Coronary microvascular dysfunction (CMD) accounts for a significant part of angina with non-obstructive coronary artery (ANOCA). Angiography-derived index of microcirculatory resistance (angio-IMR) has been developed for the evaluation of CMD but not yet validated sufficiently in ANOCA.

To validate angio-IMR against wire-based IMR and to investigate its diagnostic performance for ischemia in ANOCA patients.

This study included two independent cohorts. The angio-IMR and wire-based IMR were measured in 74 patients (74 vessels) in the wire-based IMR validation cohort. The angio-IMR and single-photon emission computed tomography-myocardial perfusion imaging (SPECT-MPI) were successfully completed in 136 patients (408 vessels) in the SPECT-MPI validation cohort. The ischemia was defined as the myocardial perfusion defect on SPECT-MPI and a summed difference score (SDS) ≥ 2.

In the wire-based IMR validation cohort, the angio-IMR ≥ 25 had the high diagnostic efficiency (area under the receiver-operating characteristics curve (AUC): 0.917, 95 %CI: 0.843-0.922; p < 0.001) and classification agreement (CA) (91.9 %) with the referenced wire-based IMR ≥ 25. In the SPECT-MPI validation cohort, more ischemia was observed in the high angio-IMR group (angio-IMR ≥ 25) compared to the low angio-IMR group (angio-IMR < 25) (55.2 % vs 10.4 %, p < 0.001). The angio-IMR ≥ 25 had a moderate diagnostic performance for ischemia (AUC: 0.759, 95 %CI: 0.670-0.849; p < 0.001), and it could improve the ability to discriminate ischemia in ANOAC patients (integrated discrimination improvement (IDI): 0.184; p < 0.001; net reclassification improvement (NRI): 0.217; p < 0.001).

The study demonstrates that angio-IMR, validated through both wire-based IMR and SPECT-MPI, presents a promising and convenient diagnostic approach for identifying ischemia in patients with ANOCA.

This study investigates the long-term prognostic significance of non-obstructive coronary artery disease (CAD) in predicting the risk of all-cause death in a multicenter study. Three hospitals in Wuhan participated in this retrospective, observational, multicenter study of 7320 patients with suspected of having CAD and who underwent clinical coronary computed tomography angiography (CTA) from June 2011 to December 2015. According to coronary CTA, the extent of CAD was categorized as non-obstructive, obstructive, and no CAD. The primary outcome was all-cause mortality. A total of 611 patients experienced all-cause mortality with a median duration of 8.0 years (7.2-8.9). The annualized mortality rate was 0.50 (95% CI: 0.43-0.58), 1.31 (95% CI: 1.16-1.47), and 2.18 (95% CI: 1.93-2.46) for the no CAD, non-obstructive CAD, and obstructive CAD, respectively. There was a significant association between the classification and the increased cumulative events, as shown by the Kaplan-Meier survival curve (P < 0.001). The multivariate Cox model showed that the hazard ratios (HR) for predicting all-cause mortality from 1.42 (95% CI: 1.15-1.75, P = 0.001) in non-obstructive CAD to 1.87 (95% CI: 1.50-2.33, P < 0.001) in obstructive CAD compared with no CAD. At 8-year follow-up, patients with non-obstructive CAD detected by coronary CTA had a 1.42-fold increased risk of all-cause mortality compared to patients without evidence of CAD. Thus, these findings suggest that non-obstructive CAD is clinically significant and that further investigation of interventions to improve the prognosis of these patients is warranted.

The incidence of acute coronary syndrome (ACS) among young individuals is increasing, making it a leading cause of mortality in this population. This study aimed to develop and validate a risk prediction model for in-hospital major adverse cardiovascular events (MACE) in young ACS patients.

A retrospective analysis was performed to predict in-hospital MACE. Patients were divided into a training set (n = 342) and a testing set (n = 171). Screening variables were optimized using least absolute shrinkage and selection operator (LASSO) regression and univariable logistic regression analysis. A predictive nomogram model was developed through multivariate logistic regression. The model's discrimination and calibration were assessed using the receiver operating characteristic (ROC) curve, calibration plots, and Hosmer-Lemeshow goodness-of-fit tests. Clinical utility was evaluated using decision curve analysis (DCA).

White blood cell count, Killip classification, lymphocyte count, heart rate, triglycerides, and Gensini score were identified as significant predictors. The constructed nomogram demonstrated strong predictive performance. The area under the ROC curve (AUC) was 0.9242 (95% confidence interval [CI]: [0.8841-0.9643]) for the training set and 0.8346 (95% CI [0.742-0.9272]) for the testing set, with respective cut-off values of 0.107 and 0.119. Calibration was confirmed with Hosmer-Lemeshow statistics of 12.454 (p = 0.2558) in the training set and 7.16 (p = 0.7102) in the testing set. DCA showed threshold probabilities ranging from 0% to 100% in the training set and 0% to 90% in the testing set.

The proposed nomogram model demonstrated robust discrimination and calibration, offering a valuable tool for predicting the risk of in-hospital MACE in young ACS patients.

Objective: Chest pain is a common complaint in emergency departments. Although most patients are admitted to emergency department intensive care, only 12% have acute coronary syndrome. An accurate, efficient score is needed to improve triage and prevent unnecessary referrals to emergency department intensive care. The Marburg Heart Score, validated to rule out acute coronary syndrome in primary care, is quick to administer and does not require test results. This study aims to assess whether the Marburg Heart Score is effective in a triage setting for patients presenting with chest pain in emergency departments. Method: This prospective, observational, multicenter study was conducted with triage nurses in four hospitals in France between July 15, 2018, and May 31, 2019. The primary endpoint was the negative predictive value of the Marburg Heart Score ≤ 2 for ruling out acute coronary syndrome. Acute coronary syndrome diagnosis was made using medical record data combined with a diagnosis from the physician in charge. Results: A total of 1045 patients were included. For a cutoff score of ≤ 2, the negative predictive value for suspected acute coronary syndrome was 95.6% (95% CI [94.0-97.2]) and the area under the curve was 0.603 (95% CI [0.521-0.685]). There were 28 false negatives, two of which were due to the score being completed incorrectly. Conclusion: This study reveals that the Marburg Heart Score is an efficient tool to direct patients presenting with chest pain and MHS < 2 to a conventional ED bed. This could potentially optimize triage in the emergency department to prevent overloading the emergency department intensive care.

Cardiac rehabilitation (CR) is effective in preventing cardiovascular diseases; however, participation in CR programs remains limited due to the associated challenges. The integration of wearable devices and real-time monitoring offers a potential solution to enhance adherence to remote CR programs and their outcomes.

This study aimed to evaluate the efficacy of a remote CR program using wearable devices and real-time monitoring with or without online coaching (OLC) in improving exercise capacity in patients with coronary artery disease (CAD).

We enrolled 50 patients with CAD in a remote CR program in this randomized, open-label, single-center pilot trial (phase III). After baseline cardiopulmonary exercise tests (CPETs), all patients were assigned a CPET-based home exercise program and were provided with a wearable device (Fitbit Sense; Fitbit, Inc) with a real-time monitoring system (Recoval; SapplyM, Inc). The patients were randomly assigned to an intervention group with OLC (n=25) or a control wearable device (CON; n=25) group. The primary outcomes were changes in peak oxygen consumption (peak VO2) and anaerobic threshold VO2 (oxygen consumption) at 12 weeks. The secondary outcomes were changes in CPET parameters, daily activity, anxiety levels, and health-related quality of life.

