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Corredoira P, Marco-Benedi V, Cenarro A, Peribáñez S, Olmos S, Civeira F. Factors associated with the presence of tendon xanthomas in familial hypercholesterolemia. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:462-470. [PMID: 38185215 DOI: 10.1016/j.rec.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/14/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION AND OBJECTIVES Tendon xanthomas (TX) are lipid deposits highly specific to familial hypercholesterolemia (FH). However, there is significant variability in their presentation among FH patients, primarily due to largely unknown causes. Lipoprotein(a) is a well-established independent risk factor for atherosclerotic cardiovascular disease in the general population as well as in FH. Given the wide variability of lipoprotein(a) among FH individuals and the likelihood that TX may result from a proatherogenic and proinflammatory condition, the objective of this study was to analyze the size of TX in the Achilles tendons of FH participants and the variables associated with their presence, including lipoprotein(a) concentration. METHODS A cross-sectional study was conducted on 377 participants with a molecular diagnosis of heterozygous FH. Achilles tendon maximum thickness (ATMT) was measured using ultrasonography with standardized equipment and procedures. Demographic variables and lipid profiles were collected. A multivariate linear regression model using a log-Gaussian approach was used to predict TX size. Classical cardiovascular risk factors and lipoprotein(a) were included as explanatory variables. RESULTS The mean low-density lipoprotein cholesterol level was 277mg/dL without lipid-lowering treatment, and the median ATMT was 5.50mm. We demonstrated that age, sex, low-density lipoprotein cholesterol, and lipoprotein(a) were independently associated with ATMT. However, these 4 variables did not account for most the interindividual variability observed (R2=0.205). CONCLUSIONS TX, a characteristic hallmark of FH, exhibit heterogeneity in their presentation. Interindividual variability can partially be explained by age, male sex, low-density lipoprotein cholesterol, and lipoprotein(a) but these factors account for only 20% of this heterogeneity.
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Affiliation(s)
- Pablo Corredoira
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain; Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - Victoria Marco-Benedi
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zaragoza, Spain
| | - Ana Cenarro
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zaragoza, Spain
| | - Sonia Peribáñez
- Servicio de Cardiología, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Salvador Olmos
- Instituto Universitario de Investigación en Ingeniería de Aragón (I3A), Universidad de Zaragoza, Zaragoza, Spain
| | - Fernando Civeira
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Miguel Servet, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Medicina, Psiquiatría y Dermatología, Universidad de Zaragoza, Zaragoza, Spain
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Létocart AJ, Svensson RB, Mabesoone F, Charleux F, Marin F, Dermigny Q, Magnusson SP, Couppé C, Grosset JF. Structure and function of Achilles and patellar tendons following moderate slow resistance training in young and old men. Eur J Appl Physiol 2024:10.1007/s00421-024-05461-y. [PMID: 38649478 DOI: 10.1007/s00421-024-05461-y] [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: 08/16/2023] [Accepted: 03/05/2024] [Indexed: 04/25/2024]
Abstract
The aim of this study was to investigate the effect of aging and resistance training with a moderate load on the size and mechanical properties of the patellar (PT) and Achilles tendon (AT) and their associated aponeuroses; medial gastrocnemius (MG) and vastus lateralis (VL). Young (Y55; 24.8 ± 3.8 yrs, n = 11) and old men (O55; 70.0 ± 4.6 yrs, n = 13) were assigned to undergo a training program (12 weeks; 3 times/week) of moderate slow resistance training [55% of one repetition maximum (RM)] of the triceps surae and quadriceps muscles. Tendon dimensions were assessed using 1.5 T magnetic resonance imaging before and after 12 weeks. AT and PT cross sectional area (CSA) were determined every 10% of tendon length. Mechanical properties of the free AT, MG aponeurosis, PT, and VL aponeurosis were assessed using ultrasonography (deformation) and tendon force measurements. CSA of the AT but not PT was greater in O55 compared with Y55. At baseline, mechanical properties were generally lower in O55 than Y55 for AT, MG aponeurosis and VL aponeurosis (Young's modulus) but not for PT. CSA of the AT and PT increased equally in both groups following training. Further, for a given force, stiffness and Young's modulus also increased equally for VL aponeurosis and AT, for boths groups. The present study highlights that except for the PT, older men have lower tendon (AT, MG aponeurosis, and VL aponeurosis) mechanical properties than young men and 12-weeks of moderate slow resistance training appears sufficient to improve tendon size and mechanical adaptations in both young and older men. New and Noteworthy: These novel findings suggest that short-term moderate slow resistance training induces equal improvements in tendon size and mechanics regardless of age.
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Affiliation(s)
- Adrien J Létocart
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France.
| | - René B Svensson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Frédéric Marin
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France
| | - Quentin Dermigny
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France
| | - S Peter Magnusson
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Couppé
- Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospitals, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital-Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jean-François Grosset
- UMR CNRS 7338 Biomécanique et Bioingénierie, Sorbonne Universités, Université de Technologie de Compiègne, 60205, Compiègne Cedex, France.
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Lai C, Li R, Tang W, Liu J, Duan XDXF, Bao D, Liu H, Fu S. Metabolic Syndrome and Tendon Disease: A Comprehensive Review. Diabetes Metab Syndr Obes 2024; 17:1597-1609. [PMID: 38616994 PMCID: PMC11015851 DOI: 10.2147/dmso.s459060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 03/21/2024] [Indexed: 04/16/2024] Open
Abstract
Metabolic syndrome (MS) is a multifaceted pathological condition characterized by the atypical accumulation of various metabolic components such as central obesity or excess weight, hyperlipidemia, low-density lipoprotein (LDL), hypertension, and insulin resistance. Recently, MS has been recognized as a notable contributor to heart and circulatory diseases. In addition, with increasing research, the impact of MS on tendon repair and disease has gradually emerged. Recent studies have investigated the relationship between tendon healing and diseases such as diabetes, dyslipidemia, obesity, and other metabolic disorders. However, diabetes mellitus (DM), hypercholesterolemia, obesity, and various metabolic disorders often coexist and together constitute MS. At present, insulin resistance is considered the major pathological mechanism underlying MS, central obesity is regarded as the predominant factor responsible for it, and dyslipidemia and other metabolic diseases are known as secondary contributors to MS. This review aims to evaluate the current literature regarding the impact of various pathological conditions in MS on tendon recovery and illness, and to present a comprehensive overview of the effects of MS on tendon recovery and diseases, along with the accompanying molecular mechanisms.
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Affiliation(s)
- Canhao Lai
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Ruichen Li
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Weili Tang
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Jinyu Liu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Xinfang D X F Duan
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Dingsu Bao
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
- Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Huan Liu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
| | - Shijie Fu
- Department of Bone and Joint, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, People’s Republic of China
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Genkel V, Kuznetsova A, Lebedev E, Salashenko A, Pykhova L, Sumerkina V, Shaposhnik I. Achilles tendon thickness normalized to body surface area as a marker of asymptomatic peripheral arterial disease. Vascular 2024; 32:353-360. [PMID: 36395485 DOI: 10.1177/17085381221140621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES The normalisation of Achilles tendon thickness (ATT) to anthropometric parameters may increase the diagnostic efficiency of the assessment of ATT. The aim of this study was to compare the diagnostic value of AT dimensions depending on their normalization to body surface area (BSA) in patients with asymptomatic peripheral arterial disease (PAD). METHODS All patients underwent duplex scanning of the carotid arteries and the lower limb arteries. Asymptomatic PAD was defined as the presence of ≥50% stenosis in the carotid and/or lower limb arteries. ATT was measured using a longitudinal scan, width (ATW) and cross-sectional area (AT CSA), which was determined during a cross-sectional scan. RESULTS The study included 369 patients, among whom asymptomatic PAD was detected in 18 (4.88%) patients. Only the ATT demonstrated diagnostic value for asymptomatic PAD. After normalizing the size of the AT to the BSA, the diagnostic performance of ATT, ATW and AT CSA became statistically significant. Among the studied parameters, only an increase in ATT/BSA >0.29 cm/m2 was associated with a significant increase in the odds ratio (OR) of asymptomatic PAD by 4.11 times (95% CI 1.08-15.7; p = .038) after adjustments. CONCLUSION An increase in ATT/BSA >0.29 cm/m2 predicted the presence of asymptomatic PAD with a sensitivity of 61.1% and a specificity of 77.9%. ATT/BSA values of less than 0.29 cm/m2 made it possible to exclude asymptomatic PAD with a probability of 97.5%. An increase in ATT/BSA >0.29 cm/m2 was associated with a 4.11-fold increase in the OR of asymptomatic PAD (95% CI 1.08-15.7).
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Affiliation(s)
- Vadim Genkel
- South-Ural State Medical University, Chelyabinsk, Russia
| | | | | | | | - Lubov Pykhova
- South-Ural State Medical University, Chelyabinsk, Russia
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Loret A, Jacob C, Mammou S, Bigot A, Blasco H, Audemard-Verger A, Schwartz IV, Mulleman D, Maillot F. Joint manifestations revealing inborn metabolic diseases in adults: a narrative review. Orphanet J Rare Dis 2023; 18:239. [PMID: 37563694 PMCID: PMC10416490 DOI: 10.1186/s13023-023-02810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 07/06/2023] [Indexed: 08/12/2023] Open
Abstract
Inborn metabolic diseases (IMD) are rare conditions that can be diagnosed during adulthood. Patients with IMD may have joint symptoms and the challenge is to establish an early diagnosis in order to institute appropriate treatment and prevent irreversible damage. This review describes the joint manifestations of IMD that may be encountered in adults. The clinical settings considered were arthralgia and joint stiffness as well as arthritis. Unspecific arthralgias are often the first symptoms of hereditary hemochromatosis, chronic low back pain may reveal an intervertebral disc calcification in relation with alkaptonuria, and progressive joint stiffness may correspond to a mucopolysaccharidosis or mucolipidosis. Gaucher disease is initially revealed by painful acute attacks mimicking joint pain described as "bone crises". Some IMD may induce microcrystalline arthropathy. Beyond classical gout, there are also gouts in connection with purine metabolism disorders known as "enzymopathic gouts". Pyrophosphate arthropathy can also be part of the clinical spectrum of Gitelman syndrome or hypophosphatasia. Oxalate crystals arthritis can reveal a primary hyperoxaluria. Destructive arthritis may be indicative of Wilson's disease. Non-destructive arthritis may be seen in mevalonate kinase deficiency and familial hypercholesterolemia.
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Affiliation(s)
- Amaury Loret
- Department of Internal Medicine, University Hospital of Tours, Tours, France.
- Department of Rheumatology, University Hospital of Tours, Tours, France.
- Department of Internal Medicine, Hôpital Bretonneau, 2 Boulevard Tonnellé, CHRU de Tours, Tours cedex, 37044, France.
| | - Claire Jacob
- Department of Internal Medicine, University Hospital of Tours, Tours, France
| | - Saloua Mammou
- Department of Rheumatology, University Hospital of Tours, Tours, France
| | - Adrien Bigot
- Department of Internal Medicine, University Hospital of Tours, Tours, France
| | - Hélène Blasco
- Biochemistry laboratory, University Hospital of Tours, Tours, France
- UMR INSERM 1253, Tours, France
- Reference center for inherited metabolic diseases, Tours, France
| | | | - Ida Vd Schwartz
- Medical Genetics Service/Genetics Department, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre - RS, Brazil
| | - Denis Mulleman
- Department of Rheumatology, University Hospital of Tours, Tours, France
| | - François Maillot
- Department of Internal Medicine, University Hospital of Tours, Tours, France
- UMR INSERM 1253, Tours, France
- Reference center for inherited metabolic diseases, Tours, France
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Munoz NR, Agwuegbo CC, Gauhar F. Eruptive Xanthomas Precipitated by Severe Hypertriglyceridemia From Diabetes and Alcohol Use. Cureus 2023; 15:e43288. [PMID: 37692713 PMCID: PMC10492636 DOI: 10.7759/cureus.43288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2023] [Indexed: 09/12/2023] Open
Abstract
Hypertriglyceridemia is a common abnormality found in patients in the clinical setting. Severe hypertriglyceridemia may manifest phenotypically as eruptive xanthomas, which are red or yellow papules found on the skin, most commonly on extensor surfaces and buttocks. We present a case of severe hypertriglyceridemia in a patient found in the outpatient setting, which manifested as eruptive xanthomas in his posterior upper arms, back, buttocks, axilla, and legs. Laboratory testing of his lipid profile revealed extremely high triglyceride levels, and the patient was immediately referred to the nearest hospital where he was admitted to the intensive care unit (ICU). He was promptly managed with a low-fat diet, anti-hypertriglyceridemic agents, and insulin infusion, with a dramatic reduction in triglyceride levels. He subsequently underwent a skin biopsy which confirmed the diagnosis of eruptive xanthoma. Rapid reduction in triglyceride levels is instrumental in the prevention of complications, most notably, acute pancreatitis. This article highlights the importance of a high index of suspicion for recognition of the signs and symptoms of severe hypertriglyceridemia, as well as the different management options available for the control of triglyceride levels and the prevention of complications.
