Acta cardiologica最新文献

Objective: The relationship between vascular endothelial function and bone mineral density (BMD) in T2DM patients with metabolic dysfunction associated fatty liver (MAFLD) is still unclear. This study aims to analyse the correlation between vascular endothelial function and BMD or fracture risk in T2DM patients with MAFLD.

Methods: A total of 872 T2DM patients aged ≥50 years were enrolled and divided into two groups according to the diagnostic criteria of MAFLD: MAFLD (+) and MAFLD (-). Flow-mediated dilation (FMD) was measured by high-resolution ultrasound to reflect vascular endothelial function. BMD was measured by dual-energy X-ray bone densitometry, and FRAX scores were calculated for 10-year hip fracture risk (HF¹) and major osteoporotic fracture risk (MOF).

Results: After multivariate adjustment, there was no significant correlation between FMD and BMD in MAFLD (-) group (p > 0.05). In MAFLD (+) and FMD < 4% group, FMD was positively correlated with WB, LS, and FN BMD, while FMD was negatively correlated with fracture risk and osteoporotic fracture history, and this correlation was only observed in female patients. However, FMD was not correlated with BMD and fracture risk and osteoporotic fracture history in 4%≤FMD ≤ 7% and FMD > 7% groups.

Conclusions: The association of FMD with BMD in T2DM patients with MAFLD varies according to FMD level. The decrease of FMD is associated with reduced BMD and increased fracture risk in female patients with FMD < 4% group. FMD may be an influential factor for the occurrence and development of osteoporosis, and has some clinical value in early diagnosis of osteoporosis in T2DM patients with MAFLD.

Background: Coronary artery disease (CAD) is the most frequent type of cardiac disorder. Initial evaluation for ischaemia using dobutamine stress echocardiography (DSE) is based on a visual interpretation of the regional wall motion abnormality.

Aims: To assess the usefulness of speckle tracking during DSE and evaluate the diagnostic accuracy of 2D global longitudinal strain (GLS) along with its additive role over wall motion abnormalities interpretation for the diagnosis of CAD.

Materials and methods: One hundred and twenty-five patients are included in the study. Full history, physical examination, ECG, echocardiography, DSE, speckle tracking echocardiography (STE) with global and regional post-systolic strain index (PSI) during rest, peak dobutamine stress and recovery phase, and coronary angiography are done.

Results: In the rest study, there is a statistically significant difference in the global and regional PSIs, both are higher in patients with CAD (group 1) than in patients without CAD (group 2) (PSI 5.1 ± 3 in group 1 and 2.7 ± 2.4 in group 2, p value .02) (regional PSI 5.4 ± 4.1 in group 1 and 3 ± 3.3 in group 2, p value .02). At peak stress, the global PSI is higher in group 1 (7 ± 4.2, p value .01) and regional PSI is higher in group 1 (7.9 ± 8.5, p value .03). In recovery period, the global PSI is higher in group 1 (8 ± 6.1, p value .01), the regional PSI is higher in group 1 (9.8 ± 8.5, p value .001) and the GLS is lower in group 1 than in group 2 (-15.5 ± 4 vs. -19.1 ± 3.1, p value .03). The most sensitive and specific parameters are the global and regional PSI in the recovery period, where both showed sensitivities of 95% and 98%, respectively, and specificities of 93% and 95%, respectively.

Conclusions: Speckle tracking during rest and DSE seems feasible in detecting the stenosis of the coronary arteries in patients with chronic CADs through the evaluation of GLS, and global and regional PSIs. The combination of DSE and STE increases accuracy, sensitivity, and specificity of diagnosing CADs.

Background: Type 2 diabetes mellitus (T2DM) is a primary contributor to coronary artery disease (CAD). Insulin resistance (IR) is a hallmark of T2DM and a significant risk factor for the progression of CAD. The triglyceride-glucose (TyG) index is a new alternative indicator to identify IR. We aimed to explore the association between the TyG index and severity of CAD in patients with T2DM.

Methods: 280 inpatients with T2DM were enrolled from November 2019 to November 2022, classified into the CAD group (n = 175) and non-CAD group (n = 105). The TyG index and SYNTAX score were calculated. According to SYNTAX score, patients were further classified into the mid-CAD group (n = 97) and moderate to severe CAD group (n = 78).

