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Kreidieh F, McQuade J. Novel insights into cardiovascular toxicity of cancer targeted and immune therapies: Beyond ischemia with non-obstructive coronary arteries (INOCA). AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2024; 40:100374. [PMID: 38510501 PMCID: PMC10946000 DOI: 10.1016/j.ahjo.2024.100374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 02/20/2024] [Indexed: 03/22/2024]
Abstract
Novel immune and targeted therapies approved over the past 2 decades have resulted in dramatic improvements in cancer-specific outcomes for many cancer patients. However, many of these agents can induce cardiovascular toxicity in a subset of patients. The field of cardio-oncology was established based on observations that anti-neoplastic chemotherapies and mantle radiation can lead to premature cardiomyopathy in cancer survivors. While conventional chemotherapy, targeted therapy, and immune therapies can all result in cardiovascular adverse events, the mechanisms, timing, and incidence of these events are inherently different. Many of these effects converge upon the coronary microvasculature to involve, through endocardial endothelial cells, a more direct effect through close proximity to cardiomyocyte with cellular communication and signaling pathways. In this review, we will provide an overview of emerging paradigms in the field of Cardio-Oncology, particularly the role of the coronary microvasculature in mediating cardiovascular toxicity of important cancer targeted and immune therapies. As the number of cancer patients treated with novel immune and targeted therapies grows exponentially and subsequently the number of long-term cancer survivors dramatically increases, it is critical that cardiologists and cardiology researchers recognize the unique potential cardiovascular toxicities of these agents.
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Affiliation(s)
- Firas Kreidieh
- Instructor of Clinical Medicine- Division of Hematology-Oncology; Associate Director- Internal Medicine Residency Program, American University of Beirut, Beirut, Lebanon
| | - Jennifer McQuade
- Associate Professor and Physician Scientist in Melanoma Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX, United States of America
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2
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Ayyad M, Albandak M, Khaleel M, N Khalil NC, Itmaizeh M. Acute Myocardial Infarction as the First Presentation of Systemic Lupus Erythematosus in a 23-Year-Old Patient. Cureus 2023; 15:e41026. [PMID: 37519572 PMCID: PMC10373106 DOI: 10.7759/cureus.41026] [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: 06/26/2023] [Indexed: 08/01/2023] Open
Abstract
ST-segment elevation myocardial infarction (STEMI) in young adults is a rare occurrence that requires a thorough investigation to determine the underlying cause. Herein, a young female patient presented with dull retrosternal chest pain associated with nausea and left arm numbness. Cardiac-specific troponin was elevated and the electrocardiogram revealed ST-segment elevation in the inferior wall leads indicative of myocardial infarction. The patient was started on dual antiplatelet therapy (DAPT) and emergency coronary angiography was performed, revealing a 20% stenosis in the left circumflex artery and evidence of a thrombotic lesion in the posterolateral branch (PLB), which was deemed unsuitable for intervention. During the diagnostic workup, the patient tested positive for antinuclear antibodies and was ultimately diagnosed with systemic lupus erythematosus (SLE) and antiphospholipid syndrome. This case highlights the rarity of STEMI as an initial presentation of SLE. It emphasizes the importance of considering autoimmune disorders in young patients with acute myocardial infarction and the need for a comprehensive evaluation and appropriate management in such cases.
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Affiliation(s)
| | | | - Mansour Khaleel
- Internal Medicine, Al-Makassed Charitable Society Hospital, Jerusalem, PSE
| | - Nabil C N Khalil
- Internal Medicine, Al-Makassed Charitable Society Hospital, Jerusalem, PSE
| | - Muaath Itmaizeh
- Rheumatology, Al-Makassed Charitable Society Hospital, Jerusalem, PSE
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3
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Gumrai P, Na-Nan K, Tepsuwan T, Suwannasom P, Louthrenoo W. Cardiac wall rupture in systemic lupus erythematosus: a case report and review of the literature. Clin Rheumatol 2023:10.1007/s10067-023-06614-8. [PMID: 37140686 DOI: 10.1007/s10067-023-06614-8] [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: 03/02/2023] [Revised: 04/05/2023] [Accepted: 04/26/2023] [Indexed: 05/05/2023]
Abstract
Cardiac wall rupture (CWR) is a serious and often fatal complication of myocardial infarction (MI). Despite an increase in the incidence of MI in patients with systemic lupus erythematosus (SLE), cases of CWR in these patients have been reported rarely. This study reports an SLE patient with CWR and pseudoaneurysm formation and reviews previously reported cases of CWR in SLE patients. An English language literature review of from the PubMed, EMBASE, and Scopus databases on published cases of CWR in SLE, up until January 2023, was performed and analyzed. The search identified 4 patients, including the present one, 5 cases altogether. All of them were female aged 27-40 years, and 3 of them had had SLE for 10 years or more. Chest pain and dyspnea were the common presentations. All had left ventricular (LV) wall rupture. Three patients had LV wall rupture with pseudoaneurysm formation (one had MI with normal coronary artery, one myocardial necrosis secondary from small coronary artery vasculitis and one MI from uncertain cause). The other 2 patients had LV free wall rupture (one had MI with extensive coronary atherosclerosis with coronary arteritis, and the other septic myocarditis with septic coronary arteritis) and these 2 patients died before the diagnosis was made. Three patients with pseudoaneurysm received surgical correction with good clinical outcomes in all. Cardiac wall rupture is a serious and often fatal cardiac complication. Emergency diagnosis and appropriate management with an experienced cardiology team is crucial. Surgical correction is the treatment of choice. Key Points • Cardiac wall rupture, a serious and often fatal cardiac complication, has rarely been described in SLE patients. • Emergency diagnosis and appropriate management with an experienced cardiology team is crucial. Surgical correction is the treatment of choice.