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Affiliation(s)
| | | | - Fatima Gauhar
- Internal Medicine, Riverside Medical Clinic, Temescal Valley, USA
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Gür V, Yapici F, Küçük U, Subaşi İÖ, Gökgöz MB, Karaköse R, Koçkara N. Patients with Achilles Tendon Rupture Are Prone to Develop Ventricular Arrhythmia. J Clin Med 2023; 12:jcm12103583. [PMID: 37240689 DOI: 10.3390/jcm12103583] [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: 04/08/2023] [Revised: 05/14/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND AND OBJECTIVES This study aimed to examine the ventricular repolarization (VR) disturbances of patients operated on for acute spontaneous Achilles tendon ruptures (ATRs), by comparing them with a healthy individual control group. MATERIALS AND METHODS Between June 2014 and July 2020, a total of 29 patients (28 males, 1 female; mean age: 40 ± 9.78 years; range, 21-66 years) who presented to the emergency department within the first three weeks of injury, and were diagnosed with acute spontaneous ATRs and treated with an open Krackow suture technique, were retrospectively analyzed. Fifty-two healthy individuals (47 males, 5 females; mean age: 39 ± 11.45 years; range, 21-66 years) were recruited as a control group from the cardiology outpatient clinic. Clinical data (demographic features and laboratory parameters (serum glucose, creatinine, hemoglobin, white blood cell count, and lipid profile)) and electrocardiograms (ECGs) were collected from medical records. ECGs were evaluated for heart rate and VR parameters of QRS width, QTc interval, cQTd interval, Tp-e interval, and Tp-e/QT ratio. The clinical data and these ECG parameters were compared between groups. RESULTS There was no statistically significant difference between groups, regarding clinical data (all p < 0.05). Among ECG parameters, heart rate, QRS width, QTc interval, and cQTd interval were similar between groups (all p < 0.05). There were two important statistically significant findings of this research: The mean Tp-e interval was longer (ATR group: 72.4 ± 24.7, control group: 58.8 ± 14.5, p: 0.01), and the Tp-e/QT ratio was higher (ATR group: 0.2 ± 0.1, control group: 0.16 ± 0.4, p: 0.027) in the ATR group. CONCLUSIONS According to the ventricular repolarization disturbances found in this study, patients with ATR may be at a higher risk of ventricular arrhythmia than healthy people. As a result, ATR patients should be assessed for ventricular arrhythmia risk by an expert cardiologist.
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Affiliation(s)
- Volkan Gür
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Furkan Yapici
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Uğur Küçük
- Department of Cardiology, Faculty of Medicine, 18 Mart University, 17020 Çanakkale, Turkey
| | - İzzet Özay Subaşi
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Mehmet Burak Gökgöz
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Reşit Karaköse
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
| | - Nizamettin Koçkara
- Department of Orthopedics and Traumatology, Faculty of Medicine, Erzincan University, 24180 Erzincan, Turkey
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Oliva F, Marsilio E, Mastrodonato F, Migliorini F, Maffulli N. Minimally invasive excision and reconstruction of Achilles tendon xanthoma using free autologous semitendinosus tendon transfer: a surgical technique. J Orthop Surg Res 2023; 18:274. [PMID: 37013640 PMCID: PMC10071761 DOI: 10.1186/s13018-023-03757-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/26/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Tendon xanthomatosis is often associated with familial hypercholesterolemia, but it can also occur in other medical conditions. The Achilles tendon is the most common site of tendon xanthomas. Reconstruction of large defects after the xanthoma excision, can be challenging. METHODS We propose a novel technique for Achilles tendon reconstruction with the use of an ipsilateral autologous semitendinosus tendon graft. The technique consists of six steps. RESULTS This procedure has a low rate of complications and provides results that are at least comparable with those reported with other surgical approaches.
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Affiliation(s)
- Francesco Oliva
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Emanuela Marsilio
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Federica Mastrodonato
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
| | - Filippo Migliorini
- Department of Orthopaedic, Trauma, and Reconstructive Surgery, RWTH University Hospital, Pauwelsstraße 30, 52074, Aachen, Germany.
- Department of Orthopaedic and Trauma Surgery, Eifelklinik St. Brigida, 52152, Simmerath, Germany.
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, 84081, Baronissi, Salerno, Italy
- School of Pharmacy and Bioengineering, Keele University Faculty of Medicine, ST4 7QB, Stoke on Trent, England
- Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, E1 4DG, London, England
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Khatoon HM, Srirambhatla A, Sharma A, Sankepally P, Arora AJ. An Unusual Case of Xanthoma of Bilateral Achilles Tendon with Gouty Infiltration: A Rare Case Report. Indian J Radiol Imaging 2023. [DOI: 10.1055/s-0043-1762934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
AbstractAchilles tendon xanthoma is a benign and rare disease with a high incidence in patients having familial hypercholesterolemia. Patients present with or without pain and thickened tendons. Gout is seen in patients with hyperuricemia. Coexistence of xanthoma and gout is extremely rare. We searched the PubMed literature with ‘Xanthoma’ and ‘Gout’ as keywords and could find only one case report. Imaging modalities such as radiography and ultrasonography, play a vital role in diagnosing this condition early, hence helping the patient to commence the use of potentially lifesaving lipid-lowering therapeutic agents. Magnetic resonance imaging is helpful in delineating the morphological changes, exact measurements, and eventually in treatment planning. It helps to rule out early involvement of other tendons by the same pathology. We present a case of a 25-year-old male patient who presented to our institute with bilateral large symmetrical swelling in the posterior aspects of ankles for 4 years, with normal serum and blood parameters. Bilaterality, enormous size and normal blood and serum parameters make this case unique.
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Affiliation(s)
- Heena M. Khatoon
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telengana, India
| | - Annapurna Srirambhatla
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telengana, India
| | - Abhimanyu Sharma
- Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telengana, India
| | - Poojitha Sankepally
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telengana, India
| | - Abhishek J. Arora
- Department of Radiodiagnosis, All India Institute of Medical Sciences, Bibinagar, Hyderabad, Telengana, India
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Giri A, O'Hanlon D, Jain NB. Risk factors for rotator cuff disease: A systematic review and meta-analysis of diabetes, hypertension, and hyperlipidemia. Ann Phys Rehabil Med 2023; 66:101631. [PMID: 35257948 PMCID: PMC9974529 DOI: 10.1016/j.rehab.2022.101631] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 10/17/2022]
Abstract
BACKGROUND Rotator cuff disease is a common cause of shoulder pain. Comorbidities such as diabetes, hypertension, and hyperlipidemia may be associated with rotator cuff disease, likely because of mechanisms related to vascular insufficiency. OBJECTIVES We performed a systematic review of the association of diabetes, hypertension, and hyperlipidemia with the diagnosis of rotator cuff disease. METHODS Following systematic queries of PubMed, Embase, Cochrane, CINAHL, and Science Direct, articles meeting eligibility criteria and reporting on the association of one or more risk factors (diabetes, hypertension, and hyperlipidemia) and rotator cuff disease were considered. Meta-analysis was performed to quantitatively summarize the associations between each risk factor and rotator cuff disease. We assessed study quality with the Newcastle-Ottawa Scale (NOS) and performed a qualitative assessment of risk of bias. RESULTS After a full-text review of 212 articles, 12 articles assessing diabetes, 5 assessing hypertension and 8 assessing hyperlipidemia were eligible. The odds of having rotator cuff disease was increased with diabetes (odds ratio [OR] 1.49, 95% confidence interval [CI] 1.43-1.55), hypertension (OR 1.40, 95% CI 1.19-1.65) and hyperlipidemia/dyslipidemia (OR 1.48, 95% CI 1.42-1.55). Diabetes was also specifically associated with rotator cuff tears (OR 1.28, 95% CI 1.07-1.52). Synthesizing assessment for risk of bias suggested that current epidemiologic evidence for an association was plausible for diabetes and hyperlipidemia but not hypertension. CONCLUSIONS Diabetes, hypertension, and hyperlipidemia were associated with rotator cuff disease in our meta-analysis. However, the possibility of bias exists for all 3 co-morbidities evaluated and is likely highest for hypertension. High-quality studies with the ability to incorporate time since first diagnosis of co-morbidity are scarce and much needed.
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Affiliation(s)
- Ayush Giri
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Division of Quantitative Sciences, Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN, USA.
| | | | - Nitin B Jain
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN, USA; Department of Physical Medicine and Rehabilitation, Orthopedics, and Population and Data Sciences, University of Texas Southwestern, Dallas, TX, United States of America
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ÇAKIR PEKÖZ B, YILDIRIM A. Aşil tendonu gerinim oranı ile mitral anulus kalsifikasyonu varlığı arasındaki ilişki. CUKUROVA MEDICAL JOURNAL 2022. [DOI: 10.17826/cumj.1132997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Amaç: Aşil tendonu (AT)- ultrasonografisi (US) ve gerinim elastografisi (SE) ile elde edilen AT- kalınlığı (T) ve AT- gerinim oranının (SR) mitral kapak kalsifikasyonlu (MAC) hastaları belirlemedeki önemini araştırmayı amaçladık.
Gereç ve Yöntem: Çalışmaya ekokardiyografi sonrası MAC tanısı alan 100 hasta (65 kadın, 35 erkek ve ortalama yaş 64.7 ± 12.1) ve kardiyovasküler risk faktörü benzer olan 50 kontrol (32 kadın, 18 erkek ve ortalama yaş 63.2 ± 12.8) alındı. Laboratuvar incelemeler ve AT US yapıldı. AT-T ve AT-SR hesaplandı.
Bulgular: MAC olan hastalarda AT-T ve AT-SR belirgin olarak yüksek olduğu bulundu. Logistic regresyon analizinde, AT-T ve AT-SR değerlerinin MAC olma riskini bağımsız olarak belirlediği bulundu. Bu analize göre AT-T (her 1 mm) ve AT-SR (her 0.1)’nin MAC olma riskini sırası ile %69.9 ve %12.7 oranlarında artırdığı saptandı. AT-T ve AT-SR değerlerinin MAC olan hastaları belirlemesi açısından ROC analizi yapıldığında, ROC eğri altında kalan alanın sırası ile 0.684 ve 0.819 belirlendi. Aynı analizde, AT-SR için sınır değer 1.25 olarak alındığında %94.1 sensitivite ve %76.2 spesivite ile MAC varlığını belirlediği tespit edildi.
Sonuç: AT SE incelemesinde saptanan AT-SR, MAC olan hastaları önceden belirlemede kullanılabilecek basit, ucuz, tekrarlanabilir ve non-invaziv bir parametredir. Bu durum MAC ve AT-SR artışının benzer fizyopatolojik mekanizma ile meydana gelebilmesinin bir sonucu olabilir.
