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Mijajlovic M, Bozovic I, Pavlovic A, Rakocevic-Stojanovic V, Gluscevic S, Stojanovic A, Basta I, Meola G, Peric S. Transcranial brain parenchyma sonographic findings in patients with myotonic dystrophy type 1 and 2. Heliyon 2024; 10:e26856. [PMID: 38434309 PMCID: PMC10907768 DOI: 10.1016/j.heliyon.2024.e26856] [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: 09/03/2023] [Revised: 02/06/2024] [Accepted: 02/21/2024] [Indexed: 03/05/2024] Open
Abstract
Introduction Myotonic dystrophy type 1 (DM1) and 2 (DM2) are genetically determined progressive muscular disorders with multisystemic affection, including brain involvement. Transcranial sonography (TCS) is a reliable diagnostic tool for the investigation of deep brain structures. We sought to evaluate TCS findings in genetically confirmed DM1 and DM2 patients, and further correlate these results with patients' clinical features. Methods This cross-sectional study included 163 patients (102 DM1, 61 DM2). Echogenicity of the brainstem raphe (BR) and substantia nigra (SN) as well as the diameter of the third ventricle (DTV) were assessed by TCS. Patients were evaluated using the Hamilton Depression Rating Scale, Fatigue Severity Scale and Daytime Sleepiness Scale. Results SN hyperechogenicity was observed in 40% of DM1 and 34% of DM2 patients. SN hypoechogenicity was detected in 17% of DM1 and 7% of DM2 patients. BR hypoechogenicity was found in 36% of DM1 and 47% of DM2 subjects. Enlarged DTV was noted in 19% of DM1 and 15% of DM2 patients. Older, weaker, depressive, and fatigued DM1 patients were more likely to have BR hypoechogenicity (p < 0.05). DTV correlated with age and disease duration in DM1 (p < 0.01). In DM2 patients SN hyperechogenicity correlated with fatigue. Excessive daytime sleepiness was associated with hypoechogenic BR (p < 0.05) and enlarged DVT (p < 0.01) in DM2 patients. Conclusions TCS is an easy applicable and sensitive neuroimaging technique that could offer new information regarding several brainstem structures in DM1 and DM2. This may lead to better understanding of the pathogenesis of the brain involvement in DM with possible clinical implications.
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Affiliation(s)
- Milija Mijajlovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivo Bozovic
- Neurology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Aleksandra Pavlovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Vidosava Rakocevic-Stojanovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Sanja Gluscevic
- Neurology Clinic, Clinical Center of Montenegro, Podgorica, Montenegro
| | | | - Ivana Basta
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Giovanni Meola
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
- Department of Neurorehabilitation Sciences, Casa Di Cura del Policlinico, Milan, Italy
| | - Stojan Peric
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Bozovic I, Jeremic M, Pavlovic A, Jovanovic C, Kresojevic N, Vojvodic N, Jovanovic D, Sokic D, Mijajlovic M. Cerebral Amyloid Angiopathy-Related Inflammation (CAA-rI): Three Heterogeneous Case Reports and a Focused Literature Review. Brain Sci 2023; 13:brainsci13050747. [PMID: 37239219 DOI: 10.3390/brainsci13050747] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 04/20/2023] [Accepted: 04/28/2023] [Indexed: 05/28/2023] Open
Abstract
Cerebral amyloid angiopathy-related inflammation (CAA-rI) is a largely reversible, subacute encephalopathy, which is considered as a rare variant of cerebral amyloid angiopathy (CAA). Although the diagnosis of this inflammatory vasculopathy is generally clinico-pathologic, a probable or possible diagnosis can often be established based on current clinico-radiological diagnostic criteria. This is important since CAA-rI is considered as a treatable disorder, which most commonly occurs in the elderly population. Behavioral changes and cognitive deterioration are highlighted as the most common clinical signs of CAA-rI, followed by a heterogeneous spectrum of typical and atypical clinical presentations. However, despite the well-established clinical and radiological features incorporated in the current diagnostic criteria for this CAA variant, this rare disorder is still insufficiently recognized and treated. Here, we have shown three patients diagnosed with probable CAA-rI, with significant heterogeneity in the clinical and neuroradiological presentations, followed by different disease courses and outcomes after the introduction of immunosuppressive treatment. Moreover, we have also summarized up-to-date literature data about this rare, yet underdiagnosed, immune-mediated vasculopathy.
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Affiliation(s)
- Ivo Bozovic
- Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, 11000 Belgrade, Serbia
| | - Marta Jeremic
- Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, 11000 Belgrade, Serbia
| | - Aleksandra Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, 11000 Belgrade, Serbia
| | - Carna Jovanovic
- Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, 11000 Belgrade, Serbia
| | - Nikola Kresojevic
- Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nikola Vojvodic
- Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dejana Jovanovic
- Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Dragoslav Sokic
- Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Milija Mijajlovic
- Neurology Clinic, University Clinical Center of Serbia, University of Belgrade, 11000 Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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Foddis M, Blumenau S, Holtgrewe M, Paquette K, Westra K, Alonso I, Macario MDC, Morgadinho AS, Velon AG, Santo G, Santana I, Mönkäre S, Kuuluvainen L, Schleutker J, Pöyhönen M, Myllykangas L, Pavlovic A, Kostic V, Dobricic V, Lohmann E, Hanagasi H, Santos M, Guven G, Bilgic B, Bras J, Beule D, Dirnagl U, Guerreiro R, Sassi C. TREX1 p.A129fs and p.Y305C variants in a large multi-ethnic cohort of CADASIL-like unrelated patients. Neurobiol Aging 2023; 123:208-215. [PMID: 36586737 DOI: 10.1016/j.neurobiolaging.2022.11.013] [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] [Received: 10/23/2022] [Revised: 11/16/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and retinal vasculopathy with cerebral leukodystrophy and systemic manifestations (RVCL-S) are the most common forms of rare monogenic early-onset cerebral small vessel disease and share clinical, and, to different extents, neuroradiological and neuropathological features. However, whether CADASIL and RVCL-S overlapping phenotype may be explained by shared genetic risk or causative factors such as TREX1 coding variants remains poorly understood. To investigate this intriguing hypothesis, we used exome sequencing to screen TREX1 protein-coding variability in a large multi-ethnic cohort of 180 early-onset independent familial and apparently sporadic CADASIL-like Caucasian patients from the USA, Portugal, Finland, Serbia and Turkey. We report 2 very rare and likely pathogenic TREX1 mutations: a loss of function mutation (p.Ala129fs) clustering in the catalytic domain, in an apparently sporadic 46-year-old patient from the USA and a missense mutation (p.Tyr305Cys) in the well conserved C-terminal region, in a 57-year-old patient with positive family history from Serbia. In concert with recent findings, our study expands the clinical spectrum of diseases associated with TREX1 mutations.
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Affiliation(s)
- Marco Foddis
- Department of Experimental Neurology, Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sonja Blumenau
- Department of Experimental Neurology, Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Manuel Holtgrewe
- Berlin Institute of Health, BIH, Core Unit Bioinformatics and Charité - Universitätsmedizin Berlin, Berlin Germany
| | - Kimberly Paquette
- Department for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, Michigan
| | - Kaitlyn Westra
- Department for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, Michigan
| | - Isabel Alonso
- CGPP and UnIGENe, Instituto Biologia Molecular Celular, Instituto de Investigação e Inovação em Saúde, Porto, Portugal
| | - Maria do Carmo Macario
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Sofia Morgadinho
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Ana Graça Velon
- Department of Neurology, Centro Hospitalar Trás-os-Montes e Alto Douro, Portugal
| | - Gustavo Santo
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Centro de Neurociências e Biologia Celular da Universidade de Coimbra, Coimbra, Portugal
| | - Isabel Santana
- Department of Neurology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Centro de Neurociências e Biologia Celular da Universidade de Coimbra, Coimbra, Portugal
| | - Saana Mönkäre
- Department of Medical Genetics, University of Helsinki, Helsinki, Finland; Turku University Hospital, Laboratory Division, Genomics, Department of Medical Genetics, Turku, Finland
| | - Liina Kuuluvainen
- Department of Clinical Genetics, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland; Department of Medical Genetics, University of Helsinki, Helsinki, Finland
| | - Johanna Schleutker
- Turku University Hospital, Laboratory Division, Genomics, Department of Medical Genetics, Turku, Finland
| | - Minna Pöyhönen
- Department of Medical Genetics, University of Helsinki, Helsinki, Finland; Department of Clinical Genetics, HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Liisa Myllykangas
- Department of Pathology, University of Helsinki and HUS Diagnostic Center, Helsinki University Hospital, Helsinki, Finland
| | - Aleksandra Pavlovic
- Clinic of Neurology, University of Belgrade, Belgrade, Serbia; Faculty for Special Education and Rehabilitation, University of Belgrade, Belgrade
| | - Vladimir Kostic
- Clinic of Neurology, University of Belgrade, Belgrade, Serbia
| | | | - Ebba Lohmann
- Behavioural Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey; Department of Neurodegenerative Diseases, Hertie Institute for Clinical Brain Research, University of Tübingen, Tübingen, Germany; DZNE, German Center for Neurodegenerative Diseases, Tübingen, Germany
| | - Hasmet Hanagasi
- Behavioural Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mariana Santos
- UnIGENe, IBMC-Institute for Molecular and Cell Biology, i3S-Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Gamze Guven
- Department of Genetics, Aziz Sancar Institute of Experimental Medicine, Istanbul University, Istanbul, Turkey
| | - Basar Bilgic
- Behavioural Neurology and Movement Disorders Unit, Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Jose Bras
- Department for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, Michigan; Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Dieter Beule
- Berlin Institute of Health, BIH, Core Unit Bioinformatics and Charité - Universitätsmedizin Berlin, Berlin Germany
| | - Ulrich Dirnagl
- Department of Experimental Neurology, Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Rita Guerreiro
- Department for Neurodegenerative Science, Van Andel Research Institute, Grand Rapids, Michigan; Division of Psychiatry and Behavioral Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Celeste Sassi
- Department of Experimental Neurology, Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
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Pavlovic A, Pekmezovic T, Mijajlovic M, Tomic G, Zidverc Trajkovic J. Is the female sex associated with an increased risk for long-term cognitive decline after the first-ever lacunar stroke? Prospective study on small vessel disease cohort. Front Neurol 2023; 13:1052401. [PMID: 36712431 PMCID: PMC9878188 DOI: 10.3389/fneur.2022.1052401] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 12/16/2022] [Indexed: 01/15/2023] Open
Abstract
Background Sex is a significant determinant of survival and functional outcome after stroke. Long-term cognitive outcome after acute lacunar stroke in the context of sex differences has been rarely reported. Methods A cohort of small vessel disease (SVD) patients presenting with first-ever acute lacunar stroke and normal cognitive status has been evaluated 4 years after the qualifying event for the presence of cognitive impairment (CI) with a comprehensive neuropsychological battery. Differences in baseline clinical and neuroimaging characteristics were compared between sexes in relation to cognitive status. Results A total of 124 female and 150 male patients were analyzed. No difference was detected between the groups regarding age (p = 0.932) or frequency of common vascular risk factors (p > 0.1 for all). At the baseline assessment, women had more disabilities compared to men with a mean modified Rankin scale (mRS) score of 2.5 (1.5 in men, p < 0.0001). Scores of white matter hyperintensities (WMH) of presumed vascular origin and a total number of lacunes of presumed vascular origin on brain MRI were higher in women compared to men (p < 0.0001 for all). As many as 64.6% of patients had CI of any severity on follow-up, women more frequently (77.4%) than men (54.0%; p < 0.0001). Univariate logistic regression analysis showed that female sex, higher NIHSS and mRS scores, presence of depression, and increasing WMH severity were associated with an increased risk for CI. Multivariate regression analysis indicated that only depression (OR 1.74, 95%CI 1.25-2.44; p = 0.001) and WMH severity (OR 1.10, 95%CI 1.03-1.17; p = 0.004) were independently associated with the CI. Conclusion At the long-term follow-up, women lacunar stroke survivors, compared to men, more frequently had CI in the presence of more severe vascular brain lesions, but this association was dependent on the occurrence of depression and severity of WMH, and could not be explained by differences in common vascular risk factors.
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Affiliation(s)
- Aleksandra Pavlovic
- Faculty of Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia,Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia,*Correspondence: Aleksandra Pavlovic ✉
| | - Tatjana Pekmezovic
- Faculty of Medicine, Institute of Epidemiology, University of Belgrade, Belgrade, Serbia
| | - Milija Mijajlovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Gordana Tomic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jasna Zidverc Trajkovic
- Neurology Clinic, University Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Pecic V, Pavlovic A, Todorovic A, Bogdanovic D, Dimitrijevic M, Bekic M, Rancic L, Rosati S, Balestra G, Jovanovic B. P-120 LAPAROSCOPIC REPAIR OF INCISIONAL HERNIA USING A NON-ABSORBABLE TRANSPARENT COMPOSITE PROSTHESIS TOTALLY IN POLYPROPYLENE - OUR EXPERIENCE. Br J Surg 2022. [DOI: 10.1093/bjs/znac308.218] [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] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Incisional ventral hernia is one of the most common surgical complications after laparotomy. The aim of this retrospective observational study is an evaluation of clinical outcomes after laparoscopic repair of incisional hernias with a non-absorbable and transparent composite prosthesis composed of a macro-porous monofilament polypropylene mesh and a transparent polypropylene film.
Materials and Methods
63 patients, from January 2016 to December 2021, were treated for incisional hernia at Center of minimal invasive surgery Nis, Serbia. The mesh was always positioned intraperitoneally after closing the defects and fixed with absorbable tacks and non-absorbable suture.
Results
In the considered cohort (54% female and 46% male) the median age and BMI were 54 years (range: 39–68) and 25,1 kg/m2 (range: 21.5–30.3), respectively. Concerning hernia position, 93.7% of the hernias were medial, 4.8% lumbar and 1.6% medio-lumbar. According to EHS classification, 58.7% of the hernias were W1, 36.5% W2 and 12.7% W3. The average duration of hospitalization was 2 days.
The rate of early post-operative complications was 6.3%, including 1 seroma (1.6%) and 3 patients reporting pain (4.8%). At a median follow up of 48 months (range: 6–60) we registered 2 cases of hernia recurrency (3.2%, both at 36 months follow-up) and 1 case of bowel obstruction (1.6%). All the considered variables did not result statistically significative in relation to post-operative complications.
