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Alam MM, Adhikary DK, Khaled FI, Chowdhury MT, Hassan SR, Saha A, Mahjabeen F, Dey D, Paul PK, Khan SS. Determinants of Pre-Hospital Delay after Myocardial Infarction in Bangladesh: A Rural Center Experience. Mymensingh Med J 2021; 30:1154-1162. [PMID: 34605490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Determinants of pre-hospital delay after myocardial infarction, strictly among South-Asian rural community, till now is largely unknown. And Bangladesh is not an exception. It is a fact that though around two third of its population still live in villages, we do not know what factors are having influence on such delay. To find out these primers of time consumption before seeking medical help, this is a picture of a medical college hospital situated in a rural precinct. This cross-sectional analytical study was conducted among 98 patients came with Myocardial Infarction (MI) who had met inclusion and exclusion criteria from July 2019 and December 2019. Both STEMI & NSTEMI patients were selected as they have similar attributes. Data was collected in the coronary care unit using a preformed questionnaire. Among 98 MI patients, where 16 female and 82 male patients had average age 53±12 years. Average income rural community was around 100 USD. Almost 50% of sample were illiterate or below 5th grade. On average 6.6 hours (95% CI: 3.5-12.3) were required to reach CCU after symptom onset, whereas distance to first medical contact (FMC) was about 10.2 Km (95% CI: 6.4-16.2). Median distance to nearest PCI-capable hospital was 140 Km (IQR- 20 Km). Only 28% of patients could reach hospital within 2 hours, where 85% had onset of symptom while they were at home. Tertiary level medical college (74.5%) followed by Upazilla (Sub-urban) government health complex (22.4%) were frequent site of FMC. Principle mode of transport to hospital was CNG-three-wheeler (75% of cases). Logistic regression analysis showed only low literacy was as significant predictor about more than 2 hours pre-hospital delay (OR=2.58; p=0.043). Other factors such as low income (OR=2.51; p=0.126), diabetes mellitus (OR=2.99; p=0.059), female sex (OR=1.56; p=0.753), house wife (OR=1.88; p=0.547), previous MI (OR=1.52; p=1.000), symptom ignorance (OR=2.14; p=0.455) increases pre-hospital delay and distance to FMC <10 Km (OR=0.44; p=0.079) no significant prediction of pre-hospital delay after myocardial infarction. As rural community has less access to education low literacy has a significant impact on pre-hospital delay after myocardial infarction. So measures should be taken in rural areas through patient education and social awareness program regarding MI symptom and danger of delayed medical attention.
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Goeller M, Duncker H, Bittner D, Ammon F, Moshage M, Dey D, Achenbach S, Marwan M. CT-derived characterization of pericoronary, paracardial and epicardial adipose tissue and its association with myocardial ischemia as assessed by adenosine stress CMR perfusion imaging. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Foundation. Main funding source(s): German Heart Foundation e.V.
Introduction
Increased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) is a new imaging biomarker to detect coronary inflammation derived from routine coronary CT angiography (CTA) and has been shown to be associated with cardiac mortality. Increased volume of epicardial adipose tissue (EAT) has been reported be associated with myocardial ischemia.
Purpose
We aimed to investigate a potential association between CTA-derived PCAT measures and myocardial ischemia as assessed by adenosine stress CMR perfusion imaging.
Methods
In this single-centre study 109 stable individuals (mean age of 62 ± 11 years, 77% males) with coronary artery disease underwent CTA followed by adenosine stress CMR perfusion imaging to detect myocardial ischemia. PCAT CT attenuation (HU) and PCAT volume (cm3) was measured around the RCA (10 to 50 mm from RCA ostium), the proximal 40 mm of the left anterior descending artery (LAD) and the circumflex artery (LCX) using semi-automated software. Per patient PCAT CT attenuation was calculated as followed: (PCAT attenuation of RCA + LAD + LCX)/3). Non-contrast CT data sets were used for coronary calcium scoring and the quantification of EAT (located between the myocardial surface and the pericardium) and paracardial adipose tissue (PAT; intrathoracic and outside of the pericardium).
