Risultati per: Informazioni per i pazienti con angina pectoris

Circulation, Volume 150, Issue Suppl_1, Page A4140212-A4140212, November 12, 2024. INTRODUCTION:Nicorandil, a dual mechanism anti-anginal used in Europe, Asia, and Australia for >20 years acts as NO donor and K+ATP channel opener, providing balanced pre- and afterload vasodilation. Antianginal efficacy matches beta and calcium channel blockers, and long-acting nitrates but without tolerance build-up. Immediate release nicorandil (IR NIC) taken 2-3 times daily with 80% dose release in 45 min, requires high patient adherence. While EU labeling and trials highlight no proarrhythmogenicity lack of recent data remains along with prior reports of potential impact of IR NIC on EKG patterns. Once-daily extended-release nicorandil (ER-NIC) AUX-001 is being developed to improve compliance, symptom control, and QoL for chronic stable angina patients.ONJECTIVE:Examine ER NIC impact on EKG patterns before and after 2 sequential 24h single-dose exposures during fed and fasting status.METHODS:12-lead EKG was recorded in 16 adult healthy volunteers at baseline. Peak systemic exposure of ER NIC was predicted at 6h post dose. Consequently, postdose EKG was scheduled at 6h after AUX-001 administration, with 24h monitoring. Variables included PR, ST, QT, and TP interval and P, QRS and T wave duration. QT interval was corrected using Bazett’s and Fridericia’s formula.Results:12-lead EKGs were available on 16 fasting and 15 fed patients. None discontinued due to safety or tolerability. 13 EKGs at baseline on day 1, and 14 on day 8 showed non-clinically relevant abnormalities. No clinically relevant abnormalities were found at baseline or 6h postdose. Mean HR was 58±5.8 and 59±6.2 at baseline and 68±8.2 and 67±6.7 at 6h for fasting and fed. Mean QTc (Bazett) was 395±19 ms pre- and 400±18 ms 6h postdose under fasting and 395±14 and 399±16 ms under fed status. Mean PR interval was 170±22 ms pre- and 160±21 ms 6h post-dose fasting and 169±17 and 158±18 under fed status.CONCLUSION:Single dose AUX-001 caused near no QTc changes in healthy volunteers compared to baseline. 6h postdose PR intervals physiologically adjusted to changing HR, and stayed within normal range. Similar to IR NIC, AUX-001 had no discernable effect on EKG patterns during fasting or fed conditions. Findings highlight no relevant AUX-001 effect on electrophysiological safety providing additional safety information supporting development of ER NIC. Findings also confirm previous healthy volunteer trials with IR NIC highlighting no tendency promoting arrhythmia in normal, non-ischemic myocardium.

Circulation, Volume 150, Issue Suppl_1, Page A4139722-A4139722, November 12, 2024. Background:There is suspicion that estrogen may protect against atherosclerosis. Women who experience menarche earlier, and thus have earlier estrogen exposure, might develop atherosclerosis later. The relationship between menarche age and the onset of angina pectoris, a symptom of coronary artery disease, remains unknown.Goal:This study aims to find the correlation between menarche age and the onset age of angina pectoris, and the association between early menarche (onset of menarche ≤ 10 y/o) and early onset of angina pectoris (onset of angina pectoris ≤ 40 y/o).Methods:A cross-sectional study using a population from the 2017-2020 National Health and Nutrition Examination Survey (NHANES). The question collects self-reported data on onset of menarche and onset of angina pectoris. The relationship between menarche age and age in onset of angina pectoris was analyzed by linear and logistic regression analysis. Multivariate analysis adjusted for race, age, body mass index (BMI), smoking , diabetes mellitus (DM), hypertension, and dyslipidemia status.Results:Among 4,816 females who reported their menarche age, 88(1.8 %) have had an angina pectoris. The study involved 82 females who reported both the age of menarche and the age of onset of angina pectoris. The mean ± SD of the age at menarche and the age at onset of angina pectoris was 12.53 ± 1.79 y/o and 51.66 ± 15.16 y/o, respectively. The study found a significant association between the menarche age and the age at onset of angina pectoris. After adjusting for confounders, we found that every 1-year increase in the age of menarche will delay the onset of angina pectoris by 1.43 years, with a 95% CI of 0.01 to 2.86.(Table 1A,Graph 1A-1B)We also found that early menarche has a significantly increased risk 2.8 times (95%CI: 1.3, 6.2) of early onset of angina pectoris.After adjusting for confounders, the association became even stronger. The odds ratio (OR) increased to 3.3 (95%CI: 1.4, 8.0), indicating that women with early menarche were 3.3 times more likely to experience early angina pectoris compared to those with later menarche.(Table 2A)Conclusion:In contrast to our hypothesis, age at menarche is positively associated with onset of angina pectoris. The earlier onset of menarche is linked to the earlier onset of angina pectoris. We suspected that factors beyond estrogen levels may contribute to this unexpected finding. Additional studies are needed to examine the cause of this correlation.

