DOI: 10.3897/bgcardio.31.e142199

Authors: F. Farabi, M. N. Afifa, P. Puspawikan, B. B. Tiksnadi

Abstract: Background: Coronary collateral plays a role in maintaining myocardial function, limiting infarct size, and reduced morbidity and mortality. Uric acid to albumin ratio (UAR) has recently been discovered as a novel biomarker associated with cardiovascular disease. However, studies investigating the relationship between UAR and coronary collateral circulation (CCC) formation are limited and have low magnitude. Therefore, this study aims to determine the relationship between UAR and CCC formation in coronary artery disease patients. Methods: The literature was searched in PubMed, Medline, SpringerLink, ScienceDirect, and Scopus for articles published before August 2024. Studies that did not report UAR results as one of the parameters but included uric acid and albumin in their laboratory parameters, had UAR values calculated using the error propagation for ratio formula. Statistical analysis for meta-analysis using Review Manager 5.4 software to evaluate the relationship between UAR and CCC. Results: A systematic search retrieved nine studies that met the eligibility criteria. The total population in these studies was 5290 subjects, including 3744 subjects with good coronary collateral circulation and 1546 subjects with poor coronary circulation. Four of the nine studies assessed albumin parameters using glycated albumin and one study assessed albumin parameters using ischemic modifi ed albumin. The uric acid/albumin ratio is correlated with CCC formation, with the lower the UAR, the more likely CCC formation will occur (SMD -0.31, 95% CI -0.56 to -0.05, p-value 0.02, I2 93%). In the subanalysis of the different parameters, uric acid is also correlated with CCC formation (SMD -0.41, 95% CI -0.74 to -0.08, p-value 0.01, I2 96%), while albumin has no strong correlation. Conclusion: Uric acid to albumin ratio could be a new parameter in predicting the formation of coronary collateral circulation in patients with stable coronary artery disease.

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DOI: 10.3897/bgcardio.31.e152709

Authors: H. Nough, M. Dehghanifirouzaadi, A. Nough, R. Sadeghi, N. Yoshany

Abstract: Background and Objective: Coronary artery ectasia (CAE), a diffuse or focal dilatation of coronary arteries, remains poorly understood. While the neutrophil-to-lymphocyte ratio (NLR) is a well-established infl ammatory marker in cardiovascular diseases, its diagnostic role in CAE is unclear. This study aimed to evaluate the diagnostic utility of NLR in CAE and explore its association with disease severity. Material and Methods: In this case-control study, 115 patients (28 CAE, 87 controls) admitted to Shahid Sadoughi Hospital (2012–2020) were analyzed. Demographic data, medical history, and complete blood count (CBC)-derived NLR were compared using SPSS and appropriate statistical tests. Results: The mean NLR did not differ signifi cantly between CAE (0.79 ± 2.01) and control groups (1.46 ± 2.07) (P = 0.830), nor by age, sex, or ectasia extent. However, NLR was lower in three-vessel involvement (0.49 ± 1.66) versus single-vessel involvement (1.04 ± 2.32) (P = 0.036). Conclusion: NLR lacks diagnostic value for CAE but may correlate with disease burden, as evidenced by reduced NLR in multi-vessel involvement. Further research should investigate NLR’s pathophysiological role and alternative infl ammatory markers in CAE.

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DOI: 10.3897/bgcardio.31.e152971

Authors: R. Talhi, S. Amrit, K. Chenni, D. Larbi, M. Raiah, A. Ghalmi, A. Abdelouahab, N. A. Khelifi Touhami, N. Ouchene, M. Bouziani, M. Farouk Mesli

