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Pucci A, Rossetti M, Lenzi C, Buja ML. The cardiovascular pathologist in the aortic team. Cardiovasc Pathol 2024; 72:107649. [PMID: 38703970 DOI: 10.1016/j.carpath.2024.107649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 04/14/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024] Open
Abstract
Aortic diseases require a multidisciplinary management for diagnosis, treatment and follow-up with better outcomes in referral centers using a team-based approach. The setting up of a multi-disciplinary aortic team for the discussion of complex cases has been already proposed; it is also supported by the ACC/AHA. Surgeons and radiologists, more or less other physicians such as cardiologists, geneticists, rheumatologists/internal medicine specialists and pathologists are involved into such a team. The role of the cardiovascular pathologist is to examine the aortic specimens, to diagnose and classify the aortic lesions. Herein, the role of the pathologist in the aortic team is discussed and the pathobiology of aortic diseases is reviewed for reference by pathologists. The aortic specimens are mainly obtained from emergency or elective surgical procedures on the thoracic aorta, less frequently from organ/tissue (including cardiac or heart valve) donors, post-mortem procedures or abdominal aortic surgery. In the last decade, together with the progress of medical sciences, the histological definitions and classifications of the aortic pathology are undergoing thorough revisions that are addressed to an etiopathogenetic approach because of possible clinico-pathological correlations, therapeutic and prognostic impact. Pathologists may also have an important role in research and teaching. Therefore, histological analyses of the aortic specimens require adequate sample processing and pathologist expertise because histology contributes to definite diagnosis, correct management of patients and even (in genetic diseases) families, but also to research in the challenging field of aortopathies.
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Affiliation(s)
- Angela Pucci
- Department of Histopathology, Pisa University Hospital, Pisa, Italy.
| | - Martina Rossetti
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Chiara Lenzi
- Department of Histopathology, Pisa University Hospital, Pisa, Italy
| | - Maximilian L Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
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2
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Briggs B, Cline D. Diagnosing aortic dissection: A review of this elusive, lethal diagnosis. J Am Coll Emerg Physicians Open 2024; 5:e13225. [PMID: 38983974 PMCID: PMC11231041 DOI: 10.1002/emp2.13225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 06/03/2024] [Accepted: 06/04/2024] [Indexed: 07/11/2024] Open
Abstract
Aortic dissection (AD) remains a difficult diagnosis in the emergency setting. Despite its rare occurrence, it is a life-threatening pathology that, if missed, is typically fatal. Previous studies have documented minimal improvement in timely and accurate diagnoses despite the advancement of computed tomography. Previous literature has highlighted aortic dissections as a major cause of serious misdiagnosis-related harm. The aim of this article is to review the available literature on AD, discussing the diversity in presentations and the prevalence of historical and exam features to better aid in the diagnosis of AD. AD remains a difficult diagnosis, even with the widespread prevalence of computed tomography angiography usage. No single feature of the history or physical examination is enough to raise suspicion. The diagnosis should be strongly considered in any patient with chest pain that is severe and unexplained by other findings or testing. Those who do not present with acute pain are often complicated by neurologic deficits, hypotension, or syncope. These patients suffer from a change in mental status limiting their ability to participate in the history and physical examination and have a higher rate of complications and mortality. An educated understanding of the atypical presentations of aortic dissection helps the clinician to realistically rank it on the differential diagnosis, culminating in judicious use of definitive imaging.
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Affiliation(s)
- Blake Briggs
- Division of Emergency MedicineDepartment of SurgeryUniversity of Tennessee Graduate School of MedicineKnoxvilleTennesseeUSA
| | - David Cline
- Department of Emergency MedicineWake Forest University School of MedicineWinston‐SalemNorth CarolinaUSA
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3
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Clement A, Pezel T, Lequipar A, Guiraud-Chaumeil P, Singh M, Poinsignon H, El Beze N, Gall E, Goncalves T, Lafont A, Henry P, Dillinger JG. [Recreative drug use and cardiovascular disease]. Ann Cardiol Angeiol (Paris) 2023; 72:101638. [PMID: 37738755 DOI: 10.1016/j.ancard.2023.101638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/24/2023]
Abstract
Widely spread, and continuously increasing, recreational drug use in general population has been associated with cardiovascular events, as illustrated by clinical studies and supported by a pathophysiological rationale. Understanding the cardiovascular effects of drugs, screening, and secondary prevention are crucial components in the management of those patients in cardiology.
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Affiliation(s)
- Arthur Clement
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Theo Pezel
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Antoine Lequipar
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Paul Guiraud-Chaumeil
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Manveer Singh
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Hugo Poinsignon
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Nathan El Beze
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Emmanuel Gall
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Trecy Goncalves
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Alexandre Lafont
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Patrick Henry
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France
| | - Jean-Guillaume Dillinger
- Université Paris Cité, Department of Cardiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, Inserm U-942, 75010 Paris, France.
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4
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Barton M, Wang H. An Uncommon Presentation of Acute Thoracic Aortic Dissection. J Clin Med Res 2023; 15:332-335. [PMID: 37434776 PMCID: PMC10332876 DOI: 10.14740/jocmr4921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/17/2023] [Indexed: 07/13/2023] Open
Abstract
We present a case of a 40-year-old Caucasian male with past medical history of polysubstance abuse (cocaine and methamphetamine), who presented to the emergency department (ED) complaining of intermittent cough with associated chest discomfort and shortness of breath for 2 weeks. Initial vital signs demonstrated borderline tachycardia (98 beats per minute), tachypnea (37 times per minutes), and hypoxia (oxygen saturation 89% on room air), and his physical exam was grossly unremarkable. A preliminary workup including a computed tomography angiography (CTA) revealed a type A aortic dissection with both thoracic and abdominal involvement for which the patient was admitted. This patient had resection of the ascending aorta with graft placement, cardiopulmonary bypass, aortic root replacement using composite prosthesis and left and right coronary reconstruction and reimplantation and survived a complicated hospital course. This case demonstrates the classic association known to exist between recreational drug use, specifically stimulants such as cocaine and amphetamines, and acute aortic dissection (AAD). However, such a presentation of borderline subacute, painless dissection in the setting of polysubstance use raises further questions, since uncommon AAD is typically found in higher-risk populations such as those with connective tissue disorders (Marfan syndrome, Ehlers-Danlos syndrome, Loeys-Dietz syndrome), bicuspid aortic valve, chronic hypertension, or previous aortic pathology. We therefore suggest clinicians strongly consider uncommon AAD as part of their differential diagnosis in patients with known or highly suspected polysubstance abuse.
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Affiliation(s)
- MacKenzie Barton
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
| | - Hao Wang
- Department of Emergency Medicine, John Peter Smith Health Network, Fort Worth, TX 76104, USA
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Morello F, Bima P, Castelli M, Nazerian P. Acute aortic syndromes: An internist's guide to the galaxy. Eur J Intern Med 2022; 106:45-53. [PMID: 36229285 DOI: 10.1016/j.ejim.2022.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/05/2022] [Accepted: 10/05/2022] [Indexed: 11/03/2022]
Abstract
Acute aortic syndromes (AASs) are severe conditions defined by dissection, hemorrhage, ulceration or rupture of the thoracic aorta. AASs share etiological and pathophysiological features, including long-term aortic tissue degeneration and mechanisms of acute aortic damage. The clinical signs and symptoms of AASs are unspecific and heterogeneous, requiring large differential diagnosis. When evaluating a patient with AAS-compatible symptoms, physicians need to integrate clinical probability assessment, bedside imaging techniques such as point-of-care ultrasound, and blood test results such as d-dimer. The natural history of AASs is dominated by engagement of ischemic, coagulative and inflammatory pathways at large, causing multiorgan damage. Medical treatment, multiorgan monitoring and outcome prognostication are therefore paramount, with internal medicine playing a key role in non-surgical management of AASs.
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Affiliation(s)
- Fulvio Morello
- S.C. Medicina d'Urgenza U (MECAU), A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; Dipartimento di Scienze Mediche, Università degli Studi di Torino, Italy
| | - Paolo Bima
- S.C. Medicina d'Urgenza U (MECAU), A.O.U. Città della Salute e della Scienza di Torino, Torino, Italy; Cardiovascular Research Institute Basel (CRIB), University Hospital Basel, University of Basel, Basel, Switzerland
| | - Matteo Castelli
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy
| | - Peiman Nazerian
- Department of Emergency Medicine, Careggi University Hospital, Firenze, Italy.
