Correction to: Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain

The original article [1] contained an error in coauthor, Balazs Ruzsics’s name which has since been corrected

Health-related qualify of life, angina type and coronary artery disease in patients with stable chest pain

Background: Health-related quality of life (HRQoL) is impaired in patients with stable angina but patients often present with other forms of chest pain. The aim of this study was to compare the pre-diagnostic HRQoL in patients with suspected coronary artery disease (CAD) according to angina type, gender, and presence of obstructive CAD. Methods: From the pilot study for the European DISCHARGE trial, we analysed data from 24 sites including 1263 patients (45.9% women, 61.1 ± 11.3 years) who were clinically referred for invasive coronary angiography (ICA; 617 patients) or coronary computed tomography angiography (CTA; 646 patients). Prior to the procedures, patients completed HRQoL questionnaires: the Short Form (SF)-12v2, the EuroQoL (EQ-5D-3 L) and the Hospital Anxiety and Depression Scale. Results: Fifty-five percent of ICA and 35% of CTA patients had typical angina, 23 and 33% had atypical angina, 18 and 28% had non-anginal chest discomfort and 5 and 5% had other chest discomfort, respectively. Patients with typical angina had the poorest physical functioning compared to the other angina groups (SF-12 physical component score; 41.2 ± 8.8, 43.3 ± 9.1, 46.2 ± 9.0, 46.4 ± 11.4, respectively, all age and gender-adjusted p < 0.01), and highest anxiety levels (8.3 ± 4.1, 7.5 ± 4.1, 6.5 ± 4.0, 4.7 ± 4.5, respectively, all adjusted p < 0.01). On all other measures, patients with typical or atypical angina had lower HRQoL compared to the two other groups (all adjusted p < 0.05). HRQoL did not differ between patients with and without obstructive CAD while women had worse HRQoL compared with men, irrespective of age and angina type. Conclusions: Prior to a diagnostic procedure for stable chest pain, HRQoL is associated with chest pain characteristics, but not with obstructive CAD, and is significantly lower in women. Trial registration: Clinicaltrials.gov, NCT02400229

Systemic periostin is associated with larger infarct size and worse clinical outcomes in patients with acute coronary syndromes and periodontal disease

Abstract Funding Acknowledgements Type of funding sources: None. Background Periodontal disease (PD) is associated with increased inflammation, which can contribute to atheromatous plaque rupture and consequent acute coronary syndrome (ACS). Periostin (Pn) is a new biomarker associated with inflammation, being involved in the complex process of myocardial recovery after an ACS; however, the association between Pn, other inflammatory biomarkers and concomitant PD in patients with ACS has not been elucidated so far. Purpose the aim of this study was to investigate the link between serum levels of Pn, other systemic inflammatory biomarkers and their impact on the clinical evolution following an ACS. Methods this was an observational prospective study in which 92 patients with ACS and concomitant PD were enrolled. Patients were divided into two groups, according to the median value of Pn which was 30,63 ng/ ml: group 1 included 46 patients with low Pn level and group 2 included 46 patients with high Pn level. Inflammatory status was investigated using serum levels of C reactive protein (CRP), interleukin 6 (IL6), endothelial/ intravascular adhesion molecules (VCAM/ICAM), P-selectin, matrixmetalloproteases (MMP9), Albumin (Ab), Apolipoprotein B (ApoB), alkaline phosphatase (AF) and sST2. For Ab, CRP, and AF the values were recorded at baseline and on day 7. Results Patients with high Pn levels presented more frequent STEMI type myocardial infarction (p=0.0004), heart failure (p=0.002) and a longer duration of hospitalization (p=0.008) and stay in the intensive coronary care unit (p=0.004). They also expressed significantly higher levels of MMP 9 (201 ± 69,37pg/ml vs 132,7 ± 112,2 pg/ml, p = 0.003), Ab (4,08 ±0,34 mg/dl vs 3,08 ± 1,46 mg/dl p=0.02), and AF at baseline at day 7 (53,84 ± 16,2 vs 47,36 ± 16,36 UI/l p=0.022; 58,73 ± 29,91 vs 42,56 ± 16,42 UI/l, p=0.0001). Patients in group 2 had also higher levels of triglycerides (p=0.02) and LDL cholesterol (p=0.0008), as well as a higher amount of myocardial necrosis, as expressed by total creatine kinase (p=0.0004) and CK-MB (p=0.0096). However, serum levels of CRP at baseline (9,2 ± 12,87 mg/ dl vs 26,61 ± 25,59 mg/dl, p=0.0009) and at day 7 (19,25 ± 26,77 mg/dl vs 31,84 ± 29,4 mg/dl, p=0.043) were significantly lower in group 2. Conclusions In patients with ACS and PD, increased systemic levels of circulating Pn indicate a larger myocardial infarction and worse clinical outcomes, being also associated with increased levels of matrixmetalloproteases, involved in the myocardial repair. </jats:sec

