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Vaez H, Soraya H, Garjani A, Gholikhani T. Toll-Like Receptor 4 (TLR4) and AMPK Relevance in Cardiovascular Disease. Adv Pharm Bull 2023; 13:36-47. [PMID: 36721803 PMCID: PMC9871286 DOI: 10.34172/apb.2023.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/04/2021] [Accepted: 09/28/2021] [Indexed: 02/03/2023] Open
Abstract
Toll-like receptors (TLRs) are essential receptors of the innate immune system, playing a significant role in cardiovascular diseases. TLR4, with the highest expression among TLRs in the heart, has been investigated extensively for its critical role in different myocardial inflammatory conditions. Studies suggest that inhibition of TLR4 signaling pathways reduces inflammatory responses and even prevents additional injuries to the already damaged myocardium. Recent research results have led to a hypothesis that there may be a relation between TLR4 expression and 5' adenosine monophosphate-activated protein kinase (AMPK) signaling in various inflammatory conditions, including cardiovascular diseases. AMPK, as a cellular energy sensor, has been reported to show anti-inflammatory effects in various models of inflammatory diseases. AMPK, in addition to its physiological acts in the heart, plays an essential role in myocardial ischemia and hypoxia by activating various energy production pathways. Herein we will discuss the role of TLR4 and AMPK in cardiovascular diseases and a possible relation between TLRs and AMPK as a novel therapeutic target. In our opinion, AMPK-related TLR modulators will find application in treating different immune-mediated inflammatory disorders, especially inflammatory cardiac diseases, and present an option that will be widely used in clinical practice in the future.
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Affiliation(s)
- Haleh Vaez
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.,Corresponding Author: Haleh Vaez, Tel:+984133344798, Fax:+984133344798,
| | - Hamid Soraya
- Department of Pharmacology, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Alireza Garjani
- Department of Pharmacology and Toxicology, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Tooba Gholikhani
- Student Research Committee, Faculty of Pharmacy, Tabriz University of Medical Sciences, Tabriz, Iran.,Nanora Pharmaceuticals Ltd, Tabriz, Iran
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2
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Lidgard B, Zelnick LR, O’Brien KD, Bansal N. Patient-Reported Symptoms and Subsequent Risk of Myocardial Infarction in Chronic Kidney Disease. Clin J Am Soc Nephrol 2022; 17:487-495. [PMID: 35301197 PMCID: PMC8993476 DOI: 10.2215/cjn.12080921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 02/16/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND AND OBJECTIVES Although patient-reported symptoms often precede acute presentations of cardiovascular disease, patients with nondialysis-requiring CKD are less likely to have typical symptoms of atherosclerotic disease when presenting with acute myocardial infarction. However, the associations between typical atherosclerotic symptoms and subsequent risk of myocardial infarction are unknown in ambulatory patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS To determine whether typical atherosclerotic symptoms are associated with risk for subsequent myocardial infarction in people with CKD, we examined participants from the Chronic Renal Insufficiency Cohort Study. Chest pain, shortness of breath, and inability to climb stairs were evaluated annually using the Kidney Disease Quality of Life Instrument. Associations between categorical time-updated symptoms and physician-adjudicated incident myocardial infarction were assessed using Cox regression models. RESULTS Among 3910 participants (mean age of 58±11 years; mean eGFR =44±15 ml/min per 1.73 m2), there were 476 incident myocardial infarctions over a median follow-up period of 10.4 years (interquartile range, 5.36-12.6 years). Median time from symptom assessment to incident myocardial infarction was 213 days (interquartile range, 111-333 days). Compared with no symptoms, mild, and moderate or worse, symptoms of chest pain (hazard ratio, 1.30; 95% confidence interval, 1.01 to 1.67; and hazard ratio, 1.70; 95% confidence interval, 1.27 to 2.27, respectively) and shortness of breath (hazard ratio, 1.37; 95% confidence interval, 1.10 to 1.70; and hazard ratio, 1.33; 95% confidence interval, 1.05 to 1.69, respectively) were significantly associated with greater risks for subsequent myocardial infarction. Participants reporting mild and severe limitations in climbing stairs (versus no limitation) had significantly higher adjusted risk of myocardial infarction (hazard ratio, 1.44; 95% confidence interval, 1.10 to 1.89; and hazard ratio, 1.89; 95% confidence interval, 1.44 to 2.49, respectively). CONCLUSIONS In a large ambulatory cohort of adults with CKD, symptoms of atherosclerotic cardiovascular disease were strongly associated with a higher risk for subsequent myocardial infarction. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_03_17_CJN12080921.mp3.
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Affiliation(s)
- Benjamin Lidgard
- Department of Medicine, University of Washington, Seattle, Washington
| | - Leila R. Zelnick
- Department of Medicine, University of Washington, Seattle, Washington
| | - Kevin D. O’Brien
- Department of Medicine, University of Washington, Seattle, Washington
| | - Nisha Bansal
- Department of Medicine, University of Washington, Seattle, Washington
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3
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Ihle-Hansen H, Ihle-Hansen H, Sandset EC, Hagberg G. Subclinical Carotid Artery Atherosclerosis and Cognitive Function: A Mini-Review. Front Neurol 2021; 12:705043. [PMID: 34393982 PMCID: PMC8355501 DOI: 10.3389/fneur.2021.705043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022] Open
Abstract
Carotid artery atherosclerosis, the result of a multitude of vascular risk factors, is a promising marker for use in risk stratification. Recent evidence suggests that carotid artery atherosclerosis affects cognitive function and is an independent risk factor for the development of cognitive impairment. Both atherosclerosis and cognitive impairment develop over a prolonged period (years), and due to the aging population, markers to identify persons at risk are needed. Carotid artery atherosclerosis can easily be visualized using non-invasive ultrasound, potentially enabling early and intensified risk factor management to preserve cognitive function or delay further decline. However, the burden of atherosclerosis and temporal exposure required to pose a risk of cognitive impairment is unclear. This mini-review aims to explore the available evidence on the association between carotid atherosclerosis and cognition, and furthermore identify the remaining gaps in knowledge.
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Affiliation(s)
- Håkon Ihle-Hansen
- Department of Medicine, Bærum Hospital- Vestre Viken Hospital Trust, Drammen, Norway
| | - Hege Ihle-Hansen
- Department of Medicine, Bærum Hospital- Vestre Viken Hospital Trust, Drammen, Norway.,Oslo Stroke Unit, Department of Neurology, Oslo University Hospital, Ullevål, Norway
| | | | - Guri Hagberg
- Department of Medicine, Bærum Hospital- Vestre Viken Hospital Trust, Drammen, Norway.,Oslo Stroke Unit, Department of Neurology, Oslo University Hospital, Ullevål, Norway
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4
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Guo N, Chen Y, Yang X, Yan H, Fan B, Quan J, Wang M, Yang H. Urinary metabolomic profiling reveals difference between two traditional Chinese medicine subtypes of coronary heart disease. J Chromatogr B Analyt Technol Biomed Life Sci 2021; 1179:122808. [PMID: 34218095 DOI: 10.1016/j.jchromb.2021.122808] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 04/21/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
The World Health Organization has shown that coronary heart disease (CHD) is a more common cause of death than cancer. In traditional Chinese medicine (TCM), CHD is classified as a form of thoracic obstruction that can be divided in different subtypes including Qi stagnation with blood stasis (QS) and Qi deficiency with blood stasis (QD). Different treatment strategies are used based on this subtyping. Owing to the lack of scientific markers in the diagnosis of these subtypes, subjective judgments made by clinicians have limited the objective manner for utility of TCM in the treatment of CHD. Untargeted (UHPLC-QTOF-MS) and targeted (UHPLC-MS/MS) metabolomics approaches were employed to search significantly different metabolites related to the QS or QD subtypes of CHD with angina pectoris in this study. A total of 42 metabolites were obtained in the untargeted metabolomics analysis and 34 amino acids were detected in the targeted metabolomics analysis. In total, 16 metabolites were found significantly different among different groups. The results showed distinct metabolic profiles of urine samples not only between CHD patients and healthy controls, but also between the two subtypes of CHD. Pathway analysis of the significantly varied metabolites revealed that there were subtype-related differences in the activity of pathways. Therefore, urinary metabolomics can reveal the pathological changes of CHD in different subtypes, make the diagnosis of CHD in different subtypes in an objective manner and comprehensive and contribute to personalized treatment by providing scientific evidence.
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Affiliation(s)
- Na Guo
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing 100700, China; State Key Laboratory Breeding Base of Dao-di Herbs, National Resource Center for Chinese Materia Medica, Center for Post-doctoral Research, China Academy of Chinese Medical Sciences, Beijing 100700, China; State Key Laboratory of Generic Manufacture Technology of Traditional Chinese Medicine, Lunan Pharmaceutical Group Co. Ltd, Shandong 276006, China
| | - Yangan Chen
- LU-European Center for Chinese Medicine and Natural Compounds, Institute of Biology, Leiden University, Sylviusweg 72, 2333 BE Leiden, the Netherlands
| | - Xiaofang Yang
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Han Yan
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Bin Fan
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Jianye Quan
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing 100700, China
| | - Mei Wang
- LU-European Center for Chinese Medicine and Natural Compounds, Institute of Biology, Leiden University, Sylviusweg 72, 2333 BE Leiden, the Netherlands; SU BioMedicine, Post Bus 546, 2300 AM Leiden, the Netherlands.
| | - Hongjun Yang
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing 100700, China.
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Acupuncture as Adjuvant Therapy for Treating Stable Angina Pectoris with Moderate Coronary Artery Lesions and the Mechanism of Heart-Brain Interactions: A Randomized Controlled Trial Protocol. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:6634404. [PMID: 34012473 PMCID: PMC8105099 DOI: 10.1155/2021/6634404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 01/05/2021] [Accepted: 04/21/2021] [Indexed: 01/09/2023]
Abstract
Background. Stable angina pectoris with moderate coronary artery lesions is a syndrome caused by coronary artery stenosis, which endangers the quality of life. Previous acupuncture studies have shown effectiveness as a complementary therapy for ischaemic heart disease. However, more clinical evidence is needed for verification, and the mechanism should be investigated, especially involving the functional interactions between the heart and brain. Therefore, we designed a clinical trial to provide more evidence for acupuncture efficacy and its mechanism in ischaemic heart disease. Methods/Design. A total of 80 participants will be randomized to the electroacupuncture group and sham-electroacupuncture group at a ratio of 1 : 1. This trial will be conducted over 8 weeks, including a 2-week screening, 2-week treatment, and 4-week follow-up. All participants will continue to receive similar basic disease treatment procedures before the trial (including lifestyle changes and treatment for standard supportive medications, hypertension, and hyperlipidaemia, such as aspirin, metoprolol succinate, atorvastatin, and sodium fosinopril). Additionally, 12 sessions of acupuncture will be administered during the treatment period. The main outcome is Seattle Angina Questionnaire scores. The other observation indices are the heart rate variability and self-rating anxiety scale and self-rating depression scale scores. To explore mechanisms based on the hypothesis of a correlation between heart and brain function, fMRI scans will be used to detect functional brain changes in 15 patients from each group at baseline and at the end of treatment. Finally, the efficacy of acupuncture will be evaluated, and the HRV and imaging data will be correlated with clinical data to investigate the possible relationships between the brain and heart activity. Discussion. This trial will provide evidence for acupuncture as adjuvant therapy for the treatment of stable angina pectoris with moderate coronary artery lesions. The results will shed light on potential mechanisms of heart-brain interactions underlying acupuncture as an adjuvant therapy for treating ischaemic heart disease. Trials registration: Clinical Trial, https://clinicaltrials.gov/ct2/show/ChiCTR1900024937. Registered 4 August 2019, http://www.chictr.org.cn/.
