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Quantification of Coronary Inflammation Using Fat Attenuation Index (FAI) in Indians: A Retrospective Study
Atul Kapoor,
Aprajita Kapoor,
Goldaa Mahajan
Issue:
Volume 5, Issue 3, September 2021
Pages:
129-134
Received:
9 June 2021
Accepted:
23 June 2021
Published:
30 June 2021
Abstract: Background: Asian Indians have the highest prevalence (11%) of coronary artery risk worldwide compared to all other races. So far no quantifiable risk factor has been shown to explain such a high prevalence. Fat attenuation index (FAI) using CT coronary angiography (CTCA) has been recently used to demonstrate coronary perivascular inflammation and to confirm that atherosclerosis is an inflammatory process. Hence this study was conducted to determine FAI using CTCA in 200 adult Indians as a retrospective study to determine if it can be the answer to establish the cause for high prevalence of CAD in Indians and whether there are differences in FAI in normal adults and those with significant CAD and to determine if it could be used as imaging biomarker for diagnosis and follow up of such patients. Material and Methods: Retrospective study of 200 patients who underwent CTCA was done. Patients were divided into two groups based on no coronary disease (NOCAD) and those with significant coronary artery disease (CAD). Patient demographics were recorded for both groups. FAI estimation was done along with Plaque volume index (PVI), pericardial volume estimation and the differences between the two groups were statistically analysed. Results: Mean patient age in both groups was 52 years with male predominance (75-80%). Mean FAI,s for left anterior descending and right coronary arteries was 45.4 and -44.7 HU and of -38.0 and -39.2 HU for NOCAD and CAD groups respectively (p<0.001). Sensitivity and specificity of FAI to differentiate NOCAD from CAD at a cut off value >-38HU was 73% and 80% respectively with LR of 3.6. Conclusion: Normal adult Indians with NOCAD showed a high FAI compared to all other races which could be reason for highest prevalence of CAD amongst Indians. FAI can be used as imaging biomarker to differentiate CAD from NOCAD with sensitivity and specificity of 73% and 80% respectively.
Abstract: Background: Asian Indians have the highest prevalence (11%) of coronary artery risk worldwide compared to all other races. So far no quantifiable risk factor has been shown to explain such a high prevalence. Fat attenuation index (FAI) using CT coronary angiography (CTCA) has been recently used to demonstrate coronary perivascular inflammation and ...
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Relationship Between Geometry and Ventricular Filling Pressures in Non-Diabetic Hypertensive Patients
Issue:
Volume 5, Issue 3, September 2021
Pages:
135-140
Received:
24 May 2021
Accepted:
16 June 2021
Published:
9 July 2021
Abstract: Hypertension and obesity make changes in the heart that are known as remodeling and diastolic dysfunction. These changes are the beginning of a later sistolic heart failure. Objectives Searching for the relation between geometry and ventricular function in hypertensive non diabetic and obese patients. 68 women and 20 men were evaluated by doppler- echocardiography. All patients had a normal ejection fraction. Results Ventricular geometry was altered in 53.4% of the subjects and diastolic function in 73.8% respectively. As body weight increased the ventricular mass, relative wall thickness, left atrial dimension and end diastolic volumes increased too. Overweight and obesity were found in 62.5% of the sample. A concentric left ventricular hypertrophy was present in 27.2% of the patients. An excentric left ventricular hypertrophy was found in 14.7% of them and 46.6% had a normal geometry. Eyection fraction values were lesser in the group with bigger ventricular mass and altered filling patterns. P=0.05, 0.1. Conclusion Arterial hypertension and obesity are risk factors for the development of cardiac abnormalities that lower systolic cardiac function in case of hypertrophy and dilatation are not resolved.
Abstract: Hypertension and obesity make changes in the heart that are known as remodeling and diastolic dysfunction. These changes are the beginning of a later sistolic heart failure. Objectives Searching for the relation between geometry and ventricular function in hypertensive non diabetic and obese patients. 68 women and 20 men were evaluated by doppler- ...
