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Pediatric heart transplantation in spain after circulatory determination of death and in situ normothermic regional perfusion - ERRATUM. Cardiol Young 2023; 33:1275. [PMID: 37387196 DOI: 10.1017/s1047951123001750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
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Bijoy Khandheria (11 May 1956-13 Feb 2023). Eur Heart J Cardiovasc Imaging 2023; 24:695. [PMID: 37070623 DOI: 10.1093/ehjci/jead064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
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C67A BLITZ-AF CANCER REGISTRY: BASELINE CHARACTERISTICS OF PATIENTS WITH ATRIAL FIBRILLATION AND CANCER. Eur Heart J Suppl 2022. [DOI: 10.1093/eurheartj/suac011.065a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Evidences on atrial fibrillation (AF) in patients with cancer are limited, specifically with respect to antithrombotic therapy.
Methods
BLITZ-AF Cancer is a prospective, non-interventional study of the epidemiology and management of AF in patients with cancer. Patients were included from 112 cardiology units in Italy, Belgium, Netherlands, Spain, Portugal, and Ireland, based on the following criteria: age ≥18 years; documented cancer other than basal-cell or squamous-cell carcinoma of the skin diagnosed within 3 years; electrocardiographically confirmed AF within 1 year; no concomitant interventional study. Follow-up is ongoing.
Results
From June 26th, 2019 to Sep. 30th, 2021, 1,514 subjects were enrolled. The most frequent cancer locations were lung (14.9%), colorectal (14.1%), breast (13.9%), prostate (8.8%), and non-Hodgkin lymphoma (8.1%); 463 (30.6%) of participants had metastases.
AF was first-detected in 323 (21.3%), paroxysmal in 460 (30.4%), persistent in 192 (12.7%), long-standing persistent in 33 (2.2%), and permanent in 506 (33.4%); 590 (39.0%) patients had symptoms attributable to AF.
Baseline characteristics are presented in the Table. Males were more than women and almost half of the subjects was >75 years-old. Cardiovascular risk factors were common and approximately 31% had heart failure or coronary artery disease. Previous thromboembolic and haemorrhagic events had occurred in 14% and 10% of subjects, respectively. The median CHA2DS2VASc score was 3.
As shown in the Figure, the prescription of oral anticoagulants, especially direct-acting ones (DOACs), rose after the cardiology assessment, while the percentage of participants without any antithrombotic therapy declined.
Among 1,427 patients with non-valvular AF (i.e., no mitral stenosis or prosthetic mechanical valve), 997 (69.9%) were prescribed on DOACs at discharge/after consultation. At multivariable logistic regression analysis, variables associated with DOAC use were female sex (OR 1.58, 95% CI 1.22-2.05), age (OR 2.00, 95% CI 1.39-2.88 and OR 2.63, 95%CI 1.84-3.76, respectively, for 65-74 years and ≥75 years vs <65 years), hypertension (OR 1.43, 95%CI 1.10-1.87), long-standing persistent or permanent AF (OR 1.36, 95%CI 1.05-1.78). Haemoglobin <12 g/dL (OR 0.57, 95%CI 0.45-0.73), and planned cancer treatment (OR 0.72, 95%CI 0.57-0.92) were independently associated with a lower prescription of DOACs.
Conclusions
BLITZ-AF Cancer provides extensive information on a large, contemporary cohort of individuals with AF and cancer. This baseline snapshot indicates that cardiologists pursue the implementation of DOACs in these patients, although residual use of other antithrombotic therapies or lack of any thrombo-prophylaxis remains substantial.
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Abstract
Approximately 4% of subjects aged 75 years or more have clinically relevant tricuspid regurgitation (TR). Primary TR results from anatomical abnormality of the tricuspid valve apparatus and is observed in only 8-10% of the patients with tricuspid valve disease. Secondary TR is more common and arises as a result of annular dilation caused by right ventricular enlargement and dysfunction as a consequence of pulmonary hypertension, often caused by left-sided heart disease or atrial fibrillation. Irrespective of its aetiology, TR leads to volume overload and increased wall stress, both of which negatively contribute to detrimental remodelling and worsening TR. This vicious circle translates into impaired survival and increased heart failure symptoms in patients with and without reduced left ventricular ejection fraction. Interventions to correct TR are underutilised in daily clinical practice owing to increased surgical risk and late patient presentation. The recently introduced transcatheter tricuspid valve interventions aim to address this unmet need. Dedicated expertise and an interdisciplinary Heart Team evaluation are essential to integrate these new techniques successfully and select patients. The present article proposes a standardised approach to evaluate patients with TR who may be candidates for transcatheter interventions. In addition, a state-of-the-art review of the available transcatheter therapies, the main criteria for patient and device selection, and information concerning the remaining uncertainties are provided.
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European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions. EUROINTERVENTION 2021; 17:e367-e375. [PMID: 33506796 PMCID: PMC9724983 DOI: 10.4244/eij-d-20-00785] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.
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Beta-blocker effect on ST-segment: a prespecified analysis of the EARLY-BAMI randomised trial. Open Heart 2021; 7:openhrt-2020-001316. [PMID: 33318150 PMCID: PMC7737101 DOI: 10.1136/openhrt-2020-001316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 09/06/2020] [Accepted: 10/23/2020] [Indexed: 11/13/2022] Open
Abstract
Objective The effect of early intravenous (IV) beta-blockers (BBs) administration in patients undergoing primary percutaneous coronary intervention (pPCI) on ST-segment deviation is unknown. We undertook a prespecified secondary analysis of the Early Beta-blocker Administration before primary PCI in patients with
ST-elevation Myocardial Infarction (EARLY-BAMI) trial to investigate the effect of early IV BB on ST-segment deviation. Methods The EARLY-BAMI trial randomised patients with ST-elevation myocardial infarction (STEMI) to IV metoprolol (2×5 mg bolus) or matched placebo before pPCI. The prespecified outcome, evaluated by an independent core laboratory blinded to study treatment, was the residual ST-segment deviation 1 hour after pPCI (ie, the percentage of patients with >3 mm cumulative ST deviation at 1 hour after pPCI). Results An ECG for the evaluation of residual ST-segment deviation 1 hour after pPCI was available in 442 out of 683 randomised patients. The BB group had a lower heart rate after pPCI compared with placebo (71.2±13.2 vs 74.3±13.6, p=0.016); however, no differences were noted in the percentages of patients with >3 mm cumulative ST deviation at 1 hour after pPCI (58.6% vs 54.1%, p=0.38, in BB vs placebo, respectively) neither a significant difference was found for the percentages of patients in each of the four prespecified groups (normalised ST-segment; 1–3 mm; 4–6 mm;>6 mm residual ST-deviation). Conclusions In patients with STEMI, who were being transported for primary PCI, early IV BB administration did not significantly affect ST-segment deviation after pPCI compared with placebo. The neutral result of early IV BB administration on an early marker of pharmacological effect is consistent with the absence of subsequent improvement of clinical outcomes.
