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Shi J, Manjunatha K, Behr M, Vogt F, Reese S. A physics-informed deep learning framework for modeling of coronary in-stent restenosis. Biomech Model Mechanobiol 2024; 23:615-629. [PMID: 38236483 DOI: 10.1007/s10237-023-01796-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 11/22/2023] [Indexed: 01/19/2024]
Abstract
Machine learning (ML) techniques have shown great potential in cardiovascular surgery, including real-time stenosis recognition, detection of stented coronary anomalies, and prediction of in-stent restenosis (ISR). However, estimating neointima evolution poses challenges for ML models due to limitations in manual measurements, variations in image quality, low data availability, and the difficulty of acquiring biological quantities. An effective in silico model is necessary to accurately capture the mechanisms leading to neointimal hyperplasia. Physics-informed neural networks (PINNs), a novel deep learning (DL) method, have emerged as a promising approach that integrates physical laws and measurements into modeling. PINNs have demonstrated success in solving partial differential equations (PDEs) and have been applied in various biological systems. This paper aims to develop a robust multiphysics surrogate model for ISR estimation using the physics-informed DL approach, incorporating biological constraints and drug elution effects. The model seeks to enhance prediction accuracy, provide insights into disease progression factors, and promote ISR diagnosis and treatment planning. A set of coupled advection-reaction-diffusion type PDEs is constructed to track the evolution of the influential factors associated with ISR, such as platelet-derived growth factor (PDGF), the transforming growth factor- β (TGF- β ), the extracellular matrix (ECM), the density of smooth muscle cells (SMC), and the drug concentration. The nature of PINNs allows for the integration of patient-specific data (procedure-related, clinical and genetic, etc.) into the model, improving prediction accuracy and assisting in the optimization of stent implantation parameters to mitigate risks. This research addresses the existing gap in predictive models for ISR using DL and holds the potential to enhance patient outcomes through predictive risk assessment.
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Affiliation(s)
- Jianye Shi
- Institute of Applied Mechanics, RWTH Aachen University, Aachen, Germany.
| | - Kiran Manjunatha
- Institute of Applied Mechanics, RWTH Aachen University, Aachen, Germany
| | - Marek Behr
- Chair for Computational Analysis of Technical Systems, RWTH Aachen University, Aachen, Germany
| | - Felix Vogt
- Department of Cardiology, Pulmonology, Intensive Care and Vascular Medicine, RWTH Aachen University, Aachen, Germany
| | - Stefanie Reese
- Institute of Applied Mechanics, RWTH Aachen University, Aachen, Germany
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Shen Y, Wang X, Gu N, Liu Z, Rong J, Shen C, Zhang W, Chen P, Deng Y, Deng C, Ma S, Zhao Y, Zhao R, Shi B. Association between periprocedural myocardial injury and neointimal characteristics in patients with in-stent restenosis: an optical coherence tomography study. Cardiovasc Diagn Ther 2024; 14:5-17. [PMID: 38434558 PMCID: PMC10904304 DOI: 10.21037/cdt-23-390] [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: 10/02/2023] [Accepted: 01/05/2024] [Indexed: 03/05/2024]
Abstract
Background The relationship between neointimal characteristics of in-stent restenosis (ISR) and periprocedural myocardial injury (PMI) remains unclear. Therefore, this study aimed to investigate the relationship between PMI and neointimal characteristics of ISR by using optical coherence tomography (OCT). Methods This was a retrospective study. We enrolled 140 patients diagnosed with ISR with normal baseline high-sensitivity troponin T (hs-cTnT) levels who underwent OCT and subsequent revascularization by means of drug-coated balloon (DCB) or drug-eluting stent (DES) between October 2018 and October 2022 in the Affiliated Hospital of Zunyi Medical University. Based on the 4th universal definition of myocardial infarction, patients whose hs-cTnT were increased five times above the upper reference limit (URL) after percutaneous coronary interventions (PCI) were deemed to PMI. The patients were subdivided into PMI (n=53) and non-PMI (n=87) groups. In the univariable analysis, variables in the baselines, angiography characteristics and OCT findings were analyzed with binary logistic regression. A P value of <0.2 was included in the multivariable model. Multivariable logistic regression analysis was used to identify the independent predictors of PMI. Results The prevalence of intra-intimal microvessels in patients with PMI was higher than in those without PMI (58.5% vs. 32.2%, P=0.003). The ratio of intra-stent plaque rupture (PR) was also higher in patients with PMI (60.4% vs. 40.2%, P=0.021). Multivariable logistic regression analysis showed that intra-intimal microvessels [odds ratio (OR): 3.193, 95% confidence interval (CI): 1.280-7.966; P=0.013] and intra-stent PR (OR: 2.124, 95% CI: 1.153-4.732; P=0.035) were independently associated with PMI. Conclusions Intra-intimal microvessels and intra-stent PR were independently associated with PMI. Accurate identification and recognition of intra-intimal microvessels and intra-stent PR may be helpful in preventing PMI.
