Ejection fraction change and coronary artery disease severity: a vasodilator contrast stress-echocardiography study

Unusual effects of PCSK9 E670G (rs505151) variation in patients with in-stent restenosis: Variable effects on restenosis risk according to concomitant chronic conditions

Recent reports showing that neo-atherosclerosis formation in stented coronary artery is characterized by the accumulation of lipid-laden macrophages within the neointima has strengthened the possibility that elevated low-density lipoprotein (LDL)-cholesterol may be a risk factor for in-stent restenosis (ISR). Protein Convertase Subtilisin/Kexin-9 (PCSK9) protein plays an important role in cholesterol metabolism by degrading of LDL receptors. The gain-of-function E670G (rs505151) mutation of the PCSK9 gene is a well-known genetic risk factor for hypercholesterolemia. This study evaluated for the first time the association of the E670G variation with the serum lipids, PCSK9 levels and concomitant diseases on the ISR risk. The study included 109 ISR, and 82 Non-ISR patients, based on the results of coronary angiography. Genotypes were determined using the real-time PCR and serum PCSK9 levels were measured by ELISA technique. The rare G allele of PCSK9 E670G (p < 0.05), hyperlipidemia (HL) (p < 0.001), and type 2 diabetes (T2DM) (p < 0.01) were associated with increased risk for ISR. In hyperlipidemic conditions, the E670G-G allele was associated with hypercholesterolemia and a higher risk of ISR (p < 0.001), while the E670G-AA genotype has been associated with a high prevalence of T2DM and hypertension. In addition, diabetic ISRs had higher serum PCSK9 levels (p < 0.05) and the E670G-AA genotype was associated with increased levels of diabetes markers. Our results indicated that the unusual effects of both G allele and AA genotype of the PCSK9 E670G variation may be involved in the risk of ISR in association with concomitant metabolic diseases.

Incidence, characteristics and risk factors of medical device-related pressure injuries: An observational cohort study

OBJECTIVES

This study aimed to investigate the cumulative incidence, characteristics, and risk factors of medical device-related pressure injuries (MDRPIs), including patient outcomes, in the intensive care unit (ICU) of a university hospital.

RESEARCH METHODOLOGY/DESIGN

A prospective observational cohort study.

SETTING

The study was conducted in an university hospital between November 2019 and October 2020.

METHODS

The study included patients over the age of 18 years who had a device in situ and stayed in the ICU for more than 24 h. Each device was monitored twice a day for 15 days; the clinical assessment was performed daily until ICU discharge or death. The Case Report Form, MDRPI Monitoring Form, Sequential Organ Failure Assessment (SOFA) score, Acute Physiology and Chronic Health Evaluation (APACHE-II), Braden Scale, National Pressure Injury Advisory Panel (NPIAP) staging and categories, and Glasgow Coma Scale (GCS) were used for data collection. Patients with and without MDRPIs were compared for demographic and clinical characteristics, length of ICU stay, and mortality by using t-test and Chi-square test. Cumulative incidence was calculated. Logistic regression model was used to investigate risk factors.

RESULTS

The incidence rate of MDRPIs was 48.8% (84/172 patients). Most of the MDRPIs developed in the mucosa; hence, they could not be staged (63.7%). Of the remaining MDRPIs on the skin, 18.7%, 13%, and 4.6% were categorized as Stage I, II, and III, respectively. In terms of anatomical locations, most commonly occurred in the head and neck region (62.3%). Among the twelve medical devices that caused MDRPIs, endotracheal tubes (61 cases), urinary catheters (46 cases), nasogastric tubes (30 cases) and non-invasive masks (17 cases) were most commonly reported. In multivariate analysis, age (46-64 years) (p = 0.008, OR = 12.457), history of cardiovascular diseases (p = 0.021, OR = 0.044), administration of vasopressors (p = 0.013, OR = 0.089), length of ICU stay (≥22 days, p = 0.048, OR = 0.055) and requirement for mechanical ventilation (p = 0.028, OR = 10.252) were identified as independent risk factors of the occurrence of MDRPI.

CONCLUSIONS

This study provides a comprehensive understanding of the risk of MDRPI in critically ill adults. The incidence of MDRPIs was high and was associated with several factors. It is critical that MDRPIs are taken seriously by all members of the healthcare team, especially nurses, and that protocols should be established for improvements.

Direct Bilirubin Levels Predict Long-Term Outcomes in Patients With Acute Coronary Syndrome Under Different Glucose Metabolism Status: A 6.5-Year Cohort Study of Three-Vessel Disease

Background: There is controversy over the relationship between bilirubin and coronary artery disease. This study aimed to evaluate the predictive value of direct bilirubin (DB) in patients with complex acute coronary syndrome (ACS).

