In the first part of this paper, we introduce the marine copepod Calanus finmarchicus, its lifecycle and ecology, and describe the technologies developed for harvesting and extracting oil from this copepod. Calanus oil has a unique composition, with its fatty acids—including a high concentration of long-chain omega-3 polyunsaturated fatty acids (PUFAs) and monounsaturated fatty acids (MUFAs)—bound to long chain fatty alcohols in the form of wax esters. In the second part of this paper, we review pre-clinical and clinical studies conducted over the last two decades, which demonstrate the potential health benefits of Calanus oil. These studies highlight its role in preventing obesity-related metabolic distortions, such as inflammation and reduced insulin sensitivity.

Introduction: Myocardial ischemia is common among patients with chest pain and non-obstructive coronary artery disease (CAD). Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Accordingly, we hypothesised that EAT volume is associated with coronary plaque vulnerability and myocardial ischemia in patients with non-obstructive CAD.Methods: We included 125 patients with chest pain and non-obstructive CAD by coronary computed tomography angiography (CCTA). EAT volume was quantified on non-contrast cardiac computed tomography images by a semiautomatic analysis software. CCTA images were analysed with respect to plaque volume and composition. Plaque vulnerability was assessed as total coronary non-calcified plaque volume and positive remodelling index >1.10. Myocardial ischemia was detected by contrast dobutamine stress echocardiography. Patients were grouped in tertiles of EAT volume and high EAT volume was defined as volumes in the highest tertile (>= 125 ml).Results: In the total study population (median age 63(58, 69) years and 58% women), the median EAT volume was 104 (77, 141) ml. High EAT volume was more common in men and associated with higher BMI, hypertension and positive remodelling (all p<0.05). There was no difference in age, prevalence of diabetes, total non-calcified plaque volume or presence of myocardial ischemia between groups (all p >= 0.34). This was confirmed in univariable logistic regression analyses (Table). After adjusting for covariables in a multivariable model, the association between positive remodelling and high EAT volume was attenuated (Table).Conclusion: High EAT volume was associated with positive remodelling, but not with total non-calcified plaque volume or myocardial ischemia, and the association was attenuated after multivariable adjustments.

doi: https://doi.org/10.12669/pjms.39.3.7571 How to cite this: Saeed S, Eriksen E, Larsen TH. Quantitative evaluation of cardiac magnetic resonance feature tracking (CMR-FT) derived strain in patients with ST-elevation myocardial infarction. Pak J Med Sci. 2023;39(3):629-630. doi: https://doi.org/10.12669/pjms.39.3.7571 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Despite significant advances in managing systemic vasculitides, cardiovascular morbidity, and mortality are still of primary concern. Advances in noninvasive imaging have broadened our understanding of the clinical heterogeneity of cardiac involvement in vasculitides. Common cardiovascular complications in primary or secondary vasculitides are; coronary artery aneurysms, acute coronary syndromes, myocarditis, pericarditis, endocarditis, and valvular dysfunction. Echocardiography, cardiac magnetic resonance , positron emission tomography, and computed tomography angiography are essential in identifying cardiac involvement and guiding treatment. Here, we present our experiences of cardiac involvement in systemic vasculitides, covering most aspects of common cardiac complications based on a multi-modality approach to challenging (real-world) cases. As many cardiac manifestations are clinically silent, heart function should be systemically assessed by a multimodality imaging-based approach, including ECG, serial echocardiograms with strain imaging and 3D, and cardiac magnetic resonance to detect early signs of cardiac manifestations. This enables timely intervention and optimal medical treatment, which is essential for a better prognosis. There is a need for better and closer collaboration in clinical practice and research fields between cardiologists and rheumatologists.

