RESUMEN

Background: There is still controversial or limited evidence on whether sex differences exist in clinical characteristics, the risk of contrast-induced nephropathy (CIN), and other clinical outcomes of patients who received coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). The aim of this study was to characterize the effect of sex on clinical characteristics and outcomes of patients undergoing CAG and/or PCI. Methods: A total of 3,340 consecutive patients undergoing CAG and/or PCI from May 2017 to December 2022 were assessed in this retrospective study. Subgroup analyses by sex were performed. Clinical characteristics, treatments, the risk of CIN, and other clinical outcomes, including in-hospital and follow-up, were compared between females and males. Results: Females undergoing CAG and/or PCI tended to have an advanced age (65.8 versus 63.3 years, p < 0.001), a higher burden of complications, and received PCI less frequently compared with males (43.2% versus 64.2%, p < 0.001). After adjustment, female sex was associated with a higher incidence of CIN [adjusted odds ratio (aOR) 1.47; 95% CI 1.08-2.01; p = 0.015] and a higher all-cause readmission rate (aOR 1.26; 95%CI 1.02-1.56; p = 0.031). Meanwhile, females undergoing CAG alone demonstrated a higher risk of severe arrhythmia compared with males after controlling for potential confounders (aOR 1.52; 95% CI 1.12-2.04; p = 0.006). Conclusion: Sex disparities exist in the clinical characteristics, treatments, the risk of CIN, and other clinical outcomes among patients undergoing CAG and/or PCI. Female sex was identified as an independent predictor of risk for CIN, all-cause readmission rate, and severe arrhythmia.

RESUMEN

Introduction: Anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA) is a rare congenital anomaly. While only a few of those born with this anomaly survive into adulthood, it becomes an extremely rare diagnosis in adults. Case presentation: Here, the authors present a case of ALCAPA in a symptomatic adult female with angina and palpitations that was repeatedly missed on transthoracic echocardiogram. Clinical discussion: The adult type of ALCAPA is often missed due to non-specific changes in electrocardiogram, leading to reluctance for angiography. Therefore, identifying abnormal coronaries in echocardiogram is crucial. Conclusion: It is essential to consider anomalous coronary arteries as a differential diagnosis in patients with chest pain, despite their rarity. This case report highlights the role of various cardiac imaging modalities in improving the diagnostic yield of ALCAPA.

RESUMEN

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

RESUMEN

BACKGROUND: Rotational atherectomy (RA) is traditionally administered for patients with heavily calcified lesions and is thereby characterized by a high risk of the performed intervention. However, the prevalence characteristics of cardiac arrest are poorly studied in this group of patients. We aimed to evaluate the frequency and risk factors of cardiac arrest during percutaneous coronary interventions (PCI) performed with RA and preceding coronary angiography (CA). METHODS: Based on the data collected in the Polish Registry of Invasive Cardiology Procedures (ORPKI) from 2014 to 2021, we included 6522 patients who were treated with RA-assisted PCI. We scrutinized patient and procedural characteristics, as well as periprocedural complications, subsequently comparing groups in terms of cardiac arrest incidence with the use of univariable and multivariable analyses. RESULTS: Thirty-five (0.5%) patients suffered from cardiac arrest during RA-PCI or preceding CA. They were characterized by significantly higher rates of prior stroke, acute coronary syndromes (ACS) as indications and higher Killip class (P < 0.001) at the admission time. Among the confirmed independent predictors of in-procedure cardiac arrest, the following can be noted: factors related to patients' clinical characteristics (e.g., older age, female sex, and disease burden), periprocedural characteristics (e.g., PCI within left main coronary artery [LMCA]), and periprocedural complications (e.g., coronary artery perforation and no-reflow phenomenon). CONCLUSIONS: Severe clinical condition at baseline, expressed by ACS presence and Killip class IV, as well as RA-PCI performed within LMCA and other periprocedural complications, were the strongest predictors of cardiac arrest during RA-assisted PCI and CA.

RESUMEN

We present the case of a 74-year-old man with dextrocardia and situs inversus who presented with non-ST-elevation acute myocardial infarction. The patient underwent successful coronary angiography without requiring percutaneous coronary intervention or coronary artery bypass grafting. We discuss the patient's clinical characteristics, electrocardiography findings, diagnosis, and treatment, and review the relevant literature.

