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Background: Chronic coronary syndrome (CCS) is one of the most life-restricting coronary artery diseases, and symptom relief is the main goal in CCS patients who suffer from angina., Objectives: To assess the potential benefits of device-guided breathing in CCS patients with angina in this randomized, controlled, single-blinded study., Methods: Fifty-one patients with CCS received device-guided breathing for 7 days/8 weeks. Exercise capacity [exercise stress test], cardiac function [transthoracic echocardiography], and angina severity [Canadian Cardiovascular Society Classification] were evaluated initially and after the training. Device-guided breathing was performed at the lowest resistance of the device (POWERbreathe® Classic LR) for the control group (n = 17). The low load training group (LLTG; n = 18) and high load training group (HLTG; n = 16) were trained at 30% and 50% of maximal inspiratory pressure. Baseline characteristics were compared using one-way ANOVA and Kruskal-Wallis test. Categorical data were compared using the chi-square test. ANCOVA was performed to compare changes between three groups. A p value < 0.05 was considered statistically significant., Results: Metabolic equivalent values were significantly improved in both HLTG and LLTG groups (p < 0.001, p = 0.003). The Duke treadmill score significantly improved and shifted to low-risk both in the HLTG (p < 0.001) and LLTG (p < 0.001) groups. Angina severity significantly alleviated after the training in both HLTG and LLTG groups (p < 0.001, p = 0.002)., Conclusions: An 8-week long program of short-term respiratory muscle training provided positive gains in exercise capacity and angina severity in CCS patients with angina. The effects of long-term training programs on CCS patients should be investigated clinically because of the possibility of helping to decrease the need for invasive treatments., Competing Interests: The authors stated that there is no conflict of interest.

Background: C-reactive protein (CRP) is an acute-phase reactant protein synthesized by the liver in response to acute stress in a wide range of acute and chronic inflammatory conditions. In healthy subjects and patients presenting with coronary artery disease (CAD), elevated levels of CRP has repeatedly been demonstrated to predict future cardiovascular events. Methods: We measured high sensitivity C-reactive protein (hs-CRP) levels in 382 consecutive patients with CAD and 60 healthy controls by immunoturbidimetry method. Risk factors like hypertension, diabetes mellitus, dyslipidaemia,smoking, obesity and family history of premature CAD were assessed. Results: The mean age of patients with CAD was 53.5±11.8 years (303 males) and that of control group was 50.83±8.07(28 males). The patient group had significant higher concentration of mean hs-CRP levels when compared with the healthy control group (1.8±1.9 mg/L vs 0.35±1.1 mg/L, p

There is a variety of conduits utilized as vascular grafts in coronary artery bypass grafting (CABG). Post-CABG graft rate of failure varies depending on the type of conduit used, with the highest failure rates seen in saphenous vein grafts (SVG). Patency rates of SVG are reported to be about 75% at 12-18 months. Left internal mammary artery (LIMA) grafts have shown higher long-term patency rates when compared to other arterial and venous grafts; however, LIMA occlusions occur, most commonly in the early postoperative period. Percutaneous coronary intervention (PCI) of LIMA graft can be challenging based on the location, the length of the lesion, as well as other factors such as vessel tortuosity. Here we present a case of a complex intervention for osteal and proximal LIMA chronic total occlusion (CTO) in a symptomatic patient. Long stent delivery is usually a challenge in LIMA intervention; however, it was successfully achieved here by placing two overlapping stents. This intervention was also complicated by the tortuosity of the lesion, as well as the difficult cannulation of the left subclavian artery requiring a longer sheath for guide support., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Ahmad et al.)

Introduction This prospective observational study reports the association between baseline high-sensitivity C-reactive protein (hs-CRP) levels and adverse events at six months in patients who were diagnosed with symptomatic chronic stable angina and then underwent percutaneous transluminal coronary angioplasty (PTCA) with a drug-eluting stent (DES). Methods A total of 104 patients were examined with chronic stable angina over a period of six months. Before conducting percutaneous coronary intervention (PCI), the baseline levels of hs-CRP were measured, and based on the levels, the patients were grouped into high and low hs-CRP groups. Results The primary causes of death or the need for repeat revascularization or myocardial infarction or angina were concluded after assessing the patients for six months. A total of 104 patients were studied, among which 72 (69.23%) had low hs-CRP and 32 (30.77%) had high hs-CRP levels. The number of males in this study was 68 (65.38%) and females were 36 (34.62%). The mean age of the patients was 55.26 ± 10.31 years. There were no significant differences among the groups in terms of gender, age, comorbidities, and risk factors except for certain predisposing factors like dyslipidemia and smoking. Moreover, we did not find any significant difference among the groups in the cause of death and myocardial infarction after a follow-up of six months. However, we observed a higher need for revascularization and angina outcomes in the group with high hs-CRP compared to low hs-CRP. Conclusion It can be concluded that a higher risk of angina and repeat revascularization is related to a high baseline hs-CRP but there is no evidence whether it is somehow linked to myocardial infarction and mortality or not., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Nath et al.)

