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Background: The aim of our current systematic dynamic phantom study was first, to optimize reconstruction parameters of coronary CTA (CCTA) acquired on photon counting CT (PCCT) for coronary artery calcium (CAC) scoring, and second, to assess the feasibility of calculating CAC scores from CCTA, in comparison to reference calcium scoring CT (CSCT) scans. Methods: In this phantom study, an artificial coronary artery was translated at velocities corresponding to 0, < 60, and 60–75 beats per minute (bpm) within an anthropomorphic phantom. The density of calcifications was 100 (very low), 200 (low), 400 (medium), and 800 (high) mgHA/cm3, respectively. CCTA was reconstructed with the following parameters: virtual non-iodine (VNI), with and without iterative reconstruction (QIR level 2, QIR off, respectively); kernels Qr36 and Qr44f; slice thickness/increment 3.0/1.5 mm and 0.4/0.2 mm. The agreement in risk group classification between CACCCTA and CACCSCT scoring was measured using Cohen weighted linear κ with 95% CI. Results: For CCTA reconstructed with 0.4 mm slice thickness, calcium detectability was perfect (100%). At < 60 bpm, CACCCTA of low, and medium density calcification was underestimated by 53%, and 15%, respectively. However, CACCCTA was not significantly different from CACCSCT of very low, and high-density calcifications. The best risk agreement was achieved when CCTA was reconstructed with QIR off, Qr44f, and 0.4 mm slice thickness (κ = 0.762, 95% CI 0.671–0.853). Conclusion: In this dynamic phantom study, the detection of calcifications with different densities was excellent with CCTA on PCCT using thin-slice VNI reconstruction. Agatston scores were underestimated compared to CSCT but agreement in risk classification was substantial. Clinical relevance statement: Photon counting CT may enable the implementation of coronary artery calcium scoring from coronary CTA in daily clinical practice. Key Points: Photon-counting CTA allows for excellent detectability of low-density calcifications at all heart rates. Coronary artery calcium scoring from coronary CTA acquired on photon counting CT is feasible, although improvement is needed. Adoption of the standard acquisition and reconstruction protocol for calcium scoring is needed for improved quantification of coronary artery calcium to fully employ the potential of photon counting CT. [ABSTRACT FROM AUTHOR]

OBJECTIVE: The potential for choline metabolism to influence the development of diabetes has received increased attention. Previous studies on circulating choline metabolites and incident diabetes have been conducted in samples of older adults, often with a high prevalence of risk factors. RESEARCH DESIGN AND METHODS: Participants were from year 15 of follow-up (2000-2001) in the Coronary Artery Risk Development in Young Adults (CARDIA) Study (n = 3,133, aged 33–45 years) with plasma choline metabolite (choline, betaine, and trimethylamine N-oxide [TMAO]) data. We quantified associations between choline metabolites and 15-year risk of incident diabetes (n = 387) among participants free of diabetes at baseline using Cox proportional hazards regression models adjusted for sociodemographics, health behaviors, and clinical variables. RESULTS: Betaine was inversely associated with 15-year risk of incident diabetes (hazard ratio 0.76 [95% CI 0.67, 0.88] per 1-SD unit betaine), and TMAO was positively associated with 15-year risk of incident diabetes (1.11 [1.01, 1.22] per 1-SD unit). Choline was not significantly associated with 15-year risk of incident diabetes (1.05 [0.94, 1.16] per 1-SD). CONCLUSIONS: Our findings are consistent with other published literature supporting a role for choline metabolism in diabetes. Our study extends the current literature by analyzing a racially diverse population-based cohort of early middle-aged individuals in whom preventive activities may be most relevant. [ABSTRACT FROM AUTHOR]

• Observational cohort study including 5115 participants over 30 years. • Current cannabis was associated with lower BMI, probably due to residual confounding. • Cannabis cessation or cumulative cannabis exposure were not associated with BMI. With increasing use of cannabis, we need to know if cannabis use and Body Mass Index (BMI) are associated. The Coronary Artery Risk Development in Young Adults Study followed Black and White adults over 30 years with assessments every 2 to 5 years in four centers in the USA. We assessed self-reported current and computed cumulative cannabis exposure at every visit, and studied associations with BMI, adjusted for relevant covariables in mixed longitudinal models. We also applied marginal structural models (MSM) accounting for the probability of having stopped cannabis over the last 5 years. At the Year 30 visit, 1,912 (58 %) identified as women and 1,600 (48 %) as Black, mean age was 56 (SD 2) years. While 2,849 (85 %) had ever used cannabis, 479 (14 %) currently used cannabis. Overall, participants contributed to 35,882 individual visits over 30 years. In multivariable adjusted models, mean BMI was significantly lower in daily cannabis users (26.6 kg/m2, 95 %CI 26.3 to 27.0) than in participants without current use (27.7 kg/m2, 95 %CI 27.5 to 27.9, p < 0.001). Cumulative cannabis use was not associated with BMI. The MSM showed no change in BMI when stopping cannabis use over a 5-year period (β=0.2 kg/m2 total, 95 %CI -0.2 to 0.6). Current cannabis use was associated with lower BMI, but cumulative cannabis use and cessation were not. This suggests that recreational cannabis use may not lead to clinically relevant changes in BMI and that the association between current cannabis use and lower BMI is likely due to residual confounding. [ABSTRACT FROM AUTHOR]

Cardiac substructure dose metrics are more strongly linked to late cardiac morbidities than to whole-heart metrics. Magnetic resonance (MR)–guided radiation therapy (MRgRT) enables substructure visualization during daily localization, allowing potential for enhanced cardiac sparing. We extend a publicly available state-of-the-art deep learning framework, "No New" U-Net, to incorporate self-distillation (nnU-Net.wSD) for substructure segmentation for MRgRT. Eighteen (institute A) patients who underwent thoracic or abdominal radiation therapy on a 0.35 T MR-guided linear accelerator were retrospectively evaluated. On each image, 1 of 2 radiation oncologists delineated reference contours of 12 cardiac substructures (chambers, great vessels, and coronary arteries) used to train (n = 10), validate (n = 3), and test (n = 5) nnU-Net.wSD by leveraging a teacher-student network and comparing it to standard 3-dimensional U-Net. The impact of using simulation data or including 3 to 4 daily images for augmentation during training was evaluated for nnU-Net.wSD. Geometric metrics (Dice similarity coefficient, mean distance to agreement, and 95% Hausdorff distance), visual inspection, and clinical dose-volume histograms were evaluated. To determine generalizability, institute A's model was tested on an unlabeled data set from institute B (n = 22) and evaluated via consensus scoring and volume comparisons. nnU-Net.wSD yielded a Dice similarity coefficient (reported mean ± SD) of 0.65 ± 0.25 across the 12 substructures (chambers, 0.85 ± 0.05; great vessels, 0.67 ± 0.19; and coronary arteries, 0.33 ± 0.16; mean distance to agreement, <3 mm; mean 95% Hausdorff distance, <9 mm) while outperforming the 3-dimensional U-Net (0.583 ± 0.28; P <.01). Leveraging fractionated data for augmentation improved over a single MR simulation time point (0.579 ± 0.29; P <.01). Predicted contours yielded dose-volume histograms that closely matched those of the clinical treatment plans where mean and maximum (ie, dose to 0.03 cc) doses deviated by 0.32 ± 0.5 Gy and 1.42 ± 2.6 Gy, respectively. There were no statistically significant differences between institute A and B volumes (P >.05) for 11 of 12 substructures, with larger volumes requiring minor changes and coronary arteries exhibiting more variability. This work is a critical step toward rapid and reliable cardiac substructure segmentation to improve cardiac sparing in low-field MRgRT. [ABSTRACT FROM AUTHOR]

The article offers a look at technological advancements in cardiac computed tomography (CT). Topics discussed include access to the cardiac catheterization laboratory, energy-integrating detectors, photon-counting detectors and spectral photon-counting CT, image reconstruction relative advances in artificial intelligence (AI) and deep learning, and CT-guided coronary risk stratification and cardiac preventative care.

The article explains the importance of assessing cardiac output for optimal vessel opacification in computed tomography for proper diagnoses. Topics discussed include different classifications of heart failure based on the sidedness and pumping abilities of the heart, determinants of cardiac output such as heartbeat, heart rate, preload, contractility and afterload, as well as Laplace's law of physiological wall stress and its effects on cardiac output.

