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Chyrek-Tomaszewska A, Popiołek AK, Piskunowicz M, Borkowska A, Budzyński J, Bieliński MK. Examining Psychological Factors in Peripheral Artery Disease: Affective Temperament, Anxiety, and Depression in Patients Undergoing Revascularization Procedures. Psychol Res Behav Manag 2024; 17:2533-2543. [PMID: 38973975 PMCID: PMC11226187 DOI: 10.2147/prbm.s463587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/03/2024] [Indexed: 07/09/2024] Open
Abstract
Purpose This study aimed to assess the prevalence of depressive and anxiety symptoms in peripheral artery disease (PAD) patients, correlating these symptoms with clinical parameters and examining affective temperaments within the study group. Material and Methods A total of 159 PAD patients, predominantly male, admitted for vascular surgery due to lower limb atherosclerosis, participated in this cross-sectional study. Various assessments were conducted, including the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Autoquestionnaire (TEMPS-A) for affective temperaments, the Hospital Anxiety and Depression Scale (HADS) for anxiety and depression symptoms, and the Numerical Rating Scale (NRS) for pain intensity. Additionally, the Ankle-Brachial Index (ABI) was measured to assess circulation in the legs. Results The findings revealed a higher prevalence of depressive and anxiety symptoms in the PAD patient group compared to the control group. Notably, depressive and anxiety symptoms correlated with the severity of PAD, as indicated by lower ABI values in the operated leg. Patients undergoing surgical revascularizations exhibited higher depressive symptoms than those undergoing endovascular procedures. Furthermore, correlations were observed between depressive symptoms and the number of previous vascular procedures and amputations, alongside increased pain levels at admission. Clinical factors such as diabetes, hypertension, heart failure, ischemic heart disease, previous revascularization procedures, amputations, and the intensity of affective temperaments did not correlate with HADS scores. Discussion The study highlighted the intricate relationship between mood disorders and PAD severity, emphasizing the potential prognostic implications of untreated depression and anxiety in PAD patients. These findings suggest the importance of closely monitoring and addressing psychological well-being in PAD management. However, the study encountered limitations such as varying assessment timing and sample size discrepancies among comorbidities, impacting the observation of associations between mood disorders and certain conditions. Conclusion In conclusion, depressive and anxiety symptoms are often in PAD. Further research is needed to explore therapeutic interventions targeting mental health and pain management to improve the course and outcomes of PAD.
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Affiliation(s)
- Aleksandra Chyrek-Tomaszewska
- Department of Clinical Neuropsychology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiac Rehabilitation and Experimental Cardiology, Władysław Biegański’s Regional Specialist Hospital, Grudziądz, Poland
| | - Alicja Katarzyna Popiołek
- Department of Clinical Neuropsychology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Internal Diseases, Jan Biziel’s University Hospital No. 2, Bydgoszcz, Poland
| | - Małgorzata Piskunowicz
- Department of Clinical Neuropsychology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Alina Borkowska
- Department of Clinical Neuropsychology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Jacek Budzyński
- Department of Vascular and Internal Diseases, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Maciej Kazimierz Bieliński
- Department of Clinical Neuropsychology, Collegium Medicum of Nicolaus Copernicus University, Bydgoszcz, Poland
- Department of Cardiac Rehabilitation and Experimental Cardiology, Władysław Biegański’s Regional Specialist Hospital, Grudziądz, Poland
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Vrsalovic M, Heimark S, Søraas CL, Mehlum MH, Kjeldsen SE, Mancia G, Julius S, Weber MA. Cardiovascular Outcomes in Hypertension-Treated Patients With Peripheral Artery Disease: The VALUE Trial. Hypertension 2024; 81:1628-1636. [PMID: 38716657 DOI: 10.1161/hypertensionaha.124.22832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 04/22/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Systolic blood pressure (BP) is a key predictor of cardiovascular events, but patients with peripheral artery disease (PAD) are rarely included in hypertension trials. The VALUE trial (Valsartan Antihypertensive Long-Term Use Evaluation) investigated the long-term effects of valsartan- or amlodipine-based treatments on cardiovascular outcomes in patients with hypertension with a high cardiovascular risk. The aim of this subanalysis was to clarify the relationship between achieved BP on treatment and cardiovascular outcomes in patients with hypertension with PAD. METHODS Patients were followed for 4 to 6 years, and BP was measured regularly. The primary end point was time to the first major adverse cardiovascular event, including myocardial infarction, stroke, cardiovascular death, and heart failure requiring hospitalization. Statistical analyses were performed using Cox regression, adjusting for various baseline covariates. RESULTS Of the 13 803 participants, 1898 (13.8%) had PAD. During a median follow-up of 4.5 years, patients with PAD had a 23% increased risk of major adverse cardiovascular events compared with patients without PAD. Patients with an achieved systolic BP <130 mm Hg and 130 to 139 mm Hg, compared with those with systolic BP ≥140 mm Hg, were associated with a decreased risk of a major adverse cardiovascular event (hazard ratio, 0.65 [95% CI, 0.43-0.97]; P=0.037; 0.85 [95% CI, 0.74-0.97]; P=0.016, respectively). Additionally, systolic BP <130 mm Hg was associated with a decreased risk of cardiovascular death (hazard ratio, 0.33 [95% CI, 0.12-0.92]; P=0.034). The incidence of the primary outcome did not differ between antihypertensive treatment regimens (P=0.365). CONCLUSIONS Our results indicate that more intensive BP control is associated with a reduction in cardiovascular morbidity and mortality in patients with hypertensive PAD.