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Pharmacokinetics and Safety of Extended-release Ranolazine in Korean and White Healthy Subjects. Clin Ther 2021; 43:526-534.e4. [PMID: 33518355 DOI: 10.1016/j.clinthera.2021.01.005] [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: 10/17/2020] [Revised: 12/15/2020] [Accepted: 01/03/2021] [Indexed: 11/23/2022]
Abstract
PURPOSE Ranolazine, an inhibitor of late inward sodium current, is an antianginal agent. In this study, the pharmacokinetic (PK) properties and tolerability of single- and multiple-dose ranolazine were compared between healthy Korean and white subjects. METHODS An open-label, ascending single- and multiple-dose study was conducted with healthy male Korean and white subjects. Subjects were administered 375-750 mg of ranolazine once in a single-dose and twice daily in multiple-dose based on their dose groups. Blood samples for the PK assessment were collected up to 48 h after dosing. The geometric mean ratio and its 90% confidence interval in Korean to white subjects for Cmax, Cmax,ss, AUClast, and AUC0-12h,ss of ranolazine were calculated. A population PK analysis was also performed. Safety profiles were assessed throughout the study. FINDINGS A total of 70 Korean and 48 white subjects completed the study. Ranolazine exposure was similar between Korean and white subjects in all dose groups; however, ranolazine exposure at 750 mg was observed to increase by up to 29% in Korean subjects compared with that in white subjects. On the basis of previous studies, these differences in ranolazine exposure between the 2 ethnic groups may not result in any clinically significant difference. Furthermore, ethnicity was not significantly correlated with the PK properties of ranolazine in the ranolazine PK model. In addition, no significant difference was found in the safety profile of ranolazine between the 2 ethnic groups. IMPLICATIONS The PK properties of ranolazine had no clinically significant difference, and no difference was found in the safety profiles of ranolazine between Korean and white subjects. It is anticipated that ranolazine can be administered in Korean subjects without dose adjustment. ClinicalTrials.gov identifier: NCT02817932.
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7
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Luo Y, Wang CZ, Sawadogo R, Tan T, Yuan CS. Effects of Herbal Medicines on Pain Management. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 48:1-16. [PMID: 32054304 DOI: 10.1142/s0192415x20500019] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pain is an unpleasant sensory and emotional experience in many diseases and is often caused by intense or damaging stimuli. Pain negatively affects the quality of life and increases high health expenditures. Drugs with analgesic properties are commonly used to relieve pain, but these Western medications could be overwhelmed by side effects including tolerance and addiction. Herbal medicines may provide alternative measures for pain management. In this review paper, after introduction of Chinese medicine theory and treatment modality, emphasis is placed on the application of Chinese herbs and herbal formulations in pain management. Three of the most commonly used herbs, i.e., Corydalis yanhusuo, Ligusticum chuanxiong, and Aconitum carmichaeli, are reviewed. Subsequently, using this ancient medical remedy, Chinese herbal formulation in treating common medical conditions associated with pain, such as headache/migraine, chest pain, abdominal pain, low back pain, neuropathic pain, osteoarthritis, and cancer pain, is presented. Chinese herbal medicines could be considered as a complementary and integrative approach in the modern armamentarium in combating pain.
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Affiliation(s)
- Yun Luo
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, P. R. China.,Tang Center for Herbal Medicine Research, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Chong-Zhi Wang
- Tang Center for Herbal Medicine Research, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
| | - Richard Sawadogo
- Tang Center for Herbal Medicine Research, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Institute for Health Science Research, 03 BP 7192 Ouagadougou 03, Burkina Faso
| | - Ting Tan
- Key Laboratory of Modern Preparation of Traditional Chinese Medicine, Ministry of Education, Jiangxi University of Traditional Chinese Medicine, Nanchang 330004, P. R. China
| | - Chun-Su Yuan
- Tang Center for Herbal Medicine Research, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Department of Anesthesia and Critical Care, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA.,Committee on Clinical Pharmacology and Pharmacogenomics, Pritzker School of Medicine, University of Chicago, Chicago, Illinois 60637, USA
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8
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Levy BI, Heusch G, Camici PG. The many faces of myocardial ischaemia and angina. Cardiovasc Res 2020; 115:1460-1470. [PMID: 31228187 DOI: 10.1093/cvr/cvz160] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 04/25/2019] [Accepted: 06/17/2019] [Indexed: 12/13/2022] Open
Abstract
Obstructive disease of the epicardial coronary arteries is the main cause of angina. However, a number of patients with anginal symptoms have normal coronaries or non-obstructive coronary artery disease (CAD) despite electrocardiographic evidence of ischaemia during stress testing. In addition to limited microvascular vasodilator capacity, the coronary microcirculation of these patients is particularly sensitive to vasoconstrictor stimuli, in a condition known as microvascular angina. This review briefly summarizes the determinants and control of coronary blood flow (CBF) and myocardial perfusion. It subsequently analyses the mechanisms responsible for transient myocardial ischaemia: obstructive CAD, coronary spasm and coronary microvascular dysfunction in the absence of epicardial coronary lesions, and variable combinations of structural anomalies, impaired endothelium-dependent and/or -independent vasodilation, and enhanced perception of pain. Lastly, we exemplify mechanism of angina during tachycardia. Distal to a coronary stenosis, coronary dilator reserve is already recruited and can be nearly exhausted at rest distal to a severe stenosis. Increased heart rate reduces the duration of diastole and thus CBF when metabolic vasodilation is no longer able to increase CBF. The increase in myocardial oxygen consumption and resulting metabolic vasodilation in adjacent myocardium without stenotic coronary arteries further acts to divert blood flow away from the post-stenotic coronary vascular bed through collaterals.
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Affiliation(s)
- Bernard I Levy
- Inserm U970 and Vessels and Blood Institute, 8 Rue Guy Patin, Paris, France
| | - Gerd Heusch
- Institute for Pathophysiology, West German Heart and Vascular Center, Universitätsklinikum Essen, Essen, Germany
| | - Paolo G Camici
- Vita Salute University and San Raffaele Hospital, Milan, Italy
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Clinical Impact of Atypical Chest Pain and Diabetes Mellitus in Patients with Acute Myocardial Infarction from Prospective KAMIR-NIH Registry. J Clin Med 2020; 9:jcm9020505. [PMID: 32059609 PMCID: PMC7074023 DOI: 10.3390/jcm9020505] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 02/04/2020] [Accepted: 02/10/2020] [Indexed: 11/27/2022] Open
Abstract
Atypical chest pain and diabetic autonomic neuropathy attract less clinical attention, leading to underdiagnosis and delayed treatment. To evaluate the long-term clinical impact of atypical chest pain and diabetes mellitus (DM), we categorized 11,159 patients with acute myocardial infarction (AMI) from the Korea AMI-National Institutes of Health between November 2011 and December 2015 into four groups (atypical DM, atypical non-DM, typical DM, and typical non-DM). The primary endpoint was defined as patient-oriented composite endpoint (POCE) at 2 years including all-cause death, any myocardial infarction (MI), and any revascularization. Patients with atypical chest pain showed higher 2-year mortality than those with typical chest pain in both DM (29.5% vs. 11.4%, p < 0.0001) and non-DM (20.4% vs. 6.3%, p < 0.0001) groups. The atypical DM group had the highest risks of POCE (hazard ratio (HR) 1.76, 95% confidence interval (CI) 1.48–2.10), all-cause death (HR 2.23, 95% CI 1.80–2.76) and any MI (HR 2.34, 95% CI 1.51–3.64) in the adjusted model. In conclusion, atypical chest pain was significantly associated with mortality in patients with AMI. Among four groups, the atypical DM group showed the worst clinical outcomes at 2 years. Application of rapid rule in/out AMI protocols would be beneficial to improve clinical outcomes.
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Zivelonghi C, Kuijk JP, Poletti E, Suttorp MJ, Eefting FD, Rensing BJ, Berg JM, Colombo A, Azzalini L, Agostoni P. A “minimalistic hybrid algorithm” in coronary chronic total occlusion revascularization: Procedural and clinical outcomes. Catheter Cardiovasc Interv 2020; 95:97-104. [DOI: 10.1002/ccd.28213] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/16/2019] [Indexed: 08/30/2023]
Affiliation(s)
- Carlo Zivelonghi
- Department of Cardiology, Sint Antonius Ziekenhuis Nieuwegein The Netherlands
- Deparment of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim Antwerp Belgium
| | - Jan Peter Kuijk
- Department of Cardiology, Sint Antonius Ziekenhuis Nieuwegein The Netherlands
| | - Enrico Poletti
- Department of Cardiology, Sint Antonius Ziekenhuis Nieuwegein The Netherlands
- Interventional Cardiology Division, Cardio‐Thoracic‐Vascular Department, San Raffaele Scientific Institute Milan Italy
| | - Maarten J. Suttorp
- Department of Cardiology, Sint Antonius Ziekenhuis Nieuwegein The Netherlands
| | - Frank D. Eefting
- Department of Cardiology, Sint Antonius Ziekenhuis Nieuwegein The Netherlands
| | - Benno J. Rensing
- Department of Cardiology, Sint Antonius Ziekenhuis Nieuwegein The Netherlands
| | - Jurrien M. Berg
- Department of Cardiology, Sint Antonius Ziekenhuis Nieuwegein The Netherlands
| | - Antonio Colombo
- Interventional Cardiology Division, Cardio‐Thoracic‐Vascular Department, San Raffaele Scientific Institute Milan Italy
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio‐Thoracic‐Vascular Department, San Raffaele Scientific Institute Milan Italy
| | - Pierfrancesco Agostoni
- Department of Cardiology, Sint Antonius Ziekenhuis Nieuwegein The Netherlands
- Deparment of Cardiology, Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA) Middelheim Antwerp Belgium
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Zahid JA, Isbrand A, Kleif J, Schou-Pedersen AMV, Lykkesfeldt J, Madsen MT, Gögenur I. The effect of melatonin on endothelial dysfunction in patients after acute coronary syndrome: The MEFACS randomized clinical trial. J Pineal Res 2019; 67:e12600. [PMID: 31355944 DOI: 10.1111/jpi.12600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/13/2019] [Accepted: 07/21/2019] [Indexed: 12/23/2022]
Abstract
Endothelial dysfunction (ED) precedes acute coronary syndrome. Oxidative stress results in ED but is reversible. Melatonin is aside from being a circadian hormone, also an antioxidant. The aim of this study was to investigate whether 25 mg melatonin administered for twelve weeks following acute coronary syndrome (ACS) could improve ED. In this placebo-controlled randomized trial, ED was measured as reactive hyperemia index (RHI) at baseline, day 14, and day 84. The effect was assessed using a generalized estimating equation adjusted for the baseline RHI. As secondary outcome, the concentrations of three biomarkers were measured: l-arginine, asymmetric dimethylarginine, and uric acid. Thirty-one patients were included in the study. The intention-to-treat analysis of the primary outcome had 26 patients due to missing data. The estimated marginal mean difference in RHI at day 14 and day 84 between the groups was 0.15 (95% CI: 0.29-0.01, P = .039) in favor of the placebo group. No significant differences in the biomarker concentrations were found. Melatonin treatment after ACS did not improve but may have aggravated ED. The significant difference between groups was in favor of placebo, but this might be due to the effect of missing data or uneven distribution of comorbidities.
