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This study tried to understand the association between exposure to indoor air pollution and angina among the aging population in India. We utilized the data from the Longitudinal Ageing Study in India (LASI) Wave–1 (2017–2018), with a sample of 62,846 aging adults. We applied Chi-square and multivariate logistic regression models. The odds of angina were higher among individuals living in households that used solid fuels for cooking (aOR = 1.15, 99% CI- 1.09-1.20), had someone smoked inside the house (aOR = 1.12, 99% CI- 1.07-1.18), and households that used of incenses inside the home (aOR = 1.11, 99% CI- 1.05-1.18). In addition, it was also found that work-limiting impairment, unhealthy behaviors, and poor health status increased the odds of angina. These results indicate the need to reduce in-house air pollution by promoting clean fuel usage and changing attitudes and practices. Other implications are discussed. [ABSTRACT FROM AUTHOR]

BACKGROUND: Yamaguchi syndrome, first described in 1979, is an apical hypertrophic cardiomyopathy, which represents 1-2% of hypertrophic cardiomyopathies with a high incidence in Japan; however, there are not population studies regarding its incidence among Latin-American patients. CLINICAL CASE: A 41-year-old male patient, who presented with chest pain, ruling out acute coronary syndrome; the electrocardiogram evidenced giant inverted T waves in the precordial leads. Magnetic resonance image established the diagnosis of predominantly apical hypertrophic cardiomyopathy. CONCLUSIONS: Despite being a very rare disease in Mexico, it is essential to consider Yamaguchi syndrome a possible differential diagnosis in the approach of chest pain. [ABSTRACT FROM AUTHOR]

Background: The coronary slow flow phenomenon (CSFP) is an angiographic finding characterised by the delayed passage of contrast through the coronary arteries, despite the absence of obstructive coronary artery disease (defined as less than 50% narrowing of the vessel lumen). Patients with the CSFP experience recurrent angina, for which there are limited evidence-based therapies. Ticagrelor may serve as an effective anti-anginal therapy for these patients by increasing adenosine levels, which could alleviate coronary microvascular dysfunction and its associated angina due to its vasodilatory properties. This study aimed to determine the anti-anginal efficacy of ticagrelor 90 mg taken twice daily on spontaneous angina episodes in patients with refractory angina (i.e., episodes ≥3/week despite two anti-anginals) and documented CSFP. Methods: In a randomised, double-blind, placebo-controlled, cross-over trial, the anti-anginal efficacy of a 4-week ticagrelor therapy regimen was evaluated in 20 patients with refractory angina (mean age 61.5 ± 10.5 years; 40% women) who had documented slow coronary flow. The primary endpoint was the frequency of angina episodes, recorded using an angina diary. Secondary endpoints included the duration and severity of angina episodes, consumption of short-acting nitrates, and health status evaluations using the Seattle Angina Questionnaire (SAQ) and the Short Form-36 (SF-36) indices. Results: During the four weeks of therapy, ticagrelor did not significantly improve angina symptoms compared to the placebo (placebo 25.7 (16.7)) vs. ticagrelor 19.8 (18.1), p > 0.05). Furthermore, it did not impact other patient-related outcome measures, including angina severity, duration, frequency of prolonged angina episodes, nitrate consumption, or the SAQ/SF-36 health outcome indices. No serious adverse events related to the study drug were observed. Conclusions: In patients with documented CSFP who were unresponsive to standard anti-anginal therapy, ticagrelor did not reduce the frequency of spontaneous angina episodes or the consumption of nitrates. Further confirmation of the potential benefits of this therapy may be obtained through a larger clinical trial. [ABSTRACT FROM AUTHOR]

Introduction: Cardiovascular Magnetic Resonance (CMR) has become an essential non-invasive imaging modality in the diagnosis and management of various cardiac conditions. Its ability to provide detailed assessments of myocardial perfusion and scar tissue without ionizing radiation offers distinct advantages over other imaging techniques. Aim is to evaluate the role of Cardiovascular Magnetic Resonance (CMR) in assessing myocardial perfusion and scar tissue and to investigate the correlation of CMR findings with clinical parameters and outcomes, including angina symptoms, history of myocardial infarction, and revascularization procedures. Materials and Methods: This prospective observational study was conducted with a sample size of 75 patients who had clinical indications for CMR. The study included adult’s aged 18 years and older, excluding those with contraindications to MRI or severe renal impairment. CMR imaging was performed using a 1.5 Tesla MRI scanner, incorporating cine imaging, stress and rest perfusion imaging, late gadolinium enhancement (LGE), and T1 and T2 mapping. Results: The study found that 30% of participants exhibited myocardial perfusion defects, with a mean scar burden of 15% across the study cohort. Participants with angina symptoms, a history of myocardial infarction, or those who underwent revascularization procedures had higher scar burdens and lower left ventricular ejection fractions (LVEF). Significant correlations were observed between CMR findings and clinical outcomes, with participants who had a history of myocardial infarction showing the highest scar burden (mean 30%) and lowest LVEF (mean 45%). Conclusion: CMR is a valuable tool for evaluating myocardial perfusion and scar tissue, with significant correlations to clinical outcomes. This study confirms the importance of CMR in the management of cardiovascular diseases and suggests that further research and advancements are necessary to enhance its accessibility and utility in diverse healthcare settings. [ABSTRACT FROM AUTHOR]

Aims/Background Coronary heart disease (CHD) and atrial fibrillation (AF) exhibit a close relationship, yet the existing body of research predominantly relies on observational study methodologies, posing challenges in establishing causal relationships. The objective of our study is to investigate the causal linkages between coronary atherosclerosis (CAAs), angina pectoris, myocardial infarction (MI), and AF. Methods This study utilizes a two-sample Mendelian randomization (TSMR) methodology, leveraging genetic variation as a means of evaluating causality. Mendelian randomization is grounded in three primary assumptions: (1) the genetic variant is linked to the exposure, (2) the genetic variant is independent of confounding factors, and (3) the genetic variant influences the outcome solely through the exposure. Results The results of our study suggest a genetic predisposition in which CAAs, angina, and MI may enhance susceptibility to AF, while AF may reciprocally elevate the risk of CAAs. Conclusion In light of these findings, it is recommended that patients with CHD undergo regular cardiac rhythm monitoring, and that patients with AF receive anticoagulant and antiplatelet therapy whenever feasible. This study posits a practical implication for clinical practice. [ABSTRACT FROM AUTHOR]

