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Candreva A, Buongiorno AL, Matter MA, Rizzini ML, Giacobbe F, Ravetti E, Giannino G, Carmagnola L, Gilhofer T, Gallo D, Chiastra C, Stähli BE, Iannaccone M, Morbiducci U, Porto I, De Ferrari GM, D'Ascenzo F. Impact of endothelial shear stress on coronary atherosclerotic plaque progression and composition: A meta-analysis and systematic review. Int J Cardiol 2024; 407:132061. [PMID: 38641263 DOI: 10.1016/j.ijcard.2024.132061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/28/2024] [Accepted: 04/17/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND AND AIMS Intracoronary pressure gradients and translesional flow patterns have been correlated with coronary plaque progression and lesion destabilization. In this study, we aimed to determine the relationship between endothelial shear stress and plaque progression and to evaluate the effect of shear forces on coronary plaque features. METHODS A systematic review was conducted in medical on-line databases. Selected were studies including human participants who underwent coronary anatomy assessment with computational fluid dynamics (CFD)-based wall shear stress (WSS) calculation at baseline with anatomical evaluation at follow-up. A total of six studies were included for data extraction and analysis. RESULTS The meta-analysis encompassed 31'385 arterial segments from 136 patients. Lower translesional WSS values were significantly associated with a reduction in lumen area (mean difference -0.88, 95% CI -1.13 to -0.62), an increase in plaque burden (mean difference 4.32, 95% CI 1.65 to 6.99), and an increase in necrotic core area (mean difference 0.02, 95% CI 0.02 to 0.03) at follow-up imaging. Elevated WSS values were associated with an increase in lumen area (mean difference 0.78, 95% CI 0.34 to 1.21) and a reduction in both fibrofatty (mean difference -0.02, 95% CI -0.03 to -0.01) and fibrous plaque areas (mean difference -0.03, 95% CI -0.03 to -0.03). CONCLUSION This meta-analysis shows that WSS parameters were related to vulnerable plaque features at follow-up. These results emphasize the impact of endothelial shear forces on coronary plaque growth and composition. Future studies are warranted to evaluate the role of WSS in guiding clinical decision-making.
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Affiliation(s)
- Alessandro Candreva
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland; PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Antonia Luisa Buongiorno
- Department of Cardiology, Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Michael Adrian Matter
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland
| | - Maurizio Lodi Rizzini
- PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Federico Giacobbe
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Emanuele Ravetti
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giuseppe Giannino
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Ludovica Carmagnola
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Thomas Gilhofer
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland
| | - Diego Gallo
- PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Chiastra
- PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Barbara E Stähli
- Department of Cardiology, University Heart Center, Zurich University Hospital, Zurich, Switzerland; University of Zurich, Zurich, Switzerland
| | - Mario Iannaccone
- Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliTo(BIO) Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Italo Porto
- Department of Cardiology, Cardiovascular Disease Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy
| | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
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Schindler TH, Sadhu J. Moving towards PET determined coronary flow capacity in outcome prediction after coronary revascularization? Int J Cardiol 2024; 405:131921. [PMID: 38432610 DOI: 10.1016/j.ijcard.2024.131921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Affiliation(s)
- Thomas H Schindler
- Mallinckrodt Institute of Radiology, Division of Nuclear Medicine, Cardiovascular Medicine, Washington University School of Medicine, St. Louis, MO, USA; Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA.
| | - Justin Sadhu
- Cardiovascular Division, John T. Milliken Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO, USA
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Toftholm MH, Højstrup S, Talleruphuus U, Marner L, Bjerking L, Jakobsen L, Christiansen EH, Bouchelouche K, Galatius S, Prescott E, Skak-Hansen KW. 82-rubidium positron emission tomography determined myocardial flow reserve and outcomes following cardiac revascularisation - A multicentre registry study. Int J Cardiol 2024; 405:131865. [PMID: 38365013 DOI: 10.1016/j.ijcard.2024.131865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/21/2024] [Accepted: 02/12/2024] [Indexed: 02/18/2024]
Abstract
BACKGROUND Finding patients with chronic coronary syndromes (CCS) whom revascularization could benefit, is complicated. Myocardial flow reserve (MFR), a measurement of myocardial perfusion, has proven prognostic value on survival and risk of major adverse cardiac events (MACE). We investigated if MFR identifies who may benefit from revascularization. METHODS Among 7462 patients from Danish hospitals examined with 82Rb PET between January 2018 and August 2020, patients with ≥5% reversible perfusion defects were followed for MACE and all-cause mortality. Associations between revascularisation (within 90 days) and outcomes according to MFR (< and ≥ 2) was assessed by Cox regression adjusted by inverse probability weighting for demographics, cardiovascular risk factors, comorbidities, and 82Rb PET variables. RESULTS Of 1806 patients with ≥5% reversible perfusion defect, 893 (49%) had MFR < 2 and 491 underwent revascularisation (36.6% in MFR < 2 versus 17.9% MFR ≥ 2, p < 0.001). During a median follow-up of 37.0 [31.0-45.8 IQR] months, 251 experienced a MACE and 173 died. Revascularisation was associated with lower adjusted risk of all-cause mortality (hazard ratio [HR], 0.51 [95% CI, 0.30-0.88], p = 0.015) and MACE (HR, 0.54 [0.33-0.87], p = 0.012) in patients with MFR < 2 but not MFR ≥ 2 for all-cause mortality (HR 1.33 [0.52-3.40], p = 0.542) and MACE (HR 1.50 [0.79-2.84], p = 0.211). MFR significantly modified the association between revascularisation and MACE, but not all-cause mortality (interaction p-value 0.021 and 0.094, respectively). CONCLUSIONS Revascularization was associated with improved prognosis among patients with impaired MFR. No association was seen in patients with normal MFR. In patients with regional ischemia, MFR may identify patients with a prognostic benefit from revascularization.
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Affiliation(s)
- M H Toftholm
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark.
| | - S Højstrup
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark.
| | - U Talleruphuus
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Clinical Physiology and Nuclear Medicine, Denmark
| | - L Marner
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Clinical Physiology and Nuclear Medicine, Denmark
| | - L Bjerking
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - L Jakobsen
- Aarhus University Hospital, Department of Cardiology, Denmark
| | | | - K Bouchelouche
- Aarhus University Hospital, Department of Nuclear Medicine & PET Centre, Denmark
| | - S Galatius
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - E Prescott
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
| | - K W Skak-Hansen
- Copenhagen University Hospital, Bispebjerg and Frederiksberg, Department of Cardiology, Denmark
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Cao R, Wu X, Zheng X. Right ventricular-pulmonary artery coupling is an independent risk factor for coronary artery lesions in children with Kawasaki disease. Coron Artery Dis 2024; 35:328-332. [PMID: 38241041 DOI: 10.1097/mca.0000000000001335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND The recognition ability of right ventricular-pulmonary artery (RV-PA) coupling for coronary artery lesions (CAL) in children with Kawasaki disease (KD) has not been well characterized. This study aimed to determine whether RV-PA coupling is an independent the risk factors for CAL in children with KD. METHODS Between October 2021 and August 2023, RV-PA coupling was assessed in 59 KD children using the ratio between echocardiographic tricuspid annular plane systolic excursion and pulmonary artery systolic pressure (PASP). Multivariable logistic regression analysis was used to identify the independent risk factors for CAL among the demographic, clinical, laboratory and echocardiographic data. RESULTS Twenty-nine of 59 KD children had CAL according to the diagnostic criteria of echocardiography. There were significantly different white blood cell count, C-reactive protein, erythrocyte sedimentation rate, left ventricular ejection fraction, PASP and RV-PA coupling at admission, and significantly different acute/subacute phase ratio of RV-PA coupling between KD children with and without CAL ( P < 0.05). Multivariate logistic regression analysis identified that acute/subacute phase ratio of RV-PA coupling (OR = 26.800; 95% CI, 1.276-562.668; P = 0.034) was an independent risk factor for CAL in children with KD. The area under receiver operating characteristic curve for the acute/subacute phase ratio of RV-PA coupling was 0.715 (95%CI: 0.624 - 0.825) to predict CAL in KD children ( P < 0.05), with a sensitivity of 81.25% and a specificity of 62.57% at the optimal cutoff value of 0.839. CONCLUSION The acute/subacute phase ratio of RV-PA coupling was an independent risk factor for CAL in KD children.
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Affiliation(s)
- Ran Cao
- Department of Ultrasound, Fuding Hospital Fujian Province/Fuding Hospital Affiliated to Fujian University of Traditional Chinese Medicine, Fuding City, Fujian Province
| | - Xuchu Wu
- Department of Ultrasound, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
| | - Xiaozhi Zheng
- Department of Ultrasound, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, People's Republic of China
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Mela JL, Riou L, Barone-Rochette G. Coronary microvascular dysfunction and atrial reservoir function. Cardiovasc Ultrasound 2024; 22:5. [PMID: 38745211 PMCID: PMC11092318 DOI: 10.1186/s12947-024-00324-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 05/05/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) refers to structural and functional abnormalities of the coronary microcirculation, which may be diagnosed using invasive coronary physiology. CMD is responsible for impaired diastolic cardiac function. It has recently been suggested that left atrial strain (LASr) represents a highly sensitive tool for detecting cardiac diastolic function abnormalities. Accordingly, the aim of this study was to investigate the relationship between CMD and LASr. METHODS Consecutively enrolled patients with non-obstructed coronary arteries (NOCA) underwent CMD and LASr evaluation by invasive thermodilution and noninvasive echocardiography, respectively. RESULTS Forty-two (42) patients were included, out of which 26 presented with CMD. There were no significant differences between CMD-positive and negative patients in terms of clinical and echocardiographic characteristics. LASr was significantly reduced in patients with CMD (24.6% ± 6.1 vs. 30.3 ± 7.8%, p = 0.01). A moderate correlation was observed between coronary flow reserve and LAsr (r = 0.47, p = 0.002). A multivariate logistic regression analysis demonstrated that CMD was independently associated with LASr (OR = 0.88, 95%CI 0.78-0.99.135, p = 0.04). A LASr cut-off of 25.5% enabled an optimal classification of patients with or without CMD. CONCLUSION Patients with NOCA and CMD had a significantly reduced LASr compared with patients without CMD, suggesting the early impairment of diastolic function in these patients.
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Affiliation(s)
- Julien La Mela
- Department of Cardiology, University Hospital, Grenoble, 38000, France
| | - Laurent Riou
- University Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, 38000, France
| | - Gilles Barone-Rochette
- Department of Cardiology, University Hospital, Grenoble, 38000, France.
- University Grenoble Alpes, INSERM, CHU Grenoble Alpes, LRB, Grenoble, 38000, France.
- French Clinical Research Infrastructure Network, Paris, 75018, France.
- Clinique Universitaire de Cardiologie, Pôle Thorax et Vx, CHU de Grenoble, 38043, Grenoble cedex 09, France.
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6
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Asano T, Tanigaki T, Hoshino M, Yasunaga M, Nonaka H, Emori H, Katagiri Y, Miyazaki Y, Sotomi Y, Kogame N, Kuramitsu S, Saito A, Miyata K, Takaoka Y, Kanie T, Yamasaki M, Yoshino K, Wakabayashi N, Ouchi K, Kodama H, Shiina Y, Tamaki R, Nishihata Y, Masuda K, Suzuki T, Reiber JHC, Okamura T, Higuchi Y, Kakuta T, Misumi H, Abe K, Komiyama N, Tanabe K, Matsuo H, Qfr Investigators OBOTD. Quantitative flow ratio versus fractional flow reserve for Heart Team decision-making in multivessel disease: the randomised, multicentre DECISION QFR trial. EUROINTERVENTION 2024; 20:561-570. [PMID: 38726719 PMCID: PMC11067723 DOI: 10.4244/eij-d-23-00674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 02/23/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Vessel-level physiological data derived from pressure wire measurements are one of the important determinant factors in the optimal revascularisation strategy for patients with multivessel disease (MVD). However, these may result in complications and a prolonged procedure time. AIMS The feasibility of using the quantitative flow ratio (QFR), an angiography-derived fractional flow reserve (FFR), in Heart Team discussions to determine the optimal revascularisation strategy for patients with MVD was investigated. METHODS Two Heart Teams were randomly assigned either QFR- or FFR-based data of the included patients. They then discussed the optimal revascularisation mode (percutaneous coronary intervention [PCI] or coronary artery bypass grafting [CABG]) for each patient and made treatment recommendations. The primary endpoint of the trial was the level of agreement between the treatment recommendations of both teams as assessed using Cohen's kappa. RESULTS The trial included 248 patients with MVD from 10 study sites. Cohen's kappa in the recommended revascularisation modes between the QFR and FFR approaches was 0.73 [95% confidence interval {CI} : 0.62-0.83]. As for the revascularisation planning, agreements in the target vessels for PCI and CABG were substantial for both revascularisation modes (Cohen's kappa=0.72 [95% CI: 0.66-0.78] and 0.72 [95% CI: 0.66-0.78], respectively). The team assigned to the QFR approach provided consistent recommended revascularisation modes even after being made aware of the FFR data (Cohen's kappa=0.95 [95% CI:0.90-1.00]). CONCLUSIONS QFR provided feasible physiological data in Heart Team discussions to determine the optimal revascularisation strategy for MVD. The QFR and FFR approaches agreed substantially in terms of treatment recommendations.