Abstract: Acute coronary syndrome (ACS) is a heterogeneous and severe acute cardiovascular event, with an early mortality rate estimated at 10.5% in western Algeria. Existing ischemic risk stratifi cation scores for ACS vary in complexity and present certain limitations. The primary objective of this study is to develop and validate a prognostic score for ACS, based on a cohort of patients admitted to the three cardiology departments of Oran ; University Hospital Establishment (UHE), University Hospital Center (UHC) and Regional Military University Hospital (RMUH), with the aim of predicting 30-day mortality. This epidemiological, multicenter, observational study included all patients hospitalized for ACS between 2018 and 2020, with 30-day all-cause mortality as the primary endpoint. The fi nal predictive model was derived using binary logistic regression in a cohort representing 71% of the initial population, while the remaining 29% was used for validation. Model calibration was assessed using the Hosmer-Lemeshow test, and discrimination was evaluated based on the area under the Receiver Operating Characteristic (ROC) curve and C-statistic. A total of 1692 eligible patients were recruited, with a predominance of males (75%) and a mean age of 61 ± 12 years. The developed score consists of seven independent dichotomous variables, yielding a maximum total of ten points. It demonstrated good calibration (p = 0.906) and a discrimination of 0.76 [95% CI: 0.73-0.78] in the derivation cohort, compared to 0.71 [95% CI: 0.66-0.75] in the validation cohort. A new, simple, reproducible, and validated decision-support tool is proposed for practitioners. This prognostic score, designed to be quickly and easily calculated, provides an effective means of predicting 30-day mortality in ACS patients and is well-suited to emergency department practices.

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DOI: 10.3897/bgcardio.30.e139418

Authors: J.W. Martha, A.H.S. Katamihardja, A. Nazir, N. Sylviana, D.K. Turbawaty, B.B. Tiksnadi

Abstract: Introduction: Cardiac rehabilitation may improve health outcomes in coronary artery disease (CAD) patients, but the mechanism is still unknown. Collateralization and improvement of microvascular fl ow is one of the hypotheses underlying this mechanism, however research on this is scant and inconclusive. Collateralization is affected by VEGF expression and has the effect of improving myocardial perfusion. Therefore, this study aimed to assess VEGF levels and myocardial perfusion before and after cardiac rehabilitation. Methods and Results: This study is a comparative study of patients who received cardiovascular rehabilitation treatment at Dr. Hasan Sadikin Hospital. The subjects of this study were consecutively selected from patients who received cardiovascular rehabilitation treatment at Dr. Hasan Sadikin Hospital. The primary outcome of this study is to assess the expression of VEGF A and myocardial perfusion in coronary artery disease patients who have undergone complete revascularization before and after phase II cardiac rehabilitation. Conclusion: This study will assess the benefi cial effects of phase II rehabilitation in more detail as it uses proteomics parameters to determine the underlying mechanism and assesses myocardial perfusion as an outcome.

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DOI: 10.3897/bgcardio.30.e138638

Authors: D. Junior, I G.N.A.S. Diksha, I G.A.M.H. Prawista, R.C. Suteja, I K.H. Adiputra, G.V. Purnama, C.A.W. Purnamasidhi, C.W.D. Sinardja, I G.B.G.P. Putra, S. Harkitasari

Abstract: Myocardial infarction is one of the leading causes of global mortality and is strongly associated with permanent damage and sudden cardiac death. The human heart loses its proliferative ability after birth as cardiomyocytes are compelled to differentiate into mature cells focusing on hypertrophy. Based on the review of existing studies, we hypothesised that the combination of hypoxia and 3, 3', 5-triiodo-L-thyronine (T3) inhibitors could potentially be a more sustainable treatment method. We searched trusted scientific databases, such as PubMed, Directory of Open Access Journals (DOAJ), and Scopus, for relevant studies. T3 is a physiological hormone that was found to promote cardiomyocyte differentiation and inhibit its proliferation. Studies implied that inhibiting T3 during perinatal development could preserve the heart’s proliferative and regenerative capacities for a more extended period. Several animal experiments and human studies have found that inducing a hypoxic environment could revert cardiomyocytes to their endogenous proliferative state. However, long periods of hypoxia were not sustainable due to its deleterious effects on the human body. We suggested that administering T3 inhibitors after the cardiomyocytes have been reverted under hypoxic conditions could enable patients to leave the hypoxic environment while preventing physiological maturation by T3, thus preserving the heart’s regenerative capacity.

