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Bajraktari G, Bytyçi I, Bajraktari A, Henein MY. Non-inferiority of 1 month versus longer dual antiplatelet therapy in patients undergoing PCI with drug-eluting stents: a systematic review and meta-analysis of randomized clinical trials. Ther Adv Chronic Dis 2022; 13:20406223221093758. [PMID: 35602665 PMCID: PMC9118452 DOI: 10.1177/20406223221093758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/23/2022] [Indexed: 11/15/2022] Open
Abstract
Aim: The aim of this meta-analysis was to evaluate the safety of 1-month dual antiplatelet therapy (DAPT) followed by aspirin or a P2Y12 receptor inhibitor, after percutaneous coronary intervention (PCI) with drug-eluting stents (DES), based on the available evidence. Methods: PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL, and ClinicalTrials.gov database search identified four RCTs of 26,431 patients who underwent PCI with DES and compared 1-month versus >1-month DAPT. The primary endpoint was major bleeding and co-primary endpoint stent thrombosis, and secondary endpoints included all-cause mortality, cardiovascular death, myocardial infarction (MI), stroke, and major adverse clinical events (MACE). Results: Compared with >1-month DAPT, the 1-month DAPT was associated with a similar rate of major bleeding (OR = 0.74, 95%CI: 0.51–1.07, p = 0.11, I2 = 67%), stent thrombosis (OR = 1.10, 95%CI: 0.82–1.47, p = 0.53, I2 = 0.0%), similar risk for all-cause mortality (OR = 0.89, 95%CI: 0.77–1.04, p = 0.14, I2 = 0%), CV death (OR = 0.80, 95% CI: 0.55–1.60, p = 0.24, I2 = 0.0%), MI (OR = 1.02, 95% CI: 0.88–1.19, p = 0.78, I2 = 0.0%), and stroke (OR = 0.76, 95% CI: 0.54–1.08, p = 0.13, I2 = 29%). The risk of MACE was lower (OR = 0.84, 95% CI: 0.73–0.98, p = 0.02, I2 = 39%) in the 1-month DAPT compared with the >1-month DAPT. Only patients with stable CAD had lower risk of MACE with 1-month DAPT (OR = 0.81, 95% CI: 0.67–0.98, p = 0.03, I2 = 21%) compared with >1-month DAPT. Conclusion: This meta-analysis proved the non-inferiority of 1-month DAPT followed by aspirin or a P2Y12 receptor inhibitor compared with long-term DAPT in patients undergoing PCI with DES.
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Affiliation(s)
- Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, University of Prishtina, Prishtina, Kosovo
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, University of Prishtina, Prishtina, Kosovo
| | - Artan Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, University of Prishtina, Prishtina, Kosovo
| | - Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
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Bajraktari G, Rexhaj Z, Elezi S, Zhubi-Bakija F, Bajraktari A, Bytyçi I, Batalli A, Henein MY. Radial Access for Coronary Angiography Carries Fewer Complications Compared with Femoral Access: A Meta-Analysis of Randomized Controlled Trials. J Clin Med 2021; 10:jcm10102163. [PMID: 34067672 PMCID: PMC8156941 DOI: 10.3390/jcm10102163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/04/2021] [Accepted: 05/06/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM In patients undergoing diagnostic coronary angiography (CA) and percutaneous coronary interventions (PCI), the benefits associated with radial access compared with the femoral access approach remain controversial. The aim of this meta-analysis was to compare the short-term evidence-based clinical outcome of the two approaches. METHODS The PubMed, Embase, Cochrane Central Register of Controlled Trials, and ClinicalTrials.gov databases were searched for randomized controlled trials (RCTs) comparing radial versus femoral access for CA and PCI. We identified 34 RCTs with 29,352 patients who underwent CA and/or PCI and compared 14,819 patients randomized for radial access with 14,533 who underwent procedures using femoral access. The follow-up period for clinical outcome was 30 days in all studies. Data were pooled by meta-analysis using a fixed-effect or a random-effect model, as appropriate. Risk ratios (RRs) were used for efficacy and safety outcomes. RESULTS Compared with femoral access, the radial access was associated with significantly lower risk for all-cause mortality (RR: 0.74; 95% confidence interval (CI): 0.61 to 0.88; p = 0.001), major bleeding (RR: 0.53; 95% CI:0.43 to 0.65; p ˂ 0.00001), major adverse cardiovascular events (MACE)(RR: 0.82; 95% CI: 0.74 to 0.91; p = 0.0002), and major vascular complications (RR: 0.37; 95% CI: 0.29 to 0.48; p ˂ 0.00001). These results were consistent irrespective of the clinical presentation of ACS or STEMI. CONCLUSIONS Radial access in patients undergoing CA with or without PCI is associated with lower mortality, MACE, major bleeding and vascular complications, irrespective of clinical presentation, ACS or STEMI, compared with femoral access.