Peak VO2 and anaerobic threshold VO2 increased significantly from baseline to 12 weeks in the OLC (+1.6 mL/kg/min, P<.001; +1.0 mL/kg/min, P=.001) and CON (+0.6 mL/kg/min, P=.008; +1.3 mL/kg/min, P=.002) groups with no significant between-group differences (P=.65 and P=.90). In the latter half of the intervention, the daily distance and highly active time in the OLC group were significantly increased compared with those in the CON group (all P<.05). Mental status and health-related quality of life scores showed no significant differences between the groups. No major adverse cardiac events were reported. One patient in the OLC group dropped out due to lower limb muscle strain.

Remote CR using wearable devices and a real-time monitoring system significantly improved exercise capacity in patients with CAD over a 12-week intervention program. The addition of regular OLC to the intervention program further enhanced the physical activity levels, particularly in high-intensity activities. Future studies are warranted to validate these findings in more diverse populations and over longer intervention periods to optimize the benefits and safety of remote CR programs.

This study investigates the knowledge, attitudes, and practices (KAP) regarding atherosclerosis ultrasound screening among adults in the general population of Shanghai. A cross-sectional study was conducted from April 5 to May 30, 2024, at the Department of Ultrasound Medicine, Shanghai Eighth People's Hospital, involving the general public. An investigator-designed questionnaire collected demographic information and KAP scores. Path analysis was performed to assess the relationships between overall KAP scores, with subgroup analysis for participants with atherosclerotic cardiovascular disease (CVD). A total of 617 valid questionnaires were analyzed, revealing a high reliability coefficient of 0.949. Mean KAP scores were as follows: knowledge 9.73 ± 5.80 (/24, 40.54%), attitude 56.38 ± 10.94 (/65, 86.74%), and practice 21.66 ± 5.54 (/35, 61.89%), indicating poor knowledge but positive attitudes and proactive practices. Knowledge significantly influenced both attitude (β = 0.354, P = 0.028) and practice (β = 0.357, P = 0.021). In participants with CVD, mean scores were 11.14 ± 4.10 for knowledge, 59.69 ± 11.94 for attitude, and 23.17 ± 5.32 for practice. In the general Shanghai population, knowledge about atherosclerosis ultrasound screening is poor, yet attitudes are positive, and practices are proactive. Targeted educational interventions are necessary to enhance knowledge and attitudes, thus improving screening practices.

This study aimed to investigate the prognostic significance of stress dynamic myocardial CT perfusion imaging (CTP) and determine whether it has incremental advantages over coronary computed tomography angiography (CTA)-derived parameters.

This prospective multicenter study included patients with suspected coronary artery disease who had undergone coronary CTA and CTP and were followed for 6 years. The endpoint was time-to-first major adverse cardiovascular event (MACE). MACEs included all-cause mortality, cardiac death, nonfatal myocardial infarction, unstable angina, late revascularization, and heart failure or aggravated angina symptoms requiring hospitalization. The CTP-derived absolute myocardial blood flow (MBF), relative MBF ratio (r-MBF), and the CTA-derived fractional flow reserve (CT-FFR) and stenosis were analyzed. The independent predictors, time-to-event distributions and the incremental prognostic value of CTP over CTA-derived parameters were assessed.

A total of 226 patients (66.7 ± 11.3 years, 37.6% women) were enrolled with a median follow-up time of 1233 days. Twenty-one patients (9.29%) experienced MACEs and ten patients (4.4%) experienced hard MACEs. The r-MBF was the only independent predictor for MACEs in both all patients (hazard ratio [HR]: 0.82 (0.69-0.97), p = 0.01) and patients available for CTA stenosis (%) and CT-FFR calculation (HR: 0.72 (0.57-0.91), p = 0.006). The incremental prognostic significance of r-MBF over CT-FFR was confirmed after combining with CTA-derived parameters (concordance index: 0.919 vs. 0.811; p < 0.01). Patients with r-MBF < 0.77 were more likely to experience MACEs and have a lower average survival time (1565 vs. 1790 days; p < 0.01) after stent implantation.

CTP-assessed r-MBF was independently correlated with MACEs and provided incremental prognostic significance.

Question The prognostic significance of CT perfusion (CTP) lacks sufficient support from clinical research. Findings In this Chinese population, CTP has the strongest prognostic significance, over CT-Fractional Flow Reserve (FFR) and CTA stenosis in predicting major adverse cardiovascular events (MACEs). Clinical relevance Relative myocardial blood flow ratio had the strongest prognostic value and incremental advantages in predicting MACEs beyond CT-FFR and coronary CTA stenosis quantification, as well as advantages in patients with stents, aiding in personalized diagnosis and treatment plans.

The present study aimed to develop a comprehensive clinical- and echocardiography-based risk score for predicting cardiovascular (CV) adverse outcomes in patients with ischemic heart failure (IHF) and reduced left ventricular ejection fraction (LVEF).

This retrospective cohort study included 1341 hospitalized patients with IHF and LVEF < 50% at our hospital from 2009 to 2017. Cox regression models and nomogram were utilized to develop a comprehensive prediction model (C&E risk score) for CV mortality and CV-related events (hospitalization or death).

Over a median 26-month follow-up, CV mortality and CV events rates were 17.4% and 40.9%, respectively. The C&E risk score, incorporating both clinical and echocardiographic factors, demonstrated superior predictive performance for CV outcomes compared to models using only clinical or echocardiographic factors. Internal validation confirmed the stable predictive ability of the C&E risk score, with an AUC of 0.740 (95% CI 0.709-0.775, P < 0.001) for CV mortality and an AUC of 0.678 (95% CI 0.642-0.696, P < 0.001) for CV events. Patients were categorized into low-, intermediate-, and high-risk based on the C&E risk score, with progressively increasing CV mortality (5.3% vs. 14.6% vs. 31.9%, P < 0.001) and CV events (28.8% vs. 38.2% vs. 55.0%, P < 0.001). External validation also confirmed the risk score's prognostic efficacy within additional IHF patient datasets.

This study establishes and validates the novel C&E risk score as a reliable tool for predicting CV outcomes in IHF patients with reduced LVEF. The risk score holds potential for enhancing risk stratification and guiding clinical decision-making for high-risk patients.

The Qu-shi-hua-tan decoction (QSHTD), formulated by academician Chen Keji, is an empirical decoction for coronary heart disease (CHD). We conducted a randomized controlled trial to assess the effectiveness and safety of QSHTD in managing angina after coronary revascularization (AACR) in CHD patients.

This double-blind randomized controlled trial will be conducted at Guangdong Provincial Hospital of Traditional Chinese Medicine. We will allocate 98 qualified participants to either the experimental or control group in a 1:1 ratio through random selection. The experimental group will be given standard care along with QSHTD, whereas the control group will receive standard care and a placebo. The study will span 26 weeks, consisting of a 2-week initial phase, a 12-week intervention phase, and a 12-week monitoring phase. The main outcome measure will be myocardial blood flow (MBF) assessed using adenosine stress real-time myocardial perfusion echocardiography (RTMPE). The secondary outcomes will be Canadian Cardiovascular Sociation Classification, Seattle Angina Questionnaire, Traditional Chinese Medicine (TCM) symptom evaluation; and major adverse cardiac events (MACE).

