D. Zateyshchikov - Academia.edu (original) (raw)
Papers by D. Zateyshchikov
International Journal of Molecular Sciences
Hypertrophic cardiomyopathy (HCM) is the most common inherited myocardial disease with significan... more Hypertrophic cardiomyopathy (HCM) is the most common inherited myocardial disease with significant genetic and phenotypic heterogeneity. To search for novel biomarkers, which could increase the accuracy of HCM diagnosis and improve understanding of its phenotype formation, we analyzed the levels of circulating miRNAs—stable non-coding RNAs involved in post-transcriptional gene regulation. Performed high throughput sequencing of miRNAs in plasma of HCM patients and controls pinpointed miR-499a-5p as one of 35 miRNAs dysregulated in HCM. Further investigation on enlarged groups of individuals showed that its level was higher in carriers of pathogenic/likely pathogenic (P/LP) variants in MYH7 gene compared to controls (fold change, FC = 8.9; p < 0.0001). Just as important, carriers of variants in MYH7 gene were defined with higher miRNA levels than carriers of variants in the MYBPC3 gene (FC = 14.1; p = 0.0003) and other patients (FC = 4.1; p = 0.0008). The receiver operating charac...
European Journal of Preventive Cardiology, 2021
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main fu... more Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This research was supported by FMBA of Russia Background. There are still very limited data about physiological cardiac adaptation in strength athletes. Purpose. To describe structural and functional features of left ventricular (LV) in a large cohort of healthy strength athletes. Methods. A total of 673 Caucasian athletes (weight-lifting, males/females = 238/157, and Martial Arts, males/females = 200/78) competing in Russian National and International level events were recruited within 2010-2017. Data of standard 2D echocardiography (Echo) and comprehensive medical history were analyzed. Data are presented as median (IQR) and compared by nonparametric tests (table). To assess LV geometry all athletes were divided into 6 groups according to 4-tiered classification based on mass index, concentricity and end-diastolic volume (EDV) index of LV (Figure). Results. Both abso...
European Heart Journal, 2020
Left ventricular (LV) global function index (LVGFI) is a MRI marker of left ventricular remodel... more Left ventricular (LV) global function index (LVGFI) is a MRI marker of left ventricular remodeling. LVGFI has high predictive significance in young healthy individuals. The aim of the study was to assess prognostic significance in patients with acute coronary syndrome (ACS). We include into this analysis 2169 patients with ACS (1340 (61.8%) men and 829 (38.2%) women), mean age 64.08±12.601 years. All patients were observed in 2 Russian multicenter observational studies: ORACLE I (ObseRvation after Acute Coronary syndrome for deveLopment of trEatment options) (2004–2007 years) and ORACLE II (NCT04068909) (2014–2019 years). 1886 (87.0%) pts had arterial hypertension, 1539 (71.0%) – history of coronary artery disease, 647 (29.8%) – history of myocardial infarction, 444 (20.5%) - diabetes mellitus. Duration of the follow-up was 1 years after the hospital discharge. Cases of death from any cause, coronary deaths, repeated coronary events (fatal and non-fatal) were recorded. An echocard...
European Heart Journal, 2021
Aims The aim of this study was to determine the frequency of heterozygous truncating ALPK3 varian... more Aims The aim of this study was to determine the frequency of heterozygous truncating ALPK3 variants (ALPK3tv) in patients with hypertrophic cardiomyopathy (HCM) and confirm their pathogenicity using burden testing in independent cohorts and family co-segregation studies. Methods and results In a discovery cohort of 770 index patients with HCM, 12 (1.56%) were heterozygous for ALPK3tv [odds ratio(OR) 16.11, 95% confidence interval (CI) 7.94–30.02, P = 8.05e−11] compared to the Genome Aggregation Database (gnomAD) population. In a validation cohort of 2047 HCM probands, 32 (1.56%) carried heterozygous ALPK3tv (OR 16.17, 95% CI 10.31–24.87, P < 2.2e−16, compared to gnomAD). Combined logarithm of odds score in seven families with ALPK3tv was 2.99. In comparison with a cohort of genotyped patients with HCM (n = 1679) with and without pathogenic sarcomere gene variants (SP+ and SP−), ALPK3tv carriers had a higher prevalence of apical/concentric patterns of hypertrophy (60%, P < 0.0...
