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Mancio J. Pericoronary Fat Attenuation on Computed Tomography Unveils a Guilty Factor of Coronary Artery Disease Associated with Anabolic-Androgenic Steroids. Arq Bras Cardiol 2024; 120:e20230843. [PMID: 38477722 PMCID: PMC11098588 DOI: 10.36660/abc.20230843] [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: 12/06/2023] [Revised: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 03/14/2024] Open
Affiliation(s)
- Jennifer Mancio
- Royal Brompton HospitalLondresReino UnidoRoyal Brompton Hospital, Londres – Reino Unido
- Faculdade de Medicina do PortoPortoPortugalFaculdade de Medicina do Porto, Porto – Portugal
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2
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Mancio J. Empowering the Imagers with 3D-Speckle Tracking Echocardiography to Detect Subclinical Cancer Therapy-Related Myocardial Dysfunction. Arq Bras Cardiol 2023; 120:e20230554. [PMID: 37792785 DOI: 10.36660/abc.20230554] [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] [Received: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 10/06/2023] Open
Affiliation(s)
- Jennifer Mancio
- Royal Brompton Hospital, Guy's and St Thomas NHS Trust Foundation, Londres - Reino Unido
- Faculdade de Medicina da Universidade do Porto, Porto - Portugal
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Domingues R, Nunes F, Mancio J, Fontes-Carvalho R, Coimbra M, Pedrosa J, Renna F. Automatic Contrast Generation from Contrastless Computed Tomography. Annu Int Conf IEEE Eng Med Biol Soc 2023; 2023:1-4. [PMID: 38083590 DOI: 10.1109/embc40787.2023.10340695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The use of contrast-enhanced computed tomography (CTCA) for detection of coronary artery disease (CAD) exposes patients to the risks of iodine contrast-agents and excessive radiation, increases scanning time and healthcare costs. Deep learning generative models have the potential to artificially create a pseudo-enhanced image from non-contrast computed tomography (CT) scans.In this work, two specific models of generative adversarial networks (GANs) - the Pix2Pix-GAN and the Cycle-GAN - were tested with paired non-contrasted CT and CTCA scans from a private and public dataset. Furthermore, an exploratory analysis of the trade-off of using 2D and 3D inputs and architectures was performed. Using only the Structural Similarity Index Measure (SSIM) and the Peak Signal-to-Noise Ratio (PSNR), it could be concluded that the Pix2Pix-GAN using 2D data reached better results with 0.492 SSIM and 16.375 dB PSNR. However, visual analysis of the output shows significant blur in the generated images, which is not the case for the Cycle-GAN models. This behavior can be captured by the evaluation of the Fréchet Inception Distance (FID), that represents a fundamental performance metric that is usually not considered by related works in the literature.Clinical relevance- Contrast-enhanced computed tomography is the first line imaging modality to detect CAD resulting in unnecessary exposition to the risk of iodine contrast and radiation in particularly in young patients with no disease. This algorithm has the potential of being translated into clinical practice as a screening method for CAD in asymptomatic subjects or quick rule-out method of CAD in the acute setting or centres with no CTCA service. This strategy can eventually represent a reduction in the need for CTCA reducing its burden and associated costs.
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Edwards J, Shanmugam N, Ray R, Jouhra F, Mancio J, Wiles J, Marciniak A, Sharma R, O’Driscoll J. Exercise Mode in Heart Failure: A Systematic Review and Meta-Analysis. Sports Med Open 2023; 9:3. [PMID: 36622511 PMCID: PMC9829948 DOI: 10.1186/s40798-022-00549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Optimising exercise prescription in heart failure (HF) with a preserved (HFpEF) or reduced (HFrEF) ejection fraction is clinically important. As such, the aim of this meta-analysis was to compare traditional moderate intensity training (MIT) against combined aerobic and resistance training (CT) and high-intensity interval training (HIIT) for improving aerobic capacity (VO2), as well as other clinically relevant parameters. METHODS A comprehensive systematic search was performed to identify randomised controlled trials published between 1990 and May 2021. Research trials reporting the effects of MIT against CT or HIIT on peak VO2 in HFpEF or HFrEF were considered. Left-ventricular ejection fraction (LVEF) and various markers of diastolic function were also analysed. RESULTS Seventeen studies were included in the final analysis, 4 of which compared MIT against CT and 13 compared MIT against HIIT. There were no significant differences between MIT and CT for peak VO2 (weighted mean difference [WMD]: 0.521 ml min-1 kg-1, [95% CI] = - 0.7 to 1.8, Pfixed = 0.412) or LVEF (WMD: - 1.129%, [95% CI] = - 3.8 to 1.5, Pfixed = 0.408). However, HIIT was significantly more effective than MIT at improving peak VO2 (WMD: 1.62 ml min-1 kg-1, [95% CI] = 0.6-2.6, Prandom = 0.002) and LVEF (WMD: 3.24%, [95% CI] = 1.7-4.8, Prandom < 0.001) in HF patients. When dichotomized by HF phenotype, HIIT remained significantly more effective than MIT in all analyses except for peak VO2 in HFpEF. CONCLUSIONS HIIT is significantly more effective than MIT for improving peak VO2 and LVEF in HF patients. With the exception of peak VO2 in HFpEF, these findings remain consistent in both phenotypes. Separately, there is no difference in peak VO2 and LVEF change following MIT or CT, suggesting that the addition of resistance exercise does not inhibit aerobic adaptations in HF.
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Affiliation(s)
- Jamie Edwards
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK
| | - Nesan Shanmugam
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Robin Ray
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Fadi Jouhra
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jennifer Mancio
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jonathan Wiles
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK
| | - Anna Marciniak
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Rajan Sharma
- grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
| | - Jamie O’Driscoll
- grid.127050.10000 0001 0249 951XSchool of Psychology and Life Sciences, Canterbury Christ Church University, North Holmes Road, Canterbury, Kent, CT1 1 QU UK ,grid.451349.eDepartment of Cardiology, St George’s Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT UK
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5
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McFadyen C, Garfield B, Mancio J, Ridge CA, Semple T, Keeling A, Ledot S, Patel B, Samaranayake CB, McCabe C, Wort SJ, Price S, Price LC. Use of sildenafil in patients with severe COVID-19 pneumonitis. Br J Anaesth 2022; 129:e18-e21. [PMID: 35568507 PMCID: PMC9010282 DOI: 10.1016/j.bja.2022.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 04/08/2022] [Indexed: 12/01/2022] Open
Affiliation(s)
- Charles McFadyen
- Adult Intensive Care Unit, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK; Bloomsbury Institute for Intensive Care Medicine, University College London, London, UK.
| | - Ben Garfield
- Adult Intensive Care Unit, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Jennifer Mancio
- Adult Intensive Care Unit, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Carole A Ridge
- Radiology Department, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Tom Semple
- Radiology Department, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Archie Keeling
- Radiology Department, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Stephane Ledot
- Adult Intensive Care Unit, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Brijesh Patel
- Adult Intensive Care Unit, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK; Anaesthetics, Pain Medicine & Intensive Care, Surgery & Cancer Division, Imperial College London, London, UK
| | - Chinthaka B Samaranayake
- Department of Respiratory Medicine, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Colm McCabe
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - S John Wort
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Laura C Price
- National Heart and Lung Institute, Imperial College London, London, UK; National Pulmonary Hypertension Service, Royal Brompton Hospital, Guy's & St. Thomas' NHS Foundation Trust, London, UK
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6
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Vasques-Nóvoa F, Angélico-Gonçalves A, Alvarenga JMG, Nobrega J, Cerqueira RJ, Mancio J, Leite-Moreira AF, Roncon-Albuquerque R. Myocardial oedema: pathophysiological basis and implications for the failing heart. ESC Heart Fail 2022; 9:958-976. [PMID: 35150087 PMCID: PMC8934951 DOI: 10.1002/ehf2.13775] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/27/2021] [Accepted: 12/02/2021] [Indexed: 12/04/2022] Open
Abstract
Myocardial fluid homeostasis relies on a complex interplay between microvascular filtration, interstitial hydration, cardiomyocyte water uptake and lymphatic removal. Dysregulation of one or more of these mechanisms may result in myocardial oedema. Interstitial and intracellular fluid accumulation disrupts myocardial architecture, intercellular communication, and metabolic pathways, decreasing contractility and increasing myocardial stiffness. The widespread use of cardiac magnetic resonance enabled the identification of myocardial oedema as a clinically relevant imaging finding with prognostic implications in several types of heart failure. Furthermore, growing experimental evidence has contributed to a better understanding of the physical and molecular interactions in the microvascular barrier, myocardial interstitium and lymphatics and how they might be disrupted in heart failure. In this review, we summarize current knowledge on the factors controlling myocardial water balance in the healthy and failing heart and pinpoint the new potential therapeutic avenues.