This study seeks to deliver compelling proof of the superior methodological and reporting standards of QSHTD's effectiveness and safety within AACR treatment.

Chinese Clinical Trial Registration Center [www.chictr.org.cn]. The trial was registered on November 26, 2020 [ChiCTR2000040270].

To explore the possible causal link between stable angina pectoris (SAP) and gastric cancer (GC) through Mendelian randomization analysis. We used data from genome-wide association studies (GWAS) statistical datasets, with SAP and GC screened as relevant instrumental variables for exposure factors, respectively. To evaluate the causal link between SAP and GC, a two-sample bidirectional Mendelian randomization analysis was conducted, leveraging genetic variants as instrumental variables. In addition, effects of horizontal pleiotropy were evaluated using MR-PRESSO and MR-Egger intercept analysis. Sensitivity analysis was performed using Cochran Q test and "leave one out" method. The study showed a significant causal relationship between SAP and GC in the analysis with SAP as the exposure variable (odds ratio [OR] = 0.78, 95% confidence interval [CI] = 0.69-0.87, p = 0.000027 using inverse variance weighting [IVW]). Sensitivity analysis confirmed the robustness of Mendelian randomization results. In the analysis of GC as an exposure variable, gastric cancer and SAP also showed a significant causal association (OR = 0.87, 95%CI = 0.77-0.98, p = 0.024 using IVW), but sensitivity analysis suggested a significant pleiotropy between instrumental variables (p = 0.0093 using MR-Egger intercept analysis), which cast doubt on the reliability of the study and requires careful interpretation of the results. Existing studies suggest that individuals with SAP may have a lower risk of developing GC. However, the precise causal relationship, particularly regarding whether GC contributes to an increased risk of SAP, remains unclear and warrants further investigation. GC and ischemic heart disease which represented by SAP are both associated with oxidative stress in their pathogenesis. Local tissue-induced mitochondrial autophagy or cellular ferroptosis triggers a systemic response, potentially underlying the negative correlation between GC and SAP. Thus, therapeutic strategies that target the interplay between local tissue and systemic responses in oxidative stress may hold promise for the benefits to patients.

Stress hyperglycemia ratio (SHR) is recognized as a reliable indicator of acute hyperglycemia during stress. Patients undergoing coronary artery bypass grafting (CABG) are at high risk of stress hyperglycemia, but little attention has been paid to this population. This study is the first to investigate the association between SHR and both short-term and long-term prognosis in CABG patients, with a further exploration of the impact of SHR across different glucose metabolic states.

A total of 18,307 patients undergoing isolated CABG were consecutively enrolled and categorized into three groups based on SHR tertiles. The perioperative outcome was defined as a composite of in-hospital death, myocardial infarction, cerebrovascular accident, and reoperation during hospitalization. The long-term outcome was major adverse cardiovascular and cerebrovascular events (MACCEs). Restricted cubic spline and logistic regression linked SHR to perioperative risks. Kaplan-Meier and Cox regression analyses were used to determine the relationship with long-term prognosis. Subgroup analyses were further conducted based on different glucose metabolic states.

A U-shaped association was observed between SHR and perioperative outcome in the overall population (P for nonlinear < 0.001). As SHR increased, the risk of perioperative events initially decreased (OR per SD: 0.87, 95% CI 0.79-0.97, P = 0.013) and then elevated (OR per SD: 1.16, 95% CI 1.04-1.28, P =  0.004), with an inflection point at 0.79. A similar U-shaped pattern was identified in patients with normal glucose regulation. Among those with prediabetes, the association was J-shaped, while in patients with diabetes, the association became nonsignificant when SHR exceeded 0.76. Adding SHR to the existing risk model improved the predictive performance for perioperative outcomes in the overall population (AUC: 0.720 → 0.752, P < 0.001; NRI: 0.036, P =  0.003; IDI: 0.015, P < 0.001). For long-term outcomes, the risk of events was monotonically elevated with increasing SHR, regardless of glucose metabolic status. The third tertile showed a 10.7% greater risk of MACCEs (HR: 1.107, 95% CI 1.023-1.231, P =  0.024).

SHR was significantly associated with prognosis in CABG patients, demonstrating a non-linear U-shaped relationship with short-term outcomes and a linear positive association with long-term outcomes. The in-hospital risk associated with SHR was attenuated in patients with diabetes.

WHAT IS CURRENTLY KNOWN ABOUT THIS TOPIC?: Stress hyperglycemia is common during the perioperative period in CABG patients and is linked to adverse short- and long-term outcomes. The stress hyperglycemia ratio (SHR) is a novel metric that accounts for baseline glycemia to better reflect acute stress-induced hyperglycemia. However, SHR has not been studied in the CABG population. WHAT IS THE KEY RESEARCH QUESTION?: This study is the first to investigate the association between SHR and both short-term and long-term prognosis in patients undergoing CABG, while further exploring its impact across different glucose metabolic states, categorized as normal glucose regulation, prediabetes, and diabetes. WHAT IS NEW?: In CABG patients, SHR shows a U-shaped relationship with perioperative events and a linear positive association with long-term outcomes, both of which are modulated by glucose metabolic status. HOW MIGHT THIS STUDYINFLUENCE CLINICAL PRACTICE?: Findings support the incorporation of SHR for risk stratification and personalized glucose management in CABG patients, ultimately improving both in-hospital and long-term prognosis.

Background: Endothelial dysfunction and inflammation are associated with the progression of coronary artery disease (CAD) and the pathophysiology of acute coronary syndrome (ACS). We examined the prognostic role of endothelial function and pro-inflammatory cytokines in patients admitted with ACS. Methods: The study population consisted of 864 subjects. From 663 subjects who presented with chest pain, ACS was diagnosed in 460. We additionally recruited 201 consecutive patients with stable CAD. Endothelial function was assessed using flow-mediated dilatation (FMD). Tumor necrosis factor alpha (TNF-α) and interleukin-6 (IL-6) levels were measured via ELISA. Subjects with ACS were followed up for major adverse cardiovascular events (MACE), defined as cardiovascular death, cardiac arrest, myocardial infarction, stroke, nonfatal stroke, other arterial thrombotic events, and hospitalization due to cardiovascular conditions. Results: There was a stepwise impairment in FMD, logTNF-α, and logIL-6 in patients with chest pain of non-epicardial CAD etiology compared to patients with stable CAD and those with ACS (p < 0.001 for all). Moreover, patients who presented with chest pain had increased odds of ACS in accordance with the increasing levels of TNF-α, IL-6, and impaired FMD (p < 0.05 for all). Interestingly, from all these markers, in patients with ACS, we found that only TNF-α levels above 5.19 pg/mL had a 2.5-times-increased risk of MACE compared to patients with TNF-α levels below 5.19 pg/mL, independently of other confounders. Conclusions: In the current study, we found that patients who presented with ACS had impaired endothelial function and increased levels of IL-6 and TNF-α.

