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Zhong YL, Hu RY, Huang X. Aberrant Neurovascular Coupling in Diabetic Retinopathy Using Arterial Spin Labeling (ASL) and Functional Magnetic Resonance Imaging (fMRI) methods. Diabetes Metab Syndr Obes 2024; 17:2809-2822. [PMID: 39081370 PMCID: PMC11288319 DOI: 10.2147/dmso.s465103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 07/07/2024] [Indexed: 08/02/2024] Open
Abstract
Background Previous imaging studies have demonstrated that diabetic retinopathy (DR) is linked to structural and functional abnormalities in the brain. However, the extent to which DR patients exhibit abnormal neurovascular coupling remains largely unknown. Methods Thirty-one patients with DR and 31 sex- and age-matched healthy controls underwent resting-state functional magnetic resonance imaging (rs-fMRI) to calculate functional connectivity strength (FCS) and arterial spin-labeling imaging (ASL) to calculate cerebral blood flow (CBF). The study compared CBF-FCS coupling across the entire grey matter and CBF/FCS ratios (representing blood supply per unit of connectivity strength) per voxel between the two groups. Additionally, a support vector machine (SVM) method was employed to differentiate between diabetic retinopathy (DR) patients and healthy controls (HC). Results In DRpatients compared to healthy controls, there was a reduction in CBF-FCS coupling across the entire grey matter. Specifically, DR patients exhibited elevated CBF/FCS ratios primarily in the primary visual cortex, including the right calcarine fissure and surrounding cortex. On the other hand, reduced CBF/FCS ratios were mainly observed in premotor and supplementary motor areas, including the left middle frontal gyrus. Conclusion An elevated CBF/FCS ratio suggests that patients with DR may have a reduced volume of gray matter in the brain. A decrease in its ratio indicates a decrease in regional CBF in patients with DR. These findings suggest that neurovascular decoupling in the visual cortex, as well as in the supplementary motor and frontal gyrus, may represent a neuropathological mechanism in diabetic retinopathy.
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Affiliation(s)
- Yu-Lin Zhong
- Department of Ophthalmology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Rui-Yang Hu
- School of Ophthalmology and Optometry, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, 330006, People’s Republic of China
| | - Xin Huang
- Department of Ophthalmology, Jiangxi Provincial People’s Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, 330006, People’s Republic of China
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Akasha R, Ahmad S, Abdeen R, Abulgasim S, Barnawi H, Elhussein N, Hussien A R, Alshammari DN, Elafandy N, Alouffi S. Linking elevated HbA1c with atherogenic lipid profile among high risk cardiovascular patients at Qassim, Saudi Arabia. Bioinformation 2024; 20:212-216. [PMID: 38711997 PMCID: PMC11069612 DOI: 10.6026/973206300200212] [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] [Received: 03/01/2024] [Revised: 03/31/2024] [Accepted: 03/31/2024] [Indexed: 05/08/2024] Open
Abstract
The relationship between glycated hemoglobin (HbA1c) and an atherogenic lipid profile which is associated with a higher risk of cardiovascular disease is of interest. A retrospective cross-sectional study was conducted on 83 participants aged between 14 and 77 years. Their venous blood was drawn to determine the HbA1c and fasting lipid profile including total cholesterol triglycerides and high-density lipoprotein cholesterol (HDL-C) low-density lipoprotein cholesterol (LDL-C) non-HDL cholesterol and the LDL/HDL ratio were also calculated. The correlations between HbA1c levels and these lipid profile parameters were analyzed. The study showed a significant correlation between HbA1c and LDL-C non-HDL-C and the LDL/HDL ratio. Although there was no significant difference in total cholesterol levels among all groups the levels of total cholesterol and HbA1c were positively correlated. HDL-C exhibited direct correlations with HbA1c there was no correlation between HbA1c and clinical characteristics except for age. Data shows that HbA1c can be used as a predictor of dyslipidemia in diabetic patients there is a significant correlation between HbA1c and an atherogenic lipid profile which highlights the importance of glycemic control in reducing the risk of cardiovascular disease.
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Affiliation(s)
- Rihab Akasha
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Saheem Ahmad
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Rnada Abdeen
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Sara Abulgasim
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Heba Barnawi
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Nagwan Elhussein
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Rehab Hussien A
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Dina Nawaf Alshammari
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Nancy Elafandy
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
| | - Sultan Alouffi
- Department of Clinical Laboratory Sciences,College of Applied Medical Sciences,University of Hail, Saudi Arabia
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Chu TW, Hsieh TH, Lin TY, Hung SC. Association of diabetic retinopathy with risk of developing cardiovascular diseases in patients undergoing hemodialysis: A population-based cohort study. Nutr Metab Cardiovasc Dis 2023; 33:1565-1573. [PMID: 37246078 DOI: 10.1016/j.numecd.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 04/18/2023] [Accepted: 05/05/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS While patients undergoing dialysis have substantially increased cardiovascular event rates compared with the general population, predicting individual risk remains difficult. Whether diabetic retinopathy (DR) is associated with cardiovascular diseases in this population is unclear. METHODS AND RESULTS We conducted a nationwide cohort study of 27,686 incident hemodialysis patients with type 2 diabetes who were enrolled in Taiwan's National Health Insurance Research Database between January 1, 2010, and December 31, 2014, and had follow-up data until December 31, 2015. The primary outcome was a composite of macrovascular events, including acute coronary syndrome (ACS), acute ischemic stroke, and peripheral artery disease (PAD). A total of 10,537 (38.1%) patients had DR at baseline. We matched 9164 patients without DR (mean age, 63.7 years; 44.0% women) to 9164 patients with DR (mean age, 63.5 years; 43.8% women) by propensity score. During a median follow-up of 2.4 years, 5204 patients in the matched cohort experienced a primary outcome. The presence of DR was associated with a higher risk of a primary outcome (subdistribution hazard ratio [sHR] 1.07; 95% CI, 1.01-1.13), which reflected a higher risk of acute ischemic stroke (sHR 1.26; 95% CI, 1.14-1.39) and PAD (sHR 1.14; 95% CI, 1.05-1.25) but not ACS (sHR 0.99; 95% CI, 0.92-1.06). CONCLUSIONS The presence of DR signifies an increased risk of acute ischemic stroke and PAD in hemodialysis patients with type 2 diabetes, independent of the known risk factors. These results highlight the need for more comprehensive cardiovascular assessment and management in hemodialysis patients with DR.