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O'Keefe EL, Dhore A, Lavie CJ. Early Onset Cardiovascular Disease from Cocaine, Amphetamines, Alcohol, and Marijuana. Can J Cardiol 2022; 38:1342-1351. [PMID: 35840019 DOI: 10.1016/j.cjca.2022.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 01/16/2023] Open
Abstract
Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens the young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early onset CVD. While this remains a global phenomenon, the epicenter of substance abuse is rooted in North America where it has been exacerbated by the COVID-19 pandemic. For the first time in history, the United States (US) crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada's recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis unfolding, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death and early mortality.
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Affiliation(s)
| | | | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA.
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7
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Saleh QW, Diederichsen ACP, Lindholt JS. Individualized prediction of risk of ascending aortic syndromes. PLoS One 2022; 17:e0270585. [PMID: 35759492 PMCID: PMC9236241 DOI: 10.1371/journal.pone.0270585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Accepted: 06/13/2022] [Indexed: 12/03/2022] Open
Abstract
Objectives Although ascending aortic diameter changes acutely after dissection, recommendation for prophylactic surgery of thoracic aortic aneurysms rely on data from dissected aortas. In this case-control study we aim to identify risk markers for acute and chronic aortic syndromes of the ascending aorta (ACAS-AA). Furthermore, to develop a predictive model for ACAS-AA. Methods We collected data of 188 cases of ACAS-AA and 376 controls standardized to age- and sex of the background population. Medical history and CT-derived aortic morphology were collected. For the dependent outcome ACAS-AA, potential independent risk factors were identified by univariate logistic regression and confirmed in multivariate logistic regression. As post-dissection tubular ascending aortic diameter is prone to expand, this factor was not included in the first model. The individual calculated adjusted odds ratios were then used in ROC-curve analysis to evaluate the diagnostic accuracy of the model. To test the influence of post-ACAS-AA tubular ascending aortic diameter, this was added to the model. Results The following risk factors were identified as independent risk factors for ACAS-AA in multivariate analysis: bicuspid aortic valve (OR 20.41, p = 0.03), renal insufficiency (OR 2.9, p<0.01), infrarenal abdominal aortic diameter (OR 1.08, p<0.01), left common carotid artery diameter (OR 1.40, p<0.01) and aortic width (OR 1.07, p<0.01). Area under the curve was 0.88 (p<0.01). Adding post-ACAS-AA tubular ascending aortic diameter to the model, negated the association of bicuspid aortic valve, renal insufficiency, and left common carotid artery diameter. Area under the curve changed to 0.98 (p<0.01). Conclusions A high performing predictive model for ACAS-AA, free of ascending aortic diameter, can be achieved. Furthermore, we have identified abdominal aortic ectasia as an independent risk factor of ACAS-AA. Integration of potential biomarkers and morphologic variables, derived from undissected aortas, would probably improve the model.
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Affiliation(s)
- Qais Waleed Saleh
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
- * E-mail:
| | - Axel Cosmus Pyndt Diederichsen
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Jes Sanddal Lindholt
- Department of Thoracic-, Cardiac- and Vascular Surgery, Odense University Hospital, Odense, Denmark
- Centre for Individualized Medicine in Arterial Diseases (CIMA), Odense, Denmark
- Centre of Clinical Excellence in Southern Denmark (CAVAC), Odense, Denmark
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8
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Lucyk SN. Acute Cardiovascular Toxicity of Cocaine. Can J Cardiol 2022; 38:1384-1394. [PMID: 35697321 DOI: 10.1016/j.cjca.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 04/22/2022] [Accepted: 05/02/2022] [Indexed: 11/27/2022] Open
Abstract
Cocaine is one of the most commonly abused drugs and represents a major public health concern. Cocaine users frequently present to the emergency department, with chest pain being the most common presenting complaint. The incidence of acute myocardial infarction in patients with cocaine-associated chest pain is often quoted as 6%, but it is highly variable depending on the included population. Risk assessment can be challenging in these patients; serial assessment of electrocardiograms and troponins is often required. This review focuses on the assessment and management of patients presenting with cocaine-associated chest pain and cardiotoxicity. Specific treatments are discussed, including benzodiazepines, nitroglycerin, calcium channel blockers, and phentolamine, and how treatment priorities differ from patients with noncocaine presentations. The use of beta-blockers in this population remains controversial, and the literature around its use is reviewed. The most recent literature and recommendations for the use of percutaneous coronary intervention and fibrinolytics in cocaine-associated myocardial infarction is discussed as well. Cocaine-associated dysrhythmias are suggested to be the cause of sudden cardiac death in some users. The pathophysiology and evidence-based treatments for dysrhythmias are reviewed. This review provides evidence-based recommendations for the assessment and management of patients presenting with cocaine-associated cardiovascular toxicity.
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Affiliation(s)
- Scott N Lucyk
- Poison and Drug Information Service, Alberta Health Services, Calgary, Alberta, Canada; Department of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada; Section of Clinical Pharmacology and Toxicology, Alberta Health Services, Calgary, Alberta, Canada.
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9
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Zhao K, Zhu H, Zhang L, Liu J, Pei Y, Zhou J, Jing Z. Elevated Admission Cardiac Troponin I Predicts Adverse Outcomes of Acute Type B Aortic Dissection after Endovascular Treatment. Front Surg 2022; 9:789954. [PMID: 35747434 PMCID: PMC9209658 DOI: 10.3389/fsurg.2022.789954] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 05/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background There is a lack of evidence about the predictive role of serum cardiac troponin I (cTnI) on the long-term adverse outcomes of acute type B aortic dissection (aTBAD) patients after thoracic endovascular aortic repair (TEVAR). In this study, we identified whether cTnI was an independent risk factor of 5-year adverse outcomes for aTBAD patients after TEVAR. Methods We reviewed consecutive aTBAD patients without previous heart disease who were admitted for TEVAR. The total study population was divided into the cTnI(+) group (≥0.03 ng/mL) and the cTnI(−) group (<0.03 ng/mL) according to the time-dependent receiver operating characteristic curve analysis. The differences in clinical characteristics, operative details and clinical outcomes were compared between the two groups. Results There was no difference in age and male prevalence between the two groups. Compared with the cTnI(−) group, the incidence of chronic kidney disease was higher in patients with cTnI ≥0.03 ng/mL. In addition, the cTnI(+) group presented with more frequent premature beats and non-myocardial-infarction ST-T segment changes. In terms of laboratory examinations, white blood cell counts, neutrophil counts, serum D-dimer and serum fibrin degradation products showed an increase in the cTnI(+) group, while lymphocyte and platelet counts showed a decrease in these patients. Patients with elevated cTnI suffered from increased risks of 5-year aortic-related adverse events (hazard ratio, HR = 1.822, 95% confidence interval, CI: 1.094–3.035; p = 0.021) and all-cause mortality (HR = 4.009, 95% CI: 2.175–7.388; p < 0.001). Conclusion Among aTBAD patients without previous heart disease, preoperative elevated cTnI identified patients at an increased risk of long-term adverse outcomes after TEVAR.
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Affiliation(s)
- Kaiwen Zhao
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Hongqiao Zhu
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Lei Zhang
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Junjun Liu
- Department of Vascular Surgery, the First Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yifei Pei
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
| | - Jian Zhou
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
- Correspondence: Jian Zhou Zaiping Jing
| | - Zaiping Jing
- Department of Vascular Surgery, the First Affiliated Hospital of the Navy Medical University, Shanghai, China
- Correspondence: Jian Zhou Zaiping Jing
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10
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Riley ED, Chow FC, Josephson SA, Dilworth SE, Lynch KL, Wade AN, Braun C, Hess CP. Cocaine Use and White Matter Hyperintensities in Homeless and Unstably Housed Women. J Stroke Cerebrovasc Dis 2021; 30:105675. [PMID: 33677311 DOI: 10.1016/j.jstrokecerebrovasdis.2021.105675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 02/01/2021] [Accepted: 02/06/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Cocaine use has been linked to stroke in several studies. However, few studies have considered the influence of cocaine use on stroke mechanisms such as small vessel disease (SVD). We conducted a study to assess associations between the toxicology-confirmed use of multiple drugs, including cocaine, and a marker of SVD, white matter hyperintensities (WMH). MATERIALS AND METHODS We conducted a nested case-control study (n = 30) within a larger cohort study (N = 245) of homeless and unstably housed women recruited from San Francisco community venues. Participants completed six monthly study visits consisting of an interview, blood draw, vital sign assessment and baseline brain MRI. We examined associations between toxicology-confirmed use of multiple substances, including cocaine, methamphetamine, heroin, alcohol and tobacco, and WMH identified on MRI. RESULTS Mean study participant age was 53 years, 70% of participants were ethnic minority women and 86% had a history of cocaine use. Brain MRIs indicated the presence of WMH (i.e., Fazekas score>0) in 54% (18/30) of imaged participants. The odds of WMH were significantly higher in women who were toxicology-positive for cocaine (Odd Ratio=7.58, p=0.01), but not in women who were toxicology-positive for other drugs or had several other cerebrovascular risk factors. CONCLUSIONS Over half of homeless and unstably housed women showed evidence of WMH. Cocaine use is highly prevalent and a significant correlate of WMH in this population, while several traditional CVD risk factors are not. Including cocaine use in cerebrovascular risk calculators may improve stroke risk prediction in high-risk populations and warrants further investigation.
