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Jang JS. Growth Differentiation Factor-15 in Asian IHD Patients: Should We Use to Guide Therapeutic Decision? JACC. ASIA 2023; 3:472-474. [PMID: 37396426 PMCID: PMC10308089 DOI: 10.1016/j.jacasi.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Affiliation(s)
- Jae-Sik Jang
- Address for correspondence: Dr Jae-Sik Jang, Department of Internal Medicine, Busan Paik Hospital, University of Inje College of Medicine, 75, Bokji-ro, Busanjin-gu, Busan 47392, Republic of Korea.
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Wang A, Lv G, Cheng X, Ma X, Wang W, Gui J, Hu J, Lu M, Chu G, Chen J, Zhang H, Jiang Y, Chen Y, Yang W, Jiang L, Geng H, Zheng R, Li Y, Feng W, Johnson B, Wang W, Zhu D, Hu Y. Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition). BURNS & TRAUMA 2020; 8:tkaa017. [PMID: 32685563 PMCID: PMC7336185 DOI: 10.1093/burnst/tkaa017] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 03/21/2020] [Indexed: 02/07/2023]
Abstract
In recent years, as living standards have continued to improve, the number of diabetes patients in China, along with the incidence of complications associated with the disease, has been increasing. Among these complications, diabetic foot disease is one of the main causes of disability and death in diabetic patients. Due to the differences in economy, culture, religion and level of medical care available across different regions, preventive and treatment methods and curative results for diabetic foot vary greatly. In multidisciplinary models built around diabetic foot, the timely assessment and diagnosis of wounds and appropriate methods of prevention and treatment with internal and external surgery are key to clinical practice for this pathology. In 2019, under the leadership of the Jiangsu Medical Association and Chinese Diabetes Society, the writing group for the Guidelines on multidisciplinary approaches for the prevention and management of diabetic foot disease (2020 edition) was established with the participation of scholars from the specialist areas of endocrinology, burn injury, vascular surgery, orthopedics, foot and ankle surgery and cardiology. Drawing lessons from diabetic foot guidelines from other countries, this guide analyses clinical practices for diabetic foot, queries the theoretical basis and grades and gives recommendations based on the characteristics of the pathology in China. This paper begins with assessments and diagnoses of diabetic foot, then describes treatments for diabetic foot in detail, and ends with protections for high-risk feet and the prevention of ulcers. This manuscript covers the disciplines of internal medicine, surgical, nursing and rehabilitation and describes a total of 50 recommendations that we hope will provide procedures and protocols for clinicians dealing with diabetic foot. Registry number: IPGRP-2020cn124
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Affiliation(s)
- Aiping Wang
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Guozhong Lv
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214062, China
| | - Xingbo Cheng
- Department of endocrinology, the First Affiliated Hospital of Suzhou University, Suzhou, 215006, China
| | - Xianghua Ma
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China.,Department of endocrinology, Xuzhou Central Hospital, Xuzhou, 221009,China
| | - Wei Wang
- Vascular Surgery, Gulou Hospital, Nanjing, 210008, China
| | - Jianchao Gui
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Ji Hu
- Department of endocrinology, The Second Affiliated Hospital of Suzhou University, Suzhou, 215004, China
| | - Meng Lu
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Guoping Chu
- Department of Burn and Plastic Surgery, Affiliated Hospital of Jiangnan University, Wuxi, 214062, China
| | - Jin'an Chen
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Hao Zhang
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Yiqiu Jiang
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Yuedong Chen
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Wengbo Yang
- Department of orthopedics, Nanjing First Hospital, Nanjing, 210006, China
| | - Lin Jiang
- Department of endocrinology, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Houfa Geng
- Department of endocrinology, Xuzhou Central Hospital, Xuzhou, 221009,China
| | - Rendong Zheng
- Department of endocrinology, Jiangsu Province Hospital on Traditional of Chinese and Western Medicine, 210028, China
| | - Yihui Li
- Diabetic Foot Centre, The Air Force Hospital From Eastern Theater of PLA, Nanjing, 210002, China
| | - Wei Feng
- Operating department, Jiangsu Medical Association, Nanjing, 210008, China
| | - Boey Johnson
- Diabetic Foot Centre, The National University Hospital, 119077, Singapore
| | - Wenjuan Wang
- Department of Chronic Non-Communicable Diseases, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Dalong Zhu
