Instituto Nacional de Cardiología

Patients with coronary ectasia (CAE) have an increased risk of major cardiovascular events (MACE). Current preventive treatments are uncertain, with oral anticoagulants often prescribed based on limited retrospective studies. Our aim is to help address the question: what is the most appropriate treatment? Using a retrospective cohort of patients with an ACS and CAE in a single center in Mexico City, two groups were observed based on the treatment at discharge: dual antiplatelet therapy (group 1) and anticoagulation with either a VKA or a DOAC, regardless of antiplatelet therapy (group 2). The main outcome was MACE, which was a composite of all-cause mortality, reinfarction, and ischemic stroke at 4.5years follow-up. A total of 354 patients admitted for ACS and CAE were included. 228 (64.4%) patients were classified in the DAPT group and 126 (35.5%) in the anticoagulants group. The DAPT group had higher type 2 diabetes rates, NSTEMI presentation, and lower-grade ectasia. The anticoagulation group had higher STEMI presentation and higher-grade ectasia. The DAPT group had 33 (14.5%) events of MACE, whereas the anticoagulation group had 16 (13.1%) events. Anticoagulants were not associated with a risk reduction of the primary endpoint (HR 0.95; 95% CI, 0.47-1.54; p = 0.59), nor any of the individual components. This retrospective cohort study showed similar effectiveness between DAPT and anticoagulation in patients with ACS and CAE for preventing MACE, and lower bleeding risk. Further research is needed to identify optimal candidates for each antithrombotic regime.

The ankle-brachial index (ABI) is the most non-invasive technique used for diagnosing and assessing peripheral artery disease (PAD), although it is operator-dependent and limited by arterial calcification. Since photoplethysmography (PPG) is a non-invasive, low-cost, and easy-to-use technique that is not limited by arterial compressibility, PPG morphological parameters have been studied for PAD diagnosis, mostly based on mean values. In this work, the relationship between variability indices of PPG morphological parameters and ABI was studied in 52 legs of 32 PAD patients. The morphological PPG parameters, including amplitude, pulse transit time (PTT), and maximum systolic slope, were measured. The mean, standard deviation, and frequency spectral energy for very low, low, and high frequencies were computed as PPG morphological variability indices. The variability indices of PPG morphological parameters have a significant correlation with ABI, indicating that they differ not only between legs with altered and normal ABI but also that they may relate to PAD progression. Fourteen of the 15 variability indices showed significant diagnostic value, with the standard deviation of PTT being the most effective (sensitivity of 96% and specificity of 71%). The differences between normal and non-compressible legs were not significant. The comparison between contralateral legs was also not significant. This suggests that variability indices may provide valuable insights into changes in physiological regulatory mechanisms as PAD progresses, which could aid in the diagnosis, assessment, and prognosis of PAD in future research.

Advances in human microbiome research have highlighted its influence on host health. This study aimed to characterize the oral microbiome (OM) and gut microbiome (GM) and to examine their relationships with systemic fatty acid and cytokine profiles across different age groups in healthy adults. Participants aged 18-76years without diagnosed diseases were grouped into young (18-29years), middle-aged (30-49years), and older adults (≥50years). Blood, dental plaque, and fecal samples were collected. OM and GM composition were evaluated using 16 rRNA sequencing. Circulating free fatty acids (FFAs) were quantified by gas chromatography-mass spectrometry, and serum cytokines were assessed using flow cytometry. In the OM, Fusobacterium and Haemophilus were notably abundant in young adults, while Haemophilus and Neisseria predominated in middle-aged adults. In older adults, Neisseria and Capnocytophaga were the most prevalent oral genera. In the GM, Bacteroides was the most prevalent genus across all age groups, followed by Faecalibacterium, Blautia, and Prevotella_9. Additionally, circulating levels of decanoic, hexadecanoic, and octadecanoic acids, as well as the cytokine IP-10, were higher in young adults compared with the other age groups. To our knowledge, this study is the first to characterize and correlate the diversity of both the OM and GM with systemic FFA and cytokine profiles in a cohort of healthy adults, highlighting the critical role of age in shaping microbiome composition and associated metabolites. Integrating microbial profiling with serum FFA and cytokine measurements enhances our understanding of how the microbiome may influence health and disease risk across the adult lifespan.