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Affiliation(s)
- Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
- UBT College, 10000 Prishtina, Kosovo
- Correspondence:
| | - Zarife Rexhaj
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Shpend Elezi
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
| | - Fjolla Zhubi-Bakija
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Artan Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
| | - Arlind Batalli
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (Z.R.); (S.E.); (F.Z.-B.); (A.B.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.); (M.Y.H.)
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Abstract
Aim: The aim of this meta-analysis is to assess the impact of wall shear stress (WSS) severity on arterial plaque vulnerability. Methods: We systematically searched electronic databases and selected studies which assessed the relationship between WSS measured by intravascular ultrasound and coronary artery plaque features. In 7 studies, a total of 615 patients with 28 276 arterial segments (median follow-up: 7.71 months) were identified. At follow-up, the pooled analysis showed high WSS to be associated with regression of plaque fibrous area, weighted mean difference (WMD) −0.11 (95% CI: −0.20 to −0.02, P = .02) and fibrofatty area, WMD −0.09 (95% CI: −0.17 to −0.01, P = .02), reduction in plaque total area, WMD −0.09 (95% CI: −0.14 to −0.04, P = .007) and increased necrotic core area, and WMD 0.04 (95% CI: 0.01-0.09, P = .03) compared with low WSS. Dense calcium deposits remained unchanged in high and low WSS (0.01 vs 0.02 mm2; P > .05). High WSS resulted in profound remodeling (40% vs 18%, P < .05) and with more constructive remodeling than low WSS (78% vs 40%, P < .01). Conclusions: High WSS in coronary arteries is associated with worsening plaque vulnerability and more profound arterial wall remodeling compared with low WSS.
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Affiliation(s)
- Artan Bajraktari
- Institute of Public Health and Clinical Medicine, Umea University, Sweden
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umea University, Sweden.,University College, Bardhosh, Kosovo.,Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina, Kosovo
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, Sweden.,Molecular and Clinic Research Institute, St George University, London, and Brunel University, United Kingdom
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Bajraktari G, Zhubi-Bakija F, Ndrepepa G, Alfonso F, Elezi S, Rexhaj Z, Bytyçi I, Bajraktari A, Poniku A, Henein MY. Long-Term Outcomes of Patients with Unprotected Left Main Coronary Artery Disease Treated with Percutaneous Angioplasty versus Bypass Grafting: A Meta-Analysis of Randomized Controlled Trials. J Clin Med 2020; 9:jcm9072231. [PMID: 32674522 PMCID: PMC7408984 DOI: 10.3390/jcm9072231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 07/04/2020] [Accepted: 07/09/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM Treatment of patients with left main coronary artery disease (LMCA) with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) remains controversial. The aim of this meta-analysis was to compare the long-term clinical outcomes of patients with unprotected LMCA treated randomly by PCI or CABG. METHODS PubMed, MEDLINE, Embase, Scopus, Google Scholar, CENTRAL and ClinicalTrials.gov database searches identified five randomized trials (RCTs) including 4499 patients with unprotected LMCA comparing PCI (n = 2249) vs. CABG (n = 2250), with a minimum clinical follow-up of five years. Random effect risk ratios were used for efficacy and safety outcomes. The study was registered in PROSPERO. The primary outcome was major adverse cardiac events (MACE), defined as a composite of death from any cause, myocardial infarction or stroke. RESULTS Compared to CABG, patients assigned to PCI had a similar rate of MACE (risk ratio (RR): 1.13; 95% CI: 0.94 to 1.36; p = 0.19), myocardial infarction (RR: 1.48; 95% CI: 0.97 to 2.25; p = 0.07) and stroke (RR: 0.87; 95% CI: 0.62 to 1.23; p = 0.42). Additionally, all-cause mortality (RR: 1.07; 95% CI: 0.89 to 1.28; p = 0.48) and cardiovascular (CV) mortality (RR: 1.13; 95% CI: 0.89 to 1.43; p = 0.31) were not different. However, the risk of any repeat revascularization (RR: 1.70; 95% CI: 1.34 to 2.15; p < 0.00001) was higher in patients assigned to PCI. CONCLUSIONS The findings of this meta-analysis suggest that the long-term survival and MACE of patients who underwent PCI for unprotected LMCA stenosis were comparable to those receiving CABG, despite a higher rate of repeat revascularization.
