Lipid analysis of coronary atherosclerotic plaques and the mechanism of restenosis after coronary endarterectomy / 中华胸心血管外科杂志

Objective:To analyze the lipid composition of coronary atherosclerotic plaques and explore the mechanism of its influence on the medium and long-term efficacy of coronary endarterectomy(CE).Methods:From January 2018 to December 2019, a total of 50 patients with diffuse coronary artery disease(DCAD)and hyperlipidemia in Beijing Anzhen Hospital were enrolled to undergo coronary artery bypass grafting combined with anterior descending CE. After the informed consent was signed before the operation, the coronary endarterectomy plaque tissue and blood plasma samples were taken during the operation. Patients were further examined by coronary atherosclerosis T1-weighted characterization(CATCH) and power domain non-orthogonal multiple access(NOMA)postoperatively to analyze middle and long-term coronary restenosis risks. They were divided into high-risk group(restenosis rate >25%, study group) and matched low-risk group(control group). Lipid and molecular biological analysis were performed in the two groups to detect the tissue and cytochrome P450 3A4 enzyme(CYP3A4) content of plaque samples.Results:8 patients were enrolled in each group. The lipid analysis showed that and tissue samples from patients in the study group had a significantly higher level of 4α- Hydroxycholesterol(4α-OHC)as compared to the control group(0.050 μmol/g vs. 0.016 μmol/g, P<0.05). Further, 12 months after the operation, CATCH results showed that the patency rate of the control group was better than that of the study group[coronary artery stenosis rate(9.01±1.9)% vs.(22. 31±2.3)%, P<0.05]. Comparison of CYP3A4 content showed that: the CYP3A4 in blood plasma for the study group was higher than that in the control group[immediate(0.88±0.05)ng/ml vs.(0. 45±0.03) ng/ml and(2. 08± 0.40) ng/ml vs.(1. 58± 0.16)ng/ml, P<0.05]. Conclusion:High expression of 4 α- OHC may accelerate atherosclerosis(AS) after CE and cause restenosis in the middle and long term; It was also confirmed that 4 α- OHC is a biomarker of CYP3A4, which suggests for further investigation of the mechanism of progression after CE.

Obesidad central, sarcopenia y conductas sedentarias en el riesgo cardiovascular por score Framingham y área total de placa carotídea / Central Obesity, Sarcopenia, and Sedentary Behaviors Related to Cardiovascular Risk by Framingham Score and Total Carotid Plaque Area

Resumen Antecedentes: las enfermedades cardiovasculares son la principal causa de morbimortalidad mundial. La obesidad, sarcopenia, actividad física insuficiente y las conductas sedentarias impactan de manera sinérgica en el riesgo cardiovascular. Objetivo: evaluar el riesgo cardiovascular en relación con la actividad física, las conductas sedentarias y la composición corporal. Materiales y métodos: estudio observacional transversal de 95 personas adultas de ambos sexos. Se determinó el riesgo cardiovascular mediante el score de Framingham y el score de Framingham corregido por área total de placa aterosclerótica; la composición corporal, por antropometría, bioimpedancia y dinamometría como indicador indirecto; y la actividad física y las conductas sedentarias, por cuestionario validado. Se condujeron análisis descriptivos, de correlación y asociación con un 95 % de confianza. Resultados: el 95 % de las mujeres y el 98 % de los varones presentaron riesgo cardiovascular elevado; el 51,5 %, obesidad; el 95,5%, obesidad central; y el 47,3 %, fuerza muscular disminuida. Se observaron asociaciones positivas significativas entre riesgo cardiovascular y circunferencia de cintura (rho=0,26; p=0,024). No hubo asociación significativa entre la fuerza muscular y el riesgo cardiovascular (rho=-0,21; p=0,065). La conducta sedentaria tuvo un efecto promotor del riesgo cardiovascular (OR=3,9; p=0,033). Conclusiones: la obesidad central y permanecer más de 6/h día en posición sedente son factores asociados al riesgo cardiovascular.