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Affiliation(s)
- Burçak ÇAKIR PEKÖZ
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
| | - Arafat YILDIRIM
- SAĞLIK BİLİMLERİ ÜNİVERSİTESİ, ADANA ŞEHİR SAĞLIK UYGULAMA VE ARAŞTIRMA MERKEZİ
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12
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Huang H, Jiesisibieke D, Zhou X, Zhang Z, Duan X, Cheng X, Shao Z, Wang J, Zhang X. A lipid metabolite lipidomics assay for prediction and severity evaluation of rotator cuff injury. Front Nutr 2022; 9:1000947. [PMID: 36211515 PMCID: PMC9537637 DOI: 10.3389/fnut.2022.1000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveRotator cuff injury can be caused by local inflammation and fibrosis of musculotendinous cuff. Hypercholesterolemia can lead to physiological changes of rotator cuff that resemble rotator cuff injury. However, the relationship between lipid metabolism and rotator cuff injury and its potential pathological mechanism remain unclear. Herein, we aimed to investigate the correlation between the plasma lipidome, rotator cuff injury, and successive fatty infiltration pathology, and hoped to identify biomarkers for predicting higher risk or higher severity rotator cuff injury by assessing metabolic perturbations and dyslipidemia using lipidomics.MethodsWe quantitatively analyzed 60 lipids species of seven lipids classes and subclasses from 66 subjects using lipidomics. Subjects were divided into four groups: (1) normal rotator cuff with normal clinical routine serum lipid test results (NN group = 13); (2) normal rotator cuff with abnormal clinical routine serum lipid test results (NA group = 10); (3) rotator cuff tear with normal routine serum lipid test results (RN group = 30); (4) rotator cuff tear with abnormal routine serum lipid test results (RA group = 13). Independent-sample t-tests and Kruskal-Wallis tests were used to compare lipid metabolite levels in serum between different groups in patients with rotator cuff tears. The orthogonal partial least squares-discriminant analysis (OPLS-DA) model was used to verify the ability of five lysophosphatidylcholines (LPCs) to distinguish rotator cuff injuries. In the rotator cuff tear group, magnetic resonance imaging (MRI) was used to classify fatty infiltration according to Goutallier's classification. Kruskal-Wallis tests were used to analyze molecular differences between high-grade (grade 3–4) and low-grade (grade 0–2) fatty infiltration groups. Receiver operator characteristic (ROC) curves were drawn for each diagnostic method via different metabolites. The area under the curve (AUC), cutoff, specificity, sensitivity, and accuracy of each diagnostic criterion were calculated.ResultsOur results showed that some rotator cuff injury patients yielded unique lipidomic profiles. Based on Kruskal-Wallis tests, our results showed significant differences in three lipid molecules, 17:1 Lyso PI, 18:0–22:6 PE, and 18:3 (Cis) PC, among all four groups independent of clinical blood lipid levels. Also, independent of clinical blood lipid levels, two lipid molecules, 22:0 Lyso PC and 24:0 Lyso PC, were significantly different between the two groups based on Independent sample t-tests. Kruskal-Wallis test results showed that in the rotator cuff tear group, two metabolites (24:0 SM and 16:0 ceramide) differed between high-grade and low-grade fatty infiltration. The AUC values for 22:0 Lyso PC, 24:0 Lyso PC, 18:0–22:6 PE, 24:0 SM, and 16:0 ceramide were 0.6036, 0.6757, 0.6712, 0.8333, and 0.8981, respectively.ConclusionThe results provide insight into how the metabolic mechanisms associated with dyslipidemia impact rotator cuff diseases. Five lipid molecules, 17:1 Lyso PI, 18:0–22:6 PE, 18:3 (Cis) PC, 22:0 Lyso PC, and 24:0 Lyso PC, were closely related to rotator cuff tear based on two statistical analysis methods, independent of clinical routine serum lipid test results, which indicates that lipidomics assays are more sensitive than conventional lipid tests, and more suitable for studying rotator cuff lipid metabolism. In addition, two lipid metabolites, 24:0 SM and 16:0 ceramide, are potentially useful for predicting fatty infiltration severity. Further research with a larger number of samples is needed to verify whether these two metabolites can serve as potential markers of severe fatty infiltration. The findings illuminate how metabolic mechanisms associated with dyslipidemia affect rotator cuff disease.
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Affiliation(s)
- Hongjie Huang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Dina Jiesisibieke
- School of Clinical Medicine, Peking University Health Science Center, Beijing, China
| | - Xiang Zhou
- School of Clinical Medicine, Peking University Health Science Center, Beijing, China
| | - Zhu Zhang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xiaoning Duan
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Xu Cheng
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Zhenxing Shao
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
| | - Jianquan Wang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- *Correspondence: Jianquan Wang
| | - Xin Zhang
- Institute of Sports Medicine, Beijing Key Laboratory of Sports Injuries, Peking University Third Hospital, Beijing, China
- Xin Zhang
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Murugan A, Kanakaraju K, R M S, Sanjoy Mishra V. Achilles Tendon Softness and Thickness in Patients With Hypercholesterolemia. Cureus 2022; 14:e28340. [PMID: 36168354 PMCID: PMC9504804 DOI: 10.7759/cureus.28340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background Hypercholesterolemia is a condition where blood levels of cholesterol are high. It is of two types: The first type is familial hypercholesterolemia, which is hereditary, and the second one is due to diseases like diabetes, thyroid, etc. Achilles tendon xanthomas are noted in both types of hypercholesterolemia, which can be used as an indicator that predicts early cardiovascular disease. The aim of the study is to estimate the Achilles tendon thickness (ATT) and softness among hypercholesterolemia patients and to find the correlation between ATT and total cholesterol. Methodology A hospital-based cross-sectional, analytical study was done in a tertiary care hospital, Salem, for eight months. Patients of age over 18 years of both sexes who came for screening of total cholesterol in the outpatient department were included in the study. Those patients with a history of previous leg injury involving the Achilles tendon were excluded from the study. A pre-structured questionnaire was used to collect the data, and analysis was done using Statistical Package for the Social Sciences (SPSS) v20 (IBM Corp., Armonk, NY). The analysts performed the Pearson correlation test to determine the correlation between two continuous variables. A p-value of less than 0.05 was used to indicate statistical significance. Results In this study, there are 40 participants in the normal group and about 60 participants in the secondary hypercholesterolemia group. The mean ATT value among males and females was 9.3 and 6.1 mm, respectively. A positive correlation was noted between the ATT and total cholesterol value (p-value = 0.0001). Conclusion The thickness and softness of the Achilles tendon are positively correlated with the serum total cholesterol level. Males are the group where this correlation is most significant. As a result, men have a higher risk of developing Achilles tendon thickening than women. The thickness of the Achilles tendon can therefore be one of the early signs of high cholesterol levels. The clinician can utilize this indicator to evaluate early abnormal cardiac illness.
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Adorni MP, Biolo M, Zimetti F, Palumbo M, Ronda N, Scarinzi P, Simioni P, Lupo MG, Ferri N, Previato L, Bernini F, Zambon A. HDL Cholesterol Efflux and Serum Cholesterol Loading Capacity Alterations Associate to Macrophage Cholesterol Accumulation in FH Patients with Achilles Tendon Xanthoma. Int J Mol Sci 2022; 23:ijms23158255. [PMID: 35897824 PMCID: PMC9332368 DOI: 10.3390/ijms23158255] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/22/2022] [Accepted: 07/24/2022] [Indexed: 02/05/2023] Open
Abstract
Achilles tendon xanthoma (ATX) formation involves macrophage cholesterol accumulation within the tendon, similar to that occurring in atheroma. Macrophage cholesterol homeostasis depends on serum lipoprotein functions, namely the high-density lipoprotein (HDL) capacity to promote cell cholesterol efflux (cholesterol efflux capacity, CEC) and the serum cholesterol loading capacity (CLC). We explored the HDL-CEC and serum CLC, comparing 16 FH patients with ATX to 29 FH patients without ATX. HDL-CEC through the main efflux mechanisms mediated by the transporters ATP binding cassette G1 (ABCG1) and A1 (ABCA1) and the aqueous diffusion (AD) process was determined by a cell-based radioisotopic technique and serum CLC fluorimetrically. Between the two groups, no significant differences were found in terms of plasma lipid profile. A trend toward reduction of cholesterol efflux via AD and a significant increase in ABCA1-mediated HDL-CEC (+18.6%) was observed in ATX compared to no ATX patients. In ATX-presenting patients, ABCG1-mediated HDL-CEC was lower (−11%) and serum CLC was higher (+14%) compared to patients without ATX. Considering all the patients together, ABCG1 HDL-CEC and serum CLC correlated with ATX thickness inversely (p = 0.013) and directly (p < 0.0001), respectively. In conclusion, lipoprotein dysfunctions seem to be involved in ATX physiopathology and progression in FH patients.
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Affiliation(s)
- Maria Pia Adorni
- Unit of Neuroscience, Department of Medicine and Surgery, University of Parma, 43125 Parma, Italy;
| | - Marta Biolo
- Department of Medicine, University of Padua, 35128 Padua, Italy; (M.B.); (P.S.); (P.S.); (M.G.L.); (N.F.); (L.P.)
| | - Francesca Zimetti
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (F.Z.); (M.P.); (N.R.)
| | - Marcella Palumbo
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (F.Z.); (M.P.); (N.R.)
| | - Nicoletta Ronda
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (F.Z.); (M.P.); (N.R.)
| | - Paolo Scarinzi
- Department of Medicine, University of Padua, 35128 Padua, Italy; (M.B.); (P.S.); (P.S.); (M.G.L.); (N.F.); (L.P.)
| | - Paolo Simioni
- Department of Medicine, University of Padua, 35128 Padua, Italy; (M.B.); (P.S.); (P.S.); (M.G.L.); (N.F.); (L.P.)
| | - Maria Giovanna Lupo
- Department of Medicine, University of Padua, 35128 Padua, Italy; (M.B.); (P.S.); (P.S.); (M.G.L.); (N.F.); (L.P.)
| | - Nicola Ferri
- Department of Medicine, University of Padua, 35128 Padua, Italy; (M.B.); (P.S.); (P.S.); (M.G.L.); (N.F.); (L.P.)
| | - Lorenzo Previato
- Department of Medicine, University of Padua, 35128 Padua, Italy; (M.B.); (P.S.); (P.S.); (M.G.L.); (N.F.); (L.P.)
| | - Franco Bernini
- Department of Food and Drug, University of Parma, 43124 Parma, Italy; (F.Z.); (M.P.); (N.R.)
- Correspondence: ; Tel.: +39-0521-905039
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Hamaguchi H. Can Achilles Tendon Assessment of Adult Familial Hypercholesterolemia be Reflected as a Risk Factor for Arteriosclerosis? J Atheroscler Thromb 2022; 29:1568-1570. [PMID: 35718451 DOI: 10.5551/jat.ed206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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The Achilles Tendon: Imaging Diagnoses and Image-Guided Interventions- AJR Expert Panel Narrative Review. AJR Am J Roentgenol 2022; 219:355-368. [PMID: 35506554 DOI: 10.2214/ajr.22.27632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The Achilles tendon is commonly affected by both chronic repetitive overuse and traumatic injuries. Achilles tendon injuries can potentially affect any individual but have a particularly high incidence in professional athletes. Appropriate imaging evaluation and diagnosis are paramount to guiding appropriate management. In this AJR Expert Panel Narrative Review, we discuss the role of various imaging modalities (particularly ultrasound and MRI) in the assessment of Achilles tendon pathology, focusing on modalities' relative advantages and technical considerations. We describe the most common diagnoses affecting the Achilles tendon and adjacent structures, highlighting key imaging findings and providing representative examples. Various image-guided interventions that may be employed in the management of Achilles tendon pathology are also reviewed, including high-volume injection, tendon fenestration, prolotherapy, and corticosteroid injection. The limited evidence supporting such interventions are summarized, noting an overall paucity of large-scale studies showing benefit. Finally, a series of consensus statements by the panel on imaging and image-guided intervention for Achilles tendon pathology are provided.
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Baragetti A, Casula M, Scarinzi P, Ristè F, Scicali R, Biolo M, Lugari S, Dall'Agata M, Gazzotti M, Olmastroni E, Alieva AS, Nascimbeni F. Achilles tendon ultrasonography in familial hypercholesterolemia: A sub-study of the LIpid transPort disorders Italian GEnetic Network (LIPIGEN). J Intern Med 2022; 291:702-704. [PMID: 34875114 PMCID: PMC9300130 DOI: 10.1111/joim.13421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Andrea Baragetti
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.,Centre for the Study of Atherosclerosis, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Multimedica Hospital, Sesto San Giovanni, Italy
| | - Manuela Casula
- Centre for the Study of Atherosclerosis, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) Multimedica Hospital, Sesto San Giovanni, Italy.,Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Paolo Scarinzi
- U. O. C. Clinica Medica 1, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Federica Ristè
- U. O. Medicina Interna Universitaria, Institute of Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Roberto Scicali
- Department of Clinical and Experimental Medicine, Internal Medicine, University of Catania, Catania, Italy
| | - Marta Biolo
- U. O. C. Clinica Medica 1, Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Simonetta Lugari
- Unit of Internal and Metabolic Medicine, Civil Hospital of Baggiovara, A. O. U. of Modena and University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Dall'Agata
- U. O. Medicina Interna Universitaria, Institute of Internal Medicine, University of Ferrara, Ferrara, Italy
| | - Marta Gazzotti
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Elena Olmastroni
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Asiiat S Alieva
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.,Research Laboratory of Lipid Metabolism Disorders and Atherosclerosis, Almazov National Medical Research Centre, St. Petersburg, Russian Federation
| | - Fabio Nascimbeni
- Unit of Internal and Metabolic Medicine, Civil Hospital of Baggiovara, A. O. U. of Modena and University of Modena and Reggio Emilia, Modena, Italy
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- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
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Michikura M, Ogura M, Hori M, Matsuki K, Makino H, Hosoda K, Harada-Shiba M. Association between Achilles Tendon Softness and Atherosclerotic Cardiovascular Disease in Patients with Familial Hypercholesterolemia. J Atheroscler Thromb 2022; 29:1603-1612. [PMID: 35013021 DOI: 10.5551/jat.63151] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Achilles tendon (AT) xanthomas are a specific physical finding of familial hypercholesterolemia (FH) and AT thickness has been used for its diagnosis and evaluation of its severity. Recently, we reported that the AT of FH patients was softer than that of non-FH patients and the combined use of a cut-off value for AT softness with that for AT thickness improved diagnostic accuracy. However, an association between AT softness and severity of atherosclerosis has not been reported. Accordingly, the present study aimed to investigate whether AT softness was associated with carotid atherosclerosis and presence of atherosclerotic cardiovascular disease (ASCVD) in FH. METHODS The AT of 176 genetically diagnosed FH patients and 98 non-FH patients was examined to measure AT thickness and the elasticity index (EI) as an indicator for assessing AT softness using ultrasonography. RESULTS Increased age was associated with AT softness, and overweight was negatively related to AT softness. There were significant inverse correlations between EI and maximum and mean intima-media thickness (IMT) within the common carotid artery only among FH patients. In multiple linear regression analysis, although the relationship between EI and mean IMT was attenuated, the association between EI and maximum IMT remained robust. In logistic regression analysis adjusted for age, sex and traditional cardiovascular risk factors (smoking history, presence of hypertension, presence of diabetes mellitus, overweight, LDL-cholesterol, HDL-cholesterol, and Log triglycerides), EI was associated with presence of ASCVD (Odds ratio per 1-SD increase, 0.37;95% CI, 0.15 - 0.86; P=0.0252). CONCLUSION The degree of lipid deposition in the AT of FH patients could be assessed by its thickness as well as its softness. AT softness is not only useful in diagnosing FH but is also associated with the severity of carotid atherosclerosis and presence of ASCVD. In addition, these findings suggest that AT softness would be helpful in risk assessment for FH patients.
