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Coschignano MA, De Ciuceis C, Agabiti-Rosei C, Brami V, Rossini C, Chiarini G, Malerba P, Famà F, Cosentini D, Muiesan ML, Salvetti M, Petelca A, Capellini S, Arnoldi C, Nardin M, Grisanti S, Rizzoni D, Berruti A, Paini A. Microvascular Structural Alterations in Cancer Patients Treated With Antiangiogenic Drugs. Front Cardiovasc Med 2021; 8:651594. [PMID: 33778028 PMCID: PMC7987651 DOI: 10.3389/fcvm.2021.651594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 02/19/2021] [Indexed: 12/24/2022] Open
Abstract
Objective: Antiangiogenic therapies (tyrosine kinase inhibitors-TKI and direct anti-VEGF monoclonal antibodies) are being increasingly used in the treatment of solid tumors; hypertension represents a common side effect of these agents. Several mechanisms are involved in the development of hypertension, including microvascular rarefaction and other microvascular alterations. Therefore, the aim of our study was to evaluate whether TKI and direct anti-VEGF agents may affect the structure of retinal arterioles or capillary density. Design and Methods: We investigated 20 patients with a diagnosis of cancer who underwent a treatment with either a TKI or an anti-VEGF antibody. Patients were submitted to ambulatory monitoring blood pressure for blood pressure evaluation. Basal and total capillary density were assessed by capillaroscopy whereas, retinal arteriole morphology was measured by Adaptive Optics. Patients were evaluated before starting the antiangiogenic therapy (T0) and re-evaluated after 3 (T3) and 6 (T6) months after treatment. Fourteen patients completed the study. Results: Systolic and diastolic blood pressure values were similar in all patients at T3 and T6 compared to T0. However, during the study antihypertensive treatment was optimized (increased dose and/or addition of drugs) in 57% of patients (n = 8). No differences were observed in retinal arteriole structural parameters and in large artery stiffness. Basal capillary density was reduced by antiangiogenic drugs after 3 or 6 months. Conclusions: Our data suggest that an increase of antihypertensive treatment is necessary in patients treated with a TKI or a direct VEGF inhibitor, confirming pro-hypertensive effects of these drugs. However, under adequate blood pressure control, microvascular structure seem to be partially preserved, since a worsening of basal capillary density but no changes in retinal arteriole morphology were observed.
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Affiliation(s)
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Spedali Civili di Brescia, Clinica Medica University of Brescia and 2nd Division of Medicine, Brescia, Italy
| | - Claudia Agabiti-Rosei
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Spedali Civili di Brescia, Clinica Medica University of Brescia and 2nd Division of Medicine, Brescia, Italy
| | - Valeria Brami
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Claudia Rossini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Giulia Chiarini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Paolo Malerba
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Francesca Famà
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Deborah Cosentini
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Spedali Civili di Brescia, Clinica Medica University of Brescia and 2nd Division of Medicine, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Spedali Civili di Brescia, Clinica Medica University of Brescia and 2nd Division of Medicine, Brescia, Italy
| | - Alina Petelca
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Sara Capellini
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Chiara Arnoldi
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Matteo Nardin
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salvatore Grisanti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.,Division of Medicine, Spedali Civili di Brescia, Brescia, Italy
| | - Alfredo Berruti
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Medical Oncology, Spedali Civili di Brescia, University of Brescia, Brescia, Italy
| | - Anna Paini
- Spedali Civili di Brescia, Clinica Medica University of Brescia and 2nd Division of Medicine, Brescia, Italy
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Chen X, Liu H, Zhang Y, Wang C, Xu D, Yang B, Ju W, Zhang F, Chen H, Cao K, Chen M. Atrial electromechanical delay assessment in early phase after catheter ablation for patients with atrial fibrillation. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2019; 42:327-332. [PMID: 30632635 DOI: 10.1111/pace.13602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 01/02/2019] [Accepted: 01/06/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Variation of atrial electromechanical delay (AED) in early phase after catheter ablation in patients with atrial fibrillation (AF) is lacking. METHODS Fifty-five consecutive patients restored sinus rhythm after ablation was included. Echocardiography was performed at 4 h, 1 day, and 3 days after radiofrequency catheter ablation, and AED was measured simultaneously by echocardiography with pulse Doppler imaging and pulse wave tissue Doppler imaging. RESULTS AED parameters were significantly longer in the nonparoxysmal atrial fibrillation (NPAF) group than in the paroxysmal atrial fibrillation (PAF) group at each checking point after ablation (P < 0.05). Compared with other checking points, AED parameters were significantly longer 4 h postablation in the NPAF group, while no significant difference was found between different checking points in the PAF group. AED-leap, representing the variation of AED in NPAF patients, was significantly positively correlated with the duration of NPAF (r = 0.5291, P = 0.0113). CONCLUSIONS Compared with PAF, NPAF patients have a longer AED postablation, and an abrupt decrease in the initial-h postablation. Such phenomenon gives rise to the different clinical features of PAF and NPAF, and could guide different assessment and treatment strategies for different types of AF.