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Affiliation(s)
- Elise D Riley
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Felicia C Chow
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA; University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
| | - S Andrew Josephson
- University of California, San Francisco, Department of Neurology, San Francisco, CA, USA.
| | - Samantha E Dilworth
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Kara L Lynch
- University of California, San Francisco, Department of Laboratory Medicine, San Francisco, CA, USA.
| | - Amanda N Wade
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Carl Braun
- University of California, San Francisco, Department of Medicine, 1001 Potrero Ave., UCSF Mailbox 0874, San Francisco 94143-0874, CA, USA.
| | - Christopher P Hess
- University of California, San Francisco, Department of Radiology and Biomedical Imaging, San Francisco, CA, USA.
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Blinick R, Chaya N, Zalta B, Haramati LB, Shmukler A. Cracking the Opium Den: Cardiothoracic Manifestations of Drug Abuse. J Thorac Imaging 2021; 36:W16-W31. [PMID: 32102017 DOI: 10.1097/rti.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recreational drug use is increasing worldwide, with emergency room visits and total deaths from drug overdose rising in recent years. Complications from prescription and recreational drug use may result from the biochemical effects of the drugs themselves, impurities mixed with substances, or from causes related to the method of drug administration. The presentation of drug overdose may be complex due to multisubstance abuse, including cigarette smoking and alcoholism, and can impact any organ system. Patients may present without history, and radiologists may be the first clinicians to suggest the diagnosis. We aim to explore the cardiothoracic manifestations of drug abuse and their multimodality imaging manifestations.
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Affiliation(s)
| | - Nathan Chaya
- Montefiore Medical Center, Bronx
- Staten Island University Hospital, Staten Island, NY
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12
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Shalhub S, Wallace S, Okunbor O, Newhall K. Genetic aortic disease epidemiology, management principles, and disparities in care. Semin Vasc Surg 2021; 34:79-88. [PMID: 33757640 DOI: 10.1053/j.semvascsurg.2021.02.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Patients with syndromic and nonsyndromic heritable aortopathies (also known as genetic aortic disease) are a heterogeneous group of patients who present at younger ages with more rapid growth of aortic aneurysms and/or increased frequency of dissections compared with patients with atherosclerotic aortopathies. In this review, we describe the etiology, epidemiology, and appropriate care delivery for these conditions at each stage of management. Within each section, we discuss sex, gender, and race differences and highlight disparities in care and knowledge. We then discuss the role of the vascular team throughout the cycle of care and the evolving inclusion of patient input in research. This understanding is essential to the creation of effective health care policies that support equitable, appropriate, and patient-centered clinical practices.
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Affiliation(s)
- Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195.
| | - Stephanie Wallace
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195
| | - Osa Okunbor
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195
| | - Karina Newhall
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, 1959 NE Pacific Street, Box 356410, Seattle, WA 98195
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13
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Di Fusco SA, Rossini R, Flori M, Pollarolo L, Ingianni N, Malvezzi Caracciolo D'Aquino M, Galati G, Zilio F, Iorio A, Scotto di Uccio F, Lucà F, Gulizia MM, Ciccirillo F, Gabrielli D, Colivicchi F. Pathophysiology and management of recreational drug-related acute coronary syndrome: ANMCO position statement. J Cardiovasc Med (Hagerstown) 2021; 22:79-89. [PMID: 32858637 DOI: 10.2459/jcm.0000000000001091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recreational drug use may cause coronary artery disease through several mechanisms. An increasing number of young patients with drug-related acute coronary syndrome have been reported over recent years. The present position statement reports the most recent epidemiological data on acute coronary syndrome in the setting of drug abuse, describes the main pathophysiological mechanisms underlying coronary artery disease and acute events in these patients, and provides practical recommendations on management and an overview of prognosis.
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Affiliation(s)
| | - Roberta Rossini
- U.O.C. Cardiologia, Azienda Ospedaliera Santa Croce e Carle, Cuneo
| | - Marco Flori
- U.O.C. Cardiologia, Presidio Ospedaliero Unico Urbino (PU)
| | - Luigi Pollarolo
- U.O.C Cardiologia, Ospedale Santo Spirito, Casale Monferrato (AL)
| | - Nadia Ingianni
- U.O.C. Cardiologia, Presidio Ospedaliero Paolo Borsellino, Marsala (TP)
| | | | - Giuseppe Galati
- Divisione di Cardiologia, IRCCS Ospedale San Raffaele, Milan
| | | | - Annamaria Iorio
- U.S.C. Cardiologia 2, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo
| | | | - Fabiana Lucà
- U.O.C. Cardiologia, A.O. Bianchi Melacrino Morelli, Reggio Calabria
| | - Michele Massimo Gulizia
- U.O.C. Cardiologia, Ospedale Garibaldi-Nesima, Azienda di Rilievo Nazionale e Alta Specializzazione 'Garibaldi', Catania
- Presidente Fondazione per il Tuo cuore, Firenze - Heart Care Foundation Onlus, Florence
| | | | - Domenico Gabrielli
- U.O.C Cardiologia, Ospedale Civile Augusto Murri, Area Vasta 4 Fermo, ASUR Marche, Fermo (AN), Italy
| | - Furio Colivicchi
- U.O.C. Cardiologia Clinica e Riabilitativa, P.O San Filippo Neri - ASL Roma1, Rome
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14
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Greve D, Funke J, Khairi T, Montagner M, Starck C, Falk V, Sá MPBO, Kurz SD. Cocaine-Related Aortic Dissection: what do we know? Braz J Cardiovasc Surg 2020; 35:764-769. [PMID: 33118742 PMCID: PMC7598981 DOI: 10.21470/1678-9741-2020-0333] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction Cocaine use is known to be associated with an increased risk for vascular diseases. It is likely to trigger or increase the risk for an aortic dissection. We conducted an analysis of 45 cases of cocaine-related aortic dissection to further characterize the clinical features and outcomes of this patient cohort. Methods Our study cohort of 45 patients consisted of 11 cases from our institutional database and 34 published case reports. Results The observed cases of acute aortic dissection related to cocaine use showed a high proportion of young (41.3±8.67 years) and male (88.9%) patients. Most of the cases (75%) were classified as Stanford type A. Also, in 75% of the cases, cocaine use was prevalent for more than one year. Median time from last cocaine use to onset of symptoms was one hour. In-hospital mortality was 21.4%, while additional 11.9% of the cases died before arriving at the hospital. Conclusion Acute aortic dissection related to cocaine use occurs in predominantly young male patients and has a dismal outcome when compared to all comer series.
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Affiliation(s)
- Dustin Greve
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Joana Funke
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Tiam Khairi
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Matteo Montagner
- German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Christoph Starck
- German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
| | - Volkmar Falk
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research) Berlin Germany DZHK (German Centre for Cardiovascular Research), Partner Site, Berlin, Germany.,Swiss Federal Institute of Technology Department of Health Science and Technology Zurich Switzerland Department of Health Science and Technology, Swiss Federal Institute of Technology, Zurich, Switzerland
| | - Michel Pompeu B O Sá
- Universidade de Pernambuco (UPE) Pronto-Socorro Cardiológico de Pernambuco (PROCAPE) Division of Cardiovascular Surgery Recife Brazil Division of Cardiovascular Surgery, Pronto-Socorro Cardiológico de Pernambuco (PROCAPE), Universidade de Pernambuco (UPE), Recife, Brazil
| | - Stephan D Kurz
- Charité Universitätsmedizin Berlin Department of Cardiovascular Surgery Berlin Germany Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,German Heart Center Berlin Department of Cardiothoracic and Vascular Surgery Berlin Germany Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany
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15
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Cerebrovascular and cardiovascular diseases caused by drugs of abuse. Hypertens Res 2019; 43:363-371. [PMID: 31801994 DOI: 10.1038/s41440-019-0367-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 11/07/2019] [Accepted: 11/10/2019] [Indexed: 11/08/2022]
Abstract
Drugs such as stimulants, sedatives, sleeping pills, and narcotics are associated with drug abuse and are therefore regulated by law. Physical dependence on these drugs is sometimes difficult to control despite an awareness of the problems they cause in daily life and the harm they can cause to the body. Drug dependence is a social problem worldwide, and the physical implications are serious. Many of these drugs cause cerebrovascular and cardiovascular diseases, which often require emergency medical treatment. Differential diagnosis is essential because of the likelihood of life-threatening events, especially among young people who exhibit cerebrovascular and cardiovascular diseases without any of the typical risk factors. Drugs of abuse, especially stimulants, induce a hyperadrenergic state that evokes vasoconstriction and tachycardia, as well as subsequent ischemic and hemorrhagic stroke, acute coronary syndrome, arrhythmias, and aortic dissection. Chronic drug abuse can also cause cardiac hypertrophy and left ventricular dysfunction. As a treatment for these conditions, sedative drugs can be effective but the use of vasodilators may also be required. There are concerns that the use of both alpha- and beta-adrenergic receptor blockers may cause tachycardia and increased blood pressure. Therefore, careful differential diagnosis and selection of therapeutic agents is required.
