1
|
Kavousi M, Desai CS, Ayers C, Blumenthal RS, Budoff MJ, Mahabadi AA, Ikram MA, van der Lugt A, Hofman A, Erbel R, Khera A, Geisel MH, Jöckel KH, Lehmann N, Hoffmann U, O'Donnell CJ, Massaro JM, Liu K, Möhlenkamp S, Ning H, Franco OH, Greenland P. Prevalence and Prognostic Implications of Coronary Artery Calcification in Low-Risk Women: A Meta-analysis. JAMA 2016; 316:2126-2134. [PMID: 27846641 DOI: 10.1001/jama.2016.17020] [Citation(s) in RCA: 89] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The role of coronary artery calcium (CAC) testing for guiding preventive strategies among women at low cardiovascular disease (CVD) risk based on the American College of Cardiology and American Heart Association CVD prevention guidelines is unclear. OBJECTIVE To assess the potential utility of CAC testing for CVD risk estimation and stratification among low-risk women. DESIGN, SETTING, AND PARTICIPANTS Women with 10-year atherosclerotic CVD (ASCVD) risk lower than 7.5% from 5 large population-based cohorts: the Dallas Heart Study (United States), the Framingham Heart Study (United States), the Heinz Nixdorf Recall study (Germany), the Multi-Ethnic Study of Atherosclerosis (United States), and the Rotterdam Study (the Netherlands). The 5 cohorts were selected based on the availability of CAC data in a sizable group of low-risk women from the general population together with the long detailed follow-up data. Across the cohorts, events were assessed from the date of CAC scan (performed from 1998 through 2006) until January 1, 2012; January 1, 2014; or March 6, 2015. Fixed-effects meta-analysis was conducted to combine the results of the 5 studies. EXPOSURES CAC score by computed tomography. MAIN OUTCOMES AND MEASURES Main outcome was incident ASCVD, including nonfatal myocardial infarction, coronary heart disease (CHD) death, and stroke. Association of CAC with ASCVD was examined using Cox proportional hazards models. To assess whether CAC was associated with improved ASCVD risk predictions beyond the traditional risk factors, the C statistic and the continuous net reclassification improvement (cNRI) index were calculated. RESULTS Among 6739 women with low ASCVD risk from the 5 studies, mean age ranged from 44 to 63 years and CAC was present in 36.1%. Across the cohorts, median follow-up ranged from 7.0 to 11.6 years. A total of 165 ASCVD events occurred (64 nonfatal myocardial infarctions, 29 CHD deaths, and 72 strokes), with the ASCVD incidence rates ranging from 1.5 to 6.0 per 1000 person-years. Compared with the absence of CAC (CAC = 0), presence of CAC (CAC >0) was associated with an increased risk of ASCVD (incidence rates per 1000 person-years, 1.41 for CAC absence vs 4.33 for CAC presence; difference, 2.92 [95% CI, 2.02-3.83]; multivariable-adjusted hazard ratio, 2.04 [95% CI, 1.44-2.90]). The addition of CAC to traditional risk factors improved the C statistic from 0.73 (95% CI, 0.69-0.77) to 0.77 (95% CI, 0.74-0.81) and provided a cNRI of 0.20 (95% CI, 0.09-0.31) for ASCVD prediction. CONCLUSIONS AND RELEVANCE Among women at low ASCVD risk, CAC was present in approximately one-third and was associated with an increased risk of ASCVD and modest improvement in prognostic accuracy compared with traditional risk factors. Further research is needed to assess the clinical utility and cost-effectiveness of this additional accuracy.