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Affiliation(s)
- Youcheng Shen
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xi Wang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ning Gu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhijiang Liu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Jidong Rong
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Changyin Shen
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wei Zhang
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Panke Chen
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yi Deng
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chancui Deng
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shuai Ma
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yongchao Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ranzun Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Bei Shi
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
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Rong J, Gu N, Tian H, Shen Y, Deng C, Chen P, Ma S, Ma Y, Hu X, Zhao R, Shi B. Association of the monocytes to high-density lipoprotein cholesterol ratio with in-stent neoatherosclerosis and plaque vulnerability: An optical coherence tomography study. Int J Cardiol 2024; 396:131417. [PMID: 37802300 DOI: 10.1016/j.ijcard.2023.131417] [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: 05/30/2023] [Revised: 09/06/2023] [Accepted: 10/02/2023] [Indexed: 10/08/2023]
Abstract
BACKGROUND Monocyte-to-high-density lipoprotein cholesterol ratio (MHR) is an independent predictor of atherosclerosis and in-stent restenosis (ISR). However, the association between MHR and the incidence of in-stent neoatherosclerosis (ISNA) remains to be validated. METHODS This study included 216 patients with acute coronary syndrome who had 220 ISR lesions and had undergone optical coherence tomography (OCT). All eligible patients were divided into three groups according to their MHR tertile level. OCT characteristics were comparatively analyzed between groups of different MHR levels, and univariate and multivariate logistic regression analyses were constructed to assess correlations between MHR level and ISNA as well as in-stent thin-cap fibroatheroma (TCFA). A receiver operating characteristic curve was used to determine the optimal MHR thresholds for predicting ISNA and in-stent TCFA. RESULTS The incidence of ISNA (70.3% vs. 61.1% vs. 20.3%, P < 0.001) and in-stent TCFA (40.5% vs. 31.9% vs. 6.8%, P < 0.001) was the highest in the third tertile, followed by the second and first tertiles, respectively. Multivariate analysis revealed that MHR was independently associated with ISNA (odds ratio [OR], 7.212; 95% confidence interval [CI], 1.287-40.416; P = 0.025) and in-stent TCFA (OR, 5.610; 95% CI, 1.743-18.051; P = 0.004) after adjusting for other clinical factors. The area under the curve was 0.745 (95% CI, 0.678-0.811; P < 0.001) for the prediction of ISNA and 0.718 (95% CI, 0.637-0.778; P < 0.001) for the prediction of in-stent TCFA. CONCLUSION MHR levels are an independent risk factor for ISNA.
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Affiliation(s)
- Jidong Rong
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ning Gu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Hongqin Tian
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Youcheng Shen
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Chancui Deng
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Panke Chen
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Shuai Ma
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yi Ma
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Xingwei Hu
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Ranzun Zhao
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
| | - Bei Shi
- Department of Cardiology, Affiliated Hospital of Zunyi Medical University, Zunyi, China.