The Coronary Artery Disease—Reporting and Data System (CAD-RADS) is a standardised reporting method which was created in order to improve communication with referring physicians as well as for management considerations. The CAD-RADS score denotes the absence or presence of stenosis, while plaque burden and potential modifiers provide insight into plaque extent and characteristics. The modifier ischaemia enables the incorporation of fractional flow reserve CT and CT perfusion, while the modifier exception is used to denote potential coronary abnormalities. Higher CAD-RADS categories demonstrate incremental prognostic value, with further improvement when taking plaque burden into account. CAD-RADS improves communication with the referring clinician as well as guiding therapeutic management and as such is relevant to uniform patient care in the Netherlands. [ABSTRACT FROM AUTHOR]

Background: The inflammatory burden index (IBI), a novel inflammation-based indicator, to is associated with the presence and prognosis of various diseases. However, few studies have focused on exploring the relationship between IBI and the coronary slow flow phenomenon (CSFP). In this study, we aimed to investigate the predictive value of IBI for CSFP in patients with chest pain and no obstructive coronary artery disease. Methods: A total of 1126 individuals with chest pain and no obstructive coronary arteries were consecutively included in this study. 71 patients developed CSFP were included in the CSFP group. A 1:2 age- and sex-matched patient with normal blood flow and angiographically proven normal coronary arteries was selected as the control group (n = 142). Plasma C-reactive protein (CRP), neutrophil, and lymphocyte counts were measured to determine the value of IBI. Results: The IBI were significantly higher in the CSFP group than in the controls (21.1 ± 6.5 vs. 14.5 ± 6.4, P < 0.001). The IBI increasedelevated with the increase of the numbers of vessels affected by CSFP. Multivariate logistic regression analysis revealed that IBI and body mass index (BMI) were independent predictors of CSFP. Receiver operating characteristic (ROC) curve analysis showed that when IBI was > 15.74, the sensitivity and specificity were 77.5% and 67.6%, respectively, and the area under the ROC curve (AUC) was 0.799 (95% CI: 0.737-0.862, P<0.001). Conclusion: The IBI may be an independent predictor of CSFP in patients with chest pain and normal coronary arteries. The IBI could improve the predictive value of CSFP compared with the indicators alone. [ABSTRACT FROM AUTHOR]

Introduction and importance: Spontaneous coronary artery dissection is a rare cause of acute coronary syndromes not related to atherosclerosis. It involves the sudden tearing of the coronary artery wall, separating the inner intimal lining from the outer vessel wall, typically affecting a single coronary vessel. In 20% of cases, the cause of spontaneous coronary artery dissection is unknown. The other cases often occur in pregnant or postpartum women or in individuals with conditions such as connective tissue disorders or vasculitis. Case presentation: Here, we describe a case of a 69-year-old African female presenting with non-ST-segment elevation myocardial infarction. Coronary angiography revealed an unusual triple-vessel spontaneous coronary artery dissection affecting peripheral segments, with further investigations suggesting polyarteritis nodosa. Conclusion: While triple-vessel spontaneous coronary artery dissection and polyarteritis nodosa (PAN) are individually rare, their coexistence is exceptionally uncommon and presents diagnostic and therapeutic challenges. Clinicians should be alert to vasculitic causes in patients with spontaneous coronary artery dissection, especially with atypical clinical features. [ABSTRACT FROM AUTHOR]

Background: Coronary computed tomography angiography (CCTA) offers non-invasive diagnostics of the coronary arteries. Vessel evaluation requires the administration of intravenous contrast. The purpose of this study was to evaluate the utility of gadolinium-based contrast agent (GBCA) as an alternative to iodinated contrast for CCTA on a first-generation clinical dual-source photon-counting-detector (PCD)-CT system. Methods: A dynamic circulating phantom containing a three-dimensional-printed model of the thoracic aorta and the coronary arteries were used to evaluate injection protocols using gadopentetate dimeglumine at 50%, 100%, 150%, and 200% of the maximum approved clinical dose (0.3 mmol/kg). Virtual monoenergetic image (VMI) reconstructions ranging from 40 keV to 100 keV with 5 keV increments were generated on a PCD-CT. Contrast-to-noise ratio (CNR) was calculated from attenuations measured in the aorta and coronary arteries and noise measured in the background tissue. Attenuation of at least 350 HU was deemed as diagnostic. Results: The highest coronary attenuation (441 ± 23 HU, mean ± standard deviation) and CNR (29.5 ± 1.5) was achieved at 40 keV and at the highest GBCA dose (200%). There was a systematic decline of attenuation and CNR with higher keV reconstructions and lower GBCA doses. Only reconstructions at 40 and 45 keV at 200% and 40 keV at 150% GBCA dose demonstrated sufficient attenuation above 350 HU. Conclusion: Current PCD-CT protocols and settings are unsuitable for the use of GBCA for CCTA at clinically approved doses. Future advances to the PCD-CT system including a 4-threshold mode, as well as multi-material decomposition may add new opportunities for k-edge imaging of GBCA. Relevance statement: Patients allergic to iodine-based contrast media and the future of multicontrast CT examinations would benefit greatly from alternative contrast media, but the utility of GBCA for coronary photon-counting-dector-CT angiography remains limited without further optimization of protocols and scanner settings. Key Points: GBCA-enhanced coronary PCD-CT angiography is not feasible at clinically approved doses. GBCAs have potential applications for the visualization of larger vessels, such as the aorta, on PCD-CT angiography. Higher GBCA doses and lower keV reconstructions achieved higher attenuation values and CNR. [ABSTRACT FROM AUTHOR]

Sirtuin 3 has been shown to regulate endothelial function and coronary flow reserve in mice. Knockout of SIRT3 reduced endothelial nitric oxide synthase expression in the mouse hearts. In this study, we investigate whether endothelial SIRT3 regulates vascular function and myogenic responses in distal intramural branches of the left anterior descending coronary artery (CA) and middle cerebral artery (MCA) of mice. Both male and female endothelial SIRT3 knockout (SIRT3ECKO) mice and control SIRT3LoxP mice were used and CA and MCA were dissected and mounted in a myograph system. The myogenic response was evaluated by measuring changes in inner diameter in response to 20 mmHg stepwise increases in intraluminal pressure in PSS (active diameter) and Ca2+‐free PSS (passive diameter). Acetylcholine (Ach)‐induced endothelial‐dependent relaxation (EDR) and sodium nitroprusside (SNP)‐induced endothelial‐independent relaxation (EIR) were examined. Our results showed that the myogenic responses were significantly impaired in both the CA and MCA of SIRT3ECKO mice. Furthermore, female mice had worsened myogenic response in MCA. In CA, EDR was abolished in both male and female SIRT3ECKO mice. Intriguingly, EIR was only reduced in the female mice. In MCA, EDR was reduced in male SIRT3ECKO mice, whereas EIR was decreased in both male and female mice. Female SIRT3ECKO mice had profound dysfunction in CA, whereas male mice exhibited more dysfunction in MCA. These data revealed a sex and organ‐specific role of endothelial SIRT3 in vascular function and myogenic responses. Our study suggests that endothelial SIRT3 is necessary for maintaining vascular function and blood flow autoregulation. [ABSTRACT FROM AUTHOR]

Abdominal aortic aneurysm (AAA) often remains undetected until rupture due to limited access to diagnostic ultrasound. This trial evaluated a deep learning (DL) algorithm to guide AAA screening by novice nurses with no prior ultrasonography experience. Ten nurses performed 15 scans each on patients over 65, assisted by a DL object detection algorithm, and compared against physician-performed scans. Ultrasound scan quality, assessed by three blinded expert physicians, was the primary outcome. Among 184 patients, DL-guided novices achieved adequate scan quality in 87.5% of cases, comparable to the 91.3% by physicians (p = 0.310). The DL model predicted AAA with an AUC of 0.975, 100% sensitivity, and 97.8% specificity, with a mean absolute error of 2.8 mm in predicting aortic width compared to physicians. This study demonstrates that DL-guided POCUS has the potential to democratize AAA screening, offering performance comparable to experienced physicians and improving early detection. [ABSTRACT FROM AUTHOR]

Background: Different responses in human coronary arteries (HCA) and human middle meningeal arteries (HMMA) were observed for some of the novel CGRP receptor antagonists, the gepants, for inhibiting CGRP-induced relaxation. These differences could be explained by the presence of different receptor populations in the two vascular beds. Here, we aim to elucidate which receptors are involved in the relaxation to calcitonin gene-related peptide (CGRP), adrenomedullin (AM) and adrenomedullin 2 (AM2) in HCA and HMMA. Methods: RNA was isolated from homogenized human arteries (23 HCAs; 12 F, 11 M, age 50 ± 3 years and 26 HMMAs; 14 F, 12 M, age 51 ± 3 years) and qPCR was performed for different receptor subunits. Additionally, relaxation responses to CGRP, AM or AM2 of the human arteries were quantified using a Mulvany myograph system, in the presence or absence of the adrenomedullin 1 receptor antagonist AM22-52 and/or olcegepant. Results: Calcitonin-like receptor (CLR) mRNA was expressed equally in both vascular beds, while calcitonin receptor (CTR) and receptor activity-modifying protein 3 (RAMP3) expression was low and could not be detected in all samples. RAMP1 expression was similar in HCA and HMMA, while RAMP2 expression was higher in HMMA. Moreover, receptor component protein (RCP) expression was higher in HMMA than in HCA. Functional experiments showed that olcegepant inhibits relaxation to all three agonists in both vascular beds. In HCA, antagonist AM22-52 did not inhibit relaxation to any of the agonists, while a trend for blocking relaxation to AM and AM2 could be observed in HMMA. Conclusion: Based on the combined results from receptor subunit mRNA expression and the functional responses in both vascular tissues, relaxation of HCA is mainly mediated via the canonical CGRP receptor (CLR-RAMP1), while relaxation of HMMA can be mediated via both the canonical CGRP receptor and the adrenomedullin 1 receptor (CLR-RAMP2). Future research should investigate whether RAMP2 predominance over RAMP1 in the meningeal vasculature results in altered migraine susceptibility or in a different response to anti-migraine medication in these patients. Moreover, the exact role of RCP in CGRP receptor signalling should be elucidated in future research. [ABSTRACT FROM AUTHOR]