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Affiliation(s)
- Pawut Gumrai
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kittiya Na-Nan
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Thitipong Tepsuwan
- Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pannipa Suwannasom
- Division of Cardiology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worawit Louthrenoo
- Division of Rheumatology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
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Felix A, Delion F, Suzon B, Martin E, Ogrizek A, Mohamed Sahnoun M, Hospice C, Armougon A, Cuadro E, Elenga N, Dramé M, Bader-Meunier B, Deligny C, Hatchuel Y. Systemic lupus of pediatric onset in Afro-Caribbean children: a cohort study in the French West Indies and French Guiana. Pediatr Rheumatol Online J 2022; 20:95. [PMID: 36371201 PMCID: PMC9652926 DOI: 10.1186/s12969-022-00759-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 10/29/2022] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Systemic diseases of pediatric onset are more frequent in the Afro-Caribbean population. We performed a study of patients followed in the French overseas departments of America (FOAD) for pediatric systemic lupus erythematosus (pSLE). The aims were to describe the clinical and biological specificities during childhood in this population. METHODS A retrospective study was conducted between January 2000 and September 2021. Patients with pSLE were identified from multiple sources: computerized hospital archives, registry of referring pediatricians, adult specialists in internal medicine and the French National Registry for rare diseases. We studied SLE with pediatric onset defined by international criteria. RESULTS Overall, 2148 patients were identified, of whom 54 were included. The average follow-up was 8.3 years (range: 0.3-25 years). We observed an increase in new diagnoses over time. At onset, pSLE patients had a median of 10 SLICC criteria (range: 4-12), and the median EULAR/ACR 2019 score was 38 (12-54). At onset, one third of patients had renal involvement, 15% had neurolupus and 41% cardiac involvement. During childhood, 54% had renal involvement, and 26% suffered from neurolupus. Patients suffered a median of 3 flares during childhood, and 26% had more than 5 flares. Patients with younger age at onset had worse outcomes than those who were older at diagnosis, i.e., more flares (median 5, p = 0.02) and requiring an average of 4 background therapies (p = 0.04). CONCLUSION The outcomes of Afro-Caribbean patients were similar to those in Western population, but with worse disease activity at onset. Further studies should be performed to identify the genetic and environmental factors in this population.
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Affiliation(s)
- Arthur Felix
- Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France.
| | - Frederique Delion
- Department of Pediatrics, Guadeloupe University Hospital, Pointe-À-Pitre, France
| | - Benoit Suzon
- grid.412874.c0000 0004 0641 4482Department of Internal Medicine, Martinique University Hospital, Fort-de France, France
| | - Elise Martin
- Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, France
| | - Anais Ogrizek
- grid.412874.c0000 0004 0641 4482Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France
| | - M’hamed Mohamed Sahnoun
- Department of Pediatrics, Centre Hospitalier de L’ouest Guyanais, St-Laurent-du-Maroni, France
| | - Claudia Hospice
- grid.412874.c0000 0004 0641 4482Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France
| | - Aurelie Armougon
- grid.412874.c0000 0004 0641 4482Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France
| | - Emma Cuadro
- Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, France
| | - Narcisse Elenga
- Department of Pediatrics, Andrée Rosemon Hospital, Cayenne, France
| | - Moustapha Dramé
- grid.412874.c0000 0004 0641 4482Department of Clinical Research and Innovation, Martinique University Hospital, Fort-de-France, France
| | - Brigitte Bader-Meunier
- grid.412134.10000 0004 0593 9113Department of Pediatric Rheumatology, Necker Hospital, Paris, France
| | - Christophe Deligny
- grid.412874.c0000 0004 0641 4482Department of Internal Medicine, Martinique University Hospital, Fort-de France, France
| | - Yves Hatchuel
- grid.412874.c0000 0004 0641 4482Department of Pediatrics, Martinique University Hospital, MFME. CHU de La Martinique, La Meynard 97261, Fort-de France, France
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5
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Freeman H, Lutz K, Riquelme P, Kahl L. Non-ST-elevation myocardial infarction hiding behind myopericarditis in a patient with systemic lupus erythematosus. BMJ Case Rep 2022; 15:e243540. [PMID: 35217546 PMCID: PMC8883200 DOI: 10.1136/bcr-2021-243540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/03/2022] Open
Abstract
Systemic lupus erythematosus (SLE) is a chronic inflammatory condition with various cardiovascular sequelae. Pericarditis is the most common cardiac manifestation, yet patients also have a markedly elevated risk of premature atherosclerosis and acute coronary syndrome (ACS). This makes the diagnosis of ischaemic chest pain both challenging and crucial in these patients. Here, we examine the case of a 39-year-old male who presented with acute myopericarditis and pericardial tamponade in the setting of newly diagnosed SLE. Several days later, the patient experienced an infero-septal non-ST-elevation myocardial infarction. Urgent percutaneous coronary intervention showed 100% proximal right coronary artery (RCA) occlusion with subsequent placement of two overlapping drug-eluting stents to the proximal-mid RCA. This case illustrates the need to carefully evaluate patients with SLE for underlying cardiovascular disease regardless of age or the presence of tradition risk factors. Recognition of the increased incidence of ACS in SLE patients is crucial for early diagnosis and revascularisation.
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Affiliation(s)
- Howard Freeman
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Katherine Lutz
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Patricio Riquelme
- Department of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Leslie Kahl
- Division of Arthritis and Rheumatic Diseases, Oregon Health & Science University, Portland, Oregon, USA
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Visualization of Concurrent Epicardial and Microvascular Coronary Artery Disease in a Patient with Systemic Lupus Erythematosus by Magnetic Resonance Imaging. Top Magn Reson Imaging 2022; 31:3-8. [PMID: 35225839 DOI: 10.1097/rmr.0000000000000294] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
ABSTRACT We present a patient with history of systemic lupus erythematosus who presented with acute chest pain. Electrocardiography, invasive coronary angiography, and cardiac MRI were performed during the course of her evaluation. Invasive coronary angiography demonstrated obstructive disease in the diagonal system and cardiovascular MRI confirmed an anterior infarct consistent with the electrocardiographic findings. However, MRI also revealed focal inferoseptal hypoperfusion inconsistent with electrocardiographic and angiographic findings. Rather, these findings indicate the presence of concurrent microvascular coronary artery disease, which has a high prevalence among women with autoimmune disease.
