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Khan I, Berge CA, Eskerud I, Larsen TH, Pedersen ER, Lønnebakken MT. Epicardial adipose tissue volume, plaque vulnerability and myocardial ischemia in non-obstructive coronary artery disease. IJC HEART & VASCULATURE 2023; 49:101240. [PMID: 38173787 PMCID: PMC10761305 DOI: 10.1016/j.ijcha.2023.101240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/17/2023] [Accepted: 06/20/2023] [Indexed: 01/05/2024]
Abstract
Background Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Whether increased EAT volume is associated with coronary plaque vulnerability and demand myocardial ischemia in patients with non-obstructive coronary artery disease (CAD) is less explored. Methods In 125 patients (median age 63[58, 69] years and 58% women) with chest pain and non-obstructive CAD, EAT volume was quantified on non-contrast cardiac CT images. EAT volume in the highest tertile (>125 ml) was defined as high EAT volume. Total coronary plaque volume and plaque vulnerability were quantified by coronary CT angiography (CCTA). Demand myocardial ischemia was detected by contrast dobutamine stress echocardiography. Results High EAT volume was more common in men and associated with higher BMI, hypertension, increased left ventricular mass index (LVMi), C-reactive protein (CRP) and positive remodelling (all p < 0.05). There was no difference in age, coronary calcium score, total and non-calcified plaque volume or presence of demand myocardial ischemia between groups (all p ≥ 0.34). In a multivariable model, obesity (p = 0.006), hypertension (p = 0.007) and LVMi (p = 0.016) were independently associated with high EAT volume. Including plaque vulnerability in an alternative model, positive remodelling (p = 0.038) was independently associated with high EAT volume. Conclusion In non-obstructive CAD, high EAT volume was associated with cardiometabolic risk factors, inflammation and plaque vulnerability, while there was no association with demand myocardial ischemia or coronary plaque volume. Following our results, the role of EAT volume as a biomarker in non-obstructive CAD remains unclear.
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Affiliation(s)
- Ingela Khan
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Caroline A. Berge
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
| | - Ingeborg Eskerud
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
| | - Terje H. Larsen
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
- Institute of Biomedicine, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway
| | - Eva R. Pedersen
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
| | - Mai Tone Lønnebakken
- Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Haukelandsveien 22, 5021 Bergen, Norway
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Zebic Mihic P, Saric S, Bilic Curcic I, Mihaljevic I, Juric I. The Association of Severe Coronary Tortuosity and Non-Obstructive Coronary Artery Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1619. [PMID: 37763738 PMCID: PMC10534717 DOI: 10.3390/medicina59091619] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/26/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: There is an increasing interest in the coronary tortuosity as a novel pathophysiological mechanism of ischemia in coronary artery disease without significant obstruction, but there are a lack of studies to confirm this relationship in the clinical setting. The aim of our study was to evaluate the association of severe coronary tortuosity and the potential role of coronary blood supply dominance in the appearance of myocardial ischemia in patients with non-obstructive coronary artery disease (non-CAD), compared to patients with obstructive coronary artery disease (CAD). Materials and Methods: The study enrolled 131 participants (71 male and 60 female), recruited among patients referred to cardiologists due to angina symptoms with ischemic alterations established by cardiac stress tests, as well as those admitted to the hospital for acute coronary syndrome. Results: Mean age of recruited patients was 61.6 (±10.1) years. According to the coronary angiography, they were divided into two groups: non-obstructive and obstructive CAD (77 and 54, respectively). There were significantly more women (61% vs. 24%, p < 0.001) in the non-CAD group. Both tortuous coronary arteries (50.6% vs. 14.8%, p < 0.001) and left coronary dominance (37.7% vs. 16.7%, p = 0.006) were more frequent in the non-CAD group compared to the CAD group. Female sex (OR = 17.516, p = 0.001), tortuous coronary arteries (OR = 7.962, p = 0.006) and left dominance of blood supply were significant predictors for non-CAD. Conclusions: Non-obstructive CAD is common among patients, especially women, who are referred for coronary angiography. Severe coronary artery tortuosity is the strongest independent predictor of non-obstructive CAD, followed by female gender and left coronary dominance.
