简介：Coronaryarterycalcification(CAC)isasanindependentriskpredictorofcardiovasculardiseaseandcanclassifyanindividual’sriskofatheroscleroticcardiovasculardisease,particularlyinintermediate-riskindividuals.Also,CACprogressionisassociatedwithgreaterratesofcardiovascularevents.ThisarticleprovidesavailabledataandexpertrecommendationsforCACbasedoncurrentpublications.WefocusontheutilityofCACforstratificationofindividualsanddescribeitsdiagnosticvalueinidentifyingpatientsatrisk.WealsodescribetheimportantabilityofCACtoderiskapatientwithascoreofzero.

简介：Coronaryarterychronictotalocclusion(CTO)isdefinedasanoccludedcoronaryarterysegmentwithoutanterogradeflowforatleastthreemonths.Itcanbeclassifiedasa“true”or“functional”CTObasedonflowcharacteristics.In“true”CTO,thereisnoanterogradeflow.In“functional”CTO,thereisminimalanterogradeflowthroughtheoccludedsegmentofthecoronaryartery.CTOisacommonfindingduringcoronaryangiographyanditsprevalencemayvarydependingonthereportedliterature.Amongpatientswithoutpreviouscoronaryarterybypassgrafting(CABG),CTOisfoundinabout20–30%ofthepatients.CTOmaydevelopinsidiouslyoveraperiodoftimeandinvolveacomplexinterplaybetweenintracellularandextracellularfactors,smoothmuscleandfoamcells,calcification,andneovascularization.ThereisagrowingbodyofevidencetosupportthatCTOrevascularizationmayimproveclinicaloutcomewhencomparedtomedicalmanagement.BoththeEuropeanandAmericancardiovascularsocietiessupportCTOrevascularizationwithaclass2arecommendation(levelofevidenceB).Historically,duetolowproceduralsuccessrate,apparentinefficientresourceutilization,potentialincreaseincomplicationratesanduncertainclinicalbenefits,onlyabout10–20%ofpatientswithCTOaretreatedwithpercutaneouscoronaryintervention(PCI).RecentadvancesusingnovelandinnovativetechniqueswithdedicatedequipmenthavesignificantlyimprovedtheproceduralsuccessrateforCTOPCItoabout90%inthehandsofexperiencedoperators.WithincreasinginterestinCTOPCIcoupledwithincreasededucationaleffort,CTOPCIlikelywillbecomemoreaccessibletopatientsinneedofCTOrevascularization.OngoingadvancementininnovativetechniquesandequipmentwillcontinuetoimproveproceduralsuccessratesandreduceproceduralcomplicationrateforCTOPCI.Furthermore,thereareanumberofprospectiveclinicaltrialsonthehorizonwhichshouldhelpdefinetheclinicalbenefitsandlimitationsofCTOPCIinthenear

简介：Cardiaccatheterizationandpercutaneouscoronaryinterventionplayanimportantroleinthemanagementofcoronaryarterydisease.Althoughthetransfemoralapproachhasbeenthetraditionallydominantmethod,therehasbeenanincreasedutilizationofthetransradialapproach.Multipleobservationalstudiesandrandomizedclinicaltrialshaveshownfewerbleedingcomplications,reducedmorbidityandmortality,improvedqualityoflife,andbettereconomicoutcomeswhenthetransradialapproachisutilizedwhencomparedtothetransfemoralapproach.Despiteitsmanybenefits,utilizationofthisapproachincertaincountriesincludingtheUnitedStateshasbeenlessthanoptimalduetoaloweradoptionratesmostlydrivenbylackoftrainingopportunitiesanddecreasedawarenessofclinicalbenefitsofthetransradialapproach.Inthisreview,thehistory,observationaltrends,efficacy,andtechnicalaspectsoftransradialcardiaccatheterizationandpercutaneouscoronaryinterventionarediscussed.

简介：Recentdevelopmentsinthenovelimagingtechnologyofcardiaccomputedtomography(CT)notonlypermitdetailedassessmentofcardiacanatomybutalsoprovideinsightintocardiovascularphysiology.Foremost,coronaryCTangiography(CCTA)enablesdirectnoninvasiveexaminationofbothcoronaryarterystenosesandatheroscleroticplaquecharacteristics.CalculationofcomputationalfluiddynamicsbycardiacCTallowsthenoninvasiveestimationoffractionalflowreserve,whichincreasesthediagnosticaccuracyfordetectionofhemodynamicallysignificantcoronaryarterydisease.Inaddition,acombinationofmyocardialCTperfusionandCCTAcanprovidesimultaneousanatomicalandfunctionalassessmentofcoronaryarterydisease.Finally,detailedanatomicalevaluationofatrial,ventricular,andvalvularanatomyprovidesdiagnosticinformationandguidanceforproceduralplanning,suchasfortranscatheteraorticvalvereplacement.TheclinicalapplicationsofcardiacCTwillbeextendedwiththedevelopmentofthesenovelmodalities.