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Affiliation(s)
- Masahito Michikura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center Hospital
| | - Masatsune Ogura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of General Medical Science, Chiba University Graduate School of Medicine.,Department of Metabolism and Endocrinology, Eastern Chiba Medical Center
| | - Mika Hori
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of Endocrinology, Research Institute of Environmental Medicine, Nagoya University
| | - Kota Matsuki
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine
| | - Hisashi Makino
- Department of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center Hospital
| | - Kiminori Hosoda
- Department of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center Hospital
| | - Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute.,Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
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Tada H, Okada H, Nohara A, Takamura M, Kawashiri MA. Genetic mutations, regression of Achilles tendon thickness, and cardiovascular events among patients with familial hypercholesterolemia. Atherosclerosis 2021; 340:28-34. [PMID: 34871818 DOI: 10.1016/j.atherosclerosis.2021.11.031] [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: 10/08/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND AIMS Achilles tendon thickness (ATT) can be regressed through LDL-lowering in patients with familial hypercholesterolemia (FH). We aimed to determine factors associated with regression of ATT and its role in development of major adverse cardiovascular events (MACE). METHODS Patients with clinically diagnosed FH (N = 1,050, male/female = 490/560) were retrospectively assessed. FH-related gene mutations and ATT data using X-ray were collected. Multivariable linear regression analysis was exploited to test the factors associated with deterioration of ATT. Cox proportional hazards models were used to assess factors associated with MACE, including cardiovascular death and acute coronary events. RESULTS The median follow-up period was 12.6 years. FH-linked mutations were identified in 777 patients. During the follow-up period, 113 MACEs were observed, and median ATT was regressed from 8.7 to 8.5 mm. We found that there was more significant positive correlation between cholesterol-year score and ATT among patients with FH-related gene mutation (p < 2.2 × 10-16; Spearman's r = 0.42). Multivariable linear regression analyses revealed that age (standardized coefficients [SCs] = 0.307, 95% confidence interval [CI] = 0.241-0.373), hypertension (SCs = 0.069, 95%CI = 0.001-0.138), and diabetes (SCs = 0.059, 95% CI = 0.003-0.115) were positively correlated with changes in ATT (progression). Baseline ATT (SCs = -0.474, 95%CI = -0.535-0.413) and FH-related mutations (SCs = -0.058, 95%CI = -0.091-0.024) were negatively correlated with changes in ATT (regression). Considering this confounding factors, regression of ATT was significantly associated with reduced MACE (hazard ratio [HR] = 0.67, 95%CI = 0.51-0.89, per 1.0 mm). CONCLUSIONS Assessed ATT condition and presence of FH-linked gene mutations represent diagnostic values and risk stratification information among patients with FH.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan.
| | - Hirofumi Okada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Atsushi Nohara
- Department of Genetics, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Achilles tendon thickness is associated with coronary lesion severity in acute coronary syndrome patients without familial hypercholesterolemia. J Cardiol 2021; 79:311-317. [PMID: 34657775 DOI: 10.1016/j.jjcc.2021.09.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 09/19/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Thickening of Achilles tendon (≥9 mm on radiography) is one of the diagnostic criteria for familial hypercholesterolemia (FH). Since FH is associated with premature coronary artery disease (CAD) including acute coronary syndrome (ACS), measurement of Achilles tendon thickness (ATT) is important for early diagnosis of FH. However, clinical significance of mild thickening of Achilles tendon in non-FH patients with CAD is unclear. The present study investigated the association of ATT with coronary lesion severity in early-onset ACS without clinically diagnosed FH. METHODS From outpatients who had a history of ACS under 60 years old, 76 clinically non-FH subjects (71 men and 5 women; mean age at the onset of ACS, 50.5 years) with maximum ATT of <9 mm were enrolled in this study. The severity of coronary lesions was assessed by SYNTAX score derived from coronary angiography at the onset of ACS. RESULTS ATT levels were not significantly different among patients with ST-elevation myocardial infarction (STEMI, n=47), non-STEMI (n=12), and unstable angina (n=17). Whereas, both average and maximum ATT were significantly larger in patients with multivessel lesions (n=25) than in those with single-vessel disease (n=51). Furthermore, SYNTAX score was positively correlated with average ATT (r=0.368, p=0.0011) and maximum ATT (r=0.388, p=0.0005). As for the relation to clinical parameters, maximum ATT had positive correlations with body mass index and C-reactive protein. A multiple regression analysis revealed that average and maximum ATT were significantly associated with SYNTAX score, independently of various confounding factors. CONCLUSIONS Our findings demonstrated that ATT, even though its level was <9 mm, was associated with coronary lesion severity in clinically non-FH patients with early-onset ACS. Apart from diagnosing FH, ATT may be a predictor of the progression of CAD.
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Chua YA, Razman AZ, Ramli AS, Mohd Kasim NA, Nawawi H. Familial Hypercholesterolaemia in the Malaysian Community: Prevalence, Under-Detection and Under-Treatment. J Atheroscler Thromb 2021; 28:1095-1107. [PMID: 33455995 PMCID: PMC8560842 DOI: 10.5551/jat.57026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 10/29/2020] [Indexed: 11/15/2022] Open
Abstract
AIM Familial hypercholesterolaemia (FH) is the most common autosomal dominant lipid disorder, leading to severe hypercholesterolaemia. Early detection and treatment with lipid-lowering medications may reduce the risk of premature coronary artery disease in FH patients. However, there is scarcity of data on FH prevalence, detection rate, treatment and control with lipid-lowering therapy in the Malaysian community. METHODS Community participants (n=5130) were recruited from all states in Malaysia. Blood samples were collected for lipid profiles and glucose analyses. Personal and family medical histories were collected by means of assisted questionnaire. Physical examination for tendon xanthomata and premature corneal arcus were conducted on-site. FH were clinically screened using Dutch Lipid Clinic Network Criteria. RESULTS Out of 5130 recruited community participants, 55 patients were clinically categorised as potential (Definite and Probable) FH, making the prevalence FH among the community as 1:100. Based on current total population of Malaysia (32 million), the estimated number of FH patients in Malaysia is 320,000, while the detection rates are estimated as 0.5%. Lipid-lowering medications were prescribed to 54.5% and 30.5% of potential and possible FH patients, respectively, but none of them achieved the therapeutic LDL-c target. CONCLUSION Clinically diagnosed FH prevalence in Malaysian population is much higher than most of the populations in the world. At community level, FH patients are clinically under-detected, with majority of them not achieving target LDL-c level for high-risk patients. Therefore, public health measures are warranted for early detection and treatment, to enhance opportunities for premature CAD prevention.
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Affiliation(s)
- Yung-An Chua
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Aimi Zafira Razman
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Anis Safura Ramli
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Departments of Primary Care Medicine, Universiti Teknologi MARA, Selayang, Selangor, Malaysia
| | - Noor Alicezah Mohd Kasim
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Pathology, Faculty of Medicine, Universiti Teknologi MARA, Selayang, Selangor, Malaysia
| | - Hapizah Nawawi
- Institute of Pathology, Laboratory and Forensic Medicine (I-PPerForM), Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Pathology, Faculty of Medicine, Universiti Teknologi MARA, Selayang, Selangor, Malaysia
- Specialist Lipid and Coronary Risk Prevention Clinics, Clinical Training Centre, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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22
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Squier K, Scott A, Hunt MA, Brunham LR, Wilson DR, Screen H, Waugh CM. The effects of cholesterol accumulation on Achilles tendon biomechanics: A cross-sectional study. PLoS One 2021; 16:e0257269. [PMID: 34529718 PMCID: PMC8445482 DOI: 10.1371/journal.pone.0257269] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/31/2021] [Indexed: 11/18/2022] Open
Abstract
Familial hypercholesterolemia, a common genetic metabolic disorder characterized by high cholesterol levels, is involved in the development of atherosclerosis and other preventable diseases. Familial hypercholesterolemia can also cause tendinous abnormalities, such as thickening and xanthoma (tendon lipid accumulation) in the Achilles, which may impede tendon biomechanics. The objective of this study was to investigate the effect of cholesterol accumulation on the biomechanical performance of Achilles tendons, in vivo. 16 participants (10 men, 6 women; 37±6 years) with familial hypercholesterolemia, diagnosed with tendon xanthoma, and 16 controls (10 men, 6 women; 36±7 years) underwent Achilles biomechanical assessment. Achilles biomechanical data was obtained during preferred pace, shod, walking by analysis of lower limb kinematics and kinetics utilizing 3D motion capture and an instrumented treadmill. Gastrocnemius medialis muscle-tendon junction displacement was imaged using ultrasonography. Achilles stiffness, hysteresis, strain and force were calculated from displacement-force data acquired during loading cycles, and tested for statistical differences using one-way ANOVA. Statistical parametric mapping was used to examine group differences in temporal data. Participants with familial hypercholesterolemia displayed lower Achilles stiffness compared to the control group (familial hypercholesterolemia group: 87±20 N/mm; controls: 111±18 N/mm; p = 0.001), which appeared to be linked to Achilles loading rate rather than an increased strain (FH: 5.27±1.2%; controls: 4.95±0.9%; p = 0.413). We found different Achilles loading patterns in the familial hypercholesterolemia group, which were traced to differences in the centre of pressure progression that affected ankle moment. This finding may indicate that individuals with familial hypercholesterolemia use different Achilles loading strategies. Participants with familial hypercholesterolemia also demonstrated significantly greater Achilles hysteresis than the control group (familial hypercholesterolemia: 57.5±7.3%; controls: 43.8±10%; p<0.001), suggesting that walking may require a greater metabolic cost. Our results indicate that cholesterol accumulation could contribute to reduced Achilles function, while potentially increasing the chance of injury.
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Affiliation(s)
- Kipling Squier
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Alexander Scott
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Michael A. Hunt
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Liam R. Brunham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R. Wilson
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
- Department of Orthopaedics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hazel Screen
- School of Engineering & Materials Science, Queen Mary University of London, London, United Kingdom
| | - Charlie M. Waugh
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
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23
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A Rare Case of Bilateral Achilles Tendon Xanthomas in a Teenager, Successfully Treated with Tendon Sparing Technique. Case Rep Orthop 2021; 2021:1932763. [PMID: 34395005 PMCID: PMC8360742 DOI: 10.1155/2021/1932763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 06/09/2021] [Accepted: 07/17/2021] [Indexed: 11/30/2022] Open
Abstract
Background Xanthoma of the Achilles tendon, even though being benign, is a surgically challenging orthopaedic condition. Causality is believed to be due to a pathological error in the metabolism of low-density lipoprotein and their resultant accumulation, as foam cells within the tendon. Tendon xanthomas are often found to accompany heterozygous familial hypercholesterolemia. Case Presentation. A 19-year-old girl presented to our institution (a District General Hospital), with soft tissue lumps over posterior aspect of the ankle on both sides for several years. She had noticed a rapid increase in size in recent 3 months and sought medical advice. During investigation, she was diagnosed having bilateral Achilles tendon xanthomas clinically, confirmed by ultrasound scan and magnetic resonance imaging, and familial hypercholesterolemia concomitantly. The former was managed with intralesion subtotal resection where the histology further confirmed the diagnosis. The patient was commenced on statins and followed up while assessing the functional outcome and recurrences up to 2 years, with favourable results. Conclusion Subtotal resection of Achilles tendon xanthoma (tendon sparingly) offers cosmetically and functionally acceptable outcomes, with faster recovery and no recurrences over 2 years.
