Extent of coronary artery disease in patients undergoing angiography for stable or acute coronary syndromes

The relationship of circulating neuregulin 4 and irisin, and traditional and novel cardiometabolic risk factors with the risk and severity of coronary artery disease

BACKGROUND AND AIMS

Neuregulin 4 (NRG4) and irisin are adipokines that have been suggested to be associated with cardiometabolic risk factors and coronary artery disease (CAD), but the data are inconclusive. This study aimed to investigate the relationship between circulating NRG4 and irisin and cardiometabolic risk factors with CAD risk and severity.

METHODS AND RESULTS

In this cross-sectional study, the presence of CAD and the severity of stenosis (gensini score) were documented based on coronary angiography in 166 adults. Circulating NRG4 and irisin, glucose homeostasis markers, hs-CRP, lipid profiles, blood pressure, and anthropometric measurements were assessed as well. Age (p = 0.005), sex (p = 0.008), SBP (p = 0.033), DBP (p = 0.04), MAP (p = 0.018), FBG (p = 0.012), insulin (p = 0.039) and HOMA-IR (p = 0.01) were significantly associated with odds of having CAD. The final logistic regression model showed that age, sex, HOMA-IR, and MAP were the most important determinants of having CAD. There were no significant associations between circulating irisin and NRG4 with odds of having CAD. The final general linear model showed that being men (β = 17.303, 95% CI: 7.086-27.52, P = 0.001), age (Aβ = 0.712, 95% CI: 0.21-1.214, P = 0.006), HOMA-IR (Aβ = 2.168, 95% CI: 0.256 to 4.079, P = 0.027), and NRG4 level (β = 1.836, 95% CI: 0.119-3.553, P = 0.036) were directly associated with higher gensini score. Participants with the three-vessel disease had a mean increase of about 5 units in circulating irisin compared to those with no clinical CAD (β = 5.221, 95% CI: 0.454-9.987, p = 0.032).

CONCLUSIONS

This study showed that the adipokines NRG4 and Irisin might be associated with the severity of coronary stenosis.

Early Diagnosis of Coronary Artery Disease by Inflammatory Biomarkers of Atherosclerosis in Patients with Angina

Early diagnosis of coronary artery disease (CAD) in patients with chest pain is a challenge. Currently diagnosis of CAD is confirmed by coronary angiography, which is invasive and not easily available in developing countries. Therefore, it is imperative to establish noninvasive biomarker for early diagnosis of CAD in patients with angina and determine the diagnostic accuracy of inflammatory biomarkers of atherosclerosis in comparison to angiography and correlate with severity of CAD in patients with angina. Diagnostic accuracy study was carried out in tertiary care hospitals, Rawalpindi, Pakistan. Total of 58 patients aged 55.24 ± 11.61 years, with chest pain and troponin-I -ve, having coronary artery stenosis ≥50% were included as cases of CAD and 55 subjects having stenosis <50% were included as controls. Nuclear factor kappa-B (NF-κB), tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), and high-sensitivity C-reactive protein (hs-CRP) were analyzed on immunoassay analyzers. The receiver operating characteristic curve analysis revealed significant (P < 0.05) high area under curve (95% confidence interval) with sensitivity and specificity of NF-κB 0.76 (0.65-0.85), 73% and 65%; TNF-α 0.72 (0.61-0.81), 71% and 69%; IL-6 0.62 (0.52-0.71), 64% and 53% and hs-CRP 0.62 (0.52-0.71), and 53% and 56% in CAD patients compared to controls. There was significant positive correlation between NF-κB (r = 0.44), TNF-α (r = 0.37), IL-6 (r = 0.23), and hs-CRP (r = 0.23) with severity of CAD by Gensini score. The inflammatory biomarkers, especially NF-κB and TNF-α, have highest diagnostic accuracy and indicate severity of atherosclerosis in patients with angina. These markers may be used as noninvasive biomarkers to exclude healthy individuals before undergoing angiography.

Plasma P-selectin level is associated with severity of coronary heart disease in Chinese Han population

Objective

This study aimed to evaluate the association between plasma P-selectin levels and the severity of coronary heart disease (CHD) in a Chinese Han population.

