Diagnosis of Coronary Artery Disease

In this study, a layer-by-layer assembly method was employed for the fabrication of composite electrode interface that was composed of multi-walled carbon nanotubes (MWCT) with quasi 1D structure and graphene with 2D plane structure. Specifically, the composite was synthesized via electrostatic adsorption between negatively charged MWCT and GR and positively charged poly(diallyldimethylammonium chloride) (PDDA). Cyclic voltammetry and electrochemical impedance spectroscopy (EIS) were applied for investigate the electron transfer performance of as- prepared electrode. In addition, a nanobody-based electrochemical immunoassay was fabricated with the as-prepared MWCTs and GR modified electrode for the detection of protein Apo-A. The proposed immunosensor demonstrated promising potential use in the diagnosis of coronary artery disease owing to the observed excellent detection performance toward Apo-A in human serum.

In this report, the activities of the first year are explained, which are the detailed study of the computer aided diagnosis systems, their requirement, earlier work done in this field and the comparative analysis of data mining techniques. After this, the formation of hybrid system with integration of different techniques is designed to proceed for implementation by optimizing associated parameters and functions. The features of the selected dataset are processed to transform them in acceptable form for further extraction. The selection of the features is done on the basis of their importance to enhance the overall system performance. In later phases of second year, the system will be cross validated, trained and tested with desired subsets from the dataset. At the end, different data sets (subsets) will be used for the CAD detection including ECG signals. To identify CAD presence, we are using a UCI heart dataset with thirteen attributes like age, sex, chest pain type, resting blood pressure, serum cholesterol, fasting blood sugar, resting ECG result, maximum heart rate achieved, the occurrence of exercise induced angina, ST depression induced by exercise relative to rest, slope of the peak exercise ST segment, a number of major vessels colored by fluoroscopy, and thal. These attributes are enough to assist us in detecting CAD patient by taking help of angiography result like zero means patient is normal while one for single- vessel, two for double-vessel disease, three for triple-vessel disease, and four for left main Coronary Artery Disease [2- 4].

Abstract— Medical diagnosis is a tedious process in which the result of the diagnosis has to be accurate. In this paper, an evolutionary fuzzy expert system is proposed for the diagnosis of the Coronary Artery Disease (CAD) based on Cleveland clinic foundation datasets for heart diseases. The decision tree is used to select the most significant attributes and the output is converted into crisp if-then rules. The crisp sets of rules are transformed into the fuzzy rules and these rules constitute the fuzzy rule base. Genetic Algorithm (GA) is used to tune the fuzzy membership functions and the optimized of membership functions using GA helps to achieve better accuracy. The performance of the proposed system is analyzed using various parameters like classification accuracy, sensitivity and specificity and it is observed that that this system achieves better accuracy than the existing systems.

Analysis of multiple noninvasive tests offers the promise of more accurate diagnosis of coronary artery disease, but discordant test responses can occur frequently and, when observed, result in diagnostic uncertainty. Accordingly, 43 patients undergoing diagnostic coronary angiography were evaluated by noninvasive testing and the results subjected to analysis using Bayes' theorem of conditional probability. The procedures used included electrocardiographic stress testing for detection of exercise-induced ST segment

electrode, the state of the decorated electrode was observed to gradually decrease after several cycles of use. To acquire R.S.D. of 3.4%, the measurements with 50 CV in working buffer, was employed, where the study of durability of consecutive assays was carried out. Investigation of long-time immunosensor stability was conducted on 90-day period. The immunosensors could remain the 82.4% and 93.5% of initial after the storing time with 90 days and 60 days at 4 °C respectively, which demonstrated acceptable storage stability. To determine the periostin in human serum for routine clinical early diagnosis of coronary artery disease, the present immunoassay method, where immunosensor displayed acceptable storage stability, is suitable.

Atherosclerosis, stable myocardial infarction (MI), non-stable MI are the most common manifestations of coronary artery disease (CAD). CAD is one of leading causes of substantial morbidity and mortality in the global scenario. There are several biomarkers and methods for the diagnosis of CAD such as cardiac specific troponin, electrocardiogram (ECG), CT angiography. Recent- ly, many studies have shown that miRNAs are involved in regulation of gene expression on post-transcriptional level by inhibiting translation protein from mRNA that miRNAs dysregulated in the plasma of patients with CAD (cases). These suggested miRNAs can be detected in circulating blood which might be a diagnostic and prognostic biomarker for CAD. Besides these studies, there is an additional need in studies about miRNAs family, so that miRNAs might serve as potential therapeutic target in the treatment of CAD, as well as other complex diseases. In this review, we have summarized some studies as miR- NAs as diagnostic and assessment of prognosis biomarker in patients with CAD.