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Affiliation(s)
- Taku Asano
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Toru Tanigaki
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
| | - Masahiro Hoshino
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Motoki Yasunaga
- Cardiovascular Division, Osaka Police Hospital, Osaka, Japan
| | - Hideaki Nonaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hiroki Emori
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yuki Katagiri
- Department of Cardiovascular Medicine, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yosuke Miyazaki
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Norihiro Kogame
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | | | - Akira Saito
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Kotaro Miyata
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Yoshimitsu Takaoka
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Takayoshi Kanie
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Manabu Yamasaki
- Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Kunihiko Yoshino
- Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Naoki Wakabayashi
- Department of Radiology, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Kouki Ouchi
- Department of Radiology, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Hiroyuki Kodama
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Yumi Shiina
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Rihito Tamaki
- Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Yosuke Nishihata
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Keita Masuda
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Takahiro Suzuki
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Johan H C Reiber
- Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Takayuki Okamura
- Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, Ube, Japan
| | | | - Tsunekazu Kakuta
- Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - Hiroyasu Misumi
- Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Kohei Abe
- Department of Cardiovascular Surgery, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Nobuyuki Komiyama
- Department of Cardiovascular Medicine, St. Luke's International Hospital, St. Luke's International University, Tokyo, Japan
| | - Kengo Tanabe
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | - Hitoshi Matsuo
- Department of Cardiovascular Medicine, Gifu Heart Center, Gifu, Japan
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Baruś P, Hunia J, Kaczorowski R, Bednarek A, Ochijewicz D, Gumiężna K, Kołtowski Ł, Kochman J, Grabowski M, Tomaniak M. Renal Dysfunction Increases Risk of Adverse Cardiovascular Events in 5-Year Follow-Up Study of Intermediate Coronary Artery Lesions. Med Sci Monit 2024; 30:e943956. [PMID: 38720443 DOI: 10.12659/msm.943956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Progression of chronic coronary syndrome (CCS) is influenced by chronic kidney disease (CKD). This 5-year follow-up study aimed to assess 100 patients with 118 intermediate coronary artery lesions evaluated by fractional flow reserve (FFR) and intravascular imaging stratified according to renal function. MATERIAL AND METHODS This prospective study enrolled patients with intermediate coronary stenosis identified by coronary angiogram. Patients with severe renal dysfunction (estimated glomerular filtration rate (eGFR) <45 ml/min/1.73 m²) were excluded from the study. The remaining were divided into 2 groups according to eGFR: 45-60 ml/min/1.73 m² for mild-to-moderate renal dysfunction and >60 ml/min/1.73 m² for no renal dysfunction. We analyzed intermediate-grade stenoses (40-80% as assessed in coronary angiography) with the use of optical coherence tomography (OCT), FFR, and intravascular ultrasound (IVUS). RESULTS Renal dysfunction patients were older (67.7±8.1 vs 63.6±9.7 years, P=0.044). Lesion characteristics, including plaque type and minimal lumen area in OCT, showed no significant differences between the renal dysfunction and no renal dysfunction groups. Thin-cap fibroatheroma, calcific plaques, lipidic plaques, and fibrous plaques had similar prevalence. FFR values and IVUS parameters did not significantly differ between the groups. Over a 5-year follow-up, individuals with mild-to-moderate renal dysfunction had an elevated risk of all-cause mortality and major adverse cardiovascular events in multivariate analyses adjusted for age and sex. CONCLUSIONS Mild-to-moderate renal dysfunction was not associated with significant differences in OCT- and IVUS-derived plaque morphology nor with functional indices characterizing intermediate-grade coronary stenoses. Renal dysfunction was related to a higher risk of all-cause mortality and major adverse cardiovascular events prevalence in 5-year follow-up.
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Affiliation(s)
- Piotr Baruś
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Jaromir Hunia
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Rafał Kaczorowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Adrian Bednarek
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Dorota Ochijewicz
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Karolina Gumiężna
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Łukasz Kołtowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Janusz Kochman
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Grabowski
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Mariusz Tomaniak
- First Department of Cardiology, Medical University of Warsaw, Warsaw, Poland
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8
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Sun W, Mei L, Zhang A, Lai S, Qu X. Computed tomography myocardial perfusion imaging to detect myocardial ischemia in patients with anxiety and obstructive coronary heart disease post-exposure to mental stressors. Sci Rep 2024; 14:10685. [PMID: 38724607 PMCID: PMC11082233 DOI: 10.1038/s41598-024-61568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
This study aims to measure myocardial blood flow (MBF) using dynamic CT- myocardial perfusion imaging (CT-MPI) combined with mental stressors in patients with obstructive coronary artery disease (OCAD) and in patients with anxiety and no obstructive coronary artery disease (ANOCAD). A total of 30 patients with OCAD with 30 patients with ANOCAD were included in this analysis. Using the 17-segment model, the rest and stress phase MBF of major coronary arteries in participants were recorded respectively. Compared with ANOCAD patients, OCAD patients were more likely to have localized reduction of MBF (p < 0.05). For patients with ANOCAD, both global MBF and MBF of the main coronary arteries in the stress phase were lower than those in the rest phase (all p < 0.05), but there was no significant difference in MBF among the main coronary arteries in the rest or stress phase (p = 0.25, p = 0.15). For patients with OCAD, the MBF of the target area was lower than that of the non-target area in both the rest and stress phase, and the MBF of the target area in the stress phase was lower than that in the rest phase (all p < 0.05). However, there was no significant difference in MBF between the rest or stress phase in the non-target area (p = 0.73). Under mental stress, the decrease in MBF in ANOCAD patients was diffuse, while the decrease in MBF in OCAD patients was localized. Dynamic CT-MPI combined with mental stressors can be used to detect MBF changes in anxiety patients.
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Affiliation(s)
- Weihang Sun
- Department of Radiology, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, China
| | - Lingjun Mei
- Department of Radiology, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, China
| | - Aodan Zhang
- Department of Radiology, The Second Hospital of Dalian Medical University (Diamond Bay), Dalian City, Liaoning Province, China, No. 216 Shanzhong Road, Ganjingzi District
| | - Shengyuan Lai
- Department of Radiology, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, China.
| | - Xiaofeng Qu
- Department of Radiology, The Second Hospital of Dalian Medical University, No.467 Zhongshan Road, Shahekou District, Dalian City, Liaoning Province, China.
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9
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Akhiyat N, Ozcan I, Gulati R, Prasad A, Tchkonia T, Kirkland JL, Lewis B, Lerman LO, Lerman A. Patients With Coronary Microvascular Dysfunction Have Less Circulating α-Klotho. J Am Heart Assoc 2024; 13:e031972. [PMID: 38639380 DOI: 10.1161/jaha.123.031972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) represents an early functional characteristic of coronary vascular aging. Klotho (α-klotho) is a circulating protein inversely linked to physiological aging. We examined low klotho as a potential marker for vascular aging in patients with CMD and no coronary artery disease. METHODS AND RESULTS Patients undergoing nonurgent angiogram for chest pain who had no coronary artery disease underwent invasive coronary microvascular and endothelial function testing. CMD was defined by ≤50% increase in coronary blood flow (percentage change in coronary blood flow) in response to intracoronary acetylcholine or coronary flow reserve ≤2. Fresh arterial whole blood was used to analyze circulating endothelial progenitor cells with flow cytometry. Stored arterial plasma was used for klotho analysis by ELISA. Participants with CMD (n=62) were compared with those without CMD (n=36). Those with CMD were age 55±10 years (versus 51±11 years; P=0.07) and 73% women (versus 81%; P=0.38). Traditional risk factors for coronary artery disease were similar between groups. Patients with CMD had less klotho (0.88±1.50 versus 1.75±2.38 ng/mL; P=0.03), and the odds of low klotho in CMD were significant in a logistic regression model after adjusting for traditional cardiovascular risk factors (odds ratio [OR], 0.80 [95% CI, 0.636-0.996]; P=0.05). Higher klotho was associated with higher numbers of endothelial progenitor cells with vascular regenerative potential (CD34+ and CD34+CD133+KDR+). Among a subgroup of patients with atherosclerotic cardiovascular disease risk <5% (n=58), CMD remained associated with lower klotho (OR, 0.80 [95% CI, 0.636-0.996]; P=0.047). CONCLUSIONS Klotho may be a biomarker for CMD and may be a therapeutic target for groups of patients without significant traditional cardiovascular risk.
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Affiliation(s)
- Nadia Akhiyat
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Ilke Ozcan
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Rajiv Gulati
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Abhiram Prasad
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
| | - Tamara Tchkonia
- Department of Physiology and Biomedical Engineering Mayo Clinic Rochester MN USA
| | - James L Kirkland
- Department of Physiology and Biomedical Engineering Mayo Clinic Rochester MN USA
- Division of General Internal Medicine, Department of Medicine Mayo Clinic Rochester MN USA
| | - Bradley Lewis
- Division of Clinical Trials and Biostatistics Mayo Clinic Rochester MN USA
| | - Lilach O Lerman
- Division of Nephrology and Hypertension, Department of Medicine Mayo Clinic Rochester MN USA
| | - Amir Lerman
- Department of Cardiovascular Medicine Mayo Clinic Rochester MN USA
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10
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Weber B, Weisenfeld D, Massarotti E, Seyok T, Cremone G, Lam E, Golnik C, Brownmiller S, Liu F, Huang S, Todd DJ, Coblyn JS, Weinblatt ME, Cai T, Dahal K, Kohler M, Yinh J, Barrett L, Solomon DH, Plutzky J, Schelbert HR, Campisi R, Bolster MB, Di Carli M, Liao KP. Interplay Between Systemic Inflammation, Myocardial Injury, and Coronary Microvascular Dysfunction in Rheumatoid Arthritis: Results From the LiiRA Study. J Am Heart Assoc 2024; 13:e030387. [PMID: 38686879 DOI: 10.1161/jaha.123.030387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 01/17/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Coronary microvascular dysfunction as measured by myocardial flow reserve (MFR) is associated with increased cardiovascular risk in rheumatoid arthritis (RA). The objective of this study was to determine the association between reducing inflammation with MFR and other measures of cardiovascular risk. METHODS AND RESULTS Patients with RA with active disease about to initiate a tumor necrosis factor inhibitor were enrolled (NCT02714881). All subjects underwent a cardiac perfusion positron emission tomography scan to quantify MFR at baseline before tumor necrosis factor inhibitor initiation, and after tumor necrosis factor inhibitor initiation at 24 weeks. MFR <2.5 in the absence of obstructive coronary artery disease was defined as coronary microvascular dysfunction. Blood samples at baseline and 24 weeks were measured for inflammatory markers (eg, high-sensitivity C-reactive protein [hsCRP], interleukin-1b, and high-sensitivity cardiac troponin T [hs-cTnT]). The primary outcome was mean MFR before and after tumor necrosis factor inhibitor initiation, with Δhs-cTnT as the secondary outcome. Secondary and exploratory analyses included the correlation between ΔhsCRP and other inflammatory markers with MFR and hs-cTnT. We studied 66 subjects, 82% of which were women, mean RA duration 7.4 years. The median atherosclerotic cardiovascular disease risk was 2.5%; 47% had coronary microvascular dysfunction and 23% had detectable hs-cTnT. We observed no change in mean MFR before (2.65) and after treatment (2.64, P=0.6) or hs-cTnT. A correlation was observed between a reduction in hsCRP and interleukin-1b with a reduction in hs-cTnT. CONCLUSIONS In this RA cohort with low prevalence of cardiovascular risk factors, nearly 50% of subjects had coronary microvascular dysfunction at baseline. A reduction in inflammation was not associated with improved MFR. However, a modest reduction in interleukin-1b and no other inflammatory pathways was correlated with a reduction in subclinical myocardial injury. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT02714881.
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Affiliation(s)
- Brittany Weber
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Dana Weisenfeld
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Elena Massarotti
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Thany Seyok
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Gabrielle Cremone
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Ethan Lam
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Charlotte Golnik
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Seth Brownmiller
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Feng Liu
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Sicong Huang
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Derrick J Todd
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Jonathan S Coblyn
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Michael E Weinblatt
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Tianrun Cai
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Kumar Dahal
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Minna Kohler
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Janeth Yinh
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Leanne Barrett
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Daniel H Solomon
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Jorge Plutzky
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | | | - Roxana Campisi
- Instituto Argentino de Diagnóstico y Tratamiento S.A. Buenos Aires Argentina
| | - Marcy B Bolster
- Division of Rheumatology, Allergy and Immunology Massachusetts General Hospital, Harvard Medical School Boston MA
| | - Marcelo Di Carli
- Division of Cardiovascular Medicine, Department of Medicine, Heart and Vascular Center Brigham and Women's Hospital, Harvard Medical School Boston MA
| | - Katherine P Liao
- Division of Rheumatology, Inflammation, and Immunity Brigham and Women's Hospital, Harvard Medical School Boston MA
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11
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Wu B, Kheiwa A, Swamy P, Mamas MA, Tedford RJ, Alasnag M, Parwani P, Abramov D. Clinical Significance of Coronary Arterial Dominance: A Review of the Literature. J Am Heart Assoc 2024; 13:e032851. [PMID: 38639360 DOI: 10.1161/jaha.123.032851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/20/2024]
Abstract
Coronary dominance describes the anatomic variation of coronary arterial supply, notably as it relates to perfusion of the inferior cardiac territories. Differences in the development and outcome in select disease states between coronary dominance patterns are increasingly recognized. In particular, observational studies have identified higher prevalence of poor outcomes in left coronary dominance in the setting of ischemic, conduction, and valvular disease. In this qualitative literature review, we summarize anatomic, physiologic, and clinical implications of differences in coronary dominance to highlight current understanding and gaps in the literature that should warrant further studies.
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Affiliation(s)
- Bovey Wu
- Department of Medicine Loma Linda University Medical Center Loma Linda CA USA
| | - Ahmed Kheiwa
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Pooja Swamy
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research Keele University Stoke-on-Trent United Kingdom
| | - Ryan J Tedford
- Department of Medicine, Division of Cardiology Medical University of South Carolina Charleston SC USA
| | - Mirvat Alasnag
- Cardiac Center King Fahd Armed Forces Hospital Jeddah Saudi Arabia
| | - Purvi Parwani
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
| | - Dmitry Abramov
- Department of Cardiology Loma Linda University Medical Center Loma Linda CA USA
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12
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Ottosson F, Engström G, Orho-Melander M, Melander O, Nilsson PM, Johansson M. Plasma Metabolome Predicts Aortic Stiffness and Future Risk of Coronary Artery Disease and Mortality After 23 Years of Follow-Up in the General Population. J Am Heart Assoc 2024; 13:e033442. [PMID: 38639368 DOI: 10.1161/jaha.123.033442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/29/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Increased aortic stiffness (arteriosclerosis) is associated with early vascular aging independent of age and sex. The underlying mechanisms of early vascular aging remain largely unexplored in the general population. We aimed to investigate the plasma metabolomic profile in aortic stiffness (vascular aging) and associated risk of incident cardiovascular disease and mortality. METHODS AND RESULTS We included 6865 individuals from 2 Swedish population-based cohorts. Untargeted plasma metabolomics was performed by liquid-chromatography mass spectrometry. Aortic stiffness was assessed directly by carotid-femoral pulse wave velocity (PWV) and indirectly by augmentation index (AIx@75). A least absolute shrinkage and selection operator (LASSO) regression model was created on plasma metabolites in order to predict aortic stiffness. Associations between metabolite-predicted aortic stiffness and risk of new-onset cardiovascular disease, cardiovascular mortality, and all-cause mortality were calculated. Metabolite-predicted aortic stiffness (PWV and AIx@75) was positively associated particularly with acylcarnitines, dimethylguanidino valeric acid, glutamate, and cystine. The plasma metabolome predicted aortic stiffness (PWV and AIx@75) with good accuracy (R2=0.27 and R2=0.39, respectively). Metabolite-predicted aortic stiffness (PWV and AIx@75) was significantly correlated with age, sex, systolic blood pressure, body mass index, and low-density lipoprotein. After 23 years of follow-up, metabolite-predicted aortic stiffness (PWV and AIx@75) was significantly associated with increased risk of new-onset coronary artery disease, cardiovascular mortality, and all-cause mortality. CONCLUSIONS Aortic stiffness is associated particularly with altered metabolism of acylcarnitines, cystine, and dimethylguanidino valeric acid. These metabolic disturbances predict increased risk of new-onset coronary artery disease, cardiovascular mortality, and all-cause mortality after more than 23 years of follow-up in the general population.
