Search Results (90)

Background: Quantitative Flow Ratio (QFR) is a novel, wire-free, and hyperemia-free physiological assessment for guiding Percutaneous Coronary Intervention (PCI), which may offer advantages over traditional angiography-guided PCI. This systematic review with meta-analysis compares clinical outcomes after one year in patients who underwent QFR-guided versus angiography-guided PCI. Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered on 4 November 2024 in PROSPERO (ID: CRD42024609799). A systematic search was performed across multiple databases to identify clinical trials comparing QFR-guided and angiography-guided PCI. Random-effects models were used to assess one-year outcomes of major adverse cardiovascular events (MACEs), revascularization, and rehospitalization, with heterogeneity measured using I², H², and Cochran’s Q statistics. Study quality was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool. Results: Compared to traditional angiography-guided PCI, QFR-guided PCI was associated with numerically lower but statistically non-significant risks of MACEs (risk difference: −0.08, 95% CI: −0.20 to 0.04), revascularization (risk difference: −0.02, 95% CI: −0.08 to 0.03), and rehospitalization (risk difference: −0.02, 95% CI: −0.08 to 0.04) over one year. Substantial heterogeneity was observed for MACEs (I² = 84.95%, H² = 6.64) and revascularization (I² = 94.18%, H² = 17.18), whereas rehospitalization exhibited low heterogeneity (I² = 17.17%, H² = 1.21). The risk of bias was assessed by the RoB 2 tool, which revealed low to some concern risk of bias across key domains. Conclusions: Quantitative Flow Ratio (QFR) has demonstrated comparable one-year clinical outcomes to traditional angiography for PCI guidance, with a trend toward improved results. However, the high heterogeneity among studies and the risk of bias necessitate the need for larger, high-quality trials to validate these findings. Full article

Objective: We aimed to evaluate the feasibility, added value, and radiation dose of coronary computed tomography angiography (CCTA) and stress dynamic CT myocardial perfusion imaging (MPI) in patients with coronary artery disease (CAD) in a real-world setting. Materials and Methods: This retrospective study included 65 patients (mean age: 51.2 ± 11.5 years; 21 female) with moderate CAD, selected from the Radiological Database of our hospital between May 2022 and December 2024. All patients underwent CCTA and stress dynamic CT-MPI using a third-generation dual-source CT scanner. The shuttle-mode acquisition technique was used for CT-MPI with 60 mL of contrast (iopamidol, 370 mg iodine/mL) administered at a flow rate of 6 mL/s. The mean myocardial blood flow (MBF) and other quantitative parameters were measured for both CAD and reference segments (RSs). A 17-segment-based analysis was employed (excluding the apex). The MBF ratio, defined as the mean MBF value of CAD segments divided by that of RS, was used with a cut-off value of 0.85 to distinguish hypoperfused from non-hypoperfused segments within CAD territories. Non-parametric statistical tests were applied. Results: A total of 1040 segments were evaluated. In 62 segments, the mean MBF of CAD territories was found to have decreased. The mean MBF and myocardial blood volume (MBV) in hypoperfused CAD segments were 65.1 ± 19.8 mL/100 mL/min and 14.5 ± 2.7 mL/100 mL, respectively, both significantly lower compared to non-hypoperfused CAD segments and RSs (p < 0.001). The mean effective dose of the protocol was 6.3 ± 1.4 mSv, corresponding to an estimated individual lifetime cancer risk of approximately 0.06% per test, based on BEIR VII Phase 2 modeling. This risk is cumulative, with repeat testing over a 10-year period potentially increasing lifetime cancer risk in proportion to total radiation exposure. The mean total examination time was 26 ± 4 min. Conclusion: The combined CCTA and dynamic CT-MPI protocol is feasible in real-world clinical practice and offers a comprehensive morphological and functional assessment of moderate CAD, with a manageable radiation dose and examination time. Full article