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16
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Baggett TP, Liauw SS, Hwang SW. Cardiovascular Disease and Homelessness. J Am Coll Cardiol 2019; 71:2585-2597. [PMID: 29852981 DOI: 10.1016/j.jacc.2018.02.077] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/09/2018] [Accepted: 02/11/2018] [Indexed: 01/14/2023]
Abstract
Cardiovascular disease (CVD) is a major cause of death among homeless adults, at rates that exceed those in nonhomeless individuals. A complex set of factors contributes to this disparity. In addition to a high prevalence of cigarette smoking and suboptimal control of traditional CVD risk factors such as hypertension and diabetes, a heavy burden of nontraditional psychosocial risk factors like chronic stress, depression, heavy alcohol use, and cocaine use may confer additional risk for adverse CVD outcomes beyond that predicted by conventional risk estimation methods. Poor health care access and logistical challenges to cardiac testing may lead to delays in presentation and diagnosis. The management of established CVD may be further challenged by barriers to medication adherence, communication, and timely follow-up. The authors present practical, patient-centered strategies for addressing these challenges, emphasizing the importance of multidisciplinary collaboration and partnership with homeless-tailored clinical programs to improve CVD outcomes in this population.
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Affiliation(s)
- Travis P Baggett
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Boston, Massachusetts; Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Samantha S Liauw
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Stephen W Hwang
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada.
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17
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Morentin Campillo B, Molina Aguilar P, Monzó Blasco A, Laborda Gálvez JL, Arrieta Pérez J, Sancho Jiménez J, Lamas Ruiz J, Lucena Romero J. Muerte súbita por disección de aorta torácica en jóvenes: estudio multicéntrico forense. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.05.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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18
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Yammine H, Krcelic D, Ballast JK, Briggs CS, Stanley G, Nussbaum T, Frederick JR, Arko FR. Cocaine use is associated with worse outcomes in patients treated with thoracic endovascular repair for type B aortic dissection. J Vasc Surg 2019; 70:60-66. [PMID: 30792056 DOI: 10.1016/j.jvs.2018.10.061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/14/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To describe and compare the clinical and anatomical characteristics and outcomes of patients with and without known cocaine use who underwent thoracic endovascular repair for type B aortic dissections. METHODS Between January 2012 and January 2017, 186 patients underwent thoracic endovascular repair for type B aortic dissection at our institution. Clinical data and anatomical characteristics were collected under an institutional review board-approved protocol. Survival, reintervention, complications, and characteristics of dissection were compared between patients with cocaine use (C+; n = 14) and those with no known cocaine use (C-; n = 172). RESULTS Cocaine users were more likely to be young African American males who smoked. They tended to present with more extensive dissections as evidenced by larger false lumen diameters. They also had higher rates of endoleaks and more reinterventions. CONCLUSIONS These results suggest that special care should be taken to provide close follow-up for these patients.
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Affiliation(s)
- Halim Yammine
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | - Daniel Krcelic
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | | | | | - Gregory Stanley
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | - Tzvi Nussbaum
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC
| | | | - Frank R Arko
- Sanger Heart & Vascular Institute, Atrium Health, Charlotte, NC.
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19
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Morentin Campillo B, Molina Aguilar P, Monzó Blasco A, Laborda Gálvez JL, Arrieta Pérez J, Sancho Jiménez J, Lamas Ruiz J, Lucena Romero J. Sudden Death Due to Thoracic Aortic Dissection in Young People: A Multicenter Forensic Study. ACTA ACUST UNITED AC 2018; 72:553-561. [PMID: 30177458 DOI: 10.1016/j.rec.2018.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/24/2018] [Indexed: 01/28/2023]
Abstract
INTRODUCTION AND OBJECTIVES Thoracic aortic dissection (TAD) is infrequent in young people and its characteristics differ from those in the adult population. This study aimed to analyze the clinical and pathological characteristics of sudden death due to TAD in people aged 1 to 35 years. METHODS Multicenter population-based study based on forensic autopsies conducted in the provinces of Biscay (1991-2016), Valencia (2000-2016), and Seville (2004-2016). RESULTS We identified 35 individuals with sudden death due to TAD (80% males), with a mean age of 29±5 years. The incidence was 0.09/100 000 inhabitants/y. Eighteen persons had at least 1 risk factor for TAD, and this figure increased to 29 when postmortem findings were included: congenital heart disease (n=16), suspicion of familial TAD (n=11), cocaine use (n=6), and hypertension (n=5). Twenty-four individuals, 12 with at least 1 risk factor, had prodromal symptoms, and 16 of them visited their physician, but TAD was not suspected in any of them. The most frequent symptom was chest pain (n=12). The main autopsy findings were cystic degeneration of the media (n=27), dilatation of the ascending aorta (n=21), cardiac hypertrophy (n=20), and bicuspid aortic valve (n=14). CONCLUSIONS The incidence of sudden death due to TAD in young people was very low. The most frequent risk factors were congenital heart disease followed by suspicion of familial TAD and cocaine use. TAD should be included in the differential diagnosis of chest pain in young people, mainly male patients with at least 1 risk factor.
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Affiliation(s)
- Benito Morentin Campillo
- Servicio de Patología Forense, Instituto Vasco de Medicina Legal y Ciencias Forenses, Bilbao, Vizcaya, Spain
| | - Pilar Molina Aguilar
- Servicio de Patología Forense, Instituto de Medicina Legal y Ciencias Forenses, Valencia, Spain
| | - Ana Monzó Blasco
- Servicio de Patología Forense, Instituto de Medicina Legal y Ciencias Forenses, Valencia, Spain
| | | | - Jon Arrieta Pérez
- Servicio de Patología Forense, Instituto Vasco de Medicina Legal y Ciencias Forenses, Bilbao, Vizcaya, Spain
| | - Jennifer Sancho Jiménez
- Servicio de Patología Forense, Instituto de Medicina Legal y Ciencias Forenses, Valencia, Spain
| | - Julia Lamas Ruiz
- Servicio de Patología Forense, Instituto Vasco de Medicina Legal y Ciencias Forenses, Bilbao, Vizcaya, Spain
| | - Joaquín Lucena Romero
- Servicio de Patología Forense, Instituto de Medicina Legal y Ciencias Forenses, Sevilla, Spain.
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20
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Knapp J, Zylla M, Schaper A, Michalski D, Hartwig S, Bernhard M. Energydrinks in der Notfallmedizin – verleihen nicht nur Flügel. Notf Rett Med 2018. [DOI: 10.1007/s10049-017-0386-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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21
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D'Errico S, Niballi S, Bonuccelli D. Aortic dissection in cocaine abuse: A fatal case. J Forensic Leg Med 2018; 58:179-182. [PMID: 30005338 DOI: 10.1016/j.jflm.2018.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/20/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Affiliation(s)
- S D'Errico
- Department of Legal Medicine, Azienda USL Toscana Nordovest Lucca, Italy.
| | - S Niballi
- Department of Legal Medicine, Azienda USL Toscana Nordovest Lucca, Italy
| | - D Bonuccelli
- Department of Legal Medicine, Azienda USL Toscana Nordovest Lucca, Italy
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22
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Morentin B, Callado LF, García-Hernández S, Bodegas A, Lucena J. The role of toxic substances in sudden cardiac death. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.remle.2017.05.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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23
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Dewar K, Nolan S. Chronic hypertension, recreational cocaine use and a subsequent acute aortic dissection in a young adult. BMJ Case Rep 2017; 2017:bcr-2016-218235. [DOI: 10.1136/bcr-2016-218235] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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24
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Havakuk O, Rezkalla SH, Kloner RA. The Cardiovascular Effects of Cocaine. J Am Coll Cardiol 2017; 70:101-113. [PMID: 28662796 DOI: 10.1016/j.jacc.2017.05.014] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 04/26/2017] [Accepted: 05/08/2017] [Indexed: 10/19/2022]
Abstract
Cocaine is the leading cause for drug-abuse-related visits to emergency departments, most of which are due to cardiovascular complaints. Through its diverse pathophysiological mechanisms, cocaine exerts various adverse effects on the cardiovascular system, many times with grave results. Described here are the varied cardiovascular effects of cocaine, areas of controversy, and therapeutic options.