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Novel Animal Model for Ventricular Ejection Fraction Measured by MRI
Josefino Tunac,
Frederick Valeriote,
Joseph Media,
Robert Knight
Issue:
Volume 5, Issue 3, September 2021
Pages:
141-146
Received:
18 August 2021
Accepted:
30 August 2021
Published:
11 September 2021
Abstract: Aim: The objective of this study is to evaluate an animal model, herein called the Tunac Arterial Plaque (TAP) mouse as a model for reduced left ventricle ejection fraction (LVEF). Traditional mouse models involve genetically modified or surgically altered animals, whereas the TAP model is a wild mouse (C57Bl/6 strain) fed with a high fat diet and treated with an environmental chemical pollutant 3,3',4,4'-Tetrachlorobiphenyl (PCB) to mimic human lifestyle. Thus, the LVEF volume of treated and untreated mice will be measured per MRI, as well as an assessment for the presence of arterial plaque. Methods and results: Ten-week-old male C57/Bl6 mice were fed with either normal or high fat diet, acclimated for 1 week and then PCB was administered by gavage. Magnetic resonance imaging (MRI) was performed using a 7-Tesla Varian magnet. Briefly, the heart was aligned to the proper orientation, then an intragate scan was carried out for a CINE presentation (motion sensitive MRI in which a series of static images are obtained at various stages of the cardiac cycle and then played back as a movie). A black blood method was used that caused the blood to appear darker than the adjacent tissue and a CINE sequence to sort images, from which another program a (Medviso Segment) calculated percent ejection fraction (EF), heart rate (HR) and respiratory rate (RR). For the aorta and carotid artery imaging, cross-sectional images of the aortic arch were obtained, which produced multiple contrast weightings. Mice fed with normal diet showed normal ejection fraction volume (75.1%). The high fat diet alone without PCB also effectively reduced EF% (67.7%), and the lowest reduction in EF were for mice fed with high fat and PCB (57.2%). In the high fat-PCB-treated group, there was a gradual reduction in % EF starting at 2 weeks with 65.2% EF and 52.5% at the 8-wk time point. MRI scan of the aortal arch showed plaques in mice fed with high fat diet and PCB treatment. Conclusions: First to demonstrate LVEF per cine MRI in a wild non-surgical or non-genetically modified mouse model. Plaque formation in aortal arch was confirmed by MRI.
Abstract: Aim: The objective of this study is to evaluate an animal model, herein called the Tunac Arterial Plaque (TAP) mouse as a model for reduced left ventricle ejection fraction (LVEF). Traditional mouse models involve genetically modified or surgically altered animals, whereas the TAP model is a wild mouse (C57Bl/6 strain) fed with a high fat diet and ...
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Assessment of Right Ventricular Function in Patients with Cor Pulmonale: Strain Imaging Study
Mohamed Elnoamany,
Tarek Khalil,
Ghada Soltan,
Naglaa Fahim,
Mohamed Omran
Issue:
Volume 5, Issue 3, September 2021
Pages:
147-152
Received:
20 August 2021
Accepted:
1 September 2021
Published:
14 September 2021
Abstract: Background: Cor pulmonale is one of the leading causes of heart failure. Speckle tracking echocardiography is a potential modality for evaluation of systolic and diastolic functions, myocardial mechanics and other cardiac pathophysiological processes. Objective: This study aims to assess the right ventricular (RV) function in patients with cor pulmonale using Strain Imaging and conventional echocardiography. Methods: Fifty patients with cor pulmonale compared to twenty age and sex matched controls selected for echocardiographic examination for assessment of RV indices; Pulmonary Artery Systolic Pressure (PASP), Tricuspid Annular systolic Excursion (TAPSE), Fractional Area Change (FAC), Tissue Doppler Imaging (TDI), Strain and Strain rate of RV free wall in addition to conventional left ventricular data. Results: TAPSE (1.4±0.16 vs 2.3±0.31 cm), RV FAC (30.5±4.3% vs 47.2±4.5%), PASP (60.98±15.6 vs 18.9±5.41 mmHg) and Systolic velocity of tricuspid annulus S' (8.9±1.4 vs 13.4±1.9 cm/sec) were significantly impaired in patients vs controls respectively with p<0.001 for all. Also, The global RV free wall peak systolic longitudinal strain (ε sys) for patients was 16.9±3.4% vs 25.2±2.9%, The RV free wall systolic strain rate (S-1 s) was 0.98±0.18 vs 1.7±0.18, RV free wall early diastolic strain rate (S-1 e) was 1.2±0.25 vs 1.92±0.28 and RV free wall late diastolic strain rate (S-1 a) was 1.11±0.27 vs 1.8±0.21 with (p<0.001 for all). The RV free wall systolic Longitudinal Strain (ε sys) was negatively correlated with PASP (r=-0.950, p<0.001) and positively correlated with TAPSE, RV FAC and Systolic velocity of tricuspid annulus S' (r=0.635, r=0.919, r=0.890 respectively with p<0.001 for all). Conclusion: Strain and Strain Rate are reliable tools to assess systolic and diastolic functions of the RV in patients with cor pulmonale even at early disease stages and correlate well with other conventional echo parameters for RV assessment.