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Affiliation(s)
- Jawad Ahmad Zahid
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Anders Isbrand
- Department of Clinical Physiology and Nuclear Medicine, Herlev Hospital, Herlev, Denmark
| | - Jakob Kleif
- Department of Surgery, Nordsjaellands Hospital, Hillerød, Denmark
| | | | - Jens Lykkesfeldt
- Faculty of Health & Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Michael Tvilling Madsen
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
| | - Ismail Gögenur
- Department of Surgery, Centre for Surgical Science, Zealand University Hospital, Køge, Denmark
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Doi S, Suzuki M, Funamizu T, Takamisawa I, Tobaru T, Daida H, Isobe M. Clinical features of potential after-effects of percutaneous coronary intervention in the treatment of silent myocardial ischemia. Heart Vessels 2019; 34:1917-1924. [DOI: 10.1007/s00380-019-01444-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Accepted: 05/31/2019] [Indexed: 01/11/2023]
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Affiliation(s)
- Paolo G Camici
- Vita Salute University, IRCCS Ospedale San Raffaele, Milano, Italy
| | - Marco Magnoni
- Vita Salute University, IRCCS Ospedale San Raffaele, Milano, Italy
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14
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Waheed N, Kaufman N, Seawright J, Park K. Ischemic Heart Disease in Women. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2019. [DOI: 10.15212/cvia.2019.0006] [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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15
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Hajibandeh S, Hajibandeh S, Antoniou SA, Torella F, Antoniou GA. Effect of beta-blockers on perioperative outcomes in vascular and endovascular surgery: a systematic review and meta-analysis. Br J Anaesth 2018; 118:11-21. [PMID: 28039238 DOI: 10.1093/bja/aew380] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To investigate the role of perioperative beta-blocker use in vascular and endovascular surgery. METHODS We performed a systematic review in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. The review protocol was registered with International Prospective Register of Systematic Reviews (registration number:CRD42016038111). We searched electronic databases to identify all randomized controlled trials and observational studies investigating outcomes of patients undergoing vascular and endovascular surgery with or without perioperative beta blockade. We used the Cochrane tool and the Newcastle-Ottawa scale to assess the risk of bias of trials and observational studies, respectively. Random-effects models were applied to calculate pooled outcome data. RESULTS We identified three randomized trials, five retrospective cohort studies, and three prospective cohort studies, enrolling a total of 32,602 patients. Our analyses indicated that perioperative use of beta-blockers did not reduce the risk of all-cause mortality [odds ratio (OR) 1.10, 95% confidence interval (CI) 0.59-2.04, P = 0.77], cardiac mortality (OR 2.62, 95% CI 0.86-8.05, P = 0.09), myocardial infarction (OR 0.89, 95% CI 0.59-1.35, P = 0.58), unstable angina (OR 1.34, 95% CI 0.41- 4.38, P = 0.63), stroke (OR 2.45, 95% CI 0.89-6.75, P = 0.08), arrhythmias (OR 0.76, 95% CI 0.41-1.43, P = 0.40), congestive heart failure (OR 1.12, 95% CI 0.77-1.63, P = 0.56), renal failure (OR 1.48, 95% CI 0.90-2.45, P = 0.13), composite cardiovascular events (OR 0.88, 95% CI 0.55-1.40, P = 0.58), rehospitalisation (OR 0.86, 95% CI 0.48-1.52, P = 0.60), and reoperation (OR 1.17, 95% CI 0.42-3.27, P = 0.77) in vascular surgery. CONCLUSIONS Beta-blockers do not improve perioperative outcomes in vascular and endovascular surgery.
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Affiliation(s)
- S Hajibandeh
- Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK
| | - S Hajibandeh
- Department of General Surgery, Royal Blackburn Hospital, Blackburn, UK
| | - S A Antoniou
- Department of General Surgery, University Hospital of Heraklion, University of Crete, Heraklion, Greece
| | - F Torella
- Department of Mathematical Sciences, School of Physical Sciences, University of Liverpool, Liverpool, UK
| | - G A Antoniou
- Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, Pennine Acute Hospitals NHS Trust, Manchester, UK
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Xu Y, Shao B. Circulating lncRNA IFNG-AS1 expression correlates with increased disease risk, higher disease severity and elevated inflammation in patients with coronary artery disease. J Clin Lab Anal 2018; 32:e22452. [PMID: 29744951 PMCID: PMC6817098 DOI: 10.1002/jcla.22452] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/23/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This study aimed to investigate the associations of circulating long, non-coding (lncRNA) IFNG-AS1, lncRNA ANRIL and lncRNA ITSN1 relative expressions with disease risk, severity and inflammatory cytokines levels in coronary artery disease (CAD) patients. METHODS One hundred and ninety-one patients suspected of CAD who underwent coronary angiography were consecutively enrolled in this casecontrol study, and divided into CAD patients (N = 102) and controls (N = 89) according to coronary angiographic results. Blood samples of all participants were collected. Plasma lncRNA IFNG-AS1, lncRNA ANRIL and lncRNA ITSN1 expressions were detected using quantitative polymerase chain reaction (qPCR). Serum tumor necrosis factor-α (TNF-α), interleukin (IL)-1β (IL-1β), IL-6, IL-8, IL-10, and IL-17 were assessed using enzyme-linked immunosorbent assay (ELISA). Gensini Score was used to evaluate the disease severity of CAD patients. RESULTS LncRNA IFNG-AS1 relative expression in CAD patients was upregulated compared with that in controls (P < .001), and the receiver operating characteristic (ROC) curve showed that the area under curve (AUC) of lncRNA-IFNG-AS1 for predicting the risk of CAD was 0.755 (95% CI: 0.688-0.821). lncRNA IFNG-AS1 relative expression was remarkably associated with Gensini Score (r = .259, P = .009). Additionally, lncRNA IFNG-AS1 relative expression was positively associated with high-sensitivity C-reactive protein (hs-CRP) (r = .283, P = .004), TNF-α (r = .269, P = .006), and IL-6 levels (r = .425, P < .001), while it was negatively correlated with IL-10 level (r = -.263, P = .008). lncRNA ANRIL or lncRNA ITSN1 was not correlated with CA D risk, Gensini Score, hs-CRP, ESR, TNF-α, IL-1β, IL-6, IL-8, IL-10, or IL-17 levels (all P > .05). CONCLUSION Circulating lncRNA IFNG-AS1 expression correlates with increased disease risk, higher disease severity and elevated inflammation in CAD patients.
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Affiliation(s)
- Yahuan Xu
- Department of Cardiothoracic SurgeryHuangshi Central HospitalEdong Healthcare GroupAffiliated Hospital of Hubei Polytechnic UniversityHuangshiChina
| | - Bibo Shao
- Department of Intensive Care UnitHuangshi Central HospitalEdong Healthcare GroupAffiliated Hospital of Hubei Polytechnic UniversityHuangshiChina
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17
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Association between perioperative β-blocker use and clinical outcome of non-cardiac surgery in coronary revascularized patients without severe ventricular dysfunction or heart failure. PLoS One 2018; 13:e0201311. [PMID: 30067841 PMCID: PMC6070245 DOI: 10.1371/journal.pone.0201311] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 07/12/2018] [Indexed: 01/06/2023] Open
Abstract
Perioperative use of β-blocker has been encouraged in patients undergoing non-cardiac surgery despite weak evidence, especially in patients without left ventricular systolic dysfunction (LVSD) or heart failure (HF). This study evaluated the effects of perioperative β-blocker on clinical outcomes after non-cardiac surgery among coronary revascularized patients without LVSD or HF. Among a total of 503 patients with a history of coronary revascularization (either by percutaneous coronary intervention or coronary arterial bypass grafts) undergoing non-cardiac surgery, those without severe LVSD defined by ejection fraction over 30% or HF were evaluated. The primary outcome was a composite of death, myocardial infarction, repeat revascularization, and stroke during 1-year follow-up. Perioperative β-blocker was used in 271 (53.9%) patients. During 1-year follow-up, we found no significant difference in primary outcome between the two groups on multivariate analysis (hazard ratio [HR], 1.01; confidence interval [CI] 95%, 0.56–1.82; P = 0.963). The same result was shown in propensity-matched population (HR, 1.25; CI 95%, 0.65–2.38; P = 0.504). In coronary revascularized patients without severe LVSD or HF, perioperative β-blocker use may not be associated with postoperative clinical outcome of non-cardiac surgery. Larger registry data is needed to support this finding.
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18
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Balla C, Pavasini R, Ferrari R. Treatment of Angina: Where Are We? Cardiology 2018; 140:52-67. [DOI: 10.1159/000487936] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 02/23/2018] [Indexed: 12/16/2022]
Abstract
Ischaemic heart disease is a major cause of death and disability worldwide, while angina represents its most common symptom. It is estimated that approximately 9 million patients in the USA suffer from angina and its treatment is challenging, thus the strategy to improve the management of chronic stable angina is a priority. Angina might be the result of different pathologies, ranging from the “classical” obstruction of a large coronary artery to alteration of the microcirculation or coronary artery spasm. Current clinical guidelines recommend antianginal therapy to control symptoms, before considering coronary artery revascularization. In the current guidelines, drugs are classified as being first-choice (beta-blockers, calcium channel blockers, and short-acting nitrates) or second-choice (ivabradine, nicorandil, ranolazine, trimetazidine) treatment, with the recommendation to reserve second-line modifications for patients who have contraindications to first-choice agents, do not tolerate them, or remain symptomatic. However, such a categorical approach is currently questioned. In addition, current guidelines provide few suggestions to guide the choice of drugs more suitable according to the underlying pathology or the patient comorbidities. Several other questions have recently emerged, such as: is there evidence-based data between first- and second-line treatments in terms of prognosis or symptom relief? Actually, it seems that newer antianginal drugs, which are classified as second choice, have more evidence-based clinical data that are more contemporary to support their use than what is available for the first-choice drugs. It follows that actual guidelines are based more on tradition than on evidence and there is a need for new algorithms that are more individualized to patients, their comorbidities, and pathophysiological mechanism of chronic stable angina.
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Magdy G, Sadaka M, Elzawawy T, Elmaghraby A. Effect of elective percutaneous coronary intervention of left anterior descending coronary artery on regional myocardial function using strain imaging. Egypt Heart J 2018; 70:83-88. [PMID: 30166887 PMCID: PMC6112371 DOI: 10.1016/j.ehj.2017.12.003] [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: 08/02/2017] [Accepted: 12/03/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Percutaneous coronary intervention (PCI) is a commonly used procedure for revascularization, however the impairment of regional myocardial function in patients with stable coronary artery disease (CAD) has not been well characterized, our study aimed to assess the improvement of left ventricular (LV) systolic function after elective PCI of the left anterior descending artery (LAD) using strain and strain rate imaging techniques. MATERIALS AND METHODS The study included 30 patients (aged 56.8 ± 6.6 years, 66.7% males) presented with stable CAD on optimal medical therapy, and recommended for elective PCI to LAD, all patients included in the study had a normal LV wall motions, and normal LV systolic function. Tissue Doppler imaging (TDI) was done before PCI, immediately, and three months post PCI. The peak systolic longitudinal strain (PSLS), and peak systolic strain rate (PSSR) were measured and averaged for the 6 LAD segments (the basal, mid, and apical segments of the anterior wall, the basal, mid anteroseptal, and the apicoseptal segments), 15 healthy control subjects were included as a control group. RESULTS The average PSLS and PSSR of the ischemic segments were significantly lower in patients compared to control in the ischemic segments, and significantly increased 3 months post PCI but not immediately post PCI. Using the ROC curve a cutoff value of -13.69% for PSLS can detect regional ischemia with a sensitivity 93.3% and a specificity of 80%. CONCLUSIONS TDI derived strain and strain rate can detect resting regional myocardial dysfunction in presence of preserved LV systolic function, and can assess the improvement of regional myocardial function after successful elective PCI in patients with stable CAD.
