1
|
Lu J, McCabe K, Drucker C, Blitzer D, Nagarsheth K, Toursavadkohi S. A Prosthetic Conduit can be Used Safely for TransCarotid Artery Revascularization Under Local Anesthesia in High-Risk Patients. Vasc Endovascular Surg 2024:15385744241285580. [PMID: 39292960 DOI: 10.1177/15385744241285580] [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: 09/20/2024]
Abstract
Surgical management of carotid stenosis has evolved from open carotid endarterectomy (CEA) to include multiple alternative procedures including transfemoral carotid artery stenting (tfCAS) and transcarotid artery stenting. In recent years, Transcarotid Artery Revascularization (TCAR) has emerged as a third option, combining open cut down to the common carotid artery (CCA) with endovascular stenting and neuroprotection via reversal of cerebral blood flow. In this case series, a modified TCAR procedure using a prosthetic conduit was successfully performed exclusively under local anesthesia in a total of 10 patients with carotid artery stenosis, high cardiac risk, and anatomical contraindications to a traditional TCAR.
Collapse
Affiliation(s)
- Jeffrey Lu
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Katey McCabe
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Charlie Drucker
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - David Blitzer
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Khanjan Nagarsheth
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| | - Shahab Toursavadkohi
- Division of Vascular Surgery, Department of Surgery, University of Maryland, Baltimore, MD, USA
| |
Collapse
|
2
|
Agarwal V, Sherwani P, Chauhan U, Kumar B. Assessment of Carotid Plaque Enhancement on Contrast-Enhanced Ultrasound as a Predictor for Severe Coronary Artery Disease. Indian J Radiol Imaging 2024; 34:460-468. [PMID: 38912243 PMCID: PMC11188725 DOI: 10.1055/s-0044-1779522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2024] Open
Abstract
Background and Aim Contrast-enhanced ultrasound (CEUS) can reliably identify vulnerable plaques. As atherosclerosis is a systemic disease, we evaluated whether contrast enhancement of carotid plaque (CECP) can predict severe coronary artery disease (CAD) by comparing CECP in patients who have had acute coronary syndromes (ACS) recently with asymptomatic individuals. Settings and Design This case-control study was done at a tertiary care center during 2022. Materials and Methods Fourteen participants were recruited in each group, after screening in-patients for carotid plaques and inclusion and exclusion criteria. Those who had history of ACS were enrolled as cases, while those who did not were enrolled as controls. All these patients underwent grayscale, Doppler, and CEUS examination for characterization of the carotid plaque. For cases, findings on CEUS were also compared with the severity of CAD on catheter coronary angiography. Statistical Analysis Diagnostic parameters including sensitivity, specificity, and diagnostic accuracy were calculated and proportions were compared by using Fisher's exact test. Results Eight out of 28 patients showed CECP. CECP and CAD were positively associated with p -Value of 0.033. Eighty-three percent patients with triple vessel disease and 50% patients with double vessel disease on coronary angiography showed CECP. Sensitivity and specificity of CECP for prediction of CAD were 50 and 92.9%, respectively. Conclusion CECP on CEUS can predict CAD and is a more reliable indicator of severe CAD than plaque characteristics on grayscale and Doppler imaging; making it useful for screening of patients at risk of having CAD.
Collapse
Affiliation(s)
- Vanshika Agarwal
- Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
| | - Poonam Sherwani
- Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
| | - Udit Chauhan
- Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
| | - Barun Kumar
- Department of Cardiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
| |
Collapse
|
3
|
Agarwal R, Gadupati J, Ramaiah SS, Babu VG, Jain A, Prakash VS. Carotid Artery Doppler: A Possible Non-invasive Diagnostic Approach to Assessing the Severity of Coronary Artery Disease. Cureus 2024; 16:e62886. [PMID: 39040738 PMCID: PMC11261422 DOI: 10.7759/cureus.62886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2024] [Indexed: 07/24/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Carotid artery Doppler ultrasound is being explored for its potential as a non-invasive tool for evaluating coronary artery disease (CAD) severity and cardiovascular risk. This study aimed to investigate the association between carotid Doppler parameters and CAD severity, as determined by the Gensini score (GS) and multi-vessel disease presence. METHODS Ninety patients undergoing coronary angiography (CAG) and carotid ultrasound were retrospectively analysed. Carotid Doppler parameters and CAD severity were assessed through bivariate and multivariable analyses. RESULTS Among the patients studied, 80% were male, with a mean age of 65.24 years (±9.91). Triple vessel disease (68.9%) and dominant vessel disease (73.3%) were prevalent coronary findings, with a mean GS of 139.2 (±76.6). Increased intima-media thickness (IMT) in the common carotid artery (CCA) and internal carotid artery (ICA) showed significant associations (CCA IMT: OR = 0.312, p = 0.037; ICA IMT: OR = 0.354, p = 0.017) with high GS (>125) and multi-vessel disease. Significant carotid stenosis (>50% diameter stenosis) emerged as an independent predictor of CAD severity. Fibrocalcific plaques, detected in 62.2% of cases, correlated significantly with elevated GS. Plaque burden, especially plaques in >3 locations, indicated a higher likelihood of triple vessel disease and a higher GS. CONCLUSION Carotid Doppler parameters, particularly IMT and significant stenosis, are robust predictors of CAD severity, including high GS and multi-vessel disease. Integrating carotid artery assessment into clinical protocols can aid in timely interventions and preventive strategies for CAD management.
Collapse
Affiliation(s)
- Ritika Agarwal
- Radiology, M. S. Ramaiah Medical College, Bengaluru, IND
| | | | | | - Varsha G Babu
- Radiology, M. S. Ramaiah Medical College, Bengaluru, IND
| | - Aditi Jain
- Radiology, M. S. Ramaiah Medical College, Bengaluru, IND
| | - V S Prakash
- Cardiology, M. S. Ramaiah Medical College, Bengaluru, IND
| |
Collapse
|
4
|
Yu S, Chaney MA. Combined Coronary and Carotid Artery Disease: What to Operate on First? Or Both at the Same Time? J Cardiothorac Vasc Anesth 2024; 38:1417-1422. [PMID: 37839940 DOI: 10.1053/j.jvca.2023.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Sherman Yu
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL
| | - Mark A Chaney
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, IL.
| |
Collapse
|
5
|
Sideri AM, Kanakis M, Katsimpris A, Karamaounas A, Brouzas D, Petrou P, Papakonstaninou E, Droutsas K, Kandarakis S, Giannopoulos G, Georgalas I. Correlation Between Coronary and Retinal Microangiopathy in Patients With STEMI. Transl Vis Sci Technol 2023; 12:8. [PMID: 37145590 PMCID: PMC10168007 DOI: 10.1167/tvst.12.5.8] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
Purpose To investigate the morphological and functional correlation between microvascular retinal changes in optical coherence tomography angiography (OCTA) and the microvascular coronary circulation in patients with ST elevation myocardial infarction (STEMI) coronary heart disease (CHD). Methods A total of 330 eyes from 165 participants (88 cases and 77 controls) were enrolled and imaged. Superficial capillary plexus (SCP) and deep capillary plexus (DCP) vascular density was measured in the central (1 mm) and perifoveal (1-3 mm) areas and in the superficial foveal avascular zone (FAZ) and choriocapillaris (3 mm). These parameters were then correlated to the left ventricular ejection fraction (LVEF), and the number of affected coronary arteries. Results Decreased vessel densities in the SCP and DCP and choriocapillaris were positively correlated to the LVEF values (P = 0.006, P = 0.026, and P = 0.002, respectively). No statistically significant correlation between the SCP and DCP central area or FAZ area was found. Regarding the number of affected vessels, significant negative correlations were revealed for the SCP and DCP central vessel densities (P < 0.001 and P < 0.001, respectively) and the SCP perifoveal vascular density (P = 0.009). Conclusions OCTA vascular indices are significantly correlated with morphological and functional parameters in patients with STEMI CHD. SCP vascular density especially seems to be a promising biomarker for the extent of both macrovascular damage (number of affected coronary arteries) and microvascular damage, as mirrored in the decreased LVEF at admission. Translational Relevance OCTA vascular indices offer a valuable insight into the microvascular status of coronary circulation.
Collapse
Affiliation(s)
- Anna-Maria Sideri
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Menelaos Kanakis
- School of Medicine, University of Patras, University Eye Clinic, Rion University Hospital, Patras, Greece
| | - Andreas Katsimpris
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Aristotelis Karamaounas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Dimitrios Brouzas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Petros Petrou
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Evangelia Papakonstaninou
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Konstantinos Droutsas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Stylianos Kandarakis
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| | - Georgios Giannopoulos
- 3rd Department of Cardiology, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ilias Georgalas
- School of Medicine, National and Kapodistrian University of Athens, 1st University Eye Clinic, G. Gennimatas General Hospital of Athens, Athens, Greece
| |
Collapse
|
6
|
Gao J, He S, Hu J, Chen G. A hybrid system to understand the relations between assessments and plans in progress notes. J Biomed Inform 2023; 141:104363. [PMID: 37054961 DOI: 10.1016/j.jbi.2023.104363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
OBJECTIVE The paper presents a novel solution to the 2022 National NLP Clinical Challenges (n2c2) Track 3, which aims to predict the relations between assessment and plan subsections in progress notes. METHODS Our approach goes beyond standard transformer models and incorporates external information such as medical ontology and order information to comprehend the semantics of progress notes. We fine-tuned transformers to understand the textual data and incorporated medical ontology concepts and their relationships to enhance the model's accuracy. We also captured order information that regular transformers cannot by taking into account the position of the assessment and plan subsections in progress notes. RESULTS Our submission earned third place in the challenge phase with a macro-F1 score of 0.811. After refining our pipeline further, we achieved a macro-F1 of 0.826, outperforming the top-performing system during the challenge phase. CONCLUSION Our approach, which combines fine-tuned transformers, medical ontology, and order information, outperformed other systems in predicting the relationships between assessment and plan subsections in progress notes. This highlights the importance of incorporating external information beyond textual data in natural language processing (NLP) tasks related to medical documentation. Our work could potentially improve the efficiency and accuracy of progress note analysis.
Collapse
Affiliation(s)
- Jifan Gao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, 610 Walnut St, Madison, 53726, WI, USA
| | - Shilu He
- Department of Mathematics, University of Wisconsin-Madison, 480 Lincoln Dr, Madison, 53706, WI, USA
| | - Junjie Hu
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, 610 Walnut St, Madison, 53726, WI, USA.
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, 610 Walnut St, Madison, 53726, WI, USA.
| |
Collapse
|
7
|
Suzuki M, Okawa M, Okuno Y, Yang T, Takenobu Y, Shiomi H, Katano T, Suzuki K, Takayama N, Yamamoto Y, Yamada K, Yoshida K, Miyamoto S. Prevalence of carotid artery stenosis with coronary artery disease in Japanese patients: A single-center study. J Neurol Sci 2022; 443:120492. [PMID: 36410187 DOI: 10.1016/j.jns.2022.120492] [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: 05/26/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 11/15/2022]
Abstract
There are a few reports of the prevalence of extracranial internal carotid artery stenosis (ICAS) in Asian patients with coronary artery disease (CAD). This was a prospective registry study of 157 consecutive Japanese patients undergoing coronary angiography that aimed to determine the prevalence of extracranial ICAS in recent Japanese patients. The associations between ICAS and the extent or the maximal stenosis of CAD were also investigated. The 131 eligible patients with suspected CAD were prospectively analyzed. Their mean age was 69.0 ± 8.2 years, and 75.6% were males. A total of 111 patients (84.7%) were angiographically diagnosed with CAD. ICAS (area stenosis ≥50% on ultrasonography) was present in 9 patients, and the prevalence in patients with CAD was 8.1%. All patients in the ICAS group had CAD, and this group was significantly more likely to have a history of stroke (p = 0.03). Although no significant relationships were found between the severity of ICAS and the maximal stenosis of CAD, the severity of ICAS increased gradually with the extent of CAD. The prevalence of ICAS in patients with CAD treated with current medical treatment was relatively low (8.1%) compared to previous reports, and the severity of ICAS was significantly associated with the extent of CAD.
