1
|
Gao F, Zhao Y, Zhang B, Xiao C, Sun Z, Gao Y, Dou X. Orientin alleviates ox-LDL-induced oxidative stress, inflammation and apoptosis in human vascular endothelial cells by regulating Sestrin 1 (SESN1)-mediated autophagy. J Mol Histol 2024; 55:109-120. [PMID: 38165567 DOI: 10.1007/s10735-023-10176-z] [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: 07/21/2023] [Accepted: 11/04/2023] [Indexed: 01/04/2024]
Abstract
Endothelial cells are a crucial component of the vessel-tissue wall and exert an important role in atherosclerosis (AS). To explore the role of Orientin in AS, human vascular endothelial cells (HUVECs) were induced by oxidized low-density lipoprotein (ox-LDL) to simulate the vascular endothelial injury during AS. Cell viability was detected by CCK-8 assay. Oxidative stress and inflammation related markers were measured using kits, RT-qPCR or western blot. Besides, cell apoptosis was assessed with TUNEL staining and cell autophagy was evaluated by LC3 immunofluorescent staining. Additionally, western blot was utilized to evaluate the expression of Sestrin 1 (SESN1) and proteins in AMPK/mTOR signaling. Afterwards, SESN1 was silenced to determine the expression of autophagy-related proteins. The further application of autophagy inhibitor 3-methyladenine (3-MA) was used to clarify the regulatory mechanism of Orientin on autophagy. Results showed that the decreased viability of HUVECs caused by ox-LDL induction was elevated by Orientin. Oxidative stress and inflammation were also attenuated after Orientin addition in HUVECs under ox-LDL condition. Moreover, Orientin suppressed apoptosis and induced autophagy of HUVECs stimulated by ox-LDL, accompanied by enhanced level of phospho (p)-AMPK and declined level of p-mTOR. Interestingly, SESN1 level was elevated by Orientin, and SESN1 depletion alleviated autophagy and reduced p-AMPK expression but enhanced p-mTOR expression. The further experiments indicated that SESN1 silencing or 3-MA addition reversed the inhibitory effects of Orientin on the oxidative stress, inflammation and apoptosis of HUVECs. Collectively, Orientin could induce autophagy by activating SESN1 expression, thereby regulating AMPK/mTOR signaling in ox-LDL-induced HUVECs.
Collapse
Affiliation(s)
- Feng Gao
- Department of Cardiovascular Surgery, Xuzhou Cancer Hospital, No. 131, Huancheng Road, Xuzhou, 221005, Jiangsu, People's Republic of China.
| | - Yongcheng Zhao
- Department of Cardiovascular Surgery, Xuzhou Cancer Hospital, No. 131, Huancheng Road, Xuzhou, 221005, Jiangsu, People's Republic of China
| | - Bin Zhang
- Department of Cardiovascular Surgery, Xuzhou Cancer Hospital, No. 131, Huancheng Road, Xuzhou, 221005, Jiangsu, People's Republic of China
| | - Chunwei Xiao
- Department of Cardiovascular Surgery, Xuzhou Cancer Hospital, No. 131, Huancheng Road, Xuzhou, 221005, Jiangsu, People's Republic of China
| | - Zhanfa Sun
- Department of Cardiovascular Surgery, Xuzhou Cancer Hospital, No. 131, Huancheng Road, Xuzhou, 221005, Jiangsu, People's Republic of China
| | - Yuan Gao
- Department of Cardiovascular Surgery, Xuzhou Cancer Hospital, No. 131, Huancheng Road, Xuzhou, 221005, Jiangsu, People's Republic of China
| | - Xueyong Dou
- Department of Cardiovascular Surgery, Xuzhou Cancer Hospital, No. 131, Huancheng Road, Xuzhou, 221005, Jiangsu, People's Republic of China
| |
Collapse
|
2
|
Cepoi MR, Duca ST, Chetran A, Costache AD, Spiridon MR, Afrăsânie I, Leancă SA, Dmour BA, Matei IT, Miftode RS, Miftode L, Prepeliuc CS, Haba MȘC, Bădescu MC, Costache II. Chronic Kidney Disease Associated with Ischemic Heart Disease: To What Extent Do Biomarkers Help? Life (Basel) 2023; 14:34. [PMID: 38255650 PMCID: PMC10817293 DOI: 10.3390/life14010034] [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: 11/20/2023] [Revised: 12/17/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024] Open
Abstract
Chronic kidney disease represents a complex and multifaceted pathology characterized by the presence of structural or functional renal anomalies associated with a persistent reduction in renal function. As the disease progresses, complications arise due to the chronic inflammatory syndrome, hydro-electrolytic disorders, and toxicity secondary to the uremic environment. Cardiovascular complications are the leading cause of death for these patients. Ischemic cardiac pathology can be both a consequence and complication of chronic kidney disease, highlighting the need to identify specific cardiorenal dysfunction biomarkers targeting pathophysiological mechanisms common to both conditions. This identification is crucial for establishing accurate diagnoses, prognoses, and risk stratifications for patients. This work is intended to elucidate the intricate relationship between chronic kidney disease and ischemic heart disease and to investigate the roles of cardiorenal biomarkers, including cardiac troponin, natriuretic peptides, galectin-3, copeptin, fibroblast growth factor 23 and its co-receptor Klotho, soluble suppression of tumorigenicity 2, and plasma growth differentiation factor 15.
Collapse
Affiliation(s)
- Maria-Ruxandra Cepoi
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Stefania Teodora Duca
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Adriana Chetran
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Alexandru Dan Costache
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iași, Romania
| | - Marilena Renata Spiridon
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Irina Afrăsânie
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Sabina Andreea Leancă
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Bianca-Ana Dmour
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of III Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Iulian Theodor Matei
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Radu Stefan Miftode
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Larisa Miftode
- Department of Infectious Diseases, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (L.M.); (C.S.P.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
| | - Cristian Sorin Prepeliuc
- Department of Infectious Diseases, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (L.M.); (C.S.P.)
- “St. Parascheva” Clinical Hospital of Infectious Diseases, 700116 Iași, Romania
| | - Mihai Ștefan Cristian Haba
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| | - Minerva Codruța Bădescu
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of III Internal Medicine Clinic, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania
| | - Irina Iuliana Costache
- Department of Internal Medicine, Faculty of Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iași, Romania; (M.-R.C.); (S.T.D.); (A.C.); (I.A.); (S.A.L.); (B.-A.D.); (I.T.M.); (R.S.M.); (M.Ș.C.H.); (M.C.B.); (I.I.C.)
- Department of Cardiology, “St. Spiridon” County Clinical Emergency Hospital, 700111 Iași, Romania;
| |
Collapse
|
3
|
Zambrano Chaves JM, Wentland AL, Desai AD, Banerjee I, Kaur G, Correa R, Boutin RD, Maron DJ, Rodriguez F, Sandhu AT, Rubin D, Chaudhari AS, Patel BN. Opportunistic assessment of ischemic heart disease risk using abdominopelvic computed tomography and medical record data: a multimodal explainable artificial intelligence approach. Sci Rep 2023; 13:21034. [PMID: 38030716 PMCID: PMC10687235 DOI: 10.1038/s41598-023-47895-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/20/2023] [Indexed: 12/01/2023] Open
Abstract
Current risk scores using clinical risk factors for predicting ischemic heart disease (IHD) events-the leading cause of global mortality-have known limitations and may be improved by imaging biomarkers. While body composition (BC) imaging biomarkers derived from abdominopelvic computed tomography (CT) correlate with IHD risk, they are impractical to measure manually. Here, in a retrospective cohort of 8139 contrast-enhanced abdominopelvic CT examinations undergoing up to 5 years of follow-up, we developed multimodal opportunistic risk assessment models for IHD by automatically extracting BC features from abdominal CT images and integrating these with features from each patient's electronic medical record (EMR). Our predictive methods match and, in some cases, outperform clinical risk scores currently used in IHD risk assessment. We provide clinical interpretability of our model using a new method of determining tissue-level contributions from CT along with weightings of EMR features contributing to IHD risk. We conclude that such a multimodal approach, which automatically integrates BC biomarkers and EMR data, can enhance IHD risk assessment and aid primary prevention efforts for IHD. To further promote research, we release the Opportunistic L3 Ischemic heart disease (OL3I) dataset, the first public multimodal dataset for opportunistic CT prediction of IHD.
Collapse
Affiliation(s)
- Juan M Zambrano Chaves
- Department of Biomedical Data Science, Stanford University, 1265 Welch Road, MSOB West Wing, Third Floor, Stanford, CA, 94305, USA
| | - Andrew L Wentland
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Ave, Madison, WI, 53792, USA
| | - Arjun D Desai
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Department of Electrical Engineering, Stanford University, 350 Jane Stanford Way, Stanford, CA, 94305, USA
| | - Imon Banerjee
- Department of Radiology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Gurkiran Kaur
- Department of Radiology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Ramon Correa
- Department of Radiology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA
| | - Robert D Boutin
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - David J Maron
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Department of Medicine, Stanford Prevention Research Center, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Alexander T Sandhu
- Division of Cardiovascular Medicine, Department of Medicine, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Daniel Rubin
- Department of Biomedical Data Science, Stanford University, 1265 Welch Road, MSOB West Wing, Third Floor, Stanford, CA, 94305, USA
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Akshay S Chaudhari
- Department of Biomedical Data Science, Stanford University, 1265 Welch Road, MSOB West Wing, Third Floor, Stanford, CA, 94305, USA
- Department of Radiology, School of Medicine, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
- Cardiovascular Institute, Stanford University, 300 Pasteur Drive, Stanford, CA, 94305, USA
| | - Bhavik N Patel
- Department of Radiology, Mayo Clinic, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA.
| |
Collapse
|
4
|
Yildirim F, Yildiz AB, Kanbay M. A promising tool: triglyceride-glucose index to stratify the risk of cardiovascular events in chronic kidney disease. Clin Kidney J 2022; 15:1653-1656. [PMID: 36003667 PMCID: PMC9394708 DOI: 10.1093/ckj/sfac084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Indexed: 11/14/2022] Open
Abstract
Lipid profile management is one of the crucial components to optimize outcomes in patients with chronic kidney disease (CKD). CKD is associated with poor cardiovascular outcomes due to both a direct cardiovascular impact of CKD and the presence of metabolic comorbidities. Low-density lipoprotein cholesterol is the main target of current lipid-lowering drugs. However, the derangement of lipid metabolism in CKD is more complex. The recently described triglyceride-glucose index (TyG) is associated with cardiovascular outcomes in the general population. In recent studies, the TyG was associated with CKD progression in CKD patients and with cardiovascular death in patients on peritoneal dialysis. Quiroga et al. now show that the TyG is associated with the occurrence of major cardiovascular events in individuals free from diabetes with non-dialysis-dependent CKD.