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European position paper on the management of patients with patent foramen ovale. Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions. Eur Heart J 2021; 42:1545-1553. [PMID: 33507260 DOI: 10.1093/eurheartj/ehaa1070] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 10/07/2020] [Accepted: 11/17/2020] [Indexed: 02/05/2023] Open
Abstract
Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.
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ANATOMICAL PREDICTORS AND CLINICAL IMPLICATIONS OF MILD OR LESS (0/1+) MR AFTER TMVR: RESULTS FROM THE GLOBAL EXPAND STUDY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02448-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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9
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Proton pump inhibitors and risk for recurrent ischemic events or death in outpatients with symptomatic artery disease. Atherosclerosis 2020; 292:84-89. [DOI: 10.1016/j.atherosclerosis.2019.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Revised: 10/01/2019] [Accepted: 11/12/2019] [Indexed: 02/08/2023]
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P1459 Flu-like syndrome complicated in a rare form of infective endocarditis. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The HACEK group of organisms are one of the infrequent causes of infective endocarditis (IE)(5% of cases in adults).Cultures require long incubation time and clinical presentation may be insidious,delaying final diagnosis.We report a case of subacute atypical presentation of native mitral valve Haemophilus parainfluenzae IE
A 33 yo female with no history of cardiac disease was presented in our hospital with malaise,weakness &high fever till 39oC for at about two weeks.The patient was treated with levofloxacin and discharged. The 1st blood culture was negative.After 25 days the patient was presented with prolonged fever,neurological signs of TIA(motor aphasia and septic embolic episode of 2nd level on the right hand&foot).Physical exam normal,no cardiac murmurs. ECG:normal. Echo:TTE-mitral valve with thickened leaflet, presence of structures suggestive for vegetations (15x19 mm) at the posterior leaflet, perforation of the posterior leaflet causing an IM mild-moderate.TEE-mitral valve with small posterior leaflet, big anterior leaflet with mobile vegetations of coral-forms with diameter maximum 20x10 mm,located at A3 scallop of mitral valve at posteromedial commissural,with a perforation at this level causing moderate IM.No other pathological findings.Cranial CT scan-no data of any acute intracranial abnormality.Body CT scan-a low uptake area of the renal parenchyma related to acute pyelonephritis/infarction.Blood tests-elevated CRP & thrombocytopenia.Blood culture(2nd one): Haemophilus parainfluenzae.Treatment-The patient went on ceftriaxone and underwent a surgical mitral valve repair with mitral annuloplasty and patch placement because of the size of the vegetation and the embolic risk.We also respect the desire of the patient to be pregnant.The patient improved, no fever. Follow-up:CRP normal.TTE echo showed no evidence of the previously detected vegetation with a residual mild MR.The patient was discharged home followed up after 6 weeks with full recovery.
Discussion
We present the case of a young healthy woman without any diseases,admitted with the symptoms of a simple flu-like syndrome with a negative blood culture, but complicated later in one of the rarest forms of IE with Haemophilus parainfluenzae.
HACEK organisms are most often associated with IE, although rare, can be extremely serious because of the tendency of big size vegetation and embolic episodes,but outcomes generally are successful if the organism is identified early and treated appropriately.The treatment of a HACEK infection is based on the location of the infection,clinical severity and available susceptibility data.According to the ESC recommendations Ceftriaxone or ampicillin/sulbactam is the therapy of choice for patients with HACEK endocarditis in both native and prosthetic-valve endocarditis.Fluoroquinolones may be considered as alternative therapy.Regardless of the agent chosen,treatment should last 4– 6 weeks,depending upon the type of valve involved
Abstract P1459 Figure.
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Chronic Kidney Disease Has a Graded Association with Death and Cardiovascular Outcomes in Stable Coronary Artery Disease: An Analysis of 21,911 Patients from the CLARIFY Registry. J Clin Med 2019; 9:E4. [PMID: 31861379 PMCID: PMC7019870 DOI: 10.3390/jcm9010004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 12/01/2022] Open
Abstract
: Chronic kidney disease (CKD) is associated with an increased cardiovascular risk in a broad spectrum of populations. However, the risk associated with a reduced estimated glomerular filtration rate (eGFR) in patients with stable coronary artery disease receiving standard care in the modern era, independently of baseline cardiovascular disease, risk factors, and comorbidities, remains unclear. We analyzed data from 21,911 patients with stable coronary artery disease, enrolled in 45 countries between November 2009 and July 2010 in the CLARIFY registry. Patients with abnormal renal function were older, with more comorbidities, and received slightly lower-although overall high-rates of evidence-based secondary prevention therapies than patients with normal renal function. The event rate of patients with CKD stage 3b or more (eGFR <45 mL/min/1.73 m2) was much higher than that associated with any comorbid condition. In a multivariable adjusted Cox proportional hazards model, lower eGFR was independently associated with a graded increased risk of cardiovascular mortality, with adjusted HRs (95% CI) of 0.98 (0.81-1.18), 1.31 (1.05-1.63), 1.77 (1.38-2.27), and 3.12 (2.25-4.33) for eGFR 60-89, 45-59, 30-44, and <30 mL/min/1.73 m2, compared with eGFR ≥90 mL/min/1.73 m2. A strong graded independent relationship exists between the degree of CKD and cardiovascular mortality in this large cohort of patients with chronic coronary artery disease, despite high rates of secondary prevention therapies. Among clinical risk factors and comorbid conditions, CKD stage 3b or more is associated with the highest cardiovascular mortality.
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P5566Prognostic value of quantitative assessment of tricuspid regurgitation. Correlation between echocardiography and cardiac magnetic resonance. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Significant tricuspid regurgitation (TR) is related to poor prognosis independently of the etiology. TR severity and right ventricular (RV) size and function are determinant in the evaluation of patients with RT and are independently related to outcomes. While TR severity is commonly evaluated with echocardiography (echo), cardiac magnetic resonance (CMR) is the gold standard to study the RV. The association between CMR and echocardiographic measures of quantitative TR is unknown.
Purpose
Our aim was to evaluate the association between the most commonly used methods in both techniques: biplane vena contracta (VC) and effective regurgitant orifice (ERO) parameters evaluated by echo and TR volume (TRV) and TR regurgitant fraction (TRF) by CMR; secondly we aimed to evaluate the prognostic value of each parameter.