Conclusion
Our clinical experience showed that intraperitoneal treatment of incisional hernia using a transparent composite prosthesis. The minimally invasive procedure allows a fast postoperative recovery and a consequent low economical cost.
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Affiliation(s)
- V Pecic
- Center of minimal invasive surgery, University Clinical Center , Nis , Serbia
| | - A Pavlovic
- Center for minimal invasive surgery, University Clinical Center , Nis , Serbia
| | - A Todorovic
- Center for minimal invasive surgery, University Clinical Center , Nis , Serbia
| | - D Bogdanovic
- Center for minimal invasive surgery, University Clinical Center , Nis , Serbia
| | - M Dimitrijevic
- Center for minimal invasive surgery, University Clinical Center , Nis , Serbia
| | - M Bekic
- Center for minimal invasive surgery, University Clinical Center , Nis , Serbia
| | - L Rancic
- Center for minimal invasive surgery, University Clinical Center , Nis , Serbia
| | - S Rosati
- Politecnico di Torino, Politecnico di Torino , Torino , Italy
| | - G Balestra
- Politecnico di Torino, Politecnico di Torino , Torino , Italy
| | - B Jovanovic
- Center for minimal invasive surgery, University Clinical Center , Nis , Serbia
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Lopes LR, Losi MA, Sheikh N, Laroche C, Charron P, Gimeno J, Kaski JP, Maggioni AP, Tavazzi L, Arbustini E, Brito D, Celutkiene J, Hagege A, Linhart A, Mogensen J, Garcia-Pinilla JM, Ripoll-Vera T, Seggewiss H, Villacorta E, Caforio A, Elliott PM, Beleslin B, Budaj A, Chioncel O, Dagres N, Danchin N, Erlinge D, Emberson J, Glikson M, Gray A, Kayikcioglu M, Maggioni A, Nagy KV, Nedoshivin A, Petronio AS, Hesselink JR, Wallentin L, Zeymer U, Caforio A, Blanes JRG, Charron P, Elliott P, Kaski JP, Maggioni AP, Tavazzi L, Tendera M, Komissarova S, Chakova N, Niyazova S, Linhart A, Kuchynka P, Palecek T, Podzimkova J, Fikrle M, Nemecek E, Bundgaard H, Tfelt-Hansen J, Theilade J, Thune JJ, Axelsson A, Mogensen J, Henriksen F, Hey T, Nielsen SK, Videbaek L, Andreasen S, Arnsted H, Saad A, Ali M, Lommi J, Helio T, Nieminen MS, Dubourg O, Mansencal N, Arslan M, Tsieu VS, Damy T, Guellich A, Guendouz S, Tissot CM, Lamine A, Rappeneau S, Hagege A, Desnos M, Bachet A, Hamzaoui M, Charron P, Isnard R, Legrand L, Maupain C, Gandjbakhch E, Kerneis M, Pruny JF, Bauer A, Pfeiffer B, Felix SB, Dorr M, Kaczmarek S, Lehnert K, Pedersen AL, Beug D, Bruder M, Böhm M, Kindermann I, Linicus Y, Werner C, Neurath B, Schild-Ungerbuehler M, Seggewiss H, Pfeiffer B, Neugebauer A, McKeown P, Muir A, McOsker J, Jardine T, Divine G, Elliott P, Lorenzini M, Watkinson O, Wicks E, Iqbal H, Mohiddin S, O'Mahony C, Sekri N, Carr-White G, Bueser T, Rajani R, Clack L, Damm J, Jones S, Sanchez-Vidal R, Smith M, Walters T, Wilson K, Rosmini S, Anastasakis A, Ritsatos K, Vlagkouli V, Forster T, Sepp R, Borbas J, Nagy V, Tringer A, Kakonyi K, Szabo LA, Maleki M, Bezanjani FN, Amin A, Naderi N, Parsaee M, Taghavi S, Ghadrdoost B, Jafari S, Khoshavi M, Rapezzi C, Biagini E, Corsini A, Gagliardi C, Graziosi M, Longhi S, Milandri A, Ragni L, Palmieri S, Olivotto I, Arretini A, Castelli G, Cecchi F, Fornaro A, Tomberli B, Spirito P, Devoto E, Bella PD, Maccabelli G, Sala S, Guarracini F, Peretto G, Russo MG, Calabro R, Pacileo G, Limongelli G, Masarone D, Pazzanese V, Rea A, Rubino M, Tramonte S, Valente F, Caiazza M, Cirillo A, Del Giorno G, Esposito A, Gravino R, Marrazzo T, Trimarco B, Losi MA, Di Nardo C, Giamundo A, Musella F, Pacelli F, Scatteia A, Canciello G, Caforio A, Iliceto S, Calore C, Leoni L, Marra MP, Rigato I, Tarantini G, Schiavo A, Testolina M, Arbustini E, Di Toro A, Giuliani LP, Serio A, Fedele F, Frustaci A, Alfarano M, Chimenti C, Drago F, Baban A, Calò L, Lanzillo C, Martino A, Uguccioni M, Zachara E, Halasz G, Re F, Sinagra G, Carriere C, Merlo M, Ramani F, Kavoliuniene A, Krivickiene A, Tamuleviciute-Prasciene E, Viezelis M, Celutkiene J, Balkeviciene L, Laukyte M, Paleviciute E, Pinto Y, Wilde A, Asselbergs FW, Sammani A, Van Der Heijden J, Van Laake L, De Jonge N, Hassink R, Kirkels JH, Ajuluchukwu J, Olusegun-Joseph A, Ekure E, Mizia-Stec K, Tendera M, Czekaj A, Sikora-Puz A, Skoczynska A, Wybraniec M, Rubis P, Dziewiecka E, Wisniowska-Smialek S, Bilinska Z, Chmielewski P, Foss-Nieradko B, Michalak E, Stepien-Wojno M, Mazek B, Lopes LR, Almeida AR, Cruz I, Gomes AC, Pereira AR, Brito D, Madeira H, Francisco AR, Menezes M, Moldovan O, Guimaraes TO, Silva D, Ginghina C, Jurcut R, Mursa A, Popescu BA, Apetrei E, Militaru S, Coman IM, Frigy A, Fogarasi Z, Kocsis I, Szabo IA, Fehervari L, Nikitin I, Resnik E, Komissarova M, Lazarev V, Shebzukhova M, Ustyuzhanin D, Blagova O, Alieva I, Kulikova V, Lutokhina Y, Pavlenko E, Varionchik N, Ristic AD, Seferovic PM, Veljic I, Zivkovic I, Milinkovic I, Pavlovic A, Radovanovic G, Simeunovic D, Zdravkovic M, Aleksic M, Djokic J, Hinic S, Klasnja S, Mircetic K, Monserrat L, Fernandez X, Garcia-Giustiniani D, Larrañaga JM, Ortiz-Genga M, Barriales-Villa R, Martinez-Veira C, Veira E, Cequier A, Salazar-Mendiguchia J, Manito N, Gonzalez J, Fernández-Avilés F, Medrano C, Yotti R, Cuenca S, Espinosa MA, Mendez I, Zatarain E, Alvarez R, Pavia PG, Briceno A, Cobo-Marcos M, Dominguez F, Galvan EDT, Pinilla JMG, Abdeselam-Mohamed N, Lopez-Garrido MA, Hidalgo LM, Ortega-Jimenez MV, Mezcua AR, Guijarro-Contreras A, Gomez-Garcia D, Robles-Mezcua M, Blanes JRG, Castro FJ, Esparza CM, Molina MS, García MS, Cuenca DL, de Mallorca P, Ripoll-Vera T, Alvarez J, Nunez J, Gomez Y, Fernandez PLS, Villacorta E, Avila C, Bravo L, Diaz-Pelaez E, Gallego-Delgado M, Garcia-Cuenllas L, Plata B, Lopez-Haldon JE, Pena Pena ML, Perez EMC, Zorio E, Arnau MA, Sanz J, Marques-Sule E. Association between common cardiovascular risk factors and clinical phenotype in patients with hypertrophic cardiomyopathy from the European Society of Cardiology (ESC) EurObservational Research Programme (EORP) Cardiomyopathy/Myocarditis registry. Eur Heart J Qual Care Clin Outcomes 2022; 9:42-53. [PMID: 35138368 PMCID: PMC9745665 DOI: 10.1093/ehjqcco/qcac006] [Citation(s) in RCA: 8] [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] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Revised: 02/02/2022] [Accepted: 02/04/2022] [Indexed: 12/15/2022]
Abstract
AIMS The interaction between common cardiovascular risk factors (CVRF) and hypertrophic cardiomyopathy (HCM) is poorly studied. We sought to explore the relation between CVRF and the clinical characteristics of patients with HCM enrolled in the EURObservational Research Programme (EORP) Cardiomyopathy registry. METHODS AND RESULTS 1739 patients with HCM were studied. The relation between hypertension (HT), diabetes (DM), body mass index (BMI), and clinical traits was analysed. Analyses were stratified according to the presence or absence of a pathogenic variant in a sarcomere gene. The prevalence of HT, DM, and obesity (Ob) was 37, 10, and 21%, respectively. HT, DM, and Ob were associated with older age (P<0.001), less family history of HCM (HT and DM P<0.001), higher New York Heart Association (NYHA) class (P<0.001), atrial fibrillation (HT and DM P<0.001; Ob p = 0.03) and LV (left ventricular) diastolic dysfunction (HT and Ob P<0.001; DM P = 0.003). Stroke was more frequent in HT (P<0.001) and mutation-positive patients with DM (P = 0.02). HT and Ob were associated with higher provocable LV outflow tract gradients (HT P<0.001, Ob P = 0.036). LV hypertrophy was more severe in Ob (P = 0.018). HT and Ob were independently associated with NYHA class (OR 1.419, P = 0.017 and OR 1.584, P = 0.004, respectively). Other associations, including a higher proportion of females in HT and of systolic dysfunction in HT and Ob, were observed only in mutation-positive patients. CONCLUSION Common CVRF are associated with a more severe HCM phenotype, suggesting a proactive management of CVRF should be promoted. An interaction between genotype and CVRF was observed for some traits.
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Affiliation(s)
- Luis R Lopes
- Corresponding author. Tel: +447765109343, , Twitter handle: @LuisRLopesDr
| | - Maria-Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, Corso Umberto I, 40, Naples 80138, Italy
| | - Nabeel Sheikh
- Department of Cardiology and Division of Cardiovascular Sciences, Guy's and St. Thomas’ Hospitals and King's College London, Strand, London WC2R 2LS, UK
| | - Cécile Laroche
- EORP, European Society of Cardiology, Sophia-Antipolis, France
| | | | | | - Juan P Kaski
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,Centre for Inherited Cardiovascular Diseases, Great Ormond Street Hospital, London WC1N 3JH, UK
| | - Aldo P Maggioni
- EORP, European Society of Cardiology, Sophia-Antipolis, France,Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | - Luigi Tavazzi
- Maria Cecilia Hospital, GVM Care&Research, Via Corriera, 1, Cotignola 48033 RA, Italy
| | | | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisbon 1169-050, Portugal,CCUL, Faculdade de Medicina, Universidade de Lisboa, Av. Prof. Egas Moniz MB, Lisbon 1649-028, Portugal
| | - Jelena Celutkiene
- Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Universiteto g. 3, Vilnius 01513, Lithuania,State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
| | | | - Ales Linhart
- 2nd Department of Internal Cardiovascular Medicine, General University Hospital and First Medical Faculty, Charles University, Opletalova 38, Prague 110 00, Czech Republic
| | - Jens Mogensen
- Department of Cardiology, Odense University Hospital, J. B. Winsløws Vej 4, Odense 5000, Denmark
| | - José Manuel Garcia-Pinilla
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares. Servicio de Cardiología. Hospital Universitario Virgen de la Victoria. IBIMA. Málaga and Ciber-Cardiovascular. Instituto de Salud Carlos III. Madrid, Spain
| | - Tomas Ripoll-Vera
- Inherited Cardiovascular Disease Unit Son Llatzer University Hospital & IdISBa, Palma de Mallorca, Spain
| | - Hubert Seggewiss
- Universitätsklinikum Würzburg, Deutsches Zentrum für Herzinsuffizienz (DZHI), Comprehensive Heart Failure Center (CHFC), Am Schwarzenberg 15, Haus 15A, 97078 Wurzburg, Germany
| | - Eduardo Villacorta
- Member of National Centers of expertise for familial cardiopathies (CSUR), Cardiology Department, University Hospital of Salamanca. Institute of Biomedical Research of Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | | | - Perry M Elliott
- Institute of Cardiovascular Science, University College London, Gower St, London WC1E 6BT, UK,St. Bartholomew's Hospital, Barts Heart Centre, Barts Health NHS Trust, Whitechapel Rd, London E1 1BB, UK
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Lackovic M, Ivkovic M, Vicentic S, Jerotic S, Nestorovic M, Stojkovic T, Pavlovic A. The role of the blood-brain barrier in psychiatric disorders. SRP ARK CELOK LEK 2022. [DOI: 10.2298/sarh220417081l] [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] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The blood-brain barrier (BBB) is formed by continuous, closely connected
endothelial cells, enveloped in the basal lamina, pericytes, and foot
extensions of astrocytes. BBB has a vital role in brain metabolism and
protects the brain parenchyma from harmful agents present in the systemic
circulation. Damage to the BBB and an increase in its permeability have an
important role in many neurodegenerative diseases. This paper aims to
review the literature on the impact of the BBB damage on psychiatric
illness, a largely neglected and under researched area. Links between BBB
impairment and specific neuropsychiatric disorders are described including
schizophrenia, affective disorders, dementias with behavioral disorders, and
alcohol use disorder, with comparison to typical hereditary small vessel
diseases affecting the BBB such as cerebral autosomal dominant arteriopathy
with subcortical infarction and leukoencephalopathy (CADASIL) and
mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes
(MELAS). The authors critically summarize possible pathogenic mechanisms
linking BBB damage and these common disorders.