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Affiliation(s)
- Filip Ottosson
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
- Section for Clinical Mass Spectrometry Statens Serum Institut Copenhagen Denmark
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
| | | | - Olle Melander
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
- Department of Internal Medicine Skåne University Hospital Malmö Sweden
| | - Peter M Nilsson
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
- Department of Internal Medicine Skåne University Hospital Malmö Sweden
| | - Madeleine Johansson
- Department of Clinical Sciences in Malmö Lund University Malmö Sweden
- Department of Cardiology Skåne University Hospital Malmö Sweden
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13
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Zhang S, Zhou Q, Li X, Wang Y, Ma L, Huang D, Li G. Value of 2D speckle tracking technique combined with real-time 3-dimensional echocardiography in the evaluation of the right atrial function in patients with 3-branch coronary artery disease without myocardial infarction. Medicine (Baltimore) 2024; 103:e38058. [PMID: 38701248 PMCID: PMC11062688 DOI: 10.1097/md.0000000000038058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
To evaluate the right atrial function in patients with 3-branch coronary artery disease (TBCAD) without myocardial infarction by 2D speckle tracking echocardiography (2D-STE) combined with real-time 3-dimensional echocardiography (RT-3DE). Fifty-six patients admitted to our hospital without myocardial infarction with TBCAD were selected. We divided them into 2 groups according to the coronary angiography results: 28 patients in group B (the rate of stenosis is 50% ~< 75%); 28 patients in group C (the rate of stenosis is ≥75%); in addition, 30 healthy volunteers were screened as group A. All subjects underwent RT-3DE to obtain the right atrial volume (RAVmax, RAVmin, and RAVp), and then we calculated the right atrial passive and active ejection fraction (RAPEF, RAAEF), and maximum volume index (RAVImax). In addition, to measure the strain rates (RASRs, RASRe, RASRa) of the right atrium during systole, early diastole, and late diastole, 2D-STE was applied. Correlations between the 2D-STE parameters and the results of N-terminal pro-brain natriuretic peptide (NT-proBNP) and Gensini scores were analyzed by Pearson linear analysis. Compared with group A, RAPEF and RASRe were reduced, while RAAEF and RASRa were elevated in group B (P < .05). RAPEF, RASRs, RASRe, and RASRa were decreased compared with groups A and B, while RAVmax, RAVmin, RAVp, RAVImax, and RAAEF were increased in group C (P < .05). There was a significant correlation between 2D-STE parameters and the results of NT-proBNP and Gensini scores (P < .05). The storage, conduit, and pump functions of the right atrium are reduced in patients with 3-branch coronary artery disease without myocardial infarction; 2D-STE combined with RT-3DE is valuable in the evaluation of the right atrium in patients with coronary artery disease.
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Affiliation(s)
- Siran Zhang
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Qiao Zhou
- Department of Obstetrics and Gynecology Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Xiya Li
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yifan Wang
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Le Ma
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Dongmei Huang
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Guangsen Li
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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14
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Huang B, Han X, Huang Y, Chen D, Xie P, Chen S. Early predictors of severe left main and/or three-vessel disease in patients with non-ST-segment elevation myocardial infarction: A dual-center retrospective study. Ann Noninvasive Electrocardiol 2024; 29:e13120. [PMID: 38706219 PMCID: PMC11070634 DOI: 10.1111/anec.13120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/08/2023] [Accepted: 04/18/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Early detection of patients concomitant with left main and/or three-vessel disease (LM/3VD) and high SYNTAX score (SS) is crucial for determining the most effective revascularization options regarding the use of antiplatelet medications and prognosis risk stratification. However, there is a lack of study for predictors of LM/3VD with SS in patients with non-ST-segment elevation myocardial infarction (NSTEMI). We aimed to identify potential factors that could predict LM/3VD with high SS (SS > 22) in patients with NSTEMI. METHODS This dual-center retrospective study included a total of 481 patients diagnosed with NSTEMI who performed coronary angiography procedures. Clinical factors on admission were collected. The patients were divided into non-LM/3VD, Nonsevere LM/3VD (SS ≤ 22), and Severe LM/3VD (SS > 22) groups. To identify independent predictors, Univariate and logistic regression analyses were conducted on the clinical parameters. RESULTS A total of 481 patients were included, with an average age of 60.9 years and 75.9% being male. Among these patients, 108 individuals had severe LM/3VD. Based on the findings of a multivariate logistic regression analysis, the extent of ST-segment elevation observed in lead aVR (OR: 7.431, 95% CI: 3.862-14.301, p < .001) and age (OR: 1.050, 95% CI: 1.029-1.071, p < .001) were identified as independent predictors of severe LM/3VD. CONCLUSION This study indicated that the age of patients and the extent of ST-segment elevation observed in lead aVR on initial electrocardiogram were the independent predictive factors of LM/3VD with high SS in patients with NSTEMI.
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Affiliation(s)
- Bihan Huang
- Department of CardiologyHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Xueying Han
- Department of Intensive CareHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Yulian Huang
- Department of CardiologyHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Dongdong Chen
- Department of CardiologyThe First Affiliated Hospital of Jinan UniversityGuangzhouChina
| | - Peiyi Xie
- Department of CardiologyHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
| | - Shaoyuan Chen
- Department of CardiologyHuazhong University of Science and Technology Union Shenzhen HospitalShenzhenChina
- Department of CardiologyThe 6th Affiliated Hospital of Shenzhen University Medical SchoolShenzhenChina
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15
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Obisesan OH, Boakye E, Wang FM, Dardari Z, Dzaye O, Cainzos-Achirica M, Meyer ML, Gottesman R, Palta P, Coresh J, Howard-Claudio CM, Lin FR, Punjabi N, Nasir K, Matsushita K, Blaha MJ. Coronary artery calcium as a marker of healthy and unhealthy aging in adults aged 75 and older: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2024; 392:117475. [PMID: 38408881 PMCID: PMC11088977 DOI: 10.1016/j.atherosclerosis.2024.117475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND AND AIMS Coronary artery calcium (CAC) is validated for risk prediction among middle-aged adults, but there is limited research exploring implications of CAC among older adults. We used data from the Atherosclerosis Risk in Communities (ARIC) study to evaluate the association of CAC with domains of healthy and unhealthy aging in adults aged ≥75 years. METHODS We included 2,290 participants aged ≥75 years free of known coronary heart disease who underwent CAC scoring at study visit 7. We examined the cross-sectional association of CAC = 0, 1-999 (reference), and ≥1000 with seven domains of aging: cognitive function, hearing, ankle-brachial index (ABI), pulse-wave velocity (PWV), forced vital capacity (FVC), physical functioning, and grip strength. RESULTS The mean age was 80.5 ± 4.3 years, 38.6% male, and 77.7% White. 10.3% had CAC = 0 and 19.2% had CAC≥1000. Individuals with CAC = 0 had the lowest while those with CAC≥1000 had the highest proportion with dementia (2% vs 8%), hearing impairment (46% vs 67%), low ABI (3% vs 18%), high PWV (27% vs 41%), reduced FVC (34% vs 42%), impaired grip strength (66% vs 74%), and mean composite abnormal aging score (2.6 vs 3.7). Participants with CAC = 0 were less likely to have abnormal ABI (aOR:0.15, 95%CI:0.07-0.34), high PWV (aOR:0.57, 95%CI:0.41-0.80), and reduced FVC (aOR:0.69, 95%CI:0.50-0.96). Conversely, participants with CAC≥1000 were more likely to have low ABI (aOR:1.74, 95%CI:1.27-2.39), high PWV (aOR:1.52, 95%CI:1.15-2.00), impaired physical functioning (aOR:1.35, 95%CI:1.05-1.73), and impaired grip strength (aOR:1.46, 95%CI:1.08-1.99). CONCLUSIONS Our findings highlight CAC as a simple measure broadly associated with biological aging, with clinical and research implications for estimating the physical and physiological aging trajectory of older individuals.
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Affiliation(s)
- Olufunmilayo H Obisesan
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD, USA; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Ellen Boakye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Frances M Wang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Zeina Dardari
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Omar Dzaye
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA
| | - Miguel Cainzos-Achirica
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; Division of Cardiology, Hospital del Mar- Parc de Salut Mar, Barcelona, Spain
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca Gottesman
- Stroke, Cognition, and Neuroepidemiology Section of the National Institutes of Health, Bethesda, MD, USA
| | - Priya Palta
- Department of Medicine, Columbia University School of Medicine, New York, NY, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Frank R Lin
- Johns Hopkins Cochlear Center for Hearing and Public Health, Baltimore, MD, USA
| | - Naresh Punjabi
- Division of Critical Care Medicine, Pulmonology, Sleep Medicine, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart & Vascular Center, Houston, TX, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Michael J Blaha
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Baltimore, MD, USA; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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16
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Gaibazzi N, Ciampi Q, Cortigiani L, Wierzbowska-Drabik K, Zagatina A, Djordjevic-Dikic A, Manganelli F, Boshchenko A, Borguezan-Daros C, Arbucci R, Marconi S, Lowenstein J, Haberka M, Celutkiene J, D'Andrea A, Rodriguez-Zanella H, Rigo F, Monte I, Costantino MF, Ostojic M, Merli E, Pepi M, Carerj S, Kasprzak JD, Pellikka PA, Picano E. Multiple Phenotypes of Chronic Coronary Syndromes Identified by ABCDE Stress Echocardiography. J Am Soc Echocardiogr 2024; 37:477-485. [PMID: 38092306 DOI: 10.1016/j.echo.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Regional wall motion abnormality is considered a sensitive and specific marker of ischemia during stress echocardiography (SE). However, ischemia is a multifaceted entity associated with either coronary artery disease (CAD) or angina with normal coronary arteries, a distinction difficult to make using a single sign. The aim of this study was to evaluate the diagnostic potential of the five-step ABCDE SE protocol for CAD detection. METHODS From the 2016-2022 Stress Echo 2030 study data bank, 3,229 patients were selected (mean age, 66 ± 12 years; 2,089 men [65%]) with known CAD (n = 1,792) or angina with normal coronary arteries (n = 1,437). All patients were studied using both the ABCDE SE protocol and coronary angiography, within 3 months. In step A, regional wall motion abnormality is assessed; in step B, B-lines and diastolic function; in step C, left ventricular contractile reserve; in step D, coronary flow velocity reserve in the left anterior descending coronary artery; and in step E, heart rate reserve. RESULTS SE response ranged from a score of 0 (all steps normal) to a score of 5 (all steps abnormal). For CAD, rates of abnormal results were 347 for step A (19.4%), 547 (30.5%) for step B, 720 (40.2%) for step C, 615 (34.3%) for step D, and 633 (35.3%) for step E. For angina with normal coronary arteries, rates of abnormal results were 81 (5.6%) for step A, 429 (29.9%) for step B, 432 (30.1%) for step C, 354 (24.6%) for step D, and 445 (31.0%) for step E. The dominant "solitary phenotype" was step B in 109 patients (9.1%). CONCLUSIONS Stress-induced ischemia presents with a wide range of diagnostic phenotypes, highlighting its complex nature. Using a comprehensive approach such as the advanced ABCDE score, which combines multiple markers, proves to be more valuable than relying on a single marker in isolation.
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Affiliation(s)
| | - Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
| | | | | | - Angela Zagatina
- Cardiology Department, Research Cardiology Center "Medika", Saint Petersburg, Russian Federation
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia and School of Medicine University of Belgrade, Belgrade, Serbia
| | - Fiore Manganelli
- Department of Cardiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | | | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Sofia Marconi
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Maciej Haberka
- Cardiology Department, University of Silesia, Katowice, Poland
| | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Center for Innovative Medicine, Vilnius, Lithuania
| | | | | | - Fausto Rigo
- Villa Salus Foundation/IRCCS San Camillo Hospital, Venice, Italy
| | - Ines Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | | | - Miodrag Ostojic
- University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital G. Martino, University of Messina, Messina, Italy
| | | | | | - Eugenio Picano
- CNR Institute of Clinical Physiology Biomedicine Department, Pisa, Italy
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17
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Mancini GBJ, Kamimura C, Yeoh E, Ryomoto A. Effects of adaptive or fixed thresholds and different platforms on the assessment of plaque characteristics using coronary computed tomography angiography. J Cardiovasc Comput Tomogr 2024; 18:297-303. [PMID: 38514283 DOI: 10.1016/j.jcct.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/05/2024] [Accepted: 03/13/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Coronary computed tomography angiography (CCTA) is used to evaluate components of atherosclerosis. Either adaptive or diverse, fixed Hounsfield Units (HU) are used to define components such as low attenuation (LAP), mixed (MP) and calcified plaque (CP). Comparisons of different platforms and different thresholding approaches have not been extensively evaluated. We compare two fixed threshold options to an adaptive threshold option within a specific platform and to fixed threshold options measured with another platform. METHODS Coronary segments (n = 24) of good image quality, with well-defined boundaries and representing a broad range of atheroma were analyzed for LAP, MP and CP. Thresholds for LAP vs MP and MP vs CP were either Fixed30/350, Fixed75/350 or based on an automatically determined Adaptive option. Pearson correlation and Bland-Altman analyses were undertaken. RESULTS Within a single platform, measures were highly correlated irrespective of use of Adaptive or Fixed30/350 and Fixed75/350 thresholds (R ≥ 0.819, p < 0.000001). The correlation slope for measures of LAP progressively diminished comparing the Adaptive versus Fixed30/350 and the Fixed75/350 versus the Fixed30/350 approaches but bias was small. Between-platform comparisons yielded less optimal results, particularly with respect to measures of LAP and with one platform yielding both very small LAP volumes and very small ranges of volumes. CONCLUSION Measures of plaque components are highly correlated irrespective of use of Adaptive or Fixed threshold approaches within a given platform. But measures are more affected by the specific proprietary algorithms employed than by specific thresholding options, especially for LAP.
