A device-related fistula between coronary artery and left atrial appendage following left atrial appendage closure: Case presentation

INTRODUCTION

Left atrial appendage (LAA) closure (LAAC) is considered a viable alternative to anticoagulation therapy for stroke prevention in nonvalvular atrial fibrillation, we report a case with a less common shunt resulting from a device-related coronary artery-appendage fistula (CAAF) following LAAC.

METHODS AND RESULTS

A 67-year-old male with a history of LAAC was referred to our emergency room with recurrent chest pain and palpitations and was diagnosed with ischemic angina pectoris. Subsequent coronary angiography (CAG) revealed 70% in-stent restenosis and an abnormal shunt of contrast originating from the left circumflex artery (LCA) to the LAA tip which did not exist before. The restenosis was successfully dilated using a drug-coated balloon, the procedure was safely completed without pericardial effusion. The patient had been implanted with a LAmbre occluder (Lifetech Scientific Corp.) in the previous LAAC procedure. This occluder had a lobe-disk design, and the distal umbrella was not fully opened after release, particularly in the lower portion. This could make the hooks embedded on the umbrella contact the LAA wall more tightly, possibly resulting in microperforation and coincidental impingement of the LCA. The epicardial adipose and hyperplastic tissue then chronically wrapped the perforated site, prevented blood outflow into the epicardium, and ultimately formed a CAAF.

CONCLUSION

CAAF is a rare complication after LAAC but may be underestimated, especially for lobe-disk designed occluders. Therefore, CAG is perhaps necessary to detect this complication.

Intramural coronary artery and myocardial pathology in captive tigers (Panthera tigris) and African lions (Panthera leo)

There is limited published data regarding cardiovascular disease in nondomestic felid populations. To address this knowledge gap, necropsy cases of tigers and lions with representative myocardial samples submitted to a diagnostic laboratory were histologically assessed with hematoxylin and eosin and Sirius red stains. A total of 32 submissions (15 tigers, 17 lions) were identified in a 4-year period. All tigers and lions had some degree of coronary artery lesions in the left ventricle and/or interventricular septum. Major findings included moderate to marked arteriosclerosis in 8 tigers (53%) and 4 lions (24%) and moderate to marked perivascular fibrosis in 10 tigers (67%) and 9 lions (53%). Moreover, 10 tigers (67%) and 8 lions (47%) had coronary artery lesions with variable degrees of perivascular cardiomyocyte degeneration and/or loss. To our knowledge, this is the first report describing coronary artery pathology in captive tigers and lions.

Progeria-based vascular model identifies networks associated with cardiovascular aging and disease

Hutchinson-Gilford Progeria syndrome (HGPS) is a lethal premature aging disorder caused by a de novo heterozygous mutation that leads to the accumulation of a splicing isoform of Lamin A termed progerin. Progerin expression deregulates the organization of the nuclear lamina and the epigenetic landscape. Progerin has also been observed to accumulate at low levels during normal aging in cardiovascular cells of adults that do not carry genetic mutations linked with HGPS. Therefore, the molecular mechanisms that lead to vascular dysfunction in HGPS may also play a role in vascular aging-associated diseases, such as myocardial infarction and stroke. Here, we show that HGPS patient-derived vascular smooth muscle cells (VSMCs) recapitulate HGPS molecular hallmarks. Transcriptional profiling revealed cardiovascular disease remodeling and reactive oxidative stress response activation in HGPS VSMCs. Proteomic analyses identified abnormal acetylation programs in HGPS VSMC replication fork complexes, resulting in reduced H4K16 acetylation. Analysis of acetylation kinetics revealed both upregulation of K16 deacetylation and downregulation of K16 acetylation. This correlates with abnormal accumulation of error-prone nonhomologous end joining (NHEJ) repair proteins on newly replicated chromatin. The knockdown of the histone acetyltransferase MOF recapitulates preferential engagement of NHEJ repair activity in control VSMCs. Additionally, we find that primary donor-derived coronary artery vascular smooth muscle cells from aged individuals show similar defects to HGPS VSMCs, including loss of H4K16 acetylation. Altogether, we provide insight into the molecular mechanisms underlying vascular complications associated with HGPS patients and normative aging.

Asymmetric Dimethylarginine Enables Depolarizing Spikes and Vasospasm in Mesenteric and Coronary Resistance Arteries

BACKGROUND

Increased vasoreactivity due to reduced endothelial NO bioavailability is an underlying feature of cardiovascular disease, including hypertension. In small resistance arteries, declining NO enhances vascular smooth muscle (VSM) reactivity partly by enabling rapid depolarizing Ca2+-based spikes that underlie vasospasm. The endogenous NO synthase inhibitor asymmetric dimethylarginine (ADMA) is metabolized by DDAH1 (dimethylarginine dimethylaminohydrolase 1) and elevated in cardiovascular disease. We hypothesized ADMA might enable VSM spikes and vasospasm by reducing NO bioavailability, which is opposed by DDAH1 activity and L-arginine.

METHODS

Rat isolated small mesenteric arteries and myogenic rat-isolated intraseptal coronary arteries (RCA) were studied using myography, VSM intracellular recording, Ca2+ imaging, and DDAH1 immunolabeling. Exogenous ADMA was used to inhibit NO synthase and a selective DDAH1 inhibitor, NG-(2-methoxyethyl) arginine, to assess the functional impact of ADMA metabolism.

RESULTS

ADMA enhanced rat-isolated small mesenteric arteries vasoreactivity to the α1-adrenoceptor agonist, phenylephrine by enabling T-type voltage-gated calcium channel-dependent depolarizing spikes. However, some endothelium-dependent NO-vasorelaxation remained, which was sensitive to DDAH1-inhibition with NG-(2-methoxyethyl) arginine. In myogenically active RCA, ADMA alone stimulated depolarizing Ca2+ spikes and marked vasoconstriction, while NO vasorelaxation was abolished. DDAH1 expression was greater in rat-isolated small mesenteric arteries endothelium compared with RCA, but low in VSM of both arteries. L-arginine prevented depolarizing spikes and protected NO-vasorelaxation in rat-isolated small mesenteric artery and RCA.

CONCLUSIONS

ADMA increases VSM electrical excitability enhancing vasoreactivity. Endothelial DDAH1 reduces this effect, and low levels of DDAH1 in RCAs may render them susceptible to endothelial dysfunction contributing to vasospasm, changes opposed by L-arginine.

Sorbs2 Deficiency and Vascular BK Channelopathy in Diabetes

BACKGROUND

Vascular large conductance Ca2+-activated K+ (BK) channel, composed of the α-subunit (BK-α) and the β1-subunit (BK-β1), is a key determinant of coronary vasorelaxation and its function is impaired in diabetic vessels. However, our knowledge of diabetic BK channel dysregulation is incomplete. The Sorbs2 (Sorbin homology [SoHo] and Src homology 3 [SH3] domains-containing protein 2), is ubiquitously expressed in arteries, but its role in vascular pathophysiology is unknown.

METHODS

The role of Sorbs2 in regulating vascular BK channel activity was determined using patch-clamp recordings, molecular biological techniques, and in silico analysis.

RESULTS

Sorbs2 is not only a cytoskeletal protein but also an RNA-binding protein that binds to BK channel proteins and BK-α mRNA, regulating BK channel expression and function in coronary smooth muscle cells. Molecular biological studies reveal that the SH3 domain of Sorbs2 is necessary for Sorbs2 interaction with BK-α subunits, while both the SH3 and SoHo domains of Sorbs2 interact with BK-β1 subunits. Deletion of the SH3 or SoHo domains abolishes the Sorbs2 effect on the BK-α/BK-β1 channel current density. Additionally, Sorbs2 is a target gene of the Nrf2 (nuclear factor erythroid-2-related factor 2), which binds to the promoter of Sorbs2 and regulates Sorbs2 expression in coronary smooth muscle cells. In vivo studies demonstrate that Sorbs2 knockout mice at 4 months of age display a significant decrease in BK channel expression and function, accompanied by impaired BK channel Ca2+-sensitivity and BK channel-mediated vasodilation in coronary arteries, without altering their body weights and blood glucose levels. Importantly, Sorbs2 expression is significantly downregulated in the coronary arteries of db/db type 2 diabetic mice.