Collapse
Affiliation(s)
- Fatma Yildirim
- Department of Medicine, Koc University School of Medicine,
Istanbul, Turkey
| | - Abdullah B Yildiz
- Department of Medicine, Koc University School of Medicine,
Istanbul, Turkey
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of
Medicine, Istanbul, Turkey
| |
Collapse
|
5
|
Kanbay M, Xhaard C, Le Floch E, Dandine‐Roulland C, Girerd N, Ferreira JP, Boivin J, Wagner S, Bacq‐Daian D, Deleuze J, Zannad F, Rossignol P. Weak Association Between Genetic Markers of Hyperuricemia and Cardiorenal Outcomes: Insights From the STANISLAS Study Cohort With a 20-Year Follow-Up. J Am Heart Assoc 2022; 11:e023301. [PMID: 35470676 PMCID: PMC9238600 DOI: 10.1161/jaha.121.023301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 02/04/2022] [Indexed: 11/16/2022]
Abstract
Background Hyperuricemia is associated with poor cardiovascular outcomes, although it is uncertain whether this relationship is causal in nature. This study aimed to: (1) assess the heritability of serum uric acid (SUA) levels, (2) conduct a genome-wide association study on SUA levels, and (3) investigate the association between certain single-nucleotide polymorphisms and target organ damage. Methods and Results The STANISLAS (Suivi Temporaire Annuel Non-Invasif de la Santé des Lorrains Assurés Sociaux) study cohort is a single-center longitudinal cohort recruited between 1993 and 1995 (visit 1), with a last visit (visit 4 [V4]) performed ≈20 years apart. Serum lipid profile, SUA, urinary albumin/creatinine ratio, estimated glomerular filtration rate, 24-hour ambulatory blood pressure monitoring, transthoracic echocardiography, pulse wave velocity, and genotyping for each participant were assessed at V4. A total of 1573 participants were included at V4, among whom 1417 had available SUA data at visit 1. Genome-wide association study results highlighted multiple single-nucleotide polymorphisms on the SLC2A9 gene linked to SUA levels. Carriers of the most associated mutated SLC2A9 allele (rs16890979) had significantly lower SUA levels. Although SUA level at V4 was highly associated with diabetes, prediabetes, higher body mass index, CRP (C-reactive protein) levels, estimated glomerular filtration rate variation (visit 1-V4), carotid intima-media thickness, and pulse wave velocity, rs16890979 was only associated with higher carotid intima-media thickness. Conclusions Our findings demonstrate that rs16890979, a genetic determinant of SUA levels located on the SLC2A9 gene, is associated with carotid intima-media thickness despite significant associations between SUA levels and several clinical outcomes, thereby lending support to the hypothesis of a link between SUA and cardiovascular disease.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Division of NephrologyDepartment of MedicineKoc University School of MedicineIstanbulTurkey
| | - Constance Xhaard
- Université de LorraineINSERM CIC‐P 1433CHRU de NancyINSERM U1116F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Edith Le Floch
- Centre National de Recherche en Génomique HumaineInstitut François JacobCEAUniversité Paris‐SaclayEvryFrance
| | - Claire Dandine‐Roulland
- Centre National de Recherche en Génomique HumaineInstitut François JacobCEAUniversité Paris‐SaclayEvryFrance
| | - Nicolas Girerd
- Université de LorraineINSERM CIC‐P 1433CHRU de NancyINSERM U1116F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - João Pedro Ferreira
- Université de LorraineINSERM CIC‐P 1433CHRU de NancyINSERM U1116F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Jean‐Marc Boivin
- Université de LorraineINSERM CIC‐P 1433CHRU de NancyINSERM U1116F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Sandra Wagner
- Université de LorraineINSERM CIC‐P 1433CHRU de NancyINSERM U1116F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Delphine Bacq‐Daian
- Centre National de Recherche en Génomique HumaineInstitut François JacobCEAUniversité Paris‐SaclayEvryFrance
| | - Jean‐François Deleuze
- Centre National de Recherche en Génomique HumaineInstitut François JacobCEAUniversité Paris‐SaclayEvryFrance
| | - Faiez Zannad
- Université de LorraineINSERM CIC‐P 1433CHRU de NancyINSERM U1116F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| | - Patrick Rossignol
- Université de LorraineINSERM CIC‐P 1433CHRU de NancyINSERM U1116F‐CRIN INI‐CRCT (Cardiovascular and Renal Clinical Trialists)NancyFrance
| |
Collapse
|
6
|
Farrukh Mustafa S, Zafar MR, Vira A, Halalau A, Rabah M, Dixon S, Hanson I. In-hospital outcomes of patients with chronic kidney disease undergoing percutaneous coronary intervention for chronic total occlusion: a systematic review and meta-analysis. Coron Artery Dis 2021; 32:681-688. [PMID: 33587359 DOI: 10.1097/mca.0000000000001026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The relative safety and efficacy of percutaneous coronary intervention (PCI) for chronic total occlusions (CTO) in patients with chronic kidney disease (CKD) have not been well defined. We performed a systematic review and meta-analysis of observational studies to assess in-hospital outcomes in this population. METHODS We searched MEDLINE, EMBASE, and Cochrane Library databases from inception to April 2020 for all clinical trials and observational studies. Five observational studies with a total of 6769 patients met our inclusion criteria. Patients were divided into two groups based on estimated glomerular filtration rate (eGFR <60 ml/min/1.73m2 in CKD group and ≥ 60 ml/min/1.73m2 in non-CKD group). The primary outcome was in-hospital mortality. Secondary outcomes were acute kidney injury, coronary injury (perforation, dissection or tamponade), stroke and procedural success. Mantel-Haenszel random-effects model was used to calculate the odds ratio (OR) and 95% confidence intervals (CI). RESULTS In-hospital mortality was significantly higher among patients with CKD undergoing PCI for CTO (OR: 5.16, 95% CI: 2.60-10.26, P < 0.00001). Acute kidney injury (OR: 2.54, 95% CI: 1.89-3.40, P < 0.00001) and major bleeding (OR: 2.58, 95% CI: 1.20-5.54, P < 0.01) were also more common in the CKD group. No significant difference was observed in the occurrence of stroke (OR: 2.36, 95% CI: 0.74-7.54, P < 0.15) or coronary injury (OR: 1.38, 95% CI: 0.98-1.93, P < 0.06) between the two groups. Non-CKD patients had a higher likelihood of procedural success compared to CKD patients (OR: 0.66, 95% CI: 0.57-0.77, P < 0.00001). CONCLUSION Patients with CKD undergoing PCI for CTO have a significantly higher risk of in-hospital mortality, acute kidney injury and major bleeding when compared to non-CKD patients. They also have a lower procedural success rate.
Collapse
Affiliation(s)
| | - Meer R Zafar
- Division Cardiology, Department of Medicine, Jacob's School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Amit Vira
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak
| | - Alexandra Halalau
- Department of Internal Medicine, Beaumont Health, Royal Oak, Michigan
- Department of Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Maher Rabah
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak
- Department of Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Simon Dixon
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak
- Department of Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| | - Ivan Hanson
- Department of Cardiovascular Medicine, Beaumont Health, Royal Oak
- Department of Medicine, Oakland University William Beaumont School of Medicine, Rochester, Michigan, USA
| |
Collapse
|
7
|
Kanbay M, Tapoi L, Ureche C, Bulbul MC, Kapucu I, Afsar B, Basile C, Covic A. Coronary artery bypass grafting versus percutaneous coronary intervention in end-stage kidney disease: A systematic review and meta-analysis of clinical studies. Hemodial Int 2021; 25:288-299. [PMID: 34085386 DOI: 10.1111/hdi.12946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 03/25/2021] [Accepted: 05/16/2021] [Indexed: 01/04/2023]
Abstract
The most significant complication of end-stage kidney disease (ESKD) is cardiovascular disease, mainly coronary artery disease (CAD). Although the effective treatment of CAD is an important prognostic factor, whether percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is better for treating CAD in this group of patients is still controversial. We searched Pubmed/Medline, Web of Science, Embase, the Cochrane Central Register of Controlled Trials articles that compared the outcomes of CABG versus PCI in patients with ESKD requiring dialysis. A total of 10 observational studies with 39,666 patients were included. Our analysis showed that when compared to PCI, CABG had lower risk of need for repeat revascularization (relative risk [RR] = 2.25, 95% confidence interval [CI] 2.1-2.42, p < 0.00001) and cardiovascular death (RR = 1.19, 95% CI 1.14-1.23, p < 0.00001) and higher risk for short-term mortality (RR = 0.43, 95% CI 0.38-0.48, p < 0.00001). There was no statistically significant difference between the PCI and CABG groups in the risk for late mortality (RR = 1.05, 95% CI 0.97-1.14, p = 0.25), myocardial infarction (RR = 1.05, 95% CI 0.46-2.36, p = 0.91) or stroke (RR = 1.02, 95% CI 0.64-1.61, p = 0.95). This meta-analysis showed that in ESKD patients requiring dialysis, CABG was superior to PCI in regard to cardiovascular death and need for repeat revascularization and inferior to PCI in regard to short term mortality. However, this meta-analysis has limitations and needs confirmation with large randomized controlled trials.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Laura Tapoi
- Cardiovascular Diseases Institute, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Carina Ureche
- Cardiovascular Diseases Institute, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Mustafa C Bulbul
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Irem Kapucu
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Carlo Basile
- Division of Nephrology, Miulli General Hospital, Acquaviva delle Fonti, Italy
| | - Adrian Covic
- Department of Nephrology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| |
Collapse
|
8
|
Kanbay M, Guler B, Ertuglu LA, Dagel T, Afsar B, Incir S, Baygul A, Covic A, Andres-Hernando A, Sánchez-Lozada LG, Lanaspa MA, Johnson RJ. The Speed of Ingestion of a Sugary Beverage Has an Effect on the Acute Metabolic Response to Fructose. Nutrients 2021; 13:nu13061916. [PMID: 34199607 PMCID: PMC8228203 DOI: 10.3390/nu13061916] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/26/2021] [Accepted: 04/29/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The consumption of sweetened beverages is associated with increased risk of metabolic syndrome, cardiovascular disease, and type 2 diabetes mellitus. OBJECTIVE We hypothesized that the metabolic effects of fructose in sugary beverages might be modulated by the speed of ingestion in addition to the overall amount. DESIGN Thirty healthy subjects free of any disease and medication were recruited into two groups. After overnight fasting, subjects in group 1 drank 500 mL of apple juice over an hour by drinking 125 mL every 15 min, while subjects in group 2 drank 500 mL of apple juice over 5 min. Blood samples were collected at time zero and 15, 30, 60, and 120 min after ingestion to be analyzed for serum glucose, insulin, homeostatic model assessment (HOMA-IR) score, fibroblast growth factor 21, copeptin, osmolarity, sodium, blood urea nitrogen (BUN), lactate, uric acid, and phosphate levels. RESULTS Serum glucose, insulin, HOMA-IR, fibroblast growth factor 21, copeptin, osmolarity, sodium, BUN, and lactate levels increased following apple juice ingestion. The increases were greater in the fast-drinking group, which were more significant after 15 min and 30 min compared to baseline. The changes in uric acid were not statistically different between the groups. Phosphate levels significantly increased only in the fast-drinking group. CONCLUSION Fast ingestion of 100% apple juice causes a significantly greater metabolic response, which may be associated with negative long-term outcomes. Our findings suggest that the rate of ingestion must be considered when evaluating the metabolic impacts of sweetened beverage consumption.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul 34010, Turkey;
- Correspondence: or ; Tel.: +90-21-2250-8250
| | - Begum Guler
- Department of Medicine, Koc University School of Medicine, Istanbul 34450, Turkey; (B.G.); (L.A.E.)
| | - Lale A. Ertuglu
- Department of Medicine, Koc University School of Medicine, Istanbul 34450, Turkey; (B.G.); (L.A.E.)
| | - Tuncay Dagel
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul 34010, Turkey;
| | - Baris Afsar
- Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta 32260, Turkey;
| | - Said Incir
- Department of Biochemistry, Koc University School of Medicine, Istanbul 34010, Turkey;
| | - Arzu Baygul
- Department of Bioistastics, Koc University School of Medicine, Istanbul 34010, Turkey;
| | - Adrian Covic
- Department of Nephrology, Grigore T. Popa’ University of Medicine, 700115 Iasi, Romania;
| | - Ana Andres-Hernando
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO 80045, USA; (A.A.-H.); (M.A.L.); (R.J.J.)