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Affiliation(s)
- G B John Mancini
- University of British Columbia, Division of Cardiology, Centre for Cardiovascular Innovation, Cardiovascular Imaging Research Core Laboratory (CIRCL), Vancouver, British Columbia, Canada.
| | - Craig Kamimura
- University of British Columbia, Division of Cardiology, Centre for Cardiovascular Innovation, Cardiovascular Imaging Research Core Laboratory (CIRCL), Vancouver, British Columbia, Canada
| | - Eunice Yeoh
- University of British Columbia, Division of Cardiology, Centre for Cardiovascular Innovation, Cardiovascular Imaging Research Core Laboratory (CIRCL), Vancouver, British Columbia, Canada
| | - Arnold Ryomoto
- University of British Columbia, Division of Cardiology, Centre for Cardiovascular Innovation, Cardiovascular Imaging Research Core Laboratory (CIRCL), Vancouver, British Columbia, Canada
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18
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Yang S, Chung J, Lesina K, Doh JH, Jegere S, Erglis A, Leipsic JA, Fearon WF, Narula J, Koo BK. Long-term prognostic implications of CT angiography-derived fractional flow reserve: Results from the DISCOVER-FLOW study. J Cardiovasc Comput Tomogr 2024; 18:251-258. [PMID: 38378313 DOI: 10.1016/j.jcct.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 01/08/2024] [Accepted: 01/26/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND & OBJECTIVES The long-term prognostic implications of CT angiography-derived fractional flow reserve (FFRCT) remains unclear. We aimed to explore the long-term outcomes of FFRCT in the first-in-human study of it. MATERIALS & METHODS A total of 156 vessels from 102 patients with stable coronary artery disease, who underwent coronary CT angiography (CCTA) and invasive FFR measurement, were followed. The primary endpoint was target vessel failure (TVF), including cardiovascular death, target vessel myocardial infarction, and target vessel revascularization. Outcome analysis with FFRCT was performed on a per-vessel basis using a marginal Cox proportional hazard model. RESULTS During median 9.9 years of follow-up, TVF occurred in 20 (12.8%) vessels. FFRCT ≤0.80 discriminated TVF (hazard ratio [HR] 2.61, 95% confidence interval [CI] 1.06, 6.45). Among 94 vessels with deferral of percutaneous coronary intervention (PCI), TVF risk was inversely correlated with FFRCT (HR 0.62 per 0.1 increase, 95% CI 0.44, 0.86), with the cumulative incidence of TVF being 2.6%, 15.2%, and 28.6% for vessels with FFRCT >0.90, 0.81-0.90, and ≤0.80, respectively (p-for-trend 0.005). Predictive value for clinical outcomes of FFRCT was similar to that of invasive FFR (c-index 0.79 vs 0.71, P = 0.28). The estimated TVF risk was higher in the deferral of PCI group than the PCI group for vessels with FFRCT ≤0.81. CONCLUSION FFRCT showed improved long-term risk stratification and displayed a risk continuum similar to invasive FFR. CLINICAL TRIAL REGISTRATION NCT01189331.
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Affiliation(s)
- Seokhun Yang
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Jaewook Chung
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea
| | - Krista Lesina
- Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Joon-Hyung Doh
- Department of Medicine, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Sanda Jegere
- Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Andrejs Erglis
- Department of Medicine, Pauls Stradins Clinical University Hospital, Riga, Latvia
| | - Jonathon A Leipsic
- Department of Medicine and Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - William F Fearon
- Division of Cardiology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Jagat Narula
- The University of Texas Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - Bon-Kwon Koo
- Department of Internal Medicine and Cardiovascular Center, Seoul National University Hospital, Seoul, South Korea.
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Teira Calderón A, Sorrolla Romero J, Echavarria-Pinto M, Hussain B, Diez Gil JL, Martinez Dolz L, Sanz Sánchez J, Garcia-Garcia HM. Does fractional flow reserve impact on clinical outcomes by reducing number of stents and contrast media? Findings from a systematic review (N = 56,185) and meta-analysis. Cardiovasc Revasc Med 2024; 62:135-136. [PMID: 38171984 DOI: 10.1016/j.carrev.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Affiliation(s)
| | | | | | - Bilal Hussain
- Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY, United States of America
| | - José Luis Diez Gil
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Luis Martinez Dolz
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain
| | - Jorge Sanz Sánchez
- Hospital Universitari i Politecnic La Fe, Valencia, Spain; Centro de Investigación Biomedica en Red (CIBERCV), Madrid, Spain.
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20
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Sugane H, Asaumi Y, Ogata S, Kimura M, Kanaya T, Hoshi T, Sato A, Miura H, Tomishima Y, Morita Y, Nakao K, Otsuka F, Kataoka Y, Kawasaki T, Nishimura K, Narula J, Yasuda S, Noguchi T. Evaluation of fractional flow reserve and atherosclerotic plaque characteristics on coronary non-contrast T1-weighted magnetic resonance imaging. Atherosclerosis 2024; 392:117530. [PMID: 38583287 DOI: 10.1016/j.atherosclerosis.2024.117530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 03/05/2024] [Accepted: 03/22/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND AND AIMS The relationship between high-risk coronary plaque characteristics regardless of the severity of lesion stenosis and myocardial ischemia remains unsettled. High-intensity plaques (HIPs) on non-contrast T1-weighted magnetic resonance imaging (T1WI) have been characterized as high-risk coronary plaques. We sought to elucidate whether the presence of coronary HIPs on T1WI influences fractional flow reserve (FFR) in the distal segment of the vessel. METHODS We retrospectively analyzed 281 vessels in 231 patients with chronic coronary syndrome who underwent invasive FFR measurement and coronary T1WI using a multicenter registry. The plaque-to-myocardial signal intensity ratio (PMR) of the most stenotic lesion was evaluated; a coronary plaque with PMR ≥1.4 was defined as a HIP. RESULTS The median PMR of coronary plaques on T1WI in vessels with FFR ≤0.80 was significantly higher than that of plaques with FFR >0.80 (1.17 [interquartile range (IQR): 0.99-1.44] vs. 0.97 [IQR: 0.85-1.09]; p < 0.001). Multivariable analysis showed that an increase in PMR of the most stenotic segment was associated with lower FFR (beta-coefficient, -0.050; p < 0.001). The presence of coronary HIPs was an independent predictor of FFR ≤0.80 (odds ratio (OR), 6.18; 95% confidence interval (CI), 1.93-19.77; p = 0.002). Even after adjusting for plaque composition characteristics based on computed tomography angiography, the presence of coronary HIPs was an independent predictor of FFR ≤0.80 (OR, 4.48; 95% CI, 1.19-16.80; p = 0.026). CONCLUSIONS Coronary plaques with high PMR are associated with low FFR in the corresponding vessel, indicating that plaque morphology might influence myocardial ischemia severity.
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Affiliation(s)
- Hiroki Sugane
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiology, Chikamori Hospital, Kochi-city, Japan
| | - Yasuhide Asaumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Soshiro Ogata
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Michito Kimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Tomoaki Kanaya
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Cardiovascular Medicine, Dokkyo Medical Univeristy, Mibu, Japan
| | - Tomoya Hoshi
- Department of Cardiovascular Medicine, University of Tsukuba, Tsukuba, Japan
| | - Akira Sato
- Second Department of Internal Medicine, University of Yamanashi, Yamanashi, Japan
| | - Hiroyuki Miura
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiyuki Tomishima
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Kazuhiro Nakao
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Fumiyuku Otsuka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Yu Kataoka
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | | | - Kunihiro Nishimura
- Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
| | - Jagat Narula
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan; Department of Advanced Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Teruo Noguchi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan
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21
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Grandinetti M, Locorotondo G, Leccisotti L, Guarneri A, Bruno P, Marcolini A, Farina P, Gaudino MF, Lanza GA, Crea F, Giordano A, Massetti M. Quantitative analysis of myocardial blood flow in surgically revascularized and not revascularized myocardial segments. A pilot PET study. Eur J Nucl Med Mol Imaging 2024; 51:1632-1638. [PMID: 38105304 DOI: 10.1007/s00259-023-06563-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
PURPOSE To prospectively compare changes in myocardial blood flow (MBF) and myocardial flow reserve (MFR) in multivessel coronary artery disease (MVCAD) patients undergoing incomplete revascularization (IR) versus complete revascularization (CR) by coronary artery bypass grafting (CABG). METHODS Seven male patients (age 68 ± 9 years) with MVCAD underwent myocardial perfusion PET/CT with [13N]ammonia before and at least 4 months after CABG. Segmental resting and stress MBF as well as MFR were measured. Resting and during stress left ventricle ejection fraction (LVEF) were also calculated. RESULTS Three patients (43%) underwent CR and four (57%) IR. Among 119 myocardial segments, 101 (85%) were revascularized, and 18 (15%) were not. After CABG, stress MBF (mL/min/gr) and MFR are significantly increased in all myocardial segments, with a greater increase in the revascularized segments (p = 0.013). In both groups, LVEF significantly decreased during stress at baseline PET (p = 0.04), but not after CABG. CONCLUSION Stress MBF and MFR significantly improve after CABG in both revascularized and not directly revascularized myocardial segments. IR strategy may be considered in patients with high surgical risk for CR.
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Affiliation(s)
- M Grandinetti
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - G Locorotondo
- Non Invasive Cardiac Diagnostics Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - L Leccisotti
- Section of Nuclear Medicine, Department of Radiological and Haematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy.
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy.
| | - A Guarneri
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - P Bruno
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - A Marcolini
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - P Farina
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - M F Gaudino
- Department of Cardio-Thoracic Surgery, Weill Cornell Medicine, New York, NY, USA
| | - G A Lanza
- Non Invasive Cardiac Diagnostics Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Unit of Cardiology, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - F Crea
- Unit of Cardiology, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Giordano
- Section of Nuclear Medicine, Department of Radiological and Haematological Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
- Unit of Nuclear Medicine, Department of Diagnostic Imaging, Radiation Oncology and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo A. Gemelli 8, 00168, Rome, Italy
| | - M Massetti
- Cardiac Surgery Unit, Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Cardiovascular and Pulmonary Sciences, Università Cattolica del Sacro Cuore, Rome, Italy
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22
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Iusupova AO, Slepova OA, Pakhtusov NN, Popova LV, Ageev AA, Lishuta AS, Privalova EV, Khabarova NV, Dadashovа GМ, Belenkov YN. Assessment of the Level of Matrix Metalloproteinases, VEGF and MicroRNA-34a in Patients With Non-obstructive and Obstructive Lesions of the Coronary Arteries. Kardiologiia 2024; 64:14-21. [PMID: 38742511 DOI: 10.18087/cardio.2024.4.n2622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/26/2024] [Indexed: 05/16/2024]
Abstract
AIM To assess the levels of matrix metalloproteinases (MMP), vascular endothelial growth factor (VEGF), and miRNA-34a expression in patients with ischemic heart disease (IHD) and obstructive and nonobstructive coronary artery (CA) disease. MATERIAL AND METHODS This cross-sectional observational study included 64 patients with IHD (diagnosis verified by coronary angiography or multislice computed tomography coronary angiography), of which 33 (51.6%) were men aged 64.9±8.1 years. 20 patients had nonobstructive CA disease (stenosis <50%), and 44 had hemodynamically significant stenoses. The control group consisted of 30 healthy volunteers. MMP-1, -9, -13, and -14, miRNA-34a, and VEGF were measured in all patients. RESULTS The concentration of MMP-1 was significantly higher in patients with ischemia and nonobstructive CA disease (INOCAD) (p=0.016), and the concentration of MMP-9 was the highest in the group with obstructive CA disease (p<0.001). The concentrations of MMP-13 and MMP-14 did not differ significantly between the groups. The highest VEGF concentrations were observed in the INOCAD group (p<0.001). The expression of miRNA-34a significantly differed between the IHD groups with different types of CA disease and controls (p <0.001). Patients with hemodynamically significant stenosis showed moderate relationships between the concentrations of MMP-14 and VEGF (ρ=0.418; p=0.024), as well as between VEGF and miRNA-34a (ρ=0.425; p=0.022). Patients with INOCAD had a significant negative correlation between the concentrations of MMP-13 and VEGF (ρ= -0.659; p=0.003). Correlation analysis showed in all IHD patients a moderate relationship of the concentrations of MMP-1 and MMP-14 with VEGF (ρ=0.449; p=0.002 and p=0.341; p=0.019, respectively). According to ROC analysis, a MMP-9 concentration above 4.83 ng/ml can be a predictor for the presence of hemodynamically significant CA obstruction in IHD patients; a VEGF concentration higher than 27.23 pg/ml suggests the absence of hemodynamically significant CA stenosis. CONCLUSION IHD patients with INOCAD had the greatest increase in MMP-1, whereas patients with obstructive CA disease had the highest level of MMP-9. According to our data, concentrations of MMP-9 and VEGF can be used to predict the degree of CA obstruction. The expression of miRNA-34a was significantly higher in IHD patients with INOCAD and CA obstruction than in the control group, which suggested a miRNA-34a contribution to the development and progression of coronary atherosclerosis. In the future, it may be possible to use this miRNA as a diagnostic marker for IHD.
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Affiliation(s)
- A O Iusupova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - O A Slepova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - N N Pakhtusov
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - L V Popova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A A Ageev
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - A S Lishuta
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - E V Privalova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | - N V Khabarova
- Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Yu N Belenkov
- Sechenov First Moscow State Medical University, Moscow, Russia
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23
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Iyer M, Shah R, Zheng W, Ziada KM, Khot U, Krishnaswamy A, Kapadia SR, Reed GW. Aetiology and predictors of major bleeding events in patients with heart failure with reduced ejection fraction undergoing percutaneous coronary intervention. Open Heart 2024; 11:e002572. [PMID: 38663889 PMCID: PMC11043724 DOI: 10.1136/openhrt-2023-002572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Accepted: 03/24/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES We sought to determine the relationship between the degree of left ventricular ejection fraction (LVEF) impairment and the frequency and type of bleeding events after percutaneous coronary intervention (PCI). DESIGN This was an observational retrospective cohort analysis. Patients who underwent PCI from 2009 to 2017 were identified from our institutional National Cardiovascular Disease Registry (NCDR) CathPCI database. Patients were stratified by pre-PCI LVEF: preserved (≥50%), mildly reduced (41%-49%) and reduced (≤40%) LVEF. PRIMARY OUTCOME MEASURES The outcome was major bleeding, defined by NCDR criteria. Events were classified based on bleeding aetiology and analysed by multivariable logistic regression. RESULTS Among 13 537 PCIs, there were 817 bleeding events (6%). The rate of bleeding due to any cause, blood transfusion, gastrointestinal bleeding and coronary artery perforation or tamponade each increased in a stepwise fashion comparing preserved, mildly reduced and reduced LVEF reduction (p<0.05 for all comparisons). However, there were no differences in bleeding due to asymptomatic drops in haemoglobin, access site haematoma or retroperitoneal bleeding. After multivariable adjustment, mildly reduced and reduced LVEF remained independent predictors of bleeding events (OR 1.36, 95% CI 1.06 to 1.74, p<0.05 and OR 1.73, 95% CI 1.45 to 2.06, p<0.0001). CONCLUSIONS The degree of LV dysfunction is an independent predictor of post-PCI major bleeding events. Patients with mildly reduced or reduced LVEF are at greatest risk of post-PCI bleeding, driven by an increased need for blood transfusion, major GI bleeding events and coronary artery perforation or tamponade. Pre-PCI LV dysfunction does not predict asymptomatic declines in haemoglobin, access site haematoma or retroperitoneal bleeding.