Circulation, Volume 150, Issue Suppl_1, Page A4146931-A4146931, November 12, 2024. Introduction:Despite the continuous development of the medical therapeutic revolution, there are many conditions that pose a great challenge and are still spreading at increasing rates, such as refractory angina (RA), which is considered a burden on patients and on the health systems. However, with the emergence of effective treatment options such as a coronary sinus reducer (CSR) that works to narrow the coronary sinus in controlled manner aiming to restore efficient blood flow and reduce symptoms.Purpose:We aimed to study the effectiveness of CSR in patients with refractory angina (RA), and give a comprehensive appraisal from the published records.Methods:A comprehensive search was done on PubMed, Cochrane Library, Scopus, and WOS until Feb 2024. We included studies that assessed the effectiveness of CSR in patients with RA. Clinical improvement, implantation success, periprocedural complications, revascularization, 6MWT distance and change in SAQ score were our outcomes of interest.Results:18 studies comprising 1149 patients were included in the analysis. The pooled implantation success was 98% (95% CI: 97% to 99%), clinical improvement > 1 class was 63% (95% CI: 52% to 72%), and clinical improvement > 2 class was 37% (95% CI: 32% to 41%). The incidence rate of periprocedural complications and PCI was reported as follows, respectively (OR: 0.05, 95% CI: 0.03 to 0.08, and 0.37, 95% CI: 0.18 to 0.61). Moreover, the incidence rate of all-cause mortality was low (OR: 0.06, 95% CI: 0.03 to 0.11). Regarding physical activity and quality of life, CSR improved 6MWT distance (MD = 323.82, 95% CI: 273.52 to 372.13), and all categories of SAQ score either angina frequency, angina stability, physical limitation, quality of life, or treatment satisfaction.Conclusion:Coronary Sinus Reducer is a promising treatment for the management of refractory angina, as it showed clinical improvement with higher implantation success. It also improved the physical activity and quality of life scores. Large-volume RCTs are warranted to test the efficacy of CSR in a long-term manner.

Circulation, Volume 150, Issue Suppl_1, Page A4137895-A4137895, November 12, 2024. Background:Poor clinical outcomes for patients undergoing hemodialysis (HD) after drug-eluting stent (DES) implantation have been reported. High-density lipoprotein (HDL) cholesterol is well-established as a negative risk factor for coronary artery disease, and its anti-oxidant property has been attributed mainly to the HDL-bound enzyme paraoxonase-1 (PON-1). Myeloperoxidase (MPO), a pro-oxidant enzyme released from activated neutrophils, has been shown to alter the atheroprotective function of HDL to a dysfunctional form. The aim of this study was to investigate the relationship between plasma MPO and serum PON-1 levels after implantation of DES in patients with stable angina pectoris (SAP) with and without HD.Methods:Serum PON-1 concentrations and PON-arylesterase activity were measured in 183 patients with SAP after DES implantation (HD group, n=37; non-HD group, n=146) with a sandwich ELISA method. Cardiovascular events were defined as sudden cardiac death, fatal or non-fatal myocardial infarction, cerebral infarction and other non-fatal events including unstable angina pectoris or coronary revascularization.Results:Serum PON-1 concentrations and PON-arylesterase activity were significantly lower in the HD group than in the non-HD group (PON-1 concentrations, P