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Affiliation(s)
- Ting-Wen Chu
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, MacKay Medical College, New Taipei City, Taiwan
| | - Tsung-Han Hsieh
- Department of Research, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City, Taiwan
| | - Ting-Yun Lin
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan.
| | - Szu-Chun Hung
- Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Moyá-Amengual A, Ruiz-García A, Pallarés-Carratalá V, Serrano-Cumplido A, Prieto-Díaz MÁ, Segura-Fragoso A, Cinza-Sanjurjo S. Elevated pulse pressure and cardiovascular risk associated in Spanish population attended in primary care: IBERICAN study. Front Cardiovasc Med 2023; 10:1090458. [PMID: 37229234 PMCID: PMC10203900 DOI: 10.3389/fcvm.2023.1090458] [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] [Received: 11/05/2022] [Accepted: 04/12/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Elevated pulse pressure (ePP) is an independent marker of cardiovascular risk (CVR) in people older than 60, and a functional marker of subclinical target organ damage (sTOD) which can predict cardiovascular events in patients with hypertension (HTN), regardless of sTOD. Objective To evaluate the prevalence of ePP in adult population seen in primary care and its association with other vascular risk factors, sTOD and with cardiovascular disease (CVD). Materials and methods Observational multicentre study conducted in Spain (8,066 patients, 54.5% women) from the prospective cohort study IBERICAN recruited in Primary Care. Pulse pressure (PP) was defined as the difference between the systolic blood pressure (SBP) and the diastolic blood pressure (DBP) ≥60 mmHg. Adjusted (for age and sex) ePP prevalence were determined. Bivariate and multivariate analyses of the possible variables associated with ePP were carried out. Results The mean of PP was 52.35 mmHg, and was significantly higher (p < 0.001) in patients with HTN (56.58 vs. 48.45 mmHg) The prevalence of ePP adjusted for age and sex was 23.54% (25.40% men vs. 21.75% women; p < 0.0001). The ePP prevalence rates increased linearly with age (R2 = 0.979) and were significantly more frequent in population aged ≥65 than in population aged <65 (45.47% vs. 20.98%; p < 0.001). HTN, left ventricular hypertrophy, low estimated glomerular filtration rate, alcohol consumption, abdominal obesity, and CVD were independently associated with ePP. 66.27% of patients with ePP had a high or very high CVR, as compared with 36.57% of patients without ePP (OR: 3.41 [95% CI 3.08-3.77]). Conclusions The ePP was present in a quarter of our sample, and it was increased with the age. Also, the ePP was more frequent in men, patients with HTN, other TOD (as left ventricular hypertrophy or low estimated glomerular filtration rate) and CVD; because of this, the ePP was associated a higher cardiovascular risk. In our opinion, the ePP is an importer risk marker and its early identification lets to improve better diagnostic and therapeutic management.
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Affiliation(s)
- Ana Moyá-Amengual
- Occupational and Physical Education and Sports Physician, Santa Catalina Health Centre, Palma, Spain
| | - Antonio Ruiz-García
- Lipids and Cardiovascular Prevention Unit, Pinto University Health Centre, Madrid, Spain
| | - Vicente Pallarés-Carratalá
- Health Surveillance Unit, Mutual Insurance Union, Castellón, Spain
- Department of Medicine, Jaume I University, Castellon, Spain
| | | | | | | | - Sergio Cinza-Sanjurjo
- Occupational and Physical Education and Sports Physician, Santa Catalina Health Centre, Palma, Spain
- Milladoiro Health Center, Santiago de Compostela, Spain
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O'Murchadha L, Egan AM, Cahill K, Flynn C, O'Flynn D, O'Neill J, Sreenan S, McDermott JH. Utility of screening for silent myocardial ischaemia in diabetes with an annual electrocardiogram. Diabet Med 2023; 40:e14983. [PMID: 36264255 DOI: 10.1111/dme.14983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/24/2022] [Accepted: 10/18/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND METHODS Asymptomatic coronary artery disease (CAD) is common in people with diabetes mellitus, but there is a lack of consensus regarding appropriate screening for the condition. We performed a 12-lead electrocardiogram (ECG) on 312 consecutive participants with diabetes mellitus attending for routine annual outpatient review in order to determine the effectiveness of a yearly ECG in screening people with diabetes for asymptomatic CAD. RESULTS Three of 312 participants (0.96%, 95% CI 0.2%-2.78%) had a newly identified ECG abnormality. One person had newly discovered atrial fibrillation. Two people had abnormalities which prompted further investigation for asymptomatic CAD. One of these participants underwent percutaneous coronary intervention. Seventeen further participants had abnormalities on ECG which had been previously documented, the majority having been present since their diagnosis of diabetes. CONCLUSION A low positive yield of routine annual ECG in our study does not support its use as a screening tool for asymptomatic CAD in diabetes. Our findings support advice to perform an ECG at diagnosis of diabetes and to repeat only if a person develops relevant symptoms.
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Affiliation(s)
- Liam O'Murchadha
- Department of Endocrinology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Aoife M Egan
- Department of Endocrinology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Kathleen Cahill
- Department of Endocrinology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Carly Flynn
- Department of Endocrinology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Dearbhail O'Flynn
- Department of Endocrinology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
- Department of Cardiology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - James O'Neill
- Department of Cardiology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - Seamus Sreenan
- Department of Endocrinology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
| | - John H McDermott
- Department of Endocrinology, Connolly Hospital Blanchardstown, Dublin 15, Ireland
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Pitale S, Sahasrabuddhe A, Gandhi P, Joshi P, Sakhare A, Balankhe N, Khobragade S, Sengupta S, Ambulkar S, Ganeriwal M, Shembalkar J, Naidu S. Clinical and Demographic Profile of Diabetic Patients from Central India - Results from Diabetes Registry. Indian J Endocrinol Metab 2022; 26:471-477. [PMID: 36618524 PMCID: PMC9815190 DOI: 10.4103/ijem.ijem_63_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 07/21/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022] Open
Abstract
Objective This study was done to analyse the demographic profile and presentation of diabetes in Central India. Design Data was collected for this cross-sectional study from an electronic diabetes registry from 2014 to 2019. Demographic details, patient history and presence or absence of co-morbid conditions, duration of diabetes, age of onset of diabetes, drug history, personal history, presence of micro and/or macrovascular complications and investigations done were obtained. Statistical Analysis The association between each factor and the outcome was studied in terms of prevalence ratio (PR) using the R-3.0.0 programming (R Foundation for Statistical Computing, Vienna, Austria) language. Statistical significance was evaluated at a 5% level. Results Among 12,434 patients, 54.95% were below 50 years and 45.05% were above 50 years. 50.21% were females and 49.79% were males. The mean age was 47.49 ± 14.78 years and the mean body mass index (BMI) was 26.85 ± 5.19 kg/m2 with 62.29% of obese patients (>25 kg/m2). The mean overall duration of diabetes was 7.64 ± 7.63 years. Mean Glycosylated Haemoglobin (HbA1c) in patients <=50 years was 8.60 ± 2.63 and 8.90 ± 1.91 for over 50. 65.59% had uncontrolled blood sugars. 25.19% of patients had hypertension and 18.1% had dyslipidaemia. Coronary artery disease (CAD), nephropathy, neuropathy and retinopathy were observed in 21.49%, 9.60%, 33.65% and 14.65%, respectively. The adjusted PR of cardiovascular disease (CVD) was 5.374 times higher for patients over 50 (P < 0.0001); 3.775 times higher for males (P < 0.0001), 1.64 times higher for patients with BMI >25 kg/m2 (P < 0.0001) and 3.643 times higher in hypertensive cases (P < 0.0001). Similar associations were observed with nephropathy, neuropathy and retinopathy. Conclusion From a large population study on diabetes, it was found a majority of the type 2 diabetes mellitus (T2DM) cases (65%) are sub-optimally controlled with HbA1c levels. Also, microvascular complications were related to the sub-optimal glycaemic control, but not the macro-vascular complications.