Collapse
Affiliation(s)
- Megumu Suzuki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Masakazu Okawa
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan.
| | - Yoshinori Okuno
- Department of Primary Care & Emergency Medicine, Kyoto University Hospital 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Tao Yang
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yohei Takenobu
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Department of Neurology, Japanese Red Cross Osaka Hospital, 5-30 Fudegasaki-cho, Tennoji ward, Osaka, Japan
| | - Hiroki Shiomi
- Department of Cardiology, Kyoto University Hospital, 54 Kawahara-cho, Shogoin, Sakyo ward, Kyoto 606-8507, Japan
| | - Takehiro Katano
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Department of Neurology, Nippon Medical School Hospital, 1-1-5 Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
| | - Keita Suzuki
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Naoki Takayama
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Yu Yamamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Kiyofumi Yamada
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan; Department of Neurosurgery, Hyogo College of Medicine Hospital, 1-1 Mukogawa-cho, Nishinomiya City, Hyogo 663-85501, Japan
| | - Kazumichi Yoshida
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| | - Susumu Miyamoto
- Department of Neurosurgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto 606-8507, Japan
| |
Collapse
|
8
|
Weight N, Moledina S, Zoccai GB, Zaman S, Smith T, Siller-Matula J, Dafaalla M, Rashid M, Nolan J, Mamas MA. Impact of pre-existing vascular disease on clinical outcomes. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2022; 9:64-75. [PMID: 35575608 DOI: 10.1093/ehjqcco/qcac026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 04/28/2022] [Accepted: 05/10/2022] [Indexed: 12/15/2022]
Abstract
AIMS Little is known about the outcomes and processes of care of patients with non-ST-segment myocardial infarction (NSTEMI) who present with 'polyvascular' disease. METHODS AND RESULTS We analysed 287 279 NSTEMI patients using the Myocardial Ischaemia National Audit Project registry. Clinical characteristics and outcomes were analysed according to history of affected vascular bed-coronary artery disease (CAD), cerebrovascular disease (CeVD), and peripheral vascular disease (PVD)-with comparison to a historically disease-free control group, comprising 167 947 patients (59%). After adjusting for demographics and management, polyvascular disease was associated with increased likelihood of major adverse cardiovascular events (MACEs) [CAD odds ratio (OR): 1.06; 95% confidence interval (CI): 1.01-1.12; P = 0.02] (CeVD OR: 1.19; 95% CI: 1.12-1.27; P < 0.001) (PVD OR: 1.22; 95% CI: 1.13-1.33; P < 0.001) and in-hospital mortality (CeVD OR: 1.24; 95% CI: 1.16-1.32; P < 0.001) (PVD OR: 1.33; 95% CI: 1.21-1.46; P < 0.001). Patients without vascular disease were less frequently discharged on statins (PVD 88%, CeVD 86%, CAD 90%, and control 78%), and those with moderate [ejection fraction (EF) 30-49%] or severe left ventricular systolic dysfunction (EF < 30%) were less frequently discharged on angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs) (CAD 82%, CeVD 77%, PVD 77%, and control 74%). Patients with polyvascular disease were less likely to be discharged on dual antiplatelet therapy (DAPT) (PVD 78%, CeVD 77%, CAD 80%, and control 87%). CONCLUSION Polyvascular disease patients had a higher incidence of in-hospital mortality and MACEs. Patients with no history of vascular disease were less likely to receive statins or ACE inhibitors/ARBs, but more likely to receive DAPT.
Collapse
Affiliation(s)
- Nicholas Weight
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Saadiq Moledina
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Giuseppe Biondi Zoccai
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy.,Mediterranea Cardiocentro, Napoli, Italy
| | - Sarah Zaman
- Department of Cardiology, Westmead Hospital, Sydney, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, Australia
| | - Triston Smith
- Department of Cardiology, Trinity Health System, Steubenville, Ohio, USA
| | - Jolanta Siller-Matula
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology (CEPT), Warsaw, Poland
| | - Mohamed Dafaalla
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Muhammad Rashid
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - James Nolan
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, UK
| |
Collapse
|
9
|
Zhang Y, Chen Z, Mai Z, Zhou W, Wang H, Zhang X, Wei W, Du J, Wu G. Acute Hemodynamic Responses to Enhanced External Counterpulsation in Patients With Coronary Artery Disease. Front Cardiovasc Med 2021; 8:721140. [PMID: 34869627 PMCID: PMC8632772 DOI: 10.3389/fcvm.2021.721140] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 10/12/2021] [Indexed: 11/16/2022] Open
Abstract
Purpose: Enhanced external counterpulsation is a non-invasive treatment that increases coronary flow in patients with coronary artery disease (CAD). However, the acute responses of vascular and blood flow characteristics in the conduit arteries during and immediately after enhanced external counterpulsation (EECP) need to be verified. Methods: Forty-two patients with CAD and 21 healthy controls were recruited into this study to receive 45 min-EECP. Both common carotid arteries (CCAs), namely, the left carotid (LC) and right carotid (RC), the right brachial (RB), and right femoral (RF) artery were imaged using a Color Doppler ultrasound. The peak systolic velocity (PSV), end-diastolic velocity (EDV), mean inner diameter (ID), resistance index (RI), and mean flow rate (FR) were measured and calculated before, during, and after the 45 min-EECP treatment. Results: During EECP, in the CCAs, the EDV was significantly decreased, while the RI was markedly increased in the two groups (both P < 0.01). However, immediately after EECP, the RI in the RC was significantly lower than that at the baseline in the patients with CAD (P = 0.039). The FR of the LC was markedly increased during EECP only in the CAD patients (P = 0.004). The PSV of the patients with CAD was also significantly reduced during EECP (P = 0.015) and immediately after EECP (P = 0.005) compared with the baseline. Moreover, the ID of the LC, RB, and RF was significantly higher immediately after EECP than that at the baseline (all P < 0.05) in the patients with CAD. In addition, they were also higher than that in the control groups (all P < 0.05). Furthermore, by the subgroup analysis, there were significant differences in the FR, PSV, and RI between females and males during and immediately after EECP (all P < 0.05). Conclusions: Enhanced external counterpulsation creates different responses of vascular and blood flow characteristics in carotid and peripheral arteries, with more significant effects in both the carotid arteries. Additionally, the beneficial effects in ID, blood flow velocity, RI, and FR after 45 min-EECP were shown only in the patients with CAD. More importantly, acute improvement of EECP in the FR of the brachial artery was showed in males, while the FR and RI of the carotid arteries changed in females.
Collapse
Affiliation(s)
- Yahui Zhang
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Ziqi Chen
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Zhouming Mai
- Department of Cardiology, Huizhou Third People's Hospital, Huizhou, China
| | - Wenjuan Zhou
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- Department of Cardiac Ultrasound, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Xiaodong Zhang
- Department of Physical Education, Nanjing University of Finance and Economics, Nanjing, China
| | - Wenbin Wei
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Jianhang Du
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Guifu Wu
- Department of Cardiology, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| |
Collapse
|
10
|
Goranov G, Tokmakova M, Nikolov P. Survival and Prognostic Factors After Carotid Artery Stenting in Patients with Concomitant Coronary Disease. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The aim of the study was to analyze the prognostic factors in patients after carotid artery stenting (CAS).
METHODS: In 329 patients after CAS, the median survival (MS) and overall survival (OS) were calculated for a follow-up period of 2–101 months. All patients underwent coronary angiography before carotid stenting and, if indicated, coronary revascularization. Four groups of factors were analyzed: Carotid disease, coronary artery disease (CAD), underlying cardiac pathology, and concomitant diseases.
RESULTS: MS in all patients was 86 months, OS at 1, 3, 5, and 9 years was - 94%, 85%, 73%, and 51%, respectively. Event free survival was 85 months. Log Rank-Mantel-Cox analysis demonstrated significantly reduced MS in 21 tested factors, most of them related to CAD. Two-step multifactorial Cox regression analysis defined only 7 of them as independent prognostic factors for the survival of patients after CAS: Left main stenosis, complete revascularization, late myocardial infarction, stroke, age over 70 years, valvular disease, and carotid score.
CONCLUSION: Survival of patients after CAS is limited mainly by CAD and underlying cardiac pathology. Staged revascularization treatment strategy may improve the prognosis and survival of patients with both carotid and coronary disease.
Collapse
|
11
|
Cardiovascular Disease in Older Women. Clin Geriatr Med 2021; 37:651-665. [PMID: 34600729 DOI: 10.1016/j.cger.2021.05.010] [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: 11/20/2022]
Abstract
Cardiovascular disease is the major cause of death in women. Older women remain at risk for coronary artery disease/cardiovascular disease, but risk-modifying behavior can improve outcomes. Women have a different symptom profile and have been underdiagnosed and undertreated as compared with men. Although older women are underrepresented in trials, clinicians should be more attuned to the prevention, diagnosis, and treatment of cardiovascular disease in older women.
Collapse
|
12
|
Bokhari S, Schneider RH, Salerno JW, Rainforth MV, Gaylord-King C, Nidich SI. Effects of cardiac rehabilitation with and without meditation on myocardial blood flow using quantitative positron emission tomography: A pilot study. J Nucl Cardiol 2021; 28:1596-1607. [PMID: 31529385 PMCID: PMC9178923 DOI: 10.1007/s12350-019-01884-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/21/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Psychosocial stress is recognized as a risk factor for coronary heart disease (CHD). High rates of CHD in African-Americans may be related to psychosocial stress. However, standard cardiac rehabilitation (CR) usually does not include a systematic stress-reduction technique. Previous studies suggest that the Transcendental Meditation (TM) technique may reduce CHD risk factors and clinical events. This pilot study explored the effects of standard CR with and without TM on a measure of CHD in African-American patients. METHODS Fifty-six CHD patients were assigned to CR, CR + TM, TM alone, or usual care. Testing was done at baseline and after 12 weeks. The primary outcome was myocardial flow reserve (MFR) assessed by 13N-ammonia positron emission tomography (PET). Secondary outcomes were CHD risk factors. Based on guidelines for analysis of small pilot studies, data were analyzed for effect size (ES). RESULTS For 37 patients who completed posttesting, there were MFR improvements in the CR + TM group (+20.7%; ES = 0.64) and the TM group alone (+12.8%; ES = 0.36). By comparison, the CR-alone and usual care groups showed modest changes (+ 5.8%; ES = 0.17 and - 10.3%; ES = - 0.31), respectively. For the combined TM group, MFR increased (+ 14%, ES = 0.56) compared to the combined non-TM group (- 2.0%, ES = - 0.08). CONCLUSIONS These pilot data suggest that adding the TM technique to standard cardiac rehabilitation or using TM alone may improve the myocardial flow reserve in African-American CHD patients. These results may be applied to the design of controlled clinical trials to definitively test these effects. TRIAL REGISTRATION ClinicalTrials.gov registration # NCT01810029.