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DOI: 10.3897/bgcardio.30.e143668

Authors: Aleksandar Aleksandrov

Abstract: Editorial

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DOI: 10.3897/bgcardio.29.e100666

Authors: G. Slavchev, N. Mileva, A. Dacheva, E. Mekov, S. Dzhambazov, D. Vassilev

Abstract: Introduction: Fractional fl ow reserve (FFR) implies the ratio of the maximal hyperemic myocardial blood fl ow in the case of a pathologically changed coronary artery to the maximal hyperemic myocardial blood fl ow in the case of a healthy coronary artery. Aims: The aim of the current study is to perform an economic evaluation and budget impact analysis of measuring FFR as a medical activity in Bulgaria. Material and Methods: For the purpose of the current analysis, two models using Microsoft Excel and TreeAge Pro were developed to evaluate the cost-effectiveness of the FFR-guided percutaneous coronary intervention (PCI) compared to the classic angiography-guided PCI in patients with ischemic heart disease (IHD) with one-vessel coronary artery disease (CAD) or multivessel CAD. The analysis will focus on the health perspective and the payer perspective - National Health Insurance Fund (NHIF). Results: The medico-diagnostic activity related to measuring FFR in patients with multi-vessel coronary artery disease is shown to be a cost-effective therapeutic approach in Bulgaria compared to the angiography-guided PCI (ICER = 50 456 BGN/QALY) with a cost-effectiveness threshold of 51 510 BGN/QALY. FFR- guided PCI strategy in one-vessel coronary artery disease patients is a cost-saving approach (-853 BGN) when compared to the angiography-guided PCI (4 150 BGN). Conclusion: Budget impact analysis revealed that the FFR-guided PCI strategy is a cost-saving alternative approach to the angiographyguided PCI. The savings of the NHIF during the fi rst year of reimbursement of FFR would be -1,1 million BGN and could reach -1,6 million BGN in the third year.

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DOI: 10.3897/bgcardio.28.e81705

Authors: P. Gatzov

Abstract: The antithrombotic therapy is an important part of medical treatment in percutaneous coronary interventions (PCI). The so called dual antiplatelet therapy (DAPT), usually including acetyl salicylic acid (aspirin) plus platelet P2Y12 receptor inhibitors is an important part of that therapy. The careful balance between the protective effect regarding thrombotic/ischemic events and the risk of bleeding is an important task of the attending physician. Apart of the standard dosing regiments, in some of the cases a judgment regarding shortened or prolonged DAPT, as its de-escalation is mandatory. To present the causes and the way of application of that individualized approach in patients with PCI is the aim of this review.

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DOI: 10.3897/bgcardio.28.e87553

Authors: I. Petrov, Z. Stankov, S. Vasilev

Abstract: The cardiogenic shock is a state of low cardiac output, primarily due to cardiac dysfunction, which leads to severe organ hypoperfusion with tissue hypoxia and increased lactate levels. It presents a severe complication with a prevalence of around 15% of all forms of shock and 2-5% of the cardiogenic shock is a complications of acute heart failure. Despite the diverse etiology of the cardiogenic shock, up to 80% of the cases are due to acute myocardial infarction. The ischemia, leads to dysfunction of the myocardium cells, which causes a decline in the blood pressure and subsequent tissue hypoperfusion. The most important part is to start the treatment regime as soon as possible in the pre-shock stage. The treatment of refractory cardiogenic shock is complex, as it contains an intravenous therapy with inotropes/vasopressors and mechanical circulatory support (MCS). The MCS devices are supposed to reduce the workload of the heart and the oxygen need of the myocardial cells and in the same time to maintain an adequate coronary and systemic perfusion. There are different MCS devices like IABP, Impella, Tandem Heart, V-A ECMO. The aim of this review article is to present the new trends in the treatment approach to cardiogenic shock and to bring clarity in the treatment regimes, based on the latest studies and guidelines.

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DOI: 10.3897/bgcardio.26.e60521

Authors: Svetlin Tsonev

Abstract: Etiology, diagnostics and treatment of patients with angina like symptoms and angiographically coronary arteries with no changes remain uncertain. Microvascular dysfunction is main cause for the symptoms in these patients. Chest pain is usually severe and longer than in patients with obstructive coronary artery disease and this results in reduced functional capacity and often hospitalizations. Classic scheme of antiischemic treatment is insufficient in patients with microvascular dysfunctions, but metabolic class medicines reduce anginal episodes and their duration. We represent original data from our study and clinical case of a woman with long history of severe stenocardia and verified microvascular angina.

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