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Metabolic Disturbances Identified in Plasma Samples from ST-Segment Elevation Myocardial Infarction Patients. DISEASE MARKERS 2019; 2019:7676189. [PMID: 31354891 PMCID: PMC6636502 DOI: 10.1155/2019/7676189] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 05/07/2019] [Accepted: 05/16/2019] [Indexed: 12/17/2022]
Abstract
ST-segment elevation myocardial infarction (STEMI) is the most severe form of myocardial infarction (MI) and the main contributor to morbidity and mortality caused by MI worldwide. Frequently, STEMI is caused by complete and persistent occlusion of a coronary artery by a blood clot, which promotes heart damage. STEMI impairment triggers changes in gene transcription, protein expression, and metabolite concentrations, which grants a biosignature to the heart dysfunction. There is a major interest in identifying novel biomarkers that could improve the diagnosis of STEMI. In this study, the phenotypic characterization of STEMI patients (n = 15) and healthy individuals (n = 19) was performed, using a target metabolomics approach. Plasma samples were analyzed by UPLC-MS/MS (ultra-high-performance liquid chromatography-tandem mass spectrometry) and FIA-MS (MS-based flow injection analysis). The goal was to identify novel plasma biomarkers and metabolic signatures underlying STEMI. Concentrations of phosphatidylcholines, lysophosphatidylcholines, sphingomyelins, and biogenic amines were altered in STEMI patients in relation to healthy subjects. Also, after multivariate analysis, it was possible to identify alterations in the glycerophospholipids, alpha-linolenic acid, and sphingolipid metabolisms in STEMI patients.
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102
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Syyli N, Hautamäki M, Antila K, Mahdiani S, Eskola M, Lehtimäki T, Nikus K, Lyytikäinen LP, Oksala N, Hernesniemi J. Left ventricular ejection fraction adds value over the GRACE score in prediction of 6-month mortality after ACS: the MADDEC study. Open Heart 2019; 6:e001007. [PMID: 31328004 PMCID: PMC6609116 DOI: 10.1136/openhrt-2019-001007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 04/25/2019] [Accepted: 05/30/2019] [Indexed: 01/21/2023] Open
Abstract
Background Reduced left ventricular ejection fraction (LVEF) is a risk marker for mortality after an acute coronary syndrome (ACS). Global Registry of Acute Coronary Events (GRACE) risk score, developed almost two decades ago, is the preferred scoring system for risk stratification in ACS. The aim of this study was to validate the GRACE score and evaluate whether LVEF has incremental predictive value over the GRACE in predicting 6-month mortality after ACS in a contemporary setting. Methods A retrospective analysis of all 1576 consecutive patients who were admitted to Tays Heart Hospital and underwent coronary angiography for a first episode of ACS (2015–2016). Clinical risk factors were extensively recorded. Adjusted Cox regression analysis was used to analyse the associations between LVEF and the GRACE score with 6-month all-cause mortality. The incremental predictive value was assessed by the change in C-statistic by Delong’s method for paired samples and by index of discrimination improvement (IDI). Results In univariable analysis, both LVEF and the GRACE were associated with 6-month mortality, and after applying both variables into the same model, the results remained significant (GRACE score: HR: 1.036, 95% CI 1.030 to 1.042; LVEF: HR: 0.965, 95% CI 0.948 to 0.982, both HRs corresponding to a one unit change in the exposure variable). The GRACE score demonstrated good discrimination for mortality (C-statistic: 0.833, 95% CI 0.795 to 0.871). Adding LVEF to the model with the GRACE score improved model performance significantly (C-statistic: 0.848, 95% CI 0.813 to 0.883, p=0.029 for the improvement and IDI 0.0171, 95% CI 0.0016 to 0.0327, p=0.031). Conclusions Adding LVEF to the GRACE score significantly improves risk prediction of 6-month mortality after ACS.
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Affiliation(s)
- Nina Syyli
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Markus Hautamäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Kari Antila
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Shadi Mahdiani
- VTT Technical Research Centre of Finland, Tampere, Finland
| | - Markku Eskola
- Tays Heart Hospital, Tampere University Hospital, Tampere, Finland
| | - Terho Lehtimäki
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland
| | - Kjell Nikus
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland
| | - Leo-Pekka Lyytikäinen
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Department of Clinical Chemistry, Fimlab Laboratories, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland
| | - Niku Oksala
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland.,Centre for Vascular Surgery and Interventional Radiology, Tampere University Hospital, Tampere, Finland
| | - Jussi Hernesniemi
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Tays Heart Hospital, Tampere University Hospital, Tampere, Finland.,Finnish Cardiovascular Research Center Tampere, Tampere, Finland
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103
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Szelenberger R, Kacprzak M, Bijak M, Saluk-Bijak J, Zielinska M. Blood platelet surface receptor genetic variation and risk of thrombotic episodes. Clin Chim Acta 2019; 496:84-92. [PMID: 31233737 DOI: 10.1016/j.cca.2019.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Revised: 06/19/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
Abstract
Haemostasis is a set of processes whose main task is to prevent blood loss by creating barriers in damaged vessels. Because of the large number of platelet surface receptors and their many agonists, platelets can be activated in normal and pathologic states leading to thromboembolic complications. Although age, blood pressure, LDL and HDL, diabetes, lack of physical activity, obesity and stress are well established risk factors, recent work has shown that platelet receptor polymorphisms also impact platelet function. The most common polymorphisms include 14A/T (PAR-1), 139C/T, 744T/C, 52G/T, i-ins801A (P2Y12), 1622A/G, -5T/C (GPIbα) 1565C/T (GPIIb/IIIa) and 807C/T (GPIa/IIa). This review examines the influence of these polymorphisms on cardiovascular disease including myocardial infarction, deep venous thromboembolism and acute coronary syndromes. Elucidation of these genetic variations will facilitate our understanding of the complex molecular mechanisms involved with physiologic and pathophysiologic platelet activation and clot formation.
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Affiliation(s)
- Rafal Szelenberger
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland.
| | - Michal Kacprzak
- Intensive Cardiac Therapy Clinic, Medical University of Lodz, Pomorska 251, 91-213 Lodz, Poland
| | - Michal Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Marzenna Zielinska
- Intensive Cardiac Therapy Clinic, Medical University of Lodz, Pomorska 251, 91-213 Lodz, Poland
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104
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Lin CY, Cheng YT, Chang ML, Chien RN. The extrahepatic events of Asian patients with primary biliary cholangitis: A 30-year cohort study. Sci Rep 2019; 9:7577. [PMID: 31110209 PMCID: PMC6527707 DOI: 10.1038/s41598-019-44081-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 05/09/2019] [Indexed: 12/16/2022] Open
Abstract
The extrahepatic complications of primary biliary cholangitis (PBC) in Asian patients remain elusive. A 30-year cohort study of 150 Taiwanese PBC patients treated with ursodeoxycholic acid (UDCA) was conducted. Patients with alkaline phosphatase levels >1.67 × ULN after 1-year treatment were considered suboptimal responders. At baseline, of 150 patients (mean age: 53.75 years), 128 (85.3%) were females, and 34 (22.8%) had cirrhosis. The cumulative incidences of various incident events were all-cause mortality or liver transplantation: 46.7%; extrahepatic mortality: 24.5%; extrahepatic malignancies: 8.1%; hypertension: 46.2%; dyslipidemia: 44.1%; diabetes: 30.6%; hyperuricemia: 11.2%; acute coronary syndrome: 3.1%; cerebral vascular accident (CVA): 8.9%; autoimmune diseases: 16%; and osteoporosis: 20.9%. The 5- to 20-year cumulative incidences for all-cause mortality or liver transplantation and extrahepatic mortality were 16.2–41.3% and 3.1–11.9%, respectively. Baseline associations were age and alpha-fetoprotein levels with extrahepatic mortality, 80% due to sepsis; age with extrahepatic malignancies and hypertension; gender and hyperuricemia with CVA; and UDCA response with autoimmune disease. Conclusions: Sepsis accounted for most extrahepatic mortality in PBC patients, and the longer the follow-up was, the higher the extrahepatic/all-cause mortality ratio. Baseline age is crucial for incident extrahepatic events and only CVA shows gender-dimorphism; the association between UDCA response and autoimmune disease requires further investigation.
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Affiliation(s)
- Cheng-Yu Lin
- Liver Research Center, Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ya-Ting Cheng
- Liver Research Center, Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Ling Chang
- Liver Research Center, Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Rong-Nan Chien
- Liver Research Center, Division of Gastroenterology, Department of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Department of Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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105
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Kaçmaz Y, Gürlertop HY, Turgay Yıldırım Ö, Akşit E, Aydın F. Koroner Arter Hastalığında Endotelyal Nitrik Oksit Sentaz Geninin Glu 298-Asp Ve T786-C Polimorfizmlerinin Araştırılması. ACTA MEDICA ALANYA 2019. [DOI: 10.30565/medalanya.469411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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106
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Gezen M, Yılmaz Ü, Fazlıoğulları O, Yılmaz N, Horozoğlu C, Ergen A, Zeybek Ü. Thymosin beta-4 A/T polymorphism and acute coronary syndrome risk. ARCHIVES OF CLINICAL AND EXPERIMENTAL MEDICINE 2019. [DOI: 10.25000/acem.475094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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107
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Fehr N, Witassek F, Radovanovic D, Erne P, Puhan M, Rickli H. Antidepressant prescription in acute myocardial infarction is associated with increased mortality 1 year after discharge. Eur J Intern Med 2019; 61:75-80. [PMID: 30704672 DOI: 10.1016/j.ejim.2018.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Revised: 12/07/2018] [Accepted: 12/17/2018] [Indexed: 12/18/2022]
Abstract
AIMS To assess the impact of antidepressant (AD) prescription at discharge on 1-year outcome of patients presenting with acute myocardial infarction (AMI) in Switzerland. METHODS We used data from the AMIS Plus registry including patients admitted between March 2005 and August 2016 with AMI to a Swiss hospital who were followed up by telephone, 12 months after discharge. We compared patients who received AD medication at discharge with those who did not, with regard to baseline characteristics and outcomes in 1-year follow-ups using logistic regression. Outcome endpoints included mortality, re-hospitalisation, cerebrovascular events, re-infarction, percutaneous coronary intervention (PCI), coronary artery bypass graft as well as pacemaker and/or cardioverter-defibrillator implantations. Additionally, work and daily life conditions were compared between the groups. RESULTS Among 8911 AMI patients, 565 (6.3%) received AD at discharge. These patients were predominantly female, older, experienced more often non-ST-segment elevation myocardial infarction, were in higher Killip classes, and had more frequently hypertension, diabetes, dyslipidaemia, obesity and comorbidities. They underwent less frequently PCI, and stayed in hospital longer. The AD-receiving group had higher crude all-cause mortality at 1-year follow-up than the non-receiving group (7.4% vs 3.4%; p < .001) and AD prescription was an independent predictor for mortality (OR 1.67; CI: 1.17 to 2.40). CONCLUSION AD medication at discharge was associated with poorer prognosis in AMI patients at 1-year follow-up. However, this study has limited data on depression diagnosis and drug classes. Further research is needed to pinpoint the causes and underlying pathomechanisms for the higher mortality observed in this patient group.