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Affiliation(s)
- Maja Lackovic
- University Clinical Center of Serbia, Clinic of Psychiatry, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Maja Ivkovic
- University Clinical Center of Serbia, Clinic of Psychiatry, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Sreten Vicentic
- University Clinical Center of Serbia, Clinic of Psychiatry, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Stefan Jerotic
- University Clinical Center of Serbia, Clinic of Psychiatry, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Milica Nestorovic
- University Clinical Center of Serbia, Clinic of Psychiatry, Belgrade, Serbia + University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - Tihomir Stojkovic
- University of Belgrade, Faculty of Medicine, Institute of Clinical and Medical Biochemistry, Belgrade, Serbia
| | - Aleksandra Pavlovic
- University of Belgrade, Faculty of Special Education and Rehabilitation, Belgrade, Serbia
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8
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Milasinovic D, Mladenovic DJ, Jelic D, Zobenica V, Zaharijev S, Vratonjic J, Isailovic N, Radomirovic M, Pavlovic A, Vukcevic V, Asanin M, Stankovic G. Relative impact of acute heart failure and acute kidney injury on short- and long-term prognosis of patients with STEMI treated with primary PCI. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1448] [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
Although both acute heart failure (AHF) and acute kidney injury (AKI) have been separately recognized as contributors to an increased mortality risk in patients with ST-segment elevation myocardial infarction (STEMI), their relative importance has not been extensively studied.
Purpose
Our aim was to investigate the relative impact of AHF and AKI on 30-day and 5-year mortality following primary PCI for STEMI.
Methods
8 054 patients referred to primary PCI during the years 2009–2019, and with the available repeated creatinine measurements, were analyzed. AKI was defined as ≥25% relative or ≥0.5 mg/dl absolute rise in creatinine from baseline, within 72 hours of intervention. Acute heart failure was defined as Killip class ≥2 on admission to hospital. Cox regression model was used to assess the effect of the interaction of AHF and AKI on mortality. Median follow-up was 5 years.
Results
The incidence of AKI was 9.9% (n=805) and of AHF 12.3% (n=1050). Concurrence of AHF and AKI was noted in 1.7% of the included patients (n=315). The combined presence of AHF and AKI significantly increased mortality both at 30 days (30.7%) and at 5 years (73.3%), as compared with AKI alone (8.2% at 30 days and 32.3% at 5 years) and AHF alone (13.0% and 53.0%). When adjusted for other significant predictors, such as age, prior stroke, hyperlipidemia, atrial fibrillation, ejection fraction, final TIMI flow in the culprit artery, the use of intra-aortic balloon pump and multivessel disease, both AKI and AHF were independently associated with mortality. The adjusted relative impact of AKI on mortality was stronger than that of AHF at 30 days (adjusted HR 3.5 and 2.2, respectively), whereas it was comparable at 5 years (adjusted HR 1.3 and 1.4, respectively). Furthermore, the combined presence of AHF on admission and the post-primary PCI development of AKI was associated with the highest magnitude of risk at both 30 days (HR 5.0, CI95% 3.0–8.3, p<0.001) and 5 years (HR 2.4, CI95% 1.83–3.16, p<0.001).
Conclusion
Acute kidney injury following primary PCI for STEMI was associated with a higher adjusted risk of short-term mortality when compared with acute heart failure, whereas their relative impact was comparable in the long-term.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Milasinovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D J Mladenovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Jelic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Zaharijev
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - J Vratonjic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - N Isailovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - A Pavlovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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9
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Verdelho A, Biessels GJ, Chabriat H, Charidimou A, Duering M, Godefroy O, Pantoni L, Pavlovic A, Wardlaw J. Cerebrovascular disease in patients with cognitive impairment: A white paper from the ESO dementia committee - A practical point of view with suggestions for the management of cerebrovascular diseases in memory clinics. Eur Stroke J 2021; 6:111-119. [PMID: 34414285 PMCID: PMC8370070 DOI: 10.1177/2396987321994294] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/19/2021] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Practical suggestions on clinical decisions about vascular disease management in patients with cognitive impairment are proposed. METHODS The document was produced by the Dementia Committee of the European Stroke Organisation (ESO) based on the evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. FINDINGS Vascular risk factors and cerebrovascular disease are frequent in patients with cognitive impairment. While acute stroke treatment has evolved substantially in last decades, evidence of management of cerebrovascular pathology beyond stroke in patients with cognitive impairment and dementia is quite limited. Additionally, trials to test some daily-life clinical decisions are likely to be complex, difficult to undertake and take many years to provide sufficient evidence to produce recommendations. This document was conceived to provide some suggestions until data from field trials are available. It was conceived for the use of clinicians from memory clinics or involved specifically in cognitive disorders, addressing practical aspects on diagnostic tools, vascular risk management and suggestions on some therapeutic options. DISCUSSION AND CONCLUSIONS The authors did not aim to do an exhaustive or systematic review or to cover all current evidence. The document approach in a very practical way frequent issues concerning cerebrovascular disease in patients with known cognitive impairment.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Instituto de Medicina Molecular – IMM e Instituto de Saude Ambiental-ISAMB, Faculdade de Medicina. University of Lisbon, Lisbon, Portugal
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Hugues Chabriat
- Department of Neurology, FHU NeuroVasc, Hôpital Lariboisiere, University of Paris and INSERM U1141, Paris, France
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Marco Duering
- Institute for Stroke and Dementia Research (ISD), University Hospital, LMU Munich, Germany
- Medical Image Analysis Center (MIAC AG) and qbig, Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Olivier Godefroy
- Departments of Neurology, Amiens University Hospital, and Laboratory of Functional Neurosciences1,6 (UR UPJV 4559), Jules Verne Picardy University, Amiens, France
| | - Leonardo Pantoni
- Stroke and Dementia Lab, “Luigi Sacco” Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Aleksandra Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
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10
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Verdelho A, Wardlaw J, Pavlovic A, Pantoni L, Godefroy O, Duering M, Charidimou A, Chabriat H, Biessels GJ. Cognitive impairment in patients with cerebrovascular disease: A white paper from the links between stroke ESO Dementia Committee. Eur Stroke J 2021; 6:5-17. [PMID: 33817330 PMCID: PMC7995319 DOI: 10.1177/23969873211000258] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 02/04/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Many daily-life clinical decisions in patients with cerebrovascular disease and cognitive impairment are complex. Evidence-based information sustaining these decisions is frequently lacking. The aim of this paper is to propose a practical clinical approach to cognitive impairments in patients with known cerebrovascular disease. METHODS The document was produced by the Dementia Committee of the European Stroke Organisation (ESO), based on evidence from the literature where available and on the clinical experience of the Committee members. This paper was endorsed by the ESO. FINDINGS Many patients with stroke or other cerebrovascular disease have cognitive impairment, but this is often not recognized. With improvement in acute stroke care, and with the ageing of populations, it is expected that more stroke survivors and more patients with cerebrovascular disease will need adequate management of cognitive impairment of vascular etiology. This document was conceived for the use of strokologists and for those clinicians involved in cerebrovascular disease, with specific and practical hints concerning diagnostic tools, cognitive impairment management and decision on some therapeutic options.Discussion and conclusions: It is essential to consider a possible cognitive deterioration in every patient who experiences a stroke. Neuropsychological evaluation should be adapted to the clinical status. Brain imaging is the most informative biomarker concerning prognosis. Treatment should always include adequate secondary prevention.
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Affiliation(s)
- Ana Verdelho
- Department of Neurosciences and Mental Health, CHLN-Hospital de Santa Maria, Instituto de Medicina Molecular – IMM e Instituto de Saúde Ambiental –ISAMB, Faculdade de Medicina, University of Lisbon, Lisbon, Portugal
| | - Joanna Wardlaw
- Centre for Clinical Brain Sciences, UK Dementia Research Institute, University of Edinburgh, Edinburgh, UK
| | - Aleksandra Pavlovic
- Faculty for Special Education and Rehabilitation, University of Belgrade, Belgrade, Serbia
| | - Leonardo Pantoni
- Stroke and Dementia Lab, "Luigi Sacco" Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Olivier Godefroy
- Department of Neurology, Amiens University Hospital, Laboratory of Functional Neurosciences1,6 (UR UPJV 4559), Jules Verne Picardy University, Amiens, France
| | - Marco Duering
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Germany
- Department of Biomedical Engineering, University of Basel, Basel, Switzerland
| | - Andreas Charidimou
- Hemorrhagic Stroke Research Program, J. Philip Kistler Stroke Research Center, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Department of Neurology, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Hugues Chabriat
- Department of Neurology, FHU NeuroVasc, Hôpital Lariboisiere, University of Paris, Paris, France
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center Utrecht, the Netherlands
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11
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Zobenica V, Milasinovic D, Jelic D, Mehmedbegovic Z, Zaharijev S, Radomirovic M, Djurosev I, Pavlovic A, Dudic J, Dedovic V, Asanin M, Vukcevic V, Stankovic G. Prognostic impact of elevated baseline CRP levels in primary PCI-treated patients with residual cholesterol risk. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1563] [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
Recent large randomized studies have indicated the potential of anti-inflammatory therapies to reduce adverse cardiovascular events in patients with myocardial infarction, with the most pronounced benefit in patients with baseline elevated C-reactive protein (CRP).
Purpose
Our aim was to assess the association of CRP levels with 30-day and 1-year mortality in patients with acute myocardial infarction treated with primary PCI and with residual cholesterol risk.
Methods
The study included 1531 patients admitted for primary PCI, with the residual cholesterol risk, i.e. low-density lipoprotein cholesterol (LDL-C) levels of >1.80 mmol/l (70 mg/dl), from a prospectively kept electronic registry of a high-volume tertiary center, for whom in-hospital CRP measurements were available. Elevated CRP was defined as ≥5 mg/l (local laboratory cut off value), measured during index hospitalization. Cox regression models were constructed to assess the impact of elevated CRP on 30-day and 1-year mortality.
Results
72% of the included patients with LDL-C >1.80 mmol/l had elevated in-hospital CRP (n=1107). Compared with patients with CRP levels within reference limit, elevated CRP was associated with older age (62 vs. 60, p<0.001), higher rates of diabetes (25.8% vs. 18.5%, p=0.002), renal failure (6.4% vs. 2.1%, p<0.001) and Killip class >1 at presentation (22.5% vs. 12.3%, p<0.001), as well as lower EF (44% vs. 48%, p<0.001) and lower haemoglobin on admission (13.9 g/dl vs. 14.2 g/dl, p<0.001). Crude mortality rates were increased in patients with CRP ≥5mg/l at both 30 days (6.0% vs. 2.4%, p=0.003) and 1 year (13.2% vs. 6.3%, p<0.001) (Figure). After adjusting for the observed baseline differences, CRP ≥5mg/l remained an independent predictor of mortality at 1 year (HR 1.691, 95% CI: 1.050–2.724, p=0.03), but not at 30 days (HR 1.690, 95% CI: 0.859–3.324, p=0.13).
Conclusion
In primary PCI-treated patients with residual cholesterol risk, elevated in-hospital CRP was independently associated with 1-year mortality. Our findings may thus suggest a potential window of opportunity, for anti-inflammatory therapies to improve outcomes beyond the acute phase.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Zobenica
- Clinical center of Serbia, Belgrade, Serbia
| | | | - D Jelic
- Clinical center of Serbia, Belgrade, Serbia
| | | | | | | | - I Djurosev
- Clinical center of Serbia, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - J Dudic
- Clinical center of Serbia, Belgrade, Serbia
| | - V Dedovic
- Clinical center of Serbia, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Belgrade, Serbia
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12
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Mehmedbegovic Z, Milasinovic D, Jelic D, Zobenica V, Radomirovic M, Vratonjic J, Zaharijev S, Pavlovic A, Vukcevic V, Asanin M, Stankovic G. Characteristics, predictors and outcomes after unprotected left main stem primary percutaneous coronary intervention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2564] [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
Reports about outcomes of patients undergoing primary percutaneous coronary intervention (PCI) for unprotected left main (ULM) coronary artery are limited. We aimed to investigate the characteristics, in-hospital and the long-term outcomes of these patients.
Methods
From a high-volume, single-centre, prospective registry, in a period from 2009–2019, we identified 111 pts (0.96%) who undergone primary PCI for ULM culprit lesion. The short- and the long-term outcomes in this subset was evaluated and compared to 9463 (82.5%) patients undergoing pPCI for lesions located in other segments (Non-LM group). Technical success was defined as final TIMI 3 flow in both, left main and distal vessels, anterior descending and circumflex artery, without significant residual stenosis (>20% following balloon angioplasty or stent implantation) and side branch compromise (residual stenosis >75%).
Results
Patients with ULM were older and more likely to present as Non-ST-elevation MI (77% vs. 93%; p<0.000) and in cardiogenic shock (40% vs. 2.2%; p<0.000), having less occlusive disease with TIMI 0–1 flow prior to PCI (44% vs. 78%; p<0.000) compared to Non-LM patients. Also, greater procedure complexity was observed with longer lesions >20mm (50% vs. 29%; p<0.000), more intraluminal thrombus (86% vs. 45%; p<0.000), greater number (1,48±0,9 vs. 1,28±0,7; p<0.01) and longer stents (30,5±15,8 vs. 27,4±14,3; p=0.028), more GP IIb/IIIa inhibitors (32% vs. 23%; p=0.022), intra-aortic counterpulsations (7% vs. 0.6%; p<0.000) and contrast media used (202±96 vs. 172±66; p<0.000) in ULM group. Despite obtaining comparable rates of final TIMI 3 flow in main branch (91.9% vs. 95.4%; p=0.084), patients with LMCA had significantly higher in-hospital (27% vs. 4.7%: p<0.000), and one-year all-cause mortality (41% vs. 11%: p<0.000), but for the remaining duration of clinical follow-up (available for 97.8% pts, median duration 51±37 months) survival rates were comparable between ULM and Non-LM pts (18% vs. 15%: p=0.506) (Figure 1).
Regression analysis showed that final TIMI 3 in main branch at 30 days (HR 0.05 [95% CI 0.005–0.604]; p=0.018), while peri-procedural cardiogenic shock (hazard ratio (HR) 8.3 [95% CI 2.5–28.1]; p=0.001), creatinine clearance <60 ml/min (HR 7.5 [95% CI 2.3–25.1]; p=0.001) and technical success (HR 0.16 [95% CI 0.45–0.57]; p=0.005) at 5 years, independently predicted mortality in ULM patients.