Journal of Hypertension, 2018
The problems of high quality training of future workers for cultural-and-leisure sphere are consi... more The problems of high quality training of future workers for cultural-and-leisure sphere are considered to be up-to-date these days. That is a characteristic feature of nowadays and is one of the most important trends of domestic education modernization, a significant factor of providing the educational demands. Recently, in Ukraine the tendency of wide introduction of interactive methods and training technologies is observed. At present, the problem of development and introduction of innovative pedagogical technologies into educational process of the higher educational institution is studied both in theoretical and didactic aspects, moreover, the foreign experience as for introduction of pedagogical innovations is actively investigated. Appearance, development and introduction of interactive methods into the higher education system are stipulated by the fact that modern education faces new tasks: not only to give students knowledge but provide them with formation and development of their cognitive activities and abilities, creative thinking, independent thinking work skills.
European Heart Journal, 2019
Introduction Familial hypercholesterolemia (FH) is the most common genetically inherited disease ... more Introduction Familial hypercholesterolemia (FH) is the most common genetically inherited disease in the world, which leads to a significant increase in blood cholesterol and an increased risk of early atherosclerosis and, consequently, an increase in mortality from ischemic heart disease (IHD). The actual prevalence of genetic variants causing FH in every population remains unknown. Purpose To compare the frequency of mutations in patients with FH who underwent acute coronary syndrome (ACS) and patients with stable IHD. Material and methods We included 120 patients (male-79, female-41) who had a clinical diagnosis of FH based on the Dutch Lipid Clinic Network (DLCN) score and Simon Broome criteria. The men and women included in the study were ≤55 and ≤60 years of age, respectively. 40 of them were patients with ACS; the remaining 80 were patients with stable IHD. Genetic studies were performed using a multiple approach based on targeted Next Generation Sequencing (NGS) in the Health...
European Heart Journal, 2019
Background Genetic predisposition makes a considerable contribution to premature acute coronary s... more Background Genetic predisposition makes a considerable contribution to premature acute coronary syndrome (ACS) development. Tumour necrosis factor (TNF) is an important proinflammatory cytokine influencing intravascular inflammation. Annexin A2 (ANXA2) is an endogenous PCSK9 inhibitor. Higher LDL level is associated with AA genotype of ANXA2 gene SNP rs17845226. Aim The aim of the study was to elucidate the association of TNF and ANXA2 gene polymorphism with coronary angiography features and outcome in patients (pts) with early ACS. Methods We analyzed data from two prospective observational trials (2004–2007; 2014–2016) - 672 pts (498 men and 174 women) with premature ACS (men≤55, women≤60 years of age). Coronary angiography (CAG) data were analyzed in 225 pts. Genotyping of SNP rs1800629 of TNF (502 pts) and rs17845226 of ANXA2 gene (235 pts) was performed by RT-PCR with allele-specific primers. The primary endpoint was calculated as a combination of all-cause mortality, recurrent...
New England Journal of Medicine, 2019
British Journal of Anaesthesia, 2018
Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and fac... more Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associatedeas any anticoagulantewith a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an
Atherosclerosis, 2018
R46L (rs11591147), R237W (rs148195424), I474V (rs562556), and E670G (rs505151) and observed 2,261... more R46L (rs11591147), R237W (rs148195424), I474V (rs562556), and E670G (rs505151) and observed 2,261 cardiovascular deaths and 14,651 deaths from any cause during a median follow-up of 8.6 years (range 0-41) and 1,097,778 person years. Results: An increasing number of weighted PCSK9 alleles were associated with stepwise lower LDL cholesterol of up to 0.61 mmol/L (24 mg/dL; 18.2%; p for trend<0.001) and with lower cardiovascular (p¼0.002) and all-cause mortality (p¼0.04). In causal, genetic analyses a 1mmol/L (38.7 mg/dL) lower LDL cholesterol was associated with risk ratios of 0.33 (95% confidence interval: 0.19-0.58; p<0.001) for cardiovascular mortality and of 0.72 (0.60-0.88; p¼0.001) for all-cause mortality. Conclusions: Genetically low LDL cholesterol due to PCSK9 variation was causally associated with low risk of cardiovascular and all-cause mortality in the general population.