Ischemic heart disease (IHD) mainly is created by atheromatous plaque that gradu- ally narrow or occlude coronary arteries. Other causes include endothelial dysfunction, microvascular disease and vasospasm that either alone or in combination with atheros- clerosis are due to myocardial ischemia. The predominant symptom in IHD is chest discomfort. Angina is a pain in the chest and adjacent areas caused by activity and is also described as squeezing, heaviness, tightness, numbness or tingling. The pain is in the retrosternal area and spread to other parts is also common. In some patients atypi- cal angina or angina equivalent, such as epigastric pain, exercise intolerance, dyspnea and fatigue is a symptom too. The angina caused by imbalance between oxygen supply and demand. Non-invasive tests give us useful diagnostic and prognostic data. The ac- curacy and reliability of any test not only the sensitivity and specificity but also depends on the prevalence and pretest probability of disease. The maximum value of these tests is when there is moderate risk for disease. The sensitivity of test used for screening co- ronary artery disease is more important than its specificity. The sensitivity and specific- ity of exercise test (and also cardiogoniometry) with the use of angiography as the gold standard for diagnosis is limited and can create bias so that increase sensitivity and de- crease specificity because the patients selected for angiography more likely to have co- ronary artery disease.

prescribed in order to specify the nature and extent of the coronary lesions. The procedure of coronary angiography involves the transmission of a catheter to the root of the coronary arteries, followed by the injection of contrast medium into the coronary bloodstream, which is visible under the performed X-ray examination. Figure 1.6.a shows an example of the 2D ICA scan of the coronary artery with the performed quantiative assessment of the detected stenosis including DS, reference diameter, and length of the stenosed segment. Being the gold standard technique in CAD diagnosis [6,23], ICA provides visual information that can be used to recognise lesions such as stenosis, restenosis occlusion, thrombosis, aneurysms together with the myocardium contraction function and measured coronary artery pressure. The obtained information is further analysed for identification of a treatment strategy, such as coronary intervention or coronary bypass surgery. The decision on the required surgical intervention is normally based on angiographic results alone. However, in the case of multiple medium- severity epicardial artery stenoses, the decision on which of the lesions is the main cause of ischemia and thus requires stenting cannot be completely clear from the angiography data alone. ICA visualises only the blood inside a vessel replicating luminal changes but not the actual atherosclerotic lesions and can either underestimate or overestimate the lesion burden.

pooled sensitivity and specificity of 91% and 81%, including studies with qualitative and quantitative approaches for the detection of a ≥ 50% diameter stenosis [87]. The benefit of quantitative analysis, though, has most recently been pointed out again by Patel et al. [88], and especially holds true for triple-vessel disease patients. Possible discrepancies of MR perfusion imaging with regard to standards such as quanti- tative coronary angiography (QCA) may not be related to the technical shortcomings of either imaging technique, but to the limitations of QCA in the assessment of the haemody- namic significance of a stenosis. While first-pass myocardial perfusion imaging evaluates functional aspects, QCA dem- onstrates morphological features, but delivers no functional information. Schwitter et al. [89] have demonstrated a higher sensitivity and specificity of first-pass perfusion imaging in comparison with PET definitions of ischaemia (91% and 94%, respectively) compared with the QCA diagnosis of >50% coronary artery stenosis (87% and 85%, respectively). The limited accuracy of QCA in the assessment of the haemodynamic severity of a given stenosis, especially in intermediate lesions, has been pointed out repeatedly [90, 91]. Regarding MR myocardial perfusion, most recent studies in fact focused on the use of invasive fractional flow reserve (FFR) measurements, serving as the standard of reference [92 – 94]. Using an FFR of <0.75 as a cut-off value for the differentiation of haemodynamic significant versus non-significant lesions, first-pass MR perfusion imaging showed a sensitivity and specificity of 91% and 94% [93].

to the presence of significant coronary artery stenosis. They demonstrated that prolonged duration of ESL at rest enabled detection of significant CAD by using visual estimation on CAG, and provided incremental value over peak systolic longitudinal strain for the identification of patients with significant CAD. 5 However, whether dura- tion of LV ESL provides added value for prediction of the presence of physiological significant CAD had not been previously studied. Contrary to our expectations, duration of LV ESL did not predict an FFR, which is the current gold standard for evaluating the physiolog- ical myocardial ischaemia, in patients with CAD in the present study.

