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Triantafyllias K, Thiele LE, Mandel A, Cavagna L, Baraliakos X, Bertsias G, Hasseli R, Minnich P, Schwarting A. Arterial Stiffness as a Surrogate Marker of Cardiovascular Disease and Atherosclerosis in Patients with Vasculitides: A Literature Review. Diagnostics (Basel) 2023; 13:3603. [PMID: 38132187 PMCID: PMC10743173 DOI: 10.3390/diagnostics13243603] [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: 10/13/2023] [Revised: 11/25/2023] [Accepted: 11/30/2023] [Indexed: 12/23/2023] Open
Abstract
Vasculitis, a group of systemic inflammatory diseases that affect the cardiovascular (CV) system, presents with a variety of clinical manifestations that depend on the size of the affected blood vessels. While some types of vasculitis reveal distinct symptoms, others are characterized by more diffuse and nonspecific presentations that can result in delayed diagnosis and treatment initiation. Interestingly, patients with vasculitides share a significant comorbidity: an elevated CV risk, contributing to increased rates of CV events and mortality. This heightened risk is caused by cumulative inflammatory burden, traditional CV risk factors, medication effects, and reduced physical fitness. Traditional risk assessment tools, commonly used in the general population, frequently underestimate the CV risk in patients with inflammatory rheumatic conditions. Consequently, novel approaches are necessary to stratify the precise CV risk in vasculitis patients. A number of surrogate parameters for CV risk have been investigated, with arterial stiffness emerging as a promising marker. Pulse wave velocity (PWV) is a well-established method for assessing arterial stiffness and predicting CV risk across different populations. Among numerous PWV variants, carotid-femoral PWV (cfPWV) stands out as the most extensively studied and accepted reference standard. It has demonstrated its utility as a surrogate CV parameter both in the general population and in patients with systemic inflammatory rheumatic diseases. In recent years, research has expanded to assess arterial stiffness in systemic rheumatic diseases, such as arthritis, connective tissue diseases, rheumatologic overlap syndromes, and chronic pain disorders, using measurements of PWV and other markers of arterial compliance and elasticity. Despite burgeoning research in rheumatologic diseases, data on CV risk markers in vasculitides remain limited and fragmented. This narrative review aims to provide a comprehensive overview of arterial stiffness as a potential screening marker for CV diseases, atheromatosis, and ultimately CV risk among patients with vasculitides.
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Affiliation(s)
- Konstantinos Triantafyllias
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543 Bad Kreuznach, Germany (P.M.)
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
| | - Leif-Erik Thiele
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543 Bad Kreuznach, Germany (P.M.)
| | - Anna Mandel
- Department of Internal Medicine, Helios Clinic, 47805 Krefeld, Germany
| | - Lorenzo Cavagna
- Department of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation Pavia, 27100 Pavia, Italy
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet Herne, Ruhr-University Bochum, 44649 Herne, Germany
| | - George Bertsias
- Department of Internal Medicine and Rheumatology, School of Medicine, University of Crete, 71500 Heraklion, Greece
| | - Rebecca Hasseli
- Department of Internal Medicine D, Section of Rheumatology and Clinical Immunology, University Hospital Munster, 48149 Munster, Germany
| | - Pascal Minnich
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543 Bad Kreuznach, Germany (P.M.)
| | - Andreas Schwarting
- Rheumatology Center Rhineland-Palatinate, Kaiser-Wilhelm-Str. 9-11, 55543 Bad Kreuznach, Germany (P.M.)
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center, Johannes Gutenberg University, 55131 Mainz, Germany
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Karakasis P, Patoulias D, Stachteas P, Lefkou E, Dimitroulas T, Fragakis N. Accelerated Atherosclerosis and Management of Cardiovascular Risk in Autoimmune Rheumatic Diseases: An Updated Review. Curr Probl Cardiol 2023; 48:101999. [PMID: 37506959 DOI: 10.1016/j.cpcardiol.2023.101999] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Even though diagnosis and management pathways have been substantially improved over the last years, autoimmune rheumatic diseases (AIRDs) such as rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome, Sjögren's syndrome, and systemic vasculitides have been linked to elevated rates of cardiovascular morbidity and mortality, primarily secondary to accelerated atherosclerosis. This phenomenon can be partially attributed to the presence of established cardiovascular risk factors but may also be a result of other inflammatory and autoimmune mechanisms that are enhanced in AIRDs. According to the current guidelines, the recommendations regarding cardiovascular disease prevention in patients with AIRDs are not significantly different from those applied to the general population. Herein, we present a review of the current literature on the risk of accelerated atherosclerosis in AIRDs and provide a summary of available recommendations for the management of cardiovascular risk in rheumatic diseases.