The synthetic nitro‐alcohol 2‐nitro‐1‐phenyl‐1‐propanol (NPP) has endothelium‐independent relaxing properties in isolated preparations of rat aorta and mesenteric artery. In this study, we investigated whether the vasodilator effects occur in coronary vessels and explored whether hyperpolarization is involved in the underlying mechanism of NPP‐induced smooth muscle relaxation. The relaxing responses were studied in isolated preparations of the left anterior descending coronary (ADC) and the septal coronary (SC) arteries, which had been previously maintained under sustained contraction induced by the thromboxane A2 analogue U‐46619. Administered cumulatively, NPP elicited concentration‐dependent vasorelaxation with similar potency in both vessels. The relaxant effect remained unaffected by the nitric oxide synthase inhibitor L‐NAME, the protein kinase C inhibitor bisindolylmaleimide IV and the Rho‐associated protein kinase inhibitor Y‐27632. However, it was significantly diminished by the adenylyl cyclase inhibitor MDL‐12,330A, the guanylyl cyclase inhibitor ODQ, as well as the K+ channel inhibitors tetraethylammonium and CsCl. In ADC preparations impaled with intracellular micropipettes, NPP hyperpolarized the vascular preparation. When the isolated preparation was precontracted by 5‐hydroxytryptamine or 80 mM KCl, NPP‐induced relaxation with lower pharmacological potency compared to the vessels contracted by U‐46619. In conclusion, NPP exhibits vasorelaxant effects on rat coronary arteries, likely involving pathways that include cyclic nucleotide production and membrane hyperpolarization. [ABSTRACT FROM AUTHOR]

Introduction: The incidence and prevalence of Coronary Artery Disease (CAD) are rising worldwide, particularly in India. CAD can be asymptomatic in the general population. Aim: To analyse the significance of morphometric measurements of the coronary arteries in autopsy cases of unnatural deaths. Materials and Methods: This was a retrospective cross-sectional autopsy study conducted from January to December 2020 in the Department of Pathology in collaboration with the Department of Forensic Medicine at Sri Devaraj Urs Medical College, Kolar, Karnataka, India. Cases of deaths due to unnatural causes were considered. Morphometric parameters such as Luminal Area (LA), Internal Elastic Lamina Area (IELA), External Elastic Lamina Area (EELA), width of the intima at maximal thickness, width of the media at maximal thickness, intimal area, medial area, percentage of luminal narrowing, Intimal Thickness Index (ITI), and Intima to Media Ratio (IMR) were estimated using a Zeiss microscope on Verhoeff-Van-Gieson (VVG) stained tissue sections and analysed with ZEN software. All data were entered into a Microsoft Excel spreadsheet and analysed using Statistical Package for the Social Sciences (SPSS) version 22.0. Results: A total of 80 autopsy cases were considered for the current research, of which 62 were males and 18 were females. The mean age of the cases was 37.6 years. Two cases (11.1%) among females and nine cases (14.5%) among males had asymptomatic atherosclerotic lesions in their coronary arteries. With increasing age, the percentage of asymptomatic atherosclerotic cases also increased. The p-values for the width of the intima at maximal intimal thickness and IMR were 0.005 and 0.027, respectively, between the non atherosclerotic and atherosclerotic groups. Conclusion: The morphometric parameters, such as the width of the intima at maximal intimal thickness and IMR, predict the presence of atherosclerotic lesions/CAD in the asymptomatic general population. This information can be used to implement preventive measures and inform health policy by the medical community. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Early recognition and management of familial hypercholesterolemia (FH) are crucial, especially in patients with extensive xanthomas and premature coronary artery disease. Prompt diagnosis and aggressive lipid‐lowering therapy can significantly reduce morbidity and mortality rates. Careful clinical assessment in resource‐limited settings is essential for optimal outcomes. Familial hypercholesterolemia (FH) is an autosomal dominant inherited disorder that causes chronically elevated levels of low‐density lipoprotein (LDL) cholesterol. Based on LDL levels, FH can be heterozygous or homozygous, further established through clinical features, laboratory findings, and genetic analysis. Elevated cholesterol levels cause atherosclerosis, coronary artery disease, myocardial infarction, and sudden death. Xanthomas are a clinical manifestation of FH that reveal the underlying systemic genetic disease. We present the case of a 47‐year‐old male with triple vessel coronary artery disease and widespread xanthomas, diagnosed with homozygous FH based on "The Dutch Lipid Clinic Network Diagnostic Criteria for Familial Hypercholesterolemia." Lifelong therapy with lipid‐lowering medications and lifestyle changes is necessary in such cases. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Microvascular angina (MVA) can present with recurrent chest pain and normal coronary angiography. Recognizing MVA is crucial as it significantly impacts patient morbidity and mortality. Early diagnosis and management with antianginal medications are essential for improving outcomes and quality of life. Cardiovascular diseases are still the main cause of death in many parts of the world. Chest pain and dyspnea are always concerning due to the implications of cardiovascular disease. However, in patients with the involvement of the small coronary vessels (Microvascular Angina), symptoms might be recurrent and persistent despite the presence of normal coronary vessel evaluations. A 45‐year‐old man with a 25‐year smoking history presented with recurrent chest pain, especially during physical activity, and mild shortness of breath. He was admitted, and a coronary angiography the next day appeared normal. However, a cardiac PET scan revealed the involvement of small coronary vessels not visible on angiography. The Patient was a 45‐year‐old man who presented with recurrent chest pain, more prominent during physical activity. He also had mild shortness of breath. The patient was admitted, and the next day, he underwent normal coronary angiography. The cardiac positron emission tomography (PET scan) showed the involvement of small coronary vessels that were not obvious on angiography. [ABSTRACT FROM AUTHOR]

There are numerous known risks associated with coronary artery angiography. Acute pancreatitis is a seldom reported side effect that can have fatal consequences. Here is the case series of 3 patients who experienced acute pancreatitis shortly after coronary artery intervention. Two processes are implicated in the development of acute pancreatitis during coronary artery angiography: toxicity from contrast agents and cholesterol emboli. [ABSTRACT FROM AUTHOR]

Background & objectives: Hypertension is one of the most widely prevalent diseases throughout the world, which is emerging as one of the leading causes of premature morbidity and mortality globally. Nocturnal blood pressure readings measured by ABPM also provide prognostic data. 24 hr Ambulatory BP and specifically nocturnal blood pressure has been found to be associated with superior predictive and prognostic value for target organ dysfunction and CVD events either symptomatic or asymptomatic. Purpose of our study is to find out the prevalence of dipper, non-dipper, reverse dipper and extreme dipper in patients with stable CAD and their association with severity of CAD. Methods: This study was conducted in NH-Rabindranath Tagore Institute, Kolkata. Study lasted for 18 months. This study is a single centre cross sectional observational study. All patients who met inclusion criteria were included in this study after a thorough informed consent. Once the patient was recruited, he was admitted for an elective angiogram. Routine clinical history, baseline demographics like age, sex, height, weight, Body Mass Index (BMI), and comorbidities like diabetes hypertension and history of smoking were recorded. During the admission the patient underwent a 24-hr ambulatory BP monitoring after significant coronary artery disease was diagnosed on an elective diagnostic coronary angiogram. All data was anonymized and entered into Microsoft excel spread sheets and computed with SPSS version 20 for measures of statistical significance. Patients were classified into non-dipper& (with a nocturnal drop of mean BP less than 10%), dipper (nocturnal drop of mean BP 10%), extreme dipper (nocturnal drop of mean BP), or reverse dipper (nocturnal elevation of mean BP). Coronary artery disease was classified angiographically into single vessel and multi-vessel coronary artery disease. Results: In this present study population, mean age was 57.7±10.55 years, 88.5% were males, while 11.5% were females. 52.5% diabetic, while 34.8% was overweight and, 16.5% was obese. A total of 62.6 % had multi-vessel coronary artery disease and 37.4% patients had single vessel involvement. In multivessel group vs single vessel group dipper were less (25.29% vs 44.23% p=0.02) and non-dipper were more (50.57% vs 3077% p=0.02), which is statistically significant. Comparison of individual parameters of BP between the multivessel and single vessel CAD, average night SBP (116.15±17.27 vs 109.17±14.91 p<0.05) and average night DBP (63.82±8.65 vs 60.87±7.77 p=0.01) were higher and statistically significant in multivessel group as compare to single vessel group. Conclusion: There is a statistically significant association was seen between CAD burden and nocturnal dipping pattern. Multivessel coronary artery disease have more blunted nocturnal blood pressure as compare to single vessel coronary artery disease. Correlation between BMI, smoking, age and DM with circadian pattern was not observed. [ABSTRACT FROM AUTHOR]

The article explores the impact of bifurcation angles on computed tomography (CT)-derived fractional flow reserve (FFRCT) decline in vessels with no apparent coronary artery disease (CAD). Topics include the correlation between bifurcation angles and FFRCT changes, the identification of optimal cut-off values for bifurcation angles in the left anterior descending (LAD) and left circumflex (LCX) arteries and the significance of vessel length as a predictor of distal FFRCT values.