Abstract Background: Cardiovascular diseases are the principal cause of morbidity and mortality worldwide. Obesity, sarco-penia, insufficient physical activity, and sedentary behaviors synergistically impact cardiovascular risk. Objective: Evaluate cardiovascular risk in relation to physical activity, sedentary behaviors, and body composition. Materials and Methods: Cross-sectional observational study in 95 total males and females. Cardiovascular risk was determined using the Framingham score, which corrects for total area of atherosclerotic plaque. Risk was also determined using body composition, anthropometry, bioimpedance and dynamometry as indirect indicators, physical activity, sedentary behaviors, and a validated questionnaire. Descriptive, correlation and association analyses were conducted with 95% confidence. Results: 95% of women and 98% of men presented with an elevated cardiovascular risk; 51.5% with obesity, 95.5% central obesity, and 47.3% with diminished muscular strength. Significant positive associations were observed between cardiovascular risk and waist circumference (rho=0.26; p=0.024). There was no significant association between muscle strength and cardiovascular risk (rho=-0.21, p=0.065). Sedentary behavior increased cardiovascular risk (OR=3.9; p=0.033). Conclusions: Central obesity and staying more than six hours per day in a sitting position are factors associated with cardiovascular risk.

Effectiveness of Transverse Abdominis Plane Block as a Method of Regional Anaesthesia in Unilateral Inguinal Hernia Repair

The Transverses Abdominis Plane (TAP) block is a relatively new regional technique which is often used for sensory blockade of the lower abdominal wall mainly for post-operative pain relief. It causes sensory blockade mainly because of injection of local anaesthetic between the internal oblique and the transverse abdominis muscle. TAP block was performed using a blind landmark technique in the lumbar petit triangle. Nowadays USG guided TAP block is being performed in many centers. TAP block is known to improve postoperative pain, reduce the opioid demand, and also reduce the time to rescue analgesia in patients undergoing lower abdominal surgeries. In our study, we have used TAP block as a main anaesthetic technique in patients posted for unilateral inguinal hernia repair under elective conditions. TAP Block in this study was given with 0.5 % bupivacaine. Duration of anaesthesia / analgesia, effectiveness of block, period of block, cardiac stability and haemodynamic stability were studied. METHODSA prospective observational study was conducted on 30 randomly selected individuals posted for elective inguinal hernia repair who belonged to American Society of Anaesthesiologists classification 1 and 2; age group between 20 and 70 years; satisfying all inclusion and exclusion criteria. All the patients received 0.5 % bupivacaine for TAP block, dose not more than 2.5 mg / Kg body weight. RESULTSWe have found that TAP block gives good anaesthesia for patients posted for inguinal hernia repair with good haemodynamic stability. With inj. Bupivacaine 0.5 % having an onset of anaesthesia at about 7.45 + / - 2.32 minutes (p value < 0.001). The block was complete and effectively elevated nociceptive stimuli. The block lasted till the end of surgery in all cases, with no complications. CONCLUSIONSTAP block other than being the main anaesthetic technique for lower abdominal surgery, also provides good post-operative analgesia with minimal post-operative analgesic requirement with less haemodynamic variations.

Correlation between type H hypertension and the development of coronary atherosclerosis Correlation between type H hypertension and the development of coronary atherosclerosis / 中国综合临床