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Affiliation(s)
- Ofer Havakuk
- Department of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Department of Cardiology, Tel Aviv Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Shereif H Rezkalla
- Department of Cardiology and Marshfield Clinic Research Institute, Marshfield, Wisconsin
| | - Robert A Kloner
- Department of Cardiology, Keck School of Medicine, University of Southern California, Los Angeles, California; Huntington Medical Research Institute, Los Angeles, California.
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25
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Shemirani H, Mirmohamadsadeghi A, Mahaki B, Farhadi S, Badalabadi RM, Bidram P, Badalabadi MM. Evaluation of Acute Aortic Dissection Type a Factors and Comparison the Postoperative Clinical Outcomes between Two Surgical Methods. Adv Biomed Res 2017; 6:85. [PMID: 28808651 PMCID: PMC5539669 DOI: 10.4103/2277-9175.210662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Although aortic dissection is a rare disease, it causes high level of mortality. If ascending aorta gets involved in this disease, it is known as type A. According to small number of studies about this disease in Iran, this study conducted to detect the factors related to acute aortic dissection type A, its surgery consequences and the factors affecting them. MATERIALS AND METHODS In this historical cohort study, all patients having acute aortic dissection type A referring to Chamran Hospital from 2006 to 2012 were studied. The impact of two surgical methods including antegrade cerebral perfusion (ACP) and retrograde cerebral one (RCP) on surgical and long-term mortality and recurrence of dissection was determined. The relation of mortality rate and hemodynamic instability before surgery, age more than 70 years old, ejection fraction lower than 50%, prolonged cardiopulmonary bypass pump (CPBP) time and excessive blood transfusion, was assessed. RESULTS Surgery and long-term mortality and recurrence of dissection were 35.3%, 30.8% and 30.4%. Surgical and long-term death in the patients being operated by ACP method was lower than those one being operated by RCP (P < 0.001). Excessive blood transfusion and unstable hemodynamic condition had significant effect on surgical mortality (P = 0.014, 0.030, respectively). CPBP time and unstable hemodynamic condition affected long-term mortality significantly (P = 0.002). CONCLUSION The result found that ACP is the preferable kind of surgery in comparison with RCP according to the surgical and long-term mortality.
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Affiliation(s)
- Hasan Shemirani
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Behzad Mahaki
- Department of Biostatistics, School of Public Health, University of Medical Sciences, Isfahan, Iran
| | - Sadaf Farhadi
- Department of Dermatology, Isfahan University of Medical Sciences, Isfahan, Iran
| | | | - Peyman Bidram
- Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
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26
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Bachi K, Mani V, Jeyachandran D, Fayad ZA, Goldstein RZ, Alia-Klein N. Vascular disease in cocaine addiction. Atherosclerosis 2017; 262:154-162. [PMID: 28363516 PMCID: PMC5757372 DOI: 10.1016/j.atherosclerosis.2017.03.019] [Citation(s) in RCA: 85] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 03/06/2017] [Accepted: 03/12/2017] [Indexed: 12/11/2022]
Abstract
Cocaine, a powerful vasoconstrictor, induces immune responses including cytokine elevations. Chronic cocaine use is associated with functional brain impairments potentially mediated by vascular pathology. Although the Crack-Cocaine epidemic has declined, its vascular consequences are increasingly becoming evident among individuals with cocaine use disorder of that period, now aging. Paradoxically, during the period when prevention efforts could make a difference, this population receives psychosocial treatment at best. We review major postmortem and in vitro studies documenting cocaine-induced vascular toxicity. PubMed and Academic Search Complete were used with relevant terms. Findings consist of the major mechanisms of cocaine-induced vasoconstriction, endothelial dysfunction, and accelerated atherosclerosis, emphasizing acute, chronic, and secondary effects of cocaine. The etiology underlying cocaine's acute and chronic vascular effects is multifactorial, spanning hypertension, impaired homeostasis and platelet function, thrombosis, thromboembolism, and alterations in blood flow. Early detection of vascular disease in cocaine addiction by multimodality imaging is discussed. Treatment may be similar to indications in patients with traditional risk-factors, with few exceptions such as enhanced supportive care and use of benzodiazepines and phentolamine for sedation, and avoiding β-blockers. Given the vascular toxicity cocaine induces, further compounded by smoking and alcohol comorbidity, and interacting with aging of the crack generation, there is a public health imperative to identify pre-symptomatic markers of vascular impairments in cocaine addiction and employ preventive treatment to reduce silent disease progression.
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Affiliation(s)
- Keren Bachi
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Venkatesh Mani
- Translational Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Devi Jeyachandran
- Pathology, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Zahi A Fayad
- Translational Molecular Imaging Institute (TMII), Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Rita Z Goldstein
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA
| | - Nelly Alia-Klein
- Brain Imaging Center (BIC), Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY 10029, USA.
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27
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Radunski UK, Fuger U, Bohnen S, Lund GK, Stehning C, Zeller T, Tahir E, Avanesov M, Adam G, Blankenberg S, Reimer J, Muellerleile K. Asymptomatic Cocaine Abuse - Myocardial Tissue Characterization Using Cardiac Biomarkers and Cardiovascular Magnetic Resonance Imaging. Circ J 2017; 81:701-708. [PMID: 28179611 DOI: 10.1253/circj.cj-16-0941] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Use of cocaine is widespread and associated with several cardiovascular diseases. Recent CMR studies indicate frequent myocardial scar/fibrosis in asymptomatic cocaine abusers (CA).Methods and Results:This study used a combination of advanced CMR tissue characterization techniques, including late gadolinium enhancement (LGE) for focal, and extracellular volume (ECV) imaging for diffuse myocardial injury/fibrosis, with circulating biomarkers for a comprehensive characterization of myocardial injury. We included 20 cardiac asymptomatic CA and a control group of 20 healthy volunteers. The comprehensive assessment included physical examination, resting ECG, exercise ECG, cardiac biomarkers, transthoracic echocardiogram and CMR. We did not find significant differences between CA and controls either in functional CMR parameters such as LVEDVi, LVESVi, LVEF, LV mass index, or in global myocardial ECV. Neither CA nor controls had evidence of myocardial edema on T2-weighted CMR, but 8 CA (40%), and none of the controls had focal myocardial scar (P<0.01). Interestingly, CA with focal myocardial scar on LGE had significantly higher high-sensitivity troponin I (hs-TNI) compared with CA without focal scar (median, 1.7 ng/L; IQR, 1.3-2.5 ng/L vs. 0.6 ng/L; 0.4-1.3 ng/L; P<0.01). CONCLUSIONS Focal myocardial injury in terms of subtle LGE in 40% of asymptomatic CA was associated with higher hs-TNI. Comprehensive assessment including advanced ECV imaging indicates a focal rather than diffuse pattern of myocardial involvement in asymptomatic CA.
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Affiliation(s)
- Ulf K Radunski
- Department of General and Interventional Cardiology, University Heart Center Hamburg
| | - Ulrike Fuger
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf
| | - Sebastian Bohnen
- Department of General and Interventional Cardiology, University Heart Center Hamburg
| | - Gunnar K Lund
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | | | - Tanja Zeller
- Department of General and Interventional Cardiology, University Heart Center Hamburg
| | - Enver Tahir
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | - Maxim Avanesov
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | - Gerhard Adam
- Department of Diagnostic and Interventional Radiology and Nuclear Medicine, University Medical Center Hamburg-Eppendorf
| | - Stefan Blankenberg
- Department of General and Interventional Cardiology, University Heart Center Hamburg
| | - Jens Reimer
- Center for Psychosocial Medicine, Health North.,Center for Interdisciplinary Addiction Medicine, University of Hamburg
| | - Kai Muellerleile
- Department of General and Interventional Cardiology, University Heart Center Hamburg
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28
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Riley ED, Hsue PY, Vittinghoff E, Wu AHB, Coffin PO, Moore PK, Lynch KL. Higher prevalence of detectable troponin I among cocaine-users without known cardiovascular disease. Drug Alcohol Depend 2017; 172:88-93. [PMID: 28157591 PMCID: PMC5464776 DOI: 10.1016/j.drugalcdep.2016.11.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 11/28/2016] [Accepted: 11/29/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND While cocaine use is an established risk factor for acute cardiovascular complications, associations between cocaine use and markers of cardiac injury outside of acute hospital presentation remain poorly characterized. We leveraged advances in cardiac troponin (cTnI) testing to assess low but clinically meaningful levels of cardiac injury among cocaine users and non-users. METHODS We conducted a case control study comparing cTnI levels by the presence of cocaine among patients presenting for non-cardiac care in an urban safety net hospital. Samples were chosen sequentially among those for which urine drug screens were ordered by providers hospital-wide. RESULTS During 2015, 14% of all hospital drug screens ordered were cocaine-positive. Among unique persons providing cocaine-positive (N=100) and cocaine-negative (N=100) samples, 37% were female, 45% were African-American and the median age was 51. Detectable cTnI (> 0.02ng/mL) was observed in 21 samples (11%). It was more common in subjects using cocaine (Adjusted OR=2.81; 95% CI=1.03-7.65), but not other drugs. Moreover, there was a significant correlation between concentrations of cTnI and the cocaine metabolite, benzoylecgonine (Spearman Correlation=0.34, p<0.01). CONCLUSIONS Among urban safety net hospital patients, 11% had detectable cTnI, and cTnI concentration was significantly correlated with benzoylecgonine concentration. While these preliminary results require additional confirmation, they suggest the potential utility of considering cocaine use as more than just an episodic exposure leading to acute cardiac events. The consideration of cocaine use as an ongoing chronic exposure leading to subclinical cardiac injury may improve risk-stratification and patient outcomes in populations where cocaine use is high.