RESUMEN

Indigenous Australians are known to have a higher prevalence of coronary artery disease (CAD) than non-Indigenous counterparts. Atherogenic lipid profiles, characterised by low serum levels of high-density lipoprotein (HDL) and higher serum triglycerides, have been shown to be more prevalent in Indigenous Australians. The use of computed tomography coronary angiography (CTCA) for risk stratification and diagnosis of CAD has been validated in moderate risk populations, but limited data exists in specific high-risk populations such as Indigenous Australians. Through a retrospective study of patient records, we aimed to confirm if an atherogenic lipid profile occurred in Indigenous Australians undergoing CTCA in the Northern Territory of Australia and if so, whether this correlated with the prevalence or burden of CAD. We demonstrate that Indigenous Australians have similar prevalence (52.6% vs. 50.3%, P=0.80) and burden of CAD (Leaman score 6.03±4.66 vs. 6.96±4.82, P=0.44) on CTCA as non-Indigenous patients, but were 8 years younger (41.9±8.9 vs. 50.0±11.9 years, P<0.001) at the time of examination. We confirmed the presence of an atherogenic lipid profile in Indigenous patients and showed low serum-HDL was associated with very premature (patients aged 18-35 years) CAD in comparison to premature (patients aged 36-55 years) and mature-onset (patients aged 56 years and older) CAD (0.71±0.25 vs. 1.09±0.35 vs. 1.18±0.36 mmol/L, P=0.009). Future clinical guidelines should consider the role of CTCA in Indigenous Australians and whether younger patients may benefit. The causes of premature CAD, including atherogenic lipid profiles, require an ongoing focus in order to achieve equitable cardiovascular outcomes for Indigenous and non-Indigenous Australians.

RESUMEN

Spontaneous coronary artery dissection (SCAD) is a rare condition that is frequently under-recognized. It has been connected to several triggers and predisposing factors. Interestingly, hypothyroidism has been linked to a higher likelihood of arterial dissections. We present the case of a 49-year-old woman who was admitted for acute coronary syndrome. Coronary angiography revealed signs of SCAD affecting the distal left anterior descending artery and the right ventricular branch. Additionally, microaneurysms were detected in the distal circumflex artery, the main septal artery, and a branch of the distal right coronary artery. During her hospitalization, a goiter was identified, and further evaluation confirmed autoimmune thyroiditis. The patient was managed with conservative treatment. A follow-up angiogram 6 months later showed that the previously dissected coronary segments and microaneurysms had regressed. This case highlights the possible role of hypothyroidism in increasing risk of SCAD and possibly microaneurysms which has been suggested in only isolated cases in the literature. It also demonstrates the effectiveness of a conservative treatment approach for this condition.

RESUMEN

BACKGROUND: For over 50 years, music therapy and breathing exercises have been widely utilized as interventions to help individuals cope with fatigue, stress and pain globally. AIM: To analyse the effects of music and breathing exercises on anxiety and pain in patients undergoing coronary angiography. STUDY DESIGN: This is a single-blind, randomized controlled trial. The sample comprised 165 patients: 55 in the control group, 55 in the breathing exercise group and 55 in the music therapy group. Patients in the music group listened to music during angiography, those in the breathing exercise group practised exercises 30 min before the procedure and the control group received standard treatment. Anxiety levels were assessed before and after the procedure, and pain levels were measured post-procedure. The Consolidated Standards of Reporting Trials (CONSORT) checklist for reporting randomized trials was used to guide reporting. RESULTS: Anxiety scores rose significantly in the control group from 33.9 ± 4.2 pre-angiography to 37.7 ± 4.9 post-angiography. Conversely, the breathing group's anxiety scores decreased from 34.3 ± 3.5 before angiography to 31.7 ± 1.5 after angiography, and the music group exhibited a reduction from 32.3 ± 3.6 to 30.8 ± 1.6. Post-angiography, the control group reported a mean pain score of 64 ± 0.8 mm, while the breathing and music groups had significantly lower scores of 35 ± 0.6 and 29 ± 0.8 mm, respectively. Statistical analysis showed a highly significant difference in pain scores between the intervention and control groups. CONCLUSIONS: This study provides support for the beneficial effects of employing breathing exercises and music in alleviating pain and anxiety during coronary angiography procedures. RELEVANCE TO CLINICAL PRACTICE: Integrating these findings into clinical practice could be significant for improving patients' pain experiences and anxiety, enhancing the tolerance of invasive medical procedures.

