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Davies A, Wenzl FA, Li XS, Winzap P, Obeid S, Klingenberg R, Mach F, Räber L, Muller O, Matter CM, Laaksonen R, Wang Z, Hazen SL, Lüscher TF. Short and medium chain acylcarnitines as markers of outcome in diabetic and non-diabetic subjects with acute coronary syndromes. Int J Cardiol 2023; 389:131261. [PMID: 37574027 DOI: 10.1016/j.ijcard.2023.131261] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 07/27/2023] [Accepted: 08/10/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Carnitine metabolism produces numerous molecular species of short-, medium-, and long-chain acylcarnitines, which play important roles in energy homeostasis and fatty acid transport in the myocardium. Given that disturbances in the carnitine metabolism are linked to cardiometabolic disease, we studied the relationship of circulating acylcarnitines with outcomes in patients with acute coronary syndromes (ACS) and evaluated differences in circulating levels of these metabolites between diabetic and non-diabetic patients. METHODS Harnessing a prospective multicentre cohort study (SPUM-ACS; NCT01000701), we measured plasma levels of acylcarnitines, carnitine, and carnitine metabolites to assess their relationship with adjudicated major adverse cardiac events (MACE), defined as composite of myocardial infarction, stroke, clinically indicated revascularization, or death of any cause. The SPUM-ACS study enrolled patients presenting with ACS to Swiss University Hospitals between 2009 and 2012. Acetylcarnitine, octanoylcarnitine, proprionylcarnitine, butyrylcarnitine, pentanoylcarnitine, hexanoylcarnitine, carnitine, γ-butyrobetaine, and trimethylamine N-oxide were measured in plasma using stable isotope dilution high-performance liquid chromatography with online electrospray ionization tandem mass spectrometry. RESULTS A total of 1683 patients with ACS were included in the study. All measured metabolites except γ-butyrobetaine and carnitine were higher in diabetic subject (n = 294) than in non-diabetic subjects (n = 1389). On univariate analysis, all metabolites, apart from octenoylcarnitine, were significantly associated with MACE at 1 year. After multivariable adjustment for established risk factors, acetylcarnitine remained an independent predictor of MACE at 1-year (quartile 4 vs. quartile 1, adjusted hazard ratio 2.06; 95% confidence interval 1.12-3.80, P = 0.020). CONCLUSION Circulating levels of acetylcarnitine independently predict residual cardiovascular risk in patients with ACS.
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Affiliation(s)
- Allan Davies
- Royal Brompton and Harefield Hospitals, London, UK
| | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Xinmin S Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Patric Winzap
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Slayman Obeid
- Division of Cardiology, Department of Medicine, Aarau Cantonal Hospital, Aarau, Switzerland; Herzklinik Kreuzlingen, Kreuzlingen, Switzerland
| | - Roland Klingenberg
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany; Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Rhine-Main, Bad Nauheim, Germany
| | - François Mach
- Department of Cardiology, Hopital Universitaire de Geneve, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, Lausanne, Switzerland
| | - Christian M Matter
- University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland
| | - Reijo Laaksonen
- Zora Biosciences Oy, Espoo, Finland; Department of Clinical Chemistry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland; Faculty of Medicine and Health Technology, Finnish Cardiovascular Research Center Tampere, Tampere University, Tampere, Finland
| | - Zeneng Wang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Stanley L Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA; Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals, London, UK; Center for Molecular Cardiology, University of Zurich, Switzerland; National Heart and Lung Institute, Imperial College, London, UK; School of Cardiovascular Medicine and Sciences, Kings College London, London, UK.
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2
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Bruno F, Adjibodou B, Obeid S, Kraler SC, Wenzl FA, Akhtar MM, Denegri A, Roffi M, Muller O, von Eckardstein A, Räber L, Templin C, Lüscher TF. Occlusion of the infarct-related coronary artery presenting as acute coronary syndrome with and without ST-elevation: impact of inflammation and outcomes in a real-world prospective cohort. Eur Heart J Qual Care Clin Outcomes 2023; 9:564-574. [PMID: 37197909 DOI: 10.1093/ehjqcco/qcad027] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 04/18/2023] [Accepted: 05/16/2023] [Indexed: 05/19/2023]
Abstract
BACKGROUND Patients with ST-segment elevation typically feature total coronary occlusion (TCO) of the infarct-related artery (IRA) on angiography, which may result in worse outcomes. Yet, relying solely on electrocardiogram (ECG) findings may be misleading and those presenting with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs) may have TCO as well. Herein, we aimed to delineate clinical characteristics and outcomes of patients with ACS stratified by IRA location. METHODS A total of 4787 ACS patients were prospectively recruited between 2009 and 2017 in SPUM-ACS (ClinicalTrials.gov Identifier: NCT01000701). The primary endpoint was major adverse cardiovascular events (MACEs), a composite of all-cause death, non-fatal myocardial infarction and non-fatal stroke at 1 year. Multivariable-adjusted survival models were fitted using backward selection. RESULTS A total of 4412 ACS patients were included in this analysis, 56.0% (n = 2469) ST-elevation myocardial infarction (STEMI) and 44.0% (n = 1943) NSTE-ACS. The IRA was the right coronary artery (RCA) in 33.9% (n = 1494), the left-anterior descending coronary artery (LAD) in 45.6% (n = 2013), and the left circumflex (LCx) in 20.5% (n = 905) patients. In STEMI patients, TCO (defined as TIMI 0 flow at angiography) was observed in 55% of cases with LAD, in 63% with RCA, and in 55% with LCx. In those presenting with NSTE-ACS, TCO was more frequent in those with LCx and RCA as compared to the LAD (27 and 24%, respectively, vs. 9%, P < 0.001). Among patients with NSTE-ACS, occlusion of the LCx was associated with an increased risk of MACE during 1 year after the index ACS (fully adjusted hazard ratio 1.68, 95% confidence interval 1.10-2.59, P = 0.02; reference: RCA and LAD). Features of patients with NSTE-ACS associated with TCO of the IRA included elevated lymphocyte and neutrophil counts, higher levels of high-sensitivity C reactive protein (hs-CRP) and high-sensitivity cardiac troponin T, lower eGFR, and notably a negative history of MI. CONCLUSION In NSTE-ACS, both LCx and RCA involvement was associated with TCO at angiography despite the absence of ST-segment elevation. Involvement of the LCx, but not the LAD or RCA, as the IRA represented an independent predictor of MACE during 1-year follow-up. Hs-CRP, lymphocyte, and neutrophil counts were independent predictors of total IRA occlusion, suggesting a possible role of systemic inflammation in the detection of TCO irrespective of ECG presentation.
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Affiliation(s)
- Francesco Bruno
- Royal Brompton & Harefield Hospitals, Imperial College and King's College, Sydney Street, London SW3 6NP, UK
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Corso Bramante, 88, 10126, Turin, Italy; Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Boris Adjibodou
- Division of Cardiology, Department of Medicine, Aarau Cantonal Hospital, Tellstrasse 25, 5001 Aarau, Switzerland
| | - Slayman Obeid
- Division of Cardiology, Department of Medicine, Aarau Cantonal Hospital, Tellstrasse 25, 5001 Aarau, Switzerland
- Cardiology Liestal, Kantonsspital Baselland, Rheinstreet 26, CH-4410 Liestal, Switzerland
| | - Simon C Kraler
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - M Majid Akhtar
- Royal Brompton & Harefield Hospitals, Imperial College and King's College, Sydney Street, London SW3 6NP, UK
| | - Andrea Denegri
- Division of Cardiology, Parma University Hospital, via Antonio Gramsci 14, 43126, Parma, Italy
| | - Marco Roffi
- Division of Cardiology, Department of Medicine, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, Rue du Bugnon46, 1011 Lausanne, Switzerland
| | | | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Raemistreet 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Royal Brompton & Harefield Hospitals, Imperial College and King's College, Sydney Street, London SW3 6NP, UK
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Switzerland
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Denegri A, Magnani G, Kraler S, Bruno F, Klingenberg R, Mach F, Gencer B, Räber L, Rodondi N, Rossi VA, Matter CM, Nanchen D, Obeid S, Lüscher TF. History of peripheral artery disease and cardiovascular risk of real-world patients with acute coronary syndrome: Role of inflammation and comorbidities. Int J Cardiol 2023; 382:76-82. [PMID: 36958395 DOI: 10.1016/j.ijcard.2023.03.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/23/2023] [Accepted: 03/20/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND Patients with acute coronary syndromes (ACS) remain at risk of cardiovascular disease (CVD) recurrences. Peripheral artery disease (PAD) may identify a very high risk (VHR) group who may derive greater benefit from intensified secondary prevention. METHODS Among ACS-patients enrolled in the prospective multi-center Special Program University Medicine (SPUM), we assessed the impact of PAD on major cardiovascular events (MACE: composite of myocardial infarction, stroke and all-cause death) and major bleeding. Multivariate analysis tested the relation of each significant variable with MACE, as well as biomarkers of inflammation and novel markers of atherogenesis. RESULTS Out of 4787 ACS patients, 6.0% (n = 285) had PAD. PAD-patients were older (p < 0.001), with established CVD and signs of increased persistent inflammation (hs-CRP; 23.6 ± 46.5 vs 10.4 ± 27.2 mg/l, p < 0.001 and sFlt-1; 1399.5 ± 1501.3 vs 1047.2 ± 1378.6 ng/l, p = 0.018). In-hospital-death (3.2% vs 1.4%, p = 0.022) and -MACE (5.6% vs 3.0%, p = 0.017) were higher in PAD-patients. MACE at 1 year (18.6% vs 7.9%,p < 0.001) remained increased even after adjustment for confounders (Adj. HR 1.53, 95% CI: 1.14-2.08, p = 0.005). Major bleeding did not differ between groups (Adj. HR 1.18; 95% CI 0.71-1.97, p = 0.512). Although PAD predicted MACE, PAD-patients were prescribed less frequently for secondary prevention at discharge. CONCLUSIONS In this real-world ACS patient cohort, concomitant PAD is a marker of VHR and is associated with increased and persistent inflammation, higher risk for MACE without an increased risk of major bleeding. Therefore, a history of PAD may be useful to identify those ACS patients at VHR who require more aggressive secondary prevention.
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Affiliation(s)
- Andrea Denegri
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Giulia Magnani
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Francesco Bruno
- Royal Brompton and Harefield Hospitals, Imperial College and Kings College, London, United Kingdom; Division of Cardiology, "Città della Salute e della Scienza di Torino" Hospital, Department of Medical Sciences, University of Turin, Turin 10126, Italy
| | - Roland Klingenberg
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Kerckhoff-Klinik, Campus of the Justus Liebig University of Giessen, Germany; DZHK (German Center for Cardiovascular Research), partner site Rhine-Main, Bad Nauheim, Germany
| | - Francois Mach
- Department of Cardiology, University Hospital Geneva, Switzerland
| | - Baris Gencer
- Department of Cardiology, University Hospital Geneva, Switzerland; Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital, Bern, Switzerland
| | - Nicolas Rodondi
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland; Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | | | | | - David Nanchen
- Center for Primary Care and Public Health, University of Lausanne, Switzerland
| | - Slayman Obeid
- Division of Cardiology, Cantonal Hospital, Aarau, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Switzerland; Royal Brompton and Harefield Hospitals, Imperial College and Kings College, London, United Kingdom.
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Winzap PA, Kraler S, Obeid S, Wenzl FA, Templin C, Klingenberg R, von Eckardstein A, Roffi M, Muller O, Räber L, Lüscher TF. Initial systolic blood pressure associates with systemic inflammation, myocardial injury and outcomes in patients with acute coronary syndromes. Eur Heart J Acute Cardiovasc Care 2023:7157005. [PMID: 37155643 DOI: 10.1093/ehjacc/zuad047] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/25/2022] [Accepted: 05/03/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Outcomes after acute coronary syndromes (ACS) are determined by baseline risk profiles, including initial systolic blood pressure (sBP). Herein, we aimed to characterize ACS patients stratified by initial sBP levels and study the relation to inflammation, myocardial injury and post-ACS outcomes. METHODS We analysed 4'724 prospectively recruited ACS patients according to invasively assessed sBP (<100, 100-139, and ≥140mmHg) at admission. Biomarkers of systemic inflammation (high-sensitivity C-reactive protein, hs-CRP) and myocardial injury (high-sensitivity cardiac troponin, hs-cTnT) were measured centrally. Major adverse cardiovascular events (MACE; non-fatal myocardial infarction (MI), non-fatal stroke and cardiovascular (CV) death) were externally adjudicated. RESULTS Leukocyte numbers, hs-CRP, hs-cTnT and creatine kinase (CK) levels decreased from low to high sBP strata (ptrend < 0.001). Expectedly, patients with sBP < 100mmHg developed more often cardiogenic shock (CS; p < 0.001), and had a 1.7- and 1.4-fold increased multi-variable-adjusted MACE risk at 30 days (HR 1.68, 95% CI 1.05-2.69, p = 0.031) and one year (HR 1.38, 95% CI 0.92-2.05, p = 0.117). Those with sBP < 100 mmHg and CS showed a higher leukocyte count (p < 0.001), an increased neutrophil-to-lymphocyte-ratio (p = 0.031), and higher hs-cTnT and CK levels relative to those without CS (p < 0.001 and p = 0.002, respectively), whereas hs-CRP levels did not differ. Patients who developed CS had a 3.6- and 2.9-fold increased MACE risk at 30 days (HR 3.58, 95% CI 1.77-7.24, p < 0.001) and at one year (HR 2.94 95% CI, 1.57-5.53, p < 0.001), which was attenuated after controlling for distinct inflammatory profiles. CONCLUSIONS In patients with ACS, proxies of systemic inflammation and myocardial injury are inversely associated with sBP, with highest levels in those <100mmHg. If linked to high levels of cellular inflammation, these patients are prone to develop CS and are at high MACE and mortality risk.
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Affiliation(s)
- Patric A Winzap
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Simon Kraler
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | | | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | | | - Roland Klingenberg
- Kerckhoff Heart and Thorax Centre, Department of Cardiology, Kerckhoff-Klinik, Bad Nauheim, Germany
- Campus of the Justus Liebig University of Giessen, Germany
- German Center for Cardiovascular Research (DZHK), Partner site Rhein-Main, Bad Naunheim, Germany
| | | | - Marco Roffi
- Division of Cardiology, Hôpitaux Universitaires de Genève, Switzerland
| | - Olivier Muller
- Cardiology, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - Lorenz Räber
- Cardiology, Swiss Heart Centre, Inselspital Bern
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Switzerland
- Royal Brompton and Harefield Hospitals and Imperial College and Kings College, London, United Kingdom
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Obeid S, Adjibodou B, Denegri A, Kraler S, Katsarov K, Roffi M, Raeber L, Muller O, Staehli B, Luescher TF. Collaterals and extent of myocardial injury in patients with acute coronary syndromes – an analysis of the prospective SPUM-ACS cohort. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1310] [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: 11/12/2022] Open
Abstract
Abstract
Introduction
The impact of collateral circulation in the presence of severe coronary artery disease such as chronic total occlusion (CTO) has been extensively studied, with results despite few discrepancies, supporting an overall benefit on preservation of myocardial tissue and left ventricular ejection fraction (LVEF). However, less is known about the protective effects of collaterals in the context of acute coronary syndromes (ACS). In the current study we sought to analyze the incidence, grade and impact of collateral circulation in a large prospectively recruited cohort of patients presenting with ACS with independent events adjudication.
Methods and results
4'546 ACS patients presenting with ACS, enrolled in the prospective Special Program University Medicine ACS (SPUM-ACS) cohort were included. The current analysis showed the presence of a collateralized culprit lesion in 12.9% (n=586) of patients, 84% (n=492) originating from the contralateral side and 16% (n=94) from the ipsilateral side. Of those 64.6% (n=378) were being graded as Rentrop 2 or more. There were no differences in baseline characteristics between the two groups including incidence of diabetes, coronary artery disease, age and gender. However, despite the presence of collaterals graded Rentrop 2 or more, those patients had a significantly lower LVEF mean 48,44% vs 51.6%, p=0.025 and higher creatinine Kinase levels, mean (CK) 981 U/I vs 957 UI, p<0.001 as compared to patients with absent collateral-circulation on admission. Interestingly a sub analysis of the STEMI population showed no significant differences in both LVEF and CK at presentation, while troponin (TNT) plasma levels were significantly lower in patients with collaterals (mean TNT 0.0031 ug/l vs 0.035 ug/l p=0.001). Additionally no differences in cardiovascular mortality, stent thrombosis or MI was seen at one year follow-up.