Collapse
Affiliation(s)
- Sabahat Bokhari
- Division of Cardiology, Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Robert H Schneider
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA.
| | - John W Salerno
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Maxwell V Rainforth
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Carolyn Gaylord-King
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| | - Sanford I Nidich
- Center for Natural Medicine and Prevention, Maharishi University of Management Research Institute, 2100 Mansion Drive, Maharishi Vedic City, IA, 52556, USA
| |
Collapse
|
13
|
Relation Between Syntax Score and Complexity of Carotid Artery Disease. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.904471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
14
|
Zhang Y, Mai Z, Du J, Zhou W, Wei W, Wang H, Yao C, Zhang X, Huang H, Wu G. Acute Effect of Enhanced External Counterpulsation on the Carotid Hemodynamic Parameters in Patients With High Cardiovascular Risk Factors. Front Physiol 2021; 12:615443. [PMID: 34220527 PMCID: PMC8247765 DOI: 10.3389/fphys.2021.615443] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 05/21/2021] [Indexed: 11/20/2022] Open
Abstract
Purpose Enhanced external counterpulsation (EECP) can improve carotid circulation in patients with coronary artery disease. However, the response of carotid hemodynamic parameters induced by EECP in patients with high cardiovascular risk factors remains to be clarified. This study aimed to investigate the acute effect of EECP on the hemodynamic parameters in the carotid arteries before, during, and immediately after EECP in patients with hypertension, hyperlipidemia, and type 2 diabetes. Methods Eighty-three subjects were recruited into this study to receive 45-min EECP, including patients with simple hypertension (n = 21), hyperlipidemia (n = 23), type 2 diabetes (n = 18), and healthy subjects (n = 21). Hemodynamic parameters in both common carotid arteries (CCAs) were measured and calculated from Doppler ultrasound images. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean inner diameter (ID), systolic/diastolic flow velocity ratio (VS/VD), flow rate (FR), and resistance index (RI) were monitored before, during, and immediately after 45-min EECP. Results EDV and VS/VD were significantly reduced, while RI of CCAs was significantly increased among four groups during EECP (all P < 0.01). Additionally, the ID of CCAs and the FR of left CCA increased in patients with hyperlipidemia during EECP (P < 0.05). PSV of left CCA was reduced in patients with type 2 diabetes (P < 0.05). Moreover, immediately after EECP, ID was significantly higher in patients with hyperlipidemia. The RI of patients with hypertension and PSV and VS/VD of patients with type 2 diabetes were significantly lower compared with baseline (all P < 0.05). Conclusion EECP created an acute reduction in EDV, PSV, and VS/VD, and an immediate increase in the RI, FR, and ID of CCAs among the four groups. Additionally, a single 45-min session of EECP produced immediate improvement in the ID of patients with hyperlipidemia, the RI of patients with hypertension, and the PSV and VS/VD of patients with type 2 diabetes. The different hemodynamic responses induced by EECP may provide theoretical guidance for making personalized plans in patients with different cardiovascular risk factors.
Collapse
Affiliation(s)
- Yahui Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Zhouming Mai
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Jianhang Du
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Wenjuan Zhou
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Wenbin Wei
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Hui Wang
- Department of Cardiac Ultrasound, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Chun Yao
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Xinxia Zhang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Hui Huang
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| | - Guifu Wu
- Department of Cardiology, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China.,National Health Commission (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China.,Guangdong Innovative Engineering and Technology Research Center for Assisted Circulation, Shenzhen, China
| |
Collapse
|
15
|
Takeuchi M, Wada H, Ogita M, Takahashi D, Okada-Nozaki Y, Nishio R, Yasuda K, Takahashi N, Sonoda T, Yatsu S, Shitara J, Tsuboi S, Dohi T, Suwa S, Miyauchi K, Daida H, Minamino T. Impact of Prior Stroke on Long-Term Outcomes in Patients With Acute Coronary Syndrome. Circ Rep 2021; 3:267-272. [PMID: 34007940 PMCID: PMC8099664 DOI: 10.1253/circrep.cr-21-0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background:
Cerebrovascular disease often coexists with coronary artery disease (CAD), and it has been associated with worse clinical outcomes in CAD patients. However, the prognostic effect of prior stroke on long-term outcomes in patients with acute coronary syndrome (ACS) is still unclear. Methods and Results:
An observational cohort study of ACS patients who underwent emergency percutaneous coronary intervention (PCI) between January 1999 and May 2015 was conducted. Patients were divided into 2 groups according to their history of stroke. We evaluated both all-cause death and cardiac death. Of the 2,548 consecutive ACS patients in the current cohort, 268 (10.5%) had a history of stroke at the onset of ACS. Patients with a history of stroke were older and had a higher prevalence of comorbidities such as hypertension or renal deficiency. The cumulative incidences of all-cause death and cardiac death were significantly higher in patients with a history of stroke (both log-rank P<0.0001). Multivariate Cox hazard regression analysis showed that a history of stroke was significantly associated with the incidences of all-cause death (hazard ratio [HR] 1.49, 95% confidence interval [CI] 1.20–1.85, P=0.0004) and cardiac death (HR 1.41, 95% CI 1.03–1.93, P=0.03). Conclusions:
About 10% of the ACS patients had a history of stroke and had worse clinical outcomes.
Collapse
Affiliation(s)
- Mitsuhiro Takeuchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Manabu Ogita
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Daigo Takahashi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Yui Okada-Nozaki
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan
| | - Ryota Nishio
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Kentaro Yasuda
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Norihito Takahashi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan
| | - Taketo Sonoda
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Shoichiro Yatsu
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Shuta Tsuboi
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan
| | - Satoru Suwa
- Department of Cardiovascular Medicine, Juntendo University Shizuoka Hospital Shizuoka Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan
| | - Tohru Minamino
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine Tokyo Japan.,Japan Agency for Medical Research and Development-Core Research for Evolutionary Medical Science and Technology (AMED-CREST), Japan Agency for Medical Research and Development Tokyo Japan
| |
Collapse
|
16
|
O'Brien AJ, Donlan J, Vrazas JI. Prevalence of internal carotid artery stenosis in ambulatory patients presenting for non-emergent percutaneous coronary angiogram in a single Australian centre. Australas J Ultrasound Med 2020; 24:31-36. [PMID: 34760609 DOI: 10.1002/ajum.12220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 06/12/2020] [Accepted: 06/22/2020] [Indexed: 11/06/2022] Open
Abstract
Introduction Association between coronary artery disease (CAD) and internal carotid artery stenosis (ICAS) could prove clinically relevant. However, evidence defining this association is currently inconclusive. Our study investigates the prevalence of ICAS in non-emergent, ambulatory patients presenting for PCA with suspected CAD in an Australian context. Methods Between February 2019 and June 2019, 121 consecutive participants were verbally consented and enrolled in our study. The data were analysed retrospectively. PCA and CUS were performed within 24 h of each other. Multinomial logistic regression assessed independent predictors for ICAS, with statistical significance set at P value < 0.05. Linear regression analysis correlated CAD and ICAS severity, with significance of a P-value < 0.05. Analysis was conducted using IBM SPSS 26 software (Chicago, Illinois). Results The final study included 121 patients (age 73 ± 9 years, 76.9% male). ICAS on CUS was present in 55.4% of participants for PCA. CAD was an independent risk factor for ICAS on multinomial logistic regression odds ratio 3.87 (P = 0.023). CAD severity (multi vessel disease) showed significant correlation with ICAS r = 0.22 (P = 0.014) using linear regression analysis. Conclusion CAD is an independent predictor of ICAS, and severity of ICAS is correlated with CAD disease. However, most participants had only minor ICAS (16-49% diameter stenosis). Our findings are consistent with internationally published studies, suggesting their data are generalisable to the Australian population. Larger studies are needed to address the applicability of CUS screening in patients with advanced CAD.
Collapse
Affiliation(s)
- Andrew J O'Brien
- Department of Medicine University of Melbourne Parkville Victoria 3010 Australia.,St. Vincent's Private Hospital 59-61 Victoria Parade Fitzroy Victoria 3065 Australia.,Melbourne Institute of Vascular and Interventional Radiology 59-61 Victoria Parade Fitzroy Victoria 3065 Australia
| | - John Donlan
- St. Vincent's Private Hospital 59-61 Victoria Parade Fitzroy Victoria 3065 Australia.,Melbourne Institute of Vascular and Interventional Radiology 59-61 Victoria Parade Fitzroy Victoria 3065 Australia
| | - John I Vrazas
- Department of Medicine University of Melbourne Parkville Victoria 3010 Australia.,St. Vincent's Private Hospital 59-61 Victoria Parade Fitzroy Victoria 3065 Australia.,Melbourne Institute of Vascular and Interventional Radiology 59-61 Victoria Parade Fitzroy Victoria 3065 Australia
| |
Collapse
|
17
|
Effects of moderate aerobic exercise on thoracic aortic remodeling of female LDL-receptor knockout ovariectomized mice. Acta Histochem 2020; 122:151575. [PMID: 32622433 DOI: 10.1016/j.acthis.2020.151575] [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: 03/10/2020] [Revised: 06/01/2020] [Accepted: 06/05/2020] [Indexed: 11/24/2022]
Abstract
Menopause is a major factor involved in dyslipidemia increasing the risk of atherosclerosis which may be reversed by a routine of aerobic physical activity. Thus, this study aimed to analyze the effects of aerobic training on the thoracic aorta of female LDL-receptor knockout mice submitted to estrogen deprivation. Fifteen genetically modified female mice, knockout for the low-density lipoprotein receptor (LDL-Knockout group) were used as experimental groups and fifteen wild female mice (C57BL/6 J) were used as control groups. Animals were divided as (n = 5/per group): sedentary control (SC); sedentary control ovariectomized (SCO); trained control ovariectomized (TCO); LDL-Knockout sedentary (KS); LDL-Knockout sedentary ovariectomized (KOS); and LDL-Knockout trained ovariectomized (KOT). Immunohistochemical techniques for TIMP-1 and metalloproteinases 2 and 9 were used to evaluate thoracic aorta remodeling. Picrosirius stain was used to highlight the collagen fibers. Verhoff-Van Gienson was used for the quantitative analyses of elastic lamellae. Our results demonstrate a positive remodeling promoted by physical exercise in ovariectomized and dyslipidemic animals. However, further studies are needed including the evaluation of inflammatory markers present in dyslipidemia.
Collapse
|
18
|
Akahori H, Masuyama T, Imanaka T, Nakao K, Ozaki Y, Kimura K, Ako J, Noguchi T, Suwa S, Fujimoto K, Nakama Y, Morita T, Shimizu W, Saito Y, Hirohata A, Morita Y, Inoue T, Okamura A, Mano T, Hirata K, Tanabe K, Shibata Y, Owa M, Tsujita K, Funayama H, Kokubu N, Kozuma K, Uemura S, Tobaru T, Saku K, Oshima S, Nishimura K, Miyamoto Y, Ogawa H, Ishihara M. Impact of peripheral artery disease on prognosis after myocardial infarction: The J-MINUET study. J Cardiol 2020; 76:402-406. [PMID: 32532585 DOI: 10.1016/j.jjcc.2020.05.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Revised: 04/10/2020] [Accepted: 04/20/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) are at high risk of cardiovascular events, including myocardial infarction (MI), stroke, and cardiovascular death. However, the impact of PAD on prognosis in Japanese patients with acute MI remains unclear. METHODS The Japanese registry of acute Myocardial INfarction diagnosed by Universal dEfiniTion (J-MINUET) is a prospective multicenter registry that registered 3283 patients with acute MI. Among them, 2970 patients with available data of PAD were divided into the following 4 groups: 2513 patients without prior MI or PAD (None group), 320 patients with only prior MI (Prior MI group), 100 patients with only PAD (PAD group), and 37 patients with both previous MI and PAD (Both group). The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure, and urgent revascularization for unstable angina. RESULTS The 3-year cumulative incidence of the primary endpoint was 26.9% in None group, 41.4% in Prior MI group, 48.0% in PAD group, and 60.3% in Both group (p < 0.001). In multivariate analysis, hazard ratio using None group as reference was 1.55 (95% confidence intervals 1.25-1.91; p < 0.001) for MI group, 2.26 (1.61-3.07; p < 0.001) for PAD group, and 2.52 (1.52-3.90; p < 0.001) for Both group. CONCLUSIONS Concomitant PAD was associated with poor prognosis in Japanese patients with acute MI.