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Affiliation(s)
- Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90737 Umeå, Sweden; (I.B.); (A.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (F.Z.-B.); (Z.R.); (A.P.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo;
- Correspondence: ; Tel.: +37-745-80-0808
| | - Fjolla Zhubi-Bakija
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (F.Z.-B.); (Z.R.); (A.P.)
| | - Gjin Ndrepepa
- Deutsches Herzzentrum München, Technische Universität, 80636 Munich, Germany;
| | - Fernando Alfonso
- Cardiac Department, La Princesa University Hospital, Institute of Health Research, IIS-IP, CIBER-CV University Autónoma of Madrid, 28029 Madrid, Spain;
| | - Shpend Elezi
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo;
| | - Zarife Rexhaj
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (F.Z.-B.); (Z.R.); (A.P.)
| | - Ibadete Bytyçi
- Department of Public Health and Clinical Medicine, Umeå University, 90737 Umeå, Sweden; (I.B.); (A.B.); (M.Y.H.)
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (F.Z.-B.); (Z.R.); (A.P.)
| | - Artan Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University, 90737 Umeå, Sweden; (I.B.); (A.B.); (M.Y.H.)
| | - Afrim Poniku
- Clinic of Cardiology, University Clinical Centre of Kosova, 10000 Prishtina, Kosovo; (F.Z.-B.); (Z.R.); (A.P.)
- Medical Faculty, University of Prishtina “Hasan Prishtina”, 10000 Prishtina, Kosovo;
| | - Michael Y. Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90737 Umeå, Sweden; (I.B.); (A.B.); (M.Y.H.)
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Bytyçi I, Dini FL, Bajraktari A, Pugliese NR, D’Agostino A, Bajraktari G, Lindqvist P, Henein MY. Speckle Tracking-Derived Left Atrial Stiffness Predicts Clinical Outcome in Heart Failure Patients with Reduced to Mid-Range Ejection Fraction. J Clin Med 2020; 9:jcm9051244. [PMID: 32344825 PMCID: PMC7287788 DOI: 10.3390/jcm9051244] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/18/2020] [Accepted: 04/21/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM Left atrial stiffness (LASt) is an important marker of cardiac function, especially in patients with heart failure (HF); it explains symptoms on the basis of pressure transfer to the pulmonary circulation. The aim of this study was to evaluate the relationship between LASt and cardiac events (CE) in HF patients with reduced to mid-range ejection fraction. METHODS The study included 215 consecutive ambulatory HF patients with ejection fraction (EF) < 50% (162 HF reduced EF and 53 HF mid-range EF) of mean age 66 ± 11 years and 24.4% females. Peak LA strain (PALS) was measured by speckle tracking echocardiography and E/e' recorded from the apical four-chamber view. Non-invasive LASt was calculated using the equation: LASt = E/e' ratio/PALS. Documented cardiac events (CE) were HF hospitalization and cardiac death. RESULTS During a median follow up of 41 ± 34 months, 65 patients (30%) had CE. In multivariate analysis model, only raised LV filling pressure (E/e') (OR = 0.292, (95% CI 0.099 to 0.859), p = 0.02), peak pulmonary artery pressure (PAP) (OR = 1.050 (1.009 to 1.094), p = 0.01), PALS (OR = 0.932 (0.873 to 0.994), p = 0.02) and LASt (OR = 3.781 (1.144 to 5.122), p = 0.001) independently predicted CE. LASt ≥ 0.76% was the most powerful predictor of CE, with 80% sensitivity and 73% specificity (AUC 0.82, CI = 0.73 to 0.87, p < 0.001) followed by PALS ≤ 16%, with 74% sensitivity and 72% specificity (AUC 0.77, CI = 0.71 to 0.84, p < 0.001). These results were consistent irrespective of EF (p < 0.05). CONCLUSION In this cohort of ambulatory HFrEF and HFmrEF patients, LASt proved the most powerful predictor of clinical outcome.