Background: Retrospective studies indicate that radiation damage to left anterior descending coronary artery (LAD) may be critical for late‐stage radiation‐induced cardiac morbidity. Developing a method that accurately depicts LAD motion and perform dose assessment is crucial. Purpose: To construct a generalized cardiac surface motion model for LAD dose assessment in left breast cancer radiotherapy. Methods: Cine MRI of 25 cases were divided into training and testing sets for model construction, and five external cases were gathered for generalization validation. Motion prediction from average intensity projection images (AIP) surface point cloud to that of each phase was realized by mapping the relationship between datum points and corresponding points with statistical shape modeling (SSM). Root mean square error (RMSE) for predicted corresponding points and Euclidean distance (ED) for predicted surface point cloud were used to assess model's accuracy. LAD dose assessment for 10 left breast cancer radiotherapy cases was perform by model application. Results: The RMSE in testing cases and external cases were 0.209 ± 0.020 mm to 0.841 ± 0.074 mm and 0.895 ± 0.093 mm to 1.912 ± 0.138 mm, respectively; while the ED were 1.399 ± 0.029 mm to 1.658 ± 0.100 mm, 1.571 ± 0.080 mm to 1.779 ± 0.104 mm, respectively, proving the generalized model's high accuracy. The volume of LAD characterizing motion range (WPLAD) (2.392 ± 0.639 cm3) was approximately twice that of LAD from superimposed images (SPLAD) (0.927 ± 0.326 cm3) with p < 0.05, and the former's Dmax (3582.06 ± 575.92 cGy) was significantly larger than latter's (3222.71 ± 665.37 cGy) (p < 0.05). While WPLAD's Dmean (1408.06 ± 413.06 cGy) was slightly smaller than that of SPLAD (1504.15 ± 448.03 cGy), the difference did not reach statistical significance (p > 0.05). WPLAD's V20 (23.42% ± 16.62%) was less than SPLAD's (29.18% ± 21.07%) with p < 0.05, but their comparison in V30 and V40 did not yield statistically significant results. It implies the conventional LAD dose assessment ignores motion impact and may not be justified. Conclusions: The generalized cardiac surface motion model informs LAD dose accurate assessment in left breast cancer radiotherapy. [ABSTRACT FROM AUTHOR]

The artery of Kugel is defined as a rare anatomical variant of the coronary arteries. It consists of an anastomotic connection between the branches of the right coronary artery (RCA) and the left circumflex artery (LCx). In patients with coronary artery occlusion, the presence of this connection bypassing the area of the occluded vessel may be a factor that prevents significant necrosis of a specific area of the myocardium. Most cases are detected by invasive coronary angiography. We present images from coronary computed tomography angiography (CCTA), which documented the existence of Kugel's artery in a 67-year-old patient with subtotal stenosis of the left main artery. The presented images clearly indicate that CCTA can visualize the existing rescue collateral circulation in patients with significant coronary artery disease. [ABSTRACT FROM AUTHOR]

Myocardial infarction (MI) triggers a complex inflammatory response that is essential for cardiac repair but can also lead to adverse outcomes if left uncontrolled. Recent studies have highlighted the importance of epigenetic modifications in regulating post-MI inflammation. This study investigated the role of the autotaxin (ATX)/lysophosphatidic acid (LPA) signaling axis in modulating myocardial inflammation through epigenetic pathways in a mouse model of MI. C57BL/6 J mice underwent left anterior descending coronary artery ligation to induce MI and were treated with the ATX inhibitor, PF-8380, or vehicle. Cardiac tissue from the border zone was collected at 6 h, 1, 3, and 7 days post-MI for epigenetic gene profiling using RT2 Profiler PCR Arrays. The results revealed distinct gene expression patterns across sham, MI + Vehicle, and MI + PF-8380 groups. PF-8380 treatment significantly altered the expression of genes involved in inflammation, stress response, and epigenetic regulation compared to the vehicle group. Notably, PF-8380 downregulated Hdac5, Prmt5, and Prmt6, which are linked to exacerbated inflammatory responses, as early as 6 h post-MI. Furthermore, PF-8380 attenuated the reduction of Smyd1, a gene important in myogenic differentiation, at 7 days post-MI. This study demonstrates that the ATX/LPA signaling axis plays a pivotal role in modulating post-MI inflammation via epigenetic pathways. Targeting ATX/LPA signaling may represent a novel therapeutic strategy to control inflammation and improve outcomes after MI. Further research is needed to validate these findings in preclinical and clinical settings and to elucidate the complex interplay between epigenetic mechanisms and ATX/LPA signaling in the context of MI. [ABSTRACT FROM AUTHOR]

The purpose of this study is to analyze the early clinical features of coronary artery lesion (CAL) in Kawasaki disease (KD), evaluate systemic inflammation indicators, and enhance early recognition of CAL in the acute phase of KD. A total of 314 children with KD were divided into those with CAL (CAL group) and without CAL (NCAL group) using echocardiographic results, and their clinical data were retrospectively analyzed. For KD patients, male, children aged 3 to 9 years, and those with fever longer than 6 days before intravenous immunoglobulin (IVIG) use were more likely to have CAL. There were significant differences in sex, age, and fever time (P <.05). Moreover, some laboratory indicator test results revealed there was a significant difference between N-terminal pro-brain natriuretic peptide (NT-pro-BNP) and interleukin-6 (IL-6), and the CAL (P <.05). This study has certain guiding significance for early clinical evaluation. [ABSTRACT FROM AUTHOR]

Coronary artery aneurysms (CAAs) are morphologically classified as saccular and fusiform. There is still a great deal of clinical controversy as to which types of CAA are more likely to cause thrombosis. Therefore, the main objective of this study was to evaluate the trend of thrombus growth in CAAs with different morphologies and to assess the risk of possible long-term complications based on hemodynamic parameters. Utilizing computed tomography angiography (CTA) data from eight healthy coronary arteries, two distinct morphologies of coronary artery aneurysms (CAAs) were reconstructed. Distribution of four wall shear stress (WSS)-based indicators and three helicity indicators was analyzed in this study. Meanwhile, a thrombus growth model was introduced to analyze the thrombus formation in CAAs with different morphologies. The research results showed the distribution of most WSS indicators between saccular and fusiform CAAs was not statistically significant. However, due to the presence of a more pronounced helical flow pattern, irregular helical flow structure and longer time of flow stagnation in saccular CAAs during the cardiac cycle, the mean and maximum relative residence time (RRT) were significantly higher in saccular CAAs than in fusiform CAAs (P < 0.05). This may increase the risk of saccular coronary arteries leading to aneurysmal dilatation or even rupture. Although the two CAAs had similar rates of thrombosis, fusiform CAAs may more early cause obstruction of the main coronary flow channel where the aneurysm is located due to thrombosis growth. Thus, the risk of thrombosis in fusiform coronary aneurysms may warrant greater clinical concern. [ABSTRACT FROM AUTHOR]

Coronary artery ectasia (CAE) is a rare vascular phenotype characterized by abnormal dilation of blood vessels and disruption of coronary artery blood flow, which may promote thrombosis and an inflammatory response. We performed a cross-sectional study to investigate the association of white blood cells to mean platelet volume ratio (WMR) with CAE. Consecutive eligible patients (n = 492) were divided into two groups: including 238 patients with CAE and 254 patients in the normal coronary artery (NCA) group. WMR, the systemic immune-inflammation index (SII), and neutrophil-to-lymphocyte ratio (NLR) were found to be significantly associated with CAE in both univariate and multivariate logistic regression analyses. In multivariate analysis, the presence of WMR was associated with CAE (the odds ratios (OR) = 1.002, 95% CI: 1.001–1.003, P <.001). In the ROC analysis, the statistics (Z-values) of WMR vs SII and WMR vs NLR were 2.427 and 2.670 and were statistically significant (P =.015 and P =.008), indicating that WMR was superior to SII and NLR in distinguishing WMR. The optimal cut-off value was calculated from the point of maximal sensitivity and specificity by using Youden's index, which was determined to be 635.50. WMR has the potential to be a cost-effective tool to monitor CAE. [ABSTRACT FROM AUTHOR]

