Diagnostics

Editorial

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Open AccessEditorial

Editorial for Special Issue “Advance in Diagnostic and Management of Ischemic Heart Disease”

by Maria Dorobanțu

Diagnostics 2023, 13(6), 1185; https://doi.org/10.3390/diagnostics13061185 - 20 Mar 2023

Cited by 1 | Viewed by 1112

Abstract

Ischemic heart disease is one of the leading causes of morbidity and mortality worldwide [...] Full article

(This article belongs to the Special Issue Advance in Diagnostic and Management of Ischemic Heart Disease)

Research

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20 pages, 1005 KiB

Open AccessArticle

Clinical Utility of Amplification Refractory Mutation System-Based PCR and Mutation-Specific PCR for Precise and Rapid Genotyping of Angiotensin-Converting Enzyme 1 (ACE1-rs4646996 D>I) and Angiotensin-Converting Enzyme 2 (ACE2-rs4240157T>C) Gene Variations in Coronary Artery Disease and Their Strong Association with Its Disease Susceptibility and Progression

by Aadil Yousif, Rashid Mir, Jamsheed Javid, Jameel Barnawi, Mohammed M. Jalal, Malik A. Altayar, Salem Owaid Albalawi and Faisel M. Abuduhier

Diagnostics 2022, 12(6), 1321; https://doi.org/10.3390/diagnostics12061321 - 26 May 2022

Cited by 2 | Viewed by 2579

Abstract

Background: Experimental clinical and research studies demonstrated that the renin–angiotensin system (RAS) affects the pathogenesis of atherosclerosis and the prognosis of coronary heart disease (CHD). The results show that ACE2 (angiotensin I-converting enzyme 2) might act as a protective protein for cardiovascular diseases; [...] Read more.

Background: Experimental clinical and research studies demonstrated that the renin–angiotensin system (RAS) affects the pathogenesis of atherosclerosis and the prognosis of coronary heart disease (CHD). The results show that ACE2 (angiotensin I-converting enzyme 2) might act as a protective protein for cardiovascular diseases; however, only a few studies in human populations have been carried out. The aim of this study was to develop, optimize, and validate a direct T-ARMS-based PCR assay for the precise and rapid genotyping of ACE1-rs4646996 D>I and ACE2-rs4240157T>C and study their association with coronary artery disease susceptibility and progression. Methodology: This study included 149 consecutive coronary artery disease patients and 150 healthy controls. We utilized T-ARMS for the precise and rapid genotyping of ACE2-rs4240157; rs4646994. Results: Our results indicated that the ACE1-rs4646996 D>I genotypes observed between CAD cases and controls were statistically significant (p < 0.008) and, similarly, the ACE2-rs4240157T>C genotypes observed were significant (p < 0.0001). Moreover, the frequency of the D allele (ACE1-D>I) and C allele (ACE2-rs4240157T>C) was found to be higher among CAD patients than the HC. Our results indicated that in the codominant model, the ACE2-ID genotype was strongly associated with increased CAD susceptibility in a codominant model with an OR of 2.37, (95%) CI = (1.023–5.504), and p < 0.04. Similarly, the ACE2-DD genotype was strongly associated with an increased CAD susceptibility with an OR of 3.48, (95%) CI = (1.49 to 8.117), and p < 0.003. Similarly, in allelic comparison, the D allele was strongly associated with CAD susceptibility with an OR of 1.59, (95%) CI = (1.12–2.24), and p < 0.003. Our results revealed that there was a significant correlation between ACE2-I/D genotypes and hypertension, T2D, and obesity (p < 0.05). The results of ACE2 rs4240157 genotyping indicated a strong association in the codominant model with an increased CAD susceptibility with an OR of 3.62, (95%) CI = (2.027 to 6.481), and p < 0.0001. Similarly, in a dominant inheritance model, a strong association is observed between the ACE2 rs4240157 (CT+CC) genotype with an OR of 6.34, (95%) CI = (3.741 to 10.749), and p < 0.0001. In allelic comparison, the T allele was strongly associated with CAD susceptibility with an OR of 5.56, (95% CI = (3.56 to 7.17), and p < 0.0001. Similarly, our results revealed that there was a significant association of the ACE2-rs4240157T>C genotypes with Triglycerides (mg/dL), HDL-C (mg/dL), total Cholesterol (mg/dL), and C-reactive protein (mg/L) in CAD. Conclusion: It was indicated that the ARMS technique and MS-PCR assay proved to be fast, accurate, and reliable for ACE2-rs4240157T>C and ACE1-rs4646996 D>I, respectively, and can be used as a potential molecular tool in the diagnosis of genetic diseases in undeveloped and developing countries—where there might be a shortage of medical resources and supplies. ACE1-I>D genotypes were strongly associated with T2D, hypertension, and obesity (p < 0.002). Besides the ACE2-rs4240157 CT heterozygosity genotype, the T allele was strongly associated with CAD susceptibility. Future longitudinal studies in different ethnic populations with larger sample sizes are recommended to validate these findings Full article