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Affiliation(s)
- Shailesh Pitale
- Department of Endocrinology, DEW Medicare and Trinity Hospital, Nagpur, Maharashtra, India
| | - Anagha Sahasrabuddhe
- Department of Physiology, DMMC and Shalinitai Meghe Hospital, Nagpur, Maharashtra, India
| | - Pramod Gandhi
- Department of Endocrinology, Kingsway Hospitals, Nagpur, Maharashtra, India
| | - Prashant Joshi
- Department of Medicine, All India Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Ajay Sakhare
- Department of Medicine, Viveka Hospitals, Nagpur, Maharashtra, India
| | - Nikhil Balankhe
- Department of Medicine, Viveka Hospitals, Nagpur, Maharashtra, India
| | | | - Shantanu Sengupta
- Department of Medicine, Sengupta Hospital, Nagpur, Maharashtra, India
| | - Sunil Ambulkar
- Department of Endocrinology, Institute of Endocrinology, Nagpur, Maharashtra, India
| | - Mukund Ganeriwal
- Department of Medicine, Ganeriwal Clinic, Nagpur, Maharashtra, India
| | | | - Sanjay Naidu
- Department of Endocrinology, Naidu Hospital, Nagpur, Maharashtra, India
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MicroRNA-134-5p and the Extent of Arterial Occlusive Disease Are Associated with Risk of Future Adverse Cardiac and Cerebral Events in Diabetic Patients Undergoing Carotid Artery Stenting for Symptomatic Carotid Artery Disease. Molecules 2022; 27:molecules27082472. [PMID: 35458670 PMCID: PMC9032654 DOI: 10.3390/molecules27082472] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/31/2022] [Accepted: 04/08/2022] [Indexed: 12/24/2022] Open
Abstract
There is little known about the prognostic value of serum microRNAs (miRs) in diabetic patients with symptomatic internal carotid artery disease (ICAS) who underwent stent supported angioplasty (PTA) for ICAS. The present study aimed to investigate expression levels of selected miRs for future major adverse cardiac and cerebral events (MACCE) as a marker in diabetic patients following ICAS-PTA. The expression levels of 11 chosen circulating serum miRs were compared in 37 diabetic patients with symptomatic ICAS and 64 control group patients with symptomatic ICAS, but free of diabetes. The prospective median follow-up of 84 months was performed for cardiovascular outcomes. Diabetic patients, as compared to control subjects, did not differ with respect to age (p = 0.159), distribution of gender (p = 0.375), hypertension (p = 0.872), hyperlipidemia (p = 0.203), smoking (p = 0.115), coronary heart disease (p = 0.182), lower extremities arterial disease (LEAD, p = 0.731), and miRs expressions except from lower miR-16-5p (p < 0.001). During the follow-up period, MACCE occurred in 16 (43.2%) diabetic and 26 (40.6%) non-diabetic patients (p = 0.624). On multivariate Cox analysis, hazard ratio (HR) and 95% Confidence Intervals (95%CI) for diabetic patients associated with MACCE were miR-134-5p (1.12; 1.05−1.21, p < 0.001), miR-499-5p (0.16; 0.02−1.32, p = 0.089), hs-CRP (1.14; 1.02−1.28; p = 0.022), prior myocardial infarction (8.56, 1.91−38.3, p = 0.004), LEAD (11.9; 2.99−47.9, p = 0.005), and RAS (20.2; 2.4−167.5, p = 0.005), while in non-diabetic subjects, only miR-16-5p (1.0006; 1.0001−1.0012, p = 0.016), miR-208b-3p (2.82; 0.91−8.71, p = 0.071), and hypertension (0.27, 0.08−0.95, p = 0.042) were associated with MACCE. Our study demonstrated that different circulating miRs may be prognostic for MACCE in diabetic versus non-diabetic patients with symptomatic ICAS. Higher expression levels of miR-134 were prognostic for MACCE in diabetic patients, while higher expression levels of miR-16 were prognostic in non-diabetic patients.
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Nnakenyi ID, Nnakenyi EF, Parker EJ, Uchendu NO, Anaduaka EG, Ezeanyika LU. Relationship between glycaemic control and lipid profile in type 2 diabetes mellitus patients in a low-resource setting. Pan Afr Med J 2022; 41:281. [PMID: 35855025 PMCID: PMC9250661 DOI: 10.11604/pamj.2022.41.281.33802] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 03/17/2022] [Indexed: 11/11/2022] Open
Abstract
Introduction diabetes mellitus can lead to complications including cardiovascular disease (CVD). Glycated haemoglobin (HbA1C) is a test of glycaemic control in T2DM patients, and its association with CVD can be mediated through modulation of risk factors such as dyslipidaemia. It is suggested that correlation of HbA1c with blood lipids may enable its use as a dual marker for glycaemic status and dyslipidaemia. The aim of this study was to determine the relationship between glycaemic control and blood lipid concentrations in T2DM patients. Methods a cross-sectional study of T2DM patients at Enugu, Nigeria. After obtaining informed consent, questionnaires were administered, and then venous blood was collected for determination of HbA1c and fasting lipid profile. Student T-test was used to compare mean results of two groups and Pearson correlation coefficient was used to determine relationships. A p-value <0.05 was considered to be statistically significant. Results fifty -five (55) T2DM patients comprising of 24 females and 31 males, with mean±SD age 57±12 years were studied. Prevalence of patients with poor glycaemic control (HbA1c≥7%) was 34 (61.8%). More males (36.4%) than females (25.4%) had poor glycaemic control. There was a positive, statistically significant correlation between HbA1c and TC (r=0.406); Low-Density Lipoprotein Cholesterol (LDL-C) (r=0.409); and triglyceride (TG) (r=0.273), p<0.05. Correlation between HbA1c and HDL-C was negative (r=-0.269, p<0.05). Conclusion the significant correlation between HbA1c and various lipid parameters may suggest the importance of glycaemic control as well as managing dyslipidaemia in the reduction of risk for CVD in T2DM patients, for which HbA1c may be used to monitor both, thereby reducing cost.