The purpose of this study is to determine whether adding intravenous methylprednisolone pulse (IVMP) to primary adjunctive prednisolone with intravenous immunoglobulin (IVIG) improves treatment resistance and coronary artery aneurysms (CAA) in patients with Kawasaki disease (KD) with a high risk of treatment resistance. This multicenter, prospective, observational study was conducted at 28 hospitals in Japan from October 2016 to June 2020. For patients predicted to be resistant to treatment based on a Kobayashi score ≥ 5 and total bilirubin ≥ 1.0 mg/dL, each hospital independently decided to add IVMP followed by prednisolone, prednisolone alone, or nothing to the primary IVIG therapy. In total, 2856 consecutive KD patients were enrolled; of these, 399 (14.0%) were predicted to be treatment resistant. Patients who were resistant to the primary treatment and required additional treatment comprised 59%, 20%, and 26% of the IVIG-alone group, IVIG-plus-prednisolone group, and IVIG-plus-IVMP group, respectively (P <.0001). The CAA incidence (Z score ≥ 2.5) at month 1 was similar among the treatment groups (6.7%, 4.8%, and 7.3%, respectively; P =.66). CAA occurred more frequently in patients who needed third- or later-line therapy. Conclusions: Primary adjunctive corticosteroid therapy improved the treatment response and suppressed inflammation. However, the study found no benefit of adding IVMP to prednisolone therapy. Patients receiving IVIG alone achieved coronary outcomes comparable to those of patients receiving primary adjunctive corticosteroid therapy although they were more likely to require additional rescue treatment. KD inflammation should be resolved no later than the third line of additional treatment to reduce the risk of CAA. Trial registration: University Hospital Medical Information Network Clinical Trials Registry in Japan (https://www.umin.ac.jp/ctr/index.htm) under code UMIN000024937. What is Known: • Children with Kawasaki disease (KD) who are resistant to standard intravenous immunoglobulin (IVIG) therapy have a high risk of developing coronary artery aneurysms (CAA). • Although primary adjunctive corticosteroid therapy reportedly reduced CAA development, the appropriate dosage and method are unknown. • Patients may experience treatment resistance and CAA development despite receiving timely treatment. What is New: • Primary adjunctive corticosteroid therapy with IVIG significantly improved the treatment response and suppressed inflammation. • The study found no benefit in adding methylprednisolone pulse to prednisolone therapy in KD patients with a high risk of treatment resistance. • Patients receiving primary IVIG alone achieved comparable coronary outcomes to those receiving adjunctive corticosteroid therapy although they were more likely to require additional rescue treatments. • Inflammation related to KD should be resolved no later than the third line of additional rescue treatment to prevent CAA development. [ABSTRACT FROM AUTHOR]

While Kawasaki disease (KD) induced coronary artery aneurysms (KD CAAs) in children are well studied, the features and prognosis of non-KD induced CAAs (non-KD CAAs) in the pediatric population are poorly documented. This case series study is to analyze the etiology and prognosis of non-KD CAAs in children and compare the characteristics of non-KD CAAs and KD CAAs. Non-KD CAA and KD CAA cases at our department from January 2022 to December 2023 were retrospectively collected. Etiologies and prognosis of non-KD CAAs were analyzed. Furthermore, demographic data, biochemical parameters and outcomes between children with Non-KD CAAs and children with KD CAAs were comparatively studied. Fifteen children with non-KD CAAs with a median age of 6 years and 117 children with KD CAAs with a median age of 2.0 years (p = 0.022) were included in this study. The causes of non-KD CAAs include: unknown etiologies (2 cases), coronary artery structural abnormalities (4), Takayasu arteritis (2), virus infection (2), cardiomyopathy (2), aplastic anemia with agranulocytosis (1), ANCA-associated vasculitis (1), and mucopolysaccharidosis (1). In the non-KD CAA group, there were a total of 19 CAAs with 3 being giant, 5 medium, and 11 small; 4 patients had complete CAA regression; an infant with a fistula between the right coronary artery and the coronary sinus complicated with cardiac enlargement died of heart failure. The KD group had significantly higher levels of CRP, white cells counts and ESR with zero mortality. Non-KD CAA cases had a significantly lower regression rate than KD-CAA cases (26.7% vs 66.7%, p = 0.004), and the probability of CAA regression in non-KD patients was 0.341 of that in KD patients (p = 0.006, OR = 0.341, 95% CI: 0.179–0.647). Conclusions: Various etiologies for Non-KD CAAs are identified. Patients with Non-KD CAAs were observed to have lower inflammatory indexes but poorer recovery than patients with KD CAAs. Therapeutic strategies different than those for KD may be needed for non-KD CAAs. What is Known: • Coronary artery aneurysm (CAA) in children is most commonly induced by Kawasaki disease (KD CAA), with a 50 ~ 70% regression rate in 1 to 2 years. • CAA induced by diseases other than KD (non-KD CAA) in children is rare and its prognosis remains largely unknown. What is New: • Most non-KD CAA cases are caused by coronary artery structural malformations. • Non-KD CAA in children has poorer prognosis and lower regression rate compared with KD CAA. • In addition to guideline directed anti-platelet and anti-coagulant therapies, treatments targeting the causal factor are necessary for non-KD CAA. [ABSTRACT FROM AUTHOR]

The management of patients with an anomalous aortic origin of a coronary artery (AAOCA) remains controversial despite the publication of the 2017 American Association for Thoracic Surgery (AATS) expert guidelines. We surveyed the American Academy of Pediatrics Section on Cardiology and Cardiac Surgery and the Pediheart.net online community regarding their care of patients with anomalous origins of the right or left coronary from the opposite cusp with inter-arterial courses and compared them to the AATS guidelines. We received 111 complete responses. Four notable variations from the AATS recommendations were identified. Respondents were more likely to use ECG exercise testing than the stress imaging recommended in the AATS guidelines. For a 16-year-old with AAOCA, recommendations for surgery generally followed the AATS guidelines. However, for asymptomatic left AAOCA without signs of ischemia on stress imaging, only 69.4% felt surgery was appropriate or somewhat appropriate. In the setting of a 16-year-old with right AAOCA free from signs or symptoms of ischemia, respondents were more likely to recommend surgery if the patient was a competitive athlete, a topic not directly addressed in the AATS guidelines. After surgical treatment of AAOCA, only 24% of respondents recommended lifelong antiplatelet therapy despite recommendations for this in the AATS guidelines. Respondents recommendations were generally consistent with the 2017 AATS guidelines but with important variations in the use of stress imaging, indications for surgery in asymptomatic left AAOCA, the impact of identification as a competitive athlete and duration of postoperative antiplatelet therapy. [ABSTRACT FROM AUTHOR]

Revascularization of ischemic myocardium following cardiac damage is an important step in cardiac regeneration. However, the mechanism of arteriogenesis has not been well described during cardiac regeneration. Here we investigated coronary artery remodeling and collateral growth during cardiac regeneration. Neonatal MI was induced by ligature of the left descending artery (LAD) in postnatal day (P) 1 or P7 pups from the Cx40-GFP mouse line and the arterial tree was reconstructed in 3D from images of cleared hearts collected at 1, 2, 4, 7 and 14 days after infarction. We show a rapid remodeling of the left coronary arterial tree induced by neonatal MI and the formation of numerous collateral arteries, which are transient in regenerating hearts after MI at P1 and persistent in non-regenerating hearts after MI at P7. This difference is accompanied by restoration of a perfused or a non-perfused LAD following MI at P1 or P7 respectively. Interestingly, collaterals ameliorate cardiac perfusion and drive LAD repair, and lineage tracing analysis demonstrates that the restoration of the LAD occurs by remodeling of pre-existing arterial cells independently of whether they originate in large arteries or arterioles. These results demonstrate that the restoration of the LAD artery during cardiac regeneration occurs by pruning as the rapidly forming collaterals that support perfusion of the disconnected lower LAD subsequently disappear on restoration of a unique LAD. These results highlight a rapid phase of arterial remodeling that plays an important role in vascular repair during cardiac regeneration. [Display omitted] • Rapid remodeling of the arterial tree is induced by myocardial infarction. • The endocardial response to ischemia differs between regenerated and non-regenerated hearts following myocardial infarction. • Collateral growth is rapid and transient in regenerated hearts while delayed and persistent in non-regenerated hearts. • Collateral arteries ameliorate cardiac perfusion and drive LAD repair. • The restoration of the LAD occurs by remodeling of pre-existing arterial cells. [ABSTRACT FROM AUTHOR]