CONCLUSIONS

Sorbs2, a downstream target of Nrf2, plays an important role in regulating BK channel expression and function in vascular smooth muscle cells. Vascular Sorbs2 is downregulated in diabetes. Genetic knockout of Sorbs2 manifests coronary BK channelopathy and vasculopathy observed in diabetic mice, independent of obesity and glucotoxicity.

Study on the related factors of TCM constitution and hemodynamics in patients with coronary heart disease

Background

The concepts of "individualization" and "preventive treatment" should be incorporated into the precise diagnosis and treatment of coronary heart disease (CHD). Both hemodynamics and Chinese medicine constitution studies align with these two concepts.

Methods

This study utilized data from 81 patients with CHD, including 12 patients with balanced constitution (BC), 20 patients with blood stasis constitution (BSC), 17 patients with phlegm-dampness constitution (PDC), 15 patients with qi-deficiency constitution (QDC), and 17 patients with other constitutions. Clinical data provided information on the patients' blood property, heart function, degree of coronary stenosis, coronary hemodynamics, and so on. These parameters were compared between patients with balanced constitution vs. biased constitutions as well as between those with blood stasis constitution, phlegm-dampness constitution, and qi-deficiency constitution.

Results

Compared to biased constitution (BC), patients with balanced constitution exhibited lower total cholesterol (TC) levels and low-density lipoprotein (LDL) levels. Additionally, they had lighter stenosis degrees in the Left anterior descending branch (LAD) and Left circumflex branch (LCX) branches. The hemodynamic condition of the LAD and LCX was better for those with balanced constitution; however there was no difference in heart function. Among the groups categorized by blood stasis, phlegm dampness or qi deficiency constituions, patients classified under phlegm dampness had higher levels of LDL compared to those classified under blood stasis or qi deficiency, while patients classified under qi deficiency had higher levels of blood glucose compared to those classified under blood stasis or phlegm dampness. Hemodynamic environments also differed among the LAD and LCX for each group but there were no significant differences observed in heart function or degree of coronary stenosis among these three groups.

Conclusion

The balanced constitution demonstrates superior blood property, degree of coronary artery stenosis, and coronary hemodynamics compared to the biased constitution. Furthermore, among the three constitutions with CHD, variations in blood property and certain hemodynamic parameters are observed. These findings emphasize the significant clinical value of incorporating physical factors into the diagnosis and treatment of patients with CHD.

Incidentally discovered cold hemagglutinins within autologous blood bag and cardioplegia line in a patient with a recent history of COVID-19 undergoing coronary artery surgery

INTRODUCTION

Cold agglutinin disease (CAD) is a rare autoimmune disorder characterized by destruction (hemolysis) of erythrocytes. In CAD, autoantibodies that cause agglutination at temperature of optimum +3-+4 ℃ degree cause symptoms. It is known that CAD often occurs after viral infections. Also, it has been reported in case reports that COVID-19 disease can cause CAD.

CASE REPORT

46-year-old male patient with a history of diabetes mellitus and hypertension presented to outpatient clinic in our department to have CABG surgery. He recovered from COVID-19 disease 1.5 months ago. Cardiopulmonary bypass was initiated and the cross-clamp was placed and antegrade Delnido cardioplegia solution was started to be given at +4 ℃. It was observed that the cardioplegia line was agglutinated. On the other hand, it was seen that the autologous blood taken by the anesthesiologist was also agglutinated and formed air bubbles and became unusable. X-clamp was removed and the heart rhythm recovered. The patient was consulted to hematology during postoperative intensive care follow-ups. The cold agglutinin test performed at of +4 ℃ was reported as positive. In this case, we associated the CAD with covid-19 for three main reasons. First one, the patient's complaints about CAD started after COVID-19 disease. Secondly, in the national health archive, the patient's pre-COVID-19 blood tests were completely normal but it was seen that LDH increased and RBC-HCT incompatibility started after COVID-19. As the third, when we search the literature, we have seen the COVID-19 related CAD in many case reports published by hematologists.

CONCLUSION

With the rare cold agglutinin disease, it seems that we will encounter it more often after the COVID-19 pandemic. Except for deep hypothermia, the most important problem is seen during cardioplegia administration. Therefore, non-blood cardioplegia can be lifesaving.

Monolithic Integration of Ultraslim Flow Sensor and Medical Guidewire by Laser Filament Scanning Sintering for In Vivo Diagnostics of Cardiovascular Diseases

In this study, an ultraslim thermal flow sensor system integrated onto a 340 μm diameter medical guidewire was developed using a laser filament scanning sintering method for the early diagnosis of cardiovascular diseases. The proposed system is a calorimetric-based micro thermal flow sensor comprising a microheater and two thermistors. Prior to fabrication, the sensor design was optimized through flow simulation, and the patterned sensor was successfully implemented on a thin and curved surface of the medical guidewire using a laser patterning method with Ag nanoparticles. The performance of the ultraslim thermal flow sensor-on-guidewire system (SoW) was evaluated under pulsatile flow by using an artificial heartbeat simulator with differentially induced fluid flow velocities of up to 60 cm/s. The resulting electrical signals generated by the temperature difference between the two thermistors caused by the fluid flow were measured across different velocity ranges. Based on the obtained data, a calibration curve was derived to establish the relationship between the fluid velocity and the sensor output voltage. Furthermore, the SoW was tested on living animals, whereby the measured blood flow velocities were 60-90 cm/s in the left coronary artery of pigs. This research demonstrates the potential of ultraslim microsensors, such as the developed thermal flow sensor system, for various industries, particularly in the medical field.

The effect of ultrasound-assisted thrombolysis studied in blood-on-a-chip

BACKGROUND

Thromboembolism, which leads to pulmonary embolism and ischemic stroke, remains one of the main causes of death. Ultrasound-assisted thrombolysis (UAT) is an effective thrombolytic method. However, further studies are required to elucidate the mechanism of ultrasound on arterial and venous thrombi.

METHODS

We employed the blood-on-a-chip technology to simulate thrombus formation in coronary stenosis and deep vein valves. Subsequently, UAT was conducted on the chip to assess the impact of ultrasound on thrombolysis under varying flow conditions. Real-time fluorescence was used to assess thrombolysis and drug penetration. Finally, scanning electron microscopy and immunofluorescence were used to determine the effect of ultrasound on fibrinolysis.

RESULTS

The study revealed that UAT enhanced the thrombolytic rate by 40% in the coronary stenosis chip and by 10% in the deep venous valves chip. This enhancement is attributed to the disruption of crosslinked fibrin fibers by ultrasound, leading to increased urokinase diffusion within the thrombus and accumulation of plasminogen on the fibrinogen α chain. Moreover, the acceleration of the dissolution rate of thrombi in the venous valve chip by ultrasound was not as significant as that in the coronary stenosis chip.

CONCLUSION

These findings highlight the differential impact of ultrasound on thrombolysis under various flow conditions and emphasize the valuable role of the blood-on-a-chip technology in exploring thrombolysis mechanisms.

The role of computed tomography angiography in assessing the correlation between properties of coronary atherosclerotic plaque and blood lipids

BACKGROUND

Coronary atherosclerotic heart disease (CAHD) is the leading cause of death in developed countries.

OBJECTIVE

This study aimed to explore the correlation between the properties of coronary atherosclerotic plaque and blood lipids using computed tomography angiography (CTA).

METHODS

A total of 83 patients with coronary heart disease were included in this study (males: 50; females: 33; average age: [59 ± 8] years old). They were classified into the stable angina group and unstable angina group. Atherosclerotic plaques were classified as fatty plaques (soft plaques), fibrous plaques, and calcified plaques based on the computed tomography (CT) values. SPSS 17.0 statistical software was used to analyze the correlation between the properties of angina and the CT values of atherosclerotic plaques, blood lipids, and plaque properties, and then compared between the stable and unstable angina groups.

RESULTS

There were statistically significant differences in plaque properties between the stable and unstable angina groups (P< 0.001). During CTA examination, we found statistically significant differences in the CT density values of atherosclerotic plaques between the stable and unstable angina groups (P< 0.001). There were statistically significant differences between the properties of angina and the level of blood lipids (P< 0.05).