Peak global myocardial work efficiency (GWE), a measure of peak global myocardial constructive to wasted work ratio, has been shown to discriminate coronary ischemia during treadmill stress echocardiography (SE). We wanted to assess additive utility of peak global longitudinal strain (GLS), global work index (GWI), and GWE in improving positive predictive value (PPV) of an abnormal dobutamine stress echocardiography (DSE) and calculate cost-savings by avoiding secondary tests.

We prospectively enrolled patients with abnormal DSE who underwent secondary confirmatory tests to confirm significant CAD as our primary cohort, and measured baseline and peak GLS, GWI, and GWE. We also included a control group with normal DSE results and similar measurements. The cost of secondary testing was used to calculate potential savings.

Among the 45 patients (71% females, mean age 60 ± 12 yrs.), 9 had significant CAD, 11 had non-significant CAD, and 25 were controls (N). Patients with significant CAD had significantly lower peak GLS [-15 (-17, -12.5) vs. -20 (-22, -19.5)%, p < 0.001], peak GWI [1,057 (810.5, 1,057) vs. 2,245 (1,928.5, 2,961) mmHg%, p = 0.02], peak GWE [82 (74.5, 86.5) vs. 89 [(86, 93.5)%, p = 0.001], and peak GCW [1,618 (1,153.5, 2,003) vs. 2,585 (2,262.5, 3,262) mmHg%, p = 0.02] compared to control. ROC analysis demonstrated peak GWE [AUC 0.76 (0.55, 0.97) p = 0.01] to discriminate coronary ischemia. Incorporating peak GWE of <87% into abnormal DSE interpretation improved PPV from 45% to 81%, resulting in an estimated cost savings of $8,274.00 per screened patient.

Incorporating peak GWE into standard DSE interpretation enhanced diagnostic accuracy and reduced the cost of downstream testing.

This study aimed to evaluate image quality, myocardial perfusion, and diagnostic performance of a novel [18F]F-labeled PET tracer, XTR004 PET, myocardial perfusion imaging (MPI) compared with [13N]Ammonia (NH3) PET MPI.

Forty-seven patients with suspected or known coronary artery disease (CAD) were prospectively enrolled to undergo one-day rest/ATP-stress XTR004 and NH3 electrocardiograph-gated PET imaging within 2 weeks. Among them, twenty-six patients underwent invasive coronary angiography (ICA), and nineteen were identified with flow-limited CAD (stenosis ≥ 70%). Image quality (excellent/good/average) and certainty of interpretation were evaluated by two independent, blinded readers. Despite a higher liver uptake, XTR004 achieved good to excellent image quality in 83% of cases, comparable to 95.7% of NH3(P = 0.091). Additionally, the diagnostic certainty, measured as the percentage of cases with definitely abnormal or normal interpretations, was similar between XTR004 and NH3, with results of 87.2% and 89.2%, respectively. The sensitivity and specificity levels of XTR004 and NH3 MPI were similar (79% vs. 79%, 86% vs. 71%, P = 1.00). Linear regression of rest/stress myocardial perfusion in 17 segments revealed the linear slope close to unity with excellent R2 value (rest: slope = 0.954-1.074, R2 = 0.990-0.997; stress: slope = 0.951-1.082, R2 = 0.971-0.996). XTR004 was tolerated well by all patients. No adverse events were reported.

XTR004 PET MPI demonstrated promising image quality, diagnostic certainty and myocardial perfusion characteristics comparable to NH3 PET MPI. Future research should concentrate on the quantitative analysis of myocardial blood flow to explore the clinical implications of XTR004 PET MPI.

Cardiovascular complications following non-cardiac surgery pose a significant global concern, affecting millions of patients annually. These complications, ranging from asymptomatic troponin elevations to major adverse cardiac events, contribute to heightened morbidity, mortality, and health care expenditures. The underlying mechanisms involve oxygen supply-demand imbalances and acute coronary syndromes precipitated by perioperative stressors. High-risk surgeries, including vascular and major abdominal procedures, are particularly susceptible to these complications. Risk assessment tools and biomarkers, especially high-sensitivity cardiac troponins, play pivotal roles in prognostication. However, despite advances in perioperative care, optimal management strategies remain elusive, as underscored by conflicting guidelines regarding interventions such as β-blockers and statins. This review aims to consolidate current evidence on cardiovascular complications following non-cardiac surgery, evaluate the utility of biomarkers, and discuss international guidelines for risk mitigation. An enhanced understanding regarding the standardized approaches is imperative in mitigating these complications effectively. Further research is essential to refine risk prediction models, validate biomarker thresholds, and elucidate the efficacy of preventive measures. Addressing these challenges can eventually lead to improved patient outcomes and more efficient healthcare resource utilization worldwide.

This study aimed to investigate the safety of vericiguat in patients with coronary artery disease.

We conducted a comprehensive literature review of the PubMed, ClinicalTrials.gov, and Cochrane Library databases up to 27 March 2024. We included studies that compared vericiguat with placebo in patients with coronary artery disease. Clinical data were extracted, and adverse events were analyzed using Review Manager software (version 5.4) after conducting a quality assessment of the enrolled studies.

Three randomized controlled trials involving 151 patients were included in this meta-analysis. Compared with the placebo group, vericiguat treatment resulted in a decrease in systolic blood pressure by 1.4-10 mmHg and diastolic blood pressure by 0.4-6 mmHg, along with an increase in heart rate by 1.8-7 bpm, all of which are clinically insignificant. Vericiguat treatment demonstrated no significant serious adverse events [odds ratio (OR) = 1.97; 95% confidence interval (CI) = 0.39-9.91; P = 0.41]. However, a significant difference in adverse events between the two groups was noted (OR = 4.04; 95% CI = 2.17-7.52; P < 0.001).

This meta-analysis suggests that vericiguat is a safe drug for use in patients with coronary artery disease; however, further clinical trials are needed to validate these findings.

The study protocol has been prospectively registered in PROSPERO (CRD42024528105).

Downregulated in Metastasis Protein (DRIM) was discovered in malignant epithelial cells and was thought to be mainly a nucleus protein affecting cancer cells. Recent single-cell sequencing analysis suggests that DRIM is abundantly expressed in vascular endothelial cells. There has been no knowledge of the role of DRIM in the endothelium. In the present study, using protein fraction method and cell imaging, we identified that the DRIM protein was abundantly present in both nucleus and the cytoskeletal fractions of human vascular endothelial cells. Knockdown of DRIM in the endothelial cells significantly affected growth, migration, and angiogenic tubule formation. Proteomics analyses revealed that Src was an important direct target protein of DRIM, a finding further confirmed by protein interaction assay. Silencing DRIM activated the tyrosine 419 site phosphorylation of Src kinase in endothelial cells, thereby affecting the downstream proteins of Src including p-FAK and p-STAT3, and exerting biological effects. To conclude, our results provide evidence of DRIM being a nuclear and cytoskeletal-associated protein, having a novel key role of the protein in vascular endothelial cells.

