Impact of short-term air pollution exposure on acute coronary syndrome in two cohorts of industrial and non-industrial areas: A time series regression with 6,000,000 person-years of follow-up (ACS - Air Pollution Study).

BACKGROUND: There is a lack of studies directly comparing the effect of air pollution on acute coronary syndrome (ACS) occurrence in industrial and non-industrial areas. OBJECTIVES: A comparison of association of air pollution exposure with ACS in two cohorts of industrially different areas. MATERIALS AND METHODS: The study covered 6,000,000 person-years of follow-up and five pollutants between 2008 and 2017. A time series regression analysis with 7-lag was used to assess the effects air pollution on ACS. RESULTS: A total of 9046 patients with ACS were included in the analysis, of whom 3895 (43.06%) had ST-elevation myocardial infarction (STEMI) - 45.39% from non-industrial area, and 42.37% from industrial area; and 5151 (56.94%) had non-ST-elevation myocardial infarction (NSTEMI) - 54.61% from non-industrial area and 57.63% from industrial area. The daily concentrations of PM2.5, PM10, NO2, SO2, CO were higher in industrial than in non-industrial area (P < 0.001). In non-industrial area, an increase of 10 µg/m3 of NO2 concentration (Odds Ratio (OR) = 1.126, 95%CI = 1.009-1.257; P = 0.034, lag-0) and an increase of 1 mg/m3 in CO concentration (RR = 1.055, 95%CI = 1.010-1.103; P = 0.017, lag-0) were associated with an increase in the number of hospitalization due to NSTEMI (for industrial area increase of 10 µg/m3 in NO2 (OR = 1.062, 95%CI = 1.020-1.094; P = 0.005, lag-0), SO2 (OR = 1.061, 95%CI = 1.010-1.116; P = 0.018, lag-4), PM10 (OR = 1.010, 95%CI = 1.001-1.030; P = 0.047, lag-6). In STEMI patients in industrial area, an increased hospitalization was found to be associated with an increase of 10 µg/m3 in SO2 (OR = 1.094, 95%CI = 1.030-1.162; P = 0.002, lag-1), PM2.5 (OR = 1.041, 95%CI = 1.020-1.073; P < 0.001, lag-1), PM10 (OR = 1.030, 95%CI = 1.010-1.051; P < 0.001, lag-1). No effects of air pollution on the number of hospitalization due to STEMI were noted from non-industrial area. CONCLUSION: The risk of air pollution-related ACS was higher in industrial over non-industrial area. The effect of NO2 on the incidence of NSTEMI was observed in both areas. In industrial area, the effect of PMs and SO2 on NSTEMI and STEMI were also observed. A clinical effect was more delayed in time in patients with NSTEMI, especially after exposure to PM10. Chronic exposure to air pollution may underlie the differences in the short-term effect between particulate air pollution impact on the incidence of STEMI.

Second-generation drug-eluting stents in the elderly patients with acute coronary syndrome: the in-hospital and 12-month follow-up of the all-comer registry.