(This article belongs to the Special Issue Advance in Diagnostic and Management of Ischemic Heart Disease)

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12 pages, 869 KiB

Open AccessArticle

Implications of Myocardial Bridge on Coronary Atherosclerosis and Survival

by Roxana Oana Darabont, Ionela Simona Vișoiu, Ștefania Lucia Magda, Claudiu Stoicescu, Vlad Damian Vintilă, Cristian Udroiu and Dragoș Vinereanu

Diagnostics 2022, 12(4), 948; https://doi.org/10.3390/diagnostics12040948 - 10 Apr 2022

Cited by 4 | Viewed by 2789

Abstract

Background: In this study, we aimed to describe the impact of MBs on atherosclerosis and survival, in patients with coronary artery disease (CAD). Methods: We retrospectively studied 1920 consecutive patients who underwent conventional coronary angiography for suspected CAD. Atherosclerotic load (AL), defined as [...] Read more.

Background: In this study, we aimed to describe the impact of MBs on atherosclerosis and survival, in patients with coronary artery disease (CAD). Methods: We retrospectively studied 1920 consecutive patients who underwent conventional coronary angiography for suspected CAD. Atherosclerotic load (AL), defined as the sum of degrees of stenosis, and general atherosclerotic load (GAL), representing the sum of AL, were compared between patients with MB and a control group without MB; patients in these groups were similar in age and sex. We assessed survival at 10 years after the last enrolled patient. Results: Prevalence of MB was 3.96%, predominantly in the mid-segment of left anterior descendent artery (LAD). In the presence of MB, GAL was lower (158.1 ± 93.7 vs. 205.3 ± 117.9, p = 0.004) with a lesser AL in the proximal (30.3 ± 39.9 vs. 42.9 ± 41.1, p = 0.038) and mid-segments (8.1 ± 20.0 vs. 25.3 ± 35.9, p < 0.001) of LAD. Based on a Multinominal Logistic Regression, we found that the presence of MB on LAD (regardless of its location on this artery) is a protective factor against atherosclerotic lesions, decreasing the probability of significant stenosis, especially of those ≥70%, on the entire artery (B −1.539, OR 4660; 95% CI = 1.873–11.595, p = 0.001) and on each of its segments as well: proximal LAD (B −1.275, OR 0.280; 95% CI = 0.015–5.073; p = 0.038), mid-LAD (B −1.879, OR 6.545; 95% CI = 1.492–28.712; p = 0.013) and distal LAD (B −0.900, OR 2.459, 95% CI = 2.459–2.459, p = 0.032). However, 10-year survival was similar between groups (76.70% vs. 74.30%, p = 0.740). Conclusion: The presence of MB on LAD proved to be a protective factor against atherosclerosis for the entire artery and for each of its segments, but it does not influence long-term survival in patients with CAD. Full article

(This article belongs to the Special Issue Advance in Diagnostic and Management of Ischemic Heart Disease)

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13 pages, 2545 KiB

Open AccessArticle

Pulse Wave Velocity as a Marker of Vascular Dysfunction and Its Correlation with Cardiac Disease in Children with End-Stage Renal Disease (ESRD)

by Cristina Filip, Cătălin Cirstoveanu, Mihaela Bizubac, Elena Camelia Berghea, Andrei Căpitănescu, Mihaela Bălgrădean, Carmen Pavelescu, Alin Nicolescu and Marcela Daniela Ionescu

Diagnostics 2022, 12(1), 71; https://doi.org/10.3390/diagnostics12010071 - 29 Dec 2021

Cited by 7 | Viewed by 2695

Abstract

One of the main markers of arterial stiffness is pulse wave velocity (PWV). This parameter is well studied as a marker for end-organ damage in the adult population, being considered a strong predictor of major cardiovascular events. This study assessed PWV in children [...] Read more.