Conclusions
Despite performance of primary PCI, patients with MI due to ULM lesions are associated with worse in-hospital and one-year mortality but following that period mortality was comparable to control group. Suboptimal final coronary flow best predicted the 30 day, while peri-procedural cardiogenic shock, renal dysfunction at admission and suboptimal technical procedure result, predicted long-term mortality in these patients.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Z Mehmedbegovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - D Jelic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - J Vratonjic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - S Zaharijev
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
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13
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Vratonjic J, Milasinovic D, Asanin M, Vukcevic V, Zaharijev S, Pavlovic A, Jelic D, Radomirovic M, Zobenica V, Mehmedbegovic Z, Stankovic G. Clinical characteristics and long-term mortality of patients with midrange ejection fraction undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0941] [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 associated midrange ejection fraction (mrEF) with impaired prognosis in patients with ST-elevation myocardial infarction (STEMI).
Purpose
Our aim was to assess clinical profile and short- and long-term mortality of patients with mrEF after STEMI treated with primary percutaneous coronary intervention (PCI).
Methods
This analysis included 8148 patients admitted for primary PCI during 2009–2019, from a high-volume tertiary center, for whom echocardiographic parameters obtained during index hospitalization were available. Midrange EF was defined as 40–49%. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard of mrEF, with the reference category being preserved EF (>50%).
Results
mrEF was present in 29.8% (n=2 427), whereas low ejection fraction (EF<40%) was documented in 24.7% of patients (n=2 016). mrEF was associated with a higher baseline risk as compared with preserved EF patients, but lower when compared with EF<40%, in terms of prior MI (14.5% in mrEF vs. 9.9% in preserved EF vs. 24.2% in low EF, p<0.001), history of diabetes (26.5% vs. 21.2% vs. 30.0%, p<0.001), presence of Killip 2–4 on admission (15.7% vs. 6.9% vs. 26.5%, p<0.001) and median age (61 vs. 59 vs. 64 years, p<0.001). At 30 days, mortality was comparable in mrEF vs. preserved EF group, while it was significantly higher in the low EF group (2.7% vs. 1.6% vs. 9.4%, respectively, p<0.001). At 5 years, mrEF patients had higher crude mortality rate as compared with preserved EF, but lower in comparison with low EF (25.1% vs. 17.0% vs. 48.7%, p<0.001) (Figure). After adjusting for the observed baseline differences mrEF was independently associated with increased mortality at 5 years (HR 1.283, 95% CI: 1.093–1.505, p=0.002), but not at 30 days (HR 1.444, 95% CI: 0.961–2.171, p<0.001).
Conclusion
Patients with mrEF after primary PCI for STEMI have a distinct baseline clinical risk profile, as compared with patients with reduced (<40%) and preserved (≥50%) EF. Importantly, mrEF did not have a significant impact on short-term mortality following STEMI, but it did independently predict the risk of 5-year mortality.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- J Vratonjic
- University Belgrade Medical School, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Cardiology department, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Cardiology department, Belgrade, Serbia
| | - S Zaharijev
- Clinical center of Serbia, Cardiology department, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - D Jelic
- Clinical center of Serbia, Cardiology department, Belgrade, Serbia
| | - M Radomirovic
- Clinical center of Serbia, Cardiology department, Belgrade, Serbia
| | - V Zobenica
- Clinical center of Serbia, Cardiology department, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical center of Serbia, Cardiology department, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Cardiology department, Belgrade, Serbia
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14
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Radomirovic M, Milasinovic D, Mehmedbegovic Z, Pavlovic A, Zaharijev S, Zobenica V, Jelic D, Tesic M, Ivanovic B, Stankovic G, Vukcevic V, Asanin M. Prognostic impact of gender and young age in patients with acute myocardial infarction undergoing primary PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2519] [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: 11/15/2022] Open
Abstract
Abstract
Background
Previous studies showed higher unadjusted mortality rates in female patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (PCI). However, after adjusting for differences in baseline characteristics, including age, female gender was not consistently associated with higher mortality.
Purpose
Our aim was to investigate the impact of gender on short- and long-term mortality in patients aged 18 to 55 years with AMI undergoing primary PCI.
Methods
We included 11 288 patients admitted for primary PCI during 2009–2019, from a prospectively kept, electronic registry of a high-volume tertiary center. Adjusted Cox regression models were used to assess 30-day and 5-year mortality hazard. Median follow up was 1 507 days.
Results
3 505 patients were younger than 55 years (31%). In this age group, 18.9% were female patients (n=661). Baseline characteristics were similar for females vs. males below the age of 55 years, including similar reperfusion times (338 min. vs. 341 min., p=0.8), with only exceptions being a higher rate of previous hypertension (64% vs. 58%, p=0.002) and stroke (3.6% vs. 2.2%, p=0.049), as well as lower ejection fraction (48% vs. 51%, p<0.001), in female patients. MINOCA (Myocardial Infarction with Nonobstructive Coronary Arteries) was more frequently present in female vs. male patients aged ≤55 years (10.1% vs. 5.0%, p<0.001). In the overall population, crude mortality was higher in female patients at 30 days (9.8% vs. 6.0%, p<0.001) and 5 years (38.4% vs. 30.2%, p<0.001). In younger patients (≤55 years), mortality rates were low and similar between the sexes at both 30 days (3.6% in females vs. 2.5% in males, p=0.136) and 5 years (14.5% vs. 13.4%, p=0.58). On the contrary, in patients aged >55 years, crude mortality was higher in female patients at both 30 days (11.3% vs. 7.9%, p<0.001) and 5 years (43.9% vs. 39.4%, p=0.02), albeit mainly driven by the differences in baseline characteristics between the sexes in this older age group (adjusted HR for female sex 1.220, CI95% 0.920–0.617, p=0.17, at 30 days; and adjusted HR 1.033, CI95% 0.908–0.175, p=0.62, at 5 years).
Conclusion
Differences in crude mortality rates between sexes in patients with AMI admitted for primary PCI appear to be mainly dependent on age, with similar rates of both short- and long-term mortality in younger patients (≤55 years). The observed excess in mortality in older (>55 years) female vs. male patients could be explained by the differences in baseline clinical characteristics.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | | | - A Pavlovic
- University Children's Hospital of Belgrade, Cardiology, Belgrade, Serbia
| | | | - V Zobenica
- Clinical center of Serbia, Belgrade, Serbia
| | - D Jelic
- Clinical center of Serbia, Belgrade, Serbia
| | - M Tesic
- Clinical center of Serbia, Belgrade, Serbia
| | - B Ivanovic
- Clinical center of Serbia, Belgrade, Serbia
| | | | - V Vukcevic
- Clinical center of Serbia, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Belgrade, Serbia
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15
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Pavlovic A, Milasinovic D, Mehmedbegovic Z, Jelic D, Zaharijev S, Zobenica V, Radomirovic M, Dudic J, Asanin M, Vukcevic V, Stankovic G. Prognostic impact of atrial fibrillation in patients undergoing primary PCI with versus without left ventricular function impairment. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2522] [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
Atrial fibrillation (AF) and impaired left ventricular (LV) function have both been separately associated with increased risk of mortality following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI).
Purpose
Our aim was to comparatively evaluate the impact of LV dysfunction and AF on the risk of mortality in primary PCI-treated patients.
Methods
This analysis included 8561 patients admitted for primary PCI during 2009–2019, from a prospectively kept, electronic registry of a high-volume tertiary center, from whom echocardiographic parameters were available. LV dysfunction was defined as EF<40%. Adjusted Cox regression models were used to assess 30-day and 1-year mortality hazard.
Results
AF was present in 3.2% (n=273), whereas 37% had LV dysfunction (n=3189). Crude mortality rates were increased in the presence of either AF or LV dysfunction, and were the highest in the group of patients having both AF and impaired LV function, at 30 days (1.8% in no AF and no LV dysfunction vs. 5.4% if AF only vs. 7.0% if EF<40% only vs. 14.9% if AF and LV dysfunction concurrently present, p<0.001) and at 3 years (10.5% if no AF and no LV dysfunction vs. 35.8% if AF only vs. 28.5% if EF<40% only vs. 60.3% if AF and LV dysfunction both present, p<0.001). After multivariable adjustment for other significant mortality predictors, including age, previous stroke, MI, diabetes, hyperlipidemia, anemia and Killip≥2, LV dysfunction alone and in combination with AF was an independent predictor of mortality at both 30 days (HR=2.2 and HR=2.5, respectively, p<0.001 for both) and at 3 years (HR=1.9 and HR=2.9, respectively, p<0.001 for both). However, presence of AF alone, in the absence of an impaired LV function, was not independently associated with mortality at 30 days (HR 1.34, CI 95% 0.58–3.1, p=0.48), but rather at 3 years (HR 1.74, CI 95% 1.91–2.54, p=0.004).
Conclusion
Atrial fibrillation is associated with long-term mortality in STEMI patients undergoing primary PCI, irrespective of the LV function. Conversely, short-term prognostic relevance of atrial fibrillation in STEMI is dependent on the presence of LV dysfunction.
Kaplan Meier curve_AF_LV dysfunction
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- A Pavlovic
- University Children's Hospital of Belgrade, Cardiology, Belgrade, Serbia
| | | | | | - D Jelic
- Clinical center of Serbia, Belgrade, Serbia
| | | | - V Zobenica
- Clinical center of Serbia, Belgrade, Serbia
| | | | - J Dudic
- Clinical center of Serbia, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Belgrade, Serbia
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16
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Jelic D, Mehmedbegovic Z, Milasinovic D, Radomirovic M, Pavlovic A, Zobenica V, Zaharijev S, Vratonjic J, Asanin M, Vukcevic V, Stankovic G. Comparison of contrast induced nephropathy definitions and in-hospital mortality in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2516] [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
Contrast induced nephropathy (CIN) has been associated with increased mortality in patients with acute myocardial infarction (AMI). However, different definitions of CIN have so far been used.
Purpose
We aimed to compare predictive accuracy of the 2 contemporary CIN definitions in patients with AMI undergoing primary percutaneous coronary intervention (PCI).
Method
From a high-volume, single-centre, prospective registry, in a period from 2009–2019, we identified 7987 pts who underwent primary PCI for AMI in whom creatinine measurements were available for analysis. CIN incidence was evaluated according to relative creatinine increases of ≥25% (CIN25) and ≥50% (CIN50) from baseline levels within 72 hours after intervention. The primary end point was in-hospital mortality.
Results
Overall, 1116 (13.9%), and 345 (4.3%) patients developed CIN25, CIN50, respectively. Crude in-hospital mortality rate was 3.9% (312 pts) in the overall population. Both definitions were independently associated with in-hospital mortality (CIN25 adjusted odds ratio (OR) 4.2, 95% CI 2.7–6.6; p<0.001, and CIN 50 adjusted OR 8.2, 95% CI 4.9–13.9; p<0.001). Comparison of ROC curves showed that only the addition of the CIN50 (and not CIN25) definition to the combined model of clinical predictors of in-hospital mortality, which included pre-intervention TIMI flow 0–1, cardiogenic shock on admission, baseline creatinine clearance, prior stroke, chronic occlusion of non-culprit artery, post-intervention TIMI flow 3, left ventricular ejection fraction and procedure time, improved prognostic accuracy of the model (Figure 1).
Conclusion
Only acute kidney injury according to the CIN50 definition, but not the CIN25 definition, offers additional prognostic information above and beyond the combination of baseline predictors of in-hospital mortality in patients with AMI undergoing primary PCI.
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Jelic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - V Zobenica
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - S Zaharijev
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - J Vratonjic
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
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17
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Milasinovic D, Mladenovic D, Jelic D, Mehmedbegovic Z, Radomirovic M, Zobenica V, Pavlovic A, Vratonjic J, Vukcevic V, Asanin M, Stankovic G. Impact of a CTO in a non-infarct-related artery on long-term mortality in patients undergoing primary PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2565] [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 increased mortality rates in patients with ST-elevation myocardial infarction (STEMI) and a chronic total occlusion (CTO) in a non-infarct-related artery, but long-term data are scarce.
Purpose
Our aim was to assess all-cause mortality during 5 years follow-up in patients with a remaining nonculprit CTO after being treated with primary PCI.
Methods
The study included 9504 patients admitted for primary PCI during 2009–2019, with available baseline angiography, from an electronic, prospective registry of a high-volume catheterization laboratory. Kaplan Meier cumulative mortality curves for non-culprit CTO vs. no CTO were compared with the log-rank test, with landmarks set at 30 days and then annually up to 5 years follow-up. Adjusted Cox regression models were constructed to assess 30-day and 5-year mortality risk of a non-culprit CTO. Median follow-up was 1507 days.
Results
Nonculprit CTO was present in 13.2% of patients (n=1253). Presence of a nonculprit CTO was associated with older age (64 vs. 61, p<0.001), more frequent history of cardiovascular disease including prior MI (33% vs. 14%, p<0.001), stroke (10.3% vs. 5.9%, p<0.001) and CABG (10.5% vs. 1.5%, p<0.001), higher rates of renal failure (10.7% vs. 4.8%, p<0.001), as well as more often Killip class 2–4 on admission (29% vs. 16%, p<0.001) and a lower ejection fraction (40% vs. 47%, p<0.001). Crude mortality rates were significantly increased in patients with a nonculprit CTO vs. no CTO, at both 30 days (15.7% vs. 5.6%, p<0.001) and 5 years (54.6% vs. 27.9%, p<0.001). After adjusting for the observed baseline differences, nonculprit CTO was still associated with an elevated mortality risk at both 30-days (HR 1.5, CI95% 1.1–1.9, p=0.007) and 5 years (HR 1.6, CI95% 1.4–1.9, p<0.001). Landmark analyses showed continuously increasing risk of mortality in the presence of a nonculprit CTO, as compared with primary PCI-treated patients with no CTO (30 days to 1 year 11.4% vs. 4.9%, p<0.001; 1st to 2nd year of follow-up 6.3% vs. 3.4%, p<0.001; 2nd to 3rd year 6.2% vs. 2.8%, p<0.001; 3rd to 4th year 7.4% vs. 3.0%, p<0.001; and 4th to 5th year 5.2% vs. 3.6%, p=0.1).