CONCLUSION

Anginal properties negatively correlated with calcified plaques and positively correlated with non-calcified plaques. Calcified plaques negatively correlated with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and triglycerides (TG), and positively correlated with high-density lipoprotein cholesterol (HDL-C). Non-calcified plaques negatively correlated with HDL-C and positively correlated with TC, LDL-C, and TG.

Motion artifact correction in cardiac CT using cross-phase temporospatial information and synergistic attention gate and spatial transformer sub-networks

Objectives.To improve quality of coronary CT angiography (CCTA) images using a generalizable motion-correction algorithm.Approach. A neural network with attention gate and spatial transformer (ATOM) was developed to correct coronary motion. Phantom and patient CCTA images (39 males, 32 females, age range 19-92, scan date 02/2020 to 10/2021) retrospectively collected from dual-source CT were used to create training, development, and testing sets corresponding to 140- and 75 ms temporal resolution, with 75 ms images as labels. To test generalizability, ATOM was deployed for locally adaptive motion-correction in both 140- and 75 ms patient images. Objective metrics were used to assess motion-corrupted and corrected phantom and patient images, including structural-similarity-index (SSIM), dice-similarity-coefficient (DSC), peak-signal-noise-ratio (PSNR), and normalized root-mean-square-error (NRMSE). In objective quality assessment, ATOM was compared with several baseline networks, including U-net, U-net plus attention gate, U-net plus spatial transformer, VDSR, and ResNet. Two cardiac radiologists independently interpreted motion-corrupted and -corrected images at 75 and 140 ms in a blinded fashion and ranked diagnostic image quality (worst to best: 1-4, no ties).Main results. ATOM improved quality metrics (p< 0.05) before/after correction: in phantom, SSIM 0.87/0.95, DSC 0.85/0.93, PSNR 19.4/22.5, NRMSE 0.38/0.27; in patient images, SSIM 0.82/0.88, DSC 0.88/0.90, PSNR 30.0/32.0, NRMSE 0.16/0.12. ATOM provided more consistent improvement of objective image quality, compared to the presented baseline networks. The motion-corrected images received better ranks than un-corrected at the same temporal resolution (p< 0.05): 140 ms images 1.65/2.25, and 75 ms images 3.1/3.2. The motion-corrected 75 ms images received the best rank in 65% of testing cases. A fair-to-good inter-reader agreement was observed (Kappa score 0.58).Significance. ATOM reduces motion artifacts, improving visualization of coronary arteries. This algorithm can be used to virtually improve temporal resolution in both single- and dual-source CT.

Multi-ancestry genetic analysis of gene regulation in coronary arteries prioritizes disease risk loci

Genome-wide association studies (GWASs) have identified hundreds of risk loci for coronary artery disease (CAD). However, non-European populations are underrepresented in GWASs, and the causal gene-regulatory mechanisms of these risk loci during atherosclerosis remain unclear. We incorporated local ancestry and haplotypes to identify quantitative trait loci for expression (eQTLs) and splicing (sQTLs) in coronary arteries from 138 ancestrally diverse Americans. Of 2,132 eQTL-associated genes (eGenes), 47% were previously unreported in coronary artery; 19% exhibited cell-type-specific expression. Colocalization revealed subgroups of eGenes unique to CAD and blood pressure GWAS. Fine-mapping highlighted additional eGenes, including TBX20 and IL5. We also identified sQTLs for 1,690 genes, among which TOR1AIP1 and ULK3 sQTLs demonstrated the importance of evaluating splicing to accurately identify disease-relevant isoform expression. Our work provides a patient-derived coronary artery eQTL resource and exemplifies the need for diverse study populations and multifaceted approaches to characterize gene regulation in disease processes.

Positive Echocardiographic Association between Carotid Artery and Coronary Artery Diameter and Z-Score in a Mouse Model of Kawasaki Disease

Kawasaki disease (KD) occurs in young children, has an unknown etiology, and can cause such life-threatening complications as coronary artery aneurysm. A mouse model using Lactobacillus casei cell wall extract (LCWE) with intraperitoneal injection was established for KD years ago. Histological examination of coronary artery lesions indicated features similar to those of vascular lesions of patients with KD. Since animals must be sacrificed during histological examination, the longitudinal survey of coronary artery lesions (CALs) is difficult. The aim of this study was to survey the vasculitis status of the coronary artery and the carotid artery in a KD mouse model.

METHOD

LCWE was intraperitoneally injected into 5-week-old male C57BL/6 mice to induce CALs. We studied the longitudinal status of the carotid and coronary arteries and analyzed the Z-score of coronary artery diameter.

RESULTS

Carotid artery wall thickness (day 7) and diameter (day 14) significantly increased in the LCWE group with a dose-dependent effect (p < 0.05). Aortic diameter and wall thickness demonstrated significant increases on day 28 and day 7, respectively (p < 0.05). Carotid artery outer diameter and wall thickness were positively associated with coronary artery diameter on day 28 (p < 0.01). Coronary artery diameter significantly increased in the LCWE group after day 7 (p < 0.05). The percentage of Z > 3.0 indicated was more than 80% in the high-dose LCWE group and 0% in the control group.

CONCLUSIONS

This report is the first to use coronary artery Z-score in a mouse model of KD by echocardiography and to find a positive association between carotid artery and coronary artery diameter.

Mitochondrial Melatonin: Beneficial Effects in Protecting against Heart Failure

Cardiovascular disease is the cause of physical infirmity and thousands of deaths annually. Typically, during heart failure, cardiomyocyte mitochondria falter in terms of energy production and metabolic processing. Additionally, inflammation and the accumulation of non-contractile fibrous tissue contribute to cardiac malfunction. Melatonin, an endogenously produced molecule, experimentally reduces the initiation and progression of atherosclerotic lesions, which are often the basis of coronary artery disease. The current review critically analyzes published data related to the experimental use of melatonin to forestall coronary artery pathologies. Collectively, these studies document melatonin's anti-atherosclerotic actions in reducing LDL oxidation and triglyceride levels, lowering endothelial malfunction, limiting adhesion molecule formation, preventing macrophage polarization to the M1 pro-inflammatory phenotype, changing cellular metabolism, scavenging destructive reactive oxygen species, preventing the proliferation and invasion of arterial smooth muscle cells into the lesioned area, restricting the ingrowth of blood vessels from the vasa vasorum, and solidifying the plaque cap to reduce the chance of its rupture. Diabetic hyperglycemia, which aggravates atherosclerotic plaque formation, is also inhibited by melatonin supplementation in experimental animals. The potential value of non-toxic melatonin as a possible inhibitor of cardiac pathology in humans should be seriously considered by performing clinical trials using this multifunctional molecule.

Prediction of Hemodynamic-Related Hemolysis in Carotid Stenosis and Aiding in Treatment Planning and Risk Stratification Using Computational Fluid Dynamics

Atherosclerosis affects human health in many ways, leading to disability or premature death due to ischemic heart disease, stroke, or limb ischemia. Poststenotic blood flow disruption may also play an essential role in artery wall impairment linked with hemolysis related to shear stress. The maximum shear stress in the atherosclerotic plaque area is the main parameter determining hemolysis risk. In our work, a 3D internal carotid artery model was built from CT scans performed on patients qualified for percutaneous angioplasty due to its symptomatic stenosis. The obtained stenosis geometries were used to conduct a series of computer simulations to identify critical parameters corresponding to the increase in shear stress in the arteries. Stenosis shape parameters responsible for the increase in shear stress were determined. The effect of changes in the carotid artery size, length, and degree of narrowing on the change in maximum shear stress was demonstrated. Then, a correlation for the quick initial diagnosis of atherosclerotic stenoses regarding the risk of hemolysis was developed. The developed relationship for rapid hemolysis risk assessment uses information from typical non-invasive tests for treated patients. Practical guidelines have been developed regarding which stenosis shape parameters pose a risk of hemolysis, which may be adapted in medical practice.

