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Din N, Kanwal S, Aamir AH, Ghaffar T. Predictors of limb saving in diabetic foot ulcer. Pak J Med Sci 2024; 40:1378-1383. [PMID: 39092062 PMCID: PMC11255825 DOI: 10.12669/pjms.40.7.9182] [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: 12/13/2023] [Revised: 03/25/2024] [Accepted: 04/18/2024] [Indexed: 08/04/2024] Open
Abstract
Objectives This study was aimed to determine the various factors which could serve as predictor of saving of lower limb from amputation in patients with diabetic foot ulcer (DFU). Method This three-year retrospective study was conducted in the Diabetes and Endocrinology Unit of Hayatabad Medical complex Peshawar, Pakistan. Demographic, clinical, laboratory and radiological information of the diabetic patients with DFU admitted between January 2020 to December 2022 was retrieved from the hospital files. Information regarding initial and final decision regarding amputation and the outcome of the ulcer was also recorded. Results A total of 502 patients of diabetes mellitus (DM) with DFU were included in the study, of whom there were 279 (55.6%) males and 223 (44.4%) females. The mean age of the study population, mean duration of DM and mean HbA1c were 55.2 ± 9.8 years, 13.7 ± 6.7 years and 11.2 ± 2.4 %, respectively. Patients who had an amputation of their lower limbs had an increased age (p= 0.034), raised total leucocyte count (TLC) (p= <0.001), higher HbA1c (p= 0.025), had osteomyelitis (p= <0.001), and had a higher-grade ulcer (p= <0.001). On binary logistic regression analysis, ulcer grade (OR=7.4, p= <0.001), osteomyelitis (OR=11.8, p= <0.001), and initial decision of no amputation at the time of admission (OR=33.6, p=<0.001) were independently associated with the lower limb salvage. Conclusion DFU which were of grade I to II, had no evidence of osteomyelitis and for which an initial decision was of no amputation were more likely to be salvaged.
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Affiliation(s)
- Nizamud Din
- Nizamud Din, FCPS Medicine. Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
| | - Shaista Kanwal
- Shaista Kanwal, FCPS Medicine, FCPS Endocrinology, MRCP. Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
| | - Azizul Hasan Aamir
- Azizul Hasan Aamir, MRCP, FRCP (Edin), FACE. Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
| | - Tahir Ghaffar
- Tahir Ghaffar, FCPS Medicine, FCPS Endocrinology, MRCP. Department of Diabetes, Endocrinology and Metabolic Diseases, MTI Hayatabad Medical Complex, Peshawar, Pakistan
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Chen W, Liu J, Shi Y. Machine learning predictions of the adverse events of different treatments in patients with ischemic left ventricular systolic dysfunction. Intern Emerg Med 2024:10.1007/s11739-024-03672-x. [PMID: 38874880 DOI: 10.1007/s11739-024-03672-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 06/04/2024] [Indexed: 06/15/2024]
Abstract
This study aimed to develop several new machine learning models based on hibernating myocardium to predict the major adverse cardiac events(MACE) of ischemic left ventricular systolic dysfunction(LVSD) patients receiving either percutaneous coronary intervention(PCI) or optimal medical therapy(OMT). This study included 329 LVSD patients, who were randomly assigned to the training or validation cohort. Least absolute shrinkage and selection operator(LASSO) regression was used to identify variables associated with MACE. Subsequently, various machine learning models were established. Model performance was compared using receiver operating characteristic(ROC) curves, the Brier score(BS), and the concordance index(C-index). A total of 329 LVSD patients were retrospectively enrolled between January 2016 and December 2021. Utilizing LASSO regression analysis, five factors were selected. Based on these factors, RSF, GBM, XGBoost, Cox, and DeepSurv models were constructed. In the development and validation cohorts, the C-indices were 0.888 vs. 0.955 (RSF). The RSF model (0.991 vs. 0.982 vs. 0.980) had the highest area under the ROC curve (AUC) compared with the other models. The BS (0.077 vs. 0.095vs. 0.077) of RSF model were less than 0.25 at 12, 18, and 24 months. This study developed a novel predictive model based on RSF to predict MACE in LVSD patients who underwent either PCI or OMT.