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Simard T, Jung R, Di Santo P, Sarathy K, Majeed K, Motazedian P, Short S, Dhaliwal S, Labinaz A, Sarma D, Ramirez FD, Froeschl M, Labinaz M, Holmes DR, Alkhouli M, Hibbert B. Evaluation of a Rabbit Model of Vascular Stent Healing: Application of Optical Coherence Tomography. J Cardiovasc Transl Res 2023; 16:1194-1204. [PMID: 37227686 DOI: 10.1007/s12265-023-10399-1] [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: 12/22/2022] [Accepted: 05/10/2023] [Indexed: 05/26/2023]
Abstract
Percutaneous coronary intervention (PCI) is a management strategy for symptomatic obstructive coronary artery disease (CAD). Despite advancements, in-stent restenosis (ISR) still imparts a 1-2% annual rate of repeat revascularization-a focus of ongoing translational research. Optical coherence tomography (OCT) provides high resolution virtual histology of stents. Our study evaluates the use of OCT for virtual histological assessment of stent healing in a rabbit aorta model, enabling complete assessment of intraluminal healing throughout the stent. ISR varies based on intra-stent location, stent length, and stent type in a rabbit model-important considerations for translational experimental design. Atherosclerosis leads to more prominent ISR proliferation independent of stent-related factors. The rabbit stent model mirrors clinical observations, while OCT-based virtual histology demonstrates utility for pre-clinical stent assessment. Pre-clinical models should incorporate clinical and stent factors as feasible to maximize translation to clinical practice.
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Affiliation(s)
- Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Richard Jung
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada
| | - Pietro Di Santo
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Kiran Sarathy
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
| | - Kamran Majeed
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
- Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
| | - Pouya Motazedian
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Spencer Short
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Shan Dhaliwal
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Alisha Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Dhruv Sarma
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - F Daniel Ramirez
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Michael Froeschl
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - Marino Labinaz
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada
| | - David R Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Benjamin Hibbert
- Division of Cardiology, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, ON, Canada.
- Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Canada.
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Chen M, Dun Y, Zhang W, Liu S. Identification of differentially expressed genes associated with coronary in-stent restenosis by integrated bioinformatics approaches. Ann Palliat Med 2022; 11:1940-1953. [PMID: 35144391 DOI: 10.21037/apm-21-2681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 12/21/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND In-stent restenosis (ISR) is a common complication following percutaneous coronary intervention (PCI). Designing ISR-specific therapeutic targets is important for optimizing coronary stenosis therapy. This study aims to find new potential key genes related to ISR and the usefulness of differentially expressed genes (DEGs) as diagnostic biomarkers for ISR. METHODS : Microarray datasets of peripheral blood was downloaded from the Gene Expression Omnibus (GEO) public database (GSE46560, n=11). The DEGs between the ISR group and the control were obtained through the limma package analysis of the R language. Gene ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses were used to obtain the related signal pathways. STRING database was used to constructed a protein-to-protein interaction network with DEGs. Networkanalyst database was used to predict the target miRNA of the target gene. The area under the curve (AUC) value obtained from receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic effectiveness of the hub gene in distinguishing ISR patients from normal individuals. RESULTS A total of 154 DEGs were identified between ISR group and control group, including 57 up-regulated and 97 down-regulated DEGs. GO enrichment analysis showed that genes were enriched in homeostasis, cell morphology and cell connection. KEGG pathway analysis shows that genes are mainly involved in human papillomavirus infection, salmonella infection, human T-cell leukemia virus type 1 infection, axon guidance and MAPK signaling pathway. CLTA, CAT, STAT5A, CD300A, CA1, NCF2, HBQ1, AHSP, SLC4A1 and EPB42 were identified as 10 hub genes. A total of 151 target miRNAs of 7 DEGs were obtained, and 149 mRNA-miRNA pairs were identified. ROC curve indicates that CA1, STAT5A and HBQ1 have high diagnostic value in ISR. CONCLUSIONS CA1, STAT5A and HBQ1 are identified as specific related genes for ISR patients. These genes may provide new targets for the early identification and treatment of ISR.