Results: A significant positive correlation between the TyG index and SYNTAX score was found in the CAD group (r = 0.70, p < 0.01). The TyG index predicted the presence of moderate to severe CAD significantly, and the area under the ROC curve was 0.79 (95% CI: 0.71-0.85, p < 0.01). The higher LDL-C and TyG index, the higher risk of developing moderate to severe CAD (OR = 4.40, 95% CI 1.28 - 15.16, p = 0.02; OR = 9.00, 95% CI 3.69 - 21.96, p < 0.01).

Conclusions: There was a significantly positive correlation between the TyG index and SYNTAX score in T2DM patients who developed CAD; the TyG index could predict a mid/high SYNTAX score (≥ 23) and increase the risk of moderate to severe CAD.

Objective: The present study sought to compare the reliability and radiation dose of coronary artery calcium (CAC) scoring using low tube current (16 mAs), low kilo-voltage peak (100 kVp) and advanced modelled iterative reconstruction (ADMIRE 5) with the standard protocol (80 mAs, 120 kVp, ADMIRE 3).

Material and methods: A prospective single centre study including 200 consecutive patients with suspected coronary artery disease referred for CT coronary angiography was conducted. All 200 patients underwent CAC scoring using the low current-low kVp protocol as well as standard protocol and were subdivided into a derivation and validation cohorts.

Results: Correlation between CAC scores obtained using low current-low kVp protocol and standard protocol in derivation cohort was excellent (r = 0.99; p < 0.001). A linear regression model was used to derive a formula for predicting CAC that enabled conversion of CAC(low current-low kVp) to CAC(corrected) [CAC(corrected) = 1.067 × CAC(low current-low kVp)]. The formula was applied in validation cohort where CAC (corrected) showed excellent agreement with CAC(standard) (intraclass correlation coefficient, 0.9970; 95%CI, 0.9956-0.9980). Excellent agreement for risk classification (weighted kappa, 0.94379; 95%CI, 0.89629-0.99130) was observed between CAC(corrected) and CAC(standard) scores. The low current-low kVp protocol demonstrated an 88.87% reduction in radiation dose (0.0679 ± 0.01032 mSv vs. 0.610 ± 0.2403 mSv; p < 0.0001).

Conclusion: The low current-low kVp protocol for CAC scoring has comparable reliability to the standard technique with significant radiation dose reduction. This extremely low-dose protocol may prove useful as an alternative to standard CAC scoring, particularly for screening in the low-to-intermediate risk population.

Background: Trans-radial coronary angiogram (TR-CAG) has gained popularity due to lower complication rates compared to transfemoral access. Operators can use either conventional catheters, such as Judkins, or single dedicated catheters, such as Tiger-II. This meta-analysis compared the safety and efficacy of Tiger-II versus Judkins catheters in TR-CAG.

Methods: We searched PubMed, Web of Science, Scopus, and Cochrane Library through February 2024 for studies comparing Tiger-II and Judkins catheters in TR-CAG. Fixed- and random-effect models pooled estimates of odds ratios (ORs) and standardised mean differences (SMDs). Primary outcomes included fluoroscopy time and contrast volume. Secondary outcomes included procedural time, radiation exposure, procedural success, radial artery vasospasm, and crossover rate.

Results: Seven studies with 2879 patients (1799 in Tiger-II and 1080 in Judkins) were included. Tiger-II use significantly reduced fluoroscopy time (SMD = -0.50 min, 95% CI [-0.80, -0.19], p < 0.01), procedural time (MD = -2.00 min, 95% CI [-2.35, -1.66], p < 0.01), and contrast volume (MD = -7.48 ml, 95% CI [-12.66, -2.29], p < 0.01). Radial artery spasm incidence was also lower (OR = 0.30, 95% CI [0.12, 0.75], p = 0.01). There were no significant differences in radiation exposure, procedural success, or crossover rate.

Conclusion: Tiger-II catheters offer reduced fluoroscopy time, procedural time, contrast volume, and radial artery spasm rates in TR-CAG.