One of the main markers of arterial stiffness is pulse wave velocity (PWV). This parameter is well studied as a marker for end-organ damage in the adult population, being considered a strong predictor of major cardiovascular events. This study assessed PWV in children with chronic kidney disease (CKD) as a marker of cardiovascular risk. We conducted a prospective observational single-center cohort study of 42 consecutively pediatric patients (9–18 years old) with terminal CKD and dialysis, at the Hemodialysis Department of the “M. S. Curie” Hospital, Bucharest. We measured PWV by echocardiography in the ascending aorta (AscAo) and the descending aorta (DescAo), and we correlated them with left ventricular hypertrophy (LVH). Fifteen patients (35.7%) presented vascular dysfunction defined as PWV above the 95th percentile of normal values in the AscAo and/or DescAo. Cardiac disease (LVH/LV remodeling) was discovered in 32 patients (76.2%). All patients with vascular damage also had cardiac disease. Cardiac damage was already present in all patients with vascular disease, and the DescAo is more frequently affected than the AscAo (86.6% vs. 46.9%). Elevated PWV could represent an important parameter for identifying children with CKD and high cardiovascular risk. Full article

(This article belongs to the Special Issue Advance in Diagnostic and Management of Ischemic Heart Disease)

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18 pages, 930 KiB

Open AccessArticle

Importance of Visual Estimation of Coronary Artery Stenoses and Use of Functional Evaluation for Appropriate Guidance of Coronary Revascularization—Multiple Operator Evaluation

by Lucian Calmac, Nicoleta-Monica Popa-Fotea, Vlad Bataila, Vlad Ploscaru, Adrian Turea, Irina Andra Tache, Diana Stoian, Lucian Itu, Elisabeta Badila, Alexandru Scafa-Udriste and Maria Dorobantu

Diagnostics 2021, 11(12), 2241; https://doi.org/10.3390/diagnostics11122241 - 30 Nov 2021

Cited by 6 | Viewed by 1775

Abstract

Background: Visual estimation (VE) of coronary stenoses is the first step during invasive coronary angiography. The aim of this study was to evaluate the accuracy of VE together with invasive functional assessment (IFA) in defining the functional significance (FS) of coronary stenoses based [...] Read more.

Background: Visual estimation (VE) of coronary stenoses is the first step during invasive coronary angiography. The aim of this study was to evaluate the accuracy of VE together with invasive functional assessment (IFA) in defining the functional significance (FS) of coronary stenoses based on the opinion of multiple operators. Methods: Fourteen independent operators visually evaluated 133 coronary lesions which had a previous FFR measurement, indicating the degree of stenosis (DS), FS and IFA intention. We determined the accuracy of FS prediction using several scenarios combining individual and group decision, considering IFA as deemed necessary by the operator or only in intermediate lesions. Results: The accuracy of VE in predicting FS was largely variable between operators (average 66.1%); it improved significantly when IFA was used either as per operator’s opinion (86.3%; p < 0.0001) or only in intermediate DS (82.9; p < 0.0001). There was no significant difference between using IFA per observer’s opinion or only in intermediate DS lesions (p = 0.166). The poorest accuracy of VE for FS was obtained in intermediate DS lesions (59.1%). Conclusions: There are significant inter-observer differences in reporting the degree of DS, while the accuracy of VE prediction of FS is also largely dependent on the operator, and the worst performance is obtained in the evaluation of intermediate DS. Full article

(This article belongs to the Special Issue Advance in Diagnostic and Management of Ischemic Heart Disease)

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Review

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19 pages, 1339 KiB

Open AccessReview

Troponin Cut-Offs for Acute Myocardial Infarction in Patients with Impaired Renal Function—A Systematic Review and Meta-Analysis

by Jan Kampmann, James Heaf, Christian Backer Mogensen, Andreas Kristian Pedersen, Jeff Granhøj, Hans Mickley and Frans Brandt

Diagnostics 2022, 12(2), 276; https://doi.org/10.3390/diagnostics12020276 - 21 Jan 2022

Cited by 13 | Viewed by 4834

Abstract

Identifying acute myocardial infarction in patients with renal disease is notoriously difficult, due to atypical presentation and chronically elevated troponin. The aim of this study was to identify a specific troponin T/troponin I cut-off value for diagnosis of acute myocardial infarction in patients [...] Read more.

Identifying acute myocardial infarction in patients with renal disease is notoriously difficult, due to atypical presentation and chronically elevated troponin. The aim of this study was to identify a specific troponin T/troponin I cut-off value for diagnosis of acute myocardial infarction in patients with renal impairment via meta-analysis. Two investigators screened 2590 publications from MEDLINE, Embase, PubMed, Web of Science, and the Cochrane library. Only studies that investigated alternative cut-offs according to renal impairment were included. Fifteen articles fulfilled the inclusion criteria. Six studies were combined for meta-analysis. The manufacturer’s upper reference level for troponin T is 14 ng/L. Based on the meta-analyses, cut-off values for troponin in patients with renal impairment with myocardial infarction was 42 ng/L for troponin I and 48 ng/L for troponin T. For patients on dialysis the troponin T cut-off is even higher at 239 ng/L. A troponin I cut-off value for dialysis patients could not be established due to lack of data. The 15 studies analyzed showed considerable diversity in study design, study population, and the definition of myocardial infarction. Further studies are needed to define a reliable troponin cut-off value for patients with kidney disease, especially in dialysis patients, and to allow necessary subanalysis. Full article