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Affiliation(s)
- Meijuan Chen
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China
| | - Yaoshan Dun
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China; Division of Preventive Cardiology, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Wenliang Zhang
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
| | - Suixin Liu
- Division of Cardiac Rehabilitation, Department of Physical Medicine & Rehabilitation, Xiangya Hospital of Central South University, Changsha, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital of Central South University, Changsha, China
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Zhao Y, Zang G, Yin T, Ma X, Zhou L, Wu L, Daniel R, Wang Y, Qiu J, Wang G. A novel mechanism of inhibiting in-stent restenosis with arsenic trioxide drug-eluting stent: Enhancing contractile phenotype of vascular smooth muscle cells via YAP pathway. Bioact Mater 2020; 6:375-385. [PMID: 32954055 PMCID: PMC7484501 DOI: 10.1016/j.bioactmat.2020.08.018] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 08/13/2020] [Accepted: 08/23/2020] [Indexed: 12/18/2022] Open
Abstract
Objective Arsenic trioxide (ATO or As2O3) has beneficial effects on suppressing neointimal hyperplasia and restenosis, but the mechanism is still unclear. The goal of this study is to further understand the mechanism of ATO's inhibitory effect on vascular smooth muscle cells (VSMCs). Methods and results Through in vitro cell culture and in vivo stent implanting into the carotid arteries of rabbit, a synthetic-to-contractile phenotypic transition was induced and the proliferation of VSMCs was inhibited by ATO. F-actin filaments were clustered and the elasticity modulus was increased within the phenotypic modulation of VSMCs induced by ATO in vitro. Meanwhile, Yes-associated protein (YAP) nuclear translocation was inhibited by ATO both in vivo and in vitro. It was found that ROCK inhibitor or YAP inactivator could partially mask the phenotype modulation of ATO on VSMCs. Conclusions The interaction of YAP with the ROCK pathway through ATO seems to mediate the contractile phenotype of VSMCs. This provides an indication of the clinical therapeutic mechanism for the beneficial bioactive effect of ATO-drug eluting stent (AES) on in-stent restenosis (ISR).
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Affiliation(s)
- Yinping Zhao
- Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing, 400016, China.,Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Guangchao Zang
- Laboratory of Tissue and Cell Biology, Lab Teaching & Management Center, Chongqing Medical University, Chongqing, 400016, China
| | - Tieying Yin
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Xiaoyi Ma
- Beijing Amsinomed Medical Co., Ltd, Beijing, 100021, China
| | - Lifeng Zhou
- Beijing Amsinomed Medical Co., Ltd, Beijing, 100021, China
| | - Lingjuan Wu
- Medical School, Newcastle University, Newcastle Upon Tyne, NE2 4AX, UK
| | - Richard Daniel
- Medical School, Newcastle University, Newcastle Upon Tyne, NE2 4AX, UK
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, Chengdu, 610065, China
| | - Juhui Qiu
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
| | - Guixue Wang
- Key Laboratory for Biorheological Science and Technology of Ministry of Education, State and Local Joint Engineering Laboratory for Vascular Implants, Bioengineering College of Chongqing University, Chongqing, 400030, China