Indian Heart Journal, 2018
BACKGROUND The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an... more BACKGROUND The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range IQR: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
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](Journal of Hypertension, 2017
The study included 100 healthy volunteers and 312 patients with I-II grade of EH. For linkage dis... more The study included 100 healthy volunteers and 312 patients with I-II grade of EH. For linkage disequilibrium research, have been taken microsatellite SSR-markers. Results: We have studied genotype of 20 gene of cardiovascular continuum and identifi ed 12 diagnostically signifi cant genes. Registration of the genotyping results has identifi ed an association SNP genes
Clinical Case Reports and Reviews, 2016
Volume 2(10): 1-3 inferior hypokynesis. On physical examination at admission his pulse rate was 8... more Volume 2(10): 1-3 inferior hypokynesis. On physical examination at admission his pulse rate was 80 bpm and his blood pressure was 110/70 mm Hg. Laboratory values included hemoglobin 164 g/l, total cholesterol 5,5 mmol/l, low-density-lipoprotein cholesterol 3,3 mmol/l, creatinine 86 µmol/l. Electrocardiography at rest showed sinus rhythm and no ST segment changes (Figure 2). The patient was suspected to have coronary artery disease. Multislice computed tomography coronary angiography showed enlargement of all coronary arteries and normal coronary veins structure (Figure 3). The patient underwent cardiac catheterization. There was no atheroma or stenotic lesion, but a heavy stream of contrast agent entered the LV via distal segments of both the left and right coronary arterial systems. The angiogram showed multiple coronary artery fistulas. Two fistulas originated from the distal segments of left anterior descending artery and diagonal artery, another from obtuse marginal branch (Figure 2) and two more from the distal segments of posterior
Atherosclerosis Supplements, 2011
New England Journal of Medicine, 2013
International Journal of Molecular Sciences
Hypertrophic cardiomyopathy (HCM) is the most common inherited myocardial disease with significan... more Hypertrophic cardiomyopathy (HCM) is the most common inherited myocardial disease with significant genetic and phenotypic heterogeneity. To search for novel biomarkers, which could increase the accuracy of HCM diagnosis and improve understanding of its phenotype formation, we analyzed the levels of circulating miRNAs—stable non-coding RNAs involved in post-transcriptional gene regulation. Performed high throughput sequencing of miRNAs in plasma of HCM patients and controls pinpointed miR-499a-5p as one of 35 miRNAs dysregulated in HCM. Further investigation on enlarged groups of individuals showed that its level was higher in carriers of pathogenic/likely pathogenic (P/LP) variants in MYH7 gene compared to controls (fold change, FC = 8.9; p < 0.0001). Just as important, carriers of variants in MYH7 gene were defined with higher miRNA levels than carriers of variants in the MYBPC3 gene (FC = 14.1; p = 0.0003) and other patients (FC = 4.1; p = 0.0008). The receiver operating charac...
European Journal of Preventive Cardiology, 2021
Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main fu... more Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): This research was supported by FMBA of Russia Background. There are still very limited data about physiological cardiac adaptation in strength athletes. Purpose. To describe structural and functional features of left ventricular (LV) in a large cohort of healthy strength athletes. Methods. A total of 673 Caucasian athletes (weight-lifting, males/females = 238/157, and Martial Arts, males/females = 200/78) competing in Russian National and International level events were recruited within 2010-2017. Data of standard 2D echocardiography (Echo) and comprehensive medical history were analyzed. Data are presented as median (IQR) and compared by nonparametric tests (table). To assess LV geometry all athletes were divided into 6 groups according to 4-tiered classification based on mass index, concentricity and end-diastolic volume (EDV) index of LV (Figure). Results. Both abso...
European Heart Journal, 2020
Left ventricular (LV) global function index (LVGFI) is a MRI marker of left ventricular remodel... more Left ventricular (LV) global function index (LVGFI) is a MRI marker of left ventricular remodeling. LVGFI has high predictive significance in young healthy individuals. The aim of the study was to assess prognostic significance in patients with acute coronary syndrome (ACS). We include into this analysis 2169 patients with ACS (1340 (61.8%) men and 829 (38.2%) women), mean age 64.08±12.601 years. All patients were observed in 2 Russian multicenter observational studies: ORACLE I (ObseRvation after Acute Coronary syndrome for deveLopment of trEatment options) (2004–2007 years) and ORACLE II (NCT04068909) (2014–2019 years). 1886 (87.0%) pts had arterial hypertension, 1539 (71.0%) – history of coronary artery disease, 647 (29.8%) – history of myocardial infarction, 444 (20.5%) - diabetes mellitus. Duration of the follow-up was 1 years after the hospital discharge. Cases of death from any cause, coronary deaths, repeated coronary events (fatal and non-fatal) were recorded. An echocard...