Methods

We enrolled 219 patients with CHD and 168 healthy individuals without CHD as a control group. Coronary stenosis was evaluated based on the number of diseased coronary arteries and the Gensini scoring system. P-selectin levels were quantified by enzyme-linked immunosorbent assay and the association between CHD and plasma P-selectin level was analyzed.

Results

P-selectin levels were significantly higher in CHD patients compared with controls. Levels were highest in patients with three-vessel disease and lowest in those with one-vessel disease, with significant differences among the groups. P-selectin levels were also highest in the high-score and lowest in the low-score group according to Gensini score, with significant differences among the groups. P-selectin level was significantly positively correlated with Gensini score and C-reactive protein level. Elevated P-selectin was identified as an independent risk factor for CHD.

Conclusion

P-selectin levels were increased in Chinese Han patients with CHD. P-selectin level is an independent risk factor for CHD and may serve as a biomarker reflecting the severity of CHD in the Chinese Han population.

Relationship between high sensitivity C-reactive protein and angiographic severity of coronary artery disease

Background

Coronary artery disease (CAD) remains a leading cause of morbidity and mortality. Cytokines play a potential role in atherosclerosis pathogenesis and progression. We investigated the association between high sensitive C-reactive protein (hsCRP) and severity of CAD.

Methods

CAD patients were stratified according to hsCRP cut-off value into high levels hsCRP group (≥ 8.4 mg/L) and low levels hsCRP group (< 8.4 mg/L). Severity of CAD was assessed according to artery stenosis degree and the number of vessel involved. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS, version 23.0).

Results

The mean age was 60.3 ± 11.0 years. The level of hsCRP was increased and ranged from 0.2 to 1020.0 mg/L. Biochemical risk factors and severity of CAD didn't show significant differences between the two groups. In multivariate linear analysis, cardiac troponin I (cTnI) and serum amyloid A (SAA) were predictors of hsCRP. As shown in receiver operating characteristic (ROC) curve analysis performed in patients with ST-segment elevation myocardial infarction (STEMI) and compared to myonecrosis biomarkers, hsCRP (area under the curve (AUC): 0.905; 95%CI: 0.844-0.966; P < 0.001) could be a powerful predictor marker in evaluating the infarct size after myocardial infarction but not better than cTnI.

Conclusions

HsCRP levels were not associated with the severity of CAD but could be useful in the evaluation of myocardial necrosis in patients with STEMI.

Predictive value of leukocyte telomere length for the severity of coronary artery disease

Aim: This study aimed to explore leukocyte telomere length (LTL) in the prediction of the severity of coronary artery disease (CAD). Materials & methods: A total of 359 CAD patients who underwent coronary angiography were enrolled in this study. Severity of coronary artery was assessed by Gensini score (GS). Results: LTL is negatively correlated with GS (Spearman's rank correlation coefficient = -0.335; p < 0.001). Multivariate logistic regression results showed that LTL was an independent predictor of high GS (p = 0.001). Area under the curve value of LTL for predicting high GS was 0.659 (p < 0.001). Conclusion: LTL could be considered as a potential predictor of the severity of coronary artery in patients with CAD.

CT coronary angiography in asymptomatic male patients with high atherosclerosis risk: Is it justified?

PURPOSE

To study the necessity of coronary artery screening with computerized tomography coronary angiography (CTCA) in asymptomatic male patients.

MATERIAL AND METHODS

A total of 226 asymptomatic male patients aged over 50 years were included in this prospective study, according to a clinical protocol approved by the Heraklion University Hospital's Ethics Committee. All participants had at least 3 or more known atherosclerosis risk factors. All patients had none or normal noninvasive cardiological tests in the past and had no contraindications for CTCA. All patients gave their informed consent after being notified regarding contrast medium and radiation dose risks.

RESULTS

Significant stenoses were found in 52 asymptomatic males (23%). Out of them, 38 male patients underwent invasive coronography and 14 patients were lost in follow-up. In 18 patients, no lesions were found (47.4%). In the other 20 (52.6%) patients, 28 lesions were found. Stent placement was performed in 11 patients, bypass surgery was proposed in 3 patients, and in another 6 patients conservative treatment was suggested. Patients with findings in CTCA were more likely to have a family history of coronary artery disease, compared to patients with normal CTCA (P < 0.05 by using Fischer's Exact Test). Sensitivity of CTCA for significant stenosis was 74.3% with a specificity of 62%.