Conclusion
The current analysis highlights a possible protective impact of a pre-existing collateral circulation against myocardial injury in the setting of ACS and ST elevation myocardial infarction. However this was not translated into improvement in hard outcomes acutely and up to one year of follow up, but may be important in the long run.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Swiss National Research Foundation - ZurichHeart House
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Affiliation(s)
- S Obeid
- Cantonal Hospital Aarau , Aarau , Switzerland
| | - B Adjibodou
- Cantonal Hospital Aarau , Aarau , Switzerland
| | - A Denegri
- University of Modena & Reggio Emilia, Cardiology , Modena , Italy
| | - S Kraler
- University of Zurich, Center for molecular cardiology , Schlieren , Switzerland
| | - K Katsarov
- Cantonal Hospital Aarau , Aarau , Switzerland
| | - M Roffi
- Hopitaux Universitaires De Geneve, Cardiology , Geneva , Switzerland
| | - L Raeber
- Inselspital - University of Bern, Cardiology , Bern , Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Cardiology , Lausanne , Switzerland
| | - B Staehli
- University Hospital Zurich, Cardiology , Zurich , Switzerland
| | - T F Luescher
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust , London , United Kingdom
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Obeid S, Libby P, Husni E, Wang Q, Wisniewski LM, Davey DA, Wolski KE, Xia F, Bao W, Walker C, Ruschitzka F, Nissen SE, Lüscher TF. Cardiorenal risk of celecoxib compared with naproxen or ibuprofen in arthritis patients: insights from the PRECISION trial. Eur Heart J Cardiovasc Pharmacother 2022; 8:611-621. [PMID: 35234840 DOI: 10.1093/ehjcvp/pvac015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 02/05/2022] [Accepted: 02/26/2022] [Indexed: 06/14/2023]
Abstract
AIMS Non-steroidal anti-inflammatory drugs (NSAIDs) are among the most frequently used drugs, both prescribed and over the counter. The long-term cardiovascular safety of NSAIDs in patients with arthritis has engendered controversy. Concerns remain regarding the relative incidence and severity of adverse cardiorenal effects, particularly in arthritis patients with established cardiovascular (CV) disease or risk factors for disease as illustrated by the PRECISION (Prospective Randomized Evaluation of Celecoxib Integrated Safety vs. Ibuprofen Or Naproxen) trial participants (NCT00346216).We further investigated whether the selective COX-2 Inhibitor celecoxib has a superior cardiorenal safety profile compared with ibuprofen or naproxen in the PRECISION population. METHODS AND RESULTS Twenty-four thousand eighty-one patients who required NSAIDs for osteoarthritis or rheumatoid arthritis (RA) and had increased CV risk randomly received celecoxib, ibuprofen, or naproxen. The current pre-specified secondary analysis assessed the incidence, severity, and NSAID-related risk of the pre-specified composite cardiorenal outcome (adjudicated renal event, hospitalization for congestive heart failure, or hospitalization for hypertension) in the intention-to-treat (ITT) population. An on-treatment analysis assessed safety in those taking the study medication. Following a mean treatment duration of 20.3 ± 16.0 months and a mean follow-up of 34.1 ± 13.4 months, the primary cardiorenal composite outcome occurred in 423 patients (1.76%) in the ITT population. Of these 423 patients, 118 (28%) were in the celecoxib, 166 (39%) in the ibuprofen, and 139 (33%) in the naproxen group. In a multivariable Cox regression model adjusted for independent clinical variables, celecoxib showed a significantly lower risk compared with ibuprofen [hazard ratio (HR) 0.67, confidence interval (CI) 0.53-0.85, P = 0.001) and a trend to lower risk compared with naproxen (HR 0.79, CI 0.61-1.00, P = 0.058). In the ITT analysis, clinically significant renal events occurred in 220 patients with events rates of 0.71%, 1.14%, and 0.89% for celecoxib, ibuprofen, and naproxen, respectively (P = 0.052), while in the on-treatment analysis the rates were 0.52%, 0.91%, and 0.78% (P &lt; 0.001). CONCLUSION In the current era, long-term NSAID use was associated with few cardiorenal events in arthritis patients. At the doses studied, celecoxib displayed fewer renal events and hence more favourable cardiovascular safety compared with ibuprofen or naproxen. These results have considerable clinical implications for practitioners managing individuals with chronic arthritis pain and high risk of impaired renal function and/or heart failure.Clinical Trial Registration: NCT00346216.
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Affiliation(s)
- Slayman Obeid
- University Heart Center, Department of Cardiology, University Hospital, CH-8091 Zurich, Switzerland
| | - Peter Libby
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| | | | | | | | | | | | - Feng Xia
- Pfizer Inc., New York, NY 10017, USA
| | | | | | - Frank Ruschitzka
- University Heart Center, Department of Cardiology, University Hospital, CH-8091 Zurich, Switzerland
| | | | - Thomas F Lüscher
- Cardiology, Royal Brompton & Harefield Hospitals Trust Imperial College, Sidney Street, SW3 5RN London, UK
- Imperial College, SW3 6LY London, UK
- Center for Molecular Cardiology, University of Zurich, CH-8952 Schlieren, Switzerland
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7
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Kraler S, Wenzl FA, Georgiopoulos G, Obeid S, Liberale L, von Eckardstein A, Muller O, Mach F, Räber L, Losdat S, Schmiady MO, Stellos K, Stamatelopoulos K, Camici GG, Srdic A, Paneni F, Akhmedov A, Lüscher TF. Soluble lectin-like oxidized low-density lipoprotein receptor-1 predicts premature death in acute coronary syndromes. Eur Heart J 2022; 43:1849-1860. [PMID: 35567560 DOI: 10.1093/eurheartj/ehac143] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 02/10/2022] [Accepted: 03/07/2022] [Indexed: 08/27/2023] Open
Abstract
AIMS The lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) and its shedding product [soluble LOX-1 (sLOX-1)] are implicated in atherosclerotic cardiovascular disease (ASCVD) pathogenesis. Herein, we examined the relationship of sLOX-1 with both fatal events and plaque progression in patients with acute coronary syndromes (ACS). METHODS AND RESULTS Plasma sLOX-1 was assessed at baseline in ACS and chronic coronary syndrome (CCS) patients prospectively recruited in the multicentre SPUM-ACS study, with sex- and age-matched healthy subjects serving as additional controls (n = 2924). Compared with both CCS and controls, ACS patients showed markedly elevated sLOX-1 levels (median, 2.00 and 2.00 vs. 35.08 pg/mL; P < 0.0001) which were independently associated with increased mortality risk over 30-day [tertile (T)3: adjusted hazard ratio (HR), 3.11; 95% confidence interval (CI), 1.44-10.61; P = 0.0055] and 1-year intervals (T3: adjusted HR, 2.04; 95% CI, 1.19-3.92; P = 0.0098). Results remained consistent after adjustment for GRACE 2.0 (T3: adjusted HR, 1.86; 95% CI, 1.04-3.74; P = 0.0391) and were primarily driven by the pronounced relationship of sLOX-1 with cardiovascular mortality at 30 days (T3: adjusted HR, 3.81; 95% CI, 1.62-19.62; P = 0.0036) and at 1 year (T3: adjusted HR, 2.29; 95% CI, 1.19-5.34; P = 0.0148). In ACS patients undergoing serial intracoronary imaging and statin therapy, sLOX-1 dropped significantly in those with coronary plaque regression at 1 year (ΔsLOX-1: -4.64 ± 1.80; P = 0.0057), and showed a good discrimination for predicting plaque progression (area under the curve = 0.74; 95% CI, 0.59-0.86; P = 0.0031). CONCLUSION Plasma sLOX-1 levels are increased during ACS and predict fatal events beyond traditional and emerging risk factors. Persistently high sLOX-1 associates with coronary plaque progression in patients with established ASCVD. CLINICAL TRIAL REGISTRATION NCT01000701.
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Affiliation(s)
- Simon Kraler
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Florian A Wenzl
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Georgios Georgiopoulos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- School of Biomedical Engineering and Imaging Sciences, King's College, London, UK
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Slayman Obeid
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Luca Liberale
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | | | - Olivier Muller
- Department of Cardiology, University Hospital of Lausanne, University of Lausanne, Lausanne, Switzerland
| | - François Mach
- Cardiology, University Hospital Geneva, Geneva, Switzerland
| | | | | | - Martin O Schmiady
- University Heart Center, Department of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
- Department of Congenital Cardiovascular Surgery, University Children's Hospital, Zurich, Switzerland
| | - Konstantinos Stellos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
- Department of Cardiovascular Research, European Center for Angioscience (ECAS), Heidelberg University, Mannheim, Germany
- German Centre for Cardiovascular Research (DZHK), Partner Site Heidelberg/Mannheim, Mannheim, Germany
| | - Kimon Stamatelopoulos
- Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, UK
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens School of Health Sciences, Athens, Greece
| | - Giovanni G Camici
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
- Department of Research and Education, University Hospital Zurich, Zurich, Switzerland
| | - Annie Srdic
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Francesco Paneni
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
- University Heart Center, Department of Cardiology, University Hospital, Zurich, Switzerland
| | - Alexander Akhmedov
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zürich, Wagistrasse 12, 8952 Schlieren, Zurich, Switzerland
- Research, Education & Development, Royal Brompton and Harefield Hospitals and Imperial College, Sydney Street, London SW3 6NP, UK
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8
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Denegri A, Obeid S, Raeber L, Windecker S, Gencer B, Mach F, Rodondi N, Heg D, Nanchen D, Matter CM, Klingenberg R, Luescher TF. Systemic immune-inflammation index predicts major adverse cardiovascular events in patients with ST-elevation myocardial infarction. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1353] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 11/15/2022] Open
Abstract
Abstract
Background
ST-elevation myocardial infarction (STEMI) represents the life-threatening manifestation of atherosclerosis, a chronic inflammatory disease of arterial wall, and is associated with high rate of morbidity and mortality. Thus, inflammatory biomarkers may be useful in identifying high inflammatory burden patients who may benefit from tailored high-intensity secondary prevention therapy.
Purpose
We therefore assessed the relationship between the systemic immune-inflammation index (SII) and CV outcomesamong 1144 all-comers patients admitted to four Swiss University Hospital for STEMI and enrolled in the prospective multicenter SPUM registry cohort I (NCT 01000701).
Methods
SII was calculated as platelet counts x neutrophil counts / lymphocyte counts. Patients were subdivided into three groups according to SII tertiles. The composite primary endpoint was major adverse cardiac and cerebrovascular events (MACCE: stroke, myocardial infarction, CV death). Adjusted Cox proportional hazards regression models were implemented to determine the risk associated with SII and outcomes.
Results
Out of 1144 STEMI patients, 912 patients (79,7%) had available for SII. Patients within the highest tertile were slightly more frequently male (23.0 vs 22.0%, p=0.05), with higher plasma values of neutrophils (11.4±2.4 vs 6.5±3.7 G/l, p<0.001), platelets (275.3±97.5 vs 202.5±51.6 G/l, p<0.001) and lower levels of lymphocytes (1.0±0.6 vs 2.1±1.1 G/l, p<0.001) and LVEF (46.4±11.5% vs 50.4±10.3%, p<0.001) (Fig. 1A). At 1 year, these patients presented the highest rate of all-cause mortality (7.2% vs 2.6%, p=0.02) and MACCE (8.2% vs 3.3, p=0.03). This enhanced risk persisted for all-cause mortality and MACCE, after adjustment for age, sex, ace-inhibitors and statin therapy (Adj. HR 2.85, 95% CI 1.30–6.70, p=0.03 and Adj. HR 2.63, 95% CI 1.25–5.55, p=0.03, respectively, Fig. 1B).
Conclusions
Among a real-world cohort of STEMI-patients, SII highlights the highest inflammatory risk phenotype, being associated with significant increased rates of MACCE and all-cause of death. These observations might help clinicians to furtherly identify patients who may derive the greatest benefit from tailored more intense secondary prevention therapies including inflammatory modulation.
Funding Acknowledgement
Type of funding sources: None. Figure 1
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Affiliation(s)
- A Denegri
- Azienda Ospedaliero Universitaria, Modena, Italy
| | - S Obeid
- Cantonal Hospital Aarau, Division of Cardiology, Aarau, Switzerland
| | - L Raeber
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Gencer
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - F Mach
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - N Rodondi
- University Hospital, Department of Family Medicine, Bern, Switzerland
| | - D Heg
- Institute of Social and Preventive Medicine. University of Bern, Bern, Switzerland
| | - D Nanchen
- Centre for Primary Care and Public Health (Unisante), Lausanne, Switzerland
| | - C M Matter
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - R Klingenberg
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - T F Luescher
- Royal Brompton and Harefield Hospital, London, United Kingdom
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Adjibodou B, Obeid S, Kraler S, Denegri A, Mach F, Matter CM, Nanchen D, Roffi M, Muller O, Raeber L, Luescher T. Location and impact of the infarct-related artery in acute coronary syndrome: insight from the Swiss SPUM- ACS cohort. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1348] [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
Identifying the infarct-related artery (IRA) in patients with acute coronary syndromes (ACS) has prognostic and therapeutic implications.
Purpose
We aimed to evaluate the distribution, clinical presentation and impact of the culprit lesion location on long-term outcomes in ACS patients treated with primary percutaneous coronary intervention, medication and secondary prevention according to Guidelines.
Methods
Patients referred for ACS to one of the participating centres of the observational SPUM-ACS study between 2009 and 2017 with one year outcomes and independent events adjudication were included. The distribution of IRA, clinical presentation (STEMI/NSTEMI) and impact of IRA location on major adverse cardiac events (cardiac death, myocardial infarction, stent thrombosis, target vessel revascularisation) at one year were investigated.
Results
4'546 patients were included with 55% presenting as STEMI (mean age 62-years; 20% women), 42% as NSTEMI and 3% as unstable angina. The left anterior descending (LAD) artery was involved in 44.3%, the right coronary artery (RCA) and left circumflex artery (LCX) in 32.9% and 20%, respectively. Proximal and middle segments of the 3 main vessels were more often the culprit location compared to distal segments and side branches (78% versus. 22%). Left main (LM) and bypass graft were rarely involved (1.6% and 1.2% respectively), but most often responsible to overall cardiac dysfunction (higher NT-proBNP and hs troponin levels). Patients with an occluded IRA at angiography usually presented as STEMI on ECG (100% for LM, 90.5% for LAD territory, 83.8% for RCA territory, 56.6% for LCX territory). However 43.1% of patients with occluded LCX presented as NSTEMI. These patients were prone to extensive cardiac damage and significantly higher hs troponin levels as compared to those with patent LCX or STEMI presentation (626 ng/l vs 310 ng/l and 626 ng/l vs 580 ng/l respectively, p<0.001). Overall, 1-year MACE occurred in 11.8%. In native coronaries, the location of IRA had no impact on outcomes (20% LM, 10.9% LAD, 11.8% RCA, 11.8% LCX, p=0.112). However, in NSTEMI-ACS there were twice as many events when the LM was the IRA (MACE 20%, p=0.023) and 3-times higher when a bypass-graft was the IRA (33.9%, p=0.0001).