简介：BackgroundIncreasedlevelofglycatedhemoglobin(HbA1c)isassociatedwithhigherincidenceofcoronaryarterydisease(CAD)inthediabetics.However,therelationshipbetweenHbA1candtheriskofcoronaryarterystenosisinthenon-diabeticsiscontroversial.MethodsAretrospectiveresearchwasconductedon338enrolledparticipantswhohaveundergone2timesofcoronaryangiographicexaminationwithinthepastyear.Clinicalandlaboratoryvariablesattheinitialandthesecondtimeofadmissionwerecollected.AccordingtotheinitialmedianHbA1clevel,allparticipantsweredividedintotwogroupsnamedlowerandhighergroups.TherelationshipbetweenHbA1clevelandtheriskofcoronaryarterystenosisovertimewasevaluated.ResultsTheinitialvaluesofHbA1cinloweranduppergroupswere5.78±0.35%and6.21±0.32%(P<0.05).Ascomparedtothelowergroup,thepercentagesofmaleandsmokingparticipants,andtheserumlevelofCRPweresignificantlyhigherinthehighergroup(P<0.05).Othertraditionalriskfactorswerecomparablebetweenthetwogroups.Therewere54.2%and55.2%participantswithsinglevesselstenosis,and45.8%and44.8%withmultiplevesselstenoses,respectivelyinthetwogroupswithoutsignificantdifference.Thesecondtimeofadmission,were308.5±25.4days(lowergroup)and300.7±30.1days(highergroup)fromtheinitialadmission.AlthoughnosignificantchangesofHbA1clevelwereobservedwhencomparedtoinitial,HbA1clevelinthehighergroupwasstillsignificantlyhigherincomparisontothelowergroup(6.24±0.39%vs.5.80±0.36%,P=0.008).Thepercentageofnewcoronaryarterystenosis(≥50%stenosis)washigherinthehighergroupthanthatinthelowergroup(41.7%vs.32.3%,P<0.001).MultivariateregressionanalysessuggestedthatHbA1cremainedindependentfactorassociatedwithcoronaryarterystenosesafterextensiveadjustmentforriskfactors.ConclusionInthenondiabetics,increasedbaselineHbA1clevelportendstheriskofcorona

简介：Cardiovasculardisease(CVD)istheleadingcauseofdeathandamajorhealthcarechallengeglobally.Coronaryarterydisease(CAD)isaprimaryunderlyingpathologicalprocessinthemajorityofcardiovasculardiseasecases.Magneticresonanceimaging(MRI)canplayapotentiallyimportantroleinthemanagementofCADasanoninvasiveimagingmodalitywithoutionizingradiation,althoughitsearlypromisehasnotbeendeliveredbecauseofseveralcrucialtechnicallimitations.However,recentinnovationsinMRIhavereopenedthedoor,withtremendousopportunitiesformultiparametricassessmentofCADincludingluminalstenosis,plaqueburdenandcomposition,anddiseaseactivitiessuchasinflammationandhemorrhage.NovelMRIacquisitionandreconstructionstrategiesnowoffermuchincreasedspatialresolutionandimagequalityandshortenedexaminationtimescomparedwithconventionalapproaches.RecentclinicalexperiencesofcoronaryMRIindicatedthepotentialtoimprovethecurrentmanagementofcoronaryatherosclerosis,suchasidentifyingthepatientsatthehighestriskandevaluatingtherapeuticresponses.InthisreviewwediscussthelatesttechnicaladvancesandclinicalinsightsincoronaryMRI.

