Association of Angio-LncRNAs MIAT rs1061540/MALAT1 rs3200401 Molecular Variants with Gensini Score in Coronary Artery Disease Patients Undergoing Angiography

Long non-coding RNAs (lncRNAs) have emerged as essential biomolecules with variable diagnostic and/or prognostic utility in several diseases, including coronary artery disease (CAD). We aimed for the first time to investigate the potential association of five angiogenesis-related lncRNAs (PUNISHER, SENCR, MIAT, MALAT1, and GATA6-AS) variants with CAD susceptibility and/or severity. TaqMan Real-Time genotyping for PUNISHER rs12318065A/C, SENCR rs12420823C/T, MIAT rs1061540C/T, MALAT1 rs3200401T/C, and GATA6-AS1 rs73390820A/G were run on the extracted genomic DNA from 100 unrelated patients with stable CAD undergoing diagnostic coronary angiography and from 100 controls. After adjusting covariates, the studied variants showed no association with disease susceptibility; however, MIAT*T/T genotype was associated with a more severe Gensini score. In contrast, MALAT1*T/C heterozygosity was associated with a lower score. The lipid profile, and to a lesser extent smoking status, male sex, weight, hypertension, and MALAT1 (T > C) (negative correlation), explained the variance between patients/control groups via a principal component analysis. Incorporating the principal components into a logistic regression model to predict CAD yielded a 0.92 AUC. In conclusion: MIAT rs1061540 and MALAT1 rs3200401 variants were associated with CAD severity and Gensini score in the present sample of the Egyptian population. Further large multi-center and functional analyses are needed to confirm the results and identify the underlying molecular mechanisms.

Nonalcoholic Fatty Liver Disease-Associated Liver Fibrosis Is Linked with the Severity of Coronary Artery Disease Mediated by Systemic Inflammation

Background and Aim. Nonalcoholic fatty liver disease (NAFLD) is an independent risk factor for cardiovascular disease. Hepatic fibrosis is the most significant determinant of all-cause- and liver -related mortality in NAFLD. However, the relationship between NAFLD fibrosis and severe coronary artery disease (CAD) remains unclear. Methods and Results. We conducted a retrospective study of 531 patients with ultrasonogram-confirmed NAFLD who underwent percutaneous coronary intervention (PCI). Then, all patients were separated into four categories by Gensini score (0, 0-9, 9-48, and ≥48) for use in ordinal logistic regression analysis to determine whether NAFLD fibrosis was associated with increased Gensini scores. Mediation analysis was used to investigate whether systemic inflammation is a mediating factor in the association between NAFLD fibrosis and CAD severity. FIB − 4 > 2.67 ( OR = 5.67 , 95% CI 2.59-12.38) and APRI > 1.5 ( OR = 14.8 , 95% CI 3.24-67.60) remained to be independent risk factors for the severity of CAD after adjusting for conventional risk factors, whereas among the inflammation markers, only neutrophils and neutrophil-to-lymphocyte ratio (NLR) were independently associated with CAD. Multivariable ordinal regression analysis suggested that increasing Gensini score (0, 0-9, 9-48, and ≥48) was associated with advanced NAFLD fibrosis. ROC curve showed that either fibrosis markers or inflammation markers, integrating with traditional risk factors, could increase the predictive capacity for determining CAD. Inflammation markers, especially neutrophils and NLR, were mediators of the relationship between NAFLD fibrosis and CAD severity. Conclusions. NAFLD patients with advanced fibrosis are at a high risk of severe coronary artery stenosis, and inflammation might mediate the association between NAFLD fibrosis and CAD severity.

The Role of Neutrophil Lymphocyte Ratio as a Major Adverse Cardiac Events Predictor and Its Correlation with Coronary Severity in Acute Coronary Syndrome Patients with Chronic Kidney Disease: A Case Control and Cross-Sectional Study

BACKGROUND: Acute coronary syndrome (ACS) patients with chronic kidney disease (CKD) are known to have a higher risk of mortality compared to ACS patients without CKD. In ACS patients with CKD, chronic inflammation plays an important role in morphological and functional changes in endothelial cells, resulting in atherosclerosis acceleration associated with coronary severity that leads to an increase in major adverse cardiac events (MACE). AIM: Therefore, this study aims to determine the role of neutrophil lymphocyte ratio (NLR) as a predictor of MACE and its correlation with coronary severity in ACS patients with CKD. METHODS: The study was conducted at National General Hospital Cipto Mangunkusumo Jakarta, Indonesia in October to November 2019. We used quota sampling with two designs study. First, a nested case control study was conducted with a total of 59 ACS patients with CKD: 31 subjects who had experienced MACE as a case group and 28 subjects who had not experienced MACE as a control group. Second, a correlative study with a cross-sectional approach was undertaken. RESULTS: There was no significant difference or relationship between NLR and MACE (p > 0.05; OR = 2.16 [95% CI = 0.63–7.51]), also no correlation between NLR and coronary severity degree assessed using the Gensini score (r = 0.10; p = 0.474). CONCLUSION: NLR can not predict MACE in ACS patients with CKD nor be employed interchangeably with the Gensini score in assessing coronary severity in ACS patients with CKD.