European Heart Journal, 2021
Aims The aim of this study was to determine the frequency of heterozygous truncating ALPK3 varian... more Aims The aim of this study was to determine the frequency of heterozygous truncating ALPK3 variants (ALPK3tv) in patients with hypertrophic cardiomyopathy (HCM) and confirm their pathogenicity using burden testing in independent cohorts and family co-segregation studies. Methods and results In a discovery cohort of 770 index patients with HCM, 12 (1.56%) were heterozygous for ALPK3tv [odds ratio(OR) 16.11, 95% confidence interval (CI) 7.94–30.02, P = 8.05e−11] compared to the Genome Aggregation Database (gnomAD) population. In a validation cohort of 2047 HCM probands, 32 (1.56%) carried heterozygous ALPK3tv (OR 16.17, 95% CI 10.31–24.87, P < 2.2e−16, compared to gnomAD). Combined logarithm of odds score in seven families with ALPK3tv was 2.99. In comparison with a cohort of genotyped patients with HCM (n = 1679) with and without pathogenic sarcomere gene variants (SP+ and SP−), ALPK3tv carriers had a higher prevalence of apical/concentric patterns of hypertrophy (60%, P < 0.0...
Journal of Hypertension, 2018
The problems of high quality training of future workers for cultural-and-leisure sphere are consi... more The problems of high quality training of future workers for cultural-and-leisure sphere are considered to be up-to-date these days. That is a characteristic feature of nowadays and is one of the most important trends of domestic education modernization, a significant factor of providing the educational demands. Recently, in Ukraine the tendency of wide introduction of interactive methods and training technologies is observed. At present, the problem of development and introduction of innovative pedagogical technologies into educational process of the higher educational institution is studied both in theoretical and didactic aspects, moreover, the foreign experience as for introduction of pedagogical innovations is actively investigated. Appearance, development and introduction of interactive methods into the higher education system are stipulated by the fact that modern education faces new tasks: not only to give students knowledge but provide them with formation and development of their cognitive activities and abilities, creative thinking, independent thinking work skills.
European Heart Journal, 2019
Introduction Familial hypercholesterolemia (FH) is the most common genetically inherited disease ... more Introduction Familial hypercholesterolemia (FH) is the most common genetically inherited disease in the world, which leads to a significant increase in blood cholesterol and an increased risk of early atherosclerosis and, consequently, an increase in mortality from ischemic heart disease (IHD). The actual prevalence of genetic variants causing FH in every population remains unknown. Purpose To compare the frequency of mutations in patients with FH who underwent acute coronary syndrome (ACS) and patients with stable IHD. Material and methods We included 120 patients (male-79, female-41) who had a clinical diagnosis of FH based on the Dutch Lipid Clinic Network (DLCN) score and Simon Broome criteria. The men and women included in the study were ≤55 and ≤60 years of age, respectively. 40 of them were patients with ACS; the remaining 80 were patients with stable IHD. Genetic studies were performed using a multiple approach based on targeted Next Generation Sequencing (NGS) in the Health...
European Heart Journal, 2019
Background Genetic predisposition makes a considerable contribution to premature acute coronary s... more Background Genetic predisposition makes a considerable contribution to premature acute coronary syndrome (ACS) development. Tumour necrosis factor (TNF) is an important proinflammatory cytokine influencing intravascular inflammation. Annexin A2 (ANXA2) is an endogenous PCSK9 inhibitor. Higher LDL level is associated with AA genotype of ANXA2 gene SNP rs17845226. Aim The aim of the study was to elucidate the association of TNF and ANXA2 gene polymorphism with coronary angiography features and outcome in patients (pts) with early ACS. Methods We analyzed data from two prospective observational trials (2004–2007; 2014–2016) - 672 pts (498 men and 174 women) with premature ACS (men≤55, women≤60 years of age). Coronary angiography (CAG) data were analyzed in 225 pts. Genotyping of SNP rs1800629 of TNF (502 pts) and rs17845226 of ANXA2 gene (235 pts) was performed by RT-PCR with allele-specific primers. The primary endpoint was calculated as a combination of all-cause mortality, recurrent...
New England Journal of Medicine, 2019
British Journal of Anaesthesia, 2018
Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and fac... more Non-vitamin K antagonist oral anticoagulants (NOACs), which inhibit thrombin (dabigatran) and factor Xa (rivaroxaban, apixaban, edoxaban) have been introduced in several clinical indications. Although NOACs have a favourable benefit-risk profile and can be used without routine laboratory monitoring, they are associatedeas any anticoagulantewith a risk of bleeding. In addition, treatment may need to be interrupted in patients who need surgery or other procedures. The objective of this article, developed by a multidisciplinary panel of experts in thrombosis and haemostasis, is to provide an
Atherosclerosis, 2018
R46L (rs11591147), R237W (rs148195424), I474V (rs562556), and E670G (rs505151) and observed 2,261... more R46L (rs11591147), R237W (rs148195424), I474V (rs562556), and E670G (rs505151) and observed 2,261 cardiovascular deaths and 14,651 deaths from any cause during a median follow-up of 8.6 years (range 0-41) and 1,097,778 person years. Results: An increasing number of weighted PCSK9 alleles were associated with stepwise lower LDL cholesterol of up to 0.61 mmol/L (24 mg/dL; 18.2%; p for trend<0.001) and with lower cardiovascular (p¼0.002) and all-cause mortality (p¼0.04). In causal, genetic analyses a 1mmol/L (38.7 mg/dL) lower LDL cholesterol was associated with risk ratios of 0.33 (95% confidence interval: 0.19-0.58; p<0.001) for cardiovascular mortality and of 0.72 (0.60-0.88; p¼0.001) for all-cause mortality. Conclusions: Genetically low LDL cholesterol due to PCSK9 variation was causally associated with low risk of cardiovascular and all-cause mortality in the general population.