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Affiliation(s)
- Wenjie Chen
- Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang, 100029, Beijing, China
| | - Jinghua Liu
- Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang, 100029, Beijing, China.
| | - Yuchen Shi
- Center for Coronary Artery Disease (CCAD), Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang, 100029, Beijing, China.
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Tassetti L, Sfriso E, Torlone F, Baggiano A, Mushtaq S, Cannata F, Del Torto A, Fazzari F, Fusini L, Junod D, Maragna R, Volpe A, Carrabba N, Conte E, Guglielmo M, La Mura L, Pergola V, Pedrinelli R, Indolfi C, Sinagra G, Perrone Filardi P, Guaricci AI, Pontone G. The Role of Multimodality Imaging (CT & MR) as a Guide to the Management of Chronic Coronary Syndromes. J Clin Med 2024; 13:3450. [PMID: 38929984 PMCID: PMC11205051 DOI: 10.3390/jcm13123450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 06/06/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Chronic coronary syndrome (CCS) is one of the leading cardiovascular causes of morbidity, mortality, and use of medical resources. After the introduction by international guidelines of the same level of recommendation to non-invasive imaging techniques in CCS evaluation, a large debate arose about the dilemma of choosing anatomical (with coronary computed tomography angiography (CCTA)) or functional imaging (with stress echocardiography (SE), cardiovascular magnetic resonance (CMR), or nuclear imaging techniques) as a first diagnostic evaluation. The determinant role of the atherosclerotic burden in defining cardiovascular risk and prognosis more than myocardial inducible ischemia has progressively increased the use of a first anatomical evaluation with CCTA in a wide range of pre-test probability in CCS patients. Functional testing holds importance, both because the role of revascularization in symptomatic patients with proven ischemia is well defined and because functional imaging, particularly with stress cardiac magnetic resonance (s-CMR), gives further prognostic information regarding LV function, detection of myocardial viability, and tissue characterization. Emerging techniques such as stress computed tomography perfusion (s-CTP) and fractional flow reserve derived from CT (FFRCT), combining anatomical and functional evaluation, appear capable of addressing the need for a single non-invasive examination, especially in patients with high risk or previous revascularization. Furthermore, CCTA in peri-procedural planning is promising to acquire greater importance in the non-invasive planning and guiding of complex coronary revascularization procedures, both by defining the correct strategy of interventional procedure and by improving patient selection. This review explores the different roles of non-invasive imaging techniques in managing CCS patients, also providing insights into preoperative planning for percutaneous or surgical myocardial revascularization.
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Affiliation(s)
- Luigi Tassetti
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Enrico Sfriso
- Radiology Unit, Department of Medical, Surgical and Health Sciences, University of Trieste, 34127 Trieste, Italy;
| | | | - Andrea Baggiano
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Saima Mushtaq
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Francesco Cannata
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Alberico Del Torto
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Fabio Fazzari
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Laura Fusini
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Daniele Junod
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Riccardo Maragna
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Alessandra Volpe
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
| | - Nazario Carrabba
- Department of Cardiothoracovascular Medicine, Azienda Ospedaliero-Universitaria Careggi, 50134 Florence, Italy;
| | - Edoardo Conte
- Department of Clinical Cardiology and Cardiovascular Imaging, Galeazzi-Sant’Ambrogio Hospital IRCCS, 20157 Milan, Italy;
| | - Marco Guglielmo
- Department of Cardiology, Division of Heart and Lungs, Medical Center Utrecht, Utrecht University, 3584 Utrecht, The Netherlands;
| | - Lucia La Mura
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (L.L.M.); (P.P.F.)
| | - Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy;
| | - Ciro Indolfi
- Istituto di Cardiologia, Dipartimento di Scienze Mediche e Chirurgiche, Università degli Studi “Magna Graecia”, 88100 Catanzaro, Italy;
| | - Gianfranco Sinagra
- Cardiology Specialty School, University of Trieste, 34127 Trieste, Italy;
- Center for Diagnosis and Treatment of Cardiomyopathies, Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano-Isontina (ASUGI), 34149 Trieste, Italy
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University Federico II of Naples, 80131 Naples, Italy; (L.L.M.); (P.P.F.)
| | - Andrea Igoren Guaricci
- Cardiology Unit, Interdisciplinary Department of Medicine, University of Bari Aldo Moro, 70126 Bari, Italy;
| | - Gianluca Pontone
- Perioperative Cardiology and Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (L.T.); (A.B.); (S.M.); (F.C.); (F.F.); (L.F.); (D.J.); (R.M.); (A.V.)
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, 20122 Milan, Italy
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Endrikat J, Gutberlet M, Barkhausen J, Schöckel L, Bhatti A, Harz C, Hoffmann KT. Clinical Efficacy of Gadobutrol: Review of Over 25 Years of Use Exceeding 100 Million Administrations. Invest Radiol 2024; 59:345-358. [PMID: 37972293 DOI: 10.1097/rli.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Gadobutrol has been administered more than 100 million times worldwide, since February 1998, that is, over the last 25 years. Numerous clinical studies in a broad range of indications document the long-term experience with gadobutrol. OBJECTIVE The aim of this study was to provide a literature-based overview on gadobutrol's efficacy in 9 approved indications and use in children. MATERIALS AND METHODS Efficacy results in patients of all age groups including sensitivity, specificity, accuracy, and positive/negative predictive values were identified by a systematic literature search on Embase until December 31, 2022. Nine approved indications were considered: central nervous system (CNS), magnetic resonance angiography (MRA), breast, heart, prostate, kidney, liver, musculoskeletal, whole body, and various indications in children. RESULTS Sixty-five publications (10 phase III, 2 phase IV, 53 investigator-initiated studies) reported diagnostic efficacy results obtained from 7806 patients including 271 children, at 369 centers worldwide. Indication-specific sensitivity ranges were 59%-98% (CNS), 53%-100% (MRA), 80%-100% (breast), 64%-90% (heart), 64%-96% (prostate), 71-85 (kidney), 79%-100% (liver), 53%-98% (musculoskeletal), and 78%-100% (children). Indication-specific specificity ranges were 75%-100% (CNS), 64%-99% (MRA), 58%-98% (breast), and 47%-100% (heart). CONCLUSIONS The evaluated body of evidence, consisting of 65 studies with 7806 patients, including 271 children and 7535 adults, showed that gadobutrol is an efficacious magnetic resonance imaging contrast agent for all age groups in various approved indications throughout the whole body.
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Affiliation(s)
- Jan Endrikat
- From the Radiology, Bayer AG, Berlin, Germany (J.E., L.S., C.H.); Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg/Saar, Germany (J.E.); Department of Diagnostic and Interventional Radiology, University of Leipzig, Heart Center, Leipzig, Germany (M.G.); Department of Radiology and Nuclear Medicine, University Hospital Schleswig Holstein-Campus Luebeck, Luebeck, Germany (J.B.); Bayer US LLC, Benefit-Risk Management Pharmacovigilance, Whippany, NJ (A.B.); and Department of Neuroradiology, University of Leipzig, Leipzig, Germany (K.-T.H.)