Magnetic soft continuum robots (MSCRs) hold significant potential in fulfilling the requirements of vascular interventional robots, enabling safe access to difficult-to-reach areas with enhanced active maneuverability, shape morphing capabilities, and stiffness variability. Their primary advantage lies in their tether-less actuation mechanism that can safely adapt to complex vessel structures. Existing commercial MSCRs primarily employ a magnetic-pull strategy, which suffers from insufficient driving force and a single actuation strategy, limiting their clinical applicability. Inspired by the inchworm crawling locomotion gait, we herein present a novel MSCR that integrates a magnetic sinusoidal actuation mechanism with adjustable frequency and kirigami structures. The developed MSCRs consist of two permanent magnets connected by a micro-spring, which is coated with a silicone membrane featuring a specific notch array. This design enables bio-inspired crawling with controllable velocity and active maneuverability. An analytical model of the magnetic torque and finite element analysis (FEA) simulations of the MSCRs has been constructed. Additionally, the prototype has been validated through two-dimensional in-vitro tracking experiments with actuation frequencies ranging from 1 to 10 Hz. Its stride efficiency has also been verified in a three-dimensional (3D) coronary artery phantom. Diametrically magnetized spherical chain tip enhances active steerability. Kirigami skin is coated over the novel guidewire and catheter, not only providing proximal anchorage for improved stride efficiency but also serving similar function as a cutting balloon. Under the actuation of an external magnetic field, the proposed MSCRs demonstrate the ability to traverse bifurcations and tortuous paths, indicating their potential for dexterous flexibility in pathological vessels. [ABSTRACT FROM AUTHOR]

Background. Oxidative stress and inflammation are typically implied in atherosclerosis pathogenesis and progression, especially in coronary artery disease (CAD). Our objective was to investigate the oxidative stress and inflammation burden directly associated with atherosclerotic plaque in patients with stable coronary disease undergoing coronary artery bypass graft (CABG) surgery. Specifically, markers of oxidative stress and inflammation were compared in blood samples obtained from the atherosclerotic left anterior descending artery (LAD) and blood samples obtained from the healthy left internal thoracic artery (LITA), used as a bypass graft, within the same patient. Methods. Twenty patients scheduled for off-pump CABG were enrolled. Blood samples were collected from the LITA below anastomosis and the LAD below the stenosis. Samples were analysed for oxidative stress (sNOXdp, H2O2, NO) and inflammation markers (TNFα, IL-6, IL-1β, IL-10). Results. The analysis showed a significant increase in oxidative stress burden in the LAD as compared to LITA, as indicated by higher sNOX2-dp and H2O2 levels and lower NO levels (p < 0.01). Also, pro-inflammatory cytokines were increased in the LAD as compared to the LITA, as indicated by higher TNFα and IL-6 amounts (p < 0.01). On the other hand, no significant differences could be seen regarding IL-1β and IL-10 levels between the two groups. Conclusions. The oxidative stress and inflammatory burden are specifically enhanced in the LAD artery of stable coronary patients compared to systemic blood from the LITA of stable coronary patients. [ABSTRACT FROM AUTHOR]

Introduction: Excessive stent strut protrusion in the distal left main (LM) from either the left anterior descending (LAD) or circumflex (Cx) artery following inadequate ostial stenting may complicate any later procedure involving the left coronary artery. In such case scenarios, intravascular ultrasound (IVUS) guidance provides accurate assessment of the ostial stent position and may facilitate subsequent management strategies and treatment. Case summary: We present a complex percutaneous coronary intervention (PCI) of LM bifurcation in a 49-year-old man following inadequate ostial Cx stenting that resulted in excessive stent protrusion in the distal LM segment, accompanied by a subsequent short 80–90% ostial LAD stenosis. Initially, IVUS was performed to confirm "floating struts" from a previous Cx ostial stenting and to ensure complete intraluminal placement of the wire within the stent leading to the Cx, precluding any side passage through the stent struts. Then, a second wire was inserted into the LAD through the most distal stent strut under live IVUS guidance. Further PCI was completed according to the principles of the double kissing mini-culotte technique. Final IVUS runs confirmed correct stent apposition and expansion in the LM, LAD and Cx segments. Conclusions: In cases involving the treatment of "free-floating" struts in the distal LM artery, intravascular imaging is essential to ensure optimal PCI outcomes. [ABSTRACT FROM AUTHOR]

Objectives: We retrospectively analyzed the usefulness and safety of intracoronary acetylcholine (ACh) 200 μg into the left coronary artery (LCA) as vasoreactivity testing compared with intracoronary ACh 100 μg. Methods: We recruited 1433 patients who had angina‐like chest pain and intracoronary ACh testing in the LCA, including 1234 patients with a maximum ACh 100 μg and 199 patients with a maximum ACh 200 μg. ACh was injected in incremental doses of 20/50/100/200 μg into the LCA. Positive spasm was defined as ≥ 90% stenosis, usual chest pain, and ischemic electrocardiogram (ECG) changes. Results: The incidence of coronary constriction ≥ 90%, usual chest pain, and ischemic ECG changes with a maximum ACh of 100 μg was markedly higher than that with a maximum ACh of 200 μg. The frequency of unusual chest pain in patients with a maximum ACh of 200 μg was higher than that in those with a maximum ACh of 100 μg (13% vs. 3%, p < 0.001). In patients with rest angina, positive spasm of maximum ACh 100 μg was significantly higher than that of maximum ACh 200 μg, whereas there was no difference regarding positive spasm in patients with atypical chest pain between the two ACh doses. Major complications (1.38% vs. 1.51%, p = 0.8565) and the occurrence of paroxysmal atrial fibrillation (1.81% vs. 2.63%, p = 0.6307) during ACh testing in the LCA were not different between the two maximum ACH doses. Conclusions: Intracoronary ACh 200 μg into the LCA is clinically useful and safe for vasoreactivity testing when intracoronary ACh 100 μg dose not provoke spasms. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular disease (CVD) has emerged as a pervasive source of illness and a prominent factor in death rates throughout the majority of nations. Atherosclerosis has been identified as the primary cause of this global health concern. Methods: 150 cases older than 30 years were subjected to medicolegal autopsy in the Department of Forensic Medicine, Government Medical College, Kannur. During a medicolegal autopsy, while dissecting the aorta, coronary arteries and cerebral arteries; gross macroscopic changes brought on by atherosclerosis were examined and documented. Results: The study group consisted primarily of males (62.7%) with an average age of 46.90±16.34 years. Nearly half of them were in their fourth and fifth decades of life. A total of 67 instances were diagnosed with atherosclerosis, with 22 of them falling within the age range of 40 to 49 years. 79 percent of these incidents involved males. Conclusion: Atherosclerosis is becoming increasingly recognized as the primary cause of around one-third of all fatalities in India. Conducting a study on atherosclerosis in living individuals is challenging, as it requires invasive and costly procedures. This is particularly true in underdeveloped nations. Therefore, autopsies are crucial for documenting the occurrence of atherosclerosis in the population. This study will assist doctors in evaluating the overall arterial health of patients and developing therapeutic protocols and courses of treatment. Additionally, it will aid forensic pathologists in determining the cause of death in cases of sudden death. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is leading cause of morbidity and mortality worldwide. However, this endemic disease rarely involves heart. Cardiac TB can involve any structure of heart with pericarditis is most frequent manifestation. Methods: This retrospective study was conducted at Department of Pathology from January 2012 to December 2020. Autopsy records of all cases suggestive of tuberculosis in any part of heart were selected and slides were reviewed. Results: A total of 11 cases of cardiac TB were recorded on autopsy, including 6 cases of isolated myocarditis, 2 cases of myopericarditis 2 cases of isolated pericarditis and one case of necrotizing arteritis in left coronary artery. Concomitant pulmonary TB was present in 72.7% cases. Conclusion: This study highlights that in all patients of pulmonary tuberculosis with appearance of any cardiovascular sign or symptom, cardiac TB should be suspected as one of the differentials. [ABSTRACT FROM AUTHOR]

Metastasis to the heart is uncommon compared to other organs, posing notable diagnostic challenges. Incidence in autopsy studies typically ranges between 0.7% and 3.5%. Lung, breast, and hematologiccancers are the main sources of such metastases, leading to varied clinical presentations and severe complications. Postmortem viscera from a 47 year old male with a suspected history of jaundice. Only limited information was available. Gross examination showed a solid mass in the gall bladder with areas of hemorrhage and necrosis, while no other abnormalities were observed in other viscera received. Brain examination showed congested blood vessels, while heart sections exhibited atypical cell deposits in the pericardium and myocardium. Coronary arteries displayed pathological thickening. Lung and liver sections also displayed similar metastatic atypical cell deposits, infiltrating tissue and causing necrosis. Gall bladder examination revealed irregular glandular formations lined with polygonal tumor cells positive for cytokeratin. The final diagnosis based on histomorphological features and immunohistochemistry confirmed gall bladder adenocarcinoma metastasising to the heart, liver and lungs. [ABSTRACT FROM AUTHOR]