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Affiliation(s)
- Ifeyinwa Dorothy Nnakenyi
- Department of Chemical Pathology, University of Nigeria, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
| | - Emeka Francis Nnakenyi
- Department of Morbid Anatomy, University of Nigeria, University of Nigeria Teaching Hospital, Ituku Ozalla, Enugu, Nigeria
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Mauricio D, Alonso N, Gratacòs M. Chronic Diabetes Complications: The Need to Move beyond Classical Concepts. Trends Endocrinol Metab 2020; 31:287-295. [PMID: 32033865 DOI: 10.1016/j.tem.2020.01.007] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 11/22/2019] [Accepted: 01/09/2020] [Indexed: 12/11/2022]
Abstract
Chronic-diabetes-related complications simultaneously compromise both the micro- and macrovascular trees, with target organs considered as the paradigm of large vessel injury also entailing microangiopathic changes. However, complications independent or partially independent from vascular damage are often overlooked. This includes neuronal dysfunction (e.g., retinal neurodegeneration), interstitial injury (e.g., tubulointerstitial disease), metabolic damage (e.g., in the heart and liver), and nonclassical conditions such as cognitive decline, impaired pulmonary function, or increased risk of cancer. In this scenario, researchers, endocrinologists and primary care physicians should have a holistic view of the disease and pay further attention to all organs and all potential clinical repercussions, which would certainly contribute to a more rational and integrated patient health care.
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Affiliation(s)
- Dídac Mauricio
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain; CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain.
| | - Núria Alonso
- CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Barcelona, Spain; Department of Endocrinology and Nutrition, Health Sciences Research Institute & University Hospital Germans Trias i Pujol, Badalona, Spain
| | - Mònica Gratacòs
- DAP-Cat group, Unitat de Suport a la Recerca Barcelona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
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10
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Xiao-Rong Z, Hui-Rong Z, Mei L, Zhen Z, Wei L, Jing L, Guang-Ran Y, Jian-Bo Z, Jin-Kui Y. Risk of silent myocardial ischemia detected by single photon emission computed tomography (SPECT) among asymptomatic Chinese patients with type 2 diabetes. Medicine (Baltimore) 2019; 98:e15618. [PMID: 31096471 PMCID: PMC6531126 DOI: 10.1097/md.0000000000015618] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
To explore the prevalence and risk factors of silent myocardial ischemia (SMI) detected by using single photon emission computed tomography (SPECT) in Chinese asymptomatic patients with type 2 diabetes (T2D).In this hospital-based retrospective study, 821 T2D patients who were screened for SMI detected by stress myocardial perfusion imaging using SPECT between June 2014 and July 2016 were investigated. Clinical indicators were compared between the patients with SMI and controls without SMI. Risk factors for SMI were evaluated by univariate and multivariate analysis.In this study, there were 131 patients with SMI in asymptomatic diabetes and the prevalence of SMI was 21.3% of 614 individuals. Logistic regression analysis indicated that diabetic retinopathy (OR = 1.474, 95%CI: 1.113-1.951, P = .007), male gender (OR = 1.805, 95%CI: 1.183-2.747, P = .006), and low-density lipoprotein (LDL) cholesterol (OR = 1.298, 95%CI: 1.042-1.615, P = .02) were risk factors associated with SMI. Besides, the prevalence of SMI increased in associated with the progression of retinopathy (P = .041). The percentage of SMI diagnosed in patients with no diabetic retinopathy (NDR), non-proliferative diabetic retinopathy (NPDR), and proliferative diabetic retinopathy (PDR) were 18.5% (75/405), 25.2% (37/147), and 30.6% (19/62), respectively. The percentage of SMI in male (24.5%, 85/347) was higher than that in female (17.2%, 46/267), P = .029.Physicians should be aware of these conditions when examining male patients with type 2 diabetes, especially with DR and/or high level of low-density lipoprotein cholesterol (LDL cholesterol), even if otherwise asymptomatic. A routine screening for SMI may thus be considered advisable in these patients.
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Affiliation(s)
- Zhu Xiao-Rong
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Zhang Hui-Rong
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Li Mei
- Department of Nuclear Medicine Department, Beijing Tongren Hospital
| | - Zhou Zhen
- Department of Mathematics, School of Biomedical Engineering, Capital Medical University, Beijing
| | - Liu Wei
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Lu Jing
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
- Beijing Key Laboratory of Diabetes Research and Care
| | - Yang Guang-Ran
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Zhou Jian-Bo
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
| | - Yang Jin-Kui
- Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University
- Beijing Key Laboratory of Diabetes Research and Care
- Beijing Diabetes Institute, China
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11
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Pearce I, Simó R, Lövestam‐Adrian M, Wong DT, Evans M. Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review. Diabetes Obes Metab 2019; 21:467-478. [PMID: 30280465 PMCID: PMC6667892 DOI: 10.1111/dom.13550] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023]
Abstract
The aim of this systematic review was to examine the associations between diabetic retinopathy (DR) and the common micro- and macrovascular complications of diabetes mellitus, and how these could potentially affect clinical practice. A structured search of the PubMed database identified studies of patients with diabetes that assessed the presence or development of DR in conjunction with other vascular complications of diabetes. From 70 included studies, we found that DR is consistently associated with other complications of diabetes, with the severity of DR linked to a higher risk of the presence of, or of developing, other micro- and macrovascular complications. In particular, DR increases the likelihood of having or developing nephropathy and is also a strong predictor of stroke and cardiovascular disease, and progression of DR significantly increases this risk. Proliferative DR is a strong risk factor for peripheral arterial disease, which carries a risk of lower extremity ulceration and amputation. Additionally, our findings suggest that a patient with DR has an overall worse prognosis than a patient without DR. In conclusion, this analysis highlights the need for a coordinated and collaborative approach to patient management. Given the widespread use of DR screening programmes that can be performed outside of an ophthalmology office, and the overall cost-effectiveness of DR screening, the presence and severity of DR can be a means of identifying patients at increased risk for micro- and macrovascular complications, enabling earlier detection, referral and intervention with the aim of reducing morbidity and mortality among patients with diabetes. Healthcare professionals involved in the management of diabetes should encourage regular DR screening.