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Affiliation(s)
- Elise D Riley
- Division of HIV, Infectious Diseases and Global Health, Department of Medicine, University of California, San Francisco, CA, USA.
| | - Priscilla Y Hsue
- Division of Cardiology, Department of Medicine, University of California, San Francisco, CA, USA
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
| | - Alan H B Wu
- Department of Laboratory Medicine, San Francisco General Hospital, University of California, SanFrancisco, CA, USA
| | - Phillip O Coffin
- Division of HIV, Infectious Diseases and Global Health, Department of Medicine, University of California, San Francisco, CA, USA; San Francisco Department of Public Health, San Francisco, CA, USA
| | - Peter K Moore
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, CA, USA; Division of Hospital Medicine, Department of Medicine, San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Kara L Lynch
- Department of Laboratory Medicine, San Francisco General Hospital, University of California, SanFrancisco, CA, USA
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Nienaber CA, Clough RE. Management of Acute Aortic Syndromes. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch71] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Carmody K, Asaly M, Blackstock U. Point of Care Echocardiography in an Acute Thoracic Dissection with Tamponade in a Young Man with Chest Pain, Tachycardia, and Fever. J Emerg Med 2016; 51:e123-e126. [PMID: 27595373 DOI: 10.1016/j.jemermed.2016.06.046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 05/24/2016] [Accepted: 06/29/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although thoracic aortic dissections are uncommon in young patients, they must be considered in the differential diagnosis in the presence of chest pain and abnormal vital signs. Although computed tomography angiography is the test of choice for thoracic dissection in the emergency department, point of care (POC) transthoracic echocardiography has a high specificity in the diagnosis of this disease. It is especially helpful in patients with proximal ascending dissections in the presence of a pericardial effusion. CASE REPORT This case report illustrates a young patient presenting with chest pain, persistent tachycardia, and fever with a presumed upper respiratory infection who had an ascending thoracic dissection with tamponade discovered on POC echocardiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: POC echocardiography should be an important part of the algorithm in young patients presenting with chest pain and abnormal vital signs that do not improve with supportive measures. Definitive care in patients who present with a thoracic aortic dissection in the presence of cardiac tamponade diagnosed on POC echocardiography should not be delayed in order to wait for other imaging methods to be performed. POC echocardiography may expedite care and treatment in young patients presenting with this deadly disease.
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Affiliation(s)
- Kristin Carmody
- Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Michael Asaly
- Department of Emergency Medicine, New York University School of Medicine, New York, New York
| | - Uché Blackstock
- Department of Emergency Medicine, New York University School of Medicine, New York, New York
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Kanahara S, El-Refai M, Lakkis N, Tabbaa R. Acute ascending aortic dissection after MDMA/ecstasy use: A case report. Hellenic J Cardiol 2016; 57:351-354. [DOI: 10.1016/j.hjc.2016.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Accepted: 06/26/2015] [Indexed: 10/20/2022] Open
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Abstract
Aortic dissection is a relatively uncommon but catastrophic illness classically thought to present with acute, sharp, chest pain with radiation to the back. However, aortic dissection can manifest in a number of different ways that include congestive heart failure, inferior myocardial infarction, stroke, focal pulse and neurologic deficits, abdominal pain, or acute renal failure. According to some studies, only about 80% of patients with type A dissection present with severe anterior chest pain, and only about 60% describe their pain as being sharp. Another series reports that treating clinicians fail to initially entertain the diagnosis of aortic dissection in up to 35% of cases. Many patients later found to have aortic dissection are initially suspected to have other conditions such as acute coronary syndrome, pericarditis, pulmonary embolism, or even cholecystitis. In this article we present a case of an unusual presentation of aortic dissection and a review of this condition.
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Affiliation(s)
- John Afshin Kasher
- Department of Medicine and Cardiology, Olive View-UCLA Medical Center and the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
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Consensus statement on surgical pathology of the aorta from the Society for Cardiovascular Pathology and the Association For European Cardiovascular Pathology: II. Noninflammatory degenerative diseases - nomenclature and diagnostic criteria. Cardiovasc Pathol 2016; 25:247-257. [PMID: 27031798 DOI: 10.1016/j.carpath.2016.03.002] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/03/2016] [Accepted: 03/08/2016] [Indexed: 01/09/2023] Open
Abstract
Surgical aortic specimens are usually examined in Pathology Departments as a result of treatment of aneurysms or dissections. A number of diseases, genetic syndromes (Marfan syndrome, Loeys-Dietz syndrome, etc.), and vasculopathic aging processes involved in vascular injury can cause both distinct and nonspecific histopathologic changes with degeneration of the media as a common denominator. Terminology for these changes has varied over time leading to confusion and inconsistencies. This consensus document has established a revised, unified nomenclature for the variety of noninflammatory degenerative aortic histopathologies seen in such specimens. Older terms such as cystic medial necrosis and medionecrosis are replaced by more technically accurate terms such as mucoid extracellular matrix accumulation (MEMA), elastic fiber fragmentation and/or loss, and smooth muscle cell nuclei loss. A straightforward system of grading is presented to gauge the extent of medial degeneration and synoptic reporting tables are provided. Herein we present a standardized nomenclature that is accessible to general pathologists and useful for future publications describing these entities.
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Karimi A, Milewicz DM. Structure of the Elastin-Contractile Units in the Thoracic Aorta and How Genes That Cause Thoracic Aortic Aneurysms and Dissections Disrupt This Structure. Can J Cardiol 2016; 32:26-34. [PMID: 26724508 PMCID: PMC4839280 DOI: 10.1016/j.cjca.2015.11.004] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 11/04/2015] [Accepted: 11/04/2015] [Indexed: 01/01/2023] Open
Abstract
The medial layer of the aorta confers elasticity and strength to the aortic wall and is composed of alternating layers of smooth muscle cells (SMCs) and elastic fibres. The SMC elastin-contractile unit is a structural unit that links the elastin fibres to the SMCs and is characterized by the following: (1) layers of elastin fibres that are surrounded by microfibrils; (2) microfibrils that bind to the integrin receptors in focal adhesions on the cell surface of the SMCs; and (3) SMC contractile filaments that are linked to the focal adhesions on the inner side of the membrane. The genes that are altered to cause thoracic aortic aneurysms and aortic dissections encode proteins involved in the structure or function of the SMC elastin-contractile unit. Included in this gene list are the genes encoding protein that are structural components of elastin fibres and microfibrils, FBN1, MFAP5, ELN, and FBLN4. Also included are genes that encode structural proteins in the SMC contractile unit, including ACTA2, which encodes SMC-specific α-actin and MYH11, which encodes SMC-specific myosin heavy chain, along with MYLK and PRKG1, which encode kinases that control SMC contraction. Finally, mutations in the gene encoding the protein linking integrin receptors to the contractile filaments, FLNA, also predispose to thoracic aortic disease. Thus, these data suggest that functional SMC elastin-contractile units are important for maintaining the structural integrity of the aorta.
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Affiliation(s)
- Ashkan Karimi
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida and the Division of Medical Genetics, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Dianna M Milewicz
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida and the Division of Medical Genetics, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA.