Background: The heart rate variability (HRV) is a prognostic value of cardiovascular risk. It is unknown the correlation between HRV and coronary severity on patients with chronic angina. The objective was to determine the correlation between HRV and the SYNTAX II score in chronic angina. Methods: Cross-sectional study in patients of 18 years or older with stable angina and indication of coronary angiography who went to a third level center. The SYNTAX II score was established by using coronary angiography, while HRV was obtained by a 24-hour Holter ECG. The correlation between SYNTAX II and HRV was performed with Pearson's test. Values of SDNN < 100 ms and RMSSD < 15 ms were considered risk factors. Results: 61 patients were included. 45 had a decreased value of SDNN (73.77%) and eight had a decreased value of RMSSD (13.11%). There was no correlation between HRV and SYNTAX II score. There were more events of ventricular tachycardia in the group of patients with low SDNN than in those with normal SDNN (15.5% vs. 0.0%; p = 0.04). Conclusions: There was no correlation between HRV and the severity of coronary artery disease in stable chronic ischemic heart disease. However, those patients with low HRV showed more events of ventricular tachycardia. [ABSTRACT FROM AUTHOR]

Despite continuous advances in myocardial revascularization procedures and intracoronary devices, patients with ischemic heart disease (IHD) still experience worse prognosis and poor quality of life (QoL). Indeed, chronic stable angina (CSA) is a common disease with a large burden on healthcare costs. Traditionally, CSA is interpreted as episodes of reversible myocardial ischemia related to the presence of stable coronary artery plaque causing myocardial demand/supply mismatch when myocardial oxygen consumption increases. Accordingly, revascularization procedures are performed with the aim to remove the flow limiting stenosis, whereas traditional medical therapy (hemodynamic agents) aims at reducing myocardial oxygen demands. However, although effective, none of these treatment strategies or their combination is either able to confer symptomatic relief in all patients, nor to reduce mortality. Failure to significantly improve QoL and prognosis may be attributed at least in part to this 'restrictive' understanding of IHD. Despite for many years myocardial metabolic derangement has been overlooked, recently it has gained increased attention with the development of new pharmacological agents (metabolic modulators) able to influence myocardial substrate selection and utilization thus improving cardiac efficiency. Shifting cardiac metabolism from free fatty acids (FA) towards glucose is a promising approach for the treatment of patients with stable angina, independently of the underling disease (macrovascular and/or microvascular disease). In this sense cardiac metabolic modulators open the way to a 'revolutionary' understanding of ischemic heart disease and its common clinical manifestations, where myocardial ischemia is no longer considered as the mere oxygen and metabolites demand/supply unbalance, but as an energetic disorder. Keeping in mind such an alternative approach to the disease, development of new pharmacological agents directed toward multiple metabolic targets is mandatory. [ABSTRACT FROM AUTHOR]

Among the innovative drugs recently introduced for the management of chronic stable angina, Ranolazine and ivabradine represent two most true innovations. In fact, even if both drugs act by reducing myocardial work and thus oxygen consumption, this happens by a peculiar mechanism unlike that of conventional antischemic drugs. Ranolazine mediates its antianginal effects by the inhibition of cardiac late sodium current. This improves myocardial relaxation favoring myocardial perfusion. Ivabradine is a selective If channel blocker and acts by reducing firing rate of pacemaker cells in the sinoatrial node, without affecting the duration of action potential. The reduction of heart rate causes a reduction of left ventricular end diastolic pressure and increases the time useful to coronary flow by a prolongation of the diastole. A body of evidence found that two drugs are useful in ischemic patients whether at rest or during exercise. In addition, they can be used in monotherapy or in association with other conventional anti-ischemic drugs. The two medications could be used with advantage also in microvascular angina when standard therapy is ineffective. Thus, the two drugs represent an adjunctive and powerful therapeutic modality for the treatment of chronic stable angina, especially when conventional antianginal drugs were insufficient or inadequate. [ABSTRACT FROM AUTHOR]

