR is superior to conventional CCTA-based anatomical analysis in the assessment of moderate NCLs; however, its diagnostic capacity is not sufficient to make it a gatekeeper to invasive functional evaluation. Moreover, based on its comparison with DSE, CT-FFR might not yield any information on the microvascular dysfunction in the territory of an NCL. Full article
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29 pages, 2334 KiB  
Review
Current Concepts and Future Applications of Non-Invasive Functional and Anatomical Evaluation of Coronary Artery Disease
by Evangelos Oikonomou, Panagiotis Theofilis, Stamatios Lampsas, Ourania Katsarou, Konstantinos Kalogeras, Georgios Marinos, Aikaterini Tsatsaragkou, Artemis Anastasiou, Antonios Lysandrou, Maria-Ioanna Gounaridi, Ioannis Gialamas, Michael-Andrew Vavuranakis, Dimitris Tousoulis, Manolis Vavuranakis and Gerasimos Siasos
Life 2022, 12(11), 1803; https://doi.org/10.3390/life12111803 - 07 Nov 2022
Cited by 7 | Viewed by 2498
Abstract
Over the last decades, significant advances have been achieved in the treatment of coronary artery disease (CAD). Proper non-invasive diagnosis and appropriate management based on functional information and the extension of ischemia or viability remain the cornerstone in the fight against adverse CAD [...] Read more.
Over the last decades, significant advances have been achieved in the treatment of coronary artery disease (CAD). Proper non-invasive diagnosis and appropriate management based on functional information and the extension of ischemia or viability remain the cornerstone in the fight against adverse CAD events. Stress echocardiography and single photon emission computed tomography are often used for the evaluation of ischemia. Advancements in non-invasive imaging modalities such as computed tomography (CT) coronary angiography and cardiac magnetic resonance imaging (MRI) have not only allowed non-invasive imaging of coronary artery lumen but also provide additional functional information. Other characteristics regarding the plaque morphology can be further evaluated with the latest modalities achieving a morpho-functional evaluation of CAD. Advances in the utilization of positron emission tomography (PET), as well as software advancements especially regarding cardiac CT, may provide additional prognostic information to a more evidence-based treatment decision. Since the armamentarium on non-invasive imaging modalities has evolved, the knowledge of the capabilities and limitations of each imaging modality should be evaluated in a case-by-case basis to achieve the best diagnosis and treatment decision. In this review article, we present the most recent advances in the noninvasive anatomical and functional evaluation of CAD. Full article
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12 pages, 2494 KiB  
Review
Endothelin System and Ischemia-Induced Ventricular Tachyarrhythmias
by Eleni-Taxiarchia Mouchtouri, Thomas Konstantinou, Panagiotis Lekkas and Theofilos M. Kolettis
Life 2022, 12(10), 1627; https://doi.org/10.3390/life12101627 - 18 Oct 2022
Cited by 2 | Viewed by 1673
Abstract
Despite the contemporary treatment of acute coronary syndromes, arrhythmic complications occurring prior to medical attendance remain significant, mandating in-depth understanding of the underlying mechanisms. Sympathetic activation has long been known to play a key role in the pathophysiology of ischemia-induced arrhythmias, but the [...] Read more.
Despite the contemporary treatment of acute coronary syndromes, arrhythmic complications occurring prior to medical attendance remain significant, mandating in-depth understanding of the underlying mechanisms. Sympathetic activation has long been known to play a key role in the pathophysiology of ischemia-induced arrhythmias, but the regulating factors remain under investigation. Several lines of evidence implicate the endothelin system (a family of three isopeptides and two specific receptors) as an important modulator of sympathetic activation in the setting of acute coronary syndromes. Such interaction is present in the heart and in the adrenal medulla, whereas less is known on the effects of the endothelin system on the central autonomic network. This article summarizes the current state-of-the-art, placing emphasis on early-phase arrhythmogenesis, and highlights potential areas of future research. Full article
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11 pages, 895 KiB  
Article
The Impact of Myocardial Bridging on the Coronary Functional Test in Patients with Ischaemia with Non-Obstructive Coronary Artery Disease
by Hiroki Teragawa, Chikage Oshita and Yuko Uchimura
Life 2022, 12(10), 1560; https://doi.org/10.3390/life12101560 - 08 Oct 2022
Cited by 6 | Viewed by 1549
Abstract
Background: The possibility of myocardial bridging (MB) causing chest pain has been widely reported; however, the effect of MB on coronary microvessels has not been thoroughly investigated. Therefore, this study evaluated the effects of MB on epicardial coronary artery and coronary microvascular function [...] Read more.