Methods
Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 with a contemporaneous echo and CMR were included. TR severity was evaluated by VC and ERO method, using EPIQ system and by VRF and TRF using a 1.5 Tesla CMR Philips scanner. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure.
Results
A total of 36 patients were included (mean age was 72±7 years, 72% females, 94% functional TR). Both VC and ERO showed moderate to strong and significant correlations with VRF and TRF (table). During a median follow up of 20 months [IQR: 10–29], 38% of the patients reached the combined end point (n=7 developed right heart failure, n=11 underwent tricuspid valve surgery, and n=2 died). Patients with events showed a larger ERO and higher VRF and TRF (p<0.01 for all) and a tendency to larger VC (p=0.06). PISA, VRF and TRF were prognostic factors of the combined endpoint (PISA per 0.1 cm2, HR: 282 [3.9–20362], p=0.01; VC per 1 mm, HR 1.27 [0.98–1.64] p=0.06; VRF per 1ml: HR: 1.02 [1.005–1.025], p=0.003; FRT per 1%, HR: 219.5 [4.8–9897], p=0.06). A value of PISA of 0.42, of VRF of 46 ml and FRV of 43% reached the best accuracy to predicted poor outcomes (p<0.01 for all).
Table 1. Bivariate correlations ERO VC Regurgitant volume by CMR R=0.57, p=0.004 R=0.55, p=0.003 Regurgitant fraction by CMR R=0.61, p<0.001 R=0.56, p=0.01
Conclusion
Validated echocardiographic parameters of TR are significantly correlated with quantitative measures by CMR. PISA by echo, and VRF and FRV by CMR are predictive of impaired prognosis. Further studies confirming our CMR cut-off values of poor outcomes are needed for clinical implementation.
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P6488Prognostic value of right ventricular systolic function by speckle tracking echocardiography beyond conventional echocardiography in significant tricuspid regurgitation. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.1078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Right ventricular (RV) systolic function is determinant in the evaluation of patients with significant tricuspid regurgitation (TR). Timely detection of RV dysfunction with conventional 2D echocardiography is limited by the geometry of the RV. RV strain has emerged as an accurate and sensitive tool for evaluation of RV function that can allow detection of subclinical RV dysfunction
Purpose
This study was aimed to evaluate the prognostic value of RV strain in stable patients with significant TR, in comparison with conventional parameters of RV systolic function.
Methods
Consecutive patients in stable clinical status with significant TR evaluated in the Heart Valve Clinic between 2015–2018 were included. RV systolic function was measured with conventional echocardiographic parameters (RV fractional area change [FAC], tricuspid annular plane systolic excursion [TAPSE]), DTI S wave (`S) and with STE derived peak global and free wall longitudinal strain (GLS, FW-LS respectively) using the EPIQ system. End-point included cardiovascular mortality, tricuspid valve surgery or heart failure
Results
A total of 70 patients were included (mean age was 74±8 years, 71% females). 5 patients were excluded due to poor acoustic window. According to ethyology, 94% were functional TR (60% due to left valve disease, 27% due to tricuspid annulus dilatation, 13% others). Mean values of RV function parameters are shown in the table. During a median follow up of 18 months [IQR: 4–28], 37% of the patients reached the combined end point (n=15 developed right heart failure, n=17 underwent tricuspid valve surgery, and n=3 died). Patients with events showed impaired RV-GLS and FW-LS. Both parameters were predictive of the combined endpoint (table 1). Conventional parameters of RV systolic function were not associated with outcomes.
Mean ± SD Mean ± SD Mean ± SD HR (95% confidence interval) P value in Cox regression analysis in all patients in patients with events in patients without events TAPSE 20±5 20±7 21±5 0.97 (0.9–1.06) 0.56 DTI S wave 10.5±2 11±3 10±2 1.08 (0.87–1.35) 0.49 FAC 44±7 43±6 45±8 1.04 (0.97–1.1) 0.22 FW longitudinal strain (FW-LS) 18±5 −16±5* −20±5 0.91 (0.84–0.98) 0.02 Global longitudinal strain (GLS) 19±4 −16±4* −21±4 0.87 (0.81–0.95) 0.001
Conclusion
In patients with asymptomatic TR, RV strain values are superior to conventional parameters to detect RV dysfunction. Among different measurements of RV function, RV GLS and FW-LS were the only predictors of poor prognosis. These parameters may be included in the serial evaluation of these patients.
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The use of handheld ultrasound devices: a position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019; 20:245-252. [PMID: 30351358 DOI: 10.1093/ehjci/jey145] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022] Open
Abstract
Recent technological advances in echocardiography, with progressive miniaturization of ultrasound machines, have led to the development of handheld ultrasound devices (HUD). These devices, no larger than some mobile phones, can be used to perform partial, focused exams as an extension to the physical examination. The European Association of Cardiovascular Imaging (EACVI) acknowledges that the dissemination of appropriate HUD use is inevitable and desirable, because of its potential impact on patient management. However, as a scientific society of cardiac imaging, our role is to provide guidance in order to optimize patient benefit and minimize drawbacks from inappropriate use of this technology. This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users. It also addresses gaps in evidence, controversial issues, and future technological developments.
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European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. EUROINTERVENTION 2019; 14:1389-1402. [PMID: 30141306 DOI: 10.4244/eij-d-18-00622] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/03/2023]
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European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism. Eur Heart J 2018; 40:3182-3195. [PMID: 30358849 DOI: 10.1093/eurheartj/ehy649] [Citation(s) in RCA: 165] [Impact Index Per Article: 27.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 09/28/2018] [Indexed: 02/05/2023] Open
Abstract
Abstract
The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism. For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.
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Coronary Calcification and Male Gender Predict Significant Stenosis in Symptomatic Patients in Northern and Southern Europe and the USA: A Euro-CCAD Study. INTERNATIONAL CARDIOVASCULAR FORUM JOURNAL 2018. [DOI: 10.17987/icfj.v13i0.487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and Aims: Significant stenosis is the principal cause of stable angina but its predictors and their variation by geographical region are unclear.Methods and Results: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 5515 symptomatic patients from northern Europe (Denmark, France, Germany), southern Europe (Italy, Spain) and USA. All had conventional cardiovascular risk factor assessment, angiography and CT scanning for coronary artery calcium (CAC) scoring. There were differences in the patient characteristics between the groups, with the USA patients being younger and having more diet and lifestyle-related risk factors, although hypertension may have been better controlled than in Europe. USA patients had a two-fold increase in prevalence of significant stenosis and a three-fold increase in median CAC score. In all three groups, the log CAC score proved to be the strongest predictor of >50% stenosis followed by male gender. In the USA group, there were no additional independently predictive risk factors, although in northern Europe obesity, hypertension, smoking and hypercholesterolaemia remained predictive, with all risk factors other than hypertension proving to be predictive in the southern Europe group. Without the CAC score as a variable, male gender followed by diabetes were the most important predictors in all three regions, with hypertension also proving predictive in northern Europe.Conclusion: In symptomatic patients, the CAC score and male gender were the two most important predictors of significant stenosis in symptomatic patients in northern and southern Europe and the USA.