Indian Heart Journal, 2018
BACKGROUND The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an... more BACKGROUND The Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF) is an ongoing prospective noninterventional registry, which is providing important information on the baseline characteristics, treatment patterns, and 1-year outcomes in patients with newly diagnosed non-valvular atrial fibrillation (NVAF). This report describes data from Indian patients recruited in this registry. METHODS AND RESULTS A total of 52,014 patients with newly diagnosed AF were enrolled globally; of these, 1388 patients were recruited from 26 sites within India (2012-2016). In India, the mean age was 65.8 years at diagnosis of NVAF. Hypertension was the most prevalent risk factor for AF, present in 68.5% of patients from India and in 76.3% of patients globally (P < 0.001). Diabetes and coronary artery disease (CAD) were prevalent in 36.2% and 28.1% of patients as compared with global prevalence of 22.2% and 21.6%, respectively (P < 0.001 for both). Antiplatelet therapy was the most common antithrombotic treatment in India. With increasing stroke risk, however, patients were more likely to receive oral anticoagulant therapy [mainly vitamin K antagonist (VKA)], but average international normalized ratio (INR) was lower among Indian patients [median INR value 1.6 (interquartile range IQR: 1.3-2.3) versus 2.3 (IQR 1.8-2.8) (P < 0.001)]. Compared with other countries, patients from India had markedly higher rates of all-cause mortality [7.68 per 100 person-years (95% confidence interval 6.32-9.35) vs 4.34 (4.16-4.53), P < 0.0001], while rates of stroke/systemic embolism and major bleeding were lower after 1 year of follow-up. CONCLUSION Compared to previously published registries from India, the GARFIELD-AF registry describes clinical profiles and outcomes in Indian patients with AF of a different etiology. The registry data show that compared to the rest of the world, Indian AF patients are younger in age and have more diabetes and CAD. Patients with a higher stroke risk are more likely to receive anticoagulation therapy with VKA but are underdosed compared with the global average in the GARFIELD-AF. CLINICAL TRIAL REGISTRATION-URL: http://www.clinicaltrials.gov. Unique identifier: NCT01090362.
Journal of Hypertension, 2017
The study included 100 healthy volunteers and 312 patients with I-II grade of EH. For linkage dis... more The study included 100 healthy volunteers and 312 patients with I-II grade of EH. For linkage disequilibrium research, have been taken microsatellite SSR-markers. Results: We have studied genotype of 20 gene of cardiovascular continuum and identifi ed 12 diagnostically signifi cant genes. Registration of the genotyping results has identifi ed an association SNP genes
Clinical Case Reports and Reviews, 2016
Volume 2(10): 1-3 inferior hypokynesis. On physical examination at admission his pulse rate was 8... more Volume 2(10): 1-3 inferior hypokynesis. On physical examination at admission his pulse rate was 80 bpm and his blood pressure was 110/70 mm Hg. Laboratory values included hemoglobin 164 g/l, total cholesterol 5,5 mmol/l, low-density-lipoprotein cholesterol 3,3 mmol/l, creatinine 86 µmol/l. Electrocardiography at rest showed sinus rhythm and no ST segment changes (Figure 2). The patient was suspected to have coronary artery disease. Multislice computed tomography coronary angiography showed enlargement of all coronary arteries and normal coronary veins structure (Figure 3). The patient underwent cardiac catheterization. There was no atheroma or stenotic lesion, but a heavy stream of contrast agent entered the LV via distal segments of both the left and right coronary arterial systems. The angiogram showed multiple coronary artery fistulas. Two fistulas originated from the distal segments of left anterior descending artery and diagonal artery, another from obtuse marginal branch (Figure 2) and two more from the distal segments of posterior
Atherosclerosis Supplements, 2011
New England Journal of Medicine, 2013