Headache and visceral pain are common clinical painful conditions, which often co-exist in the same patients. Numbers relative to their co-occurrence suggest possible common pathophysiological mechanisms. The aim of the present narrative review is to describe the most frequent headache and visceral pain associations and to discuss the possible underlying mechanisms of the associations and their diagnostic and therapeutic implications based on the most recent evidence from the international literature. The conditions addressed are as follows: visceral pain from the cardiovascular, gastrointestinal, and urogenital areas and primary headache conditions such as migraine and tension-type headache. The most frequent comorbidities involve the following: cardiac ischemic pain and migraine (possible shared mechanism of endothelial dysfunction, oxidative stress, and genetic and hormonal factors), functional gastrointestinal disorders, particularly IBS and both migraine and tension-type headache, primary or secondary dysmenorrhea and migraine, and painful bladder syndrome and headache (possible shared mechanisms of peripheral and central sensitization processes). The data also show that the various visceral pain–headache associations are characterized by more than a simple sum of symptoms from each condition but often involve complex interactions with the frequent enhancement of symptoms from both, which is crucial for diagnostic and treatment purposes. [ABSTRACT FROM AUTHOR]

Three cats were presented for unusual collapsing episodes. Echocardiography revealed a hypertrophic cardiomyopathy (HCM) phenotype in each cat. Continuous electrocardiographic monitoring showed that the clinical signs coincided with periods of severe ST-segment elevation in each cat. The first cat was treated with amlodipine and diltiazem but did not improve and was euthanized due to poor quality of life. Postmortem examination revealed cardiac lymphoma without obstructive coronary disease. The second cat was thought to have cardiac lymphoma, based on pericardial effusion cytology, and was euthanized before starting therapy. The third cat was diagnosed with HCM and left ventricular outflow tract obstruction and was treated with atenolol and diltiazem. This treatment reduced the frequency of episodic clinical signs, but the cat subsequently developed congestive heart failure and was euthanized. This case series describes clinical signs associated with severe ST elevation in cats with an HCM phenotype, and their outcomes. Continuous electrocardiographic monitoring was necessary to detect transient ST elevation in each case. [ABSTRACT FROM AUTHOR]

Background Coronary stents have been reported to cause endothelial dysfunction, potentially leading to spasm at the edges of the stent. However, the clinical significance of vascular spasm in stent-jailed side branches remains poorly understood. Case summary A 67-year-old woman was referred to our hospital for angina occurring both during exercise and at rest. An everolimus-eluting stent was implanted for a physiologically significant stenosis in the proximal left anterior descending artery, while an intermediate stenosis persisted in the jailed first diagonal branch. Although her exertional angina resolved, her rest symptoms worsened after percutaneous coronary intervention (PCI). She was admitted with acute myocardial infarction 1 month later. Urgent coronary angiography showed no stent failure, but an acetylcholine provocation test induced a spasm leading to total occlusion of the jailed diagonal branch. An additional stent was implanted in the diagonal branch due to a residual stenosis even after isosorbide dinitrate administration. After the second PCI, her chest pain completely resolved. Discussion This is the first documentation of aggregated coronary spasm observed at the ostium of stent-jailed side branch. Stent implantation may induce endothelial dysfunction and promote inflammation, leading to spasms particularly at stent edges. This phenomenon can extend to side branches jailed by the stent, and invasive intervention may be a viable therapeutic strategy for such cases. [ABSTRACT FROM AUTHOR]

Coronary spasm related to thyrotoxicosis is a complication rarely reported in the literature. Its initial clinical presentation is often more severe with more diffuse involvement and resistance to medical treatment compared to classic coronary spasm. Its diagnosis relies on a careful clinical analysis and a comparative study of electrocardiographic data. Coronary angiography should be avoided as much as possible as well as treatment by nonselective beta-blocking agents because of the risk of worsening hyperthyroidism and coronary vasoconstriction. We report a case of coronary spasm secondary to Graves' disease whose management was inspired by lessons learned from clinical cases reported in the literature. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

The 2019 European Society of Cardiology (ESC) guidelines proposed a pre-test probability (PTP) model to determine the likelihood of coronary artery disease (CAD). However, the prediction accuracy of this model has not yet been evaluated in Chinese populations. This study aimed to validate the 2019 ESC-PTP model in predicting CAD using coronary computed tomography angiography (CCTA) outcomes in a Chinese population. A total of 26,346 consecutive patients with suspected CAD who underwent CCTA were included. The 2019 ESC-PTP model and 2013 ESC-PTP model were calculated for each patient, considering age, sex, and the symptom of chest pain, and the patients were categorized into low-, intermediate-, and high-risk groups. The predictive performance of the 2019 ESC-PTP model was evaluated by comparing it with the 2013 ESC-PTP model and the observed prevalence of CAD from CCTA. Among the 11,234 patients analyzed in the study, 1896 (16.9%) patients were found to have obstructive CAD from CCTA. The 2019 ESC-PTP model had better calibration compared to the 2013 ESC-PTP model. After categorization, 80.9% of patients (67.9% in men and 94.4% in women) were in the same risk category as in the 2019 ESC-PTP model, but the risks of younger patients (7.5% versus 2.5%; P ​< ​0.001) and patients with non-anginal chest pain (13.7% versus 8.2%; P ​< ​0.001) were underestimated in the 2019 ESC-PTP model. The 2019 ESC-PTP model demonstrated a good calibration in predicting CAD in a Chinese population who underwent CCTA, but it exhibited an underestimation of CAD probability in younger patients and patients with non-anginal chest pain. [ABSTRACT FROM AUTHOR]

Objective To retrospectively analyze the application effect of nursing model intervention under the precision medicine framework in elderly patients with coronary heart disease (CHD). Methods A total of 114 elderly CHD patients were selected, and divided into precision medicine group (n = 57) and routine group (n = 57) according to different nursing methods. The routine group received routine care while the precision medicine group received nursing model intervention under the precision medicine framework based on routine care. Cardiac function [stroke volume (SV) and LVEF], angina control [Seattle Angina Questionnaire (SAQ)], negative emotions (SCL-90), quality of life [Minnesota Heart Failure Quality of Life Scale (LHFQ)], and nursing satisfaction were compared between the two groups. Results After intervention, SV and LVEF indexes in the precision medicine group were both higher than those in the routine group (P<0. 05); the SAQ scores of angina stable state, angina attack, degree of physical activity limitation, degree of disease cognition and satisfaction with treatment in the precision medicine group were all lower than those in the routine group (P<0. 05). SCL-90 and LHFQ scores of both groups after intervention were lower than before (P<0. 05); the SCL-90 score of the precision medicine group was lower than that of the routine group after intervention (P < 0. 05); the above scores of the precision medicine group were significantly lower than those of the routine group after intervention (P < 0. 05). Nursing satisfaction of the precision medicine group was higher than that of the routine group (98. 25% vs. 85. 96%, P < 0. 05 ). Conclusion Implementing nursing model intervention under the precision medicine framework for elderly CHD patients could improve heart function, angina control, negative emotions, patients' quality of life and nursing satisfaction. [ABSTRACT FROM AUTHOR]

