Sayf Khaleel bala

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).

Atherosclerosis Burden in Patients with Acute Chest Pain: Obesity Paradox

Obesity paradox has been described in various populations of coronary artery disease, mainly asymptomatic subjects. However, relationship between obesity and coronary artery calcification detected by cardiac CT in symptomatic patients has rarely been demonstrated. This study seeks to investigate whether the paradoxical relationship between obesity and coronary artery calcification exists in patients with acute chest pain. A final cohort of 1030 chest pain patients presenting at our emergency department who underwent coronary evaluation by multidetector cardiac CT were examined. With absent-to-mild coronary calcification (CAC score < 100) as a referent, multivariable analysis showed that presence of obesity (OR 0.564; 95% CI 0.395, 0.806; P 0.002), body mass index (OR 0.945; 95% CI 0.920, 0.971; P < 0.001), body weight (OR 0.987; 95% CI 0.979, 0.995; P 0.001), and body surface area (OR 0.582; 95% CI 0.369, 0.920; P 0.020) were inversely associated with moderate-to-severe coronary calcification (CAC score ≥ 100). This study extends the concept of obesity paradox to symptomatic patients undergoing coronary artery calcium score assessment. However, biological explanation(s) of this paradox remains unanswered.

PROGNOSTIC VALUE OF CORONARY COMPUTED TOMOGRAPHIC ANGIOGRAPHY WITH PROSPECTS ECG GATING

Coronary Computed Tomographic Angiography (CCTA) with prospective ECG gating (PG) reduces radiation exposure as compared to retrospective ECG gating (RG), yet its prognostic value is less validated. Our aim was to compare prognostic performance of 64 slice CCTA with PG vs RG in patients (pts) with