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Bossone E, Dean JH, Eagle KA. The Reply. Am J Med 2015; 128:e39-40. [PMID: 26500211 DOI: 10.1016/j.amjmed.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 07/13/2015] [Indexed: 11/25/2022]
Affiliation(s)
| | - Joshua H Dean
- Cardiovascular Center, University of Michigan, Ann Arbor
| | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor
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Lucyk SN, Kanter C, Lugassy D, Hoffman RS. Cocaine-related Aortic Dissection: Questions yet to Be Resolved. Am J Med 2015; 128:e37. [PMID: 26500210 DOI: 10.1016/j.amjmed.2015.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 01/09/2015] [Accepted: 01/09/2015] [Indexed: 10/22/2022]
Affiliation(s)
- Scott N Lucyk
- Division of Medical Toxicology, Department of Emergency Medicine, New York University School of Medicine, New York
| | | | - Daniel Lugassy
- Division of Medical Toxicology, Department of Emergency Medicine, New York University School of Medicine, New York
| | - Robert S Hoffman
- Division of Medical Toxicology, Department of Emergency Medicine, New York University School of Medicine, New York
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Cocaine-Induced Acute Aortic Dissection. J Emerg Med 2015; 49:e87-9. [DOI: 10.1016/j.jemermed.2015.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Revised: 01/23/2015] [Accepted: 02/17/2015] [Indexed: 11/23/2022]
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Stankowski RV, Kloner RA, Rezkalla SH. Cardiovascular consequences of cocaine use. Trends Cardiovasc Med 2015; 25:517-26. [DOI: 10.1016/j.tcm.2014.12.013] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/03/2014] [Accepted: 12/17/2014] [Indexed: 11/28/2022]
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Wickremaarachchi C, Olinga J, Ooi SY, Cranney G. Complete Angiographic Resolution of Cocaine Induced Coronary Artery Dissection within Eight Days without Coronary Stenting--A Case Report. Heart Lung Circ 2015; 25:e24-8. [PMID: 26699935 DOI: 10.1016/j.hlc.2015.06.829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Coronary dissection is a rarely reported complication of cocaine use for which there are no specific guidelines on management despite the widespread use of the drug. METHODS We report a case of a 26-year-old otherwise fit and healthy Caucasian male smoker who presented to our facility with an infero-lateral ST elevation myocardial infarction (STEMI) following nasal inhalation of 1 gram of cocaine. Coronary angiography showed a mid left anterior descending (LAD) artery dissection with distal occlusive embolism and another dissection of the distal right coronary artery (RCA) with embolism and occlusion of the distal posterolateral branch. OUTCOME Wiring of both vessels with a High-Torque Floppy wire successfully re-established TIMI 3 flow with relief of pain and resolution of his ST-segment elevation. Given the absence of any flow-limiting lesions, stenting was avoided. He was subsequently put on a combination of therapeutic dose enoxaparin, aspirin, ticagrelor, atorvastatin and metoprolol. A repeat angiogram eight days later showed complete healing of the dissections. CONCLUSION This case shows that percutaneous management without stenting coupled with aggressive anti-coagulation of cocaine induced coronary dissection may result in an acceptable outcome especially in a young otherwise fit and healthy patient.
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Affiliation(s)
- Chathupa Wickremaarachchi
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia; Prince of Wales Hospital, Sydney, NSW, Australia
| | - Jude Olinga
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Sze-Yuan Ooi
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Gregory Cranney
- Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia.
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Management of aortic dissection: medical therapy and intervention. Is there a growing role for endovascular techniques? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2015; 17:386. [PMID: 25895739 DOI: 10.1007/s11936-015-0386-x] [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: 10/23/2022]
Abstract
OPINION STATEMENT Historically, type B aortic dissection was managed as a medical condition with limited surgical intervention unless aortic rupture occurred. Today, however, evidence is building that highlights the importance of strict medical management, timely surveillance, and windows of opportunity for surgical intervention to address both early and late aortic-based morbidities.
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Thoracic aortic dissection and rupture in conotruncal cardiac defects: A population-based study. Int J Cardiol 2015; 184:521-527. [DOI: 10.1016/j.ijcard.2015.03.061] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 01/06/2015] [Accepted: 03/03/2015] [Indexed: 11/27/2022]
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Hajsadeghi S, Mohammadpour F, Manteghi MJ, Kordshakeri K, Tokazebani M, Rahmani E, Hassanzadeh M. Effects of energy drinks on blood pressure, heart rate, and electrocardiographic parameters: An experimental study on healthy young adults. Anatol J Cardiol 2015; 16:94-9. [PMID: 26467367 PMCID: PMC5336743 DOI: 10.5152/akd.2015.5930] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: To evaluate the effects of the consumption of energy drinks on cardiovascular parameters in a group of healthy young individuals. Methods: In a quasi-experimental study, 44 healthy adult participants aged between 15 and 30 years were evaluated. The blood pressure (BP) as well as electrocardiographic indices, including heart rate (HR), PR interval, QRS duration, corrected QT (QTc) interval, and ST-T changes were recorded before consumption of a caffeine-containing energy drink and at the specific time points over a 4-h test duration. Results: We found statistically significant HR decline (p=0.004) and more frequent ST-T changes (p=0.004) after the participants consumed the energy drink. However, readings for systolic BP (p=0.44), diastolic BP (p=0.26), PR interval (p=0.449), QRS duration (p=0.235), and QTc interval (p=0.953) showed no significant change post-consumption. Conclusion: In conclusion, we demonstrated that the consumption of energy drinks could contribute to HR decline and ST-T change in healthy young adults.
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Affiliation(s)
- Shokoufeh Hajsadeghi
- Department of Cardiology, Rasoul-e-Akram Hospital, Faculty of Medicine, Iran University of Medical Sciences; Tehran-Iran.
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Morentin B, Ballesteros J, Callado LF, Meana JJ. Recent cocaine use is a significant risk factor for sudden cardiovascular death in 15-49-year-old subjects: a forensic case-control study. Addiction 2014; 109:2071-8. [PMID: 25041688 DOI: 10.1111/add.12691] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 03/17/2014] [Accepted: 07/10/2014] [Indexed: 11/29/2022]
Abstract
AIMS The aims of the present study were to: (i) evaluate the prevalence of recent cocaine use in adolescents and young adults who had died by sudden cardiovascular death (SCVD); (ii) assess if recent cocaine use was associated with an increased risk of SCVD; and (iii) determine the demographic, clinical-pathological and toxicological characteristics of SCVD related to recent cocaine use. DESIGN This was a case-control autopsy-based observational retrospective study. SETTING/CASES Cases were all SCVD in individuals aged between 15 and 49 years during the period ranging from 1 January 2003 to 31 December 2009, with autopsies performed in Biscay, Spain. Medico-legal sudden deaths not due to cardiovascular diseases (SnoCVD) were used as the control group. In all deaths a complete autopsy and toxicological and histopathological studies were carried out. Recent cocaine use was considered when cocaine and/or benzoylecgonine were detected in blood. MEASUREMENTS The risk for SCVD according to demographic variables (sex and age), cardiovascular risk factors (obesity, hypertension, diabetes and smoking) and toxicological variables (opioids, benzodiazepines, amphetamines, cannabis and alcohol) was analysed using three logistic regression models. We also estimated the prevalence of recent cocaine use in the general population aged 15-49 years based on the projection of population surveys. FINDINGS Recent cocaine use was significantly higher in the SCVD group (27 of 311 subjects, 9%) than in the SnoCVD group (three of 126 subjects, 2%). In a full logistic regression controlling for all recorded covariates, the main risk factor for SCVD was recent cocaine use (odds ratio 4.10; 95% confidence interval 1.12-15.0). Compared with the estimated data in the general population, the prevalence of recent cocaine use was 13-58 times higher in people with SCVD. CONCLUSIONS Recent cocaine use is associated significantly with an increased risk for sudden cardiovascular death in people aged 15-49 years.
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Affiliation(s)
- Benito Morentin
- Section of Forensic Pathology, Basque Institute of Legal Medicine, Bilbao, Spain
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Wray T, Powell E, Hinckley W, Tilney PVR. A 55-year-old man with An aortic dissection. Air Med J 2014; 33:184-9. [PMID: 25179948 DOI: 10.1016/j.amj.2014.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/20/2014] [Indexed: 10/24/2022]
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Dean JH, Woznicki EM, O'Gara P, Montgomery DG, Trimarchi S, Myrmel T, Pyeritz RE, Harris KM, Suzuki T, Braverman AC, Hughes GC, Kline-Rogers E, Nienaber CA, Isselbacher EM, Eagle KA, Bossone E. Cocaine-related aortic dissection: lessons from the International Registry of Acute Aortic Dissection. Am J Med 2014; 127:878-85. [PMID: 24835037 DOI: 10.1016/j.amjmed.2014.05.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 05/01/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Acute aortic dissection associated with cocaine use is rare and has been reported predominantly as single cases or in small patient cohorts. METHODS Our study analyzed 3584 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2012. We divided the population on the basis of documented cocaine use (C+) versus non cocaine use (C-) and further stratified the cohorts into type A (33 C+/2332, 1.4%) and type B (30 C+/1252, 2.4%) dissection. RESULTS C+ patients presented at a younger age and were more likely to be male and black. Type B dissections were more common among C+ patients than in C- patients. Cocaine-related acute aortic dissection was reported more often at US sites than at European sites (86.4%, 51/63 vs 13.6%, 8/63; P < .001). Tobacco use was more prevalent in the C+ cohort. No differences were seen in history of hypertension, known atherosclerosis, or time from symptom onset to presentation. Type B C+ patients were more likely to be hypertensive at presentation. C+ patients had significantly smaller ascending aortic diameters at presentation. Acute renal failure was more common in type A C+ patients; however, mortality was significantly lower in type A C+ patients. CONCLUSIONS Cocaine use is implicated in 1.8% of patients with acute aortic dissection. The typical patient is relatively young and has the additional risk factors of hypertension and tobacco use. In-hospital mortality for those with cocaine-related type A dissection is lower than for those with non cocaine-related dissection, likely due to the younger age at presentation.