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Affiliation(s)
- Nadia Fehr
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Fabienne Witassek
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Paul Erne
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Milo Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Switzerland
| | - Hans Rickli
- Department of Cardiology, Kantonsspital St. Gallen, Switzerland.
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108
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Kaambwa B, Gesesew H, Horsfall M, Chew DP. Impact of patient's health-related quality of life on physicians' therapy and perceived benefit in acute coronary syndromes: protocol for a systemic review of quantitative and qualitative studies. BMJ Open 2019; 9:e026595. [PMID: 30819712 PMCID: PMC6398748 DOI: 10.1136/bmjopen-2018-026595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Percutaneous coronary interventions (PCIs) and coronary angiography are two of the treatments administered to acute coronary syndrome (ACS) patients. However, whether and how patients' health-related quality of life (HRQoL) influences treatment decisions and subsequent risk benefit analyses is unclear. In this study, we will review the available evidence on the impact of patients' HRQoL on physicians' prescribing or treatment decisions and on the estimation of mortality and bleeding risk in ACS patients. METHODS AND ANALYSIS We will undertake a systematic review of all quantitative and qualitative studies. The search will include studies that describe the impact of HRQoL on prescribing PCIs or angiography, and impact of HRQoL on perceived risks in terms of mortality and bleeding events. We will conduct an initial search on Google scholar and MEDLINE to build the searching terms followed by a full search strategy using all identified keywords and index terms across the five databases, namely MEDLINE, PubMed, CINAHL, SCOPUS and Web of Sciences. We will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for protocol guidelines to present the protocol. Only English language articles will be included for the review. We will use a standardised Joanna Briggs Institute data extraction tool to synthesise the information extracted from the selected studies into themes with summary findings presented in a table. ETHICS AND DISSEMINATION We will not require a formal ethical approval as we will not be collecting primary data. Review findings will be disseminated through a peer-reviewed publication, workshops, conference presentations and a media release. PROSPERO REGISTRATION NUMBER CRD42018108438.
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Affiliation(s)
- Billingsley Kaambwa
- Health Economics, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Hailay Gesesew
- Epidemiology, Institute of Health, Jimma University, Jimma, Oromia, Ethiopia
- Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Horsfall
- South Australian Health and Medical Research Institute, SAHMRI, Adelaide, South Australia, Australia
| | - Derek P Chew
- Department of Cardiovascular Medicine, Flinders Medical Centre, Bedford Park, South Australia, Australia
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109
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Kunlamas Y, Areepium N, Ariyachaipanich A, Bunditanukul K. Real-World Effectiveness of High- Versus Moderate-Intensity Statin Therapy in Thai Patients With Acute Coronary Syndrome and Who Had Undergone Primary Percutaneous Coronary Intervention. J Pharm Pract 2019; 33:640-646. [PMID: 30776951 DOI: 10.1177/0897190019825915] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Although high-intensity statins are recommended for atherosclerotic cardiovascular disease, evidence has shown that Asians may need lower dose statins to achieve similar effect when compared to Caucasians. Moreover, awareness of adverse effects leads physicians to initiate moderate-intensity statins. Comparative of high versus moderate-intensive statins on LDL-C among patients who had undergone primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) are less established in Thailand. We conducted a retrospective cohort study to identify pattern of statins prescribing and explored the effectiveness on lipid profiles, including LDL-C goal achievement (<70 mg/dL) in STEMI patients underwent PPCI. A total of 983 patients with STEMI who had undergone PPCI were identified during 2005-2015. At 3-month follow-up, 31.9% patients were investigated for their lipid profile. There was 26.11% of patients who received high-intensity statins. When compared to baseline, we found more LDL-C reduction (38.22% ± 26.75% vs 22.36% ± 35.05%, P < .01) in the high-intensity group. Eighty-one patients achieved the target LDL-C, the high-intensity group were able to achieve the LDL-C goal than moderate-intensity group, but did not reach statistical significance (24.1% vs 30.5%, P = .26). This study confirmed that high-intensity statins have superior for LDL-C reduction and tend to achieve LDL-C goal more than moderate-intensity statins.
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Affiliation(s)
- Yotsaya Kunlamas
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, 26683Chulalongkorn University, Bangkok, Thailand
| | - Nutthada Areepium
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, 26683Chulalongkorn University, Bangkok, Thailand
| | - Aekarach Ariyachaipanich
- Division of Cardiology, Department of Medicine, 26683Chulalongkorn University, Bangkok, Thailand
| | - Krittin Bunditanukul
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, 26683Chulalongkorn University, Bangkok, Thailand
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110
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Anwar MA, Dai DL, Wilson‐McManus J, Smith D, Francis GA, Borchers CH, McManus BM, Hill JS, Cohen Freue GV. Multiplexed LC–ESI–MRM‐MS‐based Assay for Identification of Coronary Artery Disease Biomarkers in Human Plasma. Proteomics Clin Appl 2019; 13:e1700111. [DOI: 10.1002/prca.201700111] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Revised: 12/07/2018] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | - Derek Smith
- The UVic‐Genome BC Proteomics CentreUniversity of Victoria Victoria British Columbia Canada
| | - Gordon A. Francis
- Providence Heart and Lung Institute and the James Hogg Research CenterSt. Paul's HospitalUniversity of British Columbia Vancouver British Columbia Canada
- Department of MedicineUniversity of British Columbia Vancouver British Columbia Canada
| | - Christoph H Borchers
- The UVic‐Genome BC Proteomics CentreUniversity of Victoria Victoria British Columbia Canada
- Department of Biochemistry and MicrobiologyUniversity of Victoria Victoria British Columbia Canada
| | - Bruce M. McManus
- NCE CECR PROOF Centre of Excellence Vancouver British Columbia Canada
- Department of Pathology and Laboratory MedicineUniversity of British Columbia Vancouver British Columbia Canada
| | - John S. Hill
- The UVic‐Genome BC Proteomics CentreUniversity of Victoria Victoria British Columbia Canada
- Department of Pathology and Laboratory MedicineUniversity of British Columbia Vancouver British Columbia Canada
| | - Gabriela V. Cohen Freue
- NCE CECR PROOF Centre of Excellence Vancouver British Columbia Canada
- Department of StatisticsUniversity of British Columbia Vancouver British Columbia Canada
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111
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Trajectories of perceived social support in acute coronary syndrome. Qual Life Res 2019; 28:1365-1376. [DOI: 10.1007/s11136-018-02095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 01/14/2023]
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112
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Sawhney JPS, Mullasari A, Kahali D, Mehta V, Nair T, Kaul U, Hirematth MS. Short- and long-term follow-up of antithrombotic management patterns in patients hospitalized with acute coronary syndrome: Indian subgroup of EPICOR Asia study. Indian Heart J 2019; 71:25-31. [PMID: 31000179 PMCID: PMC6477169 DOI: 10.1016/j.ihj.2018.12.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 11/14/2018] [Accepted: 12/26/2018] [Indexed: 01/09/2023] Open
Abstract
Background Acute coronary syndrome (ACS) is associated with emergency hospitalizations, and there are limited real-world data on clinical outcomes in post-ACS Asian patients. This article presents data on the Indian subgroup from the Long-term Follow-up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia (EPICOR-Asia) study. Methods EPICOR included patients with ACS [ST-segment elevation myocardial infarction (STEMI), non–ST-segment elevation myocardial infarction (NSTEMI), or unstable angina (UA)]. The study had two phases: acute phase and follow-up phase. The primary objective was to describe short- and long-term antithrombotic management patterns. Results EPICOR-India enrolled 2468 patients (STEMI-1482; NSTEMI-562; and UA-424). Cardiovascular risk factors were present in 1362 (55.2%) patients. Prehospital care was received by 879 (35.6%) patients, and the median time from the symptom onset to the first medical attention was 3 h (0.08, 100.33). The most common drug regimen prescribed during the acute phase was ≥2 antiplatelet agents + anticoagulants with no glycoprotein IIb/IIIa inhibitors and at discharge were aspirin + clopidogrel. About 78.8% of patients were discharged on dual antiplatelet therapy (DAPT) and 16%, on single antiplatelet therapy (SAPT). At 23 months after discharge, 55.6% were on DAPT, while 16.4% were on SAPT. Postdischarge outcomes at 2 years included death in 165 (6.7%) patients, composite events of death, myocardial infarction (MI), or ischemic stroke in 182 (7.4%) patients, and bleeding events in seven (0.3%) patients. Conclusion This study showed a gap between international recommendations and implementation for managing ACS in Indian patients. Most of the patients prefer to undergo invasive management instead of non-invasive therapy. At the end of the 2-year follow-up, more than half of the population was receiving DAPT, with most patients on receiving a combination of aspirin and clopidogrel. The mortality along with composite events of death, MI, or ischemic stroke was highest for patients with NSTEMI.