Methods: From April 2004 to February 2011, 5,322 ACS patients presenting with three-vessel disease were consecutively enrolled. Disease severity and complexity were determined by SYNTAX score (SS) and SS II. The primary endpoint was all-cause death, and the secondary endpoints were major adverse cardiovascular and cerebrovascular events (MACCE). Stratification of normal glucose regulation, prediabetes, and diabetes was based on a previous diagnosis, hypoglycemic medications, fasting blood glucose, and hemoglobin A1c.

Results: Subjects were divided into quartiles according to baseline DB (μmol/L): Q1 (0–1.6), Q2 (1.61–2.20), Q3 (2.21–2.80), and Q4 (>2.80). Multivariable logistic regression analysis showed that DB was an independent predictor of intermediate–high SS. During a median follow-up time of 6.5 years, elevated DB was associated with more all-cause death (p < 0.001) but not MACCE. DB remained to be predictive of all-cause death in the multivariable Cox regression model (Q2 vs. Q1: HR 1.043, 95% CI 0.829–1.312, p = 0.719; Q3 vs. Q1: HR 1.248, 95% CI 1.001–1.155, p = 0.048; Q4 vs. Q1: HR 1.312, 95% CI 1.063–1.620, p = 0.011). When subjects are stratified according to glucose metabolism regulation and treatment strategies, the predictivity of DB was only profound in patients with diabetes or with conservative treatment. Additionally, incorporating DB further improved the discrimination and reclassification abilities of SS II for risk prediction.

Conclusion: DB is a potential biomarker for predicting lesion severity and long-term outcomes in ACS patients.

Patients with Coronary Artery Disease Have Lower Levels of Antibody to Heat-Stressed Fibroblast Derived Proteins, versus Normal Subjects

Cellular stress response plays an important role in the pathophysiology of coronary artery disease (CAD). Inhibition of cellular stress may provide a novel clinical approach regarding the diagnosis and treatment of CAD. Fibroblasts constitute 60-70% of cardiac cells and have a crucial role in cardiovascular function. Hence, the aim of this study was to show a potential therapeutic application of proteins derived from heat-stressed fibroblast in CAD patients. Fibroblasts were isolated from the foreskin and cultured under heat stress conditions. Surprisingly, 1.06% of the cells exhibited a necrotic death pattern. Furthermore, heat-stressed fibroblasts produced higher level of total proteins than control cells. In SDS-PAGE analysis, a 70 kDa protein band was observed in stressed cell culture supernatants which appeared as two acidic spots with close pI in the two-dimensional electrophoresis. To evaluate the immunogenic properties of fibroblast-derived heat shock proteins (HSPs), the serum immunoglobulin-G (IgG) was measured by ELISA in 50 CAD patients and 50 normal subjects who had been diagnosed through angiography. Interestingly, the level of anti-HSP antibody was significantly higher in non-CAD individuals in comparison with the patient's group (p < 0.05). The odds ratio for CAD was 5.06 (95%CI = 2.15‐11.91) in cut-off value of 30 AU/mL of anti-HSP antibody. Moreover, ROC analysis showed that anti-HSP antibodies had a specificity of 74% and a sensitivity of 64%, which is almost equal to 66% sensitivity of exercise stress test (EST) as a CAD diagnostic method. These data revealed that fibroblast-derived HSPs are suitable for the diagnosis and management of CAD through antibody production.

Predictive value of pressure ulcer risk for obstructive coronary artery disease

AIM

To investigate the relationship between pressure ulcers risk and severity of obstructive coronary artery disease (CAD) by invasive coronary angiography.

DESIGN

Cross-sectional study.

METHODS

A total of 193 consecutive patients with underlying pressure ulcers risk who underwent invasive coronary angiography were enrolled. Subjects were divided into three groups according to severity of coronary artery stenosis. Pressure ulcers risk score, fall risk score, self-care ability score and cardiovascular risk factors were compared among the three groups. Multivariate regression analysis and receiver operating curve analysis were performed to explore the diagnostic value of Braden score for left main or three-vessel disease.

RESULTS

Patients with more severe CAD had higher pressure ulcers risk. The percentage of high-pressure ulcers risk was highest in left main or three-vessel disease group, compared with control group and single- or two-vessel disease group. After adjusting for age, body mass index, diabetes, chronic kidney disease and other confounding factors, Braden score was an independent predictor of left main or three-vessel disease. Moreover, higher Braden score had a moderate area under the curve for excluding more severe CAD. In conclusion, among patients planning for coronary angiography, pressure ulcers risk assessment is conducive to predict the severity of obstructive CAD.