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Affiliation(s)
- Francisco Vasques-Nóvoa
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - António Angélico-Gonçalves
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - José M G Alvarenga
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - João Nobrega
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Rui J Cerqueira
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Jennifer Mancio
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Adelino F Leite-Moreira
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
| | - Roberto Roncon-Albuquerque
- Cardiovascular R&D Center, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Al. Prof. Hernâni Monteiro, Porto, 4200-319, Portugal
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7
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Fragão-Marques M, Teixeira F, Mancio J, Seixas N, Rocha-Neves J, Falcão-Pires I, Leite-Moreira A. Impact of oral anticoagulation therapy on postoperative atrial fibrillation outcomes: a systematic review and meta-analysis. Thromb J 2021; 19:89. [PMID: 34798896 PMCID: PMC8603521 DOI: 10.1186/s12959-021-00342-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/01/2021] [Indexed: 02/07/2023] Open
Abstract
Background Post-operative atrial fibrillation (POAF) is the most common complication after cardiac surgery. Recent studies had shown this phenomenon is no longer considered transitory and is associated with higher risk of thromboembolic events or death. The aim of this study was to systematically review and analyze previous studies comparing oral anticoagulation therapy with no anticoagulation, regarding these long-term outcomes. Methods PubMed/MEDLINE, EMBASE, Web of Science and Cochrane Database were systematically searched to identify the studies comparing the risk of stroke, or thromboembolic events or mortality of POAF patients who received anticoagulation compared with those who were not anticoagulated. Incidence of stroke, thromboembolic events and all-cause mortality were evaluated up to 10 years after surgery. Time-to-event outcomes were collected through hazard ratio (HR) along with their variance and the early endpoints using frequencies or odds ratio (OR). Random effect models were used to compute statistical combined measures and 95% confidence intervals (CI). Heterogeneity was evaluated through Q statistic-related measures of variance (Tau2, I2, Chi-squared test). Results Eight observational cohort studies were selected, including 15,335 patients (3492 on Oral Anticoagulants (OAC) vs 11,429 without OAC) that met the inclusion criteria for qualitative synthesis. Patients had a wide gender distribution (38.6–82.3%), each study with a mean age above 65 years (67.5–85). Vitamin K antagonists were commonly prescribed anticoagulants (74.3–100%). OAC was associated with a protective impact on all-cause mortality at a mean of 5.0 years of follow-up (HR is 0.85 [0.72–1.01]; p = 0.07; I2 = 48%). Thromboembolic events did not differ between the two treatment arms (HR 0.68 [0.40–1.15], p = 0.15). Conclusion Current literature suggests a possibly protective impact of OAC therapy for all-cause mortality in patients with new-onset atrial fibrillation after cardiac surgery. However, it does not appear to impact thromboembolism rate. Supplementary Information The online version contains supplementary material available at 10.1186/s12959-021-00342-2.
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Affiliation(s)
- Mariana Fragão-Marques
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal. .,São João University Hospital Center, Porto, Portugal. .,Faculty of Medicine of the University of Porto, Porto, Portugal.
| | | | - Jennifer Mancio
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Nair Seixas
- Vila Nova de Gaia Hospital Center, Vila Nova de Gaia, Portugal
| | - João Rocha-Neves
- São João University Hospital Center, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Cardiovascular Research and Development Center, Faculty of Medicine of the University of Porto, 4200, Porto, Portugal.,São João University Hospital Center, Porto, Portugal.,Faculty of Medicine of the University of Porto, Porto, Portugal
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8
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Machado RJ, Saraiva FA, Mancio J, Sousa P, Cerqueira RJ, Barros AS, Lourenço AP, Leite-Moreira AF. A systematic review and meta-analysis of randomized controlled studies comparing off-pump versus on-pump coronary artery bypass grafting in the elderly. J Cardiovasc Surg (Torino) 2021; 63:60-68. [PMID: 34792312 DOI: 10.23736/s0021-9509.21.12012-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
AIM Comparison of short and mid-term outcomes between off-pump CABG (OPCAB) and on-pump CABG (ONCAB) in patients older than 65 throughout a meta-analysis of randomized clinical trials (RCTs). EVIDENCE ACQUISITION A literature search was conducted using 3 databases. RCTs reporting mortality outcomes of OPCAB versus ONCAB among the elderly were included. Data on myocardial infarction, stroke, re-revascularization, renal failure and composite endpoints after CABG were also collected. Random effects models were used to compute statistical combined measures and 95% confidence intervals (CI). EVIDENCE SYNTHESIS Five RCTs encompassing 6221 patients were included (3105 OPCAB and 3116 ONCAB). There were no significant differences on mid-term mortality (pooled HR: 1.02, 95%CI: 0.89-1.17, p=0.80) and composite endpoint incidence (pooled HR: 0.98, 95%CI: 0.88-1.09, p=0.72) between OPCAB and ONCAB. At 30-day, there were no differences in mortality, myocardial infarction, stroke and renal complications. The need for early re-revascularization was significantly higher in OPCAB (pooled OR: 3.22, 95%CI: 1.28-8.09, p=0.01), with a higher percentage of incomplete revascularization being reported for OPCAB in trials included in this pooled result (34% in OPCAB vs 29% in ONCAB, p<0.01). CONCLUSIONS Data from RCTs in elderly patients showed that OPCAB and ONCAB provide similar mid-term results. OPCAB was associated with a higher risk of early rerevascularization. As CABG on the elderly is still insufficiently explored, further RCTs, specifically designed targeting this population, are needed to establish a better CABG strategy for these patients.
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Affiliation(s)
- Rui J Machado
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca A Saraiva
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Jennifer Mancio
- Intensive Care and Perioperative Medicine Department, Royal Brompton and Harefield & Guys and St. Thomas NHS Foundation Trust, London, UK
| | - Patrícia Sousa
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Rui J Cerqueira
- Cardiothoracic Surgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - António S Barros
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André P Lourenço
- Anaesthesiology Department, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Adelino F Leite-Moreira
- Surgery and Physiology Department and Cardiovascular Research & Development Centre, Faculty of Medicine, University of Porto, Porto, Portugal - .,Cardiothoracic Surgery Department, Centro Hospitalar Universitário São João, Porto, Portugal
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9
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Machado RJ, Saraiva FA, Mancio J, Sousa P, Cerqueira RJ, Barros AS, Lourenco AP, Leite-Moreira AF. A meta-analysis of randomized controlled studies comparing off-pump vs on-pump CABG in the elderly. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The increasing demand for coronary revascularization in the elderly has raised the interest in off-pump coronary artery bypass graft (CABG) as an option in these high-risk patients.
Purpose
We sought to investigate the differences between off-pump CABG (OPCAB) and on-pump CABG (ONCAB), among patients older than 60, in short and mid-term results throughout a meta-analysis of randomized clinical trials (RCTs).
Methods
A literature search was conducted using MEDLINE, ISI Web of Science and Cochrane Library (1960–2020). RCTs reporting mortality outcomes of OPCAB vs ONCAB within elderly patients (as prespecified or secondary analysis) were included. Data on myocardial infarction, stroke, repeat revascularization, renal failure and composite endpoints after CABG were also collected. Hazard ratio (HR) and variance for follow-up outcomes and frequencies or odds ratio (OR) for early endpoints were collected. Random effect models were used to compute statistical combined measures and 95% confidence intervals (CI).