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Affiliation(s)
- Petra Zebic Mihic
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Sandra Saric
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
| | - Ines Bilic Curcic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Endocrinology, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Ivan Mihaljevic
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
- Department of Nuclear Medicine, University Hospital Center Osijek, 31000 Osijek, Croatia
| | - Iva Juric
- Department of Cardiovascular Diseases, University Hospital Center Osijek, 31000 Osijek, Croatia
- Faculty of Medicine Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia
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Zhao X, Gong Y, Xu L, Xia L, Zhang J, Zheng D, Yao Z, Zhang X, Wei H, Jiang J, Liu H, Mao J. Entropy-based reliable non-invasive detection of coronary microvascular dysfunction using machine learning algorithm. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2023; 20:13061-13085. [PMID: 37501478 DOI: 10.3934/mbe.2023582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
PURPOSE Coronary microvascular dysfunction (CMD) is emerging as an important cause of myocardial ischemia, but there is a lack of a non-invasive method for reliable early detection of CMD. AIM To develop an electrocardiogram (ECG)-based machine learning algorithm for CMD detection that will lay the groundwork for patient-specific non-invasive early detection of CMD. METHODS Vectorcardiography (VCG) was calculated from each 10-second ECG of CMD patients and healthy controls. Sample entropy (SampEn), approximate entropy (ApEn), and complexity index (CI) derived from multiscale entropy were extracted from ST-T segments of each lead in ECGs and VCGs. The most effective entropy subset was determined using the sequential backward selection algorithm under the intra-patient and inter-patient schemes, separately. Then, the corresponding optimal model was selected from eight machine learning models for each entropy feature based on five-fold cross-validations. Finally, the classification performance of SampEn-based, ApEn-based, and CI-based models was comprehensively evaluated and tested on a testing dataset to investigate the best one under each scheme. RESULTS ApEn-based SVM model was validated as the optimal one under the intra-patient scheme, with all testing evaluation metrics over 0.8. Similarly, ApEn-based SVM model was selected as the best one under the intra-patient scheme, with major evaluation metrics over 0.8. CONCLUSIONS Entropies derived from ECGs and VCGs can effectively detect CMD under both intra-patient and inter-patient schemes. Our proposed models may provide the possibility of an ECG-based tool for non-invasive detection of CMD.
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Affiliation(s)
- Xiaoye Zhao
- School of Instrument Science and Opto-electronic Engineering, Hefei University of Technology, Hefei 230009, Anhui, China
- School of Electrical and Information Engineering, North Minzu University, Yinchuan 750001, Ningxia, China
- Key Laboratory of Atmospheric Environment Remote Sensing of Ningxia, Yinchuan 750001, Ningxia, China
| | - Yinlan Gong
- Institute of Wenzhou, Zhejiang University, Wenzhou 325000, Zhejiang, China
| | - Lihua Xu
- Hangzhou Linghua Biotech Ltd, Hangzhou 310009, Zhejiang, China
| | - Ling Xia
- Key Laboratory for Biomedical Engineering of Ministry of Education, Hangzhou 310009, Zhejiang, China
- Institute of Biomedical Engineering, Zhejiang University, Hangzhou 310009, Zhejiang, China
| | - Jucheng Zhang
- Department of Clinical Engineering, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
| | - Dingchang Zheng
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, United Kingdom
| | - Zongbi Yao
- Department of Cardiology, Ningxia Hui Autonomous Region People's Hospital, Yinchuan 750021, Ningxia, China
| | - Xinjie Zhang
- Department of Cardiology, Ningxia Hui Autonomous Region People's Hospital, Yinchuan 750021, Ningxia, China
| | - Haicheng Wei
- School of Electrical and Information Engineering, North Minzu University, Yinchuan 750001, Ningxia, China
| | - Jun Jiang
- Department of Cardiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, Zhejiang, China
| | - Haipeng Liu
- Research Centre for Intelligent Healthcare, Coventry University, Coventry, CV1 5FB, United Kingdom
| | - Jiandong Mao
- School of Instrument Science and Opto-electronic Engineering, Hefei University of Technology, Hefei 230009, Anhui, China
- School of Electrical and Information Engineering, North Minzu University, Yinchuan 750001, Ningxia, China
- Key Laboratory of Atmospheric Environment Remote Sensing of Ningxia, Yinchuan 750001, Ningxia, China
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