- Vascular Surgery, Gulou Hospital, Nanjing, 210008, China
| | - Yin Hu
- Operating department, Jiangsu Medical Association, Nanjing, 210008, China
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Sedykh DY, Kashtalap VV, Velieva RM, Barbarash OL. Possibilities of PRECISE-DAPT Score for Risk Prediction of Ischemic and Hemorrhagic Events in ST-Elevated Myocardial Infarction (According to the Data of the Registry Study in Kemerovo). RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2020. [DOI: 10.20996/1819-6446-2019-15-6-806-812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Aim.We aimed to study in real clinical practice the clinical and anamnestic characteristics, the peculiarities of double antiplatelet therapy (DAPT) prescription as well the incidence of ischemic and hemorrhagic events in patients with ST-elevated myocardial infarction (MI) during a year of follow-up, taking into account the baseline PRECISE-DAPT scores.Material and methods.The study included 680 patients with MI from the database of Kemerovo observational registry for acute coronary syndrome (ACS). All the patients retrospectively underwent an individual calculation using the PRECISE-DAPT score. Then, depending on the number of the points, all the patients were divided into the low (less than 25 points) and high (25 or more points) risks groups. Differences in clinical and anamnestic parameters, the peculiarities of DAPT prescription, as well as the incidence of ischemic and hemorrhagic outcomes during a year of follow-up after MI were estimated in the groups.Results.The Russian patients with ST-elevated MI and the high PRECISE-DAPT hemorrhagic risk score had a history of renal pathology (р=0.010), multivessel coronary artery disease and polyvascular disease (р=0.002), prior angina pectoris (р=0.001), as well as the course of the index event with the manifestations of acute coronary failure (р=0.001) more often than the patients from the low-risk group. The patients of the high-risk group less often underwent coronary angiography with stenting (р=0.001), as well as coronary artery bypass grafting (р=0.010) at hospitalization and had a higher in-hospital mortality rate (р=0.002). The patients at high hemorrhagic risk according to the PRECISE-DAPT score were less often prescribed with DAPT within a year after MI (р=0.001) and aspirin monotherapy was preferred more often (р=0.001). At the same time, the patients at high hemorrhagic risk on the PRECISE-DAPT score had more often major bleedings, recurrent MI and deaths (р=0.001) within a year after MI.Conclusion.In the present study, the possibilities of risk assessment with the PRECISE-DAPT score were retrospectively tested on the sample of patients with MI from the ACS registry in Kemerovo city. Good identification of patients with the high risks of hemorrhagic events and ischemic outcomes within 12 months of the follow-up after index MI has been shown, which allows to recommend the PRECISE-DAPT score for a clinical practice in order to rationalize the approaches to DAPT prescription and to optimize the existing approaches to the comprehensive risk assessment of patients with ACS along with existing scales.
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Affiliation(s)
- D. Yu. Sedykh
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Cardiology Dispensary
| | - V. V. Kashtalap
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
| | - R. M. Velieva
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Cardiology Dispensary
| | - O. L. Barbarash
- Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
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De Filippo O, Cortese M, D´Ascenzo F, Raposeiras-Roubin S, Abu-Assi E, Kinnaird T, Ariza-Solé A, Manzano-Fernández S, Templin C, Velicki L, Xanthopoulou I, Cerrato E, Rognoni A, Boccuzzi G, Montefusco A, Montabone A, Taha S, Durante A, Gili S, Magnani G, Autelli M, Grosso A, Blanco PF, Garay A, Quadri G, Varbella F, Queija BC, Paz RC, Fernández MC, Pousa IM, Gallo D, Morbiducci U, Dominguez-Rodriguez A, Valdés M, Cequier A, Alexopoulos D, Iñiguez-Romo A, Rinaldi M. Real-World Data of Prasugrel vs. Ticagrelor in Acute Myocardial Infarction: Results from the RENAMI Registry. Am J Cardiovasc Drugs 2019; 19:381-391. [PMID: 31030413 DOI: 10.1007/s40256-019-00339-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Limited data are available concerning differences in clinical outcomes for real-life patients treated with ticagrelor versus prasugrel after percutaneous coronary intervention (PCI). OBJECTIVE Our objective was to determine and compare the efficacy and safety of ticagrelor and prasugrel in a real-world population. METHODS RENAMI was a retrospective, observational registry including the data and outcomes of consecutive patients with acute coronary syndrome (ACS) who underwent primary PCI and were discharged with dual antiplatelet therapy (DAPT) between January 2012 and January 2016. The mean