News Update on Coronary Artery Disease Research: May – 2019

Incremental Diagnostic Value of Stress Computed Tomography Myocardial Perfusion With Whole-Heart Coverage CT Scanner in Intermediate- to High-Risk Symptomatic Patients Suspected of Coronary Artery Disease

Objectives The goal of this study was to guage the diagnostic accuracy of stress X-raying heart muscle intromission (CTP) for the detection of functionally important arteria coronaria unwellness (CAD) by mistreatment invasive coronary X-ray photography (ICA) and invasive down flow reserve (FFR) because the reference normal in consecutive intermediate- to unsound symptomatic patients.

Background Stress CTP recently emerged as a possible strategy to mix the anatomic and purposeful analysis of CAD in an exceedingly single scan.

Methods a complete of a hundred consecutive symptomatic patients scheduled  for ICA were prospectively registered. All patients underwent rest coronary X-raying X-ray photography (CTA) followed by stress static CTP with a whole-heart coverage CT scanner (Revolution CT, GE care, Milwaukee, Wisconsin). Diagnostic accuracy and overall effective dose were assessed and compared versus those of ICA and invasive FFR.

Results The prevalence of clogging CAD and functionally important CAD were sixty nine and forty four, severally. Coronary CTA alone incontestable  a per-vessel and per-patient sensitivity, specificity, negative prognostic worth, positive prognostic worth, and accuracy of ninety eight, 76%, 99%, 63%, and eighty three and of ninety eight, 54%, 96%, 68%, and 76%, severally. Combining coronary CTA with stress CTP, per-vessel and per-patient sensitivity, specificity, negative prognostic worth, positive prognostic worth, and accuracy were ninety one, 94%, 96%, 86%, and ninety three and ninety eight, 83%, 98%, 86%, and 91%, with a major improvement in specificity, positive prognostic worth, and accuracy in each models. The mean effective dose for coronary CTA and stress CTP were a pair of.8 ± 1.4 mSv and a couple of.5 ± 1.1 mSv.

Conclusions The inclusion of stress CTP for the analysis of patients with associate degree intermediate to high risk for CAD is possible and improved the diagnostic performance of coronary CTA for police work functionally important CAD. [1]

Exercise responsive micro ribonucleic acids identify patients with coronary artery disease

Aims

Exercise could be a trigger for acute coronary events particularly within the untrained . distinctive subjects in danger remains a challenge. we tend to began to assess whether or not a definite pattern of small ribonucleic acids (miRNAs) expressed in response to an acute bout of full-scale exercise might exist that will permit discrimination between health and unwellness.

Methods

Twenty healthy subjects associated twenty patients with arteria unwellness (CAD) performed an full-scale cycle ergometry. Total polymer was extracted from blood drawn before and when exercise. every blood sample was analysed for 187 target miRNAs by quantitative reverse transcription enzyme chain reaction.

Results

At baseline, eighteen miRNAs allowed discrimination between healthy subjects and CAD patients. In response to associate acute full-scale exercise in healthy subjects fifty one miRNAs and in CAD patients sixty miRNAs were considerably modulated (all p [2]

Management of established coronary artery disease in aircrew without myocardial infarction or revascularisation

This paper is a component of a series of professional accord documents covering all aspects of aviation medical specialty. during this manuscript, we have a tendency to specialise in the broad aerospace medicine issues that are needed to optimally manage crew with established arteria coronaria sickness in those while not MI or revascularisation (both pilots and non-pilot aviation professionals). we have a tendency to gift professional accord opinion and associated recommendations. it’s counseled that in crew with non-obstructive arteria coronaria sickness or preventative coronary artery disease not deemed haemodynamically vital, nor meeting the standards for excessive burden (based on plaque morphology and combination stenosis), a come to flying duties could also be attainable, though with restrictions. it’s counseled that crew with haemodynamically vital arteria coronaria sickness (defined by a decrease in third flow reserve) or a complete burden of disease that exceeds associate degree aggregate stricture of one hundred twenty are grounded. With aggressive viscus risk issue modification and, at a minimum, annual follow-up with routine non-invasive viscus analysis, the bulk of crew with arteria coronaria sickness will safely come to flight duties.