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Affiliation(s)
- Xiaodong Chen
- Department of Cardiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Hailei Liu
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yi Zhang
- Department of Cardiology, Shanghai Tenth People's Hospital, Shanghai, China
| | - Chunru Wang
- Department of Cardiology, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing, China.,Jiangsu Province Academy of Traditional Chinese Medicine, Nanjing, China
| | - Di Xu
- Department of Cardiology, Geriatrics, The First Affiliate Hospital of Nanjing Medical University, Nanjing, China
| | - Bing Yang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Weizhu Ju
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Fengxiang Zhang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hongwu Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Kejiang Cao
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Minglong Chen
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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Acıkgoz N, Yagmur J, Kurtoglu E, Ermis N, Cansel M. Left atrial volume and function in patients with cardiac syndrome X assessed by real time three-dimensional echocardiography. Echocardiography 2017; 34:862-868. [PMID: 28374918 DOI: 10.1111/echo.13534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate left atrial (LA) volume and function using real time three-dimensional echocardiography (RT3DE) in patients with cardiac syndrome X (CSX). METHODS Fifty patients with CSX (28 females; mean age 50.9±10.9 years) and 50 age- and gender-matched healthy controls (30 females; mean age 52.3±9.8 years) who had negative treadmill exercise test and normal coronary arteries on invasive coronary angiography were included in the study. Comprehensive two-dimensional (2D), pulsed and tissue Doppler, speckle tracking echocardiography, and RT3DE for the assessment of LA dynamics were performed in all study participants. RESULTS Cardiac syndrome X and control groups have similar clinical characteristics regarding age, sex, body mass index, hypertension, diabetes, and smoking habit. 2D echocardiographic parameters were also similar between groups. Pulsed- and tissue Doppler parameters, IVRT, A, and Am values, were higher in CSX group, while Em , E/A, and Em /Am ratios were higher in the control group reflecting mild diastolic dysfunction. Regarding RT3DE parameters, LA maximum volume, minimum volume, volume before atrial contraction, LA maximum volume index, total and active stroke volumes were found to be increased in CSX patients. However, LA total stroke fraction, passive stroke volume, passive stroke fraction, peak systolic, and diastolic longitudinal strains were found to be lower in CSX patients. CONCLUSION The main finding of this study was that CSX patients had altered LA booster pump, reservoir, and conduit functions. This finding may have clinical implications for early detection of abnormal LA dynamics in CSX patients.
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Affiliation(s)
- Nusret Acıkgoz
- Clinic of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Julide Yagmur
- Clinic of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Ertugrul Kurtoglu
- Clinic of Cardiology, Malatya Education and Research Hospital, Malatya, Turkey
| | - Necip Ermis
- Clinic of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
| | - Mehmet Cansel
- Clinic of Cardiology, Inonu University Faculty of Medicine, Malatya, Turkey
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Yaman M, Arslan U, Beton O, Asarcıklı LD, Aksakal A, Dogdu O. Atrial Electromechanical Coupling in Patients with Lichen Planus. Korean Circ J 2016; 46:530-5. [PMID: 27482262 PMCID: PMC4965432 DOI: 10.4070/kcj.2016.46.4.530] [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: 09/23/2015] [Revised: 11/15/2015] [Accepted: 12/01/2015] [Indexed: 11/17/2022] Open
Abstract
Background and objectives A chronic inflammatory disease, lichen planus may cause disturbance of atrial electromechanical coupling and increase the risk of atrial fibrillation. The aim of this study was to evaluate atrial electromechanical delay with both electrocardiography (ECG) and echocardiography in patients with lichen planus (LP). Subjects and Methods Seventy-two LP patients (43 males [59.7%], mean age: 44.0±16.7 years) were enrolled in this cross-sectional case-control study. The control group was selected in a 1:1 ratio from 70 patients in an age and sex matched manner. P wave dispersion was measured by ECG to show atrial electromechanical delay. All of the patients underwent transthoracic echocardiography for measuring inter- and intra-atrial electromechanical delays. Results The baseline characteristics of the patients and the control group were similar except for the presence of LP. P-wave dispersion measured by ECG was significantly higher in patients with LP (p<0.001). Patients with LP had significantly prolonged intra- and interatrial electromechanical delays when compared to the control group (p<0.001). In addition, all of these variables were significantly correlated with high sensitive C-reactive protein (hsCRP) levels. Conclusion Atrial electromechanical coupling, which is significantly correlated with increased hsCRP levels, is impaired in patients with LP.