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Affiliation(s)
- Mislav Vrsalovic
- School of Medicine, University of Zagreb, Croatia (M.V.)
- Department of Cardiology, Sestre Milosrdnice University Hospital, Zagreb, Croatia (M.V.)
| | - Sondre Heimark
- Department of Nephrology (S.H.), Oslo University Hospital, Ullevaal, Norway
- Cardiovascular and Renal Research Center (S.H., C.L.S., S.E.K.), Oslo University Hospital, Ullevaal, Norway
- Institute of Clinical Medicine, University of Oslo, Norway (S.H., S.E.K.)
| | - Camilla L Søraas
- Department of Environmental and Occupational Medicine (C.L.S.), Oslo University Hospital, Ullevaal, Norway
- Cardiovascular and Renal Research Center (S.H., C.L.S., S.E.K.), Oslo University Hospital, Ullevaal, Norway
| | - Maria H Mehlum
- Department of Geriatrics (M.H.M.), Oslo University Hospital, Ullevaal, Norway
| | - Sverre E Kjeldsen
- Department of Cardiology (S.E.K.), Oslo University Hospital, Ullevaal, Norway
- Cardiovascular and Renal Research Center (S.H., C.L.S., S.E.K.), Oslo University Hospital, Ullevaal, Norway
- Institute of Clinical Medicine, University of Oslo, Norway (S.H., S.E.K.)
| | | | - Stevo Julius
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI (S.J.)
| | - Michael A Weber
- Department of Cardiovascular Medicine, State University New York Downstate College of Medicine, New York, NY (M.A.W.)
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Jakubiak GK. Cardiac Troponin Serum Concentration Measurement Is Useful Not Only in the Diagnosis of Acute Cardiovascular Events. J Pers Med 2024; 14:230. [PMID: 38540973 PMCID: PMC10971222 DOI: 10.3390/jpm14030230] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Revised: 02/14/2024] [Accepted: 02/19/2024] [Indexed: 08/01/2024] Open
Abstract
Cardiac troponin serum concentration is the primary marker used for the diagnosis of acute coronary syndrome. Moreover, the measurement of cardiac troponin concentration is important for risk stratification in patients with pulmonary embolism. The cardiac troponin level is also a general marker of myocardial damage, regardless of etiology. The purpose of this study is to conduct a literature review and present the most important information regarding the current state of knowledge on the cardiac troponin serum concentration in patients with chronic cardiovascular disease (CVD), as well as on the relationships between cardiac troponin serum concentration and features of subclinical cardiovascular dysfunction. According to research conducted to date, patients with CVDs, such as chronic coronary syndrome, chronic lower extremities' ischemia, and cerebrovascular disease, are characterized by higher cardiac troponin concentrations than people without a CVD. Moreover, the literature data indicate that the concentration of cardiac troponin is correlated with markers of subclinical dysfunction of the cardiovascular system, such as the intima-media thickness, pulse wave velocity, ankle-brachial index, coronary artery calcium index (the Agatston score), and flow-mediated dilation. However, further research is needed in various patient subpopulations and in different clinical contexts.