Collapse
Affiliation(s)
| | | | | | - Koichi Nakao
- Saiseikai Kumamoto Hospital Cardiovascular Center, Kumamoto, Japan
| | | | - Kazuo Kimura
- Yokohama City University Medical Center, Yokohama, Japan
| | - Junya Ako
- Kitasato University, Sagamihara, Japan
| | - Teruo Noguchi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Satoru Suwa
- Juntendo University Shizuoka Hospital, Izunokuni, Japan
| | - Kazuteru Fujimoto
- National Hospital Organization Kumamoto Medical Center, Kumamoto, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Kenichi Tsujita
- Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | | | | | | | | | - Keijiro Saku
- Fukuoka University School of Medicine, Fukuoka, Japan
| | - Shigeru Oshima
- Gunma Prefectural Cardiovascular Center, Maebashi, Japan
| | | | | | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Japan
| | | | | |
Collapse
|
19
|
Toyoda S, Tokoi S, Takekawa H, Matsumoto H, Inami S, Sakuma M, Arikawa T, Abe S, Nakajima T, Hirata K, Inoue T. Relationship between brachial flow-mediated dilation and carotid intima-media thickness in patients with coronary artery disease. INT ANGIOL 2020; 39:433-442. [PMID: 32057215 DOI: 10.23736/s0392-9590.20.04315-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Although flow-mediated vasodilation (FMD) of brachial artery and carotid intima-media thickness (IMT) are important surrogate markers in the process of atherosclerosis, information about relationship between both markers is insufficient. In the present study, we assessed extensively the relationship in patients with coronary artery disease (CAD). METHODS The values of brachial FMD and carotid ultrasonography findings in 159 patients (67±8 years, 130 males) with angiographically verified CAD were retrospectively analyzed. RESULTS In all patients, mean carotid IMT tended to be correlated with FMD, although the correlation was not statistically significant (R=-0.149, P=0.061). Maximum IMT was not correlated with the FMD (R=0.053, P=0.508). In addition, carotid artery diameter was significantly correlated with the FMD (R=0.290, P=0.0002). Prevalence of high IMT value (≥1.0 mm) was higher in the abnormal FMD group (4%>; N.=67), compared with the normal FMD group (≥7%; N.=24; P<0.05). Carotid artery diameter was larger in abnormal FMD group, compared with both groups of normal FMD (P<0.01) and borderline FMD (4-7%; N.=68) (P<0.01). In all patients, receiver operating characteristics analysis demonstrated that cut-off value of FMD to predict the prevalence of ischemic stroke was 3.7% (AUC=0.735, P<0.001). The cut-off value of maximum IMT was 1.9 mm, but was not significant (AUC=0.522, P=0.829). CONCLUSIONS Brachial FMD and carotid IMT would be different in clinical significance as a surrogate marker for pathophysiology of atherosclerotic disease.
Collapse
Affiliation(s)
- Shigeru Toyoda
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan -
| | - Seiko Tokoi
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Hidehiro Takekawa
- Center for Medical Ultrasonography, Dokkyo Medical University Hospital, Mibu, Japan.,Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Hisae Matsumoto
- Department of Clinical Laboratory, Yuai Memorial Hospital, Koga, Japan
| | - Shu Inami
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Masashi Sakuma
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Takuo Arikawa
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Shichiro Abe
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Toshiaki Nakajima
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan
| |
Collapse
|
20
|
Synchronous Carotid Endarterectomy and Coronary Artery Bypass Graft versus Staged Carotid Artery Stenting and Coronary Artery Bypass Graft for Patients with Concomitant Severe Coronary and Carotid Stenosis: A Systematic Review and Meta-analysis. Ann Vasc Surg 2020; 62:463-473.e4. [DOI: 10.1016/j.avsg.2019.06.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 06/02/2019] [Accepted: 06/05/2019] [Indexed: 11/18/2022]
|
21
|
Drakopoulou M, Oikonomou G, Soulaidopoulos S, Toutouzas K, Tousoulis D. Management of patients with concomitant coronary and carotid artery disease. Expert Rev Cardiovasc Ther 2019; 17:575-583. [DOI: 10.1080/14779072.2019.1642106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Maria Drakopoulou
- First Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece
| | - Georgios Oikonomou
- First Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece
| | - Konstantinos Toutouzas
- First Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece
| | - Dimitrios Tousoulis
- First Department of Cardiology, Medical School of Athens University, Hippokration Hospital, Athens, Greece
| |
Collapse
|
22
|
Thermal heterogeneity of carotid arteries as a novel biomarker in patients with diabetes mellitus assessed for coronary artery disease. Int J Cardiol 2018; 262:20-24. [DOI: 10.1016/j.ijcard.2018.03.102] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2017] [Revised: 03/10/2018] [Accepted: 03/21/2018] [Indexed: 11/23/2022]
|
23
|
Polak JF, O'Leary DH. Carotid Intima-Media Thickness as Surrogate for and Predictor of CVD. Glob Heart 2018; 11:295-312.e3. [PMID: 27741977 DOI: 10.1016/j.gheart.2016.08.006] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 07/29/2016] [Accepted: 08/04/2016] [Indexed: 12/17/2022] Open
Abstract
Carotid artery intima-media thickness (IMT) is a noninvasive measurement of the artery wall thickness, inclusive of atherosclerotic plaque, obtained using ultrasound imaging. In the MESA (Multi-Ethnic Study of Atherosclerosis) study, IMT measurements are used as a surrogate for subclinical cardiovascular disease and as a variable predictive of cardiovascular events. IMT measurements of the common carotid artery are available in more than 99% of the MESA population and are predictive of cardiovascular events. More importantly, IMT and plaque thickness measurements made in the internal carotid artery and carotid bulb are also available in more than 98% of the population and are also strongly predictive of cardiovascular events. This article reviews the techniques used to obtain the MESA IMT values, compares them to those made in other epidemiological studies, and summarizes how they have been used in the MESA study as both surrogates for and predictors of cardiovascular disease.
Collapse
Affiliation(s)
- Joseph F Polak
- Department of Radiology, Tufts Medical Center, Boston, MA, USA; Ultrasound Reading Center, Boston, MA, USA.
| | | |
Collapse
|
24
|
Neisius U, Olson E, Rossi SH, Ibrahim HA, Currie G, Dominiczak AF, Delles C. Evaluation of the systemic micro- and macrovasculature in stable angina: A case-control study. PLoS One 2017; 12:e0178412. [PMID: 28542516 PMCID: PMC5444845 DOI: 10.1371/journal.pone.0178412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 05/13/2017] [Indexed: 11/18/2022] Open
Abstract
Aims The diagnosis of stable angina involves the use of probability estimates based on clinical presentation, age, gender and cardiovascular risk factors. In view of the link between the cardiac and systemic vasculature we tested whether non-invasive measures of systemic micro- and macrovascular structure and function differentiate between individuals with flow-limiting coronary artery disease (CAD) and those with normal coronary arteries (NCA). Methods and results We recruited 84 patients undergoing elective coronary angiography for investigation of symptoms of stable angina. Patients were selected for either having significant CAD or NCA (n = 43/41; age, 56±7 vs 57±7 years, P = 0.309). Only microvascular endothelial function, measured using the Endo-PAT2000 device to determine reactive hyperaemia index (CAD vs. NCA; 1.9 [1.5; 2.3] vs. 2.1 [1.8; 2.4], P = 0.03) and sonographic carotid plaque score (CAD vs. NCA; 3.0 [1.5; 4.5] vs. 1.2 [0; 2.55], P<0.001) were significantly different between patients with CAD and NCA. No significant differences were detected in reflection magnitude (CAD vs. NCA; 1.7 [1.5; 1.8] % vs 1.7 [1.5; 1.9] %, P = 0.342), pulse wave velocity (CAD vs. NCA; 7.8±1.4 m/sec vs. 8.3±1.5 m/sec, P = 0.186), carotid intima-media thickness (CAD vs. NCA; 0.73±0.10 mm vs. 0.75±0.10 mm, P = 0.518) or carotid distensibility (CAD vs. NCA; 3.8±1.2 10-3/kPa vs. 3.4±0.9 10-3/kPa, P = 0.092). Also, the c-statistic of the pre-test probability based on history and traditional risk factors (c = 0.665; 95% CI, 0.540–0.789) was improved by the addition of the inverse RHI (c = 0.720; 95% CI, 0.605–0.836), carotid plaque score (c = 0.770, 95% CI, 0.659–0.881), and of both markers in combination (c = 0.801; 95% CI, 0.701–0.900). Conclusion There are distinct differences in the systemic vasculature between patients with CAD and NCA that may have the potential to guide diagnostic and therapeutic decisions. Carotid artery plaque burden and microvascular function appear to be most promising in this context.
Collapse
Affiliation(s)
- Ulf Neisius
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Erin Olson
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Sabrina H. Rossi
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Hagar A. Ibrahim
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Gemma Currie
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Anna F. Dominiczak
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Christian Delles
- BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
- * E-mail:
| |
Collapse
|
25
|
Athanasopoulos LV, Athanasiou T. Off-pump coronary artery bypass grafting in left main stem stenosis: outcomes, concerns and controversies. J Thorac Dis 2016; 8:S787-S794. [PMID: 27942396 DOI: 10.21037/jtd.2016.09.72] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Left main stem (LMS) disease is known to be a poor prognostic factor in terms of morbidity or mortality. Traditionally, it has been treated with constitution of bypass to provide required haemodynamic stability. We searched the literature for evidence on off-pump (OFP) surgery for treating this high-risk group of patients focusing in our review on postoperative outcomes, concerns and controversies. The majority of the studies identified showed favourable or equal outcomes of OFP when compared to conventional approach. All of the studies, apart from two, which showed lower incidence of postoperative deaths, demonstrated equal mortality rates. Stroke rates were found less in three studies. Less blood transfusions, inotropic use and length of study has been also demonstrated. The main concerns of OFP surgery are: haemodynamic instability and less complete revascularization. Main controversies are: same or favourable outcomes despite lower number of grafts with OFP surgery and less stroke rates despite manipulation of aorta with side-clamping. Despite these concerns and controversies OFP surgery has been proven to be feasible and safe as demonstrated by results from numerous studies.