Objective To investigate the correlation between type H hypertension and the development of coronary atherosclerosis.Methods From January 2015 to December 2016,three hundred and sixty patients with essential hypertension complicated with coronary atherosclerosis were treated in First Hospital of Shijiazhuang were selected,according to the level of serum homocysteine (Hcy),the patients were divided into the observation group (n =197 cases,Hcy ≥ 10 μ mol/L) and the control group (n =163 cases,Hcy＜10 μmol/L),all patients underwent coronary angiography and intravascular ultrasound.Results The cross-sectional area of extravascular elastic membrane (EEMCSA),plaque area (PA) and plaque burden(PB) of the observed group were (15.10±0.91) mm2,(8.80±0.99) mm2 and (62.03±3.20)％,wrere obviously higher than thoseat of the control group((13.72±0.96) mm2、(7.92±0.89) mm2、(56.87 ±3.37) ％),and the difference was statistically significant (t =14.079,、8.864,and 14.983,P＜0.05),and the minimum lumen cross section area (MLA) was (5.40 ±0.64) mm2,were obviously lower than that of the control group ((5.89 ± 0.52) mm2),and the difference was statistically significant (t =-7.937,P＜0.05);The Gensini score of the coronary artery in the observation group was (67.64± 13.19) points,which was significantly higher than that in the control group ((55.34± 12.20) points),and the difference was statistically significant (t =9.190,P＜0.05);the Serum Hcy were positively correlated with PA,PB and Gensini scores in the observation group (r =0.873,0.732and 0.856,P ＜ 0.05),which was negatively correlated with MLA (r =-0.773,P＜0.05).Conclusion There is a certain correlation between the severity of coronary atherosclerosis and the level of serum Hcy in patients with type H hypertension,which is worthy of further study.

Understanding Vulnerable Plaques: Current Status and Future Directions

The main cause of acute myocardial infarction is plaque rupture accompanied by superimposed coronary thrombosis. Thin-cap fibroatheromas (TCFAs) have been suggested as a type of lesion with a vulnerability that can cause plaque rupture. However, not only the existence of a TCFA but also the fine and complex interactions of other anatomical and hemodynamic factors, such as microcalcification in the fibrous cap, cholesterol crystal-induced inflammasome activation, the apoptosis of intraplaque macrophages, and endothelial shear stress distribution should precede a clinical event caused by plaque rupture. Recent studies are being conducted to identify these mechanisms through molecular imaging and hemodynamic assessment using computational fluid dynamics, which will result in better clinical results through selective coronary interventions.

Comparison of Risk Factors for the Progression of Coronary Lesions in Patients with Type 2 Diabetes and Non-diabetes Mellitus / 中山大学学报(医学科学版)

@#【Objective】Diabetes mellitus is a risk equivalent for coronary heart disease. This retrospective study was designed to investigate the risk factors of the progression of coronary lesions in patients with type 2 diabetes（T2DM）and Non- diabetes Mellitus（NDM）.【Methods】 526 patients with T2DM and 425 patients with NDM at the Third Affiliated Hospital of Sun Yat-sen University between March 2001 and January 2017 who underwent coronary imaging studies（coronary angiography or coronary CTA）twice during the same period were enrolled. The effects of cardiovascular risk factors on the progression of coronary lesions were analyzed in parallel in these two types of patients.【Results】Risk factors of the progression of coronary lesions in T2DM patients included smoking（OR = 1.836，95% CI：1.030~3.371，P = 0.04），Lp（a） ［OR = 1.001，95% CI：1.000~1.002，P = 0.004（baseline）；OR = 1.001，95% CI：1.000~1.002，P = 0.009（re-examined）］，HbA1c leve［l OR = 1.471，95% CI：1.030~2.100，P = 0.034（re-examined）］，uncontrolled LDL-C（OR = 1.882，95% CI：1.091~3.245，P = 0.023），TC［OR = 2.029，95% CI：1.028~4.008，P = 0.041（re-examined）］and low HDL-C ［OR = 0.017，95% CI：0.040~0.729，P = 0.017（re-examined）］. Comparative risk factors in NDM included BMI［OR =1.746，95%CI：2.462~2.712，P = 0.026（baseline）；OR = 0.001，95%CI：0~0.394，P = 0.025（re-examined）］，uncontrolled LDL-C（OR = 2.875，95%CI：1.669~4.952，P < 0.001）and low ApoA［OR = 0.282，95%CI：0.082~0.971，P = 0.045 （baseline）；OR = 0.117，95%CI：0.038~0.835，P = 0.029（re-examined）］. Lowest level of progression was found in the group with HbA1c<6.5%［0（0~3.4）points/year vs 0.3（0~3.0）points/year vs 1.0（0~5.1）points/year，P = 0.049. 0（-0.4~2.7）points/year vs 0.6（0~4.0）points/year vs 0.9（0~4.2）points/year，P=0.029］in T2DM patients.【Conclusion】Except for achievement of LDL- C goals，there might be some differences in risk factors for progression of coronary lesions between T2DM and NDM patients. Smoking，Lp（a），TC，HDL- C and control levels of HbA1c are independent predictors in T2DM as well as BMI and ApoA in NDM. Lowering HbA1c to less than 6.5% may delay progression of lesion.