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Multimodality Imaging in Restrictive Cardiomyopathies: An EACVI expert consensus document In collaboration with the "Working Group on myocardial and pericardial diseases" of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography. Eur Heart J Cardiovasc Imaging 2018; 18:1090-1121. [PMID: 28510718 DOI: 10.1093/ehjci/jex034] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 02/14/2017] [Indexed: 12/11/2022] Open
Abstract
Restrictive cardiomyopathies (RCMs) are a diverse group of myocardial diseases with a wide range of aetiologies, including familial, genetic and acquired diseases and ranging from very rare to relatively frequent cardiac disorders. In all these diseases, imaging techniques play a central role. Advanced imaging techniques provide important novel data on the diagnostic and prognostic assessment of RCMs. This EACVI consensus document provides comprehensive information for the appropriateness of all non-invasive imaging techniques for the diagnosis, prognostic evaluation, and management of patients with RCM.
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Clinical practice of contrast echocardiography: recommendation by the European Association of Cardiovascular Imaging (EACVI) 2017. Eur Heart J Cardiovasc Imaging 2018; 18:1205-1205af. [PMID: 28950366 DOI: 10.1093/ehjci/jex182] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/16/2022] Open
Abstract
Contrast echocardiography is widely used in cardiology. It is applied to improve image quality, reader confidence and reproducibility both for assessing left ventricular (LV) structure and function at rest and for assessing global and regional function in stress echocardiography. The use of contrast in echocardiography has now extended beyond cardiac structure and function assessment to evaluation of perfusion both of the myocardium and of the intracardiac structures. Safety of contrast agents have now been addressed in large patient population and these studies clearly established its excellent safety profile. This document, based on clinical trials, randomized and multicentre studies and published clinical experience, has established clear recommendations for the use of contrast in various clinical conditions with evidence-based protocols.
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IL-4 and IL-13 Receptor Signaling From 4PS to Insulin Receptor Substrate 2: There and Back Again, a Historical View. Front Immunol 2018; 9:1037. [PMID: 29868002 PMCID: PMC5962649 DOI: 10.3389/fimmu.2018.01037] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 04/25/2018] [Indexed: 12/11/2022] Open
Abstract
In this historical perspective, written in honor of Dr. William E. Paul, we describe the initial discovery of one of the dominant substrates for tyrosine phosphorylation stimulated by IL-4. We further describe how this “IL-4-induced phosphorylated substrate” (4PS) was characterized as a member of the insulin receptor substrate (IRS) family of large adaptor proteins that link IL-4 and insulin receptors to activation of the phosphatidyl-inositol 3′ kinase pathway as well as other downstream signaling pathways. The relative contribution of the 4PS/IRS pathway to the early models of IL-4-induced proliferation and suppression of apoptosis are compared to our more recent understanding of the complex interplay between positive and negative regulatory pathways emanating from members of the IRS family that impact allergic responses.
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Multivariate analysis for coronary heart disease in heterozygote familial hypercholesterolemia patients. Per Med 2018; 15:87-92. [PMID: 29714125 DOI: 10.2217/pme-2017-0075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
AIM rs599839 polymorphism has been related with low levels of cholesterol and reduced coronary heart disease (CHD). METHODS We investigated the frequency of this polymorphism in patients with heterozygous familial hypercholesterolemia (HeFH) in the Spanish familial hypercholesterolemia cohort, 230 with and 202 without CHD. Results & discussion: A lower G-allele prevalence was observed in HeFH patients with CHD with respect to controls, 35 versus 45%, respectively (p = 0.029), suggesting a protective effect. However, it was found that there was no association between rs599839 alleles and CHD in the multivariate analysis. CONCLUSION The frequency of the protective G-allele of the rs599839 polymorphism was lower in HeFH patients with CHD compared with those HeFH patients without CHD. However, its role in HeFH may be masked by very high levels of cholesterol.
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CARDIAC TROPONIN T CONCENTRATIONS MEASURED WITH A HIGH-SENSITIVITY ASSAY INTEGRATE INFORMATION ON REVERSIBLE MYOCARDIAL ISCHEMIA AND LEFT VENTRICULAR MASS IN PATIENTS WITH SUSPECTED STABLE ANGINA PECTORIS: A DOPPLER-CIP SUBSTUDY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)30773-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Multimodality imaging in restrictive cardiomyopathies: an european association of cardiovascular imaging expert consensus document in collaboration with the “Working group on myocardial and pericardial diseases” of the european society of cardiology endorsed by the indian academy of echocardiography. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2018. [DOI: 10.4103/2543-1463.227042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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P4604Residual stroke risk of anticoagulated patients with atrial fibrillation: PREFER in AF European registry. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx504.p4604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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4818Anatomic and functional imaging to predict long-term outcome and benefits of early revascularization in patients with suspected coronary artery disease: results from the EVINCI study. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.4818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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P2402Low flow aortic stenosis: early improvement in left ventricular function after TAVI. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p2402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Diabetes and male sex are key risk factor correlates of the extent of coronary artery calcification: A Euro-CCAD study. J Diabetes Complications 2017; 31:1096-1102. [PMID: 28499962 DOI: 10.1016/j.jdiacomp.2017.03.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/04/2017] [Accepted: 03/28/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND AIMS Although much has been written about the conventional cardiovascular risk factor correlates of the extent of coronary artery calcification (CAC), few studies have been carried out on symptomatic patients. This paper assesses the potential ability of risk factors to associate with an increasing CAC score. METHODS From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and the USA. All had conventional cardiovascular risk factor assessment and CT scanning for CAC scoring. RESULTS Among all patients, male sex (OR = 4.85, p<0.001) and diabetes (OR = 2.36, p<0.001) were the most important risk factors of CAC extent, with age, hypertension, dyslipidemia and smoking also showing a relationship. Among patients with CAC, age, diabetes, hypertension and dyslipidemia were associated with an increasing CAC score in males and females, with diabetes being the strongest dichotomous risk factor (p<0.001 for both). These results were echoed in quantile regression, where diabetes was consistently the most important correlate with CAC extent in every quantile in both males and females. To a lesser extent, hypertension and dyslipidemia were also associated in the high CAC quantiles and the low CAC quantiles respectively. CONCLUSION In addition to age and male sex in the total population, diabetes is the most important correlate of CAC extent in both sexes.