Background: The possibility of myocardial bridging (MB) causing chest pain has been widely reported; however, the effect of MB on coronary microvessels has not been thoroughly investigated. Therefore, this study evaluated the effects of MB on epicardial coronary artery and coronary microvascular function during coronary angiography (CAG) and coronary function test (CFT) in patients with ischaemia with non-obstructive coronary artery disease (INOCA). Methods: This study included 62 patients with INOCA who underwent CAG and CFT for the left anterior descending coronary artery (LAD) to evaluate chest pain. In the CFT, acetylcholine was first administered intracoronarily in a stepwise manner, followed by chest symptoms, electrocardiographic ST-T changes and CAG. Positive coronary spasm was defined as coronary vasoconstriction of >90% on CAG accompanied by chest symptoms or electrocardiographic ST-T changes. After nitroglycerin administration, CAG was performed to assess MB, which was defined as systolic narrowing of the coronary artery diameter by >20% compared with that in diastole. Coronary flow reserve (CFR) and index of microcirculatory resistance (IMR) were subsequently obtained via transvenous adenosine triphosphate infusion using a pressure wire. Coronary microvascular vasodilatory dysfunction (CMD) was defined as a CFR of <2.0 or an IMR of ≥25 units. Results: Of the 62 patients, 15 (24%) had MB. The patients’ characteristics did not differ between the two groups. Regarding the CAG and CFT results, the presence of coronary spasm in the LAD was higher in the MB (+) group (87%) than in the MB (−) group (53%, p = 0.02), whereas the values of CFR (MB (+): 2.7 ± 1.4, MB (−): 2.8 ± 1.1) and IMR (MB (+): 26.9 ± 1.0, MB (−): 30.0 ± 17.3) and the presence of CMD (MB (+): 53%, MB (−): 60%) were similar in the two groups. Conclusions: The findings suggest that MB predisposes patients with INOCA to coronary spasms. Conversely, MBs may have a limited effect on microvessels, particularly in such patients. Full article
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16 pages, 569 KiB  
Article
Adulthood Psychosocial Disadvantages and Risk of Hypertension in U.S. Workers: Effect Modification by Adverse Childhood Experiences
by Timothy A. Matthews, Yifang Zhu, Wendie Robbins, Mary Rezk-Hanna, Paul M. Macey, Yeonsu Song and Jian Li
Life 2022, 12(10), 1507; https://doi.org/10.3390/life12101507 - 27 Sep 2022
Cited by 2 | Viewed by 1746
Abstract
Hypertension is a key driver of cardiovascular diseases. However, how stressors contribute to the development of hypertension remains unclear. The objective of this study was to examine prospective associations of adverse childhood experiences (ACEs) and adulthood psychosocial disadvantages (APDs) with incident hypertension. Data [...] Read more.
Hypertension is a key driver of cardiovascular diseases. However, how stressors contribute to the development of hypertension remains unclear. The objective of this study was to examine prospective associations of adverse childhood experiences (ACEs) and adulthood psychosocial disadvantages (APDs) with incident hypertension. Data were from the Mid-life in the United States (MIDUS) study, a national, population-based, prospective cohort study. ACEs were examined via retrospective reports, and APDs including work stress and social isolation were assessed using survey measures. Incident hypertension was defined based on self-reported physician diagnosis. Baseline data were collected in 1995, with follow-up in 2004–2006 and 2013–2014. Cox proportional hazards regression was applied to assess prospective associations of ACEs and APDs with incident hypertension in 2568 workers free from hypertension at baseline. After adjustment for covariates, baseline APDs were associated with increased incident hypertension (aHR and 95% CI = 1.48 [1.09, 2.01]) during a 20-year follow-up, whereas ACEs showed null associations. Moreover, a moderating effect by ACEs was observed—the effect of APDs on risk of hypertension was stronger when ACEs were present (aHR and 95% CI = 1.83 [1.17, 2.86]). These findings underscore the importance of psychosocial stressors as nontraditional risk factors of cardiometabolic disorders. Full article
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10 pages, 889 KiB  
Article
Clinical Outcomes and Provoked Epicardial Spasm Phenotypes via Intracoronary Acetylcholine Testing in 680 Patients with Angina and Nonobstructive Coronary Arteries
by Shozo Sueda, Keisho Kurokawa, Tsukasa Kurokawa, Tomoki Sakaue and Shuntaro Ikeda
Life 2022, 12(10), 1465; https://doi.org/10.3390/life12101465 - 21 Sep 2022
Cited by 2 | Viewed by 1173
Abstract
Background: Epicardial spasm (ES) phenotypes may be related to the prognosis in patients with coronary spastic angina. Objectives: The purpose of this study was to elucidate the relationship between angiographic coronary vasomotor responses to intracoronary acetylcholine (ACh) injection and prognosis in [...] Read more.