Results
Seven RCTs encompassing a total of 6,609 patients were included (3,303 OPCAB and 3,306 ONCAB, 50% were men). Five trials reported mortality during follow-up (6 months (2 studies) to 5 years). There were no significant differences on mid-term mortality (pooled HR: 1.02, 95% CI: 0.88–1.17, p=0.82) and composite endpoint incidence (4 studies pooled HR: 0.98, 95% CI: 0.88–1.09, p=0.73) between OPCAB and ONCAB. At 30-days, no differences between groups were noted in mortality (5 studies pooled OR: 0.90, 95% CI: 0.62–1.31, p=0.59), early myocardial infarction (5 studies pooled OR: 0.95, 95% CI: 0.60–1.51, p=0.82) and renal complications (3 studies pooled OR: 0.74, 95% CI: 0.50–1.11, p=0.14). The need for early repeat revascularization was significantly higher in OPCAB (2 studies pooled OR: 2.58, 95% CI: 1.16–5.75, p=0.02), with higher percentage of incomplete revascularization among OPCAB in both trials included in this pooled result (34% in OPCAB vs 29% in ONCAB, p<0.01). However, OPCAB showed a tendency for lower risk of early stroke (6 studies pooled OR: 0.70, 95% CI: 0.48–1.03, p=0.07).
Conclusions
Pooling data from RCTs in elderly patients showed that OPCAB and ONCAB provide similar mid-term results. However, OPCAB was associated with a higher risk of early repeat revascularization and there was a trend for reduced early stroke risk. Further randomized studies, specifically designed to include elderly patients, are needed to establish the better CABG strategy.
Funding Acknowledgement
Type of funding sources: Other. Main funding source(s): Universidade do Porto/FMUP and FSE-Social European Fund; Fundação para a Ciência e Tecnologia Early and Mid-term Results
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Affiliation(s)
- R J Machado
- Faculty of Medicine University of Porto, Surgery and Physiology Department and Cardiovascular & Research Centre, Porto, Portugal
| | - F A Saraiva
- Faculty of Medicine University of Porto, Surgery and Physiology Department and Cardiovascular & Research Centre, Porto, Portugal
| | - J Mancio
- Faculty of Medicine University of Porto, Surgery and Physiology Department and Cardiovascular & Research Centre, Porto, Portugal
| | - P Sousa
- Faculty of Medicine University of Porto, Surgery and Physiology Department and Cardiovascular & Research Centre, Porto, Portugal
| | - R J Cerqueira
- Faculty of Medicine University of Porto, Surgery and Physiology Department and Cardiovascular & Research Centre, Porto, Portugal
| | - A S Barros
- Faculty of Medicine University of Porto, Surgery and Physiology Department and Cardiovascular & Research Centre, Porto, Portugal
| | - A P Lourenco
- Faculty of Medicine University of Porto, Surgery and Physiology Department and Cardiovascular & Research Centre, Porto, Portugal
| | - A F Leite-Moreira
- Faculty of Medicine University of Porto, Surgery and Physiology Department and Cardiovascular & Research Centre, Porto, Portugal
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10
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Saraiva FA, Moreira R, Cerqueira RJ, Mancio J, Barros AS, Lourenço AP, Leite-Moreira AF. Multiple versus single arterial grafting in the elderly: a meta-analysis of randomized controlled trials and propensity score studies. J Cardiovasc Surg (Torino) 2021; 63:169-178. [PMID: 34235900 DOI: 10.23736/s0021-9509.21.11826-9] [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] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION The benefit of adding a second arterial conduit is still controversial, mainly in specific subgroups. We conducted a meta-analysis of randomized controlled trials (RCTs) and propensity score (PS) studies comparing survival and early results in elderly patients who underwent coronary artery bypass grafting (CABG) with multiple (MAG) versus single arterial grafting (SAG). EVIDENCE ACQUISITION MEDLINE, Web of Science and Cochrane Library were used to find relevant literature (1960-April 2020). Survival at a ≥ 1-year follow-up and early outcomes were evaluated. Outcomes were collected from matched samples or PS adjusted analysis: hazard ratio (HR) along with their variance, frequencies or odds ratios. Random effect models were used to compute combined statistical measures and 95% confidence intervals (CI) through generic inverse variance method (time-to-event) or Mantel-Haenszel method (binary events). EVIDENCE SYNTHESIS Eleven PS cohorts and 1 RCT comprising > 18,800 patients older than 70 (>6200 MAG and >12,500 SAG) were included in this meta-analysis. MAG was associated with lower long-term mortality (pooled HR: 0.81, 95%CI: 0.72-0.91, p<0.01, I2=64%) in the absence of higher risk of early mortality (pooled OR: 0.74, 95%CI: 0.44 to 1.25, p=0.27, I2=0%). In a meta-regression, MAG survival advantage was more pronounced in studies with a higher MAG usage rate (β = -0.0052, p=0.021). CONCLUSIONS Current evidence suggests that advanced age should not limit MAG's use considering its benefits in long-term survival. Of note, an individualized patient selection for this approach is warranted.
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Affiliation(s)
- Francisca A Saraiva
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Raquel Moreira
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Rui J Cerqueira
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Cardiothoracic Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Jennifer Mancio
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.,St. Bartholomew's Hospital, Bart's Health NHS Trust, London, UK
| | - António S Barros
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - André P Lourenço
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal.,Department of Anesthesiology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Adelino F Leite-Moreira
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal - .,Department of Cardiothoracic Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
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11
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Mancio J, Pashakhanloo F, El-Rewaidy H, Jang J, Joshi G, Csecs I, Ngo L, Rowin E, Manning W, Maron M, Nezafat R. Machine learning phenotyping of scarred myocardium from cine in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2021; 23:532-542. [PMID: 33779725 DOI: 10.1093/ehjci/jeab056] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Indexed: 12/12/2022] Open
Abstract
AIMS Cardiovascular magnetic resonance (CMR) with late-gadolinium enhancement (LGE) is increasingly being used in hypertrophic cardiomyopathy (HCM) for diagnosis, risk stratification, and monitoring. However, recent data demonstrating brain gadolinium deposits have raised safety concerns. We developed and validated a machine-learning (ML) method that incorporates features extracted from cine to identify HCM patients without fibrosis in whom gadolinium can be avoided. METHODS AND RESULTS An XGBoost ML model was developed using regional wall thickness and thickening, and radiomic features of myocardial signal intensity, texture, size, and shape from cine. A CMR dataset containing 1099 HCM patients collected using 1.5T CMR scanners from different vendors and centres was used for model development (n=882) and validation (n=217). Among the 2613 radiomic features, we identified 7 features that provided best discrimination between +LGE and -LGE using 10-fold stratified cross-validation in the development cohort. Subsequently, an XGBoost model was developed using these radiomic features, regional wall thickness and thickening. In the independent validation cohort, the ML model yielded an area under the curve of 0.83 (95% CI: 0.77-0.89), sensitivity of 91%, specificity of 62%, F1-score of 77%, true negatives rate (TNR) of 34%, and negative predictive value (NPV) of 89%. Optimization for sensitivity provided sensitivity of 96%, F2-score of 83%, TNR of 19% and NPV of 91%; false negatives halved from 4% to 2%. CONCLUSION An ML model incorporating novel radiomic markers of myocardium from cine can rule-out myocardial fibrosis in one-third of HCM patients referred for CMR reducing unnecessary gadolinium administration.