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Affiliation(s)
- Ian Pearce
- St Paul's Eye UnitRoyal Liverpool University HospitalLiverpoolUK
| | - Rafael Simó
- Vall d'Hebron Research Institute (VHIR) and Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM)BarcelonaSpain
| | | | - David T. Wong
- St. Michael's Hospital, University of TorontoTorontoCanada
| | - Marc Evans
- University Hospital Llandough, LlandoughWalesUK
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Simó R, Bañeras J, Hernández C, Rodríguez-Palomares J, Valente F, Gutierrez L, González-Alujas T, Ferreira I, Aguadé-Bruix S, Montaner J, Seron D, Genescà J, Boixadera A, García-Arumí J, Planas A, Simó-Servat O, García-Dorado D. Diabetic retinopathy as an independent predictor of subclinical cardiovascular disease: baseline results of the PRECISED study. BMJ Open Diabetes Res Care 2019; 7:e000845. [PMID: 31908800 PMCID: PMC6936469 DOI: 10.1136/bmjdrc-2019-000845] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Detection of subclinical cardiovascular disease (CVD) has significant impact on the management of type 2 diabetes. We examined whether the assessment of diabetic retinopathy (DR) is useful for identifying patients at a higher risk of having silent CVD. RESEARCH DESIGN AND METHODS Prospective case-control study comprising 200 type 2 diabetic subjects without history of clinical CVD and 60 age-matched non-diabetic subjects. The presence of subclinical CVD was examined using two parameters: (1) calcium coronary score (CACs); (2) composite of CACs >400 UA, carotid plaque ≥3 mm, carotid intima-media thickness ratio >1, or the presence of ECG changes suggestive of previous asymptomatic myocardial infarction. In addition, coronary angio-CT was performed. DR was assessed by slit-lamp biomicroscopy and retinography. RESULTS Type 2 diabetic subjects presented higher CACs than non-diabetic control subjects (p<0.01). Age, male gender, and the presence of DR were independently related to CACs >400 (area under the receiver operating characteristic curve (AUROC) 0.76). In addition, an inverse relationship was observed between the degree of DR and CACs <10 AU. The variables independently associated with the composite measurement of subclinical CVD were age, diabetes duration, the glomerular filtration rate, microalbuminuria, and the presence of DR (AUROC 0.71). In addition, a relationship (p<0.01) was observed between the presence and degree of DR and coronary stenosis. CONCLUSIONS The presence and degree of DR is independently associated with subclinical CVD in type 2 diabetic patients. Our results lead us to propose a rationalized screening for coronary artery disease in type 2 diabetes based on prioritizing patients with DR, particularly those with moderate-severe degree.
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Affiliation(s)
- Rafael Simó
- Diabetes and Metabolism Research Unit, Endocrinology Department, Vall d'Hebron Research Unit, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBERDEM, ISCIII, Madrid, Spain
| | - Jordi Bañeras
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Cristina Hernández
- Diabetes and Metabolism Research Unit, Endocrinology Department, Vall d'Hebron Research Unit, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBERDEM, ISCIII, Madrid, Spain
| | - José Rodríguez-Palomares
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Filipa Valente
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Laura Gutierrez
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Teresa González-Alujas
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Ignacio Ferreira
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
| | - Santiago Aguadé-Bruix
- Medical and Metabolic Research Area, Nuclear Medicine, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Montaner
- Neurovascular Research Laboratory, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniel Seron
- Nephrology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- REDinREN, ISCIII, Madrid, Spain
| | - Joan Genescà
- Liver Unit, Department of Medicine, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBEREHD, ISCIII, Madrid, Spain
| | - Anna Boixadera
- Ophthalmology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - José García-Arumí
- Ophthalmology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandra Planas
- Diabetes and Metabolism Research Unit, Endocrinology Department, Vall d'Hebron Research Unit, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
| | - Olga Simó-Servat
- Diabetes and Metabolism Research Unit, Endocrinology Department, Vall d'Hebron Research Unit, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBERDEM, ISCIII, Madrid, Spain
| | - David García-Dorado
- Cardiology Research Group, Cardiology Department, Vall d'Hebron Research Institute, Vall d'Hebron Hospital, Autonomous University of Barcelona, Barcelona, Spain
- CIBER CV, ISCIII, Madrid, Spain
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Cai S, Yang Q, Li X, Zhang Y. The efficacy and safety of aflibercept and conbercept in diabetic macular edema. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:3471-3483. [PMID: 30410308 PMCID: PMC6197825 DOI: 10.2147/dddt.s177192] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diabetic macular edema (DME) has shown an increasing prevalence during the past years and is the leading cause of diabetic retinopathy blindness. Traditional treatment modalities include laser and corticosteroid therapy, which, however, either act through unclear mechanisms or cause cataracts and elevated intraocular pressure. In recent years, as the pathogenic role of VEGF in DME has been well-recognized, the intravitreal injection of anti-VEGF drugs has become the first-line treatment of DME due to their great efficacy in improving visual acuity and mitigating macular edema. Advantages have been shown for aflibercept and conbercept, the two recombinant decoy receptors that can bind VEGF with high specificity and affinity, in DME treatment in clinical trials conducted both worldwide and in People’s Republic of China. This review introduces the structural characteristics and molecular mechanisms of action of these two anti-VEGF drugs, and summarizes the clinical trials evaluating their efficacy and safety, with the hope to provide clues for designing optimal and personalized therapeutic regimens for DME patients.
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Affiliation(s)
- Siwei Cai
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, College of Optometry and Ophthalmology, Tianjin Medical University, Tianjin 300384, People's Republic of China, ;
| | - Qianhui Yang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, College of Optometry and Ophthalmology, Tianjin Medical University, Tianjin 300384, People's Republic of China, ;
| | - Xiaorong Li
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, College of Optometry and Ophthalmology, Tianjin Medical University, Tianjin 300384, People's Republic of China, ;
| | - Yan Zhang
- Tianjin Medical University Eye Hospital, Tianjin Medical University Eye Institute, College of Optometry and Ophthalmology, Tianjin Medical University, Tianjin 300384, People's Republic of China, ;
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Manikkan AT. Elevated Troponin I Levels in Diabetic Ketoacidosis Without Obstructive Coronary Artery Disease. J Endocr Soc 2018; 2:1020-1023. [PMID: 30187014 PMCID: PMC6117402 DOI: 10.1210/js.2018-00152] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 07/13/2018] [Indexed: 11/19/2022] Open
Abstract
Elevated troponin levels have been observed in a wide spectrum of patients who do not have ischemic heart disease, including nonacute coronary syndrome and cardiovascular and noncardiovascular conditions. The cases of two patients with diabetic ketoacidosis who had elevated troponin levels in the absence of coronary artery disease are presented. This clinical scenario can pose a diagnostic dilemma for the physician. The objective of the present report is to highlight the mechanism of troponin elevation in patients with diabetic ketoacidosis, in addition to the clinical and prognostic significance of this finding.
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15
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Erectile dysfunction as a predictor of asymptomatic coronary artery disease in elderly men with type 2 diabetes. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:552-6. [PMID: 27582774 PMCID: PMC4987428 DOI: 10.11909/j.issn.1671-5411.2016.06.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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16
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Comparison of Choroidal Thickness Changes following Intravitreal Dexamethasone, Ranibizumab, and Triamcinolone in Eyes with Retinal Vein Occlusion. Eur J Ophthalmol 2016; 26:627-632. [DOI: 10.5301/ejo.5000734] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2016] [Indexed: 11/20/2022]
Abstract
Purpose To evaluate short-term choroidal thickness changes following intravitreal dexamethasone implant (DEX), ranibizumab (RAN), and triamcinolone acetonide (TA) in eyes with retinal vein occlusion (RVO) and macular edema (ME). Methods In this prospective study, 35 eyes of 35 patients with RVO and ME who were treated with intravitreal injections of DEX, RAN, and TA were included. Choroidal thickness was measured using semiautomated segmentation of enhanced depth imaging with optical coherence tomography at fovea and parafoveal areas. Changes in choroidal thickness following treatment were compared statistically. Results Choroidal thickness decreased following DEX, RAN, and TA treatments (all p>0.05). In the DEX group, at the first month nasal 1,500 µm (N11,500) and at the third month subfoveal (SF3) and nasal 500 µm (N3500) choroidal thickness revealed a significant reduction compared to RAN and TA groups (all p<0.05). In the TA group, choroidal thickness showed a significant reduction only at nasal 1,500 µm (N31,500) at the third month (p<0.05). Conclusions Choroidal thickness was decreased in all 3 groups. The DEX and TA groups showed a significant reduction at some areas. Ranibizumab had the smallest effect on choroidal thickness after 3 months among all groups.