Atherosclerosis plaque tissue classification using self-attention-based conditional variational auto-encoder generative adversarial network using OCT plaque image

Adults with coronary artery disease often have atherosclerosis, this is defined as the accumulation of plaque in the tissues of the arterial wall. Cardiologists utilize optical coherence tomography (OCT), a light-based imaging method, to examine the layers of intracoronary tissue along pathological formations, such as plaque accumulation. Intracoronary cross-sectional images produced by state-of-the-art catheter-based imaging scheme have 10-15 µm high resolution. Nevertheless, interpretation of the obtained images depends on the operator, which takes a lot of time and is exceedingly error-prone from one observer to another. OCT image post-processing that automatically and accurately tags coronary plaques can help the technique become more widely used and lower the diagnostic error rate. To overcome these problems, Atherosclerosis plaque tissue classification using Self-Attention-Based Conditional Variational Auto-Encoder Generative Adversarial Network (APC-OCTPI-SACVAGAN) is proposed which classifies the Atherosclerosis plaque images as Fibro calcific plaque, Fibro atheroma, Thrombus, Fibrous plaque and Micro-vessel. The proposed APC-OCTPI-SACVAGAN technique is executed in MATLAB. The efficiency of proposed APC-OCTPI-SACVAGAN method attains 16.19 %, 17.93 %, 19.81 % and 1.57 % higher accuracy; 16.92 %, 11.54 %, 5.29 % and 1.946 % higher Area under curve; and 28.06 %, 25.32 %, 32.19 % and 39.185 % lower computational time comparing to the existing methods respectively.

IgG4-related disease involving coronary and pulmonary arteries: a case report and literature review

Background

IgG4-related disease (IgG4-RD) is an inflammation-mediated autoimmune disease characterized by infiltration of IgG4 plasma cells in target organs, storiform fibrosis and obliterative phlebitis, accompanied by or without elevated serum IgG4 concentrations. Multiple sites can be involved, including large vessels. Coronary and pulmonary arteries are less involved, while simultaneous involvement of coronary and pulmonary arteries is less reported. This case is unique in terms of simultaneous involvement of coronary and pulmonary arteries in a female patient with possible IgG4-RD and the first review of relevant domestic literature.

Case Description

This case is a middle-aged female patient with both coronary artery and pulmonary artery involvement, with cardiac insufficiency as the main manifestation. Cardiac ultrasound revealed the cardiac insufficiency and abnormal wrapping of multiple arteries. Imaging examinations including coronary artery computed tomography angiography (CTA), pulmonary artery CTA and cardiac magnetic resonance imaging (MRI) further confirmed the lesions of the left main coronary artery, anterior descending branch, circumflex branch and pulmonary artery. Then the patient was diagnosed with possible IgG4-RD. After glucocorticoid treatment, the patient's clinical symptoms and cardiac function improved, and her serum IgG4 levels decreased.

Conclusions

When the arterial system is involved in IgG4 disease, it is known as IgG4-related artery disease. Combined with the case of this patient, this paper reviewed the literature on IgG4-related artery disease, and searched and summarized the related domestic literature on coronary/pulmonary artery disease to improve people's understanding of IgG4-related artery disease.

Coil Embolization of a Left Anterior Descending Coronary Artery-Pulmonary Artery Fistula: A Case Report

Coronary artery fistulas may be defined as abnormal connections between a coronary artery and either a heart chamber or the pulmonary artery. Although usually asymptomatic, they can become enlarged and rupture in rare instances, requiring prompt intervention. We present a case of a 66-year-old male patient with a left anterior descending-pulmonary artery fistula managed with coil embolization.

Automated Coronary Artery Tracking with a Voronoi-Based 3D Centerline Extraction Algorithm

Coronary artery disease is one of the leading causes of death worldwide, and medical imaging methods such as coronary artery computed tomography are vitally important in its detection. More recently, various computational approaches have been proposed to automatically extract important artery coronary features (e.g., vessel centerlines, cross-sectional areas along vessel branches, etc.) that may ultimately be able to assist with more accurate and timely diagnoses. The current study therefore validated and benchmarked a recently developed automated 3D centerline extraction method for coronary artery centerline tracking using synthetically segmented coronary artery models based on the widely used Rotterdam Coronary Artery Algorithm Evaluation Framework (RCAAEF) training dataset. Based on standard accuracy metrics and the ground truth centerlines of all 32 coronary vessel branches in the RCAAEF training dataset, this 3D divide and conquer Voronoi diagram method performed exceptionally well, achieving an average overlap accuracy (OV) of 99.97%, overlap until first error (OF) of 100%, overlap of the clinically relevant portion of the vessel (OT) of 99.98%, and an average error distance inside the vessels (AI) of only 0.13 mm. Accuracy was also found to be exceptionally for all four coronary artery sub-types, with average OV values of 99.99% for right coronary arteries, 100% for left anterior descending arteries, 99.96% for left circumflex arteries, and 100% for large side-branch vessels. These results validate that the proposed method can be employed to quickly, accurately, and automatically extract 3D centerlines from segmented coronary arteries, and indicate that it is likely worthy of further exploration given the importance of this topic.

Gβγ subunit signalling underlies neuropeptide Y-stimulated vasoconstriction in rat mesenteric and coronary arteries

BACKGROUND AND PURPOSE

Raised serum concentrations of the sympathetic co-transmitter neuropeptide Y (NPY) are linked to cardiovascular diseases. However, the signalling mechanism for vascular smooth muscle (VSM) constriction to NPY is poorly understood. Therefore, the present study investigated the mechanisms of NPY-induced vasoconstriction in rat small mesenteric (RMA) and coronary (RCA) arteries.

EXPERIMENTAL APPROACH

Third-order mesenteric or intra-septal arteries from male Wistar rats were assessed in wire myographs for isometric tension, VSM membrane potential and VSM intracellular Ca2+ events.

KEY RESULTS

NPY stimulated concentration-dependent vasoconstriction in both RMA and RCA, which was augmented by blocking NO synthase or endothelial denudation in RMA. NPY-mediated vasoconstriction was blocked by the selective Y1 receptor antagonist BIBO 3304 and Y1 receptor protein expression was detected in both the VSM and endothelial cells in RMA and RCA. The selective Gβγ subunit inhibitor gallein and the PLC inhibitor U-73122 attenuated NPY-induced vasoconstriction. Signalling via the Gβγ-PLC pathway stimulated VSM Ca2+ waves and whole-field synchronised Ca2+ flashes in RMA and increased the frequency of Ca2+ flashes in myogenically active RCA. Furthermore, in RMA, the Gβγ pathway linked NPY to VSM depolarization and generation of action potential-like spikes associated with intense vasoconstriction. This depolarization activated L-type voltage-gated Ca2+ channels, as nifedipine abolished NPY-mediated vasoconstriction.

CONCLUSIONS AND IMPLICATIONS

These data suggest that the Gβγ subunit, which dissociates upon Y1 receptor activation, initiates VSM membrane depolarization and Ca2+ mobilisation to cause vasoconstriction. This model may help explain the development of microvascular vasospasm during raised sympathetic nerve activity.

Clinical Benefit of Intravascular Imaging Compared With Conventional Angiography in Left Main Coronary Artery Intervention

BACKGROUND

The RENOVATE-COMPLEX-PCI (Randomized Controlled Trial of Intravascular Imaging Guidance Versus Angiography-Guidance on Clinical Outcomes After Complex Percutaneous Coronary Intervention) demonstrated that intravascular imaging-guided percutaneous coronary intervention (PCI) improved clinical outcome compared with angiography-guided PCI for patients with complex coronary artery lesions. This study aims to assess whether the prognostic benefit of intravascular imaging-guided procedural optimization persists in patients undergoing PCI for left main coronary artery disease.

METHODS

Of 1639 patients enrolled in the RENOVATE-COMPLEX-PCI, 192 patients with left main coronary artery disease were selected for the current prespecified substudy. Selected patients were randomly assigned to either the intravascular imaging-guided PCI group (n=138) or the angiography-guided PCI group (n=54). The primary end point was target vessel failure defined as a composite of cardiac death, target vessel-related myocardial infarction, or clinically driven target vessel revascularization.

RESULTS

At a median follow-up of 2.1 years (interquartile range 1.1 to 3.0 years), intravascular imaging-guided PCI was associated with lower incidence of primary end point compared with angiography-guided PCI (6.8% versus 25.1%; hazard ratio, 0.31 [95% CI, 0.13-0.76]; P=0.010). This significant reduction in primary end point was mainly driven by a lower risk of cardiac death or spontaneous target vessel-related myocardial infarction (1.6% versus 12.7%; hazard ratio, 0.16 [95% CI, 0.03-0.82]; P=0.028). Intravascular imaging-guided PCI was independently associated with a lower risk of primary end point, even after adjusting for various clinical factors (hazard ratio, 0.29 [95% CI, 0.12-0.72]; P=0.007).