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Affiliation(s)
- Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece.
| | - Dimitrios Patoulias
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece; Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece; Second Department of Internal Medicine, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Panagiotis Stachteas
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece
| | - Eleftheria Lefkou
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece; Perigenesis, Institute of Obstetric Haematology, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece; Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece
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Meng K, Xiao X, Wei W, Chen G, Nashalian A, Shen S, Xiao X, Chen J. Wearable Pressure Sensors for Pulse Wave Monitoring. ADVANCED MATERIALS (DEERFIELD BEACH, FLA.) 2022; 34:e2109357. [PMID: 35044014 DOI: 10.1002/adma.202109357] [Citation(s) in RCA: 142] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/21/2021] [Indexed: 05/15/2023]
Abstract
Cardiovascular diseases remain the leading cause of death worldwide. The rapid development of flexible sensing technologies and wearable pressure sensors have attracted keen research interest and have been widely used for long-term and real-time cardiovascular status monitoring. Owing to compelling characteristics, including light weight, wearing comfort, and high sensitivity to pulse pressures, physiological pulse waveforms can be precisely and continuously monitored by flexible pressure sensors for wearable health monitoring. Herein, an overview of wearable pressure sensors for human pulse wave monitoring is presented, with a focus on the transduction mechanism, microengineering structures, and related applications in pulse wave monitoring and cardiovascular condition assessment. The conceptualizations and methods for the acquisition of physiological and pathological information related to the cardiovascular system are outlined. The biomechanics of arterial pulse waves and the working mechanism of various wearable pressure sensors, including triboelectric, piezoelectric, magnetoelastic, piezoresistive, capacitive, and optical sensors, are also subject to systematic debate. Exemple applications of pulse wave measurement based on microengineering structured devices are then summarized. Finally, a discussion of the opportunities and challenges that wearable pressure sensors face, as well as their potential as a wearable intelligent system for personalized healthcare is given in conclusion.
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Affiliation(s)
- Keyu Meng
- School of Electronic and Information Engineering Jilin Provincial Key Laboratory of Human Health Status Identification and Function Enhancement, Changchun University, Changchun, 130022, China
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Xiao Xiao
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Wenxin Wei
- Department of Anesthesiology, China Medical University, Shenyang, 110022, China
| | - Guorui Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Ardo Nashalian
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Sophia Shen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Xiao Xiao
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, 90095, USA
| | - Jun Chen
- Department of Bioengineering, University of California, Los Angeles, Los Angeles, California, 90095, USA
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Nakamura Y, Matsubara Y, Kosami K, Ae R, Sasahara T, Aoyama Y, Koike S, Ishikawa S, Makino N. Follow up of Kawasaki disease based on nationwide survey data in Japan: Mortality among those with a history of Kawasaki disease in Japan: Results of a 30-year follow up: Mortality among those with a history of Kawasaki disease in Japan: Results of a 30-year follow up. Pediatr Int 2022; 64:e15268. [PMID: 36257613 DOI: 10.1111/ped.15268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/31/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The long-term prognosis of those with a history of Kawasaki disease (KD) is still unknown. METHODS Using a permanent registry system in Japan (koseki), 6,576 persons with a history of KD were followed up. The average follow-up period was 30 years. The endpoint was death. RESULTS With a 99.5% follow-up rate, 68 deaths (48 males and 20 females) were observed. The overall standardized mortality ratio, of which reference was vital statistics in Japan, was not elevated. However, the observation according to the presence or absence of cardiac sequelae showed that the standardized mortality ratio for those with cardiac sequelae significantly elevated. Nine persons, all of whom were males, died of KD (including those cases where KD was suspected), but all deaths occurred in individuals who were under 30 years of age. CONCLUSIONS This study revealed the long-term prognosis for KD, but almost all participants were younger than 40 years. Continuing follow up of this cohort is required to clarify whether a history of KD relates to the development of atherosclerosis when participants become middle aged or older.