This study aimed to verify whether increased body mass index (BMI) increases the noise in computed tomography (CT) images due to heightened effective thickness, impacting calcium scores. Calcium scores were measured in 30 sets of images from normal weight patients. Calcium scores were also measured in 30 sets of images from hypothetical overweight and obese patients, generated by extracting the noise from overweight and obese patients, respectively, and inserting it into the images of normal weight patients. In addition, a phantom study was performed using three calcium phantoms with intensities below the threshold of 130 Hounsfield units and three calcium phantoms with intensities above this threshold. Calcium scores were measured in the absence and presence of a bolus at the heart level to simulate an obese patient. All calcium scores were measured by three radiologists. In the patient study, the total calcium scores of the hypothetical overweight and hypothetical obese groups were 14.93% (p = 0.014) and 22.19% (p = 0.012) higher than those of the normal weight group. In the phantom study, the total calcium score of the six calcium phantoms without a bolus was 1.61% higher at a tube voltage of 120 kV than at 100 kV, and 12.06% higher at a slice thickness of 1 mm than at 3 mm. The total calcium score of the six calcium phantoms with a bolus was 0.13% higher at a tube voltage of 120 kV than at 100 kV, and 14.76% higher at a slice thickness of 1 mm than at 3 mm. These results can be used as a reference to train automated calcium scoring programs on effective thickness through deep learning to reduce calcium score errors caused by increased BMI. [ABSTRACT FROM AUTHOR]

Aims Epicardial fat is a metabolically active adipose tissue depot situated between the myocardium and visceral pericardium that covers ∼80% of the heart surface. While epicardial fat has been associated with the development of atherosclerotic coronary artery disease, less is known about the relationship between epicardial fat and coronary vascular function. Moreover, the relations between excess epicardial fat and cardiac morphology and function remain incompletely understood. Methods and results To address these knowledge gaps, we retrospectively analysed data from 294 individuals from our database of women with suspected ischaemia with no obstructive coronary disease (INOCA) who underwent both invasive coronary function testing and cardiac magnetic resonance imaging. Epicardial fat area, biventricular morphology, and function, as well as left atrial function, were assessed from cine images, per established protocols. The major novel findings were two-fold: first, epicardial fat area was not associated with coronary vascular dysfunction. Secondly, epicardial fat was associated with increased left ventricular concentricity (β = 0.15, P = 0.01), increased septal thickness (β = 0.17, P = 0.002), and reduced left atrial conduit fraction (β = −0.15, P = 0.02), even after accounting for age, BMI, and history of hypertension. Conclusion Taken together, these data do not support a measurable relationship between epicardial fat and coronary vascular dysfunction but do suggest that epicardial fat may be related to concentric remodelling and diastolic dysfunction in women with suspected INOCA. Prospective studies are needed to elucidate the long-term impact of epicardial fat in this patient population. [ABSTRACT FROM AUTHOR]

Introduction: Intravenous immunoglobulin is the standard of care in Kawasaki disease. However, a subset of patients exhibits resistance to intravenous immunoglobulin treatment, even when Kawasaki disease is promptly diagnosed and managed. While intravenous immunoglobulin reduces the occurrence of coronary artery abnormalities from 15–25% to 3–5%, it does not entirely eliminate the risk. Besides, management guidelines for non-coronary complications of Kawasaki disease, for instance, myocarditis, remain speculative. Areas covered: Recent literature suggests that a subset of patients with Kawasaki disease may benefit from treatment intensification with drugs, such as corticosteroids, infliximab, anakinra, and/or ciclosporin. In this manuscript, we have reviewed recent advances in the management of Kawasaki disease, especially with regard to preemptive intensification of therapy in children at high risk of cardiac complications. A comprehensive search was made using Web of Science, Scopus, and PubMed databases to gather English articles published from 1967 to 2023 on the treatment of Kawasaki disease. We incorporated the following words in the search strategy: 'Kawasaki disease,' 'intravenous immunoglobulin/IVIg,' 'intravenous immunoglobulin/IVIg-resistant Kawasaki disease,' 'treatment intensification,' or 'primary intensification of treatment/therapy.' Expert opinion: The 'high-risk' group in Kawasaki disease needs to be identified with early intensification of primary therapy for better coronary and myocardial outcomes. [ABSTRACT FROM AUTHOR]

Introduction: The debate remains open as to the difference in prevalence of mortality and occurrence of acute events in patients with Myocardial infarction with non-obstructive coronary arteries (MINOCA) and others with Myocardial infarction with coronary arteries disease (MI-CAD). Methods: We conducted a 2-year retrospective study for patients admitted for Acute coronary syndrome (ACS) to analyze the clinical and prognostic characteristics of patients with MINOCA versus MI-CAD. We defined 1-year all-cause mortality as the primary outcome, and the secondary outcome as a composite of 1-year readmission for myocardial infarction or acute heart failure (AHF). Results: Our study included 1077 patients, 95.3% with MI-CAD and 4.7% with MINOCA. At admission, 71.1% patient were diagnosed STEMI and 28.9% with NSTEMI. The difference between the 2 groups was found on age (P <.001), hypertension, diabetes with consecutive P -values of.007 and.001, as well as Ejection fraction (P <.001). For the outcomes studied, the difference was significant between the 2 groups for all events, and MINOCA patients had a better prognosis than MI-CAD patients, with adjusted hazard ratios (HR) for 1-year mortality (HR = 0.601 P =.004), for readmission for ACS (HR = 0.662; P =.002) and for readmission for AHF (HR = 0.539; P =.019). Conclusion: Despite the ambiguity in the genesis of MINOCA, the short- and long-term prognosis of these patients remains generally favorable. [ABSTRACT FROM AUTHOR]

Background: The pericoronary fat attenuation index (FAI) has emerged as a novel and sensitive biomarker reflecting the degree of coronary artery inflammation. Semaglutide has been demonstrated to exert a cardiovascular protective effect independent of hypoglycemia; however, its impact on coronary artery inflammation remains elusive. This study aimed to investigate the association between semaglutide treatment and coronary artery inflammation based on FAI in patients with type 2 diabetes mellitus (T2DM). Methods: This study enrolled 497 T2DM patients who underwent coronary computed tomography angiography (CCTA) at Hebei General Hospital, of whom 93 treated with semaglutide (Sema+) and 404 did not (Sema-). Clinical data, laboratory indicators, and CCTA parameters were collected and compared between the two groups at baseline. Propensity score matching (PSM) was used to adjust for confounders, and pericoronary FAI was compared. Multivariate linear regression models were used to analyze the association between semaglutide treatment and pericoronary FAI. Results: Before PSM, pericoronary FAI of the LAD and LCX was lower in patients treated with semaglutide than those without semaglutide treatment. The results of the PSM analysis revealed a lower FAI in all three major coronary arteries in the Sema + group compared to the Sema- group. Multivariate linear regression analyses revealed an independent association between semaglutide treatment and reduced FAI in all three major coronary arteries. This association varied across T2DM patients of differing profiles. Conclusion: Semaglutide treatment may be associated with lower coronary artery inflammation in patients with T2DM, which might partially explain its cardiovascular protective mechanism. [ABSTRACT FROM AUTHOR]

Objectives: To investigate the feasibility of a deep learning-constrained compressed sensing (DL-CS) method in non-contrast-enhanced modified DIXON (mDIXON) coronary magnetic resonance angiography (MRA) and compare its diagnostic accuracy using coronary CT angiography (CCTA) as a reference standard. Methods: Ninety-nine participants were prospectively recruited for this study. Thirty healthy subjects (age range: 20–65 years; 50% female) underwent three non-contrast mDIXON-based coronary MRA sequences including DL-CS, CS, and conventional sequences. The three groups were compared based on the scan time, subjective image quality score, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR). The remaining 69 patients suspected of coronary artery disease (CAD) (age range: 39–83 years; 51% female) underwent the DL-CS coronary MRA and its diagnostic performance was compared with that of CCTA. Results: The scan time for the DL-CS and CS sequences was notably shorter than that of the conventional sequence (9.6 ± 3.1 min vs 10.0 ± 3.4 min vs 13.0 ± 4.9 min; p < 0.001). The DL-CS sequence obtained the highest image quality score, mean SNR, and CNR compared to CS and conventional methods (all p < 0.001). Compared to CCTA, the accuracy, sensitivity, and specificity of DL-CS mDIXON coronary MRA per patient were 84.1%, 92.0%, and 79.5%; those per vessel were 90.3%, 82.6%, and 92.5%; and those per segment were 98.0%, 85.1%, and 98.0%, respectively. Conclusion: The DL-CS mDIXON coronary MRA provided superior image quality and short scan time for visualizing coronary arteries in healthy individuals and demonstrated high diagnostic value compared to CCTA in CAD patients. Critical relevance statement: DL-CS resulted in improved image quality with an acceptable scan time, and demonstrated excellent diagnostic performance compared to CCTA, which could be an alternative to enhance the workflow of coronary MRA. Key Points: Current coronary MRA techniques are limited by scan time and the need for noise reduction. DL-CS reduced the scan time in coronary MR angiography. Deep learning achieved the highest image quality among the three methods. Deep learning-based coronary MR angiography demonstrated high performance compared to CT angiography. [ABSTRACT FROM AUTHOR]