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Affiliation(s)
- Meghana Iyer
- Cleveland Clinic Lerner College of Medicine of CWRU, Cleveland, Ohio, USA
| | - Rohan Shah
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Weili Zheng
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Khaled M Ziada
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Umesh Khot
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amar Krishnaswamy
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir R Kapadia
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Grant W Reed
- Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio, USA
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24
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Min CY, Gao Y, Jiang YN, Guo YK, Shi K, Yang ZG, Li Y. The additive effect of metabolic syndrome on left ventricular impairment in patients with obstructive coronary artery disease assessed by 3.0 T cardiac magnetic resonance feature tracking. Cardiovasc Diabetol 2024; 23:133. [PMID: 38654269 DOI: 10.1186/s12933-024-02225-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/07/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Metabolic syndrome (MetS) can increase the risk of morbidity and mortality of cardiovascular disease and obstructive coronary artery disease (OCAD), which usually have a poor prognosis. This study aimed to explore the impact of MetS on left ventricular (LV) deformation and function in OCAD patients and investigate the independent factors of impaired LV function and deformation. MATERIALS AND METHODS A total of 121 patients with OCAD and 52 sex- and age-matched controls who underwent cardiac magnetic resonance scanning were enrolled in the study. All OCAD patients were divided into two groups: OCAD with MetS [OCAD(MetS+), n = 83] and OCAD without MetS [OCAD(MetS-), n = 38]. LV functional and global strain parameters were measured and compared among the three groups. Multivariable linear regression analyses were constructed to investigate the independent factors of LV impairment in OCAD patients. Logistic regression analysis and receiver operating characteristic (ROC) curve analysis were performed to test the prediction efficiency of MetS for LV impairment. RESULTS From controls to the OCAD(MetS-) group to the OCAD(MetS+) group, LV mass (LVM) increased, and LV global function index (LVGFI) and LV global longitudinal peak strain (GLPS) decreased (all p < 0.05). Compared with the OCAD(MetS-) group, the LV GLPS declined significantly (p = 0.027), the LVM increased (p = 0.006), and the LVGFI decreased (p = 0.043) in the OCAD(MetS+) group. After adjustment for covariates in OCAD patients, MetS was an independent factor of decreased LV GLPS (β = - 0.211, p = 0.002) and increased LVM (β = 0.221, p = 0.003). The logistic multivariable regression analysis and ROC analysis showed that combined MetS improved the efficiency of predicting LV GLPS reduction (AUC = 0.88) and LVM (AUC = 0.89) increase. CONCLUSIONS MetS aggravated the damage of LV deformation and function in OCAD patients and was independently associated with LV deformation and impaired LV strain. Additionally, MetS increased the prediction efficiency of increased LVM and decreased LV GLPS. Early detection and intervention of MetS in patients with OCAD is of great significance.
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Affiliation(s)
- Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yue Gao
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Yi-Ning Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Ying-Kun Guo
- Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, Department of Radiology, West China Second University Hospital, Sichuan University, 20# Section 3, Renmin South Road, Chengdu, 610041, Sichuan, China
| | - Ke Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, China.
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Jabbour RJ, Curzen N. How will coronary physiology, plaque vulnerability and ischemia be integrated in future patient pathways with chest pain? Expert Rev Cardiovasc Ther 2024; 22:141-143. [PMID: 38679907 DOI: 10.1080/14779072.2024.2347224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Richard J Jabbour
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Nick Curzen
- Cardiology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
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Kern MJ, Seto AH. Virtual FFR From Optical Coherence Tomography: A 1-Stop Shop for PCI Guidance? Circ Cardiovasc Interv 2024; 17:e014077. [PMID: 38525652 DOI: 10.1161/circinterventions.124.014077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
Affiliation(s)
- Morton J Kern
- Interventional Cardiology, Division of Cardiology, Long Beach Veteran's Administration Medical Center, CA
| | - Arnold H Seto
- Interventional Cardiology, Division of Cardiology, Long Beach Veteran's Administration Medical Center, CA
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Jian B, Liu H, Zhang Y, Li G, Yang S, Fu G, Huang S, Huang Y, Zhou Z, Wu Z, Liang M. Postoperative Dipping Patterns of Mean Arterial Pressure and Mortality After Coronary Artery Bypass Grafting. J Cardiovasc Transl Res 2024; 17:287-297. [PMID: 38196010 DOI: 10.1007/s12265-023-10475-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/18/2023] [Indexed: 01/11/2024]
Abstract
Blood pressure dipping patterns have long been considered to be associated with adverse events. We aimed to investigate whether dipping patterns of postoperative MAP were related to 90-day and hospital mortality in patients undergoing CABG. Four thousand three hundred ninety-one patients were classified into extreme dippers (night-to-day ratio of MAP ≤ 0.8), dippers (0.8 < night-to-day ratio of MAP ≤ 0.9), non-dippers (0.9 < night-to-day ratio of MAP ≤ 1), and reverse dippers (> 1). Compared with non-dippers, reverse dippers were at a higher risk of 90-day mortality (aHR = 1.58; 95% CI, 1.10-2.27) and hospital mortality (aOR = 1.97; 95% CI, 1.12-3.47). A significant interaction was observed between hypertension and dipping patterns (P for interaction = 0.02), with a significant increased risk of 90-day mortality in non-hypertensive reverse dippers (aHR = 1.90; 95% CI, 1.17-3.07) but not in hypertensive reverse dippers (aHR = 1.26; 95% CI, 0.73-2.19).
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Affiliation(s)
- Bohao Jian
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Haoliang Liu
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yi Zhang
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Gang Li
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Song Yang
- Department of Cardiothoracic Surgical ICU, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Guangguo Fu
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Suiqing Huang
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yang Huang
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Zhuoming Zhou
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Zhongkai Wu
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
| | - Mengya Liang
- Department of Cardiac Surgery, the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China.
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Xu D, Zhang J, Liu B, Fu D, Li J, Fan L. Determination of viable myocardium through delayed enhancement cardiac magnetic resonance imaging combined with 18F-FDG PET myocardial perfusion/metabolic imaging before CABG. Int J Cardiovasc Imaging 2024; 40:887-895. [PMID: 38265540 PMCID: PMC11052819 DOI: 10.1007/s10554-024-03057-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 01/25/2024]
Abstract
PURPOSE Study aims to investigate the consistency of delayed enhancement cardiac magnetic resonance imaging (DE-CMR) and 18F-FDG PET myocardial imaging in evaluating myocardial viability before CABG. METHODS The study analyzed data from 100 patients who were examined with DE-CMR, PET imaging, and echocardiography before and after CABG. All subjects were followed up for 6-12 month post- CABG. RESULTS DE-CMR and PET imaging have high consistency (90.1%; Kappa value = 0.71, p < 0.01) in determining myocardial viability. The degree of delayed enhancement was negatively correlated with the improvement in myocardial contractile function in this segment after revascularization (P < 0.001). The ratio of scarred myocardial segments and total DE score was significantly lower in the improvement group than non-improvement group. Multivariate regression identified that hibernating myocardium (OR = 1.229, 95%CI: 1.053-1.433, p = 0.009) was influencing factor of LVEF improvement after CABG. CONCLUSION Both imaging techniques are consistent in evaluating myocardial viability. Detecting the number of hibernating myocardium by PET is also important to predict the left heart function improvement after CABG.
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Affiliation(s)
- Dongsheng Xu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Jiwang Zhang
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Bing Liu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Donghai Fu
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Jianming Li
- Department of Nuclear Medicine, TEDA International Cardiovascular Hospital, Tianjin, 300457, China
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China
| | - Lijuan Fan
- Department of Radiology, TEDA International Cardiovascular Hospital, Tianjin, 300457, China.
- Tianjin Key Laboratory of Molecular Regulation of Cardiovascular Diseases and Translational Medicine, Tianjin, 300457, China.
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29
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Hamimi AH, Ghanem AM, Hannah-Shmouni F, Elgarf RM, Matta JR, Gharib AM, Abd-Elmoniem KZ. Ascending Aorta 4D Time to Peak Distention Sexual Dimorphism and Association with Coronary Plaque Burden Severity in Women. J Cardiovasc Transl Res 2024; 17:298-307. [PMID: 37556037 DOI: 10.1007/s12265-023-10422-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2023] [Accepted: 07/31/2023] [Indexed: 08/10/2023]
Abstract
Coronary artery disease (CAD) risk and plaque scores are often subjective and biased, particularly in mid-age asymptomatic women, whose CAD risk assessment has been historically underestimated. In this study, a new automatic ascending aorta time-to-peak-distention (TPD) analysis was developed for fast screening and as an independent surrogate for subclinical atherosclerosis in asymptomatic women. CCTA was obtained in 50 asymptomatic adults. Plaque burden segment involvement score (SIS) and automatic TPD were obtained from all subjects. Logistic regression analyses were performed to investigate the association between CAD risk scores and TPD with severe coronary plaque burden (SIS>5). TPD, individually, was found to be a significant predictor of SIS>5. Additionally, sex was a significant effect modifier of TPD, with a stronger statistically significant association with women. Four-dimensional aortic time-to-peak distention could supplement conventional CCTA analysis and offer a quick objective screening tool for plaque burden severity and CAD risk stratification, especially in women.
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Affiliation(s)
- Ahmed H Hamimi
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Ahmed M Ghanem
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Fady Hannah-Shmouni
- Internal Medicine, Endocrinology, and Genetics, Division of Endocrinology, University of British Columbia, Vancouver, BC, Canada
| | - Reham M Elgarf
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Jatin R Matta
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA
| | - Ahmed M Gharib
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA.
| | - Khaled Z Abd-Elmoniem
- Biomedical and Metabolic Imaging Branch (BMIB), National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH), 10 Center Drive, 1C334, Bethesda, MD, 20892, USA.
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Hidalgo Santiago JC, Perelló Martínez J, Vargas Romero J, Luis Pallares J, Michan Doña A, Gómez-Fernández P. Association of aortic stiffness with abdominal vascular and coronary calcifications in patients with stage 3 and 4 chronic kidney disease. Nefrologia 2024; 44:256-267. [PMID: 38555207 DOI: 10.1016/j.nefroe.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/03/2023] [Indexed: 04/02/2024] Open
Abstract
RATIONALE AND OBJECTIVES Increased central (aortic) arterial stiffness has hemodynamic repercussions that affect the incidence of cardiovascular and renal disease. In chronic kidney disease (CKD) there may be an increase in aortic stiffness secondary to multiple metabolic alterations including calcification of the vascular wall (VC). The objective of this study was to analyze the association of central aortic pressures and aortic stiffness with the presence of VC in abdominal aorta (AAC) and coronary arteries(CAC). MATERIALS AND METHODS We included 87 pacientes with CKD stage 3 and 4. Using applanation tonometry, central aortic pressures and aortic stiffness were studied. We investigated the association of aortic pulse wave velocity (Pvc-f) and Pvc-f adjusted for age, blood pressure, sex and heart rate (Pvc-f index) with AAC obtained on lumbar lateral radiography and CAC assessed by multidetector computed tomography. AAC and CAC were scored according to Kauppila and Agatston methods, respecti-vely. For the study of the association between Pvc-f index, Kauppila score, Agatston score, central aortic pressures, clinical parameters and laboratory data, multiple and logistic regression were used. We investigated the diagnosis performance of the Pvc-f index for prediction of VC using receiver-operating characteristic (ROC). RESULTS Pvc-f and Pvc-f index were 11.3 ± 2.6 and 10.6 m/s, respectively. The Pvc-f index was higher when CKD coexisted with diabetes mellitus (DM). AAC and CAC were detected in 77% and 87%, respectively. Albuminuria (β = 0.13, p = 0.005) and Kauppila score (β = 0.36, p = 0.001) were independently associated with Pvc-f index. In turn, Pvc-f index (β = 0.39, p = 0.001), DM (β = 0.46, p = 0.01), and smoking (β = 0.53; p = 0.006) were associated with Kauppila score, but only Pvc-f index predicted AAC [OR: 3.33 (95% CI: 1.6-6.9; p = 0.001)]. The Kauppila score was independently associated with the Agatston score (β = 1.53, p = 0.001). The presence of AAC identified patients with CAC with a sensitivity of 73%, a specificity of 100%, a positive predictive value of 100% and a negative predictive value of 38%. The Vpc-f index predicted the presence of CAC [OR: 3.35 (95% CI: 1.04-10.2, p = 0.04)]. In the ROC curves, using the Vpc-f index, the AUC for AAC and CAC was 0.82 (95%CI: 0.71-0.93, p = 0.001) and 0.81 (95% CI: 0.67-0.96, p = 0.02), respectively. CONCLUSIONS When stage 3-4 CKD coexists with DM there is an increase in aortic stiffness determined by the Vpc-f index. In stage 3-4 CKD, AAC and CAC are very prevalent and both often coexist. The Vpc-f index is independently associated with AAC and CAC and may be useful in identifying patients with VC in these territories.
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Affiliation(s)
| | | | - Javier Vargas Romero
- Unidad de Radiodiagnóstico, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
| | - José Luis Pallares
- Unidad de Radiodiagnóstico, Hospital Universitario de Jerez, Jerez de la Frontera, Spain
| | - Alfredo Michan Doña
- Unidad de medicina Interna, Hospital Universitario de Jerez, Biomedical Research and Innovation Institute of Cadiz (INiBICA), Jerez de la Frontera, Spain
| | - Pablo Gómez-Fernández
- Unidad de Factores de Riesgo Vascular, Hospital Universitario de Jerez, Jerez de la Frontera, Spain.