Conclusions
ST elevations are highly suggestive of an occluded IRA. However more than 40% of patients presenting with ACS involving an occluded LCX did not demonstrate ST-elevation and were prone to extensive cardiac damage, urging the necessity for early invasive measures in these patients. In native coronaries the IRA location did not affect outcomes except in NSTEMI with LM involvement or ACS with bypass grafts as IRA that had much worse outcomes.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): - Swiss National Research Foundation - Zurich Heart House
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Affiliation(s)
| | - S Obeid
- Cantonal Hospital Aarau, Aarau, Switzerland
| | - S Kraler
- University of Zurich, Center for molecular cardiology, Schlieren, Switzerland
| | - A Denegri
- University of Modena & Reggio Emilia, Cardiology, Modena, Italy
| | - F Mach
- Hopitaux Universitaires De Geneve, Cardiology, Geneva, Switzerland
| | - C M Matter
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - D Nanchen
- University Hospital Centre Vaudois (CHUV), Ambulatory care and community medicine, Lausanne, Switzerland
| | - M Roffi
- Hopitaux Universitaires De Geneve, Cardiology, Geneva, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Cardiology, Lausanne, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Cardiology, Bern, Switzerland
| | - T Luescher
- University of Zurich, Center for molecular cardiology, Schlieren, Switzerland
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10
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Kraler S, Obeid S, Aghlmandi S, Wenzl F, Paneni F, Matter C, Muller O, Raeber L, Mach F, Luescher TF. Sex-specific differences in total ischemic time coincide with similar cardiovascular outcome in patients with acute coronary syndrome: a Swiss multicentre cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1355] [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: 11/13/2022] Open
Abstract
Abstract
Background
Previous studies showed prolonged patient and system delay in female patients with acute coronary syndromes (ACS) which is thought to be a major driver of discrepancies in their cardiovascular (CV) outcomes. Indeed, timely management is particularly important in patients with ST-segment elevation myocardial infarction (STEMI), as increased total ischemic time augments infarct size and relates to poor CV survival. However, contemporary evidence on sex-specific differences in ACS management and discrepancies in outcomes is limited and controversial.
Purpose
We sought to systematically investigate whether a sex-gap in symptom-to-door (STD), door-to-balloon (DTB)/door-to-PCI (DTP) time exists in a prospective ACS cohort and if such differences translate into different rates of major adverse cardiovascular events (MACE) at one year.
Methods
From 2009 to 2019, 4'930 ACS patients with a main diagnosis of NSTEMI (43.3%), STEMI (53.3%) or unstable angina (3.4%) were enrolled in the multicentre, prospective SPUM-ACS study of which 4'671 completed follow-up at one year. STD, DTB and DTP time was analyzed. The primary endpoint, a composite measure of all-cause death, nonfatal myocardial infarction, nonfatal stroke and ischemia-driven revascularization, was adjudicated by an independent clinical endpoint committee. Kaplan-Meier and multivariate-adjusted Cox proportional hazard regression models were used for time-to-event analyses.
Results
A total of 1'019 (20.7%) women and 3'911 (79.3%) men with a main diagnosis of ACS were included in the study. At presentation, women were older (69.6±12.0 vs. 62.2±12.1 years, P<0.001), more likely to have impaired renal function (median, 81.2 vs. 89.2 ml/min/1.73m2, P<0.001) and a history of hypertension (63.9% vs. 54.3%, P<0.001). STD time was significantly higher in female STEMI (median, 3.2 vs. 2.5 hours, P<0.001) and NSTEMI patients (median, 7.0 vs. 5.0 hours, P=0.015). Importantly, DTB time did not differ between sexes in STEMI patients (1.0 vs. 1.0 hour, P=0.430). Similarly, DTP time of female NSTEMI patients was comparable to males (4.3 vs. 4.4 hours, P=0.855). In the entire cohort, female ACS patients did not show a higher occurrence of the primary endpoint at one year (crude HR 0.86, 95% CI 0.72–1.04; adjusted HR 0.83, 95% CI, 0.66–1.05). In a multivariate-adjusted subgroup analysis, neither female STEMI (adjusted HR 0.82, 95% CI 0.59–1.15) nor NSTEMI patients (adjusted HR 0.87, 95% CI 0.61–1.24) showed higher hazards for the primary endpoint compared to male patients.
Conclusions
Women with a main diagnosis of STEMI show considerably higher prehospital delay, thus prolonged total ischemic time which is mainly driven by increased STD time. Intriguingly, this does not translate into higher rates of MACE compared to men at one year. Women with ACS may particularly benefit from measures aimed at reducing prehospital delay, as this may further improve long-term prognosis after the acute event.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss National Science Foundation - SNFFoundation for Cardiovascular Research - Zurich Heart House
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Affiliation(s)
- S Kraler
- University of Zurich, Zurich, Switzerland
| | - S Obeid
- University Hospital Zurich, Zurich, Switzerland
| | - S Aghlmandi
- University Hospital Basel, Basel, Switzerland
| | - F Wenzl
- University of Zurich, Zurich, Switzerland
| | - F Paneni
- University Hospital Zurich, Zurich, Switzerland
| | - C Matter
- University Hospital Zurich, Zurich, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Mach
- Hopitaux Universitaires De Geneve, Geneva, Switzerland
| | - T F Luescher
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, United Kingdom
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11
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Kraler S, Obeid S, Liberale L, Von Eckardstein A, Wenzl FA, Paneni F, Matter C, Muller O, Raeber L, Mach F, Akhmedov A, Luescher TF. High plasma levels of soluble LOX-1 portends poor survival in acute coronary syndromes beyond GRACE 2.0: a multicentre prospective cohort study. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1157] [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: 11/13/2022] Open
Abstract
Abstract
Background
While inflammatory states and dyslipidemias confer a dismal prognosis following myocardial ischaemia, the role of the lectin-like oxidized low-density lipoprotein receptor-1 (LOX-1) which sits at the confluence of these conditions remains elusive. Given soluble LOX-1' (sLOX-1) pivotal role in inflammatory processes underlying atherosclerotic plaque progression, we sought to study its prognostic utility on the risk of adverse events in acute coronary syndromes (ACS).
Purpose
Hence, we aimed to investigate whether sLOX-1 is an independent predictor of all-cause death at one year beyond traditional and emerging risk factors for poor survival following ACS.
Methods
2678 ACS patients were recruited in the prospective, multicentre SPUM-ACS trial, of which 2525 completed follow-up at one year. Major adverse cardiovascular events, including death from any cause, were adjudicated by an independent clinical endpoint committee. By employing high-sensitive enzyme-linked immunosorbent assay, sLOX-1 was assessed in the plasma at the time of presentation in ACS and age-matched chronic coronary syndrome (CCS) patients. Kaplan-Meier survival analysis and Cox proportional hazard regression models, adjusted for baseline variables and the GRACE 2.0 score, were used to study the predictive utility of sLOX-1.
Results
At the time of presentation, ACS patients, specifically those with ST-segment elevation ACS, had significantly elevated sLOX-1 levels as compared to patients with CCS (median, 35.40 vs. 2.00 pg/ml, P<0.0001). Patients in the upper sLOX-1 tertile were at heightened risk for both death from any cause (crude HR 1.785, 95% CI 1.083–2.941, P<0.05; adjusted HR 2.035, 95% CI 1.176–3.519, P<0.05) and CV death (crude HR 2.447, 95% CI 1.285–4.663, P<0.01; adjusted HR 2.383, 95% CI 1.206–4.710, P<0.05) compared to those in the first tertile. Importantly, sLOX-1 remained an independent predictor of all-cause death after adjustment for known risk factors of adverse outcome and the GRACE 2.0 score (adjusted + GRACE 2.0 HR 1.896, 95% CI 1.034–3.476, P<0.05).
Conclusions
Plasma sLOX-1 is elevated in ACS patients and predicts poor survival independent of both traditional and emerging risk factors and provides prognostic information beyond GRACE 2.0.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss National Science FoundationFoundation for Cardiovascular Research - Zurich Heart House
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Affiliation(s)
- S Kraler
- University of Zurich, Zurich, Switzerland
| | - S Obeid
- University Hospital Zurich, Zurich, Switzerland
| | - L Liberale
- University of Zurich, Zurich, Switzerland
| | | | - F A Wenzl
- University of Zurich, Zurich, Switzerland
| | - F Paneni
- University Hospital Zurich, Zurich, Switzerland
| | - C Matter
- University Hospital Zurich, Zurich, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - F Mach
- Hopitaux Universitaires De Geneve, Geneva, Switzerland
| | - A Akhmedov
- University of Zurich, Zurich, Switzerland
| | - T F Luescher
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, United Kingdom
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12
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Kraler S, Wenzl F, Obeid S, Aghlmandi S, Paneni F, Matter C, Muller O, Raeber L, Von Eckardstein A, Mach F, Luescher TF. Limited sex-specific performance of the GRACE 2.0 score to predict reinfarction or death in NSTEMI patients during pro-inflammatory states. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1478] [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
Non-ST segment elevation myocardial infarction (NSTEMI) is particularly common in female patients with acute coronary syndrome (ACS), as women tend to present at older age and with higher comorbidity burden than men. High-sensitive C-reactive protein (hs-CRP) and growth differentiation factor 15 (GDF-15) plasma levels are elevated in NSTEMI patients and mirror inflammatory states, while conferring poor prognosis following the acute event. The GRACE 2.0 score is an established tool to stratify ACS patients according to their risk and to guide treatment, however, its sex-specific performance has not been systematically investigated.
Purpose
We sought to investigate the sex-specific performance of GRACE 2.0 to predict reinfarction or death within one year in NSTEMI patients in the presence or absence of inflammatory states.
Methods
Between 2009 and 2019, 2111 NSTEMI patients were enrolled in the multicentre prospective SPUM-ACS cohort of which 2001 completed follow-up at one year. Hs-CRP and GDF-15 plasma levels at presentation were measured by immunoassay and risks for MI or all-cause death within one year were estimated by GRACE 2.0. Discrimination was evaluated by the area under the receiver operating curve (AUC) and compared between both sexes using the De-Long's test.
Results
A total of 411 (20.5%) women and 1590 (79.5%) men with NSTEMI were included in the study. At presentation, women were older (69.8±11.8 years vs. 63.6±12.0 years, P<0.01), more likely to have a history of systemic inflammatory disease (4.6% vs. 2.1%, P<0.01) and had higher GDF-15 levels (median, 1325 vs. 1093 pg/ml, P<0.01) compared to men. In the entire cohort, the performance of GRACE 2.0 to predict the composite of MI or death was similar in both sexes (AUC: 0.66 vs. 0.74, P=0.24). However, score performance in patients with hs-CRP≥2 mg/l was significantly worse in women than in men (AUC: 0.61 vs. 0.76, P<0.05). These findings were recapitulated in patients with plasma GDF-15≥1133 pg/ml (AUC: 0.61 vs. 0.75, P<0.05) suggesting that GRACE 2.0 performs poorly in female NSTEMI patients with excessive inflammation at presentation. Intriguingly, opposite findings were observed in patients with hs-CRP<2 mg/l (AUC: 0.81 vs. 0.58, P<0.05). Also, GDF-15 plasma levels correlated with hs-CRP at presentation (Rs=0.35, P<0.01) and predicted the composite of MI or death well in men, while the discriminative ability was surprisingly poor in women (0.80 vs. 0.64, P<0.05), results similarly observed with hs-CRP.
Conclusions
Our results suggest that the established risk prediction model GRACE 2.0 lacks discriminative power in female NSTEMI patients during high inflammatory states. In addition, inflammatory biomarkers such as GDF-15 show sex-specific differences in their predictive utility of adverse events which should be appreciated by future risk-scoring algorithms to overcome inequalities in certain patient populations presenting with ACS.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Swiss National Science FoundationFoundation for Cardiovascular Research
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Affiliation(s)
- S Kraler
- University of Zurich, Zurich, Switzerland
| | - F Wenzl
- University of Zurich, Zurich, Switzerland
| | - S Obeid
- University Hospital Zurich, Zurich, Switzerland
| | - S Aghlmandi
- University Hospital Basel, Basel, Switzerland
| | - F Paneni
- University Hospital Zurich, Zurich, Switzerland
| | - C Matter
- University Hospital Zurich, Zurich, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - L Raeber
- Bern University Hospital, Inselspital, Bern, Switzerland
| | | | - F Mach
- Hopitaux Universitaires De Geneve, Geneva, Switzerland
| | - T F Luescher
- Royal Brompton and Harefield NHS Foundation Trust, Harefield, United Kingdom
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13
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Zakhour M, Haddad C, Sacre H, Tarabay C, Zeidan RK, Akel M, Hallit R, Kheir N, Obeid S, Salameh P, Hallit S. Differences in the Associations between Body Dissatisfaction and Eating Outcomes by Gender? A Lebanese Population Study. Rev Epidemiol Sante Publique 2021; 69:134-144. [PMID: 33965268 DOI: 10.1016/j.respe.2021.02.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 04/29/2020] [Revised: 01/22/2021] [Accepted: 02/16/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The objective of this study was to evaluate the impact of the interaction between body dissatisfaction and gender on eating disorders (restrained eating, binge eating, orthorexia nervosa, and emotional eating) among a sample of Lebanese adults. METHODS This cross-sectional study, conducted between January and May 2018, enrolled 811 participants selected randomly from all Lebanese Mohafazat. The mean age of the participants was 27.6±11.8 years. The majority were females (66.5%), had a high level of education (73.2%), and low income (77.9%). This study used the following scales: body dissatisfaction subscale of the Eating Disorder Inventory-second version, binge eating scale, Dutch restrained eating scale, orthorexia nervosa scale (ORTHO-15 scale), emotional eating scale, perceived stress scale, Hamilton Anxiety Rating Scale, and Hamilton Depression Rating Scale. RESULTS Body dissatisfaction was positively correlated to restrained eating (r=0.293, P<0.001), emotional eating (r=0.073, P=0.042) and binge eating (r=0.250, P<0.001). The interaction between body dissatisfaction and gender was significantly associated with more restrained eating (Beta=0.01, P<0.001) and orthorexia nervosa (Beta=-0.09, P<0.001), but not with emotional (Beta=-0.43, P=0.103) and binge eating (Beta=-0.08, P=0.358). When stratifying the analysis by gender, the results revealed that higher body dissatisfaction was significantly associated with more restrained eating in both genders, but particularly among women. Body dissatisfaction was significantly associated with higher emotional eating in men only and with higher orthorexia nervosa tendencies and behaviors in females only. CONCLUSION The interaction between body dissatisfaction and gender was significantly associated with orthorexia nervosa and restrained eating but not with binge or emotional eating. Higher body dissatisfaction was significantly associated with higher restrained eating, more pronounced in women, while it was significantly associated with higher orthorexia tendencies (lower ORTO-15 scores) in women only. Body dissatisfaction was associated with emotional eating in men only.
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Affiliation(s)
- M Zakhour
- Faculty of Science, Lebanese University, Fanar, Lebanon
| | - C Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon,INSERM, Univ. Limoges, CH Esquirol Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France,INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - H Sacre
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon
| | - C Tarabay
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - R K Zeidan
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon,CERIPH: Center for Research in Public Health, Pharmacoepidemiology Surveillance Unit, Faculty of Public Health, Lebanese University, Fanar, Lebanon,Faculty of Public Health, Lebanese University, Fanar, Lebanon
| | - M Akel
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon,School of Pharmacy, Lebanese International University, Beirut, Lebanon
| | - R Hallit
- Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - N Kheir
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon
| | - S Obeid
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon,INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon,Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - P Salameh
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon,Faculty of Pharmacy, Lebanese University, Hadat, Lebanon,University of Nicosia Medical School, Nicosia, Cyprus
| | - S Hallit
- INSPECT-LB (Institut National de Santé Publique, d’Épidémiologie Clinique et de Toxicologie-Liban), Beirut, Lebanon,Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
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14
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Haddad CE, Salameh P, Hallit S, Obeid S, Haddad G, Clément JP, Calvet B. Cross-cultural adaptation and validation of the lebanese arabic version of the BACS scale (the brief assessment of cognition in schizophrenia) among stable schizophrenic inpatients. Eur Psychiatry 2021. [PMCID: PMC9471265 DOI: 10.1192/j.eurpsy.2021.1405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction The assessment of cognitive disorders in schizophrenia is becoming a part of clinical and research practice by using batteries that differ widely in their content. The Brief Assessment of Cognition in Schizophrenia (BACS) was developed to cover the main cognitive deficits of schizophrenia. Objectives The objective of this study was to assess concurrent validity of the Arabic version of the BACS with a standard neurocognitive battery of tests in Lebanese patients with schizophrenia and healthy controls. Methods A sample of 120 stable inpatients diagnosed with schizophrenia and 60 healthy controls received the Arabic version of the BACS in a first session, and a standard battery in a second session. Results The mean duration of completion for the BACS was 31.2 ± 5.4 min in patients with schizophrenia. All tests demonstrated significant differences between controls and patients (p<0.01). A principal components analysis demonstrated that a one-factor solution best fits our dataset (64.8% of the variance). A high Cronbach alpha was found (0.85). The BACS composite scores were significantly correlated with the standard battery composite scores in patients (r=0.78, p < 0.001) and healthy controls (r=0.77, p < 0.001). Also, the correlation analysis between the BACS sub-scores and the standard battery sub-scores showed significant results (p < 0.05). The Arabic-BACS demonstrated high ability to discriminate patients with schizophrenia from healthy controls. Conclusions The results showed that the Arabic version of the BACS is a useful tool for assessing cognition in patients with schizophrenia and could be used in clinical practice in Lebanon.