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Affiliation(s)
- Yosikazu Nakamura
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Yuri Matsubara
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Koki Kosami
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Ryusuke Ae
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Teppei Sasahara
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Yasuko Aoyama
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Soichi Koike
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Shizukiyo Ishikawa
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
| | - Nobuko Makino
- Department of Public Health, Jichi Medical University, Shimotsuke, Japan
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Du J, Ren Y, Liu J, Li T, Zhang Y, Yang S, Kang T, Ning S, Chen L, Guo X, Liu W, Pan L. Association of Prolonged Disease Duration and TG/HDL-C Ratio in Accelerating Atherosclerosis in Patients with Takayasu's Arteritis. Clin Appl Thromb Hemost 2022; 28:10760296221121297. [PMID: 35979594 PMCID: PMC9393669 DOI: 10.1177/10760296221121297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background and aim: Takayasu's arteritis (TA) is a chronic
inflammation that frequently involves the aorta and its major branches. It has
been known that atherosclerosis can occur in some TA patients.
Objectives: This study aimed to identify the risk factors
associated with the development of atherosclerosis in TA. Methods:
This retrospective study enrolled a total of 101 TA patients. All patients were
divided into two groups according to the absence or presence of atherosclerosis.
Baseline demographic features and clinical characteristics were compared between
two groups. A logistic model was applied to determine the risk factors
associated with the development of atherosclerosis. Results: Our
data suggested that the disease duration of patients in the atherosclerosis
group was significantly longer than that of patients in the non-atherosclerosis
group [96(18.00, 180.00) versus 48.00(12.00, 111.00) months]
(P = .015). In addition, the average age of patients with
atherosclerosis was significantly older compared to patients without
atherosclerosis [44.00(38.00, 48.00)versus 28.50(24.00,37.00)years]
(P < .001). Logistic regression
analysis showed that the risk of developing atherosclerosis increased by 9.2%
per 1 year increase in the disease duration (P = .005, OR
1.092, 95%CI: 1.027-1.162). Patients with TG/HDL-C ratio more than 0.8875 were
associated with a 5.861fold increase of risk developing atherosclerosis
(P < .001, OR 5.861, 95%CI:
2.299-14.939). Conclusion: Our study indicated that prolonged
disease duration and elevated TG/HDL-C ratio are associated with the development
of atherosclerosis in TA patients.
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Affiliation(s)
- Juan Du
- Department of Rheumatology and Immunology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanlong Ren
- Department of Cardiology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiayi Liu
- Department of Radiology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taotao Li
- Department of Rheumatology and Immunology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yaxin Zhang
- Department of Rheumatology and Immunology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shiyu Yang
- Department of Rheumatology and Immunology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Tieduo Kang
- Department of Cardiology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shangqiu Ning
- Department of Cardiology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Liying Chen
- Department of Cardiology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xi Guo
- Department of Interventional Radiology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wenxian Liu
- Department of Cardiology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lili Pan
- Department of Rheumatology and Immunology, Beijing 12667Anzhen Hospital, Capital Medical University, Beijing, China
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6
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Vascular consequences of inflammation: a position statement from the ESH Working Group on Vascular Structure and Function and the ARTERY Society. J Hypertens 2021; 38:1682-1698. [PMID: 32649623 DOI: 10.1097/hjh.0000000000002508] [Citation(s) in RCA: 79] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
: Inflammation is a physiological response to aggression of pathogenic agents aimed at eliminating the aggressor agent and promoting healing. Excessive inflammation, however, may contribute to tissue damage and an alteration of arterial structure and function. Increased arterial stiffness is a well recognized cardiovascular risk factor independent of blood pressure levels and an intermediate endpoint for cardiovascular events. In the present review, we discuss immune-mediated mechanisms by which inflammation can influence arterial physiology and lead to vascular dysfunction such as atherosclerosis and arterial stiffening. We also show that acute inflammation predisposes the vasculature to arterial dysfunction and stiffening, and alteration of endothelial function and that chronic inflammatory diseases such as rheumatoid arthritis, inflammatory bowel disease and psoriasis are accompanied by profound arterial dysfunction which is proportional to the severity of inflammation. Current findings suggest that treatment of inflammation by targeted drugs leads to regression of arterial dysfunction. There is hope that these treatments will improve outcomes for patients.