Background: Readmission of elderly angina patients has become a serious problem, with a dearth of available prediction tools for readmission assessment. The objective of this study was to develop a machine learning (ML) model that can predict 180-day all-cause readmission for elderly angina patients. Methods: The clinical data for elderly angina patients was retrospectively collected. Five ML algorithms were used to develop prediction models. Area under the receiver operating characteristic curve (AUROC), area under the precision recall curve (AUPRC), and the Brier score were applied to assess predictive performance. Analysis by Shapley additive explanations (SHAP) was performed to evaluate the contribution of each variable. Results: A total of 1502 elderly angina patients (45.74% female) were enrolled in the study. The extreme gradient boosting (XGB) model showed good predictive performance for 180-day readmission (AUROC = 0.89; AUPRC = 0.91; Brier score = 0.21). SHAP analysis revealed that the number of medications, hematocrit, and chronic obstructive pulmonary disease were important variables associated with 180-day readmission. Conclusions: An ML model can accurately identify elderly angina patients with a high risk of 180-day readmission. The model used to identify individual risk factors can also serve to remind clinicians of appropriate interventions that may help to prevent the readmission of patients. [ABSTRACT FROM AUTHOR]

Background Chest pain (CP) in patients with nonobstructive coronary artery disease is a therapeutic challenge affecting morbidity and mortality. We aimed to identify clinical factors associated with CP in this population, hypothesizing that obesity and depressive symptoms are associated with CP. Methods and Results In 814 patients with angiographically confirmed nonobstructive coronary artery disease, we measured sociodemographic variables, clinical risk factors, medications, and Patient Health Questionnaire 9 scores for depressive symptoms. We assessed CP frequency and prevalence by using all items from the Seattle Angina Questionnaire angina frequency domain to generate an angina frequency composite score. In the overall sample (58.8±11.7 years old, 52.6% female), 42.8% had obesity, and 71.5% had CP, with an angina frequency composite score (SD) score of 76.4 (22.1). Compared with individuals without obesity, individuals with obesity had a higher prevalence (77.6% versus 67%, P

Abstract Background Pheochromocytoma is rare in pregnant women. It presents as diverse symptoms, including hypertension and sweating. The symptoms of pregnant women with pheochromocytoma and comorbid hypertension often mimic the clinical manifestations of preeclampsia, and these women are often misdiagnosed with preeclampsia. Case presentation In this case, a pregnant woman presented with chest pain as the primary symptom, and a diagnosis of pheochromocytoma was considered after ruling out myocardial ischemia and aortic dissection with the relevant diagnostic tools. This patient then underwent successful surgical resection using a nontraditional management approach, which resulted in a positive clinical outcome. Conclusions It is essential to consider pheochromocytoma as a potential cause of chest pain and myocardial infarction-like electrocardiographic changes in pregnant women, even if they do not have a history of hypertension.

Sagliker syndrome (SS) develops in chronic kidney disease patients because of insufficiently treated secondary hyperparathyroidism (SHPT) at an early stage. Studies indicating the potential association of the pathophysiology of the syndrome with genetic mutations are available. Phenotypic characteristics such as Brown tumors, lytic non-neoplastic bone lesions resulting from abnormal bone metabolism, deformities in the mandible and maxilla, irregularly spaced teeth, hypertrophic prominence of the lips, short neck, and slender upper and lower extremities are prominent in these patients. Brown tumors are often found in the metaphyses of the long bones, pelvis, maxilla, and costae, with significant involvement observed in our patient’s bilateral costae. The facial deformities in our patient were consistent and similar to the phenotype findings in other cases reported in the literature. In patients with chronic kidney disease (CKD), anemia is frequently observed because of increased SHPT, with a direct toxic effect on erythropoietin synthesis and erythropoietin progenitors in bone marrow. While anemia is common, bone marrow fibrosis and pancytopenia are much rarer. Although hyperparathyroidism is considered to be the responsible factor in the pathophysiology of SS, the literature does not report an association between SS and bone marrow fibrosis, making our case the first presentation of such an association. The high prevalence and early onset of coronary artery diseases (CAD) in patients with CKD are associated with a combination of systemic inflammation, oxidative stress, hypertension, vascular calcification, and disruptions in bone metabolism. In the patient’s medical history, there was no presence of hypertension, diabetes, smoking, or a family history of these conditions. SHPT in end-stage renal disease has been shown to accelerate vascular calcification and subclinical atherosclerosis. The presence of early-onset CAD in our patient, despite the absence of traditional risk factors, raises the question of whether hyperparathyroidism, a prominent factor in this syndrome, played a significant role in its etiology.

Background: Pheochromocytoma is rare in pregnant women. It presents as diverse symptoms, including hypertension and sweating. The symptoms of pregnant women with pheochromocytoma and comorbid hypertension often mimic the clinical manifestations of preeclampsia, and these women are often misdiagnosed with preeclampsia. Case presentation: In this case, a pregnant woman presented with chest pain as the primary symptom, and a diagnosis of pheochromocytoma was considered after ruling out myocardial ischemia and aortic dissection with the relevant diagnostic tools. This patient then underwent successful surgical resection using a nontraditional management approach, which resulted in a positive clinical outcome. Conclusions: It is essential to consider pheochromocytoma as a potential cause of chest pain and myocardial infarction-like electrocardiographic changes in pregnant women, even if they do not have a history of hypertension. [ABSTRACT FROM AUTHOR]

Background Increasing mortality and morbidity of coronary artery disease (CAD) highlight the emerging need for novel noninvasive markers such as circulating microRNAs (miRNAs). Objective To evaluate the circulating levels of miR-126-3p, miR-210-3p, let-7g-5p, and miR-326, and their associations with known contributors to CAD, in CAD subgroups. Methods We divided the cohort into 4 groups: non-CAD controls (≤30% stenosis; n = 55), and patients with stable angina pectoris (SAP; n = 48), unstable AP (UAP; n = 46), and myocardial infarction (MI; n = 36). The circulating levels of miR-126-3p, miR-210-3p, let-7g-5p, and miR-326 were determined using TaqMan Advanced miRNA Assays in serum specimens. Results Circulating miR-126-3p levels were lower in the MI and UAP groups, compared with the non-CAD group, whereas miR-210-3p circulating levels were lower in the MI group than others. The levels of circulating let-7g-5p were shown to be useful for distinguishing UAP from MI, and there were substantial differences in circulating let-7g-5p levels between the UAP and MI groups. Moreover, lipid levels and ratios were lower in individuals with high circulating miR-126-3p and miR-210-3p levels. Conclusions The study results suggest that circulating miR-126-3p, miR-210-3p, and let-7g-5p are differentiated between different clinical presentations of CAD and associated with lipid levels, which are important risk factors and determinants of CAD. [ABSTRACT FROM AUTHOR]