| | | | - Miguel A. Lanaspa
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO 80045, USA; (A.A.-H.); (M.A.L.); (R.J.J.)
| | - Richard J. Johnson
- Division of Renal Diseases and Hypertension, University of Colorado Denver, Aurora, CO 80045, USA; (A.A.-H.); (M.A.L.); (R.J.J.)
| |
Collapse
|
9
|
Jiang S, Tam DY, Fremes SE. Commentary: Another Battle Between PCI and CABG: The Chronic Kidney Disease Edition. Semin Thorac Cardiovasc Surg 2021; 33:972-973. [PMID: 33600977 DOI: 10.1053/j.semtcvs.2021.01.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 01/05/2021] [Indexed: 11/11/2022]
Affiliation(s)
| | - Derrick Y Tam
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada
| | - Stephen E Fremes
- Division of Cardiac Surgery, Schulich Heart Centre, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, ON, Canada.
| |
Collapse
|
10
|
Chen WJ, Lai YJ, Lee JL, Wu ST, Hsu YJ. CREB/ATF3 signaling mediates indoxyl sulfate-induced vascular smooth muscle cell proliferation and neointimal formation in uremia. Atherosclerosis 2020; 315:43-54. [PMID: 33227547 DOI: 10.1016/j.atherosclerosis.2020.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 09/15/2020] [Accepted: 11/06/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Uremic patients are characterized by an increased risk of atherosclerotic cardiovascular diseases. Vascular smooth muscle cell (VSMC) proliferation contributes to neointimal formation, a main pathological feature in atherosclerosis. Activation of CREB/ATF3 signaling is pivotal in VSMC proliferation, yet its role in uremic atherosclerosis is unknown. This study aimed to explore whether CREB/ATF3 signaling is involved in the molecular mechanism underlying neointimal formation in uremia. METHODS AND RESULTS Treatment of VSMCs with uremic toxin (indoxyl sulfate [IS]) activated cAMP/CREB/ATF3/cyclin D signaling, which was reflected by increased VSMC proliferation. Blocking cAMP/PKA/CREB/ATF3 signaling attenuated the promoting effect of IS on cyclin D1 expression and VSMC proliferation. Loss-of-function and time-dependent experiments showed that ATF3 lies downstream of the CREB signaling. Mutational analysis of cyclin D1 promoter along with chromatin immunoprecipitation assays showed that CREB/ATF3 signaling participated in IS-induced cyclin D transcription. In vivo, phosphorylated CREB (an active form of CREB) and ATF3 were prominently upregulated in the neointima of experimental uremic rats, the atherosclerotic plaques of uremic ApoE-/- mice, and the iliac arteries of uremic patients. Notably, the use of lentivirus to knock down ATF3 in the neointima of balloon-injured arteries could suppress the effect of uremia in vivo, including neointimal formation and cyclin D expression. CONCLUSIONS In this study, we demonstrated that CREB/ATF3-related signaling may be involved in IS-induced VSMC proliferation and the pathogenesis of neointimal formation during uremia.
Collapse
Affiliation(s)
- Wei-Jan Chen
- Division of Cardiology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Ying-Ju Lai
- Department of Respiratory Therapy, Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Jia-Lin Lee
- Institute of Molecular and Cellular Biology and Department of Medical Science, National Tsing Hua University, Hsinchu, Taiwan
| | - Sheng-Tang Wu
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Juei Hsu
- Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Biochemistry, National Defense Medical Center, Taipei, Taiwan.
| |
Collapse
|
11
|
Jonas M, Kagan M, Sella G, Haberman D, Chernin G. Cardiovascular outcomes following percutaneous coronary intervention with drug-eluting balloons in chronic kidney disease: a retrospective analysis. BMC Nephrol 2020; 21:445. [PMID: 33097001 PMCID: PMC7583297 DOI: 10.1186/s12882-020-02089-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/05/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with poorer outcomes following percutaneous coronary intervention (PCI) with drug-eluting stents. Drug-eluting balloons are used for in-stent restenosis and selected cases of de-novo coronary lesions. Little is known regarding the outcomes of individuals with CKD who undergo PCI with drug-eluting balloons. The goal of this study was to assess outcomes of PCI with drug-eluting balloons in individuals with CKD. METHODS In a retrospective analysis, outcomes of PCI with drug-eluting balloons were compared between 101 patients with CKD and 261 without CKD. CKD was defined as estimated glomerular filtration rate < 60 ml/min/1.73m2. We compared demographics, procedure data and clinical outcomes in the first and second years following the procedure. RESULTS Rates of major adverse cardiac events (MACE) and myocardial infarction were higher in patients with than without CKD: 23.8% vs. 13.8%, P < 0.005 and 15.9% vs. 3.8%, P < 0.001, respectively. Rates of target lesion revascularization were similar, 14.9 and 11.5%, respectively, P = 0.4. Shorter duration of dual anti-platelet therapy was observed among patients with than without CKD (10.0 + 3.4 vs. 10.9 + 3.7 months, P < 0.05). First-year hemorrhage episodes were similar in the two groups (0.08 ± 0.4 and 0.03 ± 0.2, respectively, P = 0.2). In a multivariate regression analysis, CKD was associated with increased risks of first year MACE (OR 2.1; 95% confidence interval 1.0-4.3, P < 0.001). CONCLUSIONS PCI with drug-eluting balloons was associated with increased cardiovascular morbidity and mortality in patients with than without CKD. However, rates of target lesion revascularization were similar in the two groups. Shorter duration of dual anti-platelet therapy was observed in the CKD group.
Collapse
Affiliation(s)
- Michael Jonas
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Maayan Kagan
- Department of Nephrology and Hypertension, Kaplan Medical Center, Hebrew University School of Medicine, Pasternak St. POB1, 76100, Rehovot, Israel
| | - Gal Sella
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Dan Haberman
- Heart Institute, Kaplan Medical Center, Hebrew University School of Medicine, Rehovot, Israel
| | - Gil Chernin
- Department of Nephrology and Hypertension, Kaplan Medical Center, Hebrew University School of Medicine, Pasternak St. POB1, 76100, Rehovot, Israel.
| |
Collapse
|
12
|
Reduced effects of cardiac extracorporeal shock wave therapy on angiogenesis and myocardial function recovery in patients with end-stage coronary artery and renal diseases. Biomed J 2020; 44:S201-S209. [PMID: 35300948 PMCID: PMC9068516 DOI: 10.1016/j.bj.2020.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 09/17/2020] [Accepted: 10/06/2020] [Indexed: 11/25/2022] Open
Abstract
Background Growing evidence have shown cardiac extracorporeal shock wave therapy (ESWT) improve clinical symptoms and left ventricular ejection fraction (LVEF) for patients with end-stage diffuse coronary artery disease (EnD-CAD) unsuitable for coronary interventions. However, little is known whether cardiac ESWT remains effective on symptomatic relief and improvement of LVEF for the EnD-CAD patients with end-stage renal disease (ESRD). Methods This was a small-scale prospective study. Between August 2016 and January 2019, a total of 16 subjects received cardiac ESWT for their EnD-CAD. They were divided into two groups according to ESRD or not, i.e., EnD-CAD group (n = 8) and EnD-CAD/ESRD group (n = 8). Clinical symptoms including angina and dyspnea, levels of circulating endothelial progenitor cells (EPC), LVEF, and adverse events were regularly followed up for one year to compare safety and efficacy of cardiac ESWT between the EnD-CAD patients with or without ESRD. Results All participants tolerated cardiac ESWT without any relevant side effects such as skin allergic reaction, local redness/tenderness or cardiac arrhythmia. There were similar baseline comorbidities and clinical features between two groups, but the EnD-CAD/ESRD group had significantly higher serum potassium level as well as lower renal function and lipid profile (all p-values <0.03). After cardiac ESWT, the patients in both groups had significant improvement in angina and dyspnea at 1 year (all p-values <0.03). However, the EnD-CAD/ESRD group did not have increase in either circulating EPC levels or LVEF at 6 months (mean change in LVEF: −4.00% ± 8.32%, p = 1.000). In contrast, the EnD-CAD group had gradually improving levels of circulating EPC surface markers and increased LV systolic function (mean change in LVEF: +4.87% ± 8.76%, p = 0.092). Notably, patients in the EnD-CAD/ESRD group suffered from high incidental clinical adverse events before and after enrollment into the ESWT study (75% vs. 25%, p = 0.132). Conclusion Although cardiac ESWT provided improvement of clinical symptoms in the EnD-CAD patients, its long-term effects on the angiogenesis and LVEF were reduced for those high-risk patients with concomitant EnD-CAD and ESRD. Trial registration none.
Collapse
|
13
|
Kanbay M, Siriopol D, Copur S, Tapoi L, Benchea L, Kuwabara M, Rossignol P, Ortiz A, Covic A, Afsar B. Effect of Coffee Consumption on Renal Outcome: A Systematic Review and Meta-Analysis of Clinical Studies. J Ren Nutr 2020; 31:5-20. [PMID: 32958376 DOI: 10.1053/j.jrn.2020.08.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/02/2020] [Accepted: 08/05/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Drinking coffee is one of the most common daily habits, especially in the developed world. Along with caffeine, coffee has various ingredients that have been suggested to have beneficial effects, including antioxidant, antiinflammatory, anticarcinogenic, antithrombotic and antifibrotic effects. In this systematic review and meta-analysis, we investigated the relationship between coffee intake and chronic kidney disease (CKD) related outcomes. DESIGN AND METHODS Literature search was performed through PubMed/Medline, Web of Science, Embase (Elsevier), and the Cochrane Central Register of Controlled Trials (Wiley) from 1960 to February 2020. Incidence of CKD, the progression of CKD, and CKD-associated mortality have been evaluated in relation to coffee consumption and the amount of consumption. The Newcastle-Ottawa scale was used for quality assessment of included studies. RESULTS 12 studies were included in the analysis (7 prospective, 5 cross-sectional) involving 505,841 subjects. 7 studies investigated the relationship between coffee consumption and incident CKD and showed that coffee consumption was associated with a significant decrease in the risk for incident CKD outcome (RR 0.86, 95% CI 0.76 to 0.97, P = .01) with a greater decrease in individuals taking ≥2 cups/day compared to those who drank ≤1 cup/day. There was a significantly lower risk of incident end stage kidney disease (ESKD) in coffee users (HR 0.82, 95% CI 0.72 to 0.94, P = .005). Coffee consumption was also associated with a lower risk of albuminuria (OR 0.81, 95% CI 0.68 to 0.97, P = .02). Overall, the risk of death related to CKD was lower in coffee users (HR 0.72, 95% CI 0.54 to 0.96, P = .02). CONCLUSION Coffee intake was dose-dependently associated with lower incident CKD, ESKD, and albuminuria.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey.