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24
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Zahradnik TM, Cresswell M, Squier K, Waugh C, Brunham L, Screen H, Scott A. Can Achilles tendon xanthoma be distinguished from Achilles tendinopathy using Dixon method MRI? A cross-sectional exploratory study. BMC Musculoskelet Disord 2021; 22:627. [PMID: 34271888 PMCID: PMC8285885 DOI: 10.1186/s12891-021-04494-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/28/2021] [Indexed: 11/15/2022] Open
Abstract
Background Familial hypercholesterolemia is a genetic condition characterized by life-long elevations of plasma low-density lipoprotein cholesterol. In addition to life-threatening cardiovascular complications, intratendinous cholesterol deposits (xanthomas) can lead to pain and tendon thickening, particularly in the Achilles. Clinical detection of xanthomas currently relies upon visual assessment and palpation, or ultrasound-based measures of tendon thickening or echotexture. Misdiagnosis of xanthoma can delay the commencement of potentially life-saving lipid-lowering therapy. Our primary purpose was to determine whether analysis of separated fat and water magnetic resonance images may be able to differentiate between xanthomatic and nonxanthomatic Achilles tendons through quantification of intratendinous fat content. The main hypothesis was that Achilles tendon xanthomas will demonstrate greater lipid content than Achilles tendinopathy or healthy control tendons. Methods Bilateral MRI scans of Achilles tendons from 30 participants (n = 10 Achilles tendon xanthoma, n = 10 Achilles overuse tendinopathy, n = 10 healthy controls) were analyzed for total lipid content using the Dixon method of fat and water signal separation. Secondary outcome measures included tendon water content, as well as ultrasound characterization of tendon tissue organization and thickness. Results Fat content was greater in Achilles tendon xanthomas compared to the tendinopathy (p < 0.0001) and control groups (p < 0.0001). Water content was also greater in Achilles tendon xanthomas compared to the tendinopathy (p < 0.0001) and control groups (p = 0.0002). Ultrasound tissue characterization revealed worse tissue organization in Achilles tendon xanthoma tendons compared to Achilles tendinopathy (p < 0.05) but demonstrated largely overlapping distributions. Achilles tendon xanthoma tendons were, on average, significantly thicker than the tendons of the other two groups (p < 0.01 and p < 0.001, respectively). Conclusion MRI-derived measures of Achilles tendon fat content may be able to distinguish xanthomas from control and tendinopathic tissue. Dixon method MRI warrants further evaluation in an adequately powered study to develop and test clinically relevant diagnostic thresholds. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04494-0.
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Affiliation(s)
- Thomas Michael Zahradnik
- Centre for Hip Health and Mobility, University of British Columbia, BC, Vancouver, Canada.,Ottawa Health Research Institute, University of Ottawa, Ottawa, ON, Canada
| | - Mark Cresswell
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Kip Squier
- Centre for Hip Health and Mobility, University of British Columbia, BC, Vancouver, Canada
| | - Charlotte Waugh
- Centre for Hip Health and Mobility, University of British Columbia, BC, Vancouver, Canada
| | - Liam Brunham
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, BC, Canada
| | - Hazel Screen
- Bioengineering Division, School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Alex Scott
- Centre for Hip Health and Mobility, University of British Columbia, BC, Vancouver, Canada. .,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada.
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25
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Ogura M, Harada-Shiba M, Masuda D, Arai H, Bujo H, Ishibashi S, Daida H, Koga N, Oikawa S, Yamashita S. Factors Associated with Carotid Atherosclerosis and Achilles Tendon Thickness in Japanese Patients with Familial Hypercholesterolemia: A Subanalysis of the Familial Hypercholesterolemia Expert Forum (FAME) Study. J Atheroscler Thromb 2021; 29:906-922. [PMID: 34108342 PMCID: PMC9174085 DOI: 10.5551/jat.62925] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIMS Familial hypercholesterolemia (FH) is characterized by high low-density lipoprotein (LDL) cholesterol levels, xanthomas including Achilles tendon thickening, and premature coronary artery disease (CAD). Carotid intima-media thickness (IMT) is a well-established surrogate marker for CAD in FH and Achilles tendon thickening is a specific physical finding in patients with FH. The objective of the present study was to identify factors associated with carotid IMT and Achilles tendon thickness in FH heterozygotes on lipid-lowering therapy. This study also aimed to examine the follow-up changes in carotid IMT and Achilles tendon thickness among them in the current real-world FH practice. METHODS The current study is a subanalysis of the Familial Hypercholesterolemia Expert Forum (FAME) Study. The severity of carotid atherosclerosis was assessed with the maximal and mean IMT using ultrasonography, and Achilles tendon thickness was measured using X-rays. The present study used 571 patients under medical treatment for heterozygous FH who had baseline measurements for maximal IMT (n=511), mean IMT (n=459), or Achilles tendon thickness (n=486). The IMT was measured annually, and Achilles tendon thickness was evaluated every two years. RESULTS Higher LDL cholesterol (LDL-C) level and lower HDL cholesterol (HDL-C) level were associated with greater maximal and mean IMT as well as greater Achilles tendon thickness. Achilles tendon thickness tended to be greater in patients who had a smoking history than in never-smokers. Maximal IMT and Achilles tendon thickness were significantly greater in patients with CAD than in those without. Additionally, lower HDL-C level and hypertension were associated with higher values of maximal and mean IMT, suggesting the importance of comprehensive risk management including reduced HDL-C and blood pressure control in FH care. In longitudinal observations, percentage changes in maximal IMT and mean IMT gradually increased during the observation period. In contrast, percentage changes in Achilles tendon thickness became progressively thinner throughout the observation period. CONCLUSIONS We found a positive association between LDL-C levels and severity of carotid atherosclerosis in heterozygous FH patients on treatment. This observation suggests the insufficiency of lipid-lowering therapy and the presence of therapeutic inertia among clinicians in the real-world FH practice.
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Affiliation(s)
- Masatsune Ogura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
| | - Mariko Harada-Shiba
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
| | - Daisaku Masuda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Hideaki Bujo
- Department of Clinical Laboratory and Experimental Research Medicine, Toho University, Sakura Medical Center
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | | | - Shinichi Oikawa
- Diabetes and Lifestyle Disease Center, Fukujyuji Hospital, Japan Anti-Tuberculosis Association (JATA)
| | - Shizuya Yamashita
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine.,Department of Community Medicine, Osaka University Graduate School of Medicine
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26
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Maffulli N, Oliva F, Maffulli GD, Migliorini F. Failed Surgery for Patellar Tendinopathy in Athletes: Midterm Results of Further Surgical Management. Orthop J Sports Med 2021; 9:2325967121994550. [PMID: 33855096 PMCID: PMC8013696 DOI: 10.1177/2325967121994550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Tendon injuries are commonly seen in sports medicine practice. Many elite players involved in high-impact activities develop patellar tendinopathy (PT) symptoms. Of them, a small percentage will develop refractory PT and need to undergo surgery. In some of these patients, surgery does not resolve these symptoms. Purpose: To report the clinical results in a cohort of athletes who underwent further surgery after failure of primary surgery for PT. Study Design: Case series; Level of evidence, 4. Methods: A total of 22 athletes who had undergone revision surgery for failed surgical management of PT were enrolled in the present study. Symptom severity was assessed through the Victorian Institute of Sport Assessment Scale for Patellar Tendinopathy (VISA-P) upon admission and at the final follow-up. Time to return to training, time to return to competition, and complications were also recorded. Results: The mean age of the athletes was 25.4 years, and the mean symptom duration from the index intervention was 15.3 months. At a mean follow-up of 30.0 ± 4.9 months, the VISA-P score improved 27.8 points (P < .0001). The patients returned to training within a mean of 9.2 months. Fifteen patients (68.2%) returned to competition within a mean of 11.6 months. Of these 15 patients, a further 2 had decreased their performance, and 2 more had abandoned sports participation by the final follow-up. The overall rate of complications was 18.2%. One patient (4.5%) had a further revision procedure. Conclusion: Revision surgery was feasible and effective in patients in whom PT symptoms persisted after previous surgery for PT, achieving a statistically significant and clinically relevant improvement of the VISA-P score as well as an acceptable rate of return to sport at a follow-up of 30 months.
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Affiliation(s)
- Nicola Maffulli
- Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
- Nicola Maffulli, MD, MS, PhD, Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Via S. Allende, 84081 Baronissi (SA), Italy ()
| | - Francesco Oliva
- Department of Musculoskeletal Disorders, Faculty of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
| | | | - Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
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27
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Poonia A, Giridhara P, Sheoran D. Cutaneous Manifestations in Homozygous Familial Hypercholesterolemia. Am J Med Sci 2020; 361:e49-e50. [PMID: 33771338 DOI: 10.1016/j.amjms.2020.10.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Revised: 06/25/2020] [Accepted: 10/30/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Amitabh Poonia
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India.
| | - Priya Giridhara
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
| | - Divya Sheoran
- Pandit BD Sharma University of Health Sciences, Rohtak, Haryana, India
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28
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Schmidt EB, Hedegaard BS, Retterstøl K. Familial hypercholesterolaemia: history, diagnosis, screening, management and challenges. Heart 2020; 106:1940-1946. [DOI: 10.1136/heartjnl-2019-316276] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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29
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Migliorini F, Tingart M, Maffulli N. Progress with stem cell therapies for tendon tissue regeneration. Expert Opin Biol Ther 2020; 20:1373-1379. [DOI: 10.1080/14712598.2020.1786532] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Filippo Migliorini
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Markus Tingart
- Department of Orthopaedics, University Clinic Aachen, RWTH Aachen University Clinic, Aachen, Germany
| | - Nicola Maffulli
- Department of Medicine, Surgery and Dentistry, University of Salerno, Baronissi, Italy
- School of Pharmacy and Bioengineering, Keele University School of Medicine, Stoke on Trent, UK
- Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, UK
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30
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Genkel V, Kuznetsova A, Lebedev E, Sinitskii A, Pykhova L, Shaposhnik I. Achilles Tendon Thickness Is an Independent Predictor of Carotid Atherosclerosis and Is Associated With a Carotid Plaque Burden. Angiology 2020; 71:734-739. [PMID: 32476444 DOI: 10.1177/0003319720928226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of the study was to research the relationship between carotid atherosclerosis markers and ultrasound parameters of Achilles tendons (AT). The study included 150 patients at high and very high cardiovascular risk (CVR). All patients underwent a carotid ultrasound scanning. We evaluated carotid plaque, carotid plaque score (cPS), carotid total plaque area (cTPA), and the percentage of stenosis. All patients underwent AT ultrasound with an assessment of thickness (Achilles tendon thickness [ATT]), width (Achilles tendon width), and cross-sectional area. An increase in the ATT ≥5.07 mm was associated with a 4.55-fold increase in the relative risk of carotid atherosclerosis (sensitivity 68.3% and specificity 62.5%). Direct correlations between the ATT and carotid stenosis (r = 0.277; P = .004), cPS (r = 0.225; P = .035), and cTPA (r = 0.305; P = .004) were determined. An increase in the mean ATT by 1 mm was associated with an increase in cTPA by 8.09 mm2 (95% CI: 2.26-13.9; P = .007) and carotid stenosis by 4.11% (95% CI: 0.64-7.60; P = .021). Thus, in patients with high and very high CVR, an increase in ATT is an independent predictor of carotid atherosclerosis. The ATT directly correlates with the markers of carotid plaque burden.