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5
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Jiang Q, Huang K, Yin L, Zhang B, Wang Y, Hu S. Multimodality Cardiovascular Imaging for Totally Video-Guided Thorascopic Cardiac Surgery. Rev Cardiovasc Med 2024; 25:181. [PMID: 39076492 PMCID: PMC11267191 DOI: 10.31083/j.rcm2505181] [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: 10/11/2023] [Revised: 12/14/2023] [Accepted: 01/04/2024] [Indexed: 07/31/2024] Open
Abstract
Totally video-guided thorascopic cardiac surgery (TVTCS) represents one of the most minimally invasive access routes to the heart. Its feasibility and safety can be guaranteed by an experienced surgeon with skilled operative techniques under the guidance of a video signal via thoracoscopy and the imaging from transesophageal echocardiography. At present, this surgical approach has been applied for atrioventricular valve disease, atrial septum defects plus and partial anomalous pulmonary venous drainage, cardiac tumors, hypertrophic obstructive cardiomyopathy, aortic valve disease, and atrial fibrillation. Multimodality cardiovascular imaging, including echocardiography, X-ray, computed tomography (CT), magnetic resonance imaging (MRI) and cardiac catheterization, provides morphologic characteristics and function status of the cardiovascular system and a comprehensive view of the target anatomy. In this review, the benefits of multimodality cardiovascular imaging are summarized for the clinical practice of TVTCS, including the preoperative preparation, intraoperative guidance and postoperative supervision. The disease categories are also individually reviewed on the basis of multimodality cardiovascular imaging, to ensure the feasibility and safety for TVTCS. Cardiovascular imaging technologies not only confirm who is a candidate for this surgical technique, but also provide technical support during the procedure and for postop follow to assess the clinical outcomes. Multimodality cardiovascular imaging is instrumental to provide the requirements to solve the problems for conduction of TVTCS; and to provide individualized protocols with high-resolution and real-time dynamic imaging fusion.
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Affiliation(s)
- Qin Jiang
- Department of Cardiac Surgery, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 610072 Chengdu, Sichuan, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 610072 Chengdu, Sichuan, China
| | - Keli Huang
- Department of Cardiac Surgery, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 610072 Chengdu, Sichuan, China
| | - Lixue Yin
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, 610072 Chengdu, Sichuan, China
| | - Bo Zhang
- Department of Operating Room, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 610072 Chengdu, Sichuan, China
| | - Yiping Wang
- Department of ICU, Sichuan Provincial People’s Hospital, Affiliated Hospital of University of Electronic Science and Technology, 610072 Chengdu, Sichuan, China
| | - Shengshou Hu
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, 100037 Beijing, China
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Khan SU, Khan SU, Suleman M, Khan MU, Khan MS, Arbi FM, Hussain T, Mohammed Alsuhaibani A, S Refat M. Natural Allies for Heart Health: Nrf2 Activation and Cardiovascular Disease Management. Curr Probl Cardiol 2024; 49:102084. [PMID: 37714318 DOI: 10.1016/j.cpcardiol.2023.102084] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 09/11/2023] [Indexed: 09/17/2023]
Abstract
The term "cardiovascular diseases" (CVD) refers to various ailments that affect the heart and blood vessels, including myocardial ischemia, congenital heart defects, heart failure, rheumatic heart disease, hypertension, peripheral artery disease, atherosclerosis, and cardiomyopathies. Despite significant breakthroughs in preventative measures and treatment choices, CVDs significantly contribute to morbidity and mortality, imposing a considerable financial burden. Oxidative stress (OS) is a fundamental contributor to the development and progression of CVDs, resulting from an inherent disparity in generating reactive oxygen species. The disparity above significantly contributes to the aberrant operation of the cardiovascular system. To tackle this issue, therapeutic intervention primarily emphasizes the nuclear erythroid 2-related factor 2 (Nrf2), a transcription factor crucial in regulating endogenous antioxidant defense systems against OS. The Nrf2 exhibits potential as a promising target for effectively managing CVDs. Significantly, an emerging field of study is around the utilization of natural substances to stimulate the activation of Nrf2, hence facilitating the promotion of cardioprotection. This technique introduces a new pathway for treating CVD. The substances above elicit their advantageous effects by mitigating the impact of OS via initiating Nrf2 signaling. The primary objective of our study is to provide significant insights that can contribute to advancing treatment methods, including natural products. These strategies aim to tackle the obstacles associated with CVDs.