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Yuan Y, Liu X, Hao S, He Q, Shen Z. Plasma levels of miR-143 and miR-145 are associated with coronary in-stent restenosis within 1 year of follow-up after drug-eluting stent implantation. Ann Transl Med 2020; 8:756. [PMID: 32647681 PMCID: PMC7333105 DOI: 10.21037/atm-20-4227] [Citation(s) in RCA: 6] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background ISR remains the major adverse outcome after percutaneous coronary intervention (PCI). MicroRNAs have been demonstrated to be associated with coronary plaque and stable in the blood and can be used as biomarkers/predictors. This study aimed to investigate whether circulating microRNAs could predict in-stent restenosis (ISR). Methods MicroRNA array was used to detect differently expressed microRNAs between 30 ISR patients and 30 non-ISR patients in the derivation cohort. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to validate the microRNA array results and to detect levels of target microRNAs in the validation cohort. All patients were followed up for at least 1 year, and major adverse cardiac events (MACEs) were recorded. Univariate and multivariate logistic regression analysis were applied to find factors associated with ISR. Receiver operating characteristics (ROC) and Kaplan-Meier survival curves were used to analyze the predictive ability of the microRNA score for ISR. Results MicroRNA array and qRT-PCR showed that miR-143, 145, 425, 208, and let-7g were differently expressed between ISR patients and non-ISR patients. Multivariate analysis demonstrated that lower levels of mir-143 (OR =2.36, 95% CI: 1.43–3.67) and mir-145 (OR =2.12, 95% CI: 1.56–3.48) were associated with ISR. MicroRNA scores differed statistically between ISR patients and non-ISR patients (49.18±2.05 vs. 52.10±2.41, P<0.01) and has predictive ability for ISR with an area under the curve (AUC) of 0.8206 (95% CI: 0.7155–0.9256, P<0.01). In the validation cohort, Kaplan-Meier survival curves demonstrated that patients with higher microRNA scores have better prognosis in 1 year of follow-up. Conclusions A lower plasma level of mir-143/145 predicts a higher risk of ISR and a worse outcome.
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Affiliation(s)
- Yuan Yuan
- Department of Emergency Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Xiaoxian Liu
- ICU of Internal Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Shengyun Hao
- Department of Emergency Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Qian He
- Department of Emergency Medicine, Affiliated Hospital of Guizhou Medical University, Guiyang, China
| | - Zheng Shen
- Department of Cardiology, Affiliated Hospital of Guizhou Medical University, Guiyang, China
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Zhang Y, Wang X, Ma Z, Bai B, Liu J, Yang L, Qin G, Zhang E. A potential strategy for in-stent restenosis: Inhibition of migration and proliferation of vascular smooth muscle cells by Cu ion. Mater Sci Eng C Mater Biol Appl 2020; 115:111090. [PMID: 32600694 DOI: 10.1016/j.msec.2020.111090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 11/23/2022]
Abstract
The in-stent restenosis (ISR) often happens after the implantation of metal stents, including both bare metal stents (BMSs) and drug-eluting stents (DESs). Drug release from DESs could reduce significantly the occurrence of ISR but also suppress the revascularization and cause thrombosis. In this study, the effect of Cu ion in a range of 0 to 500 μM on the migration and proliferation of rat aortic smooth muscle cells (RASMCs) was investigated by a series of in vitro experiments including wound-healing assay, cell viability assay and flow cytometric analysis. It has been found that the critical concentration of Cu ion should be at least 250 μM in order to significantly inhibit the migration of RASMCs and the proliferation of RASMCs were impeded by every dose of Cu ion used in this study. In addition, the protein level of caspase-3 was upregulated by 250 μM and 500 μM Cu2+ exposure, which might be the main reason for RASMCs apoptosis. Thus, it is proposed that ISR might be prevented by the constant release of Cu ion.