Conclusions
Presence of a nonculprit CTO is independently associated with 5-year mortality after primary PCI. Importantly, the mortality risk increases continuously with an average annual absolute difference of 3%, in patients with a nonculprit CTO vs. those with no CTO.
Nonculprit CTO vs. no CTO
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- D Milasinovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D.J Mladenovic
- Clinical center of Serbia, Department of Pulmology, Belgrade, Serbia
| | - D Jelic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Department of Cardiology, Belgrade, Serbia
| | - J Vratonjic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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18
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Zaharijev S, Mehmedbegovic Z, Milasinovic D, Jelic D, Zobenica V, Radomirovic M, Vratonjic J, Pavlovic A, Djurosev I, Vukcevic V, Asanin M, Stankovic G. Comparison of the FASTEST and the ZWOLLE risk scores for identification of very low-risk patients for all-cause mortality and MACE following primary PCI. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1772] [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
Prior studies suggest that low-risk ST-segment-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (pPCI) can be considered for early discharge in order to reduce healthcare costs and improve resource utilization. Novel, simple, the FASTEST score, demonstrated additional prognostic value over guideline recommended ZWOLLE score in a derivation cohort, but robust data about external validation are lacking.
Purpose
We aimed to compare overall predictive ability and discriminating power in identification of low-risk patients of novel FASTEST score compared to validated ZWOLLE score.
Methods
From a high-volume, single-center, prospective registry, in a period from 2009–2019, we included STEMI patients who underwent successful pPCI in whom both, FASTEST (1 point added for: femoral access, age>65, LVEF <50, TIMI <3, creatinine >1.5 mg/dl; left main disease; and Killip≥2) and ZWOLLE (age, anterior infarct, Killip class, TIMI flow, ischemia time, 3 vessel disease) scores were both calculated. Predictive ability of scores for in-hospital, 30 days and 1 year mortality and hospital MACE was tested using ROC analysis and comparing AUC. Also, event rate was compared between low-risk patients as classified by FASTEST (score=0) or ZWOLLE (score≤3).
Results
We included 5650 patients (age 60.8±11.4, male (71%), anterior STEMI (44%) and femoral approach (81%)). Overall, mortality rates were 2.1%, 3.1% and 8.1% for hospital, 30 days and one-year. As Low-risk subjects, ZWOLLE identified broader proportion of population compared to FASTEST (67% vs. 5.5%) mainly due to high prevalence of femoral approach (FASTEST low-risk 30% in radial approach subset), still, later had numerically lower mortality rates at hospital (0.7% vs. 0.3% (only 1 pt); p=0.62), 30 days (1.3% vs. 0.7%; p=0.39) and at one-year (4% vs. 2%; p=0.14). Both scores showed similar and very good predictive ability for in-hospital (AUC 0.81 vs. 0.81; p=0.66) and 30 days mortality (AUC 0.79 vs. 0.77; p=0.29), while at one-year, discrimination of crude mortality by FASTEST trended, but didn't reach statistical significance compared to ZWOLLE score, respectively (AUC 0.77 vs. 0.75; p=0.07). FASTEST showed better prediction for composite endpoint of in-hospital MACE - death, stroke, reinfarction and bleeding BARC class 3 or higher (AUC 0.71 vs. 0.67; p<0.000) (Figure 1).
Conclusion
Both the FASTEST and the ZWOLLE scores showed very good discriminating power for in-hospital, 30 day mortality and one-year mortality, yet the FASTEST score offered comparative advantage for prediction of in-hospital MACE and could be used to identify selected patients where an early hospital discharge can be considered.
ZWOLLE vs FASTEST ROC analisys
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Zaharijev
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | | | - D Milasinovic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - D Jelic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - J Vratonjic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Cardiology, Belgrade, Serbia
| | - I Djurosev
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
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19
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Lorenzano S, Kremer C, Pavlovic A, Jovanovic DR, Sandset EC, Christensen H, Bushnell C, Arsovska A, Sprigg N, Roffe C, Ijäs P, Gdovinova Z, Alexandrov A, Zedde M, Tassi R, Acciaresi M, Lantz M, Sunnerhagen K, Zarkov M, Rantanen K, Perren F, Iversen HK, Kruuse C, Slowik A, Palazzo P, Korv J, Fromm A, Lovrencic-Huzjan A, Korompoki E, Fonseca AC, Gall SL, Brunner F, Caso V, Sacco S. SiPP (Stroke in Pregnancy and Postpartum): A prospective, observational, international, multicentre study on pathophysiological mechanisms, clinical profile, management and outcome of cerebrovascular diseases in pregnant and postpartum women. Eur Stroke J 2020; 5:193-203. [PMID: 32637653 DOI: 10.1177/2396987319893512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 08/07/2019] [Accepted: 11/15/2019] [Indexed: 11/17/2022] Open
Abstract
Rationale Cerebrovascular diseases associated with pregnancy and postpartum period are uncommon; however, they can have an important impact on health of both women and foetus or newborn. Aims To evaluate the frequency, characteristics and management of cerebrovascular events in pregnant/postpartum women, to clarify pathophysiological mechanisms underlying the occurrence of these events including biomolecular aspects, and to assess the short- and long-term cerebrovascular and global cardiovascular outcome of these patients, their predictors and infant outcome. Methods and design This is an observational, prospective, multicentre, international case-control study. The study will include patients with cerebrovascular events during pregnancy and/or within six months after delivery. For each included case, two controls will be prospectively recruited: one pregnant or puerperal subject without any history of cerebrovascular event and one non-pregnant or non-puerperal subject with a recent cerebrovascular event. All controls will be matched by age, ethnicity and type of cerebrovascular event with their assigned cases. The pregnant controls will be matched also by pregnancy weeks/trimester. Follow-up will last 24 months for the mother and 12 months for the infant. Summary To better understand causes and outcomes of uncommon conditions like pregnancy/postpartum-related cerebrovascular events, the development of multisite, multidisciplinary registry-based studies, such as the Stroke in Pregnancy and Postpartum study, is needed in order to collect an adequate number of patients, draw reliable conclusions and give definite recommendations on their management.
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Affiliation(s)
- Svetlana Lorenzano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Christine Kremer
- Neurology Department, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Aleksandra Pavlovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Dejana R Jovanovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | | | | | - Cheryl Bushnell
- Wake Forest Baptist Health, Medical Center Boulevard, Winston Salem, NC, USA
| | - Anita Arsovska
- University Clinic of Neurology, Medical Faculty, University 'Ss Cyril and Methodius', Skopje, Republic of North Macedonia
| | - Nikola Sprigg
- Nottingham University Hospitals NHS Trust, University of Nottingham, Nottingham, UK
| | - Christine Roffe
- Institute for Science and Technology in Medicine, Keele University, c/o Guy Hilton Research Centre, Keele, UK
| | - Petra Ijäs
- Department of Neurology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Zuzana Gdovinova
- Department of Neurology, Pavol Jozef Safarik University, Košice, Slovak Republic
| | - Anne Alexandrov
- Department of Neurology, College of Nursing and College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Marialuisa Zedde
- Neurology and Stroke Units, Azienda Unità Sanitaria Locale, IRCCS Reggio Emilia, Italy
| | - Rossana Tassi
- Stroke Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Monica Acciaresi
- Medicina Interna Vascolare - Stroke Unit, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Maria Lantz
- Neurology Department, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Sunnerhagen
- Department of Neurology and Rehabilitation, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marija Zarkov
- Clinical Center of Vojvodina, Clinic of Neurology, Novi Sad, Serbia
| | - Kirsi Rantanen
- Department of Neurology, University of Helsinki, Helsinki, Finland
| | - Fabienne Perren
- Neuroscience Center, University of Geneva, Geneva, Switzerland
| | - Helle K Iversen
- Stroke Centre Rigshospitalet, Department of Neurology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Kruuse
- Department of Neurology and Neurovascular Research Unit, Herlev Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Agnieszka Slowik
- Department of Neurology, Jagiellonian University, Krakow, Poland
| | - Paola Palazzo
- Department of Neurology, Poitiers University Hospital and University of Poitiers, Poitiers, France
| | - Janika Korv
- Department of Neurology and Neurosurgery, University of Tartu, Tartu, Estonia
| | - Annette Fromm
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | | | - Eleni Korompoki
- Division of Brain Sciences, Imperial College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Greece
| | - Ana Catarina Fonseca
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Seana L Gall
- Menzies Institute for Medical Research Tasmania, University of Tasmania, Hobart, Australia
| | | | - Valeria Caso
- Stroke Unit, Ospedale Santa Maria della Misericordia, University of Perugia, Perugia, Italy
| | - Simona Sacco
- Department of Clinical Sciences and Biotechnology, University of L'Aquila, L'Aquila, Italy
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20
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Polovina M, Milinkovic I, Krljanac G, Veljic I, Petrovic-Djordjevic I, Djikic D, Simic J, Pavlovic A, Kovacevic V, Asanin M, Seferovic PM. 3269Impact of type 2 diabetes on incidence and phenotype of heart failure in patients with atrial fibrillation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0054] [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
Type 2 diabetes (T2DM) portends adverse prognosis in patients with atrial fibrillation (AF). Whether T2DM independently increases the risk of incident heart failure (HF) in AF is uncertain. Also, HF phenotype developing in patients with vs. those without T2DM has not been characterised.
Purpose
In AF patients without a history of prior HF, we aimed to assess: 1) the impact of T2DM on the risk of new-onset HF; and 2) the association between T2DM and HF phenotype developing during the prospective follow-up.
Methods
We included diabetic and non-diabetic AF patients, without a history of HF. Baseline T2DM status was inferred from medical history, haemoglobin A1c levels and oral glucose tolerance test. Study outcome was the first hospital admission or emergency department treatment for new-onset HF during the prospective follow-up. The phenotype of new-onset HF was determined by echocardiographic exam performed following clinical stabilisation (at hospital discharge, or within a month after HF diagnosis). HF phenotype was defined as HFrEF (left ventricular ejection fraction [LVEF] <40%), HFmrEF (LVEF 40–49%) or HFpEF (LVEF≥50%). Cox regression analyses adjusted for age, sex, baseline LVEF, comorbidities, smoking status, alcohol intake, AF type (paroxysmal vs. non-paroxysmal) and T2DM treatment was used to analyse the association between T2DM and incident HF.
Results
Among 1,288 AF patients without prior HF (mean age: 62.1±12.7 years; 61% male), T2DM was present in 16.5%. Diabetic patients had higher mean baseline LVEF compared with nondiabetic patients (50.0±6.2% vs. 57.6±9.0%; P<0.001). During the median 5.5-year follow-up, new-onset HF occurred in 12.4% of patients (incidence rate, 2.9; 95% confidence interval [CI], 2.5–3.3 per 100 patient-years). Compared with non-diabetic patients, those with T2DM had a hazard ratio of 2.1 (95% CI, 1.6–2.8; P<0.001) for new-onset HF, independent of baseline LVEF or other factors. In addition, diabetic patients had a significantly greater decline in covariate-adjusted mean LVEF (−10.4%; 95% CI, −9.8% to −10.8%) at follow-up, compared with nondiabetic patients (−4.0%; 95% CI, −3.8% to −4.2%), P<0.001. The distribution of HF phenotypes at follow-up is presented in Figure. Among patients with T2DM, HFrEF (56.9%) was the most common phenotype of HF, whereas in patients without T2DM, HF mostly took the phenotype of HFpEF (75.0%).
Conclusions
T2DM is associated with an independent risk of new-onset HF in patients with AF and confers a greater decline in LVEF compared to individuals without T2DM. HFrEF was the most prevalent presenting phenotype of HF in AF patients with T2DM.
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Affiliation(s)
- M Polovina
- University Clinical Center of Serbia, Cardiology Clinic, Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - I Milinkovic
- University Clinical Center of Serbia, Cardiology Clinic, Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - G Krljanac
- University Clinical Center of Serbia, Cardiology Clinic, Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - I Veljic
- University Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | | | - D Djikic
- University Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - J Simic
- University Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - A Pavlovic
- University Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - V Kovacevic
- University Clinical Center of Serbia, Cardiology Clinic, Belgrade, Serbia
| | - M Asanin
- University Clinical Center of Serbia, Cardiology Clinic, Faculty of Medicine, Belgrade University, Belgrade, Serbia
| | - P M Seferovic
- University Clinical Center of Serbia, Cardiology Clinic, Faculty of Medicine, Belgrade University, Belgrade, Serbia
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21
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Mehmedbegovic Z, Milasinovic D, Jelic D, Zobenica V, Matic D, Dedovic V, Radomirovic M, Pavlovic A, Veljic I, Zaharijev S, Asanin M, Vukcevic V, Stankovic G. P4619Comparison of the CRUSADE, ACUITY-HORIZONS, and ACTION bleeding risk scores for predicting in-hospital bleeding in acute myocardial infarction patients undergoing primary PCI. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.1001] [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
Considering clinical importance of bleeding complications in patients with acute myocardial infarction (AMI), bleeding risk stratification is a key part of the management of these patients. CRUSADE, ACTION and ACUITY-HORIZONS bleeding risk scores are available for predicting in-hospital major bleeding events in patients with acute myocardial infarction.
Purpose
We aimed to evaluate performance of the three above mentioned risk scores for predicting in-hospital bleeding events defined according to The Bleeding Academic Research Consortium (BARC) criteria.
Methods
From a prospective electronic registry of a high-volume catheterization laboratory in a period from January 2009 to December 2017, a total of 6505 consecutive patients with acute myocardial infarction who underwent pPCI were included in analysis. Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively.
Results
Overall there were 372 (5.7%) bleeding events out of which 117 (1.8%) fulfilled stage BARC 3 or higher bleeding criteria. All three scores showed good model calibration as assessed by the H-Ls test and very good discriminative power for BARC 3 of higher bleeding events detection as assessed by C-statistics (Table 1 & Figure 1):
Bleeding events stage BARC 3 or higher were statistically highly related with higher in-hospital mortality (13.7% vs. 3.5%; p<0.000).