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Affiliation(s)
- Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
- Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, Kosovo
| | - Frank L. Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy; (F.L.D.); (N.R.P.); (A.D.)
| | - Artan Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
| | - Nicola Riccardo Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy; (F.L.D.); (N.R.P.); (A.D.)
| | - Andreina D’Agostino
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56124 Pisa, Italy; (F.L.D.); (N.R.P.); (A.D.)
| | - Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
- Clinic of Cardiology, University Clinical Centre of Kosovo, 10000 Prishtina, Kosovo
| | - Per Lindqvist
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
- Faculty of Medicine, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, 90187 Umeå, Sweden
| | - Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (I.B.); (A.B.); (G.B.); (P.L.)
- Molecular and Clinic Research Institute, St George University, London SW17 0QT, UK
- Institute of Fluid Dynamics, Brunel University, London UB8 3PH, UK
- Correspondence: ; Tel.: +46-90-785-14-31
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Bytyci I, Bajraktari A, Henein MY. HIGH CORONARY WALL SHEAR STRAIN RESULTS IN PROFOUND ARTERIAL WALL REMODELING COMPARED TO LOW SHEAR STRAIN A SYSTEMATIC REVIEW AND META ANALYSIS. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)30889-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Bajraktari A, Bytyçi I, Henein MY. The Relationship between Coronary Artery Wall Shear Strain and Plaque Morphology: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2020; 10:diagnostics10020091. [PMID: 32046306 PMCID: PMC7168174 DOI: 10.3390/diagnostics10020091] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 11/26/2022] Open
Abstract
Background and Aim: Arterial wall shear strain (WSS) has been proposed to impact the features of atherosclerotic plaques. The aim of this meta-analysis was to assess the impact of different types of WSS on plaque features in coronary artery disease (CAD). Methods: We systematically searched PubMed-Medline, EMBASE, Scopus, Google Scholar, and the Cochrane Central Registry, from 1989 up to January 2020 and selected clinical trials and observational studies which assessed the relationship between WSS, measured by intravascular ultrasound (IVUS), and plaque morphology in patients with CAD. Results: In four studies, a total of 72 patients with 13,098 coronary artery segments were recruited, with mean age 57.5 ± 9.5 years. The pooled analysis showed that low WSS was associated with larger baseline lumen area (WMD 2.55 [1.34 to 3.76, p < 0.001]), smaller plaque area (WMD −1.16 [−1.84 to −0.49, p = 0.0007]), lower plaque burden (WMD −12.7 [−21.4 to −4.01, p = 0.04]), and lower necrotic core area (WMD −0.32 [−0.78 to 0.14, p = 0.04]). Low WSS also had smaller fibrous area (WMD −0.79 [−1.88 to 0.30, p = 0.02]) and smaller fibro-fatty area (WMD −0.22 [−0.57 to 0.13, p = 0.02]), compared with high WSS, but the dense calcium score was similar between the two groups (WMD −0.17 [−0.47 to 0.13, p = 0.26]). No differences were found between intermediate and high WSS. Conclusions: High WSS is associated with signs of plaque instability such as higher necrotic core, higher calcium score, and higher plaque burden compared with low WSS. These findings highlight the role of IVUS in assessing plaque vulnerability.
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Affiliation(s)
- Artan Bajraktari
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.)
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.)
- Clinic of Cardiology, University Clinical Centre of Kosovo, Prishtina 10000, Kosovo
| | - Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden; (A.B.); (I.B.)
- Institute of Environment & Health and Societies, Brunel University, Middlesex UB8 3PH, UK
- Molecular and Clinic Research Institute, St George University, London SW17 0RE, UK
- Correspondence: ; Tel.: +46-90-785-1431
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Bytyci I, Pugliese NR, Bajraktari A, Mazzola M, Bajraktari G, Henein MY, Dini FL. P791 Left atrial stiffness as a predictor of cardiac events in patients with heart failure and reduced ejection fraction: the impact of diabetes. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and Aim
Diabetes mellitus (DM) affects left ventricular remodeling in patients with heart failure (HF), but its effect on left atrial (LA) remodeling and their combined effect on survival and other clinical events (CE) remain to be elucidated. We evaluated in this study the relationship between DM and left atrial (LA) remodeling in a group of HF patients with reduced ejection fraction (HFrEF),
Methods
This studied 136 consecutive HFrEF patients (65 ± 11 years), 36 diabetics, using conventional and tissue Doppler echocardiography. LA dimension and function were measured and cavity stiffness was calculated with the formula: LA stiffness = E/e’ratio/LA strain.