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Affiliation(s)
- Jennifer Mancio
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Farhad Pashakhanloo
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Hossam El-Rewaidy
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Computer Science, Technical University of Munich, Arcisstraße 21, 80333 Munich, Germany
| | - Jihye Jang
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Computer Science, Technical University of Munich, Arcisstraße 21, 80333 Munich, Germany
| | - Gargi Joshi
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Ibolya Csecs
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Long Ngo
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115, USA
| | - Ethan Rowin
- HCM Institute, Division of Cardiology, Tufts Medical Centre, 860 Washington St Building, 6th Floor, Boston, MA 02111, USA
| | - Warren Manning
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA.,Department of Radiology, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
| | - Martin Maron
- HCM Institute, Division of Cardiology, Tufts Medical Centre, 860 Washington St Building, 6th Floor, Boston, MA 02111, USA
| | - Reza Nezafat
- Department of Medicine, Beth Israel Deaconess Medical Centre and Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215, USA
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12
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Azevedo D, Mancio J, Pessoa-Amorim G, Monteiro D, Almeida N, Ladeiras-Lopes R, Faria R, Ferreira N, Vouga L, Gama Ribeiro V, Leite-Moreira A, Bettencourt N. Left ventricular reverse remodeling and function by strain analysis in aortic stenosis: A CMR analysis of the EPICHEART study. Revista Portuguesa de Cardiologia (English Edition) 2021. [DOI: 10.1016/j.repce.2020.06.009] [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] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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13
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Jang J, El‐Rewaidy H, Ngo LH, Mancio J, Csecs I, Rodriguez J, Pierce P, Goddu B, Neisius U, Manning W, Nezafat R. Sensitivity of Myocardial Radiomic Features to Imaging Parameters in Cardiac
MR
Imaging. J Magn Reson Imaging 2021; 54:787-794. [DOI: 10.1002/jmri.27581] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 02/04/2021] [Accepted: 02/13/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Jihye Jang
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Hossam El‐Rewaidy
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Long H. Ngo
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
- Department of Biostatistics Harvard T.H. Chan School of Public Health Boston Massachusetts USA
| | - Jennifer Mancio
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Ibolya Csecs
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Patrick Pierce
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Beth Goddu
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Ulf Neisius
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Warren Manning
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
- Radiology Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division) Beth Israel Deaconess Medical Center and Harvard Medical School Boston Massachusetts USA
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14
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Fragão-Marques M, Mancio J, Oliveira J, Falcão-Pires I, Leite-Moreira A. Gender Differences in Predictors and Long-Term Mortality of New-Onset Postoperative Atrial Fibrillation Following Isolated Aortic Valve Replacement Surgery. Ann Thorac Cardiovasc Surg 2020. [PMID: 32350163 DOI: 10.5761/atcs.oa.19-00314.] [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] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) has been associated with increased risk of death in women but not in men. We aimed to explore predictors and long-term mortality in POAF following isolated aortic valve replacement (AVR) surgery in men and women. METHODS This study included 379 severe aortic stenosis patients with no prior atrial fibrillation (AF) who underwent isolated AVR surgery. We used multiple logistic regression to investigate independent gender-specific predictors of new-onset POAF, and we performed Kaplan-Meier (KM) to determine the impact of POAF in long-term mortality according to gender. RESULTS Advanced age and coronary artery disease prevalence were higher among POAF patients in both genders. On multiple analysis, increased postoperative peak lactate was independently associated with POAF in men, while lower mean aortic valve gradient was associated with POAF in women. Area under the curve (AUC) for the model was 0.77 [0.68-0.86] and 0.69 [0.60-0.78] for men and women, respectively. At 4-year follow-up, POAF was linked to increased risk of death in men but not in women. CONCLUSION In severe aortic stenosis, factors associated with POAF and its impact on mortality differed between genders, with an increased risk of death observed only in men.
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Affiliation(s)
- Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.,São João University Hospital Center, Porto, Portugal
| | - Jennifer Mancio
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - João Oliveira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Inês Falcão-Pires
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.,São João University Hospital Center, Porto, Portugal
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15
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Mancio J, Barros AS, Conceicão G, Santa C, Pessoa-Amorim G, Bartosch C, Fragao-Marques M, Ferreira W, Carvalho M, Ferreira N, Vouga L, Miranda IM, Vitorino R, Fontes-Carvalho R, Manadas B, Falcão-Pires I, Ribeiro VG, Leite-Moreira A, Bettencourt N. Influence of EPICardial adipose tissue in HEART diseases (EPICHEART) study: Protocol for a translational study in coronary atherosclerosis. Rev Port Cardiol 2020; 39:625-633. [PMID: 33168363 DOI: 10.1016/j.repc.2020.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 03/02/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Accumulation of epicardial adipose tissue (EAT) is associated with coronary artery disease (CAD) and increased risk of coronary events in asymptomatic subjects and low-risk patients, suggesting that EAT promotes atherosclerosis in its early stage. Recent studies have shown that the presence of CAD affects the properties of adjacent EAT, leading to dynamic changes in the molecular players involved in the interplay between EAT and the coronary arteries over the history of the disease. The role of EAT in late-stage CAD has not been investigated. OBJECTIVES In a comparative analysis with mediastinal and subcutaneous adipose tissue, we aim to investigate whether the volume of EAT assessed by computed tomography and its proteome assessed by SWATH-MS mass spectrometry are associated with late stages of CAD in an elderly cohort of severe aortic stenosis patients. METHODS The EPICHEART study (NCT03280433) is a prospective study enrolling patients with severe degenerative aortic stenosis referred for elective aortic valve replacement, whose protocol includes preoperative clinical, nutritional, echocardiographic, cardiac computed tomography and invasive coronary angiographic assessments. During cardiac surgery, samples of EAT and mediastinal and subcutaneous thoracic adipose tissue are collected for proteomics analysis by SWATH-MS. In addition, pericardial fluid and peripheral and coronary sinus blood samples are collected to identify circulating and local adipose tissue-derived biomarkers of CAD. CONCLUSION We designed a translational study to explore the association of EAT quantity and quality with advanced CAD. We expect to identify new biochemical factors and biomarkers in the crosstalk between EAT and the coronary arteries that are involved in the pathogenesis of late coronary atherosclerosis, especially coronary calcification, which might be translated into new therapeutic targets and imaging tools by biomedical engineering.
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Affiliation(s)
- Jennifer Mancio
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal.
| | - António S Barros
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Glória Conceicão
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Cátia Santa
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Guilherme Pessoa-Amorim
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Mariana Fragao-Marques
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Wilson Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Mónica Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Nuno Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Luís Vouga
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Isabel M Miranda
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Rui Vitorino
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Bruno Manadas
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Inês Falcão-Pires
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal; Cardiothoracic Surgery, Centro Hospitalar de Sao João, Portugal
| | - Nuno Bettencourt
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
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16
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Elnabawi YA, Oikonomou EK, Dey AK, Mancio J, Rodante JA, Aksentijevich M, Choi H, Keel A, Erb-Alvarez J, Teague HL, Joshi AA, Playford MP, Lockshin B, Choi AD, Gelfand JM, Chen MY, Bluemke DA, Shirodaria C, Antoniades C, Mehta NN. Association of Biologic Therapy With Coronary Inflammation in Patients With Psoriasis as Assessed by Perivascular Fat Attenuation Index. JAMA Cardiol 2020; 4:885-891. [PMID: 31365032 DOI: 10.1001/jamacardio.2019.2589] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [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: 12/13/2022]
Abstract
Importance Psoriasis is a chronic inflammatory skin disease associated with increased coronary plaque burden and cardiovascular events. Biologic therapy for psoriasis has been found to be favorably associated with luminal coronary plaque, but it is unclear whether these associations are attributable to direct anti-inflammatory effects on the coronary arteries. Objective To investigate the association of biologic therapy with coronary inflammation in patients with psoriasis using the perivascular fat attenuation index (FAI), a novel imaging biomarker that assesses coronary inflammation by mapping spatial changes of perivascular fat composition via coronary computed tomography angiography (CCTA). Design, Setting, and Participants This prospective cohort study performed from January 1, 2013, through March 31, 2019, analyzed changes in FAI in patients with moderate to severe psoriasis who underwent CCTA at baseline and at 1 year and were not receiving biologic psoriasis therapy at baseline. Exposures Biologic therapy for psoriasis. Main Outcomes and Measures Perivascular FAI mapping was performed based on an established method by a reader blinded to patient demographics, visit, and treatment status. Results Of the 134 patients (mean [SD] age, 51.1 [12.1] years; 84 [62.5%] male), most had low cardiovascular risk by traditional risk scores (median 10-year Framingham Risk Score, 3% [interquartile range, 1%-7%]) and moderate to severe skin disease. Of these patients, 82 received biologic psoriasis therapy (anti-tumor necrosis factor α, anti-interleukin [IL] 12/23, or anti-IL-17) for 1 year, and 52 did not receive any biologic therapy and were given topical or light therapy (control group). At baseline, 46 patients (27 in the treated group and 19 in the untreated group) had a focal coronary atherosclerotic plaque. Biologic therapy was associated with a significant decrease in FAI at 1 year (median FAI -71.22 HU [interquartile range (IQR), -75.85 to -68.11 HU] at baseline vs -76.09 HU [IQR, -80.08 to -70.37 HU] at 1 year; P < .001) concurrent with skin disease improvement (median PASI, 7.7 [IQR, 3.2-12.5] at baseline vs 3.2 [IQR, 1.8-5.7] at 1 year; P < .001), whereas no change in FAI was noted in those not receiving biologic therapy (median FAI, -71.98 [IQR, -77.36 to -65.64] at baseline vs -72.66 [IQR, -78.21 to -67.44] at 1 year; P = .39). The associations with FAI were independent of the presence of coronary plaque and were consistent among patients receiving different biologic agents, including anti-tumor necrosis factor α (median FAI, -71.25 [IQR, -75.86 to -66.89] at baseline vs -75.49 [IQR, -79.12 to -68.58] at 1 year; P < .001) and anti-IL-12/23 or anti-IL-17 therapy (median FAI, -71.18 [IQR, -75.85 to -68.80] at baseline vs -76.92 [IQR, -81.16 to -71.67] at 1 year; P < .001). Conclusions and Relevance In this study, biologic therapy for moderate to severe psoriasis was associated with reduced coronary inflammation assessed by perivascular FAI. This finding suggests that perivascular FAI measured by CCTA may be used to track response to interventions for coronary artery disease.