BACKGROUND: Katowice-Zabrze registry provides data that can be used to evaluate clinical outcomes of percutaneous coronary interventions in elderly patients (≥70 y/o) treated with either first- (DES-I) or second-generation (DES-II) drug-eluting stents (DES). METHODS: The registry consisted of data from 1916 patients treated with coronary interventions using either DES-I or DES-II stents. For our study, we defined patients ≥70 years of age as elderly. We evaluated any major adverse cardiac and cerebral events (MACCE) at 12-month follow-up. RESULTS: Coronary angiography revealed a higher incidence of multivessel coronary artery disease in this elderly patient population. There were no differences in acute and subacute stent thrombosis (0.4 vs. 0.6%, p = 0.760; 0.4 vs. 0.4%; p = 0.712). Elderly patients experienced more in-hospital bleeding complications requiring blood transfusion (2.0 vs. 0.9%; p = 0.003). Resuscitated cardiac arrests (2.0 vs. 0.9%; p = 0.084) were observed more often in this elderly patients during hospitalization. The composite in-hospital MACCE rates did not differ statistically between both groups (1.4 vs. 1.1%; p = 0.567). Data from a twelve-month follow-up disclosed that mortality was higher (7.1 vs. 1.8%; p < 0.001) in the elderly, with no difference in TVR (7.2 vs. 9.9%, p = 0.075), MI (6.0 vs. 4.8%, p = 0.300), stroke (0.8 vs. 0.6%, p = 0.600) and composite MACCE (15.0 vs. 13.4%, p = 0.324). The age of 70 years or over was an independent predictor of death [HR = 2.55 (95% CI 1.49-4.37); p < 0.001]. The use of DES-II reduced the risk of MI [HR = 0.40 (95% CI 0.19-0.82); p = 0.012] in the elderly. CONCLUSION: This elderly patient population had an increased risk of in-hospital bleeding complications requiring blood transfusion and a higher risk of death at 12-month follow-up. The use of new-generation DES reduced the risk of MI in the elderly population.

Quality of Life 6 Months after COVID-19 Hospitalisation: A Single-Centre Polish Registry.

BACKGROUND: The COVID-19 pandemic, which affected the entire global population, had an impact on our health and quality of life. Many people had complications, were hospitalised or even died due to SARS-CoV-2 infection. The health systems of many countries had to radically change their way of functioning and scientists around the world worked intensively to develop a vaccine for the SARS-CoV-2 virus. AIM: The aim of this work is to assess the quality of life of patients who were hospitalised for COVID-19, using the SF-36 questionnaire. METHODS: Between May and August 2022, we conducted a telephone assessment of quality of life in patients who were hospitalised for COVID-19 at the Temporary Hospital in Pyrzowice (Silesia, Poland), between November 2021 and January 2022. RESULTS: Quality of life was significantly lower in women (p = 0.040), those with DM2 (p = 0.013), CKD (p = 0.041) and the vaccinated (p = 0.015). CONCLUSIONS: People with chronic kidney disease, diabetes mellitus and women had a lower quality of life after COVID-19 disease. However, people who were vaccinated for SARS-CoV-2 had a lower quality of life than non-vaccinated people did. This is possibly due to the higher mean age, and probably the higher disease burden, in the vaccinated group.

Cardiovascular System during SARS-CoV-2 Infection.

SARS-CoV-2 virus can not only damage the respiratory system but may also pose a threat to other organs, such as the heart or vessels. This review focuses on cardiovascular complications of COVID-19, including acute cardiac injury, arrhythmias, biomarkers, accompanying comorbidities and outcomes in patients diagnosed with SARS-CoV-2 infection. The research was conducted on the databases: PubMed, Springer, ScienceDirect, UpToDate, Oxford Academic, Wiley Online Library, ClinicalKey. Fifty-six publications from 1 November 2020 till 15 August 2021 were included in this study. The results show that cardiac injury is present in about 1 in 4 patients with COVID-19 disease, and it is an independent risk factor, which multiplies the death rate several times in comparison to infected patients without myocardial injury. New-onset cardiac injury occurs in nearly every 10th patient of the COVID-19-suffering population. Comorbidities (such as hypertension, cardiovascular disease and diabetes) severely deteriorate the outcome. Therefore, patients with SARS-CoV-2 infection should be carefully assessed in terms of cardiac medical history and possible cardiological complications.

Five-Year Comparative Efficacy of Everolimus-Eluting vs. Resolute Zotarolimus-Eluting Stents in Patients with Acute Coronary Syndrome Undergoing Percutaneous Coronary Intervention.