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Affiliation(s)
- Grzegorz K Jakubiak
- Department and Clinic of Internal Medicine, Angiology, and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Batorego 15 St., 41-902 Bytom, Poland
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Hijikata S, Yamaguchi T, Ueshima D, Umemoto T, Mizuno A, Matsui A, Kaneko N, Ozaki S, Doijiri T, Jujo K, Kodama T, Higashitani M. Prognostic impact of atrial fibrillation on the outcomes of peripheral artery disease according to preoperative symptoms for endovascular revascularization. Heart Vessels 2023; 38:106-113. [PMID: 35831635 DOI: 10.1007/s00380-022-02134-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 06/29/2022] [Indexed: 01/06/2023]
Abstract
Peripheral artery disease (PAD) and atrial fibrillation (AF) are associated with major cardiovascular and cerebrovascular events (MACCE). However, outcomes stratified according to the preoperative symptoms of PAD in patients with AF have not been sufficiently investigated. This was a retrospective study of prospectively collected data pertaining to 2237 patients (1179 patients with intermittent claudication [IC] and 1058 patients with critical limb-threatening ischemia [CLTI]) who underwent endovascular therapy at 34 hospitals between August 2014 and August 2016. AF was present in 91 (7.7%) patients with IC and 150 (14.2%) patients with CLTI. In the CLTI group, patients with AF had a higher event rate of MACCE and all-cause death than those without AF (1-year rates of freedom from MACCE: 0.66 and 0.81 in patients with and without AF, respectively, p < 0.001). In contrast, in the IC group, there was no statistically significant difference in the rates of MACCE between patients with and without AF. In the Cox multivariate analysis, AF was a significant predictor of MACCE in patients with CLTI but not in patients with IC, even after adjusting for covariates. The impact of AF on the outcome of patients with PAD was greater in those with CLTI. Further studies are needed to clarify the possible mechanisms underlying these differences.
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Affiliation(s)
- Sadahiro Hijikata
- Department of Cardiovascular Medicine, Shin-Yurigaoka General Hospital, Kanagawa, Japan
| | - Tetsuo Yamaguchi
- Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan.
| | - Daisuke Ueshima
- Department of Cardiovascular Medicine, Kameda Medical Center, Chiba, Japan
| | - Tomoyuki Umemoto
- Department of Cardiology, Tokyo Medical and Dental University Hospital, Tokyo, Japan
| | - Atsushi Mizuno
- Department of Cardiology, St. Lukes International Hospital, Tokyo, Japan
| | - Akihiro Matsui
- Department of Cardiology, Kasukabe Chuo General Hospital, Saitama, Japan
| | - Nobuhito Kaneko
- Department of Cardiology, Kasukabe Chuo General Hospital, Saitama, Japan
| | - Shunsuke Ozaki
- Department of Cardiology, Itabashi Chuo Medical Center, Tokyo, Japan
| | - Tatsuki Doijiri
- Department of Cardiology, Yamato Seiwa Hospital, Kanagawa, Japan
| | - Kentaro Jujo
- Department of Cardiology, Saitama Medical Center, Saitama, Japan
| | - Takahide Kodama
- Department of Cardiovascular Center, Toranomon Hospital, 2-2-2, Toranomon, Minato-ku, Tokyo, 105-8470, Japan
| | - Michiaki Higashitani
- Department of Cardiology, Tokyo Medical University Ibaraki Medical Center, Ibaraki, Japan
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Mouselimis D, Hagstotz S, Lichtenberg M, Donas KP, Heinrich U, Avranas K, Dimitriadis Z, Blessing E, Langhoff R, Frey N, Katus HA, Korosoglou G. Cardiac Troponins for the Clinical Management of Patients with Claudication and without Cardiac Symptoms. J Clin Med 2022; 11:jcm11247287. [PMID: 36555902 PMCID: PMC9785062 DOI: 10.3390/jcm11247287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/01/2022] [Accepted: 12/05/2022] [Indexed: 12/13/2022] Open
Abstract
Many patients with peripheral arterial disease (PAD) exhibit undiagnosed obstructive coronary artery disease. We aim to identify the patients with lifestyle limiting claudication due to PAD and without cardiac symptoms, requiring coronary revascularization based on high-sensitive troponin T (hsTnT) values. We assessed hsTnT in consecutive patients referred for elective endovascular treatment due to claudication [Rutherford categories (RC) 2 & 3] between January 2018 and December 2021. Diagnostic work-up by non-invasive imaging and, if required, cardiac catheterization was performed according to clinical data, ECG findings and baseline hsTnT. The occurrence of cardiac death, myocardial infarction or urgent revascularization during follow-up was the primary endpoint. Of 346 patients, 14 (4.0%) exhibited elevated hsTnT ≥ 14 ng/L, including 7 (2.0%) with acute myocardial injury by serial hsTnT sampling. Coronary revascularization by percutaneous coronary intervention was necessary in 6 of 332 (1.5%) patients with normal versus nine of 14 (64.3%) patients with elevated hsTnT (p < 0.001). During 2.4 ± 1.4 years of follow-up, 20 of 286 (7.0%) patients with normal versus four of 13 (30.8%) with elevated hsTnT at baseline reached the composite primary endpoint (p = 0.03 by log-rank test). In conclusion, elevated troponins in cardiac asymptomatic patients with claudication modify subsequent cardiac management and may increase the need for closer surveillance and more aggressive conservative management in polyvascular disease.