Results
Between patients with evidence of significant myocardial ischemia as assessed by adenosine stress CMR perfusion imaging (n = 35) and patients without myocardial ischemia (n = 74) there was no significant difference in the CT attenuation of RCA (-85.3 HU vs. -85.7 HU, p = 0.87), LAD (-84.8 HU vs. -85.7 HU, p = 0.66) and LCX (-82.8 HU vs. -83.2 HU, p = 0.79) as well as in the per patient PCAT CT attenuation (-84.2 HU vs. -84.9 HU, p = 0.76). Neither did patients with myocardial ischemia within the RCA territory show increased RCA PCAT CT attenuation (-87.7 HU vs. -85.3 HU, p = 0.40); nor was such a relationship found for the territory of the LAD (-80.6 HU vs. 85.8 HU, p = 0.11) or LCX (-83.1 HU vs. -83.0 HU, p = 0.99). The CT attenuation of EAT (-77.9 vs. -78.7 HU, p = 0.65) and PAT (-89.9 HU vs. -90.0 HU, p = 0.93) did not differ between patients with myocardial ischemia compared to patients without myocardial ischemia. Between patients with myocardial ischemia and patients without myocardial ischemia there was no significant difference in the volumes of EAT (118.1 cm3 vs. 110.6 cm3, p = 0.55), PAT (279.5 cm3 vs. 240.9 cm3, p = 0.20) and the per patient PCAT volume (1021.9 mm3 vs. 1015.5 mm3, p = 0.90). In logistic regression analysis the volume and CT attenuation of the different intrathoracic fat compartments PCAT, EAT and PAT were not independently associated with the presence of myocardial ischemia (n.s.).
Conclusions
In this single-centre study CTA-derived quantified CT attenuation and volume of PCAT, EAT and PAT were not associated with myocardial ischemia as assessed by adenosine stress CMR perfusion imaging.
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Lin A, van Diemen P, Motwani M, McElhinney P, Otaki Y, Han D, Kwan A, Tzolos E, Klein E, Kuronuma K, Grodecki K, Shou B, Cadet S, Danad I, Driessen R, Slomka P, Berman D, Dey D, Knaapen P. Machine Learning From Quantitative Coronary Computed Tomography Angiography Predicts Ischemia And Impaired Myocardial Blood Flow. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Tzolos E, Williams M, McElhinney P, Lin A, Grodecki K, Guadalupe F, Cadet S, Kwiecinski J, Doris M, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Dweck M, Newby D, Dey D. Pericoronary Adipose Tissue Attenuation, Low Attenuation Plaque Burden And 5-year Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Chen M, Almeida S, Shaikh K, Shekar C, Dey D, Budoff M, Karlsberg R, Packard R. Distal-Vessel FFR-CT To Evaluate Cumulative Coronary Artery Disease Burden. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Scheiner J, Chen L, Fouladi Nashta N, Weber J, Zhou Q, Rapelje K, Dey D, Guerci A, Cao J. Favorable Change Of Epicardial Fat Features Is Associated With Improved Lipid Profile From Statin Therapy And Reduced Long Term All-Cause Mortality. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Han D, Lin A, Kuronuma K, Tzolos E, Kwan A, Klein E, Andreini D, Bax J, Cademartiri F, Chinnaiyan K, Chow B, Cury R, Feuchtner G, Hadamitzky M, Leipsic J, Maffei E, Marques H, Plank F, Pontone G, Villines T, Al-Mallah M, de Araújo Gonçalves P, danad I, Gransar H, Lu Y, lee J, Baskaran L, Al'Aref S, Budoff M, Samady H, Virmani R, Narula J, Chang H, Min J, Lin F, Shaw L, Slomka P, Dey D, Berman D. Plaque Location And Vessel Geometry On Coronary Computed Tomography Angiography Predict Future Culprit Lesions Associated With Acute Coronary Syndrome: Results From The ICONIC Study. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Williams M, Kwiecinski J, Doris M, McElhinney P, Cadet S, Adamson P, Moss A, Alam S, Hunter A, Shah A, Mills N, Pawade T, Wang C, Weir-McCall J, Roditi G, van Beek E, Shaw L, Nicol E, Berman D, Slomka P, Newby D, Dweck M, Dey D. Sex-specific CT Coronary Plaque Characterization And Risk Of Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Meah M, Bularga A, Chapman A, Gray A, Newby D, Dey D, Williams M. Differences In Quantitative Coronary Computed Tomography Angiography Between Type 1 And Type 2 Myocardial Infarction. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Roesner C, Göller M, Dey D, Raaz-Schrauder D, Achenbach S, Marwan M, Bittner D. Monocyte Chemoattractant Protein-1, Interleukin-1a And Interleukin-17 And Their Conflicting Association With Vulnerable Plaque:a Coronary Cta Study. J Cardiovasc Comput Tomogr 2021. [DOI: 10.1016/j.jcct.2021.06.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Salles G, Goswami B, Bagnardi V, Dey D, Winderlich M, Ambarkhane S, Huang D, Nowakowski GS. ESTIMATION OF LONG‐TERM SURVIVAL WITH TAFASITAMAB + LENALIDOMIDE (LEN) IN RELAPSED/REFRACTORY DIFFUSE LARGE B‐CELL LYMPHOMA (R/R DLBCL). Hematol Oncol 2021. [DOI: 10.1002/hon.90_2880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Shanmuganathan N, Ramanathan R, Dey D, Goeller M, Kusk MW, Sidelmann JJ, Norgaard BL, Gram JB, Sand NPR. Pericoronary adipose tissue attenuation in low-risk asymptomatic individuals, sex-differences and association with markers of cardiovascular disease. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Pericoronary adipose tissue (PCAT) attenuation by coronary computed tomography angiography (CCTA) is a marker of coronary inflammation and predicts clinical outcomes in symptomatic patients undergoing CCTA. Sex-differences in PCAT CT attenuation among asymptomatic individuals are not previously described.
Purpose
To evaluate PCAT CT attenuation according to sex and markers of cardiovascular disease (CVD).
Methods
Cross-sectional cohort study including asymptomatic individuals, 50- or 60-year of age, not taking any medicine and without known CVD or type-2 diabetes. At baseline and 5-year follow-up smoking habits, blood pressures and biochemistry (lipids, CRP, fibrinogen, D-dimer, t-PA, PAI-1, vWF) were recorded and Agatston Score measured. At follow-up, CCTA was achieved. Quantitative coronary plaque analysis was performed and PCAT CT attenuation within a radial distance of 3 mm from the outer vessel wall 10–50 mm distal to the origin of the right coronary artery measured. A validated PCAT CT attenuation threshold (high vs low risk) of -70.1 Hounsfield units was applied.
Results
Included were 123 participants (60 women). Independent of co-variation, PCAT CT attenuation (median, [IQR]) was lower in women (-71.0, [-77.2- -67.0]) vs men (-64.5, [-69.9- -57.4]), p < 0.001. No associations between PCAT CT attenuation (high vs low) and risk factors of CVD, CAC or coronary plaque volumes were demonstrated (Table). Variations in blood pressures, biochemical markers and CAC over five years were not associated with PCAT CT attenuation.
Conclusion
In low-risk asymptomatic individuals, PCAT CT attenuation was lower in women compared to men, irrespective of markers of CVD.
Table. Patient characteristics stratified by PCAT CT attenuation PCAT CT attenuation ≤ -70.1 HU (n = 49) PCAT CT attenuation > -70.1 HU (n = 74) p-value Risk factors Age65-years55-years 2623 3143 0.32 SexMenWomen 1534 4826 <0.001 TobaccoNeverCurrent/previous 1732 3737 0.10 Systolic BP, mmHgDiastolic BP, mmHgTotal cholesterol, mmol/lLDL-cholesterol, mmol/lHDL-cholesterol, mmol/lTriglycerides, mmol/l 137 (17)76 (10)5.61 (0.92)3.50 (0.93)1.41 (0.30)1.65 (0.99 - 2.22) 136 (16)77 (10)5.42 (0.82)3.30 (0.82)1.45 (0.35)1.35 (1.03 - 2.11) 0.660.590.230.220.570.52 Biochemistry CRP, mg/lFibrinogen, μmol/lD-dimer, mg/lvWFt-PAPAI-1 1.16 (0.99 - 2.22)9.5 (8.5 - 10.7)0.40 (0.30 - 0.49)128 (102 - 154)7.1 (5.8 - 8.8)20.5 (16.2 - 31.8) 0.61 (0.30 - 1.14)9.0 (7.8 - 10.0)0.32 (0.24 - 0.47)116 (92 - 146)6.3 (5.1 - 8.8)20.3 (14.7 - 26.3) <0.010.10<0.050.110.200.34 Coronary plaque data Agatston ScoreTotal plaque volume, mm³NCP volume, mm³CP volume, mm³LD-NCP volume, mm³ 1 (0 - 36)15.7 (0 - 143.3)0 (0 - 128.1)0 (0 - 14.6)0.5 (0 - 18.7) 8 (0 - 115)15.6 (0 - 268.2)13.5 (0 - 220.5)1.7 (0 - 31.7)1.8 (0 - 21.8) 0.300.450.490.360.74 Values are n (%), mean (SD) or median (IQR).Abbreviations: HU =Hounsfield unit; LDL =low-density lipoprotein; HDL =high-density lipoprotein; BP =blood pressure; CRP = c-reactive protein: vWF =von-Willebrand Factor; t-PA =tissue plasminogen activator; PAI-1 =plasminogen activator inhibitor -1; NCP =non-calcified plaque; CP =calcified plaque; LD-NCP =low-density non-calcified plaque.
