Arya Atherosclerosis
Volume:21 Issue: 1, Jan-Feb 2025

Left main coronary artery disease (LMCAD) is a potentially life-threatening situation. The medical treatment of LMCAD can lead to critical cardiovascular events. The association between LMCAD and gender has been studied in the medical field.

This cross-sectional study was conducted at Imam Hossein Hospital in Tehran. At the beginning of the project, patient files were collected for 6,250 individuals who presented with heart complaints between 2016 and 2021 and underwent angiography examinations. These files were reviewed, and patients diagnosed with left main coronary artery disease during the angiography were identified.

After reviewing 6,250 angiography results from 2016 to 2021, it was found that 274 patients had significant stenosis in the left main coronary artery, resulting in a prevalence of LMCAD of 4.38%. The mean age of the 274 patients with LMCAD was 65.98 ± 10.29 years, and 22.63% of them had premature CAD. Males constituted 75.18% of the group, with 25.18% being smokers. Common comorbidities included hypertension (51.82%), diabetes (42.70%), and chronic kidney disease (13.50%). The gender-based analysis highlighted variations, with women being older on average (P = 0.007), more likely to have premature left main involvement (P = 0.011), and exhibiting lower rates of smoking (P < 0.001) and chronic kidney diseases (P = 0.013) but higher prevalence of hypertension (P < 0.001) and diabetes (P = 0.011) compared to men.

Our findings showed that these gender-specific differences are crucial for tailored management strategies in patients with left main coronary artery disease. Further research is needed to optimize outcomes for this high-risk population.

Arrhythmia is one of the important cardiac manifestations of SARS-CoV-2 disease with possible mechanisms such as direct damage to the myocardium, hypoxia, myocardial damage, cytokine storm, and electrolyte imbalances. Bradyarrhythmia is a manifestation of conduction system involvement, which is associated with an unfavorable prognosis and sometimes requires treatments such as implanting a pacemaker. Whether bradycardia in the acute phase of the COVID pandemic is a transient complication of the virus or whether it will be permanent can affect the treatment approach.Is the effect of SARS-CoV-2 on the conduction system of the heart temporary or permanent, and in the one-year follow-up, how many patients will need a pacemaker?

The study population was among patients with symptomatic bradyar-rhythmias who were referred to Chamran Heart Center, Isfahan, Iran, from the outbreak of SARS-CoV-2 (February 2020) until February 2022 and were diagnosed with COVID-19 based on the polymerase chain reaction (PCR) test. They underwent permanent pacemaker implantation and were monitored for 1 month and 12 months after device implantation.

The most common comorbid disease was hypertension. Systolic blood pressure and respiratory rate in hospitalized patients decreased significantly during discharge. Also, oxygen saturation and heart rate increased significantly during discharge (P < 0.001). In this study, high-degree atrioventricular block remained permanent in most patients and was not transient.

Based on the experiences gained from this study, the implantation of a permanent pacemaker for the treatment of bradyarrhythmia should be done based on the existing guidelines, regardless of the status of COVID-19.

Chest pain is a common complaint among children referred to treatment centers. This study aimed to investigate the electrocardiographic changes in children aged 5-15 years with chest pain referred to Hajar and Imam Ali Hospitals of Shahrekord.

In this descriptive-analytic study, 350 children with chest pain who were referred to Hajar and Imam Ali Hospitals were included. After clinical examination, electrocardiography was performed. Echocardiography was conducted in cases with electrocardiographic changes, and CPK-MB and troponin I tests were performed if required. Data were analyzed using SPSS-22 software.

The children’s ages ranged from 5 to 15 years, with a mean of 10.6 ± 2.7 years. Abnormal electrocardiographic findings were observed in 28 (8%) of the 350 children. Findings included left axis deviation (2.6%), ST elevation (2.9%), ST depression (0.3%), shortened PR interval (0.9%), delta wave changes (0.06%), and cardiac hypertrophy (0.9%). Echocardiography was performed in 70 cases (23.33%), of which 28 (40%) were normal and 42 (60%) had abnormal findings. Mild changes were observed in 39 cases (55.7%), moderate changes in 2 cases (2.9%), and elevated pulmonary arterial pressure in 1 case (1.4%). Thirty girls (8.5%) and 12 boys (3.4%) experienced tachycardia, while 1 boy (0.2%) presented with bradycardia. Troponin I tests were conducted on 2 boys, with both results being negative.

Given the importance of heart disease, electrocardiography is recommended for all children presenting with chest pain. Electrocardiography may also serve as a valuable tool for screening heart disease in such cases.

Intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI) is useful for stent optimization. Outcomes of the ultrathin Supralimus Tetriflex stent (Sahajanand Medical Technologies Pvt. Ltd., India) using IVUS were evaluated among patients with short (≤ 20 mm) versus long lesions (≥ 20 mm). A total of 207 patients underwent PCI, and IVUS was performed post-deployment. The primary outcome was optimal stent deployment, defined as (a) mean surface area (MSA) >5.0 mm²; (b) plaque burden <50%; (c) complete apposition; and (d) no edge dissection. Secondary outcomes were target lesion failure (TLF)—a composite of cardiac death, target vessel myocardial infarction (TVMI), and target lesion revascularization (TLR)—stent thrombosis, and major adverse cardiovascular events (MACE; a composite of death, MI, stent thrombosis, and repeat revascularization). Suboptimal deployment was significantly more frequent among patients with longer lesions (30.1% vs. 23.3%; p=0.03) due to higher rates of malapposition (17.3% vs. 10.6%) and MSA <5 mm² (9.6% vs. 7.7%). Following post-dilatation, suboptimal deployment was observed in 7.6% and 5.8% of patients, respectively. Residual plaque burden was 4.5% and 5.7%, respectively. The MSA in both groups was 6.3 mm² and 6.5 mm². Minimum and mean stent expansions were 82.1% versus 81.7% and 106.3% versus 109.8%, respectively, with no significant differences. TLF and stent thrombosis were observed in 0.9% versus 0.9% and 2.9% versus 3.8% of patients, respectively, with no significant differences. However, MACE was significantly higher (10.5% vs. 8.7%; p=0.05) among patients with longer lesions. Supralimus Tetriflex stent has very good optimal deployment based on angiogram and becomes better with IVUS imaging, making it safe among long lesions(≥ 20mm).

This study was conducted to estimate the power of anthropometric markers to predict 10-year CVD across different age groups in the Yazd Healthy Heart cohort.

A total of 1,623 individuals aged 20 to 74, who were free of CVD, participated in the study. A conditional time-dependent receiver operating characteristic (ROC) curve was used to estimate the predictive power of anthropometric indices, including the Abdominal Volume Index (AVI), Body Adiposity Index (BAI), and Waist-to-Height Ratio (WHtR), adjusted for age and sex.

Of the 1,623 participants, 818 were males (50.40%) and 805 were females (49.60%). The Area Under the Curve (AUC) for the BAI ranged from 0.50 to 0.70 for males aged 40 to 70 years. In females, the BAI biomarker demonstrated considerable to excellent predictive power (AUC > 0.8) for individuals aged 20 to approximately 33 years. For males, AVI and WHtR showed fair to considerable predictive power in participants aged 20 to 30 years. In the age group of 30 to approximately 68 years, the predictive power varied from poor to ineffective, except for individuals close to 50 years old. In females, the predictive power of the AVI and WHtR biomarkers ranged from fair to considerable for those aged 20 to around 33 years.

This study found that AVI and WHtR can fairly predict 10-year CVD risk in young individuals of both sexes, while the BAI was specifically applicable for predicting risk in young women. These markers are valuable and affordable tools for youth CVD screening.

The triglyceride-to-high-density lipoprotein cholesterol (TG/HDL-C) ratio, Metabolic Score for Insulin Resistance (METS-IR), triglyceride-glucose (TyG) index, and triglyceride-glucose body mass index (TyG-BMI) have been associated with the occurrence and severity of coronary artery disease (CAD), although evidence remains limited. A total of 1,017 patients undergoing coronary angiography for the first time were included. Insulin resistance (IR) indices were calculated based on patients’ laboratory data. Significant CAD was defined as more than 50% stenosis observed in coronary angiography1. A positive correlation was found between CAD and the TyG index (ρ = 0.083, p = 0.008). Patients with CAD had a significantly elevated TyG index (9.02 ± 0.62) compared to those with single-vessel disease (SVD) (8.87 ± 0.59) (p = 0.012). A strong association was observed between CAD and the TG/HDL-C ratio (ρ = 0.114, p < 0.001). Patients with multi-vessel disease exhibited a considerably higher index (4.47 ± 2.46) compared to those with SVD (3.77 ± 2.45) (p = 0.003). The TyG index cut-off was 9.22 (27.5% sensitivity, 79.3% specificity, 82.2% positive predictive value (PPV), and 23.89% negative predictive value (NPV)), while the TG/HDL-C ratio cut-off was 3.6 (44% sensitivity, 65.2% specificity, 81.5% PPV, and 25.5% NPV). Our findings indicate that the TG/HDL-C ratio, with a cut-off point of 3.6, and the TyG index, with a threshold of 9.22, are associated with the presence of CAD. (ClinicalTrials.gov registration number: NCT06237244).

Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare but severe condition that can develop in children who have had COVID-19. It can lead to cardiovascular complications, potentially caused by endothelial dysfunction and arterial stiffness.

This study aimed to investigate the cardiovascular health of children with MIS-C compared to healthy controls. Fifty-nine children with MIS-C and fifty-nine healthy individuals were included in this cohort study. Non-invasive techniques were employed to measure the brachial artery’s flow-mediated dilation (FMD), aortic distensibility (AD), and aortic strain (AS).

The MIS-C group demonstrated significantly higher systolic blood pressure (P = 0.012), with a mean of 100.2 (10.1) mmHg compared to 95.3 (9.6) mmHg in the healthy group. The relative risk (RR) for elevated pulse pressure in the MIS-C group was borderline higher than in the healthy group (RR 95% CI: 1.06 [1.01–1.14]; P = 0.046). However, FMD, AS, and AD values were lower in the MIS-C group, with means of 13.6 (8.9), 10.4 (4.1), and 15.5 (2.7), respectively, although no significant differences were observed (P > 0.05).

Children with MIS-C exhibited higher pulse pressure, indicating potential arterial stiffness. They also showed lower FMD, suggesting endothelial dysfunction. FMD appears to be a more reliable indicator of endothelial dysfunction in MIS-C patients compared to aortic strain. These findings underscore the importance of early assessment and monitoring of cardiovascular complications in MIS-C patients. Endothelial dysfunction and arterial stiffness are well-established risk factors for future cardiovascular events.