Epicardial Adipose Tissue Thickness A Novel Cardiometabolic Risk In Hypertensive Obese Adults

INTRODUCTION :–Obesity is a independent risk factor for DM, HTN, OSA, stroke, MI, Arrhythmias etc.Epicardial Adipose Tissue (EAT)is a lipid–storing depot (an endocrine organ) secreting cytokines & chemokines So it could play roles in the pathogenesis of coronary atherosclerosis & cardiomyopathy AIM/OBJECTIVE:–Study Epicardial Adipose Tissue (EAT) as an independent prognostic marker in hypertensive obese adult as recent cardiovascular risk marker and its comparison with Body mass index(BMI). MATERIAL & METHOD:–All adults patient attending the Medicine OPD in two year duration were enrolled in the study.Anthropometric data collection :–Weight(Kg), Height(cm), Waist Circumference(cm), Hip Circumference(cm).Echocardiography was performed after anthropometric measurements.Two dimensional targeted M–mode measurement of EAT as recommended by American Society of echocardiography(ASE). RESULT:–The BMI was found higher in the experimental group 42.48(+/–7.35)than control group 21.69(+/–3.32).BSA & WHR both were significantly higher in experimental than control group.EAT are significantly higher in experimental group than control group. CONCLUSION:–Reduction in BMI , marker of Obesity will lead to improvement of epicardial adipose tissue thickness& will likely to prevent further cardiovascular morbidity &mortality”

Correlation between plasma zine-α2-glycoprotein and degree of coronary atherosclerosis lesion / 重庆医学

Objective To observe the correlation between zinc-a2-glycoprotein (ZAG) in human plasma and the degree of coronary atherosclerosis lesion.Methods A total of 242 research subjects were included.The clinical indexes were perfected and plasma ZAG level was detected.The coronary angiography was performed.The subjects were divided into the coronary atherosclerosis group (CAD group) and control group according to the examination results.The Gensini score was used to assess the degree of coronary artery lesion,different degree subgroups were divided according to the assessment results.The correlation between the ZAG level with the clinical indexes was analyzed by Spearman analysis.The ROC curve was used to evaluate the efficiency of ZAG in the diagnosis of coronary atherosclerosis and its sensitivity and specificity were analyzed.Results The plasma ZAG level in the CAD group was significantly lower than that in control group,the difference was statistically significant [(45.12±5.02)μg/mL vs.(53.93±2.96)μg/mL,P＜0.01].With the increase of Gensini score,plasma ZAG level showed the decreasing trend,the difference among the groups were statistically significant (P＜0.05).The Spearman correlation analysis showed that body mass index (BMI),waist circumference and waist to hip ratio(WHR) were negatively correlated with ZAG (P＜0.05),and positively correlated with high density lipoprotein cholesterol(HDL-C,P＜0.05).The sensitivity of plasma ZAG for evaluating coronary atherosclerosis was 89.8％ and its specificity was 91.2％.Conclusion Plasma ZAG is negatively correlated with the severity of coronary atherosclerosis lesion,and its level detection has a certain value in the screening of coronary atherosclerosis.