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The use of imaging in new transcatheter interventions: an EACVI review paper. Eur Heart J Cardiovasc Imaging 2016; 17:835-835af. [PMID: 27311822 DOI: 10.1093/ehjci/jew043] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 02/15/2016] [Indexed: 01/28/2023] Open
Abstract
Transcatheter therapies for the treatment of valve heart diseases have expanded dramatically over the last years. The new developments and improvements in devices and techniques, along with the increasing expertise of operators, have turned the catheter-based approaches for valvular disease into an established treatment option. Various imaging techniques are used during these procedures, but echocardiography plays an essential role during patient selection, intra-procedural monitoring, and post-procedure follow-up. The echocardiographic assessment of patients undergoing transcatheter interventions places demands on echocardiographers that differ from those of the routine evaluation of patients with valve disease, and there is a need for specific expertise for those working in the cath lab. In the context of the current rapid developments and growing use of transcatheter valve therapies, this document intends to update the previous recommendations and address new advancements in imaging, particularly for those involved in any stage of the treatment of patients with valvular heart diseases.
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Wireless Ultrasound-Guided Axillary Vein Cannulation for the Implantation of Cardiovascular Implantable Electric Devices. J Cardiovasc Electrophysiol 2016; 27:482-7. [PMID: 26749504 DOI: 10.1111/jce.12917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Revised: 12/10/2015] [Accepted: 12/28/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Ultrasound guidance for vascular cannulation seems safer and more effective than an anatomical landmark approach, though it has not gained widespread support partly due to workflow interference of wired probes. A wireless ultrasound transducer (WUST) may overcome this issue. We report the effectiveness, time consumption, and safety of the first-in-human experience in axillary vein cannulation guided with a novel WUST for the implantation of cardiovascular implantable electric devices (CIEDs). METHODS AND RESULTS After a one-month training period, we routinely performed WUST-guided puncture to all first implants, prospectively registering data from the first 50 patients. We analyzed the time needed for preparing the WUST and for achieving each vein cannulation, and the rate of unsuccessful or accidental arterial punctures and complications. WUST-guided axillary vein access was successful in 49 out of 50 patients, totaling 86 cannulated veins. Median WUST preparation time was 55 [44-62] seconds and median time needed for each venous cannulation was 56 [36-71] seconds. A total of 84.9% of the veins were cannulated at the first attempt. There were 7 unsuccessful puncture attempts and 1 accidental arterial puncture. No pneumothorax, hemothorax, or nervous injury occurred in the 49 successfully cannulated patients. The unsuccessful one (distal subclavian occlusion) developed a minor local subcutaneous emphysema with no confirmed radiologic pneumothorax, not requiring intervention. During a follow-up of 2.5 ± 1.1 months, a patient developed a pocket infection, with no other significant complications. CONCLUSION Ultrasound-guided axillary vein cannulation using a wireless transducer for the implantation of CIEDs is a feasible, fast, and safe method.
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Comparison of right ventricular septal pacing and right ventricular apical pacing in patients receiving cardiac resynchronization therapy defibrillators: the SEPTAL CRT Study. Eur Heart J 2016; 37:473-83. [PMID: 26374852 PMCID: PMC5841219 DOI: 10.1093/eurheartj/ehv422] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 07/17/2015] [Accepted: 08/10/2015] [Indexed: 11/29/2022] Open
Abstract
AIMS Cardiac resynchronization therapy (CRT) is a recommended treatment of heart failure (HF) patients with depressed left ventricular ejection fraction and wide QRS. The optimal right ventricular (RV) lead position being a matter of debate, we sought to examine whether RV septal (RVS) pacing was not inferior to RV apical (RVA) pacing on left ventricular reverse remodelling in patients receiving a CRT-defibrillator. METHODS AND RESULTS Patients (n = 263, age = 63.4 ± 9.5 years) were randomly assigned in a 1:1 ratio to RVS (n = 131) vs. RVA (n = 132) pacing. Left ventricular end-systolic volume (LVESV) reduction between baseline and 6 months was not different between the two groups (-25.3 ± 39.4 mL in RVS group vs. -29.3 ± 44.5 mL in RVA group, P = 0.79). Right ventricular septal pacing was not non-inferior (primary endpoint) to RVA pacing with regard to LVESV reduction (average difference = -4.06 mL; P = 0.006 with a -20 mL non-inferiority margin). The percentage of 'echo-responders' defined by LVESV reduction >15% between baseline and 6 months was similar in both groups (50%) with no difference in the time to first HF hospitalization or death (P = 0.532). Procedural or device-related serious adverse events occurred in 68 patients (RVS = 37) with no difference between the two groups (P = 0.401). CONCLUSION This study demonstrates that septal RV pacing in CRT is non-inferior to apical RV pacing for LV reverse remodelling at 6 months with no difference in the clinical outcome. No recommendation for optimal RV lead position can hence be drawn from this study. CLINICALTRIALS GOV NUMBER NCT 00833352.
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Long-Term Loss of Response in Proton Pump Inhibitor-Responsive Esophageal Eosinophilia Is Uncommon and Influenced by CYP2C19 Genotype and Rhinoconjunctivitis. Am J Gastroenterol 2015; 110:1567-75. [PMID: 26416193 DOI: 10.1038/ajg.2015.314] [Citation(s) in RCA: 82] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 08/14/2015] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Proton pump inhibitor-responsive esophageal eosinophilia (PPI-REE) is diagnosed in at least one-third of patients with suspected eosinophilic esophagitis (EoE). We aimed to evaluate the durability and factors influencing long-term efficacy of PPI therapy. METHODS Retrospective multicenter cohort study of patients with PPI-REE who had at least 12 months of follow-up. PPI therapy was tapered to the lowest dose, which maintained clinical remission. Primary outcomes were the proportion of patients with loss of histological response (<15 eos/HPF) and predictors of loss of response. CYP2C19 polymorphisms were determined from blood samples in a subset of patients. RESULTS Seventy-five PPI-REE patients were included (mean follow-up 26 months (12-85)), of whom fifty-five (73%) had sustained histological remission on low-dose PPI therapy. Loss of response was significantly higher in those patients with a CYP2C19 rapid metabolizer genotype (36% vs. 6%, P = 0.01) and with rhinoconjunctivitis (40% vs. 13%, P = 0.007). On the multivariate analysis, a CYP2C19 rapid metabolizer genotype (odds ratio (OR) 12.5; 95% confidence interval (CI): 1.3-115.9) and rhinoconjunctivitis (OR 8.6; 95% CI: 1.5-48.7) were independent predictors of loss of response. Among relapsing patients, eosinophilia was limited to the distal esophagus in 14/20 (70%). Nine of ten relapsers, with distal eosinophilia, all showing a CYP2C19 rapid metabolizer genotype, regained histological remission after PPI dose intensification. CONCLUSIONS Most PPI-REE patients remain in long-term remission on low-dose PPI therapy. CYP2C19 rapid metabolizer genotypes and rhinoconjunctivitis were independent predictors of loss of response to PPI, but patients frequently responded to PPI dose escalation.