follow-up period was 17 ± 9 months. In total, 11 university hospitals from six European countries participated. After propensity-score matching, there were no substantial differences in the baseline clinical and interventional features. All patients were treated with acetylsalicylic acid plus prasugrel 10 mg once daily or acetylsalicylic acid plus ticagrelor 90 mg twice daily. Mean duration of DAPT was 12.04 ± 3.4 months with prasugrel and 11.90 ± 4.1 months with ticagrelor (p = 0.47). The primary and secondary endpoints were long-term net adverse clinical events (NACE) and major adverse cardiovascular events (MACE), respectively, along with their single components. Subgroup analysis for freedom from NACE and MACE was performed according to length of DAPT and clinical presentation [ST-elevation myocardial infarction (STEMI)-ACS versus non-ST-elevation myocardial infarction (NSTEMI)-ACS]. RESULTS In total, 4424 patients (2725 ticagrelor, 1699 prasugrel) were enrolled. After propensity-score matching, 1290 patients in each cohort were included in the analysis. At 12 months, the incidence of both NACE and MACE was lower with prasugrel (NACE: 5.3% vs. 8.5% [p = 0.001]; MACE: 5% vs. 8.1% [p = 0.001]) mainly driven by a reduction in recurrent myocardial infarction (MI) (2.4 vs. 4.0%; p = 0.029) and a lower rate of Bleeding Academic Research Consortium (BARC) 3-5 bleeding (1.5 vs. 2.9%; p = 0.011). The benefit of prasugrel was confirmed for patients with NSTEMI and for those discharged with a DAPT regimen of ≤ 12 months. Only a trend in the reduction of NACE and MACE was noted for STEMI or for those treated with longer DAPT. CONCLUSIONS Comparison of these drugs suggested that prasugrel is safer and more efficacious than ticagrelor in combination with aspirin after NSTEMI but not STEMI. No differences were found for events occurring after 12 months. The nonrandomized design of the present research means further studies are required to support these findings.
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Incidence and predictors of bleeding in ACS patients treated with PCI and prasugrel or ticagrelor: An analysis from the RENAMI registry. Int J Cardiol 2018; 273:29-33. [DOI: 10.1016/j.ijcard.2018.09.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 08/14/2018] [Accepted: 09/04/2018] [Indexed: 01/28/2023]
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Flores-Blanco PJ, Cambronero-Sánchez F, Raposeiras-Roubin S, Abu-Assi E, Leithold G, Cobas-Paz R, Rodríguez Serrano AI, Calvo-Iglesias F, Valdés M, Januzzi JL, Iñiguez-Romo A, Manzano-Fernández S. Asociación entre las escalas de riesgo isquémico y hemorrágico y el uso de los nuevos inhibidores del P2Y 12 en pacientes con síndrome coronario agudo. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.09.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Flores-Blanco PJ, Cambronero-Sánchez F, Raposeiras-Roubin S, Abu-Assi E, Leithold G, Cobas-Paz R, Rodríguez Serrano AI, Calvo-Iglesias F, Valdés M, Januzzi JL, Iñiguez-Romo A, Manzano-Fernández S. Association Between Ischemic and Bleeding Risk Scores and the Use of New P2Y 12 Inhibitors in Patients With Acute Coronary Syndrome. ACTA ACUST UNITED AC 2017; 71:538-544. [PMID: 29146484 DOI: 10.1016/j.rec.2017.10.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Accepted: 09/21/2017] [Indexed: 12/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Acute coronary syndrome (ACS) guidelines recommend the use of newer P2Y12 inhibitors (prasugrel and ticagrelor) over clopidogrel in patients with moderate-to-high ischemic risk, unless they have an increased bleeding risk. The aim of our study was to assess the GRACE risk score and the CRUSADE bleeding risk score relative to prescription of newer P2Y12 inhibitors at discharge in ACS patients. METHODS Retrospective analysis of a multicenter ACS registry; 3515 consecutive patients were included. The association between risk scores and prescription of newer P2Y12 inhibitors was assessed by binary logistic regression analysis. RESULTS A total of 1021 patients (29%) were treated with prasugrel or ticagrelor. On multivariate analyses, both GRACE (OR per 10 points, 0.89; 95%CI, 0.86-0.92; P < .001) and CRUSADE (OR per 10 points, 0.96; 95%CI, 0.94-0.98; P < .001) risk scores were inversely associated with the use of newer P2Y12 inhibitors. Moreover, other factors not included in these scores (revascularization approach, in-hospital stent thrombosis, major bleeding, and concomitant indication for anticoagulation therapy) also predicted the use of newer P2Y12 inhibitors. CONCLUSIONS New P2Y12 inhibitors were more frequently prescribed among ACS patients with lower CRUSADE bleeding risk. However, an ischemic risk paradox was found, with higher use of these agents in patients with lower ischemic risk based on GRACE risk score estimates. These results underscore the importance of risk stratification to safely deliver optimal therapies.