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Affiliation(s)
- Joshua H Dean
- Cardiovascular Center, University of Michigan, Ann Arbor
| | | | - Patrick O'Gara
- Cardiology Department, Brigham & Women's Hospital, Boston, Mass
| | | | - Santi Trimarchi
- Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy
| | - Truls Myrmel
- Department of Thoracic and Cardiovascular Surgery, Tromso University Hospital, Tromso, Norway
| | - Reed E Pyeritz
- Departments of Medicine and Genetics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | - Kevin M Harris
- Cardiovascular Division, Minneapolis Heart Institute, Minneapolis, Minn
| | - Toru Suzuki
- Cardiovascular Medicine, University of Tokyo, Tokyo, Japan
| | - Alan C Braverman
- Cardiovascular Division, Washington University School of Medicine, St Louis, Mo
| | - G Chad Hughes
- Division of Thoracic Cardiovascular Surgery, Duke University Medical Center, Durham, NC
| | | | - Christoph A Nienaber
- Division of Cardiology and Vascular Medicine, University of Rostock, Rostock, Germany
| | | | - Kim A Eagle
- Cardiovascular Center, University of Michigan, Ann Arbor
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Addiction aux drogues stimulantes (cocaïne, méthamphétamine et nouveaux produits de synthèse). MEDECINE INTENSIVE REANIMATION 2014. [DOI: 10.1007/s13546-014-0913-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Maceira AM, Ripoll C, Cosin-Sales J, Igual B, Gavilan M, Salazar J, Belloch V, Pennell DJ. Long term effects of cocaine on the heart assessed by cardiovascular magnetic resonance at 3T. J Cardiovasc Magn Reson 2014; 16:26. [PMID: 24758161 PMCID: PMC4026110 DOI: 10.1186/1532-429x-16-26] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Accepted: 03/24/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cocaine is an addictive, sympathomimetic drug with potentially lethal effects. The prevalence and features of cocaine cardiotoxicity are not well known. We aimed to assess these effects using a comprehensive cardiovascular magnetic resonance (CMR) protocol in a large group of asymptomatic cocaine users. METHODS Consecutive (n = 94, 81 males, 36.6 ±7 years), non-selected, cocaine abusers were recruited and had a medical history, examination, ECG, blood test and CMR. The CMR study included measurement of left and right ventricular (LV, RV) dimensions and ejection fraction (EF), sequences for detection of myocardial oedema and late gadolinium enhancement (LGE). Images were compared to a cohort of healthy controls. RESULTS Years of regular cocaine use were 13.9 ± 9. When compared to the age-matched healthy cohort, the cocaine abusers had increased LV end-systolic volume, LV mass index and RV end-systolic volume, with decreased LVEF and RVEF. No subject had myocardial oedema, but 30% had myocardial LGE indicating myocardial damage. CONCLUSIONS CMR detected cardiovascular disease in 71% of this cohort of consecutive asymptomatic cocaine abusers and mean duration of abuse was related to probability of LV systolic dysfunction.
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MESH Headings
- Adult
- Asymptomatic Diseases
- Case-Control Studies
- Cocaine-Related Disorders/complications
- Contrast Media
- Edema, Cardiac/diagnosis
- Edema, Cardiac/etiology
- Edema, Cardiac/pathology
- Electrocardiography
- Female
- Fibrosis
- Humans
- Magnetic Resonance Imaging, Cine
- Male
- Middle Aged
- Myocardium/pathology
- Predictive Value of Tests
- Prospective Studies
- Risk Factors
- Stroke Volume
- Time Factors
- Ventricular Dysfunction, Left/diagnosis
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/pathology
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Right/diagnosis
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/pathology
- Ventricular Dysfunction, Right/physiopathology
- Ventricular Function, Left
- Ventricular Function, Right
- Young Adult
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Affiliation(s)
- Alicia M Maceira
- Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
| | - Carmen Ripoll
- Addictions Treatment Unit of Campanar, La Fe Hospital, Valencia, Spain
| | - Juan Cosin-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
| | - Begoña Igual
- Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
| | - Mirella Gavilan
- Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
| | - Jose Salazar
- Department of Psychiatry, Consorcio Hospital General, Valencia, CIBERSAM, Spain
| | - Vicente Belloch
- Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
| | - Dudley J Pennell
- NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Imperial College, London, UK
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Bossone E, Pyeritz RE, O'Gara P, Harris KM, Braverman AC, Pape L, Russo MJ, Hughes GC, Tsai TT, Montgomery DG, Nienaber CA, Isselbacher EM, Eagle KA. Acute aortic dissection in blacks: insights from the International Registry of Acute Aortic Dissection. Am J Med 2013; 126:909-15. [PMID: 23953874 DOI: 10.1016/j.amjmed.2013.04.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 04/19/2013] [Accepted: 04/21/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Few data exist on race-related differences in acute aortic dissection patients. METHODS We evaluated black (n = 189, 14%) or white (n = 1165, 86%) patients (mean age 62.8 ± 15.3 years; 36.4% women) enrolled in 13 US centers participating in the International Registry of Acute Aortic Dissection. We excluded patients of other racial descent. RESULTS Type B acute aortic dissection was more frequent in the black cohort (52.4% vs 39.3%, P = .001). Black patients were younger (mean age 54.6 ± 12.8 years vs 64.2 ± 15.2 years, P <.001) and more likely to have a history of cocaine abuse (12% vs 1.6%, P <.001), hypertension (89.7% vs 73.9%, P <.001), and diabetes (13.2% vs 6.4%, P = .001). Conversely, they were less likely to have bicuspid aortic valve (1.8% vs 5.8%, P = .029), iatrogenic dissection (0.5% vs 4.5%, P = .010), and prior aortic dissection repair (7.7% vs 12.8%, P = .047). Presenting features were similar except for more abdominal pain (44.6% vs 30.6%, P <.001) and left ventricular hypertrophy on echocardiogram (44.2% vs 20.1%, P <.001) in blacks. Management was similar. Hypotension/shock/tamponade was less common (7.6% vs 20.1%, P <.001), whereas acute kidney failure was more common (41.0% vs 21.7%, P <.001) in blacks. Mortality was similar in-hospital (14.3% vs 19.1%, P = .110, odds ratio 0.704, 95% confidence interval 0.457-1.085) and at 3 years postdischarge, as evaluated by Kaplan-Meier survival analysis (22.0% vs 14.3%, P = .224, SE = 0.062 and 0.018). CONCLUSIONS Our study shows differences in type, etiology, and presentation of blacks and whites with acute aortic dissection, yet similar mortality for these cohorts.
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Elman I, Gurvits TV, Tschibelu E, Spring JD, Lasko NB, Pitman RK. Neurological soft signs in individuals with pathological gambling. PLoS One 2013; 8:e60885. [PMID: 23593341 PMCID: PMC3617209 DOI: 10.1371/journal.pone.0060885] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 03/04/2013] [Indexed: 01/26/2023] Open
Abstract
Increased neurological soft signs (NSSs) have been found in a number of neuropsychiatric syndromes, including chemical addiction. The present study examined NSSs related to perceptual-motor and visuospatial processing in a behavioral addiction viz., pathological gambling (PG). As compared to mentally healthy individuals, pathological gamblers displayed significantly poorer ability to copy two- and three-dimensional figures, to recognize objects against a background noise, and to orient in space on a road-map test. Results indicated that PG is associated with subtle cerebral cortical abnormalities. Further prospective clinical research is needed to address the NSSs' origin and chronology (e.g., predate or follow the development of PG) as well as their response to therapeutic interventions and/or their ability to predict such a response.
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Affiliation(s)
- Igor Elman
- Providence VA Medical Center, Harvard Medical School, Cambridge, Massachusetts, United States of America.
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