Background: Patients diagnosed with coronary artery disease (CAD) have been seen to exhibit increases in health-related quality of life (HRQoL) following percutaneous coronary interventions (PCIs). This study thus aimed to assess the impact of PCI on health outcomes among Jordanian patients three months post-procedure. Methods: This prospective descriptive study evaluated health outcomes three months post-PCI among Jordanian patients who had been originally diagnosed with Chronic Coronary Syndrome (CCS) before being scheduled for PCIs. Quantitative data was collected using the updated version of the Coronary Revascularization Outcome Questionnaire (CROQ v2) across a non-probability sample, based on accessibility, of Jordanian patients who had received the procedure at any of several hospitals in Jordan. Multivariate analysis of covariance (MANCOVA) was employed to examine the mean scores of patient-reported outcomes following revascularization, while partial correlations were employed to investigate associations among patients’ age, weight, gender, and the reported results. Results: A total of 101 patients participated in the study, with a predominance of males (n = 85, 84.2%) relative to females (n = 16, 15.8%). The results indicated a statistically significant improvement across all measures assessed across these patients. Furthermore, the results demonstrated that males showed higher physical function, psychological functioning, and cognitive performance relative to females following coronary revascularization surgery. Nevertheless, the results also revealed varied levels of adverse effects following coronary revascularization, with the most commonly reported being discomfort around the groin or arm wound, followed by pain in the same areas. Conversely, the least significant concerns pertained to the emergence of bruises and similar issues in the groin or arm areas where the catheter was inserted. Conclusions: This study shows that PCI improves CAD patients’ quality of life over the initial three-month period post-procedure. Understanding the positive associations of this and the negative consequences that it entails may help healthcare practitioners better identify those patients likely to benefit or suffer from PCI, enabling more appropriate interventions. To understand how PCI affects HRQoL in CAD patients over time, more research based on rigorous study designs and validated metrics is required, however. Full article

Background: Atherosclerotic disease is the leading global cause of death, driven by progressive plaque accumulation in the arteries. Ultrasound (US) imaging, both conventional (CUS) and intravascular (IVUS), is crucial for the non-invasive assessment of atherosclerotic plaques. Deep learning (DL) techniques have recently gained attention as tools to improve the accuracy and efficiency of image analysis in this domain. This paper reviews recent advancements in DL-based methods for the segmentation, classification, and quantification of atherosclerotic plaques in US imaging, focusing on their performance, clinical relevance, and translational challenges. Methods: A systematic literature search was conducted in the PubMed, Scopus, and Web of Science databases, following PRISMA guidelines. The review included peer-reviewed original articles published up to 31 January 2025 that applied DL models for plaque segmentation, characterization, and/or quantification in US images. Results: A total of 53 studies were included, with 72% focusing on carotid CUS and 28% on coronary IVUS. DL architectures, such as UNet and attention-based networks, were commonly used, achieving high segmentation accuracy with average Dice similarity coefficients of around 84%. Many models provided reliable quantitative outputs (such as total plaque area, plaque burden, and stenosis severity index) with correlation coefficients often exceeding R = 0.9 compared to manual annotations. Limitations included the scarcity of large, annotated, and publicly available datasets; the lack of external validation; and the limited availability of open-source code. Conclusions: DL-based approaches show considerable promise for advancing atherosclerotic plaque analysis in US imaging. To facilitate broader clinical adoption, future research should prioritize methodological standardization, external validation, data and code sharing, and integrating 3D US technologies. Full article

Patients with end-stage renal disease (ESRD) are at increased risk of cardiovascular disease (CVD), such as myocardial infarction (MI). Uremic toxins and endothelial dysfunction are central to this process. In this exploratory study, we used the Affymetrix GeneChip microarray to investigate the gene expression profile in uremic serum-induced human coronary arterial endothelial cells (HCAECs) from ESRD patients with and without MI (UWI and UWOI groups) as an approach to its underlying mechanism. We also explored which pathways are involved in this process. We found 100 differentially expressed genes (DEGs) among the conditions of interest by supervised principal component analysis and hierarchical cluster analysis. The expressions of four major DEGs were validated by quantitative RT-PCR. Pathway analysis and molecular network were used to analyze the interaction and expression patterns. Ten pathways were identified as the main enriched metabolic pathways according to the transcriptome profiling analysis, which were, among others, positive regulation of inflammatory response, positive regulation of extracellular signal-regulated kinases 1 and 2 (ERK1/2) cascade, cardiac muscle cell development, highlighting positive regulation of mitogen-activated protein kinase (MAPK) activity (p = 0.00016). Up- and down-regulation of genes from HCAECs exposed to uremic serum could contribute to increased endothelial dysfunction and CVD in ESRD patients. Our study suggests that inflammation and the ERK-MAPK pathway are highly enriched in kidney disease patients with MI, suggesting their role in ESRD pathology. Further studies and approaches based on MAPK pathway interfering strategies are needed to confirm these data. Full article