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31
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Searles CD. Shedding Light on the Roles of Ceramide in Human Microvascular Function. Circ Res 2024; 134:97-99. [PMID: 38175911 DOI: 10.1161/circresaha.123.323868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Affiliation(s)
- Charles D Searles
- Atlanta VA Healthcare System, Decatur, GA. Emory University, Atlanta, GA
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32
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Taqueti VR. Prevalence of Abnormal Coronary Function in Patients With Angina and No Obstructive Coronary Artery Disease on Coronary Computed Tomography Angiography: Insights From the CorCTA Trial. Circulation 2024; 149:24-27. [PMID: 38153994 DOI: 10.1161/circulationaha.123.066571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2023]
Affiliation(s)
- Viviany R Taqueti
- Cardiovascular Imaging Program, Departments of Radiology and Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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Douglas PS, Nanna MG, Kelsey MD, Yow E, Mark DB, Patel MR, Rogers C, Udelson JE, Fordyce CB, Curzen N, Pontone G, Maurovich-Horvat P, De Bruyne B, Greenwood JP, Marinescu V, Leipsic J, Stone GW, Ben-Yehuda O, Berry C, Hogan SE, Redfors B, Ali ZA, Byrne RA, Kramer CM, Yeh RW, Martinez B, Mullen S, Huey W, Anstrom KJ, Al-Khalidi HR, Vemulapalli S. Comparison of an Initial Risk-Based Testing Strategy vs Usual Testing in Stable Symptomatic Patients With Suspected Coronary Artery Disease: The PRECISE Randomized Clinical Trial. JAMA Cardiol 2023; 8:904-914. [PMID: 37610731 PMCID: PMC10448364 DOI: 10.1001/jamacardio.2023.2595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/26/2023] [Indexed: 08/24/2023]
Abstract
Importance Trials showing equivalent or better outcomes with initial evaluation using coronary computed tomography angiography (cCTA) compared with stress testing in patients with stable chest pain have informed guidelines but raise questions about overtesting and excess catheterization. Objective To test a modified initial cCTA strategy designed to improve clinical efficiency vs usual testing (UT). Design, Setting, and Participants This was a pragmatic randomized clinical trial enrolling participants from December 3, 2018, to May 18, 2021, with a median of 11.8 months of follow-up. Patients from 65 North American and European sites with stable symptoms of suspected coronary artery disease (CAD) and no prior testing were randomly assigned 1:1 to precision strategy (PS) or UT. Interventions PS incorporated the Prospective Multicenter Imaging Study for the Evaluation of Chest Pain (PROMISE) minimal risk score to quantitatively select minimal-risk participants for deferred testing, assigning all others to cCTA with selective CT-derived fractional flow reserve (FFR-CT). UT included site-selected stress testing or catheterization. Site clinicians determined subsequent care. Main Outcomes and Measures Outcomes were clinical efficiency (invasive catheterization without obstructive CAD) and safety (death or nonfatal myocardial infarction [MI]) combined into a composite primary end point. Secondary end points included safety components of the primary outcome and medication use. Results A total of 2103 participants (mean [SD] age, 58.4 [11.5] years; 1056 male [50.2%]) were included in the study, and 422 [20.1%] were classified as minimal risk. The primary end point occurred in 44 of 1057 participants (4.2%) in the PS group and in 118 of 1046 participants (11.3%) in the UT group (hazard ratio [HR], 0.35; 95% CI, 0.25-0.50). Clinical efficiency was higher with PS, with lower rates of catheterization without obstructive disease (27 [2.6%]) vs UT participants (107 [10.2%]; HR, 0.24; 95% CI, 0.16-0.36). The safety composite of death/MI was similar (HR, 1.52; 95% CI, 0.73-3.15). Death occurred in 5 individuals (0.5%) in the PS group vs 7 (0.7%) in the UT group (HR, 0.71; 95% CI, 0.23-2.23), and nonfatal MI occurred in 13 individuals (1.2%) in the PS group vs 5 (0.5%) in the UT group (HR, 2.65; 95% CI, 0.96-7.36). Use of lipid-lowering (450 of 900 [50.0%] vs 365 of 873 [41.8%]) and antiplatelet (321 of 900 [35.7%] vs 237 of 873 [27.1%]) medications at 1 year was higher in the PS group compared with the UT group (both P < .001). Conclusions and Relevance An initial diagnostic approach to stable chest pain starting with quantitative risk stratification and deferred testing for minimal-risk patients and cCTA with selective FFR-CT in all others increased clinical efficiency relative to UT at 1 year. Additional randomized clinical trials are needed to verify these findings, including safety. Trial Registration ClinicalTrials.gov Identifier: NCT03702244.
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Affiliation(s)
- Pamela S. Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Michael G. Nanna
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Michelle D. Kelsey
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Eric Yow
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Daniel B. Mark
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Manesh R. Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
| | | | - James E. Udelson
- Division of Cardiology and the CardioVascular Center, Tufts Medical Center, Boston, Massachusetts
| | - Christopher B. Fordyce
- Division of Cardiology, Department of Medicine, Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Curzen
- Faculty of Medicine, University of Southampton, Cardiothoracic Unit, University Hospital Southampton, Southampton, United Kingdom
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino Instituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Bernard De Bruyne
- Cardiovascular Center Aalst, Onze Lieve Vrouwziekenhuis Clinic, Aalst, Belgium
- Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - John P. Greenwood
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds Teaching Hospitals NHS Trust, United Kingdom
| | - Victor Marinescu
- Midwest Cardiovascular Institute, Chicago Medical School, Edward-Elmhurst Health, Naperville, Illinois
| | - Jonathon Leipsic
- Departments of Radiology and Medicine (Cardiology), University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregg W. Stone
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Colin Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, United Kingdom
| | - Shea E. Hogan
- CPC Clinical Research, University of Colorado School of Medicine, Aurora
| | - Bjorn Redfors
- Cardiovascular Research Foundation, New York, New York
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ziad A. Ali
- St Francis Hospital & Heart Center, Roslyn, New York
| | - Robert A. Byrne
- Department of Cardiology, Cardiovascular Research Institute Dublin, Mater Private Network, Dublin, Ireland
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Robert W. Yeh
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Beth Martinez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | | | | | | | - Hussein R. Al-Khalidi
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, North Carolina
| | - Sreekanth Vemulapalli
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
- Division of Cardiology, Duke University School of Medicine, Durham, North Carolina
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Liu J, Zhang K, Wang X, Liu Z, Chen M, Fan F, Jia J, Hong T, Li J, Huo Y, Gong Y, Zheng B. Complete revascularization based on angiography derived fractional flow reserve versus incomplete revascularization in patients with ST-segment elevation myocardial infarction. Cardiol J 2023; 31:226-234. [PMID: 37772351 DOI: 10.5603/cj.92762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 07/29/2023] [Accepted: 08/09/2023] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Nearly half of ST-segment elevation myocardial infarction (STEMI) patients present with significant multivessel coronary artery disease, they are at high risk of subsequent adverse events. Whether complete revascularization guided by coronary angiography-derived fractional flow reserve (caFFR) further reduces such events risk is not fully investigated. METHODS In this study, 367 consecutive STEMI patients who underwent successful primary percutaneous coronary intervention (PCI) were enrolled. caFFR of all three coronary vessels were measured, including 367 culprit vessels and 703 non-culprit vessels. Complete revascularization was defined as post-PCI caFFR > 0.8 of all three coronary vessels. The primary endpoint was major adverse cardiovascular events (MACE, a composite of cardiovascular death, non-fatal recurrent myocardial infarction, ischemia-driven revascularization and non-fatal stroke/transient ischemic attacks) during follow-up. RESULTS At a median follow-up of 3.8 years, MACE had occurred in 39 patients of the 220 (17.7%) in the complete revascularization group as compared with 49 patients of the 131 (37.4%) in the incomplete revascularization group (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.2-3.0; p = 0.005). The incomplete revascularization in culprit vessels evaluated by caFFR showed the highest risk for MACE occurrence. CONCLUSIONS In STEMI patients with multivessel coronary artery disease, incomplete revascularization based on caFFR might contribute to identifying patients at high-risk.
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Affiliation(s)
- Jiahui Liu
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Department of Hypertension, Peking University People's Hospital, Beijing, China
| | - Kaiping Zhang
- Department of Cardiology, Hospital 302 Attached to Guizhou Aviation Group, Guizhou, China
| | - Xingang Wang
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Zhaoping Liu
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Ming Chen
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Fangfang Fan
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jia Jia
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Tao Hong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Jianping Li
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China
| | - Yanjun Gong
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Bo Zheng
- Department of Cardiology, Peking University First Hospital, Beijing, China.
- Institute of Cardiovascular Disease, Peking University First Hospital, Beijing, China.
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van Nieuwkerk AC, Delewi R, Wolters FJ, Muller M, Daemen M, Biessels GJ. Cognitive Impairment in Patients With Cardiac Disease: Implications for Clinical Practice. Stroke 2023; 54:2181-2191. [PMID: 37272393 DOI: 10.1161/strokeaha.123.040499] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Cognitive impairment is common in patients with cardiovascular disease. One in 3 patients presenting at cardiology clinics have some degree of cognitive impairment, depending on the cardiac condition, comorbidities, and age. In up to half of these cases cognitive impairment may go unrecognized; however, it may affect self-management and treatment adherence. The high prevalence of cognitive impairment in patients with cardiac disease is likely due to shared risk factors, as well as direct consequences of cardiac dysfunction on the brain. Moreover, cardiac interventions may have beneficial as well as adverse effects on cognitive functioning. In this review, we describe prevalence and risk factors for cognitive impairment in patients with several common cardiac conditions: heart failure, coronary artery disease, and aortic valve stenosis. We discuss the potential effects of guideline-based treatments on cognition and identify open questions and unmet needs. Given the high prevalence of unrecognized cognitive impairment in cardiac patients, we recommend a stepwise approach to improve detection and management of cognitive impairment.
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Affiliation(s)
- Astrid C van Nieuwkerk
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.C.v.N., R.D.)
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
| | - Ronak Delewi
- Department of Cardiology, Amsterdam UMC, University of Amsterdam, the Netherlands (A.C.v.N., R.D.)
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
| | - Frank J Wolters
- Department of Epidemiology (F.J.W.), Erasmus University Medical Center, Rotterdam, the Netherlands
- Department of Radiology & Nuclear Medicine and Alzheimer Centre Erasmus MC (F.J.W.), Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Majon Muller
- Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, the Netherlands (A.C.v.N., R.D., M.M.)
- Amsterdam UMC, location Vrije Universiteit Amsterdam, Department of Internal Medicine section Geriatrics, the Netherlands (M.M.)
| | - Mat Daemen
- Department of Pathology, Amsterdam University Medical Center, Locations AMC and VUmc, University of Amsterdam, the Netherlands (M.D.)
| | - Geert Jan Biessels
- Department of Neurology, UMC Utrecht Brain Center, University Medical Center, the Netherlands (G.J.B.)
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Babayiğit E, Dural M, Görenek B. Sudden cardiac death and atrial depolarization in coronary artery disease. Europace 2023; 25:euad115. [PMID: 37099676 PMCID: PMC10227759 DOI: 10.1093/europace/euad115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Affiliation(s)
- Erdi Babayiğit
- Department of Cardiology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Muhammet Dural
- Department of Cardiology, Eskisehir Osmangazi University, Eskişehir, Turkey
| | - Bülent Görenek
- Department of Cardiology, Eskisehir Osmangazi University, Eskişehir, Turkey
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Perkiömäki JS, Hekkanen JJ, Junttila MJ, Huikuri HV. Sudden cardiac death and atrial depolarization in coronary artery disease-Authors' reply. Europace 2023; 25:euad111. [PMID: 37099638 PMCID: PMC10227753 DOI: 10.1093/europace/euad111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2023] Open
Affiliation(s)
- Juha S Perkiömäki
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Jenni J Hekkanen
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - M Juhani Junttila
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Heikki V Huikuri
- Research Unit of Biomedicine and Internal Medicine, Medical Research Center Oulu, University of Oulu and Oulu University Hospital, Oulu, Finland
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Jin K. Does coronary microvascular dysfunction have a role in cardiovascular oncology? Eur J Prev Cardiol 2023; 30:206-208. [PMID: 36200324 DOI: 10.1093/eurjpc/zwac229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Kai Jin
- Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology & Population Health, London School of Hygiene and Tropical Medicine, Kepple Street, London WC1E 7HT, UK
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Niewiara Ł, Kleczyński P, Guzik B, Szolc P, Baran J, Podolec J, Diachyshyn M, Żmudka K, Legutko J. Impaired coronary flow reserve in patients with poor type 2 diabetes control: Preliminary results from prospective microvascular dysfunction registry. Cardiol J 2022; 31:185-192. [PMID: 36342032 PMCID: PMC11076028 DOI: 10.5603/cj.a2022.0100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Type 2 diabetes (DM) is a common comorbidity associated with cardiovascular disease, especially when poor glucose control is present. Extracardiac microcirculatory complications prevalence is well documented, however coronary microcirculatory dysfunction (CMD) seem to be underreported in this group. METHODS The present study analyzed coronary physiology measurements (coronary flow reserve [CFR], index of microcirculatory resistance [IMR], resistance reserve ratio [RRR]) in 47 diabetic patients (21 subjects with poor glycemia control defined as fasting glucose levels > 7.2 mmol/L and 26 with normal fasting glucose), and compared to 54 non-diabetic controls, who had undergone coronary angiography due to symptoms of chronic coronary syndrome. The median age of patients was 65.5 [59.0; 73.0] years old, 74% male, similar in terms of cardiovascular risk factors and prior myocardial infarction. Insulin was used by 19% of diabetic patients with poor glucose control and by 15% of those with DM and low fasting glucose. RESULTS Prevalence of CMD was 38% in poor glycemia control patients, 27% in DM-patients with proper glucose control and 31% of non-diabetics. Median CFR values were the lowest in poor DM control patients compared to both, normal fasting glucose (1.75 [1.37; 2.32] vs. 2.30 [1.75; 2.85], p = 0.026) and to non-diabetics (1.75 [1.37; 2.32] vs. 2.15 [1.50; 2.95], p = 0.045). Levels of IMR, RRR and MRR did not differ significantly between compared groups (p > 0.05 for all comparisons). CONCLUSIONS Poor glycemia control in type 2 DM might be associated with a higher prevalence of CMD driven by decreased coronary flow reserve, however, further research in larger groups of patients should be performed to confirm this observation.
