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Maltes S, Rocha BML, Cunha GJL, Paiva MS, Vasques AC, Freitas P, Guerreiro S, Marta L, Abecasis J, Regina R, Andrade MJ, Aguiar CT, Martins A, Mendes M. Prevalence of RV dysfunction in patients under cardiotoxic chemoterapy: a preliminary analysis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Chemotherapy-induced cardiotoxicity is a serious complication often leading to heart failure. While the left ventricle (LV) has been thoroughly implicated in this process, data is scarce on right ventricular (RV) function following cardiotoxic chemotherapies. Our goal was to determine the prevalence and clinical significance of RV dysfunction in a cohort of patients who had received these drugs.
Methodology
Single-center retrospective study of cancer patients performing 2D transthoracic echocardiogram between January 2020 and December 2021. Those previously exposed to anthracyclines and/or anti-HER2 agents (≥6 months prior to echocardiogram) were included. Patients with known coronary artery disease or cardiomyopathy were excluded. LV function was assessed through LV ejection fraction (LVEF) and global longitudinal strain (GLS). LV cardiotoxicity was defined as per 2020 ESMO guidelines. RV function was considered abnormal if the following criteria were met: tricuspid annular plane systolic excursion (TAPSE) <17 mm, peak systolic velocity of the tricuspid annulus by pulsed wave TDI (S'VD) <12 cm/s, fraction area change (FAC) <35% and mean free wall longitudinal strain (FWLS) >−20%.
Results
Forty patients were included (58±13 years; 95% female; 93% with breast cancer; 30%, 20% and 50% previously treated with anthracyclines, anti-HER2 or both, respectively). Mean LVEF and GLS were 56±7% and −17±3%. Overall, 13 patients had current LV cardiotoxicity. RV dysfunction was documented in 15 (38%) patients (7 [18%] with isolated RV dysfunction), most often detected through FWLS (14 [35%], 7 [18%], 6 [15%] and 5 [13%] patients with abnormal FWLS, TAPSE, FAC and S'VD, respectively) – Figure 1. Seven patients (18%) and one patient (3%) had ≥2 and ≥3 abnormal RV parameters. Those with RV dysfunction were more often symptomatic (NYHA class ≥2: 53% vs. 16%; p=0.013), had higher NT-proBNP levels (516 [204–2400] vs. 66 [46–191] pg/mL; p=0.003) and most often had LV cardiotoxicity (62% vs. 26%, p=0.029); pulmonary artery systolic pressures were similar between both groups.
Conclusion
In our cohort of patients treated with cardiotoxic anti-neoplastic drugs, RV dysfunction was observed in two out of every five patients, most often detected by RV 2D strain and associated with worse symptoms and higher NT-proBNP levels. This data suggests that RV cardiotoxicity may be common and clinically impactful in those under cardiotoxic chemotherapies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | - M S Paiva
- Hospital Santa Cruz , Lisbon , Portugal
| | - A C Vasques
- Hospital de Sao Francisco Xavier , Lisbon , Portugal
| | - P Freitas
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - L Marta
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - R Regina
- Hospital Santa Cruz , Lisbon , Portugal
| | | | | | - A Martins
- Hospital de Sao Francisco Xavier , Lisbon , Portugal
| | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
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Maltes S, Paiva MS, Madeira S, Teles RC, Almeida MS, Mendes M. Correlation between NSTE-ACS risk scores with Syntax: can we predict coronary lesion complexity before angiography? Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background and aim
Standard single antiplatelet regimen (SAPT) is currently recommended before invasive risk stratification in non-ST elevation acute coronary syndromes (NSTE-ACS). However, there are subsets in whom dual antiplatelet therapy (DAPT) may be more protective according to the coronary anatomy and revascularization strategy. We aimed to identify pre-procedural predictors of coronary artery complexity that may be helpful in selecting an individualized antiplatelet regimen.
Methodology
Retrospective single-center study including patients with NSTE-ACS performing coronary angiography between January 2020 and July 2021. Clinical variables and classical NSTE-ACS risk scores (TIMI, GRACE and HEART) were captured and SYNTAX 1 score was calculated. Patients were divided into low (0–22), moderate (23–32) and high (≥33) SYNTAX score. Multivariate logistic regression analysis was performed to determine predictors of anatomical complexity (defined as significant left main disease [stenosis ≥50%] or SYNTAX ≥33).
Results
A total of 448 patients were included (mean age 67±13 years; 74% males; 85% with NSTE-myocardial infarction). Overall, 350 (78%), 63 (14%) and 35 (8%) patients had a low, moderate or high-SYNTAX score, respectively. Thirty-one (7%) patients had significant left main disease.