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113
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Sheta SM, El-Sheikh SM, Abd-Elzaher MM, Ghanem ML, Salem SR. A novel, fast, high sensitivity biosensor for supporting therapeutic decisions and onset actions for chest pain cases. RSC Adv 2019; 9:20463-20471. [PMID: 35514688 PMCID: PMC9065451 DOI: 10.1039/c9ra03030a] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 06/20/2019] [Indexed: 12/19/2022] Open
Abstract
In this work, a novel and promising organic nano linker (NL) was prepared via refluxing 5-aminoisophthalic acid and 1,2-phenylenediamine at 80 °C for 48 h. After that, this linker was reacted with manganese chloride to afford a novel manganese metal–organic framework (Mn–MOF). The produced materials were characterized using 1H-NMR, 13C-NMR, mass spectrometry, elemental analysis, UV, IR, FE-SEM, EDX, TEM, and thermal study. In addition to X-ray diffraction, XPS, magnetic properties and photoluminescence investigation for Mn–MOF. The study was extended to apply Mn–MOF as electroactive material for the preparation of a novel cardiac troponin I (cTn) potentiometric membrane biosensor. The biosensor, based on Mn–MOF with an optimized membrane composition, exhibits a fast, stable and linear-Nernstian response to cTn in the concentration range between 0.01 and 30.0 ng mL−1 with a pH range between 5.6 and 10.1 and a fast response time of 20 ± 5 s. The detection and quantification limits are 0.055 and, 0.168 ng mL−1, respectively. The lifetime of the electrode is between 3–12 week without a significant change in the membrane compositions and the performance characteristics based on the storage conditions. The electrode shows high selectivity towards cTn with respect to common interfering analytes. This approach of Mn–MOF-electrode could be addressed, facilitated and helped an emergency departments (EDs) decision-making in patients with chest pain and early myocardial infarction diagnosis. The future vision is converting the present approach to a small device with satisfactory results which will be used in term of point-of-care testing (POCT) for measuring the most important cardiac blood biomarkers. A novel organic nano linker (NL) and manganese metal–organic framework (Mn–MOF) were synthesized and fully characterized. A promising cardiac troponin-I potentiometric biosensor based on Mn–MOF could be used for early myocardial infarction diagnosis.![]()
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Affiliation(s)
- Sheta M. Sheta
- Inorganic Chemistry Department
- National Research Centre
- Giza
- Egypt
| | - Said M. El-Sheikh
- Nanomaterials and Nanotechnology Department
- Central Metallurgical R & D Institute
- Cairo
- Egypt
| | | | | | - Salem R. Salem
- Biochemistry Department
- Egypt Center for Research and Regenerative Medicine
- Cairo
- Egypt
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114
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Statin Utilization Patterns and Outcomes for Patients with Acute Coronary Syndrome During and Following Inpatient Admissions. Cardiovasc Drugs Ther 2018; 32:273-280. [PMID: 29855748 PMCID: PMC6018577 DOI: 10.1007/s10557-018-6800-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE High-intensity statins (HIS) are recommended by current treatment guidelines for patients with clinical atherosclerotic cardiovascular disease and should be administered soon after an acute coronary syndrome (ACS) event and maintained thereafter. However, adherence to guidelines remains adequate. Statin utilization patterns during index hospitalization and the first year after ACS event, and the association between statin utilization and post-discharge clinical and economic outcomes, are described. METHODS Retrospective, observational study of US adults from the MarketScan Research Databases (2002-2014) with ≥ 1 inpatient admission for ACS and no evidence of previous ACS event < 12 months prior to index. RESULTS In total, 7802 patients met inclusion criteria. The most common index hospitalization primary diagnosis was myocardial infarction (94.6%). In the 3-month period before ACS admission, 3.4 and 14.9% of patients received HIS or low-to-moderate intensity statin, versus 13.2 and 30.7% during index hospitalization, and 16.4 and 45.1% in the year of follow-up. Of 1336 patients with a statin prescription filled on/after discharge, 53.2% filled prescriptions within 15 days of discharge and 14.9% delayed for > 91 days. The most common post-index hospital admissions for cardiovascular events were due to recurrent ACS (incidence rate = 115.2), heart failure (110.0), and revascularization (76.4). During follow-up, 2355 patients (30.2%) had all-cause inpatient admissions and 1136 (14.6%) had cardiovascular-specific admissions; mean all-cause medical and healthcare costs were $2456 and $2870, respectively, per patient per month. CONCLUSIONS Statin dosing and utilization of HIS remains lower than recommended in current treatment guidelines, leaving patients at considerable risk of subsequent cardiovascular events.
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Li H, Wu TT, Liu PC, Liu XS, Mu Y, Guo YS, Chen Y, Xiao LP, Huang JF. Characteristics and outcomes of in-hospital cardiac arrest in adults hospitalized with acute coronary syndrome in China. Am J Emerg Med 2018; 37:1301-1306. [PMID: 30401593 DOI: 10.1016/j.ajem.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 11/30/2022] Open
Abstract
AIMS This retrospective study aims to analyze and explore the clinical characteristics, risk factors, and in-hospital outcomes - including return of spontaneous circulation (ROSC) and survival to discharge - of hospitalized patients admitted with acute coronary syndrome (ACS) suffering cardiac arrest. METHODS ACS patients admitted to three tertiary hospitals in Fujian, China, were evaluated retrospectively from January 1, 2012 to December 30, 2016. Data were collected, based on the Utstein Style, for all cases of attempted resuscitation for IHCA. We analyzed patient characteristics, pre-event variables, event variables, and the main outcomes, including ROSC and survival to discharge, and identified the influencing factors on the outcomes. RESULTS The total number of ACS admissions across the three hospitals during this study period was 21,337. Among these admissions, 320 ACS patients experienced IHCA (incidence: 1.50%); 134 (41.9%) patients experienced ROSC; and 68 (21.2%) survived to discharge. The findings indicated that four factors were associated with ROSC, including age <70 years-old, shockable rhythm, duration of resuscitation (≤15 min and 16-30 min), and PCI. Five factors were associated with survival to discharge, including age <70 years-old, shockable rhythm, the duration of resuscitation (≤15 min and 16-30 min), Killip ≤ II, and CCI ≤ 2. CONCLUSION Younger age, shockable rhythm, and shorter duration of resuscitation were all factors demonstrated to be a predictor of ROSC and survival to hospital discharge.
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Affiliation(s)
- Hong Li
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University, Fujian, China.
| | - Ting Ting Wu
- Department of Nursing, Fujian Health College, Fujian, China
| | - Pei Chang Liu
- Department of Anesthesiology, Fujian Union Hospital Clinical Medical College, Fujian, China
| | - Xue Song Liu
- Department of Cardiovascular Medicine, Fujian Provincial Hospital Clinical Medical College, Fujian, China
| | - Yan Mu
- Department of Nursing, Fujian Provincial Hospital, Fujian Medical University, Fujian, China
| | - Yang Song Guo
- Department of Cardiovascular Medicine, Fujian Provincial Hospital Clinical Medical College, Fujian, China
| | - Yuan Chen
- Department of Nursing, Xiamen Cardiovascular Disease Hospital, Xiamen University Medical School, Xiamen, China
| | - Li Ping Xiao
- Department of Nursing, First Hospital of Longyan, Fujian Medical University, Longyan, China
| | - Jiang Feng Huang
- School of Public Health, Fujian Medical University, Fujian, China
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Almer J, Elmberg V, Bränsvik J, Nordlund D, Khoshnood A, Ringborn M, Carlsson M, Ekelund U, Engblom H. Ischemic QRS prolongation as a biomarker of myocardial injury in STEMI patients. Ann Noninvasive Electrocardiol 2018; 24:e12601. [PMID: 30265437 DOI: 10.1111/anec.12601] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 08/31/2018] [Accepted: 09/04/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Patients with acute coronary occlusion (ACO) may not only have ischemia-related ST-segment changes but also changes in the QRS complex. It has recently been shown in dogs that a greater ischemic QRS prolongation (IQP) during ACO is related to lower collateral flow. This suggests that greater IQP could indicate more severe ischemia and thereby more rapid infarct development. Therefore, the purpose was to evaluate the relationship between IQP and measures of myocardial injury in patients presenting with acute ST-elevation myocardial infarction (STEMI). METHODS Seventy-seven patients with first-time STEMI were retrospectively included from the recently published SOCCER trial. All patients underwent a cardiac magnetic resonance (CMR) examination 2-6 days after the acute event. Infarct size (IS), myocardium at risk (MaR), and myocardial salvage index (MSI) were assessed and related to IQP. IQP measures assessed were; computer-generated QRS duration, QRS duration at maximum ST deviation, absolute IQP and relative IQP, all derived from a pre-PCI, 12-lead ECG. RESULTS Median absolute IQP was 10 ms (range 0-115 ms). There were no statistically significant correlations between measures of IQP and any of the CMR measures of myocardial injury (absolute IQP vs IS, r = 0.03, p = 0.80; MaR, r = -0.01, p = 0.89; MSI, r = -0.05, p = 0.68). CONCLUSIONS Unlike previous experimental studies, the IQP was limited in patients presenting at the emergency room with first-time STEMI and no correlation was found between IQP and CMR variables of myocardial injury in these patients. Therefore, IQP does not seem to be a suitable biomarker for triaging patients in this clinical context.
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Affiliation(s)
- Jakob Almer
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | - Viktor Elmberg
- Department of Clinical Physiology, Blekingesjukhuset, Karlskrona, Sweden
| | - Josef Bränsvik
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | - David Nordlund
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | - Ardavan Khoshnood
- Department of Emergency Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | | | - Marcus Carlsson
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | - Ulf Ekelund
- Department of Emergency Medicine, Skåne University Hospital and Lund University, Lund, Sweden
| | - Henrik Engblom
- Department of Clinical Physiology and Nuclear Medicine, Skåne University Hospital and Lund University, Lund, Sweden
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Malandraki-Miller S, Lopez CA, Al-Siddiqi H, Carr CA. Changing Metabolism in Differentiating Cardiac Progenitor Cells-Can Stem Cells Become Metabolically Flexible Cardiomyocytes? Front Cardiovasc Med 2018; 5:119. [PMID: 30283788 PMCID: PMC6157401 DOI: 10.3389/fcvm.2018.00119] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/10/2018] [Indexed: 12/15/2022] Open
Abstract
The heart is a metabolic omnivore and the adult heart selects the substrate best suited for each circumstance, with fatty acid oxidation preferred in order to fulfill the high energy demand of the contracting myocardium. The fetal heart exists in an hypoxic environment and obtains the bulk of its energy via glycolysis. After birth, the "fetal switch" to oxidative metabolism of glucose and fatty acids has been linked to the loss of the regenerative phenotype. Various stem cell types have been used in differentiation studies, but most are cultured in high glucose media. This does not change in the majority of cardiac differentiation protocols. Despite the fact that metabolic state affects marker expression and cellular function and activity, the substrate composition is currently being overlooked. In this review we discuss changes in cardiac metabolism during development, the various protocols used to differentiate progenitor cells to cardiomyocytes, what is known about stem cell metabolism and how consideration of metabolism can contribute toward maturation of stem cell-derived cardiomyocytes.
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Affiliation(s)
| | | | | | - Carolyn A. Carr
- Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, United Kingdom
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Mashayekhi S, Ziaee M, Garjani A, Sarbakhsh P, Ghaffari S. Prognostic Value of sLOX-1 Level in Acute Coronary Syndromes Based on Thrombolysis in Myocardial Infarction Risk Score and Clinical Outcome. J Emerg Med 2018; 55:390-398. [DOI: 10.1016/j.jemermed.2018.06.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/26/2018] [Accepted: 06/12/2018] [Indexed: 11/24/2022]
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MIF mRNA Expression and Soluble Levels in Acute Coronary Syndrome. Cardiol Res Pract 2018; 2018:9635652. [PMID: 30057807 PMCID: PMC6051124 DOI: 10.1155/2018/9635652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 06/03/2018] [Indexed: 12/11/2022] Open
Abstract
Acute coronary syndrome (ACS) describes any condition characterized by myocardial ischaemia and reduction in blood flow. The physiopathological process of ACS is the atherosclerosis where MIF operates as a major regulator of inflammation. The aim of this study was to assess the mRNA expression of MIF gene and its serum levels in the clinical manifestations of ACS and unrelated individuals age- and sex-matched with patients as the control group (CG). All samples were run using the conditions indicated in TaqMan Gene Expression Assay protocol. Determination of MIF serum levels were performed by enzyme-linked immunosorbent assay and MIF ELISA Kit. ST-segment elevation myocardial infraction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) showed 0.8 and 0.88, respectively, less expression of MIF mRNA with regard to CG. UA and STEMI presented more expression than NSTEMI 5.23 and 0.68, respectively. Otherwise, ACS patients showed significant higher MIF serum levels (p=0.02) compared with CG. Furthermore, the highest soluble levels of MIF were presented by STEMI (11.21 ng/dL), followed by UA (10.34 ng/dL) and finally NSTEMI patients (8.75 ng/dL); however, the differences were not significant. These novel observations further establish the process of MIF release after cardiovascular events and could support the idea of MIF as a new cardiac biomarker in ACS.