Collapse
Affiliation(s)
- Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Chintan S Desai
- Division of Cardiology, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Colby Ayers
- Division of Clinical Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Roger S Blumenthal
- Division of Cardiology, Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-University of California, Los Angeles Medical Center, Los Angeles
| | - Amir-Abbas Mahabadi
- Department of Cardiology, West German Heart and Vascular Center, University Clinic Essen, Essen, Germany
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands6Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands7Department of Neurology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Aad van der Lugt
- Department of Radiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands8Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Raimund Erbel
- Institute for Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Amit Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Marie H Geisel
- Institute for Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Karl-Heinz Jöckel
- Institute for Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Nils Lehmann
- Institute for Medical Informatics, Biometry, and Epidemiology, University of Duisburg-Essen, Essen, Germany
| | - Udo Hoffmann
- Cardiac MR PET CT Program, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston
| | - Christopher J O'Donnell
- Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston13National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts14National Heart, Lung and Blood Institute, Bethesda, Maryland
| | - Joseph M Massaro
- National Heart, Lung and Blood Institute's Framingham Heart Study, Framingham, Massachusetts15Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Kiang Liu
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Hongyan Ning
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Oscar H Franco
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Philip Greenland
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois18Senior Editor, JAMA
| |
Collapse
|
2
|
Desai CS, Bartz TM, Gottdiener JS, Lloyd-Jones DM, Gardin JM. Usefulness of Left Ventricular Mass and Geometry for Determining 10-Year Prediction of Cardiovascular Disease in Adults Aged >65 Years (from the Cardiovascular Health Study). Am J Cardiol 2016; 118:684-90. [PMID: 27457431 DOI: 10.1016/j.amjcard.2016.06.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 06/03/2016] [Accepted: 06/03/2016] [Indexed: 01/19/2023]
Abstract
Left ventricular (LV) mass and geometry are associated with risk of cardiovascular disease (CVD). We sought to determine whether LV mass and geometry contribute to risk prediction for CVD in adults aged ≥65 years of the Cardiovascular Health Study. We indexed LV mass to body size, denoted as LV mass index (echo-LVMI), and we defined LV geometry as normal, concentric remodeling, and eccentric or concentric LV hypertrophy. We added echo-LVMI and LV geometry to separate 10-year risk prediction models containing traditional risk factors and determined the net reclassification improvement (NRI) for incident coronary heart disease (CHD), CVD (CHD, heart failure [HF], and stroke), and HF alone. Over 10 years of follow-up in 2,577 participants (64% women, 15% black, mean age 72 years) for CHD and CVD, the adjusted hazards ratios for a 1-SD higher echo-LVMI were 1.25 (95% CI 1.14 to 1.37), 1.24 (1.15 to 1.33), and 1.51 (1.40 to 1.62), respectively. Addition of echo-LVMI to the standard model for CHD resulted in an event NRI of -0.011 (95% CI -0.037 to 0.028) and nonevent NRI of 0.034 (95% CI 0.008 to 0.076). Addition of echo-LVMI and LV geometry to the standard model for CVD resulted in an event NRI of 0.013 (95% CI -0.0335 to 0.0311) and a nonevent NRI of 0.043 (95% CI 0.011 to 0.09). The nonevent NRI was also significant with addition of echo-LVMI for HF risk prediction (0.10, 95% CI 0.057 to 0.16). In conclusion, in adults aged ≥65 years, echo-LVMI improved risk prediction for CHD, CVD, and HF, driven primarily by improved reclassification of nonevents.
Collapse
Affiliation(s)
- Chintan S Desai
- Division of Cardiology, Department of Medicine, The Johns Hopkins Hospital, Baltimore, Maryland
| | - Traci M Bartz
- Department of Biostatistics, University of Washington, Seattle, Washington
| | | | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| | - Julius M Gardin
- Department of Medicine, Hackensack University Medical Center, Hackensack, New Jersey
| |
Collapse
|
3
|
Handy CE, Desai CS, Dardari ZA, Al-Mallah MH, Miedema MD, Ouyang P, Budoff MJ, Blumenthal RS, Nasir K, Blaha MJ. The Association of Coronary Artery Calcium With Noncardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. JACC Cardiovasc Imaging 2016; 9:568-576. [PMID: 26970999 DOI: 10.1016/j.jcmg.2015.09.020] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 08/31/2015] [Accepted: 09/03/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES This study sought to determine if coronary artery calcium (CAC) is associated with incident noncardiovascular disease. BACKGROUND CAC is considered a measure of vascular aging, associated with increased risk of cardiovascular and all-cause mortality. The relationship with noncardiovascular disease is not well defined. METHODS A total of 6,814 participants from 6 MESA (Multi-Ethnic Study of Atherosclerosis) field centers were followed for a median of 10.2 years. Modified Cox proportional hazards ratios accounting for the competing risk of fatal coronary heart disease were calculated for new diagnoses of cancer, pneumonia, chronic obstructive pulmonary disease (COPD), chronic kidney disease (CKD), deep vein thrombosis/pulmonary embolism, hip fracture, and dementia. Analyses were adjusted for age; sex; race; socioeconomic status; health insurance status; body mass index; physical activity; diet; tobacco use; number of medications used; systolic and diastolic blood pressure; total and high-density lipoprotein cholesterol; antihypertensive, aspirin, and cholesterol medication; and diabetes. The outcome was first incident noncardiovascular disease diagnosis. RESULTS Compared with those with CAC = 0, those with CAC >400 had an increased hazard of cancer (hazard ratio [HR]: 1.53; 95% confidence interval [CI]: 1.18 to 1.99), CKD (HR: 1.70; 95% CI: 1.21 to 2.39), pneumonia (HR: 1.97; 95% CI: 1.37 to 2.82), COPD (HR: 2.71; 95% CI: 1.60 to 4.57), and hip fracture (HR: 4.29; 95% CI: 1.47 to 12.50). CAC >400 was not associated with dementia or deep vein thrombosis/pulmonary embolism. Those with CAC = 0 had decreased risk of cancer (HR: 0.76; 95% CI: 0.63 to 0.92), CKD (HR: 0.77; 95% CI: 0.60 to 0.98), COPD (HR: 0.61; 95% CI: 0.40 to 0.91), and hip fracture (HR: 0.31; 95% CI: 0.14 to 0.70) compared to those with CAC >0. CAC = 0 was not associated with less pneumonia, dementia, or deep vein thrombosis/pulmonary embolism. The results were attenuated, but remained significant, after removing participants developing interim nonfatal coronary heart disease. CONCLUSIONS Participants with elevated CAC were at increased risk of cancer, CKD, COPD, and hip fractures. Those with CAC = 0 are less likely to develop common age-related comorbid conditions, and represent a unique population of "healthy agers."