CONCLUSIONS

Intravascular imaging-guided PCI showed clinical benefit over angiography-guided PCI for left main coronary artery disease in reducing the risk of cardiac death, target vessel-related myocardial infarction, or target vessel revascularization.

REGISTRATION

URL: https://www.clinicaltrials.gov; Unique identifier: NCT03381872.

Investigating the Cardiovascular Benefits of Dapagliflozin: Vasodilatory Effect on Isolated Rat Coronary Arteries

Dapagliflozin, a sodium-glucose co-transporter 2 (SGLT2) inhibitor, is an antidiabetic medication that reduces blood glucose. Although it is well known that dapagliflozin has additional benefits beyond glycemic control, such as reducing blood pressure and lowering the risk of cardiovascular events, no sufficient research data are available on the direct effect of dapagliflozin on cardiovascular function. Thus, in this study, we investigated the direct vascular effect of dapagliflozin on isolated rat coronary arteries. The left descending coronary arteries of 13-week-old male Sprague Dawley rats were cut into segments 2-3 mm long and mounted in a multi-wire myography system to measure isometric tension. Dapagliflozin effectively reduced blood vessel constriction induced by U-46619 (500 nM) in coronary arteries regardless of the endothelium. Treatment with an eNOS inhibitor (L-NNA, 100 μM), sGC inhibitor (ODQ, 5 μM), or COX inhibitor (indomethacin, 3 μM) did not affect the vasodilation induced by dapagliflozin. The application of a Ca2+-activated K+ channel (KCa) blocker (TEA, 2 mM), voltage-dependent K+ channel (KV) blocker (4-AP, 2 mM), ATP-sensitive K+ channel blocker (KATP) glibenclamide (3 μM), and inward-rectifier K+ channel (KIR) blocker (BaCl2, 30 μM) did not affect the dapagliflozin-induced vasodilation either. The treatment with dapagliflozin decreased contractile responses induced by the addition of Ca2+, which suggested that the extracellular Ca2+ influx was inhibited by dapagliflozin. Treatment with dapagliflozin decreased the phosphorylation level of the 20 kDa myosin light chain (MLC20) in vascular smooth muscle cells. In the present study, we found that dapagliflozin has a significant vasodilatory effect on rat coronary arteries. Our findings suggest a novel pharmacologic approach for the treatment of cardiovascular diseases in diabetic patients through the modulation of Ca2+ homeostasis via dapagliflozin administration.

Ticagrelor Versus Prasugrel in Patients With Acute Coronary Syndrome: A Systematic Review and Meta-Analysis

Limited data comparing prasugrel and ticagrelor in acute coronary syndrome are available. Online databases, including MEDLINE and Cochrane Central, were queried to compare these drugs. The primary outcomes of this meta-analysis are myocardial infarction (MI), all-cause mortality, cardiovascular mortality, noncardiovascular mortality, stent thrombosis, and stroke. The secondary outcome is major bleeding. A total of 9 studies, including 94,590 patients (prasugrel group = 32,759; ticagrelor group = 61,831), were included in this meta-analysis. The overall mean age was 62.73 years, whereas the mean age for the ticagrelor and prasugrel groups was 63.80 and 61.65 years, respectively. Prasugrel is equally effective as compared with ticagrelor in preventing MI. There was no difference between the 2 groups regarding all-cause mortality, stent thrombosis, stroke, or major bleeding. In patients with acute coronary syndrome, prasugrel is equally effective when compared with ticagrelor in preventing MI.

Pharmacological and mechanical properties of isolated pig coronary veins

Recent successful cardiac transplantation from pig to non-human primates and the first pig-to-human transplantation has put the focus on the properties of the pig heart. In contrast to the coronary arteries, the coronary veins are less well characterized and the aim was to examine the mechanical and pharmacological properties of coronary veins in comparison to the arteries. Vessel segments from the left anterior descending coronary artery (LAD) and the concomitant vein were isolated from pig hearts in cardioplegia and examined in vitro. The wall thickness, active tension and active stress at optimal circumference were lower in coronary veins, reflecting the lower intravascular pressure in vivo. Reverse transcription polymerase chain reaction (RT-PCR) analysis of myosin isoforms showed that the vein could be characterized as having a slower smooth muscle phenotype compared to the artery. Both vessel types contracted in response to the thromboxane agonist U46619 with EC50 values of about 20 nM. The artery contracted in response to acetylcholine. Precontracted arteries relaxed in noradrenaline and substance P. In contrast, the veins relaxed in acetylcholine, contracted in noradrenaline and were unresponsive to substance P. In conclusion, these results demonstrate significant differences between the coronary artery and vein in the smooth muscle properties and in the responses to sympathetic and parasympathetic stimuli.

ACR Appropriateness Criteria® Congenital or Acquired Heart Disease

Pediatric heart disease is a large and diverse field with an overall prevalence estimated at 6 to 13 per 1,000 live births. This document discusses appropriateness of advanced imaging for a broad range of variants. Diseases covered include tetralogy of Fallot, transposition of great arteries, congenital or acquired pediatric coronary artery abnormality, single ventricle, aortopathy, anomalous pulmonary venous return, aortopathy and aortic coarctation, with indications for advanced imaging spanning the entire natural history of the disease in children and adults, including initial diagnosis, treatment planning, treatment monitoring, and early detection of complications. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.

Lecompte maneuver for compressed left coronary artery after pulmonary artery banding

A one-month-old baby boy with a complete atrioventricular septal defect underwent pulmonary artery banding. A high take-off of the left coronary artery, overlooked on the echocardiogram, was identified. It was compressed by the right pulmonary artery that was dilated owing to pulmonary artery banding. The patient developed severe heart failure, and a Lecompte maneuver was performed. The procedure helped effectively treat this congenital heart disease with a high take-off coronary artery compressed by the right pulmonary artery.

Multi-Omics Profiling of Human Endothelial Cells from the Coronary Artery and Internal Thoracic Artery Reveals Molecular but Not Functional Heterogeneity

Major adverse cardiovascular events occurring upon coronary artery bypass graft surgery are typically accompanied by endothelial dysfunction. Total arterial revascularisation, which employs both left and right internal thoracic arteries instead of the saphenous vein to create a bypass, is associated with better mid- and long-term outcomes. We suggested that molecular profiles of human coronary artery endothelial cells (HCAECs) and human internal mammary artery endothelial cells (HITAECs) are coherent in terms of transcriptomic and proteomic signatures, which were then investigated by RNA sequencing and ultra-high performance liquid chromatography-mass spectrometry, respectively. Both HCAECs and HITAECs overexpressed molecules responsible for the synthesis of extracellular matrix (ECM) components, basement membrane assembly, cell-ECM adhesion, organisation of intercellular junctions, and secretion of extracellular vesicles. HCAECs were characterised by higher enrichment with molecular signatures of basement membrane construction, collagen biosynthesis and folding, and formation of intercellular junctions, whilst HITAECs were notable for augmented pro-inflammatory signaling, intensive synthesis of proteins and nitrogen compounds, and enhanced ribosome biogenesis. Despite HCAECs and HITAECs showing a certain degree of molecular heterogeneity, no specific markers at the protein level have been identified. Coherence of differentially expressed molecular categories in HCAECs and HITAECs suggests synergistic interactions between these ECs in a bypass surgery scenario.

Takotsubo Cardiomyopathy Induced by Stress From Amyotrophic Lateral Sclerosis and a Mechanical Fall

Named after the Japanese octopus trap, Takotsubo cardiomyopathy is an acute myocardial condition characterized by a reversible ventricular dysfunction with ballooning of the left ventricle (LV) during systole. A catecholamine surge is likely the primary mechanism responsible for myocardial damage in this condition. The association between amyotrophic lateral sclerosis (ALS) and Takotsubo cardiomyopathy has not been well established. We present a unique case of Takotsubo cardiomyopathy diagnosed in a patient with ALS who presented after a fall with shortness of breath, generalized weakness, and hypotension. She was found to have troponinemia, elevated brain natriuretic peptide, and Osborn waves without ST-segment changes noted on electrocardiography (EKG). The diagnosis of Takotsubo cardiomyopathy was confirmed via transthoracic echocardiography (TTE), which revealed reduced left ventricular ejection fraction, apical ballooning of the LV, akinesis of the ventricular apex, and hyperkinesis of the base of the heart. Coronary angiography revealed no coronary artery disease. She was managed medically and was hemodynamically stable at the time of discharge.