Table 1 Risk score H-L H-L p AUC 95% CI p CRUSADE 11.46 0.177 0.761 0.750–0.771 vs. ACUITY = ns vs. ACTION <0.000 ACUITY-HORIZONS 10.47 0.236 0735 0.724–0.745 vs. ACTION = ns ACTION 5.74 0.677 0.701 0.698–0.712
Figure 1
Conclusions
All three evaluated scores showed very good discriminative capacity for predicting BARC 3 or higher bleeding events in patients undergoing pPCI for AMI.
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Affiliation(s)
- Z Mehmedbegovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - D Jelic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - D Matic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - V Dedovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - M Radomirovic
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - I Veljic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - S Zaharijev
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
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22
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Milasinovic D, Radomirovic M, Jelic D, Mehmedbegovic Z, Zobenica V, Dudic J, Zaharijev S, Zivkovic I, Pavlovic A, Obreski A, Dolicanin A, Vukcevic V, Asanin M, Stankovic G. P5481Predictors of mortality in patients with non-anterior ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0435] [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
Previous studies have indicated that patients with non-anterior ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) have a more favorable prognosis compared with anterior STEMI, especially in the short term.
Purpose
Our aim was to identify predictors of increased 30-day mortality in patients with non-anterior STEMI undergoing primary PCI.
Methods
This analysis included 8188 patients referred to primary PCI during 2009–2017, from a prospective electronic registry of a high-volume catheterization laboratory, for whom 30-day follow-up was available. Non-anterior infarction was defined as presence of ST-segment elevation in inferior and/or lateral ECG leads or true posterior MI. Multivariable Cox regression was used to assess the mortality risk at 30 days.
Results
59.4% (n=4863) of the included patients presented with a non-anterior STEMI. Mortality rate was significantly lower in patients with non-anterior vs. anterior STEMI (4.2% vs. 8.3%, p<0.001). Older age (> median of 61, HR 2.2, p=0.002), baseline renal failure (eGFR <60, HR 4.0, p<0.001), Killip class ≥2 (HR 3.8, p<0.001), previous stroke (HR 1.8, p=0.004), non-culprit chronic total occlusion (CTO, HR 2.0, p<0.001) and final TIMI flow grade <3 in the infarct-related artery (HR 3.1, p<0.001) were independently associated with an increased risk of 30-day mortality in non-anterior STEMI. The presence of at least one of these high-risk factors was noted in 61.2% of patients with non-anterior STEMI and was associated with a significantly higher risk of 30-day mortality (HR 18.2, p<0.001), similarly to the overall risk associated with anterior STEMI (HR 22.9, p<0.001), as compared with patients with non-anterior STEMI but without any of the here identified high-risk factors (Figure).
Figure 1
Conclusions
Crude mortality rate was significantly lower in patients with non-anterior vs. anterior STEMI. However, the majority of non-anterior STEMI patients had at least one of the high-risk factors (older age, previous CVI, baseline renal failure, Killip class ≥2, non-culprit CTO or final TIMI flow <3), which predisposed these patients to a similar increase in short-term mortality risk as in patients with anterior STEMI.
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Affiliation(s)
- D Milasinovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Jelic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - J Dudic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Zaharijev
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Zivkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - A Pavlovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - A Obreski
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - A Dolicanin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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23
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Radomirovic M, Milasinovic D, Mehmedbegovic Z, Jelic D, Zobenica V, Zaharijev S, Zivkovic I, Pavlovic A, Dudic J, Obreski A, Dolicanin A, Vukcevic V, Asanin M, Stankovic G. P5011Impact of guideline-recommended medical therapy at discharge on long-term mortality in patients with or without left ventricular dysfunction after primary PCI for STEMI. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0189] [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
Clinical practice guidelines provide class I recommendation for the use of angiotensin-converting enzyme inhibitors (ACE-I) and beta-blockers in patients with prior myocardial infarction and left ventricular (LV) dysfunction, whereas their use in patients without LV dysfunction is considered to be a class IIa recommendation.
Purpose
Our aim was to comparatively assess the impact of ACE-I and/or beta-blockers on 3-year mortality in patients with or without impaired left ventricular (LV) function undergoing primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI).
Methods
The analysis included 4425 patients admitted for primary PCI during 2009–2015 from a prospective, electronic registry of a high-volume tertiary center, who survived initial hospitalization, and for whom information on LV function and discharge medication were available. Patients were stratified according to LV systolic dysfunction, defined as LVEF <40%. Unadjusted and adjusted Cox regression models were created to investigate the impact of beta-blocker and/or ACE-I therapy on 3-year mortality.
Results
22.9% (n=1013) had LV dysfunction, 23.0% (n=1017) received either an ACE-I or a beta-blocker and 72.2% received both medications at discharge (n=3197). The concurrent use of both ACE-I and beta-blockers was not different in LVEF≥40% vs. LVEF<40% (72.4% vs. 71.7%, p=0.43). The use of at least one of the guideline-recommended medications was associated with a significantly lower 3-year mortality in both patients with LVEF≥40% (18.7% if neither was used, 11.2% if either a beta-blocker or an ACE-I were used and 9.4% if both were used, p=0.001), and LVEF<40% (55.4% if neither was used, 32.5% if either a beta-blocker or an ACE-I were used and 22.9% if both were used, p<0.001) (Figure). After adjusting for significant mortality predictors including older age, diabetes, hypertension, renal failure, previous stroke, Killip class ≥2 and non-culprit chronic total occlusion (CTO), the concurrent use of both a beta-blocker and an ACE-I remained independently associated with lower 3-year mortality in both patients with LVEF<40% (HR 0.30, p<0.001) and LVEF≥40% (HR=0.41, p=0.001). The use of a single agent was independently associated with lower mortality in patients with LVEF<40% (HR 0.45, p=0.002), but not in patients with LVEF≥40% (HR 0.61, p=0.07).
Conclusions
Guideline-recommended use of both a beta-blocker and an ACE-I in post-MI patients was associated with a lower 3-year mortality regardless of the LV function, whereas using only one of the two agents was associated with improved prognosis only in patients with LV dysfunction, but not in patients without LV impairment.
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Affiliation(s)
- M Radomirovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - D Jelic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - S Zaharijev
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - I Zivkovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - A Pavlovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - J Dudic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - A Obreski
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - A Dolicanin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Clinic for Cardiology, Belgrade, Serbia
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24
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Mehmedbegovic Z, Milasinovic D, Jelic D, Zobenica V, Radomirovic M, Veljic I, Pavlovic A, Dedovic V, Dudic J, Asanin M, Vukcevic V, Stankovic G. P849Comparison of long-term mortality risk assessed with recalculated (maximal) CADILLAC score vs. baseline (admission) CADILLAC score in STEMI patients undergoing primary PCI. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0447] [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
Since patients with STEMI have high rate of adverse events not only during hospital stay, but also during short and long-term follow–up, appropriate risk stratification is a key part of the management of these patients following hospital discharge. CADILLAC score was derived and subsequently validated as accurate clinical tool for identifying patients with heightened risk following index event.
Purpose
We aimed to compare predictive value of recalculated, maximal, (M-) CADILLAC score vs. baseline (B-) CADILLAC score for long-term mortality in hospital survivors.
Methods
From a prospective electronic registry of a high-volume catheterization laboratory in a period from January 2009 to December 2017, a total of 5387 consecutive patients STEMI who underwent primary PCI were included in analysis. For each patient B-CADILLAC score was calculated, and for survivors, we recalculated M-CADILLAC score, incorporating changes in three variable score individual contributors (worsening of Killip class, anemia development and renal function deterioration). As in original score derivation, patients with cardiogenic shock were excluded from analysis. Discrimination of the two risk models was evaluated by the C-statistic, Net reclassification index (NRI) and Integrated Discrimination Improvement (IDI) index.
Results
For 111 (2.1%) patients that died in-hospital, B-CADILLAC very well predicted the event (AUC 0.87, 95% CI 0.86–0.88; p<0.0001) (Figure 1A). For hospital survivors, both evaluated scores showed good discriminative ability for long-term mortality (11.7%) but recalculated M-CADILLAC score was statistically better predictor of long-term mortality, as assessed by C-statistics (Table 1 & Figure 1B):
NRI showed that 38% of patients were reclassified with M-CADILLAC with IDI slope 0.8% higher than in first model.
Table 1 4723 pts (follow-up=90% pts, 41±27 months) AUC 95% CI p B-CADILLAC 0.756 0.744–0.768 p=0.018 M-CADILLAC 0.776 0.754–0.779
Figure 1
Conclusions
Baseline CADILLAC score has very good predictive ability for in-hospital mortality, but recalculated, maximal CADILLAC score offers discriminative advantage in hospital survivors for prediction of long-term mortality in STEMI patients undergoing primary PCI.
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Affiliation(s)
- Z Mehmedbegovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - D Jelic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - I Veljic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - V Dedovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - J Dudic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Department of cardiology, Belgrade, Serbia
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25
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Mehmedbegovic Z, Milasinovic D, Jelic D, Zobenica V, Dedovic V, Radomirovic M, Zaharijev S, Pavlovic A, Dudic J, Tesic M, Zivkovic M, Veljic I, Asanin M, Vukcevic V, Stankovic G. P845Comparison of the performance of the five validated risk scores in acute myocardial infarction patients undergoing primary PCI. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0443] [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
Several risk scores have been developed to predict mortality of patients with acute myocardial infarction (AMI) undergoing primary percutaneous coronary intervention (pPCI), with limited data on the comparative prognostic value of these models.
Purpose
We aimed to compare the prognostic value of five validated risk scores for in-hospital and one-year mortality of patients with AMI undergoing pPCI.
ume catheterization laboratory in a period from January 2009 to December 2017, a total of 3868 consecutive patients who underwent pPCI were available for analysis. For each patient, the Thrombolysis In Myocardial Infarction (TIMI), Controlled Abciximab and Device Investigation to Lower Late Angioplasty complications (CADILLAC), ACTION Registry-GWTG in-hospital mortality risk score (ACTION), Age, Creatinine, and Ejection Fraction (ACEF), and ZWOLLE risk scores were calculated using required clinical and angiographic characteristics. In-hospital and one-year mortality were assessed (follow-up available for 92% of pts). Calibration and discrimination of the three risk models were evaluated by the Hosmer-Lemeshow (H-L) goodness-of-fit test and C-statistic, respectively.
Results
Mortality rates for in-hospital and one-year mortality were 1.8% and 6.9% respectively. All five scores showed good model calibration as assessed by the H-L test and very good discriminative power for in-hospital and one-year mortality as assessed by C-statistics (Table 1 & Figure 1):
Table 1 Risk score H-L H-L p AUC in-hospital 95% CI Significant p AUC one-year 95% CI Significant p ZWOLLE 1.3 0.7 0.90 0.89–0.91 vs. CADILLAC <0.05 0.75 0.74–0.77 vs. TIMI <0.005 ACTION 13.1 0.1 0.87 0.86–0.88 vs. TIMI <0.005 0.79 0.77–0.80 CADILLAC 5.5 0.2 0.85 0.84–0.86 vs. TIMI <0.01 0.81 0.80–0.83 vs. ZWOLLE <0.000 vs. TIMI <0.000 ACEF 9.9 0.3 0.814 0.83–0.85 0.80 0.78–0.81 vs. ZWOLLE <0.000 vs. TIMI <0.05 TIMI 7.1 0.3 0.79 0.78–0.80 0.76 0.75–0.78
Figure 1
Conclusion
Risk stratification of patients with AMI undergoing pPCI using the ZWOLLE, ACTION, CADILLAC, ACEF or TIMI risk scores enables accurate identification of high-risk patients for in-hospital and one-year mortality in an all-comers population. Among evaluated scores, ZWOLLE model was better fitted for prediction of in-hospital mortality while CADILLAC and ACEF better predicted late events.
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Affiliation(s)
- Z Mehmedbegovic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - D Jelic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - V Dedovic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - M Radomirovic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - S Zaharijev
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - J Dudic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - M Tesic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - M Zivkovic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - I Veljic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Department of Cardiology, Belgrade, Serbia
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26
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Mitic S, Stojanovic B, Tosic S, Pavlovic A, Kostic D, Mitic M. Comparative Study on Minerals in Peel and Pulp of Peach (Prunus persica L.) Fruit. Rev Chim 2019. [DOI: 10.37358/rc.19.6.7323] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In this study, variations of minerals contents between peel and pulp parts of six different peach varieties originated from Serbia were investigated by using inductively coupled plasma optical emission spectrophotometry and one-way analysis of variance (ANOVA) with Tukey�s post-hoc test. The content of fifteen elements was determined and content of K was highest among macroelements and Fe among microelements in both parts of the peach fruit. Also, peach peel had higher levels of all minerals with the exception of K. Greater differences between the peel and the pulp and the same parts of different types of peaches are observed in the case of macroelements than the microelements. Hg and Cd are not detected while the contents of Pb and As are below prescribed values.
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27
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Miller RJH, Heidary S, Pavlovic A, Schlachter A, Dash R, Fleischmann D, Ashley EA, Wheeler MT, Yang PC. Defining genotype-phenotype relationships in patients with hypertrophic cardiomyopathy using cardiovascular magnetic resonance imaging. PLoS One 2019; 14:e0217612. [PMID: 31199839 PMCID: PMC6568393 DOI: 10.1371/journal.pone.0217612] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/16/2019] [Indexed: 01/28/2023] Open
Abstract
PURPOSE HCM is the most common inherited cardiomyopathy. Historically, there has been poor correlation between genotype and phenotype. However, CMR has the potential to more accurately assess disease phenotype. We characterized phenotype with CMR in a cohort of patients with confirmed HCM and high prevalence of genetic testing. METHODS Patients with a diagnosis of HCM, who had undergone contrast-enhanced CMR were identified. Left ventricular mass index (LVMI) and volumes were measured from steady-state free precession sequences. Late gadolinium enhancement (LGE) was quantified using the full width, half maximum method. All patients were prospectively followed for the development of septal reduction therapy, arrhythmia or death. RESULTS We included 273 patients, mean age 51.2 ± 15.5, 62.9% male. Of those patients 202 (74.0%) underwent genetic testing with 90 pathogenic, likely pathogenic, or rare variants and 13 variants of uncertain significance identified. Median follow-up was 1138 days. Mean LVMI was 82.7 ± 30.6 and 145 patients had late gadolinium enhancement (LGE). Patients with beta-myosin heavy chain (MYH7) mutations had higher LV ejection fraction (68.8 vs 59.1, p<0.001) than those with cardiac myosin binding protein C (MYBPC3) mutations. Patients with MYBPC3 mutations were more likely to have LVEF < 55% (29.7% vs 4.9%, p = 0.005) or receive a defibrillator than those with MYH7 mutations (54.1% vs 26.8%, p = 0.020). CONCLUSIONS We found that patients with MYBPC3 mutations were more likely to have impaired ventricular function and may be more prone to arrhythmic events. Larger studies using CMR phenotyping may be capable of identifying additional characteristics associated with less frequent genetic causes of HCM.