Results
The age, gender, LV end-systolic dimension, LV end-diastolic dimension, LV EF and BNP level did not differ between diabetic and non-diabetic patients. Diabetic patients with HFrEF had higher NYHA functional class (p = 0.02), reduced right ventricle (RV) systolic function (p = 0.01) and increased LA stiffness (p = 0.02) .
At follow up of 55 ± 37 months, survival free from CE was 69% in non-diabetics compared with 44.4% in diabetics (X2 12.7; p< 0.0001). The CE free survival was lower in patients with increased LA stiffnes, irrespective of the presence of DM: 1) Patients with HFrEF without DM and normal LA stiffness (85%); 2) Patients with HFrEF without DM and with increased LA stiffness (50%); 3) Patients with HFrEF with DM and with normal LA stiffness (71%) and patients with HFrEF with DM and with increased LA stiffness (27%) (X2 29.6; p< 0.0001, Figure 1).
Conclusion
Compromised LA stiffness as surrogate of LA remodeling is associated with poor outcome in patients with heart failure and reduced EF. The presence of diabetes in patients with HFrEF and increased LA stiffness has incremental prognostic value.
Abstract P791 Figure.
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Affiliation(s)
- I Bytyci
- University Clinical Centre of Kosova, Clinic of Cardiology, Pristina, Kosovo Republic of
| | - N R Pugliese
- University of Pisa, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy, Pisa, Italy
| | - A Bajraktari
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | - M Mazzola
- University of Pisa, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy, Pisa, Italy
| | - G Bajraktari
- University Clinical Centre of Kosova, Clinic of Cardiology, Pristina, Kosovo Republic of
| | - M Y Henein
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | - F L Dini
- University of Pisa, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy, Pisa, Italy
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Bytyci I, Riccardo N, Bajraktari A, Mazzola M, Bajraktari G, Henein M, Dini FL. P1544 Independent prognostic significance of non invasive left atrial stiffness in outpatients with heart failure and reduced ejection fraction. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background and Aim
Left atrial (LA) stiffness is an important marker of cardiac pump function, especially in patients with heart failure (HF) and preserved ejection fraction (HFpEF). The aim of this study was to evaluate the relationship between LA stiffness and cardiac events (CE) in HF patients with reduced ejection fraction (HFrEF).
Methods
This study included 136 consecutive HFrEF outpatients (mean age: 65 ± 11 years). A complete conventional and tissue Doppler imaging study was performed. The LA dimension and function were measured. Non invasive LA stiffness was calculated with the following formula: LA stiffness = E/e’ratio/LA strain. The cardiac events were HF hospitalization and cardiac death.
Results
During a median follow up of 55 ± 37 months, 51 patients had CE, they had higher NYHA functional class (p = 0.001), higher LV end-diastolic dimension (p = 0.001), higher LV end-systolic dimension (p = 0.04), lower EF (p < 0.001), higher E/A ratio (p = 0.01) and reduced TAPSE (p = 0.001) compared with patients without CE. LA volume index was higher (p = 0.001), LA strain was reduced and LA stiffness was increased in patients with CE compared to those without CE (p = 0.0001, p < 0.0001, respectively). LA stiffness exhibited the closest relationship with E/e’ ratio (r = 0.67, p < 0.001). Survival analyses showed that LA stiffness [HR: 4.026 (1.300–12.468), p = 0.001] was the most powerful independent predictor of cardiac events[C1] . On ROC curve analysis, a LA stiffness < 0.82% was 81% sensitive and 73% specific (AUC 0.81, p < 0.001) in predicting clinical events (Figure 1).
Conclusion
In this cohort of outpatients with HFrEF, LA stiffness proved the most important predictor of clinical outcome.
[C1]
Abstract P1544 Figure.