Apolipoprotein B/A1 Ratio Is Associated with Severity of Coronary Artery Stenosis in CAD Patients but Not in Non-CAD Patients Undergoing Percutaneous Coronary Intervention

Background and Aims. Lipid metabolism plays important roles in atherosclerosis. Several studies have found that lipoprotein is associated with coronary artery disease (CAD) and hyperlipidemia. Although the roles of the apolipoprotein B/A1 ratio (ApoB/A1) were originally thought to be atherosclerotic, few studies have focused on the specific relationship between ApoB/A1 and severity of coronary artery stenosis with or without the presence of CAD. Methods. A total of 6956 consecutive patients aged 21–98 years with suspected CAD who had undergone coronary angiography were enrolled. The severity of coronary lesions was evaluated using the Gensini score (GS). The relationships between ApoB/A1 and severity of coronary artery stenosis were evaluated. Results. A total of 1795 non-CAD patients and 5161 CAD patients were included in the observational analysis. Patients with CAD had higher ApoB/A1 than individuals without CAD (0.67 (0.53-0.82) vs. 0.61 (0.49-0.75), p < 0.001 ). In CAD patients, the higher the ApoB/A1 was, the higher the proportion of patients with MI, triple-vessel lesions, and higher Gensini scores. ApoB/A1 was significantly positively correlated with HbA1c and Gensini scores in CAD patients but not in non-CAD patients (all p < 0.001 ). Logistic analyses showed that ApoB/A1 could be a risk factor for multivessel disease (OR: 2.768, 95% CI: 1.868-4.103, p < 0.001 ). ApoB/A1 was found to be significantly positively correlated with the Gensini score in CAD patients. Conclusions. ApoB/A1 is highly associated with the presence and severity of coronary artery stenosis in patients with CAD but not in non-CAD patients.

Correlation between Changes in Serum RBP4, hs-CRP, and IL-27 Levels and Rosuvastatin in the Treatment of Coronary Heart Disease

Objective. To investigate the correlation between changes in serum RBP4, hs-CRP, and IL-27 levels and rosuvastatin in the treatment of coronary heart disease (CHD). Methods. One hundred and twenty patients with CHD admitted in our hospital were selected as the research object, including 60 patients with acute coronary syndrome as the ACS group, and 60 patients with stable angina as the SA group. Another 60 patients without CHD who were examined in our hospital at the same time were included in the non-CHD group. The patients with CHD were further divided into the control group (CG) (n = 42, with routine treatment) and the study group (SG) (n = 78, with routine treatment and rosuvastatin) to measure serum RBP4, hs-CRP, and IL-27 levels and analyze the correlation between each index and rosuvastatin in the treatment of CHD. Results. After retrospective analysis, no significant difference was found among the ACS group, the SA group, and the non-CHD group ( P > 0.05). As for serum RBP4, hs-CRP, and IL-27 levels, ACS group > SA group > non-CHD group, with obvious differences among groups ( P < 0.05). After Spearman correlation analysis, a positive correlation was observed between Gensini score and serum RBP4, hs-CRP, and IL-27 levels in patients with CHD ( P < 0.05). After treatment, serum RBP4, hs-CRP, and IL-27 levels were gradually reduced. At 4 weeks after treatment, serum RBP4, hs-CRP, and IL-27 levels of the CG and the SG were decreased conspicuously, and compared with the control, each index of the SG was obviously lower ( P < 0.05). Conclusion. Serum RBP4, hs-CRP, and IL-27 play an important role in the occurrence and development of CHD, with a positive correlation to the Gensini score, which can indicate the severity of cardiovascular disease to a certain extent. Meanwhile, rosuvastatin can remarkably reduce serum RBP4, hs-CRP, and IL-27 levels, which is of significance for prognosis.

Serum levels of Branched Chain Amino Acids and its Correlation with CA disease severity in diabetics and non-diabetics

Background: Branched chain amino acids are classified as essential amino acids, their role in metabolic disease has recently been established. The current research sort to identify the correlation of BCAAs with severity of coronary artery disease in diabetics and non-diabetics. Aim: To measure and compare blood levels of BCAAs in the following groups of subjects: Diabetics and Non diabetics undergoing angiography under the clinical suspicion of coronary artery disease. Secondly, to correlate serum BCAA levels with Coronary Artery Disease severity by using Gensini Score in each group. Methods: 119 patients who underwent angiography were recruited from cardiology department Mayo hospital, Lahore. They were allocated into two groups, diabetic and non-diabetic on the basis of HBA1c. 5 ml blood was collected, serum was separated and BCAA levels were measured by using internationally available calorimetric kit. Results were described as mean ± SD. Normality of continuous variables were assessed by using Shapiro Wilks test. Variables which were not normally distributed were log transformed. Results: Over all three factors affected BCAA levels; age (Beta= -0.32, p <0.001), male gender (Beta=-0.32, p=<0.001) and diabetic status (Beta=-0.20, p=0.03). Significant factors affecting severity of CAD as indicated by Gensini score were BMI (p=0.016, Beta=-0.22) and age (p=0.019, Beta=0.23). Factors determining the likely diabetes in CAD patients were male gender (p=0.013, Odds ratio 4.92s), BCAA levels (p=0.03, Odds ratio 1.05), age (p=0.01, odds ratio=1.08) and Gensini Score (p=0.05, odds ratio=1.013). Conclusions In CAD patient’s serum BCAA level are affected by age, male gender and diabetes status. Secondly the severity CAD is mainly affected by BMI and age. However the correlation between Gensini score and BCAA is not significant. Keywords: Coronary artery disease, branched chain amino acids, diabetic, serum level