This study proposed noninvasive machine-learning models for the detection of lesion-specific ischemia (LSI) in patients with stable angina with intermediate stenosis severity based on coronary computed tomography (CT) angiography. This single-center retrospective study analyzed 76 patients (99 vessels) with stable angina who underwent coronary CT angiography (CCTA) and had intermediate stenosis severity (40-69%) on invasive coronary angiography. LSI, defined as a resting full-cycle ratio < 0.86 or fractional flow reserve ≤ 0.80, was determined in 40 patients (46 vessels) using a hybrid resting full-cycle ratio-fractional flow reserve strategy. The resting full-cycle ratio and/or fractional flow reserve were measured using invasive coronary angiography as references for functional severity indices of coronary stenosis in the machine-learning models. LSI detection models were constructed using noninvasive machine-learning models that predicted the resting full-cycle ratio and fractional flow reserve by feeding machine-learning models with image features extracted from CCTA. The diagnostic performance of the proposed LSI detection models was assessed using a nested 10-fold cross-validation test. The LSI detection models with the highest diagnostic performance achieved an accuracy of 0.88 (95% CI: 0.81, 0.94), sensitivity of 0.78 (95% CI: 0.70, 0.86) and specificity of 0.96 (95% CI: 0.92, 1.00) on a vessel basis and 0.88 (95% CI: 0.81, 0.95), 0.80 (95% CI: 0.70, 0.86) and 0.97 (95% CI: 0.92, 1.00), respectively, on a patient basis. These findings suggest that LSI detection models with features extracted from CCTA can noninvasively detect LSI in patients with stable angina with intermediate stenosis severity.

Coronary microvascular disease (CMVD) has emerged as a new target for the occurrence and development of heart failure treatment. Various indicators such as Index of Microvascular Resistance, Coronary Flow Reserve, Microvascular Resistance Reserve, Hyperemic Microvascular Resistance and Coronary Flow Velocity Reserve can be used to assess CMVD. Coronary microcirculation dysfunction is one of the important pathogenic mechanisms of heart failure. Sodium-Glucose Co-Transporter 2 (SGLT2) Inhibitors have been widely used in the treatment of various types of heart failure, but their specific pharmacological mechanisms are not yet fully understood. Studies have shown that SGLT2 inhibitors may be involved in the pathophysiology of CMVD by regulating cellular pathophysiological processes such as oxidative stress, mitochondrial function, energy metabolism, vascular genesis, and signalling pathways. Therefore, coronary microvascular dysfunction may be one of the treatment targets of using SGLT2 inhibitors in heart failure. Several animal experiments have found that SGLT2 inhibitors can improve microcirculatory dysfunction. However, the results of several clinical trials on the effects of SGLT2 inhibitors on coronary microcirculation have been different. Therefore, it is still lack of conclusive evidence on the effects of SGLT2 inhibitors on microcirculatory dysfunction. This review aims to summarize the completed and ongoing experiments regarding the effects of SGLT2 inhibitors on coronary microcirculation, in order to better elucidate the impact of SGLT2 inhibitors on microcirculation. It seeks to provide valuable information for the pharmacological mechanisms of SGLT2 inhibitors, the study of diseases related to coronary microcirculation disorders, and the treatment of heart failure.

The advantages and disadvantages of direct invasive coronary angiography (ICA) and coronary computed tomographic angiography (CCTA) + ICA were compared in patients with suspected chronic coronary syndrome (CCS) who presented with angina symptoms or who had nonangina chest pain with abnormal electrocardiogram results.

A total of 1200 patients who met the inclusion criteria at TEDA International Cardiovascular Hospital from January 2021 to December 2022 were randomly divided into two groups at a 1:1 ratio: the CCTA + ICA strategy (CCTA group) and the direct ICA strategy (ICA group). The baseline data were collected. All patients in the CCTA group underwent CCTA examination first. If these results showed positive obstructive coronary artery disease (CAD), then typical angina with coronary artery stenosis ranging from 50 to 70% or vascular segments could not be analysed due to severe calcification, so ICA was further performed for definitive diagnosis, and the ICA results were taken as the final diagnosis. All patients in the ICA group underwent ICA examination directly. Demographic data, cardiovascular risk factors, biochemical criteria, chest pain classification, coronary vessel lesion severity and drug use were compared between the two groups. All patients were followed for 1 year after discharge to observe major adverse cardiovascular events (MACE). The differences in unnecessary ICA rates, 1-year MACE rates, allergic reactions to contrast agents and hospitalization costs between the two groups were analysed. On the basis of the baseline clinical data of patients included in this study, a risk prediction model for obstructive CAD was established by logistic regression.

(1) There were 592 patients in the CCTA group and 594 patients in the ICA group. The percentage of unnecessary ICA procedures was 7.5% in the CCTA group and 55.2% in the ICA group (P < 0.001), which was a decrease of 86.4%. (2) Eighteen patients in the CCTA group were readmitted for severe angina, 4 of whom underwent unplanned percutaneous coronary intervention (PCI). Eight patients in the ICA group were readmitted for severe angina, 2 of whom underwent unplanned PCI. There were no cardiac deaths, nonfatal myocardial infarctions or strokes in either group over the 1-year follow-up. There was no statistically significant difference in the rate of MACE-free survival between the two groups (97.0% vs. 98.7%, log-rankχ²=1.996, P = 0.158). (3) Allergic reactions to contrast agent were observed in 28 patients in the CCTA group and 16 in the ICA group (P = 0.190). (4) The median hospitalization cost in the CCTA group was $1259.54, and that in the ICA group was $1399.41, which was a significant difference (P < 0.001) and a decrease of 9.99%. (5) Based on the combination of the logistic regression forward selection method and backward elimination method, variables with P < 0.05, including creatinine, age, physical activity-induced symptoms, hyperlipidaemia, diabetes and smoking history, were selected from the baseline data of patients to predict obstructive CAD. The above variables were used to establish a risk prediction model for obstructive CAD. The area under the ROC curve (AUC) of this model was 0.721, indicating good predictive ability.

In patients with suspected CCS, including typical angina, atypical angina and nonangina chest pain with abnormal electrocardiogram results, the use of CCTA as a first-line diagnostic test can reduce the unnecessary incidence of ICA and hospitalization costs without increasing the incidence of MACE. A risk prediction model of obstructive CAD was established on the basis of the baseline data of the patients enrolled in this study, providing a clinical basis for the decision to use CCTA or ICA. Patients with a low probability of obstructive CAD can be given priority for CCTA, whereas patients with a high probability can be given priority for ICA.

Single-photon emission computed tomography (SPECT) is widely used in myocardial perfusion imaging (MPI) in clinic. However, conventional dual-head SPECT scanners require lengthy scanning times and gantry rotation, which limits the application of SPECT MPI. In this work, we proposed a deep learning-based approach to reconstruct dual-view projections, aiming to reduce acquisition time and enable non-rotational imaging for MPI based on conventional dual-head SPECT scanners. U-Net was adopted for the dual-view projection reconstruction. Initially, 2D U-Nets were used to evaluate various data organization schemes for dual-view projection as input, including paved projection, interleaved projection, and stacked projection, with and without an attenuation map. Subsequently, we developed 3D U-Nets using the optimal data organization scheme as input to further enhance reconstruction performance. The dataset consisted of a total of 116 SPECT/CT scans with 99mTc-tetrofosmin tracer acquired on a GE NM/CT 640 scanner. Reconstruction performance was assessed using quantitative metrices and absolute percentage errors, while the reconstruction images from the full-view projection were used as reference images. The 2D U-Nets provided reasonable transverse view images but exhibited slight axial discontinuity compared to the reference images, regardless of the data organization schemes. Incorporating the attenuation map reduced this axial discontinuity. Quantitatively, the 2D U-Net trained using both stacked projection and attenuation map achieved the best performance, with a normalized mean absolute error of 0.6%±0.3% and a structural similarity index measure (SSIM) of 0.93±0.04. The 3D U-Net further improved the performance with less axial discontinuity and a higher SSIM of 0.94±0.03. The localized absolute percentage errors were 1.8±16.8% and -2.0±6.3% in the left ventricular (LV) cavity and myocardium, respectively. We developed a deep learning-based image reconstruction approach for dual-view projection from a conventional SPECT scanner. The 3D U-Net, trained with the stacked projection with an attenuation map is effective for non-rotational imaging and could benefit dynamic myocardium perfusion imaging.