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Abel D, Ardoin SP, Gorelik M. The potential role of Colchicine in preventing coronary vascular disease in childhood-onset lupus: a new view on an old drug. Pediatr Rheumatol Online J 2021; 19:15. [PMID: 33593369 PMCID: PMC7885423 DOI: 10.1186/s12969-021-00504-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 02/08/2021] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Patients with systemic lupus erythematous have a significantly increased risk of cardiovascular disease, which is not fully explained by traditional cardiovascular disease risk factors. Despite increasing life expectancy in patients with systemic lupus erythematous, mortality due to cardiovascular disease, the major cause of death in these patients, has not changed. Children with lupus suffer from more aggressive disease compared to their adult counterparts, and there is a growing concern for their increased risk of cardiovascular disease as they age. BODY: There is an unmet need for therapies to address the increased risk of cardiovascular disease in childhood-onset lupus. Colchicine has many anti-inflammatory and cardiovascular protective properties, including inhibition of IL-1β and IL-18 activity, key proinflammatory cytokines that are predictive of future adverse cardiovascular events. In the Colchicine Cardiovascular Outcomes Trial (COLCOT), colchicine was recently found to have significant benefit with minimal risk in adults with previous myocardial infarction for prevention of secondary vascular disease. While adult studies are promising, no studies have been conducted in pediatric patients to investigate colchicine's potential for cardiovascular protection in children and adolescents with lupus. CONCLUSIONS Studies investigating colchicine's potential role for cardiovascular protection are needed in pediatric patients with systemic lupus erythematous.
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Affiliation(s)
- Dori Abel
- Department of Pediatrics, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, 630 W. 168th Street, New York, NY, 10032-3702, USA.
| | - Stacy P. Ardoin
- grid.261331.40000 0001 2285 7943Department of Medicine, Division of Rheumatology and Immunology, The Ohio State University, 370 W. 9th Ave, Columbus, OH 43210 USA ,grid.240344.50000 0004 0392 3476Department of Rheumatology, Nationwide Children’s Hospital, 700 Children’s Dr, Columbus, OH 43205 USA
| | - Mark Gorelik
- grid.21729.3f0000000419368729Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Columbia University Irving Medical Center, 630 W. 168th St, New York, NY 10032-3702 USA
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8
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Khunger A, Battel L, Wadhawan A, More A, Kapoor A, Agrawal N. New Insights into Mechanisms of Immune Checkpoint Inhibitor-Induced Cardiovascular Toxicity. Curr Oncol Rep 2020; 22:65. [DOI: 10.1007/s11912-020-00925-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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9
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Ke SR, Liu CW, Wu YW, Lai KR, Wu CY, Lin JW, Chan CL, Pan RH. Systemic lupus erythematosus is associated with poor outcome after acute myocardial infarction. Nutr Metab Cardiovasc Dis 2019; 29:1400-1407. [PMID: 31648884 DOI: 10.1016/j.numecd.2019.08.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 07/31/2019] [Accepted: 08/13/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND Systemic lupus erythematosus (SLE) is associated with a higher risk of cardiovascular disease. However, it is not clear whether or not SLE is associated with poor outcomes after acute myocardial infarction (AMI). METHODS AND RESULTS Using the Taiwan National Health Insurance Database, we identified the SLE group as patients with AMI who have a concurrent discharge diagnosis of SLE. We also selected an age-, sex-, hospital level-, and admission calendar year-matched non-SLE group at a ratio of 1:3 from the total non-SLE group. One hundred fifty-one patients with SLE, 113,791 patients without SLE, and 453 matched patients without SLE were admitted with a diagnosis of AMI. Patients with SLE were significantly younger, predominantly female, and more likely to have chronic kidney disease than those without SLE. The in-hospital mortality rates were 12.6%, 9.0%, and 4.2% in the SLE, total non-SLE, and matched non-SLE groups, respectively. The in-hospital mortality was significantly higher in the SLE group than in the total non-SLE group (OR = 1.98; 95% CI = 1.2-3.26) and the matched non-SLE group (mortality OR = 2.20; 95% CI = 1.06-4.58). In addition, the SLE group was associated with a borderline significant risk of prolonged hospitalization when compared with the non-SLE group. CONCLUSION SLE is associated with a higher risk of in-hospital mortality and a borderline significantly higher risk of prolonged hospitalization after AMI.
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Affiliation(s)
- Shin-Rong Ke
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Cheng-Wei Liu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Internal Medicine, Tri-Service General Hospital Songshan branch, National Defense Medical Center Taipei, Taipei, Taiwan; Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yen-Wen Wu
- Cardiology Division of Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Nuclear Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan; Department of Nuclear Medicine, Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - K Robert Lai
- Department of Computer Science and Engineering, Yuan Ze University, Taoyuan, Taiwan
| | - Chiung-Yi Wu
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan
| | - Jeng-Wei Lin
- Department of Information Management, Tunghai University, Taichung, Taiwan
| | - Chien-Lung Chan
- Department of Information Management, Yuan Ze University, Taoyuan, Taiwan.
| | - Ren-Hao Pan
- Innovation Center for Big Data and Digital Convergence, Yuan Ze University, Taoyuan, Taiwan; Department of Information Management, Tunghai University, Taichung, Taiwan; La Vida Tec Co. Ltd., Taichung, Taiwan.
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10
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Choi KU, Kim U. Acute left main coronary artery thrombosis as an initial presentation of systemic lupus erythematosus. Yeungnam Univ J Med 2018; 35:227-231. [PMID: 31620599 PMCID: PMC6784701 DOI: 10.12701/yujm.2018.35.2.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Revised: 03/14/2018] [Accepted: 03/28/2018] [Indexed: 11/06/2022] Open
Abstract
Left main coronary artery (LMCA) thrombosis is rare and the cause should be determined. A previously healthy young man presented with severe chest pain and dyspnea. The electrocardiogram showed typical ST-segment elevation myocardial infarction with clinical instability. Emergency coronary angiography revealed complete LMCA occlusion by thrombosis. After reperfusion, the patient was admitted to the cardiac care unit. He was diagnosed with hemolytic anemia and tested positive for antinuclear antibodies. Systemic lupus erythematosus (SLE) and LMCA disease due to systemic thrombosis were diagnosed. Steroids were started and the patient was discharged without complications. We report this rare case of LMCA thrombosis as an initial presentation of SLE.