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Affiliation(s)
- Vadim Genkel
- Department of Internal Medicine, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Alla Kuznetsova
- Department of Hospital Therapy, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Evgeny Lebedev
- Department of Internal Medicine, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Anton Sinitskii
- Central Research Laboratory, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Lubov Pykhova
- Central Research Laboratory, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Igor Shaposhnik
- Department of Internal Medicine, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
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31
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Torgutalp ŞŞ, Babayeva N, Taş S, Dönmez G, Korkusuz F. Effects of hyperlipidemia on patellar tendon stiffness: A shear wave elastography study. Clin Biomech (Bristol, Avon) 2020; 75:104998. [PMID: 32335470 DOI: 10.1016/j.clinbiomech.2020.104998] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/13/2020] [Accepted: 03/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent studies presented that increased adiposity and hyperlipidemia may cause tendon pathology. The aim of this study was to evaluate the effect of hyperlipidemia on the patellar tendon stiffness by shear wave elastography. METHODS A total of 51 participants (19 female, 32 male) were included. Participants were divided into two groups, according to their low-density lipoprotein levels, as the study group (hyperlipidemia, n = 24) and the control group (non-hyperlipidemia, n = 27). The patellar tendon and rectus femoris muscle shear wave velocities were measured by shear wave elastography. FINDINGS Patellar tendon shear wave velocities was 5.02 (SD: 0.78) m/s in the control group and 5.98 (SD: 1.19) m/s in the hyperlipidemia group (ES = 0.95, P = .001). There was a positive moderate statistically significant correlation between patellar tendon shear wave velocity and low-density lipoprotein (r = 0.432, p < .002). In the multiple linear regression analysis, only low-density lipoprotein was found as a significant predictor of patellar tendon shear wave velocity (CI: 0.005-0.028, P = .007). INTERPRETATION We evaluated the effects of hyperlipidemia and body mass index on patellar tendon mechanical properties with shear wave elastography. We found that the blood low-density lipoprotein level had an impact on patellar tendon stiffness independently of body mass index. Accordingly, it is important to evaluate individuals' low-density lipoprotein levels when examining risk factors for tendon pathology.
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Affiliation(s)
- Şerife Şeyma Torgutalp
- Hacettepe University, Faculty of Medicine, Department of Sports Medicine, 06100 Ankara, Turkey.
| | - Naila Babayeva
- Hacettepe University, Faculty of Medicine, Department of Sports Medicine, 06100 Ankara, Turkey
| | - Serkan Taş
- Toros University, School of Health Sciences, Department of Physiotherapy and Rehabilitation, 33140, Mersin, Turkey
| | - Gürhan Dönmez
- Hacettepe University, Faculty of Medicine, Department of Sports Medicine, 06100 Ankara, Turkey
| | - Feza Korkusuz
- Hacettepe University, Faculty of Medicine, Department of Sports Medicine, 06100 Ankara, Turkey
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32
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Dell'Aversano Orabona G, Dato C, Oliva M, Ugga L, Dotti MT, Fratta M, Gisonni P. Multi-imaging study in a patient with cerebrotendinous xanthomatosis: radiology, clinic and pathology correlation of a rare condition. BJR Case Rep 2020; 6:20190047. [PMID: 32201602 PMCID: PMC7068097 DOI: 10.1259/bjrcr.20190047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 07/17/2019] [Accepted: 07/30/2019] [Indexed: 01/14/2023] Open
Abstract
Cerebrotendinous xanthomatosis (CTX) is a rare metabolic disease with autosomal recessive inheritance. It is caused by mutations of the CYP27A1 gene, which codifies for sterol 27-hydroxylase, an enzyme that is responsible for the synthesis of cholic acids. In CTX, cholic acid synthesis is impaired, leading to accumulation of the precursor chenodessossicholic acid) in various organs and tissues. The clinical manifestations of CTX include chronic diarrhea, early-onset cataracts, tendon xanthomas and neurological disturbances. Therapy with oral chenodessossicholic acid has been shown to provide significantly better outcomes for affected individuals; therefore, recognition of this disease and awareness of its suggestive instrumental signs is extremely important. In this study, we describe the imaging findings in a 43-years-old male who was diagnosed with CTX and studied through ultrasound, CT and MRI. It is important that the neurology and radiology communities are aware of this multi-imaging findings: recognition of them is important, as due to the high variability of the manifestation of this disease; it could impact on early diagnosis of a condition rarely seen, but manageable.
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Affiliation(s)
| | | | - Mariano Oliva
- Second Department of Neurology, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
| | - Maria Teresa Dotti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Mario Fratta
- Second Department of Neurology, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Pietro Gisonni
- Department of Advanced Biomedical Sciences, "Federico II" University of Naples, Naples, Italy
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Constantin AT, Covacescu SM, Kozma A, Gherghina I, Lazarescu H. STATINS TREATMENT AND ORO-DENTAL ASPECTS IN A CASE OF HEREDITARY HYPERCHOLESTEROLEMIA IN A CHILD UNDER 6 YEARS. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 15:378-383. [PMID: 32010359 DOI: 10.4183/aeb.2019.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Familial hypercholesterolemia (FH) is a genetic disease with autosomal dominant transmission, characterised by high blood cholesterol levels. The evolution of this disease leads to primary atherosclerosis and cardiovascular disease. Patients with HF develop atherosclerosis by the age of 20 and usually do not survive past the age of 30. We present the case and oro-dental aspects of a preschooler that was diagnosed at the age of 4 with FH, compound heterozygote (mutation/genotype1 LDLR: C20IX, exon 4; mutation/genotype2 LDLR: G571E, exon 12) and the experience of our clinic in the management of this patient that received off-label treatment with statins. When diagnosed, his cholesterol level was 932 mg/dL and his LDL-cholesterol level was 792 mg/dL. Treatment with rosuvastatin and ezetimibe was prescribed. Both substances (rosuvastatin and ezetimibe) are not approved for children under the age of 6 in Europe. Taking into considerations the diagnosis and prognosis for unfavorable evolution, treatment with statins was started at the age of 5 years.
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Affiliation(s)
- A T Constantin
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Clinical Department of Pediatrics, Bucharest, Romania
| | - S M Covacescu
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Clinical Department of Pediatrics, Bucharest, Romania
| | - A Kozma
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Department of Research in Social Pediatrics and Obstetrics, Bucharest, Romania.,"Alessandrescu-Rusescu" National Institute for Mother and Child Health - National Institute for Recovery, Physical Medicine and Balneoclimatology - Research Department, Bucharest, Romania
| | - I Gherghina
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - Clinical Department of Pediatrics, Bucharest, Romania
| | - H Lazarescu
- "Alessandrescu-Rusescu" National Institute for Mother and Child Health - National Institute for Recovery, Physical Medicine and Balneoclimatology - Research Department, Bucharest, Romania
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Erim A, Udoh B, Paulinus S, Ukpong E. Sonographic assessment of tendo calcaneus thickness in a Nigerian population. NIGERIAN JOURNAL OF MEDICINE 2020. [DOI: 10.4103/njm.njm_93_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kapoor N, Johnson J, Paul J, Cherian K, Asha HS, Paul T. Familial hypercholesterolemia: The skin speaks. J Family Med Prim Care 2020; 9:4451-4453. [PMID: 33110883 PMCID: PMC7586528 DOI: 10.4103/jfmpc.jfmpc_819_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/14/2020] [Accepted: 07/07/2020] [Indexed: 11/18/2022] Open
Abstract
Familial hypercholesterolaemia (FH) is an autosomal dominant inherited disorder of lipoprotein metabolism caused by defects in the low-density lipoprotein receptor (LDLR) gene. It is characterized by high low-density lipoprotein (LDL) cholesterol levels, premature cardiovascular disease (CVD), and tendon xanthomas. We present the case of a 26-year-old gentleman who presented with multiple nodular eruptions over the extensor aspects of upper and lower limbs and was diagnosed as FH on the basis of positive family history, typical lipid profile abnormalities, and biopsy of the nodule consistent with tendon xanthomas. The diagnosis and management of this case is deftly feasible at the primary care level.
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Kuo LT, Chen HM, Yu PA, Chen CL, Hsu WH, Tsai YH, Chen KJ, Chen VCH. Depression increases the risk of rotator cuff tear and rotator cuff repair surgery: A nationwide population-based study. PLoS One 2019; 14:e0225778. [PMID: 31765424 PMCID: PMC6876882 DOI: 10.1371/journal.pone.0225778] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 11/12/2019] [Indexed: 01/22/2023] Open
Abstract
Background Chronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression. Methods This retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000–2013) between these two cohorts. Results This study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36–1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04–2.06). Conclusion The present study showed that depression was associated with an increased risk of rotator cuff tear and rotator cuff repair surgery.
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Affiliation(s)
- Liang-Tseng Kuo
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hong-Ming Chen
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Pei-An Yu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Chi-Lung Chen
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Wei-Hsiu Hsu
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yao-Hung Tsai
- Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Ko-Jung Chen
- Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Vincent Chin-Hung Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan
- * E-mail:
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Miname MH, Santos RD. Reducing cardiovascular risk in patients with familial hypercholesterolemia: Risk prediction and lipid management. Prog Cardiovasc Dis 2019; 62:414-422. [PMID: 31669498 DOI: 10.1016/j.pcad.2019.10.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 01/17/2023]
Abstract
Familial hypercholesterolemia (FH) is a frequent genetic disorder characterized by elevated low-density lipoprotein (LDL)-cholesterol (LDL-C) levels and early onset of atherosclerotic cardiovascular disease. FH is caused by mutations in genes that regulate LDL catabolism, mainly the LDL receptor (LDLR), apolipoprotein B (APOB) and gain of function of proprotein convertase subtilisin kexin type 9 (PCSK9). However, the phenotype may be encountered in individuals not carrying the latter monogenic defects, in approximately 20% of these effects of polygenes predominate, and in many individuals no molecular defects are encountered at all. These so-called FH phenocopy individuals have an elevated atherosclerotic cardiovascular disease risk in comparison with normolipidemic individuals but this risk is lower than in those with monogenic disease. Individuals with FH are exposed to elevated LDL-C levels since birth and this explains the high cardiovascular, mainly coronary heart disease, burden of these subjects. However, recent studies show that this risk is heterogenous and depends not only on high LDL-C levels but also on presence of previous cardiovascular disease, a monogenic cause, male sex, smoking, hypertension, diabetes, low HDL-cholesterol, obesity and elevated lipoprotein(a). This heterogeneity in risk can be captured by risk equations like one from the SAFEHEART cohort and by detection of subclinical coronary atherosclerosis. High dose high potency statins are the main stain for LDL-C lowering in FH, however, in most situations these medications are not powered enough to reduce cholesterol to adequate levels. Ezetimibe and PCSK9 inhibitors should also be used in order to better treat LDL-C in FH patients.
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Affiliation(s)
- Marcio H Miname
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil; Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
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Sun D, Cao YX, Li S, Guo YL, Wu NQ, Gao Y, Dong QT, Liu G, Dong Q, Li JJ. A modified algorithm with lipoprotein(a) added for diagnosis of familial hypercholesterolemia. Clin Cardiol 2019; 42:988-994. [PMID: 31436336 PMCID: PMC6788465 DOI: 10.1002/clc.23251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 08/04/2019] [Accepted: 08/14/2019] [Indexed: 12/28/2022] Open
Abstract
Background Previous studies have observed that high level of lipoprotein (a) [Lp(a)] was common in the phenotypic familial hypercholesterolemia (FH) and may explain part of the clinical diagnosis of FH. Hypothesis We aim to develop a modified model including Lp(a) and compare its diagnostic performance with Dutch Lipid Clinic Network (DLCN) criteria. Methods Data of 10 449 individuals were utilized for the model establishment (7806 for derivation and 2643 for validation) from January 2011 to March 2018. The novel score model was modified on the basis of DLCN. Furthermore, 718 patients were screened for LDLR, APOB, and PCSK9 gene mutations. Results The novel modified model consisted of untreated low‐density lipoprotein cholesterol (LDL‐C) level, Lp(a), personal premature coronary heart disease (CHD), tendon xanthomas and family history of CHD and/or hypercholesterolemia. It has shown high discrimination (area under curve [AUC] 0.991, 95% confidence interval [CI[ 0.988‐0.994, P < .001) for distinguishing clinical FH from non‐FH diagnosed using DLCN. Furthermore, a concordance analysis was performed to compare the modified model with DLCN and it showed a good agreement with DLCN (κ = 0.765). External validation of the novel model also showed good accordance (κ = 0.700). Further genetic analysis showed that the agreements between the new model and mutation improved a little compared to that between DLCN and mutation. Conclusions The novel modified model, including Lp(a), could provide new insights into FH diagnosis in Chinese population with more concerns on the patients with high level of Lp(a).
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Affiliation(s)
- Di Sun
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ye-Xuan Cao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Sha Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuan-Lin Guo
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Na-Qiong Wu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ying Gao
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiu-Ting Dong
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Geng Liu
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qian Dong
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian-Jun Li
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, Fu Wai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Fu Y, Huang QL. Xanthoma Combined With Gout Infiltration of the Achilles Tendon: A Case Report. CLINICAL MEDICINE INSIGHTS-ARTHRITIS AND MUSCULOSKELETAL DISORDERS 2019; 12:1179544119865261. [PMID: 31384134 PMCID: PMC6657120 DOI: 10.1177/1179544119865261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 07/01/2019] [Indexed: 11/16/2022]
Abstract
Xanthoma is a rare condition mostly caused by hyperlipidemia. The pathogenesis of gout is hyperuricemia, which is caused by a disorder of purine metabolism and/or a decrease in uric acid excretion. Xanthoma combined with gout is very rare. This case report presents magnetic resonance images of a case of xanthoma combined with gout infiltration of the Achilles tendon.