ObjectiveTo compare administration of the glucagon-like peptide-1 (GLP-1) analogue, exenatide, versus dietary supplementation with the omega-3 fatty acid-rich Calanus oil on obesity-induced alterations in mitochondrial respiration.MethodsSix-week-old female C57BL/6JOlaHSD mice were given high fat diet (HFD, 45% energy from fat) for 12 weeks to induce obesity. Thereafter, they were divided in three groups where one received exenatide (10 μg/kg/day) via subcutaneously implanted mini-osmotic pumps, a second group received 2% Calanus oil as dietary supplement, while the third group received HFD without any treatment. Animals were sacrificed after 8 weeks of treatment and tissues (skeletal muscle, liver, and white adipose tissue) were collected for measurement of mitochondrial respiratory activity by high-resolution respirometry, using an Oroboros Oxygraph-2k (Oroboros instruments, Innsbruck, Austria).ResultsIt was found that high-fat feeding led to a marked reduction of mitochondrial respiration in adipose tissue during all three states investigated – LEAK, OXPHOS and ETS. This response was to some extent attenuated by exenatide treatment, but not with Calanus oil treatment. High-fat feeding had no major effect on hepatic mitochondrial respiration, but exenatide treatment resulted in a significant increase in the various respiratory states in liver. Mitochondrial respiration in skeletal muscle was not significantly influenced by high-fat diet or any of the treatments. The precise evaluation of mitochondrial respiration considering absolute oxygen flux and ratios to assess flux control efficiency avoided misinterpretation of the results.ConclusionsExenatide increased hepatic mitochondrial respiration in high-fat fed mice, but no clear beneficial effect was observed in skeletal muscle or fat tissue. Calanus oil did not negatively affect respiratory activity in these tissues, which maintains its potential as a dietary supplement, due to its previously reported benefits on cardiac function

Background: Multislice computed tomography (MSCT) offers a non-invasive method of imaging bioresorbable scaffolds (BRS). Objectives: To investigate the advantages and challenges using MSCT in the follow-up after BRS implantation. Method: The BRS cohort consisting of 31 patients in the ‘BRS in STEMI’ trial was examined by multimodality imaging and followed long-term. Minimum lumen area (MLA) and average lumen area (ALA) were examined 12 and 36 months after BRS implantation with MSCT. Optical coherence tomography (OCT) at 12 months was used as a reference. Results: Measured by MSCT, the mean MLA was 0.05 ± 1.32 mm² (P = 0.85), but ALA was 1.32 (±2.59 mm², P = 0.015) greater than by OCT. ALA and MLA did not change significantly from 12 to 36 months. MSCT identified all cases of restenosis but missed one patient with massive malapposition. Conclusion: Our data support using MSCT in the follow-up after BRS implantation. Invasive investigation should still be considered for patients with unexplained symptoms.

BACKGROUND:COPD and coronary heart disease (CHD) frequently co-occur, yet which COPD phenotypes are most prone to CHD is poorly understood. The aim of this study was to see whether COPD patients did have a true higher risk for CHD than subjects without COPD, and to examine a range of potential factors associated with CHD in COPD patients and controls. METHODS:347 COPD patients and 428 non-COPD controls, were invited for coronary computed tomography angiography (CCTA) and pulmonary CT. Arterial blood gas, bioelectrical impedance and lung function was measured, and a detailed medical history taken. The CCTA was evaluated for significant coronary stenosis and calcium score (CaSc), and emphysema defined as >10% of total area <-950 Hounsfield units. RESULTS:12.6% of the COPD patients and 5.7% of the controls had coronary stenosis (p<0.01), whereas 55.9% of the COPD patients had a CaSc>100 compared to 31.6% of the controls (p<0.01). In a multivariable model adjusting for sex, age, body composition, pack-years, CRP, cholesterol/blood pressure lowering medication use and diabetes mellitus, the OR (95% CI) for having significant stenosis was 1.80 (0.86-3.78) in COPD patients compared with controls. In a similar model, the OR (95% CI) for having CaSc>100 was 1.68 (1.12-2.53) in COPD patients compared with controls. Examining the risk of significant stenosis and CaSc>100 among COPD patients, no variable was associated with significant stenosis, whereas male sex [OR 2.85 (1.56-5.21)], age [OR 3.74 (2.42-5.77)], statin use [OR 2.23 (1.23-4.50)] were associated with CaSc>100, after adjusting for body composition, pack-years, C-reactive protein, use of angiotensin converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), diabetes, emphysema score, GOLD category, exacerbation frequency, eosinophilia, and hypoxemia. CONCLUSION:COPD patients were more likely to have CHD, but neither emphysema score, lung function, exacerbation frequency, nor hypoxemia predicted presence of either coronary stenosis or CaSc>100.