Background: Epicardial spasm (ES) phenotypes may be related to the prognosis in patients with coronary spastic angina. Objectives: The purpose of this study was to elucidate the relationship between angiographic coronary vasomotor responses to intracoronary acetylcholine (ACh) injection and prognosis in patients with angina and nonobstructive coronary artery disease (ANOCAD). Methods: This was a retrospective, observational, single-center study of 680 patients with ANOCAD. ACh spasm provocation tests on both coronary arteries were performed without administering nitroglycerine to relieve provoked spasm in a first-attempt artery. ACh was injected in incremental doses of 20/50/100/200 μg into the left coronary artery and 20/50/80 μg into the right coronary artery. Positive ES was defined as ≥90% stenosis and usual chest pain and ischemic ECG changes. Results: Provoked positive ES was observed in 310 patients (46%), including 85 patients (13%) with focal spasm, 150 patients (22%) with diffuse spasm, and 75 patients (11%) with combined spasm (diffuse spasm and focal spasm), whereas the remaining 370 patients (54%) had no provoked spasm. An unclassified ACh test was observed in 186 patients (27%), while 184 patients (27%) had a complete negative ACh test. The clinical outcomes in patients with complete negative ES were satisfactory compared with those with positive ES and unclassified ACh test results. The prognosis in patients with an unclassified ACh test was not different from those with a positive ES. Furthermore, prognosis in patients with ES phenotypes was not different among the three groups. Conclusions: There was no correlation between provoked ES phenotypes via intracoronary ACh testing and prognosis in patients with ANOCAD; however, clinical outcomes in patients with positive ES and unclassified ACh tests were worse compared to those with complete negative ACh tests. We should focus on the treatments in patients with unclassified ACh tests as well as those with ESs. Full article
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13 pages, 1713 KiB  
Article
Is There Any Improvement in Image Quality in Obese Patients When Using a New X-ray Tube and Deep Learning Image Reconstruction in Coronary Computed Tomography Angiography?
by Anne-Sofie Brunebjerg Pfeffer, Svea Deppe Mørup, Thomas Rueskov Andersen, Roda Abdulkadir Mohamed and Jess Lambrechtsen
Life 2022, 12(9), 1428; https://doi.org/10.3390/life12091428 - 13 Sep 2022
Cited by 1 | Viewed by 1581
Abstract
Deep learning image reconstruction (DLIR) is a technique that should reduce noise and improve image quality. This study assessed the impact of using both higher tube currents as well as DLIR on the image quality and diagnostic accuracy. The study consisted of 51 [...] Read more.