| | - Dimitrie Siriopol
- Department of Nephrology, Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Laura Tapoi
- Department of Cardiology, 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | - Laura Benchea
- Department of Cardiology, 'Grigore T. Popa' University of Medicine, Iasi, Romania
| | | | - Patrick Rossignol
- Université de Lorraine, INSERM CIC-P 1433, CHRU de Nancy, INSERM U1116, FCRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Avd. Reyes Católicos 2, 28040, Madrid, Spain
| | - Adrian Covic
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Division of Nephrology, Department of Internal Medicine, Suleyman Demirel University School of Medicine, Isparta Turkey
| |
Collapse
|
14
|
Noninvasive optical coherence tomography imaging correlates with anatomic and physiologic end-organ changes in healthy normotensives with systemic blood pressure variability. Blood Press Monit 2020; 25:89-94. [DOI: 10.1097/mbp.0000000000000430] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
15
|
Ambrosetti M, Abreu A, Corrà U, Davos CH, Hansen D, Frederix I, Iliou MC, Pedretti RF, Schmid JP, Vigorito C, Voller H, Wilhelm M, Piepoli MF, Bjarnason-Wehrens B, Berger T, Cohen-Solal A, Cornelissen V, Dendale P, Doehner W, Gaita D, Gevaert AB, Kemps H, Kraenkel N, Laukkanen J, Mendes M, Niebauer J, Simonenko M, Zwisler ADO. Secondary prevention through comprehensive cardiovascular rehabilitation: From knowledge to implementation. 2020 update. A position paper from the Secondary Prevention and Rehabilitation Section of the European Association of Preventive Cardiology. Eur J Prev Cardiol 2020; 28:460-495. [PMID: 33611446 DOI: 10.1177/2047487320913379] [Citation(s) in RCA: 346] [Impact Index Per Article: 86.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/26/2020] [Indexed: 12/24/2022]
Abstract
Secondary prevention through comprehensive cardiac rehabilitation has been recognized as the most cost-effective intervention to ensure favourable outcomes across a wide spectrum of cardiovascular disease, reducing cardiovascular mortality, morbidity and disability, and to increase quality of life. The delivery of a comprehensive and 'modern' cardiac rehabilitation programme is mandatory both in the residential and the out-patient setting to ensure expected outcomes. The present position paper aims to update the practical recommendations on the core components and goals of cardiac rehabilitation intervention in different cardiovascular conditions, in order to assist the whole cardiac rehabilitation staff in the design and development of the programmes, and to support healthcare providers, insurers, policy makers and patients in the recognition of the positive nature of cardiac rehabilitation. Starting from the previous position paper published in 2010, this updated document maintains a disease-oriented approach, presenting both well-established and more controversial aspects. Particularly for implementation of the exercise programme, advances in different training modalities were added and new challenging populations were considered. A general table applicable to all cardiovascular conditions and specific tables for each clinical condition have been created for routine practice.
Collapse
Affiliation(s)
- Marco Ambrosetti
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Ana Abreu
- Serviço de Cardiologia, Hospital Universitário de Santa Maria/Centro Hospitalar Universitário Lisboa Norte (CHULN), Centro Académico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal
| | - Ugo Corrà
- Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Italy
| | - Constantinos H Davos
- Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Greece
| | - Dominique Hansen
- REVAL and BIOMED-Rehabilitation Research Centre, Hasselt University, Belgium
| | | | - Marie C Iliou
- Department of Cardiac Rehabilitation and Secondary Prevention, Hôpital Corentin Celton, Assistance Publique Hopitaux de Paris Centre-Universite de Paris, France
| | | | | | | | - Heinz Voller
- Klinik am See, Rehabilitation Centre for Internal Medicine, Rüdersdorf and Centre of Rehabilitation Medicine, University Potsdam, Germany
| | - Matthias Wilhelm
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Massimo F Piepoli
- Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Italy
| | - Birna Bjarnason-Wehrens
- Department of Preventive and Rehabilitative Sport Medicine and Exercise Physiology, Institute for Cardiology and Sports Medicine, German Sport University Cologne, Germany
| | | | - Alain Cohen-Solal
- Cardiology Department, Hopital Lariboisiere, Paris University, France
| | | | - Paul Dendale
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium
| | - Wolfram Doehner
- Department of Cardiology (Virchow Klinikum), German Centre for Cardiovascular Research (DZHK), Germany.,BCRT - Berlin Institute of Health Centre for Regenerative Therapies, and Centre for Stroke Research Berlin, Charité Universitätsmedizin Berlin, Germany
| | - Dan Gaita
- University of Medicine & Pharmacy 'Victor Babes' Cardiovascular Prevention & Rehabilitation Clinic, Romania
| | - Andreas B Gevaert
- Heart Centre, Jessa Hospital Campus Virga Jesse, Belgium.,Research group Cardiovascular Diseases, GENCOR Department, University of Antwerp, Belgium
| | - Hareld Kemps
- Department of Cardiology, Maxima Medical Centre, The Netherlands
| | - Nicolle Kraenkel
- Charité - University Medicine Berlin, Germany.,German Centre for Cardiovascular Research (DZHK), Germany
| | - Jari Laukkanen
- Central Finland Health Care District Hospital District, Finland
| | - Miguel Mendes
- Cardiology Department, CHLO-Hospital de Santa Cruz, Portugal
| | - Josef Niebauer
- University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University, Austria
| | - Maria Simonenko
- Physiology Research and Blood Circulation Department, Cardiopulmonary Exercise Test SRL, Heart Transplantation Outpatient Department, Federal State Budgetary Institution, 'V.A. Almazov National Medical Research Centre' of the Ministry of Health of the Russian Federation, Russian Federation
| | - Ann-Dorthe Olsen Zwisler
- REHPA-Danish Knowledge Centre for Rehabilitation and Palliative Care, University of Southern Denmark, Odense University Hospital, Denmark
| |
Collapse
|
16
|
Pereverzev AP, Shevchenko DA, Filippova AV, Kirichenko AA, Krotkova IF, Ostroumova OD. Levocarnitine for the Treatment of Polymorbid Patients. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2020-02-11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Effective and safe treatment of patients with polymorbidity is an urgent task of modern healthcare. Of particular difficulty is the treatment of patients with cardiovascular comorbidity, which requires an integrated approach to the treatment and development of a special, so-called patient-oriented approach. Modern scientific evidence proposes the use of levocarnitine, as part of complex therapy to increase its effectiveness. So, it was shown that levocarnitine can have a beneficial effect on blood pressure in patients with hypertension, especially those who are overweight and obese. Levocarnitine is also effective in the treatment of heart failure, which has been studied in several clinical studies, which demonstrated its ability to increase the ejection fraction of the left ventricle, stroke volume of blood and other indicators. Optimization of the bioavailability of nitrogen oxide (NO) and a decrease in systemic oxidative stress while taking levocarnitine plays an important positive role in complex therapy in patients with coronary artery disease: exertional angina and post-infarction cardiosclerosis, reducing the number of anginal attacks. Since levocarnitine has powerful antioxidant effects, it also has the neuroprotective effect found in in vitro studies in animal experiments. In case of impaired renal function, due to accelerated elimination and impaired reabsorption, a deficiency of levocarnitine in the body tissues develops, and therefore the US Food and Drug Administration (US FDA) decided on the possibility of using levocarnitine in patients on hemodialysis. Thus, taking into account the positive effects of levocarnitine in a number of frequently combined diseases, it can be considered as the drug of choice in the treatment of patients with polymorbidity.
Collapse
Affiliation(s)
| | | | | | | | - I. F. Krotkova
- Russian Medical Academy of Continuous Professional Education
| | | |
Collapse
|
17
|
Amod A, Buse JB, McGuire DK, Pieber TR, Pop-Busui R, Pratley RE, Zinman B, Hansen MB, Jia T, Mark T, Poulter NR. Glomerular Filtration Rate and Associated Risks of Cardiovascular Events, Mortality, and Severe Hypoglycemia in Patients with Type 2 Diabetes: Secondary Analysis (DEVOTE 11). Diabetes Ther 2020; 11:53-70. [PMID: 31667706 PMCID: PMC6974100 DOI: 10.1007/s13300-019-00715-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION The associations of chronic kidney disease (CKD) severity, cardiovascular disease (CVD), and insulin with the risks of major adverse cardiovascular events (MACE), mortality, and severe hypoglycemia in patients with type 2 diabetes (T2D) at high cardiovascular (CV) risk are not known. This secondary, pooled analysis of data from the DEVOTE trial examined whether baseline glomerular filtration rate (GFR) categories were associated with a higher risk of these outcomes. METHODS DEVOTE was a treat-to-target, double-blind trial involving 7637 patients with T2D at high CV risk who were randomized to once-daily treatment with either insulin degludec (degludec) or insulin glargine 100 units/mL (glargine U100). Patients with estimated GFR data at baseline (n = 7522) were analyzed following stratification into four GFR categories. RESULTS The risks of MACE, CV death, and all-cause mortality increased with worsening baseline GFR category (P < 0.05), with a trend towards higher rates of severe hypoglycemia. Patients with prior CVD, CKD (estimated GFR < 60 mL/min/m2), or both were at higher risk of MACE, CV death, and all-cause mortality. Only CKD was associated with a higher rate of severe hypoglycemia, and the risk of MACE was higher in patients with CVD than in those with CKD (P = 0.0003). There were no significant interactions between randomized treatment and GFR category. CONCLUSION The risks of MACE, CV death, and all-cause mortality were higher with lower baseline GFR and with prior CVD, CKD, or both. The relative effects of degludec versus glargine U100 on outcomes were consistent across baseline GFR categories, suggesting that the lower rate of severe hypoglycemia associated with degludec use versus glargine U100 use was independent of baseline GFR category. FUNDING Novo Nordisk.
Collapse
Affiliation(s)
- Aslam Amod
- Life Chatsmed Garden Hospital and University of KwaZulu-Natal, Durban, South Africa.
| | - John B Buse
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Darren K McGuire
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Rodica Pop-Busui
- Internal Medicine, Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI, USA
| | - Richard E Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, FL, USA
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mt. Sinai Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Ting Jia
- Novo Nordisk A/S, Søborg, Denmark
| | | | | |
Collapse
|
18
|
Wright RS, Collins MG, Stoekenbroek RM, Robson R, Wijngaard PLJ, Landmesser U, Leiter LA, Kastelein JJP, Ray KK, Kallend D. Effects of Renal Impairment on the Pharmacokinetics, Efficacy, and Safety of Inclisiran: An Analysis of the ORION-7 and ORION-1 Studies. Mayo Clin Proc 2020; 95:77-89. [PMID: 31630870 DOI: 10.1016/j.mayocp.2019.08.021] [Citation(s) in RCA: 88] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/02/2019] [Accepted: 08/23/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the pharmacodynamic properties of inclisiran, a small interfering RNA targeting proprotein convertase subtilisin-kexin type 9 (PCSK9), in individuals with normal renal function and renal impairment (RI). PATIENTS AND METHODS The analysis included participants with normal renal function and mild, moderate, and severe RI from the phase 1 ORION-7 renal study (n=31) and the phase 2 ORION-1 study (n=247) who received 300 mg of inclisiran sodium or placebo. RESULTS In ORION-7, PCSK9 values were reduced at day 60 in the normal renal function group (68.1%±12.4%), mild RI group (74.2%±12.3%), moderate RI group (79.8%±4.9%), and severe RI group (67.9%±16.4%) (P<.001 vs placebo in all groups). Low-density lipoprotein cholesterol levels were significantly reduced versus placebo: normal renal function, 57.6%±10.7%; mild RI, 35.1%±13.5%; moderate RI, 53.1%±21.3%; severe RI, 49.2%±26.6% (P<.001 for all). In ORION-1, PCSK9 level reductions at day 180 were 48.3% to 58.6% in the 300-mg single-dose groups and 67.3% to 73.0% in the 300-mg 2-dose groups (P<.001 vs placebo in all groups). The corresponding low-density lipoprotein cholesterol level reductions were 35.7% to 40.2% in the 300-mg single-dose groups and 50.9% to 58.0% in the 300 mg 2-dose groups (P<.001 vs placebo in all groups). In ORION-7, exposure to inclisiran was proportionally greater in individuals with increasing RI; inclisiran was undetectable in plasma 48 hours after administration in any group. CONCLUSION The pharmacodynamic effects and safety profile of inclisiran were similar in study participants with normal and impaired renal function. Dose adjustments of inclisiran are not required in these patients. TRIAL REGISTRATION clinicaltrials.gov Identifiers: NCT02597127 and NCT03159416.
