Spiral Computed Tomography in the Quantitative Measurement of the Adjacent Structure of the Left Atrial Appendage in Patients with Atrial Fibrillation

Cardiac arrhythmias are common clinical cardiovascular diseases. Arrhythmias are abnormalities in the frequency, rhythm, site of origin, conduction velocity, or sequence of excitation of the cardiac impulses. Arrhythmia mechanisms include foldback, altered autonomic rhythm, and triggering mechanisms. It can cause palpitations, dizziness, black dawn, syncope, and angina pectoris and can worsen a preexisting cardiac disease, reduce the quality of life, and increase mortality. Also, by making it one of the constant challenges for the clinical cardiovascular physician, we can get more information. The study included 94 patients with atrial fibers, including 56 men and 38 women aged 57, 46, 11, and 68 years. There are 80 patients with nonatrial fibers, including 44 men and 36 women aged 56, 10, and 83 years. Those who can perform a normal coronary angiography and exclude congenital heart disease, heart valve disease, and other cardiovascular diseases. In both groups, a 256-layer spiral CT examination was performed. A pulmonary vein scanning protocol was applied to the patients with atrial fibrillation, and this can perform normal coronary angiography and exclude those with cardiovascular diseases such as congenital heart disease and valvular heart disease. The purpose of this study is to investigate the anatomical changes of the left atrium and its adjacent structures by applying the 256 nm spiral CT imaging to visualize the left atrium and its adjacent structures and by applying the MPR technology, VR technology, and simulation endoscope techniques.

A cost analysis of cardiac magnetic resonance imaging in the diagnostic pathway of a population with unexplained acute myocardial injury and normal coronary angiography

Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): National Institute for Health Research (NIHR) Biomedical Research Centre at St Bartholomew"s Hospital London. Irish Cardiac Society OnBehalf European Association of Cardiovascular Imaging (EACVI) -Task Force for Cost Effectiveness. Background Acute presentations with myocardial injury that occur despite culprit-free coronary angiography were first reported over 70 years ago, with a prevalence between 5-9%. 1-3 There is increasing evidence that a more accurate diagnosis is available and that CMR is a key tool to determine the underlying pathology. This is reflected with the most recent international guidelines advocating for the use of CMR in the diagnostic pathways of this heterogeneous population. However, to date there is no formal assessment of the financial implications of adopting these new guidelines. Purpose To determine the financial impact of implementing cardiac magnetic resonance imaging in the diagnostic pathway of a population with unexplained acute myocardial injury and normal coronary angiography in comparison to existing clinical practice. Methods We performed a focused cost-benefit analysis using a hypothetical population of 2,000 patients with unexplained acute myocardial injury and normal coronary angiography. The population was split evenly into two groups of either standard, or CMR guided management, and extrapolated over a ten-year period. Standard management was defined as 66% of the population receiving dual antiplatelet therapy (ticagrelor and aspirin) for one year followed by aspirin for life, and the remaining 34% of the population receiving aspirin for life. CMR guided management determined antiplatelet therapy according to the imaging findings. This analysis focused on CMR’s ability to accurately identify those patients who may have had an MI and facilitate tailored treatment with evidence based dual antiplatelet therapy. Costs and rates were defined in Table 1. A one-way sensitivity analysis was also performed to determine the variables with largest impact on the costs. Each variable was varied by +/- 20% and the change in cost determined at year 10. Results Using CMR in the diagnostic pathway resulted in an increased cost of £72,656 in the first year. After year 7, CMR guided practice becomes cost neutral, resulting in cost saving of £24,054 over a ten-year period in a population of 1000 patients. Figure 1. Utilizing CMR in this population also resulted in 7 fewer myocardial infarctions and 14 fewer major bleeding events over a ten-year time horizon. The three most sensitive variables were, in decreasing order, the cost of CMR, the cost of ticagrelor and the percentage of the population with MI requiring DAPT. A 20% change from baseline resulted in a 320%, 247% and 162% change in costs at 10 years, respectively. Conclusion Utilizing CMR in this population may be associated with reduced costs in the medium to long term. The initial increased cost of CMR is offset over time, by delivering a more personalised, higher quality level of care to patients.

Gene Expression Analysis Suggests Immunological Changes of Peripheral Blood Monocytes in the Progression of Patients With Coronary Artery Disease