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Affiliation(s)
- Gehan Magdy
- Department of Cardiology, Alexandria University, Egypt
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20
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Zivelonghi C, van Kuijk JP, Nijenhuis V, Poletti E, Suttorp MJ, van der Heyden JAS, Eefting FD, Rensing BJ, ten Berg JM, Azzalini L, van den Brink FS, Ribichini F, Colombo A, Henriques JPS, Agostoni P. First report of the use of long-tapered sirolimus-eluting coronary stent for the treatment of chronic total occlusions with the hybrid algorithm. Catheter Cardiovasc Interv 2018; 92:E299-E307. [DOI: 10.1002/ccd.27539] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 01/17/2018] [Accepted: 01/20/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Carlo Zivelonghi
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
- Department of Cardiology; University of Verona; Verona Italy
| | - Jan P. van Kuijk
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Vincent Nijenhuis
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Enrico Poletti
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department; San Raffaele Scientific Institute; Milano Italy
| | - Maarten J. Suttorp
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | | | - Frank D. Eefting
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Benno J. Rensing
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Jurrien M. ten Berg
- Department of Cardiology; St Antonius Ziekenhuis; Nieuwegein The Netherlands
| | - Lorenzo Azzalini
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department; San Raffaele Scientific Institute; Milano Italy
| | | | | | - Antonio Colombo
- Interventional Cardiology Division, Cardio-Thoracic-Vascular Department; San Raffaele Scientific Institute; Milano Italy
| | - José P. S. Henriques
- Department of Cardiology; Academic Medical Center, University of Amsterdam; Amsterdam the Netherlands
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Wu H, Zhang J. miR-126 in Peripheral Blood Mononuclear Cells Negatively Correlates with Risk and Severity and is Associated with Inflammatory Cytokines as well as Intercellular Adhesion Molecule-1 in Patients with Coronary Artery Disease. Cardiology 2018; 139:110-118. [PMID: 29316562 DOI: 10.1159/000484236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/16/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate the association of miR-126 with risk and severity of coronary artery disease (CAD) as well as its correlation with inflammatory cytokines and endothelial related proteins. METHODS In total, 215 patients suspected of CAD who underwent coronary angiography were enrolled in this case control study and were divided into a CAD group (n = 119) and control group (n = 96). miR-126 relative expression was assessed by real-time polymerase chain reaction. RESULTS The relative expression of miR-126 decreased in CAD patients compared to controls (p < 0.001), and the receiver operating characteristic curve showed a good diagnostic value of miR-126 for CAD risk with an area under the curve of 0.801 (95% CI 0.740-0.861). Additionally, miR-126 was negatively correlated with high-sensitivity C-reactive protein levels (p < 0.001) and reversely associated with TNF-α (p = 0.008) and IL-6 (p < 0.001) levels, while it was positively correlated with the IL-10 level (p < 0.001). In addition, miR-126 was negatively associated with intercellular adhesion molecule-1 (ICAM-1) levels (p = 0.001), and no association of miR-126 with vascular endothelial growth factor was detected (p = 0.142). Meanwhile, the miR-126 relative level was negatively associated with the Gensini score (p < 0.001). CONCLUSIONS Peripheral blood mononuclear cell miR-126 predicts risk and severity and correlates with inflammatory cytokines as well as ICAM-1 in patients with CAD.
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Affiliation(s)
- Huiliang Wu
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Simonavičius J, Jarašūnienė D. Angina pectoris and sinus of Valsalva aneurysm: a rare manifestation of an uncommon disease. Acta Med Litu 2018; 25:234-239. [PMID: 31308829 DOI: 10.6001/actamedica.v25i4.3934] [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] [Indexed: 01/16/2023] Open
Abstract
Sinus of Valsalva aneurysm is an uncommon finding. The present paper describes a case report of a 57-year-old female patient who developed angina pectoris due to the left sinus of Valsalva aneurysm. Clinical presentation, localization, unruptured status and concomitant coarctation of the aorta make the case presented in this document extremely rare and interesting. Current knowledge about the disease is briefly discussed.
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Affiliation(s)
- Justas Simonavičius
- Centre of Cardiology and Angiology, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
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Newer Therapies for Management of Stable Ischemic Heart Disease With Focus on Refractory Angina. Am J Ther 2017; 23:e1842-e1856. [PMID: 25590765 DOI: 10.1097/mjt.0000000000000187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Ischemic heart disease remains a major public health problem nationally and internationally. Stable ischemic heart disease (SIHD) is one of the clinical manifestations of ischemic heart disease and is generally characterized by episodes of reversible myocardial demand/supply mismatch, related to ischemia or hypoxia, which are usually inducible by exercise, emotion, or other stress and reproducible-but which may also be occurring spontaneously. Improvements in the treatment of acute coronary syndromes along with increasing prevalence of cardiovascular risk factors, including diabetes and obesity, have led to increasing population of patients with SIHD. A significant number of these continue to have severe angina despite medical management and revascularization procedures performed and may progress to refractory angina. This article reviews the newer therapies in the treatment of SIHD with special focus in treating patients with refractory angina.
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Pivotal Cytoprotective Mediators and Promising Therapeutic Strategies for Endothelial Progenitor Cell-Based Cardiovascular Regeneration. Stem Cells Int 2016; 2016:8340257. [PMID: 28090210 PMCID: PMC5206447 DOI: 10.1155/2016/8340257] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/11/2016] [Accepted: 10/27/2016] [Indexed: 02/07/2023] Open
Abstract
Cardiovascular diseases (CVDs), including atherosclerosis, stroke, and myocardial infarction, is a major cause of death worldwide. In aspects of cell therapy against CVD, it is generally accepted that endothelial progenitor cells (EPCs) are potent neovascular modulators in ischemic tissues. In response to ischemic injury signals, EPCs located in a bone marrow niche migrate to injury sites and form new vessels by secreting various vasculogenic factors including VEGF, SDF-1, and FGF, as well as by directly differentiating into endothelial cells. Nonetheless, in ischemic tissues, most of engrafted EPCs do not survive under harsh ischemic conditions and nutrient depletion. Therefore, an understanding of diverse EPC-related cytoprotective mediators underlying EPC homeostasis in ischemic tissues may help to overcome current obstacles for EPC-mediated cell therapy for CVDs. Additionally, to enhance EPC's functional capacity at ischemic sites, multiple strategies for cell survival should be considered, that is, preconditioning of EPCs with function-targeting drugs including natural compounds and hormones, virus mediated genetic modification, combined therapy with other stem/progenitor cells, and conglomeration with biomaterials. In this review, we discuss multiple cytoprotective mediators of EPC-based cardiovascular repair and propose promising therapeutic strategies for the treatment of CVDs.
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Javed F, Ramee S. The Unknown Association of PPIs With Chest Pain in Patients With Known, Treated Coronary Artery Disease-A Diagnostic Dilemma. Curr Probl Cardiol 2016; 41:235-244. [PMID: 27908388 DOI: 10.1016/j.cpcardiol.2016.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Patients with coronary artery disease (CAD) are destined to lifelong antiplatelet therapy in form of aspirin (acetylsalicylic acid) alone, or in combination with other P2Y2 inhibitors. Proton pump inhibitors (PPIs) are the preferred agents for the treatment and prophylaxis of gastrointestinal injury associated with nonsteroidal anti-inflammatory drug or acetylsalicylic acid or both,1 but recent data has raised questions about their association with negative cardiovascular events. We report 2 cases of patients with known CAD presented with chest pain mimicking angina pectoris that successfully resolved on discontinuation of the PPIs. One male and one female patient with known history of CAD receiving PPIs were referred to us with symptoms of refractory angina that was unresponsive to conventional optimized medical therapy. The angina was reported to be related to exertion in both the patients. Neither patient had a diagnosis of Prinzmetal angina or peptic ulcer disease; however, both patients reported a history of gastroesophageal reflux disease. Both patients were on dual antiplatelet therapy. No ischemic changes on the electrocardiogram were noted for either patient. Patient 1 had an exercise stress test that was negative for any inducible ischemia whereas patient 2 had no obstructive lesion seen on coronary angiography. Both patients reported to be symptom free after discontinuation of PPIs at 8 months of follow-up. It is our opinion that a relationship between PPIs and angina-like chest pain is plausible, as these 2 cases demonstrate the causative role of PPIs in precipitation of their symptoms. We postulate that this association should be considered in differential diagnosis of chest pain. In light of above findings we suggest that this is hypothesis generating and we are exploring the role of PPIs in patients with history of CAD and refractory angina-like symptoms despite complete revascularization.
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Kureshi F, Shafiq A, Arnold SV, Gosch K, Breeding T, Kumar AS, Jones PG, Spertus JA. The prevalence and management of angina among patients with chronic coronary artery disease across US outpatient cardiology practices: insights from the Angina Prevalence and Provider Evaluation of Angina Relief (APPEAR) study. Clin Cardiol 2016; 40:6-10. [PMID: 28146269 DOI: 10.1002/clc.22628] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 09/03/2016] [Accepted: 09/11/2016] [Indexed: 11/10/2022] Open
Abstract
Although eliminating angina is a primary goal in treating patients with chronic coronary artery disease (CAD), few contemporary data quantify prevalence and severity of angina across US cardiology practices. The authors hypothesized that angina among outpatients with CAD managed by US cardiologists is low and its prevalence varies by site. Among 25 US outpatient cardiology clinics enrolled in the American College of Cardiology Practice Innovation and Clinical Excellence (PINNACLE) registry, we prospectively recruited a consecutive sample of patients with chronic CAD over a 1- to 2-week period at each site between April 2013 and July 2015, irrespective of the reason for their appointment. Eligible patients had documented history of CAD (prior acute coronary syndrome, prior coronary revascularization procedure, or diagnosis of stable angina) and ≥1 prior office visit at the practice site. Angina was assessed directly from patients using the Seattle Angina Questionnaire Angina Frequency score. Among 1257 patients from 25 sites, 7.6% (n = 96) reported daily/weekly, 25.1% (n = 315) monthly, and 67.3% (n = 846) no angina. The proportion of patients with daily/weekly angina at each site ranged from 2.0% to 24.0%, but just over half (56.3%) were on ≥2 antianginal medications, with wide variability across sites (0%-100%). One-third of outpatients with chronic CAD managed by cardiologists report having angina in the prior month, and 7.6% have frequent symptoms. Among those with frequent angina, just over half were on ≥2 antianginal medications, with wide variability across sites. These findings suggest an opportunity to improve symptom control.
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Affiliation(s)
- Faraz Kureshi
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City
| | - Ali Shafiq
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City
| | - Suzanne V Arnold
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Tracie Breeding
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | | | - Philip G Jones
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - John A Spertus
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri.,University of Missouri-Kansas City
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Elgendy IY, Winchester DE, Pepine CJ. Experimental and early investigational drugs for angina pectoris. Expert Opin Investig Drugs 2016; 25:1413-1421. [PMID: 27791405 DOI: 10.1080/13543784.2016.1254617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Ischemic heart disease (IHD) is a major cause of death and disability among Western countries and angina pectoris is the most prevalent symptomatic manifestation. Strategies to improve management of chronic stable angina are a priority. Areas covered: A comprehensive review was conducted using the Medline and Cochrane databases as well as the clinical trial databases in the United States and Europe. Traditional therapies for angina will be discussed. This review particularly emphasizes investigational therapies for angina (including pharmacological agents, cell and gene based therapies, and herbal medications). Expert opinion: There has been renewed interest in older anti-angina agents (e.g., perhexiline, amiodarone, and phosphodiestrase-5 inhibitors). Other anti-inflammatory agents (e.g., allopurinol and febuxostat) are currently undergoing evaluation for angina therapy. Therapeutic angiogenesis continues to face some challenges. Future trials should evaluate the optimum patient population that would benefit from this form of therapy.