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Qanitha A, Uiterwaal CSPM, Henriques JPS, Mappangara I, Idris I, Amir M, de Mol BAJM. Predictors of medium-term mortality in patients hospitalised with coronary artery disease in a resource-limited South-East Asian setting. Open Heart 2018; 5:e000801. [PMID: 30057767 PMCID: PMC6059341 DOI: 10.1136/openhrt-2018-000801] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/24/2018] [Accepted: 06/13/2018] [Indexed: 01/30/2023] Open
Abstract
Objective To measure medium-term outcomes and determine the predictors of mortality in patients with coronary artery disease (CAD) both during and after hospitalisation in a resource-limited South-East Asian setting. Methods From February 2013 to December 2014, we conducted a prospective observational cohort study of 477 patients admitted to Makassar Cardiac Center, Indonesia, with acute coronary syndrome and stable CAD. We actively obtained data on clinical outcomes and after-discharge management until April 2017. Multivariable Cox proportional hazard analysis was performed to examine predictors for our primary outcome, all-cause mortality. Results From hospital admission, patients were followed over a median of 18 (IQR 6-36) months; in total 154 (32.3%) patients died. More patients with acute myocardial infarction died in the hospital compared with patients with unstable and stable angina (p=0.002). Over the total follow-up, there was a difference in mortality between non-ST-segment elevation myocardial infarction (n=41, 48.2%), ST-segment elevation myocardial infarction (n=65, 30.8%), unstable angina (n=18, 26.5%) and stable coronary artery disease (n=30, 26.5%) groups (p=0.007). The independent predictors of all-cause mortality were hyperglycaemia on admission (HR 1.55 (95% CI 1.12 to 2.14), p=0.008), heart failure/Killip class ≥2 (HR 2.50 (95% CI 1.76 to 3.56), p<0.001), estimated glomerular filtration rate <60 mL/min (HR 1.77 (95% CI 1.26 to 2.50), p=0.001), no revascularisation (percutaneous coronary intervention/coronary artery bypass grafting) (HR 2.38 (95% CI 1.31 to 4.33), p=0.005) and poor adherence to after-discharge medications (HR 10.28 (95% CI 5.52 to 19.16), p<0.001). Poor medication adherence predicted postdischarge mortality and did so irrespective of underlying CAD diagnosis (p interaction=0.88). Conclusions Patients with CAD in a poor South-East Asian setting experience high in-hospital and medium-term mortality. The initial severity of the disease, lack of access to guidelines-recommended therapy and poor adherence to after-discharge medications are the main drivers for excess mortality. Improved access to early and late hospital care and patient education should be prioritised for better survival.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands
| | - Jose P S Henriques
- Department of Cardiology, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Idar Mappangara
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Irfan Idris
- Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Muzakkir Amir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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Transforming Growth Factor Beta (TFG-β) Concentration Isoforms are Diminished in Acute Coronary Syndrome. Cell Biochem Biophys 2018; 76:433-439. [PMID: 30003432 DOI: 10.1007/s12013-018-0849-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
Acute coronary syndrome (ACS) is the leading cause of death in elderly patients worldwide. Due its participation in apoptosis, fibrosis, and angiogenesis, transforming growth factor-β (TGF-β) isoforms had been categorized as risk factors for cardiovascular diseases. However, due their contradictory activities, a cardioprotective role has been suggested. The aim was to measure the plasma levels of TGF-β1, 2, and 3 proteins in patients with ACS. This was a case-control study including 225 subjects. The three activated isoforms were measured in serum using the Bio-Plex Pro TGF-β assay by means of magnetic beads; the fluorescence intensity of reporter signal was read in a Bio-Plex Magpix instrument. We observed a significant reduction of the three activated isoforms of TGF-β in patients with ACS. The three TGF-β isoforms were positively correlated with each other in moderate-to-strong manner. TGFβ-2 was inversely correlated with glucose and low-density lipoprotein (LDL)-cholesterol, whereas TGF-β3 was inversely correlated with the serum cholesterol concentration. The production of TGF-β1, TGF-β2, and TGF-β3 are decreased in the serum of patients with ACS. Further follow-up controlled studies with a larger sample size are needed, in order to test whether TGF-β isoforms could be useful as biomarkers that complement the diagnosis of ACS.
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Shin H, Jang BH, Lim TH, Lee J, Kim W, Cho Y, Ahn C, Choi KS. Diagnostic accuracy of adding copeptin to cardiac troponin for non-ST-elevation myocardial infarction: A systematic review and meta-analysis. PLoS One 2018; 13:e0200379. [PMID: 29979797 PMCID: PMC6034895 DOI: 10.1371/journal.pone.0200379] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/24/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION This study aimed to determine the diagnostic accuracy of adding copeptin to cardiac troponin (cTn) on admission to the emergency department (ED) for non-ST elevation myocardial infarction (NSTEMI) compared to cTn alone. MATERIALS AND METHODS A literature search of MEDLINE, EMBASE, and the Cochrane Library was performed (search date: April 13, 2018). Primary studies were included if they accurately reported on patients with symptoms suggestive of acute myocardial infarction and measured both cTn alone and cTn with copeptin upon admission to the ED. The patients with evidence of ST elevation myocardial infarction were excluded. To assess the risk of bias for the included studies, the QUADAS-2 tool was used. RESULTS The study participants included a total of 7,998 patients from 14 observational studies. The addition of copeptin to cTn significantly improved the sensitivity (0.81 [0.74 to 0.87] vs. 0.92 [0.89 to 0.95], respectively, p <0.001) and negative predictive value (0.96 [0.95 to 0.98] vs. 0.98 [0.96 to 0.99], respectively, p <0.001) at the expense of lower specificity (0.88 [0.80 to 0.97] vs. 0.57 [0.49 to 0.65], respectively, p <0.001) compared to cTn alone. Furthermore, adding copeptin to cTn showed significantly lower diagnostic accuracy for NSTEMI compared to cTn alone (0.91[0.90 to 0.92] vs. 0.85 [0.83 to 0.86], respectively, p < 0.001). CONCLUSIONS Adding copeptin to cTn improved the sensitivity and negative predictive value for the diagnosis of NSTEMI compared to cTn alone. Thus, adding copeptin to cTn might help to screen NSTEMI early upon admission to the ED.
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Affiliation(s)
- Hyungoo Shin
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Bo-Hyoung Jang
- Department of Preventive Medicine, College of Korean Medicine, Kyung Hee University, Seoul, Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
- Convergence Technology Center for Disaster Preparedness, Hanyang University, Seoul, Korea
| | - Juncheol Lee
- Department of Emergency Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Wonhee Kim
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Korea
- Department of Biomedical Engineering, Graduate School of Medicine, Hanyang University, Seoul, Korea
| | - Youngsuk Cho
- Department of Emergency Medicine, College of Medicine, Hallym University, Seoul, Korea
- Department of Biomedical Engineering, Graduate School of Medicine, Hanyang University, Seoul, Korea
| | - Chiwon Ahn
- Department of Biomedical Engineering, Graduate School of Medicine, Hanyang University, Seoul, Korea
- Department of Emergency Medicine, Armed Forces Yangju Hospital, Yangju, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, College of Medicine, Hanyang University, Seoul, Korea
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Franzon J, Haren MT, Kourbelis C, Marin T, Newman P, Jones M, Muir-Cochrane E, Clark RA. Recommendations and practices for the screening of depression and anxiety in acute coronary syndrome. ACTA ACUST UNITED AC 2018; 16:1503-1510. [DOI: 10.11124/jbisrir-2017-003487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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124
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Mirza AJ, Taha AY, Khdhir BR. Risk factors for acute coronary syndrome in patients below the age of 40 years. Egypt Heart J 2018; 70:233-235. [PMID: 30591735 PMCID: PMC6303353 DOI: 10.1016/j.ehj.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Accepted: 05/24/2018] [Indexed: 01/26/2023] Open
Abstract
Background Acute coronary syndrome (ACS) refers to a spectrum of symptoms compatible with acute myocardial ischemia. Plasma markers of inflammation have been recently identified as diagnostic aid and risk predictors. The present study, conducted in Slemani Cardiac Hospital (SCH), Sulaimaniyah, Iraq aimed to recognize some risk factors for ACS in Iraqi adults younger than 40. Methodology This is a prospective case-control study of 100 patients with ACS vs. a control group of 100 healthy volunteers. The study began at 1st January 2014 and ended at 31st December 2016. All patients were subjected to full history taking, clinical examination including measurement of waist circumference and body mass index (BMI). Investigations included electrocardiography (ECG), echocardiography, full blood count, measurement of lipid profile and C-reactive protein (CRP). The patients were managed by percutaneous coronary intervention (PCI). Results The mean age of the patients was 36 years (range 28–40). Eighty-five% of patients were male. The mean BMI (29 kg/m2) and waist circumference (98 cm) of the patients were higher than the controls (24 kg/m2 and 72 cm respectively). The leukocytes, lymphocytes and neutrophil counts as well as CRP in both groups were within the normal range. The most prevalent risk factor was obesity (n = 86). Other risk factors were smoking (n = 62), hypertension (n = 26), diabetes mellitus (n = 22) and positive family history of ACS (n = 24). Most patients (n = 83) had multi-vessel coronary artery disease (2–3 vessels). Conclusion ACS in young adults is an increasing health problem. Obesity was found to be the most prevalent risk factor.
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Affiliation(s)
- Aram J Mirza
- Department of Cardiology, Slemani Cardiac Hospital, Sulaimaniyah, Region of Kurdistan, Iraq
| | - Abdulsalam Y Taha
- Department of Thoracic & Cardiovascular Surgery, School of Medicine, Faculty of Medical Sciences, University of Sulaimaniyah and Sulaimaniyah Teaching Hospital, Sulaimaniyah, Region of Kurdistan, Iraq
| | - Bahar R Khdhir
- Department of Histology, School of Medicine, Faculty of Medical Sciences, University of Sulaimaniyah, Sulaimaniyah, Region of Kurdistan, Iraq
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Karim MT, Inam S, Ashraf T, Shah N, Adil SO, Shafique K. Areca Nut Chewing and the Risk of Re-hospitalization and Mortality Among Patients With Acute Coronary Syndrome in Pakistan. J Prev Med Public Health 2018; 51:71-82. [PMID: 29631348 PMCID: PMC5897234 DOI: 10.3961/jpmph.17.189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 01/12/2018] [Indexed: 02/05/2023] Open
Abstract
Objectives Areca nut is widely consumed in many parts of the world, especially in South and Southeast Asia, where cardiovascular disease (CVD) is also a huge burden. Among the forms of CVD, acute coronary syndrome (ACS) is a major cause of mortality and morbidity. Research has shown areca nut chewing to be associated with diabetes, hypertension, oropharyngeal and esophageal cancers, and CVD, but little is known about mortality and re-hospitalization secondary to ACS among areca nut users and non-users. Methods A prospective cohort was studied to quantify the effect of areca nut chewing on patients with newly diagnosed ACS by categorizing the study population into exposed and non-exposed groups according to baseline chewing status. Cox proportional hazards models were used to examine the associations of areca nut chewing with the risk of re-hospitalization and 30-day mortality secondary to ACS. Results Of the 384 ACS patients, 49.5% (n=190) were areca users. During 1-month of follow-up, 20.3% (n=78) deaths and 25.1% (n=96) re-hospitalizations occurred. A higher risk of re-hospitalization was found (adjusted hazard ratio [aHR], 2.05; 95% confidence interval [CI], 1.29 to 3.27; p=0.002) in areca users than in non-users. Moreover, patients with severe disease were at a significantly higher risk of 30-day mortality (aHR, 2.77; 95% CI, 1.67 to 4.59; p<0.001) and re-hospitalization (aHR, 2.72; 95% CI, 1.73 to 4.26; p<0.001). Conclusions The 30-day re-hospitalization rate among ACS patients was found to be significantly higher in areca users and individuals with severe disease. These findings suggest that screening for a history of areca nut chewing may help to identify patients at a high risk for re-hospitalization due to secondary events.