This is associate degree open access article distributed in accordance with the artistic Commons Attribution Non business (CC BY-NC four.0) license, which allows others to distribute, remix, adapt, hinge on this work non-commercially, and license their by-product works on completely different terms, provided the first work is correctly cited, acceptable credit is given, any changes created indicated, and also the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

http://dx.doi.org/10.1136/heartjnl-2018-313054 [3]

Left main coronary artery disease: pathophysiology, diagnosis, and treatment

The advent of coronary roentgenography within the Sixties allowed for the chance stratification of patients with stable angina. Patients with unprotected left main artery sickness have associate degree exaggerated risk of death associated with the big quantity of heart muscle provided by this vessel. though coronary roentgenography remains the well-liked imaging modality for the analysis of left main artery pathology, this system has necessary limitations. Angiograms of the left main artery section is tough to interpret, and nearly tierce of patients is misclassified once aliquot flow reserve is employed because the reference. In patients with clinically important unprotected left main artery sickness, surgical revascularization was shown to boost survival compared with medical medical aid and has been considered the treatment of alternative for unprotected left main artery sickness. 2 large-scale clinical trials printed in 2016 support the utility of catheter-based revascularization in elite patients with unprotected left main artery sickness. during this Review, we tend to describe the pathophysiology of unprotected left main artery sickness, discuss diagnostic approaches in lightweight of recent noninvasive and invasive imaging techniques, and detail risk stratification models to assist the center Team within the decision-making method for crucial the most effective revascularization strategy for these patients. [4]

Factors Correlating with Severity of Coronary Artery Disease in Type 2 Diabetic Patients on Treatment for More Than 5 Years

 

Aims: to guage the correlation between hormone resistance and alternative standard risk factors with reference to severity of arteria illness (CAD) in patients with over five years of treatment for sort two diabetes.

Study Design: Cross-sectional study.

Place and length of Study: Department of drugs and Department of medicine, Kasturba Medical school, Hospital Mangalore, between Gregorian calendar month 2013 and Dec 2013.

Methodology: sixty one individuals with over five years of sort two polygenic disorder United Nations agency underwent coronary X-ray photograph for the analysis of CAD were recruited during this study. hormone resistance (HOMA-IR), measure and organic chemistry parameters were determined, and was correlate with severity of CAD that was assessed by syntax score.

Results: There was important positive linear correlation between log HOMA-IR and syntax score in individuals with over five years of sort two polygenic disorder [r=0.605 (95%CI zero.417–0.744), P [5]

Reference

[1] Pontone, G., Andreini, D., Guaricci, A.I., Baggiano, A., Fazzari, F., Guglielmo, M., Muscogiuri, G., Berzovini, C.M., Pasquini, A., Mushtaq, S. and Conte, E., 2019. Incremental diagnostic value of stress computed tomography myocardial perfusion with whole-heart coverage CT scanner in intermediate-to high-risk symptomatic patients suspected of coronary artery disease. JACC: Cardiovascular Imaging12(2), pp.338-349. (Web Link)

[2] Mayr, B., Müller, E.E., Schäfer, C., Droese, S., Breitenbach-Koller, H., Schönfelder, M. and Niebauer, J., 2019. Exercise responsive micro ribonucleic acids identify patients with coronary artery disease. European journal of preventive cardiology26(4), pp.348-355. (Web Link)

[3] Davenport, E.D., Gray, G., Rienks, R., Bron, D., Syburra, T., d’Arcy, J.L., Guettler, N.J., Manen, O. and Nicol, E.D., 2019. Management of established coronary artery disease in aircrew without myocardial infarction or revascularisation. Heart105(Suppl 1), pp.s25-s30. (Web Link)

[4] Left main coronary artery disease: pathophysiology, diagnosis, and treatment

Carlos ColletDavide CapodannoYoshinobu OnumaAdrian BanningGregg W. StoneDavid P. TaggartJoseph Sabik & Patrick W. Serruys

Nature Reviews Cardiologyvolume 15, pages321–331 (2018) (Web Link)

[5] Srinivasan, M. P., Kamath, P. K., Pai, N. D., Manjrekar, P. A. and Mahabala, C. (2014) “Factors Correlating with Severity of Coronary Artery Disease in Type 2 Diabetic Patients on Treatment for More Than 5 Years”, Journal of Advances in Medicine and Medical Research, 4(26), pp. 4364-4372. doi: 10.9734/BJMMR/2014/11169. (Web Link)

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