The association between coronary computed tomography angiography (CTA) derived fractional flow reserve (FFR CT) and risk of recurrent angina in patients with new onset stable angina pectoris (SAP) and stenosis by CTA is uncertain. Multicenter 3-year follow-up study of patients presenting with symptoms suggestive of new onset SAP who underwent first-line CTA evaluation and subsequent standard-of-care treatment. All patients had at least one ≥30 ​% coronary stenosis. A per-patient lowest FFR CT -value ≤0.80 represented an abnormal test result. Patients with FFR CT ≤0.80 who underwent revascularization were categorized according to completeness of revascularization: 1) Completely revascularized (CR-FFR CT), all vessels with FFR CT ≤0.80 revascularized; or 2) incompletely revascularized (IR-FFR CT) ≥1 vessels with FFR CT ≤0.80 non-revascularized. Recurrent angina was evaluated using the Seattle Angina Questionnaire. Amongst 769 patients (619 [80 ​%] stenosis ≥50 ​%, 510 [66 ​%] FFR CT ≤0.80), 174 (23 ​%) reported recurrent angina at follow-up. An FFR CT ≤0.80 vs ​> ​0.80 associated to increased risk of recurrent angina, relative risk (RR): 1.82; 95 ​% CI: 1.31–2.52, p ​< ​0.001. Risk of recurrent angina in CR-FFR CT (n ​= ​135) was similar to patients with FFR CT >0.80, 13 ​% vs 15 ​%, RR: 0.93; 95 ​% CI: 0.62–1.40, p ​= ​0.72, while IR-FFR CT (n ​= ​90) and non-revascularized patients with FFR CT ≤0.80 (n ​= ​285) had increased risk, 37 ​% vs 15 ​% RR: 2.50; 95 ​% CI: 1.68–3.73, p ​< ​0.001 and 30 ​% vs 15 ​%, RR: 2.03; 95 ​% CI: 1.44–2.87, p ​< ​0.001, respectively. Use of antianginal medication was similar across study groups. In patients with SAP and coronary stenosis by CTA undergoing standard-of-care guided treatment, FFR CT provides information regarding risk of recurrent angina. [ABSTRACT FROM AUTHOR]

Ischemia with no obstructive coronary arteries is frequently caused by coronary microvascular dysfunction (CMD). Consensus diagnostic criteria for CMD include baseline angiographic slow flow by corrected TIMI (Thrombolysis In Myocardial Infarction) frame count (cTFC), but correlations between slow flow and CMD measured by invasive coronary function testing (CFT) are uncertain. The aim of this study was to investigate relationships between cTFC and invasive CFT for CMD. Adults with ischemia with no obstructive coronary arteries underwent invasive CFT with thermodilution-derived baseline coronary blood flow, coronary flow reserve (CFR), and index of microcirculatory resistance (IMR). CMD was defined as abnormal CFR (<2.5) and/or abnormal IMR (≥25). cTFC was measured from baseline angiography; slow flow was defined as cTFC >25. Correlations between cTFC and baseline coronary flow and between CFR and IMR and associations between slow flow and invasive measures of CMD were evaluated, adjusted for covariates. All patients provided consent. Among 508 adults, 49% had coronary slow flow. Patients with slow flow were more likely to have abnormal IMR (36% vs 26%; P = 0.019) but less likely to have abnormal CFR (28% vs 42%; P = 0.001), with no difference in CMD (46% vs 51%). cTFC was weakly correlated with baseline coronary blood flow (r = −0.35; 95% CI: −0.42 to −0.27), CFR (r = 0.20; 95% CI: 0.12 to 0.28), and IMR (r = 0.16; 95% CI: 0.07-0.24). In multivariable models, slow flow was associated with lower odds of abnormal CFR (adjusted OR: 0.53; 95% CI: 0.35 to 0.80). Coronary slow flow was weakly associated with results of invasive CFT and should not be used as a surrogate for the invasive diagnosis of CMD. [Display omitted] [ABSTRACT FROM AUTHOR]

Acute coronary syndrome is an umbrella term encompassing three types of coronary artery disease that affect millions worldwide annually. Despite the availability of diagnostic tests (blood analysis, imaging, electrocardiogram, and screening tools), the diagnosis of myocardial infarction (MI) is still sometimes missed. According to the Centers for Disease Control and Prevention, the reported prevalence of heart disease is higher among males than females, with adults over the age of 75 having the highest prevalence. Typical "heart attack" features include chest pain that feels like pressure or squeezing, pain or discomfort in one or both arms that can radiate to the neck or jaw, shortness of breath, diaphoresis, nausea, vomiting, and lightheadedness. However, there are three subgroups where the typical warning signs do not always present: the elderly, individuals with diabetes, and females. The following is an atypical case presentation of unstable angina and non-ST-elevation MI. [ABSTRACT FROM AUTHOR]

A man in his 70s with a history of mitral valve replacement (MVR) and long-standing persistent atrial fibrillation (AF) presented with effort angina. Coronary angiography revealed severe stenosis of the left main coronary artery (LMCA). As it was an emergent case, PCI (percutaneous coronary intervention) was selected for treatment. Intravascular ultrasonography revealed no atherosclerotic lesions in the LMCA. The LMCA was effectively dilated by the drug-eluting stent. No elevation in intracardiac pressure was observed in cardiac catheterization after PCI. Computed tomography scan indicated potential compression of the LMCA by the surrounding structures. In cases of long-standing persistent AF and an enlarged atrium after MVR, the possibility of LMCA stenosis due to anatomical changes should be considered. ◾ Peri-valvular regurgitation and long-standing persistent atrial fibrillation can potentially cause atrial enlargement. ◾ Coronary artery stenosis without atherosclerosis can occur due to compression from surrounding structures or shifting of the coronary artery. ◾ Stent therapy provides a temporary solution and coronary artery bypass grafting or switching should be considered if re-stenosis occurs. [ABSTRACT FROM AUTHOR]