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Affiliation(s)
- Muhammad Tariq Karim
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Sumera Inam
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Tariq Ashraf
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Nadia Shah
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Syed Omair Adil
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
| | - Kashif Shafique
- Research Evaluation Unit, College of Physicians and Surgeons Pakistan, Karachi, Pakistan
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Kourbelis C, Franzon J, Foote J, Brown A, Daniel M, Coffee NT, Newman P, Nicholls S, Clark RA. Effectiveness of discharge education on outcomes in acute coronary syndrome patients: a systematic review protocol. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:817-824. [PMID: 29634505 DOI: 10.11124/jbisrir-2017-003543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION The question of this review is what is the effectiveness of discharge education on outcomes in acute coronary syndrome patients?
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Affiliation(s)
- Constance Kourbelis
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Julie Franzon
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Jonathon Foote
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Alex Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Mark Daniel
- Centre for Research and Action in Public Health, University of Canberra, Canberra, Australia
| | - Neil T Coffee
- Centre for Research and Action in Public Health, University of Canberra, Canberra, Australia
| | - Peter Newman
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
- Flinders University Library, Flinders University, Adelaide, Australia
| | - Stephen Nicholls
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Robyn A Clark
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
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Leonardi S, Bueno H, Ahrens I, Hassager C, Bonnefoy E, Lettino M. Optimised care of elderly patients with acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2018; 7:287-295. [DOI: 10.1177/2048872618761621] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Sergio Leonardi
- Fondazione IRCCS Policlinico S. Matteo, Coronary Care Unit, Pavia, Italy
| | - Hector Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Spain
- Instituto de investigación i+12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Facultad de Medicina, Universidad Complutense de Madrid, Spain
| | - Ingo Ahrens
- Department of Cardiology and Medical Intensive Care, Augustinerinnen Hospital, Germany
- Faculty of Medicine, University of Freiburg, Germany
| | - Christian Hassager
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Denmark
| | - Eric Bonnefoy
- Intensive Cardiac Care Unit, Hospices Civils de Lyon, France
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Spinthakis N, Farag M, Rocca B, Gorog DA. More, More, More: Reducing Thrombosis in Acute Coronary Syndromes Beyond Dual Antiplatelet Therapy-Current Data and Future Directions. J Am Heart Assoc 2018; 7:e007754. [PMID: 29374045 PMCID: PMC5850258 DOI: 10.1161/jaha.117.007754] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
| | - Mohamed Farag
- Postgraduate Medical School, University of Hertfordshire, United Kingdom
| | - Bianca Rocca
- Pharmacology, Catholic University School of Medicine, Rome, Italy
| | - Diana A Gorog
- Postgraduate Medical School, University of Hertfordshire, United Kingdom
- National Heart & Lung Institute Imperial College, London, United Kingdom
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Nishi FA, de Motta Maia FO, de Lopes Monteiro da Cruz DA. Assessing sensitivity and specificity of the Manchester Triage System in the evaluation of acute coronary syndrome in adult patients in emergency care: a systematic review protocol. ACTA ACUST UNITED AC 2018; 13:64-73. [PMID: 26657465 DOI: 10.11124/jbisrir-2015-2213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The objective of this review is to assess the sensitivity and specificity of the Manchester Triage System in the evaluation of adult patients with acute coronary syndrome in emergency departments. BACKGROUND Acute coronary syndrome (ACS) is a group of clinical conditions that include myocardial infarction with or without elevation of the ST segment and unstable angina. The term acute myocardial infarction (AMI) can be applied when there is evidence of myocardium necrosis with a clinical sign compatible with myocardial ischaemia. Acute myocardial infarction can be identified using clinical methods including electrocardiography (ECG), elevation in myocardium necrosis biomarkers, and imaging. Acute myocardial infarction is one of the leading causes of death and disability worldwide, and may be the first manifestation of coronary artery disease.Estimating the prevalence of coronary diseases in the general population is quite a complex task. In 2010, the prevalence of coronary diseases was reported as 6.4% among the general population in the United States.One of the main manifestations of ACS is chest pain. However, even in the presence of this typical symptom, early diagnosis of ACS is a challenge for health care professionals who initially attend to these patients. Several authors have indicated the importance and difficulty of recognizing chest pain of cardiac origin, where immediate medical attention is required.Triage, or risk classification, is a clinical management tool used in emergency services to guide patient flow when the need for medical attention exceeds that available. The Manchester Triage Group was developed in 1994 in the United Kingdom. The aim was to establish a consensus among physicians and nurses in the emergency room by creating a triage pattern focused on the development of the following:Thus, the Manchester Triage System (MTS) was created. The MTS simplifies the clinical management of each patient, and consequently, the whole service, by utilizing a system that defines the clinical priority for adults and children. The assessment of clinical priority needs to be fast; therefore, it is separated from the process of medical diagnosis. Restricting the time allocated for patient classification prevents an attempt to make a medical diagnosis at the time of classification.The main goal of the MTS is to set a time limit for each patient to be attended to safely, that is, with no risk to the patient's health. One of the main principles of the system is the higher the perceived risk to the patient's health, the shorter the waiting time for medical attendance. The MTS comprises a scale of five priority levels ().(Table is included in full-text article.)The MTS is composed of 52 distinct flowcharts that "guide" the triage decision-making process. Based on the main presenting symptom of the patient seeking emergency care, the health care professional must choose one of the 52 flowcharts in order to proceed with evaluation. Classification into one of the five clinical priority levels is set for each patient using the selected flowchart.The lack of a risk classification system within an emergency room implies attendance on a first-come, first-served basis, which in many cases may jeopardize a patient's safety, as patients whose health status is more unstable or severe are not prioritized.The MTS is a tool that aims to define the degree of severity and associated safe waiting time for patients in the emergency department, establishing an order of priority for medical care. It determines the clinical priority of every patient who comes to the emergency department. It is possible to evaluate the sensitivity and specificity of the MTS by calculating the frequency of appropriately assigned clinical priority levels to patients presenting at the emergency department.A "diagnostic test" can be understood as a laboratory or imaging test: however, the concepts related to "test" also apply to clinical information from other findings, such as physical examination and patient history. The sensitivity of a test is understood as the capacity of the test to detect individuals who present with a particular condition, or the proportion of individuals with a particular condition who have been tested positive for this condition (true positive). Highly sensitive tests can be used at the beginning of the diagnostic process, when a great number of possibilities are being considered, with the intention of excluding as many options as possible. The specificity of a test is defined as the capacity of the test to identify individuals who do not have a particular medical condition, or the proportion of individuals without the condition who have a negative test (true negative). A triage system that presents a good sensitivity can minimize the occurrence of undertriage, the same way, systems with suitable specificity can avoid the occurrence of overtriage.The assessment of patients with ACS suspected using the MTS, can occur through different flow charts, since the patient does not always have typical symptoms and concerns such as chest pain as the main complaint. For this reason, in addition to the flowchart "chest pain", other flowcharts, including "shortness of breath in adults", "unwell adult", "collapsed adult", and "palpitations", enable distinguishing chest pain and other urgent conditions from non-urgent conditions, and can assist the appraiser to establish the highest priority level to treat patients with these urgent conditions.According to the algorithm from the American Heart Association, every patient who presents symptoms of chest discomfort suggestive of ischaemia must receive medical attention within 10 minutes. Therefore, in order to recognize patients in those conditions, the health care professional applying MTS must establish priority levels of "red" or "orange", thereby setting a safe waiting time for these patients.Although there are well-established criteria for the prioritization of patients with suspected ACS, several studies have reported the difficulties of evaluating patients with these conditions. Various factors can interfere with the outcome of this process, such as atypical presentation of symptoms, AMI classification, patient age, and professional skill.Primary studies have addressed the issue from different perspectives. Studies have been conducted to evaluate the ability of nurses using MTS to detect high-risk patients with chest pain, the impact of MTS on short-term mortality in AMI, and the sensitivity and specificity of MTS for patients with ACS, and to assess whether the MTS was used effectively in patients admitted to the hospital with a diagnosis of acute coronary syndrome.These studies concluded that use of the MTS by nurses is a sensitive method for identifying high risk cardiac chest pain, but further studies are required to assess whether additional training can improve the sensitivity of MTS. The MTS safeguards patients with typical AMI presentation and ST elevation during myocardial infarction, and who are under 70 years of age. The MTS has a high sensitivity in prioritization (immediate/very urgent) of patients with ACS. Additionally, most patients admitted for ACS are initially triaged as "orange" or "yellow", an indication for prompt assessment in the emergency department. This has a positive effect on time to first medical assessment, but has no effect on time to hospital admission.A systematic review addressing a similar theme was published. The review evaluated the efficacy of MTS for all groups of patients and included studies that evaluated the MTS in relation to different outcomes. This proposed review is different as it will include primary studies with a specific sub-population (patients with ACS). Another important difference lies in the fact that the published review did not include critical appraisal of the primary studies included in review. A systematic review that synthesizes the available evidence on the sensitivity of MTS to evaluate patients with an ACS medical diagnosis is necessary to guide decisions related to the use or adoption of the instrument, as well as providing data that can contribute to improvements to the system.
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Affiliation(s)
- Fernanda Ayache Nishi
- 1 University Hospital, University of São Paulo, Brazil2 School of Nursing, University of São Paulo, Brazil3 The Brazilian Center for Evidence-based Healthcare: a Collaborating Center of the Joanna Briggs Institute
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Seizure-Associated ST Elevation Myocardial Infarction in Absence of Plaque Rupture. Case Rep Med 2018; 2018:6186521. [PMID: 29849660 PMCID: PMC5932506 DOI: 10.1155/2018/6186521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/06/2018] [Accepted: 04/04/2018] [Indexed: 11/18/2022] Open
Abstract
Acute coronary syndrome (ACS) is a very common cause of morbidity and mortality in the U.S. Here, we present a case of acute ST elevation myocardial infarction (STEMI) in the setting of seizure activity. In this rare case, we have data from optical coherence tomography (OCT) that showed no plaque disruption, showing the role of OCT in understanding the pathophysiology of STEMI and providing some ideas for the mechanism of this seizure-induced STEMI.