Objective: The literature concerning the association between coronary slow flow (CSF) and anxiety and depression is controversial. Furthermore; there is no existing data in the literature on the potential association between CSF and adverse childhood experiences or alexithymia. Methods: The participants underwent coronary angiography through femoral access. Coronary artery blood flow rate was evaluated quantitatively for each coronary artery according to the Thrombolysis in Myocardial Infarction frame count (TFC) method. CSF was diagnosed as a corrected TFC value >27 in at least one coronary artery during the imaging. Symptoms of anxiety and depression were assessed through the Hospital Anxiety and Depression Scale (HADS). Alexithymia and ACE were evaluated by the Twenty-item Toronto Alexithymia Scale (TAS-20) and the Childhood Trauma Questionnaire (CTQ). Results: The study participants were categorized into two groups: normal coronary flow (n = 58) and CSF (n = 18). Total HADS score; HADS anxiety subscale (HADS-A) score; and HADS depression subscale (HADS-D) score were determined as significant factors associated with CSF in univariate logistic regression analysis. However; the TAS-20 and CTQ scores showed no significant association with CSF. Multivariate regression analysis performed in separate models demonstrated that total HADS score (OR: 1.27; 95 CI%: 1.08–1.50; p = 0.003); HADS-A score (OR: 1.25; 95 CI%: 1.03–1.51; p = 0.019); and HADS-D score (OR: 1.36; 95 CI%: 1.06–1.74; p = 0.014) were independently associated with CSF in multivariate logistic regression analysis. Conclusions: Neither alexithymia nor ACE was associated with CSF. On the other hand; measures of both anxiety and depression assessed through HADS were independently associated with CSF. Future studies should address the major limitations of this study; such as the limited sample size; lack of structured diagnostic interview by a psychiatrist; and the lack of establishment of causality Full article

Background. The molecular mechanisms underlying acute coronary syndrome (ACS) have been extensively investigated, with a particular focus on the role of circulating microvesicles (MVs) as carriers of regulatory elements that influence hemodynamic changes and coronary flow. Endothelial and platelet dysfunction during ACS alters MV composition, impacting clinical outcomes. This study explores the levels of miR–126–5p and miR–223–3p in circulating MVs and their association with the Thrombolysis in Myocardial Infarction (TIMI) coronary flow classification scale, proposing their potential as biomarkers. Methods. Bioinformatic tools identified miRNAs linked to ACS. Plasma MVs were isolated from ACS patients and healthy controls through high-speed centrifugation. miRNA levels were quantified using quantitative reverse transcription polymerase chain reaction (qRT-PCR) and compared across TIMI 0 and TIMI 3 groups. Diagnostic efficacy was assessed via receiver operating characteristic (ROC) curve analysis. Results. The bioinformatic analysis identified miR–126 and miR–223 present in ACS. miR–126–5p and miR–223–3p were significantly reduced in MVs from TIMI 0 patients compared to TIMI 3. ROC analysis showed high diagnostic accuracy for miR–126–5p (AUC = 0.918; 95% CI: 0.818–1.00; p = 0.001) and miR–223–3p (AUC = 1.00; 95% CI: 1.00–1.00; p < 0.001). Conclusions. Reduced levels of miR–126–5p and miR–223–3p in circulating MVs are strongly associated with impaired coronary flow, positioning these miRNAs as potential biomarkers for ACS risk stratification and therapeutic targeting. Full article