Ischemic heart disease is one of the main causes of death worldwide. In this study, the plasma samples of 47 patients with angina, 51 patients with myocardial infarction, and 80 patients with heart failure were collected. Ultra-performance liquid chromatography-high resolution mass spectrometry (UPLC-HRMS) and chemometrics were used to analyze the plasma metabolic disorder in disease progression for patients with ischemic heart disease. Chromatographic separation was performed on an ACE3 C18 column (150 mm×3.0 mm×3 μm), and MS analysis was carried out by electrospray ionization (ESI) source at positive and negative modes combined with full scanning. In total, 97 endogenous metabolites were identified and quantitative analyzed. Principal component analysis and partial least square-discriminant analysis were applied in combination with variable importance projection (VIP) and t-test to screen differentially characteristic metabolites. Metabolite concentration was analyzed using SPSS and the metabolites with significant differences (P<0.05) were found between different processes of diseases. Discriminant analysis using partial least squares-discriminant analysis (PLS-DA) was conducted on various disease processes. Classification models were established for angina, myocardial infarction, and heart failure patients. The variables with VIP>1 were selected using Variable Importance in Projection screening. Finally, disease-specific metabolites were identified using VIP>1 and t-test P<0.05. Accordingly, 28 and 32 characteristic metabolites were selected to distinguish between patients with angina and myocardial infarction, and with myocardial infarction and heart failure, respectively. The metabolic pathway analysis revealed disorders in both amino acid metabolism and the tricarboxylic acid cycle during the progression from angina to myocardial infarction, and from myocardial infarction to heart failure. In the progression from myocardial infarction to heart failure, there is a significant disturbance in lipid metabolism, including glycerophospholipid metabolism and fatty acid biosynthesis. Based on the results of 1 receiver operating character (ROC) analysis, several indicators including glycocholic acid, fumaric acid, palmitic acid, troponin, high-density lipoprotein, alanine aminotransferase, and aspartate aminotransferase, were found to have diagnostic significance for distinguishing between angina and myocardial infarction, with respective area under curve (AUC) values of 0.737 6, 0.831 9, 0.827 7, 0.938 7, 0.646 0, 0.704 5 and 0.758 9. When these indicators were combined, the AUC was increased to 1.000 0. Similarly, citrulline, citric acid, stearic acid, glycerophospholine, and NT-proBNP were found to have diagnostic significance for distinguishing between myocardial infarction and heart failure, with respective AUC values of 0.619 4, 0.748 7, 0.878 4, 0.636 0 and 0.812 1. When these indicators were combined, the AUC was increased to 0.957 0. At present, there have been some advances in understanding the metabolic characteristics of patients with angina or heart failure based on metabolomics, but there is limited research on the metabolic characteristics of patients with ischemic heart disease. The findings of this study can provide important metabolic targets for precise diagnosis of ischemic heart disease and drug and nutritional interventions during disease development. [ABSTRACT FROM AUTHOR]

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Coronary physiology is widely used to assess epicardial coronary lesions in patients with stable angina. Based on the available evidence, physiology plays a crucial role in diagnosing and treating patients. There have been invasive methods for determining cardiac physiology, such as fractional flow reserve and instantaneous wave-free ratio. Still, new non-invasive approaches provide extra anatomical information, such as fractional flow reserve computed tomography (FFR-CT) based on computed tomography and physiology based on angiography. Even though FFR-guided percutaneous coronary intervention (PCI) is clinically beneficial, one-third of patients retain suboptimal FFR after the procedure, associated with severe adverse events, rendering PCI in diffuse coronary artery disease questionable. Using the pullback pressure gradient (PPG), we can analyze the magnitude and extent of pressure losses; a lower value may indicate diffuse disease, while a high value with an abrupt curve may indicate focal disease. Since PCI is not the best option for treating diffuse coronary disease, current strategies focus on conservatively using medical therapy or bypass surgery. It has been demonstrated that patients with diffuse disease of the left anterior descending (LAD) are at a greater risk of developing occlusion of the left internal mammary artery graft than those with focal disease and that maximal medical therapy may be the most effective treatment for these patients. [ABSTRACT FROM AUTHOR]

BackgroundCoronary vasospasm (CVS) is a common cardiovascular condition, yet its implications should not be underestimated. Regrettably, the current diagnostic and treatment standards for CVS in China are not standardized, severely affecting the quality of life for patients with this condition.Case presentationA 68-year-old male presented to the hospital one month prior due to recurrent chest pain. Coronary angiography (CAG) revealed a mid-segment muscle bridge with plaque formation in the left anterior descending artery, followed by pharmacological balloon angioplasty. The primary diagnosis post-operation was acute non-ST elevation myocardial infarction (NSTEMI) and coronary artery myocardial bridging. This time, the patient experienced nocturnal chest pain with a dynamic increase in troponin levels. Emergency CAG showed the left anterior descending and right coronary arteries were fine, with segmental narrowing reaching 95%–99%. Intravascular ultrasound (IVUS) indicated negative remodeling of the mid-segment lumen associated with myocardial bridging, with the smallest lumen area being 2.19 mm2. After intracoronary administration of nitroglycerin, the original most narrowed lumen area increased to 8.81 mm2. Consequently, a definitive diagnosis of CVS with coronary artery myocardial bridging was made, and the medication treatment plan was promptly adjusted. The patient's symptoms disappeared, and he was discharged. Follow-up after more than three months showed no recurrence of symptoms.ConclusionIn cases where provocative agents are contraindicated, CAG combined with IVUS can optimize the differential diagnosis of CVS. There is an urgent need in China to improve epidemiological data on CVS and establish standardized diagnostic and treatment protocols.

Background: Asthma and cardio-cerebrovascular diseases (CVDs) share a common etiology of chronic systemic inflammation. Our manuscript was to investigate the association between childhood asthma and CVDs in middle-aged and elderly. Methods: A total of 12,070 US middle-aged and elder were enrolled in the National Health and Nutrition Examination Survey. Childhood asthma was defined as a previous diagnosis of asthma at

Zeynep Yukselen,1 Vidit Majmundar,1 Mahati Dasari,1 Pramukh Arun Kumar,1 Yuvaraj Singh2 1Department of Internal Medicine, Saint Vincent Hospital, Worcester, MA, 01608, USA; 2Division of Gastroenterology and Hepatology, UMass Chan Medical School, Worcester, MA, 01605, USACorrespondence: Yuvaraj Singh, Division of Gastroenterology and Hepatology, UMass Chan Medical School, 55 N Lake Ave, Worcester, MA, 01605, USA, Tel +1 774-641-7648 ; +1 508-334-4297, Email Yuvaraj.singh1@umassmed.eduAbstract: Chest pain is the second leading cause of all emergency department (ED) visits in adults in the United States, with nearly 11 million encounters yearly. While identifying low-risk patients is crucial for early discharge, identifying high-risk patients in ED is vital in timely and appropriate acute coronary syndrome (ACS) management. Traditional methods such as physical examination, cardiac markers, or imaging tests cannot reliably confirm or rule out ACS; they cannot be singularly incorporated to risk stratify patients. Various clinical risk scores have been proposed to address this challenge for risk stratification in patients being evaluated for suspected ACS. The ideal risk score should demonstrate high sensitivity and specificity to accurately differentiate between patients with varying levels of risk, particularly in identifying those at high risk for major adverse cardiovascular events. Simultaneously, an ideal scoring system should also be able to compute information for other non-coronary etiologies of chest pain that require time-sensitive interventions and workups (eg, aortic dissection and pulmonary embolism). In this review, we have assembled major risk scores used for risk stratification in patients with acute chest pain in ED. We have abbreviated their salient features to assist readers in their clinical decision-making.Keywords: angina, acute coronary syndrome, ED, cardiac mortality, adverse events