The aim of this study was to investigate the possible beneficial effects of exercise training (ET) with omega-3/Calanus oil supplementation on cardiorespiratory and adiposity parameters in elderly women. Fifty-five women (BMI: 19–37 kg/m2, 62–80 years old) were recruited and randomly assigned to the 4 month intervention with ET and omega-3 supplementation (Calanus oil, ET-Calanus) or ET and the placebo (sunflower oil; ET-Placebo). The body composition was determined by dual-energy X-ray absorptiometry (DXA), and cardiorespiratory parameters were measured using spiroergometry and PhysioFlow hemodynamic testing. Both interventions resulted in an increased lean mass whereas the fat mass was reduced in the leg and trunk as well as the android and gynoid regions. The content of trunk fat (in percent of the total fat) was lower and the content of the leg fat was higher in the ET-Calanus group compared with the ET-Placebo. Although both interventions resulted in similar improvements in cardiorespiratory fitness (VO2max), it was explained by an increased peripheral oxygen extraction (a-vO2diff) alone in the ET-Placebo group whereas increased values of both a-vO2diff and maximal cardiac output (COmax) were observed in the ET-Calanus group. Changes in COmax were associated with changes in systemic vascular resistance, circulating free fatty acids, and the omega-3 index. In conclusion, Calanus oil supplementation during a 4 month ET intervention in elderly women improved the cardiorespiratory function, which was due to combined central and peripheral cardiodynamic mechanisms.

Background The burden of non-obstructive coronary artery disease (CAD) in the society is high, and there is currently limited evidence-based recommendation for risk stratification and treatment. Previous studies have demonstrated an association between increasing extent of non-obstructive CAD and cardiovascular events. Whether hypertension, a modifiable cardiovascular risk factor, is associated with extensive non-obstructive CAD in patients with symptomatic chronic coronary syndrome (CCS) remains unclear. Methods We included 1138 patients (mean age 62±11 years, 48% women) with symptomatic CCS and non-obstructive CAD (1–49% lumen diameter reduction) by coronary computed tomography angiography (CCTA) from the Norwegian Registry for Invasive Cardiology (NORIC). The extent of non-obstructive CAD was assessed as coronary artery segment involvement score (SIS), and extensive non-obstructive CAD was adjudicated when SIS >4. Hypertension was defined as known hypertension or use of antihypertensive medication. Results Hypertension was found in 45% of patients. Hypertensive patients were older, with a higher SIS, calcium score, and prevalence of comorbidities and statin therapy compared to the normotensive (all p<0.05). There was no difference in the prevalence of hypertension between sexes. Univariable analysis revealed a significant association between hypertension and non-obstructive CAD. In multivariable analysis, hypertension remained associated with extensive non-obstructive CAD, independent of sex, age, smoking, diabetes, statin treatment, obesity and calcium score (OR 1.85, 95% CI [1.22–2.80], p = 0.004). Conclusion In symptomatic CCS, hypertension was associated with extensive non-obstructive CAD by CCTA. Whether hypertension may be a new treatment target in symptomatic non-obstructive CAD needs to be explored in future studies. Clinical trial registration ClinicalTrials.gov: Identifier NCT 04009421.

Background: We evaluated coronary artery calcium (CAC) scoring as an initial diagnostic tool in outpatients and in patients presenting at the emergency department due to suspected coronary artery disease (CAD). Methods: 11 609 patients underwent CAC scoring and coronary CT angiography (CCTA) at Haukeland University Hospital in Norway during 2013-2020. By linkage to the Norwegian Registry of Invasive Coronary Angiography, we obtained information on invasive coronary angiographies (ICAs) performed within 90 days after the CT examination. Obstructive CAD was defined as at least one coronary stenosis ≥50%. High-risk CAD included obstructive stenoses of the left main stem, the proximal left ascending artery or affecting all three major vascular territories with at least one proximal segment involved. Results: Median age was 59 years and 48.1% were women. The overall prevalence ofCAC=0 was 42.1%. Among those with CAC=0, 1.7% were referred to ICA due to CCTA findings of possible stenoses, whereas 1.0% had obstructive CAD and 0.4% had high-risk CAD confirmed by ICA. The sensitivity, specificity, PPV and NPV of CAC=0 for obstructive CAD were 96%, 47%, 20% and 99%, with similar estimates among hospitalized and outpatients. Conclusions: In symptomatic patients, CAC=0 correctly ruled out obstructive CAD and high-risk CAD in 99.0% and 99.6% of cases, with similar diagnostic accuracy in elective and in-hospital examinations. Our work supports the incorporation of CAC testing in the early triage of patients with chest pain and as a gatekeeper to further cardiac testing.