Among drug-eluting stents (DESs), the durable polymer everolimus-eluting stent (EES) and resolute zotarolimus-eluting stent (R-ZES) are widely used in clinical practice and have contributed to improve the outcomes of patients undergoing percutaneous coronary intervention (PCI). Few studies addressed their long-term comparative performance in patients with acute coronary syndrome (ACS). We aimed to investigate the 5 year comparative efficacy of EES and R-ZES in ACS. We queried ACTION-ACS, a large-scale database of ACS patients undergoing PCI. The treatment groups were analyzed using propensity score matching. The primary endpoint was a composite of mortality, myocardial infarction (MI), stroke, repeat PCI, and definite or probable stent thrombosis, which was addressed at the five-year follow-up. A total of 3497 matched patients were analyzed. Compared with R-ZES, a significant reduction in the primary endpoint at 5 years was observed in patients treated with EES (hazard ratio (HR) [95%CI] = 0.62 [0.54-0.71], p < 0.001). By landmark analysis, differences between the two devices emerged after the first year and were maintained thereafter. The individual endpoints of mortality (HR [95%CI] = 0.70 [0.58-0.84], p < 0.01), MI (HR [95%CI] = 0.55 [0.42-0.74], p < 0.001), and repeat PCI (HR [95%CI] = 0.65 [0.53-0.73], p < 0.001) were all significantly lower in the EES-treated patients. Stroke risk did not differ between EES and R-ZES. In ACS, a greater long-term clinical efficacy with EES vs. R-ZES was observed. This difference became significant after the first year of the ACS episode and persisted thereafter.

Long-Term Clinical Outcomes and Carotid Ultrasound Follow-Up of Transcarotid TAVI. Prospective Single-Center Registry.

This study aimed to prospectively evaluate the safety and long-term clinical outcomes of cerebral-oximetry-guided transcarotid transcatheter aortic valve implantation (TC-TAVI) with systematic follow-up with carotid ultrasound. Thirty-three TCTAVI procedures were performed in our center from 2017 to 2019. Our analysis includes in-hospital outcomes and long-term follow-up data on mortality, echocardiographic parameters, carotid Doppler ultrasound, and VARC-2 defined clinical events. Intraoperatively, one patient died, and one had a transient ischemic attack (TIA). The following events occurred in-hospital postoperatively: myocardial infarction (3.0%), cardiac tamponade (3.0%), new-onset atrial fibrillation (6.3%), need for temporary pacing (27.3%) and need for pacemaker implantation (15%). The mean follow-up was 19.5 ± 9.52 months. In the long-term follow-up, the two-year survival rate was 83% ± 14. The echocardiographic parameters did not differ significantly from the postprocedural values, and the ultrasound did not show any cases of significant vessel narrowing. The mean peak systolic velocity (PSV) was 71.6 cm/s in the left common carotid artery and 70.6 cm/s in the right common carotid artery. In conclusion, cerebral oximetry-guided TC access is safe, has a favorable long-term outcome, and does not increase the risk of plaque formation in the carotid artery. In a carefully selected group of patients, it might be considered as a first-choice alternative to TF access.

Plasma adiponectin in patients with acute myocardial infarction treated with percutaneous coronary intervention.