Baihaqi et al. [1] designed a review paper on fuzzy expert system and data mining technique with algorithm. In this paper, they also gave comparison between two techniques for accuracy. In this paper, they used UCI machine repository dataset for CAD. Agrawal-Chopde [2] presented a survey paper on CAD. In this paper, author mentions the entire possible attribute to determine heart condition with comparison of all the techniques. In this paper, they mentioned that ANFIS is better techniques to predict heart condition. Krishnasree-Rao[3] introduced a Bayesian regularization model, which is one of the statistical models for calculating nonlinear dataset. In this paper, they have implemented this model and achieved 91% accuracy. Muthukaruppan [4] presented a particle swarm optimization (PSO)-based fuzzy expert system for the diagnosis of heart disease. They have used decision tree (DT) for taking proper input attributes because dataset consist of lots of attributes. In this paper, they have given complete attribute information with their ranges and remarks.

This philosophy is supported by studies suggesting that the risk of emergency coronary angiography and bypass surgery to patients with unstable angina is equal to t[r]

Background: Obesity, type II Diabetes mellitus (DMII) and vascular damage could be implicated in prostate cancer (PCa) nevertheless no clear results has been reached. The aim of the research was to investigate the association of these alterations with PCa at initial diagnosis, without the influ- ence of hormone therapy or chemotherapy. Methods: Retrospective analysis of 400 patients un- dergoing prostate biopsy at our institution between 2005 and 2012 was conducted. We examined associations of obesity, DMII and vascular damage in 200 patients with PCa diagnosis versus 200 age-matched controls. Men with history of hormone therapy or chemotherapy, prostate or bladder surgery were excluded. Results: Obesity was significantly associated (OR 2.10, p < 0.05) with ag- gressive PCa (Gleason Score 8 - 10). DMII was significantly associated to aggressive PCa but only in obese cases (OR 4.25). Carotid vascular disease (CVD) and coronary artery disease (CAD) were significantly linked to PCa in all cases versus controls (OR 1.88, p < 0.05). Conclusions: In our study, obesity, particularly in combination with DMII, was significantly associated with aggressive PCa. Moreover, a significant relation was found between vascular disease and PCa hormone-naïve at initial diagnosis. The metabolic derangements associated to obesity and DMII may increase oxida- tive stress and cause a permanent pro-inflammatory state that predisposes to vascular disease and PCa.

Due to the first Russian registry of Htn (2006-2012), it became possible to trace for several years the level of implementation of clinical guidelines among Russian patients with Htn. It was found out that the level of guidelines implementation is low, compared to economically developed countries [34, 35, 55, 56]. In 2008, only 22% of hypertensive patients had the goal blood pressure and/or satisfactory quality of healthcare [32]. It has been shown that primary care physicians do not conduct correction of cardiovascular risk factors and diagnosis of lesions of target organs and/or associated clinical conditions, which leads to an underestimation of cardiovascular risk and inadequate choice of treatment tactics in patients with Htn [32, 34]. In 2007, 64% of hypertensive patients had medicinal purposes in medical card [34]. At the same time, assigned antihypertensive therapy is fully consistent with the clinical status in 6.5% of total patients with Htn [34].

Coronary artery disease (CAD) is a leading cause of mortality and morbidity in developed countries [1]. CAD is a common and sometimes disabling disorder, although percutaneous coronary intervention and coronary artery bypass grafting have developed. Medical doctors need to prevent acute coronary syndrome in the stage of no sig- nificant stenotic coronary artery atherosclerosis. The de- velopment of non-invasive cardiac imaging tools (par- ticularly, cardiac computed tomography, echocardiogra- phy and so on) for the diagnostic and prognostic assess- ments of patients is evolving evidence base for various treatment strategies. Cardiac catheterization is golden standard for the diagnosis of CAD. Although the risk of adverse events for invasive coronary angiography is gen- erally considered to be low, potential life-threatening complications can arise, including not only coronary ar- tery dissection, but also arrhythmia, stroke, hemorrhage, myocardial infarction (MI), and death [2]. Computed tomography (CT) imaging was introduced in 1972 [3]. The ability to obtain cross-sectional images of the com- puter-assisted tomography, Sir Geoffrey N. Hounsfield and Allan M. Cormack were awarded the Nobel prize in Medicine in 1979. Moreover, cardiac CT has been de- veloping.