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Ye G, Yin X, Yang X, Wang J, Qi P, Lu J, Wang L, Wang D. Efficacy and safety of drug-eluting stent for the intracranial atherosclerotic disease: A systematic review and meta-analysis. J Clin Neurosci 2018; 59:112-118. [PMID: 30401573 DOI: 10.1016/j.jocn.2018.10.118] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 10/27/2018] [Indexed: 12/31/2022]
Abstract
Drug-eluting stent (DES) is a potential endovascular treatment for patients with symptomatic intracranial atherosclerotic disease (sICAD). However, evidence regarding the treatment of ICAD with DES is lacking. We systematically searched Pubmed, Embase, Cochrane database (before 2017-12-21) for literature reporting the application of DES in the treatment of sICAD. The main outcomes were as follows: the incidence of any stroke or death within 30 days (perioperative complications), ischemic stroke in the territory of the qualifying artery beyond 30 days (long-term complications), in-stent restenosis rate (ISR) and symptomatic ISR during follow-up. Those studies with mean stenosis rate greater than 70% and less than 70% were defined as severe and moderate stenosis group, respectively. The random effect model was used to pool the data. Of 518 articles, 13 studies were eligible and included in our analysis (N = 336 patients with 364 lesions). After the implantation of DES, perioperative complications (mortality = 0) occurred in 6.0% (95%CI 2.0%-11.9%), long-term complications occurred in 2.2% (95%CI 0.7%-4.5%), ISR rate was 4.1% (95%CI 1.6%-7.7%) and the symptomatic ISR rate was only 0.5% (95%CI 0-2.2%). In addition, subgroup analysis showed that the perioperative complication rate in severe stenosis group [10.6% (95%CI 6.5%-15.7%)] was significantly (p < 0.01) higher than that in moderate stenosis group [1.0% (95%CI 0.3%-3.5%)]. In summary, endovascular DES implantation is a relatively safe and effective method compared with stents or medical management group in SAMMPRIS and VISSIT trials. However, a higher preoperative stenosis rate may imply a higher risk of perioperative complications. Further studies are needed.
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Affiliation(s)
- Gengfan Ye
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China; Graduate School of Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Xiaoliang Yin
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China; Graduate School of Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China
| | - Ximeng Yang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China
| | - Junjie Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China
| | - Peng Qi
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China
| | - Jun Lu
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China
| | - Lijun Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China
| | - Daming Wang
- Department of Neurosurgery, Beijing Hospital, National Center of Gerontology, No. 1 DaHua Road, Dong Dan, Beijing 100730, China; Graduate School of Peking Union Medical College, No. 9 Dongdansantiao, Dongcheng District, Beijing 100730, China.
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10
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Baktashian M, Saffar Soflaei S, Kosari N, Salehi M, Khosravi A, Ahmadinejad M, Moohebati M, Ebrahimi M, Rahmani F, Khameneh-Bagheri R, Ahmadi M, Sadabadi F, Tayefi M, Bazhdanzadeh S, Ferns GA, Hashemi SM, Pasdar A, Ghayour-Mobarhan M. Association of high level of hs-CRP with in-stent restenosis: A case-control study. Cardiovasc Revasc Med 2018; 20:583-587. [PMID: 30232022 DOI: 10.1016/j.carrev.2018.08.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 06/30/2018] [Revised: 07/31/2018] [Accepted: 08/16/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND In-stent restenosis (ISR) is one adverse outcome of coronary stent implantation. Although using drug-eluting stents has reduced the rate of ISR, it remains a major problem. Here, we have investigated the relationship between several patient characteristics including serum high sensitive C-reactive protein (hs-CRP) and ISR. METHODS This was a case-control study comprising 104 individuals with ISR and 202 patients without. Baseline characteristics were collected using a questionnaire. Fasting blood glucose (FBG), serum triglycerides (TG), total cholesterol (TC), high density lipoprotein cholesterol (HDL-C) and serum high sensitivity C-reactive protein (hs-CRP) were measured using commercial kits on an auto-analyzer. Data were analyzed using SPSS software and a p value ≤ 0.05 was considered significant. RESULTS Diabetes mellitus (p < 0.001), stent type (p = 0.005), serum hs-CRP (p = 0.006), FBG (p = 0.038) and serum TG (p = 0.039) were significantly associated with ISR. The association between hs-CRP and ISR remained significant after adjustment for stent type and DM. For patients with a serum hs-CRP <2.64 mg/dL, ISR was only associated with diabetes mellitus (p = 0.016); while for individuals with a serum hs-CRP ≥2.64 mg/dL, ISR was also associated with the presence of diabetes mellitus, serum triglycerides and stent type. CONCLUSION Higher levels of serum hs-CRP were significantly associated with the occurrence of ISR.