Association between periodontal pathogens from the red complex and inflammation in patients with acute coronary syndromes

Abstract Funding Acknowledgements Type of funding sources: None. Background Periodontal disease (PD) is an inflammatory condition that increases cardiovascular risk and favours development of acute coronary events; however, the association of periodontal pathogens and inflammatory markers in patients with acute coronary syndromes (ACS) has not been elucidated so far. Purpose the aim of this study was to evaluate the association between periodontal pathogens of the red and orange complex and inflammatory biomarkers in patients with ACS. Methods Sixteen patients with ACS and concomitant PD were enrolled in the present study. All patients underwent a complex dental examination, including DNA sampling collection from the periodontal pocket. The study population was divided into two groups according to the presence of germs from red, respectively orange complex: group 1 – 9 patients with germs from red complex (RC group) and group 2 – 7 patients with germs from red-orange complex (ROC group). Inflammatory status was assessed on the basis of interleukine 6 (IL6), endothelial/ intravascular adhesion molecules (VCAM/ICAM), P-selectin, metalloproteinase (MMP9), Albumin (Ab), Apolipoprotein B (ApoB), C reactive protein (CRP), alkaline phosphatase (AF) and sST2 and lymphocytes to monocytes ratio. Results Germs from red complex (Porphyromonas gingivalis, Tannerella forsythia and Treponema denticola) were more frequent and more expressed compared with those from orange complex (p=0.0008). There was no significant correlation between RC and RCO group and inflammatory markers; however, P-selectin level (185,4 ± 66,73 vs 89,62 ± 40,94 ng/ml, p=0.005) was higher in RC group, while AF level at baseline (47,83 ±12,53 vs 75,72 ±24,42 UI/l, p=0.006) and in day 7 (52,83 ± 6,122 vs 70,95 ± 9,71 UI/l, p =0.01) was more expreesd in ROC group. A significantly higher lymphocytes to monocytes ratio was identified in patients with ROC compared with those with RC only (3,2 ± 1,44 vs 10,94 ± 12,75, p=0.01). Conclusions in patients with ACS and PD, the presence of germs from red complex in the gingival pocket is associated with increased blood vulnerability. The severity of the PD, expressed by the presence of germs of the red complex, is associated with a higher risk of developing acute coronary events. </jats:sec

TRAINING OF HUMAN OPERATORS IN CENTRE FOR PERSONNEL TRAINING AND DEVELOPMENT OF NEW TECHNOLOGIES OF CNTEE "TRANSELECTRICA"-SA

Using new technologies to equipment maintenance have a number of advantages well known. By applying these technologies work will achieve significant increases economic efficiency only if applied properly. In this sense it must be adequately trained staff, both maintenance operators and operational operators. CNTEE "Transelectrica" SA, through its policy, proposes the use of new technologies and LW technologies (live working). To develop and promote LW technologies and new technologies, the Company promoted the foundation of a centre for the training of personnel and development of new technologies. The centre will aim to promote new technologies and prepare personnel for the correct application of new technologies in our company and to increase readiness and effectiveness of actions taken by its own staff and authorize them for LW and other technology. Also the Centre can attest companies and their services and technologies. This paper presents some aspects of the Centre and how personnel receive the training services for more effective implementation of these technologies