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Rossi VA, Denegri A, Candreva A, Klingenberg R, Obeid S, Räber L, Gencer B, Mach F, Nanchen D, Rodondi N, Heg D, Windecker S, Buhmann J, Ruschitzka F, Lüscher TF, Matter CM. Prognostic value of inflammatory biomarkers and GRACE score for cardiac death and acute kidney injury after acute coronary syndromes. Eur Heart J Acute Cardiovasc Care 2021; 10:445-452. [PMID: 33624028 DOI: 10.1093/ehjacc/zuab003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/29/2019] [Accepted: 01/12/2021] [Indexed: 11/13/2022]
Abstract
AIMS The aim of this study was to analyse the role of inflammation and established clinical scores in predicting acute kidney injury (AKI) after acute coronary syndromes (ACS). METHODS AND RESULTS In a prospective multicentre cohort including 2034 patients with ACS undergoing percutaneous coronary intervention, high-sensitivity C-reactive protein (hsCRP), neutrophil count, neutrophil-to-lymphocyte ratio (NL-ratio), and creatinine were measured at the index procedure. AKI (n = 39, defined according to RIFLE criteria) and major cardiovascular and cerebrovascular events were adjudicated after 1 year. Associations between inflammation, AKI, and cardiac death (CD) were assessed by C-statistics and Cox proportional hazard models with log-rank test to compare survival. Patients with ACS with elevated neutrophil count >7.8 × 109/L, NL-ratio >5, combined neutrophil-count/creatinine, or NL-ratio/creatinine at baseline showed a higher incidence of AKI (all P < 0.05) and CD (all P < 0.001). The risk of AKI, CD, and their combination was increased in patients with higher neutrophil count/creatinine (heart rate (HR) = 3.7, 95% cardiac index (CI) 1.9-7.1; HR = 2.7, 95% CI 1.6-4.6; HR = 3.2, 95% CI 2.1-4.9); NL-ratio/creatinine (HR = 2.1, 95% CI 1.6-4.1; HR = 2.2, 95% CI 1.3-3.8; HR = 2.3, 95% CI 1.5-3.5); and hsCRP (HR = 1.8, 95% CI 0.9-3.5; HR = 2.2, 95% CI 1.3-3.6; HR = 1.9, 95% CI 1.2-2.8) after adjustment for age, diabetes, hypertension, previous heart failure, kidney function, haemodynamic instability at admission, statin, and renin-angiotensin-aldosterone antagonists use. Subjects with higher GRACE score 1.0/NL-ratio had higher rate of AKI, CD, and both (HR = 1.4, 95% CI 0.5-4.2; HR = 2.7, 95% CI 1.3-5.9; HR = 2.1, 95% CI 1-4.3). CONCLUSIONS Inflammation markers may predict AKI after correction for renal function at the index procedure. hsCRP performed better than the NL-ratio. However, the integration of inflammation markers to traditional risk factors or scores does not add prognostic information. TRIAL REGISTRATION ClinicalTrials.gov, NCT01000701.
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Affiliation(s)
- Valentina A Rossi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Via Università 4, 41125 Modena, Italy
| | - Alessandro Candreva
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Department of Cardiology, Kerckhoff Heart and Thorax Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland
| | - Baris Gencer
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - François Mach
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Rue Gabrielle-Perret-Gentil 4, 1205 Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University Hospital of Lausanne, Rue du Bugnon 46, 1011 Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.,Bern Institute of Primary Health Care (BIHAM), University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Dik Heg
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Freiburgstrasse 4, 3010 Bern, Switzerland.,Institute of Social and Preventive Medicine, (ISPM) University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Stephan Windecker
- Department of Clinical Research, Clinical Trials Unit, ISPM, University of Bern, Hochschulstrasse 6, 3012 Bern, Switzerland
| | - Joachim Buhmann
- Institute of Neuroinformatics, University of Zurich and ETH Zurich, Winterthurerstrasse 190, 8057 Zurich, Switzerland
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, Royal Brompton and Harefield Hospitals and Imperial College, Sydney St, Chelsea, London SW3 6NP, UK.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Rämistrasse 100, 8091 Zurich, Switzerland.,Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, 8952 Schlieren, Switzerland
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16
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Haddad C, Obeid S, Ghanem L, Kazour F, Chok A, Azar J, Hallit S, Tahan F. Association of insomnia with mania in Lebanese patients with bipolar disorder. Encephale 2021; 47:314-318. [PMID: 33541713 DOI: 10.1016/j.encep.2020.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/17/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess: (1) the association between insomnia experienced at admission, sociodemographic and other patients' characteristics and mania; and (2) the variation of insomnia and mania before and after treatment in bipolar patients with manic episodes (type I). METHODS Sixty-two patients were interviewed shortly after their admission to the hospital (after 3 to 5 days). The current symptoms experienced by the patients were assessed upon admission and again at discharge from the hospital. RESULTS A poorer quality of sleep (higher PSQI scores) (Beta=0.590) was significantly associated with higher mania, whereas the intake of SSRIs (Beta=-5.952) and TCAs (Beta=-8.181) was significantly associated with lower mania. Furthermore, highly significant reductions were reported in the PSQI scores (4.96 vs. 2.75, P<0.001), ISI scores (8.30 vs. 3.45, P<0.001) and YMRS scores (8.60 vs. 3.06, P<0.001) between admission to and discharge from the hospital. CONCLUSION Insomnia in patients with bipolar disorder type I is associated with mania, with a significant reduction of sleep problems seen during a period of approximately 20 days of hospitalization. Further longitudinal studies are needed to confirm the validity of our results and identify the causes. In the meantime, this research recommends a strategy to improve sleeplessness experienced during inter-episode phases may be helpful in preventing manic episodes in BD.
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Affiliation(s)
- C Haddad
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Inserm, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, centre hospitalier Esquirol, University Limoges, Limoges, France
| | - S Obeid
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; INSPECT-LB: Institut national de santé publique, épidemiologie clinique et toxicologie-Liban, Beirut, Lebanon; Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon
| | - L Ghanem
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - F Kazour
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Faculty of Arts and Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon; Faculty of Medicine, Saint-Joseph University, Beirut, Lebanon; Faculty of Medicine, Lebanese American University, Byblos, Lebanon
| | - A Chok
- Faculty of Sciences, Lebanese University, Beirut, Lebanon
| | - J Azar
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; INSPECT-LB: Institut national de santé publique, épidemiologie clinique et toxicologie-Liban, Beirut, Lebanon; Faculty of Medicine, Lebanese American University, Byblos, Lebanon
| | - S Hallit
- INSPECT-LB: Institut national de santé publique, épidemiologie clinique et toxicologie-Liban, Beirut, Lebanon; Faculty of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), Jounieh, Lebanon.
| | - F Tahan
- Research Department, Psychiatric Hospital of the Cross, Jal Eddib, Lebanon; Faculty of Sciences, Lebanese University, Beirut, Lebanon.
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17
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Obeid S, Yousif N, Davies A, Loretz R, Saleh L, Niederseer D, Noor HA, Amin H, Mach F, Gencer B, Räber L, Windecker S, Templin C, Nanchen D, Rodondi N, Muller O, Matter CM, von Eckardstein A, Lüscher TF. Prognostic role of plasma galectin-3 levels in acute coronary syndrome. European Heart Journal. Acute Cardiovascular Care 2020; 9:869-878. [DOI: 10.1177/2048872620974612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Aim:
Cystatin C, neutrophil gelatinase-associated lipocalin and galectin-3 have emerged as biomarker candidates to predict cardiovascular outcomes and mortality in the general population as well as in patients with coronary artery or renal disease. However, their predictive role and clinical utility in patients with acute coronary syndromes alone or in combination beyond currently used risk scores remains to be determined.
Methods and results:
Cystatin C, neutrophil gelatinase-associated lipocalin, and galectin-3 were measured in plasmas of 1832 patients at the time of presentation with acute coronary syndromes requiring percutaneous coronary intervention or coronary artery bypass grafting. The primary outcomes were major adverse cardiac and cerebrovascular events (defined as the composite of all-cause mortality, cerebrovascular events, any repeat revascularization or myocardial infarction) and all-cause mortality after 1 year and occurred in 192 (10.5%) and 78 (4.3%) of patients, respectively. All three biomarkers were increased in those with major adverse cardiac and cerebrovascular events compared with those without (p<0.001). However, only galectin-3 (all-cause mortality: hazard ratio=1.027 (95% confidence interval (1.011–1.043); p=0.001), major adverse cardiac and cerebrovascular events: hazard ratio=1.025 (95% confidence interval (1.012–1.037); p<0.001)) but not cystatin C nor neutrophil gelatinase-associated lipocalin emerged as independent predictors of both major adverse cardiac and cerebrovascular events and death. The risks were particularly high in the highest quartile of galectin-3. The integration of galectin-3 into the global registry of acute coronary events (GRACE) score improved the prediction of major adverse cardiac and cerebrovascular events and all-cause mortality significantly. The areas under the receiver operator characteristics curves increased from 0.6701 to 0.6932 for major adverse cardiac and cerebrovascular events (p=0.0474) and from 0.804 to 0.8199 for all-cause mortality (p=0.0197). Finally, we applied net reclassification improvement index using different cut-offs for major adverse cardiac and cerebrovascular events which showed negative results (for the cut-offs of 5% and 15%, net reclassification improvement index 0.028, p=0.586, for the cut-offs of 10% and 20%, net reclassification improvement index 0.072, p=0.1132 and for the cut-offs of 10% and 30% the net reclassification improvement index is 0.0843, p=0.077).
Conclusion:
In acute coronary syndromes patients, galectin-3 has moderate prognostic accuracy, provides statistically significant incremental value in some, but not all models, and that the magnitude of any improvement would seem of questionable clinical value.
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Affiliation(s)
- Slayman Obeid
- Department of Cardiology, University Hospital Zurich, Switzerland
| | - Nooraldaem Yousif
- Department of Cardiology, University Hospital Zurich, Switzerland
- Mohammed Bin Khalifa Cardiac Centre, Kingdom of Bahrain
| | - Allan Davies
- Royal Brompton and Harefield Hospitals and Imperial College, UK
| | - Ruben Loretz
- Department of Cardiology, University Hospital Zurich, Switzerland
| | - Lanja Saleh
- Institute of Clinical Chemistry, University Hospital Zurich, Switzerland
| | - David Niederseer
- Department of Cardiology, University Hospital Zurich, Switzerland
| | - Husam A Noor
- Mohammed Bin Khalifa Cardiac Centre, Kingdom of Bahrain
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Centre, Kingdom of Bahrain
| | - François Mach
- Department of Cardiology, Hospital Universitaire de Geneve, Switzerland
| | - Baris Gencer
- Department of Cardiology, Hospital Universitaire de Geneve, Switzerland
| | - Lorenz Räber
- Department of Cardiology, University Hospital Bern, Switzerland
| | | | | | - David Nanchen
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Medicine, University Hospital Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - Olivier Muller
- Department of Cardiology, Centre Hospitalier Universitaire Vaudois, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Hospital Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | | | - Thomas F Lüscher
- Royal Brompton and Harefield Hospitals and Imperial College, UK
- Center for Molecular Cardiology, University of Zurich, Switzerland
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18
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Davies A, Li X, Obeid S, Roffi M, Klingenberg R, Mach F, Raber L, Windecker S, Templin C, Muller O, Nanchen D, Matter C, Wang Z, Hazen S, Luescher T. Short and medium chain acylcarnitines as markers of outcome in diabetic and non-diabetic subjects with acute coronary syndromes. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1561] [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: 11/12/2022] Open
Abstract
Abstract
Background
Dietary carnitine that is not absorbed can serve as a precursor for gut microbiota-dependent generation of trimethylamine N-oxide (TMAO), a pro-atherogenic and pro-thrombosis promoting metabolite. Gut microbiome-derived metabolites of dietary carnitine, including TMAO and g-butyrobetaine, may accelerate atherosclerosis, increase platelet reactivity and in vivo thrombosis. Carnitine metabolism also produces numerous molecular species of short, medium and long chain acylcarnitines, which play important roles in energy metabolism and intracellular fatty acid transport.
Purpose
We sought to evaluate the differences between diabetics and non-diabetics presenting with ACS with respect to acylcarnitines, and to explore their relationship with incident cardiovascular outcomes.
Methods
Using a large, prospectively recruited cohort of patients presenting to the cardiac cath lab with suspected acute coronary syndromes, we measured levels of plasma acylcarnitines, carnitine and its gut microbial-derived metabolites to assess their relationship with independently adjudicated major adverse cardiac events (MACE = myocardial infarction, stroke or TIA, need for revascularization or all-cause mortality) amongst diabetics and non-diabetics.
Results
We analysed 1683 patients who presented with ACS, were treated according to current guidelines and had undergone acylcarnitine analysis. There were 294 diabetics and 1389 non-diabetics. Diabetics had significantly higher plasma levels of all acyl carnitine metabolites than non-diabetics (P<0.001), but not of carnitine itself. Baseline plasma levels of all gut microbiome derived carnitine metabolites (TMAO, g-butyrobetaine and crotonobetaine) were also significantly higher in those who subsequently experienced a MACE. All carnitine metabolites, apart from octenoylcarnitine, were significantly associated with MACE on univariate analysis, while acetylcarnitine and crotonobetaine were independently associated with MACE after multivariate adjustment.
Conclusion
Serum short- and medium- chain acylcarnitine levels are significantly higher in diabetic patients presenting with ACS and predict MACE. After multivariate adjustment, acetylcarnitine and crotonobetaine remained an independent predictor of MACE.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): Zurich Heart House - Foundation for Cardiovascular Research
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Affiliation(s)
- A Davies
- Royal Brompton and Harefield Hospital, London, United Kingdom
| | - X Li
- Cleveland Clinic, Lerner Research Institute, Cleveland, United States of America
| | - S Obeid
- University Hospital Zurich, Zurich, Switzerland
| | - M Roffi
- Geneva University Hospitals, Geneva, Switzerland
| | | | - F Mach
- Geneva University Hospitals, Geneva, Switzerland
| | - L Raber
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Inselspital, Bern, Switzerland
| | - C Templin
- University Hospital Zurich, Zurich, Switzerland
| | - O Muller
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - D Nanchen
- University Hospital Centre Vaudois (CHUV), Lausanne, Switzerland
| | - C Matter
- University Hospital Zurich, Zurich, Switzerland
| | - Z Wang
- Cleveland Clinic, Lerner Research Institute, Cleveland, United States of America
| | - S Hazen
- Cleveland Clinic, Lerner Research Institute, Cleveland, United States of America
| | - T Luescher
- Royal Brompton and Harefield Hospital, London, United Kingdom
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Obeid S, Nietlispach F, Meier B. Plugs for left atrial appendage occlusion: an overview of available devices. Expert Rev Med Devices 2020; 17:1145-1154. [PMID: 33054430 DOI: 10.1080/17434440.2020.1837621] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Approximately one-third of all ischemic strokes and the ensuing health and economic burden can be attributed to the presence of atrial fibrillation (AF). The global prevalence of AF continues to rise, thus making it by far the most common diagnosed cardiac arrhythmia. Percutaneous left atrial appendage (LAA) occlusion or obliteration has been developed to protect from the occurrence of stroke in patients with nonvalvular AF. AREAS COVERED We address the characteristics and techniques for implantation as well as some clinical registries and randomized trials of the various catheter-based devices for the occlusion of the LAA that are either currently available or in the clinical evaluation stage. EXPERT OPINION Over less than 2 decades, LAA occlusion progressed from being a concept applied in a few specialized centers to a globally recognized procedure implemented in numerous hospitals as part of daily interventional practice. The respective devices are to date safer and easier to deploy than initially. Periprocedural and postprocedural complications will continue to decrease as already evident from prospective randomized trials and registries. Although current indications focus on patients with nonvalvular AF and contraindications for oral anticoagulation, it is all but certain that the future will bring a widening in the spectrum of indications, applicability, and usage of these devices.
