Explore the vast range of titles available.

Background Using serial coronary CT angiography (CCTA) imaging, we aimed to characterize baseline coronary plaque characteristics and quantify 10-year coronary plaque progression, including high-risk and low-density plaque presence, in patients with and without type 2 diabetes. Methods A total of 299 patients underwent CCTA with a median scan interval of 10.2 [IQR 8.7–11.2] years. Patients who underwent coronary artery bypass grafting and vessels revascularized by percutaneous coronary intervention were excluded (n = 32). Scans were analyzed using atherosclerosis imaging-quantitative CCTA analysis (AI-QCT; Cleerly Inc.). Associations between diabetic status, baseline and follow-up plaque burden and characteristics were evaluated using multivariable regression adjusted for cardiovascular risk factors, statin use, baseline plaque volumes, and scanner settings. Results In total, 267 patients were included (mean age 57 ± 7 years; 43% were women), 44 (16.5%) had type 2 diabetes (HbA1c 56 ± 14 mmol/mol). At baseline, patients with diabetes had a higher percent atheroma volume (PAV) compared to non-diabetic individuals (5.1% [1.7, 10.9] versus 2.2% [0.5, 5.8]). Adjusted for cardiovascular risk factors, patients with diabetes had a higher plaque burden at both baseline and follow-up. After adjustment for cardiovascular risk factors and baseline plaque volumes, individuals with diabetes had a more than threefold higher rate of plaque progression. After 10 years of follow-up, patients with diabetes had a higher prevalence of both high-risk plaque (OR 2.75; 95% CI 1.38–5.48; p  = 0.004) and low-density plaque (OR 2.88; 95% CI 1.45–5.70; p  = 0.002). Conclusions Patients with diabetes had a more than threefold higher rate of coronary plaque progression and an increased development of high-risk plaque. Graphical abstract

Purpose To assess coronary inflammation by measuring the volume and density of the epicardial adipose tissue (EAT), perivascular fat attenuation index (FAI) and coronary plaque burden in patients with Cushing’s syndrome (CS) based on coronary computed tomography angiography (CCTA). Methods This study included 29 patients with CS and 58 matched patients without CS who underwent CCTA. The EAT volume, EAT density, FAI and coronary plaque burden were measured. The high-risk plaque (HRP) was also evaluated. CS duration from diagnosis, 24-h urinary free cortisol (UFC), and abdominal visceral adipose tissue volume (VAT) of CS patients were recorded. Results The CS group had higher EAT volume (146.9 [115.4, 184.2] vs. 119.6 [69.0, 147.1] mL, P  = 0.006), lower EAT density (− 78.79 ± 5.89 vs. − 75.98 ± 6.03 HU, P  = 0.042), lower FAI (− 84.0 ± 8.92 vs. − 79.40 ± 10.04 HU, P  = 0.038), higher total plaque volume (88.81 [36.26, 522.5] vs. 44.45 [0, 198.16] mL, P  = 0.010) and more HRP plaques (7.3% vs. 1.8%, P  = 0.026) than the controls. The multivariate analysis suggested that CS itself ( β [95% CI], 29.233 [10.436, 48.03], P  = 0.014), CS duration ( β [95% CI], 0.176 [0.185, 4.242], P  = 0.033), and UFC ( β [95% CI], 0.197 [1.803, 19.719], P  = 0.019) were strongly associated with EAT volume but not EAT density, and EAT volume ( β [95% CI] − 0.037[− 0.058, − 0.016], P  = 0.001) not CS was strongly associated with EAT density. EAT volume, FAI and plaque burden increased (all P  < 0.05) in 6 CS patients with follow-up CCTA. The EAT volume had a moderate correlation with abdominal VAT volume ( r  = 0.526, P  = 0.008) in CS patients. Conclusions Patients with CS have higher EAT volume and coronary plaque burden but less inflammation as detected by EAT density and FAI. The EAT density is associated with EAT volume but not CS itself.

Objective To analyze the predictive value of coronary plaque burden combined with serum creatinine (Scr), monocyte/lymphocyte ratio (MLR), and neutrophil/lymphocyte ratio (NLR) in the risk of reinfarction after percutaneous coronary intervention (PCI) in middle-aged and elderly patients with acute myocardial infarction (AMI). Methods A retrospective analysis was conducted on the clinical data of 1,582 patients with AMI who underwent PCI in our hospital from January 2021 to January 2024. Based on the occurrence of reinfarction within 6 months post-PCI, patients were divided into a reinfarction group (216 cases) and a non-reinfarction group (1,366 cases). To analyze the risk factors and related predictive values of reinfarction in middle-aged and elderly AMI patients after PCI. Results Multivariate Logistic regression analysis showed that age, Killip grade, LVEF, cTnI, non-calcified plaque burden, calcified plaque burden, total calcified plaque burden, Scr, MLR, and NLR were all risk factors for reinfarction in middle-aged and elderly AMI patients after PCI ( P  < 0.05). ROC analysis showed that the combined detection of coronary plaque burden, Scr, MLR and NLR predicted the risk of reinfarction in middle-aged and elderly AMI patients after PCI, and the AUC was 0.998, 95%CI was 0.997 ~ 1.000, the sensitivity was 99.10%, and the specificity was 97.20%, all of them were significantly higher than the individual detection of each index ( P  < 0.05). Conclusion The combined detection of coronary plaque burden, Scr, MLR and NLR has a high predictive value for reinfarction after PCI in middle-aged and elderly AMI patients, and should be paid close attention to clinically.