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Affiliation(s)
- Pedro J Flores-Blanco
- Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, El Palmar, Murcia, Spain.
| | - Francisco Cambronero-Sánchez
- Departamento de Medicina Interna, Servicio de Cardiología, Hospital General Universitario Los Arcos del Mar Menor, San Javier, Murcia, Spain
| | - Sergio Raposeiras-Roubin
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Emad Abu-Assi
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Gunnar Leithold
- Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, El Palmar, Murcia, Spain
| | - Rafael Cobas-Paz
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Ana I Rodríguez Serrano
- Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, El Palmar, Murcia, Spain
| | - Francisco Calvo-Iglesias
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Mariano Valdés
- Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, El Palmar, Murcia, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, United States
| | - Andrés Iñiguez-Romo
- Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro de Vigo, Vigo, Pontevedra, Spain
| | - Sergio Manzano-Fernández
- Departamento de Medicina Interna, Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria, El Palmar, Murcia, Spain; Departamento de Medicina Interna, Facultad de Medicina, Universidad de Murcia, Murcia, Spain
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Garay A, Ariza-Solé A, Formiga F, Lorente V, Sánchez-Salado JC, Salazar-Mendiguchía J, Roura G, Muntané G, Alegre O, Fuentes L, Gómez-Hospital JA, Cequier A. Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2016.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Garay A, Ariza-Solé A, Formiga F, Lorente V, Sánchez-Salado JC, Salazar-Mendiguchía J, Roura G, Muntané G, Alegre O, Fuentes L, Gómez-Hospital JA, Cequier A. Does anemia affect the predictive ability of bleeding risk scores in patients with acute coronary syndromes? Rev Port Cardiol 2016; 35:637-644. [PMID: 27865674 DOI: 10.1016/j.repc.2016.06.011] [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: 04/24/2016] [Revised: 06/08/2016] [Accepted: 06/13/2016] [Indexed: 11/27/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Anemia is a common comorbidity in patients with acute coronary syndromes (ACS), and is associated with higher risk for both bleeding and ischemic complications. We aimed to assess the predictive ability of bleeding risk scores (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines [CRUSADE], Mehran and Acute Coronary Treatment and Intervention Outcomes Network [ACTION]) in ACS patients with anemia. METHODS All consecutive ACS patients were prospectively included. The primary outcome was in-hospital major bleeding according to the CRUSADE, Mehran and ACTION definitions. Anemia was defined as hemoglobin <130 g/l in men and <120 g/l in women. The predictive ability of the bleeding risk scores was assessed by binary logistic regression, calculating receiver operating characteristic (ROC) curves and their corresponding area under the curve (AUC). RESULTS We included 2255 patients, mean age 62.4 years. Anemia was present in 550 patients (24.4%). Patients with anemia had a significantly higher prevalence of comorbidities. The three bleeding risk scores adequately predicted major bleeding in the whole cohort. No significant differences were observed regarding the predictive ability of each of the scores in patients with and without anemia (CRUSADE: AUC 0.73 without anemia vs. 0.74 with anemia, p=0.913; ACTION: AUC 0.68 without anemia vs. 0.73 with anemia, p=0.353; Mehran: AUC 0.69 without anemia vs. 0.61 with anemia, p=0.210). Only the Mehran score showed significantly lower predictive ability in patients with hemoglobin <11 g/dl (AUC 0.51, p=0.044). CONCLUSIONS Anemia was a common comorbidity in patients with ACS from our series. Currently available bleeding risk scores showed an adequate predictive ability in patients with mild anemia.