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Affiliation(s)
- Slayman Obeid
- Cardiology, Kantonsspital Aarau , Aarau, Switzerland
| | - Fabian Nietlispach
- Cardiovascular Center Zurich, Hirslanden Klinik Im Park , Zurich, Switzerland
| | - Bernhard Meier
- Cardiology, University Hospital Bern , Bern, Switzerland
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20
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Gili S, Cammann VL, Schlossbauer SA, Kato K, D'Ascenzo F, Di Vece D, Jurisic S, Micek J, Obeid S, Bacchi B, Szawan KA, Famos F, Sarcon A, Levinson R, Ding KJ, Seifert B, Lenoir O, Bossone E, Citro R, Franke J, Napp LC, Jaguszewski M, Noutsias M, Münzel T, Knorr M, Heiner S, Katus HA, Burgdorf C, Schunkert H, Thiele H, Bauersachs J, Tschöpe C, Pieske BM, Rajan L, Michels G, Pfister R, Cuneo A, Jacobshagen C, Hasenfuß G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Banning A, Cuculi F, Kobza R, Fischer TA, Vasankari T, Airaksinen KEJ, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Empen K, Felix SB, Delmas C, Lairez O, El-Battrawy I, Akin I, Borggrefe M, Gilyarova E, Shilova A, Gilyarov M, Horowitz JD, Kozel M, Tousek P, Widimský P, Winchester DE, Ukena C, Gaita F, Di Mario C, Wischnewsky MB, Bax JJ, Prasad A, Böhm M, Ruschitzka F, Lüscher TF, Ghadri JR, Templin C. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry. Eur Heart J 2020; 40:2142-2151. [PMID: 31098611 PMCID: PMC6612368 DOI: 10.1093/eurheartj/ehz170] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 09/11/2018] [Accepted: 03/12/2019] [Indexed: 12/27/2022] Open
Abstract
AIMS We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). METHODS AND RESULTS We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. CONCLUSIONS Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.
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Affiliation(s)
- Sebastiano Gili
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Victoria L Cammann
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Susanne A Schlossbauer
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Ken Kato
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Davide Di Vece
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Stjepan Jurisic
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Jozef Micek
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Beatrice Bacchi
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Konrad A Szawan
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Flurina Famos
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Annahita Sarcon
- Keck School of Medicine, University of Southern California, Los Angeles CA, USA
| | - Rena Levinson
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland.,Division of Biological Sciences, University of California San Diego, San Diego, CA, USA
| | - Katharina J Ding
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Burkhardt Seifert
- Division of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Olivia Lenoir
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Eduardo Bossone
- Division of Cardiology 'Antonio Cardarelli' Hospital, Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital 'San Giovanni di Dio e Ruggi d'Aragona', Salerno, Italy
| | - Jennifer Franke
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | - L Christian Napp
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Milosz Jaguszewski
- First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland
| | - Michel Noutsias
- Division of Cardiology, Department of Internal Medicine III, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany
| | - Thomas Münzel
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Maike Knorr
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Susanne Heiner
- Center for Cardiology, Cardiology 1, University Medical Center Mainz, Mainz, Germany
| | - Hugo A Katus
- Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - Heribert Schunkert
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Holger Thiele
- Department of Internal Medicine/Cardiology, University of Leipzig-Heart Center, Leipzig, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | - Burkert M Pieske
- Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany
| | | | - Guido Michels
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Roman Pfister
- Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany
| | - Alessandro Cuneo
- Krankenhaus 'Maria Hilf' Medizinische Klinik, Stadtlohn, Germany
| | - Claudius Jacobshagen
- Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany
| | - Gerd Hasenfuß
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Mahir Karakas
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universität München, Munich, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Wolfgang Rottbauer
- Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany
| | - Samir M Said
- Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany
| | | | - Adrian Banning
- Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK
| | - Florim Cuculi
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Richard Kobza
- Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland
| | - Thomas A Fischer
- Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Tuija Vasankari
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | | | - Grzegorz Opolski
- Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafal Dworakowski
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Philip MacCarthy
- Department of Cardiology, Kings College Hospital, Kings Health Partners, London, UK
| | - Christoph Kaiser
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stefan Osswald
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Leonarda Galiuto
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Filippo Crea
- Department of Cardiovascular Sciences, Catholic University of the Sacred Heart Rome, Rome, Italy
| | - Wolfgang Dichtl
- University Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria
| | - Klaus Empen
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Stephan B Felix
- Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, Greifswald, Germany
| | - Clément Delmas
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France
| | - Ibrahim El-Battrawy
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ibrahim Akin
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Martin Borggrefe
- First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany
| | - Ekaterina Gilyarova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Alexandra Shilova
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - Mikhail Gilyarov
- Intensive coronary care Unit, Moscow City Hospital # 1 named after N. Pirogov, Moscow, Russia
| | - John D Horowitz
- Discipline of Medicine, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia
| | - Martin Kozel
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Tousek
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Widimský
- Third Medical Faculty, Charles University in Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David E Winchester
- Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Christian Ukena
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Fiorenzo Gaita
- Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy
| | - Carlo Di Mario
- Structural Interventional Cardiology, University Hospital Careggi, Florence, Italy
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Abhiram Prasad
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA
| | - Michael Böhm
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, Homburg/Saar, Germany
| | - Frank Ruschitzka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.,Royal Brompton and Harefield Hospitals Trust and Imperial College, London, UK
| | - Jelena R Ghadri
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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21
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Naduvathumuriyil T, Held U, Steigmiller K, Denegri A, Cantatore S, Obeid S, Flammer AJ, Ruschitzka F, Lüscher TF, Sudano I. Clinical benefits and safety of renal denervation in severe arterial hypertension: A long‐term follow‐up study. J Clin Hypertens (Greenwich) 2020; 22:1854-1864. [DOI: 10.1111/jch.14005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 05/01/2020] [Accepted: 05/17/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Tino Naduvathumuriyil
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Ulrike Held
- Epidemiology, Biostatistics and Prevention Institute University of Zurich Zurich Switzerland
| | - Klaus Steigmiller
- Epidemiology, Biostatistics and Prevention Institute University of Zurich Zurich Switzerland
| | - Andrea Denegri
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Cardiology Division Department of Biomedical, Metabolic and Neural Sciences University of Modena and Reggio EmiliaPoliclinico di Modena Modena Italy
| | - Silviya Cantatore
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Slayman Obeid
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Andreas J. Flammer
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Frank Ruschitzka
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
| | - Thomas F. Lüscher
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
- Royal Brompton & Harefield HospitalImperial College London UK
- Center for Molecular Cardiology University of Zurich Zurich Switzerland
| | - Isabella Sudano
- Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
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22
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Chuluunbaatar O, Obeid S, Joulakian B, Gusev A, Krassovitskiy P, Sevastianov L. D3h symmetry adapted correlated three center wave functions of the ground and the first five excited states of H3+. Chem Phys Lett 2020. [DOI: 10.1016/j.cplett.2020.137304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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23
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Canbek A, Obeid S, Mach F, Roffi M, Windecker S, Matter CM, Templin C, Sthli BE, Lscher TF. Acute decrease in kidney function after acute coronary syndromes predicts future bleeding and cardiac death. Cardiovasc Med 2020. [DOI: 10.4414/cvm.2020.02099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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24
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Winzap P, Davies A, Klingenberg R, Obeid S, Roffi M, Mach F, Räber L, Windecker S, Templin C, Nietlispach F, Nanchen D, Gencer B, Muller O, Matter CM, von Eckardstein A, Lüscher TF. Diabetes and baseline glucose are associated with inflammation, left ventricular function and short- and long-term outcome in acute coronary syndromes: role of the novel biomarker Cyr 61. Cardiovasc Diabetol 2019; 18:142. [PMID: 31672144 PMCID: PMC6824030 DOI: 10.1186/s12933-019-0946-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 10/11/2019] [Indexed: 02/07/2023] Open
Abstract
Background Hyperglycemia in the setting of an acute coronary syndrome (ACS) impacts short term outcomes, but little is known about longer term effects. We therefore designed this study to firstly determine the association between hyperglycemia and short term and longer term outcomes in patients presenting with ACS and secondly evaluate the prognostic role of diabetes, body mass index (BMI) and the novel biomarker Cyr61 on outcomes. Methods The prospective Special Program University Medicine-Acute Coronary Syndrome (SPUM-ACS) cohort enrolled 2168 patients with ACS between December 2009 and October 2012, of which 2034 underwent PCI (93.8%). Patients were followed up for 12 months. Events were independently adjudicated by three experienced cardiologists. Participants were recruited from four tertiary hospitals in Switzerland: Zurich, Geneva, Lausanne and Bern. Participants presenting with acute coronary syndromes and who underwent coronary angiography were included in the analysis. Patients were grouped according to history of diabetes (or HbA1c greater than 6%), baseline blood sugar level (BSL; < 6, 6–11.1 and > 11.1 mmol/L) and body mass index (BMI). The primary outcome was major adverse cardiac events (MACE) which was a composite of myocardial infarction, stroke and all-cause death. Secondary outcomes included the individual components of the primary endpoint, revascularisations, bleeding events (BARC classification) and cerebrovascular events (ischaemic or haemorrhagic stroke or TIA). Results Patients with hyperglycemia, i.e. BSL ≥ 11.1 mmol/L, had higher levels of C-reactive protein (CRP), white blood cell count (WBC), creatinine kinase (CK), higher heart rates and lower left ventricular ejection fraction (LVEF) and increased N-terminal pro-brain natriuretic peptide. At 30 days and 12 months, those with BSL ≥ 11.1 mmol/L had more MACE and death compared to those with BSL < 6.0 mmol/L or 6.0–11.1 mmol/L (HR-ratio 4.78 and 6.6; p < 0.001). The novel biomarker Cyr61 strongly associated with high BSL and STEMI and was independently associated with 1 year outcomes (HR 2.22; 95% CI 1.33–3.72; Tertile 3 vs. Tertile 1). Conclusions and relevance In this large, prospective, independently adjudicated cohort of in all comers ACS patients undergoing PCI, both a history of diabetes and elevated entry glucose was associated with inflammation and increased risk of MACE both at short and long-term. The mediators might involve increased sympathetic activation, inflammation and ischemia as reflected by elevated Cyr61 levels leading to larger levels of troponin and lower LVEF. Trial registration Clinical Trial Registration Number: NCT01000701. Registered October 23, 2009
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Affiliation(s)
- Patric Winzap
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Allan Davies
- Royal Brompton and Harefield Hospitals and Imperial College, Sydney Street, London, SW3 6NP, UK
| | - Roland Klingenberg
- Department of Cardiology, Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - Slayman Obeid
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Marco Roffi
- Department of Cardiology, Hopital Universitaire de Geneve, Geneva, Switzerland
| | - François Mach
- Department of Cardiology, Hopital Universitaire de Geneve, Geneva, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Swiss Heart Centre, Inselspital, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Swiss Heart Centre, Inselspital, Bern, Switzerland
| | - Christian Templin
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Lausanne, Switzerland
| | - Baris Gencer
- Department of Cardiology, Hopital Universitaire de Geneve, Geneva, Switzerland
| | - Olivier Muller
- Service of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Christian M Matter
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.,Department of Cardiology, University Heart Center Zurich, University Hospital Zurich, Zurich, Switzerland
| | | | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland. .,Royal Brompton and Harefield Hospitals and Imperial College, Sydney Street, London, SW3 6NP, UK.
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25
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Langfritz M, Shahin M, Nietlispach F, Taramasso M, Denegri A, Moccetti M, Pedrazzini G, Moccetti T, Keller LS, Ruschitzka F, Maisano F, Obeid S. Baseline Predictors of Renal Failure in Transcatheter Aortic Valve Implantation. J Invasive Cardiol 2019; 31:E289-E297. [PMID: 31567117] [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] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Acute kidney injury (AKI) post transcatheter aortic valve implantation (TAVI) is associated with worsened short- and long-term outcomes. We sought to identify significant baseline predictors of AKI and establish a high-risk group within patients enrolled in the multicenter SWISS-TAVI cohort. METHODS AND RESULTS A total of 526 patients who underwent TAVI were included in our analysis. Patients on hemodialysis were excluded. Within the first week after valve implantation, fifty patients (9.5%) developed AKI. There was a significantly higher prevalence of diabetes mellitus in the AKI group (45% vs 28%; P=.02). The odds ratio (OR) for patients suffering from diabetes mellitus who developed AKI was 1.9 after multivariable binary regression analysis (95% confidence interval, 1.018-3.553; P=.04). Chronic kidney disease (CKD) stage ≥4 was more prevalent in the AKI group (26% vs 14%; P=.04). Every 1 mg/dL creatinine above normal level at baseline increased AKI risk by a factor of 1.6 (OR, 1.605; 95% CI, 1.111-2.319; P=.01). Age, gender, body mass index, history of dyslipidemia, and history of hypertension were similar between the groups. In the diabetic population of 155 patients (29.5%), AKI developed in 22 patients (14.2%), compared with the non-diabetic population of 370 patients (70.5%), where AKI developed in 27 patients (7.3%). In the diabetic population, an elevation by 1 mg/dL in baseline creatinine was an independent predictor of developing kidney injury (OR, 2.061; 95% CI, 1.154-3.683; P=.02, while in non-diabetic patients, neither baseline glomerular filtration rate, CKD grade, STS score, EuroScore II, ACEF score, nor procedural contrast usage were predictors of AKI. CONCLUSION Diabetics with CKD stage ≥4 (as defined by the Kidney Disease: Improving Global Outcomes criteria) constitute a high-risk group for developing AKI after TAVI. In this high-risk subgroup, baseline creatinine in combination with amount of contrast agent used were strong risk factors for developing AKI. AKI in non-diabetics was less predictable by baseline characteristics.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Slayman Obeid
- University Heart Center, University Hospital, Zurich, Rämistrasse 100, 8091 Zürich, Switzerland.
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26
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Li XS, Obeid S, Wang Z, Hazen BJ, Li L, Wu Y, Hurd AG, Gu X, Pratt A, Levison BS, Chung YM, Nissen SE, Tang WHW, Mach F, Räber L, Nanchen D, Matter CM, Lüscher TF, Hazen SL. Trimethyllysine, a trimethylamine N-oxide precursor, provides near- and long-term prognostic value in patients presenting with acute coronary syndromes. Eur Heart J 2019; 40:2700-2709. [PMID: 31049589 PMCID: PMC7963132 DOI: 10.1093/eurheartj/ehz259] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [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: 07/24/2018] [Revised: 01/04/2019] [Accepted: 04/17/2019] [Indexed: 12/19/2022] Open
Abstract
AIMS Trimethyllysine (TML) serves as a nutrient precursor of the gut microbiota-derived metabolite trimethylamine N-oxide (TMAO) and is associated with incident cardiovascular (CV) events in stable subjects. We examined the relationship between plasma TML levels and incident CV events in patients presenting with acute coronary syndromes (ACS). METHODS AND RESULTS Plasma levels of TML were quantified in two independent cohorts using mass spectrometry, and its relationship with CV events was investigated. In a Cleveland Cohort (N = 530), comprised of patients presenting to the emergency department with chest pain and suspected ACS, TML was associated with major adverse cardiac events (MACE, myocardial infarction, stroke, need for revascularization, or all-cause mortality) over both 30 days [3rd tertile (T3), adjusted odds ratio (OR) 1.77, 95% confidence interval (CI) 1.04-3.01; P < 0.05] and 6 months (T3, adjusted OR 1.95, 95% CI 1.15-3.32; P < 0.05) of follow-up independent of traditional CV risk factors and indices of renal function. Elevated TML levels were also associated with incident long-term (7-year) all-cause mortality [T3, adjusted hazard ratio (HR) 2.52, 95% CI 1.50-4.24; P < 0.001], and MACE even amongst patients persistently negative for cardiac Troponin T at presentation (e.g. 30-day MACE, T3, adjusted OR 4.49, 95% CI 2.06-9.79; P < 0.001). Trimethyllysine in combination with TMAO showed additive significance for near- and long-term CV events, including patients with 'negative' high-sensitivity Troponin T levels. In a multicentre Swiss Cohort (N = 1683) comprised of ACS patients, similar associations between TML and incident 1-year adverse cardiac risks were observed (e.g. mortality, adjusted T3 HR 2.74, 95% CI 1.28-5.85; P < 0.05; and MACE, adjusted T3 HR 1.55, 95% CI 1.04-2.31; P < 0.05). CONCLUSION Plasma TML levels, alone and together with TMAO, are associated with both near- and long-term CV events in patients with chest pain and ACS.