An Unusual Case of Long-Segment Dissection of the Left Anterior Descending Coronary Artery During Osteoproximal Chronic Total Occlusion Intervention

Coronary artery dissection can occur after post-balloon inflation; however, a very long-segment coronary dissection (>50 mm) is a rare occurrence during routine coronary interventions. Here, we report an extremely rare case of long-segment coronary dissection in the left anterior descending coronary artery (LAD) induced during antegrade revascularization of chronic total occlusion of osteoproximal LAD with stiffer Gaia II wire. The patient had excruciating angina with hemodynamic collapse and acute pulmonary edema; the patient was rescued with long-segment coronary revascularization.

An agent-based model of cardiac allograft vasculopathy: toward a better understanding of chronic rejection dynamics

Cardiac allograft vasculopathy (CAV) is a coronary artery disease affecting 50% of heart transplant (HTx) recipients, and it is the major cause of graft loss. CAV is driven by the interplay of immunological and non-immunological factors, setting off a cascade of events promoting endothelial damage and vascular dysfunction. The etiology and evolution of tissue pathology are largely unknown, making disease management challenging. So far, in vivo models, mostly mouse-based, have been widely used to study CAV, but they are resource-consuming, pose many ethical issues, and allow limited investigation of time points and important biomechanical measurements. Recently, agent-based models (ABMs) proved to be valid computational tools for deciphering mechanobiological mechanisms driving vascular adaptation processes at the cell/tissue level, augmenting cost-effective in vivo lab-based experiments, at the same time guaranteeing richness in observation time points and low consumption of resources. We hypothesize that integrating ABMs with lab-based experiments can aid in vivo research by overcoming those limitations. Accordingly, this work proposes a bidimensional ABM of CAV in a mouse coronary artery cross-section, simulating the arterial wall response to two distinct stimuli: inflammation and hemodynamic disturbances, the latter considered in terms of low wall shear stress (WSS). These stimuli trigger i) inflammatory cell activation and ii) exacerbated vascular cell activities. Moreover, an extensive analysis was performed to investigate the ABM sensitivity to the driving parameters and inputs and gain insights into the ABM working mechanisms. The ABM was able to effectively replicate a 4-week CAV initiation and progression, characterized by lumen area decrease due to progressive intimal thickening in regions exposed to high inflammation and low WSS. Moreover, the parameter and input sensitivity analysis highlighted that the inflammatory-related events rather than the WSS predominantly drive CAV, corroborating the inflammatory nature of the vasculopathy. The proof-of-concept model proposed herein demonstrated its potential in deepening the pathology knowledge and supporting the in vivo analysis of CAV.

A Case of Strange Arterial Embolism After Uterine Curettage

Hysteroscopic local endometrial resection and curettage are common surgical procedures. Postoperative arterial thromboembolism is rare. However, coronary and renal embolism after the procedure has never been reported in the literature, so far. We report a 50-year-old woman who developed arterial thromboembolism 4 hours after local endometrial resection and curettage. Thrombus disappeared after anticoagulant therapy was started as soon as possible. How do strange clots form and by what route do they occur in the arterial system?

Comparison of inflammation in the tongue with inflammation of the aorta and coronary arteries: an autopsy study of the histologic features and immunohistochemical markers

Atherosclerosis is an inflammatory disease of the arteries responsible for a high rate of morbidity and mortality worldwide. The objective of this study was to associate the histopathologic and immunohistochemical aspects of tongue inflammation with aortic and coronary atherosclerosis in autopsied humans. A total of 4378 autopsy reports were analyzed, and cases were included in the study if fragments of the individual's tongue, aorta, and coronary artery were available for analysis (N = 16). Morphologic and immunohistochemical evaluations were performed for interleukin 1α (IL-1α), IL-6, tumor necrosis factor α (TNF-α), and interferon γ (IFN-γ). Findings of IL-1α in the aorta were associated with the following parameters evaluated in the tongue: IL-6 (P = 0.031), inflammation in the submucosa (P = 0.042), and spongiosis (P = 0.018). Findings of IL-6 in the tongue were associated with IL-1α (P = 0.031), IL-6 (P = 0.016), and TNF-α (P = 0.016) in the aorta. Tongue exocytosis was associated with IL-6 (P = 0.003) and IFN-γ (P = 0.003) in the aorta. Inflammation in the submucosa, spongiosis, and higher immunostaining by IL-6 on the tongue are associated with higher immunostaining by IL-1α in the aorta. In addition, increased intensity in the presence of IL-6 in the tongue is also associated with increases in IL-6 and TNF-α in the aorta. Because these cytokines contribute to the process of atherosclerosis, and infectious agents are a major cause of inflammation in the tongue, it seems likely that proper prevention and treatment of lingual infections could reduce the risk of atherosclerosis. However, further studies are needed to corroborate these findings.

Aneurysms involving the coronary arteries in a neonate with neurofibromatosis 1

Aneurysmal coronary artery disease (ACAD) has been reported rarely in patients with neurofibromatosis type 1 (NF1), mostly in adults. We report on a female newborn affected by NF1 with ACAD disclosed during investigation for an abnormal prenatal ultrasound along with a review of the previously reported cases. The proposita had multiple café-au-lait spots and had no cardiac symptoms. Echocardiography, and cardiac computed tomography angiography confirmed aneurysms on the left coronary artery, left anterior descending coronary artery, and of the sinus of Valsalva. Molecular analysis detected the pathogenic variant NM_001042492.3(NF1):c.3943C>T (p.Gln1315*). Literature findings on ACAD in NF1 indicated that this mostly occurs in males, showing predilection for the development of aneurysms at the left anterior descending coronary artery, and manifesting predominantly as acute myocardial infarction, inclusively in teenagers, though it may be also asymptomatic as in our case. This report documents the first case of ACAD in a patient with NF1 diagnosed at birth, emphasizing that its early diagnosis is essential to prevent potential life-threatening events attributable directly to coronary lesions.

Coronary artery bypass grafting in children aged under 1 year: a report of three cases

We performed coronary artery bypass grafting with the internal thoracic artery in three infants. Grafts were patent in all cases. One patient was lost due to chronic heart failure. Coronary artery bypass grafting can be performed even in infancy, and early surgical intervention may be necessary when myocardial ischaemia is recognised.

A feasibility study of 70 kV double low-dose coronary imaging technique in abdomen-fatty patients using dual-source CT

Objective

To investigate the aplication of low contrast agent concentration and low tube voltage in coronary CTA on patients with high BMI (26kg/m228kg/m2).

Methods

60 patients with high BMI (26kg/m228kg/m2) were randomly divided into two groups: double low group A (n=30, tube voltage = 70 KV), double low group B (n=30, tube voltage = 70 KV), processed by SAFIRE iterative reconstruction with 270 mgI/ml contrast agent. Conventional group a (n=30, tube voltage = 120 KV), conventional group b (n=30, tube voltage = 120 KV), with filtered back projection (FBP) and 370 mg I/ml contrast agent. the image excellent index (FOM), the effective radiation dose (ED), mean CT value, signal-to-noise ratio (SNR), and contrast-to-noise ratio(CNR) between corresponding groups were compared.

Result

There was no significant difference in subjective scores of coronary artery image quality between the two high BMI subgroups (P>0.05).The ED of group A (1.103±0.101 mSv) was significantly lower than that of group a (4.663±0.412 mSv) (P<0.001).There was no significant difference in mean CT value, SNR and CNR between the two subgroups (P>0.05).The image excellent index (FOM) of group A was higher than that of group a (P<0.05).The total iodine content and iodine injection rate in group A were lower than those in group a (P<0.001).The difference of subjective scores of coronary artery image quality between the two ultra-high subgroups was significant. The mean CT value, SNR and CNR of group B were lower than those of group b (P<0.05). The images of 14 patients in group B could not meet the diagnosis demand.

Conclusion

It is feasible to reduce the tube voltage to 70KV in patients with abdominal BMI with high BMI (26Kg/m228Kg/m2), under the same conditions, the 70KV can not meet the daily diagnosis requirement.