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Poster session 4: Friday 5 December 2014, 08:30-12:30 * Location: Poster area. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Proton pump inhibitor-responsive oesophageal eosinophilia correlates with downregulation of eotaxin-3 and Th2 cytokines overexpression. Aliment Pharmacol Ther 2014; 40:955-65. [PMID: 25112708 DOI: 10.1111/apt.12914] [Citation(s) in RCA: 106] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2014] [Revised: 07/09/2014] [Accepted: 07/22/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The molecular basis and effects of proton pump inhibitor (PPI) therapy on PPI-responsive oesophageal eosinophilia (PPI-REE) and eosinophilic oesophagitis (EoE) remain unknown. AIM To compare symptom-histological and cytokine gene expression in PPI-REE and EoE patients, at baseline and after specific treatment. METHODS In consecutive adult patients with an EoE phenotype (dysphagia/food impaction, typical endoscopic findings and > 15 eos/HPF), gene expression of eotaxin-3, IL-13, and IL-5 were determined in distal and proximal oesophagus, at baseline and after omeprazole 40 mg b.d. for 8 weeks. PPI-REE was defined by clinicohistological response. PPI nonresponders (EoE) were offered treatment with topical steroids. RESULTS Fifty three patients were re-evaluated on PPI therapy. 23 patients (43%) had PPI-REE and 30 patients (57%) had EoE. At baseline, eotaxin-3/IL-13/IL-5 gene expression was indistinguishable between EoE and PPI-REE, excepting increased IL-5 expression in proximal oesophagus (12.54 vs. 57, P = 0.029). PPI therapy significantly decreased eotaxin-3/IL-13 in PPI-REE, at both oesophageal sites (P ≤ 0.008), and IL-5 in distal (P = 0.016), but not in proximal oesophagus. Patients with steroid-responsive EoE also showed a significant decrease in eotaxin-3/IL-5 expression at both oesophageal sites. In EoE patients, initial PPI trial significantly decreased distal oesophageal eosinophilia (63.78 to 41.79 eos/HPF, P = 0.025) and led to symptom remission in 16%, but did not influence Th2 markers. CONCLUSIONS Baseline cytokine gene expression in PPI-REE was nearly indistinguishable from EoE. PPI therapy significantly downregulated oesophageal eotaxin-3/Th2-cytokine gene expression in PPI-REE, similarly to that seen in steroid-responsive EoE. A subset of EoE patients showed clinicohistological improvement on PPI therapy.
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rs1801275 Interleukin-4 receptor alpha polymorphism in familial hypercholesterolemia. J Clin Lipidol 2014; 8:418-22. [DOI: 10.1016/j.jacl.2014.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Revised: 03/08/2014] [Accepted: 04/20/2014] [Indexed: 10/25/2022]
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Combined Spine Conference of the Canadian Spine Society New Zealand Orthopaedic Spine Society, Spine Society of Australia: Fairmont Château Lake Louise, Lake, Louise, Alberta, Tuesday, Feb. 25 to Saturday, Mar. 1, 20141.1.01 The use of suspension radiographs to predict LIV tilt.1.1.02 Surgical correction of adolescent idiopathic scoliosis without fusion: an animal model.1.1.03 Are full torso surface topography postural measurements more sensitive to change than back only parameters in adolescents with idiopathic scoliosis and a main thoracic curve?1.2.04 Restoration of thoracic kyphosis in adolescent idiopathic kyphosis: comparative radiographic analysis of round versus rail rods.1.2.05 Scoliosis surgery in spastic quadriplegic cerebral palsy: Is fusion to the pelvis always necessary? A 4–18-year follow-up study.1.2.06 Identification and validation of pain-related biomarkers surrounding spinal surgery in adolescents.1.3.07 Cervical sagittal deformity develops after PJK in adult throacolumbar deformity correction: radiographic analysis using a novel global sagittal angular parameter, the CTPA.1.3.08 Impact of obesity on complications and patient-reported outcomes in adult spinal deformity surgery.1.3.09 The T1 pelvic angle, a novel radiographic measure of sagittal deformity, accounts for both pelvic retroversion and truncal inclination and correlates strongly with HRQOL.1.4.10 Determining cervical sagittal deformity when it is concurrent with thoracolumbar deformity.1.4.11 The influence of sagittal balance and pelvic parameters on the outcome of surgically treated patients with degenerative spondylolisthesis.1.4.12 Predictors of degenerative spondylolisthesis and loading translation in surgical lumbar spinal stenosis patients.2.1.13 Mechanical allodynia following disc herniation requires intraneural macrophage infiltration and can be blocked by systemic selenium delivery or attenuation of BDNF activity.2.1.14 The effect of alanyl-glutamine on epidural fibrosis in a rat laminectomy model.2.1.15 Anterior lumbar interbody fusion using recombinant human bone morphogenetic protein-2: a prospective study of complications.2.2.16 2-year results of a Canadian, multicentre, blinded, pilot study of a novel peptide in promoting lumbar spine fusion.2.2.17 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: long-term change in health-related quality of life.2.2.18 Changes in objectively measured walking performance, function, and pain following surgery for spondylolisthesis and lumbar spinal stenosis.2.3.19 A prospective multicentre observational data-monitored study of minimally invasive fusion to treat degenerative lumbar disorders: complications and outcomes at 1-year follow-up.2.3.20 Assessment and classification of subsidence in lateral interbody fusion using serial computed tomography.2.3.21 Predictors of willingness to undergo spinal and orthopaedic surgery after surgical consultation.2.4.22 Indirect foraminal decompression is independent of facet arthropathy in extreme lateral interbody fusion.2.4.23 Cervical artificial disc replacement with ProDisc-C: clinical and radiographic outcomes with long-term follow-up.2.4.24 Tantalum trabecular metal implants in anterior cervical corpectomy and fusion.3.1.25 Hemangiomas of the spine: results of surgical management and prognostic variables for local recurrence and mortality in a multicentre study.3.1.26 Chondrosarcomas of the spine: prognostic variables for local recurrence and mortality in a multicentre study.3.1.27 Risk factors for recurrence of surgically treated spine schwannomas: analysis of 169 patients from a multicentre international database.3.2.28 Survival pattern and the effect of surgery on health related quality of life and functional outcome in patients with metastatic epidural spinal cord compression from lung cancer — the AOSpine North America prospective multicentre study.3.2.29 A biomechanical assessment of kyphoplasty as a stand-alone treatment in a human cadaveric burst fracture model.3.2.30 What is safer in incompetent vertebrae with posterior wall defects, kyphoplasty or vertebroplasty: a study in vertebral analogs.3.3.31 Feasibility of recruiting subjects for acute spinal cord injury (SCI) clinical trials in Canada.3.3.32 Prospective analysis of adverse events in elderly patients with traumatic spinal cord injury.3.3.33 Does traction before surgery influence time to neural decompression in patients with spinal cord injury?3.4.34 Current