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Affiliation(s)
- Xinmin S Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
| | - Zeneng Wang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Benjamin J Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Lin Li
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA
| | - Alex G Hurd
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Xiaodong Gu
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Alan Pratt
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Bruce S Levison
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Yoon-Mi Chung
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Steven E Nissen
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Wai Hong Wilson Tang
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - François Mach
- Department of Cardiology, Hospital Universitaire de Geneve, Geneva, Rue Gabrielle-Perret-Gentil 4, CH-1211, Geneva 14, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Swiss Heart Center, Inselspital, Freiburgstrasse 18, CH-3010, Bern, Switzerland
| | - David Nanchen
- Center for Primary Care and Public Health (Unisanté), University of Lausanne, Rue du Bugnon 44, CH-1011, Lausanne, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Ramistrasse 100, CH-8091, Zurich, Switzerland
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, CH-8952, Schlieren, Switzerland
| | - Thomas F Lüscher
- Center for Molecular Cardiology, University of Zurich, Wagistrasse 12, CH-8952, Schlieren, Switzerland
- Department of Cardiology, Royal Brompton and Harefield Hospitals, Imperial College, London, SW3 6NP, UK
| | - Stanley L Hazen
- Department of Cardiovascular and Metabolic Sciences, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
- Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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27
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Affiliation(s)
- Thomas F Lüscher
- University Heart Center, Department of Cardiology, University Hospital and Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.,Royal Brompton & Harefield Hospital Trust and Imperial College, London, UK
| | - Slayman Obeid
- University Heart Center, Department of Cardiology, University Hospital and Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland.,Royal Brompton & Harefield Hospital Trust and Imperial College, London, UK
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28
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Baumann F, Obeid S, Gilhofer T, Siegrist P, von Spiczak J, Lüscher TF, Binder RK. Right coronary artery motion analysis: a novel method to measure right ventricular systolic function by selective coronary angiography. Int J Cardiovasc Imaging 2019; 35:1557-1561. [PMID: 31044328 DOI: 10.1007/s10554-019-01606-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/23/2018] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Abstract
Right ventricular systolic dysfunction is prognostic in various cardiovascular diseases. Right ventricular systolic function is not commonly assessed in the catheterization laboratory. Therefore, we developed a novel, reproducible method to measure right ventricular systolic function during selective coronary angiography. We analyzed the angiographic systolic translational motion and maximum speed of the right coronary artery (RCA) in 97 consecutive patients and compared it to the tricuspid annular plane systolic excursion (TAPSE) as measured by echocardiography. All measurements were performed by two independent operators on two occasions. Inter-observer variability and intra-observer variability were excellent for RCA motion distance and for RCA maximum speed. There was a significant correlation of the RCA motion distance and RCA maximum speed with the TAPSE measured by echocardiography (Pearson's correlation for RCA distance: r = 0.59, p < 0.001, r2 = 0.35; for RCA speed: r = 0.40, p < 0.001, r2 = 0.16). The area under the receiver operating curve for the RCA motion distance was 0.88 (95% CI 0.80-0.96) for discrimination of normal and abnormal right ventricular systolic function. A cut-off value less than 22.3 mm systolic RCA motion had a specificity of 93.3% and a sensitivity of 75.6% for identifying an abnormal right ventricular systolic function. Analysis of the RCA motion is a reproducible and reliable method to measure right ventricular systolic function during selective coronary angiography. It is a simple and useful tool to assess right ventricular function in the catheterization laboratory and may serve for risk assessment for right ventricular failure. CLINICAL TRIAL REGISTRATION: Data for this study was collected retrospectively from Swiss Transcatheter Aortic Valve Implantation Registry (NCT01368250). https://clinicaltrials.gov/show/NCT01368250 .
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Affiliation(s)
- Flavia Baumann
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Thomas Gilhofer
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Patrick Siegrist
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Jochen von Spiczak
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Ronald K Binder
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland. .,Department of Cardiology and Intensive Care, University Teaching Hospital Klinikum Wels-Grieskrichen, Grieskrichnerstrasse 42, 4600, Wels, Austria.
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29
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Miura M, Taramasso M, Obeid S, Nietlispach F. Valve-in-valve-in-valve with the New Valve Technology allegra transcatheter heart valve system. Eur Heart J 2019; 40:1354. [PMID: 30272167 DOI: 10.1093/eurheartj/ehy606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 09/05/2018] [Accepted: 09/10/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mizuki Miura
- Department of Cardiac Surgery, University Heart Center Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Maurizio Taramasso
- Department of Cardiac Surgery, University Heart Center Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland
| | - Fabian Nietlispach
- Department of Cardiology, University Heart Center Zurich, Rämistrasse 100, CH-8091, Zürich, Switzerland
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30
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Stähli BE, Wischnewsky MB, Jakob P, Klingenberg R, Obeid S, Heg D, Räber L, Windecker S, Mach F, Gencer B, Nanchen D, Jüni P, Landmesser U, Matter CM, Lüscher TF, Maier W. Gender and age differences in outcomes of patients with acute coronary syndromes referred for coronary angiography. Catheter Cardiovasc Interv 2019; 93:16-24. [PMID: 30291678 DOI: 10.1002/ccd.27712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 09/08/2017] [Accepted: 05/30/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVES The number of elderly patients undergoing coronary revascularization is steadily increasing, and data on the impact of gender on outcomes are scarce. This study sought to assess gender-related differences in outcomes in elderly patients with acute coronary syndromes (ACS). METHODS We investigated outcomes in elderly ACS patients referred for coronary angiography and prospectively enrolled in the Swiss ACS Cohort between December 2009 and October 2012. Adjudicated major adverse cardiovascular and cerebrovascular events (MACCE) included all-cause death, non-fatal myocardial infarction, clinically indicated repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke. RESULTS Among 2,168 patients recruited, 481 (22%) patients were >75 years of age (37% women). In patients >75 years, 1-year MACCE rates were 15% and 23% in women and men (OR 0.59, 95% CI 0.36-0.97, P = 0.04), respectively, and differences remained significant after adjustments for baseline variables (adjusted OR 0.48, 95% CI 0.26-0.90, P = 0.02). Women >75 years had a lower cardiovascular mortality (6% versus 12%, adjusted OR 0.31, 95% CI 0.12-0.81, P = 0.02). In patients ≤75 years, 1-year MACCE rates did not differ between gender (10% and 8% for women and men, adjusted OR 1.28, 95% CI 0.77-2.14, P = 0.34). Rates of TIMI major bleeding for women and men were 4% and 4% in patients >75 years (P = 0.96), and 5% and 3% in those ≤75 years (P = 0.11). CONCLUSIONS The low rates of MACCE observed in elderly women in this patient cohort suggest that with current interventional strategies the gender gap in ACS management has been attenuated.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | | | - Philipp Jakob
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dik Heg
- Department of Clinical Research, Clinical Trials Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - François Mach
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland
| | - Baris Gencer
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, Lausanne University, Lausanne, Switzerland
| | - Peter Jüni
- Department of Clinical Research, Clinical Trials Unit, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Willibald Maier
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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31
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Yousif N, Shahin M, Lüscher TF, Obeid S. Gender Differences in Types, Frequency, Clinical Manifestations and Atherosclerotic Burden of Coronary Artery Anomalies. Rev Recent Clin Trials 2019; 14:41-46. [PMID: 30124159 DOI: 10.2174/1574887113666180820111341] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Although not well established; gender may play a role in the incidence, clinical manifestations, and atherosclerotic burden of Coronary Artery Anomalies (CAAS). Our aim is to investigate the impact of gender on coronary artery anomalies. METHODS All coronary angiograms performed at the University Heart Center Zurich, Switzerland, between January 2000 and December 2016 were investigated. Those of anomalous origin, course and termination (fistula) were included in the analysis with the exclusion of coronary artery aneurysms and myocardial bridges. RESULTS Out of the original 39577 angiographic studies that included 28550 males and 11026 females, Coronary Artery Anomalies (CAAS) were documented in 130 (0.32%) patients of whom 69.2% (n=90) and 30.8%(n=40) were males and females respectively. However, the overall prevalence of coronary anomalies amongst both genders did not differ (0.32% vs 0.36%, P = 1) and so were the basic characteristics except for hypertension, which was more prevalent in females (P = 0.03644). The most prevalent anomaly overall was (left circumflex artery from right coronary artery/sinus), which was present in (n=47, 36.2%). No impact of gender on the incidence of individual anomalies except for Right Coronary Artery (RCA) originating from Left Circumflex Artery (LCX), which was only documented in men (P = 0.0000116). On the other hand malignant CAAS presented equally with a proportion of 10% for both genders (P = 1). Although males outnumbered females in terms of atherosclerotic burden in CAAS this was statistically not significant (P = 0.331). CONCLUSION Both genders have a similar impact on the overall prevalence, clinical manifestations and atherosclerotic burden of CAAs. Anomaly of RCA originating from LCX occurred more frequently in males than females.
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Affiliation(s)
- Nooraldaem Yousif
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Mohammady Shahin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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32
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Yousif N, Shahin M, Manka R, Obeid S. Extensively Thrombosed Ectatic Circumflex Coronary Artery Fistula Presenting as Acute Coronary Syndrome. Curr Cardiol Rev 2018; 15:316-319. [PMID: 30520380 PMCID: PMC8142356 DOI: 10.2174/1573403x15666181206120138] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 12/03/2018] [Accepted: 12/30/2018] [Indexed: 11/22/2022] Open
Abstract
Background: Coronary artery fistula (CAF) is an abnormal communication between the termination of a coronary artery or its branches and a cardiac chamber, a great vessel or other vascular structure. Symptomatic patients with large CAF should undergo surgical or percutanous closure of the fistula at the drainage site while still the debate on closing asymptomatic CAF and re-opening symptomatic occluded CAF is ongoing.
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Affiliation(s)
- Nooraldaem Yousif
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Mohammady Shahin
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Robert Manka
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
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33
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Niederseer D, Bracher I, Stadlmayr A, Huber-Schönauer U, Plöderl M, Obeid S, Schmied C, Hammerl S, Stickel F, Lederer D, Patsch W, Aigner E, Datz C. Association between Cardiovascular Risk and Diabetes with Colorectal Neoplasia: A Site-Specific Analysis. J Clin Med 2018; 7:jcm7120484. [PMID: 30486335 PMCID: PMC6306807 DOI: 10.3390/jcm7120484] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 11/21/2018] [Accepted: 11/22/2018] [Indexed: 12/14/2022] Open
Abstract
Several studies have shown site-specific differences in colorectal cancer (CRC) with respect to the risk factors. CRC was shown to be associated with cardiovascular risk (CVR) factors, but site-specific variations have not been investigated so far. This study aimed to assess the associations between the prevalence and subsite-specific differences of colorectal neoplasia and established CVR scores or known coronary artery disease (CAD) in a large asymptomatic European screening cohort (N = 2098). Participants underwent simultaneous screening colonoscopy and CVR evaluation, using the Framingham Risk Score and Heart Score. Lesions found in the colonoscopy were classified by location (proximal/distal colon or rectum). More neoplasias were found in the proximal versus the distal colon (p < 0.001). The Framingham Risk Score and Heart Score showed incremental risk for colorectal adenoma, across the tertiles in the proximal and the distal colon (p < 0.001). The prevalence of adenomas in the rectum was much lower, but also here, incremental risk could be shown for the Framingham Risk but not the Heart Risk Score tertiles. Prevalence of adenomas in the proximal colon was higher in subjects with type 2 diabetes (T2DM) (p = 0.006), but no association was found between adenomas and T2DM in the distal colon (p = 0.618) and the rectum (p = 0.071). Males had a higher CVR and more findings, in the screening colonoscopy, as compared to females, however, no site-specific differences were noted. Patients with known CAD and high CVR have an increased risk of colorectal neoplasia in both the proximal and distal colon. Patients with T2DM have a higher risk for neoplasia in the proximal colon.
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Affiliation(s)
- David Niederseer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
- Department of Cardiology, University Heart Centre, University Hospital Zurich, 8091 Zürich, Switzerland.
| | - Isabelle Bracher
- Department of Cardiology, University Heart Centre, University Hospital Zurich, 8091 Zürich, Switzerland.
| | - Andreas Stadlmayr
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
| | - Ursula Huber-Schönauer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
| | - Martin Plöderl
- Suicide Prevention Research Program, Paracelsus Medical University, 5020 Salzburg, Austria.
- Department of Suicide Prevention, University Clinic of Psychiatry and Psychotherapy I, Christian Doppler Clinic, 5020 Salzburg, Austria.
- University Institute of Clinical Psychology, Christian Doppler Clinic, 5020 Salzburg, Austria.
| | - Slayman Obeid
- Department of Cardiology, University Heart Centre, University Hospital Zurich, 8091 Zürich, Switzerland.
| | - Christian Schmied
- Department of Cardiology, University Heart Centre, University Hospital Zurich, 8091 Zürich, Switzerland.
| | - Sabrina Hammerl
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
| | - Felix Stickel
- Department of Gastroenterology and Hepatology, University Hospital of Zürich, 8091 Zürich, Switzerland.
| | - Dieter Lederer
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
| | - Wolfgang Patsch
- Institute of Pharmacology and Toxicology, Paracelsus Medical University Salzburg, 5020 Austria.
| | - Elmar Aigner
- Department of Internal Medicine I, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria.
- Obesity Research Group, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria.
| | - Christian Datz
- Department of Internal Medicine, General Hospital Oberndorf, Teaching Hospital of the Paracelsus Medical University Salzburg, 5110 Oberndorf, Austria.
- Obesity Research Group, Paracelsus Medical University Salzburg, 5020 Salzburg, Austria.
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34
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Weidmann L, Obeid S, Mach F, Shahin M, Yousif N, Denegri A, Muller O, Räber L, Matter CM, Lüscher TF. Pre-existing treatment with aspirin or statins influences clinical presentation, infarct size and inflammation in patients with de novo acute coronary syndromes. Int J Cardiol 2018; 275:171-178. [PMID: 30344063 DOI: 10.1016/j.ijcard.2018.10.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 10/10/2018] [Accepted: 10/15/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Influence of pre-existing treatment with aspirin and/or statins prior to a first acute coronary syndrome (ACS) on clinical presentation, infarct size and inflammation markers. We analyzed patients from the Swiss Program University Medicine ACS-cohort (SPUM-ACS; ClinicalTrials.govnumber:NCT01075867). METHODS 1639 patients were categorized into 4 groups: (1) patients without either drug (n = 1181); (2) patients only on aspirin (n = 157); (3) patients only on statins (n = 133) and (4) patients on both drugs (n = 168). Clinical features, electrocardiogram (ECG), creatinine kinase (CK, U/l), high-sensitivity troponin T (hsTNT, μg/l), N-terminal brain natriuretic peptide (NT-proBNP, ng/l), leucocytes (Lc, G/l), neutrophils (Nc, G/l), C-reactive protein (CRP, mg/l) and angiographic features were documented at baseline. RESULTS Incidences of ST-elevation myocardial infarction (STEMI) were 64% in group 1, 45% in group 2, 52% in group 3 and 40% in group 4 (p < 0.0001). Those with both drugs had significantly lower CK (median 145 U/l, interquartile range (IQR) 89-297), hsTNT (median 0.13 μg/l, IQR 0.03-0.52) and higher left ventricular ejection fraction values (LVEF) (mean 55 ± 12%) compared to untreated patients (median CK 273 U/l, IQR 128-638; median hsTNT 0.26 μg/l, IQR 0.08-0.85; mean LVEF 51 ± 11%) (p < 0.0001, p = 0.001, p = 0.028, respectively). Co-medicated groups matched for high risk factors presented less frequently as STEMIs (p < 0.0001), had significantly smaller infarcts determined by CK and hsTNT (both p < 0.0001) and lower CRP levels (p = 0.01) compared to patients without pre-existing treatment with either drug. CONCLUSION Pre-existing treatment with aspirin and/or statins and particularly with their combination changes the clinical presentation, infarct size, inflammation markers and LVEF in patients suffering their first ACS.