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Affiliation(s)
- Mojtaba Baktashian
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Modern Sciences & Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Sara Saffar Soflaei
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Modern Sciences & Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Negin Kosari
- Department of Modern Sciences & Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mansoor Salehi
- Department of Genetics, Faculty of Medicine and Genetics Laboratory, AL Zahra Hospital, Isfahan University of Medicine, Isfahan, Iran.
| | - Alireza Khosravi
- Isfahan Cardiovascular Research Institute, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maliheh Ahmadinejad
- Department of Clinical Biotechnology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohsen Moohebati
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran..
| | - Mahmood Ebrahimi
- Cardiovascular Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran..
| | - Farzad Rahmani
- Biochemistry of Nutrition Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ramin Khameneh-Bagheri
- Assistant Professor, Department of Cardiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Mostafa Ahmadi
- Assistant Professor, Department of Cardiology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Fatemeh Sadabadi
- Student Research Committee, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Department of Modern Sciences & Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Tayefi
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran; Clinical Research Unit, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | | | - Gordon A Ferns
- Brighton & Sussex Medical School, Division of Medical Education, Falmer, Brighton, Sussex BN1 9PH, UK.
| | - Seyed Mohammad Hashemi
- Department of Cardiology, Chamran Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Alireza Pasdar
- Department of Modern Sciences & Technologies, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Majid Ghayour-Mobarhan
- Metabolic Syndrome Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
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11
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Yu LB, Yan W, Zhang Q, Zhao JZ, Zhang Y, Wang R, Shao JS, Zhang D. Carotid endarterectomy for treatment of carotid in-stent restenosis: long-term follow-up results and surgery experiences from one single centre. Stroke Vasc Neurol 2017; 2:140-146. [PMID: 28994832 PMCID: PMC5628382 DOI: 10.1136/svn-2017-000089] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 04/02/2017] [Revised: 05/10/2017] [Accepted: 05/30/2017] [Indexed: 01/21/2023] Open
Abstract
Objective Few studies have reported the surgical treatment of carotid in-stent restenosis (ISR), more data and longer follow-up are needed. We describe the surgical treatment of ISR by standard carotid endarterectomy (CEA) with stent removal, including long-term follow-up in 10 patients from our centre. Methods Ten patients from our centre who underwent CEA with stent removal for ISR were retrospectively analysed, including nine symptomatic and one asymptomatic ISR of at least 70% with mean age 67.3, the median time between carotid artery stenting and CEA was 17 months (range, 2–54 months). Results Standard CEA with stent removal was performed in all 10 patients without much technical difficulty (9 male and 1 female, mean age 67.3). Two cases were performed in hybrid operation room. There were a total of three complications that happened in three patients (30%) respectively. An asymptomatic dissecting aneurysm was formed on the petrous internal carotid artery in one patient who was followed up without intervention. In the second case, dissection occurred in the arterial wall distal to the site of the stent after stent removal revealed by intraoperative angiography, and another stent was implanted. The patient sustained temporary hypoglossal nerve dysfunction postoperatively. The third patient suffered cerebral hyperperfusion with complete recovery when discharged. No neurological complications occurred in other seven patients. After follow-up of 25 months (range, 11–54 months), one patient died of rectal cancer without ischaemic attack and restenosis 4 years postoperation; in one patient occurred recurrent symptomatic restenosis (90%) 1 year later; all other patients remained asymptomatic and without recurrent restenosis (>50%) by follow-up carotid ultrasound or CT angiography. Conclusion It seems that CEA with stent removal is a reasonable choice, by experienced hand, for symptomatic ISR with higher but acceptable complications. The indication of stent removal for asymptomatic ISR needs further observation.