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Accurate measurement and interpretation of serum levels of troponin (Tn) is a central part of the clinical workup of a patient presenting with chest pain suspicious for acute coronary syndrome (ACS). Knowledge of the molecular characteristics of the troponin complex and test characteristics of troponin measurement assays allows for a deeper understanding of causes of false positive and false negative test results in myocardial injury. In this review, we discuss the molecular structure and functions of the constituent proteins of the troponin complex (TnT, TnC, and TnI); review the different isoforms of Tn and where they are from; survey the evolution of clinical Tn assays, ranging from first-generation to high-sensitivity (hs); provide a primer on statistical interpretation of assay results based on different clinical settings; and discuss potential causes of false results. We also summarize the advances in technologies that may lead to the development of future Tn assays, including the development of point of care assays and wearable Tn sensors for real-time continuous measurement. [ABSTRACT FROM AUTHOR]

Background: Patients with angina are often suffering from comorbidities such as varying degrees of hepatic dysfunction. However, the impact of angina on the incidence of hepatic failure (HF) remains unclear. Methods: The genetic data were retrieved from genome-wide association studies. Five Mendelian randomization methods were used to investigate the causal relationship between unstable angina (UA), stable angina (SA), and HF. The result of the Inverse variance weighted (IVW) method was deemed the principal result. In addition, we performed a comprehensive sensitivity analysis to verify the robustness of the results. Results: The IVW results showed that UA (Odds ratio (OR): 2.055, 95% confidence interval (CI): 1.171–3.606, p = 0.012) was causally associated with the incidence of HF. SA (OR: 1.122, 95% CI: 0.738–1.706, p = 0.591) was not causally associated with the incidence of HF. Sensitivity analysis did not identify any bias in the results. Conclusions: UA turned out to be a risk factor for HF. SA does not have a significant causal effect on HF. Therefore, it is highly recommended that patients with chronic liver disease seek prompt medical attention and undergo regular monitoring of liver function when experiencing UA. This may help them to reduce the risk of HF. [ABSTRACT FROM AUTHOR]

BACKGROUND: We investigated the usefulness of invasive coronary function testing to diagnose the cause of angina in patients with no obstructive coronary arteries. METHODS: Outpatients referred for coronary computed tomography angiography in 3 hospitals in the United Kingdom were prospectively screened. After coronary computed tomography angiography, patients with unobstructed coronary arteries, and who consented, underwent invasive endotyping. The diagnostic assessments included coronary angiography, fractional flow reserve (patient excluded if ≤0.80), and, for those without obstructive coronary artery disease, coronary flow reserve (abnormal <2.0), index of microvascular resistance (abnormal ≥25), and intracoronary infusion of acetylcholine (0.182, 1.82, and 18.2 μg/mL; 2 mL/min for 2 minutes) to assess for microvascular and coronary spasm. Participants were randomly assigned to disclosure of the results of the coronary function tests to the invasive cardiologist (intervention group) or nondisclosure (control group, blinded). In the control group, a diagnosis of vasomotor angina was based on medical history, noninvasive tests, and coronary angiography. The primary outcome was the between-group difference in the reclassification rate of the initial diagnosis on the basis of coronary computed tomography angiography versus the final diagnosis after invasive endotyping. The Seattle Angina Questionnaire summary score and Treatment Satisfaction Questionnaire for Medication were secondary outcomes. RESULTS: Of 322 eligible patients, 250 (77.6%) underwent invasive endotyping; 19 (7.6%) had obstructive coronary disease, 127 (55.0%) had microvascular angina, 27 (11.7%) had vasospastic angina, 17 (7.4%) had both, and 60 (26.0%) had no abnormality. A total of 231 patients (mean age, 55.7 years; 64.5% women) were randomly assigned and followed up (median duration, 19.9 [12.6-26.9] months). The clinician diagnosed vasomotor angina in 51 (44.3%) patients in the intervention group and in 55 (47.4%) patients in the control group. After randomization, patients in the intervention group were 4-fold (odds ratio, 4.05 [95% CI, 2.32-7.24]; P<0.001) more likely to be diagnosed with a coronary vasomotor disorder; the frequency of this diagnosis increased to 76.5%. The frequency of normal coronary function (ie, no vasomotor disorder) was not different between the groups before randomization (51.3% versus 50.9%) but was reduced in the intervention group after randomization (23.5% versus 50.9%, P<0.001). At 6 and 12 months, the Seattle Angina Questionnaire summary score in the intervention versus control groups was 59.2±24.2 (2.3±16.2 change from baseline) versus 60.4±23.9 (4.6±16.4 change) and 63.7±23.5 (4.7±14.7 change) versus 66.0±19.3 (7.9±17.1 change), respectively, and not different between groups (global P=0.36). Compared with the control group, global treatment satisfaction was higher in the intervention group at 12 months (69.9±22.8 versus 61.7±26.9, P=0.013). CONCLUSIONS: For patients with angina and no obstructive coronary arteries, a diagnosis informed by invasive functional assessment had no effect on long-term angina burden, whereas treatment satisfaction improved. [ABSTRACT FROM AUTHOR]

This study aimed to identify the symptoms used to assess angina, determine how emergency nurses make triage decisions for potential acute coronary syndrome, and determine emergency nurses' initial actions. This was a cross-sectional, survey-based design. Emergency nurses were recruited through a posting on the Emergency Nurses Association website and through postcards. Measures included demographic data, assessment of angina, and the Nurses' Cardiac Triage Instrument. Data were analyzed using descriptive statistics and ordinal logistic regression. A total of 414 registered nurses with a mean age of 41.7 (SD = 12.0) years participated. They were predominantly female (80.7%), had a baccalaureate degree (60.1%), and worked as a registered nurse for a median 10.0 years. Common terms used to assess angina were chest pain (79.5%), chest pressure (77.3%), chest tightness (72.9%), and chest discomfort (72.5%). The severity of chest pressure (median 5.0, interquartile range 1.0) and nature of chest pain (median 5.0, interquartile range 1.0) had the highest overall median scores to support initial cardiac triage decisions. Associated symptoms of diaphoresis, fatigue, and shortness of breath along with health history contributed to decision making. Emergency nurses primarily used chest symptoms and health history when deciding to evaluate for acute coronary syndrome in the emergency department. Associated symptoms of diaphoresis, fatigue, and shortness of breath, along with health history, also contributed to decision making. Initial registered nurse actions were to obtain an electrocardiogram, prepare the patient for the cardiac catheterization laboratory, and notify the emergency physician of the patient's admission. [ABSTRACT FROM AUTHOR]

