Coronary artery calcium scoring method

Considering that coronary artery disease (CAD) is the number one cause of death in the developed countries and higher than half of patients with severe clinical symptoms do not have any predictive sign for CAD necessitate the development of advanced screening tests. Coronary artery calcium score (CCS) test depending on the principle of measurement of calcium level in atherosclerotic lesions is one of the most important steps in this field. Coronary artery calcification is recognized as an active process that is closely linked to vascular inflammation and predicts future cardiac events. Presence of calcium in vascular lesions allows us to assess the lesion burden. Nowadays spiral CT is being widely used to define structural changes and calcium deposition in coronary artery segments instead of electron beam tomography which is initially used. However, since there are numerous non-calcified lipid-rich plaques with thin fibrous caps besides calcified plaques in CAD patients, CCS is not efficient test to evaluate the risk of CAD alone. The CCS percentiles defined for age and gender are more relevant in assessing risk and more predictive of hard cardiac events than absolute CCS. In asymptomatic cases, while being zero of CCS do not eliminate the risk of occurring acute cardiac events and the possibility of myocardial ischemia, the presence of high CCS rises predictive value of Framingham risk score (FRS) for coronary death and non-fatal myocardial infarction. Finally, the CCS is valuable test screening tool in selected patients such as those with an intermediate FRS, as recommended by the current guidelines; high coronary calcium score is closely related with the increased risk of CAD and serious cardiac events, and signs to requirement for secondary prevention and other advanced techniques in the diagnosis of CAD. (Anadolu Kardiyol Derg 2008; 8: Suppl 1; 12-4

Role of leucocytes in microvascular malperfusion in reperfused acute myocardial infarction

The mechanisms underlying myocardial malperfusion following restoration of epicardial coronary blood flow are likely to be multifactorial. Generation of excessive oxygen-free radicals, increased myocardial cell calcium, cellular and interstitial edema, endothelial dysfunction, vasoconstrictors, and thromboembolism have been proposed to account for impaired myocardial perfusion. Leucocytes are the most important cellular components, which promote procoagulant milieu at the microvascular level during acute myocardial infarction. In this review, crucial role and effecting mechanisms of the leucocytes in coronary microvascular malperfusion were discussed

High blood pressure: An obscuring misnomer?

High blood pressure (BP) has been identified as a major risk factor for cardiovascular complications. Although two-way association between BP and hypertensive complications makes hypertension a near-ideal biomarker, BP as "the cause" for the complications of HT per se still needs more evidence. Another entirely possible hemodynamic candidate for causing hypertensive cardiovascular adverse events can be flow or its iterations, which might have escaped the attention because of its perfect correlation with pressure and harder technical measurement. In this article, we analyze the evidence in hand to compare flow- and pressure-related phenomena to delineate which of the two is the dominant mediator of complications related to hypertension and should be the target for therapy. A "flow-" rather than a " pressure-" based factor, as the causative or major driving mediator of common hypertensive complications, may change our understanding of hypertension pathophysiology

Influence of coronary calcification patterns on hemodynamic outcome of coronary stenoses and remodeling

WOS: 000418480800006PubMed: 28990941Objective: The histological characteristics of plaque may affect the hemodynamic outcome of a given coronary stenosis. In particular, the potential effect of volumetric calcium content and the topographical distribution in the lesion segment on physiological outcome has not yet been investigated. The aim of this study was to identify any potential correlation between patterns of calcification and the fractional flow reserve (FFR) and the coronary remodeling index (RMI). Methods: A total of 26 stable angina pectoris and 34 acute coronary syndrome patients without persistent ST-segment elevation constituted the study population. FFR was used to assess 70 intermediate coronary stenosis lesions. After obtaining hemodynamic measurements, quantitative grayscale and virtual histology-intravascular ultrasound analyses were performed. The depth, length, and circumferential distribution of calcification of the lesions were also recorded. Results: Within the analyzed segment (area of interest, lesion segment), FFR was correlated with maximal thickness of deep calcification (r=-0.285; p=0.021) and calcification angle (r=-0.396; p=0.001). In lesions with a calcification angle >180 degrees, the mean FFR value was significantly lower compared with those <180 degrees (0.64 +/- 0.17 vs. 0.78 +/- 0.08; p=0.024). RMI was correlated with maximal angle of superficial (r=-0.437; p<0.001) and deep (r=0.425; p<0.001) calcification. RMI was correlated with maximal thickness of superficial (r=-0.357; p=0.003) and deep (r=0.417; p<0.001) calcification. RMI was also correlated with FFR (r=-0.477; p<0.001). Conclusion: This study demonstrated that the geometry, location, and amount of calcification of a plaque could affect hemodynamic and anatomical outcome measures in functionally significant stenoses by affecting vessel wall compliance

The accuracy of deceleration time of diastolic coronary flow measured by transthoracic echocardiography in predicting long-term left ventricular infarct size and function after reperfused myocardial infarction

Assessment of microvascular function after reperfused acute myocardial infarction (AMI) provides important insights for myocardial reperfusion and facilitates prediction of long-term left ventricular (LV) function and clinical outcome. In this study, we examined microvascular integrity 48 h after successful primary percutaneous coronary intervention (PCI) and compared predictive accuracy of the intracoronary pressure-wire- and transthoracic Doppler echocardiography-based parameters in the estimation of long-term LV infarct size and function