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Affiliation(s)
- Youssef A Elnabawi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Jennifer Mancio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Milena Aksentijevich
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Harry Choi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew Keel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Julie Erb-Alvarez
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Andrew D Choi
- Division of Cardiology, The George Washington University School of Medicine, Washington, District of Columbia
| | - Joel M Gelfand
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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17
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El-Rewaidy H, Neisius U, Mancio J, Kucukseymen S, Rodriguez J, Paskavitz A, Menze B, Nezafat R. Deep complex convolutional network for fast reconstruction of 3D late gadolinium enhancement cardiac MRI. NMR Biomed 2020; 33:e4312. [PMID: 32352197 DOI: 10.1002/nbm.4312] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/19/2020] [Accepted: 03/24/2020] [Indexed: 06/11/2023]
Abstract
Several deep-learning models have been proposed to shorten MRI scan time. Prior deep-learning models that utilize real-valued kernels have limited capability to learn rich representations of complex MRI data. In this work, we utilize a complex-valued convolutional network (ℂNet) for fast reconstruction of highly under-sampled MRI data and evaluate its ability to rapidly reconstruct 3D late gadolinium enhancement (LGE) data. ℂNet preserves the complex nature and optimal combination of real and imaginary components of MRI data throughout the reconstruction process by utilizing complex-valued convolution, novel radial batch normalization, and complex activation function layers in a U-Net architecture. A prospectively under-sampled 3D LGE cardiac MRI dataset of 219 patients (17 003 images) at acceleration rates R = 3 through R = 5 was used to evaluate ℂNet. The dataset was further retrospectively under-sampled to a maximum of R = 8 to simulate higher acceleration rates. We created three reconstructions of the 3D LGE dataset using (1) ℂNet, (2) a compressed-sensing-based low-dimensional-structure self-learning and thresholding algorithm (LOST), and (3) a real-valued U-Net (realNet) with the same number of parameters as ℂNet. LOST-reconstructed data were considered the reference for training and evaluation of all models. The reconstructed images were quantitatively evaluated using mean-squared error (MSE) and the structural similarity index measure (SSIM), and subjectively evaluated by three independent readers. Quantitatively, ℂNet-reconstructed images had significantly improved MSE and SSIM values compared with realNet (MSE, 0.077 versus 0.091; SSIM, 0.876 versus 0.733, respectively; p < 0.01). Subjective quality assessment showed that ℂNet-reconstructed image quality was similar to that of compressed sensing and significantly better than that of realNet. ℂNet reconstruction was also more than 300 times faster than compressed sensing. Retrospective under-sampled images demonstrate the potential of ℂNet at higher acceleration rates. ℂNet enables fast reconstruction of highly accelerated 3D MRI with superior performance to real-valued networks, and achieves faster reconstruction than compressed sensing.
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Affiliation(s)
- Hossam El-Rewaidy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Ulf Neisius
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Mancio
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Selcuk Kucukseymen
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Amanda Paskavitz
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Bjoern Menze
- Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
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18
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Jang J, Ngo LH, Mancio J, Kucukseymen S, Rodriguez J, Pierce P, Goddu B, Nezafat R. Reproducibility of Segmentation-based Myocardial Radiomic Features with Cardiac MRI. Radiol Cardiothorac Imaging 2020; 2:e190216. [PMID: 32734275 DOI: 10.1148/ryct.2020190216] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/19/2020] [Accepted: 03/04/2020] [Indexed: 11/11/2022]
Abstract
Purpose To investigate reproducibility of myocardial radiomic features with cardiac MRI. Materials and Methods Test-retest studies were performed with a 3-T MRI system using commonly used cardiac MRI sequences of cine balanced steady-state free precession (cine bSSFP), T1-weighted and T2-weighted imaging, and quantitative T1 and T2 mapping in phantom experiments and 10 healthy participants (mean ± standard deviation age, 29 years ± 13). In addition, this study assessed repeatability in 51 patients (56 years ± 14) who underwent imaging twice during the same session. Three readers independently delineated the myocardium to investigate inter- and intraobserver reproducibility of radiomic features. A total of 1023 radiomic features were extracted by using PyRadiomics (https://pyradiomics.readthedocs.io/) with 11 image filters and six feature families. The intraclass correlation coefficient (ICC) was estimated to assess reproducibility and repeatability, and features with ICCs greater than or equal to 0.8 were considered reproducible. Results Different reproducibility patterns were observed among sequences in in vivo test-retest studies. In cine bSSFP, the gray-level run-length matrix was the most reproducible feature family, and the wavelet low-pass filter applied horizontally and vertically was the most reproducible image filter. In T1 and T2 maps, intensity-based statistics (first-order) and gray-level co-occurrence matrix features were the most reproducible feature families, without a dominant reproducible image filter. Across all sequences, gray-level nonuniformity was the most frequently identified reproducible feature name. In inter- and intraobserver reproducibility studies, respectively, only 32%-47% and 61%-73% of features were identified as reproducible. Conclusion Only a small subset of myocardial radiomic features was reproducible, and these reproducible radiomic features varied among different sequences. Supplemental material is available for this article. © RSNA, 2020See also the commentary by Leiner in this issue.
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Affiliation(s)
- Jihye Jang
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (J.J., L.H.N., J.M., S.K., J.R., P.P., B.G., R.N.); Department of Computer Science, Technical University of Munich, Munich, Germany (J.J.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Mass (L.H.N.)
| | - Long H Ngo
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (J.J., L.H.N., J.M., S.K., J.R., P.P., B.G., R.N.); Department of Computer Science, Technical University of Munich, Munich, Germany (J.J.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Mass (L.H.N.)
| | - Jennifer Mancio
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (J.J., L.H.N., J.M., S.K., J.R., P.P., B.G., R.N.); Department of Computer Science, Technical University of Munich, Munich, Germany (J.J.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Mass (L.H.N.)
| | - Selcuk Kucukseymen
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (J.J., L.H.N., J.M., S.K., J.R., P.P., B.G., R.N.); Department of Computer Science, Technical University of Munich, Munich, Germany (J.J.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Mass (L.H.N.)
| | - Jennifer Rodriguez
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (J.J., L.H.N., J.M., S.K., J.R., P.P., B.G., R.N.); Department of Computer Science, Technical University of Munich, Munich, Germany (J.J.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Mass (L.H.N.)
| | - Patrick Pierce
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (J.J., L.H.N., J.M., S.K., J.R., P.P., B.G., R.N.); Department of Computer Science, Technical University of Munich, Munich, Germany (J.J.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Mass (L.H.N.)
| | - Beth Goddu
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (J.J., L.H.N., J.M., S.K., J.R., P.P., B.G., R.N.); Department of Computer Science, Technical University of Munich, Munich, Germany (J.J.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Mass (L.H.N.)
| | - Reza Nezafat
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave, Boston, MA 02215 (J.J., L.H.N., J.M., S.K., J.R., P.P., B.G., R.N.); Department of Computer Science, Technical University of Munich, Munich, Germany (J.J.); and Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Boston, Mass (L.H.N.)