BACKGROUND: Myocardial bridges (MBs) are prevalent and can be associated with acute and chronic ischemic syndromes. We sought to determine the substrates for ischemia in patients with angina with nonobstructive coronary arteries and a MB in the left anterior descending artery. METHODS: Patients with angina with nonobstructive coronary arteries underwent the acquisition of intracoronary pressure and flow during rest, supine bicycle exercise, and adenosine infusion. Coronary wave intensity analysis was performed, with perfusion efficiency defined as accelerating wave energy/total wave energy (%). Epicardial endothelial dysfunction was defined as a reduction in epicardial vessel diameter ≥20% in response to intracoronary acetylcholine infusion. Patients with angina with nonobstructive coronary arteries and a MB were compared with 2 angina with nonobstructive coronary arteries groups with no MB: 1 with coronary microvascular disease (CMD: coronary flow reserve, <2.5) and 1 with normal coronary flow reserve (reference: coronary flow reserve, ≥2.5). RESULTS: Ninety-two patients were enrolled in the study (30 MB, 33 CMD, and 29 reference). Fractional flow reserve in these 3 groups was 0.86±0.05, 0.92±0.04, and 0.94±0.05; coronary flow reserve was 2.5±0.5, 2.0±0.3, and 3.2±0.6. Perfusion efficiency increased numerically during exercise in the reference group (65±9%–69±13%; P=0.063) but decreased in the CMD (68±10%–50±10%; P<0.001) and MB (66±9%–55±9%; P<0.001) groups. The reduction in perfusion efficiency had distinct causes: in CMD, this was driven by microcirculation-derived energy in early diastole, whereas in MB, this was driven by diminished accelerating wave energy, due to the upstream bridge, in early systole. Epicardial endothelial dysfunction was more common in the MB group (54% versus 29% reference and 38% CMD). Overall, 93% of patients with a MB had an identifiable ischemic substrate. CONCLUSIONS: MBs led to impaired coronary perfusion efficiency during exercise, which was due to diminished accelerating wave energy in early systole compared with the reference group. Additionally, there was a high prevalence of endothelial and microvascular dysfunction. These ischemic mechanisms may represent distinct treatment targets. [ABSTRACT FROM AUTHOR]

Copyright of Polish Otorhinolaryngological Review / Polski Przegląd Otorynolaryngologiczny (Index Copernicus) is the property of Index Copernicus International and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Sagliker syndrome (SS) develops in chronic kidney disease patients because of insufficiently treated secondary hyperparathyroidism (SHPT) at an early stage. Studies indicating the potential association of the pathophysiology of the syndrome with genetic mutations are available. Phenotypic characteristics such as Brown tumors, lytic non-neoplastic bone lesions resulting from abnormal bone metabolism, deformities in the mandible and maxilla, irregularly spaced teeth, hypertrophic prominence of the lips, short neck, and slender upper and lower extremities are prominent in these patients. Brown tumors are often found in the metaphyses of the long bones, pelvis, maxilla, and costae, with significant involvement observed in our patient's bilateral costae. The facial deformities in our patient were consistent and similar to the phenotype findings in other cases reported in the literature. In patients with chronic kidney disease (CKD), anemia is frequently observed because of increased SHPT, with a direct toxic effect on erythropoietin synthesis and erythropoietin progenitors in bone marrow. While anemia is common, bone marrow fibrosis and pancytopenia are much rarer. Although hyperparathyroidism is considered to be the responsible factor in the pathophysiology of SS, the literature does not report an association between SS and bone marrow fibrosis, making our case the first presentation of such an association. The high prevalence and early onset of coronary artery diseases (CAD) in patients with CKD are associated with a combination of systemic inflammation, oxidative stress, hypertension, vascular calcification, and disruptions in bone metabolism. In the patient's medical history, there was no presence of hypertension, diabetes, smoking, or a family history of these conditions. SHPT in end-stage renal disease has been shown to accelerate vascular calcification and subclinical atherosclerosis. The presence of early-onset CAD in our patient, despite the absence of traditional risk factors, raises the question of whether hyperparathyroidism, a prominent factor in this syndrome, played a significant role in its etiology. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to identify whether fear of activity predicts exercise capacity in patients with coronary artery disease (CAD) and whether there is a difference between sexes regarding this relationship. Patients and methods: One hundred ninety-seven patients (145 males, 52 females; mean age: 56.3±10.8 years; range, 22 to 80 years) with a diagnosis of CAD or cardiac event in the previous one to 60 months were enrolled in this cross-sectional multicenter study between November 2015 and February 2017. Demographic and clinical features were recorded. Fear of activity was assessed by the fear of activity scale in patients with CAD (FactCAD). A 6-min walk test was used to assess exercise capacity. Results: Female participants were older, less educated, and less employed (p=0.045, p=0.048, and p<0.001, respectively) than males. Prevalence of myocardial infarction was higher in males. Comorbidities were higher in females. Multiple linear regression predicted 6-min walk distance (6MWD) based on FactCAD, sex, and education level with an r-squared of 0.321 (p<0.001). Fear of activity had an effect on walking distance in males (each additional score of FactCAD predicts a decrease of 1.3 m in 6MWD), together with disease duration, presence of chronic pulmonary disease, and low back pain, whereas fear of activity was not a predicting factor on walking distance in females. Age, education, and presence of angina predicted 6MWD in females. Conclusion: This study emphasizes that fear of activity is one of the predictors of 6MWD in males with CAD, and its assessment is recommended as a possible barrier to rehabilitation. [ABSTRACT FROM AUTHOR]

Background: The brain–heart axis is an intra- and bidirectional complex that links central nervous system dysfunction and cardiac dysfunction. In recent decades, brain-derived neurotrophic factor (BDNF) has emerged as a strategic molecule involved in both brain and cardiovascular disease (CVD). This systematic review of systematic reviews aimed to (1) identify and summarize the evidence for the BDNF genotype and BDNF concentration in CVD risk assessment, (2) evaluate the evidence for the use of BDNF as a biomarker of CVD recovery, and (3) evaluate rehabilitation approaches that can restore BDNF concentration. Methods: A comprehensive search strategy was developed using PRISMA. The risk of bias was assessed via ROBIS. Results: Seven studies were identified, most of which aimed to evaluate the role of BDNF in stroke patients. Only two systematic reviews examined the association of BDNF concentration and polymorphism in CVDs other than stroke. Conclusions: The overall evidence showed that BDNF plays a fundamental role in assessing the risk of CVD occurrence, because lower BDNF concentrations and rs6265 polymorphism are often associated with CVD. Nevertheless, much work remains to be carried out in current research to investigate how BDNF is modulated in different cardiovascular diseases and in different populations. [ABSTRACT FROM AUTHOR]