Abstract: Background: Cor pulmonale is one of the leading causes of heart failure. Speckle tracking echocardiography is a potential modality for evaluation of systolic and diastolic functions, myocardial mechanics and other cardiac pathophysiological processes. Objective: This study aims to assess the right ventricular (RV) function in patients with cor pulm...
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Myocardial Infarction with Non-obstructive Coronary Arteries (MINOCA): A Case Report and Review of the Literature
Jie Chen,
Wenjie Liang,
Mei Wei,
Mingqi Zheng,
Gang Liu,
Guoping Ma
Issue:
Volume 5, Issue 3, September 2021
Pages:
153-156
Received:
19 August 2021
Accepted:
3 September 2021
Published:
15 September 2021
Abstract: Background: About 5-10% of all myocardial infarction patients undergoing diagnostic coronary angiography for typical chest pain have no significant coronary stenosis (stenosis severity <50%). We classified these patients as myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), which is characterized by both the diagnostic criteria of myocardial infarction and no significant coronary stenosis (stenosis severity <50%). The pathophysiology of MINOCA is multifactorial. Potential underlying mechanisms of MINOCA include coronary causes such as coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli, and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies; and noncardiac causes, for example, pulmonary embolism. Early secondary prophylaxis with drugs including statins and renin-angiotensin-aldosterone system inhibitors may be beneficial to prognosis. Objective: To report a case of MINOCA, analyze its clinical manifestations, imaging and related treatment, and improve the understanding of clinicians on MINOCA. Methods: A case of MINOCA diagnosed in the First Hospital of Hebei Medical University on June 8, 2021 was retrospectively analyzed. Clinical data related to clinical manifestations, examination results, diagnosis and treatment process were collected, and literatures related to non-obstructive myocardial infarction were reviewed to summarize its diagnosis and treatment characteristics. Results: The patient was a 73-year-old male, who was admitted to hospital for 8 hours due to sudden precardiac pain. After admission, relevant preoperative examination was completed, and preoperative electrocardiogram (ECG) and troponin examination results were considered as acute inferior wall myocardial infarction, percutaneous coronary angiography showed no significant narrowing of the coronary vessels and was diagnosed as MINOCA. The patient regularly applied drugs outside the hospital and was generally in good condition. He did not go to the hospital again. Conclusion: 1. MINOCA accounts for 5-10% of all MI patients, and a higher proportion of MINOCA patients are female. 2. It was previously believed that MINOCA patients had a good prognosis, but the incidence of major adverse cardiovascular events was still high in clinical work. The pathogenesis of MINOCA is complex and diverse, and early drug intervention and secondary prevention targeting the etiology can improve the prognosis of patients. 3. The clinical manifestations and characteristics of MINOCA patients were summarized in this case, the possible pathogenesis and treatment, so as to improve the understanding of this disease, screen high-risk groups for early intervention, and reduce the risk of adverse cardiovascular events in these patients.
Abstract: Background: About 5-10% of all myocardial infarction patients undergoing diagnostic coronary angiography for typical chest pain have no significant coronary stenosis (stenosis severity <50%). We classified these patients as myocardial infarction (MI) with non-obstructive coronary arteries (MINOCA), which is characterized by both the diagnostic criteria of myocardial infarction and no significant coronary stenosis (stenosis severity <50%). The pathophysiology of MINOCA is multifactorial. Potential underlying mechanisms of MINOCA include coronary causes such as coronary spasm, coronary microvascular dysfunction, plaque disruption, spontaneous coronary thrombosis/emboli, and coronary dissection; myocardial disorders, including myocarditis, takotsubo cardiomyopathy, and other cardiomyopathies; and noncardiac causes, for example, pulmonary embolism. Early secondary prophylaxis with drugs including statins and renin-angiotensin-aldosterone system inhibitors may be beneficial to prognosis. Objective: To report a case of MINOCA, analyze its clinical manifestations, imaging and related treatment, and improve the understanding of clinicians on MINOCA. Met...
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