Collapse
Affiliation(s)
| | - Michael G Collins
- Auckland Clinical Studies Ltd., Auckland, New Zealand; Department of Renal Medicine, Auckland City Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Robert M Stoekenbroek
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; The Medicines Company, Parsippany, NJ
| | - Richard Robson
- Christchurch Clinical Studies Trust, Christchurch, New Zealand; Department of Nephrology, Christchurch Hospital, Christchurch, New Zealand
| | | | - Ulf Landmesser
- Centre for Cardiovascular Diseases, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lawrence A Leiter
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, UK
| | | |
Collapse
|
19
|
Kanbay M, Yerlikaya A, Sag AA, Ortiz A, Kuwabara M, Covic A, Wiecek A, Stenvinkel P, Afsar B. A journey from microenvironment to macroenvironment: the role of metaflammation and epigenetic changes in cardiorenal disease. Clin Kidney J 2019; 12:861-870. [PMID: 31807301 PMCID: PMC6885688 DOI: 10.1093/ckj/sfz106] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Indexed: 12/11/2022] Open
Abstract
Chronic non-communicable diseases have become a pandemic public problem in the 21st century, causing enormous burden on the economy, health and quality of life of societies. The role of a chronic inflammatory state in the pathogenesis of chronic disease has been more comprehensively recognized by recent findings. The new paradigm ‘metaflammation’ focuses on metabolism-induced (high fat or fructose-based diet or excessive calorie intake) chronic inflammation. There is a close correlation between the increased incidence of chronic kidney disease (CKD) and chronic heart failure with both increased inflammatory marker levels and western-type diet. In this review we describe the concept of metaflammation, its role in the development of CKD and chronic heart disease, the molecular and signalling pathways involved and the therapeutic consequences.
Collapse
Affiliation(s)
- Mehmet Kanbay
- Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey
| | - Aslihan Yerlikaya
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Alan A Sag
- Department of Radiology, Division of Vascular and Interventional Radiology, Duke University Medical Center, Durham, NC, USA
| | - Alberto Ortiz
- Dialysis Unit, School of Medicine, IIS-Fundacion Jimenez Diaz, Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Adrian Covic
- Nephrology Department, Dialysis and Renal Transplant Center, "Dr. C.I. Parhon" University Hospital, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania
| | - Andrzej Wiecek
- Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia, Katowice, Poland
| | - Peter Stenvinkel
- Department of Clinical Science Intervention and Technology, Division of Renal Medicine and Baxter Novum, Karolinska Institutet, Stockholm, Sweden
| | - Baris Afsar
- Department of Medicine, Division of Nephrology, Suleyman Demirel University School of Medicine, Isparta, Turkey
| |
Collapse
|
20
|
Ureche C, Sascău R, Țăpoi L, Covic A, Moroșanu C, Voroneanu L, Burlacu A, Stătescu C, Covic A. Multi-modality cardiac imaging in advanced chronic kidney disease. Echocardiography 2019; 36:1372-1380. [DOI: 10.1111/echo.14413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Carina Ureche
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Radu Sascău
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Laura Țăpoi
- Cardiovascular Disease Institute; Iasi Romania
| | - Andreea Covic
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | | | - Luminița Voroneanu
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital; Iasi Romania
| | - Alexandru Burlacu
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Department of Interventional Cardiology; Cardiovascular Diseases Institute; Iasi Romania
| | - Cristian Stătescu
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Adrian Covic
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital; Iasi Romania
| |
Collapse
|
21
|
Afsar B, Sag AA, Oztosun C, Kuwabara M, Cozzolino M, Covic A, Kanbay M. The role of uric acid in mineral bone disorders in chronic kidney disease. J Nephrol 2019; 32:709-717. [DOI: 10.1007/s40620-019-00615-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/24/2019] [Indexed: 01/28/2023]
|
22
|
Epicardial Adipose Tissue and Renal Disease. J Clin Med 2019; 8:jcm8030299. [PMID: 30832377 PMCID: PMC6463003 DOI: 10.3390/jcm8030299] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 01/09/2023] Open
Abstract
Epicardial adipose tissue (EAT) is derived from splanchnic mesoderm, localized anatomically between the myocardium and pericardial visceral layer, and surrounds the coronary arteries. Being a metabolically active organ, EAT secretes numerous cytokines, which moderate cardiovascular morphology and function. Through its paracrine and vasocrine secretions, EAT may play a prominent role in modulating cardiac function. EAT protects the heart in normal physiological conditions by secreting a variety of adipokines with anti-atherosclerotic properties, and in contrast, secretes inflammatory molecules in pathologic conditions that may play a dynamic role in the pathogenesis of cardiovascular diseases by promoting atherosclerosis. Considerable research has been focused on comparing the anatomical and biochemical features of EAT in healthy people, and a variety of disease conditions such as cardiovascular diseases and renal diseases. The global cardiovascular morbidity and mortality in renal disease are high, and there is a paucity of concrete evidence and societal guidelines to detect early cardiovascular disease (CVD) in this group of patients. Here we performed a clinical review on the existing evidence and knowledge on EAT in patients with renal disease, to evaluate its application as a reliable, early, noninvasive biomarker and indicator for CVD, and to assess its significance in cardiovascular risk stratification.
Collapse
|
23
|
Patel KV, Kumbhani DJ. Editorial Commentary: Oxidized LDL: The next “big thing”? Trends Cardiovasc Med 2019; 29:27-28. [DOI: 10.1016/j.tcm.2018.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
|
24
|
Allon M, Litovsky SH, Tey JCS, Sundberg CA, Zhang Y, Chen Z, Fang Y, Cheung AK, Shiu YT. Abnormalities of vascular histology and collagen fiber configuration in patients with advanced chronic kidney disease. J Vasc Access 2019; 20:31-40. [PMID: 29742957 PMCID: PMC6212345 DOI: 10.1177/1129729818773305] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION: Several histologic features have been identified in the upper-extremity arteries and veins of patients with advanced chronic kidney disease, which may affect arteriovenous fistula maturation. However, it is unclear whether these chronic kidney disease vascular features are abnormal. METHODS: We obtained upper-extremity arterial and venous specimens from 125 advanced chronic kidney disease patients undergoing arteriovenous fistula creation and from 15 control subjects. We quantified medial fibrosis, micro-calcification, and intimal hyperplasia with appropriate histology stains. We characterized medial collagen fiber configuration in second-harmonic-generation microscopy images for the fiber anisotropy index and the dominant fiber direction. RESULTS: The advanced chronic kidney disease patients were significantly younger than control subjects (53 ± 14 years vs 76 ± 11 years, p < 0.001). After controlling for age, the chronic kidney disease patients had greater arterial medial fibrosis (69% ± 14% vs 51% ± 10%, p < 0.001) and greater arterial micro-calcification (3.03% ± 5.17% vs 0.01% ± 0.03%, p = 0.02), but less arterial intimal thickness (30 ± 25 µm vs 63 ± 25 µm, p < 0.001), as compared to control subjects. The anisotropy index of medial collagen fibers was lower in both arteries (0.24 ± 0.10 vs 0.44 ± 0.04, p < 0.001) and veins (0.28 ± 0.09 vs 0.53 ± 0.10, p < 0.001) in chronic kidney disease patients, indicating that orientation of the fibers was more disordered. The dominant direction of medial collagen fibers in chronic kidney disease patients was greater in the arteries (49.3° ± 23.6° vs 4.0° ± 2.0°, p < 0.001) and the veins (30.0° ± 19.6° vs 3.9° ± 2.1°, p < 0.001), indicating that the fibers in general were aligned more perpendicular to the lumen. CONCLUSION: Advanced chronic kidney disease is associated with several abnormalities in vascular histology and collagen fiber configuration. Future research is needed to investigate whether these abnormalities affect the maturation outcomes of arteriovenous fistulas.
Collapse
Affiliation(s)
- Michael Allon
- Division of Nephrology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Silvio H. Litovsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jason Chieh Sheng Tey
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Chad A. Sundberg
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Yingying Zhang
- Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Zhen Chen
- Department of Diabetes Complications and Metabolism, Beckman Research Institute, City of Hope, Duarte, CA, USA
| | - Yun Fang
- Section of Pulmonary and Critical Care, Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Alfred K. Cheung
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
- Medical Service, Veterans Affairs Salt Lake City Healthcare System, Salt Lake City, UT, USA
- Department of Nephrology, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Yan-Ting Shiu
- Division of Nephrology & Hypertension, Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
25
|
The effect of chronic kidney disease on lipid metabolism. Int Urol Nephrol 2018; 51:265-277. [DOI: 10.1007/s11255-018-2047-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 11/27/2018] [Indexed: 12/26/2022]
|
26
|
Maia PRL, Medeiros AMC, Pereira HS, Lima KC, Oliveira PT. Presence and associated factors of carotid artery calcification detected by digital panoramic radiography in patients with chronic kidney disease undergoing hemodialysis. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126:198-204. [DOI: 10.1016/j.oooo.2018.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 04/01/2018] [Accepted: 04/13/2018] [Indexed: 12/11/2022]
|
27
|
Erbil D, Onal EM, Demirel C, Sag AA, Dagel T, Afsar B, Covic A, Kanbay M. Can Incidental Vascular Calcifications at Mammography be Used as a Screening Biomarker for Heart and Kidney Disease? Angiology 2018; 70:210-219. [PMID: 29886750 DOI: 10.1177/0003319718779322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Mammography is a screening test with extensive international application and financial infrastructure promoting accessibility and affordability. Designed specifically to detect microcalcifications, mammography is powered to detect calcifications in vessel walls. Breast arterial calcifications (BAC) are one of the most common incidental findings documented by mammography. This review considers the literature regarding BAC in relation to cardiovascular disease (CVD) and its risk factors. The aim is to assess the possibility of using BAC as an early surrogate imaging biomarker of CVD.
Collapse
Affiliation(s)
- Damla Erbil
- Koc University School of Medicine, Istanbul, Turkey
| | - Emine M Onal
- Koc University School of Medicine, Istanbul, Turkey
| | | | - Alan A Sag
- Division of Interventional Radiology, Department of Radiology, Eastern Virginia School of Medicine, Norfolk, VA, USA.,Medical Center Radiologists, Virginia Beach, VA, USA
| | - Tuncay Dagel
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Baris Afsar
- Division of Nephrology, Department of Medicine, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Adrian Covic
- Department of Nephrology, University of Medicine and Pharmacy "Gr. T. Popa," Iasi, Romania
| | - Mehmet Kanbay
- Division of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| |
Collapse
|
28
|
Zhang H, Zhao Z, Pang X, Yang J, Yu H, Zhang Y, Zhou H, Zhao J. MiR-34a/sirtuin-1/foxo3a is involved in genistein protecting against ox-LDL-induced oxidative damage in HUVECs. Toxicol Lett 2017; 277:115-122. [DOI: 10.1016/j.toxlet.2017.07.216] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Revised: 05/31/2017] [Accepted: 07/04/2017] [Indexed: 12/31/2022]
|
29
|
Hori D, Yamaguchi A, Adachi H. Coronary Artery Bypass Surgery in End-Stage Renal Disease Patients. Ann Vasc Dis 2017; 10:79-87. [PMID: 29034031 PMCID: PMC5579782 DOI: 10.3400/avd.ra.17-00024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 12/21/2022] Open
Abstract
The number of patients requiring hemodialysis is continuously increasing around the world. Hemodialysis affects patient quality of life and it is also associated with a higher risk for cardiovascular events. In addition to traditional risk factors for cardiovascular events such as hypertension, hyperlipidemia, and diabetes, hemodialysis is associated with hyperphosphatemia, chronic inflammation, vascular calcification, and anemia which accelerate atherosclerosis, vascular stiffness, and cardiac ischemia. Treatment strategy for coronary revascularization in this progressive disease remains controversial. However, a systematic treatment including medical therapy and complete revascularization through a less invasive strategy should be considered in addressing this problem. This review discusses the epidemiology, vascular pathology and current treatment options in patients with end-stage renal disease requiring coronary revascularization.