Our response to the comments by doctors Rujittika Mungmunpuntipantip and Viroj Wiwanitkit on our recent article "Incidence, clinical presentation and management of myocarditis following mRNA-based Covid-19 vaccines: A brief report", published in Cardiology.

BACKGROUND:Chest pain is a common complaint in the general practitioner's (GP) office. Computed tomography (CT) is one of the main diagnostic tools available for assessing coronary artery disease (CAD), with a low probability of a false-negative result (<1%). Despite normal CT findings, many patients with non-coronary chest pain believe they suffer from CAD.AIMS:To determine the effect of an intervention on reassurance, treatment satisfaction, and recurring chest pain in patients with non-coronary chest pain at follow-up after 1 month.METHODS:Patients with chest pain, but with normal coronary CT angiography, i.e., no CAD, were randomized into two groups. The intervention group received extended information about the CT examination, including visualization of their individual coronary calcium score images, before the radiographer conveyed the final examination result. The control group received standard care, i.e., neither extended information nor the examination result and were encouraged to consult their referring cardiologist or GP after 1 week. Items from the Seattle Angina Questionnaire and a question regarding reassurance measured the effect of the intervention at follow-up after 1 month.RESULTS:The study included 92 patients, 63 female and 29 male, with a follow-up response rate of 80%. Reassurance and overall treatment satisfaction were significantly higher in the intervention group (P = 0.016 and P = 0.046 respectively). The incidence of chest pain was significantly reduced in the intervention group (P = 0.042).CONCLUSION:This study demonstrated that the intervention group showed significantly higher reassurance, overall treatment satisfaction, and experienced significantly less chest pain at follow-up after 1 month.CLINICAL TRIALS DATABASE ID:NCT03781661.

We aimed to investigate the long-term effect of daily Calanus oil supplementation on maximal oxygen uptake (VO2max) in healthy 30- to 50-year-old participants. The study was motivated by preclinical studies reporting increased VO2max and metabolic health with omega-3 rich Calanus oil. In a double-blinded study, 71 participants were randomized to receive 2 g/day of Calanus or placebo supplementation for a total of 6 months. The participants underwent exercise testing and clinical investigations at baseline, 3 months, and 6 months. Main study endpoint was change in VO2max from baseline to 6 months. Fifty-eight participants completed the 6-month test and were included in the final data analysis (age: Calanus, 39.7 [38.0, 41.4] and placebo, 38.8 [36.8, 40.9] years; body mass index: Calanus, 24.8 [24.0, 25.6] and placebo, 24.8 [23.7, 25.8] kg/m2; and VO2max: Calanus, 50.4 [47.1, 53.8] and placebo, 50.2 [47.2, 53.1] ml·kg-1·min-1). There were no between-group differences at baseline, nor were there any between-group differences in absolute (Calanus, 3.74 [3.44, 4.04] and placebo, 3.79 [3.44, 4.14] L/min) or relative VO2max (Calanus, 49.7 [46.2, 53.2] and placebo, 49.5 [46.0, 53.1] ml·kg-1·min-1) at 6 months (mean [95% confidence interval]). There were no between-groups change in clinical measures from baseline to 3 and 6 months. In conclusion, VO2max was unaffected by 6 months of daily Calanus oil supplementation in healthy, physically fit, normal to overweight men and women between 30 and 50 years old.

BACKGROUND:Recent surveillance studies following nationwide mass vaccination are investigating rare complications such as myocarditis, pericarditis, and thromboembolic events related to mRNA-based Covid-19 vaccines.SUMMARY:In the current report, we present an overview of the incidence, clinical presentation and management of post-mRNA vaccine myocarditis, and pericarditis in view of the currently available data. Our main focus is directed toward myocarditis.KEY MESSAGES:Myocarditis following mRNA-based Covid-19 vaccines is rare, more frequently affects younger men <30 years and is usually of mild severity with spontaneous recovery. The overall benefit of mRNA vaccines in terms of protecting from severe Covid-19 infection and associated cardiovascular complications outweighs the risk of postvaccination myocarditis. Currently, there are no dedicated guidelines for patients with postvaccination myocarditis or pericarditis in terms of the frequency of follow-up including clinical assessment, repeated echocardiography, and cardiac resonance imaging. However, follow-up studies in terms of long-term consequences are underway.