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19
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Fragão-Marques M, Mancio J, Oliveira J, Falcão-Pires I, Leite-Moreira A. Gender Differences in Predictors and Long-Term Mortality of New-Onset Postoperative Atrial Fibrillation Following Isolated Aortic Valve Replacement Surgery. Ann Thorac Cardiovasc Surg 2020; 26:342-351. [PMID: 32350163 PMCID: PMC7801179 DOI: 10.5761/atcs.oa.19-00314] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Purpose: Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) has been associated with increased risk of death in women but not in men. We aimed to explore predictors and long-term mortality in POAF following isolated aortic valve replacement (AVR) surgery in men and women. Methods: This study included 379 severe aortic stenosis patients with no prior atrial fibrillation (AF) who underwent isolated AVR surgery. We used multiple logistic regression to investigate independent gender-specific predictors of new-onset POAF, and we performed Kaplan–Meier (KM) to determine the impact of POAF in long-term mortality according to gender. Results: Advanced age and coronary artery disease prevalence were higher among POAF patients in both genders. On multiple analysis, increased postoperative peak lactate was independently associated with POAF in men, while lower mean aortic valve gradient was associated with POAF in women. Area under the curve (AUC) for the model was 0.77 [0.68–0.86] and 0.69 [0.60–0.78] for men and women, respectively. At 4-year follow-up, POAF was linked to increased risk of death in men but not in women. Conclusion: In severe aortic stenosis, factors associated with POAF and its impact on mortality differed between genders, with an increased risk of death observed only in men.
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Affiliation(s)
- Mariana Fragão-Marques
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.,São João University Hospital Center, Porto, Portugal
| | - Jennifer Mancio
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - João Oliveira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Inês Falcão-Pires
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.,São João University Hospital Center, Porto, Portugal
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20
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Neisius U, El-Rewaidy H, Kucukseymen S, Tsao CW, Mancio J, Nakamori S, Manning WJ, Nezafat R. Texture signatures of native myocardial T 1 as novel imaging markers for identification of hypertrophic cardiomyopathy patients without scar. J Magn Reson Imaging 2020; 52:906-919. [PMID: 31971296 DOI: 10.1002/jmri.27048] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/17/2019] [Accepted: 12/19/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In patients with suspected or known hypertrophic cardiomyopathy (HCM), late gadolinium enhancement (LGE) provides diagnostic and prognostic value. However, contraindications and long-term retention of gadolinium have raised concern about repeated gadolinium administration in this population. Alternatively, native T1 -mapping enables identification of focal fibrosis, the substrate of LGE. However HCM-specific heterogeneous fibrosis distribution leads to subtle T1 -maps changes that are difficult to identify. PURPOSE To apply radiomic texture analysis on native T1 -maps to identify patients with a low likelihood of LGE(+), thereby reducing the number of patients exposed to gadolinium administration. STUDY TYPE Retrospective interpretation of prospectively acquired data. SUBJECTS In all, 188 (54.7 ± 14.4 years, 71% men) with suspected or known HCM. FIELD STRENGTH/SEQUENCE A 1.5T scanner; slice-interleaved native T1 -mapping (STONE) sequence and 3D LGE after administration of 0.1 mmol/kg of gadobenate dimeglumine. ASSESSMENT Left ventricular LGE images were location-matched with native T1 -maps using anatomical landmarks. Using a split-sample validation approach, patients were randomly divided 3:1 (training/internal validation vs. test cohorts). To balance the data during training, 50% of LGE(-) slices were discarded. STATISTICAL TESTS Four sets of texture descriptors were applied to the training dataset for capture of spatially dependent and independent pixel statistics. Five texture features were sequentially selected with the best discriminatory capacity between LGE(+) and LGE(-) T1 -maps and tested using a decision tree ensemble (DTE) classifier. RESULTS The selected texture features discriminated between LGE(+) and LGE(-) T1 -maps with a c-statistic of 0.75 (95% confidence interval [CI]: 0.70-0.80) using 10-fold cross-validation during internal validation in the training dataset and 0.74 (95% CI: 0.65-0.83) in the independent test dataset. The DTE classifier provided adequate labeling of all (100%) LGE(+) patients and 37% of LGE(-) patients during testing. DATA CONCLUSION Radiomic analysis of native T1 -images can identify ~1/3 of LGE(-) patients for whom gadolinium administration can be safely avoided. LEVEL OF EVIDENCE 2 Technical Efficacy Stage: 2 J. Magn. Reson. Imaging 2020. J. Magn. Reson. Imaging 2020;52:906-919.
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Affiliation(s)
- Ulf Neisius
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts, USA
| | - Hossam El-Rewaidy
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Department of Computer Science, Technical University of Munich, Munich, Germany
| | - Selcuk Kucukseymen
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Connie W Tsao
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Jennifer Mancio
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Shiro Nakamori
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Warren J Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA.,Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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21
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Pessoa Amorim G, Vouga L, Gama V, Bettencourt N, Fontes-Carvalho R, Mancio J. P789 Reverse left atrial functional remodeling after surgical aortic valve replacement is dependent on impaired left atrial function and reverse left ventricular remodeling. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.446] [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
Funding Acknowledgements
Fundação Portuguesa para a Ciência e Tecnologia (SFRH/BD/104369/2014) and Sociedade Portuguesa de Cardiologia (“Bolsa de investigação João Porto”)
OnBehalf
EPICHEART Study
Background
Left atrial (LA) functional remodeling is an important mechanism in the pathophysiology of aortic stenosis (AS), and readily-assessable using speckle-tracking echocardiography (STE). It is uncertain whether and how surgical aortic valve replacement (SAVR) affects reverse LA functional remodeling.
Aims
We aimed to evaluate LA functional remodeling post-SAVR using STE and to explore potential underlying mechanisms.
Methods
73 symptomatic severe AS patients (72.6 ± 8.14 years, 53.4% male) were assessed before and six months after SAVR (Fig.1-A). LA function was evaluated using STE-derived LA longitudinal strain during reservoir (LASr), conduit (LAScd) and contraction (LASct) phases (Fig1.-B); reverse LA remodeling was represented by their relative percentual changes. LA structure was assessed by LA area and indexed volume.
Results
LA structure and left ventricle (LV) indexed mass, end-diastolic diameter (LVEDD) and mean E/e" improved after SAVR (Table 1). Although paired-samples analysis did not show significant changes in LA function, multiple linear regression revealed that preoperative LA strain parameters were the sole baseline predictors of reverse LA remodeling: lower baseline LASr, LAScd and LASct were related to improved LASr, LAScd and LASct, respectively (Fig.1-C); mean E/e’ decrease was associated with LAScd improvement (Fig.1-D2). LV mass and LVEDD decrease were not associated with LA functional recovery.
Conclusion
Reverse LA functional remodeling is compromised after SAVR, and increased in patients with impaired baseline LA function. LV diastolic function recovery was linked to improved LA conduit function. An optimal echocardiographic cut-off should be further explored in order to better adjudicate surgical timing, and foster LA functional recovery.