ObjectivesTo analyze the gene expression profile of peripheral blood monocytes in different stages of coronary artery disease (CAD) by transcriptome sequencing, and to explore potential genes and pathway involved in CAD pathogenesis.MethodsAccording to the screening of coronary angiography and quality control of blood samples, eight intermediate coronary lesion patients were selected, then eight patients with acute myocardial infarction, and eight patients with normal coronary angiography were matched by age and gender. Transcriptomics sequencing was conducted for the peripheral blood monocytes of these 24 samples by using the Illumina HiSeq high-throughput platform. Then, differentially expressed genes (DEGs) were analyzed. Gene Ontology (GO) functional annotation, Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway annotation, and protein-protein interaction (PPI) network were applied to annotate the potential functions of DEGs.ResultsCompared with the normal coronary angiography group, we identified a total of 169 DEGs in the intermediate coronary lesion group, which were significantly enriched in 59 GO terms and 17 KEGG pathways. Compared with the normal coronary angiography group, we found a total of 2,028 DEGs, which were significantly enriched in 311 GO terms and 20 KEGG pathways in the acute myocardial infarction group. The cross-comparison between normal versus intermediate coronary lesion group, and normal versus acute myocardial infarction group included 98 differential genes with 65 up regulated and 33 down regulated genes, which were significantly enriched in 46 GO terms and 10 KEGG pathways. During the progression of CAD, there was a significant up-regulated expression of CSF3, IL-1A, CCR7, and IL-18, and down-regulated expression of MAPK14. Besides GO items such as inflammatory response was significantly enriched, KEGG analysis showed the most remarkable enrichments in IL-17 signaling pathway and cytokine-cytokine receptor interactions.ConclusionsTranscriptomics profiles vary in patients with different severity of CAD. CSF3, IL-1A, CCR7, IL-18, and MAPK14, as well as IL-17 signaling pathway and cytokine and cytokine receptor interaction signaling pathway related with inflammatory response might be the potential biomarker and targets for the treatment of coronary artery disease.

Retrospective Analysis of Cardiotoxic Scorpion Envenomation in Konkan Region of Western India with Special Reference to Echocardiography

Introduction: Mortality due to scorpion sting is high in rural India as preference is given to traditional healers above hospitalisation. In rural Indian settings where there is a lack of diagnostic facilities Electrocardiogram (ECG) was supposed to be the only test to diagnose cardiotoxicity. However, we proposed to study Echocardiography (ECHO) serially in scorpion sting cases for classifying them into mild, moderate and severe envenomation. Aim: To study serial changes of cardiac dimensions on ECHO in cardiotoxic scorpion sting patients. Materials and Methods: This study was a retrospective and cross-sectional analysis of 925 patients stung by scorpion, admitted from January 2011 to December 2017 at BKL Walawalkar Hospital, Chiplun, Maharashtra, India. All patients were classified into mild, moderate and severe envenomation based on clinical findings and electrocardiography. All patients had ECHO done on admission but only 81 severely or moderately envenomed had complete records of ECHO readings. Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21.0 (SPSS Inc., Chicago, USA). Data has been presented as mean and Standard Deviation (SD) for all the ECHO measurements. Results: In 81 patients, ECHO on admission showed severe Left Ventricular (LV) dilatation. There was significant reduction in LV size (3.69 cm to 3.025 cm for systolic and 4.19 cm to 3.82 cm for diastolic, p-value <0.001 for both) in subsequent ECHOs, showing improvement in cardiac status and LV function {Ejection Fraction (EF) 28.17% to 43.31%, p-value=0.002} with normal coronary angiography. Conclusion: Diagnosis of cardiotoxicity, following scorpion sting, is challenging on ECG. In present study, LV dimensions on serial 2D ECHO were studied. After the sting, LV dysfunction occurs initially and it is completely reversible on subsequent serial ECHO.

Retinal Changes in Patients with Angina Pectoris and Anginal Equivalents: A Study of Patients with Normal Coronary Angiography

Background and aims: Approximately 10-30% of the patients with typical symptoms of angina pectoris have normal angiography showing normal macrovasculature. In these patients, however, the microvascular problems should be monitored. Hence, the main aim of this study is to evaluate retinal changes in normal angiographic patients.Methods: In this descriptive cross-sectional study, 60 normal angiographic patients with typical chest pain or anginal equivalents visiting Modarres Hospital Cardiology Research Center between 2018 and 2019 were enrolled and retinal changes were determined in Labbafinejad Hospital by Optical Coherence Tomography Angiography using Foveal Avascular Zone (FAZ), Superficial Vascular Density (SVD), and Deep Vascular Density (DVD).Results: The results of this study demonstrated that FAZ was normal in all subjects, but SVD and DVD were abnormal in 45% and 8.3%, respectively. Totally, 18.5% and 66.7% showed abnormal SVD among stable angina (SA) and unstable angina (UA) cases, respectively (P < 0.001). There was no statistically significant difference between abnormal DVD in SA and UA cases (P=0.058). Abnormal SVD was significantly more common among diabetic patients (P < 0.001), while DVD was not related to diabetes presence in the study population (P > 0.05). Moreover, abnormal SVD was more common among patients with chest pain (P=0.036), while there was no significant difference for DVD (P=0.371). Interestingly, abnormal ECG was associated with both abnormal DVD and SVD.Conclusions: The results of this study showed that nearly half of the patients with angina pectoris or anginal equivalents who revealed normal angiographic findings may suffer from retinal changes. Thus, retinal assessment is needed in these patients to evaluate microvascular changes.