BACKGROUND: Even up-to-date reperfusion therapy using primary percutaneous intervention (PCI) in acute myocardial infarction does not result in improvement of the left ventricular (LV) function in all patients. Cellular myoblasty, a novel method using mononuclear bone marrow cells (BMC), can be applied in the infarcted myocardium area to stimulate regeneration and to limit the organ damage. However, the impact of intracoronary BMC administration on the effect of PCI is not clear. AIM: To assess angiographic outcomes in patients with anterior myocardial infarction and LV dysfunction, undergoing intracoronary BMC administration after a successful primary PCI. METHODS: The study group consisted of 40 patients (mean age 56.2 years) with LV ejection fraction below 40%, in whom 20 ml of BMC were administered to the infarct-related artery (IRA) distally to the occlusion. The control group comprised 25 age- and sex-matched patients with similar values of LV ejection fraction undergoing bare metal stenting of IRA without BMC administration. Quantitative coronary angiography was performed 6 months later to assess IRA patency. RESULTS: The reference diameter of the stented artery decreased in the study group from 3.22 +/- 0.28 mm to 3.16 +/- 0.18 mm (p < 0.05) and in the control group from 3.22 +/- 0.31 mm to 3.15 +/- 0.28 mm (p < 0.082); also in the area of the implanted stent the diameter decreased from 3.57 +/- 0.21 mm to 2.96 +/- 0.79 mm in the study group vs. 3.48 +/- 0.22 mm to 3.01 +/- 0.35 mm in the control group. For lumen diameter measured 10 mm distally to the stent, the diameter loss was similar in both groups. In 6 patients from the BMC treated group and in 3 patients from the control group there was asymptomatic lumen reduction > 70% (NS). CONCLUSION: The results of our study show that BMC administration into IRA is safe. The degree of lumen loss in the stent area was larger in the BMC group than in the control group. There was no significant difference in the lumen change distally to the stent; the artery diameter loss in both groups was similar, and the improvement in LV ejection fraction was greater in the BMC-treated group.

Prevalence of atherosclerotic stenosis of the carotid and cerebral arteries in patients with stable or unstable coronary artery disease.

INTRODUCTION: Carotid artery atherosclerosis is a recognized predictor of cardiovascular events. The coexistence of coronary atherosclerosis and cerebrovascular disease is associated with unfavorable clinical outcomes. OBJECTIVES: The aim of this study was to determine the prevalence of hemodynamically and clinically significant carotid and / or cerebral artery stenosis in patients with stable and unstable coronary artery disease (CAD). PATIENTS AND METHODS: Cardiac and neurological examinations together with coronary angiography and carotid ultrasound were performed in 241 patients, and transcranial Doppler imaging of cerebral arteries in 114. The prevalence of hemodynamically significant internal carotid artery (ICA) stenosis, intracranial artery stenosis, and clinical signs of central nervous system ischemia were compared between patients with stable and unstable CAD. RESULTS: There was no significant difference in the prevalence of ICA stenosis (15.3% vs 19%) and intracranial artery stenosis (18% vs 16%) between patients with stable and unstable CAD. Risk factors for cerebral artery stenosis included ICA stenosis (odds ratio [OR], 13.21; 95% CI, 5.93-41.89) and advanced CAD (OR, 2.38; 95% CI, 1.13-4.09), and for ischemic events within the central nervous system, ICA stenosis (OR, 1.74; 95% CI, 1.01-3.16) and intracranial artery stenosis (OR, 3.01; 95% CI, 1.66-5.57). CONCLUSIONS: No differences in the prevalence of atherosclerosis of the carotid and cerebral arteries were found between patients with stable and unstable CAD in this study. Advanced CAD is one of the risk factors for hemodynamically significant cerebral artery stenosis.

Clinical Characteristics, Treatments, and Outcomes of Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries (MINOCA): Results from a Multicenter National Registry.

BACKGROUND: Diagnosis of myocardial infarction with non-obstructive coronary arteries (MINOCA) requires both clinical evidence of acute myocardial infarction (AMI) and demonstration of non-obstructive coronary arteries using angiography. We compared the clinical features, treatments, and three-year outcomes in patients with MINOCA and myocardial infarction with obstructive coronary artery disease (MI-CAD). METHODS: We retrospectively analyzed data for 205,606 hospitalized patients with AMI. MINOCA was indicated as a working diagnosis in 6063 patients (2.94% of all AMI patients). For the control group we included 160,886 patients with MI-CAD. We evaluated the baseline characteristics, medication management options, outcomes, and readmission causes at 36 months follow-up. RESULTS: Patients in the MINOCA group were younger. Females constituted a greater proportion of patients in the MINOCA group when compared to MI-CAD patients. STEMI during admission was diagnosed less frequently in the MINOCA group when compared to the MI-CAD group. All-cause mortality at 12 months was higher in the MINOCA group (10.94% vs. 9.54%, p < 0.001). At 36 months, there was no difference in the all-cause mortality rates (MINOCA 16.18% vs. MI-CAD 14.93%, p = 0.081). All-cause readmission rates were lower in the MINOCA group when compared to the MI-CAD group at both 12 months (45.19% vs. 54.33%, p < 0.001) and 36 months follow-up (56.42% vs. 66.66%, p < 0.001). CONCLUSIONS: This is the first description of the clinical features, treatments, and three-year outcomes in a large population of Polish patients. The main finding of this study was a relatively low rate of MINOCA, with high rates of adverse events both at 12 and 36 months follow-up.