Circulation, Volume 150, Issue Suppl_1, Page A4146122-A4146122, November 12, 2024. Introduction:Clonal hematopoiesis of indeterminate potential (CHIP) poses strong relationship to the occurrence of cardiovascular diseases with the process of aging. IL-1β is associated with both CHIP and atherosclerotic lesions stabilization. However, potential protective effects of CHIP and IL-1β elevation in angina pectoris have been barely explored.Hypothesis:We hypothesis CHIP protects against angina pectoris via preventing atherosclerotic lesions rupture by the effect of IL-1β.Methods:In UK Biobank population with exome sequencing data, participants with any CHIP or large CHIP were defined as those with variant allele fraction (VAF) ≥ 2% or 10% respectively on any CHIP gene. Angina pectoris, stable angina pectoris and unstable angina pectoris was defined as main diagnosis of inpatient record in terms of ICD-10 code I20, I20.8 and I20.0, respectively. The effects of CHIP on angina pectoris were estimated in logistic regression models, including age, sex, and history of atherosclerotic heart disease as covariates. Propensity score matching (PSM) of 1:1 was applied for more stringent analysis. Proteomics analysis was carried out using linear regression model.Results:Total 465769 participants were included for final analysis (aged 56.5±8.1 years, 45.7% male) after excluding those with hematological malignancy. Covariate-adjusted models showed that large CHIP significantly protected against angina pectoris (OR=0.863, p=0.019), especially the unstable angina pectoris subtype (OR=0.931, p=0.028). Both any CHIP and large CHIP of specific genes manifested significantly protective effects on angina pectoris (ORany=0.104, p

Circulation, Volume 150, Issue Suppl_1, Page A4144001-A4144001, November 12, 2024. Introduction:Diabetes mellitus (DM) is a risk factor for coronary microvascular dysfunction (CMD) and endothelial dysfunction. These disorders and other syndromes of angina and nonobstructive coronary arteries (ANOCA) are increasingly recognized. However, the association between DM and non-CMD ANOCA endotypes, such as vasospastic angina (VA) and symptomatic myocardial bridging (MB), is not well defined. This study aims to report the findings of coronary function testing (CFT) in patients with DM and to determine the association between DM and specific ANOCA endotypes.Methods:We conducted a retrospective study of patients who underwent clinically indicated invasive coronary angiography and CFT with intracoronary acetylcholine provocation and bolus thermodilution between January 2018 and May 2024. Data regarding patient demographics, medical history, and physiological measurements—including coronary flow reserve (CFR), index of microcirculatory resistance (IMR), fractional flow reserve (FFR), resting full-cycle ratio (RFR), and post-procedure diagnosis—were obtained.Results:233 patients were included, 163 (70%) were female, with a mean age of 57 ± 11 years. Of the total cohort 52 patients (22.3%) had DM. Among patients with DM, 23 (44%) had CMD, 13 (25%) had VA, 6 (12%) had mixed CMD/VA, 11 (21%) had endothelial dysfunction, and 4 (7.7%) had other phenotypes such as elevated resting flow and MB. The median CFR was reduced in patients with DM compared to those without DM (2.6 vs. 3.45; p=0.001), and the median IMR was higher (28 vs. 19; p

Circulation, Volume 150, Issue Suppl_1, Page A4137900-A4137900, November 12, 2024. Background:The phenotype of epicardial vasospasm is classified as focal or diffuse. However, its echocardiographic characteristics are unknown. Furthermore, patients with diffuse vasospasms have poorer responses to medical therapy than patients with focal spasms because of more extensive areas of endothelial dysfunction. We hypothesized that there are differences in echocardiographic findings between the patients with diffuse and focal vasospasm, which might affect response to medical therapy.Methods:The present study was a single-center retrospective cohort study that included 77 consecutive patients diagnosed with vasospastic angina (VSA) undergoing coronary spasm provocation test using acetylcholine from 2014 to 2024. The patients with a history of cardiomyopathy and significant obstructive coronary artery disease were excluded. Diffuse VSA was defined as vasospasm in 2≧ adjacent coronary segments, and focal VSA was defined as vasospasm in one isolated coronary segment. Patients were divided into diffuse VSA group (n=45) and focal VSA group (n=32). Left ventricular function was assessed using 2D speckle tracking echocardiography. After the diagnosis of VSA and the administration of medical treatment for VSA, an emergency room (ER) visit with a chest pain attack was recorded as the event of poor response to medical therapy.Results:There was no significant difference in the follow-up period and baseline characteristics (Table). LVEF was similar between the two groups (63.1±5.8% vs. 62.9±7.6%,p=0.87). In contrast, the left ventricular global longitudinal strain (LV-GLS) was significantly lower in the diffuse VSA group than in the focal VSA group (17.4±2.8% vs. 20.2±2.4%p

Circulation, Volume 150, Issue Suppl_1, Page A4138477-A4138477, November 12, 2024. Background:Microvascular angina (MVA), resulting from coronary microvascular dysfunction, affects 40-50% of patients with exertional chest pain or dyspnea and a normal coronary angiogram. This condition significantly impairs quality of life and elevates the risk of major cardiac events, including myocardial infarction, stroke and death. MVA is classified as ‘structural’ (coronary flow reserve [CFR] 25) or ‘functional’ (CFR