简介：Therestenosisaftercoronaryarterybypassgraft(CABG)isattributedtotheformationofintimalhyperplasia(IH)attheanastomosis,whichiscloselyrelatedtohemodynamicdependonthegeometricmodel.Inordertogiveareasonableassessmentofthesurgeryeffectandjudgethelong-termpatencyrate,thehemodynamicofCABGsurgeryprogramiscomparedwiththatofsurgerydesignofthejunctionanglechanged.Basedonin-vivoCTcoronaryangiographydatasets,theindividualgeometricmodelofCABGreconstructedinsteadofidealizedgeometricmodelsareappliedtosimulatetherealphysiologicalbloodflowutilizingpulsatileflowboundarywaveformsinthepresentstudy.Thesimulationresultsshowthatthemaximumwallshearrate(WSS)valueisatthebottomofanastomosis.Moreover,thestagnationzonegrowinggraduallywiththegreaterangledownstreamtheanastomosisispronetoformtheIH,whichisconsistentwithclinicalobservation.Itisprovedthatthesurgerybeingbettersuitedtomaintaingraftpatencyissuccessful.

简介：Invasivefractionalflowreserve(FFR)measurementiscurrentlythegoldstandardforcoronaryintervention.FFRmeasurementbycoronarycomputedtomographyangiography(FFRCT)isanovelandpromisingimagingtechnologythatpermitsnoninvasiveassessmentofphysiologicallysignificantcoronarylesions.FFRCTiscapableofcombiningtheanatomicinformationprovidedbycoronarycomputedtomographyangiographywithcomputationalfluiddynamicstocomputeFFR.Todate,severalstudieshavereportedthediagnosticperformanceofFFRCTcomparedwithinvasiveFFRmeasurementasthereferencestandard.FurtherstudiesarenowbeingimplementedtodeterminetheclinicalfeasibilityandeconomicimplicationsofFFRCTtechniques.ThisarticleprovidesanoverviewanddiscussestheavailableevidenceaswellaspotentialfuturedirectionsofFFRCT.

简介：Percutaneouscoronaryintervention(PCI)improvessymptomsandprognosisinischemia-inducing,functionallysignificant,coronarylesions.Useoffractionalflowreserveallowsphysicianstoinvestigatetheischemia-inducingpotentialofaspecificlesionandcanbeusedtoguidecoronaryrevascularization,especiallyinmultivesselcoronaryarterydisease.Fractionalflowreserve-guidedPCIhasbeenextensivelyinvestigated.Resultsshowthatdeferralofstentinginnon-significantlesionsissafe,whereasdeferralofstentinginfunctionallysignificantlesionsworsensoutcome.FFR-guidedPCIimprovesoutcomeinmultivesseldiseaseoverangiography-guidedPCI.Untilrecently,therewaslittleknownaboutthelong-termoutcomeofFFR-guidedrevascularizationanditsvalidityinacutecoronarysyndromes.Thisreviewaimstoaddressthenewevidenceregardinglong-termappropriatenessofFFR-guidedPCI,theneedforhyperemiatoevaluatefunctionalseverity,andtheuseofFFRinacutecoronarysyndromes.

简介：BackgroundCoronarymicroembolization(CME)ischaracterizedbydistalmicrovascularocclusion.However,theinflammatorymechanismsandtherapeutictargetsofCMEarelargelyunknown.MethodsAtotalof11GuangxiBamaminiatureswinesweredividedintotwogroups:sham(n=5)andCME(n=6).MicrosphereswereinjectedintotheleftanteriordescendingarteryoftheCMEgrouptomakeananimalmodelofCME.TheexpressionsofmicroRNA-146a(miR-146a)andIRAK1,TRAF6,andAUF1inthemyocardiumweredetectedbyqPCR.ResultsIntheCMEgroup,microspheres,microinfarction,andinflammatorycellinfiltrationwerefoundunderanopticalmicroscope.TheexpressionlevelsofmiR-146awerelowinbothgroups.AfterCME,theexpressionlevelsofIRAK1,TRAF6,andAUF1intheCMEgroupwereupregulatedcomparedwiththoseintheshamgroup(P<0.01;P<0.05;P<0.05,respectively).ConclusionsAUF1,IRAK1andTRAF6,butnotmiR-146a,couldbeinvolved,inmyocardiuminflammationfollowingCME.