Refractory Angina (RA) is an increasingly common clinical diagnosis, in which patients unsuitable for further percutaneous or surgical procedures experience anginal symptoms, despite receiving optimal medical therapy. This clinical condition challenges the everyday activities and diminishes the quality of life of these patients. A wide variety of novel therapies for this type of angina are being investigated for clinical use. One of them is coronary sinus narrowing, which is performed as a percutaneous interventional procedure using catheter-delivered device, the Reducer. The device is implanted in the coronary sinus creating a physical narrowing and a pressure gradient in the sinus. This intervention improves the impaired blood flow in the ischemic regions of the heart leading to the relief of the anginal symptoms and, therefore, the overall clinical improvement of these patients. Several clinical trials have established both the safety and efficacy of the coronary sinus Reducer, while ongoing trials are aiming to further establish the procedure's safety and efficiency in both RA and other cardiovascular diseases, such as coronary microvascular dysfunction. This review aims to discuss the pathophysiology and the role of the coronary sinus Reducer in RA, the clinical trials documenting its safety and efficacy, as well as the future perspectives of this procedure among cardiovascular diseases. [Display omitted] • Coronary sinus narrowing is an interventional procedure creating a pressure gradient in the sinus • The increased blood backflow in the coronary system results to angina symptoms relief • Safety and efficay of Reducer in refractory angina is established. • Further research is needed in the settings of coronary microvascular dysfunction and heart failure. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cardiología (18855857) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

M Patrick Witvliet,1,2 E Karin Arkenbout,3 Pieter W Kamphuisen1,4 1Department of Internal Medicine, Tergooi Medical Center, Hilversum, the Netherlands; 2Department of General Practice, Amsterdam UMC Location University of Amsterdam, Amsterdam, the Netherlands; 3Department of Cardiology, Tergooi Medical Center, Hilversum, the Netherlands; 4Department of Vascular Medicine, Amsterdam UMC location University of Amsterdam, Amsterdam, the NetherlandsCorrespondence: M Patrick Witvliet, Department of Internal Medicine, Tergooi Medical Center, Laan van Tergooi 2, 1212 VG, Hilversum, the Netherlands, Tel +31 205664271, Email m.p.witvliet@amsterdamumc.nlBackground: The coronary artery calcium (CAC) score can be used to increase (CAC score > 0) or decrease (CAC score = 0) the likelihood of coronary artery disease (CAD). We compared the CAC score with the pre-test probability (PTP) for CAD (low, intermediate, and high). Furthermore, we compared the CAC score with exercise electrocardiography (ECG) and compared both tests with coronary angiography.Methods and Results: We retrospectively identified patients with angina and/or dyspnea for whom CAC score was used to increase or decrease the likelihood of CAD. Of 882 patients, majority had low (45%) or intermediate (44%) PTP. Patients with higher PTP had significantly higher CAC scores (Cramer’s V = 0.29, p < 0.0001). Most patients (57%) had a CAC score of zero, especially those with low (73%) and intermediate (49%) PTP. However, 20% of patients with high PTP had CAC score of zero. Higher CAC scores were observed in patients with abnormal exercise ECG, but association was weak and not significant (Cramer’s V = 0.13, p = 0.08). Moreover, more than 40% of patients with an abnormal exercise ECG had CAC score of zero. Higher CAC scores were associated with more severe abnormalities on coronary angiography (Cramer’s V = 0.43, p < 0.0001), whereas there was no association between results of exercise ECG and coronary angiography (Cramer’s V = 0.11, p = 0.91).Conclusion: CAC score can be used in addition to PTP to increase or decrease the likelihood of CAD, and it might be more useful than exercise ECG in the diagnostic work-up of chest pain.Keywords: coronary artery disease, cardiovascular disease, CT, risk factors, angina, stable

Background: There is limited evidence on the prevalence of ischaemic heart disease (IHD) and its association with risk factors and socioeconomic status (SES) in low- and middle-income countries (LMICs). Given the relatively high levels of access to healthcare in Sri Lanka, the association of IHD with SES may be different from that observed in other LMICs. Objectives: To estimate the prevalence of IHD in Sri Lanka, determine its associated risk factors and its association with SES. Methods: We analysed data from 6,513 adults aged ≥18 years examined in the 2018/19 Sri Lanka Health and Ageing Study. We used the Rose angina questionnaire to classify participants as having angina (Angina+) and used self-report or medical records to identify participants with a history of IHD (History+). The association of Angina+ and History+ with age, ethnicity, sector of residence, education level, household SES wealth quintile, area SES wealth quintile, hypertension, diabetes, smoking, total cholesterol, cholesterol-to-HDL ratio, waist-to-hip ratio and body mass index were analysed in unadjusted and adjusted models. Additional analyses were performed to investigate sensitivity to correction for missing data and to benchmark estimates against evidence from other studies. Conclusions: We estimated prevalence of History+ of 3.9% (95% CI 3.3%–4.4%) and Angina+ of 3.0% (95% CI 2.4%–3.5%) in adults aged 18 years and over. The prevalence of Angina+ was higher in women than men (3.9% vs. 1.9%, p < 0.001) whilst prevalence of History+ was lower (3.8% vs. 4.0%, p = 0.8), which may suggest a higher rate of undiagnosed IHD in women. A history of IHD was strongly associated with age, hypertension and diabetes status even after adjusting for sociodemographic factors. Though the prevalence of History+ was higher in the most developed area SES tertile and urban areas, History+ was also associated with less education but not household SES, consistent with patterns emerging from other LMICs.

Eucalyptol; a terpenoid oxide present in numerous plant-derived essential oils; is used in many foodstuffs, however, its excessive use can cause serious adverse effects. This study investigated effects of the lowest effective doses of eucalyptol in vasopressin-induced ischemia in rats which simulates human angina. In vivo evaluations included ECG, blood pressure, plasma nitric oxide (NO), aortic endothelial NO synthase (eNOS) mRNA expression, and myocardial oxidative and inflammatory markers. In vitro experiments were performed in isolated aortic and heart preparations. Eucalyptol improved angina manifestations, coronary flow, plasma NO, and aortic eNOS mRNA expression. It inhibited phenylephrine-induced contractions of endothelium-intact rings. Its relaxant effects decreased in L-NAME-pretreated rings and endothelium-denuded rings. Combination of eucalyptol and nifedipine exerted significant effects larger than each compound alone with blunting of nifedipine-induced tachycardia. The vascular eNO, antioxidant, and anti-inflammatory pathways were involved. This could lead to the development of a therapeutic antianginal system of both compounds.