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Affiliation(s)
| | - Ung Kim
- Corresponding Author: Ung Kim, Division of Cardiology, Department of Internal Medicine, Yeungnam University College of Medicine, 170, Hyunchung-ro, Nam-gu, Daegu 42415, Korea Tel: +82-53-620-3832, Fax: +82-53-654-8386 E-mail:
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Hermansen ML, Sandholt B, Fuchs A, Sillesen H, Køber L, Kofoed KF, Faurschou M, Jacobsen S. Atherosclerosis and renal disease involvement in patients with systemic lupus erythematosus: a cross-sectional cohort study. Rheumatology (Oxford) 2018; 57:1964-1971. [DOI: 10.1093/rheumatology/key201] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Indexed: 01/06/2023] Open
Affiliation(s)
- Marie-Louise Hermansen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Benjamin Sandholt
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Andreas Fuchs
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lars Køber
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Klaus Fuglsang Kofoed
- Department of Cardiology, The Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Department of Radiology, The Diagnostic Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Mikkel Faurschou
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Søren Jacobsen
- Copenhagen Lupus and Vasculitis Clinic, Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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12
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Jeudy J, White CS, Kligerman SJ, Killam JL, Burke AP, Sechrist JW, Shah AB, Hossain R, Frazier AA. Spectrum of Coronary Artery Aneurysms: From the Radiologic Pathology Archives. Radiographics 2018; 38:11-36. [DOI: 10.1148/rg.2018170175] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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13
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Saling LJ, Raptis DA, Parekh K, Rockefeller TA, Sheybani EF, Bhalla S. Abnormalities of the Coronary Arteries in Children: Looking beyond the Origins. Radiographics 2017; 37:1665-1678. [PMID: 29019754 DOI: 10.1148/rg.2017170018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Coronary arterial abnormalities are uncommon findings in children that have profound clinical implications. Although anomalies of the coronary origins are well described, there are many other disease processes that affect the coronary arteries. Immune system-mediated diseases (eg, Kawasaki disease, polyarteritis nodosa, and other vasculiditides) can result in coronary arterial aneurysms, strictures, and abnormal tapering of the vessels. Because findings at imaging are an important component of diagnosis in these diseases, the radiologist's understanding of them is essential. Congenital anomalies may present at varying ages, and findings in hemodynamically significant anomalies, such as fistulas, are key for both diagnosis and preoperative planning. Pediatric heart surgery can result in wide-ranging postoperative imaging appearances of the coronary arteries and also predisposes patients to a multitude of complications affecting the heart and coronary arteries. In addition, although rare, accidental trauma can lead to injury of the coronary arteries, and awareness and detection of these conditions are important for diagnosis in the acute setting. Patients with coronary arterial conditions at presentation may range from being asymptomatic to having findings of myocardial infarction. Recognition of the imaging findings is essential to direct appropriate treatment. ©RSNA, 2017.
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Affiliation(s)
- Lauren J Saling
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Demetrios A Raptis
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Keyur Parekh
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Toby A Rockefeller
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Elizabeth F Sheybani
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
| | - Sanjeev Bhalla
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd, Campus Box 8131, St Louis, MO 63110 (L.J.S., D.A.R., S.B.); Department of Diagnostic Radiology and Nuclear Medicine, Rush University Medical Center, Chicago, Ill (K.P.); Department of Cardiology, St Louis Children's Hospital, St Louis, Mo (T.A.R.); and Department of Radiology, Mercy Hospital, St Louis, Mo (E.F.S.)
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14
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A rare case of acute myocardial infarction with a non-specific symptom in a young female with systemic lupus erythematosus. J Cardiol Cases 2017; 16:56-61. [PMID: 30279797 DOI: 10.1016/j.jccase.2017.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/13/2017] [Accepted: 04/25/2017] [Indexed: 11/24/2022] Open
Abstract
A 31-year-old female with an 18-year history of systemic lupus erythematosus (SLE) complained of epigastralgia and consulted the emergency outpatient department at our hospital. Her physical examination revealed tenderness at the scrobiculus cordis, which was a non-specific symptom of coronary heart disease (CHD). We ultimately gave a diagnosis of acute myocardial infarction based on coronary angiography and performed percutaneous coronary intervention. Although pre-interventional intravascular ultrasound demonstrated distinct atherosclerotic lesions in the coronary arteries, there were no atherosclerotic lesions in other systemic arteries. Although CHD in young SLE patients is a significant cause of morbidity and premature death, it tends to be misdiagnosed because their symptoms may be non-specific. In addition, this case highlights the fact that even SLE patients with no systemic atherosclerosis are at risk for the development of CHD. <Learning objective: Coronary heart disease (CHD) in young systemic lupus erythematosus (SLE) patients is a significant cause of morbidity and premature death, but it tends to be misdiagnosed because their symptoms may be non-specific. Moreover, SLE patients are at risk for the development of CHD.>.
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Honigberg MC, Wallace ZS, Castelino FV. A 30-Year-Old Woman With Chest Pain and Coronary Artery Aneurysms. Arthritis Care Res (Hoboken) 2016; 68:1378-84. [DOI: 10.1002/acr.22476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/13/2014] [Accepted: 09/09/2014] [Indexed: 11/09/2022]
Affiliation(s)
| | - Zachary S. Wallace
- Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
| | - Flavia V. Castelino
- Massachusetts General Hospital and Harvard Medical School; Boston Massachusetts
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Lai CH, Lu TM, Juan YH, Chang SL, Lee WL, Sung SH. Severe Coronary Spasm in Systemic Lupus Erythematosus Resulting in Recurrent Occlusions and Guide Wire Fracture. ACTA CARDIOLOGICA SINICA 2016; 32:498-501. [PMID: 27471364 DOI: 10.6515/acs20151013b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Middle-aged female patients with systemic lupus erythematosus (SLE) have an increased risk of coronary artery disease and myocardial infarction (MI). We report a case of left anterior descending coronary artery (LAD) MI associated with severe coronary spasm in both the LAD and left circumflex artery, complicated with fracture of the distal wire within the microcatheter which was successfully removed by manual aspiration using an inflation device. From this series of rare complications of SLE with MI, severe coronary spasm and guide wire fracture, we underscore that clinicians performing coronary intervention should be aware of an elevated chance of possible severe coronary spasms in SLE patients.