Background: The aim of this study was to assess the effect of right ventricular diastolic dysfunction on the results of 5-year follow-up of patients after coronary artery bypass grafting (CABG). Methods: Patients were enrolled in this prospective observational study examined before planned CABG from 2017 to 2018. In addition to the baseline preoperative indicators and perioperative data, the initial parameters of the left and right ventricle (RV) systolic and diastolic function were assessed. The long-term results after CABG were assessed after 5 years. The following endpoints were recorded in the remote period: coronary and non-coronary death, non-fatal myocardial infarction (MI), repeat myocardial revascularization. Results: The results of long-term follow-up were assessed in 148 patients, during which time MACE was registered in 43 patients (29.1%). In the group with MACE before CABG, a history of myocardial infarction (p = 0.008), functional class 3 NYHA of chronic heart failure (CHF) (p = 0.013), an increase in the left ventricle size, a decrease in the e'/a' ratio (p = 0.041), and the presence of the right ventricle diastolic dysfunction (p = 0.037) were more often detected. Kaplan-Meier analysis revealed a better long-term prognosis (MACE-free survival) in the group without RVDD compared to the group with RVDD (p = 0.026). Conclusions: In patients after coronary artery bypass grafting, the development of adverse events was associated with both clinical factors and the presence of right ventricular diastolic dysfunction. Survival analysis revealed a worse prognosis in patients with preoperative RVDD compared with patients without RVDD.

Early diagnosis and localization of myocardial ischemia (MS) and coronary artery stenosis (CAS) play a crucial role in the effective prevention and management of ischemic heart disease (IHD). Magnetocardiography (MCG) has emerged as a promising approach for non-invasive, non-contact, and high-sensitivity assessment of cardiac dysfunction. This study presents a multi-center, AI-enabled diagnosis and localization of myocardial ischemia and coronary artery stenosis from MCG data. To this end, we collected a large-scale dataset consisting of 2,158 MCG recordings from eight clinical centers. We then proposed a multiscale vision transformer-based network for extracting spatio-temporal information from multichannel MCG recordings. Anatomical prior knowledge of the coronary artery and the irrigated left ventricular regions was incorporated by a carefully designed graph convolutional network (GCN)-based feature fusion module. The proposed approach achieved an accuracy of 84.7%, a sensitivity of 83.8%, and a specificity of 85.6% in diagnosing IHD, an average accuracy of 78.4% in localization of five MS regions, and an average accuracy of 65.3% in localization of stenosis in three coronary arteries. Subsequent validation on an independent validation dataset consisting of 268 MCG recordings collected from four clinical centers demonstrated an accuracy of 82.3%, a sensitivity of 83.8%, and a specificity of 81.3% in diagnosing IHD, an average accuracy of 77.3% in localization of five myocardial ischemic regions, and an average accuracy of 65.6% in localization of stenosis in three coronary arteries. The proposed approach can be used as a fast and accurate diagnosis tool, boosting the integration of MCG examination into clinical routine.

Ischemia with no obstructive coronary arteries (INOCA) is an increasingly recognized condition in patients presenting with angina and positive stress tests but without significant coronary artery stenosis. This review addresses the pathophysiology, diagnostic approaches, and management strategies associated with INOCA, emphasizing epicardial coronary spasms and coronary microvascular dysfunction (CMD) as underlying mechanisms and myocardial bridging (MB) as a risk factor. Diagnostic modalities include both non-invasive techniques and invasive procedures, such as acetylcholine provocation testing, to differentiate vasospasm from microvascular causes. The paper discusses a potential interference between vasodilators used in trans-radial access and coronary spasm testing. Long-term management approaches for INOCA patients, including pharmacologic therapies and lifestyle interventions, are reviewed.

Background: During the 2024 annual meeting in London, The European Society of Cardiology released new guidelines (GLs) on chronic coronary syndromes (CCSs) and simultaneously published them in the European Heart Journal. Method: A few experts on the topic from Europe, South America, India, and Asia, who attended the presentation and the Question and Answer sections, met virtually to comment on the GLs after carefully reading the 123-page document. Result: There is a consensus that the presented GLs are a comprehensive, up-to-date, clear document of the available data on how to diagnose and treat CCSs and a definite step forward compared to all previous GLs. Of particular value are (a) the efforts to link both diagnosis and treatment to the underlying pathophysiology with the recognition that not all the ischaemic episodes are the same; (b) the decision to adopt the graphic of the so-called "Diamond Approach", although its spirit that no antianginal drug is superior to another is not fully adopted; and (c) the innovative way it condenses and expresses the relevant messages with eye-catching illustrations. Conclusions: The present article summarises and comments on the 123-page GLs, highlighting strengths and weaknesses according to the thoughts of the authors.

To investigate the effect of periodontal therapy on endothelial function of subjects with periodontitis in stages III or IV and established cardiovascular disease.

A triple-blinded, parallel groups, randomized clinical trial of 6 months duration, on patients with history of coronary heart disease and periodontitis in stages III or IV was performed. Intervention consisted of steps 1 (oral hygiene instructions and professional mechanical plaque removal) and 2 (subgingival instrumentation) of periodontal therapy, including an antiseptic mouth rinse for 7 days. Patients in the control group received only step 1, with the adjunctive use of a fluoride-containing mouth rinse. Endothelial function (flow-mediated dilation [FMD]) and carotid intima-media thickness (cIMT) at baseline, 3 and 6 months, and serum markers of inflammation and cell adhesion at 3 days, 10 days, 3 and 6 months after therapy, were evaluated. Demographic characteristics, cardiovascular risk factors, history of cardiovascular diseases, medication intake, lipids profile, blood pressure, and periodontal outcomes were also evaluated. Student T, Mann-Whitney U, Chi-square and Fisher-exact tests were performed along with repeated measures ANOVA with post hoc Bonferroni's corrections.

Thirty-five patients were included. In the test group, improvements in pocket depth, bleeding on probing and suppuration at 6 months were significantly better than in control patients. Reductions in mean FMD [test group -3.43%; 95% confidence interval-CI [-2.68; 9.54], p = 0.487; control group -6.75%; 95% CI [1.29; 12.22], p = 0.012] and cIMT (test group -0.05 mm; 95% CI [0.01; 0.10], p = 0.014; control group -0.01 mm; 95% CI [-0.03; 0.05], p = 1.000) were observed in both groups from baseline to 6 months, without significant intergroup differences at any time-point. Differences between groups in serum inflammatory markers were detected at baseline and 3 days for interleukin (IL)-18, and at 10 days for IL-8.