treatment of individuals with traumatic spinal cord injury: Do we need age-specific guidelines?3.4.35 Current surgical practice for traumatic spinal cord injury in Canada.3.4.36 The importance of “time to surgery” for traumatic spinal cord injured patients: results from an ambispective Canadian cohort of 949 patients.3.5.37 Assessment of a novel coil-shaped radiofrequency probe in the porcine spine.3.5.38 The effect of norepinephrine and dopamine on cerebrospinal fluid pressure after acute spinal cord injury.3.5.39 The learning curve of pedicle screw placement: How many screws are enough?4.1.40 Preliminary report from the Ontario Inter-professional Spine Assessment and Education Clinics (ISAEC).4.1.41 A surrogate model of the spinal cord complex for simulating bony impingement.4.1.42 Clinical and surgical predictors of specific complications following surgery for the treatment of degenerative cervical myelopathy: results from the multicentre, prospective AOSpine international study on 479 patients.4.2.43 Outcomes of surgical management of cervical spondylotic myelopathy: results of the prospective, multicentre, AOSpine international study in 479 patients.4.2.44 A clinical prediction rule for clinical outcomes in patients undergoing surgery for degenerative cervical myelopathy: analysis of an international AOSpine prospective multicentre data set of 757 subjects.4.2.45 The prevalence and impact of low back and leg pain among aging Canadians: a cross-sectional survey.4.3.46 Adjacent segment pathology: Progressive disease course or a product of iatrogenic fusion?4.3.47 Natural history of degenerative lumbar spondylolisthesis in patients with spinal stenosis.4.3.48 Changes in self-reported clinical status and health care utilization during wait time for surgical spine consultation: a prospective observational study.4.3.49 The Canadian surgical wait list for lumbar degenerative spinal stenosis has a detrimental effect on patient outcomes.4.3.50 Segmental lordosis is independent of interbody cage position in XLIF.4.3.51 Elevated patient BMI does not negatively affect self-reported outcomes of thoracolumbar surgery.1.5.52 The Spinal Stenosis Pedometer and Nutrition Lifestyle Intervention (SSPANLI): development and pilot.1.5.53 Study evaluating the variability of surgical strategy planning for patients with adult spinal deformity.1.5.54 Atlantoaxial instability in acute odontoid fractures is associated with nonunion and mortality.1.5.55 Peripheral hypersensitivity to subthreshold stimuli persists after resolution of acute experimental disc-herniation neuropathy.1.5.56 Radiation induced lumbar spinal osteonecrosis: case report and literature review.1.5.57 Comparative outcomes and cost-utility following surgical treatment of focal lumbar spinal stenosis compared with osteoarthritis of the hip or knee: Part 2 — estimated lifetime incremental cost-utility ratios.1.5.58 A predictive model of progression for adolescent idiopathic scoliosis based on 3D spine parameters at first visit.1.5.59 Development of a clinical prediction model for surgical decision making in patients with degenerative lumbar spine disease.2.5.60 Canadian spine surgery fellowship education: evaluating opportunity in developing a nationally based training curriculum.2.5.61 Pedicle subtraction osteotomy for severe proximal thoracic junctional kyphosis.2.5.62 A comparison of spine surgery referrals triaged through a multidisciplinary care pathway versus conventional referrals.2.5.63 Results and complications of posterior-based 3 column osteotomies in patients with previously fused spinal deformities.2.5.64 Orthopaedic Surgical AdVerse Event Severity (Ortho-SAVES) system: identifying opportunities for improved patient safety and resource utilization.2.5.65 Spontaneous spinal extra-axial haematomas — surgical experience in Otago and Southland 2011–2013.2.5.66 Obesity and spinal epidural lipomatosis in cauda equina syndrome.2.5.67 Factors affecting restoration of lumbar lordosis in adult degenerative scoliosis patients treated with lateral trans-psoas interbody fusion.3.6.68 Systematic review of complications in spinal surgery: a comparison of retrospective and prospective study design.3.6.69 Postsurgical rehabilitation patients have similar fear avoidance behaviour levels as those in nonoperative care.3.6.70 Outcomes of surgical treatment of adolescent spondyloptosis: a case series.3.6.71 Surgical success in primary versus revision thoracolumbar spine surgery.3.6.72 The effect of smoking on subjective patient outcomes in thoracolumbar surgery.3.6.73 Modelling patient recovery to predict outcomes following elective thoracolumbar surgery for degenerative pathologies.3.6.74 Outcomes from trans-psoas versus open approaches in the treatment of adult degenerative scoliosis.3.6.75 Lumbar spinal stenosis and presurgical assessment: the impact of walking induced strain on a performance-based outcome measure. Can J Surg 2014. [DOI: 10.1503/cjs.005614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Historia natural de la enfermedad tromboembólica venosa en el área mediterránea. Una revisión sistemática. Rev Clin Esp 2014; 214:184-91. [DOI: 10.1016/j.rce.2014.01.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Revised: 01/09/2014] [Accepted: 01/20/2014] [Indexed: 01/31/2023]
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Natural history of venous thromboembolism in patients from the Mediterranean region. A systematic review. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2014.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
RATIONALE Home respiratory polygraphy (HRP) may be a cost-effective alternative to polysomnography (PSG) for diagnosis and treatment election in patients with high clinical probability of obstructive sleep apnea (OSA), but there is conflicting evidence on its use for a wider spectrum of patients. OBJECTIVES To determine the efficacy and cost of OSA management (diagnosis and therapeutic decision making) using (1) PSG for all patients (PSG arm); (2) HRP for all patients (HRP arm); and (3) HRP for a subsample of patients with high clinical probability of being treated with continuous positive airway pressure (CPAP) and PSG for the remainder (elective HRP arm). METHODS Multicentric study of 366 patients with intermediate-high clinical probability of OSA, randomly subjected to HRP and PSG. We explored the diagnostic and therapeutic decision agreements between the PSG and both HRP arms for several HRP cutoff points and calculated costs for equal diagnostic and/or therapeutic decision efficacy. RESULTS For equal diagnostic and therapeutic decision efficacy, PSG arm costs were 18% higher than HRP arm costs and 20% higher than elective HRP arm costs. HRP arm costs tended to be lower than elective HRP arm costs, and both tended to be lower than PSG arm costs if patient costs were omitted. CONCLUSION Home respiratory polygraphy is a less costly alternative than polysomnography for the diagnosis and therapeutic decision making for patients with suspected obstructive sleep apnea. We found no advantage in cost terms, however, in using home respiratory polygraphy for all patients or home respiratory polygraphy for the most symptomatic patients and polysomnography for the rest.