At multivariate analysis (adjusted for age, diabetes, renal function, GRACE and TIMI scores), the HEART score (hazard ratio 2.3, 95% confidence interval 1.5–3.3, p<0.001) predicted a high anatomical complexity. When performing ROC curve analysis, the HEART score had a high discriminative ability in identifying those with complex coronary anatomy (area under the curve 0.79, 95% CI 0.72–0.86, p<0.001) (Figure 1) – a score >7 showed a sensitivity of 76% and specificity of 75% in identifying such patients.
Conclusion
In this cohort of NSTE-ACS patients, the HEART score was an independent predictors of complex coronary anatomies. These results suggest that those with high (>7) HEART score may merit from SAPT as opposed to DAPT, given the high probability of complex lesions amenable to CABG.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- S Maltes
- Hospital Santa Cruz , Lisbon , Portugal
| | - M S Paiva
- Hospital Santa Cruz , Lisbon , Portugal
| | - S Madeira
- Hospital Santa Cruz , Lisbon , Portugal
| | - R C Teles
- Hospital Santa Cruz , Lisbon , Portugal
| | | | - M Mendes
- Hospital Santa Cruz , Lisbon , Portugal
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Bravo L, Smolenov I, Han HH, Li P, Hosain R, Rockhold F, Clemens SAC, Roa C, Borja-Tabora C, Quinsaat A, Lopez P, López-Medina E, Brochado L, Hernández EA, Reynales H, Medina T, Velasquez H, Toloza LB, Rodriguez EJ, de Salazar DIM, Rodríguez CA, Sprinz E, Cerbino-Neto J, Luz KG, Schwarzbold AV, Paiva MS, Carlos J, Montellano MEB, de Los Reyes MRA, Yu CY, Alberto ER, Panaligan MM, Salvani-Bautista M, Buntinx E, Hites M, Martinot JB, Bhorat QE, Badat A, Baccarini C, Hu B, Jurgens J, Engelbrecht J, Ambrosino D, Richmond P, Siber G, Liang J, Clemens R. Efficacy of the adjuvanted subunit protein COVID-19 vaccine, SCB-2019: a phase 2 and 3 multicentre, double-blind, randomised, placebo-controlled trial. Lancet 2022; 399:461-472. [PMID: 35065705 PMCID: PMC8776284 DOI: 10.1016/s0140-6736(22)00055-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 12/05/2021] [Accepted: 12/21/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND A range of safe and effective vaccines against SARS CoV 2 are needed to address the COVID 19 pandemic. We aimed to assess the safety and efficacy of the COVID-19 vaccine SCB-2019. METHODS This ongoing phase 2 and 3 double-blind, placebo-controlled trial was done in adults aged 18 years and older who were in good health or with a stable chronic health condition, at 31 sites in five countries (Belgium, Brazil, Colombia, Philippines, and South Africa). The participants were randomly assigned 1:1 using a centralised internet randomisation system to receive two 0·5 mL intramuscular doses of SCB-2019 (30 μg, adjuvanted with 1·50 mg CpG-1018 and 0·75 mg alum) or placebo (0·9% sodium chloride for injection supplied in 10 mL ampoules) 21 days apart. All study staff and participants were masked, but vaccine administrators were not. Primary endpoints were vaccine efficacy, measured by RT-PCR-confirmed COVID-19 of any severity with onset from 14 days after the second dose in baseline SARS-CoV-2 seronegative participants (the per-protocol population), and the safety and solicited local and systemic adverse events in the phase 2 subset. This study is registered on EudraCT (2020-004272-17) and ClinicalTrials.gov (NCT04672395). FINDINGS 30 174 participants were enrolled from March 24, 2021, until the cutoff date of Aug 10, 2021, of whom 30 128 received their first assigned vaccine (n=15 064) or a placebo injection (n=15 064). The per-protocol population consisted of 12 355 baseline SARS-CoV-2-naive participants (6251 vaccinees and 6104 placebo recipients). Most exclusions (13 389 [44·4%]) were because of seropositivity at baseline. There were 207 confirmed per-protocol cases of COVID-19 at 14 days after the second dose, 52 vaccinees versus 155 placebo recipients, and an overall vaccine efficacy against any severity COVID-19 of 67·2% (95·72% CI 54·3-76·8), 83·7% (97·86% CI 55·9-95·4) against moderate-to-severe COVID-19, and 100% (97·86% CI 25·3-100·0) against severe COVID-19. All COVID-19 cases were due to virus variants; vaccine efficacy against any severity COVID-19 due to the three predominant variants was 78·7% (95% CI 57·3-90·4) for delta, 91·8% (44·9-99·8) for gamma, and 58·6% (13·3-81·5) for mu. No safety issues emerged in the follow-up period for the efficacy analysis (median of 82 days [IQR 63-103]). The vaccine elicited higher rates of mainly mild-to-moderate injection site pain than the placebo after the first (35·7% [287 of 803] vs 10·3% [81 of 786]) and second (26·9% [189 of 702] vs 7·4% [52 of 699]) doses, but the rates of other solicited local and systemic adverse events were similar between the groups. INTERPRETATION Two doses of SCB-2019 vaccine plus CpG and alum provides notable protection against the entire severity spectrum of COVID-19 caused by circulating SAR-CoV-2 viruses, including the predominating delta variant. FUNDING Clover Biopharmaceuticals and the Coalition for Epidemic Preparedness Innovations.