P977 CT phenotype of high-risk atherosclerotic plaques causing an acute coronary syndrome compared to silent vulnerable plaques

Abstract Funding Acknowledgements PlaqueImage.- research grant no. 103544/2016, contract number 26/01.09.2016 - Background Previous studies demonstrated that plaque morphology has a crucial role in the development of an acute coronary syndrome (ACS). However, not all vulnerable coronary plaques produce an ACS and the prediction power of various vulnerability features to predict an acute coronary event in a close future, has not been elucidated so far. Objective We aimed to use multi-slice computed tomography angiography (CTA) for assessment of morphological characteristics of culprit lesions producing an ACS in the next several months after CT assessment, in comparison with morphological characteristics of unstable coronary atherosclerotic plaques which did not trigger an ACS. Material and methods We analyzed 40 patients in whom CTA revealed presence of unstable coronary lesions, exhibiting at least one marker of vulnerability: napkin ring sign (NRS), spotty calcium (SC), positive remodeling (PR) or presence of low attenuation plaque (LAP), divided in 2 groups: group 1 - 20 patients who developed an ACS in the next 6 months following CTA examination, and group 2 – 20 patients matched for age, gender and risk factors, who did not present any cardiovascular event 6 month after CTA assessment. Post-processing of multi-slice CTA images was performed in order to assess morphological characteristics and CT-derived markers of atherosclerotic plaque instability. Results Similar mean values of plaque length (17.1 +/- 5.9 mm vs 16.9 +/- 3.4 mm; p = 0.6) and total atheroma volume (188.1 +/- 104.7 mm3vs 186.4 +/- 90.7 mm3; p = 0.8) were obtained for both groups. The mean number of vulnerability markers was 1.6 in group 1 vs 1.2 in group 2 (p = 0.07). However, atherosclerotic lesions in patients from group 1 presented significantly higher values of lipid-rich atheroma (9.8 +/- 10.8 mm3vs 2.6 +/- 1.0 mm3; p = 0.01) and remodeling index (1.14 +/- 0.3 in group 1 vs 0.89 +/- 0.19 in group 2, p = 0.04). At the same time, atheromatous plaques in patients who developed an ACS during the 6-months follow-up showed in a significantly higher proportion LAP (45% in group vs 10% in group 2, p = 0.03) and PR (15%in group 1 versus 5% in group 2, p = 0.04), but not NRS (30% vs 25%, p = ns) or SC (65% vs 40%, p = 0.2). Conclusions Atherosclerotic plaques producing an ACS exhibit a different phenotype than unstable plaques that remain silent. The CTA profile of atheromatous plaques producing an ACS includes the presence of low attenuation, positive remodeling, higher RI and lipid-rich atheroma. Presence of these features in high-risk coronary plaques identifies very high risk patients, who can benefit from adapted therapeutic strategy in order to prevent the development of an ACS. </jats:sec

P1823 Feasibility of CCTA in assessment of luminal changes and coronary shear stress evolution after implantation of bioresorbable vascular scaffolds