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Boima V, Amissah-Arthur MB, Yorke E, Dey D, Fiagbe D, Yawson AE, Nonvignon J, Mate-Kole CC. Determinants of willingness to accept kidney transplantation among chronic kidney disease patients in Ghana. BMC Nephrol 2021; 22:129. [PMID: 33849488 PMCID: PMC8045236 DOI: 10.1186/s12882-021-02335-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 04/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The burden of chronic kidney disease in Africa is three to four times higher compared to high-income countries and the cost of treatment is beyond the reach of most affected persons. The best treatment for end stage renal disease is kidney transplantation which is not available in most African countries. As kidney transplantation surgery is emerging in Ghana, this study assessed factors which could influence the willingness of patients with chronic kidney disease to accept it as a mode of treatment. METHODS This cross-sectional survey was carried out among patients with chronic kidney disease in Korle-Bu Teaching Hospital. A consecutive sampling method was used to recruit consenting patients. A structured questionnaire and standardized research instruments were used to obtain information on demographic, socio-economic characteristics, knowledge about transplantation, perception of transplantation, religiosity and spirituality. Logistic regression model was used to assess the determinants of willingness to accept a kidney transplant. RESULTS 342 CKD patients participated in the study of which 56.7% (n = 194) were male. The mean age of the participants was 50.24 ± 17.08 years. The proportion of participants who were willing to accept a kidney transplant was 67.3% (95%CI: 62.0-72.2%). The factors which influenced participants' willingness to accept this treatment included; willingness to attend a class on kidney transplantation (p < 0.016), willingness to donate a kidney if they had the chance (p < 0.005), perception that a living person could donate a kidney (p < 0.001) and perceived improvement in quality of life after transplantation (p < 0.005). The barriers for accepting kidney transplantation were anticipated complications of transplant surgery and financial constraints. CONCLUSION More than two-thirds of CKD patients were willing to accept a kidney transplant and this is influenced by multiple factors. Government health agencies must consider full or partial coverage of kidney transplantation through the existing national health insurance scheme. Further, efficient educational programmes are required to improve both patients' and physicians' knowledge on the importance of kidney transplantation in the management of end stage renal disease in Ghana.