Collapse
Affiliation(s)
- Daijiro Hori
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Atsushi Yamaguchi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| | - Hideo Adachi
- Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Saitama, Japan
| |
Collapse
|
30
|
Nishi T, Shuto E, Ogawa M, Ohya M, Nakanishi M, Masuda M, Katsumoto M, Yamanaka-Okumura H, Sakai T, Takeda E, Sakaue H, Taketani Y. Excessive dietary phosphorus intake impairs endothelial function in young healthy men: a time- and dose-dependent study. THE JOURNAL OF MEDICAL INVESTIGATION 2017; 62:167-72. [PMID: 26399342 DOI: 10.2152/jmi.62.167] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Excessive dietary phosphorus (P) has been speculated to be a risk factor for cardiovascular disease (CVD). Here, we performed a double-blinded crossover study to investigate the time- and dose-dependent effects of dietary P intake on endothelial function in healthy subjects. Sixteen healthy male volunteers were given meals containing 400, 800, and 1,200 mg P (P400, P800, and P1200 meals, respectively) with at least 7 days between doses. There were no differences in nutritional composition among the experimental diets except for P content. Blood biochemistry data and flow-mediated dilation (%FMD) of the brachial artery were measured while fasted, at 0 h, 1 h, 2 h, and 4 h after meal ingestion, and the next morning while fasted. The P800 and P1200 meals significantly increased serum P levels at 1-4 h after ingestion. A significant decrease in %FMD was observed between 1-4 h,while the P400 meal did not affect %FMD. We observed no differences among meals in serum P levels or %FMD the next morning. A significant negative correlation was observed between %FMD and serum P. These results indicate that excessive dietary P intake can acutely impair endothelial function in healthy people.
Collapse
Affiliation(s)
- Tamae Nishi
- Department of Clinical Nutrition and Food Management, University of Tokushima Graduate School
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
High Prevalence of Hyperhomocysteinemia and Its Association with Target Organ Damage in Chinese Patients with Chronic Kidney Disease. Nutrients 2016; 8:nu8100645. [PMID: 27775590 PMCID: PMC5084032 DOI: 10.3390/nu8100645] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2016] [Revised: 09/27/2016] [Accepted: 10/03/2016] [Indexed: 02/07/2023] Open
Abstract
Hyperhomocysteinemia (HHcy) is recognized as a risk factor for cardiovascular disease. However, the prevalence of HHcy and its role in association with target organ damage in patients with chronickidney disease (CKD) are not well understood. This cross-sectional study included 1042 CKD patients who were admitted to our hospital. Patients were divided into two groups: hyperhomocysteinemia and normohomocysteinemia. Multivariable linear regression analyses were used to evaluate the association between plasma homocysteine and renal/cardiovascular parameters. The prevalence of HHcy in patients with CKD was 52.78%, and the prevalence in CKD stage 1, stage 2, stage 3, stage 4 and stage 5 patients was 10.73%, 29.22%, 58.71%, 75.23% and 83.75%, respectively. Patients with HHcy had higher incidences of renal damage, left ventricular hypertrophy, left ventricular diastolic dysfunction and abnormal carotid intima-media thickness compared with patients with normohomocysteinemia (p < 0.05), while multivariable linear regression analyses showed plasma homocysteine was only associated with the estimated glomerular filtration rate (eGFR). eGFR, uric acid, albumin, gender, hemoglobin and calcium×phosphate were associated with levels of plasma homocysteine in these CKD patients. The prevalence of HHcy in Chinese patients with CKD was high, and serum homocysteine levels were associated with impaired renal function in these patients.
Collapse
|
32
|
Huang WH, Hsu CW, Hu CC, Yen TH, Weng CH. Predialysis hypotension is not a predictor for mortality in long-term hemodialysis patients: insight from a single-center observational study. Ther Clin Risk Manag 2016; 12:1285-92. [PMID: 27601912 PMCID: PMC5005003 DOI: 10.2147/tcrm.s111635] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Introduction Predialysis hypotension has been noted to be a predictor of mortality in hemodialysis (HD) patients. Previous studies evaluating the impact of predialysis hypotension on the mortality of HD patients did not exclude patients with diabetes mellitus (DM) or cardiovascular disease. Methods Eight hundred and sixty-six patients on maintenance HD were recruited. Clinical parameters were recorded and subjected to the analysis of predictors of predialysis hypotension and mortality. Results Multivariate logistic regression analyses indicated that DM (odds ratio [OR]: 0.439, P=0.002), hypertension history (OR: 0.634, P=0.022), Kt/V Daugirdas (OR: 2.545, P=0.001), anuria (OR: 2.313, P=0.002), serum phosphate (OR: 0.833, P=0.010), and serum triglyceride (OR: 1.002, P=0.012) were associated with predialysis hypotension. Multivariate Cox regression analysis showed that age (P<0.001), male sex (P=0.029), anuria (P=0.004), and DM (P=0.011) were associated with higher probability of 24- and 36-month mortality. Predialysis hypotension was not associated with higher probability of 12-, 24-, and 36-month mortality. Conclusion Predialysis hypotension is not a predictor of 12-, 24-, and 36-month survival in patients without DM and with higher dialysis adequacy.
Collapse
Affiliation(s)
- Wen-Hung Huang
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Gueishan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Ching-Wei Hsu
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Gueishan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Ching-Chih Hu
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan, Republic of China
| | - Tzung-Hai Yen
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Gueishan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Cheng-Hao Weng
- Department of Nephrology, Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center, Gueishan, Taiwan, Republic of China; Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| |
Collapse
|
33
|
Moldovan D, Rusu C, Kacso IM, Potra A, Patiu IM, Gherman-Caprioara M. Mineral and bone disorders, morbidity and mortality in end-stage renal failure patients on chronic dialysis. Med Pharm Rep 2016; 89:94-103. [PMID: 27004031 PMCID: PMC4777475 DOI: 10.15386/cjmed-515] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 09/01/2015] [Accepted: 09/03/2015] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND AND AIM In spite of numerous interventions, the control of mineral disturbances remains poor in end-stage renal failure (ESRF) patients. Chronic kidney disease - mineral and bone disorders (CKD-MBD) represent an important cause of mortality and morbidity. The aim of this study is to analyze the relationship between mineral and bone disorders (MBD) and their components impact on all-cause mortality and cardiovascular (CDV) mortality and morbidity in chronic dialysis patients. METHODS This prospective study was carried out in a cohort of 92 randomly selected patients with ESRF treated with hemodialysis (HD) and peritoneal dialysis (PD). The data regarding demographic and clinical characteristics were recorded, including vascular disease (coronary, cerebral, peripheral). The follow-up lasted 40 months and the final evaluation included the number and causes of deaths, CDV events and disease. Serum Ca, P, ALP, iPTH, albumin, cholesterol, urea and creatinine levels were measured. The plain radiographic films of hands and pelvis evaluated all bone abnormalities suggestive of renal osteodystrophy (ROD) and peripheral vascular calcification (VC). RESULTS All-cause annual mortality represented 9.25% in HD and 9.09% in PD patients. The CDV mortality represented almost 44% in HD patients and 66% in PD patients from all deaths. There was a high prevalence of CDV diseases and events. High and low serum P levels were associated with a worse survival rate. Hypercalcaemia was associated with high risk for CDV events in HD patients. In PD patients, the relationship between increased ALP levels and all-cause mortality was significant. Other mineral markers were not predictive of the outcome in the studied patients. In the HD patients the severity of VC was associated with all-cause and CDV mortality, and with CDV events. Male gender, hypercholesterolemia, decreased URR, albumin and creatinine were identified as risk factors for all-cause mortality. The diabetics had higher death rates. Low dialysis efficacy represented a risk factor for mortality and CDV diseases and events. In PD patients, low albumin induced a higher death rate. In PD patients the death rate was similar to HD patients. CONCLUSION All-cause mortality was higher than in general population, but lower than the chronic dialysis patients' mortality reported in other studies. The death rates in HD and PD patients were similar. VC and serum P levels influenced the outcome in the HD patients - increased the risk for all-cause and CDV mortality, but also for CDV events. ALP levels influenced outcome in PD patients. There were no significant differences between HD and PD patients regarding outcome.
Collapse
Affiliation(s)
- Diana Moldovan
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Crina Rusu
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ina Maria Kacso
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alina Potra
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Ioan Mihai Patiu
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Mirela Gherman-Caprioara
- Nephrology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| |
Collapse
|
34
|
Zhang HP, Zhao JH, Yu HX, Guo DX. Genistein ameliorated endothelial nitric oxidase synthase uncoupling by stimulating sirtuin-1 pathway in ox-LDL-injured HUVECs. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2016; 42:118-124. [PMID: 26829290 DOI: 10.1016/j.etap.2016.01.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 06/05/2023]
Abstract
Endothelial nitric oxidase synthase (eNOS) uncoupling plays a causal role in endothelial dysfunction in atherosclerosis. Genistein consumption has been associated with the prevention of atherosclerosis. However, the effect of genistein on eNOS uncoupling has not been reported. A model of oxidized low-density lipoprotein (ox-LDL)-induced injury on human umbilical vein endothelial cells (HUVECs) was established to evaluate the effect of genistein on eNOS uncoupling. We investigated the effect of genistein on NADPH oxidase-dependent superoxide production, NOX4 expression, BH4 synthesis and oxidation, the expression of GTP cyclohydrolase 1 (GCH1) and dihydrofolate reductase (DHFR). The results showed that genistein decreased superoxide production and NOX4 expression, enhanced the ratio of BH4/BH2, augmented the expressions of GCH1 and DHFR. Accompanied with genistein ameliorating eNOS uncoupling, genistein elevated the expression of sirtuin-1; furthermore, the effects of genistein on eNOS uncoupling were blunted with sirtuin-1 siRNA. The present study indicated that genistein ameliorated eNOS uncoupling was concerned with sirtuin-1 pathway in ox-LDL-injured HUVECs.