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Gómez de Diego JJ, García-Orta R, Mahía-Casado P, Barba-Cosials J, Candell-Riera J. Update on cardiac imaging techniques 2012. ACTA ACUST UNITED AC 2014; 66:205-11. [PMID: 24775455 DOI: 10.1016/j.rec.2012.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 10/18/2012] [Indexed: 10/27/2022]
Abstract
Cardiac imaging is one of the basic pillars of modern cardiology. The potential list of scenarios where cardiac imaging techniques can provide relevant information is simply endless so it is impossible to include all relevant new features of cardiac imaging published in the literature in 2012 in the limited format of a single article. We summarize the year's most relevant news on cardiac imaging, highlighting the ongoing development of myocardial deformation and 3-dimensional echocardiography techniques and the increasing use of magnetic resonance imaging and computed tomography in daily clinical practice.
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Affiliation(s)
| | - Rocío García-Orta
- Servicio de Cardiología, Hospital Virgen de las Nieves, Granada, Spain
| | | | - Joaquín Barba-Cosials
- Departamento de Cardiología, Clínica Universidad de Navarra, Pamplona, Navarra, Spain
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18
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Lopez-Jaramillo P, Lopez-Lopez J, Lopez-Lopez C, Rodriguez-Alvarez MI. The goal of blood pressure in the hypertensive patient with diabetes is defined: now the challenge is go from recommendations to practice. Diabetol Metab Syndr 2014; 6:31. [PMID: 24594121 PMCID: PMC3973894 DOI: 10.1186/1758-5996-6-31] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Accepted: 02/22/2014] [Indexed: 02/08/2023] Open
Abstract
The recent Latin American and European guidelines published this year has proposed as a goal for blood pressure control in patients with diabetes type 2 a value similar or inferior to 140/90 mmHg. High blood pressure is the leading cause of cardiovascular diseases and deaths globally. Although once hypertension is detected, 80% of individuals are on a pharmacologic therapy only a minority is controlled. Diabetes also is a risk factor for other serious chronic diseases, including cardiovascular disease. Whether specifically targeting lower fasting glucose levels can reduce cardiovascular outcomes remains unknown. Hypertension is present in 20% to 60% of patients with type 2 diabetes, depending on age, ethnicity, obesity, and the presence of micro or macro albuminuria. High blood pressure substantially increases the risk of both macro and micro vascular complications, doubling the risk of all-cause mortality and stroke, tripling the risk of coronary heart disease and significantly hastening the progression of diabetic nephropathy, retinopathy, and neuropathy. Thus, blood pressure lowering is a major priority in preventing cardiovascular and renal events in patients with diabetes and hypertension. During many years the BP goals recommended in patients with diabetes were more aggressive than in patients without diabetes. As reviewed in this article many clinical trials have demonstrated not only the lack of benefits of lowering the BP below 130/80 mmHg, but also the J-shaped relationship in DM patients. Overall we discuss the importance of define the group of patients in whom significant BP reduction could be particularly dangerous and, on the other hand, those with a high risk of stroke who could benefit most from an intensive hypotensive therapy. In any case, the big challenge now is avoid the therapeutic inertia (leaving diabetic patients with BP values of 140/90 mmHg or higher) at all costs, as this would lead to an unacceptable toll in terms of human lives, suffering, and socioeconomic costs.
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Affiliation(s)
- Patricio Lopez-Jaramillo
- Research Institute and Clinic of Diabetes and Metabolic Syndrome, Fundación Oftalmológica de Santander (FOSCAL), Calle 155 A No 23-09, Torre Milton Salazar, Urbanizacion El Bosque, Floridablanca, Santander, Colombia
- MASIRA Research Institute, Medical School, Universidad de Santander (UDES), Bucaramanga, Colombia
| | - Jose Lopez-Lopez
- Medical School, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
| | - Cristina Lopez-Lopez
- Medical School, Universidad Autonoma de Bucaramanga (UNAB), Bucaramanga, Colombia
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Daniels A, Linz D, van Bilsen M, Rütten H, Sadowski T, Ruf S, Juretschke HP, Neumann-Haefelin C, Munts C, van der Vusse GJ, van Nieuwenhoven FA. Long-term severe diabetes only leads to mild cardiac diastolic dysfunction in Zucker diabetic fatty rats. Eur J Heart Fail 2014; 14:193-201. [DOI: 10.1093/eurjhf/hfr166] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Anneleen Daniels
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM); Maastricht University; Maastricht The Netherlands
| | - Dominik Linz
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM); Maastricht University; Maastricht The Netherlands
| | - Marc van Bilsen
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM); Maastricht University; Maastricht The Netherlands
| | | | | | - Sven Ruf
- Sanofi-Aventis Deutschland GmbH, R&D; Frankfurt Germany
| | | | | | - Chantal Munts
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM); Maastricht University; Maastricht The Netherlands
| | - Ger J. van der Vusse
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM); Maastricht University; Maastricht The Netherlands
| | - Frans A. van Nieuwenhoven
- Department of Physiology, Cardiovascular Research Institute Maastricht (CARIM); Maastricht University; Maastricht The Netherlands
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Soliman NAM, Abd-El Gawad WM. Can Ophthalmoscope Predict Silent Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus? ADVANCES IN AGING RESEARCH 2014; 03:360-367. [DOI: 10.4236/aar.2014.35046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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21
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Dominguez-Rodriguez A, Gomez MA, del Carmen Garcia-Baute M, Abreu-Gonzalez P, Gonzalez-Diaz A, Laynez-Cerdeña I. An appropriate use criterion is very important to reduce overuse for SPECT in coronary heart disease: Economic burden in time of crises. Int J Cardiol 2013; 168:4516-7. [DOI: 10.1016/j.ijcard.2013.06.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 06/30/2013] [Indexed: 10/26/2022]