Collapse
Affiliation(s)
- Leonidas V Athanasopoulos
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| | - Thanos Athanasiou
- Department of Cardiothoracic Surgery, Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, UK
| |
Collapse
|
26
|
Saba L, Araki T, Kumar PK, Rajan J, Lavra F, Ikeda N, Sharma AM, Shafique S, Nicolaides A, Laird JR, Gupta A, Suri JS. Carotid inter-adventitial diameter is more strongly related to plaque score than lumen diameter: An automated tool for stroke analysis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:210-220. [PMID: 26887355 DOI: 10.1002/jcu.22334] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/27/2015] [Accepted: 12/31/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To compare the strength of correlation between automatically measured carotid lumen diameter (LD) and interadventitial diameter (IAD) with plaque score (PS). METHODS Retrospective study on a database of 404 common carotid artery B-mode sonographic images from 202 diabetic patients. LD and IAD were computed automatically using an advanced computerized edge detection method and compared with two distinct manual measurements. PS was computed by adding the maximal thickness in millimeters of plaques in segments taken from the internal carotid artery, bulb, and common carotid artery on both sides. RESULTS The coefficient of correlation was 0.19 (p < 0.007) between LD and PS, and 0.25 (p < 0.0006) between IAD and PS. After excluding 10 outliers, coefficient of correlation was 0.25 (p < 0.0001) between LD and PS, and 0.38 (p < 0.0001) between IAD and PS. The precision of merit of automated versus the two manual measurements was 96.6% and 97.2% for LD, and 97.7% and 98.1%, for IAD, respectively. CONCLUSIONS Our automated measurement system gave satisfying results in comparison with manual measurements. Carotid IAD was more strongly correlated to PS than carotid LD in this population sample of Japanese diabetic patients.
Collapse
Affiliation(s)
- Luca Saba
- Department of Radiology, University of Cagliari, Italy
| | - Tadashi Araki
- Division of Cardiovascular Medicine, Toho University, Ohashi Medical Center, Tokyo, Japan
| | - P Krishna Kumar
- Department of Computer Science and Engineering, National Institute of Technology, Karnataka, India
- Point-of-Care Devices, Global Biomedical Technologies, Inc, Roseville, CA
| | - Jeny Rajan
- Department of Computer Science and Engineering, National Institute of Technology, Karnataka, India
- Point-of-Care Devices, Global Biomedical Technologies, Inc, Roseville, CA
| | | | - Nobutaka Ikeda
- Cardiovascular Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Aditya M Sharma
- Division of Cardiovascular Medicine, Department of Medicine, University of Virginia, VA
| | | | | | - John R Laird
- UC Davis Vascular Center, University of California, Davis, CA
| | - Ajay Gupta
- Radiology Department, Brain and Mind Research Institute, Weill Cornell Medical College, NY
| | - Jasjit S Suri
- Point-of-Care Devices, Global Biomedical Technologies, Inc, Roseville, CA
- Monitoring and Diagnostic Division, AtheroPoint, Roseville, CA
- Department of Electrical Engineering, University of Idaho (Affl.), ID
| |
Collapse
|
27
|
Gunnoo T, Hasan N, Khan MS, Slark J, Bentley P, Sharma P. Quantifying the risk of heart disease following acute ischaemic stroke: a meta-analysis of over 50,000 participants. BMJ Open 2016; 6:e009535. [PMID: 26792217 PMCID: PMC4735313 DOI: 10.1136/bmjopen-2015-009535] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE Following an acute stroke, there is a high risk of recurrence. However, the leading cause of mortality following a stroke is due to coronary artery disease (CAD) and myocardial infarction (MI) but that risk has not been robustly quantified. We sought to reliably quantify the risk of ischaemic heart disease (IHD) in patients presenting with acute ischaemic stroke (AIS) in the absence of a known cardiac history. SETTING A meta-analysis study. PubMed, MEDLINE, EMBASE and Google Scholar were searched for potential studies up to October 2015. Included studies reported an acute cerebral ischaemic event and followed for CAD or MI within 1 year in patients without known IHD. Using arcsine transformed proportions for meta-analysis, studies were combined using a generic inverse variance random-effects model to calculate the pooled standardised mean difference and 95% CIs. These were interpreted as the percentage prevalence of CAD or incidence of MI following AIS. RESULTS 17 studies with 4869 patients with AIS demonstrated a mean average of asymptomatic CAD in 52%. Anatomical methods of CAD detection revealed a prevalence of asymptomatic ≥ 50% coronary stenosis in 32% (95% CI 19% to 47%; p<0.00001). 8 studies with 47229 patients with ischaemic stroke revealed an overall risk of MI in the year following stroke of 3% (95% CI 1% to 5%; p<0.00001) despite the absence of any cardiac history. CONCLUSIONS One-third of patients with ischaemic stroke with no cardiac history have more than 50% coronary stenosis and 3% are at risk of developing MI within a year. Our findings provide a reliable quantitative measure of the risk of IHD following AIS in patients with no cardiac history.
Collapse
Affiliation(s)
- Trishna Gunnoo
- Department of Medicine, Imperial College London, London, UK
| | - Nazeeha Hasan
- Department of Medicine, Imperial College London, London, UK
| | | | - Julia Slark
- Faculty of Medical & Health Sciences, University of Auckland, Auckland, New Zealand
| | - Paul Bentley
- Department of Medicine, Imperial College London, London, UK
| | - Pankaj Sharma
- Ashford & St Peters Hospital, Surrey, UK
- Institute of Cardiovascular Research Royal Holloway University of London (ICR2UL), London, UK
| |
Collapse
|
28
|
Vagnarelli F, Corsini A, Lorenzini M, Ortolani P, Norscini G, Cinti L, Semprini F, Nanni S, Taglieri N, Soflai Sohee S, Melandri G, Letizia Bacchi Reggiani M, Rapezzi C. Long-term prognostic role of cerebrovascular disease and peripheral arterial disease across the spectrum of acute coronary syndromes. Atherosclerosis 2015; 245:43-9. [PMID: 26691909 DOI: 10.1016/j.atherosclerosis.2015.11.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 10/02/2015] [Accepted: 11/13/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In acute coronary syndromes (ACS), the influence of cerebro-vascular disease (CVD) and/or peripheral artery disease (PAD) on short-midterm outcome has been well established. Data on long-term outcome however, are limited. Our study aimed to explore the effect of CVD and PAD on long-term outcome in a cohort of unselected ACS patients, including ST-elevation (STE-ACS) and non-ST-elevation (NSTE-ACS). METHODS AND RESULTS The population consisted of 2046 consecutive patients with a confirmed final diagnosis of ACS; 896 (44%) had STE-ACS and 1150 (66%) NSTE-ACS. CVD alone was present in 98 patients (5%), 282 (14%) had PAD alone, and 30 (1.5%) had both. All cause mortality at 5 years was lowest in patients without CVD/PAD (33%), intermediate in patients with either CVD or PAD (62% and 63%, respectively) reaching 80% in those with both CVD and PAD. These findings were confirmed in the STE-ACS and NSTE-ACS subgroups. CVD and PAD remained independent predictors of mortality after multivariable analysis, the combined presence of both carrying the highest risk within each ACS type (HR 4.15, 95% CI 1.83-9.44 for STE-ACS; HR 2.14, 1.29-3.54 for NSTE-ACS). Patients with CVD and/or PAD were less likely to be treated invasively and received less evidence-based treatment at discharge. CONCLUSIONS Across the spectrum of ACS, extracardiac vascular disease harbors a negative long-term prognosis that worsens progressively with the number of affected arterial beds.
Collapse
Affiliation(s)
- Fabio Vagnarelli
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Anna Corsini
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Massimiliano Lorenzini
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Paolo Ortolani
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Giulia Norscini
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Laura Cinti
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Franco Semprini
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Samuele Nanni
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Nevio Taglieri
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Sophia Soflai Sohee
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Giovanni Melandri
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Maria Letizia Bacchi Reggiani
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy
| | - Claudio Rapezzi
- Cardiology, Department of Experimental Diagnostic and Specialty Medicine, Alma Mater Studiorum-University of Bologna, Italy.
| |
Collapse
|
29
|
Weissgerber A, Scholz M, Teren A, Sandri M, Teupser D, Gielen S, Thiery J, Schuler G, Beutner F. The value of noncoronary atherosclerosis for identifying coronary artery disease: results of the Leipzig LIFE Heart Study. Clin Res Cardiol 2015; 105:172-81. [PMID: 26362881 PMCID: PMC4735267 DOI: 10.1007/s00392-015-0900-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/30/2015] [Indexed: 11/11/2022]
Abstract
Background Despite the widespread use of noninvasive testing prior to invasive coronary diagnostic the diagnostic yield of elective coronary angiography has been reported low in subjects with suspected obstructive CAD. Objective To determine the predictive value of noncoronary atherosclerosis (NCA) in subjects with suspected stable coronary artery disease (CAD) intended to invasive coronary angiography. Methods Ultrasound-based assessment of carotid artery plaque (CAP), carotid intima-media thickness (CIMT) and ankle-brachial index (ABI) was performed in 2216 subjects with suspected CAD prior to coronary angiography. Logistic regression and c-statistics were used to analyze the diagnostic value of NCA for the presence of obstructive CAD and the intention to revascularization. Results Percentage of positive results of elective coronary angiography was low but comparable to other studies (41 % obstructive CAD). We identified 1323 subjects (60 %) with NCA, most of them were characterized by CAP (93 %). CAP independently predicted obstructive CAD in addition to traditional risk factors and clinical factors while CIMT and ABI failed to improve the prediction. The presence of NCA and typical angina were the strongest predictors for obstructive CAD (OR 4.0 and 2.4, respectively). A large subgroup of patients (n = 703, 32 %) with atypical clinical presentation and lack of NCA revealed a low indication for revascularization <15 % indicating a large proportion of subjects with non-obstructive CAD in this subgroup. Conclusion The evaluation of noncoronary atherosclerosis has the potential to impact clinical decision making and to direct subsequent diagnostic procedures in subjects with suspected coronary artery disease. Clinical trial registration NCT00497887. Electronic supplementary material The online version of this article (doi:10.1007/s00392-015-0900-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alexander Weissgerber
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany
| | - Markus Scholz
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.,Institute of Medical Informatics, Statistic and Epidemiology, University Leipzig, Leipzig, Germany
| | - Andrej Teren
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany
| | - Marcus Sandri
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany
| | - Daniel Teupser
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Ludwig-Maximilian University, Munich, Germany
| | - Stephan Gielen
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.,Department of Medicine III, University Hospital Halle (Saale), Halle/Saale, Germany
| | - Joachim Thiery
- LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.,Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University Hospital Leipzig, Leipzig, Germany
| | - Gerhard Schuler
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany.,LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany
| | - Frank Beutner
- Department of Cardiology, Heart Center University Leipzig, Strümpellstr. 39, 04289, Leipzig, Germany. .,LIFE-Leipzig Research Center for Civilization Diseases, University Leipzig, Leipzig, Germany.
| |
Collapse
|
30
|
Prasad K. Pathophysiology and Medical Treatment of Carotid Artery Stenosis. Int J Angiol 2015; 24:158-72. [PMID: 26417183 DOI: 10.1055/s-0035-1554911] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Stroke is the third leading cause of mortality. Approximately 80 to 85% strokes are ischemic due to carotid artery stenosis (CAS). The prevalence of significant CAS is 7% in women and 9% in men. Severe asymptomatic CAS varies from 0 to 3.1%. Prevalence of symptomatic CAS is high in patients with peripheral arterial disease. CAS is due to atherosclerosis, the major risk factors for which include dyslipidemia, hypertension, diabetes, obesity, cigarette smoking, advanced glycation end products (AGEs) and its receptors (RAGE, soluble RAGE [sRAGE]), lack of exercise and C-reactive protein (CRP). This article discusses the basic mechanism of atherosclerosis and the mechanisms by which these risk factors induce atherosclerosis. The role of AGEs and its receptors in the development and progression of CAS has been discussed in detail. Lifestyle changes and medical treatment of CAS such as lifestyle changes, lipid-lowering agents, antihypertensive agents, antidiabetic drugs, anti-AGE therapy, measures to elevate soluble receptors of AGE (sRAGE, esRAGE). CRP-lowering agents have been discussed in detail. The drugs especially lipid-lowering agents, and antihypertensive and antidiabetic drugs suppress, regress, and slow the progression of CAS. The possible role of lowering the levels of AGEs and raising the levels of sRAGE in the treatment of CAS has been proposed. Lifestyle changes besides medical treatment have been stressed. Lifestyle changes and medical treatment not only would slow the progression of CAS but would also regress the CAS.