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Affiliation(s)
- Safir Ullah Khan
- Hefei National Laboratory for Physical Sciences at the Microscale, School of Life Sciences, University of Science and Technology of China, Hefei, China
| | - Shahid Ullah Khan
- Integrative Science Center of Germplasm Creation in Western China (CHONGQING) Science City and South west University, College of Agronomy and Biotechnology, Southwest University, Chongqing, China; Department of Biochemistry, Women Medical and Dental College, Khyber Medical University, Abbottabad, Khyber Pakhtunkhwa, Pakistan.
| | - Muhammad Suleman
- Center for Biotechnology and Microbiology, University of Swat, Swat, Pakistan; Laboratory of Animal Research Center (LARC), Qatar University, Doha, Qatar
| | - Munir Ullah Khan
- MOE Key Laboratory of Macromolecular Synthesis and Functionalization, International Research Center for X Polymers, Department of Polymer Science and Engineering, Zhejiang University, Hangzhou, China
| | | | | | - Talib Hussain
- Women Dental College Abbottabad, Khyber Pakhtunkhwa, Pakistan
| | - Amnah Mohammed Alsuhaibani
- Department of Physical Sport Science, College of Education, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Moamen S Refat
- Department of Chemistry, College of Science, Taif University, Taif, Saudi Arabia
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Tamaki N, Manabe O. Current status and perspectives of nuclear cardiology. Ann Nucl Med 2024; 38:20-30. [PMID: 37891375 DOI: 10.1007/s12149-023-01878-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 09/29/2023] [Indexed: 10/29/2023]
Abstract
Nuclear cardiology has long been used to identify myocardial ischemia for appropriate treatment strategies for stable coronary artery disease (CAD). After the Ischemia Trial, it is time to reevaluate the significance of ischemia assessment. Functional imaging continues to play pivotal role in detecting microcirculatory disturbances. PET provides a clear image of blood flow distribution and is useful for the quantitative evaluation of myocardial flow reserve (MFR), which plays an important role in predicting treatment strategies and improving prognosis in CAD. Heart failure has become a major area of focus in cardiovascular medicine. Radionuclide imaging has been widely applied in this field. FDG PET is useful in identifying cardiac sarcoidosis and active inflammation. Clinical values of I-123 MIBG and BMIPP SPECT have been reported worldwide from Japan. Additionally, clinical experiences of Tc-99m pyrophosphate imaging have recently gained attention for assessing cardiac amyloidosis. Cardiac PET/CT and PET/MR imaging permit combined assessment of metabolic/functional/structural analyses of various cardiac diseases. While other non-invasive imaging modalities have rapidly been developed, the roles of radionuclide imaging remain to be valuable for early and accurate diagnosis and patient management in most cases of chronic CAD and various cardiovascular diseases.
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Affiliation(s)
- Nagara Tamaki
- Kyoto College of Medical Science, Kyoto, Japan.
- Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto, Japan.
| | - Osamu Manabe
- Department of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan
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Casper E. The crosstalk between Nrf2 and NF-κB pathways in coronary artery disease: Can it be regulated by SIRT6? Life Sci 2023; 330:122007. [PMID: 37544377 DOI: 10.1016/j.lfs.2023.122007] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 06/26/2023] [Accepted: 08/03/2023] [Indexed: 08/08/2023]
Abstract
Coronary artery disease (CAD) is the leading cause of death worldwide. Oxidative stress and inflammation are major mechanisms responsible for the progression of CAD. Nuclear transcription factor erythroid-2 related factor 2 (Nrf2) is a transcription factor that modulates the cellular redox status. Nrf2 upregulation increases the expression of antioxidant genes, decreases the expression of Nuclear factor-kappa B (NF-kB), and increases free radical metabolism. Activated NF-kB increases the production of inflammatory cytokines causing endothelial dysfunction. The two pathways of Nrf2 and NF-kB can regulate the expression of each other. Foremost, the Nrf2 pathway can decrease the level of active NF-κB by increasing the level of antioxidants and cytoprotective enzymes. Furthermore, the Nrf2 pathway prevents IκB-α degradation, an inhibitor of NF-kB, and thus inhibits NF-κB mediated transcription. Also, NF-kB transcription inhibits Nrf2 activation by reducing the antioxidant response element (ARE) transcription. Sirtuin 6 (SIRT6) is a member of the Sirtuins family that was found to protect against cardiovascular diseases. SIRT6 can suppress the production of Reactive oxygen species (ROS) through deacetylation of NRF2 which results in NRF2 activation. Furthermore, SIRT6 can inhibit the inflammatory process through the downregulation of NF-kB transcription. Therefore, targeting sirtuins could be a therapeutic strategy to treat CAD. This review describes the potential role of SIRT6 in regulating the crosstalk between NRF2 and NF-kB signaling pathways in CAD.
