Search Results (138)

Anomalies of coronary artery origins are rare but significant conditions that can range from benign to life-threatening. Early detection through imaging is crucial in preventing adverse outcomes. The treatment strategy varies depending on the type and severity of the anomaly, ranging from pharmacological treatment to surgery. A 22-year-old male patient, after syncope, after excluding other causes, had an exercise drill test, which was clinically negative and ECG-positive. Angio-CT revealed an undeveloped left main coronary artery (LMCA), and the circulation was supplied through the right coronary artery (RCA). The RCA provides the left anterior descending artery (LAD), and the LAD retrogradely supplies the left circumflex artery (LCX). The myocardial perfusion scintigraphy showed a slight lack of perfusion in the anterior wall (6% of total perfusion). The patient was qualified for further observation. A 77-year-old female underwent cardiac CT due to stenocardia. CT showed a lack of LMCA. The initial segment of the RCA gave rise to the left coronary artery (LCA), which encircled the aortic bulb posteriorly and bifurcated into branches resembling the LCX and LAD. After the Heart Team consultation, the patient was deemed eligible for conservative treatment. Angio-CT is a valuable tool for detecting coronary artery anomalies. Full article

Background/Objectives: Randomized studies of patients with unprotected left main coronary artery (ULMCA) disease involve highly selected populations. Therefore, we sought to investigate the 60-month event-free survival of consecutive patients undergoing ULMCA percutaneous coronary intervention (PCI) and determine the best risk score system and independent predictors of event-free survival. Methods: All patients who underwent ULMCA PCI at our center between 1 January 2007 and 31 December 2014 were included. The primary endpoint was the time to cardiac death, target lesion myocardial infarction, or target lesion revascularization (whichever came first) with a follow-up of 60 months. Results: A total of 513 patients (mean age 68 ± 12 years, 64% male, 157 elective, 356 acute) underwent ULMCA PCI. The 60-month incidence of events was 16.8% and 38.0% in elective and acute patients, respectively. There were significantly more events in the acute group during the first 6.5 months. Of the risk scores, the ACEF (AUC = 0.786) and SYNTAX II (AUC = 0.716) scores had the best predictive power in elective and acute patients, respectively. The SYNTAX score proved to be the least predictive in both groups (AUC = 0.638 and 0.614 in the elective and acute groups, respectively). Left ventricular function (hazard ratio (HR) for +10% 0.53 [95% CI, 0.38–0.75] and 0.81 [95% CI, 0.71–0.92] in elective and acute patients, respectively) and, in acute patients, access site (femoral vs. radial HR 1.76 [95% CI, 1.11–2.80]), hyperlipidemia (HR 0.58 [95% CI, 0.39–0.86]), and renal function (HR for +10 mL/min/1.73 m² higher GFR: 0.87 [95% CI, 0.78–0.97]) were independent predictors of event-free survival. Conclusions: Acute ULMCA PCI patients have worse prognosis than elective patients, having more events during the first 6.5 months. Besides anatomical complexity, clinical and procedural parameters determine the prognosis. Full article

Background/Objectives: Dobutamine stress echocardiography (DSE) is a non-invasive diagnostic technique commonly employed in routine clinical practice to identify coronary artery disease. Emerging echocardiographic methods, including strain and strain rate imaging, quantify alterations in myocardial contractility and may improve the diagnostic accuracy of DSE. The main aim of this study was to assess the correlation between visual interpretation and longitudinal strain during dobutamine stress echocardiography. Methods: Our study was observational and was conducted at the Cardiology Clinic of the University Clinical Center of the Republic of Srpska. It included 70 patients who underwent dobutamine stress echocardiography. The patients were divided into two groups (diagnostic and viable study). A visual assessment of segmental contractility of the left ventricle was performed, as well as an assessment of contractility with longitudinal strain (LS) during the test. Results: The median baseline LS of segments without impaired contractility in the diagnostic study was −20% (−21 to −18) and, at the peak of the test, −22% (−23 to −21), which was statistically significant (p < 0.05). The median baseline LS in the segments with impaired contractility was −17% (−18 to −16) and, at the peak of the test, −13% (−15 to −12), which was statistically significant (p < 0.05). In the viability study, the average baseline LS in the segments with improved contractility was −8% (−11 to −7) and, at the peak of the test, −14% (−17 to −13), which was statistically significant (p < 0.05). The average baseline LS in the segments without improved contractility was −6% (−5 to −7) and, at the peak of the test, −2% (−3 to −0), which was statistically significant (p < 0.05). Conclusions: Our study indicates a good correlation between a visual assessment of left ventricular segment contractility and longitudinal strain during dobutamine stress echocardiography. Full article