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Differential expression of CD30 on CD3 T lymphocytes in patients with systemic lupus erythematosus. Scand J Immunol 2013; 78:306-12. [PMID: 23790231 DOI: 10.1111/sji.12088] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 06/18/2013] [Indexed: 01/21/2023]
Abstract
Systemic lupus erythematosus (SLE) is an autoimmune systemic disease caused as a result of an imbalance of Th1-/Th2-type cytokines. The soluble form of CD30 (CD30s) released from peripheral blood cells has been described as a marker of active disease in Th2-type immune response as in SLE. However, the expression of CD30 on CD3 T lymphocytes from patients with SLE has not been studied yet. Therefore, we have addressed our study to attempt this issue, studying CD30 expression by flow cytometry on CD3 T lymphocytes and CD4/CD8 subsets in samples from SLE patients mainly with lupus nephritis. In parallel, we have determined the production of the cytokines IL-4 (Th2), IFNγ (Th1), IL-10 and TGFβ by intracellular staining. Differences between positive CD30 T cells in healthy controls and patients with SLE were found, with a higher percentage of CD30-expressing T cells in patients with SLE (P = 0.001). In contrast to healthy controls, CD30 was mainly expressed on CD8 T cells from patients with SLE. The intracellular cytokine staining showed that TGFβ is the main cytokine expressed in CD3 T cells from patients with SLE. In addition to this, we have found a positive correlation between CD30-expressing T cells and IL-4, IFNγ, and immunosuppressive cytokines (IL-10 and TGFβ) (P < 0.05). These results suggest that CD30 could play a role in the pathogenesis of SLE and its expression on CD3 T lymphocytes is not restricted only to Th2-type response.
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Hybrid imaging with coronary tomography and 3D speckle-tracking stress echocardiography fusion. Eur Heart J Cardiovasc Imaging 2013; 15:555. [PMID: 24204034 DOI: 10.1093/ehjci/jet236] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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A novel morphology based algorithm for prediction of antitachycardia pacing success. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht307.p550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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THE IMPACT OF CHRONIC KIDNEY DISEASE ON USE OF EVIDENCE BASED THERAPY IN STABLE CORONARY ARTERY DISEASE: A PROSPECTIVE ANALYSIS OF 22,560 PATIENTS. J Am Coll Cardiol 2013. [DOI: 10.1016/s0735-1097(13)61171-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Significance of including a surrogate arousal for sleep apnea-hypopnea syndrome diagnosis by respiratory polygraphy. Sleep 2013; 36:249-57. [PMID: 23372273 DOI: 10.5665/sleep.2384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
RATIONALE Respiratory polygraphy is an accepted alternative to polysomnography (PSG) for sleep apnea/hypopnea syndrome (SAHS) diagnosis, although it underestimates the apnea-hypopnea index (AHI) because respiratory polygraphy cannot identify arousals. OBJECTIVES We performed a multicentric, randomized, blinded crossover study to determine the agreement between home respiratory polygraphy (HRP) and PSG, and between simultaneous respiratory polygraphy (respiratory polygraphy with PSG) (SimultRP) and PSG by means of 2 AHI scoring protocols with or without hyperventilation following flow reduction considered as a surrogate arousal. METHODS We included suspected SAHS patients from 8 hospitals. They were assigned to home and hospital protocols at random. We determined the agreement between respiratory polygraphy AHI and PSG AHI scorings using Bland and Altman plots and diagnostic agreement using receiver operating characteristic (ROC) curves. The agreement in therapeutic decisions (continuous positive airway pressure treatment or not) between HRP and PSG scorings was done with likelihood ratios and post-test probability calculations. RESULTS Of 366 randomized patients, 342 completed the protocol. AHI from HRP scorings (with and without surrogate arousal) had similar agreement with PSG. AHI from SimultRP with surrogate arousal scoring had better agreement with PSG than AHI from SimultRP without surrogate arousal. HRP with surrogate arousal scoring had slightly worse ROC curves than HRP without surrogate arousal, and the opposite was true for SimultRP scorings. HRP with surrogate arousal showed slightly better agreement with PSG in therapeutic decisions than for HRP without surrogate arousal. CONCLUSION Incorporating a surrogate arousal measure into HRP did not substantially increase its agreement with PSG when compared with the usual procedure (HRP without surrogate arousal).
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Allergen stimulation induces simultaneous production of type 2 helper T cells and regulatory cytokines in patients with pollen allergy. J Investig Allergol Clin Immunol 2013; 23:54-55. [PMID: 23653976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Poster session Thursday 6 December - AM: Other myocardial diseases. Eur Heart J Cardiovasc Imaging 2012. [DOI: 10.1093/ehjci/jes255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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An unusual device-related complication: multiple painful stones after explantation of a subcutaneous Holter system. Europace 2012; 15:693. [PMID: 23034134 DOI: 10.1093/europace/eus319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Distinguishing eosinophilic esophagitis from gastroesophageal reflux disease upon PPI refractoriness: what about PPI-responsive esophageal eosinophilia? Digestion 2012; 85:210. [PMID: 22354119 DOI: 10.1159/000335932] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Aortic pseudoaneurysm with fistulization to the left ventricle. Eur Heart J Cardiovasc Imaging 2012; 14:295. [PMID: 22997200 DOI: 10.1093/ehjci/jes197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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