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Affiliation(s)
- Lukas Weidmann
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - François Mach
- Department of Cardiology, University Hospital Geneva, Switzerland
| | - Mohammady Shahin
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Nooraldaem Yousif
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Andrea Denegri
- Department of Cardiology, University Heart Center Zurich, Switzerland
| | - Olivier Muller
- Department of Cardiology, Cardiovascular Center, University Hospital Lausanne, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Switzerland
| | | | - Thomas F Lüscher
- Department of Cardiology, University Heart Center Zurich, Switzerland; Royal Brompton and Harefield Hospital Trust and Imperial College, London, United Kingdom.
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35
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Denegri A, Mehran R, Holy E, Taramasso M, Pasotti E, Pedrazzini G, Moccetti T, Maisano F, Nietlispach F, Obeid S. Post procedural risk assessment in patients undergoing trans aortic valve implantation according to the age, creatinine, and ejection fraction-7 score: Advantages of age, creatinine, and ejection fraction-7 in stratification of post-procedural outcome. Catheter Cardiovasc Interv 2018; 93:141-148. [PMID: 30269398 DOI: 10.1002/ccd.27806] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 02/01/2018] [Revised: 06/30/2018] [Accepted: 07/12/2018] [Indexed: 11/07/2022]
Abstract
BACKGROUND Post-procedural risk stratification based on renal function after trans aortic valve implantation (TAVI) was assessed by means of a modified age, creatinine, and ejection fraction (ACEF) score using the lowest glomerular filtration rate (GFR), obtained within 1 week after valve implantation. We refer to the score as ACEF-7 score. METHODS The Zurich- and Cardiocentro Ticino TAVI-Cohorts comprised of 424, and 137 patients, who were not on hemodialysis and had already survived the first post-procedural week. Zurich patients were stratified into tertiles of ACEF-7 score (ACEF-7Low ≤ 2.45 (n = 138), ACEF-7Mid 2.46-4.38 (n = 142), and ACEF-7High ≥ 4.39 (n = 144) and compared for survival using KM curves. Euroscore II, Society of Thoracic Surgeons (STS), and ACEF were also calculated at baseline in all patients and assessed for prognostic significance in predicting the primary outcome of 1-year all-cause mortality using univariate and multivariate Cox regression models. Results were then confirmed in the Cardiocentro cohort. RESULTS Six months (18.1% vs. 6.3% vs. 2.9% P < 0.001) and 1-year all-cause mortality (24.3% vs. 12.7% % vs. 5.8%, P < 0.001), as well as the composite of death or rehospitalization (35% vs. 20% vs. 11% P < 0.001) occurred significantly more frequently in the ACEF-7High compared to the other groups. Both Euroscore II and STS score were not predictors of mortality in our cohort. In a multivariate Cox regression model corrected for gender, Acute Kidney Injury, and baseline ACEF score, the ACEF-7 score was an independent predictor of 1-year all-cause mortality as a per point increment HR 1.512 [95% CI 1.227-1.862, P < 0.001] and as ACEF-7High (≥4.39); HR 5.541 [1.694-18.120]). In addition, the ACEF-7 tertiles showed a significant (P = 0.02) net reclassification improvement of 16% when compared to baseline tertiles of ACEF score, when assessing 1-year all-cause mortality. CONCLUSION Post-procedural risk stratification using the simple ACEF-7 score significantly better predicted long-term outcome than commonly used risk-scores. Practical implications could include contrast sparing and renal protection in high-risk patients, emphasizing the importance of preventative measures.
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Affiliation(s)
- Andrea Denegri
- University Heart Center, University Hospital, Zurich, Switzerland.,Cardiocentro Lugano, University of Zurich, Lugano, Switzerland.,Cardiology Unit and Laboratory of Cardiovascular Biology, IRCCS-AOU San Martino-IST University of Genova, Genoa, Italy
| | | | - Erik Holy
- University Heart Center, University Hospital, Zurich, Switzerland
| | | | - Elena Pasotti
- Cardiocentro Lugano, University of Zurich, Lugano, Switzerland
| | | | | | | | | | - Slayman Obeid
- University Heart Center, University Hospital, Zurich, Switzerland
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36
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Mosca NM, Obeid S, Yousif N, Roffi M, Mach F, Mueller X, Nietlispach F, Templin C, Klingenberg R, Matter CM, Räber L, Lüscher TF. Coronary stent thrombosis in acute coronary syndromes. Cardiovasc Med 2018. [DOI: 10.4414/cvm.2018.00581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nicole M. Mosca
- Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
Institute of General Practice, University Hospital Zurich, Switzerland
MediX Praxis Altstetten, Zurich, Switzerland; ??? eMail ???
| | - Slayman Obeid
- Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | | | - Marco Roffi
- Cardiology, Hopital Universitaire de Geneve (HUG), Geneve, Switzerland
| | - François Mach
- Cardiology, Hopital Universitaire de Geneve (HUG), Geneve, Switzerland
| | - Xavier Mueller
- Cardiology, Centre Hospitalier Universitaire Lausanne (CHUV), Lausanne, Switzerland
| | - Fabian Nietlispach
- Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Christian Templin
- Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Roland Klingenberg
- Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Christian M. Matter
- Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Lorenz Räber
- Cardiology, University Heart Center Zurich, University Hospital Zurich, Switzerland
| | - Thomas F. Lüscher
- Center for Molecular Cardiology, University of Zurich, Campus Schlieren, Switzerland and Cardiology, Royal Brompton & Harefield Hospital Trust and Imperial College, London, UK
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Denegri A, Rossi VA, Niederseer D, Obeid S, Klingenberg R, Raeber L, Gencer B, Mach F, Rodondi N, Heg D, Windecker S, Ruschitzka F, Luescher TF, Matter C. P2480Baseline inflammatory markers, NT-proBNP and LVEF predict heart failure and cardiac death one year after acute coronary syndromes. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A Denegri
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - V A Rossi
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - D Niederseer
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - S Obeid
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - R Klingenberg
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - L Raeber
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - B Gencer
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - F Mach
- Geneva University Hospitals, Cardiology, Geneva, Switzerland
| | - N Rodondi
- Bern University Hospital, Internal Medicine, Bern, Switzerland
| | - D Heg
- University of Bern, Institute of Social and Preventive Medicine, Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Cardiology, Bern, Switzerland
| | - F Ruschitzka
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - T F Luescher
- Royal Brompton Hospital, Cardiology, London, United Kingdom
| | - C Matter
- University Hospital Zurich, Cardiology, Zurich, Switzerland
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38
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Obeid S, Libby P, Husni E, Pfeffer MA, Wisniewski LM, Davey DA, Wolski KE, Wang QW, Feng R, Nissen SE, Luscher TF. P5421Cardiorenal risk of celecoxib compared to naproxen, or ibuprofen in arthritis patients: a sub-analysis of the PRECISION trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S Obeid
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - P Libby
- Brigham and Women's Hospital, Boston, United States of America
| | - E Husni
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M A Pfeffer
- Brigham and Women's Hospital, Boston, United States of America
| | - L M Wisniewski
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - D A Davey
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K E Wolski
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Q W Wang
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Feng
- Pfizer Inc, 219 E. 42nd Street, New York, NY 10017 USA, New York, United States of America
| | - S E Nissen
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - T F Luscher
- Royal Brompton Hospital, London, United Kingdom
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39
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Rossi VA, Denegri A, Obeid S, Klingenberg R, Raeber L, Gencer B, Mach F, Rodondi N, Heg D, Windecker S, Buhmann JM, Luescher TF, Ruschitzka F, Matter C. 3400Neutrophil count and neutrophil/lymphocyte ratio predict cardiac death and acute kidney injury after acute coronary syndromes independently from smoking status. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.3400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V A Rossi
- University Heart Center, Zurich, Switzerland
| | - A Denegri
- University Heart Center, Zurich, Switzerland
| | - S Obeid
- University Heart Center, Zurich, Switzerland
| | - R Klingenberg
- Kerckhoff Heart and Thorax Center, Department of Cardiology, Bad Nauheim, Germany
| | - L Raeber
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - B Gencer
- Geneva University Hospitals, Division of Cardiology, Geneva, Switzerland
| | - F Mach
- Geneva University Hospitals, Division of Cardiology, Geneva, Switzerland
| | - N Rodondi
- Bern University Hospital, Departement of Internal Medicine, Bern, Switzerland
| | - D Heg
- University of Bern, Institute of Social and Preventive Medicine (ISPM), Bern, Switzerland
| | - S Windecker
- Bern University Hospital, Department of Cardiology, Bern, Switzerland
| | - J M Buhmann
- Swiss Federal Institute of Technology Zurich (ETH Zurich), Department of Computer Science, Zurich, Switzerland
| | - T F Luescher
- Royal Brompton Hospital, Departement of Cardiology, London, United Kingdom
| | | | - C Matter
- University Heart Center, Zurich, Switzerland
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40
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Stähli BE, Wischnewsky MB, Jakob P, Klingenberg R, Obeid S, Heg D, Räber L, Windecker S, Roffi M, Mach F, Gencer B, Nanchen D, Jüni P, Landmesser U, Matter CM, Lüscher TF, Maier W. Predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes. Int J Cardiol 2018; 270:7-13. [PMID: 29885826 DOI: 10.1016/j.ijcard.2018.05.134] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [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: 02/11/2018] [Revised: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 12/22/2022]
Abstract
BACKGROUND This study sought to investigate the predictive value of the age, creatinine, and ejection fraction (ACEF) score in patients with acute coronary syndromes (ACS). The ACEF score (age/left ventricular ejection fraction +1 [if creatinine > 176 μmol/L]) has been established in patients evaluated for coronary artery bypass surgery. Data on its predictive value in all-comer ACS patients undergoing percutaneous coronary intervention are scarce. METHODS A total of 1901 patients prospectively enrolled in the Swiss ACS Cohort were included in the analysis. Optimal ACEF score cut-off values were calculated by decision tree analysis, and patients divided into low-risk (≤1.45), intermediate-risk (>1.45 and ≤2.0), and high-risk groups (>2.0). The primary endpoint was all-cause mortality. Major adverse cardiac and cerebrovascular events (MACCE) included all-cause death, non-fatal myocardial infarction, clinically indicated repeat coronary revascularization, definite stent thrombosis, and transient ischemic attack/stroke. RESULTS One-year rates of all-cause death increased across ACEF score groups (1.6% versus 5.6% versus 23.0%, p < 0.001). In multivariate analysis, the ACEF score was related with an increased risk of all-cause mortality (adjusted HR 3.53, 95% CI 2.90-4.31, p < 0.001), MACCE (adjusted HR 2.23, 95% CI 1.88-2.65, p < 0.001), and transient ischemic attack/stroke (adjusted HR 2.58, 95% CI 1.71-3.89, p < 0.001) at 1 year. Rates of Thrombolysis in Myocardial Infarction (TIMI) major and Global use of Strategies to Open Occluded Coronary Arteries (GUSTO) severe bleeding paralleled the increased ischemic risk across the groups (p < 0.001). CONCLUSIONS The ACEF score is a simple and useful risk stratification tool in patients with ACS referred for coronary revascularization.
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Affiliation(s)
- Barbara E Stähli
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.
| | | | - Philipp Jakob
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Dik Heg
- Clinical Trials Unit, Department of Clinical Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Bern, Switzerland
| | - Marco Roffi
- Division of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland
| | - François Mach
- Division of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland
| | - Baris Gencer
- Division of Cardiology, Cardiovascular Center, University Hospital Geneva, Geneva, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, Lausanne University, Lausanne, Switzerland
| | - Peter Jüni
- Clinical Trials Unit, Department of Clinical Research, Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ulf Landmesser
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Department of Cardiology, Charité Berlin - University Medicine, Campus Benjamin Franklin, Berlin, Germany; DZHK (German Center for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland; Cardiology, Royal Brompton and Harefield Hospitals and Imperial College, London, UK
| | - Willibald Maier
- Department of Cardiology, University Heart Center, University Hospital Zurich and University of Zurich, Zurich, Switzerland
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Li XS, Wang Z, Cajka T, Buffa JA, Nemet I, Hurd AG, Gu X, Skye SM, Roberts AB, Wu Y, Li L, Shahen CJ, Wagner MA, Hartiala JA, Kerby RL, Romano KA, Han Y, Obeid S, Lüscher TF, Allayee H, Rey FE, DiDonato JA, Fiehn O, Tang WHW, Hazen SL. Untargeted metabolomics identifies trimethyllysine, a TMAO-producing nutrient precursor, as a predictor of incident cardiovascular disease risk. JCI Insight 2018; 3:99096. [PMID: 29563342 DOI: 10.1172/jci.insight.99096] [Citation(s) in RCA: 100] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 02/07/2018] [Indexed: 01/26/2023] Open
Abstract
Using an untargeted metabolomics approach in initial (N = 99 subjects) and replication cohorts (N = 1,162), we discovered and structurally identified a plasma metabolite associated with cardiovascular disease (CVD) risks, N6,N6,N6-trimethyl-L-lysine (trimethyllysine, TML). Stable-isotope-dilution tandem mass spectrometry analyses of an independent validation cohort (N = 2,140) confirmed TML levels are independently associated with incident (3-year) major adverse cardiovascular event risks (hazards ratio [HR], 2.4; 95% CI, 1.7-3.4) and incident (5-year) mortality risk (HR, 2.9; 95% CI, 2.0-4.2). Genome-wide association studies identified several suggestive loci for TML levels, but none reached genome-wide significance; and d9(trimethyl)-TML isotope tracer studies confirmed TML can serve as a nutrient precursor for gut microbiota-dependent generation of trimethylamine (TMA) and the atherogenic metabolite trimethylamine N-oxide (TMAO). Although TML was shown to be abundant in both plant- and animal-derived foods, mouse and human fecal cultures (omnivores and vegans) showed slow conversion of TML to TMA. Furthermore, unlike chronic dietary choline, TML supplementation in mice failed to elevate plasma TMAO or heighten thrombosis potential in vivo. Thus, TML is identified as a strong predictor of incident CVD risks in subjects and to serve as a dietary precursor for gut microbiota-dependent generation of TMAO; however, TML does not appear to be a major microbial source for TMAO generation in vivo.