Background: Vascular calcification (VC) is a characteristic feature of atherosclerosis in patients with chronic kidney disease (CKD), and coronary artery calcification (CAC) significantly impacts future cardiovascular events and mortality. Although factors associated with CAC are well reported, only a few studies have evaluated the factors associated with the progression of CAC in pre-dialysis patients with CKD. Methods: We quantitatively evaluated CAC progression using the CAC score (CACS) measured using 16-row multi-detector computed tomography and assessed associated factors in 74 patients with CKD. Results: The median annual increase in CACS was 23.7 (IQR 2.0–73.0). CAC progression was associated with serum phosphate and plasma asymmetric dimethylarginine (ADMA) levels, an endogenous inhibitor of nitric-oxide synthase and a marker of endothelial dysfunction and atherosclerosis, in univariate analysis. Multivariate analysis revealed that ADMA is an independent risk factor for CAC progression in patients with CKD. The annual change in CACS was significantly different between patients with ADMA values <0.51 and those with ADMA values >0.51 (p < 0.05). Elevated ADMA levels were also significantly associated with estimated glomerular filtration rate (eGFR) decline in the univariate analysis. Conclusions: ADMA is a novel risk factor for CAC progression in patients with CKD. Vascular endothelial cell dysfunction, represented by elevated ADMA levels, may contribute to the progression of vascular calcification in patients with pre-dialysis CKD. Full article

Coronary artery disease remains an epidemiological challenge as global morbidity is not declining despite the fact that the risk factors are well known. Metabolomic derivatives of atherosclerosis formation have recently gained attention as a possible non-traditional risk factor. The aim of this study was to find potential differences in acetyl-carnitine chain serum concentrations between epicardial artery disease patients and a control group. There were 41 patients (25 men and 16 women), with a median (Q1–Q3) age of 69 (63–73) years, enrolled in the prospective metabolomic analysis. They were divided into two groups based on cine angiography results confirming epicardial artery disease (group 1, n = 25 (61%)) or showing characteristics corresponding to normal angiograms (group 2, n = 16 (39%)). The quantitation of metabolites was performed based on the coronary angiograms. Significant differences related to the plasma concentration of L-Acetyl-carnitine (7.49 (4.79–9.23) µM vs. 9.36 (8.57–10.23) µM (p = 0.009)), Decanoyl-carnitine (0.00 (0.00–0.37) µM vs. 0.36 (0.19–0.44) µM (p = 0.040)), C12:1-carnitine (0.17 (0.14–0.20) µM vs. 0.22 (0.18–0.24) µM (p = 0.008)), trans-2-Dodecenoyl-carnitine (0.10 (0.07–0.13) µM vs. 0.13 (0.10–0.15) µM (p = 0.002)), cis-5-Tetradecenoyl-carnitine (0.03 (0.02–0.04) µM vs. 0.04 (0.03–0.05) µM (p = 0.043)), and 3,5-Tetradecadien-carnitine (0.16 (0.14–0.18) µM vs. 0.18 (0.17–0.27) µM (p = 0.007)) in group 1 vs. group 2 were noted. Increased plasma levels of acetyl-carnitine may be characteristic of patients with normal coronary angiograms. Full article

Introduction: Percutaneous coronary intervention (PCI) with drug-eluting stents (DES) is a cornerstone of the management of ischemic heart disease. However, in-stent restenosis (ISR) remains a significant clinical challenge, occurring in approximately 5–10% of patients undergoing PCI. This study is designed to compare the efficacy and safety of the primary therapeutic approaches for DES-ISR, specifically drug-coated balloons (DCBs)—paclitaxel-coated balloons (PCBs) and sirolimus-coated balloons (SCBs)—with a new-generation everolimus-eluting stent (EES), contributing to the evolving field of personalized medicine. Methods and Analysis: This prospective, multicentre, randomised, non-inferiority trial aims to enroll 150 patients with DES-ISR, who will be randomised into one of the following: SCB, PCB, or EES. The primary endpoint comparing DCB and EES is late lumen loss (LLL) at 6 months, as measured by quantitative coronary angiography (QCA). Secondary endpoints comparing the three arms include a device-oriented composite endpoint, intraluminal gain, optical coherence tomography (OCT) measured LLL, and correlations between LLL and quantitative flow ratio (QFR). The primary endpoint will be analysed using a non-inferiority design, with a margin set at 0.25 mm, for which the sample size was calculated. Statistical analysis of the primary endpoint will be conducted on an intention-to-treat basis with a one-tailed Mann–Whitney U test with a significance level of 95. Secondary endpoints will be analysed via superiority testing using ANOVA, the Kruskal–Wallis test, logistic regression, or Fisher’s exact test, as appropriate. Ethics and Dissemination: The study protocol has been approved by the Medical Devices Department of the Hungarian National Institute of Pharmacy and Nutrition, ensuring compliance with ethical standards as outlined in the Declaration of Helsinki. All investigators declare no conflicts of interest related to this study. The trial is registered in ClinicalTrials.gov under the ID: NCT04862052. Full article