Background: Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Chronic stable angina is the initial manifestation of CAD in approximately 50% of the patients. Recent evidence suggests that vitamin D is crucial for cardiovascular health. The prevalence of vitamin D deficiency in our region is 83%. A low level of vitamin D is associated with chronic stable angina. Aim: This study was aimed at supporting or refuting this hypothesis in our population. Materials and Methods: The study was a prospective case-control study. We studied 100 cases of chronic stable angina and compared them with 100 matched controls. Vitamin D deficiency was defined as <20 ng/mL, vitamin D insufficiency as 20-30 ng/mL and normal vitamin D level as 31-150 ng/mL. Results: The prevalence of vitamin D deficiency among cases and controls was 75% and 10%, respectively. 75% of the cases were vitamin D-deficient (<20 ng/ mL); 12% were vitamin D-insufficient (20-30 ng/mL), and 13% had normal vitamin D levels (31-150 ng/mL). None had a toxic level of vitamin D. Among the controls, 10% were vitamin D-deficient, 33% were vitamin D-insufficient, and 57% had normal vitamin D levels. The mean vitamin level among cases and controls was 15.53 ng/mL and 40.95 ng/mL, respectively, with the difference being statistically significant (P ≤ 0.0001). There was no statistically significant relation between the disease severities, i.e., on coronary angiography (CAG) with vitamin D level. Among the cases, we found that an increasing age was inversely related to vitamin D levels (P = 0.027). Conclusion: Our study indicates a correlation between vitamin D deficiency and chronic stable angina. Low levels may be an independent, potentially modifiable cardiovascular risk factor. [ABSTRACT FROM AUTHOR]

Objective Primary objectives were to evaluate tolerability, compliance, and perception of ranolazine effectiveness for chronic stable angina in a routine clinical setting. The secondary objective was safety evaluation. Methods Prospective, multi-centre, observational, study with a 6-month follow-up and study visits at baseline, 3- and 6 months in patients with chronic stable angina. Ranolazine was administered according to the summary of product characteristics and investigator discretion. Data was collected on patient and disease characteristics, concomitant therapy, angina frequency and severity, quality of life (QoL), perception of effectiveness, compliance, and adverse events. Results Between July 2010 and July 2012, 189 patients were enrolled at 20 centres. Ranolazine decreased the proportion of patients experiencing angina attacks from 88.4% at baseline to 26.5% at 6 months (p < 0.001). Heart rate and blood pressure were not appreciably affected. The proportion of patients without symptoms on normal exertion (Canadian Cardiovascular Society grading class I) increased from 22.3% to 75.3% (p < 0.001); patients reporting limitations in daily activities decreased from 80.4% to 35.5%. (p < 0.001). Patient- and physician-assessed QoL improved (both p < 0.001). Therapeutic efficacy was rated “good” or “very good” in 67.7% of cases by physicians, and by 63.5% of the patients. Physicians rated compliance “good” or “very good” in 73.5% of cases. Adverse events were consistent with previous reports, and consisted of 40 events in 24 patients; 12 were serious. Conclusions Ranolazine was associated with decreased angina frequency and severity, and improvements in QoL. The benefits provided by ranolazine in controlled clinical trials are maintained in the clinical setting. [ABSTRACT FROM AUTHOR]

Background and Objective: Atherosclerosis and its complications are a major cause of ischemic heart diseases. Platelets play an important role in initiation of atherosclerosis and coronary thrombus formation. Large platelets are shown to be hemostatically more active. Evaluation of platelet volume parameters could be useful and significant in prediction and differentiation of coronary events. Methods: In this study, 100 patients with chest pain were divided into 3 groups according to clinical manifestation and standard diagnostic criteria. 25 patients were with unstable angina, 25 patients with chronic stable angina and 50 patients with non-cardiac chest pain as normal population. Platelet indices and count were assayed within 1 to 3 hours, after sampling from venous blood and collection in K3 EDTA, by a Sysmex KX21 analyzer. Data were provided for each group and surveyed by ANOVA and Tukey tests with Pearson correlation and P-value less than 0.05. Findings: Patients with unstable angina had a significant higher MPV (Mean platelet volume) (10.7±0.23 fl), PDW (Platelet distribution width) and PLCR (Platelet-lerge cell ratio) than those in chronic stable angina and normal group (P

Coronary interventions in patients with achondroplasia have been very rarely reported. The optimal approach to such patients in complex cases is not known. They pose special challenge to coronary revascularisation due to short stature, angle of their elbows, kyphoscoliosis, frequent obesity, and lack of specific equipments and experience. We present an interesting case of 67 years old man with achondroplasia who presented with significant angina symptoms and past history of IWMI. Transradial angiography showed chronic total occlusion (CTO) of right coronary artery. Coronary angioplasty was done via right radial approach using available hardware with good results. To our knowledge, this is the first case of radial angioplasty in an achondroplastic patient with CTO. The procedural difficulties and techniques have been discussed along with brief review of literature. [ABSTRACT FROM AUTHOR]