Circulation, Volume 150, Issue Suppl_1, Page A4144202-A4144202, November 12, 2024. [Background]:Evidence on the long-term prognosis of stent-less percutaneous coronary intervention (PCI) using paclitaxel-coated balloons (PBCs) is becoming established, however some prognostic indicators remain unexplored. Recently, elevated blood lipoprotein(a) levels are gaining attention as an independent risk factor for the development of atherosclerosis. We hypothesized that elevated lipoprotein(a) levels would also adversely affect the outcome of stent-less PCI.[Object]:The aim of this study is to investigate the association between lipoprotein(a) levels and outcomes after stent-less PCI.[Methods]:In this single-center retrospective study, patients with stable angina undergoing stent-less PCI with PCBs in de novo lesions at our institution were included between October 2016 and September 2022. We classified all patients into three groups according to lipoprotein(a) tertiles and performed a Cox proportional hazards analysis. The primary endpoint was a composite outcome of cardiovascular death, major bleeding, myocardial infarction, and target lesion revascularization.[Results]:A total of 207 patients were included, including a mean age of 70±11 years and 75% male. The median lipoprotein(a) level was 12.4 nmol/L (IQR 4.8-21.4 nmol/L). During a median follow-up of 18 months, the composite outcome was observed in 37 patients (17.9%). Patients with the highest lipoprotein(a) group (≧18.4 nmol/L) had a 4-fold higher risk than those with the lowest group (

Circulation, Volume 150, Issue Suppl_1, Page A4144097-A4144097, November 12, 2024. Introduction:Coronary-bronchial artery fistula (CBF) is a rare finding with an incidence of 0.08 to 0.61%. Patients may present with chest pain, dyspnea, or hemoptysis. Transcatheter interventions provide definitive treatment for symptomatic patients. Herein, we present a case of recurrent chest pain due to CBF involving the sinoatrial nodal (SAN) artery.Case:A 75-year-old lady presented with recurrent midsternal chest pain for several years. Her medical history was notable for pulmonary emboli (PE), and antiphospholipid syndrome. Initial investigation showed mildly elevated high sensitivity troponin to 28.9 ng/L. ECG showed normal sinus rhythm without ischemic abnormalities. Prior ischemic work-up including dobutamine stress echocardiogram and invasive coronary angiography was unremarkable. Ventilation perfusion (V/Q) scan showed multiple areas of VQ mismatch. Computed tomography coronary angiography (CTCA) showed a dominant RCA with a 2.5 mm communication between the SAN artery and left bronchial artery. After a heart team discussion, the patient was offered definitive treatment. A 6 Fr FR4 Mach 1 Guide catheter was used for selective right coronary angiography. A steerable microcatheter floppy 0.014”x 300 cm wire was used to engage the fistula originating from SAN artery (Figure 1). A micro vascular plug was successfully deployed over the wire without endangering sinus nodal supply. Post-intervention there was decrease in flow from the SAN to the bronchial artery (Figure 2). At one month follow up the patient was chest pain free.Discussion:Patients with pulmonary vascular disease might be predisposed to CBF, as chronic pulmonary ischemia might augment collateral blood flow. As a result, coronary steal phenomenon may lead to atypical angina. CTCA is a helpful screening tool, while transcatheter intervention may benefit symptomatic individuals.Conclusion:CBF should be considered in patients with history of PE and recurrent chest pain of unclear etiology.

Circulation, Volume 150, Issue Suppl_1, Page A4147235-A4147235, November 12, 2024. Background:Sex differences in angina frequency and health status have been previously described in patients with chronic coronary disease (CCD), with women more severely affected despite lesser coronary artery disease (CAD) severity. Psychosocial factors, such as perceived stress and depression, are associated with increased angina and are more common in women and in those with ischemia and no obstructive coronary artery disease (INOCA). We examined whether perceived stress and depressive symptoms mediate sex differences in angina severity among patients with CCD, and whether this relationship differs between those with CAD vs. INOCA.Methods:The association between sex, stress (Perceived Stress Scale-4) and depressive symptoms (Patient Health Questionnaire-8) and angina-specific health status (Seattle Angina Questionnaire, SAQ) at enrollment and changes over 1 year in North American ISCHEMIA participants and in the CIAO-ISCHEMIA study (INOCA) were compared using linear regression.Results:Among 1,626 participants (N=1,439 CAD and N=187 INOCA) with available SAQ, PSS-4 and PHQ-8 data, women had worse SAQ-7 summary scores than men in both CAD and INOCA cohorts (Table). Higher stress and depressive symptoms were associated with worse angina in both CAD and INOCA cohorts. Given consistency of results, cohorts were pooled for multivariable analysis. Female sex, PSS-4 score and PHQ-8 score were each independently associated with lower SAQ scores, (female vs. male difference -5.12 points, 95% CI -7.21, -3.02, p=0.001; PSS-4 -0.78 per point, 95% CI -1.06, -0.50, p=0.001; PHQ-8 -1.38 per point, 95% CI -1.58, -1.18, p=0.001) but CAD vs. INOCA was not and the effects were similar by sex.Conclusions:Women, with both CAD and INOCA, had worse angina and angina-related health status than men. High stress and depressive symptoms were each independently associated without a significant interaction by sex, and regardless of presence of obstructive CAD. Therefore, stress and depression levels are not a central explanation for worse health status in women than men with CAD or INOCA.