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Affiliation(s)
- Eman Casper
- Department of Clinical Pharmacy, Faculty of Pharmacy, Ain Shams University, Cairo, Egypt.
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Kodeboina M, Piayda K, Jenniskens I, Vyas P, Chen S, Pesigan RJ, Ferko N, Patel BP, Dobrin A, Habib J, Franke J. Challenges and Burdens in the Coronary Artery Disease Care Pathway for Patients Undergoing Percutaneous Coronary Intervention: A Contemporary Narrative Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095633. [PMID: 37174152 PMCID: PMC10177939 DOI: 10.3390/ijerph20095633] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/24/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023]
Abstract
Clinical and economic burdens exist within the coronary artery disease (CAD) care pathway despite advances in diagnosis and treatment and the increasing utilization of percutaneous coronary intervention (PCI). However, research presenting a comprehensive assessment of the challenges across this pathway is scarce. This contemporary review identifies relevant studies related to inefficiencies in the diagnosis, treatment, and management of CAD, including clinician, patient, and economic burdens. Studies demonstrating the benefits of integration and automation within the catheterization laboratory and across the CAD care pathway were also included. Most studies were published in the last 5-10 years and focused on North America and Europe. The review demonstrated multiple potentially avoidable inefficiencies, with a focus on access, appropriate use, conduct, and follow-up related to PCI. Inefficiencies included misdiagnosis, delays in emergency care, suboptimal testing, longer procedure times, risk of recurrent cardiac events, incomplete treatment, and challenges accessing and adhering to post-acute care. Across the CAD pathway, this review revealed that high clinician burnout, complex technologies, radiation, and contrast media exposure, amongst others, negatively impact workflow and patient care. Potential solutions include greater integration and interoperability between technologies and systems, improved standardization, and increased automation to reduce burdens in CAD and improve patient outcomes.
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Affiliation(s)
- Monika Kodeboina
- Cardiovascular Center Aalst, OLV Clinic, 9300 Aalst, Belgium
- Department of Advanced Biomedical Sciences, University of Naples Federico II, 80138 Naples, Italy
- Clinic for Internal Medicine and Cardiology, Marien Hospital, 52066 Aachen, Germany
| | - Kerstin Piayda
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Department of Cardiology and Vascular Medicine, Medical Faculty, Justus-Liebig-University Giessen, 35392 Giessen, Germany
| | | | | | | | | | | | | | | | | | - Jennifer Franke
- Cardiovascular Center Frankfurt, 60389 Frankfurt, Germany
- Philips Chief Medical Office, 22335 Hamburg, Germany
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Dorobanțu M. Editorial for Special Issue "Advance in Diagnostic and Management of Ischemic Heart Disease". Diagnostics (Basel) 2023; 13:diagnostics13061185. [PMID: 36980493 PMCID: PMC10047833 DOI: 10.3390/diagnostics13061185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/07/2023] [Indexed: 03/30/2023] Open
Abstract
Ischemic heart disease is one of the leading causes of morbidity and mortality worldwide [...].