[Massive pulmonary embolism without echocardiographic features of right ventricular overload]. / Masywny zator tetnicy plucnej bez cech przeciazenia prawej komory w badaniu echokardiograficznym.

A case of 70-year-old patient with massive pulmonary embolism confirmed in CT, but without changes in right ventricle size and function in echocardiography is presented. This case is consistent with literature data that echocardiography has relatively low sensitivity in the diagnosis of acute pulmonary embolism.

Exercise-induced mobilisation of endothelial progenitor cells in patients with premature coronary heart disease.

BACKGROUND: Endothelial progenitor cells (EPC) derive from bone marrow and participate in both endothelial regeneration and development of new blood vessels. EPC also play a role in the atherosclerotic process, and their number correlates negatively with the presence of classical risk factors. AIM: To evaluate circulating EPC count and their exercise-induced mobilisation in patients with premature coronary artery disease (CAD). METHODS: The study group included 60 patients with stable CAD diagnosed before 45 years of age. The control group consisted of 33 healthy age- and gender-matched volunteers. Venous blood was sampled 3 times in order to assess circulating EPC count immediately before an exercise test (EPC 0) and at 15 min (EPC 15) and 60 min (EPC 60) after the exercise test. RESULTS: Circulating EPC count in the study group at rest and at 15 min after exercise was comparable (2.1 vs. 2.1 cell/µL, p = 0.35) and increased significantly at 60 min after exercise in comparison to resting values (2.1 vs. 3.2 cell/µL, p < 0.00001). In the control group, circulating EPC count increased significantly at 15 min after exercise (2.0 vs. 3.5 cell/µL, p < 0.0001) but later decreased at 60 min after exercise, although it remained greater than at rest (2.7 vs. 2.0 cell/µL, p < 0.0002). Circulating EPC count at rest and at 60 min after exercise was comparable in the two groups (2.1 vs. 2.0 cell/µL, p = 0.96; and 3.2 vs. 2.7 cell/µL, p = 0.13, respectively) but it was significantly lower in the study group compared to the control group at 15 min after exercise (2.1 vs. 3.5 cell/µL, p < 0.00001). Circulating EPC count at rest and at 15 min after exercise did not correlate with the number of stenosed coronary arteries but at 60 min after exercise it was greater in patients with one-vessel disease compared to those with two- or three-vessel disease (4.2 vs. 3.4 cell/µL, p = 0.01; and 4.2 vs. 2.3 cell/µL, p = 0.00003). However, no difference in circulating EPC count was seen at 60 min after exercise between patients with two- or three-vessel disease (3.4 vs. 2.3 cell/µL, p = 0.3). CONCLUSIONS: 1. Circulating EPC count at rest is comparable between subjects with premature atherosclerosis and healthy volunteers. 2. A single bout of physical exercise causes a significant increase in circulating EPC count in both groups, but the dynamics of exercise-induced EPC mobilisation is different, with delayed exercise-induced EPC mobilisation in subjects with premature CAD. 3. The extent of atherosclerotic coronary lesions does not influence circulating EPC count at rest.

[Stenosis of the carotid arteries]. / Zwezenie tetnic szyjnych.