High bleeding risk (HBR) is a challenge in patients with complex coronary lesions undergoing percutaneous coronary intervention (PCI). This study investigates HBR in a wide and comprehensive cohort of patients undergoing left main (LM) PCI and reports in-hospital and follow-up outcomes. The analysis was performed on data from the DELTA (Drug Eluting Stent for Left Main Coronary Artery) 2 Registry, which included patients who underwent LM PCI at 19 centres worldwide. The patients were defined to be at HBR if ≥1 major criterion or ≥2 minor criteria from the Academic Research Consortium (ARC) were met. The primary endpoint was a composite of all-cause death, myocardial infarction (MI) or cerebrovascular accident (CVA) at median follow-up. A total of 1531 patients were included, and the rate of HBR was 65.8%. Besides the different clinical characteristics embedded in the ARC definition, HBR patients had higher prevalence of acute coronary syndrome (ACS) at presentation (49.2% vs. 26.8%, p < 0.001) and experienced higher in-hospital mortality (1.8% vs. 0.2%; p = 0.029) and MI (5.0% vs. 2.1%, p = 0.009). The median follow-up was 473 days. The rate of the primary endpoint was more than three times higher in HBR patients (20.8% vs. 6.1%; HR 3.3; 95%CI: 2.2–4.8) and driven by all-cause death at multivariate regression analysis. Conversely, no significant difference in target lesion revascularization and probable or defined stent thrombosis was reported. HBR patients undergoing LM PCI experienced higher rates of all-cause death at follow-up; similar outcomes were also reported in-hospital. Full article

Heart failure and diabetes mellitus are major contributors to global morbidity and mortality, with their prevalence continuously rising, primarily due to aging populations and improvements in healthcare. These conditions often coexist or develop sequentially, leading to complex interactions that significantly influence the progression and management of both diseases. Furthermore, heart failure and diabetes are commonly associated with coronary artery disease, which presents a unique challenge in clinical management, particularly in the context of myocardial revascularization. The presence of diabetes exacerbates atherosclerotic progression and impairs endothelial function, while heart failure complicates the perfusion and recovery of myocardial tissue post-intervention. This narrative review delves into the underlying mechanisms contributing to revascularization failure in patients with heart failure and diabetes, emphasizing the importance of understanding these interactions for optimal treatment. The review also summarizes key findings from randomized controlled trials, examining evidence both in the general population and in specific subgroups, including the elderly and patients with left main coronary artery disease, chronic kidney disease, peripheral artery disease, and chronic obstructive pulmonary disease. Understanding these complexities is critical for improving patient outcomes. Full article

Introduction: Ischemic heart disease represents one of the main causes of mortality and morbidity, requiring accurate, noninvasive imaging. Coronary Computed Tomography Angiography (CCTA) offers a detailed coronary assessment but can be labor-intensive and operator-dependent. Methods: We developed a bounding box-based object detection method using deep learning to identify the right coronary artery (RCA), left anterior descending artery (LCA-LAD), and left circumflex artery (LCA-CX) in the CCTA cross-sections. A total of 19,047 images, which were recorded from 52 patients, underwent a five-fold cross-validation. The evaluation metrics included Average Precision (AP), Intersection over Union (IoU), Dice Similarity Coefficient (DSC), and Mean Absolute Error (MAE) to achieve both detection accuracy and spatial localization precision. Results: The mean AP scores for RCA, LCA-LAD, and LCA-CX were 0.71, 0.70, and 0.61, respectively. IoU and DSC indicated a better overlap for LCA-LAD, whereas LCA-CX was more challenging to detect. The MAE analysis showed the largest centroid deviation in RCA, highlighting variable performance across the artery classes. Discussion: These findings demonstrate the feasibility of automated coronary artery detection, potentially reducing observer variability and expediting CCTA analysis. They also highlight the need to refine the approach for complex anatomical variants or calcified plaques. Conclusion: A bounding box-based approach can thereby streamline clinical workflows by localizing major coronary arteries. Future research with diverse datasets and advanced visualization techniques may further enhance diagnostic accuracy and efficiency. Full article