Circulation, Volume 150, Issue Suppl_1, Page A4146119-A4146119, November 12, 2024. Introduction:Refractory angina (RA) is a challenging and debilitating condition in the presence of myocardial ischemia regardless of a combination of antianginal drugs and revascularization procedures. Among the phenotypes of RA, there is angina in the absence of obstructive coronary disease (ANOCA). Coronary artery fistulas (CAF) are rare connections between coronary arteries and heart chambers or vessels. 3% of CAF drain into the left ventricle (LV), which can lead to the coronary steal phenomenon and angina in the form of ANOCA. We report here under a case of symptomatic chronic coronary syndrome (CCS) and CAF.Case Report:An 85-year-old woman with CCS had angina progression, reaching functional class 3 and frequent need of nitrate use, despite the use of three antianginal drugs. Stress myocardial perfusion scintigraphy showed reversible hypoperfusion in the lateral, inferolateral and inferior LV walls. A coronary angiogram was performed, revealing the absence of obstructions. However, CAF for the LV was identified around the ischemic territory. It was decided to start our Alopurinol protocol for RA. A treadmill test was done before and after the treatment to assess time to angina occurrence and ST segment change. After 3 months, there were an improvement in the threshold and intensity of angina (class 2) and reduction in nitrate need. In a new scintigraphy, normalization of perfusion was observed, and a new treadmill test showed reduction of 4.1 minutes for angina occurrence with an increase of 1.7 mets and no difference in ST change.Discussion:CAF are rare, identified in up to 0.2% of angiograms. They can lead to heart failure (HF), myocardial ischemia and arrhythmias. Treatment is based on the clinic, the patient’s age and the hemodynamic significance of the CAF. For adults, one of the indications for CAF occlusion is the presence of myocardial ischemia. However, the association between RA and CAF is rarely described in the literature. In the present report, we illustrate the case of an octogenarian with RA, ANOCA and FAC who, before considering interventional treatment, underwent medical optimization with excellent response and improvement in cardiac perfusion and exercise tolerance.Conclusion:In the scenario of RA and ANOCA, a combination of different antianginal drugs can promote symptoms control and improvement of myocardial perfusion and exercise performance, even in the face of uncommon causes such as the one here reported.

Perrone (Aiom) ,rischio concreto di un ulteriore aumento dei costi a carico dei malati

Colpiti 537 milioni nel mondo e 4 in Italia, tendenza in aumento

Circulation, Ahead of Print.

Introduction
Stimulating acupoints is beneficial for improving heart health but the clinical efficacy of transcutaneous electrical acupoint stimulation (TEAS) as a complementary therapy for chronic coronary syndromes (CCSs) remains unclear. This study aims to evaluate whether TEAS can alleviate angina severity in patients with CCS and to explore the potential mechanisms underlying TEAS.

Methods and analysis
This study, conducted across two clinical centres, involved 90 participants distributed equally into three groups via simple randomisation (1:1:1 ratio). The research cycle was 28 weeks including a 4-week baseline, 12-week treatment and 12-week follow-up period. All groups will receive basic treatment with the TEAS group additionally receiving 36 sessions of TEAS stimulation over the 12 weeks. The two control groups will either undergo sham TEAS or no additional intervention alongside their basic treatment. The primary outcome is the 6-minute walk test; eight other indicators will serve as secondary outcomes.

Ethics and dissemination
Approval for this study was granted by the Medical Research Ethics Committee of the Third Clinical Affiliated Hospital of Changchun University of Chinese Medicine in May 2023. Findings will be disseminated through peer-reviewed publications.

Trial registration number
ChiCTR2400079383.