Echocardiographic assessment Baseline 6-months post-SAVR Paired t-test (p-value) Mean aortic gradient (mmHg) 49.6 ± 12.2 11.2 ± 5.1 <0.0001 LA area (cm2) 20.9 ± 4.9 19.5 ± 4.1 0.02 LA indexed volume (mL/m2) 37.4 ± 12.4 30.7 ± 8.3 <0.0001 LASr (%) 30.0 ± 10.4 29.3 ± 11.2 0.57 LAScd (%) 14.3 ± 7.4 14.3 ± 6.8 0.95 LASct (%) 15.6 ± 6.5 15.0 ± 7.2 0.50 LV indexed mass (g/m2) 128.6 ± 31.8 124.5 ± 30.0 <0.0001 LV end-diastolic diameter (mm) 45.7 ± 5.19 44.7 ± 5.7 0.03 LV ejection fraction (%) 66.0 ± 6.0 64.6 ± 5.5 0.54 Mean E/e´ ratio 14.2 ± 5.5 11.2 ± 4.3 0.0004 Values are mean ± SD
Abstract P789 Figure. Left atrial remodeling after SAVR
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Affiliation(s)
| | - L Vouga
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiothoracic Surgery, Vila Nova de Gaia, Portugal
| | - V Gama
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | - N Bettencourt
- Faculty of Medicine University of Porto, Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Porto, Portugal
| | - R Fontes-Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | - J Mancio
- Beth Israel Deaconess Medical Centre and Harvard Medical School, Department of Medicine (Cardiovascular Division), Boston, United States of America
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22
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Mancio J, Barros AS, Conceicao G, Pessoa-Amorim G, Santa C, Bartosch C, Ferreira W, Carvalho M, Ferreira N, Vouga L, Miranda IM, Vitorino R, Manadas B, Falcao-Pires I, Ribeiro VG, Leite-Moreira A, Bettencourt N. Epicardial adipose tissue volume and annexin A2/fetuin-A signalling are linked to coronary calcification in advanced coronary artery disease: Computed tomography and proteomic biomarkers from the EPICHEART study. Atherosclerosis 2019; 292:75-83. [PMID: 31783201 DOI: 10.1016/j.atherosclerosis.2019.11.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 10/27/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND & AIMS The role of epicardial adipose tissue (EAT) in the pathophysiology of late stage-coronary artery disease (CAD) has not been investigated. We explored the association of EAT volume and its proteome with advanced coronary atherosclerosis. METHODS The EPICHEART Study prospectively enrolled 574 severe aortic stenosis patients referred to cardiac surgery. Before surgery, EAT volume was quantified by computed tomography (CT). During surgery, epicardial, mediastinal (MAT) and subcutaneous (SAT) adipose tissue samples were collected to explore fat phenotype by analyzing the proteomic profile using SWATH-mass spectrometry; pericardial fluid and peripheral venous blood were also collected. CAD presence was defined as coronary artery stenosis ≥50% in invasive angiography and by CT-derived Agatston coronary calcium score (CCS). RESULTS EAT volume adjusted for body fat was associated with higher CCS, but not with the presence of coronary stenosis. In comparison with mediastinal and subcutaneous fat depots, EAT exhibited a pro-calcifying proteomic profile in patients with CAD characterized by upregulation of annexin-A2 and downregulation of fetuin-A; annexin-A2 protein levels in EAT samples were also positively correlated with CCS. We confirmed that the annexin-A2 gene was overexpressed in EAT samples of CAD patients and positively correlated with CCS. Fetuin-A gene was not detected in EAT samples, but systemic fetuin-A was higher in CAD than in non-CAD patients, suggesting that fetuin-A was locally downregulated. CONCLUSIONS In an elderly cohort of stable patients, CCS was associated with EAT volume and annexin-A2/fetuin-A signaling, suggesting that EAT might orchestrate pro-calcifying conditions in the late phases of CAD.
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Affiliation(s)
- Jennifer Mancio
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal.
| | - Antonio S Barros
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Gloria Conceicao
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Guilherme Pessoa-Amorim
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Catia Santa
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; III: Institute for Interdisciplinary Research, University of Coimbra (IIIUC), Portugal
| | - Carla Bartosch
- Department of Pathology, Portuguese Oncology Institute of Porto, Porto, Portugal
| | - Wilson Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Monica Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Nuno Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Luis Vouga
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Isabel M Miranda
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Rui Vitorino
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Bruno Manadas
- CNC - Center for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal
| | - Ines Falcao-Pires
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal; Department of Cardiothoracic Surgery, Centro Hospitalar de Sao Joao, Portugal
| | - Nuno Bettencourt
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Portugal
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23
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Oikonomou EK, Marwan M, Mancio J, Kotanidis CK, Thomas KE, Alashi A, Hutt Centeno E, Antonopoulos AS, Shirodaria C, Neubauer S, Channon KM, Achenbach S, Desai MY, Antoniades C. 3258Perivascular fat attenuation index stratifies the cardiac risk associated with high-risk plaque features on coronary computed tomography angiography. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Qualitative high-risk plaque (HRP) features detected on coronary computed tomography angiography (CCTA) are associated with increased risk of adverse cardiac events. Coronary inflammation is a key determinant of plaque progression and instability and can now be captured on routine CCTA as inflammation-induced changes in perivascular adipose tissue composition, detectable by the perivascular Fat Attenuation Index (FAI).
Purpose
To explore the ability of perivascular FAI phenotyping to stratify the cardiac risk associated with the presence of adverse plaque morphology on routine CCTA.
Methods
This was a post-hoc analysis of the CRISP-CT (Cardiovascular RISk Prediction using Computed Tomography) study, which involved 3912 patients (mean age 55.7±13.7 years, 41.1% females) undergoing clinically-indicated CCTA in two centres (Erlangen, Germany & Cleveland, USA). Perivascular FAI mapping was performed around the proximal 10–50 mm of the right coronary artery and defined as the weighted mean attenuation of the perivascular adipose tissue, as previously validated. HRP features were defined as the presence of ≥1 of the following: positive remodelling, low-attenuation plaque, spotty calcification or napkin-ring sign (A). Cox regression models (adjusted for age, sex, epicardial fat volume and coronary artery disease [≥50% stenosis]) were used to explore the association between FAI, HRP, and future major adverse cardiac events (MACE: defined as the composite of cardiac mortality and non-fatal myocardial infarction).
Results
At baseline the prevalence of HRP and high FAI (≥-70.1 Hounsfield Units, as previously validated) was 23.6% (n=923) and 24.3% (n=952) respectively. Over a median follow-up period of 5.6 years (25th-75th percentile: 4.0–7.0 years) there were 91 confirmed MACE. Patients with both HRP features (HRP+) and high FAI (FAI+) had a 6.3-fold (P<0.001) higher adjusted risk of MACE compared to individuals with neither of these risk features (HRP-/FAI-) (B). Furthermore, patients without HRP features but with high FAI (HRP-/FAI+) had a 4.9-fold (P<0.001) higher adjusted risk of MACE compared to the reference (HRP-/FAI-) group. However, among patients with low FAI, there was no significant difference in the prospective risk of MACE between HRP+ and HRP- patients (P=0.87).
Conclusion
FAI is associated with an increased risk of adverse events in both patients with and without high-risk plaques, highlighting coronary inflammation as a major determinant of plaque vulnerability, independent of adverse plaque morphology. Non-invasive characterization of coronary inflammation using CCTA-derived FAI can improve risk stratification by supplementing the traditional anatomical assessment of the coronary vasculature with a functional marker of disease activity.