Atherosclerotic stenosis of carotid arteries is present in approximately 9% of patients above 60 years of age. The stenosis may be silent or may cause cerebral ischaemia--transient or permanent, including severe stroke leading to death. It is estimated that 20-25% of all strokes is caused by carotid artery stenosis in their extracranial course. Ultrasound technique with Doppler recording is an efficient method of carotid arteries stenoses assessment. Asymptomatic carotid artery stenosis treated with acetylsalicylic acid 325 mg/day bears 6-11% risk of stroke in 5 years follow-up. The risk of cerebral ischaemia is significantly higher in persons with symptomatic stenoses. The risk of TIA or stroke recurrence reaches 30-45%. The treatment of carotid arteries stenoses comprises risk factors management and revascularisation procedures. Surgical treatment decreases the risk of stroke by 17%. Surgical endarterectomy perceived as the gold standard of interventional treatment may be efficiently replaced with percutaneous angioplasty with concomitant intravascular stent implantation.

Effect of a significant asymptomatic unilateral carotid artery stenosis on outcomes in patients undergoing coronary artery bypass grafting.

BACKGROUND: Occurrence of a stroke is a major concern in patients undergoing coronary artery bypass grafting (CABG). It remains uncertain whether significant asymptomatic carotid artery stenosis (CAS) is associated with stroke incidence in such patients. AIM: To investigate the incidence of cerebrovascular events, myocardial infarction (MI), and death in patients with a significant asymptomatic CAS undergoing CABG. METHODS: We prospectively evaluated 123 consecutive patients with documented carotid artery duplex Doppler ultrasound examination who underwent isolated CABG. Patients with a significant (≥ 60%) asymptomatic unilateral CAS (n = 35) were compared with those without a significant CAS (n = 88) to assess the rates of stroke, MI and mortality after CABG. RESULTS: No significant differences between patients with a significant asymptomatic unilateral CAS and those without a significant CAS in regard to age (p = 0.5955), presence of hypertension (p = 0.2343), diabetes (p = 0.5495), smoking (p = 0.7891), serum creatinine (p = 0.47) and left ventricular systolic function as evaluated by ejection fraction (p = 0.3789). No cerebrovascular events, MI and deaths occurred during the first 30 days postoperatively. At 12 months, no differences were seen between the groups in the incidence of MI (p = 0.1005) and mortality (p = 0.3959). However, a trend towards higher stroke incidence was noted among patients with a significant asymptomatic unilateral CAS (p = 0.0692). The primary combined endpoint (stroke, MI, and mortality) occurred in 40% of patients with a significant asymptomatic unilateral CAS and 17.05% of patients without a significant CAS (p = 0.0097). Linear regression analysis showed an association between significant asymptomatic unilateral CAS and stroke (p = 0.0041), and between significant asymptomatic unilateral CAS and the primary end point (p = 0.0475). CONCLUSIONS: The presence of a significant asymptomatic unilateral CAS does not increase the risk of stroke, MI and mortality within 30 days after CABG but is was associated with an increased risk of cardiovascular events during the first 12 months postoperatively.

Circulating very small embryonic-like stem cells in cardiovascular disease.

Very small embryonic-like cells (VSELs) are a population of stem cells residing in the bone marrow (BM) and several organs, which undergo mobilization into peripheral blood (PB) following acute myocardial infarction and stroke. These cells express markers of pluripotent stem cells (PSCs), such as Oct-4, Nanog, and SSEA-1, as well as early cardiac, endothelial, and neural tissue developmental markers. VSELs can be effectively isolated from the BM, umbilical cord blood, and PB. Peripheral blood and BM-derived VSELs can be expanded in co-culture with C2C12 myoblast feeder layer and undergo differentiation into cells from all three germ layers, including cardiomyocytes and vascular endothelial cells. Isolation of VSLEs using fluorescence-activated cell sorting multiparameter live cell sorting system is dependent on gating strategy based on their small size and expression of PSC and absence of hematopoietic lineage markers. VSELs express early cardiac and endothelial lineages markers (GATA-4, Nkx2.5/Csx, VE-cadherin, and von Willebrand factor), SDF-1 chemokine receptor CXCR4, and undergo rapid mobilization in acute MI and ischemic stroke. Experiments in mice showed differentiation of BM-derived VSELs into cardiac myocytes and effectiveness of expanded and pre-differentiated VSLEs in improvement of left ventricular ejection fraction after myocardial infarction.