Collapse
Affiliation(s)
- Catherine E Handy
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Chintan S Desai
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Zeina A Dardari
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | | | - Michael D Miedema
- Minneapolis Heart Institute and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Pamela Ouyang
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Matthew J Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA, USA
| | - Roger S Blumenthal
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| | - Khurram Nasir
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
- Center for Prevention and Wellness Research, Baptist Health Medical Group, Miami Beach, FL, USA
- Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
- Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland, USA
| |
Collapse
|
4
|
Desai CS, Ning H, Liu K, Reis JP, Gidding SS, Armstrong A, Lima JAC, Lloyd-Jones DM. Cardiovascular Health in Young Adulthood and Association with Left Ventricular Structure and Function Later in Life: The Coronary Artery Risk Development in Young Adults Study. J Am Soc Echocardiogr 2015; 28:1452-61. [PMID: 26341123 DOI: 10.1016/j.echo.2015.07.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Indexed: 01/19/2023]
Abstract
BACKGROUND The aim of this study was to determine the association between cardiovascular health (CVH) in young adulthood and left ventricular (LV) structure and function later in life. METHODS Participants from the Coronary Artery Risk Development in Young Adults study, which recruited black and white participants aged 18 to 30 years at baseline, were included; echocardiography was performed at year 25. CVH at year 0 was defined on the basis of blood pressure, total cholesterol, fasting glucose, body mass index, smoking status, diet, and physical activity. Two, 1, or 0 points were assigned to each component for ideal, intermediate, and poor levels of each component. Participants were stratified into CVH groups on the basis of point score: ≤ 8 (poor), 9 to 11 (intermediate), and 12 to 14 (ideal). RESULTS The distribution of CVH at year 0 was as follows: poor, n = 264 (9%); intermediate, n = 1,315 (47%); and ideal, n = 1,224 (44%). Individuals with ideal and intermediate CVH at year 0 had significantly lower LV end-diastolic volume and lower LV mass index at year 25. In participants with ideal and intermediate CVH, the multivariate-adjusted odds ratios for diastolic dysfunction at year 25 was 0.52 (95% CI, 0.37-0.73) and 0.63 (95% CI, 0.46-0.83), respectively, compared with participants with poor CVH. Participants with ideal and intermediate CVH had significantly lower odds for LV hypertrophy; the LV mass index was 5.3 to 8.7 g/m(2.7) lower (P < .001 for both) than in participants with poor CVH. CONCLUSION Greater levels of CVH in young adulthood are associated with lower LV mass and lower risk for diastolic dysfunction 25 years later.
Collapse
Affiliation(s)
- Chintan S Desai
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Hongyan Ning
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kiang Liu
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jared P Reis
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | | | | | - Joao A C Lima
- Division of Cardiology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Donald M Lloyd-Jones
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
5
|
Cainzos-Achirica M, Desai CS, Wang L, Blaha MJ, Lopez-Jimenez F, Kopecky SL, Blumenthal RS, Martin SS. Pathways Forward in Cardiovascular Disease Prevention One and a Half Years After Publication of the 2013 ACC/AHA Cardiovascular Disease Prevention Guidelines. Mayo Clin Proc 2015; 90:1262-71. [PMID: 26269108 PMCID: PMC4567417 DOI: 10.1016/j.mayocp.2015.05.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/20/2015] [Accepted: 05/26/2015] [Indexed: 01/11/2023]
Abstract
The 2013 American College of Cardiology/American Heart Association cardiovascular disease prevention guidelines represent an important step forward in the risk assessment and management of atherosclerotic cardiovascular disease in clinical practice. Differentiated risk prediction equations for women and black individuals were developed, and convenient 10-year and lifetime risk assessment tools were provided, facilitating their implementation. Lifestyle modification was portrayed as the foundation of preventive therapy. In addition, based on high-quality evidence from randomized controlled trials, statins were prioritized as the first lipid-lowering pharmacologic treatment, and a shared decision-making model between the physician and the patient was emphasized as a key feature of personalized care. After publication of the guidelines, however, important limitations were also identified. This resulted in a constructive scientific debate yielding valuable insights into potential opportunities to refine recommendations, fill gaps in guidance, and better harmonize recommendations within and outside the United States. The latter point deserves emphasis because when guidelines are in disagreement, this may result in nonaction on the part of professional caregivers or nonadherence by patients. In this review, we discuss the key scientific literature relevant to the guidelines published in the year and a half after their release. We aim to provide cohesive, evidence-based views that may offer pathways forward in cardiovascular disease prevention toward greater consensus and benefit the practice of clinical medicine.