Deep learning image reconstruction (DLIR) is a technique that should reduce noise and improve image quality. This study assessed the impact of using both higher tube currents as well as DLIR on the image quality and diagnostic accuracy. The study consisted of 51 symptomatic obese (BMI > 30 kg/m2) patients with low to moderate risk of coronary artery disease (CAD). All patients underwent coronary computed tomography angiography (CCTA) twice, first with the Revolution CT scanner and then with the upgraded Revolution Apex scanner with the ability to increase tube current. Images were reconstructed using ASiR-V 50% and DLIR. The image quality was evaluated by an observer using a Likert score and by ROI measurements in aorta and the myocardium. Image quality was significantly improved with the Revolution Apex scanner and reconstruction with DLIR resulting in an odds ratio of 1.23 (p = 0.017), and noise was reduced by 41%. A total of 88% of the image sets performed with Revolution Apex + DLIR were assessed as good enough for diagnosis compared to 69% of the image sets performed with Revolution Apex/CT + ASiR-V. In obese patients, the combination of higher tube current and DLIR significantly improves the subjective image quality and diagnostic utility and reduces noise. Full article
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14 pages, 1373 KiB  
Article
Perceived Anxiety, Coping, and Autonomic Function in Takotsubo Syndrome Long after the Acute Event
by Davide Lazzeroni, Chiara Ciraci, Marinella Sommaruga, Carlotta Oggioni, Melissa Saccò, Valentina Ziveri, Letizia Paglialonga, Matteo Bini, Luca Moderato, Lorenzo Brambilla, Paolo Coruzzi, Gianluca Cruciani, Vittorio Lingiardi, Annalisa Tanzilli and Federica Galli
Life 2022, 12(9), 1376; https://doi.org/10.3390/life12091376 - 03 Sep 2022
Cited by 4 | Viewed by 2214
Abstract
Background: Anxiety and depressive disorders represent predisposing factors for the autonomic dysfunctions that characterize the acute phase of Takotsubo syndrome (TS). However, there is insufficient data on this relationship after the acute event. The present study aimed at evaluating the psychological and autonomic [...] Read more.
Background: Anxiety and depressive disorders represent predisposing factors for the autonomic dysfunctions that characterize the acute phase of Takotsubo syndrome (TS). However, there is insufficient data on this relationship after the acute event. The present study aimed at evaluating the psychological and autonomic status of patients with a history of TS. Methods: Ten TS patients whose acute event occurred at least 1 year prior to the evaluation and nine healthy age- and sex-matched subjects were evaluated. The cardiovascular assessment included a clinical examination, beat-to-beat heart rate monitoring to assess heart rate variability, and a psychological examination using the 16 Personality Factors-C Form (16PF), the Acceptance and Action Questionnaire-II, the Coping Orientations to Problems Experienced (COPE), the Beck Depression Inventory-II, and the State-Trait Anxiety Inventory (STAI). Results: TS patients scored significantly higher on the STAI (i.e., Anxiety Trait), 16PF (i.e., Tension), and COPE (i.e., Transcendental Orientation). TS patients also showed lower heart rate variability. Moreover, a significant inverse correlation was found between sympathetic tone (LF/HF ratio) and coping orientation. Conclusions: Long after the acute event, TS patients are characterized by elevated anxiety, high tension, and a specific religious coping strategy. Full article
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14 pages, 637 KiB  
Article
Endothelial Dysfunction in Patients with Advanced Heart Failure Treated with Levosimendan Periodic Infusion Compared with Optimal Medical Therapy: A Pilot Study
by Alessandro Maloberti, Jinwei Sun, Jessica Zannoni, Lucia Occhi, Ilaria Bassi, Saverio Fabbri, Valentina Colombo, Elena Gualini, Michela Algeri, Marisa Varrenti, Gabriella Masciocco, Enrico Perna, Fabrizio Oliva, Manlio Cipriani, Maria Frigerio and Cristina Giannattasio
Life 2022, 12(9), 1322; https://doi.org/10.3390/life12091322 - 26 Aug 2022
Viewed by 1290
Abstract
Endothelial dysfunction (ED) is frequently found in patients with heart failure (HF). Among several pharmacological agents reported to improve endothelial function, levosimendan seems to be a promising one, even though, to date, only two previously published studies have evaluated its effects on ED [...] Read more.