Introduction: Coronary cameral fistulas (CCFs) are rare congenital anomalies characterized by abnormal connections between a coronary artery and one of the cardiac chambers. These abnormal connections can lead to significant clinical implications, including heart failure and myocardial ischemia, necessitating timely diagnosis and intervention. Case presentation: A 5-year-old Iranian boy was brought to the emergency room at Heart Hospital Center complaining of chest pain and dyspnea on exertion. He had experienced similar episodes over the past 4 months, which had not been evaluated. Physical examination revealed stable vital signs and no remarkable findings. Transthoracic echocardiography demonstrated a dilated left coronary artery with a large aneurysm and a small orifice to the right ventricular body. The left ventricular ejection fraction was 55%. Cardiac computed tomography angiography confirmed the diagnosis. Cardiac angiography showed a dilated left coronary artery and a coronary cameral fistula to the right ventricular. The aneurysm was successfully occluded using two Amplatzer™ devices. Conclusion: This case underscores the critical role of multimodal imaging in diagnosing and managing coronary cameral fistulae. Early detection and appropriate intervention are paramount in preventing the progression of symptoms and potential complications such as heart failure and myocardial ischemia. The successful closure with Amplatzer™ devices highlights the efficacy of minimally invasive techniques in treating complex cardiovascular anomalies. Regular follow-up and careful monitoring are essential to ensure long-term success and to manage any potential recurrences. Clinical key message: Timely identification and management of coronary cameral fistulae are crucial to prevent complications. Advances in imaging techniques and minimally invasive treatments, such as transcatheter closure, offer effective solutions. A multidisciplinary approach and regular follow-up are essential for comprehensive care and successful long-term management. [ABSTRACT FROM AUTHOR]

Coronary artery aneurysms (CAAs) are uncommon but significant cardiovascular abnormalities characterized by an abnormal increase in vascular diameter. CAAs are classified based on their shape as either saccular or fusiform, and their causes can range from atherosclerosis, Kawasaki disease, to congenital and iatrogenic factors. CAAs often present asymptomatically, but when symptoms occur, they can include angina, myocardial infarction, or even sudden cardiac death due to intravascular thrombosis involving the CAA. Diagnosis is typically confirmed through coronary angiography, though CT and other imaging techniques can provide additional details. The management of CAAs is variable depending on their size, location, and the presence of symptoms or complications. Treatment options include medical therapy, percutaneous coronary intervention (PCI), or surgical approaches. In this paper, we describe the case report of a 79-year-old male who presented with palpitations and was diagnosed with a right coronary artery aneurysm, and a review of the literature is delineated, underscoring the importance of individualized treatment strategies for CAAs. [ABSTRACT FROM AUTHOR]

Introduction and Objective: The aim of this study was to evaluate the coronary arteries in patients undergoing thoracic CT angiography for congenital heart disease, to determine the frequency of detection of coronary artery anomalies in congenital heart diseases, and to determine which type of anomaly is more common in which disease. Materials and Methods: In our investigation, a 128-detector multidetector computed tomography machine was used to perform thorax CT angiography. The acquisition parameters were set to 80–100 kVp based on the patient's age and mAs that the device automatically determined based on the patient's weight. During the examination, an intravenous (IV) nonionic contrast material dose of 1–1.5 mL/kg was employed. An automated injector was used to inject contrast material at a rate of 1.5–2 mL/s. In the axial plane, 2.5 mm sections were extracted, and they were rebuilt with 0.625 mm section thickness. Results: Between October 2022 and May 2024, 132 patients who were diagnosed with congenital heart disease by echocardiography and underwent Thorax CT angiography in our department were retrospectively evaluated. Of the evaluated patients, 32 were excluded with exclusion criteria such as patients being younger than 3 months, older than 18 years, insufficient contrast enhancement in imaging and contrast-enhanced imaging, thin vascular structure, and motion and contrast artifacts; the remaining 100 patients were included in this study. The age range of these patients was 3 months to 18 years (mean age 4.4 years). Conclusion: In congenital heart diseases, attention to the coronary arteries on thoracic CT angiography examination in the presence of possible coronary anomalies may provide useful information. [ABSTRACT FROM AUTHOR]

Background: Anomalous origin of coronary artery is a common coronary artery anatomy anomaly. The anomalous origin of the coronary artery may lead to problems such as narrowing of the coronary arteries at the beginning of the coronary arteries and abnormal alignment, which may lead to myocardial ischemia due to the compression of the coronary arteries. Clinical symptoms include chest tightness and dyspnea, with angina pectoris as a common symptom that can be life-threatening. Timely and accurate diagnosis of anomalous coronary artery origin is of great importance. Coronary computed tomography angiography (CCTA) can provide detailed information on the characteristics of coronary arteries. Therefore, we combined CCTA and artificial intelligence (AI) technology to analyze the CCTA image features and clinical features of patients with anomalous origin of the right coronary artery to predict angina pectoris and the relevance of different features to angina pectoris. Methods: In this retrospective analysis, we compiled data on 15 characteristics from 126 patients diagnosed with anomalous right coronary artery origins. The dataset encompassed both CCTA imaging attributes, such as the positioning of the right coronary artery orifices and the alignment of coronary arteries, and clinical parameters including gender and age. To identify the most salient features, we employed the Chi-square feature selection method, which filters features based on their statistical significance. We then focused on features yielding a Chi-square score exceeding a threshold of 1, thereby narrowing down the selection to seven key variables, including cardiac function and gender. Subsequently, we evaluated seven classifiers known for their efficacy in classification tasks. Through rigorous training and testing, we conducted a comparative analysis to identify the top three classifiers with the highest accuracy rates. Results: The top three classifiers in this study are Support Vector Machine (SVM), Ensemble Learning (EL), and Kernel Approximation Classifier. Among the SVM, EL and Kernel Approximation Classifier-based classifiers, the best performance is achieved for linear SVM, optimizable Ensembles Learning and SVM kernel, respectively. And the corresponding accuracy is 75.7%, 75.7%, and 73.0%, respectively. The AUC values are 0.77, 0.80, and 0.75, respectively. Conclusions: Machine learning (ML) models can predict angina pectoris caused by the origin anomalous of the right coronary artery, providing valuable auxiliary diagnostic information for clinicians and serving as a warning to clinicians. It is hoped that timely intervention and treatment can be realized to avoid serious consequences such as myocardial infarction. [ABSTRACT FROM AUTHOR]

Background: Bentall surgery is the main method for treating aortic root lesions, but traditional Bentall method is very difficult for patients with mild aortic sinus dilation to directly anastomose the coronary artery orifice with graft. Case presentation: A 41-year-old man was admitted to hospital after severe chest pain. Computed tomography angiography(CTA)revealed a type A aortic dissection. Echocardiography showed moderate aortic valve regurgitation and an aortic sinus diameter of 38 mm(mm). The patient underwent emergency Bentall surgery (using a preset coronary artery orifice patch), total arch replacement, and implantation of a graft into the descending aorta. Follow-up echocardiography showed the patient cardiac function was good, and there was no residual leakage at the coronary artery orifice. Conclusions: This method is an alternative to traditional Bentall surgery and is suitable for all aortic root lesions, especially those with mild aortic sinus dilation or concomitant aortic dissection. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and Aim Methods Results Conclusion The study ‘Periodontitis and Its Relation to Coronary Artery Disease’ (PAROKRANK) reported an association between periodontitis (PD) and the first myocardial infarction (MI). This follow‐up study aims to test the hypothesis that those with PD—compared to periodontally healthy individuals—are at increased risk for cardiovascular (CV) events and death.A total of 1587 participants (age <75 years; females 19%) had a dental examination including panoramic radiographs between 2010 and 2014. PD was categorized as healthy (≥80% alveolar bone height), mild/moderate (79%–66%) or severe (<66%). A composite CV event (first of all‐cause death, non‐fatal MI or stroke and hospitalization following to heart failure) was investigated during a mean follow‐up period of 9.9 years (range 0.2–12.5 years). Participants were divided into two groups: those with and without PD. The primary event rate, stratified by periodontal status at baseline, was calculated using the Kaplan–Meier method and Cox regression.The number of events was 187 in the 985 periodontally healthy participants (19%) and 174 in the 602 participants with PD (29%; p < 0.0001). Those with PD had a higher likelihood for a future event (hazard ratio [HR] = 1.26; 95% CI: 1.01–1.57; p = 0.038), following adjustment for age, smoking and diabetes.The PAROKRANK follow‐up revealed that CV events were more common among participants with PD, which supports the assumption that there might be a direct relation between PD and CV disease. [ABSTRACT FROM AUTHOR]