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Annabella Benedek, Diana Opincariu, Imre Benedek, Ionuț Ferenț, Roxana Hodaș, Emese Marton and Theodora Benedek

Abstract

Acute coronary syndromes are usually triggered by the erosion or rupture of a vulnerable coronary plaque. A vulnerable plaque (VP) is an atheromatous plaque which, after suffering different transformations, is prone to rupture causing an acute coronary event. Such a VP carries inside several biomarkers considered as “signatures of vulnerability”, which, if identified, can prompt timely initiation of therapeutic measures in order to prevent the development of an acute myocardial infarction. The most freqeuntly used techniques for identification of vulnerability markers are computed tomographic angiography (CTA), intravascular ultrasound and optical coherence tomography. Endothelial shear stress (ESS) represents a new promising biomarker associated with plaque vulnerability. Determination of ESS is nowadays possible using noninvasive imaging techniques, based on complex computational post-processing of multiple datasets extracted from CTA images and advanced computational fluid dynamics technologies. The aim of this systematic review was to evaluate the role of the coronary ESS, determined using advanced computational techniques for image post-processing, as a feature associated with CTA-derived biomarkers of atheromatous plaque vulnerability, underlining the conceptual differences between high ESS and low ESS as promotors of vulnerability.

Open access

Mircea Cinteză and Imre Benedek

Open access

Marius Orzan, Beata Jako, Ciprian Blendea, Annabell Benedek, Balazs Bajka and Imre Benedek

Abstract

Background: Assessment of the hemodynamic significance of a coronary artery stenosis is a challenging task, being extremely important for the establishment of indication for revascularization in atherosclerotic coronary artery stenosis. The aim of this study was to evaluate the role of a new marker reflecting the functional significance of a coronary artery stenosis, represented by the attenuation degree of contrast density along the stenosis by Coronary CT.

Material and Method: We evaluated retrospectively 30 patients with angina and coronary luminal narrowing, who underwent 64-slice Coronary Computed Tomography Angiography. We measured the stenosis degree, intraluminal contrast density (Hounsfield units [HU]) at two levels, proximal and distal to stenosis, and the attenuation gradient was calculated on this basis.

Results: The average contrast density was 77,96 UH proximal to the stenosis and 67,6 UH distal to the stenosis. The average transluminal gradient was 10,36. The average length of the coronary lesions was 16,93 mm. In those lesions with significant stenosis, expressed by >70% luminal narrowing, we recorded a significantly higher transluminal attenuation gradient as compared to those with <70% luminal narrowing (6.16 +/−3.7, 95%CI 4.3-80 vs 16.6 +/− 8.4, 95% CI 11.3 – 21.9). The degree of luminal narrowing significantly correlated with the contrast attenuation gradient (r=0.71, p<0.001).

Conclusions: The assessment of intraluminal contrast density by Coronary Computed Tomography Angiography may represent a new noninvasive tool to obtain relevant information about the clinical significance of a coronary stenosis. Larger studies are requested to emphasize the benefits brought by CCTA in evaluating coronary lesions.

Open access

Theodora Benedek, Beata Jako, Zsuzsa Suciu and Imre Benedek

Abstract

Introduction: We aimed to assess the relationships between the persistence of elevated circulating levels of hs-CRP, a powerful inflammatory marker, determined at 30 days after an acute myocardial infarction (AMI), and the characteristics of the pre-existing coronary lesions. Material and methods: The study included 83 consecutive patients 30 days post AMI, who were subjected to coronary angiography and primary PCI. The patients were divided into two groups according to their hsCRP levels at 30 days after AMI: group 1 included 35 low-risk patients, with hsCRP levels <2 mg/l, and group 2 included 48 high-risk patients, with hsCRP levels >2 mg/l. Results: Angiographic analysis revealed the presence of a multivascular disease in 48.5% of the patients in group 1 versus 72.9% of the patients in group 2 (p=0.037). The Syntax scores for groups 1 and 2 were 22.2 +/- 6.6 and 27.07+/-0.94, respectively (p=0.001), and these values were significantly correlated with the hsCRP values (r=0.56, p<0.0001). LAD culprit lesions were found in 47.9% of the patients in group 1 and 20% of the patients in group 2 (p=0.01), and 42.8% of the group 1 patients and 83.3% of the group 2 patients had at least one significant stenosis in the LAD (p=0.0002). The ejection fraction at 30 days was significantly lower in the patients with elevated levels of hsCRP (52.91+/-4.03 vs 49.04+/-5.74, p=0.001), showing an inverse correlation with hsCRP levels (r=-0.52, p<0.0001). Conclusions: A more severe coronary artery disease was associated with am increased inflammatory status in the postinfarction phase, as evidenced by the high levels of circulating hsCRP. hsCRP can help for risk stratification in post AMI patients by identifying the subsets of patients who are at risk based on persistent elevated circulating levels of hsCRP at 30 days after infarction.

Open access

Marius Orzan, Theodora Benedek, Balázs Bajka, Kinga Pál, Nora Rat and Imre Benedek

Abstract

Introduction: According to European guidelines, ST elevation acute myocardial infarction should be treated by immediate reperfusion, if diagnosed within 12 hours from the onset of symptoms. We aimed to show the impact of a well-functioning pre-existing STEMI network in improving the results of a national program dedicated to the invasive treatment of AMI.

Methods: We followed the comparison between primary PCI rates and STEMI-related mortality in two regions, after the introduction of a nationwide program for the interventional treatment of acute myocardial infarction: region A, where the territory has been appropriately prepared via previous organizational measures in the network, and region B, where the territory has not been previously prepared.

Results: In 2011, one year after the initiation of the national program, a primary PCI rate of 12.1%, a thrombolysis rate of 10.1% and a no-reperfusion treatment rate of 77.8% have been found in these new centers for patients arriving <12 h from symptoms onset. This has been reflected in a mortality of 23.07% for “early presentations” in these new centers in 2011. In comparison, data from the territorial hospitals of the registry (only those without cathlab facilities, similar to the new centers) showed in 2011 a 73.85% primary PCI rate, 12.09% thrombolysis rate and a 14.07% conservative treatment rate, reflected in a mortality of 6.81% for “early presentations” in the registry centers.

Conclusions: The national strategy for reduction of STEMI related mortality via implementation of primary PCI, started in 2010, had a significant impact especially in that region where the territory was previously prepared with appropriate organizational efforts, including educational and logistic measures.