Postepy W Kardiologii Interwencyjnej最新文献

Introduction: The accuracy of fractional flow reserve (FFR) and quantitative flow ratio (QFR) in assessing coronary artery disease in severe aortic stenosis (AS) patients may be affected by the severity of AS.

Aim: We investigated the relationship between aortic valve area (AVA) and the diagnostic performance of QFR in this context.

Material and methods: We analyzed 416 intermediate coronary lesions in 221 severe AS patients using FFR and QFR, categorizing them based on AVA into two groups: AVA < 0.5 cm² and AVA ≥ 0.5 cm².

Results: In all, 47 (21.2%) patients had an AVA < 0.5 cm². The median FFR and QFR values were comparable between groups, with a high agreement rate: interclass coefficient of 0.96 (95% CI: 0.94 to 0.97) for AVA < 0.5 cm² and 0.97 (95% CI: 0.97 to 0.98) for AVA ≥ 0.5 cm². Concordance in detecting significant ischemia was 96.3% for AVA ≥ 0.5 cm² but dropped to 86.5% for AVA < 0.5 cm², with discrepancies mainly in cases where FFR was negative and QFR positive. Multivariable analysis showed AVA and %DS as independent predictors of discordance; AVA ≥ 0.5 cm² had an OR of 0.229 (95% CI: 0.095 to 0.548; p < 0.001), and each 1% increase in %DS increased the odds by 1.070 (95% CI: 1.034 to 1.107; p < 0.001).

Conclusions: In severe AS, QFR closely correlates with FFR. However, patients with AVA < 0.5 cm² might exhibit a higher incidence of false-positive ischemia detection by QFR.

Introduction: The incidence of minor ischemic stroke (MIS) and associated cognitive impairment is rising, particularly among younger individuals. Thus, both primary and secondary prevention strategies are essential.

Aim: This study investigated the risk factors for cerebral artery stenosis (CAS) in patients with MIS classified as large atherosclerosis (LAA) by TOAST, and examined the relationship between cognitive function and plasma lipoprotein-associated phospholipase A2 levels.

Material and methods: We conducted a retrospective analysis of 789 MIS patients admitted to two hospitals between January 2015 and December 2023. Patients were classified using the TOAST criteria, with vascular stenosis detected via computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Cognitive function was assessed using the Mini-Mental State Examination (MMSE). Univariate and multivariate regression analyses were performed to identify risk factors for CAS among LAA-type MIS patients.

Results: Among the 789 patients, 494 (62.61%) had LAA. A total of 377 (76.32%) patients exhibited LAA-type vascular stenosis. Significant risk factors for CAS included a history of hypertension, diabetes, ischemic stroke, elevated fasting blood glucose, and plasma lipoprotein-associated phospholipase 2 levels (p < 0.05). Multivariate analysis revealed hypertension and increased phospholipase A2 as independent risk factors (OR = 2.046, OR = 1.059). The area under the ROC curve for plasma lipoprotein-associated phospholipase A2 predicting CAS was 0.700 (p < 0.0001). Additionally, a negative correlation was found between plasma lipoprotein-associated phospholipase A2 levels and MMSE scores (r = -0.218, p < 0.001).

Conclusions: LAA is the predominant cause of MIS, with high rates of vascular stenosis. Hypertension and elevated plasma lipoprotein-associated phospholipase A2 levels are significant independent risk factors for CAS, and increased plasma lipoprotein-associated phospholipase A2 correlates negatively with cognitive function.

Introduction: Coronary artery ectasia (CAE) is a vascular anomaly characterized by abnormal coronary artery dilation, often associated with endothelial dysfunction and inflammation. While CAE shares features with coronary artery disease (CAD), its independent pathophysiology remains unclear, particularly in cases without concurrent CAD.

Aim: To evaluate oxidative and antioxidant biomarker levels in patients with isolated CAE to understand their role in its pathogenesis.

Material and methods: Our study was conducted involving 48 patients with isolated CAE and 32 controls with normal coronary angiograms. Oxidative stress markers, including total oxidative status (TOS), oxidative stress index (OSI), and lipid hydroperoxide (LOOH), were measured, alongside antioxidant markers such as paraoxonase-1 (PON1), ceruloplasmin (CP), free sulfhydryl (SH) groups, and total antioxidant status (TAS).

Results: CAE patients exhibited significantly higher levels of TOS (30.14 ±8.81 vs. 23.88 ±4.74 mmol H₂O₂ equiv./l, p = 0.004), OSI (3.21 ±1.12 vs. 2.43 ±0.53 arbitrary units, p < 0.001), and LOOH (11.95 ±2.88 vs. 10.13 ±1.66 µmol H₂O₂ equiv./l, p = 0.003). No significant differences were found in TAS, PON1, CP, or SH levels between groups (p > 0.05 for all). Logistic regression identified smoking, TOS, and high sensitivity C-reactive protein (hsCRP) as independent predictors of CAE.

Conclusions: Elevated oxidative stress markers, particularly TOS, OSI, and LOOH, indicate a heightened pro-oxidant state in CAE, while antioxidant defenses remain largely unaltered. These findings suggest that oxidative stress may contribute to CAE pathogenesis, emphasizing the need for therapies targeting oxidative imbalance.

Introduction: Nicorandil (2-nicotinamidoethyl-nitrate ester) is an ATP-sensitive potassium channel opener with the ability to donate nitric oxide (NO), which can increase coronary blood flow, particularly at the microcirculation level. Recent clinical trials have reported that nicorandil treatment during percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients can modulate their clinical outcomes; however, its effects on STEMI patients vary widely across different studies and patient subgroups.

Methods: PubMed, Web of Science, Scopus, and Cochrane Library were systematically searched from inception to October 6, 2024. Due to significant heterogeneity, a random-effects model was adopted to pool data.

Results: In this study, a total of 1802 participants in the control group and 1844 participants in the nicorandil group were included. Nicorandil treatment during PCI significantly decreased arrhythmia (RR = 0.52, 95% CI [0.32, 0.84], I ² = 23.98%), and the re-hospitalization of patients (RR = 0.56, 95% CI [0.33, 0.95], I ² = 0.00%); amelioration of the coronary blood flow level (RR = 1.07, 95% CI [1.01, 1.12], I ² = 40.90%) was observed as well. Other clinical outcomes such as chest pain, cardiovascular death, and heart failure showed no significant effect of nicorandil treatment during the PCI procedure.

Conclusions: Intracoronary nicorandil treatment during PCI in STEMI patients can significantly impact several important clinical outcomes, such as arrhythmia, coronary blood flow rate, and re-hospitalization incidence, but does not show significant effects on chest pain, cardiovascular death, and heart failure.