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Affiliation(s)
- Maria Dorobanțu
- Faculty of Medicine, University of Medicine and Pharmacy "Carol Davila", 050474 Bucharest, Romania
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Awen A, Hu D, Gao D, Wang Z, Wu Y, Zheng H, Guan L, Mu Y, Sheng Z. Dual-modal molecular imaging and therapeutic evaluation of coronary microvascular dysfunction using indocyanine green-doped targeted microbubbles. Biomater Sci 2023; 11:2359-2371. [PMID: 36883518 DOI: 10.1039/d2bm02155b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
Coronary microvascular dysfunction (CMD), which causes a series of cardiovascular diseases, seriously endangers human health. However, precision diagnosis of CMD is still challenging due to the lack of sensitive probes and complementary imaging technologies. Herein, we demonstrate indocyanine green-doped targeted microbubbles (named T-MBs-ICG) as dual-modal probes for highly sensitive near-infrared (NIR) fluorescence imaging and high-resolution ultrasound imaging of CMD in mouse models. In vitro results show that T-MBs-ICG can specifically target fibrin, a specific CMD biomarker, via the cysteine-arginine-glutamate-lysine-alanine (CREKA) peptide modified on the surface of microbubbles. We further employ T-MBs-ICG to achieve NIR fluorescence imaging of injured myocardial tissue in a CMD mouse model, leading to a signal-to-background ratio (SBR) of up to 50, which is 20 fold higher than that of the non-targeted group. Furthermore, ultrasound molecular imaging of T-MBs-ICG is obtained within 60 s after intravenous injection, providing molecular information on ventricular and myocardial structures and fibrin with a resolution of 1.033 mm × 0.466 mm. More importantly, we utilize comprehensive dual-modal imaging of T-MBs-ICG to evaluate the therapeutic efficacy of rosuvastatin, a cardiovascular drug for the clinical treatment of CMD. Overall, the developed T-MBs-ICG probes with good biocompatibility exhibit great potential in the clinical diagnosis of CMD.
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Affiliation(s)
- Alimina Awen
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, Xinjiang, 830011, P. R. China.
| | - Dehong Hu
- Paul C. Lauterbur Research Center for Biomedical Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Key Laboratory of Ultrasound Imaging and Therapy, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, P. R. China.
| | - Duyang Gao
- Paul C. Lauterbur Research Center for Biomedical Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Key Laboratory of Ultrasound Imaging and Therapy, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, P. R. China.
| | - Zihang Wang
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, Xinjiang, 830011, P. R. China.
| | - Yayun Wu
- Paul C. Lauterbur Research Center for Biomedical Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Key Laboratory of Ultrasound Imaging and Therapy, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, P. R. China.
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Key Laboratory of Ultrasound Imaging and Therapy, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, P. R. China.
| | - Lina Guan
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, Xinjiang, 830011, P. R. China.
| | - Yuming Mu
- Department of Echocardiography, First Affiliated Hospital of Xinjiang Medical University, Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, Xinjiang, 830011, P. R. China.
| | - Zonghai Sheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, CAS Key Laboratory of Health Informatics, Shenzhen Key Laboratory of Ultrasound Imaging and Therapy, Institute of Biomedical and Health Engineering, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, Guangdong, 518055, P. R. China.
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The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology. J Clin Med 2022; 11:jcm11237095. [PMID: 36498670 PMCID: PMC9736251 DOI: 10.3390/jcm11237095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
Over the past two decades, major technological developments and progress have been reached for all imaging modalities applied to clinical cardiology, from echocardiography to magnetic resonance, computed tomography, nuclear imaging, etc [...].