Background and Objectives: The average age of presentation of coronary artery disease (CAD) is one decade younger in the Saudi population relative to other patients worldwide. It is imperative to investigate the prevalence of premature coronary artery disease (PCAD) risk factors in Saudi Arabia’s younger population in order to prevent the incidence of cardiovascular diseases in the future. Thus, the present study aimed to evaluate the severity and identify the risk factors associated with PCAD in patients under the age of 50 at King Saud University Medical City (KSUMC), Saudi Arabia. Methods: This observational retrospective study was conducted between June 2022 and June 2023 at King Saud University Medical City, Riyadh, Saudi Arabia. A total of 718 participants were included in the study. The patients, confirmed by electrocardiographic and/or angiographic findings of coronary artery disease, were divided into three age groups: group 1 (<40 years), group 2 (40–45 years), and group 3 (45–50 years). The severity of vessel occlusions was evaluated using the Gensini scoring system. Electrocardiographic findings, sociodemographic variables, and risk factors were also taken into consideration. Results: The mean age of patients in group 1 was 35.2 ± 4.5 years, in group 2 was 43.0 ± 1.3 years, and in group 3 was 48.4 ± 1.4 years. Patients in group 2 had a significantly higher BMI (31.3 ± 10.5) compared to patients in group 3 (29.4 ± 5.3; p = 0.015). Nearly 55% of patients under 40 years had 2 or 3 vessel occlusions according to the vessel score. The percentage of patients with inferior ST elevation was significantly higher in group 1 (<40 years, 11.2%) compared to groups 2 (40–45 years, 10.1%) and 3 (45–50 years, 6.0%; p = 0.001). Non-specific ST-T changes were more common in group 1 (31.4%) and group 2 (32.0%) compared to group 3 (28.4%). Although not statistically significant, left main artery occlusion tended to be higher in group 3 (8.6%) compared to groups 1 (4.6%) and 2 (4.5%; p = 0.229). Hyperlipidemia levels were significantly higher in patients with a Gensini score > 39 compared to those with a Gensini score < 39 (47.9% vs. 37.5%, respectively; p = 0.05). The prevalence of smoking was about 54% in group 1, followed by type 2 diabetes mellitus, dyslipidemia, and hypertension (37%, 36%, and 33%, respectively). Conclusions: This study suggested that PCAD Saudi patients below 40 years of age had a higher percentage of inferior ST elevation compared to older patients, while non-specific ST-T changes were significantly higher in older patients. Astonishingly, more than 50% of patients in all groups had two or three vessel occlusions. There was a high prevalence of modifiable risk factors, such as smoking, in younger patients, whereas hyperlipidemia was a risk factor for PCAD in all age groups. In addition, hyperlipidemia was highly correlated with severe vessel occlusion according to the Gensini score. Therefore, early preventive measures should be taken into consideration to reduce the future burden of cardiovascular complications in this population. Full article

Background and Objectives: Recent studies have demonstrated that pulmonary arterial hypertension (PAH) is a vascular disease that extends beyond the pulmonary vasculature. PAH has been associated with increased intramural coronary arteriolar medial thickness and decreased coronary arteriolar luminal area in both human and experimental models of the disease. The objective of this study was to assess the luminal diameter of epicardial coronary arteries in patients with PAH. Materials and Methods: Fifty patients with PAH who underwent cardiac computed tomography (CT) angiography at our center were included in this retrospective study. Fifty patients without pulmonary hypertension matched for age, sex, and coronary dominance were also included. Coronary artery luminal diameters measured by cardiac CT angiography were compared between the groups, in addition to baseline characteristics and standard cardiac measurements. Correlation analysis was also performed. Results: The diameters of the left main coronary artery, left anterior descending artery, and left circumflex artery were comparable between the groups. However, the right coronary artery (RCA) diameter was found to be greater in the PAH group (3.51 ± 0.66 mm vs. 3.02 ± 0.49 mm, p < 0.001). The RCA diameter exhibited a positive moderate correlation with the main pulmonary artery diameter (R = 0.517, p < 0.001), right atrial area (R = 0.515, p < 0.001), and right ventricular diastolic diameter (R = 0.506, p < 0.001). Conclusion: PAH may be associated with an increase in the RCA diameter. Full article