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Clifford AH, Cohen Tervaert JW. Cardiovascular events and the role of accelerated atherosclerosis in systemic vasculitis. Atherosclerosis 2021; 325:8-15. [PMID: 33873090 DOI: 10.1016/j.atherosclerosis.2021.03.032] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 12/13/2022]
Abstract
The spectrum of inflammatory blood vessel diseases includes both atherosclerosis and the primary systemic vasculitides. Although the inciting triggers differ, significant overlap exists in the mechanisms that contribute to sustained inflammation and vascular damage in both entities. With improvement in therapeutics to control acute vasculitis leading to longer survival, cardiovascular morbidity and mortality has emerged as the leading cause of death for vasculitis patients. Cardiovascular events likely occur as a consequence of vasculitis, vascular damage from prior inflammation causing a sustained procoagulant state, and accelerated atherosclerosis. In this review, we discuss the latest evidence regarding risk of cardiovascular events in patients with major forms of primary systemic vasculitis, and review the mechanisms by which accelerated atherosclerosis may occur.
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Affiliation(s)
- Alison H Clifford
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada
| | - Jan Willem Cohen Tervaert
- Division of Rheumatology, Department of Medicine, University of Alberta, Edmonton, Alberta, T6G 2G3, Canada.
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Soulaidopoulos S, Madenidou AV, Daoussis D, Melissaropoulos K, Mavrogeni S, Kitas G, Dimitroulas T. Cardiovascular Disease in the Systemic Vasculitides. Curr Vasc Pharmacol 2020; 18:463-472. [PMID: 32000652 DOI: 10.2174/1570161118666200130093432] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/28/2019] [Accepted: 12/29/2019] [Indexed: 02/07/2023]
Abstract
The vasculitides are a heterogeneous group of disorders, characterized by inflammatory cell infiltration and necrosis of blood vessels that cause vascular obstruction or aneurysm formation, affecting various organs such as lungs, kidneys, skin and joints. Cardiac involvement is commonly encountered in primary systemic vasculitis and it is associated with increased morbidity and mortality. Depending on the dominant pathophysiological mechanism, heart complications may manifest in different ways, including myocardial ischemia due to impaired micro- or macrovascular circulation, progressive heart failure following valvular heart disease and myocardial dysfunction, (sub) clinical myocarditis, pericarditis, pulmonary hypertension as well as arteritis of coronary vessels. Beyond cardioprotective regimens, aggressive immunosuppression reduces the inflammatory burden and modulates the progression of cardiovascular complications. Perioperative management of inflammation, when surgical treatment is indicated, improves surgical success rates and postoperative long-term prognosis. We aim to provide an overview of the pathogenetic, diagnostic and therapeutic principles of cardiovascular involvement disease in the various forms of systemic vasculitis.
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Affiliation(s)
- Stergios Soulaidopoulos
- First Department of Cardiology, Athens School of Medicine, Hippokration Hospital, Athens, Greece
| | | | - Dimitrios Daoussis
- Department of Rheumatology, Patras University Hospital, Faculty of Medicine, University of Patras Medical School, Patras, Greece
| | - Konstantinos Melissaropoulos
- Department of Rheumatology, Patras University Hospital, Faculty of Medicine, University of Patras Medical School, Patras, Greece
| | | | - George Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Russells Hall Hospital, Dudley, West Midlands, United Kingdom
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Chen HJ, Tas SW, de Winther MPJ. Type-I interferons in atherosclerosis. J Exp Med 2020; 217:132613. [PMID: 31821440 PMCID: PMC7037237 DOI: 10.1084/jem.20190459] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 10/05/2019] [Accepted: 10/30/2019] [Indexed: 12/13/2022] Open
Abstract
Chen et al. review the effects of type-I IFNs and the potential of anti–type-I IFN therapies in atherosclerosis. The contribution of dyslipidemia and inflammation in atherosclerosis is well established. Along with effective lipid-lowering treatments, the recent success of clinical trials with anti-inflammatory therapies and the accelerated atherosclerosis in many autoimmune diseases suggest that targeting inflammation may open new avenues for the prevention and the treatment for cardiovascular diseases (CVDs). In the past decades, studies have widened the role of type-I interferons (IFNs) in disease, from antivirus defense to autoimmune responses and immuno-metabolic syndromes. While elevated type-I IFN level in serum is associated with CVD incidence in patients with interferonopathies, experimental data have attested that type-I IFNs affect plaque-residing macrophages, potentiate foam cell and extracellular trap formation, induce endothelial dysfunction, alter the phenotypes of dendritic cells and T and B lymphocytes, and lead to exacerbated atherosclerosis outcomes. In this review, we discuss the production and the effects of type-I IFNs in different atherosclerosis-associated cell types from molecular biology studies, animal models, and clinical observations, and the potential of new therapies against type-I IFN signaling for atherosclerosis.