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Affiliation(s)
- I Bytyci
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | - N Riccardo
- University of Pisa, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy, Pisa, Italy
| | - A Bajraktari
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | - M Mazzola
- University of Pisa, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy, Pisa, Italy
| | - G Bajraktari
- University Clinical Centre of Kosova, Clinic of Cardiology, Pristina, Kosovo Republic of
| | - M Henein
- Umea University, Department of Public Health and Clinical Medicine, Umea, Sweden
| | - F L Dini
- University of Pisa, Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy, Pisa, Italy
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Sellari-Franceschini S, Rocchi R, Marinò M, Bajraktari A, Mazzi B, Fiacchini G, Lepri P, Dallan I, Vitti P, Marcocci C. Rehabilitative orbital decompression for Graves' orbitopathy: results of a randomized clinical trial. J Endocrinol Invest 2018; 41:1037-1042. [PMID: 29450866 DOI: 10.1007/s40618-018-0847-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Accepted: 02/03/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Orbital decompression (OD) is a consolidated procedure for the treatment of exophthalmos in Graves' orbitopathy (GO). The efficacy of the various procedures remains unclear due to the variability of the techniques used. To address this issue, we performed a randomized clinical trial to compare the efficacy of two surgical techniques. The primary endpoint was the reduction in proptosis. Secondary aims were the risk of post-operative diplopia (POD) in primary gaze and other surgical complications. PATIENTS 38 patients (76 orbits) affected with GO were enrolled and randomized into single lateral decompression (LD) (n = 19) or balanced medial plus lateral wall decompression (MLD) (n = 19). Following surgery, patients were seen for a follow-up ophthalmological evaluation at 6 months. Pre-operative diplopia in secondary gaze was present in 13/38 patients (34.2%, 8/19 treated with LD and 5/19 treated with MLD). RESULTS The reduction of exophthalmos was greater in patients treated with MLD (5.1 ± 1.5 mm, range 2-8 mm) than in those treated with LD (3.5 ± 1.3 mm, range 1-6.5 mm) (p = 0.01). The overall incidence of POD in primary gaze was 5/38 (13.2%) and all of these patients had pre-operative diplopia in secondary gaze (5/13, 38.5%, vs patients with no pre-operative diplopia p = 0.005). Two of 19 patients (10.5%) treated with LD and 3/19 (15.8%) treated with MLD, developed POD in primary gaze, with no statistical difference between the two techniques. CONCLUSION MLD provides a better result in terms of proptosis reduction compared to LD. The two techniques used here appear to have a similar safety profile in terms of POD. Pre-operative diplopia in the secondary gaze remains a major risk factor for development of POD.
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Affiliation(s)
| | - R Rocchi
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - M Marinò
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - A Bajraktari
- First ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - B Mazzi
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - G Fiacchini
- First ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - P Lepri
- Unit of Ophthalmology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - I Dallan
- First ENT Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - P Vitti
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - C Marcocci
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
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11
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Sellari-Franceschini S, Dallan I, Bajraktari A, Fiacchini G, Nardi M, Rocchi R, Marcocci C, Marinò M, Casani AP. Surgical complications in orbital decompression for Graves' orbitopathy. Acta Otorhinolaryngol Ital 2017; 36:265-274. [PMID: 27734978 PMCID: PMC5066461 DOI: 10.14639/0392-100x-1082] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Accepted: 03/02/2016] [Indexed: 11/23/2022]
Abstract
The objective of this study is to analyse the complications of orbital decompression in Graves' orbitopathy. The clinical records of 946 patients who had been operated on with orbital decompression for Graves' orbitopathy were reviewed and the intra- and post-operative complications with minimum follow-up of six months were analysed. An extensive review of the literature was carried out to compare results. In the case-series reported here the most frequent complications were: wasting of the temporal region (100%) in patients operated on using a coronal approach; permanent hypoesthesia of V2 (13%) and V1 (8%) in patients operated on with an upper eyelid incision. In only one patient was a total monolateral lesion of V2 reported. The most severe complications consisted in reduction of visual acuity in 5 patients, and CSF leak with cerebral complications in 2 patients, who were operated on with a non-endoscopic endonasal approach. Three patients had intra-operative haemorrhages and 3 patients had post-operative haemorrhages requiring further surgical intervention. The incidence of symptomatic sinusitis/mucoceles was 0.75%. In conclusion, orbital decompression carried out with endoscopic endonasal technique and via transpalpebral accesses appears to be associated with a low incidence of complications. Knowledge of the causes of the possible complications in the different surgical approaches can definitely help to reduce their incidence.