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Affiliation(s)
- Dimitrios Mouselimis
- Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Roentgentrasse 1, 69469 Weinheim, Germany
| | - Saskia Hagstotz
- Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Roentgentrasse 1, 69469 Weinheim, Germany
| | | | - Konstantinos P. Donas
- Department of Vascular and Endovascular Surgery, Asclepios Clinic Langen, 63225 Langen, Germany
| | - Ulrike Heinrich
- Practice for Vascular Medicine and Gastroenterology, 69469 Weinheim, Germany
| | | | - Zisis Dimitriadis
- Department of Cardiology, University Hospital Frankfurt, 60590 Frankfurt, Germany
| | - Erwin Blessing
- SRH Hospital, Department of Internal Medicine, 76307 Karlsbad, Germany
| | - Ralf Langhoff
- Department of Angiology, Sankt-Gertrauden-Krankenhaus, 10713 Berlin, Germany
| | - Norbert Frey
- Cardiology, Angiology & Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Hugo A. Katus
- Cardiology, Angiology & Pneumology, University Hospital Heidelberg, 69120 Heidelberg, Germany
| | - Grigorios Korosoglou
- Cardiology, Vascular Medicine & Pneumology, GRN Hospital Weinheim, Roentgentrasse 1, 69469 Weinheim, Germany
- Correspondence: ; Tel.: +49-(0)-6201-89-2142
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García A, Miota N, Miró Ò, López-Ayala P, López-Barbeito B, Strebel I, Xipell C, Fuenzalida C, Martínez-Nadal G, Boeddinghaus J, Nestelberger T, Twerenbold R, Mueller C, Coll-Vinent B. Association between troponin and outcome in patients with chest pain and rapid atrial fibrillation: a retrospective study of a single-center 10-year cohort. Eur J Emerg Med 2022; 29:404-412. [PMID: 35579514 DOI: 10.1097/mej.0000000000000945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The prognosis of myocardial infarction in patients with rapid atrial fibrillation (RAF) is poorly known. We sought to ascertain if troponin concentrations are associated with a higher risk of major adverse cardiovascular events (MACE) in patients with RAF and chest discomfort suggestive of coronary origin. METHODS We retrospectively reviewed all consecutive patients attending an emergency department of a single-center (2008-2017) with chest pain suggestive of coronary origin who had RAF and at least one troponin determination. Patients were classified as having normal/increased troponin. They were followed until December 2019 to detect MACE (primary outcome), which included acute coronary syndrome (ACS), revascularization, stroke, or all-cause death. In addition to cardiovascular death and type I myocardial infarction, these were considered secondary outcomes. The adjusted risk was determined by Cox regression, and sensitivity analysis were run. Relationship between troponin as a continuous variable and outcomes was also evaluated, as well as interaction by sex. RESULTS We included 574 patients (median = 76.5 years, IQR = 14, women 56.8%, increased troponin 34.1%) followed by a median of 3.8 years (IQR = 4.8). MACE occurred in 200 patients (34.8%). Increased troponin was independently associated with MACE (adjusted hazard ratio, 1.502, 95% CI, 1.130-1.998), ACS (adjusted hazard ratio, 2.488, 95% CI, 1.256-4.928), type I myocardial infarction (adjusted hazard ratio, 2.771, 95% CI, 1.212-6.333) and stroke (adjusted hazard ratio, 3.580, 95% CI, 1.888-6.787) but not with death, cardiovascular death or revascularization. Sensitivity analyses were consistent with these results. There was no interaction by sex. When assessed continuously, an increase in troponin concentrations was lineally associated with a steady increase in the risk of MACE. CONCLUSIONS In patients with RAF who complain of chest pain, increased troponin levels are related to adverse cardiovascular outcomes.