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Affiliation(s)
- Hung-Jen Chen
- Experimental Vascular Biology, Department of Medical Biochemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Sander W Tas
- Amsterdam Rheumatology and Immunology Center, Department of Rheumatology and Clinical Immunology, and Laboratory for Experimental Immunology, Academic Medical Center/University of Amsterdam, Amsterdam, Netherlands
| | - Menno P J de Winther
- Experimental Vascular Biology, Department of Medical Biochemistry, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands.,Institute for Cardiovascular Prevention, Ludwig Maximilians University, Munich, Germany
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10
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Xue M, Wang J. Utility of color Doppler echocardiography combined with clinical markers in diagnosis and prediction of prognosis of coronary artery lesions in Kawasaki disease. Exp Ther Med 2020; 19:2597-2603. [PMID: 32256739 PMCID: PMC7086289 DOI: 10.3892/etm.2020.8519] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 09/12/2019] [Indexed: 12/12/2022] Open
Abstract
The utility of color Doppler echocardiography in the diagnosis and follow-up of Kawasaki disease (KD) with coronary artery lesions (CAL) was analyzed, and the clinical parameters associated with the disease were examined. The general data, the color Doppler echocardiography data and the biochemical indexes from 102 children with KD were analyzed. The patients were divided into a CAL group and a non-coronary artery lesion (NCAL) group based on the presence or absence of CAL. The risk factors for CAL in KD were screened by univariate and multivariate analyses. Among the 102 cases, CAL complications were identified in 47 cases (46.08%). Compared with the NCAL group, the CAL group showed significantly higher incidences of fever duration, increased levels of N-terminal pro B-type natriuretic peptide (NT-proBNP), cardiac troponin I (cTnI), C-reactive protein (CRP), intravenous immunoglobulin resistance, erythrocyte sedimentation rate (ESR), platelets, alanine aminotransferase and aspartate aminotransferase, and significantly lower serum albumin levels (P<0.05). According to the multivariate analysis, fever duration [odds ratio (OR)=2.014], NT-proBNP (OR=3.004), cTnI level (OR=2.638), ESR (OR=1.461) and CRP elevation (OR=1.094) were predictors of CAL in KD. During convalescence, the left and right coronary artery diameters in the CAL group significantly decreased (P<0.05). Color Doppler echocardiography can observe the condition of coronary artery disease in patients with KD in real time and predicts its outcomes, which may be helpful for early diagnosis and long-term follow-up. Fever duration, cTnI, NT-proBNP and ESR levels were correlated with coronary artery diameter, of which the comprehensive use may be more accurate in determining the occurrence of CAL in KD.
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Affiliation(s)
- Mei Xue
- Department of Ultrasound Diagnosis, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
| | - Jing Wang
- Department of Ultrasound Diagnosis, The Affiliated Hospital of Inner Mongolia Medical University, Hohhot, Inner Mongolia Autonomous Region 010050, P.R. China
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12
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[Giant cell arteritis: Ischemic complications]. Presse Med 2019; 48:948-955. [PMID: 31564551 DOI: 10.1016/j.lpm.2019.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
GCA ischemic complications occur generally in patients with a yet undiagnosed or uncontrolled disease. When disease control is fair, ischemic complications may be due mostly to atheromatosis. Ophtalmic complications are most frequent and are dominated by anterior ischemic optic neuropathy. Vasculitic strokes occur essentially in the vertebrobasilar arterial territory. Overt vasculitic coronary disease is exceptional. The diagnosis of upper and lower limbs ischemic complications benefit from advances in echography (halo sign) and positron emission tomography imaging. Treatment relies on corticosteroids (initially 1mg/kg prednisone or more, preceded by intravenous methylprednisolone gigadoses if necessary), the control of cardiovascular risk factors and antiplatelet drugs; heparin may be indicated for threatening limbs ischemia.