简介：BackgroundMonocytetohighdensitylipoproteinratio(MHR)hasbeenconsideredasanovelparameterrelatedwithadverserenalandcardiovascularoutcomes.InthisstudyweinvestigatedtheassociationofMHRwithmajoradverseclinicalevents(MACEs)inpatientswithtype2diabetesmellitus(T2DM)undergoingelectivepercutaneouscoronaryintervention(PCI).MethodsConsecutiveT2DMpatientstreatedwithelectivePCIwereprospectivelyrecruitedbetweenJuly2008-January2016inDepartmentofCardiologyofPanyuCentralHospital.Subjectswerecategorizedintotwogroups:aspatientswhodevelopedMACEs(MACEs+)andpatientswhodidnotdevelopMACEs(MACEs-)duringhospitalization.MACEsweredefinedasthecompositeendpoints,includingall-causemortality,oracuteheartfailure,ortargetvesselrevascularization,orstrokeorrecurrentangina.ResultsAtotalof418patientswereincludedinthestudy.64patientsdevelopedMACEs(15.3%).IntheMACEs(+)patients,monocyteswerehigher(1.12[0.78-1.42]vs.0.72[0.68-0.92]109/L,P<0.01)andHDLcholesterollevelswerelower(0.87[0.72-1.21]vs.0.96[0.81-1.11]mmol/L,P<0.01).Inaddition,MHRwassignificantlyhigherintheMACEs(+)group(1.12[0.91-2.09]vs.0.73[0.54-0.93]109mmol/L,P<0.01).ThecutoffvalueofMHRforpredictingMACEswas22,withasensitivityof81%andaspecificityof75.1%(areaunderthecurve0.79,P<0.001).Inmultivariatelogisticregressionanalysis,MHRremainedanindependentfactorcorrelatedwithMACEs(OR=3.97,95%CI=1.38-11.5,P<0.01).ConclusionHigherMHRlevelsmaypredictMACEsdevelopmentafterelectivePCIinT2DMpatients.

简介：BackgroundSepticshockcausedbybacteremiaisalife-threateninginfectionwhoseprognosisishighlydependentonearlyrecognitionandappropriatetreatment.Procalcitonin(PCT)hasbeenshowntoaccuratelyandquicklydistinguishbacteremiafromnoninfectiousinflammatorystatesincriticallyseverepatients.However,theextentofPCTmagnitudeelevationaccordingtotheGramstainresultinelderlypatientswithcoronaryheartdisease(CHD)attheonsetofsepticshockcausedbybacteremiavaries,andhasnotbeenclearlyelucidated.MethodsThemedicalrecordsofadvancedage(non-neutropenic)patientwithCHDandsepticshockbetweenMar2013andJun2015whohadbacteremiacausedbyeitherGram-positive(GP)bacteriaorGram-negative(GN)bacteriawerereviewed,andthelevelsofPCT,C-reactive(CRP)proteinandwhitebloodcellscount(WBC)inbothgroupswereanalyzed.Results75episodesofeitherGNbacteremia(n=40)orGPbacteremia(n=35)wereenrolled.PCTlevelswerefoundtobemarkedlyhigherinpatientswithGNbacteremiathaninthosewithGPbacteremia[(8.93±17.58)vs.(64.42±58.56)ng/L(P<0.001)],whereastherewasnosignificantdifferenceinCRPandWBC(P>0.05).Moreover,ahighPCTlevelwasfoundtobeindependentlyassociatedwithGNbacteremiainthisstudypopulation.APCTlevelof19.69ng/mLyieldeda72.5%sensitivity,a91.4%specificity,an8.43positivelikelihoodratioanda0.30negativelikelihoodratioforGN-relatedbacteremiainthestudycohort[AUROCC=0.870(0.041),95%CI(0.790-0.949)].ConclusionInanelderlypatient(non-neutropenic)withCHDandsepticshock,GNbacteremiacouldbeassociatedwithhigherPCTvaluesthanthosefoundinGPbacteremia(PCT>19.69ng/mL).

简介：Radiationexposureisahazardforpatientsandphysiciansduringfluoroscopically-guidedprocedures.Invasivecardiologistsareexposedtohighlevelsofscatterradiationandbothincreasingproceduralcomplexityandhigheroperatorvolumescontributetoexposureaboverecommendedthresholds.Standardshieldingdoesnotoffersufficientprotectiontotheheadandneckregionandthepotentialfornegativebiological,subclinical,andclinicaleffectsexists.Largepopulationstudiessuggestthatcranialexposuretolowdoseradiationincreasestherisksoftumordevelopment.Inaddition,modestdosesoftherapeuticcranialradiationhavebeenlinkedwiththedevelopmentofbraincancer.Althoughacausalassociationbetweenscatterradiationinthecathlabandbraincancerdoesnotcurrentlyexist,giventheknowndetrimentaleffectsofradiationexposuretotheheadandneckregionsupportafocusonpotentialmethodsofprotectionforboththepatientandtheoperator.