Acute myocardial ischemia induces reduced systolic shortening and causes postsystolic shortening (PSS). Right ventricular (RV) PSS in coronary artery disease has been less studied. We present here the case of a 51-year-old woman admitted with a non-ST segment elevation myocardial infarction and significant PSS in the RV free-wall segments on two-dimensional speckle tracking echocardiography, suggesting ongoing ischemia. A cardiac CT demonstrated occluded proximal right coronary artery with a low-attenuated/soft plaque, confirmed by coronary angiography which was treated by percutaneous coronary intervention. At 3-week follow-up, there was complete resolution of the RV-PSS, with a more synchronized pattern of maximum myocardial shortening at systole.

Myocarditis has numerous aetiologies, and Celiac Disease (CD) has been described as a rare cause. CD has received little attention in current guidelines and may be underdiagnosed. We report a case involving a 28-year-old male with myocarditis causing severe left ventricular dysfunction and dilatation that was probably related to CD. This case highlights the importance of screening for CD in patients presenting with myocarditis and signs of malabsorption when other common causes are excluded. Besides optimal medical treatment and cardiac resynchronization therapy, a gluten-free diet and immunosuppression may also be effective measures in the management of CD-related myocarditis.

Introduction: Myocardial ischemia is common among patients with chest pain and non-obstructive coronary artery disease (CAD). Epicardial adipose tissue (EAT) accumulation has been associated with inflammation, atherosclerosis and microvascular dysfunction. Accordingly, we hypothesised that EAT volume is associated with coronary plaque vulnerability and myocardial ischemia in patients with non-obstructive CAD. Methods: We included 125 patients with chest pain and non-obstructive CAD by coronary computed tomography angiography (CCTA). EAT volume was quantified on non-contrast cardiac computed tomography images by a semiautomatic analysis software. CCTA images were analysed with respect to plaque volume and composition. Plaque vulnerability was assessed as total coronary non-calcified plaque volume and positive remodelling index >1.10. Myocardial ischemia was detected by contrast dobutamine stress echocardiography. Patients were grouped in tertiles of EAT volume and high EAT volume was defined as volumes in the highest tertile (≥125 ml). Results: In the total study population (median age 63(58, 69) years and 58% women), the median EAT volume was 104 (77, 141) ml. High EAT volume was more common in men and associated with higher BMI, hypertension and positive remodelling (all p<0.05). There was no difference in age, prevalence of diabetes, total non-calcified plaque volume or presence of myocardial ischemia between groups (all p≥0.34). This was confirmed in univariable logistic regression analyses (Table). After adjusting for covariables in a multivariable model, the association between positive remodelling and high EAT volume was attenuated (Table). Conclusion: High EAT volume was associated with positive remodelling, but not with total non-calcified plaque volume or myocardial ischemia, and the association was attenuated after multivariable adjustments.

Both cannabis and amphetamine are the most commonly used illegal substances worldwide and are associated with a number of adverse cardiovascular effects including transient coronary vasospasm. Here, we present the case of a 39-year-old male admitted to our institution with a 6-h history of severe chest pain and ST-segment elevation on the ECG. Coronary angiography on admission showed normal coronary arteries. The patient had a 14-year history of substance abuse, primarily amphetamine and cannabis, and was prescribed lisdexamfetamin (Aduvanz®) for attention deficit hyperactivity disorder (ADHD) for the past 2 years. A cardiac magnetic resonance (CMR) the following day showed widely distributed focal lesions of late gadolinium enhancement in mid- and sub-epicardial myocardium in the anterior, lateral and inferior walls, suggestive of chronic fibrotic lesions. There was no sign of acute myocardial edema. No viral cause was identified during a thorough investigation, including negative SARS-COV-2 and endomyocardial biopsy. Substance-abuse-induced coronary vasospasm leading to ST-segment elevation, myocardial damage with a rise and fall of cardiac TnT, as well as a slightly reduced left ventricular ejection fraction (48%) and regional wall motion abnormalities on echocardiography, was the most likely diagnosis.