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Affiliation(s)
- Chih-Hung Lai
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; School of Medicine, National Yang-Ming University
| | - Tse-Min Lu
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei
| | - Yu-Hsiang Juan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou and Chang Gung University; ; Healthy Aging Research Center, Chang Gung University, Taoyuan
| | - Szu-Ling Chang
- School of Medicine, National Yang-Ming University; ; Department of Anesthesiology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Wen-Lieng Lee
- Division of Interventional Cardiology, Cardiovascular Center, Taichung Veterans General Hospital, Taichung; ; School of Medicine, National Yang-Ming University
| | - Shih-Hsien Sung
- School of Medicine, National Yang-Ming University; ; Division of Cardiology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei
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Reddy YNV, Sundaram V, Tam M, Parikh SA. Spontaneous coronary artery thrombosis in the setting of active lupus mesenteric vasculitis. Lupus 2015; 24:885-8. [DOI: 10.1177/0961203315570167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 01/07/2015] [Indexed: 11/16/2022]
Abstract
A 33-year-old male with systemic lupus erythematosus (SLE) presented with acute abdominal pain and was found to have lupus mesenteric vasculitis on imaging and during exploratory laparotomy. Post laparotomy he continued to have persistent nausea and dyspepsia and an electrocardiogram showed evidence of an inferior ST elevation myocardial infarction (STEMI). Emergency cardiac catheterization showed evidence of thrombotic right coronary artery occlusion. His coronaries were otherwise normal with no evidence of underlying coronary artery disease. Extensive workup with trans-esophageal echo, serologies for antiphospholipid antibody syndrome (APS) and bubble study was negative. This effectively ruled out Libman–Sacks endocarditis, APS-induced arterial thrombus and paradoxical emboli as potential causes of his STEMI. By exclusion of other causes, the etiology of his STEMI was felt to be secondary to in-situ coronary artery thrombosis in the setting of active SLE. To the best of our knowledge, this is the first report of a patient with SLE presenting with both lupus mesenteric vasculitis and in-situ coronary arterial thrombosis in the absence of APS.
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Affiliation(s)
- Yogesh N V Reddy
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - V Sundaram
- University Hospitals Case Medical Center, Harrington Heart & Vascular Institute Division of Cardiovascular Medicine
| | - M Tam
- University Hospitals Case Medical Center, Harrington Heart & Vascular Institute Division of Cardiovascular Medicine
| | - S A Parikh
- University Hospitals Case Medical Center, Harrington Heart & Vascular Institute Division of Cardiovascular Medicine
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18
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Ha Vu N, Duttmann R, De Bels D, Devriendt J, Reper P. Fatal multiple coronary involvements in a young woman with systemic lupus erythematosus. Acta Clin Belg 2014; 69:460-2. [PMID: 25109350 DOI: 10.1179/2295333714y.0000000063] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
We report a rare case of fulminant congestive heart failure with fatal outcome in a 21-year-old girl with systemic lupus erythematosus (SLE). A young woman was admitted in the intensive care unit for pericardial tamponade associated with disseminated coagulopathy and refractory shock secondary to multiple coronary aneurysms. Post-mortem examination revealed significant multiple coronary lesions with aneurysms of the interventricular and right coronary arteries, responsible of muscular necrosis, thrombosis of the coronary sinus, and significant pericardial infiltration with hemorrhagic fluid. We describe a refractory cardiac failure with extensive coronary artery involvements, which is very uncommon in young patients with SLE: few cases have been previously described in the literature. We report a rare case of fulminant congestive heart failure with fatal outcome in a young woman with SLE related to extensive coronary involvements.
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Virtual histology-intravascular ultrasound study in a patient with systemic lupus erythematosus coronary arteritis. Coron Artery Dis 2014; 25:725-6. [PMID: 25365644 DOI: 10.1097/mca.0000000000000152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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Jones Buie JN, Oates JC. Role of interferon alpha in endothelial dysfunction: insights into endothelial nitric oxide synthase-related mechanisms. Am J Med Sci 2014; 348:168-75. [PMID: 24796291 PMCID: PMC4526236 DOI: 10.1097/maj.0000000000000284] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune disease that is characterized by the production of autoantibodies against nuclear antigens such as double-stranded DNA. Lupus predominantly affects women (ratio, 9:1). Moreover, premenopausal women with SLE are 50 times more likely to have a myocardial infarction. Although specific risk factors for advanced cardiovascular complications have not been identified in this patient population, endothelial dysfunction is highly prevalent. Recent studies show that the type I interferon signature gene expression coincides with impaired brachial artery flow-mediated dilation and diminished endothelial progenitor cell circulation, both markers of impaired endothelial function. Although many factors promote the development of vascular endothelial dysfunction, all pathways converge on the diminished activity of endothelial nitric oxide synthase (eNOS) and loss of nitric oxide (NO) bioavailability. Studies examining the effects of type I interferons on eNOS and NO in SLE are missing. This literature review examines the current literature regarding the role of type I interferons in cardiovascular disease and its known effects on regulators of eNOS and NO bioavailability that are important for proper endothelial cell function.
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Affiliation(s)
- Joy N Jones Buie
- Division of Rheumatology and Immunology in the Department of Medicine, Medical University of South Carolina; and Division of Rheumatology and Immunology (JNJB, JCO), Department of Microbiology and Immunology, Medical Research Service of the Ralph H. Johnson VAMC, The Medical University of South Carolina, Charleston, South Carolina
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21
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Komatsu H, Kikuchi M, Nakagawa H, Fukuda A, Iwakiri T, Toida T, Sato Y, Kitamura K, Fujimoto S. Long-term survival of patients with IgA nephropathy after dialysis therapy. Kidney Blood Press Res 2013; 37:649-56. [PMID: 24356555 DOI: 10.1159/000355745] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS How dialysis affects the survival of patients with biopsy-proven IgA nephropathy (IgAN) is not fully understood. The present long-term cohort study quantifies the survival rates and incidence of cardio-cerebrovascular diseases (CCVDs) among such patients in Japan. METHODS Fifty-two of 433 patients with IgAN who had reached end-stage kidney disease underwent renal replacement therapy (RRT) between 1981 and 2010. The overall survival rate and incidence of CCVDs in these patients were evaluated during follow-up for 11.3 ± 6.4 years. RESULTS The mean age at starting RRT was 42.8 ± 13.3 years. Only seven patients died during follow-up (mortality rate, 1.2/100 person-years) and Kaplan-Meier analysis revealed favorable survival rates of 93.3% and 65.1% at 10 and 20 years, respectively, compared with that of patients with glomerulonephritis in the registry of the Japanese Society for Dialysis Therapy who required RRT. Malignancy and CCVDs were causes of death at 13.6 ± 4.8 and 3.9 ± 1.3 years, respectively, after starting RRT. Fatal and non-fatal CCVDs developed in 15 (incidence, 2.7/100 person-years) patients and acute coronary syndrome and cerebral hemorrhage developed relatively soon after starting RRT. Cox proportional hazards models revealed that age at the time of starting RRT was a significant factor affecting the onset of CCVDs. Meanwhile, a history of having had corticosteroid as an initial treatment did not affect the onset of events. CONCLUSION Although the survival of patients with IgAN is favorable after dialysis, the onset of CCVDs during the early phase of dialysis should be carefully monitored.