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Affiliation(s)
- Łukasz Niewiara
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Emergency Medicine, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Kleczyński
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Bartłomiej Guzik
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Szolc
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Baran
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Podolec
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Marta Diachyshyn
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
| | - Krzysztof Żmudka
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Jacek Legutko
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Krakow, Poland.
- Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
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Koo BK, Hu X, Kang J, Zhang J, Jiang J, Hahn JY, Nam CW, Doh JH, Lee BK, Kim W, Huang J, Jiang F, Zhou H, Chen P, Tang L, Jiang W, Chen X, He W, Ahn SG, Yoon MH, Kim U, Lee JM, Hwang D, Ki YJ, Shin ES, Kim HS, Tahk SJ, Wang J. Fractional Flow Reserve or Intravascular Ultrasonography to Guide PCI. N Engl J Med 2022; 387:779-789. [PMID: 36053504 DOI: 10.1056/nejmoa2201546] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND In patients with coronary artery disease who are being evaluated for percutaneous coronary intervention (PCI), procedures can be guided by fractional flow reserve (FFR) or intravascular ultrasonography (IVUS) for decision making regarding revascularization and stent implantation. However, the differences in clinical outcomes when only one method is used for both purposes are unclear. METHODS We randomly assigned 1682 patients who were being evaluated for PCI for the treatment of intermediate stenosis (40 to 70% occlusion by visual estimation on coronary angiography) in a 1:1 ratio to undergo either an FFR-guided or IVUS-guided procedure. FFR or IVUS was to be used to determine whether to perform PCI and to assess PCI success. In the FFR group, PCI was to be performed if the FFR was 0.80 or less. In the IVUS group, the criteria for PCI were a minimal lumen area measuring either 3 mm2 or less or measuring 3 to 4 mm2 with a plaque burden of more than 70%. The primary outcome was a composite of death, myocardial infarction, or revascularization at 24 months after randomization. We tested the noninferiority of the FFR group as compared with the IVUS group (noninferiority margin, 2.5 percentage points). RESULTS The frequency of PCI was 44.4% among patients in the FFR group and 65.3% among those in the IVUS group. At 24 months, a primary-outcome event had occurred in 8.1% of the patients in the FFR group and in 8.5% of those in the IVUS group (absolute difference, -0.4 percentage points; upper boundary of the one-sided 97.5% confidence interval, 2.2 percentage points; P = 0.01 for noninferiority). Patient-reported outcomes as reported on the Seattle Angina Questionnaire were similar in the two groups. CONCLUSIONS In patients with intermediate stenosis who were being evaluated for PCI, FFR guidance was noninferior to IVUS guidance with respect to the composite primary outcome of death, myocardial infarction, or revascularization at 24 months. (Funded by Boston Scientific; FLAVOUR ClinicalTrials.gov number, NCT02673424.).
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Affiliation(s)
- Bon-Kwon Koo
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Xinyang Hu
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jeehoon Kang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jinlong Zhang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jun Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joo-Yong Hahn
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Chang-Wook Nam
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joon-Hyung Doh
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Bong-Ki Lee
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Weon Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jinyu Huang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Fan Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Hao Zhou
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Peng Chen
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Lijiang Tang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Wenbing Jiang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Xiaomin Chen
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Wenming He
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Sung-Gyun Ahn
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Myeong-Ho Yoon
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Ung Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Joo-Myung Lee
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Doyeon Hwang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - You-Jeong Ki
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Eun-Seok Shin
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Hyo-Soo Kim
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Seung-Jea Tahk
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
| | - Jian'an Wang
- From Seoul National University Hospital (B.-K.K., J.K., D.H., H.-S.K.), Samsung Medical Center (J.-Y.H., J.-M.L.), and Kyung Hee University Hospital (W.K.), Seoul, Keimyung University Dongsan Medical Center (C.-W.N.) and Yeungnam University Medical Center (U.K.), Daegu, Inje University Ilsan Paik Hospital, Goyang (J.-H.D.), Kangwon National University Hospital, Chuncheon (B.-K.L.), Wonju Severance Christian Hospital, Wonju (S.-G.A.), Ajou University Hospital, Suwon (M.-H.Y., S.-J.T.), Uijeongbu Eulji Medical Center, Uijeongbu (Y-.J.K.), and Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan (E.-S.S.) - all in South Korea; the Second Affiliated Hospital, Zhejiang University School of Medicine (X.H., J.Z., J.J., J.W.), Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine (J.H.), Hangzhou Normal University Affiliated Hospital (F.J.), and Zhejiang Hospital (L.T.), Hangzhou, the First Affiliated Hospital of Wenzhou Medical University (H.Z.), the Second Affiliated Hospital of Wenzhou Medical University (P.C.), and the Third Clinical Institute Affiliated to Wenzhou Medical University (W.J.), Wenzhou, and Ningbo First Hospital (X.C.) and the Affiliated Hospital of the Medical School of Ningbo University (W.H.), Ningbo - all in China
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Du F, Zhang W, Mao H, Guo Y, Guo M, Lu Y, Chen M, Sha Z. The Effect of Long-Term External Counterpulsation Combined with Exercise Therapy on the Establishment of Collateral Circulation in Patients with Coronary Artery Occlusive Disease. Biomed Res Int 2022; 2022:1336184. [PMID: 35463986 PMCID: PMC9020965 DOI: 10.1155/2022/1336184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 03/01/2022] [Accepted: 03/05/2022] [Indexed: 11/18/2022]
Abstract
Objective By detecting the levels of external counterpulsation combined with exercise therapy on the levels of moesin, angiopoietin-like protein2 (Angptl 2), angiopoietin-like protein (Angptl 3), hypoxia inducible factor-1α (HIF-1α), and RNA-34a (miR-34a) in patients with coronary artery occlusive disease, the effect of external counterpulsation combined with exercise therapy on the establishment of occluded coronary collateral circulation was studied. Methods A retrospective analysis of 166 patients with coronary heart disease was confirmed by coronary angiography results that at least one coronary artery (anterior descending branch, circumflex branch, and right coronary artery) was completely occluded and was classified into the control group (routine medication) and the treatment group (routine drug therapy plus exercise therapy and external counterpulsation) according to the treatment plan of the patient. The serum levels of moesin, Angptl 2, Angptl 3, and HIF-1α were detected by enzyme-linked immunosorbent assay (ELISA) test. The index of microcirculatory resistance (IMR) and coronary flow reserve (CFR) of the two groups of patients were measured before and after 2 weeks of treatment. The formation of collateral circulation was analyzed according to the Rentrop classification method. Results After treatment, the IMR levels of the two groups were significantly decreased, and the CFR levels were significantly increased. The decrease of IMR level and the increase of CFR level in the experimental group were better than those in the control group (P < 0.05). There was no significant difference in the positive detection rate of moesin antibody between the two groups, but the OD detection value of the treatment group decreased significantly (P < 0.05). The levels of Angptl 2, Angptl 3, and miR-34a in the treatment group were lower than those in the control group, while the relative expression of HIF-1α was higher than that in the control group. The difference was statistically significant (P < 0.05). External counterpulsation combined with exercise therapy improved the formation rate of collateral circulation (P < 0.05). Conclusions External counterpulsation combined with exercise therapy can reduce moesin antibody, Angptl 2, Angptl 3, and miR-34a levels increase HIF-1α levels, and promote the establishment of occluded coronary collateral circulation.
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Affiliation(s)
- Feng Du
- Internal Medicine-Cardiovascular Department, The First Affiliated Hospital Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
- Internal Medicine-Cardiovascular Department, The First People's Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Wei Zhang
- Internal Medicine-Cardiovascular Department, The First Affiliated Hospital Guangzhou University of Chinese Medicine, Guangzhou, Guangdong 510405, China
| | - Hua Mao
- Internal Medicine-Cardiovascular Department, The First People's Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Yanli Guo
- Internal Medicine-Cardiovascular Department, The First People's Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Meiqin Guo
- Internal Medicine-Cardiovascular Department, The First People's Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Yuming Lu
- Internal Medicine-Cardiovascular Department, The First People's Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Min Chen
- Internal Medicine-Cardiovascular Department, The First People's Hospital of Guiyang, Guiyang, Guizhou 550002, China
| | - Zhongxin Sha
- Internal Medicine-Cardiovascular Department, The First People's Hospital of Guiyang, Guiyang, Guizhou 550002, China
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Zhang W, Mintz GS, Cao Y, Matsumura M, Lee T, Hoshino M, Usui E, Kanaji Y, Murai T, Yonetsu T, Kakuta T, Maehara A. Clinical determinants of coronary artery disease burden and vulnerability using optical coherence tomography co-registered with intravascular ultrasound. Coron Artery Dis 2022; 33:114-124. [PMID: 34411011 DOI: 10.1097/mca.0000000000001088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We investigated clinical determinants of disease burden and vulnerability using optical coherence tomography (OCT) co-registered with intravascular ultrasound (IVUS) in a large cohort of patients. METHODS A total of 704 patients [44.5% with acute coronary syndromes (ACS)] underwent coronary intervention. IVUS plaque burden and OCT lipid, macrophage and calcium indices and the presence of thrombus, plaque rupture and thin-cap fibroatheroma (TCFA) were analyzed. RESULTS Median patient age was 66 years with 81.8% men, 34.4% with diabetes mellitus and 15.5% with preadmission statins. Median lesion length was 25.7 mm, and 33.0% had a TCFA. Adjusted models indicated (1) older patient age was related to more calcium, but fewer macrophages; (2) men were related to more thrombus with plaque rupture while women had more thrombus without plaque rupture; (3) ACS presentation was related to morphological acute thrombotic events (more thrombus with/without rupture) and plaque vulnerability (more TCFA, more lipid and macrophages and larger plaque burden); (4) diabetes mellitus was related to a greater atherosclerotic disease burden (more lipid and calcium and larger plaque burden) and more thrombus without rupture; (5) hypertension was related to more macrophages; (6) current smoking was related to less calcium; and (7) renal insufficiency and preadmission statin therapy were not independently associated with IVUS or OCT plaque morphology. CONCLUSION Patient characteristics, especially diabetes mellitus and aging, affect underlying atherosclerotic burden, among which a greater lipidic burden along with sex differences influence local thrombotic morphology that affects clinical presentation.
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Affiliation(s)
- Wenbin Zhang
- Clinical Trials Center, Cardiovascular Research Foundation
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
- Department of Cardiology, Sir Run Run Shaw Hospital, College of Medicine, Zhejiang University, Hangzhou
| | - Gary S Mintz
- Clinical Trials Center, Cardiovascular Research Foundation
| | - Yang Cao
- Clinical Trials Center, Cardiovascular Research Foundation
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Tetsumin Lee
- Clinical Trials Center, Cardiovascular Research Foundation
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
| | - Masahiro Hoshino
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Eisuke Usui
- Clinical Trials Center, Cardiovascular Research Foundation
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Yoshihisa Kanaji
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Tadashi Murai
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Taishi Yonetsu
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Tsunekazu Kakuta
- Cardiovascular Medicine, Tsuchiura Kyodo Hospital, Ibaraki, Japan
| | - Akiko Maehara
- Clinical Trials Center, Cardiovascular Research Foundation
- Division of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA
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Zhang H, Xu B, Song L. Intravascular ultrasound and ultrasonic flow ratio-guided zero-contrast percutaneous coronary intervention: first report of a novel technique treating a patient with obstructive coronary artery disease and contrast allergy. Coron Artery Dis 2022; 33:148-150. [PMID: 34074910 DOI: 10.1097/mca.0000000000001077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Han Zhang
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases
| | - Bo Xu
- Catheterization Laboratories, Fu Wai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, National Clinical Research Center for Cardiovascular Diseases, Beijing, China
| | - Lei Song
- Department of Cardiology, Fu Wai Hospital, National Center for Cardiovascular Diseases
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Sen A, Singh A, Roy A, Mohanty S, Naik N, Kalaivani M, Ramakrishnan L. Role of endothelial colony forming cells (ECFCs) Tetrahydrobiopterin (BH4) in determining ECFCs functionality in coronary artery disease (CAD) patients. Sci Rep 2022; 12:3076. [PMID: 35197509 PMCID: PMC8866483 DOI: 10.1038/s41598-022-06758-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 01/31/2022] [Indexed: 01/05/2023] Open
Abstract
Nitric oxide (NO.) is critical for functionality of endothelial colony forming cells (ECFCs). Dimerization of endothelial nitric oxide synthase (eNOS) is must to produce NO. and tetrahydrobiopterin (BH4) plays a crucial role in stabilizing this state. We investigated BH4 level in ECFCs and its effect on ECFCs functionality in CAD patients. Intracellular biopterin levels and ECFCs functionality in terms of cell viability, adhesion, proliferation, in vitro wound healing and angiogenesis were assessed. Guanosine Triphosphate Cyclohydrolase-1 (GTPCH-1) expression was studied in ECFCs. Serum total reactive oxygen/nitrogen species was measured and effect of nitrosative stress on ECFC's biopterins level and functionality were evaluated by treating with 3-morpholino sydnonimine (SIN-1). BH4 level was significantly lower in ECFCs from CAD patients. Cell proliferation, wound closure reflecting cellular migration as well as in vitro angiogenesis were impaired in ECFCs from CAD patients. Wound healing capacity and angiogenesis were positively correlated with ECFC's BH4. A negative effect of nitrosative stress on biopterins level and cell functionality was observed in SIN-1 treated ECFCs. ECFCs from CAD exhibited impaired functionality and lower BH4 level. Association of BH4 with wound healing capacity and angiogenesis suggest its role in maintaining ECFC's functionality. Oxidative stress may be a determinant of intracellular biopterin levels.
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Affiliation(s)
- Atanu Sen
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Archna Singh
- Department of Biochemistry, All India Institute of Medical Sciences, New Delhi, India
| | - Ambuj Roy
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Sujata Mohanty
- Centre of Excellence for Stem Cell Research, All India Institute of Medical Sciences, New Delhi, India
| | - Nitish Naik
- Department of Cardiology, All India Institute of Medical Sciences, New Delhi, India
| | - Mani Kalaivani
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Lakshmy Ramakrishnan
- Department of Cardiac Biochemistry, All India Institute of Medical Sciences, New Delhi, India.