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Lala RI, Mercea S, Jipa RA, Puschita M, Pop-Moldovan A. The chronic coronary syndrome—Heart failure roundabout: A multimodality imaging workflow approach. Front Cardiovasc Med 2022; 9:1019529. [DOI: 10.3389/fcvm.2022.1019529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022] Open
Abstract
Heart failure (HF) is a complex syndrome of considerable burden with high mortality and hospitalization rates. Approximately two-thirds of patients with HF have ischemic etiology, which makes crucial the identification of relevant coronary artery disease (CAD). Moreover, patients with chronic coronary syndrome (CCS) can first show signs of dyspnea and left ventricular (LV) dysfunction. If establishing a diagnosis of HF and consequent management is clear enough, it will not be the same when it comes to recommendations for etiology assessment. Ischemic heart disease is the most studied disease by cardiac multimodality imaging with excellent diagnostic performance. Based on this aspect, the high prevalence of CAD, the worst outcome—HF patients should undergo a diagnostic work-up using these multimodality imaging techniques. The aim of this mini-review is to provide insights on multimodality imaging for diagnosing CCS in patients with new onset of HF and propose a diagnostic work-up based on current international studies and guidelines.
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Evangelista A, Rodríguez-Palomares J. Special Issue: State of the Art of Cardiac Multimodality Imaging. J Clin Med 2022; 11:jcm11133793. [PMID: 35807079 PMCID: PMC9267328 DOI: 10.3390/jcm11133793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Imaging has progressed significantly in recent years and plays a pivotal role in the diagnosis, prognosis, and management of cardiac diseases [...]
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Garcia-Osuna A, Sans-Rosello J, Ferrero-Gregori A, Alquezar-Arbe A, Sionis A, Ordóñez-Llanos J. Risk Assessment after ST-Segment Elevation Myocardial Infarction: Can Biomarkers Improve the Performance of Clinical Variables? J Clin Med 2022; 11:1266. [PMID: 35268358 PMCID: PMC8910980 DOI: 10.3390/jcm11051266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 02/21/2022] [Accepted: 02/24/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Myocardial infarction with ST-segment elevation (STEMI) is the coronary artery disease associated with the highest risk of morbimortality; however, this risk is heterogeneous, usually being evaluated by clinical scores. Risk assessment is a key factor in personalized clinical management of patients with this disease. AIM The aim of this study was to assess whether some new cardiac biomarkers considered alone, combined in a multibiomarker model or in association with clinical variables, improve the short- and long-term risk stratification of STEMI patients. MATERIALS AND METHODS This was a retrospective observational study of 253 patients with STEMI. Blood samples were obtained before or during the angiography. The assessed biomarkers were C-terminal fragment of insulin-like growth factor binding protein-4 (CT-IGFBP4), high sensitive cardiac troponin T (hs-cTnT), N-terminal fragment of probrain natriuretic peptide (NT-proBNP), and growth differentiation factor 15 (GDF-15); they reflect different cardiovascular (CV) physiopathological pathways and underlying pathologies. We registered in-hospital and follow-up mortalities and their causes (cardiovascular and all-cause) and major adverse cardiac events (MACE) during a two year follow-up. Discrimination, survival analysis, model calibration, and reclassification of the biomarkers were comprehensively evaluated. RESULTS AND DISCUSSION In total, 55 patients (21.7%) died, 33 in-hospital and 22 during the follow-up, most of them (69.1%) from CV causes; 37 MACE occurred during follow-up. Biomarkers showed good prognostic ability to predict mortality, alone and combined with the multibiomarker model. A predictive clinical model based on age, Killip-Kimball class, estimated glomerular filtration rate (eGFR), and heart rate was derived by multivariate analysis. GDF-15 and NT-proBNP significantly improved risk assessment of the clinical model, as shown by discrimination, calibration, and reclassification of all the end-points except for all-cause mortality. The combination of NT-proBNP and hs-cTnT improved CV mortality prediction. CONCLUSIONS GDF-15 and NT-proBNP added value to the usual risk assessment of STEMI patients.
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Affiliation(s)
- Alvaro Garcia-Osuna
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
- Department of Clinical Biochemistry, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Jordi Sans-Rosello
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | | | - Aitor Alquezar-Arbe
- Department of Clinical Biochemistry, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Department of Emergency, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Alessandro Sionis
- Department of Clinical Biochemistry, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Department of Cardiology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
| | - Jordi Ordóñez-Llanos
- Department of Clinical Biochemistry, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Spain
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