Dysfunction of endothelial progentior cells in the angiographically defined coronary atherosclerosis / Монголын Анагаах Ухаан

Introduction@#Endothelial progenitor cells (EPC) have a role in the maintenance and promotion of vascular repair and are negatively correlated with coronary atherosclerosis. @*Goal@#To culture of EPC-CFUs during coronary atherosclerosis, evaluate endothelial nitric oxide synthetase (eNOS) enzyme levels in the culture.@*Materials and Methods@#The 10 ml blood was drawn from the peripheral vein of 12 man patients that stable angina 4, acute myocardial infarction (AMI) 4 and healthy people 4. Peripheral blood mononuclear cells were isolated by Ficoll density-gradient centrifugation and EPC-CFUs was assayed after two platings and a 6 day culture on fibronectin coated, 72 well plates, as described. eNOS enzyme titers were determined by ELISA according to the protocol in the cells culture.@*Results@#The people were 52±2.12 years. The number of EPC-CFUs increases with accordance of patients with stable angina, AMI, healthy people with the statistical significance (F=17.3, p<0.001): stable angina (2.6±0.47 colony/well), AMI (6.7±0.81 colony/well), healthy people (10.5±1.34 colony/well). Furthermore, ANOVA test of eNOS enzyme levels in patients with stable angina (5.2±0.61 pg/ml), AMI (8.7±1.49 pg/ml) and healthy people (13.7±2.48 pg/ml). The significant difference (F=6.2, p=0.003) was observed among the three groups. The number of EPC-CFUs had direct significantly correlation (r=0.621, p<0.001) with the eNOS enzyme levels of this culture.@*Conclusion@#Number of EPC-CFUs and eNOS enzyme levels decrease at patient with stable angina, indicate more than endothelial dysfunction.@*Ethical approval@#The ethics committee of Mongolian National University of Medical Sciences (ID: 6/3/201506, approved on Jan 01, 2015)

Impact of Coronary Atherosclerosis on Diastolic Function in Patients With Coronary Heart Disease / 中国循环杂志

Objectives: To explore the impact of coronary atherosclerosis on diastolic function in patients with coronary heart disease. Methods: Present study included 600 patients with suspected coronary heart disease (CHD) admitted to our hospital between September 2014 to August 2017, coronary arteriography(CAG)was performed in all patients. Patients were divided into control group (n=150, CAG negative patients) , atherosclerosis group (n=150 ), and coronary heart disease group (n=300). Echocardiography, CAG, left ventriculography were measured in all patients, left ventricular diastolic function, coronary volume and pressure were compared among groups. Results: Left ventricular end-diastolic volume(LVEDV), left atrial volume index(LAVI) and left ventricular diastolic time constant (T) were significantly higher, while the ratio of early-to-late diastolic velocity (E/A) , the maximal rise velocity of left ventricular pressure (+dp/dtmax) , the maximum decrease velocity of left ventricular pressure (-dp/dtmax), the first third diastolic filling fraction (1/3 FF)and the last third of the diastolic filling fraction (p1/3 FF) were significantly reduced in the coronary atherosclerosis group and the coronary heart disease group as compared to control group (all P<0.05); left ventricular ejection fraction (LVEF) in CHD group was lower than that in control group (P<0.05); incidence of E/A<1.2 was significantly different among the 3 groups (P<0.01). Multivariate logistic regression analysis indicated that Gensini score was an independent risk factor for diastolic dysfunction(OR=1.93, 95%CI:1.31~2.68, P=0.01). The coronary artery end-diastolic volume (CEDV) , the coronary artery end-systolic volume ( CESV) , the maximum decrease velocity of coronary artery pressure (C-dp/dtmax), the maximum rise velocity of coronary artery pressure (C+dp/dtmax) were significantly decreased in the coronary sclerosis group (P<0.05) ; CEDV, CESV, C-dp/dtmax, C+dp/dtmaxwere significantly decreased in the coronary heart disease group (P<0.01) as compared with the control group. Compared with the coronary atherosclerosis group, the CEDV, CESV, C-dp/dtmax, C+dp/dtmaxwere significantly decreased in CHD group (P<0.05). CESV, C-dp/dtmax, C+dp/dtmax in the coronary sclerosis group were significantly decreased (P<0.05), CEDV, CESV, C-dp/dtmax, C+dp/dtmaxin the coronary heart disease group were significantly decreased (P<0.01).Compared with the coronary atherosclerosis group, the CEDV, CESV, C-dp/dtmax, C+dp/dtmaxwere significantly decreased in CHD group (P<0.05). Spearman correlation analysis showed that Gensini score was negatively correlated with C-dp /dtmax(r=-0.43, P<0.01). Conclusions:Diastolic dysfunction is a sensitive index of myocardial ischemia in patients with coronary heart disease. In patients with coronary atherosclerosis, cardiac diastolic dysfunction could be shown in the absence of cardiac systolic dysfunction. The severity of coronary atherosclerosis is positively related to coronary diastolic dysfunction, which may lead to decrease of coronary vascular compliance, thus induce cardiac diastolic dysfunction.