The Neutrophil to Lymphocyte Ratio (NLR) Is Associated With Residual Syntax Score in Patients With ST-Segment Elevation Myocardial Infarction

The neutrophil to lymphocyte ratio (NLR) predicts adverse clinical outcomes in several cardiovascular diseases. Our aim was to investigate the association of residual SYNTAX score (rSS) with the NLR in patients (n = 613) with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. Patients were divided into 2 groups: group 1 with low NLR (<2.59) and group 2 with high NLR (>2.59). Coronary artery disease severity was calculated for both groups besides baseline clinical and demographic variables. Receiver operating characteristic curve analysis demonstrated that NLR with a cutoff value of 2.59 had good predictive value for increased rSS (area under the curve = 0.707, 95% CI: 0.661-0.752, P < .001). The median rSS value of group 2 was higher (2.0 [0-6.0]; 4.0 [0-10.0], P < .001) compared with group 1; the number of patients with high rSS was also higher in group 2 (26 [9.7%]; 107 [31.0%], P < .001). In multivariate logistic regression analysis, the NLR (odds ratio = 3.933; 95% CI: 2.419-6.393; P < .001) was an independent predictor of high rSS. Additionally, there was a positive correlation between NLR and rSS (r = 0.216, P < .001). In conclusion, higher NLR was an independent predictor of increased rSS in patients with STEMI.

Correlation between overweightness and the extent of coronary atherosclerosis among the South Caspian population

BACKGROUND

Reported effects of obesity on the extent of angiographic coronary artery disease(CAD) have been inconsistent. The present study aimed to investigate the relationships between the indices of obesity and other anthropometric markers with the extent of CAD.

METHODS

This study was conducted on 1008 consecutive patients who underwent coronary angiography. Body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) were separately calculated for each patient. Extent, severity, and complexity of CAD were determined by the Gensini and SYNTAX scores.

RESULTS

According to the results, there was a significant inverse correlation between the SYNTAX score with BMI (r = - 0.110; P < 0.001), WC (r = - 0.074; P = 0.018), and WHtR (r = - 0.089; P = 0.005). Furthermore, a significant inverse correlation was observed between the Gensini score with BMI (r = - 0.090; P = 0.004) and WHtR (r = - 0.065; P = 0.041). However, the results of multivariate linear regression analysis did not show any association between the SYNTAX and Gensini scores with the indices of obesity and overweight. On the other hand, the patients with an unhealthy WC had a higher prevalence of diabetes mellitus (DM) (P = 0.004) and hypertension (HTN) (P < 0.001), compared to the patients with healthy values. Coexistence of HTN and DM was more prevalent in subjects with an unhealthy WC and WHR, compared to that in those with healthy values (P = 0.002 and P = 0.032, respectively).

CONCLUSION

It seems that the anthropometric indices of obesity are not the predictors of the angiographic severity of CAD. However, they are associated with an increased risk of cardiovascular risk factors and higher risk profile.

Diagnostic accuracy of resting left ventricular akinesia/hypokinesia in predicting abnormal coronary angiography

Background

Although several reports demonstrate the efficacy of stress echocardiography in diagnosing coronary artery disease, comparable studies on the competence of the same imaging technique at rest are limited. This study aimed to evaluate whether ventricular akinesia/hypokinesia and left ventricular ejection fraction (LVEF) < 55 % at rest are useful in predicting abnormal coronary angiography.

Methods

This study prospectively enrolled 100 diagnostic coronary catheterization candidates. Any routine echocardiography that the candidates had undergone before diagnostic coronary catheterization was reviewed. Patients were subclassified according to the presence and location of ventricular akinesia/hypokinesia, LVEF, and the results of diagnostic coronary catheterization. LVEF < 55 % was considered below the normal physiological limit. Abnormal coronary angiography was defined as narrowing of half or more of the caliber of at least one major coronary artery.

Results

Abnormal coronary angiography was significantly associated with akinesia/hypokinesia (OR = 4.85, P = 0.002) and LVEF < 55 % (OR = 5.75, P = 0.001). Screening of akinesia/hypokinesia and LVEF < 55 % as diagnostic tools for abnormal coronary angiography achieved comparable sensitivities (87.2 % vs. 88.9 %), specificities (41.5 vs. 41.8), and diagnostic accuracies (41.5 vs. 41.8). Left ventricular anterior wall akinesia/hypokinesia achieved a higher diagnostic odds ratio (9.7), sensitivity (95 %), and negative predictive value (96.4 %) compared with other types of akinesia/hypokinesia.

Conclusion

The overall diagnostic accuracy of akinesia/hypokinesia and LVEF < 55 % to predict abnormal coronary angiography was poor, probably owing to significant influences of macro- as well as micro-vascular ischemia on left ventricular function.