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Affiliation(s)
- Hiroyuki Komatsu
- First Department of Internal Medicine, University of Miyazaki Hospital, Miyazaki, Japan
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22
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González-Pacheco H, Eid-Lidt G, Piña-Reyna Y, Amezcua-Guerra LM, Aldana-Sepúlveda N, Martínez-Sánchez C. Acute left main coronary artery thrombosis as the first manifestation of systemic lupus erythematosus and catastrophic antiphospholipid syndrome. Am J Emerg Med 2013; 32:197.e3-5. [PMID: 24176588 DOI: 10.1016/j.ajem.2013.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 09/24/2013] [Indexed: 11/28/2022] Open
Abstract
Most coronary events in young adults are related to atherosclerosis; however, approximately 20% of coronary heart disease in young adults is related to nonatherosclerotic factors such as coronary abnormalities, connective tissue disorders, and autoimmune diseases. Different initial manifestations of systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS) have been reported. Myocardial infarction is observed in patients with SLE in all age groups; it appears during the course of the disease; and it is unusual in the APS. We present a unique case of a 28-year-old young man previously healthy who has an ST-elevation myocardial infarction by total acute thrombosis of the left main coronary artery. Laboratory studies demonstrated the presence of antibodies for SLE and APS. The patient was treated successfully with percutaneous coronary intervention. He developed catastrophic APS despite an adequate anticoagulation and was treated with intravenous steroids and plasmapheresis. Clinical evolution was satisfactory, and he discharged from the hospital. This case highlights the importance of considering in the emergency department, the prothrombotic states such as SLE and APS in young patients presenting with acute myocardial infarction caused by an unexplained intracoronary thrombosis. Early diagnosis of catastrophic APS and aggressive therapies are essential to help such patients from succumbing to this potentially fatal condition.
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Affiliation(s)
| | - Guering Eid-Lidt
- Catheterization Laboratory, National Institute of Cardiology, Mexico City, Mexico
| | - Yigal Piña-Reyna
- Catheterization Laboratory, National Institute of Cardiology, Mexico City, Mexico
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23
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Jasmin R, Ng CT, Sockalingam S, Yahya F, Cheah TE, Sadiq MA. Myocardial infarction with normal coronaries: an unexpected finding in a 13-year-old girl with systemic lupus erythematosus. Lupus 2013; 22:1518-22. [DOI: 10.1177/0961203313503913] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a 13-year-old girl diagnosed with systemic lupus erythematosus (SLE) who presented with left-sided chest pain, with ECG changes and elevation troponins that were suggestive of an acute inferior wall myocardial infarction (MI). Her multi-slice computed tomography coronary angiogram and standard angiogram were normal. The cardiac magnetic resonance imaging revealed an area of infarcted myocardium that was in the right coronary artery territory. We believe her MI was most likely secondary to coronary vasospasm. MI is rare and coronary vasospasm is an uncommon cause of MI in children and adolescents with SLE.
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Affiliation(s)
- R Jasmin
- Division of Rheumatology, Department of Medicine, University of Malaya, Malaysia
| | - C-T Ng
- Division of Rheumatology, Department of Medicine, University of Malaya, Malaysia
| | - S Sockalingam
- Division of Rheumatology, Department of Medicine, University of Malaya, Malaysia
| | - F Yahya
- Division of Rheumatology, Department of Medicine, University of Malaya, Malaysia
| | - T-E Cheah
- Division of Rheumatology, Department of Medicine, University of Malaya, Malaysia
| | - M Athar Sadiq
- Division of Cardiology, Department of Medicine, University of Malaya, Malaysia
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24
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Sokalski DG, Copsey Spring TR, Roberts WN. Large artery inflammation in systemic lupus erythematosus. Lupus 2013; 22:953-6. [PMID: 23761181 DOI: 10.1177/0961203313492241] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 23-year-old African-American woman with a history of recurrent pneumonias presented to the hospital with 2 weeks of shortness of breath, chest pain, fevers, and lightheadedness. The histologic diagnosis proved to be lupus aortitis. Optimal Framingham risk factor management by itself may not be a completely successful approach in diminishing the extra risk of atherosclerosis conferred by systemic lupus erythematosus (SLE). Therefore it remains possible that important modifiable cardiovascular risk factors may include low-grade SLE disease activity in medium-sized vessels. The implication of the idea that subclinical vessel inflammation is widespread in patients with lupus-and that this inflammation confers a significant part of the patients' risk of accelerated atherosclerosis-might be a lowering of the threshold for aggressive disease-modifying treatment of lupus, essentially a "treat-to-target" approach to systemic lupus.