Collapse
Affiliation(s)
- Kailash Prasad
- Department of Physiology, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
31
|
Gray C, Goodman P, Cullen P, Badger SA, O'Malley K, O'Donohoe MK, McDonnell CO. Screening for Peripheral Arterial Disease and Carotid Artery Disease in Patients With Abdominal Aortic Aneurysm. Angiology 2015; 67:346-9. [DOI: 10.1177/0003319715590299] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Screening for concomitant atherosclerotic disease is important in cardiovascular risk reduction. This study assessed the prevalence of carotid artery disease (CAD) and peripheral arterial disease (PAD) in patients with known abdominal aortic aneurysms (AAAs). All patients with AAA attending the vascular laboratory between the January 1, 2007, and December 31, 2009, were eligible for a carotid ultrasound and measurement of ankle brachial indices. A total of 389 (305 males) patients were identified on the AAA surveillance program with a mean (±standard deviation) age of 76 (±8) years. The mean age of the males was 75.4 (±7.8) years, and the mean age of the females was 77 (±11) years. A total of 332 patients were assessed for CAD, and 101 (30.4%) of those were found to have significant disease. A total of 289 patients were assessed for PAD of which 131 (45.3%) were found to have PAD at rest, and 289 patients were assessed for both and 59 (20.4%) patients had significant CAD + PAD. Patients with AAAs are at high risk of other atherosclerotic disorders, and, therefore, they should receive intensive medical optimization.
Collapse
Affiliation(s)
- Cleona Gray
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Patrick Goodman
- School of Physics, Dublin Institute of Technology, Dublin, Ireland
| | - Paul Cullen
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Stephen A. Badger
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Kevin O'Malley
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Martin K. O'Donohoe
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ciaran O. McDonnell
- Department of Vascular Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
| |
Collapse
|
32
|
Nemeth Z, Cziraki A, Szabados S, Horvath I, Koller A. Pericardial fluid of cardiac patients elicits arterial constriction: role of endothelin-1. Can J Physiol Pharmacol 2015; 93:779-85. [PMID: 26322806 DOI: 10.1139/cjpp-2015-0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recently, several vasoactive molecules have been found in pericardial fluid (PF). Thus, we hypothesized that in coronary artery disease due to ischemia or ischemia-reperfusion, the level of vasoconstrictors, mainly endothelin-1 (ET-1), increases in PF, which can increase the vasomotor tone of arteries. Experiments were performed using an isometric myograph. Vasomotor effects of PF from patients undergoing coronary artery bypass graft (PFCABG, n = 14) or valve replacement (PFVR, n = 7) surgery were examined in isolated rat carotid arteries (N = 14; n = 26). Vasomotor responses to KCl (40 or 60 mmol/L) were also tested. The selective endothelin A receptor antagonist BQ123 (10(-6) mol/L) was used to elucidate the role of ET-1. Both the first and the second additions of KCl elicited increases in the isometric force of the isolated arteries (KCl1, 6.1 ± 0.2 mN; KCl2, 6.5 ± 0.9 mN). PFCABG and PFVR elicited substantial increases in the isometric force of arteries (PFCABG, 3.1 ± 0.7 mN; PFVR, 3.0 ± 0.9 mN; p > 0.05). The presence of the selective endothelin A receptor blocker significantly reduced arterial contractions to PFCABG (before BQ123, 2.6 ± 0.5 mN vs. after BQ123, 0.8 ± 0.1 mN; p < 0.05). This study is the first to demonstrate that PFs of patients elicit substantial arterial constrictions, which is mediated primarily by ET-1. Interfering with the vasoconstrictor action of PF could be a potential therapeutic target to improve coronary blood flow in cardiac patients.
Collapse
Affiliation(s)
- Zoltan Nemeth
- a University of Pecs, Medical School, Department of Pathophysiology and Gerontology and Szentagothai Research Centre, Pecs, Hungary
| | - Attila Cziraki
- b University of Pecs, Medical School, Heart Institute, Pecs, Hungary
| | - Sandor Szabados
- b University of Pecs, Medical School, Heart Institute, Pecs, Hungary
| | - Ivan Horvath
- b University of Pecs, Medical School, Heart Institute, Pecs, Hungary
| | - Akos Koller
- a University of Pecs, Medical School, Department of Pathophysiology and Gerontology and Szentagothai Research Centre, Pecs, Hungary.,c University of Physical Education, Institute of Natural Sciences, Budapest, Hungary.,d Department of Physiology, New York Medical College, Valhalla, NY 10595, USA
| |
Collapse
|
33
|
Luo X, Zhang M, Deng L, Zhao J. Effects of valproate on the carotid artery intima-media thickness in epileptics. Indian J Pharmacol 2015; 47:45-8. [PMID: 25821310 PMCID: PMC4375818 DOI: 10.4103/0253-7613.150328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 06/20/2014] [Accepted: 10/16/2014] [Indexed: 11/17/2022] Open
Abstract
Objective: The objective was to explore the effects of valproate (VPA) on the carotid artery intima-media thickness (CA-IMT) in epileptics. Materials and Methods: A total of 30 epileptic patients treated with VPA was included as disease group, while 33 healthy people who matched general basic demographic details were the control group. The IMTs of the left and right carotids of the both groups were measured, and the average CA-IMT was calculated. The IMT-related risk factors were acquired for the univariate and multivariate analysis. Results: The bilateral carotid and average CA-IMTs of the disease group were significantly higher than the control group (P < 0.001). The multivariant gradual regressive analysis screened out two CA-IMT-related factors, namely the disease duration and the drug administration duration were positively correlated with the average CA-IMT. The epileptic patients with disease course of more than 3 years had much higher average CA-IMT than that of the epileptics with ≤3 years disease (P < 0.001). The average CA-IMT of the patients with VPA-administration duration >1 year was also higher than that of the patients with VPA-administration duration <1 year, while the difference was not statistically significant (P = 0.196). Conclusions: The average CA-IMT of the epileptic patients treated with VPA was higher than that of healthy people.
Collapse
Affiliation(s)
- Xinming Luo
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Ming Zhang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Liying Deng
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jing Zhao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
| |
Collapse
|
34
|
Taniguchi H, Shiba T, Maeno T, Takahashi M. Evaluation of Carotid Atherosclerosis, Peripheral Arterial Disease, and Chronic Kidney Disease in Patients with Exudative Age-Related Macular Degeneration without Coronary Artery Disease or Stroke. Ophthalmologica 2015; 233:128-33. [PMID: 25633305 DOI: 10.1159/000371716] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/17/2014] [Indexed: 11/19/2022]
Abstract
PURPOSE To evaluate the risk factors for acute atherothrombotic events in patients with exudative age-related macular degeneration (AMD) without a history of coronary artery disease or stroke. METHODS Two hundred fifty-nine patents with exudative AMD were evaluated for carotid atherosclerosis, peripheral arterial disease, and chronic kidney disease (CKD). RESULTS A mean intima-media thickness of ≥1.0 mm was found in 28.2% of patients; 8.9% of patients had severe carotid artery stenosis. The prevalence rates of severe atherosclerosis with a plaque score >10, peripheral arterial disease, and CKD were 16.6, 5.4, and 32%, respectively. Diabetes mellitus and AMD affecting eyes bilaterally were identified as risk factors for abnormal carotid artery thickening, and age and body mass index were identified as risk factors for CKD. CONCLUSION The current study confirmed that potentially 30% of patients with exudative AMD without a history of coronary artery disease or stroke have a high risk of acute atherothrombotic events.
Collapse
Affiliation(s)
- Hikari Taniguchi
- Department of Ophthalmology, Toho University Sakura Medical Center, Chiba, Japan
| | | | | | | |
Collapse
|
35
|
Arasaratnam P, Ayoub C, Ruddy TD. Canadian Multiethnicity—Differences in Coronary Artery Disease Prevalence and Progression and Relevance to Cardiac Imaging. CURRENT CARDIOVASCULAR IMAGING REPORTS 2014. [DOI: 10.1007/s12410-014-9314-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
36
|
Abstract
Background:Since the validation of carotid endarterectomy (CEA) as an effective means of stroke prevention, there has been renewed interest in its best indications and methods, as well as in how it compares to carotid angioplasty and stenting (CAS). This review examines these topics, as well as the investigation of carotid stenosis and the role of auditing and reporting CEAresults.Investigation:Brain imaging with CTor MRI should be obtained in patients considered for CEA, in order to document infarction and rule out mass lesions. Carotid investigation begins with ultrasound and, if results agree with subsequent, good-quality MRAor CTangiography, treatment can be planned and catheter angiography avoided. An equally acceptable approach is to proceed directly from ultrasound to catheter angiography, which is still the gold-standard in carotid artery assessment.Indications:Appropriate patients for CEA are those symptomatic with transient ischemic attacks or nondisabling stroke due to 70-99% carotid stenosis; the maximum allowable stroke and death rate being 6%. Uncertain candidates for CEA are those with 50 - 69% symptomatic stenosis, and those with asymptomatic stenosis ≥ 60% but, if selected carefully on the basis of additional risk factors (related to both the carotid plaque and certain patient characteristics), some will benefit from surgery. Asymptomatic patients will only benefit if surgery can be provided with exceptionally low major complication rates (3% or less). Inappropriate patients are those with less than 50% symptomatic or 60% asymptomatic stenosis, and those with unstable medical or neurological conditions.Techniques:Carotid endarterectomy can be performed with either regional or general anaesthesia and, for the latter, there are a number of monitoring techniques available to assess cerebral perfusion during carotid cross-clamping. While monitoring cannot be considered mandatory and no single monitoring technique has emerged as being clearly superior, EEG is most commonly used. “Eversion” endarterectomy is a variation in surgical technique, and there is some evidence that more widely practiced patch closure may reduce the acute risk of operative stroke and the longer-term risk of recurrent stenosis.Carotid angioplasty and stenting:Experience with this endovascular and less invasive procedure grows, and its technology continues to evolve. Some experienced therapists have reported excellent results in case series and a number of randomized trials are now underway comparing CAS to CEA. However, at this time it is premature to incorporate CAS into routine practice replacing CEA.Auditing:It has been shown that auditing of CEA indications and results with regular feed-back to the operating surgeons can significantly improve the performance of this operation. Carotid endarterectomy auditing is recommended on both local and regional levels.
Collapse
Affiliation(s)
- J Max Findlay
- Division of Neurosurgery, Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | |
Collapse
|
37
|
A Case of Severe Carotid Stenosis in a Patient with Familial Hypercholesterolemia without Significant Coronary Artery Disease. Case Rep Cardiol 2014; 2014:853921. [PMID: 25405037 PMCID: PMC4227388 DOI: 10.1155/2014/853921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 10/10/2014] [Indexed: 02/06/2023] Open
Abstract
Familial hypercholesterolemia (FH) is an inherited metabolic disorder characterized by elevated low-density lipoprotein cholesterol levels in the blood. In its heterozygous form, it occurs in 1 in 500 individuals in the general population. It is an important contributor to the early onset of coronary artery disease (CAD), accounting for 5–10% of cases of cardiovascular events in people younger than 50 years. Atherogenesis triggered by hypercholesterolemia generally progresses faster in the coronary arteries, followed by the subsequent involvement of other arteries such as the carotids. Thus, symptoms of CAD commonly appear before the onset of significant carotid stenosis. Herein, we report the case of a patient with untreated FH who had severe carotid atherosclerosis at the age of 46 years but had no evidence of significant CAD.