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Affiliation(s)
- Islam Y Elgendy
- a Division of Cardiovascular Medicine , University of Florida, and North Florida/South Georgia Veterans Health System , Gainesville , FL , USA
| | - David E Winchester
- a Division of Cardiovascular Medicine , University of Florida, and North Florida/South Georgia Veterans Health System , Gainesville , FL , USA
| | - Carl J Pepine
- a Division of Cardiovascular Medicine , University of Florida, and North Florida/South Georgia Veterans Health System , Gainesville , FL , USA
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Phongtankuel V, Amorapanth PX, Siegler EL. Pain in the Geriatric Patient with Advanced Chronic Disease. Clin Geriatr Med 2016; 32:651-661. [PMID: 27741961 DOI: 10.1016/j.cger.2016.06.008] [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: 01/29/2023]
Abstract
The World Health Organization, one of the leading authorities on pain management, stressed the need for further guidelines to help manage pain in patients with chronic disease. In light of the impact of pain on morbidity and quality of life, this article summarizes current knowledge about pain experienced by older adults in 3 advanced non-cancer-related chronic diseases (ie, congestive heart failure, end-stage renal disease, and stroke) in which pain is common but not typically a primary focus of disease management. This article examines the data on the prevalence of pain, co-occurring symptoms, and challenges in managing pain in these conditions.
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Affiliation(s)
- Veerawat Phongtankuel
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street Box 39, New York, NY 10065, USA.
| | - Prin X Amorapanth
- Department of Rehabilitation, Rusk Rehabilitation at New York University Langone Medical Center, 238 East 38th Street 15-62, New York, NY 10016, USA
| | - Eugenia L Siegler
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical College, 525 East 68th Street Box 39, New York, NY 10065, USA
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Yin X, Wang J, Zheng W, Ma J, Hao P, Chen Y. Diagnostic performance of coronary computed tomography angiography versus exercise electrocardiography for coronary artery disease: a systematic review and meta-analysis. J Thorac Dis 2016; 8:1688-96. [PMID: 27499958 DOI: 10.21037/jtd.2016.06.06] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
BACKGROUND Both coronary computed tomography angiography (CCTA) and exercise electrocardiography (ExECG) are non-invasive testing methods for the evaluation of coronary artery disease (CAD). However, there was controversy on the diagnostic performance of these methods due to the limited data in each single study. Therefore, we performed a meta-analysis to address these issues. METHODS We searched PubMed and Embase databases up to May 22, 2015. Two authors identified eligible studies, extracted data and accessed quality. Pooled estimation of sensitivity, specificity, positive likelihood ratio (PLR), negative likelihood ratio (NLR), diagnostic odds ratio (DOR), summary receiver-operating characteristic curve (SROC) and the area under curve (AUC) of CCTA and ExECG for the diagnosis of CAD were calculated using Stata, Meta-Disc and Review Manager statistical software. RESULTS Seven articles were included. Pooled sensitivity of CCTA and ExECG were 0.98 [95% confidence intervals (CIs): 0.95-0.99] and 0.66 (95% CIs: 0.59-0.72); pooled specificity of CCTA and ExECG were 0.84 (95% CIs: 0.81-0.87) and 0.75 (95% CIs: 0.71-0.79); pooled DOR of CCTA and ExECG were 110.24 (95% CIs: 35.07-346.55) and 6.28 (95% CIs: 2.06-19.13); and AUC of CCTA and ExECG were 0.9950±0.0046 and 0.7727±0.0638, respectively. There is no heterogeneity caused by threshold effect in CCTA or ExECG analysis. The Deeks' test showed no potential publication bias (P=0.17). CONCLUSIONS CCTA has better diagnostic performance than ExECG in the evaluation of CAD, which can provide a better solution for the clinical problem of the diagnosis for CAD.
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Affiliation(s)
- Xinxin Yin
- Department of Emergency, Qilu Hospital, Shandong University, Jinan 250012, China;; School of Clinical Medicine, Taishan Medical University, Taian 271016, China
| | - Jiali Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan 250012, China;; Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China;; Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan 250012, China;; Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Wen Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan 250012, China;; Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China;; Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan 250012, China;; Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Jingjing Ma
- Department of Emergency, Qilu Hospital, Shandong University, Jinan 250012, China;; Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China;; Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan 250012, China;; Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Panpan Hao
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
| | - Yuguo Chen
- Department of Emergency, Qilu Hospital, Shandong University, Jinan 250012, China;; Chest Pain Center, Qilu Hospital, Shandong University, Jinan 250012, China;; Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan 250012, China;; Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan 250012, China
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Keeley EC, Schutt RC, Marinescu MA, Burdick MD, Strieter RM, Mehrad B. Circulating fibrocytes as predictors of adverse events in unstable angina. Transl Res 2016; 172:73-83.e1. [PMID: 27012475 PMCID: PMC4866880 DOI: 10.1016/j.trsl.2016.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 02/05/2016] [Accepted: 02/28/2016] [Indexed: 11/22/2022]
Abstract
Half of the patients who present with unstable angina (UA) develop recurrent symptoms over the subsequent year. Identification of patients destined to develop such adverse events would be clinically valuable, but current tools do not allow for this discrimination. Fibrocytes are bone marrow-derived progenitor cells that co-express markers of leukocytes and fibroblasts and are released into the circulation in the context of tissue injury. We hypothesized that, in patients with UA, the number of circulating fibrocytes predicts subsequent adverse events. We enrolled 55 subjects with UA, 18 with chronic stable angina, and 22 controls and correlated their concentration of circulating fibrocytes to clinical events (recurrent angina, myocardial infarction, revascularization, or death) over the subsequent year. Subjects with UA had a >2-fold higher median concentration of both total and activated fibrocytes compared with subjects with chronic stable angina and controls. In UA subjects, the concentration of total fibrocytes identified those who developed recurrent angina requiring revascularization (time-dependent area under the curve 0.85) and was superior to risk stratification using thrombolysis in myocardial infarction risk score and N-terminal pro B-type natriuretic peptide levels (area under the curve, 0.53 and 0.56, respectively, P < 0.001). After multivariable adjustment for thrombolysis in myocardial infarction predicted death, MI, or recurrent ischemia, total fibrocyte level was associated with recurrent angina (hazard ratio, 1.016 per 10,000 cells/mL increase; 95% confidence interval, 1.007-1.024; P < 0.001). Circulating fibrocytes are elevated in patients with UA and successfully risk stratify them for adverse clinical outcomes. Fibrocytes may represent a novel biomarker of outcome in this population.
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Affiliation(s)
- Ellen C Keeley
- Department of Medicine, University of Virginia, Charlottesville, Va; Division of Cardiology, University of Virginia, Charlottesville, Va.
| | - Robert C Schutt
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Tex
| | - Mark A Marinescu
- Department of Medicine, University of Virginia, Charlottesville, Va
| | - Marie D Burdick
- Department of Medicine, University of Virginia, Charlottesville, Va; Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Va
| | - Robert M Strieter
- Department of Medicine, University of Virginia, Charlottesville, Va; Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Va
| | - Borna Mehrad
- Department of Medicine, University of Virginia, Charlottesville, Va; Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, Va; The Carter Center for Immunology, University of Virginia, Charlottesville, Va
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31
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Vainer J, Habets JHM, Schalla S, Lousberg AHP, de Pont CDJM, Vöö SA, Brans BT, Hoorntje JCA, Waltenberger J. Cardiac shockwave therapy in patients with chronic refractory angina pectoris. Neth Heart J 2016; 24:343-9. [PMID: 26936156 PMCID: PMC4840112 DOI: 10.1007/s12471-016-0821-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Cardiac shockwave therapy (CSWT) might improve symptoms and decrease ischaemia burden by stimulating collateral growth in chronic ischaemic myocardium. This prospective study was performed to evaluate the feasibility and safety of CSWT. Methods We included 33 patients (mean age 70 ± 7 years, mean left ventricular ejection fraction 55 ± 12 %) with end-stage coronary artery disease, chronic angina pectoris and reversible ischaemia on myocardial scintigraphy. CSWT was applied to the ischaemic zones (3–7 spots/session, 100 impulses/spot, 0.09 mJ/mm2) in an echocardiography-guided and ECG-triggered fashion. The protocol included a total of 9 treatment sessions (3 treatment sessions within 1 week at baseline, and after 1 and 2 months). Clinical assessment was performed using exercise testing, angina score (CCS class), nitrate use, myocardial scintigraphy, and cardiac magnetic resonance (CMR) 1 and 4 months after the last treatment session. Results One and 4 months after CSWT, sublingual nitrate use decreased from 10/week to 2/week (p < 0.01) and the angina symptoms diminished from CCS class III to CCS class II (p < 0.01). This clinical improvement was accompanied by an improved myocardial uptake on stress myocardial scintigraphy (54.2 ± 7.7 % to 56.4 ± 9.4 %, p = 0.016) and by increased exercise tolerance at 4-month follow-up (from 7.4 ± 2.8 to 8.8 ± 3.6 min p = 0.015). No clinically relevant side effects were observed. Conclusion CSWT improved symptoms and reduced ischaemia burden in patients with end-stage coronary artery disease without relevant side effects. The study provides a solid basis for a randomised multicentre trial to establish CSWT as a new treatment option in end-stage coronary artery disease.
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Affiliation(s)
- J Vainer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - J H M Habets
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S Schalla
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - A H P Lousberg
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - C D J M de Pont
- Department of Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - S A Vöö
- Department of Nuclear Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - B T Brans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J C A Hoorntje
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - J Waltenberger
- Department of Cardiovascular Medicine, University Hospital Muenster, Muenster, Germany
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Cacciapuoti F. Ranolazine and Ivabradine: two different modalities to act against ischemic heart disease. Ther Adv Cardiovasc Dis 2016; 10:98-102. [PMID: 26944071 PMCID: PMC5933631 DOI: 10.1177/1753944716636042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Among the innovative drugs recently introduced for the management of chronic stable angina, Ranolazine and ivabradine represent two most true innovations. In fact, even if both drugs act by reducing myocardial work and thus oxygen consumption, this happens by a peculiar mechanism unlike that of conventional antischemic drugs. Ranolazine mediates its antianginal effects by the inhibition of cardiac late sodium current. This improves myocardial relaxation favoring myocardial perfusion. Ivabradine is a selective If channel blocker and acts by reducing firing rate of pacemaker cells in the sinoatrial node, without affecting the duration of action potential. The reduction of heart rate causes a reduction of left ventricular end diastolic pressure and increases the time useful to coronary flow by a prolongation of the diastole. A body of evidence found that two drugs are useful in ischemic patients whether at rest or during exercise. In addition, they can be used in monotherapy or in association with other conventional anti-ischemic drugs. The two medications could be used with advantage also in microvascular angina when standard therapy is ineffective. Thus, the two drugs represent an adjunctive and powerful therapeutic modality for the treatment of chronic stable angina, especially when conventional antianginal drugs were insufficient or inadequate.