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Affiliation(s)
- Xinmin S Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Zeneng Wang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Tomas Cajka
- Department of Molecular and Cellular Biology and Genome Center, University of California Davis, Davis, California, USA
| | - Jennifer A Buffa
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ina Nemet
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Alex G Hurd
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Xiaodong Gu
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Sarah M Skye
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adam B Roberts
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, Cleveland, Ohio, USA
| | - Lin Li
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Christopher J Shahen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Matthew A Wagner
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jaana A Hartiala
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Robert L Kerby
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Kymberleigh A Romano
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Yi Han
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Slayman Obeid
- University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland
| | - Thomas F Lüscher
- University Heart Center, Department of Cardiology, University Hospital Zurich, Switzerland.,Royal Brompton and Harefield Hospitals and Imperial College, London, United Kingdom
| | - Hooman Allayee
- Departments of Preventive Medicine and Biochemistry and Molecular Medicine, University of Southern California, Keck School of Medicine, Los Angeles, California, USA
| | - Federico E Rey
- Department of Bacteriology, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Joseph A DiDonato
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Oliver Fiehn
- Department of Molecular and Cellular Biology and Genome Center, University of California Davis, Davis, California, USA.,Department of Biochemistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - W H Wilson Tang
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Stanley L Hazen
- Department of Cellular and Molecular Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
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Obeid S, Yousif N, Schelldorfer A, Shahin M, Räber L, Gencer B, Mach F, Roffi M, Matter CM, Windecker S, Lüscher TF. Short-Term Outcome After Left Main Interventions in Patients Presenting With Acute Coronary Syndrome. J Invasive Cardiol 2018; 30:98-104. [PMID: 29493510] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To assess the efficacy and safety of coronary left main (LM) disease interventions in patients with acute coronary syndromes (ACS) as compared to those without LM coronary artery disease. METHODS A total of 2899 patients with ACS, enrolled in the prospective Swiss Program University Medicine ACS (SPUM-ACS) cohort, were included. The primary endpoints of independently adjudicated major adverse cardiovascular and cerebrovascular event (MACCE) and net adverse clinical event (NACE) were determined at 30-day follow-up. RESULTS Seventy-one (2.0%) of the 2899 ACS patients had significant LM disease. At 30-day follow-up, the primary outcomes of MACCE and NACE occurred in 140 patients (4.8%) and 272 patients (9.4%), respectively. Compared to those without LM disease, patients in the LM group were significantly older (P<.001), had a higher incidence of hypertension (P<.001) and diabetes (P=.013), and more often had a history of coronary artery bypass graft (CABG) surgery (P<.001). Analyses on non-matched populations showed a nearly significant trend toward a higher incidence of MACCE (P=.06) and NACE (P=.10) in patients with LM disease compared to those without LM disease. This trend, however, disappeared after matching the populations for all significant confounding variables on a 3:1 basis. This subanalysis showed MACCE rates of 10.0% in the LM group and 7.3% in the non-LM group (P=.61). Notably, the matched patients with LM disease treated with percutaneous coronary intervention had a lower NACE incidence when compared to those undergoing urgent CABG surgery (P<.01). CONCLUSIONS In ACS patients with LM disease, revascularization with PCI is feasible and safe, with short-term outcomes comparable to ACS patients without significant LM disease.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Thomas F Lüscher
- Royal Brompton & Harefield Hospital, Imperial College, London, SW3 6NP, United Kingdom.
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Frangieh AH, Jaguszewski M, Imori Y, Obeid S, Templin C. Impact of post-dilatation on strut apposition of second-generation bioresorbable vascular scaffolds: Key role for scaffold thrombosis and prognosis? Cardiol J 2018; 25:148-150. [DOI: 10.5603/cj.2018.0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 11/12/2017] [Accepted: 11/12/2017] [Indexed: 11/25/2022] Open
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Li XS, Obeid S, Klingenberg R, Gencer B, Mach F, Räber L, Windecker S, Rodondi N, Nanchen D, Muller O, Miranda MX, Matter CM, Wu Y, Li L, Wang Z, Alamri HS, Gogonea V, Chung YM, Tang WHW, Hazen SL, Lüscher TF. Gut microbiota-dependent trimethylamine N-oxide in acute coronary syndromes: a prognostic marker for incident cardiovascular events beyond traditional risk factors. Eur Heart J 2018; 38:814-824. [PMID: 28077467 DOI: 10.1093/eurheartj/ehw582] [Citation(s) in RCA: 207] [Impact Index Per Article: 34.5] [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: 07/19/2016] [Accepted: 12/15/2016] [Indexed: 02/06/2023] Open
Abstract
Aims Systemic levels of trimethylamine N-oxide (TMAO), a pro-atherogenic and pro-thrombotic metabolite produced from gut microbiota metabolism of dietary trimethylamine (TMA)-containing nutrients such as choline or carnitine, predict incident cardiovascular event risks in stable primary and secondary prevention subjects. However, the prognostic value of TMAO in the setting of acute coronary syndromes (ACS) remains unknown. Methods and results We investigated the relationship of TMAO levels with incident cardiovascular risks among sequential patients presenting with ACS in two independent cohorts. In the Cleveland Cohort, comprised of sequential subjects (n = 530) presenting to the Emergency Department (ED) with chest pain of suspected cardiac origin, an elevated plasma TMAO level at presentation was independently associated with risk of major adverse cardiac events (MACE, including myocardial infarction, stroke, need for revascularization, or death) over the ensuing 30-day (4th quartile (Q4) adjusted odds ratio (OR) 6.30, 95% confidence interval (CI), 1.89-21.0, P < 0.01) and 6-month (Q4 adjusted OR 5.65, 95%CI, 1.91-16.7; P < 0.01) intervals. TMAO levels were also a significant predictor of the long term (7-year) mortality (Q4 adjusted HR 1.81, 95%CI, 1.04-3.15; P < 0.05). Interestingly, TMAO level at initial presentation predicted risk of incident MACE over the near-term (30 days and 6 months) even among subjects who were initially negative for troponin T (< 0.1 ng/mL) (30 days, Q4 adjusted OR 5.83, 95%CI, 1.79-19.03; P < 0.01). The prognostic value of TMAO was also assessed in an independent multicentre Swiss Cohort of ACS patients (n = 1683) who underwent coronary angiography. Trimethylamine N-oxide again predicted enhanced MACE risk (1-year) (adjusted Q4 hazard ratios: 1.57, 95% CI, 1.03-2.41; P <0.05). Conclusion Plasma TMAO levels among patients presenting with chest pain predict both near- and long-term risks of incident cardiovascular events, and may thus provide clinical utility in risk stratification among subjects presenting with suspected ACS.
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Affiliation(s)
- Xinmin S Li
- Department of Cellular & Molecular Medicine, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Roland Klingenberg
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Baris Gencer
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland
| | - François Mach
- Department of Cardiology, Cardiovascular Center, University Hospital Geneva, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Cardiovascular Center, University Hospital Bern, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, University Hospital Bern, Switzerland.,Institute of Primary Health Care (BIHAM), University of Bern, Switzerland
| | - David Nanchen
- Department of Ambulatory Care and Community Medicine, Lausanne University, Lausanne, Switzerland
| | - Olivier Muller
- Department of Cardiology, Cardiovascular Center, University Hospital Lausanne, Switzerland
| | - Melroy X Miranda
- Center for Molecular Cardiology, University of Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
| | - Yuping Wu
- Department of Mathematics, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA
| | - Lin Li
- Department of Cellular & Molecular Medicine, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Zeneng Wang
- Department of Cellular & Molecular Medicine, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Hassan S Alamri
- Department of Cellular & Molecular Medicine, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.,Department of Chemistry, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA
| | - Valentin Gogonea
- Department of Cellular & Molecular Medicine, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.,Department of Chemistry, Cleveland State University, 2121 Euclid Avenue, Cleveland, OH 44115, USA
| | - Yoon-Mi Chung
- Department of Cellular & Molecular Medicine, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - W H Wilson Tang
- Department of Cellular & Molecular Medicine, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Stanley L Hazen
- Department of Cellular & Molecular Medicine, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.,Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, Switzerland
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Denegri A, Nietlispach F, Kottwitz J, Suetsch G, Haager P, Rodriguez H, Taramasso M, Obeid S, Maisano F. Real-world procedural and 30-day outcome using the Portico transcatheter aortic valve prosthesis: A large single center cohort. Int J Cardiol 2018; 253:40-44. [DOI: 10.1016/j.ijcard.2017.10.101] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 10/13/2017] [Accepted: 10/26/2017] [Indexed: 02/06/2023]
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Shahin M, Yousif N, Luscher TF, Obeid S. Percutaneous Intervention of a Single Coronary Artery in the Setting of Acute Coronary Syndrome. Cardiol Res 2018; 8:349-353. [PMID: 29317981 PMCID: PMC5755670 DOI: 10.14740/cr613w] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 09/27/2017] [Indexed: 11/29/2022] Open
Abstract
Performing intervention of a single coronary artery (SCA) is challenging and technically difficult since a severe complication may be catastrophic if occurred. It requires a proper selection of instruments and well experienced operator to perform the intervention. However, a definitive standardization treatment for those patients is difficult; each case should be treated individually, according to the anatomical variations. We present three rare cases of SCA in setting of acute coronary syndrome (ACS) and culprit lesion in right coronary artery (RCA), treated successfully with percutaneous coronary intervention.
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Affiliation(s)
- Mohammady Shahin
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Nooraldaem Yousif
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Thomas F Luscher
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Slayman Obeid
- University Heart Center, University Hospital Zurich, Zurich, Switzerland
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Obeid S, Abi Elias Hallit C, Haddad C, Hany Z, Hallit S. Validation of the Hamilton Depression Rating Scale (HDRS) and sociodemographic factors associated with Lebanese depressed patients. Encephale 2018; 44:397-402. [PMID: 29307705 DOI: 10.1016/j.encep.2017.10.010] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [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: 07/10/2017] [Accepted: 10/16/2017] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The Hamilton Depression Rating Scale (HDRS) is the most commonly used scale for the evaluation of patients' treatments for depression. Since the HDRS has never been validated in Lebanon to our knowledge, our primary objective, therefore, is to investigate the correlation, sensitivity, specificity, as well as the reliability and the validity of the Hamilton Depression Rating Scale (HDRS) among Lebanese depressed patients. The secondary objective is to identify sociodemographic factors that would be correlated to depression among our sample. METHODS This case-control study, performed between January till May 2017, included 400 patients (200 patients, 200 controls). RESULTS The HDRS scale items converged over a solution of four factors, explaining a total of 58.88% of the variance. A high Cronbach's alpha was found for the full scale (0.862). A stepwise linear regression, using the total HDRS score as continuous variable, showed that a low socioeconomic level, divorced participants and a family history of mental disorders would significantly increase the HDRS total score (Beta=4.278; Beta=5.405; and Beta=3.922) respectively. However, having a university level of education would significantly decrease the HDRS total score (Beta=-4.248, P<0.001). CONCLUSION This study shows that the Arabic version of the HDRS has promising psychometric properties, making it a good tool to use for the diagnosis of patients with depression. Depression recognition and treatment in general practice with the aim of improving patient outcome and reducing health care expenditure, is definitely warranted.
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Affiliation(s)
- S Obeid
- Psychiatric Hospital of the Cross, 60096 Jal Eddib, Lebanon; Holy Spirit University, Faculty of Philosophy and Human Sciences, Kaslik, Lebanon; Lebanese University, Faculty of Pedagogy, Beirut, Lebanon.
| | | | - C Haddad
- Psychiatric Hospital of the Cross, 60096 Jal Eddib, Lebanon
| | - Z Hany
- Psychiatric Hospital of the Cross, 60096 Jal Eddib, Lebanon
| | - S Hallit
- Psychiatric Hospital of the Cross, 60096 Jal Eddib, Lebanon; Lebanese University, Faculty of Pharmacy, Beirut, Lebanon; Saint-Joseph University, Faculty of Pharmacy, Beirut, Lebanon; Holy Spirit University, Faculty of Medicine and Medical Sciences, Kaslik, Lebanon
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Shahin M, Obeid S, Hamed L, Templin C, Gamperli O, Nietlispach F, Maier W, Yousif N, Mach F, Roffi M, Windecker S, Raber L, Matter CM, Luscher TF. Occurrence and Impact of Time Delay to Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction. Cardiol Res 2017; 8:190-198. [PMID: 29118880 PMCID: PMC5667705 DOI: 10.14740/cr612w] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 10/03/2017] [Indexed: 11/11/2022] Open
Abstract
Background The aim of the study was to evaluate the occurrence, duration and impact of time delays to primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI). Methods A total of 357 consecutive STEMI patients enrolled in the prospective Special Program University Medicine ACS (SPUM-ACS) cohort were included. In order to identify the causes behind a possible treatment delay, we constructed four different time points which included: 1) symptom onset to hospital arrival, 2) hospital arrival to arrival in the catheterization laboratory, 3) hospital arrival to first balloon inflation, and 4) time from arrival in the catheterization laboratory to first balloon inflation in addition to total ischemic time. Patients were stratified according to a delay > 3 h, > 30 min, > 90 min and > 1 h, respectively and major adverse events at 0, 30 and 365 days were analyzed. Results Resuscitated STEMI patients (23 patients) and STEMI patients presenting at weekends (101 patients) and to lesser extent at night hours (100 patients) experienced more time delays than stable patients and those presenting at office hours. Median door-to-balloon time averaged 93 min in resuscitated, but 65 min in stable patients. Median door-to-balloon time at weekends and public holidays was 89 min, but 68 min at office hours. Median time from hospital arrival to cathlab arrival at weekends and public holidays was 30 min, but 15 min during office hours. Corresponding times for resuscitated patients was 45 and 15 min in stable patients. Of note, resuscitated patients were late presenters as regards time from symptoms onset to hospital arrival with a median time of 180 min compared to 155 min in stable patients. Median total ischemic time was 225 min for all patients, 223 min at day hours, 239 at night hours, 244 min at weekends, 233 min at office days, 220 min in stable patients and 273 min in resuscitated patients. Patients with STEMI who arrived > 3 h after symptom onset had a higher rate of myocardial infarction (MI) at 1 year (1.6% vs. 9% in < 3 h; P = 0.008). Furthermore, STEMI patients who had a delay of > 1 h from cathlab arrival to first balloon inflation had a higher rate of in hospital reinfarction at 0 day (0.6% vs. 0% in < 1 h; P = 0.007), MI at 30 days (0.8% vs. 0% in < 1 h; P = 0.001) and MI at 1 year (1.4% vs. 1.1% in < 1 h; P = 0.012). Similarly, in these patients, cardiac deaths at 0 day (0.8% vs. 0.6% in < 1 h; P = 0.035) and at 30 days (0.8% vs. 0.6% in < 1 h; P = 0.035) were higher as were major adverse cardiovascular events (MACCE) at 0 day (1.4% vs. 0.8% in < 1 h; P = 0.004). Conclusion Resuscitated STEMI patients and those presenting at weekends and to lesser extent at night hours experienced more time delays and longer ischemic time than stable patients and those presenting at office hours. In STEMI patients, any delay in treatment increased their risk of MACCE. Efforts should focus on improving patient’s awareness along with minimizing in-hospital transfer to the catheterization laboratory especially at weekends and in resuscitated patients.
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Affiliation(s)
- Mohammady Shahin
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,These authors shared first authorship
| | - Slayman Obeid
- Department of Cardiology, University Heart Center, Zurich, Switzerland.,These authors shared first authorship
| | - Lotfy Hamed
- Department of Internal Medicine, University Hospital Sohag, Egypt
| | - Christian Templin
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Oliver Gamperli
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | | | - Willbald Maier
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Nooraldaem Yousif
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Francois Mach
- Cardiovascular Center, Department of Cardiology, University Hospital Geneva, Switzerland
| | - Marco Roffi
- Cardiovascular Center, Department of Cardiology, University Hospital Geneva, Switzerland
| | - Stephan Windecker
- Cardiovascular Center, Department of Cardiology, University Hospital Bern, Switzerland
| | - Lorenz Raber
- Cardiovascular Center, Department of Cardiology, University Hospital Bern, Switzerland
| | | | - Thomas F Luscher
- Department of Cardiology, University Heart Center, Zurich, Switzerland
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Stähli B, Jakob P, Klingenberg R, Obeid S, Heg D, Raber L, Windecker S, Gencer B, Landmesser U, Matter C, Maier W. TCT-472 Predictive Value of the Age, Creatinine, and Ejection Fraction (ACEF) Score in Patients with Acute Coronary Syndromes. J Am Coll Cardiol 2017. [DOI: 10.1016/j.jacc.2017.09.585] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Susuri N, Obeid S, Ulmi M, Siontis G, Wahl A, Windecker S, Nietlispach F, Meier B, Praz F. Second transcatheter closure for residual shunt following percutaneous closure of patent foramen ovale. EUROINTERVENTION 2017; 13:858-866. [DOI: 10.4244/eij-d-17-00061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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