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Chan J, Thakkar H, Comella A, Kim J, Armstrong S, Ihdayhid A, Dey D, Nerlekar N, Brown A. Coronary Perivascular Inflammation is Not Associated With Downstream Microcirculatory Dysfunction. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Dey D, Dey N, Ghosh S, Thiagarajan P. In silico Studies Predict Efficient Binding of Remdesivir and Favipiravir with 3-chymotrypsin like protease of SARS-CoV-2 for COVID-19 Interventional Therapy. Indian J Pharm Sci 2021. [DOI: 10.36468/pharmaceutical-sciences.805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Tan S, Chan J, Thakur U, Thein P, Muthalaly R, Talman A, Dey D, Brown A, Wu A, Seneviratne S, Cameron J, Wong D, Nerlekar N. Inter-Software and Inter-Scan Variability Amongst Post-Processing Software Platforms in Measurement of Epicardial Adipose Tissue. Heart Lung Circ 2021. [DOI: 10.1016/j.hlc.2021.06.219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Boima V, Agyabeng K, Ganu V, Dey D, Yorke E, Amissah-Arthur MB, Wilson AA, Yawson AE, Mate-Kole CC, Nonvignon J. Willingness to pay for kidney transplantation among chronic kidney disease patients in Ghana. PLoS One 2020; 15:e0244437. [PMID: 33378327 PMCID: PMC7773273 DOI: 10.1371/journal.pone.0244437] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Kidney transplantation is the preferred treatment for patients with end stage renal disease. However, it is largely unavailable in many sub-Sahara African countries including Ghana. In Ghana, treatment for end stage renal disease including transplantation, is usually financed out-of-pocket. As efforts continue to be made to expand the kidney transplantation programme in Ghana, it remains unclear whether patients with Chronic Kidney Disease (CKD) would be willing to pay for a kidney transplant. AIM The aim of the study was to assess CKD patients' willingness to pay for kidney transplantation as a treatment option for end stage renal disease in Ghana. METHODS A facility based cross-sectional study conducted at the Renal Outpatient clinic and Dialysis Unit of Korle-Bu Teaching Hospital among 342 CKD patients 18 years and above including those receiving haemodialysis. A consecutive sampling approach was used to recruit patients. Structured questionnaires were administered to obtain information on demographic, socio-economic, knowledge about transplant, perception of transplantation and willingness to pay for transplant. In addition, the INSPIRIT questionnaire was used to assess patients' level of religiosity and spirituality. Contingent valuation method (CVM) method was used to assess willingness to pay (WTP) for kidney transplantation. Logistic regression model was used to determine the significant predictors of WTP. RESULTS The average age of respondents was 50.2 ± 17.1 years with most (56.7% (194/342) being male. Overall, 90 out of the 342 study participants (26.3%, 95%CI: 21.7-31.3%) were willing to pay for a kidney transplant at the current going price (≥ $ 17,550) or more. The median amount participants were willing to pay below the current price was $986 (IQR: $197 -$1972). Among those willing to accept (67.3%, 230/342), 29.1% (67/230) were willing to pay for kidney transplant at the prevailing price. Wealth quintile, social support in terms of number of family friends one could talk to about personal issues and number of family members one can call on for help were the only factors identified to be significantly predictive of willingness to pay (p-value < 0.05). CONCLUSION The overall willingness to pay for kidney transplant is low among chronic kidney disease patients attending Korle-Bu Teaching Hospital. Patients with higher socio-economic status and those with more family members one can call on for help were more likely to pay for kidney transplantation. The study's findings give policy makers an understanding of CKD patients circumstances regarding affordability of the medical management of CKD including kidney transplantation. This can help develop pricing models to attain an ideal poise between a cost effective but sustainable kidney transplant programme and improve patient access to this ultimate treatment option.
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Kwiecinski J, Tzolos E, Cadet S, Adamson P, Joshi N, Dey D, Berman D, Newby D, Dweck M, Slomka P. 18F-sodium fluoride coronary uptake in patients with coronary artery bypass grafts. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
18F-Sodium fluoride (18F-NaF) positron emission tomography (PET) provides an assessment of active calcification (microcalcification) across a wide range of cardiovascular conditions including coronary artery disease, carotid and penile atherosclerosis, aortic and mitral valve disease, and abdominal aortic aneurysms. To date the significance of 18F-NaF uptake in patients with coronary artery bypass grafts (CABG) is unknown.
We aimed to characterize 18F-NaF activity in CABG patients.
We performed 18F-NaF PET (30-min long single bed position acquisition 1h after a 250mB injection of 18F-NaF) and coronary CT angiography in patients with multivessel coronary artery disease and followed them for fatal or non-fatal myocardial infarction over 42 [31,49] months. On motion-corrected datasets we quantified the whole-vessel coronary 18F-NaF PET uptake (the coronary microcalcification activity (CMA)) by measuring the activity of voxels above the background (right atrium activity) + 2 * standard deviations threshold. All study subjects underwent a comprehensive baseline clinical assessment including evaluation of their cardiovascular risk factor profile with the SMART [Secondary Manifestations of Arterial Disease] risk score calculated, and the coronary calcium burden assessed with calcium scoring (CCS).