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13
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Chen B, Wang X, Yin W, Gao Y, Hou Z, An Y, Li Z, Ren X, Zhao S, Das P, Lu B. Assessment of disease activity in Takayasu arteritis: A quantitative study with computed tomography angiography. Int J Cardiol 2019; 289:144-149. [PMID: 31079971 DOI: 10.1016/j.ijcard.2019.04.086] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/15/2019] [Accepted: 04/28/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Identifying disease activity in Takayasu arteritis (TAK) is challenging. This study aimed to investigate the value of quantitative characterization with computed tomography angiography in the assessment of disease activity in patients with TAK. METHODS We retrospectively analysed the data on 162 aortic CT angiography from 140 TAK patients. Patients were categorized based on disease activity according to the National Institutes of Health criteria into two groups: active disease group (n = 65) and inactive disease group (n = 97). RESULTS Patients with active TAK had a thicker wall compared with patients with inactive TAK (5.2 ± 2.4 mm vs. 2.5 ± 0.8 mm, p < 0.001). The relative post-contrast enhancement ratio of the thickened wall was higher in active TAK than in inactive TAK (1.5 ± 0.3 vs. 1.1 ± 0.2, p < 0.001). Given a thickness cutoff of 3.3 mm, sensitivity for active-phase TAK was 83.1%, specificity 89.7%, positive predictive value 84.4%, and negative predictive value 88.8%. With a relative post-contrast enhancement ratio cutoff of 1.2, sensitivity for active-phase TAK was 89.2%, specificity 76.3%, positive predictive value 71.6%, and negative predictive value 91.3%. In receiver-operating characteristic curves comparison, maximal wall thickness and relative post-contrast enhancement ratio were superior to C-reactive protein and erythrocyte sedimentation rate for determining active phase disease (p < 0.05). CONCLUSIONS Quantitative characterization with CT angiography was a useful tool to assess disease activity in TAK patients. Maximal wall thickness and relative post-contrast enhancement ratio have a high sensitivity and specificity for detecting TAK activity.
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Affiliation(s)
- Baojin Chen
- Department of Radiology, Shandong Provincial Hospital, Key Laboratory of Diagnosis and Treatment of Cardio-cerebral Vascular Diseases, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China; Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital, Key Laboratory of Diagnosis and Treatment of Cardio-cerebral Vascular Diseases, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China.
| | - Weihua Yin
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Yang Gao
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Zhihui Hou
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Yunqiang An
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Zhennan Li
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Xinshuang Ren
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China
| | - Shuo Zhao
- Department of Radiology, Shandong Provincial Hospital, Key Laboratory of Diagnosis and Treatment of Cardio-cerebral Vascular Diseases, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China
| | - Pritam Das
- Department of Radiology, Shandong Provincial Hospital, Key Laboratory of Diagnosis and Treatment of Cardio-cerebral Vascular Diseases, Shandong University, #324, Jingwu Road, Jinan, Shandong 250021, PR China
| | - Bin Lu
- Department of Radiology, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Centre for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, #167 Bei-Li-Shi Street, Xi-Cheng District, Beijing 100037, PR China.
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14
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Agryropoulou O, Protogerou A, Argyris A, Tzioufas A, Vlachoyiannopoulos P. Extensive phenotyping of vascular damage in non-infectious primary vasculitides with the use of non-invasive vascular biomarkers: prevalence, pathogenesis and response to treatment. Mediterr J Rheumatol 2018; 29:173-177. [PMID: 32185320 PMCID: PMC7046042 DOI: 10.31138/mjr.29.3.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/25/2018] [Accepted: 09/04/2018] [Indexed: 11/06/2022] Open
Abstract
Non-Infectious Primary systemic vasculitides (NIPSV) encompass a subset of autoimmune diseases, characterized mainly by intramural inflammation of the vascular wall. The increased mortality that some exhibit is partially attributed to vascular complications involving both micro- and macro- circulation. Beyond the disease specific pathways of vascular damage, emerging evidence suggest that the classical pathways of arterial damage, namely, atheromatosis, inappropriate arterial remodeling and arteriosclerosis are accelerated in several NIPSV; thus participating in the development of vascular complications in NIPSV patients. The aim of the current research protocol is to optimize the understanding of vascular pathology in NIPSV and to identify useful, easy to measure, non-invasive vascular tools for the diagnosis and follow-up of NIPSV patients. Moreover, the study aims to generate hypothesis regarding the molecular basis of the association of inflammation with classical vascular pathology.
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Affiliation(s)
- Ourania Agryropoulou
- Department of Pathophysiology, "Laiko" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanase Protogerou
- Department of Pathophysiology, "Laiko" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Argyris
- Department of Pathophysiology, "Laiko" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Tzioufas
- Department of Pathophysiology, "Laiko" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Panayiotis Vlachoyiannopoulos
- Department of Pathophysiology, "Laiko" Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
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