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Affiliation(s)
- Alberto Garay
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Albert Ariza-Solé
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Francesc Formiga
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Victoria Lorente
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | | | - Gerard Roura
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Guillem Muntané
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Alegre
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Lara Fuentes
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
| | | | - Angel Cequier
- Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain
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Wollert KC, Kempf T, Wallentin L. Growth Differentiation Factor 15 as a Biomarker in Cardiovascular Disease. Clin Chem 2016; 63:140-151. [PMID: 28062617 DOI: 10.1373/clinchem.2016.255174] [Citation(s) in RCA: 353] [Impact Index Per Article: 44.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/17/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Growth differentiation factor 15 (GDF-15) is expressed and secreted in response to inflammation, oxidative stress, hypoxia, telomere erosion, and oncogene activation. Cardiovascular (CV) disease is a major driver of GDF-15 production. GDF-15 has favorable preanalytic characteristics and can be measured in serum and plasma by immunoassay. CONTENT In community-dwelling individuals higher concentrations of GDF-15 are associated with increased risks of developing CV disease, chronic kidney disease, and cancer, independent of traditional CV risk factors, renal function, and other biomarkers (C-reactive protein, B-type natriuretic peptide, cardiac troponin). Low concentrations of GDF-15 are closely associated with longevity. GDF-15 is as an independent marker of all-cause mortality and CV events in patients with coronary artery disease, and may help select patients with non-ST-elevation acute coronary syndrome for early revascularization and more intensive medical therapies. GDF-15 is independently associated with mortality and nonfatal events in atrial fibrillation and heart failure (HF) with preserved or reduced ejection fraction. GDF-15 reflects chronic disease burden and acute perturbations in HF and responds to improvements in hemodynamic status. GDF-15 is independently associated with major bleeding in patients receiving antithrombotic therapies and has been included in a new bleeding risk score, which may become useful for decision support. SUMMARY GDF-15 captures distinct aspects of CV disease development, progression, and prognosis, which are not represented by clinical risk predictors and other biomarkers. The usefulness of GDF-15 to guide management decisions and discover new treatment targets should be further explored.
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Affiliation(s)
- Kai C Wollert
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany;
| | - Tibor Kempf
- Division of Molecular and Translational Cardiology, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Lars Wallentin
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
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Burlacu A, Siriopol D, Voroneanu L, Nistor I, Hogas S, Nicolae A, Nedelciuc I, Tinica G, Covic A. Atherosclerotic Renal Artery Stenosis Prevalence and Correlations in Acute Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Interventions: Data From Nonrandomized Single-Center Study (REN-ACS)—A Single Center, Prospective, Observational Study. J Am Heart Assoc 2015; 4:e002379. [PMID: 26459932 PMCID: PMC4845148 DOI: 10.1161/jaha.115.002379] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background We are the first to evaluate the prevalence of renal artery stenosis (RAS) in consecutive patients with acute myocardial infarction (AMI) referred for primary percutaneous coronary intervention from a single tertiary center. As a novelty, we assessed hydration and metabolic status and measured arterial stiffness. We elaborated a predicting model for RAS in AMI. Methods and Results One hundred and eighty‐one patients with AMI underwent concomitantly primary percutaneous coronary intervention and renal angiography. We obtained data on demographics, medical history, cardiovascular risk factors, echocardiography, Killip class, and blood tests. In the first 24 hours post–primary percutaneous coronary intervention, we assessed bioimpedance through Body Composition Monitoring® and arterial stiffness through pulsed‐wave velocity, SphygmoCor®. Significant RAS (>50% lumen narrowing, RAS+) was present in 16.6% patients. In the RAS+ group we recorded significantly higher stiffness, CRUSADE score and dehydration, and more women with higher prevalence of multivascular coronary artery disease and heart failure. In our multivariate models, variables independently associated with RAS+ were previous percutaneous coronary intervention, low estimated glomerular filtration rate, multivascular coronary artery disease, and total/extracellular body water. These models had good specificity and low sensitivity. Conclusions We observed that RAS+ AMI patients have a particular hydration, metabolic, and endothelial profile that could generate more future major adverse cardiac events. Hence, renal angiography in AMI should be considered in specific subsets of patients. Clinical Trial Registration URL: https://www.clinicaltrials.gov/. Unique identifier: NCT02388139.
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Affiliation(s)
- Alexandru Burlacu
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania (A.B., I.N.)
| | - Dimitrie Siriopol
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
| | - Luminita Voroneanu
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
| | - Ionut Nistor
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
| | - Simona Hogas
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
| | - Ana Nicolae
- Department of Cardiology, Cardiovascular Diseases Institute, Iasi, Romania (A.N.)
| | - Igor Nedelciuc
- Department of Interventional Cardiology, Cardiovascular Diseases Institute, Iasi, Romania (A.B., I.N.)
| | - Grigore Tinica
- Department of Cardiovascular Surgery, Cardiovascular Diseases Institute, Iasi, Romania (G.T.)
| | - Adrian Covic
- Department of Nephrology, University of Medicine "Gr. T. Popa", Iasi, Romania (D.S., L.V., I.N., S.H., A.C.)
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