Collapse
|
38
|
Abd-Allah F, Kassem HH, Hashad A, Shamloul RM, Zaki A. Prevalence of intracranial atherosclerosis among patients with coronary artery disease: a 1-year hospital-based study. Eur Neurol 2014; 71:326-30. [PMID: 24776926 DOI: 10.1159/000358055] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 12/15/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND There are limited data on the prevalence of intracranial atherosclerotic disease (ICAD) in patients with coronary artery disease (CAD) worldwide and especially among Egyptians. The purpose of the present study was to determine the prevalence and correlates of ICAD in patients with CAD. METHODS From January 1, 2012 to January 1, 2013, we recruited 118 consecutive patients who had ischemic heart disease. All patients were assessed for vascular risk factors and the existence of stroke or transient ischemic attack (TIA) and were evaluated by extracranial and transcranial color-coded sonography. All patients underwent coronary angiography. Clinical, echocardiographic and angiographic variables were tested by univariate and multivariate analysis. RESULTS Out of 118 consecutive patients with CAD, intracranial disease was detected in 14 patients (11.9%). Eight patients (6.8%) had stenosis >50%, while 6 patients (5.1%) had stenosis <50%. The univariate analysis showed that the strongest variables associated with ICAD were the presence of recent or old stroke or TIA, followed by moderate or severe extracranial stenosis, and multivessel or left main CAD. CONCLUSION We observed low prevalence (6.8%) of high-grade ICAD among Egyptian patients with CAD. Multivessel or left main CAD and moderate-to-severe extracranial carotid stenosis were the strongest predictors for the existence of ICAD among CAD patients.
Collapse
Affiliation(s)
- Foad Abd-Allah
- Department of Neurology, Cairo University Hospital, Cairo, Egypt
| | | | | | | | | |
Collapse
|
39
|
Imori Y, Akasaka T, Ochiai T, Oyama K, Tobita K, Shishido K, Nomura Y, Yamanaka F, Sugitatsu K, Okamura N, Mizuno S, Arima K, Suenaga H, Murakami M, Tanaka Y, Matsumi J, Takahashi S, Tanaka S, Takeshita S, Saito S. Co-existence of carotid artery disease, renal artery stenosis, and lower extremity peripheral arterial disease in patients with coronary artery disease. Am J Cardiol 2014; 113:30-5. [PMID: 24157190 DOI: 10.1016/j.amjcard.2013.09.015] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 09/27/2013] [Accepted: 09/27/2013] [Indexed: 11/29/2022]
Abstract
In atherosclerosis, carotid artery stenosis (CAS), renal artery stenosis (RAS), lower extremity peripheral arterial disease (PAD), and coronary artery disease (CAD) are common pathologic lesions; their interrelationship is, however, unclear. We studied concomitant multiple atherosclerotic lesions in patients with CAD to understand their prevalence and relations. A cross-sectional analysis was performed on data from consecutive patients who underwent nonemergent coronary angiography. Simultaneous carotid and renal artery Doppler studies and ankle-brachial systolic pressure measurements were reviewed to diagnose concomitant lesions and their severity. The study included 1,734 patients (aged 71 ± 9 years; 70% men), with prevalences of CAS, RAS, lower extremity PAD, and CAD of 6%, 7%, 13%, and 72%, respectively. In patients with CAD (n = 1,253), the prevalences of CAS, RAS, and lower extremity PAD were 7%, 9%, and 16%, respectively; 24% CAD patients had ≥1 additional atherosclerotic lesion. Significant interactions among the prevalences of these lesions were found. In addition, the extent of CAD and the prevalences of CAS, RAS, and lower extremity PAD were significantly correlated. Multivariate analysis supported these relationships. In conclusion, the prevalences of CAS, RAS, lower extremity PAD, and CAD were strongly interrelated in the study population; CAD severity was related to that of other atherosclerotic lesions. Additional systematic screening of other concomitant atherosclerotic lesions is recommended, especially in CAD patients having multivessel disease, left main disease, and/or already diagnosed with other concomitant atherosclerotic lesions.
Collapse
Affiliation(s)
- Yoichi Imori
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan.
| | - Takeshi Akasaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Tomoki Ochiai
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kazuma Oyama
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kazuki Tobita
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Koki Shishido
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yu Nomura
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Futoshi Yamanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Kazuya Sugitatsu
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Nobuhiro Okamura
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shingo Mizuno
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Ken Arima
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Hidetaka Suenaga
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Masato Murakami
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Yutaka Tanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Junya Matsumi
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Saeko Takahashi
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shinji Tanaka
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Satoshi Takeshita
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| | - Shigeru Saito
- Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan
| |
Collapse
|
40
|
Chang CC, Chang ML, Huang CH, Chou PC, Ong ET, Chin CH. Carotid intima-media thickness and plaque occurrence in predicting stable angiographic coronary artery disease. Clin Interv Aging 2013; 8:1283-8. [PMID: 24098074 PMCID: PMC3789839 DOI: 10.2147/cia.s49166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carotid intima-media thickness (CIMT) and plaque formation have been used as surrogate end-points for evaluating the regression and/or progression of atherosclerotic cardiovascular disease, but their predictive value for stable coronary artery disease (CAD) is inconclusive. METHODS Carotid ultrasonography was performed in patients who underwent noninvasive multislice computed tomography (MSCT) angiography for CAD suspected, due to chest pain. CIMT and plaque formation on the left and right common carotid arteries (CCAs), carotid bulb (CB), and proximal internal carotid arteries (ICAs) were evaluated, and the relationship between angiographic CAD, CIMT, and plaque formation was determined. RESULTS 120 patients (95 male; 25 female), with a mean age ± standard deviation of 61 ± 11 years (range: 35-89 years) were recruited. Because age had a significant impact on CAD (r = 0.191; P = 0.036), CCA plaques (r = 0.368; P = 0.001), ICA plaques (r = 0.334; P = 0.004), and mean CIMT (r = 0.436; P = 0.001), patients were divided into two groups aged <60 years and ≥60 years. In the <60 years group, CIMT-CB was significantly higher in patients with CAD (P = 0.041), while in the ≥60 years group, mean CIMT, CIMT-CCA, and CIMT-CB were significantly higher in patients with CAD (P < 0.05, for each). In both groups, the occurrence of carotid plaques was significantly higher in patients with CAD than in those without CAD (P < 0.007, for each). After controlling for other risk factors, carotid plaques were an independent predictor of CAD in both groups (P < 0.05, for each), while CIMT-CB could independently predict CAD only in patients ≥60 years old (P = 0.031). CONCLUSION Our findings suggest that carotid plaques are a strong predictor of stable CAD. However, CIMT-CB could predict stable CAD only in patients over 60 years of age.
Collapse
Affiliation(s)
- Chao-Chien Chang
- Department of Pharmacology, School of Medicine, Taipei Medical University, Taipei, Taiwan ; Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
41
|
Erdogan B, Aslan E, Bagis T, Gokcel A, Erkanli S, Bavbek M, Altinors N. Intima-media thickness of the carotid arteries is related to serum osteoprotegerin levels in healthy postmenopausal women. Neurol Res 2013; 26:658-61. [PMID: 15327755 DOI: 10.1179/016164104225014157] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Osteoprotegerin (OPG) regulates bone mass by inhibiting osteoclast differentiation and activation, and also plays a role in vascular calcification. The objective of this study was to evaluate the relationship between serum OPG levels, and carotid artery intima-media thickness (IMT) and carotid plaque formation in healthy postmenopausal women. We recruited 68 healthy postmenopausal women for the study. Carotid plaque presence and IMT were evaluated by high resolution B-mode ultrasound. IMT was positively correlated with presence of plaque, age, menopause age and OPG, and inversely correlated with Apolipoprotein A1 (Apo A1). Serum OPG level was positively correlated with IMT (r = 0.366; p < 0.003) and age (r = 0.324; p < 0.008), and negatively correlated with Apo A1 (r = -0.481; p < 0.0001). We did not observe any significant relation between plaque occurrence and levels of serum OPG. In regression analysis OPG (p < 0.02) and menopause age (p < 0.05) were independent risk factors for IMT, and age (p < 0.05) and IMT (p < 0.05) were independent risk factors for plaque formation. Although the role of OPG in the vascular biology is poorly understood, our results suggest that elevated levels of serum OPG is associated with IMT and may play a role in the pathogenesis of atherosclerotic disease.
Collapse
Affiliation(s)
- Bulent Erdogan
- Department of Neurosurgery, Baskent University School of Medicine, Adana, Turkey.
| | | | | | | | | | | | | |
Collapse
|
42
|
Polak JF, Tracy R, Harrington A, Zavodni AEH, O'Leary DH. Carotid artery plaque and progression of coronary artery calcium: the multi-ethnic study of atherosclerosis. J Am Soc Echocardiogr 2013; 26:548-55. [PMID: 23522805 PMCID: PMC4084492 DOI: 10.1016/j.echo.2013.02.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Carotid and coronary atherosclerosis are associated with each other in imaging and autopsy studies. The aim of this study was to evaluate whether carotid artery plaque seen on carotid ultrasound can predict incident coronary artery calcification (CAC). METHODS Agatston calcium score measurements were repeated in 5,445 participants of the Multi-Ethnic Study of Atherosclerosis (MESA; mean age, 57.9 years; 62.9% women). Internal carotid artery lesions were graded as 0%, 1% to 24%, or >25% diameter narrowing, and intima-media thickness (IMT) was measured. Plaque was present for any stenosis >0%. CAC progression was evaluated with multivariate relative risk regression for CAC scores of 0 at baseline and with multivariate linear regression for CAC score > 0, adjusting for cardiovascular risk factors, body mass index, ethnicity, and common carotid IMT. RESULTS CAC was positive at baseline in 2,708 of 5,445 participants (49.7%) and became positive in 458 of 2,837 (16.1%) at a mean interval of 2.4 years between repeat examinations. Plaque and internal carotid artery IMT were both strongly associated with the presence of CAC. After statistical adjustment, the presence of carotid artery plaque significantly predicted incident CAC with a relative risk of 1.37 (95% confidence interval, 1.12-1.67). Incident CAC was associated with internal carotid artery IMT, with a relative risk of 1.13 (95% confidence interval, 1.03-1.25) for each 1-mm increase. Progression of CAC was also significantly associated (P < .001) with plaque and internal carotid artery IMT. CONCLUSIONS In individuals free of cardiovascular disease, subjective and quantitative measures of carotid artery plaques by ultrasound imaging are associated with CAC incidence and progression.