Background: Present ACS risk stratification predominantly depends on LDL-C, yet its diagnostic accuracy for coronary plaque burden remains limited. We examined whether extensive lipid profiling, specifically the TG/HDL-C ratio, could function as a more effective diagnostic instrument for forecasting significant plaque burden in treatment-naïve first-time ACS patients. Methods: Among 722 ACS patients screened, 376 treatment-naïve patients undergoing PCI with complete lipid data were included. Exclusions (n = 346) were due to prior CAD, lipid-lowering therapy, renal/hepatic dysfunction, malignancy, pregnancy, or incomplete data. Coronary plaque burden was quantified by QCA, and patients were stratified by lesion count (0, 1, 2, 3, ≥4). The levels of lipids (LDL-C, HDL-C, TC, TG) and their ratios (LDL/HDL-C, TC/HDL-C, TG/HDL-C) were measured. Analyses included ANOVA (with Bonferroni correction), correlation, ordinal regression, and logistic regression (≥3 vs. <3 lesions). ROC analysis determined thresholds. Results: TG/HDL-C ratio increased progressively from 3.3 (0 lesions) to 5.3 (≥4 lesions). After Bonferroni correction, only TG/HDL-C retained significance (p = 0.009). Logistic regression confirmed TG/HDL-C as an independent predictor of high plaque burden (OR 1.25, 95% CI 1.09–1.42, p = 0.004), outperforming LDL-C. Conclusions: TG/HDL-C ratio is a superior diagnostic biomarker compared to LDL-C for identifying extensive coronary plaque burden. Integration into admission lipid profiling offers a cost-effective, actionable tool.

ObjectiveTo determine the calcium score and coronary plaque burden in asymptomatic statin-treated patients with heterozygous familial hypercholesterolaemia (FH) compared with a control group of patients with low probability of coronary artery disease, having non-anginal chest pain, using CT.Design, setting and patients101 asymptomatic patients with FH (mean age 53±7 years; 62 men) and 126 patients with non-anginal chest pain (mean age 56±7 years; 80 men) underwent CT calcium scoring and CT coronary angiography. All patients with FH were treated with statins during a period of 10±8 years before CT. The coronary calcium score and plaque burden were determined and compared between the two patient groups.ResultsThe median total calcium score was significantly higher in patients with FH (Agatston score=87, IQR 5–367) than in patients with non-anginal chest pain (Agatston score=7, IQR 0–125; p<0.001). The overall coronary plaque burden was significantly higher in patients with FH (p<0.01). Male patients with FH, whose low-density lipoprotein cholesterol levels were reduced by statins below 3.0 mmol/l, had significantly less coronary calcium (p<0.01) and plaque burden (p=0.02).ConclusionThe coronary plaque burden is high in asymptomatic middle-aged patients with FH despite intense statin treatment.

Background Age is a major risk factor associated with the complexity of coronary artery disease (CAD), and the prognosis of elderly patients with coronary heart disease is relatively poor. Metabolic disturbances are prevalent in the elderly population and contribute to CAD morbidity and mortality. This study aimed to investigate the relationship between the triglyceride-glucose (TyG) index and total coronary atherosclerotic burden assessed non-invasively by Coronary Computed Tomography Angiogram (CCTA) in the elderly population. Methods This retrospective cross-sectional study involved 427 patients who underwent CCTA. The patients were divided into two groups based on their Leiden score: ≥5 and < 5. Comparisons between groups were conducted using t-tests or Mann-Whitney U tests for continuous variables and chi-square tests for categorical variables. The correlation between TyG and Leiden score was assessed using Spearman’s rank correlation coefficient. Univariable and multivariable logistic regression analyses were performed to assess the role of TyG in atherosclerosis risk, using clinical variables previously shown to independently predict a high Leiden score. Results The levels of age and HbA1c% were significantly higher in patients with Leiden score ≥ 5. Patients with Leiden score ≥ 5 showed no significant difference in TyG index compared to those with Leiden score < 5. Pearson correlation analysis showed that HbA1c% (r = 0.44, p < 0.01), age (r = 0.34, p < 0.01), and FBG (r = 0.15, p = 0.01) were positively correlated with Leiden score, while TyG index had no correlation with Leiden score (r = 0.05, p = 0.42). Multiple linear regression analysis showed that HbA1c% (β = 2.92, 95%CI: 2.25–3.56, P < 0.01) was positively correlated with Leiden score, while TyG index had no correlation with Leiden score (β = 0.73, 95%CI: -3.27-4.72, P < 0.01). HbA1c% was found to be an influential factor for obstructive CVD (β = 1.86, 95%CI: 1.50–2.29, P < 0.01), while TyG index was not an independent risk factor for obstructive CVD (β = 0.39, 95%CI: 0.12–1.32, P = 0.13). Conclusion The TyG index did not show any significant correlation with the Leiden score and obstructive CVD as a risk factor in elderly male population. On the other hand, HbA1c% was identified as an influential factor for both the Leiden score and obstructive CVD.