Intima-media thickness and flow-mediated dilatation in the diagnosis of coronary artery disease in perimenopausal women.

INTRODUCTION: Noninvasive diagnosis of coronary artery disease (CAD) in perimenopausal women is a considerable challenge for the clinical practice. OBJECTIVES: The aim of the study was to investigate whether ultrasound examination of the endothelial function and arterial remodeling can be useful for CAD risk assessment in perimenopausal women. PATIENTS AND METHODS: The study involved 65 women with chest pain and positive stress test. Based on the results of coronary angiography, they were divided into 2 groups: a study group with coronary lesions (n = 32) and a control group without coronary lesions (n = 33). The mean age was 50.3 +/-3.2 years (study group: 50.3 +/-3.5 years; control group: 50.2 +/-3.0 years; P = 0.9). Atherosclerotic risk factors were analyzed in all patients. The ultrasound examination was used to assess early atherosclerotic remodeling of the artery by measuring the intima-media thickness (IMT) and endothelial dysfunction by measuring the flow-mediated dilatation (FMD). RESULTS: The IMT was significantly higher in the study group compared with controls (0.059 +/-0.01 mm vs. 0.049 +/-0.01 mm, respectively; P <0.001); FMD was significantly lower in the study group compared with controls (6.53 +/-0.98 vs. 7.89 +/-0.85, respectively; P <0.001). For IMT, the area under the receiver operating characteristic curve (AUROC) was 0.73 (95% confidence interval [CI] 0.6-0.85; P <0.001); therefore, this parameter cannot be used as a predictor of CAD. FMD with the AUROC of 0.85 (95% CI 0.76-0.94; P <0.001) had a good predictive value for CAD. CONCLUSIONS: Evaluation of IMT and FMD in perimenopausal women can be a useful noninvasive diagnostic tool for CAD risk assessment.

Diagnostic value of flow mediated dilatation measurement for coronary artery lesions in men under 45 years of age.

BACKGROUND: In those without symptoms of coronary artery disease (CAD), the incidence of coronary events is still high. The aim of this study was to evaluate whether flow mediated dilatation (FMD) is a useful tool in identifying those with CAD in who are under 45 years of age. METHODS AND RESULTS: Seventy five men below 45 years of age, hospitalized in order to perform elective coronary angiography, were enrolled into the study. Based on coronary angiography findings, they were divided into two groups: study group (Group A, n = 55) with obstructive coronary lesions and the control group (Group B, n = 20) without significant lesions in coronary arteries. In all subjects atherosclerosis risk factors were analyzed. Endothelial dysfunction was assessed in ultrasound via FMD. FMD was significantly lower in the study group than in the control group (3.92 +/- 1.1 vs 6.51 +/- 1.1, p < 0.001). FMD, as well as age, diabetes and positive family history, appeared to be statistically significant CAD risk factors. AUROC for FMD was 0.957 (p < 0.001), meaning this model had an almost complete ability to predict the presence of CAD. AUROC for CAD diagnosis on the basis of significant clinical parameters was 0.992 (p < 0.001), also representing almost complete ability of this model to identify asymptomatic subjects with CAD risk. CONCLUSIONS: The evaluation of endothelial function by the use of FMD in the population of men below 45 years of age with diabetes and positive family history can help in identifying subjects at high risk of coronary artery disease.