Collapse
Affiliation(s)
- Hua-ping Zhang
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China.
| | - Jia-hui Zhao
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
| | - Hai-xia Yu
- Key Laboratory of Cellular Physiology, Ministry of Education, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
| | - Dong-xing Guo
- Department of Pharmacology, School of Basic Medical Sciences, Shanxi Medical University, Taiyuan, Shanxi 030001, PR China
| |
Collapse
|
35
|
Chen CI, Kao PF, Wu MY, Fang YA, Miser JS, Liu JC, Sung LC. Influenza Vaccination is Associated with Lower Risk of Acute Coronary Syndrome in Elderly Patients with Chronic Kidney Disease. Medicine (Baltimore) 2016; 95:e2588. [PMID: 26844466 PMCID: PMC4748883 DOI: 10.1097/md.0000000000002588] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Elderly patients with chronic kidney disease (CKD) are at a higher risk of hospitalization for cardiovascular diseases (CVD). Previous studies have showed that influenza vaccination could reduce the risk of recurrent major cardiovascular events in patients with CVD. However, the effects of influenza vaccination on the reduction of first hospitalizations for acute coronary syndrome (ACS) in elderly patients with CKD remain unknown.We conducted a cohort study using data from the Taiwan Longitudinal Health Insurance Database 1997 to 2008. This cohort study comprised elderly patients (ages ≥55 years) with a recorded diagnosis of CKD (n = 4406) between January 1, 1999, and December 31, 2007. Each patient was followed up until the end of 2008. To minimize the selection bias of vaccine therapy, a propensity score adjustment was applied. The hazard ratio (HR) and 95% confidence interval (CI) for the association between the influenza vaccination and the occurrence of first hospitalization for ACS was evaluated by Cox proportional hazards regression. We further categorized the patients into 4 groups according to their vaccination status (unvaccinated, and total number of vaccinations: 1, 2-3, and ≥4).We found that elderly CKD patients without prior CVD history receiving influenza vaccination exhibited a lower risk of hospitalization for ACS (adjusted HR = 0.35, 95% CI 0.30-0.42; P < 0.001). We observed consistent protective effects regardless of age groups (55-64, 65-74, and ≥75), gender, and seasonality of influenza. When the patients were stratified according to the total number of vaccinations, the adjusted HRs for first ACS hospitalization were 0.62 (95% CI 0.52-0.81), 0.35 (95% CI 0.28-0.45), and 0.13 (95% CI 0.09-0.19) for patients who received 1, 2 to 3, and ≥4 vaccinations. There was a significant trend of decreasing risk of ACS hospitalization with an increasing number of vaccinations.The results of our observational study could strengthen the annual vaccination policy and physicians should be aware of missed opportunities to vaccinate elderly patients with CKD against influenza. The potential public health impact of influenza vaccination, particularly in the elderly CKD patients without a history of CVD, who are at risk for ACS, should be further explored.
Collapse
Affiliation(s)
- Chang-I Chen
- From the Taipei Cancer Center (C-IC, Y-AF), Cancer Center, Wan Fang Hospital (C-IC, Y-AF), Department of Healthcare Administration (C-IC), Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital (P-FK, J-CL, L-CS), Division of Nephrology, Department of Internal Medicine, Shuang Ho Hospital (MYW), College of Medical Science and Technology (JSM), and Department of Internal Medicine, School of Medicine, College of Medicine (P-FK, JCL), Taipei Medical University, Taipei, Taiwan; City of Hope National Medical Center, Duarte, CA (JSM)
| | | | | | | | | | | | | |
Collapse
|
36
|
Guliyev O, Sayin B, Uyar ME, Genctoy G, Sezer S, Bal Z, Demirci BG, Haberal M. High-grade proteinuria as a cardiovascular risk factor in renal transplant recipients. Transplant Proc 2016; 47:1170-3. [PMID: 26036546 DOI: 10.1016/j.transproceed.2014.10.062] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 10/28/2014] [Indexed: 02/05/2023]
Abstract
BACKGROUND Proteinuria is a marker of graft damage and is closely associated with a higher risk of morbidity, mortality, and cardiovascular disease in kidney transplant recipients (KTRs). Arterial stiffness is a well-known predictor of vascular calcification and systemic arteriosclerosis. In our study, we aimed to investigate the association between proteinuria and graft/patient survival and to determine whether proteinuria may be a predictor for cardiovascular disease in our KTR population. METHODS Ninety KTRs (31 women; age, 38.7 ± 11 years, with 45.9 ± 9.6 months post-transplantation period) with normal graft functions in the 3 to 5 years of the post-transplantation period were enrolled. All patients were evaluated for their standard clinical (age, sex, and duration of hemodialysis) parameters. High-grade proteinuria was defined as proteinuria >500 mg/day in the 24-hour urine collection. All patients were evaluated by means of pulse-wave velocity (PWV) measurement at the initiation of the study. RESULTS Patients were divided into 2 groups: group 1 (high-grade proteinuria) patients with ≥500 mg/24 hours (n = 30) and group 2 (low-grade proteinuria) patients with <500 mg/24 hours (n = 60). High-grade proteinuria was correlated with higher PWV measurements and lower estimated glomerular filtration levels. Proteinuria appears to precede the elevation of serum creatinine and thus may be a useful marker of renal injury and may also be a contributing factor on deterioration of the graft. CONCLUSIONS High-grade (>500 mg/day) proteinuria in KTRs is strongly associated with poor graft survival and increased risk of cardiovascular events. In our study, we proved the significant difference between high-grade and low-grade proteinuric patients, and we suggest 500 mg/day as the threshold of proteinuria in KTR population.
Collapse
Affiliation(s)
- O Guliyev
- Department of Nephrology, Baskent University, Ankara, Turkey
| | - B Sayin
- Department of Nephrology, Baskent University, Ankara, Turkey
| | - M E Uyar
- Department of Nephrology, Baskent University, Ankara, Turkey.
| | - G Genctoy
- Department of Nephrology, Baskent University, Ankara, Turkey
| | - S Sezer
- Department of Nephrology, Baskent University, Ankara, Turkey
| | - Z Bal
- Department of Nephrology, Baskent University, Ankara, Turkey
| | - B G Demirci
- Department of Nephrology, Baskent University, Ankara, Turkey
| | - M Haberal
- Department of General Surgery, Baskent University, Ankara, Turkey
| |
Collapse
|
37
|
Hylander B, Lehtihet M. Testosterone and gonadotropins but not SHBG vary with CKD stages in young and middle aged men. Basic Clin Androl 2015; 25:9. [PMID: 26635963 PMCID: PMC4668662 DOI: 10.1186/s12610-015-0027-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 10/23/2015] [Indexed: 12/24/2022] Open
Abstract
Background The aim of this study was to assess the effects chronic kidney disease (CKD) had on sex hormones and lipids in a subgroup of men between 18 and 50 years old with CKD 1–5 stage without diabetes and not treated with hemodialysis. Methods Data were collected from 101 men with different CKD stages. Results Higher CKD stage (lower function) had a significant negative linear trend on total testosterone level (p < 0.01) and free testosterone level (p < 0.01), with a significant increase of luteinizing hormone (LH) (p < 0.01), and prolactin (p < 0.01), while SHBG remained unchanged between the CKD stages. Triglycerides but not total cholesterol, HDL –cholesterol or LDL-cholesterol increased with higher CKD stage. A negative correlation was observed between BMI, SHBG and free testosterone (p < 0.01 for both) but not with other sex hormones. Age per se was related to a significant decrease of total and free testosterone level (p < 0.01 for both) even after correction for BMI. Decreased levels of total testosterone and estimated free testosterone levels had a significant correlation with an increased level of triglyceride levels (p <0.01). Conclusions Our results indicate that CKD stage per se is a factor affecting testosterone levels in combination with age in men between 18 and 50 years old with CKD 1–5 stage, not treated with hemodialysis. With increased CKD stage there was a significant increase in LH level and a pattern of hypergonadotropic hypogonadism. SHBG remained unchanged between the CKD stages. Electronic supplementary material The online version of this article (doi:10.1186/s12610-015-0027-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Britta Hylander
- Department of Nephrology, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, S-17173 Sweden
| | - Mikael Lehtihet
- Department of Endocrinology, Metabolism and Diabetes, C2:94, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, S-141 86 Sweden
| |
Collapse
|
38
|
Glorieux G, Mullen W, Duranton F, Filip S, Gayrard N, Husi H, Schepers E, Neirynck N, Schanstra JP, Jankowski J, Mischak H, Argilés À, Vanholder R, Vlahou A, Klein J. New insights in molecular mechanisms involved in chronic kidney disease using high-resolution plasma proteome analysis. Nephrol Dial Transplant 2015; 30:1842-52. [PMID: 26160894 DOI: 10.1093/ndt/gfv254] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Accepted: 05/21/2015] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The reduced glomerular filtration rate in the advanced stages of chronic kidney disease (CKD) leads to plasma accumulation of uraemic retention solutes including proteins. It has been hypothesized that these changes may, at least in part, be responsible for CKD-associated morbidity and mortality. However, most studies focused on the role of individual proteins, while a holistic, large-scale, integrative approach may generate significant additional insight. METHODS In a discovery study, we analysed the plasma proteome of patients with stage 2-3 CKD (n = 14) and stage 5 CKD with haemodialysis (HD) (n = 15), using high-resolution LC-MS/MS analysis. Selected results were validated in a cohort of 40 patients with different CKD stages with or without HD, using ELISA. RESULTS Of a total of 2054 detected proteins, 127 displayed lower, while 206 displayed higher abundance in the plasma of patients on HD. Molecular pathway analysis confirmed the modification of known processes involved in CKD complications, including decreased haemostasis and increased inflammation, complement activation and vascular damage. In addition, we identified the plasma increase during CKD progression of lysozyme C and leucine-rich alpha-2 glycoprotein, two proteins related to vascular damage and heart failure. High level of leucine-rich alpha-2 glycoprotein was associated with higher mortality in stage 5 CKD patients on HD. CONCLUSIONS This study provides for the first time a comprehensive assessment of CKD plasma proteome, contributing to new knowledge and potential markers of CKD. These results will serve as a basis for future studies investigating the relevance of these molecules in CKD associated morbidity and mortality.
Collapse
Affiliation(s)
- Griet Glorieux
- Nephrology Section, Ghent University Hospital, Gent, Belgium
| | - William Mullen
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | | | - Szymon Filip
- Biomedical Research Foundation, Academy of Athens, Athens, Greece Charité - Universitätsmedizin Berlin, Berlin, Germany
| | | | - Holger Husi
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK
| | - Eva Schepers
- Nephrology Section, Ghent University Hospital, Gent, Belgium
| | | | - Joost P Schanstra
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Disease, Toulouse, France Université Toulouse III Paul-Sabatier, Toulouse, France
| | - Joachim Jankowski
- University Hospital RWTH, Institute for Molecular Cardiovascular Research, Aachen, Germany
| | - Harald Mischak
- BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, UK Mosaiques Diagnostics, Hannover, Germany
| | | | | | - Antonia Vlahou
- Biomedical Research Foundation, Academy of Athens, Athens, Greece School of Biomedical & Healthcare Sciences, Plymouth University Peninsula Schools of Medicine and Dentistry, Plymouth, UK
| | - Julie Klein
- Institut National de la Santé et de la Recherche Médicale (INSERM), U1048, Institute of Cardiovascular and Metabolic Disease, Toulouse, France Université Toulouse III Paul-Sabatier, Toulouse, France
| |
Collapse
|
39
|
Masola V, Zaza G, Onisto M, Lupo A, Gambaro G. Impact of heparanase on renal fibrosis. J Transl Med 2015; 13:181. [PMID: 26040666 PMCID: PMC4467599 DOI: 10.1186/s12967-015-0538-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/14/2015] [Indexed: 12/26/2022] Open
Abstract
Tubulo-interstitial fibrosis has been recognized as the hallmark of progression of chronic kidney disease, but, despite intensive research studies, there are currently no biomarkers or effective treatments for this condition. In this context, a promising candidate could be heparanase-1 (HPSE), an endoglycosidase that cleaves heparan sulfate chains and thus takes part in extracellular matrix remodeling. As largely described, it has a central role in the pathogenesis of cancer and inflammation, and it participates in the complex biological machinery involved in the onset of different renal proteinuric diseases (e.g., diabetic nephropathy, glomerulonephritis). Additionally, HPSE may significantly influence the progression of chronic kidney damage trough its major role in the biological pathway of renal fibrogenesis. Here, we briefly summarize data supporting the role of HPSE in renal damage, focusing on recent evidences that demonstrate the capability of this enzyme to modulate the signaling of pro-fibrotic factors such as FGF-2 and TGF-β and consequently to control the epithelial-mesenchymal transition in renal tubular cells. We also emphasize the need of the research community to undertake studies and clinical trials to assess the potential clinical employment of this enzyme as diagnostic and prognostic tool and/or its role as therapeutic target for new pharmacological interventions.