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Affiliation(s)
- Robert J. H. Miller
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Shahriar Heidary
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Aleksandra Pavlovic
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Audrey Schlachter
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Rajesh Dash
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, Stanford, California, United States of America
| | - Euan A. Ashley
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Matthew T. Wheeler
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- Center for Inherited Cardiovascular Disease, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
| | - Phillip C. Yang
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States of America
- * E-mail:
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McConnell MV, Shcherbina A, Pavlovic A, Homburger JR, Goldfeder RL, Waggot D, Cho MK, Rosenberger ME, Haskell WL, Myers J, Champagne MA, Mignot E, Landray M, Tarassenko L, Harrington RA, Yeung AC, Ashley EA. Feasibility of Obtaining Measures of Lifestyle From a Smartphone App: The MyHeart Counts Cardiovascular Health Study. JAMA Cardiol 2019; 2:67-76. [PMID: 27973671 DOI: 10.1001/jamacardio.2016.4395] [Citation(s) in RCA: 147] [Impact Index Per Article: 29.4] [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]
Abstract
Importance Studies have established the importance of physical activity and fitness, yet limited data exist on the associations between objective, real-world physical activity patterns, fitness, sleep, and cardiovascular health. Objectives To assess the feasibility of obtaining measures of physical activity, fitness, and sleep from smartphones and to gain insights into activity patterns associated with life satisfaction and self-reported disease. Design, Setting, and Participants The MyHeart Counts smartphone app was made available in March 2015, and prospective participants downloaded the free app between March and October 2015. In this smartphone-based study of cardiovascular health, participants recorded physical activity, filled out health questionnaires, and completed a 6-minute walk test. The app was available to download within the United States. Main Outcomes and Measures The feasibility of consent and data collection entirely on a smartphone, the use of machine learning to cluster participants, and the associations between activity patterns, life satisfaction, and self-reported disease. Results From the launch to the time of the data freeze for this study (March to October 2015), the number of individuals (self-selected) who consented to participate was 48 968, representing all 50 states and the District of Columbia. Their median age was 36 years (interquartile range, 27-50 years), and 82.2% (30 338 male, 6556 female, 10 other, and 3115 unknown) were male. In total, 40 017 (81.7% of those who consented) uploaded data. Among those who consented, 20 345 individuals (41.5%) completed 4 of the 7 days of motion data collection, and 4552 individuals (9.3%) completed all 7 days. Among those who consented, 40 017 (81.7%) filled out some portion of the questionnaires, and 4990 (10.2%) completed the 6-minute walk test, made available only at the end of 7 days. The Heart Age Questionnaire, also available after 7 days, required entering lipid values and age 40 to 79 years (among 17 245 individuals, 43.1% of participants). Consequently, 1334 (2.7%) of those who consented completed all fields needed to compute heart age and a 10-year risk score. Physical activity was detected for a mean (SD) of 14.5% (8.0%) of individuals' total recorded time. Physical activity patterns were identified by cluster analysis. A pattern of lower overall activity but more frequent transitions between active and inactive states was associated with equivalent self-reported cardiovascular disease as a pattern of higher overall activity with fewer transitions. Individuals' perception of their activity and risk bore little relation to sensor-estimated activity or calculated cardiovascular risk. Conclusions and Relevance A smartphone-based study of cardiovascular health is feasible, and improvements in participant diversity and engagement will maximize yield from consented participants. Large-scale, real-world assessment of physical activity, fitness, and sleep using mobile devices may be a useful addition to future population health studies.
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Affiliation(s)
- Michael V McConnell
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California3Verily Life Sciences LLC, South San Francisco, California
| | - Anna Shcherbina
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Aleksandra Pavlovic
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | | | - Rachel L Goldfeder
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Daryl Waggot
- Department of Medicine, Stanford University, Stanford, California5Stanford Center for Cardiovascular Innovation, Stanford University, Stanford, California
| | - Mildred K Cho
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California6Stanford Center for Biomedical Ethics, Stanford University, Stanford, California
| | - Mary E Rosenberger
- Stanford Prevention Research Center, Stanford University, Stanford, California
| | - William L Haskell
- Stanford Prevention Research Center, Stanford University, Stanford, California
| | - Jonathan Myers
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Mary Ann Champagne
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Emmanuel Mignot
- Stanford Sleep Center, Stanford University, Palo Alto, California
| | - Martin Landray
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, England
| | | | - Robert A Harrington
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California
| | - Alan C Yeung
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California5Stanford Center for Cardiovascular Innovation, Stanford University, Stanford, California
| | - Euan A Ashley
- Department of Medicine, Stanford University, Stanford, California2Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California4Department of Genetics, Stanford University, Stanford, California
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29
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Hershman SG, Bot BM, Shcherbina A, Doerr M, Moayedi Y, Pavlovic A, Waggott D, Cho MK, Rosenberger ME, Haskell WL, Myers J, Champagne MA, Mignot E, Salvi D, Landray M, Tarassenko L, Harrington RA, Yeung AC, McConnell MV, Ashley EA. Physical activity, sleep and cardiovascular health data for 50,000 individuals from the MyHeart Counts Study. Sci Data 2019; 6:24. [PMID: 30975992 PMCID: PMC6472350 DOI: 10.1038/s41597-019-0016-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/04/2019] [Indexed: 01/21/2023] Open
Abstract
Studies have established the importance of physical activity and fitness for long-term cardiovascular health, yet limited data exist on the association between objective, real-world large-scale physical activity patterns, fitness, sleep, and cardiovascular health primarily due to difficulties in collecting such datasets. We present data from the MyHeart Counts Cardiovascular Health Study, wherein participants contributed data via an iPhone application built using Apple's ResearchKit framework and consented to make this data available freely for further research applications. In this smartphone-based study of cardiovascular health, participants recorded daily physical activity, completed health questionnaires, and performed a 6-minute walk fitness test. Data from English-speaking participants aged 18 years or older with a US-registered iPhone who agreed to share their data broadly and who enrolled between the study's launch and the time of the data freeze for this data release (March 10 2015-October 28 2015) are now available for further research. It is anticipated that releasing this large-scale collection of real-world physical activity, fitness, sleep, and cardiovascular health data will enable the research community to work collaboratively towards improving our understanding of the relationship between cardiovascular indicators, lifestyle, and overall health, as well as inform mobile health research best practices.
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Affiliation(s)
- Steven G Hershman
- Department of Medicine, Stanford University, Stanford, California, USA. .,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.
| | | | - Anna Shcherbina
- Department of Medicine, Stanford University, Stanford, California, USA
| | | | - Yasbanoo Moayedi
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Ted Rogers Centre of Excellence for Heart Function, Toronto, Ontario, Canada
| | - Aleksandra Pavlovic
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Daryl Waggott
- Department of Medicine, Stanford University, Stanford, California, USA.,Stanford Center for Cardiovascular Innovation, Stanford University, Stanford, California, USA
| | - Mildred K Cho
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Stanford Center for Biomedical Ethics, Stanford University, Stanford, California, USA
| | - Mary E Rosenberger
- Stanford Center on Longevity, Stanford University, Stanford, California, USA
| | - William L Haskell
- Stanford Prevention Research Center, Stanford University, Stanford, California, USA
| | - Jonathan Myers
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Mary Ann Champagne
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Emmanuel Mignot
- Stanford Sleep Center, Stanford University, Palo Alto, California, USA
| | - Dario Salvi
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Martin Landray
- Big Data Institute, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Lionel Tarassenko
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, United Kingdom
| | - Robert A Harrington
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA
| | - Alan C Yeung
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Stanford Center for Cardiovascular Innovation, Stanford University, Stanford, California, USA
| | - Michael V McConnell
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Verily Life Sciences LLC, South San Francisco, California, USA
| | - Euan A Ashley
- Department of Medicine, Stanford University, Stanford, California, USA.,Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, California, USA.,Department of Genetics, Stanford University, Stanford, California, USA
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Kolarevic A, Pavlovic A, Djordjevic A, Lazarevic J, Savic S, Kocic G, Anderluh M, Smelcerovic A. Rutin as Deoxyribonuclease I Inhibitor. Chem Biodivers 2019; 16:e1900069. [DOI: 10.1002/cbdv.201900069] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 03/18/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Ana Kolarevic
- Department of Pharmacy, Faculty of MedicineUniversity of Nis Bulevar Dr Zorana Djindjica 81 18000 Nis Serbia
| | - Aleksandra Pavlovic
- Department of Chemistry, Faculty of Science and MathematicsUniversity of Nis Visegradska 33 18000 Nis Serbia
| | - Aleksandra Djordjevic
- Department of Chemistry, Faculty of Science and MathematicsUniversity of Nis Visegradska 33 18000 Nis Serbia
| | - Jelena Lazarevic
- Department of Chemistry, Faculty of MedicineUniversity of Nis Bulevar Dr Zorana Djindjica 81 18000 Nis Serbia
| | - Sasa Savic
- Faculty of TechnologyUniversity of Nis Bulevar Oslobodjenja 124 16000 Leskovac Serbia
| | - Gordana Kocic
- Institute of Biochemistry, Faculty of MedicineUniversity of Nis Bulevar Dr Zorana Djindjica 81 18000 Nis Serbia
| | - Marko Anderluh
- Department of Pharmaceutical Chemistry, Faculty of PharmacyUniversity of Ljubljana Askerceva cesta 7 1000 Ljubljana Slovenia
| | - Andrija Smelcerovic
- Department of Chemistry, Faculty of MedicineUniversity of Nis Bulevar Dr Zorana Djindjica 81 18000 Nis Serbia
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31
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Sandset EC, de Sousa DA, Christensen H, Cordonnier C, Fischer U, Katan M, Kremer C, Pavlovic A, Sprigg N, Bart van der Worp H, Zedde M, Caso V. Women in the European Stroke Organisation: One, two, many… - A Top Down and Bottom Up approach. Eur Stroke J 2019; 4:247-253. [PMID: 31984232 DOI: 10.1177/2396987319841979] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 11/29/2018] [Accepted: 03/10/2019] [Indexed: 11/15/2022] Open
Abstract
Background An increasing proportion of physicians are women, yet they still face challenges with career advancement. In 2014, the European Stroke Organisation established the goal of increasing the number and participation of women within the society using a Top Down and Bottom Up approach. The 'Women's Initiative for Stroke in Europe' was created the same year by a group of women active within the organisation. We aimed to assess the current status of women in European Stroke Organisation, and to explore the change in sex differences after the introduction of focused approaches to address disparities in 2014. Methods Using organisational records, we collected data on sex differences in core activities from 2008 up to 2017 including membership, participation in conferences, courses and in the official journal of the society, and positions of seniority and leadership. We estimated sex distribution differences in each of the activities from 2014 to date. Results In 2017, the proportion of female members was 40%, while 24% of fellows, 22% of the executive board and 19% of the editorial board in the official journal of the society were women. From 2014 to 2017, there was a significant increase in the proportion of female members (p = 0.0002) and in women participating in the annual conference as faculty (p = 0.001). There was no significant change in the sex distribution among the faculty members in junior educational activities (≤27%) or fellows. Interpretation In 2017, the proportion of women holding positions of seniority and leadership is still significantly lower to the proportion of women attending educational activities. Transparent data on sex distribution will assist implementing tailored programmes to achieve progress against sex-based barriers.