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Affiliation(s)
| | - I Dallan
- First ENT Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - A Bajraktari
- First ENT Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - G Fiacchini
- First ENT Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - M Nardi
- Unit of Ophthalmology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - R Rocchi
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - C Marcocci
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - M Marinò
- Unit of Endocrinology, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
| | - A P Casani
- First ENT Unit, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Italy
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12
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Re M, Gioacchini FM, Bajraktari A, Tomasetti M, Kaleci S, Rubini C, Bertini A, Magliulo G, Pasquini E. Malignant transformation of sinonasal inverted papilloma and related genetic alterations: a systematic review. Eur Arch Otorhinolaryngol 2017; 274:2991-3000. [PMID: 28432463 DOI: 10.1007/s00405-017-4571-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 04/17/2017] [Indexed: 12/31/2022]
Abstract
Schneiderian papillomas are uncommon tumors which may develop within the nasal cavity and comprise three well-defined histological types: sinonasal inverted papilloma (SNIP), exophytic papilloma, and oncocytic papilloma. It is well known the rate of Schneiderian papilloma may also present a malignant degeneration and SNIP represents the most important subgroup in consideration of its frequency and malignant propensity. Although HPV infection is always considered the first event favoring the development of SNIP, however, it is not established as an eventual connection between viral actions and malignant transformation. In fact, different molecular mechanisms are suspected to play a crucial role in this process and, currently, many authors agree that only by improving our knowledge about these mechanisms it will be possible to achieve new and effective targeted therapies. So the aim of this study was firstly to systematically review the literature focusing on different biomarkers that could be implicated in the stages of SNIP malignant degeneration. Secondly, a systematic review with meta-analysis was performed to better define the incidence of sinonasal malignancies originating from Schneiderian papilloma (SNIP, exophytic papilloma, and oncocytic papilloma). Twenty-nine studies comprising a total of 3177 patients were statistically analyzed. Results showed a 9% (95% CI = 7-11) overall rate of malignant transformation from Schneiderian papilloma. In conclusion, this analysis confirmed that the potential malignancy of Schneiderian papilloma should not be underestimated. On the other hand, our review showed the paucity of studies investigating the molecular alterations which may be related with the malignant transformation of SNIP.
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Affiliation(s)
- M Re
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Ancona, Italy
| | - F M Gioacchini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Ancona, Italy.
| | - A Bajraktari
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Ancona, Italy
| | - M Tomasetti
- Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - S Kaleci
- Department of Diagnostic Medicine, Clinical and Public Health, University Hospital of Modena, Modena, Italy
| | - C Rubini
- Pathologic Anatomy and Histopathology Division, Department of Biomedical Sciences and Public Health, Polytechnic University of the Marches, Ancona, Italy
| | - A Bertini
- ENT Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ospedali Riuniti of Ancona, Via Conca 71, 60020, Ancona, Italy
| | - G Magliulo
- Department of Otorhinolaryngology, Audiology and Phoniatrics "G. Ferreri"University La Sapienza, Rome, Italy
| | - E Pasquini
- ENT Metropolitan Unit, Bellaria Hospital, AUSL Bologna, Bologna, Italy
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13
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Bajraktari A, Seccia V, Casani AP, Franceschini SS. Isolated laryngeal leishmaniasis in an immunocompetent patient: a case report. B-ENT 2016; 12:333-337. [PMID: 29709138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023] Open
Abstract
UNLABELLED Isolated laryngeal leishmaniasis in an immunocompetent patient: a case report. OBJECTIVE Isolated laryngeal Leishmaniasis presents neither explicit laryngeal lesions nor specific symptoms. In fact, it may mimic many inflammatory and neoplastic diseases. Considering the low incidence of this atypical localization, laryngeal Leishmaniasis, is rarely contemplated by physicians in differential diagnoses of laryngeal tumour lesions. We present the case of a 62-year-old immunocompetent subject who developed a single Leishmania mucosal lesion on the left vocal cord, simulating a laryngeal cancer. METHODS A case report and discussion of the clinical case by referring to the literature. RESULTS Specific therapy with miltefosine led to clinical and endoscopic improvement. We had no relapse after three years of follow-up. CONCLUSIONS This clinical case highlights the need to consider isolated laryngeal Leishmaniasis in the differential diagnoses of laryngeal tumour lesions, even in immunocompetent subjects who live in endemic zones, in order to ensure an early and correct therapeutic approach.
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