Endothelial dysfunction (ED) is frequently found in patients with heart failure (HF). Among several pharmacological agents reported to improve endothelial function, levosimendan seems to be a promising one, even though, to date, only two previously published studies have evaluated its effects on ED in these patients. The aim of our pilot study was to further investigate the role of periodic levosimendan infusion on endothelial function in patients affected by advanced HF. In this cross-sectional study, three different groups were enrolled: 20 patients with advanced HF treated with periodic levosimendan (LEVO), 20 patients with HF on optimal medical therapy (OMT), and 20 healthy subjects (control group). ED was evaluated through flow-mediated dilation (FMD) at the level of the brachial artery. The three groups presented similar ages with significant differences in gender distribution, systolic blood pressure, and chronic kidney disease (eGFR < 30 mL/min). In HF patients, ischaemic aetiology was more prevalent in the LEVO group than in the OMT group (60 vs. 40%, p < 0.001). The New York Heart Association (NYHA) functional class was worse in the LEVO group, as well as in NT-proBNP (5636.7 ± 6164.6 ng/dL and 1243.7 ± 1487.2 ng/dL, in the LEVO and OMT groups, respectively, p = 0.005). The FMD was significantly higher in the healthy control group compared to that of the OMT group (15.7 ± 6.4 vs. 9.1 ± 6.0%, p = 0.007) while it showed an intermediate value in LEVO patients (12.4 ± 7.1%) (ANOVA p = 0.010). In conclusion, levosimendan therapy seems to ameliorate endothelial dysfunction related to heart failure. Longitudinal studies in patients on periodic therapy are needed in order to confirm the long-term effects of levosimendan on ED. Full article
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16 pages, 1009 KiB  
Review
Coronary Vasospastic Angina: A Review of the Pathogenesis, Diagnosis, and Management
by Rajan Rehan, James Weaver and Andy Yong
Life 2022, 12(8), 1124; https://doi.org/10.3390/life12081124 - 27 Jul 2022
Cited by 11 | Viewed by 6658
Abstract
Vasospastic angina (VSA) is an under-appreciated cause of chest pain. It is characterised by transient vasoconstriction of the coronary arteries and plays a significant role in the pathogenesis of stable angina and acute coronary syndromes. Complex mechanistic pathways characterised by endothelial dysfunction and [...] Read more.
Vasospastic angina (VSA) is an under-appreciated cause of chest pain. It is characterised by transient vasoconstriction of the coronary arteries and plays a significant role in the pathogenesis of stable angina and acute coronary syndromes. Complex mechanistic pathways characterised by endothelial dysfunction and smooth muscle hypercontractility lead to a broad spectrum of clinical manifestations ranging from recurrent angina to fatal arrhythmias. Invasive provocation testing using intracoronary acetylcholine or ergonovine is considered the current gold standard for diagnosis, but there is a wide variation in protocols amongst different institutions. Conventional pharmacological therapy relies on calcium channel blockers and nitrates; however, refractory VSA has limited options. This review evaluates the pathophysiology, diagnostic challenges, and management strategies for VSA. We believe global efforts to standardise diagnostic and therapeutic guidelines will improve the outcomes for affected patients. Full article
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12 pages, 1258 KiB  
Article
Impact of Diabetes Duration on Clinical Outcome in Patients Receiving Rotational Atherectomy in Calcified Lesions in Korea—Results from ROCK Registry
by Jin Jung, Sung-Ho Her, Kyusup Lee, Ji-Hoon Jung, Ki-Dong Yoo, Keon-Woong Moon, Donggyu Moon, Su-Nam Lee, Won-Young Jang, Ik-Jun Choi, Jae-Hwan Lee, Jang-Hoon Lee, Sang-Rok Lee, Seung-Whan Lee, Kyeong-Ho Yun and Hyun-Jong Lee
Life 2022, 12(7), 993; https://doi.org/10.3390/life12070993 - 04 Jul 2022
Viewed by 1316
Abstract
There are limited data regarding the clinical impact of diabetes duration for patients with heavy calcified coronary lesions. We sought to determine the clinical impact of diabetes duration on clinical outcomes in patients with heavily calcified lesions who required rotational atherectomy during percutaneous [...] Read more.
There are limited data regarding the clinical impact of diabetes duration for patients with heavy calcified coronary lesions. We sought to determine the clinical impact of diabetes duration on clinical outcomes in patients with heavily calcified lesions who required rotational atherectomy during percutaneous coronary intervention (PCI). A total of 540 diabetic patients (583 lesions) were enrolled between January 2010 and October 2019. Patients were classified into three subgroups: patients with no diabetes mellitus (non-DM), shorter duration (S-DM), and longer duration (L-DM), of which duration was divided at 10 years. During 18 months of follow-up-duration, diabetes duration was significantly associated with the primary outcome. The incidence rate of target-vessel failure (TVF), the primary outcome, was significantly higher in the L-DM group compared with non-DM or S-DM. Among secondary outcomes, any repeat revascularization (RR) was frequently observed in the L-DM compared with other groups. In multivariate analysis, the risk of TVF and any RR was 1.9 times and 2.4 times higher in L-DM than in non-DM, respectively. This study firstly demonstrated that there is an association between a longer DM duration and poor clinical outcomes in patients with severe calcified CAD after PCI. More careful monitoring for recurrence is needed during follow-up in those patients. Full article
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