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Affiliation(s)
| | - Diana Aguiar de Sousa
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Hanne Christensen
- Department of Neurology, Bispebjerg Hospital & University of Copenhagen, Copenhagen, Denmark
| | | | - Urs Fischer
- Department of Neurology, University Hospital Bern, Bern, Switzerland
| | - Mira Katan
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Christine Kremer
- Department of Neurology, Skåne University Hospital Malmö, Department of Clinical Sciences Lund University, Malmö, Sweden
| | - Aleksandra Pavlovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Sprigg
- Division of Clinical Neurosciences, University of Nottingham, Nottingham, UK
| | - H Bart van der Worp
- Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Marialuisa Zedde
- Neurology Unit-Stroke Unit, Arcispedale Santa Maria Nuova, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Valeria Caso
- Stroke Unit, Santa Maria della Misericordia, University of Perugia, Perugia, Italy
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32
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Mehmedbegovic Z, Milasinovic D, Jelic D, Zaharijev S, Zobenica V, Pavlovic A, Dedovic V, Vukcevic V, Stankovic S, Asanin M, Stankovic G. P6362Comparison of the predictive value of contemporary risk scores for CIN development in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6362] [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)
- Z Mehmedbegovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - D Milasinovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - D Jelic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - S Zaharijev
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - V Zobenica
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - V Dedovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - V Vukcevic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - S Stankovic
- Clinical center of Serbia, Center for Medical Biochemistry, Belgrade, Serbia
| | - M Asanin
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - G Stankovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
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33
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Mehmedbegovic Z, Milasinovic D, Jelic D, Zaharijev S, Zobenica V, Pavlovic A, Dedovic V, Radomirovic M, Milosevic A, Vukcevic V, Stankovic S, Asanin M, Stankovic G. 4060The effect of optimal medical therapy on hospital discharge on 3-year mortality after acute myocardial infarction in patients undergoing primary percutaneous intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.4060] [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)
- Z Mehmedbegovic
- Clinical Center of Serbia, Institute for Cardiovascular Diseases, Belgrade, Serbia
| | - D Milasinovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - D Jelic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - S Zaharijev
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - V Zobenica
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - V Dedovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - M Radomirovic
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - A Milosevic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - V Vukcevic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - S Stankovic
- Clinical center of Serbia, Center for Medical Biochemistry, Belgrade, Serbia
| | - M Asanin
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - G Stankovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
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Zobenica V, Milasinovic D, Mehmedbegovic Z, Zaharijev S, Jelic D, Pavlovic A, Dedovic V, Vukcevic V, Stankovic S, Asanin M, Stankovic G. P6198Association of heart failure and contrast-induced acute kidney injury on short- and long-term mortality in patients with STEMI undergoing primary PCI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6198] [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)
- V Zobenica
- Clinical center of Serbia, Belgrade, Serbia
| | | | | | | | - D Jelic
- Clinical center of Serbia, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - V Dedovic
- Clinical center of Serbia, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Belgrade, Serbia
| | | | - M Asanin
- Clinical center of Serbia, Belgrade, Serbia
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35
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Jelic D, Milasinovic D, Mehmedbegovic Z, Zaharijev S, Zobenica V, Pavlovic A, Dedovic V, Vukcevic V, Asanin M, Stankovic G. P4397Effect of mild renal failure on admission on short- and long-term outcomes in patients with STEMI undergoing primary PCI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4397] [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)
- D Jelic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - S Zaharijev
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - V Dedovic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Department of Cardiology, Belgrade, Serbia
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36
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Mehmedbegovic Z, Milasinovic D, Jelic D, Zaharijev S, Zobenica V, Pavlovic A, Dedovic V, Radomirovic M, Milosevic A, Stankovic S, Vukcevic V, Asanin M, Stankovic G. P778Gender stratified predictive capability of three well-validated risk scores in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p778] [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: 11/12/2022] Open
Affiliation(s)
- Z Mehmedbegovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - D Milasinovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - D Jelic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - S Zaharijev
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - V Zobenica
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Belgrade, Serbia
| | - V Dedovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - M Radomirovic
- University of Belgrade, School of Medicine, Belgrade, Serbia
| | - A Milosevic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - S Stankovic
- Clinical Center of Serbia, Center for Medical Biochemistry, Belgrade, Serbia
| | - V Vukcevic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - M Asanin
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
| | - G Stankovic
- Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
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Zaharijev S, Milasinovic D, Mehmedbegovic Z, Jelic D, Zobenica V, Pavlovic A, Dedovic V, Vukcevic V, Asanin M, Stankovic G. P5556Association of admission anemia and heart failure on short- and long-term outcomes in patients with STEMI undergoing primary PCI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5556] [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 Zaharijev
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - D Milasinovic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | | | - D Jelic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - V Zobenica
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Cardiology, Belgrade, Serbia
| | - V Dedovic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - V Vukcevic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - M Asanin
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
| | - G Stankovic
- Clinical center of Serbia, Cardiology, Belgrade, Serbia
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Dedovic V, Milasinovic D, Jelic D, Vasilev V, Zivkovic M, Marinkovic M, Zaharijev S, Zobenica V, Pavlovic A, Mehmedbegovic Z, Tesic M, Stojkovic S, Vukcevic V, Asanin M, Stankovic G. P577Differential impact of gender on the relationship between body mass index and mortality in STEMI patients undergoing primary PCI. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p577] [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)
- V Dedovic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - D Milasinovic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - D Jelic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - V Vasilev
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - M Zivkovic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - M Marinkovic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - S Zaharijev
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - V Zobenica
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - A Pavlovic
- University Children's Hospital of Belgrade, Cardiology, Belgrade, Serbia
| | - Z Mehmedbegovic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - M Tesic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - S Stojkovic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - V Vukcevic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
| | - M Asanin
- Clinical Center of Serbia, Coronary Care Unit, Belgrade, Serbia
| | - G Stankovic
- Clinical Center of Serbia, Catheterization Laboratory, Belgrade, Serbia
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Knowles JW, Zarafshar S, Pavlovic A, Goldstein BA, Tsai S, Li J, McConnell MV, Absher D, Ashley EA, Kiernan M, Ioannidis JPA, Assimes TL. Impact of a Genetic Risk Score for Coronary Artery Disease on Reducing Cardiovascular Risk: A Pilot Randomized Controlled Study. Front Cardiovasc Med 2017; 4:53. [PMID: 28856136 PMCID: PMC5558259 DOI: 10.3389/fcvm.2017.00053] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [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: 05/04/2017] [Accepted: 07/31/2017] [Indexed: 01/29/2023] Open
Abstract
Purpose We tested whether providing a genetic risk score (GRS) for coronary artery disease (CAD) would serve as a motivator to improve adherence to risk-reducing strategies. Methods We randomized 94 participants with at least moderate risk of CAD to receive standard-of-care with (N = 49) or without (N = 45) their GRS at a subsequent 3-month follow-up visit. Our primary outcome was change in low density lipoprotein cholesterol (LDL-C) between the 3- and 6-month follow-up visits (ΔLDL-C). Secondary outcomes included other CAD risk factors, weight loss, diet, physical activity, risk perceptions, and psychological outcomes. In pre-specified analyses, we examined whether there was a greater motivational effect in participants with a higher GRS. Results Sixty-five participants completed the protocol including 30 participants in the GRS arm. We found no change in the primary outcome between participants receiving their GRS and standard-of-care participants (ΔLDL-C: −13 vs. −9 mg/dl). Among participants with a higher GRS, we observed modest effects on weight loss and physical activity. All other secondary outcomes were not significantly different, including anxiety and worry. Conclusion Adding GRS to standard-of-care did not change lipids, adherence, or psychological outcomes. Potential modest benefits in weight loss and physical activity for participants with high GRS need to be validated in larger trials.
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Affiliation(s)
- Joshua W Knowles
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Shirin Zarafshar
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Aleksandra Pavlovic
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | | | - Sandra Tsai
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.,Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, CA, United States
| | - Jin Li
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael V McConnell
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
| | - Devin Absher
- HudsonAlpha Institute for Biotechnology, Huntsville, AL, United States
| | - Euan A Ashley
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States.,Department of Genetics, Stanford University School of Medicine, Stanford, CA, United States
| | - Michaela Kiernan
- Stanford University School of Medicine, Stanford Prevention Research Center, Stanford, CA, United States
| | - John P A Ioannidis
- Stanford University School of Medicine, Stanford Prevention Research Center, Stanford, CA, United States.,Department of Health Research and Policy, Stanford University School of Medicine, Stanford, CA, United States.,Department of Statistics, Stanford University School of Humanities and Sciences, Stanford, CA, United States
| | - Themistocles L Assimes
- Division of Cardiovascular Medicine, Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, United States
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Zivkovic I, Milasinovic D, Dobras J, Zaharijev S, Mehmedbegovic Z, Pavlovic A, Radomirovic M, Stevanovic M, Matic D, Tesic M, Ristic A, Seferovic P, Vukcevic V, Asanin M, Stankovic G. P4665Impact of the combined anemia and impaired left ventricular function on long-term outcome in STEMI patients undergoing primary PC. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4665] [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: 11/13/2022] Open
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Milasinovic D, Dobras J, Zaharijev S, Mehmedbegovic Z, Pavlovic A, Dedovic V, Stankovic S, Asanin M, Vukcevic V, Stankovic G. P6083Impact of beta-blocker therapy at discharge on long-term mortality in patients with or without impaired left ventricular function undergoing primary PCI for STEMI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6083] [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: 11/14/2022] Open
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Milosevic A, Milasinovic D, Dobras J, Zaharijev S, Stevanovic M, Radomirovic M, Pavlovic A, Mehmedbegovic Z, Dedovic V, Asanin M, Stankovic S, Vukcevic V, Stankovic G. P5590Association of older age with 30-day and 3-year mortality in patients undergoing primary PCI for STEMI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5590] [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: 11/12/2022] Open
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Zivkovic I, Milasinovic D, Dobras J, Zaharijev S, Mehmedbegovic Z, Pavlovic A, Radomirovic M, Stevanovic M, Matic D, Dedovic V, Ristic A, Seferovic P, Vukcevic V, Asanin M, Stankovic G. P3266Differential impact of impaired renal function and acute heart failure on short- and long-term mortality in patients undergoing primary PCI for STEMI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p3266] [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: 11/14/2022] Open
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Zaharijev S, Milasinovic D, Dobras J, Mehmedbegovic Z, Pavlovic A, Zivkovic I, Radomirovic M, Stevanovic M, Stankovic S, Asanin M, Vukcevic V, Stankovic G. P5586Association of admission anemia and renal failure on short- and long-term outcomes in patients undergoing primary percutaneous coronary intervention. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5586] [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: 11/12/2022] Open
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Milasinovic D, Zaharijev S, Dobras J, Pavlovic A, Mehmedbegovic Z, Dedovic V, Radomirovic M, Stevanovic M, Stankovic S, Asanin M, Vukcevic V, Stankovic G. P2291Impact of chronic total occlusion in non-culprit coronary artery on short- and long-term mortality in STEMI patients treated with primary PCI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2291] [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: 11/13/2022] Open
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Mehmedbegovic Z, Milasinovic D, Zaharijev S, Dobras J, Stevanovic M, Radomirovic M, Pavlovic A, Zivkovic M, Dedovic V, Tesic M, Stankovic S, Vukcevic V, Asanin M, Stankovic G. P2746Can we identify with validated risk scores a low-to-intermediate risk patients that could benefit from early discharge after primary PCI? Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2746] [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: 11/14/2022] Open
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Mehmedbegovic Z, Milasinovic D, Zaharijev S, Dobras J, Radomirovic S, Stevanovic M, Zivkovic I, Pavlovic A, Dedovic V, Zivkovic M, Stankovic S, Vukcevic V, Asanin M, Stankovic G. P6076Impact of circumflex as a culprit artery on periprocedural and long-term clinical outcome in patients with acute myocardial infarction. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6076] [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: 11/12/2022] Open
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Dobras J, Milasinovic D, Mehmedbegovic Z, Zaharijev S, Pavlovic A, Zivkovic I, Zivkovic M, Stankovic S, Stevanovic M, Asanin M, Vukcevic V, Stankovic G. P1401Impact of contrast-induced acute kidney injury on short and long-term mortality in patients with renal failure undergoing primary PCI for STEMI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1401] [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: 11/13/2022] Open
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Pavlovic A, Milasinovic D, Mehmedbegovic Z, Dobras J, Zaharijev S, Stevanovic M, Radomirovic M, Zivkovic I, Ristic A, Vukcevic V, Stankovic S, Asanin M, Stankovic G. P5124Impact of admission hyperglycemia on 3-year mortality in diabetic versus non-diabetic patients undergoing primary PCI for STEMI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p5124] [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: 11/13/2022] Open
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Malojcic B, Giannakopoulos P, Sorond FA, Azevedo E, Diomedi M, Oblak JP, Carraro N, Boban M, Olah L, Schreiber SJ, Pavlovic A, Garami Z, Bornstein NM, Rosengarten B. Ultrasound and dynamic functional imaging in vascular cognitive impairment and Alzheimer's disease. BMC Med 2017; 15:27. [PMID: 28178960 PMCID: PMC5299782 DOI: 10.1186/s12916-017-0799-3] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 08/24/2016] [Accepted: 01/21/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND The vascular contributions to neurodegeneration and neuroinflammation may be assessed by magnetic resonance imaging (MRI) and ultrasonography (US). This review summarises the methodology for these widely available, safe and relatively low cost tools and analyses recent work highlighting their potential utility as biomarkers for differentiating subtypes of cognitive impairment and dementia, tracking disease progression and evaluating response to treatment in various neurocognitive disorders. METHODS At the 9th International Congress on Vascular Dementia (Ljubljana, Slovenia, October 2015) a writing group of experts was formed to review the evidence on the utility of US and arterial spin labelling (ASL) as neurophysiological markers of normal ageing, vascular cognitive impairment (VCI) and Alzheimer's disease (AD). Original articles, systematic literature reviews, guidelines and expert opinions published until September 2016 were critically analysed to summarise existing evidence, indicate gaps in current knowledge and, when appropriate, suggest standards of use for the most widely used US and ASL applications. RESULTS Cerebral hypoperfusion has been linked to cognitive decline either as a risk or an aggravating factor. Hypoperfusion as a consequence of microangiopathy, macroangiopathy or cardiac dysfunction can promote or accelerate neurodegeneration, blood-brain barrier disruption and neuroinflammation. US can evaluate the cerebrovascular tree for pathological structure and functional changes contributing to cerebral hypoperfusion. Microvascular pathology and hypoperfusion at the level of capillaries and small arterioles can also be assessed by ASL, an MRI signal. Despite increasing evidence supporting the utility of these methods in detection of microvascular pathology, cerebral hypoperfusion, neurovascular unit dysfunction and, most importantly, disease progression, incomplete standardisation and missing validated cut-off values limit their use in daily routine. CONCLUSIONS US and ASL are promising tools with excellent temporal resolution, which will have a significant impact on our understanding of the vascular contributions to VCI and AD and may also be relevant for assessing future prevention and therapeutic strategies for these conditions. Our work provides recommendations regarding the use of non-invasive imaging techniques to investigate the functional consequences of vascular burden in dementia.
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Affiliation(s)
- Branko Malojcic
- Department of Neurology, University Hospital Center Zagreb, Zagreb School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia.
| | | | - Farzaneh A Sorond
- Department of Neurology, Northwestern University Feinberg School of Medicine Chicago, Chicago, IL, USA
| | - Elsa Azevedo
- Department of Neurology, São João Hospital Center and Faculty of Medicine of University of Porto, Porto, Portugal
| | - Marina Diomedi
- Cerebrovascular Disease Center, Stroke Unit, University of Rome Tor Vergata, Rome, Italy
| | - Janja Pretnar Oblak
- Department of Vascular Neurology and Intensive Therapy, University Medical Center Ljubljana, Ljubljana, Slovenia
| | - Nicola Carraro
- Department of Medical Sciences, Clinical Neurology-Stroke Unit, University Hospital, University of Trieste, Trieste, Italy
| | - Marina Boban
- Department of Neurology, University Hospital Center Zagreb, Zagreb School of Medicine, Kispaticeva 12, 10000, Zagreb, Croatia
| | - Laszlo Olah
- Department of Neurology, University of Debrecen, Debrecen, Hungary
| | - Stephan J Schreiber
- Department of Neurology, Charite - Universitätsmedizin Berlin, Berlin, Germany
| | - Aleksandra Pavlovic
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Zsolt Garami
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Nantan M Bornstein
- Neurology Department, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel
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