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Marei I, Chidiac O, Thomas B, Pasquier J, Dargham S, Robay A, Vakayil M, Jameesh M, Triggle C, Rafii A, Jayyousi A, Al Suwaidi J, Abi Khalil C. Angiogenic content of microparticles in patients with diabetes and coronary artery disease predicts networks of endothelial dysfunction. Cardiovasc Diabetol 2022; 21:17. [PMID: 35109843 PMCID: PMC8812242 DOI: 10.1186/s12933-022-01449-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 01/20/2022] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Elevated endothelial microparticles (EMPs) levels are surrogate markers of vascular dysfunction. We analyzed EMPs with apoptotic characteristics and assessed the angiogenic contents of microparticles in the blood of patients with type 2 diabetes (T2D) according to the presence of coronary artery disease (CAD). METHODS A total of 80 participants were recruited and equally classified as (1) healthy without T2D, (2) T2D without cardiovascular complications, (3) T2D and chronic coronary artery disease (CAD), and (4) T2D and acute coronary syndrome (ACS). MPs were isolated from the peripheral circulation, and EMPs were characterized using flow cytometry of CD42 and CD31. CD62E was used to determine EMPs' apoptotic/activation state. MPs content was extracted and profiled using an angiogenesis array. RESULTS Levels of CD42- CD31 + EMPs were significantly increased in T2D with ACS (257.5 ± 35.58) when compared to healthy subjects (105.7 ± 12.96, p < 0.01). There was no significant difference when comparing T2D with and without chronic CAD. The ratio of CD42-CD62 +/CD42-CD31 + EMPs was reduced in all T2D patients, with further reduction in ACS when compared to chronic CAD, reflecting a release by apoptotic endothelial cells. The angiogenic content of the full population of MPs was analyzed. It revealed a significant differential expression of 5 factors in patients with ACS and diabetes, including TGF-β1, PD-ECGF, platelet factor 4, serpin E1, and thrombospondin 1. Ingenuity Pathway Analysis revealed that those five differentially expressed molecules, mainly TGF-β1, inhibit key pathways involved in normal endothelial function. Further comparison of the three diabetes groups to healthy controls and diabetes without cardiovascular disease to diabetes with CAD identified networks that inhibit normal endothelial cell function. Interestingly, DDP-IV was the only differentially expressed protein between chronic CAD and ACS in patients with diabetes. CONCLUSION Our data showed that the release of apoptosis-induced EMPs is increased in diabetes, irrespective of CAD, ACS patients having the highest levels. The protein contents of MPs interact in networks that indicate vascular dysfunction.
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Affiliation(s)
- Isra Marei
- Department of Pharmacology, Weill Cornell Medicine-Qatar, Doha, Qatar
- National Heart and Lung Institute, Imperial College London, London, UK
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Omar Chidiac
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Binitha Thomas
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Jennifer Pasquier
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Soha Dargham
- Biostatistics Core, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Amal Robay
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Muneera Vakayil
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | | | | | - Arash Rafii
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Amin Jayyousi
- Department of Endocrinology, Hamad Medical Corporation, Doha, Qatar
| | | | - Charbel Abi Khalil
- Department of Genetic Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar.
- Heart Hospital, Hamad Medical Corporation, Doha, Qatar.
- Joan and Sanford I. Weill Department of Medicine, Weill Cornell Medicine, New York, USA.
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Berge CA, Eskerud I, Almeland EB, Larsen TH, Pedersen ER, Rotevatn S, Lønnebakken MT. Relationship between hypertension and non-obstructive coronary artery disease in chronic coronary syndrome (the NORIC registry). PLoS One 2022; 17:e0262290. [PMID: 35061769 PMCID: PMC8782369 DOI: 10.1371/journal.pone.0262290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022] Open
Abstract
Background The burden of non-obstructive coronary artery disease (CAD) in the society is high, and there is currently limited evidence-based recommendation for risk stratification and treatment. Previous studies have demonstrated an association between increasing extent of non-obstructive CAD and cardiovascular events. Whether hypertension, a modifiable cardiovascular risk factor, is associated with extensive non-obstructive CAD in patients with symptomatic chronic coronary syndrome (CCS) remains unclear. Methods We included 1138 patients (mean age 62±11 years, 48% women) with symptomatic CCS and non-obstructive CAD (1–49% lumen diameter reduction) by coronary computed tomography angiography (CCTA) from the Norwegian Registry for Invasive Cardiology (NORIC). The extent of non-obstructive CAD was assessed as coronary artery segment involvement score (SIS), and extensive non-obstructive CAD was adjudicated when SIS >4. Hypertension was defined as known hypertension or use of antihypertensive medication. Results Hypertension was found in 45% of patients. Hypertensive patients were older, with a higher SIS, calcium score, and prevalence of comorbidities and statin therapy compared to the normotensive (all p<0.05). There was no difference in the prevalence of hypertension between sexes. Univariable analysis revealed a significant association between hypertension and non-obstructive CAD. In multivariable analysis, hypertension remained associated with extensive non-obstructive CAD, independent of sex, age, smoking, diabetes, statin treatment, obesity and calcium score (OR 1.85, 95% CI [1.22–2.80], p = 0.004). Conclusion In symptomatic CCS, hypertension was associated with extensive non-obstructive CAD by CCTA. Whether hypertension may be a new treatment target in symptomatic non-obstructive CAD needs to be explored in future studies. Clinical trial registration ClinicalTrials.gov: Identifier NCT 04009421.
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Affiliation(s)
- Caroline A. Berge
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- * E-mail:
| | - Ingeborg Eskerud
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Elise B. Almeland
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Terje H. Larsen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Biomedicine, University of Bergen, Bergen, Norway
| | - Eva R. Pedersen
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Mai Tone Lønnebakken
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Fu D, Xiao X, Gao T, Feng L, Wang C, Yang P, Li X. Effect of Calcification Based on Computer-Aided System on CT-Fractional Flow Reserve in Diagnosis of Coronary Artery Lesion. Comput Math Methods Med 2022; 2022:7020209. [PMID: 35082914 PMCID: PMC8786524 DOI: 10.1155/2022/7020209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/10/2021] [Accepted: 12/21/2021] [Indexed: 11/18/2022]
Abstract
This study was to analyze the diagnostic value of coronary computed tomography angiography (CCTA) and fractional flow reserve (FFR) based on computer-aided diagnosis (CAD) system for coronary lesions and the possible impact of calcification. 80 patients who underwent CCTA and FFR examination in hospital were selected as the subjects. The FFR value of 0.8 was used as the dividing line and divided into the ischemic group (FFR ≤ 0.8) and nonischemic group (FFR > 0.8). The basic data and imaging characteristics of patients were analyzed. The maximum diameter stenosis rate (MDS %), maximum area stenosis rate (MAS %), and napkin ring sign (NRS) in the ischemic group were significantly lower than those in the nonischemic group (P < 0.05). Remodeling index (RI) and eccentric index (EI) compared with the nonischemic group had no significant difference (P > 0.05). The total plaque volume (TPV), total plaque burden (TPB), calcified plaque volume (CPV), lipid plaque volume (LPV), and lipid plaque burden (LPB) in the ischemic group were significantly different from those in the non-ischemic group (P < 0.05). MAS % had the largest area under curve (AUC) for the diagnosis of coronary myocardial ischemia (0.74), followed by MDS % (0.69) and LPV (0.68). CT-FFR had high diagnostic sensitivity, specificity, accuracy, truncation value, and AUC area data for patients in the ischemic group and nonischemic group. The diagnostic sensitivity, specificity, accuracy, cutoff value, and AUC area data of CT-FFR were higher in the ischemic group (89.93%, 92.07%, 95.84%, 60.51%, 0.932) and nonischemic group (93.75%, 90.88%, 96.24%, 58.22%, 0.944), but there were no significant differences between the two groups (P > 0.05). In summary, CT-FFR based on CAD system has high accuracy in evaluating myocardial ischemia caused by coronary artery stenosis, and within a certain range of calcification scores, calcification does not affect the diagnostic accuracy of CT-FFR.
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Affiliation(s)
- Dongliang Fu
- Department of Cardiology, Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing 100029, China
| | - Xiang Xiao
- Department of Cardiology, Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing 100029, China
| | - Tong Gao
- Graduate School, Peking Union Medical College, Beijing 100730, China
| | - Lina Feng
- Department of Cardiology, Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing 100029, China
| | | | - Peng Yang
- Department of Cardiology, Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing 100029, China
| | - Xianlun Li
- Department of Cardiology, Integrated Traditional Chinese and Western Medicine, China-Japan Friendship Hospital, No. 2 East Yinghua Road, Chaoyang District, Beijing 100029, China
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Sagris M, Theofilis P, Antonopoulos AS, Oikonomou E, Paschaliori C, Galiatsatos N, Tsioufis K, Tousoulis D. Inflammation in Coronary Microvascular Dysfunction. Int J Mol Sci 2021; 22:ijms222413471. [PMID: 34948272 PMCID: PMC8703507 DOI: 10.3390/ijms222413471] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/05/2021] [Accepted: 12/07/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic low-grade inflammation is involved in coronary atherosclerosis, presenting multiple clinical manifestations ranging from asymptomatic to stable angina, acute coronary syndrome, heart failure and sudden cardiac death. Coronary microvasculature consists of vessels with a diameter less than 500 μm, whose potential structural and functional abnormalities can lead to inappropriate dilatation and an inability to meet the required myocardium oxygen demands. This review focuses on the pathogenesis of coronary microvascular dysfunction and the capability of non-invasive screening methods to detect the phenomenon. Anti-inflammatory agents, such as statins and immunomodulators, including anakinra, tocilizumab, and tumor necrosis factor-alpha inhibitors, have been assessed recently and may constitute additional or alternative treatment approaches to reduce cardiovascular events in atherosclerotic heart disease characterized by coronary microvascular dysfunction.
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Affiliation(s)
- Marios Sagris
- Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (E.O.); (C.P.); (N.G.); (K.T.); (D.T.)
- Correspondence: ; Tel.:+30-213-2088099; Fax: +30-213-2088676
| | - Panagiotis Theofilis
- Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (E.O.); (C.P.); (N.G.); (K.T.); (D.T.)
| | - Alexios S. Antonopoulos
- Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (E.O.); (C.P.); (N.G.); (K.T.); (D.T.)
| | - Evangelos Oikonomou
- Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (E.O.); (C.P.); (N.G.); (K.T.); (D.T.)
- Department of Cardiology, “Sotiria” Thoracic Diseases Hospital of Athens, University of Athens Medical School, 11527 Athens, Greece
| | - Christina Paschaliori
- Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (E.O.); (C.P.); (N.G.); (K.T.); (D.T.)
| | - Nikolaos Galiatsatos
- Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (E.O.); (C.P.); (N.G.); (K.T.); (D.T.)
| | - Kostas Tsioufis
- Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (E.O.); (C.P.); (N.G.); (K.T.); (D.T.)
| | - Dimitris Tousoulis
- Cardiology Clinic, ‘Hippokration’ General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece; (P.T.); (A.S.A.); (E.O.); (C.P.); (N.G.); (K.T.); (D.T.)
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Abstract
ABSTRACT The endothelium plays a pivotal role in the regulation of vascular tone by synthesizing and liberating endothelium-derived relaxing factors inclusive of vasodilator prostaglandins (eg, prostacyclin), nitric oxide (NO), and endothelium-dependent hyperpolarization factors in a distinct blood vessel size-dependent manner. Large conduit arteries are predominantly regulated by NO and small resistance arteries by endothelium-dependent hyperpolarization factors. Accumulating evidence over the past few decades has demonstrated that endothelial dysfunction and coronary vasomotion abnormalities play crucial roles in the pathogenesis of various cardiovascular diseases. Structural and functional alterations of the coronary microvasculature have been coined as coronary microvascular dysfunction (CMD), which is highly prevalent and associated with adverse clinical outcomes in many clinical settings. The major mechanisms of coronary vasomotion abnormalities include enhanced coronary vasoconstrictive reactivity at epicardial and microvascular levels, impaired endothelium-dependent and endothelium-independent coronary vasodilator capacities, and elevated coronary microvascular resistance caused by structural factors. Recent experimental and clinical research has highlighted CMD as the systemic small artery disease beyond the heart, emerging modulators of vascular functions, novel insights into the pathogenesis of cardiovascular diseases associated with CMD, and potential therapeutic interventions to CMD with major clinical implications. In this article, we will summarize the current knowledge on the endothelial modulation of vascular tone and the pathogenesis of coronary macrovascular and microvascular diseases from bench to bedside, with a special emphasis placed on the mechanisms and clinical implications of CMD.
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Affiliation(s)
- Shigeo Godo
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; and
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; and
| | - Satoshi Yasuda
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; and
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan; and
- Graduate School, International University of Health and Welfare, Narita, Japan
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50
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Mthembu N, Norton GR, Peterson VR, Naran R, Yusuf SM, Tade G, Bello H, Bamaiyi A, Libhaber CD, Dessein P, Peters F, Sareli P, Woodiwiss AJ. Increased Backward Wave Pressures Rather than Flow Explain Age-Dependent Heart Rate Effects on Central, But not Peripheral Arterial Pressure. Hypertension 2021; 79:435-446. [PMID: 34852646 DOI: 10.1161/hypertensionaha.121.18271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Through both backward (Pb) and forward (Pf) wave effects, a lower heart rate (HR) associates with increased central (PPc), beyond brachial pulse pressure (PP). However, the relative contribution to Pf of aortic flow (Q) versus re-reflection of Pb, has not been determined. Using central pressure, aortic velocity and diameter measurements in the outflow tract (echocardiography), we constructed central pressure waveforms that account for the relative contribution of Q versus re-reflection to Pf. We thus evaluated the mechanisms of HR-PPc relations in a community sample (n=824) and the impact of age thereon. Inverse HR-PPc (P<0.0001), but not HR-brachial PP (P=0.064) relations were noted. The slope of HR-PPc relation was increased in older adults (P<0.005). HR was inversely associated with ventricular filling time, ejection duration, stroke volume, and peak Pf (P<0.001 to P<0.0001). However, an increased Q and hence pressures generated by the product of aortic characteristic impedance and Q did not account for Pf effects. Age-dependent HR-PPc and Pf relations were both accounted for by enhanced Pb (P<0.0001) with an increased Pf mediated by increments in wave re-reflection (P<0.0001). The lack of impact of ejection duration on PPc was explained by an increased time to peak Pb (P<0.0001). In conclusion, increases in PPc and Pf at a decreased HR are accounted for by an enhanced Pb rather than by a prolonged ejection or filling duration and hence flow (Q). These effects at a young-to-middle age are of little clinical significance, but at an older age, are of clinical importance.
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Affiliation(s)
- Nonhlanhla Mthembu
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Gavin R Norton
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Vernice R Peterson
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ravi Naran
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Suraj M Yusuf
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Grace Tade
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hamza Bello
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Adamu Bamaiyi
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Carlos D Libhaber
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Patrick Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Ferande Peters
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pinhas Sareli
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Angela J Woodiwiss
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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