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Shruthi DR, Kumar SS, Desai N, Raman R, Sathyanarayana Rao TS. Psychiatric comorbidities in acute coronary syndromes: Six-month follow-up study. Indian J Psychiatry 2018; 60:60-64. [PMID: 29736064 PMCID: PMC5914265 DOI: 10.4103/psychiatry.indianjpsychiatry_94_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Acute coronary syndrome (ACS) caused by coronary atherosclerosis include ST-segment elevation myocardial infarction (STEMI), non-STEMI, and unstable angina. The relation between psychiatric disorders and coronary artery disease is a complex one which includes the effect of the psychosocial factors on heart and vice versa. Point prevalence studies have been reported, but there is paucity of follow-up studies from India. MATERIALS AND METHODS The study is a follow-up evaluation at discharge of 248 consecutive patients presented with ACS at JSS Hospital, Mysuru, Karnataka, over a period of 6 months to assess the psychiatric comorbidities. The patients were assessed on a structured and validated pro forma before discharge, at 3 months, and at 6 months. Screening of psychiatric disorders was done using Mini International Neuropsychiatric Interview PLUS 5.0.0 and assessment of depression was done using Hamilton Depression Rating Scale. ANOVA, Student's t-test, and SPSS 21 were used for statistical analysis. RESULTS The most common psychiatric comorbidities include major depressive disorder (44%), it persisted at the end of 3 (P < 0.001) and 6 (P < 0.001) months. A spectrum of anxiety disorders including panic disorder (12.10%), dysthymia (3.60%), agoraphobia (2.40%), social phobia (2%), obsessive-compulsive disorder (1.6%), specific phobia (1.2%), and posttraumatic stress disorder (0.8%) in descending order at the end of 6 months were found. Significant reduction in substance use of nicotine (66.1%) and alcohol (56.0%) was reported on follow-up. CONCLUSION Depression, anxiety, and substance use occur in patients with ACS which persist on follow-up. Early recognition at discharge and appropriate counseling on follow-up improve the clinical outcomes.
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Affiliation(s)
- D. Ramya Shruthi
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
| | - S. Sunil Kumar
- Department of Cardiovascular and Thoracic Sciences, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
| | - Nagaraj Desai
- Department of Cardiovascular and Thoracic Sciences, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
| | - Rajesh Raman
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
| | - T. S. Sathyanarayana Rao
- Department of Psychiatry, JSS Medical College Hospital, JSS Academy of Higher Education and Research, Formerly JSS University, Mysuru, Karnataka, India
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Nobel L, Jesdale BM, Tjia J, Waring ME, Parish DC, Ash AS, Kiefe CI, Allison JJ. Neighborhood Socioeconomic Status Predicts Health After Hospitalization for Acute Coronary Syndromes: Findings From TRACE-CORE (Transitions, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education). Med Care 2017; 55:1008-1016. [PMID: 29016395 PMCID: PMC5687991 DOI: 10.1097/mlr.0000000000000819] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To explore the influence of contextual factors on health-related quality of life (HRQoL), which is sometimes used as an indicator of quality of care, we examined the association of neighborhood socioeconomic status (NSES) and trajectories of HRQoL after hospitalization for acute coronary syndromes (ACS). METHODS We studied 1481 patients hospitalized with acute coronary syndromes in Massachusetts and Georgia querying HRQoL via the mental and physical components of the 36-item short-form health survey (SF-36) (MCS and PCS) and the physical limitations and angina-related HRQoL subscales of the Seattle Angina Questionnaire (SAQ) during hospitalization and at 1-, 3-, and 6-month postdischarge. We categorized participants by tertiles of the neighborhood deprivation index (a residence-census tract-based measure) to examine the association of NSES with trajectories of HRQoL after adjusting for individual socioeconomic status (SES) and clinical characteristics. RESULTS Participants had mean age 61.3 (SD, 11.4) years; 33% were female; 76%, non-Hispanic white; 11.2% had household income below the federal poverty level. During 6 months postdischarge, living in lower NSES neighborhoods was associated with lower mean PCS scores (1.5 points for intermediate NSES; 1.8 for low) and SAQ scores (2.4 and 4.2 points) versus living in high NSES neighborhoods. NSES was more consequential for patients with lower individual SES. Individuals living below the federal poverty level had lower average MCS and SAQ physical scores (3.7 and 7.7 points, respectively) than those above. CONCLUSIONS Neighborhood deprivation was associated with worse health status. Using HRQoL to assess quality of care without accounting for individual SES and NSES may unfairly penalize safety-net hospitals.
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Affiliation(s)
- Lisa Nobel
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Bill M. Jesdale
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jennifer Tjia
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Molly E. Waring
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - David C. Parish
- Department of Community Medicine, Mercer University, Macon GA
| | - Arlene S. Ash
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Catarina I. Kiefe
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jeroan J. Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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Javat D, Heal C, Buchholz S, Zhang Z. Early Versus Delayed Invasive Strategies in High-Risk Non-ST Elevation Acute Coronary Syndrome Patients – A Systematic Literature Review and Meta-Analysis of Randomised Controlled Trials. Heart Lung Circ 2017; 26:1142-1159. [DOI: 10.1016/j.hlc.2017.02.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 02/18/2017] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
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Razani Z, Dastani M, Kazerani HR. Cardioprotective Effects of Pomegranate (Punica granatum) Juice in Patients with Ischemic Heart Disease. Phytother Res 2017; 31:1731-1738. [PMID: 28913846 DOI: 10.1002/ptr.5901] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 07/15/2017] [Accepted: 07/29/2017] [Indexed: 12/31/2022]
Abstract
Ischemic heart disease is the leading cause of mortality worldwide. The purpose of this study was to evaluate the cardioprotective effects of pomegranate juice in patients with ischemic heart disease. One hundred patients, diagnosed with unstable angina or myocardial infarction, were randomly assigned to the test and the control groups (n = 50, each). During 5 days of hospitalization, in addition to the conventional medical therapies, the test groups received 220 mL pomegranate juice, daily. During the hospitalization period, the blood pressure, heart rate, as well as the intensity, occurrence, and duration of the angina were evaluated on a regular basis. At the end of the hospitalization period, the serum levels of malondialdehyde, interleukin-6, and tumor necrosis factor alpha were measured in all patients. The levels of serum troponin and high-sensitive C-reactive protein levels were also assayed in patients diagnosed with myocardial infarction. Pomegranate juice caused significant reductions in the intensity, occurrence, and duration of angina pectoris in patients with unstable angina. Consistently, the test patients had significantly lower levels of serum troponin and malondialdehyde. Other studied parameters did not change significantly. The results of this study suggest protective effects of pomegranate juice against myocardial ischemia and reperfusion injury. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Zahra Razani
- MSc graduate of the School of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
| | - Mostafa Dastani
- Department of Cardiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamid Reza Kazerani
- Department of Physiology, The School of Veterinary Medicine, Ferdowsi University of Mashhad, Mashhad, Iran
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Hyun KK, Brieger D, Woodward M, Richtering S, Redfern J. The effect of socioeconomic disadvantage on prescription of guideline-recommended medications for patients with acute coronary syndrome: systematic review and meta-analysis. Int J Equity Health 2017; 16:162. [PMID: 28859658 PMCID: PMC5579970 DOI: 10.1186/s12939-017-0658-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 08/23/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND There are varying data on whether socioeconomic status (SES) affects the treatment in patients with acute coronary syndrome (ACS). Our aim was to obtain a reliable estimate of the effect of SES on discharge prescription of medications following an ACS through systematic review and meta-analysis. METHODS Medline, EMBASE and Global Health were searched systematically on 6th April 2016. Studies were eligible if the participants had ACS and reported the rate/odds of guideline-recommended ACS medications prescription (aspirin, antiplatelet, beta blocker, angiotensin co-enzyme inhibitors (ACEi)/angiotensin receptor blockers (ARB) and statin) at discharge stratified by SES. A meta-analysis was performed to pool the estimates, comparing the prescription ratio (PR) between the lowest and the highest SES groups. RESULTS Of 252 articles found from the search, seven met the eligibility criteria and it included 41,462 (20,986 from the lowest SES group) patients. We found that the individual/neighbourhood level SES did not affect the prescription of aspirin (PR (95% CI): 0.97 (0.91, 1.03)), but for beta blocker and statin, the lowest SES group were disadvantaged (0.84 (0.73, 0.94), 0.80 (0.62, 0.98), respectively). In contrast, ACEi were prescribed more often to the lowest individual/neighbourhood level SES group than the highest (1.13 (1.05, 1.22)). Although the risk of bias was low, there was considerable heterogeneity between the studies. CONCLUSIONS Despite the recommendations to close the treatment gap, the rate of prescription of guideline-recommended medications in managing ACS is significantly different between patients with the lowest and the highest groups. A solution is needed to provide equitable care across the SES groups. PROSPERO REGISTRY Systematic review registration no.: CRD42016048503. Registered 28 September 2016.
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Affiliation(s)
- Karice K Hyun
- Sydney Medical School, University of Sydney, Sydney, Australia. .,The George Institute for Global Health, Sydney, Australia. .,, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW, 2050, Australia.
| | - David Brieger
- Department of Cardiology, Concord Hospital, University of Sydney, Sydney, Australia
| | - Mark Woodward
- The George Institute for Global Health, Sydney, Australia.,The George Institute for Global Health, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Julie Redfern
- The George Institute for Global Health, Sydney, Australia
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Bijak M, Dziedzic A, Saluk-Bijak J. Flavonolignans reduce the response of blood platelet to collagen. Int J Biol Macromol 2017; 106:878-884. [PMID: 28842200 DOI: 10.1016/j.ijbiomac.2017.08.091] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/29/2017] [Accepted: 08/14/2017] [Indexed: 01/25/2023]
Abstract
The primary biological function of platelets is to form hemostatic thrombi that prevent blood loss and maintain vascular integrity. These multi-responding cells are activated by different endogenous, physiological agonists due to the vast number of receptors present on the surface of the platelets. Collagen represents up to 40% of the total protein presented in the vessel wall and is the major activator of the platelets' response after tissue injury, and is the only matrix protein which supports both platelet adhesion and complete activation. The aim of our study was to determine the effects of three major flavonolignans (silybin, silychristin and silydianin) on collagen-induced blood platelets' activation, adhesion, aggregation and secretion of PF-4. We observed that depending on the dose, silychristin and silybin have anti-platelet properties observed as inhibition of collagen-induced activation (formation of blood platelet aggregates and microparticles, as well as decreased expression of P-selectin and activation of integrin αIIbβ3), aggregation, adhesion and secretion of PF-4. These effects highlight the potential of silybin and silychristin as supplementation to prevent primary and secondary thrombotic events wherein excessive blood platelet response to a physiological agonist is observed.