Preliminary results from the present pilot study showed that steps 1 and 2 of periodontal treatment in subjects with periodontitis in stages III-IV and established cardiovascular disease induced improvements in cIMT and periodontal outcomes, although changes in FMD were not observed.

clinicaltrials.gov, Identifier, database (NCT02716259).

The present study evaluated the relationships of the serum levels of the cyclic dinucleotide 2'3'-cyclic GMP-AMP (cGAMP) marker of activation of pattern-recognition receptors with immunoglobulin G antibodies against severe acute respiratory syndrome-linked coronavirus (IgG-SARS)-positive status and endothelial dysfunction.

Selected groups from two cohorts (cohort 1 of 307 healthy volunteers and cohort 2 of 218 coronary heart disease [CHD] patients). COVID-19 infection was confirmed by detection of IgG-SARS against SARS-CoV-2 S1 protein receptor-binding domain. Cohort 1 was examined for systematic coronary risk evaluation by European Society of Cardiology (SCORE) starting from 2019 before the onset of the COVID-19 pandemic. Cohort 2 was processed starting from 2017 (three years prior to the COVID-19 pandemic) in a hospital setting to undergo coronary angiography to assess coronary lesions as Gensini score. The levels of cGAMP and endothelial markers (nitrate and nitrite combined as NOx and endothelin-1) were assessed in the serum to evaluate the associations with IgG-SARS status, SCORE, and extent of coronary lesions by correlation and receiver operating characteristic analyses.

Serum cGAMP did not discriminate between SARS-positive and SARS-negative healthy subject of cohort 1. Moreover, the level of cGAMP was not associated with endothelial biomarkers in healthy subjects. However, Serum cGAMP was associated with atherosclerosis, with area under the curve 0.69 (95 % CI 0.587-0.806; p=0.001), and with endothelial markers in cohort 2.

Low cGAMP was associated with atherosclerosis in CHD patients, suggesting that cGAMP is a new biomarker in the context of sterile inflammation.

More than 60% of patients undergoing coronary angiography present no coronary artery disease (CAD). Angina and myocardial ischemia are classically determined by epicardial vascular obstruction, but coronary microvascular dysfunction (CMD) may also represent a possible cause for these phenomena. Two endotypes of CMD have been recognized, with two different pathophysiological mechanisms: structural CMD, characterized by low coronary flow reserve (CFR) and high microvascular resistance (MVR) values; and functional CMD, characterized by low CFR and normal MVR values. According to the present data, almost half of patients with non-obstructive CAD have shown signs of CMD. For this reason, further investigations for microvascular function assessment should be considered when evaluating no-CAD patients complaining of angina or presenting signs of myocardial ischemia. The thermodilution method is currently becoming a widespread invasive technique due to its feasibility and high reproducibility for coronary physiology evaluation. Furthermore, a recently introduced technique - called continuous thermodilution - allows for direct measurement of absolute coronary flow and resistances. The role of this brand-new technique in the clinical scenario is however still to be fully investigated and its use is at present limited to research purposes only. Among no-CAD patients, both structural and functional CMD are related to a worse prognosis in term of mortality and major adverse cardiovascular events (MACE). In this review, we will discuss the present evidence supporting the definition, prevalence and clinical implication of the different forms of CMD and the technical aspects of its invasive assessment.

Recently it has been suggested that coronary microvascular dysfunction (CMD) may explain the high false-positive rate of exercise electrocardiographic stress testing (EST). However, patients with angina but non-obstructive coronary artery disease (ANOCA) present with a broader spectrum of coronary vasomotor dysfunction (CVDys), namely coronary artery spasm (CAS), CMD or a combination of both. We aim to investigate the diagnostic value of EST for the entire CVDys spectrum.

We included patients who underwent coronary function testing (CFT) in the Radboud University Medical Center. For each patient we requested the most recent EST report. ESTs were denoted as positive for ischemia if clinically significant ST-segment depression was detected. We calculated the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) with 95% confidence intervals for the diagnosis of CVDys and its endotypes.

Of the 105 included patients (87 % women, mean age 57 (±8) years), 22 (21 %) had ischemia during EST. CVDys was diagnosed in 94 patients (90 %), of whom 58 patients had an isolated endotype (CAS: n = 51, CMD: n = 7) and 36 patients had CAS and CMD. Ischemia during EST yielded a high specificity and PPV for CVDys (specificity: 100 % (71.5-100 %), PPV: 100 % (84.6-100 %)), which remained reasonably similar for CAS (specificity: 94.4 % (72.7-99.9 %), PPV: 95.5 % (77.2-99.9 %)), but was lower for CMD (specificity: 85.5 % (74.2-93.1 %), PPV: 59.1 % (36.4-79.3 %)).

Ischemia during EST is highly specific for CVDys in general and can be an indicator for CAS and to a lesser extent for CMD in patients with ANOCA.

Research on the triglyceride-glucose (TyG) index in patients with stable coronary artery disease (SCAD) remains relatively limited. Therefore, this study aims to investigate the association of the TyG index and its derived indicators, including the baseline TyG index, the baseline triglyceride glucose-body mass index (TyG-BMI), the mean TyG index, and the triglyceride glucose index-standard deviation (TyG-SD), with the prognosis of SCAD patients undergoing percutaneous coronary intervention (PCI).

This retrospective study enrolled 2,306 patients. The Cox proportional hazards model was utilized to evaluate the association between the four TyG indicators and major adverse cardiovascular and cerebrovascular events (MACCE). The predictive ability of the four TyG indicators for MACCE was assessed using the time-dependent receiver operating characteristic (ROC) curve. Kaplan-Meier survival analysis was employed to assess the prognostic differences among groups.

After a median follow-up of 26.1 months, a total of 352 patients (15.3%) experienced MACCE. The Cox regression analysis revealed that under a fully adjusted model, when the four TyG indicators were stratified by tertiles, patients in the highest tertile of each TyG indicator had a significantly increased risk of MACCE compared to those in the lowest tertile. Specifically, the hazard ratio for baseline TyG index was 1.653 (95% confidence intervals (CI): 1.234-2.214), for baseline TyG-BMI was 2.467 (95%CI: 1.849-3.293), for mean TyG index was 2.451 (95%CI: 1.794-3.349), and for TyG-SD was 1.896 (95%CI: 1.430-2.513). Time-dependent ROC curve demonstrated that the mean TyG index had the strongest predictive ability for MACCE at each follow-up time point. The Kaplan-Meier analysis results showed that when the four TyG indicators were grouped by tertiles, there were significant differences in the cumulative incidence of MACCE among the three groups for each indicator (P < 0.05).

Higher levels of the TyG index and its derived indicators were each independently and positively associated with the risk of MACCE in SCAD patients undergoing PCI. Among these indicators, the mean TyG index demonstrated the greatest predictive value for the risk of MACCE at each follow-up time point. Consequently, tracking the long-term trends of the TyG index may be prioritized in clinical practice.

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.

Remnant cholesterol (remnant-C) contributes to atherosclerotic cardiovascular disease (ASCVD), particularly in individuals with impaired glucose metabolism. Patients with impaired glucose metabolism and ASCVD remain at significant residual risk after coronary artery bypass grafting (CABG). However, the role of remnant-C in this population has not yet been investigated.