RESUMEN

Purpose: This retrospective cohort study aimed to analyze the relationship between tongue color and coronary artery stenosis severity in 282 patients after underwent coronary angiography. Methods: A retrospective cohort study was conducted to collect data from patients who underwent coronary angiography in the Department of Cardiology, Shanghai Jiading District Central Hospital from October 1, 2023 to January 15, 2024. All patients were divided into four various stenosis groups. The tongue images of each patient was normalized captured, tongue body (TC_) and tongue coating (CC_) data were converted into RGB and HSV model parameters using SMX System 2.0. Four supervised machine learning classifiers were used to establish a coronary artery stenosis grading prediction model, including random forest (RF), logistic regression, and support vector machine (SVM). Accuracy, precision, recall, and F1 score were used as classification indicators to evaluate the training and validation performance of the model. SHAP values were furthermore used to explore the impacts of features. Results: This study finally included 282 patients, including 164 males (58.16%) and 118 females (41.84%). 69 patients without stenosis, 70 patients with mild stenosis, 65 patients with moderate stenosis, and 78 patients with severe stenosis. Significant differences of tongue parameters were observed in the four groups [TC_R (P = 0.000), TC_G (P = 0.003), TC_H (P = 0.001) and TC_S (P = 0.024),CC_R (P = 0.006), CC_B (P = 0.023) and CC_S (P = 0.001)]. The SVM model had the highest predictive ability, with AUC values above 0.9 in different stenosis groups, and was particularly good at identifying mild and severe stenosis (AUC = 0.98). SHAP value showed that high values of TC_RIGHT_R, low values of CC_LEFT_R were the most impact factors to predict no coronary stenosis; high CC_LEFT_R and low TC_ROOT_H for mild coronary stenosis; low TC_ROOT_R and CC_ROOT_B for moderate coronary stenosis; high CC_RIGHT_G and low TC_ROOT_H for severe coronary stenosis. Conclusion: Tongue color parameters can provide a reference for predicting the degree of coronary artery stenosis. The study provides insights into the potential application of tongue color parameters in predicting coronary artery stenosis severity. Future research can expand on tongue features, optimize prediction models, and explore applications in other cardiovascular diseases.

Asunto(s)

RESUMEN

Kawasaki disease is an acute, self-limiting, systemic vasculitis of small and medium-sized arteries. It predominantly occurs in children under 4 years of age, though rarely older children can also be affected. This disease is the leading cause of acquired heart disease in children, with coronary aneurysms being a hallmark finding. The risk of coronary complications necessitates regular monitoring and possible preventative treatment with thromboprophylaxis. Here we discuss a rare case of a 10-year-old boy who exhibited typical symptoms of Kawasaki disease and was found to have multiple coronary artery aneurysms through diagnostic imaging.

RESUMEN

In modern medical practice, procedures that involve the use of catheters are common. These procedures can range from percutaneous coronary and peripheral vascular interventions to using catheters to drain fluid. However, complications associated with catheter usage can arise, and the most severe one is the puncture of a vital organ due to catheter misplacement. In this case, we present a rare complication related to the use of a pigtail catheter, which caused perforation of the left ventricular free wall. The patient presented with an electrocardiogram showing ST segment elevation in the anterior wall, indicative of a heart attack. The patient underwent coronary angiography, which showed that the coronary arteries were unblocked. However, during the procedure, the medical team suspected that the pigtail catheter was stuck in the left ventricle chamber, based on the use of fluoroscopy. This suspicion was later confirmed using computer tomography. To address the issue, the patient underwent an emergent cardiorrhaphy, which was performed immediately. Fortunately, the patient survived the complication.