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Affiliation(s)
- Federico Cacciapuoti
- Department of Internal Medicine, Second University of Naples, Piazza L. Miraglia, 2, 80138-Naples, Italy
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Qintar M, Spertus JA, Gosch KL, Beltrame J, Kureshi F, Shafiq A, Breeding T, Alexander KP, Arnold SV. Effect of angina under-recognition on treatment in outpatients with stable ischaemic heart disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2016; 2:208-214. [PMID: 28239488 PMCID: PMC5322471 DOI: 10.1093/ehjqcco/qcw016] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/19/2016] [Accepted: 03/21/2016] [Indexed: 01/07/2023]
Abstract
AIMS Almost a third of outpatients with chronic coronary artery disease (CAD) report having angina in the prior month, which is frequently under-recognized by their cardiologists. Whether under-recognition is associated with less treatment escalation to control angina, and potential underuse of treatment, is unknown. METHODS AND RESULTS Patients with CAD from 25 US cardiology outpatient practices completed the Seattle Angina Questionnaire (SAQ) prior to their clinic visit, and angina was categorized as daily, weekly, monthly and no angina. Cardiologists (n=155) independently quantified patients' angina, blinded to patients' SAQ scores. Under-recognition was defined as the physician reporting a lower category of angina frequency than the patient. Among 1257 patients with CAD, 411 reported angina in the past month, of whom 178 (43.3%) patients were under-recognized. Treatment escalation-defined as intensification (up-titration or addition) of antianginal medications, referral for diagnostic testing or revascularization, or hospital admission-occurred in 106 (25.8%) patients with angina. Patients with under-recognized angina were less likely to get treatment escalation than patients whose angina was appropriately recognized (8.4% vs 39.1%, P<0.001). In a hierarchical multivariable logistic regression model adjusting for demographic and clinical characteristics, as well as the burden of angina, under-recognition remained strongly associated with a lack of treatment escalation (adjusted OR 0.10, 95% CI 0.04-0.21, P<0.001). CONCLUSIONS Under-recognition of angina in cardiology outpatient practices is associated with less aggressive treatment escalation and may lead to poorer angina control. Standardizing clinical recognition of angina using validated tools could reduce under-recognition of angina, facilitate treatment, and potentially improve outcomes.
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Affiliation(s)
- Mohammed Qintar
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - John A. Spertus
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Kensey L. Gosch
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
| | | | - Faraz Kureshi
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Ali Shafiq
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
- University of Missouri-Kansas City, Kansas City, MO, USA
| | - Tracie Breeding
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
| | - Karen P. Alexander
- Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
| | - Suzanne V. Arnold
- Saint Luke's Mid America Heart Institute, 4401 Wornall Road, Kansas City, MO 64111, USA
- University of Missouri-Kansas City, Kansas City, MO, USA
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Zarifis J, Grammatikou V, Kallistratos M, Katsivas A. Antianginal Efficacy of Ivabradine in Patients With History of Coronary Revascularization. Angiology 2016; 68:10-18. [PMID: 26960667 PMCID: PMC5152794 DOI: 10.1177/0003319716630499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Although coronary revascularization procedures are widely performed in patients with coronary artery disease (CAD), angina is often reported, even after such procedures. This study evaluated the antianginal efficacy and effect of ivabradine treatment on quality of life (QOL) in patients with CAD and history of coronary revascularization. This is a post hoc analysis (926 post-revascularization patients) of a prospective, noninterventional study, which included 2403 patients with CAD and stable angina. The data were recorded at baseline, at 1 month and 4 months after inclusion. After ivabradine administration, mean number of anginal events decreased from 2.2 ± 2.3 (median: 2.0, minimum: 0.0, maximum: 21.0, range: 21.0) to 0.3 ± 0.6 (median: 0.0, minimum: 0.0, maximum: 7.0, range: 7.0) times/week (P < .001), while nitroglycerin consumption decreased from 1.5 ± 2.2 (median: 1.0, minimum: 0.0, maximum: 20.0, range: 20.0) to 0.1 ± 0.4 times/week (median: 0.0, minimum: 0.0, maximum: 5.0, range: 5.0; P < .001). Quality of life improved at study completion compared to baseline (P < .001). Ivabradine addition on top of optimal individualized dose of β-blockers is associated with decreased anginal events and improvement in QOL in patients with stable angina and history of coronary revascularization.
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Affiliation(s)
- J Zarifis
- Cardiology Department, George Papanikolaou General Hospital, Thessaloniki, Greece
| | - V Grammatikou
- Medical Department, Servier Hellas Pharmaceuticals Ltd, Athens, Greece
| | - M Kallistratos
- Medical Department, Servier Hellas Pharmaceuticals Ltd, Athens, Greece
| | - A Katsivas
- First Cardiology Department, Korgialeneio-Benakeio E.E.S. General Hospital, Athens, Greece
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Hartmann S, Ridley AJ, Lutz S. The Function of Rho-Associated Kinases ROCK1 and ROCK2 in the Pathogenesis of Cardiovascular Disease. Front Pharmacol 2015; 6:276. [PMID: 26635606 PMCID: PMC4653301 DOI: 10.3389/fphar.2015.00276] [Citation(s) in RCA: 206] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/03/2015] [Indexed: 01/26/2023] Open
Abstract
Rho-associated kinases ROCK1 and ROCK2 are serine/threonine kinases that are downstream targets of the small GTPases RhoA, RhoB, and RhoC. ROCKs are involved in diverse cellular activities including actin cytoskeleton organization, cell adhesion and motility, proliferation and apoptosis, remodeling of the extracellular matrix and smooth muscle cell contraction. The role of ROCK1 and ROCK2 has long been considered to be similar; however, it is now clear that they do not always have the same functions. Moreover, depending on their subcellular localization, activation, and other environmental factors, ROCK signaling can have different effects on cellular function. With respect to the heart, findings in isoform-specific knockout mice argue for a role of ROCK1 and ROCK2 in the pathogenesis of cardiac fibrosis and cardiac hypertrophy, respectively. Increased ROCK activity could play a pivotal role in processes leading to cardiovascular diseases such as hypertension, pulmonary hypertension, angina pectoris, vasospastic angina, heart failure, and stroke, and thus ROCK activity is a potential new biomarker for heart disease. Pharmacological ROCK inhibition reduces the enhanced ROCK activity in patients, accompanied with a measurable improvement in medical condition. In this review, we focus on recent findings regarding ROCK signaling in the pathogenesis of cardiovascular disease, with a special focus on differences between ROCK1 and ROCK2 function.
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Affiliation(s)
- Svenja Hartmann
- Institute of Pharmacology, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research, Göttingen, Germany
- Randall Division of Cell and Molecular Biophysics, King’s College London, London, UK
| | - Anne J. Ridley
- Randall Division of Cell and Molecular Biophysics, King’s College London, London, UK
| | - Susanne Lutz
- Institute of Pharmacology, University Medical Center Göttingen, Georg-August-University Göttingen, Göttingen, Germany
- German Center for Cardiovascular Research, Göttingen, Germany
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Lee SY, Shin DH, Shehata I, Kim JS, Kim BK, Ko YG, Choi D, Jang Y, Hong MK. Association between fractional flow reserve and coronary plaque characteristics assessed by optical coherence tomography. J Cardiol 2015; 68:342-5. [PMID: 26603326 DOI: 10.1016/j.jjcc.2015.10.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 10/10/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND The assessment of fractional flow reserve (FFR) in coronary lesions determines the strategy of percutaneous coronary intervention. However, the association between FFR and characteristics of the underlying coronary plaque has not been sufficiently investigated. METHODS A total of 110 coronary lesions in 106 patients were evaluated using both FFR and optical coherence tomography (OCT). Coronary plaques were classified into fibrous, fibrocalcific, or fibroatheroma according to OCT evaluation at the site of minimal lumen area. Plaque microstructures such as cap thickness, macrophage accumulation, intimal vasculature, or cholesterol crystals were also evaluated. RESULTS Lesions with FFR≤0.8 showed a higher frequency of fibroatheroma, macrophage accumulation, and cholesterol crystals when compared to those with FFR>0.8. The angle of lipid was wider in lesions with FFR≤0.8 (145.1±63.0° vs. 120.7±48.9°, p=0.047), and the longitudinal length was longer in those with FFR≤0.8 (4.2±2.8mm vs. 2.5±2.9mm, p=0.007). However, multiple linear regression analysis revealed that the morphological characteristics of plaques assessed by OCT were not independently associated with FFR. Minimal lumen area [coefficient, 0.035; 95% confidence interval (CI), 0.022-0.048; p<0.001] and area stenosis (coefficient, -0.003; 95% CI, -0.005 to -0.001; p=0.001) assessed by OCT significantly correlated with FFR. CONCLUSION The morphological characteristics of coronary plaque derived from OCT are not directly related to FFR.
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Affiliation(s)
- Seung-Yul Lee
- Sanbon Hospital, Wonkwang University College of Medicine, Gunpo, Republic of Korea
| | - Dong-Ho Shin
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Islam Shehata
- Department of Cardiology, Zagazig University, Zagazig, Egypt
| | - Jung-Sun Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Young-Guk Ko
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Donghoon Choi
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yangsoo Jang
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Myeong-Ki Hong
- Severance Cardiovascular Hospital, Yonsei University Health System, Seoul, Republic of Korea; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Abstract
Stable coronary artery disease is the most common clinical manifestation of ischaemic heart disease and a leading cause of mortality worldwide. Myocardial revascularisation is a mainstay in the treatment of symptomatic patients or those with ischaemia-producing coronary lesions, and reduces ischaemia to a greater extent than medical treatment. Documentation of ischaemia and plaque burden is fundamental in the risk stratification of patients with stable coronary artery disease, and several invasive and non-invasive techniques are available (eg, fractional flow reserve or intravascular ultrasound) or being validated (eg, instantaneous wave-free ratio and optical coherence tomography). The use of new-generation drug-eluting stents and arterial conduits greatly improve clinical outcome in patients undergoing percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG). PCI is feasible, safe, and effective in many patients with stable coronary artery disease who remain symptomatic despite medical treatment. In patients with multivessel and left main coronary artery disease, the decision between PCI or CABG is guided by the local Heart Team (team of different cardiovascular specialists, including non-invasive and invasive cardiologists, and cardiac surgeons), who carefully judge the possible benefits and risks inherent to PCI and CABG. In specific subsets, such as patients with diabetes and advanced, multivessel coronary artery disease, CABG remains the standard of care in view of improved protection against recurrent ischaemic adverse events.
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Affiliation(s)
- Raffaele Piccolo
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Gennaro Giustino
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Roxana Mehran
- The Zena and Michael A Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
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Abstract
Stable angina pectoris is characterised by typical exertional chest pain that is relieved by rest or nitrates. Risk stratification of patients is important to define prognosis, to guide medical management and to select patients suitable for revascularisation. Medical treatment aims to relieve angina and prevent cardiovascular events. Beta blockers and calcium channel antagonists are first-line options for treatment. Short-acting nitrates can be used for symptom relief. Low-dose aspirin and statins are prescribed to prevent cardiovascular events.
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Affiliation(s)
- Yong Wee
- Heart Lung Institute, Prince Charles Hospital, Brisbane
| | - Kylie Burns
- Heart Lung Institute, Prince Charles Hospital, Brisbane
| | - Nicholas Bett
- Heart Lung Institute, Prince Charles Hospital, Brisbane
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Gibbons RJ, Miller TD. Should extensive myocardial ischaemia prompt revascularization to improve outcomes in chronic coronary artery disease? Eur Heart J 2015; 36:2281-7. [DOI: 10.1093/eurheartj/ehv282] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/01/2015] [Indexed: 02/03/2023] Open
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40
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Voronina VP, Kisseleva NV, Martsevich SY. EXERCISE TESTS IN CARDIOLOGY: PAST, PRESENT AND FUTURE (PART I). КАРДИОВАСКУЛЯРНАЯ ТЕРАПИЯ И ПРОФИЛАКТИКА 2015. [DOI: 10.15829/1728-8800-2015-2-80-87] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
The literary review is focused on diagnostics of coronary heart disease (CHD) with the use of the most common functional exercise tests. The benefits and the lacks are discussed of a variety of tests for suspected CHD. The results of longitude controlled trials make now the physicians able to precisely enough estimate a risk of complications in a patient. Several diagnostic indexes are observed, that are based on complex analysis of clinical and simple instrumental parameters for long term risk evaluation in CHD and for the selection of adequate treatment method.