Collapse
Affiliation(s)
- Miguel Cainzos-Achirica
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Chintan S Desai
- Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Libin Wang
- Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Michael J Blaha
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | | | | | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Seth S Martin
- Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins University, Baltimore, MD; Ciccarone Center for the Prevention of Heart Disease, Department of Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD.
| |
Collapse
|
6
|
Affiliation(s)
- P Elliott Miller
- Osler Medical Service, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Eric L Scholten
- Osler Medical Service, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Chintan S Desai
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ryan J Tedford
- Division of Cardiology, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| |
Collapse
|
7
|
Khan KM, Desai CS, Mete M, Desale S, Girlanda R, Hawksworth J, Matsumoto C, Kaufman S, Fishbein T. Developing trends in the intestinal transplant waitlist. Am J Transplant 2014; 14:2830-7. [PMID: 25395218 DOI: 10.1111/ajt.12919] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Revised: 06/25/2014] [Accepted: 07/01/2014] [Indexed: 01/25/2023]
Abstract
The United Network for Organ Sharing database was examined for trends in the intestinal transplant (ITx) waitlist from 1993 to 2012, dividing into listings for isolated ITx versus liver-intestine transplant (L-ITx). Registrants added to the waitlist increased from 59/year in 1993 to 317/year in 2006, then declined to 124/year in 2012; Spline modeling showed a significant change in the trend in 2006, p < 0.001. The largest group of registrants, <1 year of age, determined the trend for the entire population; other pediatric age groups remained stable, adult registrants increased until 2012. The largest proportion of new registrants were for L-ITx, compared to isolated ITx; the change in the trend in 2006 for L-ITx was highly significant, p < 0.001, but not isolated ITx, p = 0.270. New registrants for L-ITx, <1 year of age, had the greatest increase and decrease. New registrants for isolated ITx remained constant in all pediatric age groups. Waitlist mortality increased to a peak around 2002, highest for L-ITx, in patients <1 year of age and adults. Deaths among all pediatric age groups awaiting L-ITx have decreased; adult L-ITx deaths have dropped less dramatically. Improved care of infants with intestinal failure has led to reduced referrals for L-ITx.
Collapse
Affiliation(s)
- K M Khan
- Transplant Institute, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
A large proportion of cardiovascular events occur in individuals classified by traditional risk factors as "low-risk." Efforts to improve early detection of coronary artery disease among low-risk individuals, or to improve risk assessment, might be justified by this large population burden. The most promising tests for improving risk assessment, or early detection, include the coronary artery calcium (CAC) score, the ankle-brachial index (ABI), and the high-sensitivity C-reactive protein (hsCRP). Data regarding the role of additional testing in low-risk populations to improve early detection or to enhance risk assessment are sparse but suggest that CAC and ABI may be helpful for improving risk classification and detecting the higher-risk people from among those at lower risk. However, in the absence of clinical trials in this patient population, such as has recently been proposed, we do not recommend routine use of any additional testing or screening in low-risk individuals at this time.
Collapse
Affiliation(s)
- Chintan S Desai
- Johns Hopkins Hospital, Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD, USA,
| | | | | |
Collapse
|
9
|
Desai CS, Ning H, Soliman EZ, Burke GL, Shea S, Nazarian S, Lloyd-Jones DM, Greenland P. Electrocardiographic abnormalities and coronary artery calcium for coronary heart disease prediction and reclassification: the Multi-Ethnic Study of Atherosclerosis (MESA). Am Heart J 2014; 168:391-7. [PMID: 25173552 DOI: 10.1016/j.ahj.2014.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Electrocardiographic (ECG) abnormalities and coronary artery calcium (CAC) identify different aspects of subclinical coronary heart disease (CHD). We sought to determine whether ECG abnormalities improve risk prediction for all CHD and fatal CHD events jointly with CAC measures. METHODS We included 6,406 men and women from the MESA aged 45 to 84 years who were free of cardiovascular disease at the time of enrollment (2000-2002). We stratified participants by presence of ST-T and Q wave abnormalities: any major, any minor/no major, and no major/minor using the Minnesota Code classifications. CAC score was defined into one of the following strata: 0, 1 to 100, 101 to 300, greater than 300. We created risk prediction models using MESA-specific coefficients for traditional risk factors (RFs) and calculated categorical net reclassification improvement (NRI) for all and fatal CHD. RESULTS Over a median follow-up of 10 years, we observed that the addition of ECG abnormalities to a risk prediction model for all CHD resulted in a categorical NRI of 0.05 (P = .04). For fatal CHD alone, the addition of ECG abnormalities resulted in categorical NRI of 0.09 (P = .02). Addition of ECG abnormalities to a model containing RFs and CAC resulted in categorical NRI of 0.02 (P = .11) for all CHD events. We also observed differences in the association between ECG abnormalities and CHD when stratifying by CAC presence. CONCLUSION Electrocardiographic abnormalities improved risk prediction for CHD when added to RFs but not when added to CAC. Electrocardiographic abnormalities particularly improved risk prediction for fatal CHD.