Background: Fractional Flow Reserve (FFR) is a method that enables the hemodynamic assessment of coronary artery stenosis. The Systemic Inflammatory Response Index (SIRI) is a new marker calculated by multiplying the neutrophil-to-lymphocyte ratio (NLR) with the monocyte count. It is indicative of the presence and severity of coronary artery disease. This study evaluates the relationship between the functional significance of FFR measurements and the SIRI in intermediate coronary stenosis. Methods: A total of 294 patients with 50–70% stenosis in their coronary arteries based on quantitative measurement following angiography who underwent FFR measurement were included in the study before the FFR procedure. Total and differential leukocyte counts and routine biochemical tests were performed. Results: A total of 37% of the patients were found to have a positive FFR, while 63% had a negative FFR. Significant differences were observed in the neutrophil count, monocyte count, Systemic Inflammation Response Index (SIRI), total cholesterol, and amount of adenosine used between the groups (p < 0.05). A SIRI value of 1.16 was 77% sensitive and 55% specific for FFR positivity. Multivariate logistic regression analysis identified the SIRI as an independent predictor of FFR positivity. Conclusions: Our study has demonstrated that high values of the SIRI may serve as a new biomarker for predicting FFR positivity. Full article

Bisphenols may negatively impact human health. In this study, we propose the use of HPLC–FLD for the simultaneous determination of bisphenols in pericardial fluid samples collected from patients with coronary artery disease undergoing coronary artery bypass surgery. For sample preparation, a fast, simple, and ”green” DLLME method was used, achieving mean recovery values in the range of 62%–98% with relative standard deviations between 2% and 6% for all analytes. Quantitative analysis of bisphenols in the samples was then performed by LC–MS/MS on a triple quadrupole (QqQ) mass spectrometer and electrospray ionization (ESI-/ESI+) was applied in the negative and positive ion modes, respectively. The LODs and LOQs ranged from 0.04 ng/mL to 0.37 ng/mL and 0.12 ng/mL to 1.11 ng/mL, respectively. Pericardial fluid was collected from patients with coronary artery disease during coronary artery bypass surgery. Bisphenol residues were identified and quantified in samples from 19 patients. The procedure was successfully applied to the biomonitoring of free forms of 14 bisphenols in pericardial fluid. After statistical examination of the relationships between the selected variables, a strongly positive correlation was found between creatinine kinase and troponin I, as well as the number of venous anastomoses, circulation time, and clamp cap time. Full article