CONCLUSION

CTCA may be used to screen for clinically significant coronary artery disease (CAD) in asymptomatic male patients, particularly those with positive family history or potentially high-risk patients with >3 risk factors for CAD.

Osteoprotegerin and Osteopontin Serum Levels are Associated with Vascular Function and Inflammation in Coronary Artery Disease Patients

BACKGROUND

Osteoprotegerin and osteopontin have recently emerged as key factors in both vascular remodelling and atherosclerosis progression. Interleukin-6 (IL-6) is an inflammatory cytokine with a key role in atherosclerosis. The relationship of osteoprotegerin, osteopontin, and IL-6 serum levels with endothelial function and arterial stiffness was evaluated in patients with coronary artery disease (CAD).

METHODS

We enrolled 219 patients with stable CAD and 112 control subjects. Osteoprotegerin, osteopontin and IL-6 serum levels were measured using an ELISA assay. Endothelial function was evaluated by flow-mediated dilation (FMD) in the brachial artery and carotid-femoral pulse wave velocity (PWV) was measured as an index of aortic stiffness.

RESULTS

There was no significant difference between control subjects and CAD patients according to age and sex. Compared with control subjects, CAD patients had significantly impaired FMD (p<0.001) and increased PWV (p=0.009). CAD patients also had significantly higher levels of osteoprotegerin (p<0.001), osteopontin (p<0.001) and IL-6 (p=0.03), compared with control subjects. Moreover, IL-6 levels were correlated with osteoprotegerin (r=0.17, p=0.01) and osteopontin (r=0.30, p<0.001) levels. FMD was correlated with osteoprotegerin levels independent of possible confounders [b coefficient= - 0.79, 95% CI (-1.54, -0.05), p=0.04].

CONCLUSION

CAD patients have increased osteoprotegerin, osteopontin and IL-6 levels. Moreover, there is a consistent association between osteoprotegerin and osteopontin serum levels, vascular function and inflammation in CAD patients. These findings suggest another possible mechanism linking osteoprotegerin and osteopontin serum levels with CAD progression through arterial wall stiffening and inflammation.

Correlation between Gensini Score and Duration of Diabetes in Patients Undergoing Coronary Angiography

Introduction The relationship between the duration of diabetes mellitus and coronary artery disease (CAD) is well established. Moreover, the Gensini score system is a reliable assessment tool for the severity of coronary artery disease (CAD). After an extensive literature search, we found that there is a knowledge gap about the relationship between the Gensini score and the duration of diabetes in our population. Therefore, the aim of this study was to find the relationship between the Gensini score and the duration of diabetes in patients undergoing a coronary angiography. Methods A cross-sectional study was conducted among 321 consecutively selected diabetic patients. Clinically diagnosed cases of diabetes on proper anti-diabetic treatment were included in this study. Patients with known severe CAD or history of coronary artery bypass grafting (CABG) surgery or primary coronary intervention (PCI) were excluded from the study. Coronary angiography was performed on all the patients and their Gensini score was calculated using the modified scoring schema. Duration of diabetes and other baseline risk factors were recorded for all patients. The relationship between the Gensini score and the duration of diabetes was assessed by calculating Pearson's correlation coefficient.  Results A total of 321 diabetic patients were included in this study, out of which 67.9% (218) were men and mean ± standard deviation age was 56.13 ± 7.67 years ranging between 40 to 70 years with a majority of the patients, 63.9% (205), being under 60 years of age. Along with diabetes, the most commonly observed risk factor was hypertension, which was observed in 77.6% (249) of the patients. Smoking and obesity were also observed in 18.7% (60) and 17.4% (56) of the patients, respectively. A significant positive correlation, 0.55 (p<0.001), was observed between the duration of diabetes and the Gensini scores. The correlation was found to be stronger in older patients (more than 60 years of age) with a correlation coefficient of 0.52 vs. 0.38, and male patients with correlation coefficients of 0.66 vs. 0.34. Conclusion A significant positive correlation between the Gensini score and the duration of diabetes mellitus was observed. This correlation is relatively stronger among male and older patients (more than 60 years of age).