Collapse
|
10
|
Desai CS, Roselli EE, Svensson LG, Bonow RO. Transcatheter aortic valve replacement: current status and future directions. Semin Thorac Cardiovasc Surg 2014; 25:193-6. [PMID: 24331140 DOI: 10.1053/j.semtcvs.2013.09.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/16/2013] [Indexed: 11/11/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a revolutionary therapy for patients with aortic stenosis. Large registries and randomized controlled trials have demonstrated that TAVR is safe and effective in patients considered inoperable because of severe comorbidities and those who are high-risk surgical candidates. As TAVR evolves for lower-risk patients, attention will need to focus on reducing the rates of vascular injury, stroke, and paravalvular regurgitation. In this review, we discuss the status of TAVR in clinical practice, including patient selection, preoperative evaluation, techniques, and complications.
Collapse
Affiliation(s)
- Chintan S Desai
- Department of Preventive Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - Eric E Roselli
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Lars G Svensson
- Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Robert O Bonow
- Department of Medicine, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
| |
Collapse
|
11
|
Abstract
Statins form the pharmacologic cornerstone of the primary and secondary prevention of atherosclerotic cardiovascular disease. In addition to beneficial cardiovascular effects, statins seem to have multiple non-cardiovascular effects. Although early concerns about statin induced hepatotoxicity and cancer have subsided owing to reassuring evidence, two of the most common concerns that clinicians have are myopathy and diabetes. Randomized controlled trials suggest that statins are associated with a modest increase in the risk of myositis but not the risk of myalgia. Severe myopathy (rhabdomyolysis) is rare and often linked to a statin regimen that is no longer recommended (simvastatin 80 mg). Randomized controlled trials and meta-analyses suggest an increase in the risk of diabetes with statins, particularly with higher intensity regimens in people with two or more components of the metabolic syndrome. Other non-cardiovascular effects covered in this review are contrast induced nephropathy, cognition, cataracts, erectile dysfunction, and venous thromboembolism. Currently, systematic reviews and clinical practice guidelines indicate that the cardiovascular benefits of statins generally outweigh non-cardiovascular harms in patients above a certain threshold of cardiovascular risk. Literature is also accumulating on the potential non-cardiovascular benefits of statins, which could lead to novel applications of this class of drug in the future.
Collapse
Affiliation(s)
- Chintan S Desai
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| | - Seth S Martin
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| | - Roger S Blumenthal
- Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD 21287, USA
| |
Collapse
|
12
|
Sosin M, Nassif SR, Girlanda R, Desai CS, Satoskar R, Kallakury B, Cermak T, Fishbein T. Isolated peritoneal donor-related plasmacytoma 3 years after liver transplantation: a case report. Am J Transplant 2014; 14:472-6. [PMID: 24373189 DOI: 10.1111/ajt.12555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 10/15/2013] [Accepted: 10/19/2013] [Indexed: 01/25/2023]
Abstract
Organ transplantation carries a risk of disease transmission from donor to recipient, primarily infection or malignancy. Although donors are thoroughly screened, donor-related malignancies are reported to occur in 0.01% of solid organ transplants. Plasma cell neoplasm, to the best of our knowledge, has not been reported as a donor-transmitted malignancy in liver transplantation. We describe a liver transplant from a donor with unrecognized plasmacytoma requiring retransplantation. Three years after the first transplant a single peritoneal mass was detected on surveillance imaging and radically excised; HLA phenotyping confirmed the mass to be an isolated extra-medullary plasmacytoma of chimeric donor and recipient origin.
Collapse
Affiliation(s)
- M Sosin
- MedStar Georgetown Transplant Institute, MedStar Georgetown University Hospital, Washington, DC
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Desai CS, Ning H, Kang J, Folsom AR, Polak JF, Sibley CT, Tracy R, Lloyd-Jones DM. Competing cardiovascular outcomes associated with subclinical atherosclerosis (from the Multi-Ethnic Study of Atherosclerosis). Am J Cardiol 2013; 111:1541-6. [PMID: 23499272 DOI: 10.1016/j.amjcard.2013.02.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 02/03/2013] [Accepted: 02/03/2013] [Indexed: 11/24/2022]
Abstract
Subclinical atherosclerosis measured by coronary artery calcium (CAC) is associated with increased risk for multiple cardiovascular disease (CVD) outcomes and non-CVD death simultaneously. The aim of this study was to determine the competing risks of specific CVD events and non-CVD death associated with varying burdens of subclinical atherosclerosis. A total of 3,095 men and 3,486 women from the Multi-Ethnic Study of Atherosclerosis (MESA), aged 45 to 84 years, from 4 ethnic groups were included. Participants were stratified by CAC score (0, 1 to 99, and ≥100). Competing Cox models were used to determine competing cumulative incidences and hazard ratios within a group (e.g., those with CAC scores ≥100) and hazard ratios for specific events between groups (e.g., CAC score ≥100 vs 0). Risks were compared for specific CVD events and also against non-CVD death. In women, during a mean follow-up period of 7.1 years, the hazard ratios for any CVD event compared with a non-CVD death occurring first for CAC score 0 and CAC score ≥100 were 1.40 (95% confidence interval 0.97 to 2.04) and 3.07 (95% confidence interval 2.02 to 4.67), respectively. Coronary heart disease was the most common first CVD event type at all levels of CAC, and coronary heart disease rates were 9.5% versus 1.6% (hazard ratio 6.24, 95% confidence interval 3.99 to 9.75) for women with CAC scores ≥100 compared with CAC scores of 0. Similar results were observed in men. In conclusion, at all levels of CAC, coronary heart disease was the most common first CVD event, and this analysis represents a novel approach to understanding the temporal sequence of cardiovascular events associated with atherosclerosis.