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Affiliation(s)
- Yuan Fu
- Department of Radiology, Ningbo First Hospital, Ningbo, China
| | - Qiu-Li Huang
- Department of Radiology, Ningbo First Hospital, Ningbo, China
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Nichols AEC, Best KT, Loiselle AE. The cellular basis of fibrotic tendon healing: challenges and opportunities. Transl Res 2019; 209:156-168. [PMID: 30776336 PMCID: PMC6545261 DOI: 10.1016/j.trsl.2019.02.002] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 01/30/2019] [Accepted: 02/04/2019] [Indexed: 12/11/2022]
Abstract
Tendon injuries are common and can dramatically impair patient mobility and productivity, resulting in a significant socioeconomic burden and reduced quality of life. Because the tendon healing process results in the formation of a fibrotic scar, injured tendons never regain the mechanical strength of the uninjured tendon, leading to frequent reinjury. Many tendons are also prone to the development of peritendinous adhesions and excess scar formation, which further reduce tendon function and lead to chronic complications. Despite this, there are currently no treatments that adequately improve the tendon healing process due in part to a lack of information regarding the contributions of various cell types to tendon healing and how their activity may be modulated for therapeutic value. In this review, we summarize recent efforts to identify and characterize the distinct cell populations involved at each stage of tendon healing. In addition, we examine the mechanisms through which different cell populations contribute to the fibrotic response to tendon injury, and how these responses can be affected by systemic factors and comorbidities. We then discuss gaps in our current understanding of tendon fibrosis and highlight how new technologies and research areas are shedding light on this clinically important and intractable challenge. A better understanding of the complex cellular environment during tendon healing is crucial to the development of new therapies to prevent fibrosis and promote tissue regeneration.
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Affiliation(s)
- Anne E C Nichols
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York
| | - Katherine T Best
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York
| | - Alayna E Loiselle
- Department of Orthopedics & Rehabilitation, Center for Musculoskeletal Research, University of Rochester Medical Center, Rochester, New York.
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Kutkienė S, Petrulionienė Ž, Laucevičius A, Čerkauskienė R, Samuilis A, Augaitienė V, Gedminaitė A, Bieliauskienė G, Šaulytė-Mikulskienė A, Staigytė J, Petrulionytė E, Gargalskaitė U, Skiauterytė E, Matuzevičienė G, Kovaitė M, Nedzelskienė I. Achilles tendon ultrasonography - A useful screening tool for cardiovascular risk estimation in patients with severe hypercholesterolemia. ATHEROSCLEROSIS SUPP 2019; 36:6-11. [PMID: 30876532 DOI: 10.1016/j.atherosclerosissup.2019.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND AIMS Achilles tendon lesions have long been associated with genetic defects in lipid metabolism and increased risk of cardiovascular diseases (CVD). With this study we aimed to evaluate the usefulness of Achilles tendon ultrasonography in identifying people at greater risk among subjects with severe hypercholesterolemia (SH) in a high-risk population. METHODS During the period of 2016-2017 a total of 213 participants were enrolled in this case-control study. Data of 110 patients with SH and 103 age and sex matched controls without dyslipidaeplemia and established CVD was collected. RESULTS Achilles tendinopathy (AT) was present in 42.7% of subjects with SH and in 29.1% of controls (p = 0.039). Stronger association between SH and AT was seen in women - 24.1% vs 2.0% (p = 0.001). SH increased odds of AT by 1.815 (95% CI, 1.028-3.206). Prevalence of AT was higher in males despite presence (SH+) or absence (SH-) of severe hypercholesterolemia (SH+ 60.7% vs 24.1%, SH- 55.8% vs 2.0%, p < 0.001). AT was associated with higher proportion of subjects exceeding normal mean values of TC (80.5% vs 52.9%, p = 0.001), LDL-C (76.6% vs 52.2%), TG (54.5% vs. 22.1%), ApoB (57.1% vs 22.2%), ApoE (44.0% vs 22.4%) levels and ApoB/ApoA ratio (46.1% vs 21.5%) (p = 0.001) and family history of premature coronary heart disease (CHD). CONCLUSIONS AT is more prevalent among subjects with SH and is associated with higher levels of TC, TG, LDL-C, ApoB, ApoE, ApoB/ApoA ratio, family history of premature CHD. SH increases the odds of developing AT.
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Affiliation(s)
- Sandra Kutkienė
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Lithuania; Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania.
| | - Žaneta Petrulionienė
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Lithuania; Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Aleksandras Laucevičius
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Lithuania; Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Rimantė Čerkauskienė
- Children's Hospital, Vilnius University Hospital Santaros Klinikos, Lithuania; Vilnius University, Faculty of Medicine, Lithuania
| | - Artūras Samuilis
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania; Vilnius University, Institute of Biomechanical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Lithuania
| | - Virginija Augaitienė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania; Vilnius University, Institute of Biomechanical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Lithuania
| | - Aurelija Gedminaitė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania; Vilnius University, Institute of Biomechanical Sciences, Department of Radiology, Nuclear Medicine and Medical Physics, Lithuania
| | - Gintarė Bieliauskienė
- Vilnius University, Faculty of Medicine, Clinic of Cardiac and Vascular Diseases, Lithuania; Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Akvilė Šaulytė-Mikulskienė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Justina Staigytė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | | | | | - Eglė Skiauterytė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Gabija Matuzevičienė
- Vilnius University, Faculty of Medicine, Lithuania; Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Milda Kovaitė
- Vilnius University Hospital Santaros Klinikos, Lithuania
| | - Irena Nedzelskienė
- Children's Hospital, Vilnius University Hospital Santaros Klinikos, Lithuania
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Koc AS, Pekoz BC, Donmez Y, Yasar S, Ardic M, Gorgulu FF, Icen YK, Sumbul HE, Koc M. Usability of Achilles tendon strain elastography for the diagnosis of coronary artery disease. J Med Ultrason (2001) 2019; 46:343-351. [PMID: 30783822 DOI: 10.1007/s10396-019-00931-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 01/15/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE There are close relationships between major coronary artery disease (CAD) risk factors and Achilles tendon thickness (AT-T) and AT strain ratio (AT-SR). Our aim was to evaluate the diagnostic importance of AT-T and AT-SR as obtained by ultrasonography (USG) and strain elastography (SE) for predicting CAD. MATERIALS AND METHODS One hundred and eighty-four patients scheduled to undergo coronary angiography were included in the study. Achilles tendon USG (B-mode and SE) and laboratory tests were performed on all patients. The patients were divided into two groups, i.e., patients with and without CAD. RESULTS The patients with CAD (72.8%) were more likely to be male, exhibited higher frequencies of diabetes mellitus (DM) and hyperlipidemia, exhibited higher levels of basal creatinine and glucose, and had higher AT-T and AT-SR values (p < 0.05 for all). Age, DM, AT-T, and AT-SR independently predicted the probability of CAD in a logistic regression analysis (p < 0.05 for all). Age (each year), DM (presence), AT-T (each 1 mm), and AT-SR (each 0.1) increased the CAD risk by 3.4%, 2.9 times, 47.1%, and 16.0%, respectively. ROC analysis revealed AUCs of 0.665 and 0.730 for the AT-T and AT-SR values, respectively (p < 0.05). The AT-SR cutoff value of 1.2 predicted the presence of CAD with 75.4% sensitivity and 72.7% specificity. CONCLUSIONS AT-SR is a simple, inexpensive, noninvasive, reproducible, and objective parameter for the prediction of CAD. We think that AT-SR evaluation should become a part of conventional USG assessments in patients who are at a high risk of CAD.
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Affiliation(s)
- Ayse Selcan Koc
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey.
| | - Burcak Cakir Pekoz
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Yurdaer Donmez
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Simge Yasar
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mustafa Ardic
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Feride Fatma Gorgulu
- Department of Radiology, University of Health Sciences-Adana Health Practice and Research Center, Dr. Mithat Özsan Bulvarı Kışla Mah. 4522 Sok. No: 1 Yüreğir, Adana, Turkey
| | - Yahya Kemal Icen
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Hilmi Erdem Sumbul
- Department of Internal Medicine, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
| | - Mevlut Koc
- Department of Cardiology, University of Health Sciences-Adana Health Practice and Research Center, Adana, Turkey
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Hashimoto T, Minami Y, Kakizaki R, Nemoto T, Fujiyoshi K, Meguro K, Shimohama T, Tojo T, Ako J. Achilles tendon thickening is associated with disease severity and plaque vulnerability in patients with coronary artery disease. J Clin Lipidol 2018; 13:194-200. [PMID: 30472278 DOI: 10.1016/j.jacl.2018.10.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Revised: 10/19/2018] [Accepted: 10/19/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tendon xanthomas are accumulations of collagen and macrophages, which contain cholesterol esters and a marker of high risk for coronary artery disease (CAD). OBJECTIVE The aim of the article was to clarify whether the presence of Achilles tendon thickening (ATT) was associated with disease severity and plaque vulnerability in patients with CAD. METHODS A total of 241 consecutive patients who underwent percutaneous coronary intervention and ATT assessment were analyzed. ATT was defined as Achilles tendon thickness of ≥9 mm on radiograph. The severity of CAD and plaque vulnerability was assessed by the findings on angiogram and optical coherence tomography, respectively. RESULTS ATT was found in 44 patients (18.2%). The frequency of multivessel disease (79.6% vs 58.4%, P = .009) and left main lesion (13.6% vs 3.1%, P = .004) was significantly higher in patients with ATT (ATT group) than in patients without ATT (no ATT group). Multivariate logistic regression analyses demonstrated that the presence of ATT was independently associated with the presence of multivessel disease (odds ratio, 2.33; 95% confidence interval, 1.08-5.46; P = .031). The ATT group had a higher prevalence of intimal vascular channels (50.0% vs 24.7%, P = .018) and macrophage accumulation (58.3% vs 33.3%, P = .028) in culprit plaque than the no ATT group. CONCLUSIONS Patients with the presence of ATT had a higher prevalence of multivessel coronary disease and left main coronary artery disease than with patients without ATT. The presence of ATT was also associated with vulnerable features, including intimal vascular channels and macrophage accumulation in culprit plaques.
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Affiliation(s)
- Takuya Hashimoto
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Yoshiyasu Minami
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan.
| | - Ryota Kakizaki
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Teruyoshi Nemoto
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kazuhiro Fujiyoshi
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan
| | - Kentaro Meguro
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Takao Shimohama
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Taiki Tojo
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Junya Ako
- Kitasato University Graduate School of Medical Sciences, Sagamihara, Japan; Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
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Yang Y, Lu H, Qu J. Tendon pathology in hypercholesterolaemia patients: Epidemiology, pathogenesis and management. J Orthop Translat 2018; 16:14-22. [PMID: 30723677 PMCID: PMC6350019 DOI: 10.1016/j.jot.2018.07.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 07/04/2018] [Accepted: 07/12/2018] [Indexed: 01/18/2023] Open
Abstract
Tendon pathology is a general term used to describe a group of musculoskeletal conditions related to tendons and surrounding structures. There is only limited evidence available regarding the exact aetiology and natural history of tendon pathology. In hypercholesterolaemia environments, lipids could accumulate within the extracellular matrix of the tendon and thus affect the mechanical properties of the tendon. Current evidence suggested that hypercholesterolaemia was an important risk factor in the development and progression of tendon pathology. The severity of hypercholesterolaemia was correlated with the severity of tendon pathology. The translational potential of this article: Hypercholesterolaemia lead to the structural, inflammatory and mechanical changes in tendons, which predispose hypercholesterolaemia patients to a greater risk of tendon pathology. Measurements of serum cholesterol are suggested to be performed in patients presenting with tendon pathology. The strict control of hypercholesterolaemia would mitigate the development and progression of tendon pathology.
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Affiliation(s)
- Yang Yang
- Department of Cardiovascular Disease, The Second Xiangya Hospital, Central South University, Changsha 410011, PR China
| | - Hongbin Lu
- Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China
| | - Jin Qu
- Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China
- Corresponding author. Department of Sports Medicine, Key Laboratory of Organ Injury, Aging and Regenerative Medicine of Hunan Province, Xiangya Hospital, Central South University, Changsha 410008, PR China.