Among 293 study participants (65±9 years; 84% male), 48 (16%) had a history of CABG. Although the majority 124/128 (97%) of coronary bypass grafts showed no uptake, 4 saphenous vein grafts presented with a CMA>0 (range: 2.5–11.5, Figure). While a similar proportion of patients with and without prior CABG showed increased coronary 18F-NaF uptake (CMA>0) (58.3% versus 71.4%, p=0.11) overall prior-CABG subjects had higher CMA (2.0 [0.3, 6.6] versus 0.6 [0, 2.7], p=0.001) and CCS (1135 [631, 2120] versus 225 [59, 542], p<0.001), respectively. In line with the differences in the calcification activity and the coronary calcium burden, the SMART risk scores were higher in CABG patients (23 [17, 28] versus 17 [12, 24], p=0.01), and these patients were also older (68±8 versus 64±8, p=0.01). Despite the aforementioned differences the incidence of myocardial infarction 5/48 (9%) versus 15/245 (6%) and MACE 6/48 (12%) versus 34/245 (14%) during follow-up between subjects with and without prior CABG was similar (p=0.44 and p=0.80, respectively).
CABG patients have a higher coronary microcalcification activity on 18F-NaF PET than multivessel coronary artery disease patients without prior CABG. Despite evidence of higher 18F-NaF uptake there is no difference in outcome between these two groups.
Figure 1. 18F-NaF uptake in CABG patients. (A) 63-year old male with prominent uptake in stented saphenous vein bypass grafts and native coronary arteries who experienced a non-fatal non ST elevation myocardial infarction during follow-up. (B) 70-year old male with evident uptake in native coronary arteries and only little 18F-NaF activity within coronary bypasses.
Funding Acknowledgement
Type of funding source: Other. Main funding source(s): National Heart, Lung, and Blood Institute/National Institute of Health (NHLBI/NIH), British Heart Foundation
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Grodecki K, Tamarappoo B, Huczek Z, Jedrzejczyk S, Cadet S, Kwiecinski J, Slomka P, Rymuza B, Filipiak K, Dey D. Non-invasive quantitative characterization of aortic valve tissue composition from computed tomography angiography improves patient risk stratification in transcatheter aortic valve implantation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Computed tomography angiography (CTA) performed for procedural planning of transcatheter aortic valve implantation (TAVI) can be used for a more complete characterization of aortic valve tissue beyond calcium assessment. Combining quantitative data on both noncalcified and calcified tissues may improve differentiation of aortic stenosis (AS) subtypes and prognostication post-TAVI.
Purpose
We sought to noninvasively assess aortic valve tissue composition with quantitative cardiac CTA in patients with AS and its prognostic vaalue in those who underwent TAVI.
Methods
In 185 consecutive AS patients in a prospective registry who underwent cardiac CTA before TAVR and 90 matched controls with normal aortic valves, non-luminal aortic valve tissue were identified using semi-automated software as non-calcified (low-attenuation [−30 to 30 Hounsfield Units (HU)], fibro-fatty (31 to 130 HU), fibrous (131 to 350 HU) and calcified (>650 HU) tissue; with total tissue as (non-calcified + calcified components). Volumes of each component and composition [(tissue component volume/total tissue volume) ×100%] were quantified. The association of aortic valve composition and clinical outcomes post-TAVI including all-cause mortality was evaluated using Valve Academic Research Consortium (VARC)-2 definitions.
Results
AS patients had greater aortic valve tissue volume (median 2000.2, vs 527.8 mm3, p<0.001) with a higher calcified tissue composition (41.8% vs 3.4%, p<0.001) compared to controls. Total aortic valve tissue (noncalcified and calcified) volume yielded the highest area under the operating curve (AUC) for diagnosing severe AS (0.93,95% CI:0.93–0.99) as compared to calcified tissue volume alone (0.87,95% CI:0.81–0.94, p=0.002). Low-flow low-gradient AS was associated with increase in total tissue volume compared to controls (1515.3 vs 527.8 mm3, p<0.001), with lower volumes of calcified tissue than high-gradient AS (412.5 vs 829.6 mm3, p<0.001). Device success was achieved in 88% (164 of 185) patients and prevalence of moderate or severe paravalvular leak was 3.8%, however no differences between in aortic valve composition were observed in patients with and without device success. Early safety endpoints occurred in 16.1% (29 of 180) patients and 30-day all-cause mortality was 4.4%. Whereas only calcified tissue volume was related to VARC-2 early safety, AUC for prediction of 30-day mortality post-TAVI was 0.793 (95% CI:0.685–0.901) for total tissue volume and 0.776 (95% CI:0.676–0.876) for calcified tissue volume.