Abstract Funding Acknowledgements PlaqueImage - financed by the National Authority of Scientific Research and Innovation and the Romanian Ministry of European Funding Background Coronary shear stress (CSS) is a well-established local mechanical factor in atherogenesis, progression and destabilization of atherosclerotic plaques. Analysis of CSS after coronary stent placement is still lacking of large clinical studies. Purpose: The aim of this study was to: (1) test the feasibility of Coronary Computed Tomography Angiography (CCTA) for assessment of local hemodynamic and luminal changes after implantation of bioresorbable vascular scaffolds (BVS), and (2) to investigate CSS modifications after BVS implantation. Methods: We conducted a single center, prospective pilot study on 73 patients with coronary artery disease who underwent elective percutaneous coronary intervention (PCI); group 1 (n = 30) – patients with BVS and group 2 (n = 43) – patients with bare metal stent (BMS) implanted. CCTA scanning was performed in all patients prior PCI and at 12 months after PCI. The mean CSS at proximal and at distal part of the stented segment and at the level of the minimal lumen area (MLA) was calculated at baseline and at 12 months after BVS placement. Results: CCTA revealed a higher incidence of severe coronary stenosis in group 1 (73%) than in group 2 (30%) (p &amp;lt; 0.0001). Sensibility of visual evaluation for identification of in-stent restenosis on CCTA was increased in BVS group (94%) than in BMS group (76.19%) (p = 0.0006), hence the group 1 had lower incidence of non-diagnostic evaluations. Mean CSS at the stented site was significantly lower at 12 months (1.9 +/- 0.68 Pa) that average CSS at baseline (2.87 +/- 3.08 Pa) (p = 0.0001). CSS analysis showed also a significantly decreased values at proximal level from 3.39 +/- 1.93 Pa at baseline to 1.91 +/- 0.68 Pa at follow up (p &amp;lt; 0.0001), but not a significant decrease at distal part – 1.3+/-0.72 Pa at baseline and 1.59 +/- 0.65 Pa at 12 months follow up (p = 0.9). Conclusions: CCTA is a feasible technique for assessment of luminal changes following BVS implantation. BVS implantation contribute to the improvement of local hemodynamics by restoring physiological pattern of coronary flow, as demonstrated by the computational fluid hemodynamics assessment of coronary circulation. </jats:sec

569 Association between periodontal disease, coronary calcium score and markers of subclinical atherosclerosis in patients with unstable angina-a CT-based sub-study from the ATHERODENT clinical trial

Abstract Funding Acknowledgements PlaqueImage financed by the National Authority of Scientific Research and Innovation and the Romanian Ministry of European Funding Background The relationship between periodontal disease (PD) and chronic inflammation is well established. PD leads to increased cardiovascular risk and favours development of acute coronary syndromes; however, the association between PD and markers of subclinical atherosclerosis has not been elucidated so far. Purpose To evaluate the interrelation between severity of PD, coronary calcium, subclinical atherosclerosis and plaque vulnerability in patients with unstable angina, who underwent coronary computed tomography angiography (CCTA). Methods Fifty-two patients with unstable angina were enrolled in the ATHERODENT clinical trial (NCT03395041). All patients underwent: (1) complex dental examination for assessment of periodontal status, expressed by the total periodontal index (PI) evaluating the following indices: gingival index, plaque index, tantrum index, furcation index, mobility, loss of attachment, pocket depth and papillary bleeding index, (2) CCTA for analysis of morphology, composition and vulnerability features of the culprit plaques causing myocardial schema. For each patient, coronary calcium score, body mass index, neck circumference, abdominal circumference and Intima-media thickness of the carotid artery were calculated. According to the median value of the total PI (set by 22) the study population was divided into two groups: group 1 included 26 patients with low PI (normal gum or gingivitis) and group 2 included 26 patients with high PI (periodontitis and severe PD). Results In patients with high PI the plaque volume (p = 0.019) and the non-calcified volume (p = 0.002) were more increased compared with patients with low PI. In patients with high risk features in the culprit coronary plaques (positive remodelling, low density atheroma, spotty calcification and napkin ring sign) the severity of PD was more expressed compared with those with low risk plaques (28.20+/-13.34 vs. 18.71+/-11.31, p = 0.001). From all PI indices, loss of gingival attachments (3.6 +/-2.91 vs. 1.66 +/- 1.8, p = 0.009) and papillary bleeding index (4.5 +/-3.06 vs. 2.04+/-1.96, p = 0.002) were significantly correlated with the plaque vulnerability. there was no significant correlation between PI and the markers of subclinical atherosclerosis expressed by the neck circumference, abdominal circumference and IMT of the carotid artery. However, total PI presented significantly correlation with the total coronary artery calcium score (r = 0.45, p = 0.0008). A higher calcium score was identified in patients with high PI compared with those with low PI (505.29 +/-478.64 vs. 93.82+/-233.0, p = 0.0001). Conclusions In patients with vulnerable coronary plaques, subclinical atherosclerosis is not correlated with PI. However, the severity of PD is directly associated with the total calcium score and with a more vulnerable phenotype of the atheromatous coronary plaques. </jats:sec