Advances in research on the mechanism of vascular endothelial injury and vascular remodeling in coronary atherosclerosis / 西安交通大学学报(医学版)

Vascular endothelial injury is the initial manifestation of coronary atherosclerosis,and currently there are many researches on the mechanism of vascular endothelial injury.If the risk factors for coronary athero-sclerotic heart disease (CAD)are sustained and not reversed,endothelial dysfunction will occur,followed by coro-nary remodeling,and ultimately will lead to the occurrence of CAD.The study on the mechanism of vascular endo-thelial injury and vascular remodeling plays an important role in predicting the development of CAD and guiding the treatment of CAD.Percutaneous coronary intervention (PCI)is one of the main revascularizations for coronary heart disease.With the evolution of drug-eluting stents,the incidence of thrombosis and restenosis caused by vascu-lar endothelial injury after PCI is reduced.Biocompatibility of coronary stent technology is also improved based on the mechanism of vascular endothelial dysfunction and vascular remodeling.

Associations of NEIL3 rs12645561 with severity of coronary atherosclerosis in Chinese Han population of Henan and Hubei regions / 临床检验杂志

Objective To assess the association of polymorphism at rs12645561 locus of Nei endonuclease Ⅷ-like 3 ( NEIL3) gene with the severity of coronary atherosclerosis in Han population of Hubei and Henan regions in central China. Methods In 947 cases undergoing coronary angiography, the severity of coronary atherosclerosis was calculated by lesion vessel number scores and Gensini scores.The genotypes of rs12645561 were analyzed by high resolution melting curve. The plasma NEIL3 levels were measured by en-zyme-linked immunosorbent assay. Results The minor allele T of rs12645561 was significantly associated with the risk of coronary ar-tery disease (χ2=12.165, P<0.05) including increased lesion vessel scores and Gensini scores (χ2=14.745 and 15.615,P<0.05). The variant risk genotypes ( CC+CT) of rs12645561, body mass index of more than 25 kg/m2 , hypelipidemia and smoking habit were all the independent risk factors for higher Gensini scores ( OR=1.50, 1.54, 2.01 and 1.42, respectively, P<0.05) . There were signifi-cantly inverse correlations of plasma NEIL3 levels with the distribution of rs12645561, lesion vessel number scores and Gensini scores ( P<0.05) . Conclusion rs12645561 may correlate with the severity of coronary atherosclerosis, and contribute to the development of coronary atherosclerosis of Han population of Henan and Hubei regions. rs12645561 may also affect the levels of NEIL3 protein.