RESUMEN

BACKGROUND: Coronary computed tomographic angiography (CCTA) is a non-invasive imaging technique that possesses the ability to provide detailed anatomical information about coronary arteries, avoiding unnecessary invasive procedures. Our aim was to assess the ability of CCTA to identify coronary artery disease compared to invasive coronary angiography (ICA) in a real-life setting. METHODS: We examined 137 consecutive patients who underwent ICA after CCTA. The latter was conducted in various non-selected centers, and data regarding stenosis were taken from individual reports without further analysis. RESULTS: A total of 60.5% of patients who underwent CCTA were found to have at least one critical stenosis, while the remaining 39.5% underwent ICA due to concurrent clinical or instrumental indications. Among these, 29.5% had angiographically critical pathology, 20.3% underwent a percutaneous coronary intervention (PCI), and 1.8% had coronary artery bypass grafting. Among the 83 patients with positive CCTA results, 34.9% had negative ICA findings. CCTA demonstrated low sensitivity (57.8%) and a positive predictive value of 42.6%. However, it retained high specificity (83.6%) and a negative predictive value of 90.4% for identifying critical stenosis. Among the 18.2% of patients who underwent CCTA without a specific indication, 60% had critical coronary lesions on their ICA and 86.6% of these subsequently underwent a PCI. CONCLUSIONS: CCTA performed in non-selective centers has a low concordance with ICA.

RESUMEN

Objectives: CT-derived fractional flow reserve (CT-FFR) can improve the specificity of coronary CT-angiography (cCTA) for ruling out relevant coronary artery disease (CAD) prior to transcatheter aortic valve replacement (TAVR). However, little is known about the reproducibility of CT-FFR and the influence of diffuse coronary artery calcifications or segment location. The objective was to assess the reliability of machine-learning (ML)-based CT-FFR prior to TAVR in patients without obstructive CAD and to assess the influence of image quality, coronary artery calcium score (CAC), and the location of measurement within the coronary tree. Methods: Patients assessed for TAVR, without obstructive CAD on cCTA were evaluated with ML-based CT-FFR by two observers with differing experience. Differences in absolute values and categorization into hemodynamically relevant CAD (CT-FFR ≤ 0.80) were compared. Results in regard to CAD were also compared against invasive coronary angiography. The influence of segment location, image quality, and CAC was evaluated. Results: Of the screened patients, 109/388 patients did not have obstructive CAD on cCTA and were included. The median (interquartile range) difference of CT-FFR values was -0.005 (-0.09 to 0.04) (p = 0.47). Differences were smaller with high values. Recategorizations were more frequent in distal segments. Diagnostic accuracy of CT-FFR between both observers was comparable (proximal: Δ0.2%; distal: Δ0.5%) but was lower in distal segments (proximal: 98.9%/99.1%; distal: 81.1%/81.6%). Image quality and CAC had no clinically relevant influence on CT-FFR. Conclusions: ML-based CT-FFR evaluation of proximal segments was more reliable. Distal segments with CT-FFR values close to the given threshold were prone to recategorization, even if absolute differences between observers were minimal and independent of image quality or CAC.

RESUMEN

Background: Arteriovenous malformations (AVMs) within the mediastinum are rare vascular anomalies. With the increasing number of coronary angiographies being performed, the number of incidentally found cases is rising. This presents challenges in terms of determining the appropriate treatment strategy. Case summary: We present the case of a 79-year-old man with aortic stenosis, experiencing functional dyspnoea and fatigue. Echocardiography showed a bicuspid aortic valve, and while left heart catheterization confirmed no significant coronary stenosis, it revealed a tortuous vessel originating from the circumflex artery (Cx), assumed to be heading toward the pulmonary circulation. The patient was scheduled for a surgical replacement of the aortic valve (SAVR). During the SAVR, the tortuous vessel was revealed to be a large, complex AVM located in the mediastinum. This increased both the duration of the surgery and the use of cardioplegia. Further, bleeding occurred per-operatively. Post-operatively, the patient developed tachy-brady syndrome and was treated with a pacemaker before discharge. Discussion: Due to the rarity of incidental AVMs in the middle/posterior mediastinum, no standard treatment protocol is available. This leaves clinicians and surgeons to manage the disease on a case-by-case basis, often with limited experience to guide their decisions. This patient case underscores the challenge of determining whether patients should be offered transcatheter aortic valve implantation (TAVI) or surgery. Furthermore, it highlights the intricate challenges that can arise when dealing with thoracic AVMs during cardiac procedures, emphasizing the importance of pre-operative awareness and tailored surgical approaches based on multidisciplinary discussions.