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Affiliation(s)
- Le-Bao Yu
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Wei Yan
- Department of Neurosurgery, Beijing Mi Yun Hospital, Capital Medical University, Beijing, China
| | - Qian Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Ji-Zong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Jun-Shi Shao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases (NCRC-ND), Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
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12
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Lin ZZ, Chang WT, Chiang CY, Chen ZC, Ku PM. IVUS-Guided Implantation of Bioresorbable Vascular Scaffolds for Very Late Paclitaxel Stent Thrombosis. Acta Cardiol Sin 2017; 33:92-95. [PMID: 28115812 PMCID: PMC5241441 DOI: 10.6515/acs20160328a] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Bioresorbable vascular scaffold (BVS) implantation has been shown to be safe in patients with stable coronary disease, and effective against the thrombotic lesion and the in-stent restenosis (ISR) of the drug-eluting stent (DES). BVSs have the advantages of a snow racket concept, positive vessel remodeling, and better conformability compared with DES in acute coronary syndrome (ACS). We report on a young patient with ST-elevation myocardial infarction (STEMI) who presented to our emergency department arising from very late stent thrombosis (VLST) of a 2.5 × 28 mm paclitaxel-eluting stent (Coroflex® Please) three years after its implantation. After the patient was treated with balloon dilation, intravascular ultrasound (IVUS) revealed a short segment of a guide wire outside the DES mesh. Two BVSs were implanted to prevent a DES recoil. Post-scaffold-implantation IVUS showed adequately expanded strut of BVSs. Six months later, optical coherence tomography (OCT) revealed that some segments of the scaffold had been absorbed and that there was no in-scaffold restenosis. The patient had not complained about angina during the out-patient clinic follow-up. This is the first report of successful BVS implantation for a STEMI patient attributable to DES VLST.
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Affiliation(s)
- Zhe-Zhong Lin
- Department of Cardiology, Chi Mei Medical Center, Liouying;
,Department of Leisure and Sports Management, Far East University
| | - Wei-Ting Chang
- Department of Cardiology, Chi Mei Medical Center, Yongkang
| | | | | | - Po-Ming Ku
- Cardiovascular Center, Chi Mei Medical Center, Liouying;
,Chia Nan University of Pharmacy & Science, Tainan, Taiwan
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13
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Buccheri D, Piraino D, Andolina G, Cortese B. Understanding and managing in-stent restenosis: a review of clinical data, from pathogenesis to treatment. J Thorac Dis 2016; 8:E1150-E1162. [PMID: 27867580 DOI: 10.21037/jtd.2016.10.93] [Citation(s) in RCA: 198] [Impact Index Per Article: 24.8] [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: 12/20/2022]
Abstract
The lumen diameter reduction after percutaneous coronary intervention (PCI) is well known as "restenosis". This phenomenon is due to vessel remodeling/recoil in case of no-stent strategy or, in case of stent employ, "neointimal proliferation" that consists in an excessive tissue proliferation in the luminal surface of the stent otherwise by a further new-occurring atherosclerotic process called "neoatherosclerosis". The exact incidence of in-stent restenosis (ISR) is not easy to determine caused by different clinical, angiographic and operative factors. In the pre-stent era the occurrence of restenosis ranged between 32-55% of all angioplasties, and drop to successively 17-41% in the bare metal stents (BMS) era. The advent of drug-eluting stent (DES), especially 2nd generation, and drug-coated balloon (DCB) further reduce restenosis rate until <10%. We here review the main characteristics of this common complication of coronary interventions, from its pathogenesis to the most appropriate treatment strategy.
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Affiliation(s)
- Dario Buccheri
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy; ; Cardiology Department, San Giacomo D'Altopasso Hospital, Licata (Agrigento), Italy
| | - Davide Piraino
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy; ; Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy
| | - Giuseppe Andolina
- Interventional Cardiology, "Paolo Giaccone" Hospital, Palermo, Italy
| | - Bernardo Cortese
- Interventional Cardiology, Fatebenefratelli Hospital, Milano, Italy; ; Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Massa, Italy
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