Research advances in the relationship between frailty and coronary heart disease / 中华老年医学杂志

Frailty is common among elderly patients with coronary artery disease.It prolongs the length of hospitalization and can independently predict poor short-term and long-term prognosis in patients with acute coronary syndrome (ACS).The assessment of frailty can contribute to a more comprehensive risk stratification in ACS patients.For patients with coronary artery disease seeking reperfusion therapy,frailty can be an independent predictor for higher short-term and long-term mortality rates after PCI and can increase the mortality rate after coronary artery bypass grafting (CABG).Previous findings suggest that frailty should be included in the preoperative risk assessment model of reperfusion therapy for patients with coronary artery disease.In addition,frailty assessment is helpful in predicting the mortality after reperfusion therapy.

The Impact of Arterial Micro-calcification of the Vascular Access on Coronary Artery Calcification and Cardiovascular Mortality in Incident Hemodialysis Patients / 대한내과학회지

BACKGROUND/AIMS: The aim of this study was to explore the relationship between arterial micro-calcification (AMiC) and coronary artery calcification, and to determine the impact of AMiC on cardiovascular mortality in incident hemodialysis patients. METHODS: One hundred and nineteen hemodialysis patients who received vascular access surgeries between April 2011 and May 2015 were included in this study. AMiC was diagnosed by pathologic examination of arterial specimens acquired during surgery, using von Kossa stain. All patients underwent multi-detector computed tomography imaging, and coronary artery calcium scores (CACS) were calculated. We evaluated the association between AMiC and CACS in these patients, and examined the incidence of cardiovascular death (through Febraury 2017) in patients with and without AMiC. RESULTS: The mean age of the patient group was 64.3 ± 13.0 years, and 64% were male (n = 76). Of 119 patients, 67 (56.3%) were positive for AMiC of the vascular access. The mean CACS was 430.4 ± 720.2 (0-3,954), and 99 patients were considered positive for CAC (83.1%). By multivariate logistic regression analysis, CACS was independently associated with AMiC. The mean follow- up period was 35.5 ± 17.8 months. During this time there were 26 all-cause deaths, of which 17 were cardiovascular. Kaplan-Meier survival analysis revealed that AMiC was associated with cardiovascular mortality (log rank = 9.0, p < 0.05). CONCLUSIONS: AMiC may be associated with coronary artery calcification in incident hemodialysis patients, and may also be a risk factor for cardiovascular mortality.

Pregnancy-Related Acute Myocardial Infarction: A Case Report / 대한법의학회지

Pregnancy-related acute myocardial infarction (AMI) is very rare and can be lethal if the diagnosis and management are delayed. The physiological changes during pregnancy, including in hemodynamics and hormonal status, can increase the risk of AMI even in young women. While atherosclerosis is the leading cause of AMI in the general population, coronary artery dissection is most common in pregnancy-related AMI. Pregnancy-related AMI, which is caused by coronary atherosclerosis, has been rarely reported in Korea. We report an autopsy case of postpartum sudden cardiac death in a 32-year-old woman.

Ethanol inhibiting the NLRP3 inflammasome activation to protect coronary heart disease / 实用医学杂志

Objective To examine whether ethanol modulates the intracellular processes involved in the secretion of IL-1α,and then exert a protective effect against coronary heart disease. Methods THP-1 cells in human were cultured for 2-3 generations , and put in PMF for 72 h to induce THP-1 into macrophage. ELISA was applied to detect effects for secretion of IL-1α by LPS, cholesterol and ethanol. In the light of ELISA re-sults, western blot was applied to detect the effects of ethanol on caspase-1 and NLRP3. Results Compared with the control group, the secretion of IL-1α in LPS group and LPS + CHOL group increased. Compared withLPS + CHOL group, the concentration of IL -1α in LPS + CHOL + etha group significantly decrease(P < 0.01). The results of western blot showed that ethanol significantly inhibited caspase-1 and NLRP3 activation. Conclu-sion Ethanol can inhibit the NLRP3 inflammasome activation in macrophages , which may represent a biological pathway underlying the protective effect of moderate alcohol consumption on coronary heart disease.

