Sama Alchalabi

Additive prognostic value of coronary artery calcium score over coronary computed tomographic angiography stenosis assessment in symptomatic patients without known coronary artery disease.

The objective of this study was to examine the additive prognostic performance of coronary artery calcium score (CACS) over coronary computed tomography angiography (CCTA) stenosis assessment in symptomatic patients suspected for coronary artery disease (CAD) undergoing CCTA. A total of 805 symptomatic patients without known history of CAD who underwent coronary evaluation by multidetector cardiac CT were analyzed. Mean age of the cohort was 58 ± 13 years. A total of 44% (354 of 805) of the patients had a 0 CACS, 27% (215 of 805) had CACS 1 to 100, 14% (111 of 805) had CACS 101 to 400, and 15% (125 of 805) had CACS >400. CCTA showed normal coronary arteries in 43% (349 of 805) of patients, ≤50% stenosis in 42% (333 of 805), and >50% stenosis in 15% (123 of 805). Patients were followed for 2.3 ± 0.9 years. Major adverse cardiac event (MACE) was defined as cardiac death, nonfatal myocardial infarction, and late coronary revascularization. Overall incidence of MACE was 1.4% per year. Both CACS and CCTA stenosis were independently associated with increased MACE (p <0.05 for both). Addition of CACS into the model with clinical risk factors and CCTA stenosis significantly improved predictive performance for MACE from the model with clinical risk factors and CCTA stenosis only (global chi-square score 108 vs 70; p = 0.019). In conclusion; in symptomatic patients without known CAD, both CACS and CCTA stenosis were independently associated with increased cardiac events, and performing non-contrast-enhanced CACS evaluation in addition to contrast-enhanced CCTA improved predictive ability for future cardiac events compared to CCTA stenosis assessment alone.

Association Between Hematological Indices and Coronary Calcification in Symptomatic Patients without History of Coronary Artery Disease

Background: Atherosclerotic coronary artery disease (CAD) has long been shown to involve chronic low-grade subclinical inflammation. However, whether there is association between hematological indices assessed by complete blood count (CBC) and coronary atherosclerotic burden has not been well studied. Materials and Methods: Consecutive 868 patients without known CAD who presented with acute chest pain to emergency department and underwent coronary artery calcium (CAC) scoring evaluation by multi-detector cardiac computed tomography were included in our study. Clinical characteristics and CBC indices were compared among different CAC groups. Results: The cohort comprised 60% male with a mean age of 61 (SD = 14) years. Median Framingham risk of CAD was 4% (range 1-16%). Median CAC score was 0 (IQR 0-43). Higher CAC groups had significantly higher Framingham risk of CAD than lower CAC groups (P < 0.001). Among different CAC categories, there was no statistically significant difference in hemoglobin level (p 0.45), mean corpuscular volume (p 0.43), mean corpuscular hemoglobin (p 0.28), mean corpuscular hemoglobin volume (p 0.36), red cell distribution width (0.42), total white blood cell counts (p 0.291), neutrophil counts (p 0.352), lymphocyte counts (p 0.92), neutrophil to lymphocyte ratio (p 0.68), monocyte count (p 0.48), and platelet counts (p 0.25). Conclusion: Our study did not detect significant association between hematological indices assessed with CBC and coronary calcification in symptomatic patients without known CAD.

Transarterial direct left ventricular pacing.

Case Report Introduction A 77-year-old male with sick sinus syndrome status post pacemaker placement was admitted for arterial embolectomy of the left foot after an embolic event. Chest X-ray revealed an abnormal course of the pacemaker suggestive of a lead in the left ventricle (LV) (Figure 1a). The lead appeared to have entered through the left subclavian artery into the aorta, crossed the aortic valve, and lodged into the LV (video clip 1). An electrocardiogram (ECG) showed right bundle branch block (RBBB) pattern of the paced beat (Figure 1b). It was thought that emboli originated from this lead and caused lower extremity ischemia. Transesophageal echocardiography was negative for thrombi and confirmed the course of the pacer wire in the aorta and LV (video clip 2). The patient underwent successful lead extraction. Subsequently, a new pacemaker was placed in the right ventricle (Figure 1c) with a different QRS morphology (Figure 1d).

CORONARY ARTERY CALCIUM SCORE OFFERS ADDITIVE VALUE TO CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY FOR PREDICTION OF MAJOR ADVERSE CARDIOVASCULAR EVENTS IN PATIENTS WITH SUSPECTED CORONARY ARTERY DISEASE

Added predictive ability of Agatston coronary artery calcium score (CACS) to coronary computed tomography angiography (CCTA) for prediction of adverse cardiovascular events has not been well described. A total of 805 patients without known history of coronary artery disease (CAD) who had chest pain