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Cosson E, Nguyen MT, Chanu B, Balta S, Takbou K, Valensi P. The report of male gender and retinopathy status improves the current consensus guidelines for the screening of myocardial ischemia in asymptomatic type 2 diabetic patients. Nutr Metab Cardiovasc Dis 2013; 23:557-565. [PMID: 22502874 DOI: 10.1016/j.numecd.2012.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 12/30/2011] [Accepted: 01/25/2012] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS American Diabetes Association (ADA), French-speaking Societies for diabetes & cardiology (ALFEDIAM-SFC) and Cardiac Radionuclide Imaging (CRI) have proposed guidelines for the screening of silent myocardial ischemia (SMI). The aim of the study was to evaluate their diagnostic values and how to improve them. METHODS AND RESULTS 731 consecutive type 2 diabetic patients with ≥1 additional risk factor were screened between 1992 and 2006 for SMI by stress myocardial scintigraphy and for silent coronary artery disease (CAD) by coronary angiography. A total of 215 (29.4%) patients had SMI, and 79 of them had CAD. ADA (Odds Ratio 1.7 [95% Confidence Interval: 1.2-2.5]; p < 0.05), ALFEDIAM-SFC (OR 1.5 [1.0-2.5], p < 0.05) and CRI criteria (OR 2.0 [1.4-2.8], p < 0.01) predicted SMI. Considering the presence of male gender and retinopathy added to the prediction of SMI allowed by ADA criteria (c statistic: area under the curve AROC 0.651 [0.605-0.697] versus 0.582 [0.534-0.630]), p < 0.01 and ALFEDIAM-SFC criteria (AROC 0.672 [0.620-0.719] versus 0.620 [0.571-0.670], p < 0.05). CRI prediction of SMI was improved by considering the presence of macroproteinuria and retinopathy (AROC 0.621 [0.575-0.667] versus 0.594 [0.548-0.641], p < 0.01). Severe retinopathy (OR 3.4 [1.2-9.4], p < 0.05), smoking habits (OR 2.1 [1.1-4.2], p < 0.05) and triglyceride levels (OR 1.3 [1.0-1.6], p < 0.05) were independent predictors of CAD in the patients with SMI. CONCLUSION Current guidelines criteria are able to predict SMI but prediction may be improved by considering male gender and the presence of retinopathy. CAD is more frequent in the patients with SMI who are current smokers, have severe retinopathy and higher triglyceride levels.
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Affiliation(s)
- E Cosson
- AP-HP, Jean Verdier Hospital, Department of Endocrinology-Diabetology-Nutrition and Paris-Nord University, CRNH-IdF, Bondy, France.
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Brown DM, Nguyen QD, Marcus DM, Boyer DS, Patel S, Feiner L, Schlottmann PG, Rundle AC, Zhang J, Rubio RG, Adamis AP, Ehrlich JS, Hopkins JJ. Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE. Ophthalmology 2013; 120:2013-22. [PMID: 23706949 DOI: 10.1016/j.ophtha.2013.02.034] [Citation(s) in RCA: 601] [Impact Index Per Article: 54.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 02/25/2013] [Accepted: 02/25/2013] [Indexed: 02/08/2023] Open
Abstract
PURPOSE To report 36-month outcomes of RIDE (NCT00473382) and RISE (NCT00473330), trials of ranibizumab in diabetic macular edema (DME). DESIGN Phase III, randomized, multicenter, double-masked, 3-year trials, sham injection-controlled for 2 years. PARTICIPANTS Adults with DME (n=759), baseline best-corrected visual acuity (BCVA) 20/40 to 20/320 Snellen equivalent, and central foveal thickness (CFT) ≥ 275 μm on optical coherence tomography. METHODS Patients were randomized equally (1 eye per patient) to monthly 0.5 mg or 0.3 mg ranibizumab or sham injection. In the third year, sham patients, while still masked, were eligible to cross over to monthly 0.5 mg ranibizumab. Macular laser was available to all patients starting at month 3; panretinal laser was available as necessary. MAIN OUTCOME MEASURES The proportion of patients gaining ≥15 Early Treatment Diabetic Retinopathy Study letters in BCVA from baseline at month 24. RESULTS Visual acuity (VA) outcomes seen at month 24 in ranibizumab groups were consistent through month 36; the proportions of patients who gained ≥15 letters from baseline at month 36 in the sham/0.5 mg, 0.3 mg, and 0.5 mg ranibizumab groups were 19.2%, 36.8%, and 40.2%, respectively, in RIDE and 22.0%, 51.2%, and 41.6%, respectively, in RISE. In the ranibizumab arms, reductions in CFT seen at 24 months were, on average, sustained through month 36. After crossover to 1 year of treatment with ranibizumab, average VA gains in the sham/0.5 mg group were lower compared with gains seen in the ranibizumab patients after 1 year of treatment (2.8 vs. 10.6 and 11.1 letters). Per-injection rates of endophthalmitis remained low over time (∼0.06% per injection). The incidence of serious adverse events potentially related to systemic vascular endothelial growth factor inhibition was 19.7% in patients who received 0.5 mg ranibizumab compared with 16.8% in the 0.3 mg group. CONCLUSIONS The strong VA gains and improvement in retinal anatomy achieved with ranibizumab at month 24 were sustained through month 36. Delayed treatment in patients receiving sham treatment did not seem to result in the same extent of VA improvement observed in patients originally randomized to ranibizumab. Ocular and systemic safety was generally consistent with the results seen at month 24. FINANCIAL DISCLOSURE(S) Proprietary or commercial disclosure may be found after the references.
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Affiliation(s)
- David M Brown
- Retina Consultants of Houston, The Methodist Hospital, Houston, Texas
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Rong J, Yu CQ, Yang P, Chen J. Association of retinopathy with coronary atherosclerosis determined by coronary 64-slice multidetector computed tomography angiography in type 2 diabetes. Diab Vasc Dis Res 2013; 10:161-8. [PMID: 22906861 DOI: 10.1177/1479164112454755] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although there are substantial analyses for association of coronary artery disease (CAD) with diabetic retinopathy (DR), which was recognized as an indicator of risk for CAD in diabetes mellitus (DM), there is as yet little rigorous evaluation of the relationship between DR and subclinical coronary atherosclerosis (CAS) determined by coronary 64-slice multidetector computed tomography angiography (MDCTA) in persons with type 2 DM. In this article, we found that CAS associated with DR was independent of the traditional risk factors for CAD [odds ratio (OR): 5.1; 95% confidence interval (CI): 2.6-10.1; p < 0.001], and the severity and extent of CAS were significantly increased with the incidence and progression of DR (all p < 0.001). An independent association between hypertension, obesity, renal dysfunction and DR was also found (all p < 0.05). The relationship of CAS with DR was relatively continuous and graded under the diabetes status. Therefore, much of CAS and DR could be still multifactorial with common pathway.
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Affiliation(s)
- Jian Rong
- Geriatric Department, Military General Hospital of Chengdu PLA, Chengdu, Sichuan, People's Republic of China.