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Affiliation(s)
- Michal Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland.
| | - Angela Dziedzic
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
| | - Joanna Saluk-Bijak
- Department of General Biochemistry, Faculty of Biology and Environmental Protection, University of Lodz, Pomorska 141/143, 90-236 Lodz, Poland
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Baschin M, Selleng S, Zeden JP, Westphal A, Kohlmann T, Schroeder HW, Greinacher A, Thiele T. Platelet transfusion to reverse antiplatelet therapy before decompressive surgery in patients with intracranial haemorrhage. Vox Sang 2017; 112:535-541. [DOI: 10.1111/vox.12542] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 05/05/2017] [Accepted: 05/08/2017] [Indexed: 12/16/2022]
Affiliation(s)
- M. Baschin
- Institut für Immunologie und Transfusionsmedizin; Abteilung Transfusionsmedizin; Universitätsmedizin Greifswald; Greifswald Germany
| | - S. Selleng
- Klinik für Anästhesiologie; Universitätsmedizin Greifswald; Greifswald Germany
| | - J.-P. Zeden
- Klinik für Neurochirurgie; Universitätsmedizin Greifswald; Greifswald Germany
| | - A. Westphal
- Institut für Immunologie und Transfusionsmedizin; Abteilung Transfusionsmedizin; Universitätsmedizin Greifswald; Greifswald Germany
| | - T. Kohlmann
- Institut für Community Medicine; Universitätsmedizin Greifswald; Greifswald Germany
| | - H. W. Schroeder
- Klinik für Neurochirurgie; Universitätsmedizin Greifswald; Greifswald Germany
| | - A. Greinacher
- Institut für Immunologie und Transfusionsmedizin; Abteilung Transfusionsmedizin; Universitätsmedizin Greifswald; Greifswald Germany
| | - T. Thiele
- Institut für Immunologie und Transfusionsmedizin; Abteilung Transfusionsmedizin; Universitätsmedizin Greifswald; Greifswald Germany
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Oktaviono YH. Case Report: INTRAPROCEDURAL STENT THROMBOSIS IN PERCUTANEOUS CORONARY ANGIOPLASTY. FOLIA MEDICA INDONESIANA 2017. [DOI: 10.20473/fmi.v52i1.5213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Stent thrombosis is a rare complication of PCI but associated with STEMI and sudden cardiac death. Intra procedural stent thrombosis (IPST) was defined new or increasing (compared with baseline) thrombus within or adjacent to a deployed stent occurring the index PCI procedure whether occlusive or nonocclusive. We describe a case with double vessel disease who has complication cardiac arrest and intra procedural stent thrombosis in LAD and Left Main coronary artery after deployed stent in bifurcation LAD-D1. Thrombectomy and rescucitation were performed, and the patient completed her hospital course without complications.
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Hossain MS, Rahaman S, Mustafa R, Andersson K. A belief rule-based expert system to assess suspicion of acute coronary syndrome (ACS) under uncertainty. Soft comput 2017. [DOI: 10.1007/s00500-017-2732-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Low-Risk Chest Pain. PHYSICIAN ASSISTANT CLINICS 2017. [DOI: 10.1016/j.cpha.2017.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Kunnumakkara AB, Bordoloi D, Padmavathi G, Monisha J, Roy NK, Prasad S, Aggarwal BB. Curcumin, the golden nutraceutical: multitargeting for multiple chronic diseases. Br J Pharmacol 2017; 174:1325-1348. [PMID: 27638428 PMCID: PMC5429333 DOI: 10.1111/bph.13621] [Citation(s) in RCA: 601] [Impact Index Per Article: 85.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/15/2016] [Accepted: 08/18/2016] [Indexed: 12/19/2022] Open
Abstract
Curcumin, a yellow pigment in the Indian spice Turmeric (Curcuma longa), which is chemically known as diferuloylmethane, was first isolated exactly two centuries ago in 1815 by two German Scientists, Vogel and Pelletier. However, according to the pubmed database, the first study on its biological activity as an antibacterial agent was published in 1949 in Nature and the first clinical trial was reported in The Lancet in 1937. Although the current database indicates almost 9000 publications on curcumin, until 1990 there were less than 100 papers published on this nutraceutical. At the molecular level, this multitargeted agent has been shown to exhibit anti-inflammatory activity through the suppression of numerous cell signalling pathways including NF-κB, STAT3, Nrf2, ROS and COX-2. Numerous studies have indicated that curcumin is a highly potent antimicrobial agent and has been shown to be active against various chronic diseases including various types of cancers, diabetes, obesity, cardiovascular, pulmonary, neurological and autoimmune diseases. Furthermore, this compound has also been shown to be synergistic with other nutraceuticals such as resveratrol, piperine, catechins, quercetin and genistein. To date, over 100 different clinical trials have been completed with curcumin, which clearly show its safety, tolerability and its effectiveness against various chronic diseases in humans. However, more clinical trials in different populations are necessary to prove its potential against different chronic diseases in humans. This review's primary focus is on lessons learnt about curcumin from clinical trials. LINKED ARTICLES This article is part of a themed section on Principles of Pharmacological Research of Nutraceuticals. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.11/issuetoc.
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Affiliation(s)
| | - Devivasha Bordoloi
- Department of Biosciences and BioengineeringIndian Institute of Technology GuwahatiAssamIndia
| | - Ganesan Padmavathi
- Department of Biosciences and BioengineeringIndian Institute of Technology GuwahatiAssamIndia
| | - Javadi Monisha
- Department of Biosciences and BioengineeringIndian Institute of Technology GuwahatiAssamIndia
| | - Nand Kishor Roy
- Department of Biosciences and BioengineeringIndian Institute of Technology GuwahatiAssamIndia
| | - Sahdeo Prasad
- Department of Experimental TherapeuticsThe University of Texas MD Anderson Cancer CenterHoustonTexasUSA
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Qanitha A, de Mol BAJM, Burgner DP, Kabo P, Pabittei DR, Yusuf I, Uiterwaal CSPM. Pregnancy-related conditions and premature coronary heart disease in adult offspring. HEART ASIA 2017; 9:90-95. [PMID: 29259659 PMCID: PMC5730950 DOI: 10.1136/heartasia-2017-010896] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Revised: 03/17/2017] [Accepted: 03/21/2017] [Indexed: 12/29/2022]
Abstract
Objective To investigate the association between complications during pregnancy and premature coronary heart disease in adult offspring. Methods We conducted a population-based case-control study of 153 Indonesian patients with a first acute coronary syndrome (ACS) (age ≤55 years) and 153 age-matched and sex-matched controls. Data on complications during pregnancy (high blood pressure, preterm delivery) and maternal infections in pregnancy were obtained, together with sociodemographic data, clinical profiles, laboratory measurements and adulthood cardiovascular disease (CVD) risk factors at hospital admission or enrolment. Conditional logistic regression was performed to assess the association between overall pregnancy complications, and specific groupings of complications and premature ACS. Results Pregnancy-related hypertension and infection were more common in mothers of cases than controls. Pregnancy complications were associated with premature offspring ACS (OR 2.9, 95% CI 1.4 to 6.0, p=0.004), and the association persisted in fully adjusted analyses (ORadjusted 4.5, 1.1 to 18.1, p=0.036). In subgroup analyses, pregnancy-related high blood pressure (ORadjusted 5.0, 1.0 to 24.7, p=0.050) and maternal infections (ORadjusted 5.2, 1.1 to 24.2, p=0.035) were associated with offspring ACS. Conclusions Offspring of mothers with complications during pregnancy have an increased risk for premature ACS in adulthood, which may be of particular relevance in populations in transition, where the incidence of both pregnancy-related morbidity and CVD are high.
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Affiliation(s)
- Andriany Qanitha
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Bastianus A J M de Mol
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - David P Burgner
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.,Department of Paediatrics, Monash University, Clayton, Victoria, Australia
| | - Peter Kabo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Dara R Pabittei
- Department of Cardio-thoracic Surgery, AMC Heart Center, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Irawan Yusuf
- Department of Physiology, Faculty of Medicine, University of Hasanuddin, Makassar, Indonesia
| | - Cuno S P M Uiterwaal
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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143
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Hromada C, Mühleder S, Grillari J, Redl H, Holnthoner W. Endothelial Extracellular Vesicles-Promises and Challenges. Front Physiol 2017; 8:275. [PMID: 28529488 PMCID: PMC5418228 DOI: 10.3389/fphys.2017.00275] [Citation(s) in RCA: 74] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 04/18/2017] [Indexed: 12/22/2022] Open
Abstract
Extracellular vesicles, including exosomes, microparticles, and apoptotic bodies, are phospholipid bilayer-enclosed vesicles that have once been considered as cell debris lacking biological functions. However, they have recently gained immense interest in the scientific community due to their role in intercellular communication, immunity, tissue regeneration as well as in the onset, and progression of various pathologic conditions. Extracellular vesicles of endothelial origin have been found to play a versatile role in the human body, since they are on the one hand known to contribute to cardiovascular diseases, but on the other hand have also been reported to promote endothelial cell survival. Hence, endothelial extracellular vesicles hold promising therapeutic potential to be used as a new tool to detect as well as treat a great number of diseases. This calls for clinically approved, standardized, and efficient isolation and characterization protocols to harvest and purify endothelial extracellular vesicles. However, such methods and techniques to fulfill stringent requirements for clinical trials have yet to be developed or are not harmonized internationally. In this review, recent advances and challenges in the field of endothelial extracellular vesicle research are discussed and current problems and limitations regarding isolation and characterization are pointed out.
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Affiliation(s)
- Carina Hromada
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyVienna, Austria.,Austrian Cluster for Tissue RegenerationVienna, Austria
| | - Severin Mühleder
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyVienna, Austria.,Austrian Cluster for Tissue RegenerationVienna, Austria
| | - Johannes Grillari
- Austrian Cluster for Tissue RegenerationVienna, Austria.,Christian Doppler Laboratory on Biotechnology of Skin Aging, Department of Biotechnology, University of Natural Resources and Life SciencesVienna, Austria.,Evercyte GmbHVienna, Austria
| | - Heinz Redl
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyVienna, Austria.,Austrian Cluster for Tissue RegenerationVienna, Austria
| | - Wolfgang Holnthoner
- AUVA Research Centre, Ludwig Boltzmann Institute for Experimental and Clinical TraumatologyVienna, Austria.,Austrian Cluster for Tissue RegenerationVienna, Austria
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144
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Abdel Maksoud SM, El-Garf WT, Ali OS, Shaaban GM, Amer NN. Association of Cholesterol Ester Transfer Protein Taq IB Polymorphism With Acute Coronary Syndrome in Egyptian National Patients. Lab Med 2017; 48:154-165. [PMID: 28387842 DOI: 10.1093/labmed/lmw071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background The association between cholesterol ester transfer protein (CETP) Taq IB polymorphism and coronary artery disease (CAD) has been studied in different populations. Acute coronary syndrome (ACS) is a group of clinical symptoms within acute myocardial ischemia, including unstable angina (UA) and myocardial infarction (MI). Because there are no data reported in the literature concerning the cholesteryl ester transfer protein (CETP) Taq IB polymorphism in Egyptians, our study aimed to investigate the frequency of different CETP Taq IB genotypes in Egyptian patients with ACS and in healthy control individuals. Methods The current study was conducted with 70 hospitalized patients who had been diagnosed with ACS and 30 controls. We used real-time polymerase chain reaction (RT-PCR) to determine CETP Taq IB in individuals with different genotypes. Results The frequency of the GA genotype was significantly lower in UA patients, compared with the control group ( P <.05). Conclusions The frequency of the CETP Taq IB genotypes and alleles in all groups was similar to that in other ethnic groups. Individuals with the Taq IB GA genotype may have a lower risk of UA.