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Affiliation(s)
- V. P. Voronina
- FSBI State Scientific-Research Centre for Preventive Medicine of the Healthcare Ministry. Moscow, Russia
| | - N. V. Kisseleva
- FSBI State Scientific-Research Centre for Preventive Medicine of the Healthcare Ministry. Moscow, Russia
| | - S. Yu. Martsevich
- FSBI State Scientific-Research Centre for Preventive Medicine of the Healthcare Ministry. Moscow, Russia
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Moattari M, Adib F, Kojuri J, Tabatabaee SHR. Angina self-management plan and quality of life, anxiety and depression in post coronary angioplasty patients. IRANIAN RED CRESCENT MEDICAL JOURNAL 2015; 16:e16981. [PMID: 25763214 PMCID: PMC4329936 DOI: 10.5812/ircmj.16981] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 05/12/2014] [Accepted: 09/08/2014] [Indexed: 01/13/2023]
Abstract
Background: Coronary artery diseases are the most frequent cause of mortality in industrialized countries as well as Iran. Coronary artery disease affects patient’s quality of life (QoL) and produces some degrees of anxiety and depression. Although self-management programs have shown significant impact on chronic diseases, there is limited evidence in Iran regarding the effectiveness of these interventions, particularly in patients with coronary artery disease. Objectives: This study aimed to evaluate the effects of angina plan on QoL, anxiety, and depression in post coronary angioplasty patients referred to selected hospitals in Shiraz. Patients and Methods: This parallel randomized, controlled trial was conducted in selected hospitals in Shiraz, Iran. We enrolled 80 post coronary angioplasty eligible patients in the study. After acquisition of the informed consent, eligible patients were randomly divided into two groups: control and experimental. Pretest data were obtained by using a demographic data form and two valid and reliable questionnaires for QoL, anxiety, and depression. Blood pressure, weight, and height (to calculate body mass index) were measured too. Patient’s history of smoking, diabetes, hypercholesterolemia, hypertension, and coronary vascular involvement (with grade and severity) were obtained from their medical records. A 12-week angina plan intervention consisted of a 30 to 40 minutes of counseling interview and telephone follow up at the end of 1, 4, 8, and 12 weeks were performed for experimental group. Post-test data were obtained three months after the pretest using the same questionnaires as pretest. QoL data were analyzed by analysis of co-variance (ANCOVA). The results (before and after intervention) regarding anxiety and depression were analyzed by independent t-tests or their equivalent nonparametric Mann-Whitney test using SPSS v. 11.5. Results: There was no statistically significant difference in demographic variables between two groups. Baseline mean scores for QoL, anxiety, and depression did not differ between the two groups. There was a significant difference between the experimental and control groups in terms of changes in perception of QoL before and after the intervention. Adjusted mean ± SD of perception of QoL for the control group was 38.48 ± 13.38 and for the experimental one was 56.30 ± 13.38, with a P value of less than 0.001. The mean difference of anxiety scores (before and after intervention) in experimental and control groups were 1.15 ± 1.99 and.0.07 ± 2.22, respectively with a P value of less than 0.01. The mean difference of depression scores (before and after intervention) in experimental and control groups were 0.4 ± 2.89 and 0.13 ± 2.76, respectively (P > 0.05). Conclusions: Our results show that the self-management angina plan was effective in improving perception of QoL and reducing anxiety. Further studies with a larger sample size and a longer follow-up period are recommended to better understand the effectiveness of this plan.
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Affiliation(s)
- Marzieh Moattari
- Department of Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding Author: Marzieh Moattari, Department of Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, P.O. Box: 71935-13-14, Shiraz, IR Iran. Tel: +98-7116467460; +98-7116474250, Fax: +98-7118215324; +98-7116474251, E-mail:
| | - Fakhteh Adib
- Department of Nursing, Faculty of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Javad Kojuri
- Department of Cardiology, Faculty of Medicine, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Exogenous nitric oxide inhibits Rho-associated kinase activity in patients with angina pectoris: a randomized controlled trial. Hypertens Res 2015; 38:485-90. [PMID: 25740292 DOI: 10.1038/hr.2015.24] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Revised: 01/06/2015] [Accepted: 01/25/2015] [Indexed: 11/08/2022]
Abstract
The RhoA/Rho-associated kinase (ROCK) pathway has a key physiological role in the pathogenesis of atherosclerosis. Increased ROCK activity is associated with cardiovascular diseases. Endogenous nitric oxide (NO) has an anti-atherosclerotic effect, whereas the exogenous NO-mediated cardiovascular effect still remains controversial. The purpose of this study was to evaluate the effect of exogenous NO on ROCK activity in patients with angina pectoris. This is a prospective, open-label, randomized, controlled study. A total of 30 patients with angina pectoris were randomly assigned to receive 40 mg day(-1) of isosorbide mononitrate (n=15, 12 men and 3 women, mean age of 63±12 years, isosorbide mononitrate group) or conventional treatment (n=15, 13 men and 2 women, mean age of 64±13 years, control group) for 12 weeks. ROCK activity in peripheral leukocytes was measured by western blot analysis. ROCK activities at 4 and 12 weeks after treatment were decreased in the isosorbide mononitrate group (0.82±0.33 at 0 week, 0.62±0.20 at 4 weeks, 0.61±0.19 at 12 weeks, n=15 in each group, P<0.05, respectively) but not altered in the control group. ROCK1 and ROCK2 expression levels were similar in all treatment periods in the two groups. These findings suggest that the administration of exogenous NO can inhibit ROCK activity, indicating that the usage of exogenous NO could have a protective effect in patients with angina pectoris.
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Werdan K, Ebelt H, Nuding S, Höpfner F, Stöckl G, Müller-Werdan U. Ivabradine in combination with Beta-blockers in patients with chronic stable angina after percutaneous coronary intervention. Adv Ther 2015; 32:120-37. [PMID: 25687888 PMCID: PMC4349945 DOI: 10.1007/s12325-015-0182-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Indexed: 12/28/2022]
Abstract
Introduction The anti-anginal efficacy of ivabradine is well established. We describe a post hoc analysis in the ADDITIONS database to investigate effectiveness and tolerability of ivabradine in combination with beta-blocker in patients with angina who have had a percutaneous coronary intervention (PCI). Methods ADDITIONS was a non-interventional, multicenter prospective study including 2,330 patients with stable angina. In addition to beta-blocker, patients were treated with ivabradine in approved dosages for 4 months. We divided the population according to whether they had previously had a PCI or not, and explored the effect of ivabradine on heart rate, number of weekly angina attacks, frequency of nitrate consumption, as well as quality of life (QoL) and tolerability. Results Data were available for 2,319 patients, of whom 51.4% had previously had a PCI. There was no difference in the effect of ivabradine on mean heart rate between patients with a previous PCI [64.4 ± 7.6 beats per minute (bpm)] than those without (66.8 ± 8.5 bpm) at 4 months (both P < 0.0001). Similarly, the number of angina attacks decreased from 1.9 ± 2.4 to 0.5 ± 1.5 per week in patients with a previous PCI and 1.5 ± 2.0 to 0.3 ± 1.0 per week in patients without a previous PCI (both P < 0.0001). The frequency of nitrate consumption fell from 2.7 ± 3.7 to 1.0 ± 1.9 per week and 1.8 ± 2.8 to 0.6 ± 1.5 per week (both P < 0.0001) in patients with and without a previous PCI, respectively. There was no difference in the improvements in Canadian Cardiovascular Society class of angina, QoL, and physicians’ assessment of effectiveness and tolerability between patients with a previous PCI and those without. Conclusion Ivabradine is an effective and well-tolerated anti-anginal treatment in patients with stable angina after PCI. Ivabradine reduced the frequency of weekly angina attacks and nitrate consumption, led to an improvement in Canadian Cardiovascular Society class and a substantial improvement in the QoL of stable angina patients. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0182-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Karl Werdan
- Department of Medicine and Heart Centre, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany,
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Zhang Z, Zhang F, Wang Y, Du Y, Zhang H, Kong D, Liu Y, Yang G. Traditional Chinese medicine for stable angina pectoris via TCM pattern differentiation and TCM mechanism: study protocol of a randomized controlled trial. Trials 2014; 15:422. [PMID: 25359307 PMCID: PMC4233055 DOI: 10.1186/1745-6215-15-422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 10/13/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Stable angina pectoris is experienced as trans-sternal or retro-sternal pressure or pain that may radiate to the left arm, neck or back. Although available evidence relating to its effectiveness and mechanism are weak, traditional Chinese medicine is used as an alternative therapy for stable angina pectoris. We report a protocol of a randomized controlled trial using traditional Chinese medicine to investigate the effectiveness, mechanism and safety for patients with stable angina pectoris. METHODS/DESIGN This is a north-east Chinese, multi-center, multi-blinded, placebo-controlled and superiority randomized trail. A total of 240 patients with stable angina pectoris will be randomly assigned to three groups: two treatment groups and a control group. The treatment groups will receive Chinese herbal medicine consisting of Yi-Qi-Jian-Pi and Qu-Tan-Hua-Zhuo granule and Yi-Qi-Jian-Pi and Qu-Tan-Hua-Yu granule, respectively, and conventional medicine. The control group will receive placebo medicine in addition to conventional medicine. All 3 groups will undergo a 12-week treatment and 2-week follow-up. Four visits in sum will be scheduled for each subject: 1 visit each in week 0, week 4, week 12 and week 14. The primary outcomes include: the frequency of angina pectoris attack; the dosage of nitroglycerin; body limited dimension of Seattle Angina Questionnaire. The secondary outcomes include: except for the body limited dimension of SAQ, traditional Chinese medicine pattern questionnaire and so on. Therapeutic mechanism outcomes, safety outcomes and endpoint outcomes will be also assessed. DISCUSSION The primary aim of this trial is to develop a standard protocol to utilize high-quality EBM evidence for assessing the effectiveness and safety of SAP via TCM pattern differentiation as well as exploring the efficacy mechanism and regulation with the molecular biology and systems biology. TRIAL REGISTRATION CLINICAL TRIALS REGISTRATION ChiCTR-TRC-13003608, registered 18 June 2013.