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Eubanks A, Raza F, Alkhouli M, Glenn AN, Homko C, Kashem A, Bove A. Clinical significance of troponin elevations in acute decompensated diabetes without clinical acute coronary syndrome. Cardiovasc Diabetol 2012; 11:154. [PMID: 23270513 PMCID: PMC3549932 DOI: 10.1186/1475-2840-11-154] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Accepted: 12/19/2012] [Indexed: 11/17/2022] Open
Abstract
Background Elevation of cardiac troponin has been documented in multiple settings without acute coronary syndrome. However, its impact on long-term cardiac outcomes in the context of acute decompensated diabetes remains to be explored. Methods We performed a retrospective analysis of 872 patients admitted to Temple University Hospital from 2004–2009 with DKA or HHS. Patients were included if they had cardiac troponin I (cTnI) measured within 24 hours of hospital admission, had no evidence of acute coronary syndrome and had a follow up period of at least 18 months. Of the 264 patients who met the criteria, we reviewed the baseline patient characteristics, admission labs, EKGs and major adverse cardiovascular events during the follow up period. Patients were categorized into two groups with normal and elevated levels of cardiac enzymes. The composite end point of the study was the occurrence of a major cardiovascular event (MACE) during the follow up period and was compared between the two groups. Results Of 264 patients, 24 patients were found to have elevated cTnI. Compared to patients with normal cardiac enzymes, there was a significant increase in incidence of MACE in patients with elevated cTnI. In a regression analysis, which included prior history of CAD, HTN and ESRD, the only variable that independently predicted MACE was an elevation in cTnI (p = 0.044). Patients with elevated CK-MB had increased lengths of hospitalization compared to the other group (p < 0.001). Conclusions Elevated cardiac troponin I in patients admitted with decompensated diabetes and without evidence of acute coronary syndrome, strongly correlate with a later major cardiovascular event. Thus, elevated troponin I during metabolic abnormalities identify a group of patients at an increased risk for poor long-term outcomes. Whether these patients may benefit from early detection, risk stratification and preventive interventions remains to be investigated.
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Affiliation(s)
- Anthony Eubanks
- Cardiology Section, Temple University School of Medicine, PA, USA
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Shargorodsky M, Omelchenko E, Matas Z, Boaz M, Gavish D. Relation between augmentation index and adiponectin during one-year metformin treatment for nonalcoholic steatohepatosis: effects beyond glucose lowering? Cardiovasc Diabetol 2012; 11:61. [PMID: 22676459 PMCID: PMC3471007 DOI: 10.1186/1475-2840-11-61] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 03/12/2012] [Indexed: 12/12/2022] Open
Abstract
Background Insulin resistance (IR) is the major driving force behind development and progression of atherosclerosis in patients with nonalcoholic fatty liver disease (NAFLD). Therefore, correction of IR is a relevant therapeutic target. We performed the current trial to evaluate whether 12- month metformin therapy improves vascular stiffness in patients with NAFLD and to assess if this improvement is associated with change in glucose control, insulin resistance or circulating adiponectin. Methods In randomized, placebo controlled study, 63 patients with NAFLD were assigned to one of two groups: Group 1 received daily metformin; Group 2 received placebo. Central aortic augmentation index (AI) was performed using SphygmoCor (version 7.1, AtCor Medical, Sydney, Australia) at baseline, at 4-and 12-month treatment period. Metabolic parameters, insulin resistance markers and serum adiponectin levels were determined. Results In placebo group: AI did not improve during the treatment period. Liver function and adiponectin levels did not change during the study. In multiple linear regression analysis, the independent predictors of arterial stiffness improvement were metformin treatment and increase in circulating adiponectin levels. Among metformin treated patients: AI decreased significantly during the study. ALP and ALT decreased during initial 4-month treatment period, however raised to the pretreatment levels after 12 months. Serum adiponectin level tended to increase during treatment period with metformin. Conclusions Metformin treatment was associated with significant decrease in AI during one year treatment in NAFLD patients. These beneficial vascular effects was associated with exposure to metformin per se as well as change in adiponectin levels suggesting that metformin may mediate its vascular effects via glicemic control-independent mechanisms. Trial registry no: NCT01084486
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El Demerdash F, Refaie W, Allakany R, Tantawy S, Dawood E. Diabetic retinopathy: A predictor of coronary artery disease. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2011.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Ruano Pérez R, Gómez-Caminero López F, Diego Domínguez M, Martín De Arriba Á, Martín Luengo C, García-Talavera Fernández J. Incidence and Prognostic Value of Ischemic Heart Disease in High Risk Cardiovascular Asymptomatic Diabetic Patients Detected by Gated Myocardial Perfusion SPECT Study. Rev Esp Med Nucl Imagen Mol 2012. [DOI: 10.1016/j.remnie.2011.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ruano Pérez R, Gómez-Caminero López F, Diego Domínguez M, Martín De Arriba A, Martín Luengo C, García-Talavera Fernández JR. [Incidence and prognostic value of ischemic heart disease in high risk cardiovascular asymptomatic diabetic patients detected by gated myocardial perfusion SPECT study]. Rev Esp Med Nucl Imagen Mol 2011; 31:83-8. [PMID: 21944188 DOI: 10.1016/j.remn.2011.04.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2011] [Revised: 04/12/2011] [Accepted: 04/29/2011] [Indexed: 12/16/2022]
Abstract
AIM To determine the clinical utility of the gated myocardial perfusion SPECT to detect silent ischemia in asymptomatic diabetic patients without previous coronary events and to evaluate the prognosis of this population. MATERIAL AND METHODS A retrospective study of 56 asymptomatic diabetics referred for a gated myocardial perfusion SPECT for diagnosis of ischemic disease was performed. The criteria for ischemia were: mild SDS<4, moderate SDS 4-8, severe SDS>8. A multivariable statistical analysis was carried out to identify possible predictive variables of an abnormal SPECT. The cardiovascular events were recorded up to December-2010. RESULTS A high proportion of the 56 patients had an abnormal perfusion study (46.4%), there being moderate-severe ischemia in 10.7%, necrosis with ischemia in 5.4% and necrosis in 7.1%. We found no statistical differences in the type of stress used (treadmill or dipyridamole). The patients had a high combination of cardiovascular risk factors. In the multivariate analysis, diabetic nephropathy was the only factor related to an abnormal SPECT (p=0.043). The events recorded in the follow-up were: 2 early revascularizations, 5 cardiology admissions, 10 non-cardiac related deaths. The existence of ischemia in the SPECT was significantly related to the appearance of cardiovascular events (p<0.05). CONCLUSION A gated myocardial perfusion SPECT in asymptomatic diabetics with high combination of cardiovascular risk factors detects silent ischemia in a significant proportion and this seems to be related to future coronary events. Diabetic nephropathy implies a greater likelihood of abnormal studies. However, the screening criteria in this population still need to be established for better performance and lower cost.
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Affiliation(s)
- R Ruano Pérez
- Servicio de Medicina Nuclear, Hospital Universitario de Salamanca, España.
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