Conclusions
Quantitative CTA assessment of aortic valve tissue volume and composition can improve identification of high-gradient AS and low-flow low-gradient AS patients referred for TAVI and predict 30-day mortality post-TAVI.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Heart, Lung, and Blood Institute (NHLBI)
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Goeller M, Achenbach S, Herrmann N, Bittner D, Ammon F, Kilian T, Smolka S, Uehlein S, Moshage M, Raaz-Schrauder D, Dey D, Marwan M. The association of pericoronary adipose tissue attenuation with major adverse cardiac events (MACE) and atherosclerosis-relevant inflammatory mediators. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Increased attenuation of pericoronary adipose tissue (PCAT) around the right coronary artery (RCA) is a new imaging biomarker to detect coronary inflammation derived from routine coronary CT angiography (CTA).
Purpose
We aimed to investigate a potential association between RCA PCAT attenuation and i) serum levels of atherosclerosis-relevant cytokines, ii) different grades of coronary calcification iii) future coronary revascularization within the same coronary artery and iV) MACE (defined by revascularization, myocardial infarction (MI) and/or cardiac death).
Methods
In 293 stable individuals (59.0±9.8 years, 69% males) with intermediate likelihood for coronary artery disease (CAD) blood was drawn and subsequently analyzed for different atherosclerosis-relevant cytokines interleukin (IL)-2, IL- 4, IL-6, IL-7, IL-8, IL-10, IL-13, Il-15, IL-17, TNF-a, IP-10, CRP, MCP-1, MIP-1a, Eotaxin and GM-CSF, followed by coronary calcium scoring (CCS) in non-contrast CT followed by CTA. PCAT CT attenuation (HU) was measured around the RCA (10 to 50 mm from RCA ostium) and the proximal 40 mm of the left anterior descending artery (LAD) and the circumflex artery (LCX) using semi-automated software. Increased RCA PCAT attenuation was defined as PCAT attenuation above the highest quartile (>−73.5 HU). A long-term follow-up over 9.6 years was performed.
Results
PCAT attenuation was similar in different grades of coronary calcification (CAC=0,-80.3 HU; CAC 1–99, −79.2 HU; CAC 100–400, −79.5 HU; CAC >400, −81.0 HU; p>0.05). Adipocytokine MCP-1 (r=0.23, p<0.01) and pro-inflammatory mediator IL-7 (r=0.12, p=0.04) correlated positively with RCA PCAT attenuation, whereas anti-inflammatory mediators Il-4, -10 and -13 correlated inversely (each r<−0.12, each p<0.05). In patients with increased RCA PCAT attenuation the serum levels of MCP-1 were increased (2.37 vs. 2.20, p<0.01), whereas anti-inflammatory mediators IL-4 and -13 were reduced (each p<0.05). 40 patients experienced MACE during follow-up. In multivariable Cox regression analysis, when adjusted by age, gender, baseline medications, obstructive coronary stenosis and CCS, the highest quartiles of PCAT attenuation are an independent predictor of MACE (HR 7.9, p=0.035). In patients with percutaneous coronary intervention (PCI) of the RCA during follow-up, RCA PCAT attenuation was increased at baseline CTA (−73.1 vs −80.2 HU, p=0.008). In patients with PCI of the LAD or LCX during follow-up, PCAT attenuation of LAD and LCX were not increased at baseline CTA (p>0.05).
Conclusions
The information captured by PCAT attenuation is independent of coronary calcification and showed a trend towards a weak association with serum levels of atherosclerosis-relevant inflammatory biomarkers. Increased RCA PCAT attenuation is an independent predictor of MACE and could guide future prevention strategies in stable patients.
Funding Acknowledgement
Type of funding source: None
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Wall C, Huang Y, Uy C, Le E, Tombetti E, Gopalan D, Manavaki R, Dweck M, Ariff B, Bennett M, Slomka P, Dey D, Mason J, Rudd J, Tarkin J. Pericoronary adipose tissue density is associated with clinical disease activity in Takayasu arteritis and coronary arterial inflammation measured by 68Ga-DOTATATE PET in atherosclerosis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Coronary artery disease (CAD) is an under-recognized complication of intense arterial inflammation in Takayasu arteritis (TAK). While pericoronary adipose tissue (PCAT) density is associated with arterial inflammation in CAD patients, this relationship has not previously been studied in TAK patients, nor directly compared with coronary arterial inflammation measured by 68Ga-DOTATATE positron emission tomography (PET).