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Affiliation(s)
- Mehmet Yaman
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Uğur Arslan
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Osman Beton
- Department of Cardiology, Diskapi Education and Research Hospital, Ankara, Turkey
| | - Lale Dinç Asarcıklı
- Department of Cardiology, Diskapi Education and Research Hospital, Ankara, Turkey
| | - Aytekin Aksakal
- Department of Cardiology, Samsun Education and Research Hospital, Samsun, Turkey
| | - Orhan Dogdu
- Department of Cardiology, Firat University, Faculty of Medicine, Elazig, Turkey
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Szymanski FM, Lip GY, Filipiak KJ, Platek AE, Hrynkiewicz-Szymanska A, Opolski G. Stroke Risk Factors Beyond the CHA₂DS₂-VASc Score: Can We Improve Our Identification of "High Stroke Risk" Patients With Atrial Fibrillation? Am J Cardiol 2015; 116:1781-8. [PMID: 26434516 DOI: 10.1016/j.amjcard.2015.08.049] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 01/17/2023]
Abstract
The prevention of stroke and other thromboembolic events plays a crucial role in the management of patients with atrial fibrillation. Not all patients with atrial fibrillation are equal in terms of thromboembolic risk; therefore, not all will benefit from oral anticoagulation treatment. The general principle is that the expected benefit of anticoagulation in reduction of thromboembolic risk must exceed the expected harm caused by possible bleeding. Some guidelines have focused on a categorical approach to stroke prevention, with a focus on identifying patients at high risk for oral anticoagulation. Various current guidelines recommend assessment of stroke risk using the CHADS2 or CHA2DS2-VASc scores to initially detect patients at low risk who require no antithrombotic therapy. However, the scores do not incorporate all possible risk factors causing a high thromboembolic risk. Factors such as impaired renal function, obstructive sleep apnea, and echocardiographic and biochemical or coagulation parameters can also predict adverse thromboembolic events. The present review aims to describe biomarkers whether blood, urine, imaging (cardiac or cerebral), or clinical that go beyond the CHA2DS2-VASc score and potentially aid stroke risk assessment. Although useful in some cases, the presented parameters should be perhaps used to further refine initial identification of patients at low risk, after which effective stroke prevention can be offered to those with ≥1 additional stroke risk factors.
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Bayar N, Üreyen ÇM, Erkal Z, Küçükseymen S, Çay S, Çağırcı G, Arslan Ş. Evaluation of the association between stroke/transient ischemic attack and atrial electromechanical delay in patients with paroxysmal atrial fibrillation. Anatol J Cardiol 2015; 16:572-578. [PMID: 27004705 PMCID: PMC5368512 DOI: 10.5152/anatoljcardiol.2015.6424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective: This study aimed to evaluate the association between the history of stroke/transient ischemic attack (TIA) and inter- and intra-atrial electromechanical delay (EMD) in patients with paroxysmal atrial fibrillation (PAF). Methods: Patients diagnosed with PAF were included in this retrospective study. Patients who had a history of stroke or TIA were defined as the symptomatic group, whereas those who did not have such a history were defined as the asymptomatic group. On the basis of the transthoracic echocardiographic records, atrial electromechanical coupling (time interval from the onset of the P wave on the surface electrocardiogram to the beginning of the A’ wave interval with tissue Doppler echocardiography) and intra- and interatrial EMD were measured. Results: In this study, 160 patients were included, 52 of whom were symptomatic. While the intra-left atrial EMD was 68.2±6.1 ms in the symptomatic group, it was found to be 50.8±6.5 ms in the asymptomatic group (p<0.001). Interatrial EMD was 91.3±5.0 ms in the symptomatic group, whereas it was 71.5±7.0 ms in the asymptomatic group (p<0.001). In multiple logistic regression analysis, intra-left atrial [odds ratio (OR): 1.417, 95% confidence interval (CI): 1.193–1.684, p<0.001] and interatrial EMDs (OR:1.398, 95% CI: 1.177–1.661, p<0.001) were found to be independently associated with the presence of stroke/TIA. Conclusion: Prolonged inter- and intra-left atrial EMDs in patients with PAF is associated with stroke/TIA. Evaluating this parameter in addition to the CHA2DS2-VASc score in patients with PAF may be helpful in identifying patients who are at a high risk of stroke/TIA. (Anatol J Cardiol 2016; 16: 572-8)
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Affiliation(s)
- Nermin Bayar
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey.
| | - Çağın Mustafa Üreyen
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
| | - Zehra Erkal
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
| | - Selçuk Küçükseymen
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
| | - Serkan Çay
- Department of Cardiology, Yu¨ksek İhtisas Education and Research Hospital, Ankara-Turkey
| | - Göksel Çağırcı
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
| | - Şakir Arslan
- Department of Cardiology, Antalya Education and Research Hospital, Antalya-Turkey
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