Collapse
Affiliation(s)
- Valentina Masola
- Renal Unit, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, VR, Italy.
| | - Gianluigi Zaza
- Renal Unit, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, VR, Italy.
| | - Maurizio Onisto
- Department of Biomedical Sciences, University of Padova, Padua, Italy.
| | - Antonio Lupo
- Renal Unit, Department of Medicine, Verona University Hospital, Piazzale A. Stefani 1, 37126, Verona, VR, Italy.
| | - Giovanni Gambaro
- Division of Nephrology and Dialysis, Columbus-Gemelli Hospital Catholic University School of Medicine, Rome, Italy.
| |
Collapse
|
40
|
Nafzger S, Fleury LA, Uehlinger DE, Plüss P, Scura N, Kurmann S. DETECTION OF MALNUTRITION IN PATIENTS UNDERGOING MAINTENANCE HAEMODIALYSIS: A QUANTITATIVE DATA ANALYSIS ON 12 PARAMETERS. J Ren Care 2015; 41:168-76. [PMID: 25899894 DOI: 10.1111/jorc.12125] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Protein-energy-malnutrition (PEM) is common in people with end stage kidney disease (ESKD) undergoing maintenance haemodialysis (MHD) and correlates strongly with mortality. To this day, there is no gold standard for detecting PEM in patients on MHD. AIM OF STUDY The aim of this study was to evaluate if Nutritional Risk Screening 2002 (NRS-2002), handgrip strength measurement, mid-upper arm muscle area (MUAMA), triceps skin fold measurement (TSF), serum albumin, normalised protein catabolic rate (nPCR), Kt/V and eKt/V, dry body weight, body mass index (BMI), age and time since start on MHD are relevant for assessing PEM in patients on MHD. METHODS The predictive value of the selected parameters on mortality and mortality or weight loss of more than 5% was assessed. Quantitative data analysis of the 12 parameters in the same patients on MHD in autumn 2009 (n = 64) and spring 2011 (n = 40) with paired statistical analysis and multivariate logistic regression analysis was performed. RESULTS Paired data analysis showed significant reduction of dry body weight, BMI and nPCR. Kt/Vtot did not change, eKt/v and hand grip strength measurements were significantly higher in spring 2011. No changes were detected in TSF, serum albumin, NRS-2002 and MUAMA. Serum albumin was shown to be the only predictor of death and of the combined endpoint "death or weight loss of more than 5%". CONCLUSION We now screen patients biannually for serum albumin, nPCR, Kt/V, handgrip measurement of the shunt-free arm, dry body weight, age and time since initiation of MHD.
Collapse
Affiliation(s)
- Sonja Nafzger
- Bern University of Applied Sciences, Bern, Switzerland
| | | | - Dominik E Uehlinger
- Department of Nephrology, Hypertension and Clinical Pharmacology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Petra Plüss
- Department of Endocrinology, Diabetology and Clinical Nutrition, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Ninetta Scura
- Bern University of Applied Sciences, Bern, Switzerland
| | - Silvia Kurmann
- Department of Endocrinology, Diabetology and Clinical Nutrition, Inselspital, Bern University Hospital, Bern, Switzerland
| |
Collapse
|
41
|
Pejchinovski M, Hrnjez D, Ramirez-Torres A, Bitsika V, Mermelekas G, Vlahou A, Zürbig P, Mischak H, Metzger J, Koeck T. Capillary zone electrophoresis on-line coupled to mass spectrometry: A perspective application for clinical proteomics. Proteomics Clin Appl 2015; 9:453-68. [DOI: 10.1002/prca.201400113] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/21/2014] [Accepted: 01/14/2015] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | - Vasiliki Bitsika
- Biotechnology Division; Biomedical Research Foundation, Academy of Athens; Athens Greece
| | - George Mermelekas
- Biotechnology Division; Biomedical Research Foundation, Academy of Athens; Athens Greece
| | - Antonia Vlahou
- Biotechnology Division; Biomedical Research Foundation, Academy of Athens; Athens Greece
- School of Biomedical and Healthcare Sciences; Plymouth University, Plymouth; UK
| | | | - Harald Mischak
- Mosaiques Diagnostics GmbH; Hanover Germany
- Institute of Cardiovascular and Medical Sciences; University of Glasgow; UK
| | | | | |
Collapse
|
42
|
Zhu Z, Yan Z, Zhang L, Du R, Zhu J, Zuo J, Chu S, Shen W, Zhang R. Increased arterial stiffness after coronary artery revascularization correlates with serious coronary artery lesions and poor clinical outcomes in patients with chronic kidney disease. Cardiorenal Med 2015; 4:280-9. [PMID: 25737692 DOI: 10.1159/000369107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/05/2014] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVES This study aimed to clarify the relationship between arterial stiffness and coronary artery lesions as well as their influence on long-term outcomes after coronary artery revascularization in patients with chronic kidney disease (CKD). METHODS A total of 205 patients who had a coronary angiography and received coronary artery revascularization on demand were enrolled and followed up for 5 years. Demographic and clinical indicators, arterial stiffness indexes, angiographic characteristics and the Gensini score (GS) were recorded at baseline. Major adverse cardiac events (MACE), including cardiac death and repeat coronary artery revascularization, that occurred during the 5 years of follow-up were also recorded. RESULTS All indexes reflecting the degree of arterial stiffness, including PWV, C1, C2, CSBP, CDBP, AP and Aix, were significantly higher in CKD than in non-CKD patients (all p < 0.05). Patients with CKD also had a higher rate of coronary artery disease and a higher GS (p < 0.05 and p < 0.01, respectively). Logistic regression analysis revealed CKD to be an independent risk factor for increased arterial stiffness (OR = 2.508, 95% CI 1.308-4.808, p = 0.006). During follow-up, CKD patients with PWV >13 m/s or Aix@75 >30 had a significantly higher MACE occurrence rate after coronary artery revascularization (both p < 0.05). CONCLUSION These results highlight that CKD and arterial stiffness correlate with the severity of coronary artery lesions. CKD patients with impaired arterial stiffness have poor clinical outcomes, suggesting a further clinical use of the arterial stiffness index as a surrogate of worse cardiovascular prognosis in CKD than in non-CKD patients.
Collapse
Affiliation(s)
- Zhengbin Zhu
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zijun Yan
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lin Zhang
- Department of Civil Aviation Administration of China (CAAC), East China Regional Administration Aviation Personnel Examination Center, Shanghai Hospital of Civil Aviation, Shanghai, China
| | - Run Du
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jinzhou Zhu
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Junli Zuo
- Department of Hypertension, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shaoli Chu
- Department of Hypertension, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weifeng Shen
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ruiyan Zhang
- Department of Cardiology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|
43
|
Microparticles: markers and mediators of sepsis-induced microvascular dysfunction, immunosuppression, and AKI. Kidney Int 2015; 87:1100-8. [PMID: 25692956 PMCID: PMC4449806 DOI: 10.1038/ki.2015.26] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/26/2014] [Accepted: 08/27/2014] [Indexed: 01/28/2023]
Abstract
Sepsis is a severe and complex syndrome that lacks effective prevention or therapeutics. The effects of sepsis on the microvasculature have become an attractive area for possible new targets and therapeutics. Microparticles (MPs) are cell membrane-derived particles that can promote coagulation, inflammation, and angiogenesis, and they can participate in cell-to-cell communication. MPs retain cell membrane and cytoplasmic constituents of their parental cells, including two procoagulants: phosphatidylserine and tissue factor. We highlight the role of microparticles released by endothelial and circulating cells after sepsis-induced microvascular injury, and we discuss possible mechanisms by which microparticles can contribute to endothelial dysfunction, immunosuppression, and multiorgan dysfunction--including sepsis-AKI. Once viewed as cellular byproducts, microparticles are emerging as a new class of markers and mediators in the pathogenesis of sepsis.
Collapse
|
44
|
Akalın N, Köroğlu M, Harmankaya Ö, Akay H, Kumbasar B. Comparison of insulin resistance in the various stages of chronic kidney disease and inflammation. Ren Fail 2014; 37:237-40. [DOI: 10.3109/0886022x.2014.982479] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
45
|
Peng T, Hu Z, Wu L, Li D, Yang X. Correlation between endothelial dysfunction and left ventricular remodeling in patients with chronic kidney disease. Kidney Blood Press Res 2014; 39:420-6. [PMID: 25412643 DOI: 10.1159/000368455] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS To investigate the role of endothelial dysfunction on left ventricular remodeling in patients with chronic kidney disease and to evaluate the correlation between endothelial dysfunction and left ventricular remodeling. METHODS Seventy-three patients with chronic kidney disease as study-group and thirty healthy volunteers as control-group were enrolled in the present study. All patients in both groups had echocardiography examination. The concentration of endothelin-1, nitric oxide, and inducible nitric oxide synthase of serum of all patients and healthy volunteers was measured. The incidence of cardiac structural abnormalities in patients with chronic kidney disease, and the relationship between endothelial dysfunction and cardiac structural abnormalities were analyzed. RESULTS The incidence of left ventricular hypertrophy, left ventricular concentric remodeling, and left ventricular systolic dysfunction was 65%, 8.33%, and 16.67%, respectively. The level of endothelin-1 and nitric oxide increased in study-group, and the concentration of inducible nitric oxide synthase decreased. There was significant positively relationship between plasma endothelin-1 and left ventricular mass index, interventricular septal thickness, left ventricular diastolic diameter. There was negatively relationship between the level of serum nitric oxide and the maximum flow velocity at the mitral in left ventricular diastolic stage. There was not any correlation between inducible nitric oxide synthase with left ventricular remodeling. CONCLUSIONS The results showed that there was a higher incidence of left ventricular hypertrophy in patients with chronic kidney disease. Endothelin-1 and nitric oxide played an important role on the development of left ventricular hypertrophy.
Collapse
Affiliation(s)
- Tao Peng
- Department of Nephrology, Shandong University Qilu Hospital, Jinan 250012, China
| | | | | | | | | |
Collapse
|
46
|
Abstract
Diabetes mellitus and heart failure are two multifaceted entities characterised by high morbidity and mortality. Early epidemiological and prospective studies have observed the frequent co-existence of both conditions. Importantly, diabetes mellitus can precipitate or worsen heart failure due to the accumulation of advanced glycation end products, oxidative stress, inflammatory status impairment, decay of intracellular calcium, changes in microRNAs expression, not to mention atherosclerosis progression and coronary artery disease. Heart failure also impairs glucose metabolism through less well-known mechanisms. Attention must especially be given in the treatment as there are frequently adverse interactions between the two diseases and novel agents against diabetic cardiomyopathy are under investigation. As several missing links still exist in the connection between heart failure and diabetes mellitus we will review, in this article, the most recent data underlying the interaction of them and provide an overview of the most important clinical perspectives.
Collapse
Affiliation(s)
- Dimitris Tousoulis
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
| | - Evangelos Oikonomou
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
| | - Gerasimos Siasos
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
| | - Christodoulos Stefanadis
- 1st Cardiology Department, University of Athens Medical School, "Hippokration" Hospital, Athens, Greece
| |
Collapse
|