Purpose
To compare PCAT density with clinical, biochemical and molecular imaging markers of inflammation in TAK and CAD patients.
Methods
PCAT density was quantified from computed tomography coronary angiography (CTCA) around each of the 17 coronary segments in patients with: (1) TAK and CAD, (2) atherosclerotic CAD, and (3) age and gender-matched healthy controls, using semi-automated software (Autoplaque). In TAK patients, PCAT density was compared to the Indian Takayasu Clinical Activity Score (ITAS) and high-sensitivity C-reactive protein (CRP). In CAD patients, PCAT density was compared to local arterial inflammation measured by coronary motion-frozen 68Ga-DOTATATE PET using image registration software (FusionQuant), and systemic (aortic) inflammation using 18F-fluorodeoxyglucose (FDG) PET. Data was acquired either during routine clinical care or prior research that established 68Ga-DOTATATE as an experimental marker of arterial inflammation that binds macrophage somatostatin receptor-2 in atherosclerotic plaques (NCT02021188).
Results
60 patients were included (TAK, n=20; CAD, n=20; healthy, n=20). Non-calcified plaque burden (TAK: 95.2%; CAD: 90.4%, p<0.0001) and CRP (TAK: 25.2 ±SD 16.1 mg/L; CAD: 2.5 ±SD 1.7 mg/L, p=0.04) were greater in TAK than CAD patients.
PCAT density varied significantly among the three groups (median [IQR] TAK: −72.9 [−81.2 to -66.1] Hounsfield unit [HU]; CAD: −79.9 [−88.0 to −72.2]; healthy: −83.8 [−90.1 to −75.8] HU, p<0.0001). Figure: box-plot showing the distribution of PCAT values by group, with corresponding representative multiplanar reconstructed and cross-sectional CTCA images with surrounding PCAT density displayed by color table in left anterior descending arteries.
PCAT density was significantly associated with ITAS (r=0.61, p=0.004) and CRP (r=0.43, p=0.03) in TAK patients, and coronary 68Ga-DOTATATE maximum tissue-to-blood ratio (r=0.31, p<0.001) in CAD patients. PCAT density was not associated with aortic 18F-FDG uptake in CAD patients, nor subcutaneous (pre-sternal) adipose tissue density in either disease group. No significant patient-level confounders were identified using linear mixed-effects regression modelling.
Conclusion
PCAT density measured by CTCA is greater in TAK than CAD patients, and is associated with clinical and biochemical markers of disease activity in TAK, and coronary arterial inflammation measured by 68Ga-DOTATATE PET in CAD. PCAT could be a useful, easy to measure marker of coronary inflammation and disease activity in both TAK and CAD.
PCAT density is greater in TAK than CAD
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Wellcome Trust
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Lin A, Wong N, Razipour A, McElhinney P, Commandeur F, Cadet S, Gransar H, Chen X, Cantu S, Miller R, Nerlekar N, Wong D, Slomka P, Rozanski A, Tamarappoo B, Berman D, Dey D. Metabolic Syndrome, Fatty Liver, And Artificial Intelligence-based Epicardial Adipose Tissue Measures Predict Long-term Risk Of Cardiac Events. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Grodecki K, Cadet S, Staruch A, Michałowska A, Kepka C, Wolny R, Slomka P, Witkowski A, Dey D, Opolski M. Computed Tomographic Quantitative Plaque Analysis Improves Prediction Of Side Branch Occlusion After Intervention In Coronary Bifurcation Lesions. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Lin A, Kolossváry M, Yuvaraj J, Cadet S, McElhinney P, Jiang C, Nerlekar N, Nicholls S, Slomka P, Maurovich-Horvat P, Wong D, Dey D. Myocardial Infarction Is Associated With A Distinct Pericoronary Adipose Tissue Radiomic Phenotype: A Prospective Case-Control Study. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Klein E, Otaki Y, Gransar H, Han D, Tzolos E, Tamarappoo B, Hayes S, Friedman J, Thomson L, Slomka P, Dey D, Cheng V, Berman D. Reproducibility Of Various Approaches To Measuring Aortic Sinus Size. J Cardiovasc Comput Tomogr 2020. [DOI: 10.1016/j.jcct.2020.06.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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