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Affiliation(s)
| | - Wael T El-Garf
- Department of Molecular Genetics, National Research Center
| | - Ola S Ali
- Biochemistry Department, Faculty of Pharmacy (Girls), Al Azhar University
| | | | - Noha N Amer
- Biochemistry Department, Faculty of Pharmacy (Girls), Al Azhar University
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145
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Andersson H, Ullgren A, Holmberg M, Karlsson T, Herlitz J, Wireklint Sundström B. Acute coronary syndrome in relation to the occurrence of associated symptoms: A quantitative study in prehospital emergency care. Int Emerg Nurs 2017; 33:43-47. [PMID: 28438478 DOI: 10.1016/j.ienj.2016.12.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 10/25/2016] [Accepted: 12/13/2016] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Acute chest pain is a common symptom among prehospital emergency care patients. Therefore, it is crucial that ambulance nurses (ANs) have the ability to identify symptoms and assess patients suffering from acute coronary syndrome (ACS). The aim of this study is to explore the occurrence of dyspnoea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients' outcome. METHODS This study has a quantitative design based on data from hospital records and from a previous interventional study (randomised controlled trial) including five Emergency Medical Service (EMS) systems in western Sweden in the years 2008-2010. RESULTS In all, 1836 patients were included in the interventional study. Dyspnoea was reported in 38% and nausea and/or vomiting in 26% of patients. The risk of death within one year increased with the presence of dyspnoea. The presence of nausea and/or vomiting increased the likelihood of a final diagnosis of acute myocardial infarction (AMI). CONCLUSION This study shows that dyspnoea, nausea and/or vomiting increase the risk of death and serious diagnosis among ACS patients. This means that dyspnoea, nausea and/or vomiting should influence the ANs' assessment and that special education in cardiovascular nursing is required.
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Affiliation(s)
- Henrik Andersson
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden.
| | - Andreas Ullgren
- Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden; Emergency Medical Service System, Skaraborg Hospital, Skövde, Sweden
| | - Mats Holmberg
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | - Thomas Karlsson
- Centre for Applied Biostatistics, Occupational and Environmental Medicine, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Johan Herlitz
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
| | - Birgitta Wireklint Sundström
- PreHospen - Centre for Prehospital Research, University of Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Sweden
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The inhibitory effects of polysaccharide peptides (PsP) of Ganoderma lucidum against atherosclerosis in rats with dyslipidemia. Heart Int 2017; 12:e1-e7. [PMID: 29114382 PMCID: PMC5460693 DOI: 10.5301/heartint.5000234] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2017] [Indexed: 01/01/2023] Open
Abstract
Background Atherosclerosis occurs as a result of low-density lipoprotein (LDL) deposits oxidation. Endothelial dysfunction is an early process of atherosclerosis. Restoring endothelial lining back to normal by endothelial progenitor cells (EPCs) is critical for slowing or reversing vascular disease progression. Oxidative stress from hydrogen peroxide (H2O2) is increased in dyslipidemia so that antioxidant agent is required to prevent destruction of blood vessels. Objectives This study aims to report Ganoderma lucidum polysaccharide peptide (PsP) effects in atherogenic process by measuring H2O2 level, IL-10 level, and EPC number in blood serum, and also intima-media thickness of aorta in dyslipidemia Wistar rat model by giving them a hypercholesterol diet (HCD). Materials and methods The study was an experimental in vivo post-test with control group design. Thirty-five Wistar rats (Rattus norwegicus) were divided into five groups (normal diet group, HCD group, and hypercholesterol groups that received 50 mg/kg, 150 mg/kg, and 300 mg/kg bodyweight PsP). Results Each treatment group showed significant results for the administration of PsP using the one-way analysis of variance test (p<0.050) for the reduction of H2O2 (p = 0.003), levels of IL-10 (p = 0.027), number of EPC in the blood serum (p = 0.011), and the intima-media thickness of the aorta (p = 0.000). PsP from G. lucidum is a potent antioxidant and may prevent atherogenesis process in patients with dyslipidemia. Conclusions The optimum doses of PsP in this study is 300 mg/kg bodyweight. Further studies are required to determine the antioxidant effects of PsP G. lucidum and its benefits in the management of dyslipidemia.
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147
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Jakó B, Sinkó J. Case report. Role of the Methylene Tetrahydrofolate Reductase (MTHFR) Gene Mutation in Acute Myocardial Infarction. JOURNAL OF CARDIOVASCULAR EMERGENCIES 2017. [DOI: 10.1515/jce-2017-0006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
This is a case report of a 36-year-old male who was diagnosed with acute inferior and right ventricular myocardial infarction and treated with percutaneous coronary angioplasty with a drug-eluting stent in the right coronary artery. A profile test for thrombophilia was performed for methylene tetrahydrofolate reductase (MTHFR) gene mutation; the test was positive for a heterozygous mutation - C677C and 1298A. The patient received a long-term treatment with folic acid supplements, taken daily. This case report shows that medical doctors should have an outside-the-box approach for the diagnosis and therapeutic management of young patients who present with acute cardiovascular events. If the patient in question does not present clear cardiovascular risk factors for acute myocardial ischemia, the clinician should seek for possible causes, thus leading to several benefits in the management and secondary prevention of such cases.
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Affiliation(s)
- Beáta Jakó
- Emergency County Hospital, Miercurea Ciuc , Romania
| | - János Sinkó
- Emergency County Hospital, Miercurea Ciuc , Romania
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148
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Risk of mortality and recurrent cardiovascular events in patients with acute coronary syndromes on high intensity statin treatment. Prev Med Rep 2017; 6:203-209. [PMID: 28373930 PMCID: PMC5374870 DOI: 10.1016/j.pmedr.2017.03.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 02/24/2017] [Accepted: 03/13/2017] [Indexed: 12/13/2022] Open
Abstract
Several randomized controlled trials have shown a benefit of high-dose intensive statin treatment in reducing risk of death and second cardiovascular disease (CVD) events in patients previously diagnosed with an acute coronary syndrome (ACS). Non-randomized studies in clinical settings support these findings, but large, long-term, observational studies addressing CVD and non-CVD endpoints are lacking. In this retrospective longitudinal study, we followed ACS patients in Sweden during 2001–2012 using national health registry and medical record data. A total of 49,857 patients were identified, of whom 10,092 (20.2%) received high dose statins and 21,174 (42.7%) received no statins. Royston-Parmar parametric time-to-event models were implemented to model hazard for second CVD events and death, stratified by gender and diabetes diagnosis. We found that risk of a second CVD event developed similarly in both treatment groups, but was much higher in the no statin group. Risk of CVD-related death remained relatively constant for the high-statin group, while it increased over time for the no-statin group. Interestingly, males had higher mortality rates in the no-statin group, but not in the high-statin group. All-cause mortality and non-CVD-related death followed similar trends to those observed for CVD-related death. This work provides additional real-world evidence for effect of statins in CVD-related mortality. The hazard functions presented here can provide a basis for future survival modeling and health economic evaluation. 10,092 ACS patients on high dose and 21,174 on no statins were followed 2001–12. Royston-Parmar models were implemented to model hazard for new CVD events and death. Risk of a new event developed similarly, but was much higher for those not on statins. Risk of death increased over time for the no-statin, but not the high statin, group. High statin treatment reduced gender effects on risk of mortality and new events.
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Key Words
- ACS, Acute Coronary Syndrome
- Acute coronary syndromes
- CVD, Cardiovascular Disease
- Cardiovascular disease
- EMR, Electronic Medical Records
- Epidemiology
- HF, Heart Failure
- ICD, International Classification of Diseases
- IS, Ischemic Stroke
- LDL, Low Density Lipoprotein
- MI, Myocardial Infarction
- Mortality
- PCI, Percutaneous Coronary Intervention
- RCT, Randomized Controlled Trial
- STEMI, ST Elevation Myocardial Infarction
- Secondary prevention
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de Batlle J, Turino C, Sánchez-de-la-Torre A, Abad J, Duran-Cantolla J, McEvoy RD, Antic NA, Mediano O, Cabriada V, Masdeu MJ, Teran J, Valls J, Barbé F, Sánchez-de-la-Torre M. Predictors of obstructive sleep apnoea in patients admitted for acute coronary syndrome. Eur Respir J 2017; 49:49/3/1600550. [DOI: 10.1183/13993003.00550-2016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 11/20/2016] [Indexed: 11/05/2022]
Abstract
Identifying undiagnosed obstructive sleep apnoea (OSA) patients in cardiovascular clinics could improve their management. Aiming to build an OSA predictive model, a broad analysis of clinical variables was performed in a cohort of acute coronary syndrome (ACS) patients.Sociodemographic, anthropometric, life-style and pharmacological variables were recorded. Clinical measures included blood pressure, electrocardiography, echocardiography, blood count, troponin levels and a metabolic panel. OSA was diagnosed using respiratory polygraphy. Logistic regression models and classification and regression trees were used to create predictive models.A total of 978 patients were included (298 subjects with apnoea–hypopnoea index (AHI) <15 events·h−1and 680 with AHI ≥15 events·h−1). Age, BMI, Epworth sleepiness scale, peak troponin levels and use of calcium antagonists were the main determinants of AHI ≥15 events·h−1(C statistic 0.71; sensitivity 94%; specificity 24%). Age, BMI, blood triglycerides, peak troponin levels and Killip class ≥II were determinants of AHI ≥30 events·h−1(C statistic of 0.67; sensitivity 31%; specificity 86%).Although a set of variables associated with OSA was identified, no model could successfully predict OSA in patients admitted for ACS. Given the high prevalence of OSA, the authors propose respiratory polygraphy as a to-be-explored strategy to identify OSA in ACS patients.
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150
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Tsutsui T, Tanaka H, Nishida A, Asukai N. Posttraumatic stress symptoms as predictive of prognosis after acute coronary syndrome. Gen Hosp Psychiatry 2017; 45:56-61. [PMID: 28274340 DOI: 10.1016/j.genhosppsych.2016.11.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 11/17/2016] [Accepted: 11/22/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Takumi Tsutsui
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan; Department of Psychiatry, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan; Niigata University Graduate School of Medical and Dental sciences, Niigata, Japan.
| | - Hiroyuki Tanaka
- Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan
| | - Atsushi Nishida
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Nozomu Asukai
- Mental Health Promotion Project, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
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