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Affiliation(s)
- D G Sokalski
- Division of Rheumatology, Allergy and Immunology, Virginia Commonwealth University, Richmond, TN, USA
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25
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Alihanoglu YI, Kilic ID, Yildiz BS. Non-Atherosclerotic Causes of Acute Coronary Syndrome
and Management of The Patients. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2013. [DOI: 10.29333/ejgm/82300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Piao ZH, Jeong MH, Jeong HC, Rhew SH, Lee KH, Park KH, Sim DS, Hong YJ, Kim JH, Ahn Y, Cho JG, Park JC. Successful Percutaneous Coronary Intervention in a Young Male Systemic Lupus Erythematosus Patient with Acute Myocardial Infarction. J Lipid Atheroscler 2013. [DOI: 10.12997/jla.2013.2.2.91] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Zhe Hao Piao
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Myung Ho Jeong
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Hae Chang Jeong
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Shi Hyun Rhew
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Ki Hong Lee
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Keun Ho Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Doo Sun Sim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Young Joon Hong
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Ju Han Kim
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Youngkeun Ahn
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Jeong Gwan Cho
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
| | - Jong Chun Park
- Cardiovascular Research Center, Chonnam National University Hospital, Gwangju, Korea
- Regeneromics Research Center, Chonnam National University, Gwangju, Korea
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Shen CC, Chung HT, Huang YL, Yeh KW, Huang JL. Coronary artery dilation among patients with paediatric-onset systemic lupus erythematosus. Scand J Rheumatol 2012; 41:458-65. [PMID: 22827323 DOI: 10.3109/03009742.2012.694470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to evaluate increased coronary artery dimensions in patients with paediatric-onset systemic lupus erythematosus (SLE) in comparison with healthy controls, and to identify risk factors associated with increased coronary artery dimensions in the SLE patients. METHODS As part of a longitudinal cohort study of coronary artery disease (CAD) in paediatric-onset SLE, 83 children with SLE and 36 healthy controls were enrolled for a cross-sectional analysis. Their coronary artery diameters were measured by echocardiography while their body mass index (BMI), blood pressure, and other cardiovascular factors were recorded. The age at diagnosis, serum uric acid (UA) and creatinine levels, and other lupus-related factors were further evaluated in SLE patients. Data were analysed using linear regression. RESULTS Mean body surface area (BSA)-adjusted dimensions of the left coronary artery (LCA) and right coronary artery (RCA) were significantly larger in SLE patients than in controls (both p < 0.001). The age at diagnosis, BMI, and serum UA and creatinine levels were associated with LCA and RCA diameters. There were no correlations between the coronary artery diameters and blood pressure, SLE duration, SLE Disease Activity Index (SLEDAI), C-reactive protein (CRP), C3, C4, anti-double-stranded-DNA (anti-dsDNA), or lipid profile. In multivariate analysis, serum UA level, age at diagnosis, and BMI were consistently associated with coronary artery dimensions (p < 0.001, p = 0.008, and p = 0.006 for LCA; p = 0.020, 0.013, and 0.008 for RCA). CONCLUSIONS Increased coronary artery diameters were found in children with SLE and were associated with higher serum UA levels. The pathogenic mechanisms warrant further investigation.
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Affiliation(s)
- C C Shen
- Division of Allergy, Asthma, and Rheumatology, Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
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Soni SS, Ronco C, Pophale R, Bhansali AS, Nagarik AP, Barnela SR, Saboo SS, Raman A. Cardio-renal syndrome type 5: epidemiology, pathophysiology, and treatment. Semin Nephrol 2012; 32:49-56. [PMID: 22365162 DOI: 10.1016/j.semnephrol.2011.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The cardio-renal syndromes (CRS) recently were defined systematically as disorders of the heart or kidney whereby dysfunction of one organ leads to dysfunction of another. Five types of CRS are defined. The first four types describe acute or chronic cardio-renal or renocardiac syndromes. Type 5 CRS refers to secondary cardio-renal syndrome or cardio-renal involvement in systemic conditions. It is a clinical and pathophysiological entity to describe the concomitant presence of renal and cardiovascular dysfunction. Type 5 CRS can be acute or chronic and it does not strictly satisfy the definition of CRS. However, it encompasses many conditions in which combined heart and kidney dysfunction is observed. Because this entity has been described only recently there is limited information about the epidemiology, clinical course, and treatment of this condition.
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Affiliation(s)
- Sachin S Soni
- Department of Nephrology, Mahatma Gandhi Mission Medical College, Aurangabad, India.
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Daikeler T, Tichelli A, Passweg J. Complications of autologous hematopoietic stem cell transplantation for patients with autoimmune diseases. Pediatr Res 2012; 71:439-44. [PMID: 22430379 DOI: 10.1038/pr.2011.57] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Autologous hematopoietic stem cell transplantation (HSCT) has been used to treat severe and refractory autoimmune diseases (ADs) in children and adults for more than 15 years. The aim of this treatment is to restore tolerance through an intense lymphodepleting conditioning, and many patients have achieved lasting remissions. However, HSCT is associated with significant morbidity and mortality and is therefore not yet standard of care. Pre-existing reduced organ function of patients with ADs may increase the organ toxicity of conditioning. In the early post-HSCT phase, bacterial or fungal infections occur and therapy-associated lymphopenia sets patients at risk for reactivation of endogenous viruses and other opportunistic infections. During re-emerging of lymphopoiesis after HSCT, de novo autoimmunity may develop through loss of central or peripheral control mechanisms. Late effects of autologous HSCT (e.g., on the endocrine system) and a potentially increased frequency of secondary malignancies are of concern. The steadily increasing knowledge about specific complications occurring in patients with ADs after HSCT has led to the adaption of treatment protocols and has already reduced toxicity. Further prospective long-term follow-up studies are needed to identify patients at risk for developing serious complications after HSCT.
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Affiliation(s)
- Thomas Daikeler
- Department of Rheumatology, University Hospital Basel, Basel, Switzerland.
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30
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Cherian J, Duculan R, Amigues I, Crow MK, Kirou KA. A 26-year-old white man with a systemic lupus erythematosus flare and acute multiorgan ischemia: Vasculitis or thrombosis? Arthritis Care Res (Hoboken) 2011; 63:766-74. [DOI: 10.1002/acr.20439] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Chandra S, Singh V, Nehra M, Agarwal D, Singh N. ST-segment elevation in non-atherosclerotic coronaries: a brief overview. Intern Emerg Med 2011; 6:129-39. [PMID: 21153605 DOI: 10.1007/s11739-010-0491-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2010] [Accepted: 11/10/2010] [Indexed: 10/18/2022]
Abstract
The most common, clinically significant cause of ST elevation is an angiographically demonstrable occlusive disease due to atherosclerotic changes in coronary artery. Often, a patient presenting with non-specific complaints and ST-segment elevation on the electrocardiogram, is sent for a cardiac catheterization only to see no luminal stenosis on the angiogram. This clinical review is intended to inform emergency medicine physicians and internists about the conditions in which ST-segment elevation is accompanied with no atherosclerotic lesion on coronary angiography. These situations make a diverse array of conditions ranging from anomalous coronaries to anatomically normal coronaries with varied degrees of myocardial injury. These conditions are briefly reviewed in this article.