Accelerated atherosclerosis is considered to be the linking factor between low bone mineral density (BMD) and increased cardiovascular events and mortality, while some coronary angiographic studies do not support this point. In this study, we attempt to provide a distinct comprehensive view of the relationship between BMD and the angiographically determined coronary atherosclerotic burden. A total of 459 consecutive patients with stable chest pain suspected of coronary artery disease (CAD) underwent both dual-energy X-ray absorptiometry scan and selective coronary angiography. The association between BMD and global coronary atherosclerotic plaque burden as represented by the multivessel involvement and the modified Gensini score was analyzed. Multivariable analysis revealed that the low BMD at femoral neck and total hip was an independent correlate of multivessel CAD. The -scores measured at femoral neck and total hip were both negatively and independently associated to the modified Gensini score. These inversely correlated relationships between BMD and CAD were not observed at lumbar spine 1-4. This cross-sectional study elucidated an inverse relationship between hip BMD and the modified Gensini score, and low hip BMD values ( -scores) were significantly and independently associated with increased risk of multivessel coronary disease in patients hospitalized for stable chest pain.

Objectives To systematically assess inter-technique and inter-/intra-reader variability of coronary CT angiography (CTA) to measure plaque burden compared with intravascular ultrasound (IVUS) and to determine whether iterative reconstruction algorithms affect variability. Methods IVUS and CTA data were acquired from nine human coronary arteries ex vivo. CT images were reconstructed using filtered back projection (FBPR) and iterative reconstruction algorithms: adaptive-statistical (ASIR) and model-based (MBIR). After co-registration of 284 cross-sections between IVUS and CTA, two readers manually delineated the cross-sectional plaque area in all images presented in random order. Results Average plaque burden by IVUS was 63.7 ± 10.7% and correlated significantly with all CTA measurements ( r  = 0.45–0.52; P  < 0.001), while CTA overestimated the burden by 10 ± 10%. There were no significant differences among FBPR, ASIR and MBIR ( P  > 0.05). Increased overestimation was associated with smaller plaques, eccentricity and calcification ( P  < 0.001). Reproducibility of plaque burden by CTA and IVUS datasets was excellent with a low mean intra-/inter-reader variability of <1/<4% for CTA and <0.5/<1% for IVUS respectively ( P  < 0.05) with no significant difference between CT reconstruction algorithms ( P  > 0.05). Conclusion In ex vivo coronary arteries, plaque burden by coronary CTA had extremely low inter-/intra-reader variability and correlated significantly with IVUS measurements. Accuracy as well as reader reliability were independent of CT image reconstruction algorithm. Key Points • IVUS is deemed the gold standard in-vivo coronary plaque assessment • But coronary CT angiography findings correlate strongly with IVUS results • Coronary CT angiography now allows plaque quantification close to IVUS • Iterative image reconstruction algorithms do not alter accuracy or reproducibility • Plaque quantification is more challenging in smaller eccentric calcified lesions

Despite the recent innovations in cardiovascular care, atherothrombosis is still a major complication of acute coronary syndromes (ACS). We evaluated the involvement of the CD31 molecule in thrombotic risk through the formation of monocyte-platelet (Mo-Plt) aggregates in patients with ACS with no-ST-segment elevation myocardial infarction (NSTEMI) on top of dual anti-platelet therapy (DAPT). We enrolled 19 control (CTRL) subjects, 46 stable angina (SA), and 86 patients with NSTEMI, of which, 16 with Intact Fibrous Cap (IFC) and 19 with Ruptured Fibrous Cap (RFC) as assessed by the Optical Coherence Tomography (OCT). The expression of CD31 on monocytes and platelets was measured. Following the coronary angiography, 52 NSTEMIs were further stratified according to thrombus grade (TG) evaluation. Finally, a series of ex vivo experiments verified whether the CD31 participates in Mo-Plt aggregate formation. In patients with NSTEMI, CD31 was reduced on monocytes and was increased on platelets, especially in NSTEMI presented with RFC plaques compared to those with IFC lesions, and in patients with high TG compared to those with zero/low TG. Ex vivo experiments documented an increase in Mo-Plt aggregates among NSTEMI, which significantly decreased after the CD31 ligation, particularly in patients with RFC plaques. In NSTEMI, CD31 participates in Mo-Plt aggregate formation in spite of optimal therapy and DAPT, suggesting the existence of alternative thrombotic pathways, as predominantly displayed in patients with RFC.