Objectives: The impact of long-term complications after robotic hybrid coronary revascularization (HCR), including persistent angina, repeat revascularization, and myocardial infarction (MI), remains limited. This study aims to determine the risk factors for coronary events after robotic HCR and their time-varying effects on outcomes. Methods: We identified all consecutive patients who underwent robotic HCR at our institution. Baseline characteristics were explored as possible risk factors for angina, MI, and repeat revascularization with stents at any time during the follow-up. Results: A total of 875 patients (mean age 71.1 ± 11.1 years) were included. After a median follow-up of 3.32 years (IQR 1.18–6.34 years), angina occurred in 134 patients (15.3%), repeat revascularization with stents in 139 patients (15.8%), and MI in 36 patients (4.1%). The hazard rates for all outcomes increased with follow-up time, with a notable early rise around two years of follow-up for angina and, to a lesser extent, repeat revascularization. The risk factors were the lack of radial artery graft use, black race, diabetes, obesity, chronic obstructive pulmonary disease, low ejection fraction <50%, severe left main coronary artery stenosis (>50%), and more than three-vessel disease. Conclusions: Optimization of modifiable periprocedural risk factors may positively impact long-term prognosis in patients undergoing robotic HCR. Full article

Objectives: True trifurcation disease of the left main coronary artery is a rare situation encountered in clinical practice. To date, there is no evidence for a standardized strategy of percutaneous coronary intervention in this type of lesion. Methods: This article describes a novel three-stent strategy using a combination of Triple-Kissing Balloon Crush in both of the side branches. This technique is based on a well-established bifurcation stenting technique, namely, the Double-Kissing Crush technique. Results: This strategy was implemented successfully, demonstrating technical feasibility and optimal stent apposition in the trifurcation lesion, ensuring the preservation of all three branches. Conclusions: Although more data and clinical trials are needed to develop proper evidence-based guidelines, three-stent implantation with Double-Trissing Crush should be taken into consideration as a viable strategy for LM trifurcation lesions in the proper set of patients. Full article

Background: Over the past decades, new treatments and guidelines have been introduced for the screening and management of familial hypercholesterolemia (FH). However, the impact of these medical and scientific advances on the characteristics and burden of coronary lesions over time in FH remains poorly documented. Objective: The primary goal of this study is to determine the characteristics of coronary lesions in HeFH patients who underwent coronary angiography within two distinct timeframes: the last five years versus those who had the procedure at the same hospital 25 years earlier. Methods: The characteristics of coronary lesions in 108 HeFH patients who consecutively underwent coronary angiography for CAD between 2017 and 2022 (2022 cohort) were compared to those of 240 patients who had an angiography between 1995 and 1998 (1998 cohort). Results: Compared to 1998, FH patients requiring coronary angiography were proportionally less numerous and significantly older in 2022 (p < 0.001). Although the number of coronary lesions (2.5 ± 1.5 in both cohorts) and the proportions of multi-vessel (70.4% vs. 70.2%), three-vessel (29.6% vs. 30.2%) and left main involvement (15.7% vs. 16.0%) did not differ significantly in 2022 compared to 1998, proximal involvement (57.7% vs. 79.5%) and total occlusion (26.8% vs. 52.7%) were less frequently observed in 2022 (p < 0.001) and referral to bypass grafting (CABG) decreased by >50% from 1998 to 2022 (15.5% vs. 39.8% p < 0.001). Conclusions: Over a 25-year period, the incidence of total coronary artery occlusion and the need for CABG among adults with FH from a high-prevalence founder population were reduced by more than 50% and occurred in older ages. However, the absence of major improvement of coronary anatomy severity underscores the persistently high cardiovascular risk in FH patients. Full article

Spontaneous coronary artery dissection is a rare cause of unstable angina, myocardial infarction, and sudden cardiac death, particularly among young women and individuals without conventional atherosclerotic risk factors. We present the case of a 43-year-old woman who had spontaneous coronary artery dissection involving the left main with extension to left anterior descending artery and left circumflex artery. She was ultimately managed medically, with a good outcome. Spontaneous coronary artery dissection is a unique and intricate condition that demands advanced diagnostic techniques and tailored management strategies. Greater awareness and advancements in imaging technologies have enhanced the detection and understanding of spontaneous coronary artery dissection. However, continued research is crucial to resolving outstanding uncertainties and optimizing patient outcomes. Full article