Upregulation of Orai Channels Contributes to Aging-Related Vascular Alterations in Rat Coronary Arteries

Vascular territories display heterogeneous sensitivity to the impacts of aging. The relevance of the STIM/Orai system to vascular function depends on the vascular bed. We aimed to evaluate the contribution of the STIM/Orai system to aging-related vascular dysfunction in rat coronary circulation. Vascular function was evaluated according to myography in coronary arteries from young (three-month-old) and older (twenty-month-old) rats. The effects of aging and STIM/Orai inhibition on the contraction and relaxation of the coronary arteries and on the protein expression of STIM-1, Orai1, and Orai3 in these vessels were determined. Aging-related hypercontractility to serotonin and endothelin-1 in arteries from male rats was reversed by STIM/Orai inhibition with YM-58483 or by specifically blocking the Orai1 channel with Synta66. The inhibitory effects of Synta66 on coronary vasoconstriction were also observed in older female rats. YM-58483 relaxed serotonin- but not KCl-contracted arteries from males. STIM/Orai inhibition improved defective endothelial vasodilations in aged arteries, even in the presence of NO synthase and cyclooxygenase inhibitors, but not in KCl-contracted segments. YM-58483 significantly enhanced relaxations to calcium-activated potassium channel stimulation in aged vessels. Increased protein expression of Orai1 and Orai3 was detected in arterial homogenates and sections from older rats. Upregulation of the Orai channel contributes to aging-related coronary dysfunction, revealing a potential target in reducing CVD risk.

Minimal-Access Coronary Revascularization: Past, Present, and Future

Minimal-access cardiac surgery appears to be the future. It is increasingly desired by cardiologists and demanded by patients who perceive superiority. Minimal-access coronary artery revascularisation has been increasingly adopted throughout the world. Here, we review the history of minimal-access coronary revascularization and see that it is almost as old as the history of cardiac surgery. Modern minimal-access coronary revascularization takes a variety of forms-namely minimal-access direct coronary artery bypass grafting (MIDCAB), hybrid coronary revascularisation (HCR), and totally endoscopic coronary artery bypass grafting (TECAB). It is noteworthy that there is significant variation in the nomenclature and approaches for minimal-access coronary surgery, and this truly presents a challenge for comparing the different methods. However, these approaches are increasing in frequency, and proponents demonstrate clear advantages for their patients. The challenge that remains, as for all areas of surgery, is demonstrating the superiority of these techniques over tried and tested open techniques, which is very difficult. There is a paucity of randomised controlled trials to help answer this question, and the future of minimal-access coronary revascularisation, to some extent, is dependent on such trials. Thankfully, some are underway, and the results are eagerly anticipated.

Clinical manifestations and computed tomography angiography features of anomalous left coronary artery from the pulmonary artery syndrome

OBJECTIVES

Anomalous left coronary artery from the pulmonary artery (ALCAPA) syndrome is a rare congenital coronary artery malformation with a high rate of clinical missed diagnosis and misdiagnosis. At present, there is a lack of reports on the clinical manifestations of ALCAPA and the imaging features of coronary computed tomography angiography (CTA). This study aims to summarize the clinical characteristics and coronary CTA imaging features of ALCAPA to improve the clinical diagnosis and treatment.

METHODS

The clinical data of 24 ALCAPA syndrome patients were retrospectively collected, analyzed and summarized from January 1, 2013 to February 1, 2023 in the Second Xiangya Hospital of Central South University. According to the left and right coronary collateral circulation, the patients were classified into infantile type (7 cases) and adult type (17 cases). The differences of clinical manifestations and CTA imaging features were compared between the 2 types of patients.

RESULTS

Of the 24 patients, a male-to-female ratio was at 1꞉5, and the median age of onset was 3.22 months for the infant type and 22.0 years for the adult type. The infantile type showed symptoms of left heart insufficiency at an early stage, while the adult type had a variety of clinical manifestations in 7 patients being asymptomatic and presented with a cardiac murmur on physical examination, 6 with symptoms of chronic myocardial ischemia, and 2 with malignant arrhythmias. CTA showed that 11 patients' the left coronary artery originated from the left posterior sinus of the pulmonary artery. All 7 infantile type patients had an enlarged left heart, left ventricular hypertrophy, reduced left heart function, lack of collateral circulation between the left and right coronary arteries, and normal coronary artery diameter. All 17 adult type patients showed dilated and tortuous coronary arteries with rich collateral circulation, and 7 adult type patients had preserved left heart function.

CONCLUSIONS

The clinical manifestations and CTA imaging features of patients with the 2 types of ALCAPA are different, while CTA performance is characteristic and can be used as a means of definitive diagnosis, staging, surgical evaluation, and postoperative follow-up of ALCAPA syndrome.

The Role of Coronary CT Angiography in the Evaluation of Dual Left Anterior Descending Artery Prevalence and Subtypes: A Retrospective Multicenter Study

BACKGROUND

The aim of this multicenter study was to evaluate the prevalence and features of dual left anterior descending artery (LAD) subtypes using coronary CT angiography (CCTA).

METHODS

A retrospective multicenter analysis of 2083 CCTA from December 2020 to November 2022 was conducted to search for the presence and morphological features of dual LAD. The two classifications used were the updated classification of Spindola-Franco and the Jariwala classification. Statistical tests were conducted to evaluate the prevalence of dual LADs among sexes and its association with angina in patients without significant coronary stenoses and/or associated cardiac anomalies.

RESULTS

Dual LAD was observed in 124 (5.96%) patients analyzed. According to the Spindola-Franco revisited classification, type I dual LAD was the most common (71/124, 57.26%). According to the Jariwala classification, all cases were group I. In the general population, there was a higher prevalence of dual LAD among females (7.3% females vs. 5.1% males; p value: 0.04). No statistically significant difference was found in the prevalence of angina in the dual LAD population compared to the no dual LAD population (2.1% vs. 1.5%; p value: 0.10).

CONCLUSIONS

The acknowledgment and reporting of LAD duplication is helpful for an optimal management of coronary patients with this condition. Dual LAD was more frequent in the female population, mainly not related with angina. Myocardial bridge was more frequent in the dual LAD population than in the no dual LAD population.

A Rare Case of Single Coronary Artery: Getting to the Heart of the Matter

Single coronary artery anomaly represents a particularly rare entity, which may present with variable clinical scenarios, but in most cases remains asymptomatic. It is considered to be one of the pathological states to cause sudden death, especially in young adults [1]. We hereby report a rare case of a R-III type of single coronary artery as classified by Lipton et al., which is only about 15% of all the cases of coronary anomalies. Coronary CT angiography as well as invasive coronarography provide accurate details regarding the origin, course and termination of coronary anomalies, as well as evaluation of associated coronary lesions, further guiding the optimal treatment strategy in each case. Teaching Point: The main teaching point of this case report is to clearly underline the importance of coronary CT angiography in obtaining a comprehensive evaluation of coronary artery anatomy and associated coronary lesions, representing important aspects, which further guide accurate treatment and management.

Comparative analysis of calcified soft tissues revealed shared deregulated pathways

Introduction

Calcification of soft tissues is a common age-related pathology that primarily occurs within vascular tissue. The mechanisms underlying pathological calcification in humans and tissue specificity of the process is still poorly understood. Previous studies examined calcified tissues on one to one basis, thus preventing comparison of deregulated pathways across tissues.

Purpose

This study aimed to establish common and tissue-specific changes associated with calcification in aorta, artery tibial, coronary artery and pituitary gland in subjects from the Genotype-Tissue Expression (GTEx) dataset using its RNA sequencing and histological data.

Methods

We used publicly available data from the GTEx database https://gtexportal.org/home/aboutGTEx. All GTEx tissue samples were derived by the GTEx consorcium from deceased donors, with age from 20 to 79, both men and women. GTEx study authorization was obtained via next-of-kin consent for the collection and banking of de-identified tissue samples for scientific research. Hematoxylin and eosin (H&E) staining of arteries were manually graded based on the presence of calcification on a scale from zero to four, where zero designates absence of calcification and four designates severe calcification. Samples with fat contamination and mislabeled tissues were excluded, which left 430 aorta, 595 artery tibial, 124 coronary artery, and 283 pituitary samples for downstream gene expression analysis. Transcript levels of protein-coding genes were associated with calcification grade using sex, age bracket and cause of death as covariates, and tested for pathway enrichment using gene set enrichment analysis.