Collapse
|
14
|
Desai CS, Ayers CR, Budoff M, Erbel R, Kavousi M, Khera A, Lehmann N, Liu K, Mohlenkamp S, Ning H, Witteman J, Greenland P. IMPROVED CORONARY HEART DISEASE RISK PREDICTION WITH CORONARY ARTERY CALCIUM IN LOW-RISK WOMEN: A META-ANALYSIS OF FOUR COHORTS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)60995-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
15
|
Desai CS, Colangelo LA, Liu K, Jacobs DR, Cook NL, Lloyd-Jones DM, Ogunyankin KO. Prevalence, prospective risk markers, and prognosis associated with the presence of left ventricular diastolic dysfunction in young adults: the coronary artery risk development in young adults study. Am J Epidemiol 2013; 177:20-32. [PMID: 23211639 DOI: 10.1093/aje/kws224] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
The authors sought to determine the prevalence, prospective risk markers, and prognosis associated with diastolic dysfunction in the Coronary Artery Risk Development in Young Adults (CARDIA) Study. The CARDIA Study cohort includes approximately equal proportions of white and black men and women. The authors collected data on risk markers at year 0 (1985-1986), and echocardiography was done at year 5 when the participants were 23-35 years of age. Participants were followed for 20 years (through 2010) for a composite endpoint of all-cause mortality, myocardial infarction, heart failure, and stroke. Diastolic function was defined according to a validated hierarchical classification algorithm. In the 2,952 participants included in the primary analysis, severe diastolic dysfunction was present in 1.1% and abnormal relaxation was present in 9.3%. Systolic blood pressure at year 0 was associated with both severe diastolic dysfunction and abnormal relaxation 5 years later, whereas exercise capacity and pulmonary function abnormalities were associated only with abnormal relaxation 5 years later. After multivariate adjustment, the hazard ratios for the composite endpoint in participants with severe diastolic dysfunction and abnormal relaxation were 4.3 (95% confidence interval: 2.0, 9.3) and 1.6 (95% confidence interval: 1.1, 2.5), respectively. Diastolic dysfunction in young adults is associated with increased morbidity and mortality, and the identification of prospective risk markers associated with diastolic dysfunction could allow for targeted primary prevention efforts.
Collapse
Affiliation(s)
- Chintan S Desai
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University,Chicago, Illinois 60611, USA
| | | | | | | | | | | | | |
Collapse
|
16
|
Desai CS, Maegawa FB, Gruessner AC, Gruessner RW, Gruesner RW, Khan KM. Age-based disparity in outcomes of intestinal transplants in pediatric patients. Am J Transplant 2012; 12 Suppl 4:S43-8. [PMID: 22642508 DOI: 10.1111/j.1600-6143.2012.04107.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Outcomes of intestinal transplants (ITx; n = 977) for pediatric patients are examined using the United Network for Organ Sharing data from 1987 to 2009. Recipients were divided into four age groups: (1) <2 years of age (n = 569), (2) 2-6 years (n = 219), (3) 6-12 years (n = 121) and (4) 12-18 years (n = 68). Of 977 ITx, 287 (29.4%) were isolated ITx and 690 (70.6%) were liver and ITx (L-ITx). Patient survival for isolated ITx at 1, 3 and 5 years, 85.3%, 71.3% and 65.0%, respectively, was significantly better than L-ITx, 68.4%, 57.0% and 51.4%, respectively, (p = 0.0001); this was true for all age groups, except for patients <2 years of age. The difference in graft survival between isolated ITx and L-ITx was significant at 1 and 3 years (Wilcoxon test, p = 0.0012). After attrition analysis of graft survival of patients who survived past first year, 3 and 5 years, graft survival for L-ITx patient was significantly better than those for isolated ITx. Isolated ITx should be considered early before the onset of liver disease in children >2 with intestinal failure but is not advantageous in patients <2 years.