(This article belongs to the Special Issue Advance in Diagnostic and Management of Ischemic Heart Disease)

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Other

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14 pages, 5356 KiB

Open AccessCase Report

Myocardial Infarction in Children after COVID-19 and Risk Factors for Thrombosis

by Eliza Cinteză, Cristiana Voicu, Cristina Filip, Mihnea Ioniță, Monica Popescu, Mihaela Bălgrădean, Alin Nicolescu and Hiyam Mahmoud

Diagnostics 2022, 12(4), 884; https://doi.org/10.3390/diagnostics12040884 - 1 Apr 2022

Cited by 6 | Viewed by 2918

Abstract

Acute myocardial infarction (AMI) in children is rather anecdotic. However, following COVID-19, some conditions may develop which may favor thrombosis, myocardial infarction, and death. Such a condition is Kawasaki-like disease (K-lD). K-lD appears in children as a subgroup of the multisystem inflammatory syndrome [...] Read more.

Acute myocardial infarction (AMI) in children is rather anecdotic. However, following COVID-19, some conditions may develop which may favor thrombosis, myocardial infarction, and death. Such a condition is Kawasaki-like disease (K-lD). K-lD appears in children as a subgroup of the multisystem inflammatory syndrome (MIS-C). In some cases, K-lD patients may develop giant coronary aneurysms. The evolution and characteristics of coronary aneurysms from K-lD appear to be different from classical Kawasaki disease (KD) aneurysms. Differences include a lower percentage of aneurysm formation than in non-COVID-19 KD, a smaller number of giant forms, a tendency towards aneurysm regression, and fewer thrombotic events associated with AMI. We present here a review of the literature on the thrombotic risks of post-COVID-19 coronary aneurysms, starting from a unique clinical case of a 2-year-old boy who developed multiple coronary aneurysms, followed by AMI. In dehydration conditions, 6 months after COVID-19, the boy developed anterior descending artery occlusion and a slow favorable outcome of the AMI after thrombolysis. This review establishes severity criteria and risk factors that predispose to thrombosis and AMI in post-COVID-19 patients. These may include dehydration, thrombophilia, congenital malformations, chronic inflammatory conditions, chronic kidney impairment, acute cardiac failure, and others. All these possible complications should be monitored during acute illness. Ischemic heart disease prevalence in children may increase in the post-COVID-19 era, due to an association between coronary aneurysm formation, thrombophilia, and other risk factors whose presence will make a difference in long-term prognosis. Full article

(This article belongs to the Special Issue Advance in Diagnostic and Management of Ischemic Heart Disease)

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10 pages, 465 KiB

Open AccessSystematic Review

The Prognostic Performance of Ferritin in Patients with Acute Myocardial Infarction: A Systematic Review

by Crischentian Brinza, Mariana Floria, Iolanda Valentina Popa and Alexandru Burlacu

Diagnostics 2022, 12(2), 476; https://doi.org/10.3390/diagnostics12020476 - 13 Feb 2022

Cited by 5 | Viewed by 2597

Abstract

The potential benefit of ferritin evaluation resides in its association with adverse outcomes in patients with various pathological conditions. We aimed to conduct the first systematic review evaluating the association between ferritin levels and adverse cardiovascular outcomes in patients with acute myocardial infarction [...] Read more.

The potential benefit of ferritin evaluation resides in its association with adverse outcomes in patients with various pathological conditions. We aimed to conduct the first systematic review evaluating the association between ferritin levels and adverse cardiovascular outcomes in patients with acute myocardial infarction (AMI) during short- or long-term follow-up. Seven studies investigating various endpoints (mortality, major adverse cardiovascular events-MACE, the decline of the left ventricular ejection fraction-LVEF, left ventricular aneurysm development-LVA) were included. AMI patients with low or increased ferritin values tended to have higher in-hospital and 30-day mortality rates. Low and high ferritin levels and chronic kidney disease were independently associated with increased risk of LVA formation. High ferritin concentrations were linked to an accentuated LVEF decline in ST-elevation myocardial infarction patients treated by percutaneous coronary intervention. Both low and high ferritin values were also associated with the duration of hospitalization in patients with AMI during hospital stay and at more extended follow-up. Ferritin evaluation represents a simple investigation that could identify high-risk patients with AMI who might benefit from closer monitoring and specific therapeutic interventions. These data should be confirmed in large trials in the context of currently available therapies for heart failure and AMI. Full article

(This article belongs to the Special Issue Advance in Diagnostic and Management of Ischemic Heart Disease)

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