Coronary artery disease and its complications are one of the most common causes of morbidity and death worldwide. The aims of this study were to assess the transcriptional activity of the studied TNF-α genes and their receptors in patients with various degrees of coronary artery disease and in the control group, as well as to attempt to link it with the size of the left ventricular ejection fraction and the number of diseased coronary arteries. Taking into account the inclusion and exclusion criteria, a total of 240 people (100%) qualified for this study. For proper interpretation of the results of the molecular analyzes, the study group (240, 100%) was divided into a control group (C: n = 60; 25%), a group of patients with early coronary artery disease (W: n = 60; 25%), a group with stable coronary artery disease (S: n = 60; 25%), and a group of patients with acute coronary syndrome (ACS: n = 60; 25%). The transcriptional activity of the TNF-α genes and their receptors was assessed in peripheral blood mononuclear cells by a quantitative real-time polymerase chain reaction. The expression of the studied genes was inferred from the number of mRNA copies per 1 ug of total RNA. The analysis of the obtained results showed a significant increase in the transcriptional activity of the TNF-α gene with the severity of coronary artery disease, accompanied by a decrease in the activity of its receptor genes. Taking into account the number of affected coronary arteries and the size of the ejection fraction in the examined patients, there were no statistically significant differences in the transcriptional activity of the TNF-α receptor gene type I and II. The observed increase in the transcriptional activity of the TNF-α gene with a concomitant decrease in the activity of its receptor genes with the advancement of coronary artery disease, compared to the control group, may indicate their significant participation in the development and progression of the disease and constitute a useful marker in non-invasive, early diagnostics. In the patients of the study group, no changes in the transcriptional activity of the TNF-α genes and their receptors were demonstrated depending on the number of diseased coronary arteries and the size of the ejection fraction of the left ventricle. Full article

Walnut (Juglans regia L.) possesses the ability to prevent coronary heart disease and promote cardiovascular health. This ability can be attributed to their rich content of polyphenols, particularly flavonoids. The biosynthesis of flavonoids is reliant on the catalytic activity of uridine diphosphate glycosyltransferase (UGT). However, the identification of UGTs in walnut has not been reported. In the current study, a total of 124 UGT genes containing the PSPG box were identified from the walnut genome. Based on phylogenetic analysis, the 124 UGTs could be classified into 16 distinct groups, which exhibited an uneven distribution across the 16 chromosomes. Subcellular localization prediction analysis revealed that approximately 78.23% of walnut UGT proteins were predominantly localized in the cytoplasmic compartment. Furthermore, motif annotation confirmed that motifs 1, 2, and 3 represented conserved structural features within UGT proteins, while interestingly, around 56.5% of walnut UGT members lacked introns. Through the analysis of promoter cis-regulatory elements, it was revealed that JrUGTs are involved in photoresponse, hormonal regulation, and other physiological responses. In conjunction with transcriptome analysis and quantitative expression, approximately 39% of UGT genes in walnut exhibited high expression levels during early fruit development. Correlation analysis between UGT genes’ expression and phenolic content in walnut indicated that JrUGT6, JrUGT38, JrUGT39, JrUGT58, JrUGT69, JrUGT75, and JrUGT82 might be involved in phenolic biosynthesis in walnut. This comprehensive study provides an overview of the UGT genes in walnut, serving as a valuable reference and theoretical foundation for further investigations into the biological functions of JrUGTs in flavonoid biosynthesis. Full article

This study investigates the role of gut microbiota in cardiovascular diseases, with an additional focus on pro-atherogenic metabolites. We use advanced network analysis and machine learning techniques to identify key microbial features linked to coronary artery disease (CAD) and heart failure with reduced ejection fraction (HFrEF). This cross-sectional study included 189 participants divided into three groups: coronary artery disease (n = 93), heart failure with reduced ejection fraction (n = 43), and controls (n = 53). Assessments included physical exams, echocardiography, dietary surveys, blood analysis, and fecal analysis. Gut microbiota composition was analyzed using next-generation sequencing (NGS) and quantitative polymerase chain reaction (qPCR). Statistical analysis methods for testing hypotheses and correlations, alpha and beta-diversity analyses, co-occurrence networks, and machine learning were conducted using Python libraries or R packages with multiple comparisons corrected using the Benjamini–Hochberg procedure. Significant gut microbiota alterations were observed, with higher Bacillota/Bacteroidota ratios in CAD and HFrEF groups compared to controls (p < 0.001). Significant differences were observed in α-diversity indices (Pielou, Chao1, Faith) between disease groups and controls (p < 0.001). β-diversity analyses also revealed distinct microbial profiles (p = 0.0015). Interestingly, trimethylamine N-oxide (TMAO) levels were lower in CAD and HFrEF groups compared to controls (p < 0.05), while indoxyl sulfate (IS) levels were comparable between the study groups. Co-occurrence network analysis and machine learning identified key microbial features linked to these conditions, highlighting complex interactions within the gut microbiota associated with cardiovascular disease. Full article