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Wang B, Zhang Q, Lin L, Pan LL, He CY, Wan XX, Zheng ZA, Huang ZX, Zou CB, Fu MC, Kutryk MJ. Association of Achilles tendon thickness and LDL-cholesterol levels in patients with hypercholesterolemia. Lipids Health Dis 2018; 17:131. [PMID: 29859112 PMCID: PMC5984811 DOI: 10.1186/s12944-018-0765-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 05/03/2018] [Indexed: 12/16/2022] Open
Abstract
Background Achilles tendons are the most common sites of tendon xanthomas that are commonly caused by disturbance of lipid metabolism. Achilles tendon thickening is the early characteristic of Achilles tendon xanthomas. The relationship between Achilles tendon thickness (ATT) and LDL-C levels, and risk factors of ATT in patients with hypercholesterolemia, have thus far been poorly documented. Methods A total of 205 individuals, aged 18-75 years, were enrolled from March 2014 to March 2015. According to the LDL-C levels and the “Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults”, all subjects were divided into 3 groups: normal group (LDL-C < 3.37 mmol/L, n = 51); borderline LDL-C group (3.37 mmol/L ≤ LDL-C ≤ 4.12 mmol/L, n = 50); and hypercholesterolemia group (LDL ≥ 4.14 mmol/L, n = 104). ATT was measured using a standardized digital radiography method and the results were compared among the 3 groups. The correlation between ATT and serum LDL-C levels was analyzed by Pearson’s correlation, and the risk factors of ATT were determined by the logistic regression model. Results ATT in borderline LDL-C group was 8.24 ± 1.73 mm, markedly higher than 6.05 ± 0.28 mm of normal group (P < 0.05). ATT in hypercholesterolemia group was 9.42 ± 3.63 mm which was significantly higher than that of normal group (P < 0.005) and that of borderline LDL-C group (P < 0.05). There was a positive correlation between the serum LDL-C levels and ATT (r = 0.346, P < 0.001). The serum LDL-C level was a risk factor (OR = 1.871, 95% CI: 1.067-3.280) while the levels of HDL-C (OR = 0.099, 95% CI: 0.017-0.573) and Apo AI (OR = 0.035, 95% CI: 0.003-0.412) were protective factors of ATT. Conclusions ATT might serve as a valuable auxiliary diagnostic index for hypercholesterolemia and used for the assessment and management of cardiovascular disease.
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Affiliation(s)
- Bei Wang
- Department of Cardiology, the Third People's Hospital of Hainan Province, 1154 Jiefang Road, Sanya, 572000, Hainan, China
| | - Qiuwang Zhang
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ling Lin
- Department of Cardiology, the Third People's Hospital of Hainan Province, 1154 Jiefang Road, Sanya, 572000, Hainan, China.
| | - Li-Li Pan
- Department of Cardiology, the Third People's Hospital of Hainan Province, 1154 Jiefang Road, Sanya, 572000, Hainan, China
| | - Cheng-Yu He
- Department of Cardiology, the Third People's Hospital of Hainan Province, 1154 Jiefang Road, Sanya, 572000, Hainan, China
| | - Xiang-Xin Wan
- Department of Radiology, the Third People's Hospital of Hainan Province, Sanya, Hainan, China
| | - Zhi-Ang Zheng
- Department of Laboratory Medicine, the Third People's Hospital of Hainan Province, Sanya, Hainan, China
| | - Zheng-Xin Huang
- Department of Cardiology, the Third People's Hospital of Hainan Province, 1154 Jiefang Road, Sanya, 572000, Hainan, China
| | - Chao-Bao Zou
- Department of Radiology, the Third People's Hospital of Hainan Province, Sanya, Hainan, China
| | - Ming-Chang Fu
- Department of Laboratory Medicine, the Third People's Hospital of Hainan Province, Sanya, Hainan, China
| | - Michael J Kutryk
- Division of Cardiology, Keenan Research Center for Biomedical Science at the Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Griffith JF, Hu M, Yeung DKW, Guo P, Lam SL, Xiao F, Wang D, Tomlinson B. Achilles Tendon Xanthomas: Fat-Water Separation at Baseline and after Treatment. Radiology 2017; 285:876-884. [PMID: 28825891 DOI: 10.1148/radiol.2017161435] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Purpose To investigate the fat-water content of Achilles tendon xanthomas at baseline and after treatment and to compare this assessment with that of ultrasonography (US) and other magnetic resonance (MR) imaging-based parameters. Materials and Methods Forty-eight Achilles tendons with clinically apparent xanthomas in 24 patients with familial hypercholesterolemia (FH) (six men, 18 women; mean age ± standard deviation, 58 years ± 9) were compared with 20 Achilles tendons in 10 control subjects without FH (two men, eight women; mean age, 62 years ± 7). US imaging measurements (thickness, width, cross-sectional area, echogenicity) and 3.0-T MR imaging measurements (thickness, width, cross-sectional area, volume, and fat-water separation) of the Achilles tendons were obtained at baseline and in patients with FH at 3 and 6 months after treatment with probucol, a cholesterol-lowering agent. Nonparametric tests compared baseline data, whereas repeated-measures analyses assessed treatment change. Results At baseline, all US and MR imaging-based parameters were higher in xanthoma tendons compared with those in control tendons (all P < .05). The mean relative water content per unit volume was 71% higher (42.0% ± 6.7) in xanthoma tendons than in control tendons (24.5% 6 5.8; P < .001). After 6 months of cholesterol-lowering treatment, only MR imaging measurements of tendon volume (P = .007), relative fat (P = .041), and relative water content (P < .001) showed significant changes. As relative tendon fat content decreased with treatment, relative water content increased. Conclusion Most of the enlargement of Achilles tendon xanthomas is due to an increase in water content rather than fat. For depicting treatment change, relative tendon water content was the most sensitive parameter, followed by tendon volume and relative tendon fat content. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- James F Griffith
- From the Departments of Imaging & Interventional Radiology (J.F.G., D.K.W.Y., F.X., D.W.), Medicine & Therapeutics (M.H., B.T.), and Chemistry (P.G., S.L.L.), Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong
| | - Miao Hu
- From the Departments of Imaging & Interventional Radiology (J.F.G., D.K.W.Y., F.X., D.W.), Medicine & Therapeutics (M.H., B.T.), and Chemistry (P.G., S.L.L.), Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong
| | - David K W Yeung
- From the Departments of Imaging & Interventional Radiology (J.F.G., D.K.W.Y., F.X., D.W.), Medicine & Therapeutics (M.H., B.T.), and Chemistry (P.G., S.L.L.), Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong
| | - Pei Guo
- From the Departments of Imaging & Interventional Radiology (J.F.G., D.K.W.Y., F.X., D.W.), Medicine & Therapeutics (M.H., B.T.), and Chemistry (P.G., S.L.L.), Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong
| | - Sik Lok Lam
- From the Departments of Imaging & Interventional Radiology (J.F.G., D.K.W.Y., F.X., D.W.), Medicine & Therapeutics (M.H., B.T.), and Chemistry (P.G., S.L.L.), Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong
| | - Fan Xiao
- From the Departments of Imaging & Interventional Radiology (J.F.G., D.K.W.Y., F.X., D.W.), Medicine & Therapeutics (M.H., B.T.), and Chemistry (P.G., S.L.L.), Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong
| | - Defeng Wang
- From the Departments of Imaging & Interventional Radiology (J.F.G., D.K.W.Y., F.X., D.W.), Medicine & Therapeutics (M.H., B.T.), and Chemistry (P.G., S.L.L.), Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong
| | - Brian Tomlinson
- From the Departments of Imaging & Interventional Radiology (J.F.G., D.K.W.Y., F.X., D.W.), Medicine & Therapeutics (M.H., B.T.), and Chemistry (P.G., S.L.L.), Prince of Wales Hospital, The Chinese University of Hong Kong, 30-32 Ngan Shing St, Shatin, NT, Hong Kong
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Huang SW, Wu CW, Lin LF, Liou TH, Lin HW. Gout Can Increase the Risk of Receiving Rotator Cuff Tear Repair Surgery. Am J Sports Med 2017; 45:2355-2363. [PMID: 28486089 DOI: 10.1177/0363546517704843] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Gout commonly involves joint inflammation, and clinical epidemiological studies on involved tendons are scant. Rotator cuff tears are the most common cause of shoulder disability, and surgery is one of the choices often adopted to regain previous function. PURPOSE To investigate the risk of receiving rotator cuff repair surgery among patients with gout and to analyze possible risk factors to design an effective prevention strategy. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS The authors studied a 7-year longitudinal follow-up of patients from the Taiwan Longitudinal Health Insurance Database 2005 (LHID2005). This included a cohort of patients who received a diagnosis of gout during 2004-2008 (gout cohort) and a cohort matched by propensity scores (control cohort). A 2-stage approach that used the National Health Interview Survey 2005 was used to obtain missing confounding variables from the LHID2005. The crude hazard ratio (HR) and adjusted HR were estimated between the gout and control cohorts. RESULTS The gout and control cohorts comprised 32,723 patients with gout and 65,446 people matched at a ratio of 1:2. The incidence of rotator cuff repair was 31 and 18 per 100,000 person-years in the gout and control cohorts, respectively. The crude HR for rotator cuff repair in the gout cohort was 1.73 (95% confidence interval [CI], 1.23-2.44; P < .01) during the 7-year follow-up period. After adjustment for covariates by use of the 2-stage approach, the propensity score calibration-adjusted HR was 1.60 (95% CI, 1.12-2.29; P < .01) in the gout cohort. Further analysis revealed that the adjusted HR was 1.73 (95% CI, 1.20-2.50; P < .001) among patients with gout who did not take hypouricemic medication and 2.70 (95% CI, 1.31-5.59; P < .01) for patients with gout aged 50 years or younger. CONCLUSION Patients with gout, particularly those aged 50 years or younger and without hypouricemic medication control, are at a relatively higher risk of receiving rotator cuff repair surgery. Strict control of uric acid levels with hypouricemic medication may effectively reduce the risk of rotator cuff repair.
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Affiliation(s)
- Shih-Wei Huang
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan
| | - Chin-Wen Wu
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Fong Lin
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,School of Gerontology Health Management, College of Nursing, Taipei Medical University, Taipei, Taiwan
| | - Tsan-Hon Liou
- Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan.,Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Hui-Wen Lin
- Department of Mathematics, Soochow University, Taipei, Taiwan.,Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
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Mangili LC, Miname MH, Silva PRS, Bittencourt MS, Rocha VZ, Mangili OC, Salgado Filho W, Chacra AP, Jannes CE, Pereira AC, Santos RD. Achilles tendon xanthomas are associated with the presence and burden of subclinical coronary atherosclerosis in heterozygous familial hypercholesterolemia: A pilot study. Atherosclerosis 2017; 263:393-397. [PMID: 28499609 DOI: 10.1016/j.atherosclerosis.2017.04.025] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/10/2017] [Accepted: 04/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Achilles tendon xanthomas (ATX) are a sign of long-term exposure to high blood cholesterol in familial hypercholesterolemia (FH) patients, which have been associated with cardiovascular disease. We evaluated the ATX association with the presence and extent of subclinical coronary atherosclerosis in heterozygous FH patients. METHODS 102 FH patients diagnosed by US-MEDPED criteria (67% with genetically proven FH), with median LDL-C 279 mg/dL (interquartile range: 240; 313), asymptomatic for cardiovascular disease, underwent computed tomography angiography and coronary artery calcium (CAC) quantification. Subclinical coronary atherosclerosis was quantified by CAC, segment-stenosis (SSS) and segment-involvement (SIS) scores. Adjusted Poisson regression was used to assess the association of ATX with subclinical atherosclerosis burden as continuous variables. RESULTS Patients with ATX (n = 21, 21%) had higher LDL-C and lipoprotein(a) [Lp(a)] concentrations as well as greater CAC scores, SIS and SSS (p < 0.05). After adjusting for age, sex, smoking, hypertension, previous statin use, HDL-C, LDL-C and Lp(a) concentrations, there was an independent positive association of ATX presence with CAC scores (β = 1.017, p < 0.001), SSS (β = 0.809, p < 0.001) and SIS (β = 0.640, p < 0.001). CONCLUSIONS ATX are independently associated with the extension of subclinical coronary atherosclerosis quantified by tomographic scores in FH patients.
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Affiliation(s)
- Leonardo C Mangili
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Marcio H Miname
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Pamela R S Silva
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Marcio S Bittencourt
- Center for Clinical and Epidemiological Research and Division of Internal Medicine, University Hospital, University of Sao Paulo, Sao Paulo, SP, Brazil; Preventive Medicine Center and Cardiology Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil
| | - Viviane Z Rocha
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Otavio C Mangili
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Wilson Salgado Filho
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Ana P Chacra
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Cinthia E Jannes
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Alexandre C Pereira
- Laboratory of Genetics and Molecular Cardiology, Heart Institute (InCor), University of São Paulo Medical School Hospital, Sao Paulo, SP, Brazil
| | - Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, SP, Brazil; Preventive Medicine Center and Cardiology Program, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
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