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Affiliation(s)
- Lulu Bravo
- University of the Philippines Manila, Ermita, Manila, Philippines
| | | | | | - Ping Li
- Clover Biopharmaceuticals, Cambridge, MA, USA
| | | | - Frank Rockhold
- Duke University Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | | | - Camilo Roa
- Manila Doctors Hospital, Manila, Philippines
| | | | | | - Pio Lopez
- Centro de Estudios en Infectología Pediátrica, Universidad Del Valle Clínica Imbanaco, Cali, Colombia
| | - Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Universidad Del Valle Clínica Imbanaco, Cali, Colombia
| | | | | | | | - Tatiana Medina
- Center of Attention in Medical Research, Bogotá, Colombia
| | | | | | | | | | | | - Eduardo Sprinz
- Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Maria Sanali Paiva
- Atena Institute of Clinical Research, Rio Grande do Norte, Natal, Brazil
| | - Josefina Carlos
- University of the East Ramon Magsaysay Memorial Medical Center, Quezon City, Philippines
| | | | | | - Charles Y Yu
- De La Salle Medical and Health Sciences Institute, Cavite City, Philippines
| | | | - Mario M Panaligan
- Infection Control Service, St Luke's Medical Center, Taguig, Philippines
| | | | | | - Maya Hites
- Clinic of Infectious Diseases, CUB-Hôpital Erasme, Bruxelles, Belgium
| | - Jean-Benoit Martinot
- Pulmonology Department, CHU Universite Catholique de Louvain Namur Site Sainte-Elisabeth, Namur, Belgium
| | - Qasim E Bhorat
- Soweto Clinical Trials Centre, Johannesburg, South Africa
| | - Aysha Badat
- Wits Clinical Research, Soweto, Johannesburg, South Africa
| | | | - Branda Hu
- Clover Biopharmaceuticals, Cambridge, MA, USA
| | - Jaco Jurgens
- DJW Research, Noordheuwel, Krugersdorp, Gauteng, South Africa
| | - Jan Engelbrecht
- Dr JM Engelbrecht Trial Site, Vergelegen Mediclinic, Western Cape, South Africa
| | | | - Peter Richmond
- Division of Paediatrics, University of Western Australia, Wesfarmers Centre of Vaccines and Infectious Diseases, Telethon Kids Institute and Perth Children's Hospital, Perth, WA, Australia
| | | | | | - Ralf Clemens
- Global Research in Infectious Diseases, Rio de Janeiro, Brazil.
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Aquino ARL, Lima KC, Paiva MS, Rôças IN, Siqueira JF. Molecular survey of atheromatous plaques for the presence of DNA from periodontal bacterial pathogens, archaea and fungi. J Periodontal Res 2011; 46:303-9. [PMID: 21261623 DOI: 10.1111/j.1600-0765.2010.01343.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND AND OBJECTIVE Chronic infections, such as periodontitis, have been associated with the development and progression of atherosclerosis. The mechanisms through which this occurs have yet to be elucidated. This study was carried out to detect periodontopathic bacteria as well as archaea and fungi in atheromatous plaques and search for factors associated with their occurrence in atheromas. MATERIAL AND METHODS A cross-sectional study was carried out including 30 patients diagnosed with atherosclerosis in the carotid, coronary or femoral arteries. Plaques were collected during surgery and analysed using PCR to detect Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Treponema denticola and members of the Synergistetes group. Samples were also surveyed with universal primers for bacterial, archaeal and fungal DNA. Patients responded to a questionnaire to determine factors associated with PCR results. RESULTS All dentate individuals (66.7%) had periodontal disease, 95% of which was severe and 65% extensive. None of the targeted periodontopathic bacteria was found in the atheromas. No sample yielded positive results for fungal and archaeal DNA. Four samples (13%) were positive for the presence of bacterial DNA. Of these, three participants were dentate (two with severely chronic generalized periodontitis and one with severely chronic localized periodontitis). CONCLUSION This study did not confirm previous findings of periodontal pathogens in atheromas, making it impossible to establish factors associated with their presence in plaques. Presence of bacterial DNA in some samples indicates that periodontal or nonoral bacterial species other than the ones targeted in this study may be involved with some cases of atherosclerosis.
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Affiliation(s)
- A R L Aquino
- Departments of Preventive Dentistry, Federal University of Rio Grande do Norte, Natal, RN, Brazil.
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