RESUMEN

Background: Transthoracic echocardiography (TTE) has traditionally been the primary method for coronary imaging in children with Kawasaki disease (KD). We aimed to evaluate coronary artery lesions (CALs) of the left circumflex artery (LCx) in KD on computed tomography coronary angiography (CTCA). Methods: Over a 9-year period (November 2013-December 2022), 225 children with KD underwent radiation-optimized CTCA on a 128-slice dual-source platform. TTE was performed on the same day, or a day prior or after CTCA. Findings: On CTCA, LCx CALs were seen in 41/225 (18.2%) patients. However, TTE detected CALs in only one third of these patients [15/41 (36.6%)]. CTCA showed 47 LCx CALs in 41 patients-aneurysms in 39 patients (40 fusiform, 2 saccular; 7 giant aneurysms), stenoses in 3, and thrombosis in 2. Thromboses and stenoses were both missed on TTE. Proximal LCx aneurysms were seen in 39 patients-of these, 12 had distal extension. Six patients had distal LCx aneurysms without proximal involvement and 2 non-contiguous multiple aneurysms. Four (9.75%) patients had isolated LCx involvement. Based on CTCA findings, treatment protocols had to be modified in 3/41 (7.3%) patients. Interpretation: This study highlights anatomical findings of LCx involvement in KD. Isolated LCx CALs were noted in 4/41 (9.75%) patients. TTE alone proved inadequate for LCx assessment in children with KD. With abnormalities detected in 18.2% of cases, including those missed by TTE, CTCA emerges as an essential imaging modality. The findings have implications for treatment planning and follow-up strategies in children with KD. Funding: None.

Asunto(s)

RESUMEN

Kawasaki disease (KD) is an acute systemic vasculitis that preferentially involves coronary arteries in young children, and predominantly affects young children. Cardiovascular lesions are the most severe complications of this disease. Even though giant aneurysms are rare, they can complicate thrombus formation, leading to myocardial ischemia, myocardial infarction, and even cardiac death. Later in life, it can lead to steno-occlusive lesions. Follow-up led to coronary artery stenosis. In this article, we report a case of a pediatric patient with KD who presented with a large thrombus within a giant coronary aneurysm as a consequence of delayed treatment with intravenous immunoglobulin (IVIG) and IVIG resistance, which contributed to the formation of coronary artery lesions. Transthoracic echocardiography is a valuable tool for detecting coronary artery abnormalities; however, computed tomography coronary angiography is valuable for precisely delineating coronary anatomy and complications. It is important to maintain a slightly higher international normalized ratio to decrease the risk of thrombosis in coronary artery aneurysms.

Asunto(s)

RESUMEN

Coronary CT angiography (CTA) derived fractional flow reserve (FFRCT) is recommended for physiological assessment in intermediate coronary stenosis for guiding referral to invasive coronary angiography (ICA). In this study, we report real-world data on the feasibility of implementing a CTA/FFRCT test algorithm as a gatekeeper to ICA at referral hospitals. Retrospective all-comer study of patients with new onset stable symptoms and suspected coronary stenosis (30-89%) by CTA. Evaluation of CTA datasets, interpretation of FFRCT analysis, and decisions on downstream testing were performed by skilled CT-cardiologists. CTA was performed in 3974 patients, of whom 381 (10%) were referred directly to ICA, whereas 463 (12%) to non-invasive functional testing: FFRCT 375 (81%) and perfusion imaging 88 (19%). FFRCT analysis was rejected in 8 (2%) due to inadequate CTA image quality. Number of patients deferred from ICA after FFRCT was 267 (71%), while 100 (27%) were referred to ICA. Obstructive coronary artery disease (CAD) was confirmed in 62 (62%) patients and revascularization performed in 53 (53%). Revascularization rates, n (%), were higher in patients undergoing FFRCT-guided versus CTA-guided referral to ICA: 30-69% stenosis, 28 (44%) versus 8 (21%); 70-89% stenosis, 39 (69%) versus 25 (46%), respectively, both p < 0.05. Implementation of FFRCT at referral hospitals was feasible, reduced the number of invasive procedures, and increased the revascularization rate.