Methods/analysis The Stratified Medical Therapy Using Invasive Coronary Function Testing In Angina (CorMicA) trial is a prospective, blinded, randomised, sham-controlled study comparing two management approaches in patients with ANOCA. We aim to recruit consecutive patients with stable angina undergoing elective invasive coronary angiography. Eligible patients with ANOCA (n=150) will be randomised to invasive coronary artery function-guided diagnosis and treatment (intervention group) or not (control group). Based on these test results, patients will be stratified into disease endotypes: microvascular angina, vasospastic angina, mixed microvascular/vasospastic angina, obstructive epicardial coronary artery disease and non-cardiac chest pain. After randomisation in CorMicA, subjects will be invited to participate in the Coronary Microvascular Angina Cardiac Magnetic Resonance Imaging (CorCMR) substudy. Patients will undergo multiparametric CMR and have assessments of MBF (using a novel pixel-wise fully quantitative method), left ventricular function and mass, and tissue characterisation (T1 mapping and late gadolinium enhancement imaging). Abnormalities of myocardial perfusion and associations between MBF and invasive coronary artery function tests will be assessed. The CorCMR substudy represents the largest cohort of ANOCA patients with paired multiparametric CMR and comprehensive invasive coronary vascular function tests.

One hundred twenty patients with OSAHS treated in the Heart Center of the First Affiliated Hospital of Xinjiang Medical University Hospital between June 2013 and June 2014 were selected, among whom 84 were males (70%) and 36 were females (30%), with a mean age of 48.64±9.45 years. The OSAHS diagnostic criteria were based on the “Guidelines for Diagnosis and Treatment of Obstructive Sleep Apnea- Hypopnea Syndrome” (2011 revised edition) [2]; specifically, patients with symptoms, such as typical nocturnal sleep snor- ing with apnea and diurnal sleepiness (ESS score≥9 points), stenosis and obstruction in any site of the airway, as indi- cated on physical examination, and a apnea-hypopnea index (AHI)≥5 times/h were diagnosed with OSAHS. For patients with non-obvious diurnal sleepiness (ESS score <9 points) and an AHI≥10 or ≥5 times/h, the presence of one or more of the following symptoms was diagnostic: cognitive dysfunction; coronary artery disease; cerebrovascular disease; diabetes; and insomnia. Based on the AHI, patients could be divided into the following three groups: patients with an AHI<10 times/h as the control group (n=25); patients with an AHI=10~15 times/h as the mild OSAHS group (n=32); and patients with an AHI>15 times/h as the moderate-to-severe OSAHS group (n=63).

The diagnosis of classic KD is based on the simultaneous presence of high fever for 5 or more days with at least four of the remaining five symptoms (bilateral conjunctival hyperemia, ulcerations of the lips and inflammation of the oral cavity, polymorphous rash, edema and desquamation of the extremities and cervical lymphadenopathy) or fever associated with less than 4 of the diagnostic criteria and echocardiographic abnormalities of the coronary arteries. Coronary artery aneurysms or ectasias may develop in 25-

[18]. CAD diagnoses in CARDIoGRAMplusC4D was defined by an inclusive CAD diagnosis (e.g. myocardial in- farction (MI), acute coronary syndrome, chronic stable an- gina, or coronary stenosis > 50%) [17]. The ISGC defined stroke by an inclusive stroke diagnosis (e.g. ischemic stroke, large artery stroke, cardioembolic stroke and small vessel stroke). We standardized GWAS summary data to minimize potential bias due to quality control proce- dures. Indels and rare/low frequency variants with a minor allele frequency of < 1% were excluded. In addition, we restricted analysis to autosomal chromosomes. Aside from RHR and HBP, both tested in Biobank, we are not aware of specific sample overlap between COPD and 4 major cardiovascular traits in this study, including RHR, HBP, CAD and stroke. Details of each dataset can be found in Additional file 1: Table S1. All subjects consent to participate the study by the time of data analysis.

Results: Five hundred twenty-two patients were assessed with median age 66 years and 21% prior revascularization. Median baseline left ventricular ejection fraction was 64%, and 62% had ≥ 50% stenosis on angiography. During 5.0 years median follow-up, 30% underwent percutaneous and 16% surgical revascularization. In multivariate analysis, only age and BNP were independently associated with outcomes. The adjusted hazard ratio per log unit increase in BNP was 2.15 for mortality (95% CI 1.45 – 3.19; p = 0.0001) and 1.27 for composite events (1.04 – 1.54; p = 0.018). Patients with baseline BNP > 100 pg/mL had substantially higher mortality and composite events (20.9% and 32.2%) than those with BNP ≤ 100 pg/mL (5.6% and 15.5%). BNP improved both classification and discrimination of outcomes ( p ≤ 0.003), regardless of left ventricular systolic function. Conversely, high-sensitivity C-reactive protein, pulse wave analysis and heart rate variability were unrelated to prognosis at 5 years after risk modification and treatment of coronary disease. Conclusions: Conventional risk factors and other markers of arterial compliance, inflammation and autonomic function have limited value for prediction of outcomes in risk-modified patients assessed for coronary disease. BNP can independently identify patients with subtle impairment of cardiac function that might benefit from more intensive management.