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Affiliation(s)
- Ana García
- Emergency Department, Hospital Clínic, University of Barcelona
- Atrial Fibrillation Unit, Hospital Clínic, Barcelona, Catalonia, Spain
- GREAT network
| | - Natalia Miota
- Emergency Department, Hospital Clínic, University of Barcelona
| | - Òscar Miró
- Emergency Department, Hospital Clínic, University of Barcelona
- GREAT network
| | - Pedro López-Ayala
- GREAT network
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | | | - Ivo Strebel
- GREAT network
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Carolina Xipell
- Emergency Department, Hospital Clínic, University of Barcelona
| | | | | | - Jasper Boeddinghaus
- GREAT network
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Thomas Nestelberger
- GREAT network
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Raphael Twerenbold
- GREAT network
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Christian Mueller
- GREAT network
- Cardiovascular Research Institute Basel and Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Blanca Coll-Vinent
- Emergency Department, Hospital Clínic, University of Barcelona
- Atrial Fibrillation Unit, Hospital Clínic, Barcelona, Catalonia, Spain
- GREAT network
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Kabłak-Ziembicka A, Badacz R, Przewłocki T. Clinical Application of Serum microRNAs in Atherosclerotic Coronary Artery Disease. J Clin Med 2022; 11:jcm11226849. [PMID: 36431326 PMCID: PMC9698927 DOI: 10.3390/jcm11226849] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/15/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022] Open
Abstract
MicroRNAs (miRs) are promising diagnostic, prognostic and therapeutic biomolecules for atherosclerotic cardiovascular disease. Atherosclerotic occlusive disease concerns a large population of patients, carrying the highest incidence of fatal and non-fatal adverse events, such as myocardial infarction, ischemic stroke, and limb ischemia, worldwide. Consistently, miRs are involved in regulation and pathogenesis of atherosclerotic coronary artery disease (CAD), acute coronary syndromes (ACS), both with ST-segment (STEMI) and non-ST segment elevation myocardial infarctions (NSTEMI), as well as cardiac remodeling and fibrosis following ACS. However, the genetic and molecular mechanisms underlying adverse outcomes in CAD are multifactorial, and sometimes difficult to interpret for clinicians. Therefore, in the present review paper we have focused on the clinical meaning and the interpretation of various miRs findings, and their potential application in routine clinical practice.
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Affiliation(s)
- Anna Kabłak-Ziembicka
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
- Noninvasive Cardiovascular Laboratory, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Correspondence:
| | - Rafał Badacz
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
| | - Tadeusz Przewłocki
- Department of Interventional Cardiology, The John Paul II Hospital, Prądnicka 80, 31-202 Kraków, Poland
- Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Medical College, św. Anny 12, 31-007 Kraków, Poland
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Manolis AA, Manolis TA, Manolis AS. Patients with Polyvascular Disease: A Very High-risk Group. Curr Vasc Pharmacol 2022; 20:475-490. [PMID: 36098413 DOI: 10.2174/1570161120666220912103321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 08/04/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
Polyvascular disease (PolyvascDis) with atherosclerosis occurring in >2 vascular beds (coronary, carotid, aortic, visceral and/or peripheral arteries) is encountered in 15-30% of patients who experience greater rates of major adverse cardiovascular (CV) events. Every patient with multiple CV risk factors or presenting with CV disease in one arterial bed should be assessed for PolyvascDis clinically and noninvasively prior to invasive angiography. Peripheral arterial disease (PAD) can be readily diagnosed in routine practice by measuring the ankle-brachial index. Carotid disease can be diagnosed by duplex ultrasound showing % stenosis and/or presence of plaques. Coronary artery disease (CAD) can be screened by determining coronary artery calcium score using coronary computed tomography angiography; further, non-invasive testing includes exercise stress and/or myocardial perfusion imaging or dobutamine stress test, prior to coronary angiography. Abdominal ultrasound can reveal an abdominal aortic aneurysm. Computed tomography angiography will be needed in patients with suspected mesenteric ischemia to assess the mesenteric arteries. Patients with the acute coronary syndrome and concomitant other arterial diseases have more extensive CAD and poorer CV outcomes. Similarly, PolyvascDis in patients with carotid disease and/or other PAD is independently associated with an increased risk for all-cause and CV mortality during long-term follow-up. Treatment of patients with PolyvascDis should include aggressive management of all modifiable risk factors by lifestyle changes and drug therapy, with particular attention to patients who are commonly undertreated, such as those with PAD. Revascularization should be reserved for symptomatic vascular beds, using the least aggressive strategy in a multidisciplinary vascular team approach.
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