D-transposition of the great arteries (D-TGA) is a common cyanotic critical congenital heart disease. An arterial switch operation (ASO) with/without a ventricular septal defect (VSD) closure is the preferred surgical approach, with an added challenge when an intramural coronary artery (IMC) is present (1), with a reported increased incidence of postoperative complications and mortality (2,3). We present our recent D-TGA with intramural coronary artery (TGA-IMC) experience, focusing on the salient features identified on echocardiography, computed tomography (CT) angiography, and invasive angiograms, as well as variations in ASO surgical techniques for repair. Diagnostic imaging evaluation allowed for identification of the lesion, as well as planning for and undertaking of two different surgical approaches. While the two patients had differing immediate postoperative courses, both were asymptomatic at discharge, with normal biventricular systolic function. Our experience demonstrates that the suspicion for a coronary anomaly in TGA can be raised prenatally and confirmed postnatally with focused trans-thoracic echocardiography and ECG-gated CT angiogram evaluation while also aiding in operative planning. Moreover, suggesting further exploration of the optimal surgical technique for the repair of TGA-IMC. Full article

Substantial evidence from previous clinical studies, randomized trials, and patient registries confirms the existence of significant differences in cardiac morphology, pathophysiology, prevalence of specific coronary artery disease (CAD), and clinical course of myocardial infarction (MI) between men and women. The aim of this review is to investigate the impact of sex or gender on the development and clinical course of MI, the mechanisms and features of left ventricular (LV) remodeling, and heart failure (HF). The main sex-related difference in post-MI LV remodeling is adverse LV dilatation in males versus concentric LV remodeling or concentric LV hypertrophy in females. In addition, women have a higher incidence of microvascular dysfunction, which manifests as impaired coronary flow reserve, distal embolism, and a higher prevalence of the no-reflow phenomenon. Consequently, impaired myocardial perfusion after MI is more common in women than in men. Regardless of age or other comorbidities, the incidence of reinfarction, hospitalization for HF, and mortality is significantly higher in females. There is therefore a “sex paradox”: despite the lower prevalence of obstructive CAD and HF with reduced ejection fraction (HFrEF), women have a higher mortality rate after MI. Different characteristics of the coronary network, such as plaque formation, microvascular dysfunction, and endothelial inflammation, as well as the prolonged time to optimal coronary flow restoration, secondary mitral regurgitation, and pulmonary vascular dysfunction, lead to a worse outcome in females. A better understanding of the mechanisms responsible for MI occurrence, LV remodeling, and HF in men and women would contribute to optimized patient therapy that would benefit both sexes. Full article

Background/Objectives: Increased lipoprotein(a) [Lp(a)] level is associated with elevated possibility of atherosclerosis progression. SYNTAX score enables to grade the anatomy of coronary arteries. To identify the impact of increased Lp(a) level on SYNTAX score in individuals with acute myocardial infarction (AMI). Methods: In our analysis, we enrolled 173 consecutive adult patients hospitalized for AMI in a tertiary cardiology center from December 2022 to August 2023. Patient characteristics were compared for patients with SYNTAX score ≥ 23 (64 patients) and SYNTAX score < 23 (109 patients). The SYNTAX score was estimated based on the results of coronary angiography. Logistic regression analyses were performed to evaluate the factors associated with SYNTAX score. Results: Individuals with the SYNTAX score ≥ 23 were more likely to have arterial hypertension, diabetes mellitus, significant stenosis in the left main coronary artery, and higher Lp(a) levels than those with SYNTAX < 23 (all p < 0.05). On univariate analysis, age (OR 1.05, 95% CI 1.02–1.08, p = 0.001), Lp(a) levels (OR 1.04, 95% CI 1.01–1.06, p = 0.001), and arterial hypertension (OR 2.69, 95% CI 1.26–5.74, p = 0.011) were associated with SYNTAX score ≥ 23. Multivariable determinants of SYNTAX score ≥ 23 were as follows: Lp(a) levels (OR 1.03, 95% CI 1.01–1.08, p = 0.029), and age (OR 1.04, 95% CI 1.01–1.07, p = 0.005). The cut-off value for Lp(a) 166.16 nmol/L identifies patients with SYNTAX score ≥ 23 with 97% sensitivity and 44% specificity (area under curve 0.78, p < 0.001). Conclusions: Elevated Lp(a) concentration is associated with a higher SYNTAX score. A cut-off value of Lp(a) above 166.16 nmol/L allows us to identify subjects with SYNTAX score ≥ 23 with good specificity and sensitivity. Full article