Adult patients with prediabetes or diabetes undergoing isolated CABG were consecutively enrolled in a longitudinal cohort between 2013 and 2018. The impact of remnant-C on short-term and long-term outcomes after CABG was evaluated. The short-term outcomes included major perioperative complications. The long-term outcomes were major adverse cardiovascular and cerebrovascular events (MACCEs). Remnant-C was analyzed as both a categorical and continuous variable. Logistic regression, Cox regression, and restricted cubic spline analyses were performed with multivariate adjustments.

In terms of perioperative outcomes, patients with elevated remnant-C had a higher incidence of acute kidney injury (AKI) stage 2/3 (high vs. low remnant-C: 3.2% vs. 2.4%; OR: 1.404, 95% CI 1.080-1.824). Each 1-standard deviation (SD) increase in remnant-C was associated with a 16.6% higher risk of AKI stage 2/3 (OR: 1.160, 95% CI 1.067-1.260). Long-term outcomes were assessed after a median follow-up of 3.2 years, during which 1,251 patients (9.3%) experienced MACCEs. Each 1-SD increase in remnant-C was associated with a 6.6% higher risk of MACCEs (HR: 1.066, 95% CI 1.012-1.124), a 7.1% higher risk of all-cause death (HR: 1.071, 95% CI 1.008-1.209), and an 11.2% higher risk of myocardial infarction (HR: 1.112, 95% CI 1.011-1.222). These associations remained consistent when remnant-C was treated as a categorical variable. Importantly, the association between remnant-C and MACCEs was independent of LDL-C levels; higher remnant-C levels were associated with increased MACCE risk regardless of whether LDL-C was ≤ 2.6 mmol/L or > 2.6 mmol/L. Subgroup analysis indicated that this risk was more pronounced in insulin-treated patients.

Remnant-C is associated with AKI and MACCEs in patients with diabetes or prediabetes undergoing CABG. The MACCE risk associated with remnant-C is independent of LDL-C and is more pronounced in insulin-treated patients.

Overtesting of low-risk patients with suspect chronic coronary syndrome (CCS) is widespread. The acoustic-based coronary artery disease (CAD)-score has superior rule-out capabilities when added to pre-test probability (PTP). FILTER-SCAD tested whether providing a CAD-score and PTP to cardiologists was superior to PTP alone in limiting testing.

At six Danish and Swedish outpatient clinics, patients with suspected new-onset CCS were randomized to either standard diagnostic examination (SDE) with PTP, or SDE plus CAD-score, and cardiologists provided with corresponding recommended diagnostic flowcharts. The primary endpoint was cumulative number of diagnostic tests at one year and key safety endpoint major adverse cardiac events (MACE).

In total, 2008 patients (46% male, median age 63 years) were randomized from October 2019 to September 2022. When randomized to CAD-score (n = 1002), it was successfully measured in 94.5%. Overall, 13.5% had PTP ≤ 5%, and 39.5% had CAD-score ≤ 20. Testing was deferred in 22% with no differences in diagnostic tests between groups (P for superiority = .56). In the PTP ≤ 5% subgroup, the proportion with deferred testing increased from 28% to 52% (P < .001). Overall MACE was 2.4 per 100 person-years. Non-inferiority regarding safety was established, absolute risk difference 0.49% (95% confidence interval -1.96-0.97) (P for non-inferiority = .003). No differences were seen in angina-related health status or quality of life.

The implementation strategy of providing cardiologists with a CAD-score alongside SDE did not reduce testing overall but indicated a possible role in patients with low CCS likelihood. Further strategies are warranted to address resistance to modifying diagnostic pathways in this patient population.

Exercise electrocardiogram (ECG) is frequently used for evaluating patients with suspected coronary artery disease (CAD). However, it has been downgraded in international guidelines due to a limited sensitivity and specificity, compared with other non-invasive tests.

We hypothesized, that a sufficient exertion going beyond 85% of the age predicted maximal heart rate (APMHR), by considering the achieved level of workload can improve sensitivity and specificity of the exercise ECG. Secondly, the performance of exercise ECG, when evaluated against a functional reference standard has barely been investigated, although an improved diagnostic accuracy has been reported for other non-invasive tests in this case. Therefore, in this pilot study, a total of 147 patients without known CAD who underwent exercise ECG followed by coronary angiography within 90 days were retrospectively evaluated.

The combined end point of 85% of APMHR and 75% of the predicted workload showed a slight but not statistically significant benefit over APMHR alone (66.7% vs. 58.1%; p = 0.545). The sensitivity of ST-segment depression was 51.3% for detecting anatomically defined CAD and 62.5% for functionally relevant CAD (p = 0.378).

Although the results of this pilot study lack statistical significance, the numeric differences clearly justify further research on this topic.

Acute chest pain is one of the most common reasons for ED visits in the United States. Most patients are eventually admitted to the hospital to "rule out ACS" even when there are no significant EKG abnormalities or elevated cardiac enzymes. In addition to undergoing expensive tests while in the hospital, patients are also exposed to iatrogenic harm thereby worsening the overall healthcare costs. Meanwhile, the use of coronary computed tomography angiography (CTA) as a "gatekeeper" diagnostic test for patients with low to intermediate risk for coronary artery diseases (CADs) has significantly lowered hospital admissions and associated costs. However, coronary CTA may not be helpful for all classes of patients. Therefore, this study seeks to determine if the distribution of patients presenting to the ED with chest pain in an acute care facility will justify an investment in coronary CTA and contribute to lowering healthcare costs. Patients' data between July 2022 and June 2023 were considered in our analysis. Results revealed that a significant number of patients who presented to the ED for chest pain and were subsequently admitted to the hospital for further work-up would have benefited from coronary CTA screening without any need for further inpatient work-up. Also, cost analysis showed that the use of coronary CTA would have helped significantly lower healthcare costs in this facility.

The management of myocardial infarction without ST segment elevation (NSTEMI) in elderly patients remains challenging, in particular the benefit/risk balance of routine revascularization remains uncertain.

EVAOLD is s a multicenter, prospective, open-label trial with 2 parallel arms in NSTEMI patients ≥80 years of age. The aim of the trial is to test whether a strategy of selective invasive management guided by ischemia stress imaging (IMG group) will be noninferior in preventing Major Adverse Cardiac and Cerebrovascular Events (MACCE, ie all-cause death, nonfatal myocardial infarction, nonfatal stroke) rates at 1 year compared with a routine invasive strategy (INV Group). Geriatric assessment and cost- effectiveness analysis will also be performed. A sample size of 1,756 patients (assuming a 10% rate of patients lost to follow-up) is needed to show noninferiority with 80% power. Noninferiority based on exponential survival curves will be declared if the upper limit of the 1-sided 97.5% confidence interval for the hazard ratio is lower than 1.24, corresponding to a noninferiority margin of 7% in absolute difference and an event rate of 40% in the INV group.

EVAOLD is a nationwide, prospective, open-label trial testing the noninferiority of a strategy of selective invasive management guided by ischemia stress imaging versus routine invasive strategy in elderly NSTEMI patients.

gov Identifier: NCT03289728.