Association between the Gensini Score and Carotid Artery Stenosis

BACKGROUND AND OBJECTIVES: The aim of this study was to evaluate the association between the extent of coronary artery disease assessed by the Gensini score and/or the SYNTAX score and the significant carotid stenosis in patients undergoing coronary artery bypass grafting (CABG). SUBJECTS AND METHODS: A total of 225 patients who had carotid doppler ultrasonography prior to CABG were included retrospectively. Significant coronary artery disease was assumed as a lumen diameter stenosis of ≥50% in any of the major epicardial coronary arteries. The severity of carotid stenosis was determined by B-mode and duplex ultrasonography. Clinically significant carotid stenosis was defined as peak systolic velocity greater than 125 cm/s. RESULTS: The mean value of SYNTAX score and Gensini score was highest in patients allocated to significant carotid stenosis (22.98±7.32, p<0.001 and 77.40±32.35, p<0.001, respectively). The other risk factors for significant carotid stenosis were found to be male gender (p=0.029), carotid bruit (p<0.001), diabetes (p=0.021), left main disease (p=0.002), 3-vessel disease (p=0.008), chronic total coronary occlusion (p=0.001), and coronary artery calcification (p=0.001) in univariate analysis. However, only the Gensini score (odds ratio[OR]=1.030, p=0.004), carotid bruit (OR=0.068, p<0.001), and male gender (OR=0.190, p=0.003) were the independent predictors. The Gensini score cut off value predicting significant carotid stenosis was 50.5 with 77% sensitivity (p<0.001). CONCLUSION: The Gensini score may be used to identify patients at high risk for significant carotid stenosis prior to CABG.

Association of Homocysteine Levels with Subclinical Coronary Atherosclerosis in Asymptomatic Subjects

BACKGROUND: Progression of atherosclerotic plaques is known to be correlated with elevated circulating homocysteine (Hcy). However, whether the level of Hcy is related with coronary atherosclerosis in the subclinical state is unclear. Therefore, we performed this study to investigate the relationship between blood Hcy levels and subclinical atherosclerosis in asymptomatic self-referred subjects. METHODS: We retrospectively enrolled 2,968 self-referred asymptomatic subjects (1,374 men, 1,594 women) who had undergone both coronary CT angiography (CCTA) and coronary artery calcium scoring. The relationships between atherosclerosis, Hcy, and other clinical factors were assessed. RESULTS: Higher levels of Hcy were related with age, male gender, body mass index (BMI), waist circumference, blood pressure, high density lipoprotein (HDL), triglyceride, blood glucose, HbA1c, hsCRP, and coronary artery calcium score (CACS). Coronary plaque was more frequently found in higher Hcy quartile groups (21.3%, 28.8%, 34.4%, and 34.3%, P50%) was also more frequent in higher Hcy quartile groups (1.8%, 5.4%, 5.0%, and 6.6%, P400) than the first quartile group. CONCLUSIONS: Blood Hcy levels were associated with an increased risk of the presence and extent of subclinical atherosclerosis in asymptomatic subjects.

Computed tomography imaging of early coronary artery lesions in stable individuals with multiple cardiovascular risk factors

OBJECTIVES: To investigate the prevalence, extent, severity, and features of coronary artery lesions in stable patients with multiple cardiovascular risk factors. METHODS: Seventy-seven patients with more than 3 cardiovascular risk factors were suspected of having coronary artery disease. Patients with high-risk factors and 39 controls with no risk factors were enrolled in the study. The related risk factors included hypertension, impaired glucose tolerance, dyslipidemia, smoking history, and overweight. The characteristics of coronary lesions were identified and evaluated by 64-slice coronary computed tomography angiography. RESULTS: The incidence of coronary atherosclerosis was higher in the high-risk group than in the no-risk group. The involved branches of the coronary artery, the diffusivity of the lesion, the degree of stenosis, and the nature of the plaques were significantly more severe in the high-risk group compared with the no-risk group (all p < 0.05). CONCLUSION: Among stable individuals with high-risk factors, early coronary artery lesions are common and severe. Computed tomography has promising value for the early screening of coronary lesions. .