Results

We identified calcification deposits in 28 (6.5%) aortas, 121 (20%), artery tibials, 54 (43%), coronary arteries, and 24 (8%) pituitary glands of GTEx subjects. We observed an age-dependent increase in incidence of calcification in all vascular tissues, but not in pituitary. Subjects with calcification in the artery tibial were significantly more likely to have calcification in the coronary artery (OR = 2.56, p = 6.3e-07). Markers of calcification previously established in preclinical and in vitro studies, e.g., BMP2 and RUNX2, were deregulated in the calcified tibial and coronary arteries, confirming the relevance of these genes to human pathology. Differentially expressed genes associated with calcification poorly overlapped across tissues suggesting tissue-specific nuances in mechanisms of calcification. Nevertheless, calcified arteries unanimously down-regulated pathways of intracellular transport and up-regulated inflammatory pathways suggesting these as universal targets for pathological calcification. In particular, PD-1 and PD-L1 genes were up-regulated in calcified tissues but not in the blood of the same subjects, suggesting that localized inflammation contributes to pathological calcification.

Conclusion

Pathological calcification is a prevalent disease of aging that shares little changes in expression in individual genes across tissues. However, our analysis suggests that it potentially can be targeted by alleviating local inflammation of soft tissues.

Multisystem Inflammatory Syndrome in Children (MIS-C) Associated With Covid-19 - Single-Center Experience

OBJECTIVES

To describe the clinical presentation, phenotype and outcome of multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (Covid-19) from a tertiary care center in southern India.

METHODS

257 children fulfilling the inclusion criteria of MIS-C were prospectively enrolled from June, 2020 to March, 2022.

RESULTS

Median (range) age at presentation was 6 year (35 day to 12 years). Presenting features were fever (98%), vomiting (75.8%), red eyes (63%), rashes (49%), pain abdomen (49%), shock (45.9%), lymphopenia (73%, thrombocytopenia (58.3%) and anemia (45%). 103 (39.7%) children required intensive care admission. Shock phenotype, Kawasaki-like phenotype and no specific phenotype were diagnosed in 45.9%, 44.4%, and 36.6% children, respectively. Left ventricular dysfunction (30.3%), acute kidney injury (13%), acute liver failure (17.4%), and hemophagolymphohistiocytosis (HLH) (13.6%) were the major system involvement in MIS-C. Mitral regurgitation (P=0.029), hyperechogenic coronaries (P=0.006), Left ventricular dysfunction (P=0.001) and low ejection fraction (P=0.007) were significantly associated with shock. Overall mortality was 11.7%.

CONCLUSION

Kawasaki-like and shock-like presentation were common in MIS-C. Coronary abnormalities were seen in 118 (45.9%) children. Children with acute kidney injury, HLH, need for mechanical ventilation, and echocardiogram evidence of mitral regurgitation in MIS-C have a poor outcome.

Ectatic Coronary Arteries: Diversity at Its Finest

Coronary artery ectasia (CAE) is an entity causing inappropriate dilatation of the coronary tree, that is angiographically defined, albeit arbitrarily, by the diameter of the ectatic segment being more than 1.5 times larger in comparison with an adjacent healthy reference segment. Although the causative mechanisms are poorly understood, atherosclerosis is greatly implicated in the causation of CAE. Clinical, angiographic, and therapeutic features have been puzzling clinicians. We illustrate three different angiographic subsets, co-existing with myocardial bridge/coronary slow flow and diversely presenting as asymptomatic, pauci, and frankly symptomatic with stable and acute coronary syndrome. These cases illuminate the diversity of CAE's clinical and angiographic presentations and pathologic progression, shedding light on this medical condition and its implications.

Coronary Artery Anomalies: A Short Case Series and Current Review

Coronary artery anomalies (CAAs) are rare congenital cardiovascular defects that can present in various ways depending on the origin, course, and termination of the abnormal coronary artery fistula. It is sometimes detected incidentally during procedures such as coronary angiography or autopsies. While adults with this condition are often asymptomatic, some may experience angina, congestive heart failure, myocardial infarction, cardiomyopathy, ventricular aneurysms, or sudden cardiac death (SCD). In fact, it is the second leading cause of SCD among young athletes and requires more studies to handle such patients efficiently. To illustrate the many possible manifestations of this unusual diagnosis, we present a series of five cases. We have also reviewed the different varieties of this rare congenital anomaly and discussed the latest diagnostic tests and treatment plans.

Sport resumption and quality of life after surgical correction of anomalous origin of a coronary artery from the opposite sinus

Objectives

We sought to assess the resumption of sport, exercise performances, and quality of life (QoL) in adults and children after surgical repair of anomalous coronary arteries originating from the opposite sinus (ACAOS).

Materials and methods

Patients who underwent surgical repair for ACAOS between 2002 and 2022 were retrospectively identified. Information about sports activity and exercise performance based on metabolic equivalents of task (METs) calculated at the last exercise stress test, were collected. QoL was assessed using age-appropriate questionnaires (Paediatric QoL Inventory, cardiac module version 3.0 for patients <18 years; SF-36 QoL Inventory for adults). Patients' METS and patients' QoL-scores were compared to reference population using the Wilcoxon test.

Results

45 patients were enrolled (males 71%, adults 49%, anomalous right coronary 84%). Median age at surgery was 15 years; median follow-up after surgery was 2.3 years [4 months-12 years]. All post-operative exercise stress tests were normal, METs and VO2 max patients' values did not differ from healthy children or adults (Exercise intensity: 12.5 ± 4.7 vs. 13.4 ± 2 METS, p = 0.3; VO2 max: 43.6 ± 16.6 vs. 46.9 ± 7 ml/kg/min, p = 0.37). For adults, QoL-scores were similar between ACAOS patients and controls. For children, there was no significant difference between the study patients' scores and those of the reference population, except for physical appearance proxy-report (p = 0.02).

Conclusion

In our study, the practice of sports, exercise stress testing and QoL were not adversely affected after ACAOS repair.

Coronaries from the Brachiocephalic Artery: Anomalous Origin of the Coronary Arteries in a Case of Situs Inversus and Truncus Arteriosus

Congenital anomalies of the coronary arteries are rare. In this article, we reported a case of 6-month-old female who was brought with breathing difficulty and poor weight gain. Echocardiography was done which showed dextrocardia and truncus arteriosus. A cardiac computed tomography confirmed these findings and additionally revealed that the coronary arteries originated from a common vascular channel from the brachiocephalic artery. This is a very rare occurrence. To our knowledge, only a few such cases have been reported in the literature.

In vivo evaluation of intravascular lithotripsy in a healthy porcine coronary model

OBJECTIVES

In this study, we aimed to investigate the vascular response to an intravascular lithotripsy (IVL) shockwave balloon in a healthy porcine coronary artery model.

BACKGROUND

IVL is a novel clinical technique for modifying heavily calcified atherosclerotic plaques.

METHODS

A total of 24 porcine coronary arteries were treated with IVL or plain old balloon angioplasty (POBA). Histology, histomorphometry, quantitative coronary angiography analysis (QCA), and optical coherence tomography (OCT) were performed postprocedure and at 1-month follow-up (1M-FU).

RESULTS

There was no significant difference in the late lumen loss and diameter stenosis (determined by QCA) and the minimal lumen area (evaluated by OCT) of the IVL and POBA groups at 1M-FU. Pathological analysis revealed that the lumen and neointima areas were similar between the two groups. However, the medial and adventitial layers were more prominent in the IVL than in the POBA group. The injury score and inflammation of the media and adventitia increased dramatically in the IVL group postprocedure and at 1M-FU. At 1M-FU, media fibrin deposition and adventitial fibrosis were also significantly increased in the IVL group. However, there was no significant difference in neointima fibrin deposition, endothelialization, and thrombosis between both groups. Layered separation of the media and adventitia was observed in the IVL group.

CONCLUSION

The findings indicate that the IVL balloon did not cause serious intimal hyperplasia and endothelial damage compared with the effects of POBA in the healthy coronary artery. However, shock waves may cause unique damage to the vascular media and adventitia in the coronary artery, which was not observed in the peripheral artery.