Collapse
Affiliation(s)
- C S Desai
- Department of Surgery, University of Arizona, Tucson, AZ, USA.
| | | | | | | | | | | |
Collapse
|
17
|
Affiliation(s)
- Chintan S Desai
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois 60611, USA
| | | |
Collapse
|
18
|
Desai CS, Ogunyankin KO. Gender-Related Differences in Left Ventricular Mass in Nonhypertensive Young Adults: It's Not All About Size. Can J Cardiol 2012; 28:411-2. [DOI: 10.1016/j.cjca.2012.01.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Revised: 01/30/2012] [Accepted: 01/30/2012] [Indexed: 11/16/2022] Open
|
19
|
Hinchcliff M, Desai CS, Varga J, Shah SJ. Prevalence, prognosis, and factors associated with left ventricular diastolic dysfunction in systemic sclerosis. Clin Exp Rheumatol 2012; 30:S30-S37. [PMID: 22338601 PMCID: PMC3507505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 09/26/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES To determine the frequency, associated clinical factors, and prognostic significance of left ventricular (LV) diastolic dysfunction in systemic sclerosis (SSc). METHODS We studied 153 consecutive patients with SSc and divided the study sample into those with and without LV diastolic dysfunction using established age-based normal cut-offs for lateral tissue Doppler early mitral annular (E') velocity, a marker of impaired relaxation and diastolic dysfunction. We compared clinical characteristics, laboratory tests, pulmonary function tests, and echocardiographic data between those with and without LV diastolic dysfunction. We used multivariable linear regression analyses to determine the factors most associated with lateral tissue Doppler E' velocity. We also performed multivariable Cox regression analyses to determine whether or not tissue Doppler E' velocity was independently associated with mortality. RESULTS LV diastolic dysfunction was present in 23% of the subjects, whereas LV systolic dysfunction was present in 5.2% of subjects. Factors independently associated with LV diastolic dysfunction on multivariable analysis included SSc disease duration, age, coronary artery disease, and systemic hypertension. During a mean follow-up of 1.9±1.3 years, LV diastolic dysfunction was independently associated with increased risk of death (hazard ratio [HR] 3.2, 95% confidence interval [CI] 1.1-9.5, p=0.034 per each standard deviation decrease in tissue Doppler E' velocity). CONCLUSIONS LV diastolic dysfunction in SSc is independently associated with disease duration and is a marker of increased risk of death.
Collapse
|
20
|
Desai CS, Ning H, Lloyd-Jones DM. Competing cardiovascular outcomes associated with electrocardiographic left ventricular hypertrophy: the Atherosclerosis Risk in Communities Study. Heart 2011; 98:330-4. [PMID: 22139711 DOI: 10.1136/heartjnl-2011-300819] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Individuals with electrocardiographically determined left ventricular hypertrophy (ECG LVH) are at risk of multiple cardiovascular disease (CVD) outcomes simultaneously. The study sought to characterise the competing incidences for subtypes of first CVD events or non-CVD death in those with and without ECG LVH. METHODS Participants in the Atherosclerosis Risk in Communities (ARIC) Study were included. ECG LVH was defined according to Sokolow-Lyon criteria. Competing Cox models were used to compare hazards for diverse outcomes within groups (e.g., among those with ECG LVH) and for a given event between groups (ECG LVH vs. no ECG LVH). RESULTS After 15 years, men with ECG LVH at baseline (N=383) had a cumulative incidence of first CVD events and non-CVD deaths of 29.2% and 6.1%, respectively (HR 4.86; 95% CI 3.04 to 7.77). In men without ECG LVH (N=6576) the incidence of any first CVD event and non-CVD death was 18.9% and 6.9%, respectively (HR 2.67; 2.39 to 2.98). Similar associations were observed in women (N=381 with and N=8187 without ECG LVH). Coronary heart disease (CHD) was the most common first event in men with ECG LVH (15.0%) and heart failure was the most common first event in women with ECG LVH (10.5%). After adjustment for risk factors including systolic blood pressure, any CVD event remained the most likely first event. CONCLUSIONS Among middle-aged individuals with ECG LVH, the most likely first events are CHD in men and heart failure in women; these results may have implications for preventive approaches.
Collapse
Affiliation(s)
- Chintan S Desai
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N. Lake Shore Drive, Suite 1402, Chicago, IL 60611, USA
| | | | | |
Collapse
|
21
|
Desai CS, Maybury R, Cummings LS, Johnson LB, Fishbein TM, Neville R, Melancon JK. Autotransplantation of solitary kidney with renal artery aneurysm treated with laparoscopic nephrectomy and ex vivo repair: a case report. Transplant Proc 2011; 43:2789-91. [PMID: 21911164 DOI: 10.1016/j.transproceed.2011.06.039] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/29/2011] [Accepted: 06/01/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Renal artery aneurysms (RAA) are extremely rare clinical entities with associated morbidities including hypertension and rupture. Although most RAA can be treated with in vivo repair or endovascular techniques, these may not be possible in patients with complex RAA beyond the renal artery bifurcation. We report a case of RAA in a patient with a solitary kidney that we treated successfully by extracorporeal repair and autotransplantation and the 2-years follow-up. CASE REPORT A 64-year-old woman with a history of right nephrectomy for renal cell carcinoma presented with RAA found on routine computed tomography (CT). Preoperative workup demonstrated a 2.2 × 2.1 × 3-cm aneurysm in the distal left renal artery that was not amendable to in vivo or endovascular repair. The patient underwent a laparoscopic-assisted left nephrectomy, ex vivo renal artery aneurysm repair, and autotransplantation. She did well postoperatively and in clinic follow-up was found to have a creatinine of 1.2 mg/dL at the end of 2 years and stable blood pressure control. DISCUSSION This patient with RAA in her solitary kidney was successfully treated with laparoscopic-assisted nephrectomy, ex vivo repair, and autotransplantation. Her creatinine was stable postoperatively despite absence of a second kidney.