Collapse
Affiliation(s)
- Joseph F Polak
- Ultrasound Reading Center, Department of Radiology, Tufts Medical Center, Boston, Massachusetts, USA.
| | | | | | | | | |
Collapse
|
43
|
Acharya UR, Faust O, S VS, Alvin APC, Krishnamurthi G, Seabra JCR, Sanches J, Suri JS. Understanding symptomatology of atherosclerotic plaque by image-based tissue characterization. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2013; 110:66-75. [PMID: 23122720 DOI: 10.1016/j.cmpb.2012.09.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Revised: 09/07/2012] [Accepted: 09/24/2012] [Indexed: 06/01/2023]
Abstract
Characterization of carotid atherosclerosis and classification into either symptomatic or asymptomatic is crucial in terms of diagnosis and treatment planning for a range of cardiovascular diseases. This paper presents a computer-aided diagnosis (CAD) system (Atheromatic) that analyzes ultrasound images and classifies them into symptomatic and asymptomatic. The classification result is based on a combination of discrete wavelet transform, higher order spectra (HOS) and textural features. In this study, we compare support vector machine (SVM) classifiers with different kernels. The classifier with a radial basis function (RBF) kernel achieved an average accuracy of 91.7% as well as a sensitivity of 97%, and specificity of 80%. Thus, it is evident that the selected features and the classifier combination can efficiently categorize plaques into symptomatic and asymptomatic classes. Moreover, a novel symptomatic asymptomatic carotid index (SACI), which is an integrated index that is based on the significant features, has been proposed in this work. Each analyzed ultrasound image yields on SACI number. A high SACI value indicates that the image shows symptomatic and low value indicates asymptomatic plaques. We hope this SACI can support vascular surgeons during routine screening for asymptomatic plaques.
Collapse
Affiliation(s)
- U Rajendra Acharya
- Department of Electrical and Computer Engineering, Ann Polytechnic, Singapore 599489, Singapore
| | | | | | | | | | | | | | | |
Collapse
|
44
|
Meenakshisundaram R, Devidutta S, Michaels AD, Senthilkumaran S, Rajendiran C, Thirumalaikolundusubramanian P. Significance of the intima-media thickness of carotid and thoracic aorta in coronary artery disease in the South Indian population. Heart Views 2012; 12:150-6. [PMID: 22574240 PMCID: PMC3345149 DOI: 10.4103/1995-705x.90901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Background: Ultrasound detected intima-media thickness (IMT) of the carotid artery and thoracic aorta are possible screening tests to assess the risk of coronary artery disease (CAD) in asymptomatic individuals. Objective: Aim of the study was to assess the utility of carotid and aortic IMT as a predictor of CAD and to assess the extent of IMT with severity of CAD in a South Indian population. Patients and Methods: A cross-sectional and analytical study was carried out among 40 cases, who had angiographic evidence of CAD against 30 healthy control subjects with a normal treadmill test. At plaque-free regions, the carotid IMT was evaluated by B-mode ultrasonography and thoracic aorta IMT was evaluated by trans-esophageal echocardiography (TEE). The significance of difference in means between two groups was analyzed using one-way ANOVA F-test and the significance of difference in proportions by Chi-square test. Multiple comparisons were done by Bonferroni t test. The correlation between IMT and severity of CAD was assessed by Spearman's method. Results: There were 38 males and 2 females among cases with age 51.7 ± 8.3 years, and 28 males and 2 females among control subjects with age 52.2 ± 7.1 years. Increased carotid IMT was noted among 24 cases and 2 control subjects, and the association was significant for CAD [P < 0.001, Chi-square = 20.89, odds ratio (OR) = 21.00, and 95% confidence interval (CI) = 4.78-89.59]. Similarly, 19 cases and one control subject had abnormal IMT with positive correlation for CAD (P < 0.001, Chi-square = 16.39, OR = 28.24, and 95% CI = 4.06-163.21). There was no association between IMT and diabetes, hypertension, or smoking; however, IMT was significantly associated with age and dyslipidemia. Also, there was no correlation between extent of IMT and severity of CAD. Conclusions: IMT of the carotid and thoracic aorta is strongly associated with risk of CAD in a South Indian population, and may be used as a non-invasive screening tool for coronary atherosclerosis in resource-limited settings. The presence of dyslipidemia influenced IMT and may be used as a tool to follow patients on hypolipidemic drugs.
Collapse
|
45
|
Kovacik M, Madarasz S, Kral M, Veverka T, Herzig R, Kanovsky P. Risk factors associated with ischemic heart disease occurence in acute ischemic stroke patients. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2012; 157:168-71. [PMID: 22660218 DOI: 10.5507/bp.2011.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 12/09/2011] [Indexed: 11/23/2022] Open
Abstract
AIMS At specific time periods following ischemic stroke (IS), acute coronary syndrome as ischemic heart disease (IHD) represents a higher risk of death than IS. Not all IS patients can undergo specific examination for IHD detection. The aim of this study was to assess exclusive risk factors (RFs) associated with IHD occurrence in IS patients. Knowledge of these RFs should help in stratifying IS patients for IHD detection. MATERIALS AND METHODS This was a hospital-based, retrospective, single centre study. The sample consisted of 192 consecutive IS patients, divided into two subgroups - Subgroup 1 (54 patients without IHD; 55.6% males; 63.1 ± 11.8 years) and Subgroup 2 (138 patients with IHD; 39.1% males; 76.3 ± 9.6 years). The following factors were identified: age; sex; presence of arterial hypertension, atrial fibrillation, diabetes mellitus; plasma levels of total cholesterol, triglycerides, low-density cholesterol, high-density cholesterol; body mass index; presence of carotid plaques. Logistic regression analysis was used for statistical evaluation. RESULTS Of all identified risk factors only age (OR=1.109; 95% CI: 1.069 - 1.150, P=0.001) and the presence of arterial hypertension (OR=6.298; 95% CI: 2.215 - 17.905, P=0.003) were exclusively and significantly associated with the presence of IHD in IS patients. CONCLUSIONS Age and arterial hypertension may be exclusive risk factors associated with IHD in IS patients.
Collapse
Affiliation(s)
- Michal Kovacik
- Comprehensive Stroke Centre, Department of Neurology, Faculty of Medicine and Dentistry, Palacky University Olomouc and University Hospital Olomouc, Czech Republic.
| | | | | | | | | | | |
Collapse
|
46
|
Dzierwa K, Pieniazek P, Musialek P, Piatek J, Tekieli L, Podolec P, Drwiła R, Hlawaty M, Trystuła M, Motyl R, Sadowski J. Treatment strategies in severe symptomatic carotid and coronary artery disease. Med Sci Monit 2011; 17:RA191-197. [PMID: 21804476 PMCID: PMC3539602 DOI: 10.12659/msm.881896] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Coexistent carotid artery stenosis (CS) and multivessel coronary artery disease (CAD) is not infrequent. One in 5 patients with multivessel CAD has a severe CS, and CAD incidence reaches 80% in those referred for carotid revascularization. We reviewed treatment strategies for concomitant severe CS and CAD. We performed a literature search (MEDLINE) with terms including carotid artery stenting (CAS), coronary artery bypass grafting (CABG), carotid endarterectomy (CEA), stroke, and myocardial infarction (MI). The main therapeutic option for CS-CAD has been (simultaneous or staged) CEA-CABG. This, however, is associated with a high risk of MI (in those with CEA prior to CABG) or stroke (CABG prior to CEA), and the cumulative major adverse event rate (MAE – death, stroke or MI) reaches 10–12%. With increasing adoption of CAS, a sequential strategy of CAS followed by CABG has emerged. Registries (usually single-centre) indicate an MAE rate of ≈7% for CAS followed by CABG (frequently after >30 days, due to double antiplatelet therapy). Recently, 1-stage CAS-CABG has been introduced. This involves different antiplatelet regimens and, in some centers, preferred off-pump CABG, with a cumulative MAE of 1.4–4.5%. No randomized trial comparing different treatment strategies in CS-CAD has been conducted, and thus far reported series are prone to selection/reporting bias. In addition to the established surgical treatment (CEA-CABG, sequential/simultaneous), hybrid revascularization (CAS-CABG) is emerging as a viable therapeutic option. Larger, preferably multi-centre, studies are required before this can become widely applied.
Collapse
Affiliation(s)
- Karolina Dzierwa
- Department of Cardiac and Vascular Diseases, Jagiellonian University, Cracow, Poland.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Hamirani YS, Nasir K, Blumenthal RS, Takasu J, Shavelle D, Kronmal R, Budoff M. Relation of mitral annular calcium and coronary calcium (from the Multi-Ethnic Study of Atherosclerosis [MESA]). Am J Cardiol 2011; 107:1291-4. [PMID: 21349485 DOI: 10.1016/j.amjcard.2011.01.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 01/06/2011] [Accepted: 01/06/2011] [Indexed: 11/30/2022]
Abstract
Atherosclerosis is a complex diffuse disorder. The close correlation between coronary artery calcium (CAC) score on computed tomogram and extent and severity of coronary atherosclerosis is well established. It has been suggested that mitral annular calcification (MAC) may be a manifestation of generalized atherosclerosis. The MESA population included a population-based sample of 4 ethnic groups (12% Chinese, 38% white, 22% Hispanic, and 28% black) of 6,814 women and men 45 to 84 years of age. Computed tomographic scans were performed for all participants. The calcium score of each lesion was calculated by multiplying lesion area by a density factor derived from maximal Hounsfield units. A total calcium score was determined by summing individual lesion scores at each anatomic site. Relative risk regression was used to model the probability of MAC as a function of CAC >0 and CAC categories (0, 1 to 99, 100 to 399, and ≥400) with the referent group being CAC 0. The final study population consisted of 6,814 subjects (mean age 62 ± 10 years, 47% men). Overall 9% and 50% had detectable MAC and CAC, respectively. Of those with absent CAC, only 4% had MAC, whereas 9%, 19%, and 15% had MAC scores with increasing CAC scores of 1 to 99, 100 to 399, and ≥400, respectively (p<0.0001 for trend). After taking into account demographics and other risk factors, the prevalence ratio of MAC in those with mild CAC (1 to 99) was 2.13 (95% confidence interval 1.69 to 2.69) and increased to 7.57 (95% confidence interval 5.95 to 9.62) for CAC ≥400. Similar statistically significant increased risk of MAC was found when CAC was assessed as a continuous variable. In conclusion, we observed a strong association between MAC and increasing burden of CAC. This association weakened but persisted after adjustment for age, gender, and other traditional cardiovascular risk factors. These findings suggest that presence of MAC is an indicator of atherosclerotic burden rather than just a degenerative change of the mitral valve.
Collapse
Affiliation(s)
- Yasmin S Hamirani
- Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, California, USA.
| | | | | | | | | | | | | |
Collapse
|
48
|
Prevalence and Predictors of Concomitant Carotid and Coronary Artery Atherosclerotic Disease. J Am Coll Cardiol 2011; 57:779-83. [PMID: 21310312 DOI: 10.1016/j.jacc.2010.09.047] [Citation(s) in RCA: 109] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Revised: 09/20/2010] [Accepted: 09/21/2010] [Indexed: 11/22/2022]
|
49
|
Brott TG, Halperin JL, Abbara S, Bacharach JM, Barr JD, Bush RL, Cates CU, Creager MA, Fowler SB, Friday G, Hertzberg VS, McIff EB, Moore WS, Panagos PD, Riles TS, Rosenwasser RH, Taylor AJ. 2011 ASA/ACCF/AHA/AANN/AANS/ACR/ASNR/CNS/SAIP/SCAI/SIR/SNIS/SVM/SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease. J Am Coll Cardiol 2011; 57:e16-94. [PMID: 21288679 DOI: 10.1016/j.jacc.2010.11.006] [Citation(s) in RCA: 194] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
50
|
Acharya RU, Faust O, Alvin APC, Sree SV, Molinari F, Saba L, Nicolaides A, Suri JS. Symptomatic vs. Asymptomatic Plaque Classification in Carotid Ultrasound. J Med Syst 2011; 36:1861-71. [DOI: 10.1007/s10916-010-9645-2] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 12/20/2010] [Indexed: 12/01/2022]
|