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Affiliation(s)
- Zhe Zhang
- />Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning China
| | - Fan Zhang
- />Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning China
| | - Yang Wang
- />Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning China
| | - Yi Du
- />Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning China
| | - Huiyong Zhang
- />Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning China
| | - Dezhao Kong
- />Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning China
| | - Yue Liu
- />Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Shenyang, Liaoning China
| | - Guanlin Yang
- />Liaoning University of Traditional Chinese Medicine, 79, Chong Shan Dong Lu Road, Huanggu District, Shenyang, 110032 Liaoning China
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Mancini GJ, Gosselin G, Chow B, Kostuk W, Stone J, Yvorchuk KJ, Abramson BL, Cartier R, Huckell V, Tardif JC, Connelly K, Ducas J, Farkouh ME, Gupta M, Juneau M, O’Neill B, Raggi P, Teo K, Verma S, Zimmermann R. Canadian Cardiovascular Society Guidelines for the Diagnosis and Management of Stable Ischemic Heart Disease. Can J Cardiol 2014; 30:837-49. [DOI: 10.1016/j.cjca.2014.05.013] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 05/22/2014] [Accepted: 05/23/2014] [Indexed: 02/05/2023] Open
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Petraco R, van de Hoef TP, Nijjer S, Sen S, van Lavieren MA, Foale RA, Meuwissen M, Broyd C, Echavarria-Pinto M, Foin N, Malik IS, Mikhail GW, Hughes AD, Francis DP, Mayet J, Di Mario C, Escaned J, Piek JJ, Davies JE. Baseline instantaneous wave-free ratio as a pressure-only estimation of underlying coronary flow reserve: results of the JUSTIFY-CFR Study (Joined Coronary Pressure and Flow Analysis to Determine Diagnostic Characteristics of Basal and Hyperemic Indices of Functional Lesion Severity-Coronary Flow Reserve). Circ Cardiovasc Interv 2014; 7:492-502. [PMID: 24987048 DOI: 10.1161/circinterventions.113.000926] [Citation(s) in RCA: 137] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Coronary flow reserve has extensive validation as a prognostic marker in coronary disease. Although pressure-only fractional flow reserve (FFR) improves outcomes compared with angiography when guiding percutaneous coronary intervention, it disagrees with coronary flow reserve classification 30% of the time. We evaluated whether baseline instantaneous wave-free ratio (iFR) could provide an improved pressure-only estimation of underlying coronary flow reserve. METHODS AND RESULTS Invasive pressure and flow velocity were measured in 216 stenoses from 186 patients with coronary disease. The diagnostic relationship between pressure-only indices (iFR and FFR) and coronary flow velocity reserve (CFVR) was compared using correlation coefficient and the area under the receiver operating characteristic curve. iFR showed a stronger correlation with underlying CFVR (iFR-CFVR, ρ=0.68 versus FFR-CFVR, ρ=0.50; P<0.001). iFR also agreed more closely with CFVR in stenosis classification (iFR area under the receiver operating characteristic curve, 0.82 versus FFR area under the receiver operating characteristic curve, 0.72; P<0.001, for a CFVR of 2). The closer relationship between iFR and CFVR was found for different CFVR cutoffs and was particularly marked in the 0.6 to 0.9 FFR range. Hyperemic FFR flow was similar to baseline iFR flow in functionally significant lesions (FFR ≤0.75; mean FFR flow, 25.8±13.7 cm/s versus mean iFR flow, 21.5±11.7 cm/s; P=0.13). FFR flow was higher than iFR flow in nonsignificant stenoses (FFR >0.75; mean FFR flow, 42.3±22.8 cm/s versus mean iFR flow, 26.1±15.5 cm/s; P<0.001). CONCLUSIONS When compared with FFR, iFR shows stronger correlation and better agreement with CFVR. These results provide physiological evidence that iFR could potentially be used as a functional index of disease severity, independently from its agreement with FFR.
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Affiliation(s)
- Ricardo Petraco
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Tim P van de Hoef
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Sukhjinder Nijjer
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Sayan Sen
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Martijn A van Lavieren
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Rodney A Foale
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Martijn Meuwissen
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Christopher Broyd
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Mauro Echavarria-Pinto
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Nicolas Foin
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Iqbal S Malik
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Ghada W Mikhail
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Alun D Hughes
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Darrel P Francis
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Jamil Mayet
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Carlo Di Mario
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Javier Escaned
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Jan J Piek
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.)
| | - Justin E Davies
- From the International Centre for Circulatory Health, National Heart and Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, London, United Kingdom (R.P., S.N., S.S., R.A.F., C.B., N.F., I.S.M., G.W.M., A.D.H., D.P.F., J.M., C.D.M., J.E.D.); Department of Cardiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands (T.P.v.d.H., M.A.v.L., J.J.P.); Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain (M.E.-P., J.E.); Amphia Hospital, Breda, The Netherlands (M.M.); and Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom (C.D.M.).
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Wolak A, Rafaeli E, Toledano R, Novack V, Gilutz H, Henkin Y. Attenuated predictive power of a normal myocardial perfusion scan in young smokers. Eur J Intern Med 2014; 25:452-7. [PMID: 24793836 DOI: 10.1016/j.ejim.2014.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Revised: 03/14/2014] [Accepted: 03/30/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The negative predictive value of a normal myocardial perfusion image (MPI) for myocardial infarction or cardiac death is very high. However, it is unclear whether a normal MPI, reflecting non-compromised blood flow in the stable state, would have the same prognostic implications in smokers as in patients who do not smoke. METHODS The incidence of total mortality, cardiovascular mortality, and myocardial infarction was evaluated in 11,812 subjects (14.6% of whom were current smokers at the time of the study) with a normal MPI study and no past history of coronary artery disease during the period 1997 to 2008. RESULTS During an average follow-up of 72.4 ± 32.4 months the risk for an acute myocardial infarction in current smokers was approximately 50% higher than the corresponding risk in non-smokers, despite a younger average age. Cox proportional regression models show that current smoking was associated with an increased hazard rate for the composite endpoint below age 60 (HR=2.09, 95%CI 1.43-3.07, p<0.001), but not at older ages (HR=1.16, 95% CI 0.81-1.66, p=0.4). CONCLUSIONS In individuals below age 60, but not at older ages, current smoking is associated with increased short- and long-term risk of cardiac death and acute myocardial infarction even in subjects with a normal MPI.
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Affiliation(s)
- Arik Wolak
- Cardiology Department, Soroka University Medical Center, Beer-Sheva 84101, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Einat Rafaeli
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Ronen Toledano
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 84101, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Victor Novack
- Clinical Research Center, Soroka University Medical Center, Beer-Sheva 84101, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Harel Gilutz
- Cardiology Department, Soroka University Medical Center, Beer-Sheva 84101, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel
| | - Yaakov Henkin
- Cardiology Department, Soroka University Medical Center, Beer-Sheva 84101, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva 84101, Israel.
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Bittencourt MS, Hulten EA, Nasir K, Blankstein R. Utility of Cardiovascular Imaging to Refine Cardiovascular Disease (CVD) Risk Assessment. CURRENT CARDIOVASCULAR RISK REPORTS 2014. [DOI: 10.1007/s12170-014-0378-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Li D, Yang M, Zhao L, Zheng H, Li Y, Chang X, Cui J, Wang R, Shi J, Lv J, Leng J, Li J, Liang F. Acupuncture for chronic, stable angina pectoris and an investigation of the characteristics of acupoint specificity: study protocol for a multicenter randomized controlled trial. Trials 2014; 15:50. [PMID: 24499445 PMCID: PMC3922315 DOI: 10.1186/1745-6215-15-50] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 01/24/2014] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Chronic stable angina pectoris (CSAP) is a common cardiovascular condition that endangers a patient's life quality and longevity. As demonstrated in several clinical trials, acupuncture is attested to be effective for CSAP. Current trials are not adequate enough to provide high-quality evidence for clinical decision making, as a result of inadequate methodology design and small sample size. Notably, stark controversy toward acupoint specificity also exists in the clinical acupuncture trials for CSAP. Therefore, we designed the present study as a randomized controlled trial primarily to investigate the effectiveness of acupuncture in addition to routine care among patients with CSAP. Meanwhile, we examined whether acupoint on the disease-affected meridian (DAM) is superior to either acupoint on the non-affected meridian (NAM) or non-acupoint (NA), to further investigate the meridian-based characteristics of acupoint specificity. METHODS/DESIGN This study was a multicenter, assessor and statistician blinded, randomized controlled trial in China. In this study, 404 participants in sum will be randomly assigned to four groups through central randomization in a 1:1:1:1 ratio. The whole study period is 20 weeks including a 4-week baseline period, a 4-week treatment period and a 12-week follow-up. Participants in the DAM group receive acupuncture stimulation at acupoints on the disease-affected meridian, and three different control groups will undergo acupuncture stimulation at the NAM, the non-acupoint and no intervention respectively, in addition to basic treatment. Participants in the acupuncture groups will receive 12 sessions of acupuncture treatment over 4 weeks, while the wait-listed (WL) group would receive free acupuncture treatment after the completion of the study. The outcome measures in this trial include the frequency of angina attack during 4 weeks as the primary outcome and eight other secondary outcomes. DISCUSSION This trial will provide new and relatively high-quality evidence in acupuncture treatment for CSAP. Moreover, this trial may further validate the meridian-based characteristics of acupoint specificity by comparing the strength of acupoints on the disease-affected meridian versus that of the non-affected meridian, to further inspire optimization of acupuncture therapy for CSAP. TRIAL REGISTRATION Clinical Trials.gov NCT01686230.
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Affiliation(s)
- Dehua Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Mingxiao Yang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ling Zhao
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Hui Zheng
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Ying Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Xiaorong Chang
- Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Jin Cui
- Guiyang College of Traditional Chinese Medicine, Guiyang, Guizhou, PR China
| | - Ruihui Wang
- Shanxi College of Traditional Chinese Medicine, Xi’an, Shanxi, China
| | - Jing Shi
- Yunnan Provincial Hospital of Traditional Chinese Medicine, Kunming, Yunnan, China
| | - Junling Lv
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Junyan Leng
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Juan Li
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Fanrong Liang
- Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
- School of Acupuncture and Tuina, Chengdu University of Traditional Chinese Medicine, No.37, Shi Er Qiao Road, Jinniu District, Chengdu 610075, China
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McGillion M, O'Keefe-McCarthy S, Carroll SL, Victor JC, Cosman T, Cook A, Hanlon JG, Jolicoeur EM, Jamal N, McKelvie R, Arthur HM. Impact of self-management interventions on stable angina symptoms and health-related quality of life: a meta-analysis. BMC Cardiovasc Disord 2014; 14:14. [PMID: 24483947 PMCID: PMC3945741 DOI: 10.1186/1471-2261-14-14] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/27/2014] [Indexed: 11/25/2022] Open
Abstract
Background Chronic stable angina (CSA) has a major negative impact on health-related quality of life (HRQL) including poor general health status, psychological distress, and inability to self-manage. Methods We used meta-analysis to assess the effectiveness of self-management interventions for improving stable angina symptoms, HRQL and psychological well-being. Nine trials, involving 1,282 participants in total, were included. We used standard inverse-variance random-effects meta-analysis to combine the trials. Heterogeneity between trials was evaluated using chi-square tests for the tau-squared statistic and quantified using the I2 statistic. Results There was significant improvement in the frequency of angina symptoms (Seattle Angina Questionnaire [SAQ], symptom diary) across trials, standardized mean difference (SMD): 0.30 (95% Confidence interval [CI] 0.14, 0.47), as well as reduction in the use of sublingual (SL) nitrates, SMD: -0.49 (95% CI -0.77, -0.20). Significant improvements for physical limitation (SAQ), SMD: 0.38 (95% CI 0.20, 0.55) and depression scores (Hospital Anxiety and Depression Scale), SMD: -1.38 (95% CI -2.46, -0.30) were also found. The impact of SM on anxiety was uncertain due to statistical heterogeneity across trials for this outcome, I2 = 98%. SM did not improve other HRQL dimensions including angina stability, disease perception, and treatment satisfaction. Conclusions SM interventions significantly improve angina frequency and physical limitation; they also decrease the use of SL nitrates and improve depression in some cases. Further work is needed to make definitive conclusions about the impact of SM on cardiac-specific anxiety.
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Affiliation(s)
- Michael McGillion
- Faculty of Health Sciences, McMaster University, 1280 Main Street West, Room HSC 2J20A, Hamilton, ON L8S 4K1, Canada.
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