Collapse
Affiliation(s)
- C S Desai
- University of Arizona, Department of Surgery, Division of Abdominal Transplantation, Tucson, AZ 85724, USA.
| | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
We report the case of a successful multivisceral transplant in which both donor and recipient presented aberrant anatomy of the celiac-mesenteric axis requiring five separate arterial anastomoses to reconstruct the blood inflow to the graft.
Collapse
Affiliation(s)
- R Girlanda
- Transplant Institute, Georgetown University Hospital, Washington, DC
| | | | | | | | | | | |
Collapse
|
23
|
Desai CS, Prabhu RY, Supe AN. Laparoscopic orchidectomy for undescended testis in adults. J Postgrad Med 2002; 48:25-6. [PMID: 12082322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND Impalpable testis is a significant diagnostic and therapeutic challenge in adults, for both radiologist and surgeons, with few reports in literature addressing this problem in adults. Laparoscopy is a reliable and definitive procedure obviating the necessity of advance investigation and subsequent inguinal exploration in adults. AIMS To study the utility of laparoscopy as combined diagnostic and therapeutic modality for undescended testis in adults. SETTINGS AND DESIGN Prospective study from a single surgical unit of a large tertiary referral centre during August 2000 to January 2002. METHODS AND MATERIAL Nine patients of unilateral undescended testis with average age 22.7 years (range 13-31 years) underwent diagnostic laparoscopy and orchidectomy subsequent to detailed clinical, ultrasound and examination under anaesthesia (EUA) procedure. All patients were operated with one 10 mm umbilical camera port, one suprapubic port and 1 lateral port. RESULTS None of the patients had palpable testis or an inguinal cough impulse on clinical examination and during EUA. In only 3(33.3%) patients, the ultrasound could locate the testis situated at the deep ring. On laparoscopy all testes were identified, 4 were present at the deep ring, 3 were intra-abdominal and 2 had blind ending vas entering the deep ring. Mesh plug was inserted in the internal ring in these 2 patients, after dissecting the peritoneum. None of the patients had intra or post-operative complications and all were discharged on the next day. CONCLUSION Laparoscopy is one of the most satisfactory methods for the diagnosis and management of non-palpable testis in adult cryptorchid patients.
Collapse
Affiliation(s)
- C S Desai
- Department of Surgery, Seth G.S. Medical College and K. E. M. Hospital, Parel, Mumbai - 400 012, India
| | | | | |
Collapse
|
24
|
Abstract
OBJECTIVE To study the incidence of antral varices (AV) and their fate in patients with portal hypertension so as to formulate a management policy. DESIGN Prospective cohort study. SETTING Single surgical unit specializing in portal hypertension management in a tertiary level centre. PARTICIPANTS Three hundred and seventy-one patients [cirrhosis 170, non-cirrhotic portal fibrosis (NCPF) 53, extrahepatic portal venous obstruction (EHPVO) 148] with history of bleeding from oesophageal varices were inducted in the chronic sclerotherapy programme. INTERVENTIONS Protocol-based endoscopic sclerotherapy and management of bleeding for oesophageal varices. OUTCOME MEASURES Development or disappearance of AV, bleeding from AV. RESULTS No patient had AV on index endoscopy. Thirteen (3.5%) patients developed AV, in cirrhosis 2.9%, EHPVO 4.1%, NCPF 3.8% (P = 0.86). AV developed after a mean of 15 months. Oesophageal varices took a longer number of sessions to obliterate in patients with AV (11.1 vs 5.98 sessions, P<0.0001). Only one patient bled, having coexistent oesophageal varices and gastropathy. AV disappeared spontaneously in seven patients, recurring in only one. Of seven persisting AV, none have bled over a mean follow-up of 30 months (SD 23.2). CONCLUSIONS AV are seen in a small proportion of patients, and are distributed equally amongst the aetiologies of portal hypertension. They rarely bleed and may be ignored during sclerotherapy of oesophageal varices.
Collapse
Affiliation(s)
- S R Shah
- Gastroenterology Surgical Services, King Edward VII Memorial Hospital, Bombay, India.
| | | | | |
Collapse
|
25
|
Muthe AV, Desai CS, Kale NR. Studies on the dissociation of tissue factor (tissue thromboplastin) on treatment with butan-1-ol. Biochem J 1972; 128:47P. [PMID: 5085616 PMCID: PMC1173685 DOI: 10.1042/bj1280047pa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|