Hyperuricemia and Smoking Correlation in Egyptian Young Adults with Coronary Artery Disease: Observational Study

Background: Young adults, especially those under 35, are often overlooked; however, previous studies have shown that coronary artery disease (CAD) incidence increases rapidly. Previous studies proved many risk factors for CAD, such as hyperlipidemia, hypertension, diabetes, and smoking. The present study ultimately aimed to figure out the correlation between Hyperuricemia (HUA) and smoking in CAD Patients under the age of 35. Methods: This observational study included 100 young adults (18–35 years of age) suspected of CAD. We used the Gensini Score system to ascertain coronary angiography outcome and CAD; based on the number of affected vessels, localization of the segment, and the stenosis grade. The Gensini score being > 0 indicated the presence of CAD. Results: In young adults under 35, there was a significant correlation between HUA and CAD. The interaction between HUA and smoking had a contrast for CAD that statistically shown the existence of CAD increased in patients who have hyperuricemia and non-smokers compared to smokers. Conclusions: By monitoring various parameters in young adults ≤ 35 years old. This study strengthens the correlation between:1) hyperuricemia and the occurrence of CAD, 2) Smoking and the CAD. Furthermore, there is a clear association between HUA and the occurrence of CAD in non-smokers.

Is Coronary Artery Ectasia a Progressive Disease? A Self-Controlled Retrospective Cohort Study

Objective: It is essential to understand whether coronary artery ectasia (CAE) progresses over time because the patients might be under the risk of coronary rupture, and stent implant should be avoided if ectatic changes progress.Methods: A consecutive series of 99 CAE patients who had undergone coronary angiography at least twice were enrolled and followed up for 1–16 years until they received a second angiogram. Subjects were divided into two groups (1–5 vs. 5–16 years of follow-up), then the basic clinical characteristics and coronary artery images were compared over time.Results: (1) All CAE patients exhibited atherosclerosis, and a majority presented with acute myocardial infarction. Most baseline clinical characteristics were relatively stable. (2) Atherosclerosis (indicated by the distribution of stenosis in coronary vessels) and the Gensini scores progressed significantly. Ectasia extent showed minimal changes as indicated by blood vessel involvement, Markis type, coronary blood flow, ectasia diameter, and ectasia length. (3) Multilinear regression analysis revealed that the underlying factors related to stenosis evolution indicated by fold of Gensini score were: longer time interval, lower baseline Gensini score, and higher hypersensitive C-reactive protein concentration. (4) There was a relationship between the ectatic diameter and the extent of stenosis.Conclusions: For CAE patients with atherosclerosis followed for 1–16 years, there was minimal CAE progression, while the atherosclerosis progressed and the ectasia extent was related to degree of stenosis. The results indicate that prevention and treatment of atherosclerotic changes might have more clinical significance than addressing ectatic changes.

623 Coronary ectasia in different clinical subsets: stable and acute coronary syndromes

Aims Coronary artery ectasia (CAE) is not a rare finding in coronary angiography with a prevalence ranging from 1% to 20% according to clinical setting. The aim of this study was to analyse the angiographic differences of coronary ectasia based on admitting diagnosis. Methods and results A cohort study was conducted including patients with angiographic evidence of CAE between January 2016 and December 2020. The study population was divided into two groups according to the clinical presentation: stable coronary artery disease (SCAD) and acute coronary syndrome (ACS). Markis classification, basal thrombolysis in myocardial infarction (TIMI) flow of each coronary artery, associated coronary artery obstruction (CAO), and respective Gensini score were reported. A total of 144 patients were included in this study. No difference were found concerning age or the traditional cardiovascular risk factors. Compared to general population, higher rates of myocardial infarction with non-obstructive coronary arteries (MINOCA) and ischaemia with non-obstructive coronary arteries (INOCA) (31% of the entire ACS cohort and 42% the SCAD group, respectively) were observed. Furthermore, irrespective of lower Gensini score values, MINOCA patients showed significantly more widespread CAE and a more severe impairment of coronary flow compared to SCAD and obstructive ACS patients. Conclusions CAE patients show a surprisingly high rate of acute coronary syndromes with non-obstructive coronary arteries. The extent of the ectatic involvement and its consequences on coronary blood flow could be the base of the higher rate of ACS events observed in this population, recognizing mechanisms other than plaque rupture.