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Affiliation(s)
- Subhash Chandra
- Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
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32
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Patel PJ, Matthai, Jr. WH, Untereker WJ. Effective Management of Acute Coronary Thrombosis in a Young Woman with Lupus Using Aggressive Medical Therapy. Cardiology 2011; 118:45-9. [DOI: 10.1159/000324308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 01/11/2011] [Indexed: 01/23/2023]
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Matsumoto Y, Wakabayashi H, Otsuka F, Inoue K, Takano M, Sada KE, Makino H. Systemic lupus erythematosus complicated with acute myocardial infarction and ischemic colitis. Intern Med 2011; 50:2669-73. [PMID: 22041378 DOI: 10.2169/internalmedicine.50.5966] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acute myocardial infarction (AMI) is one of the most severe manifestations in patients with systemic lupus erythematosus (SLE). Ischemic colitis, mainly caused by intestinal vasculitis, is also one of the most serious, but uncommon, complications in SLE patients. "SLE vasculitis" simultaneously involving cardiac and gastrointestinal vessels has yet to be reported. This is the first report of SLE accompanying AMI, ischemic colitis and perforation of the digestive tract possibly due to SLE vasculitis, which was dramatically improved by treatment with high-dose glucocorticoid.
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Affiliation(s)
- Yoshinori Matsumoto
- Department of Medicine and Clinical Science, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan.
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Acikel S, Akdemir R, Dogan M, Kilic H, Yesilay AB. Antiphospholipid Antibody Syndrome: Coexistence of Left Ventricular Apical Thrombus and Deep Vein Thrombosis Causing Pulmonary Thromboembolism in a Patient with Systemic Lupus Erythematosus. Echocardiography 2010; 27:198-201. [DOI: 10.1111/j.1540-8175.2009.01014.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Silbiger JJ. The cardiac manifestations of antiphospholipid syndrome and their echocardiographic recognition. J Am Soc Echocardiogr 2010; 22:1100-8; quiz 1195. [PMID: 19801301 DOI: 10.1016/j.echo.2009.06.023] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Indexed: 02/01/2023]
Abstract
Antiphospholipid syndrome is an autoimmune disorder characterized by the presence of antiphospholipid antibodies, hypercoagulability, vascular thrombosis, and recurrent fetal loss. Cardiac involvement occurs frequently. Leaflet thickening and vegetations are detected quite often echocardiographically, but hemodynamically significant stenotic and/or regurgitant valvular disease is uncommon. Antiphospholipid syndrome can also cause left and right ventricular systolic and diastolic dysfunction as well as pulmonary hypertension. Other findings include spontaneous echo contrast and in situ mural thrombosis. In this review, the author discusses the major cardiac manifestations of antiphospholipid syndrome and highlights the role of echocardiography in their detection.
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Acute myocardial infarction in a young woman. COR ET VASA 2009. [DOI: 10.33678/cor.2009.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Acute myocardial infarction after treatment of thrombocytopenia in a young woman with systemic lupus erythematosus. J Clin Rheumatol 2009; 14:350-2. [PMID: 19086148 DOI: 10.1097/rhu.0b013e31817de0fb] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We describe a case of an acute myocardial infarction (MI) coincident with correction of severe thrombocytopenia in a 23-year old African American woman with systemic lupus erythematosus (SLE) in the absence of coronary artery disease on angiography. Despite a history of anticardiolipin and beta(2)-glycoprotein I antibodies, she had no prior thromboembolic events. The occurrence of an acute MI after rapid normalization in the platelet count suggests the need for close monitoring of possible cardiovascular events during and after treatment of severe thrombocytopenia in the presence of antiphospholipid antibodies.
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Hersh AO, von Scheven E, Yazdany J, Panopalis P, Trupin L, Julian L, Katz P, Criswell LA, Yelin E. Differences in long-term disease activity and treatment of adult patients with childhood- and adult-onset systemic lupus erythematosus. ACTA ACUST UNITED AC 2009; 61:13-20. [PMID: 19116979 DOI: 10.1002/art.24091] [Citation(s) in RCA: 134] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To compare differences in long-term outcome between adults with childhood-onset (age at diagnosis <18 years) systemic lupus erythematosus (SLE) and with adult-onset SLE. METHODS Data were derived from the University of California Lupus Outcomes Study, a longitudinal cohort of 885 adult subjects with SLE (90 childhood-onset [cSLE], 795 adult-onset [aSLE]). Baseline and 1-year followup data were obtained via structured 1-hour telephone interviews conducted between 2002 and 2006. Using self-report data, differences in organ involvement and disease morbidity, current disease status and activity, past and current medication use, and number of physician visits were compared, based on age at diagnosis of SLE. RESULTS Average disease duration for the cSLE and aSLE subgroups was 16.5 and 13.4 years, respectively, and mean age at followup was 30.5 and 49.9 years, respectively. When compared with aSLE subjects, cSLE subjects had a higher frequency of SLE-related renal disease, whereas aSLE subjects were more likely to report a history of pulmonary disease. Rates of clotting disorders, seizures, and myocardial infarction were similar between the 2 groups. At followup, cSLE subjects had lower overall disease activity, but were more likely to be taking steroids and other immunosuppressive therapies. The total number of yearly physician visits was similar between the 2 groups, although cSLE subjects had a higher number of nephrology visits. CONCLUSION This study demonstrates important differences in the outcomes of patients with cSLE and aSLE, and provides important prognostic information about long-term SLE disease activity and treatment.
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Korkmaz C. Potential effects of cyclosporin A on coronary vasomotor function in young patients with systemic lupus erythematosus: comment on the article by Hirata et al. ARTHRITIS AND RHEUMATISM 2008; 58:330-331. [PMID: 18163479 DOI: 10.1002/art.23234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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