Acknowledgement/Funding
British Heart Foundation, National Institute of Health Research, Oxford Biomedical Research Centre
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Affiliation(s)
- E K Oikonomou
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - M Marwan
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - J Mancio
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - C K Kotanidis
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - K E Thomas
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A Alashi
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - E Hutt Centeno
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - A S Antonopoulos
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - C Shirodaria
- Oxford University Hospitals NHS Trust, Department of Cardiology, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Achenbach
- Friedrich Alexander University, Department of Cardiology, Erlangen, Germany
| | - M Y Desai
- Cleveland Clinic Foundation, Cleveland Clinic Heart and Vascular Institute, Cleveland, United States of America
| | - C Antoniades
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
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24
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Elnabawi Y, Oikonomou E, Dey A, Mancio J, Rodante J, Gelfand J, Chen M, Bluemke D, Shirodaria C, Antoniades C, Mehta N. TREATMENT WITH BIOLOGIC THERAPY IN PSORIASIS IS ASSOCIATED WITH A REDUCTION IN CORONARY ARTERY INFLAMMATION, ASSESSED BY PERIVASCULAR FAT ATTENUATION INDEX. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30695-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Mancio J, Azevedo D, Saraiva F, Azevedo AI, Pires-Morais G, Leite-Moreira A, Falcao-Pires I, Lunet N, Bettencourt N. Epicardial adipose tissue volume assessed by computed tomography and coronary artery disease: a systematic review and meta-analysis. Eur Heart J Cardiovasc Imaging 2019; 19:490-497. [PMID: 29236951 DOI: 10.1093/ehjci/jex314] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [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] [Received: 08/06/2017] [Accepted: 11/23/2017] [Indexed: 11/12/2022] Open
Abstract
To conduct a systematic review and meta-analysis on the crude and adjusted associations between epicardial adipose tissue (EAT) volume determined by computed tomography (CT) and coronary artery disease (CAD). MEDLINE, Scopus, and Web of Science databases were screened for all observational studies assessing the association between EAT volume and CAD. We calculated pooled odds ratio (OR) or hazard ratio (HR) and 95% confidence intervals (CI) for the association per 10 cm3 variation of EAT by five different definitions of CAD: obstructive or significant coronary stenosis (luminal narrowing ≥50% and ≥70%, respectively), presence of coronary artery calcification (CAC), myocardial ischaemia, and major adverse cardiovascular events (MACE) using DerSimonian and Laird random-effects models. Seventy studies were identified comprising 41 534 subjects, mainly derived from community-based or hospital-based low-to-intermediate pretest probability of CAD populations. Participants with any outcome of CAD had a higher mean volume of EAT than those without. Accordingly, the analysis of crude associations showed that EAT volume was associated with obstructive stenosis, significant stenosis, any CAC, and MACE. Based on the analysis of adjusted associations, although attenuated, EAT volume remained associated with obstructive stenosis (OR 1.055, 95% CI 1.033-1.078; I2 = 63.5%), significant stenosis (OR 1.514, 95% CI 1.262-1.815; I2 = 51.8%), myocardial ischaemia (OR 1.062, 95% CI 1.006-1.122; I2 = 86.9%), and MACE (HR 1.040, 95% CI 1.024-1.056; I2 = 64.7%) but was only borderline significant with CAC (OR 1.007, 95% CI 1.000-1.011; I2 = 75.8%). In low-to-intermediate cardiovascular risk subjects, EAT volume was independently associated with coronary artery stenosis, myocardial ischaemia, and MACE.
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Affiliation(s)
- Jennifer Mancio
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Diana Azevedo
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Francisca Saraiva
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ana Isabel Azevedo
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Gustavo Pires-Morais
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal
| | - Adelino Leite-Moreira
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.,Department of Cardiothoracic Surgery, Centro Hospitalar de Sao Joao, Porto, Portugal
| | - Ines Falcao-Pires
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Nuno Lunet
- Institute of Public Health of Porto, Rua das Taipas 135, Porto 4050-600, Portugal
| | - Nuno Bettencourt
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal
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26
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Mancio J, Azevedo D, Fragao-Marques M, Falcao-Pires I, Leite-Moreira A, Lunet N, Fontes-Carvalho R, Bettencourt N. Meta-Analysis of Relation of Epicardial Adipose Tissue Volume to Left Atrial Dilation and to Left Ventricular Hypertrophy and Functions. Am J Cardiol 2019; 123:523-531. [PMID: 30477802 DOI: 10.1016/j.amjcard.2018.10.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 07/15/2018] [Revised: 10/20/2018] [Accepted: 10/25/2018] [Indexed: 01/15/2023]
Abstract
Many studies have explored the hypothesis that epicardial adipose tissue (EAT) accumulation adversely affects cardiac remodeling. We assessed, through a systematic review and meta-analysis, whether EAT is linked to left atrial (LA) and left ventricular (LV) structure and function, irrespective of global or abdominal visceral adiposity. We searched MEDLINE, Scopus, and Web of Science for studies evaluating the association of EAT volume quantified by computed tomography with cardiac morphology and function. We used DerSimonian and Laird random-effects models to summarize the adjusted-effect of 10 ml variation of EAT on LA size, LV mass, LV diastolic and systolic functions parameters, and presence of diastolic dysfunction. We quantified heterogeneity using I2 statistic. We included 19 studies. Quantitative analysis by cardiac parameters, including LA dimension (n = 2,719), LV mass (n = 2,519), diastolic function (n = 3,741), and systolic function (n = 2,037) showed that EAT was associated with LA dilation (pooled B-coefficient: 0.12 mm; 95% confidence interval [CI] 0.08 to 0.17; I2: 97%), LV hypertrophy (pooled B-coefficient: 1.21 g; 95% CI 0.63 to 1.79; I2: 77%), diastolic dysfunction (odds ratio: 1.35; 95% CI 1.16 to 1.57; I2: 0%), higher E/E' ratio (pooled B-coefficient: 0.28 cm/s; 95% CI 0.08 to 0.49; I2: 67%), lower E' velocity (pooled B-coefficient: -0.16 cm/s; 95% CI -0.22 to -0.09; I2: 43%), and E/A ratio (pooled B-coefficient: -0.01; 95% CI -0.02 to -0.001; I2: 70%), independently of body mass index. There was no association between EAT and LV systolic function. In conclusion, EAT volume measured by computed tomography was independently associated with LA dilation, LV hypertrophy, and diastolic dysfunction.
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Affiliation(s)
- Jennifer Mancio
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Porto, Portugal.
| | - Diana Azevedo
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mariana Fragao-Marques
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ines Falcao-Pires
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiothoracic Surgery, Centro Hospitalar de Sao Joao, Porto, Portugal
| | - Nuno Lunet
- EPIUnit - Instituto de Saúde Pública, University of Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Porto, Portugal
| | - Nuno Bettencourt
- Department of Surgery and Physiology, Cardiovascular Research Unit (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal
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Oikonomou EK, Marwan M, Desai MY, Mancio J, Alashi A, Hutt Centeno E, Thomas S, Herdman L, Kotanidis CP, Thomas KE, Griffin BP, Flamm SD, Antonopoulos AS, Shirodaria C, Sabharwal N, Deanfield J, Neubauer S, Hopewell JC, Channon KM, Achenbach S, Antoniades C. Non-invasive detection of coronary inflammation using computed tomography and prediction of residual cardiovascular risk (the CRISP CT study): a post-hoc analysis of prospective outcome data. Lancet 2018; 392:929-939. [PMID: 30170852 PMCID: PMC6137540 DOI: 10.1016/s0140-6736(18)31114-0] [Citation(s) in RCA: 532] [Impact Index Per Article: 88.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/29/2018] [Accepted: 05/10/2018] [Indexed: 02/08/2023]
Abstract
BACKGROUND Coronary artery inflammation inhibits adipogenesis in adjacent perivascular fat. A novel imaging biomarker-the perivascular fat attenuation index (FAI)-captures coronary inflammation by mapping spatial changes of perivascular fat attenuation on coronary computed tomography angiography (CTA). However, the ability of the perivascular FAI to predict clinical outcomes is unknown. METHODS In the Cardiovascular RISk Prediction using Computed Tomography (CRISP-CT) study, we did a post-hoc analysis of outcome data gathered prospectively from two independent cohorts of consecutive patients undergoing coronary CTA in Erlangen, Germany (derivation cohort) and Cleveland, OH, USA (validation cohort). Perivascular fat attenuation mapping was done around the three major coronary arteries-the proximal right coronary artery, the left anterior descending artery, and the left circumflex artery. We assessed the prognostic value of perivascular fat attenuation mapping for all-cause and cardiac mortality in Cox regression models, adjusted for age, sex, cardiovascular risk factors, tube voltage, modified Duke coronary artery disease index, and number of coronary CTA-derived high-risk plaque features. FINDINGS Between 2005 and 2009, 1872 participants in the derivation cohort underwent coronary CTA (median age 62 years [range 17-89]). Between 2008 and 2016, 2040 patients in the validation cohort had coronary CTA (median age 53 years [range 19-87]). Median follow-up was 72 months (range 51-109) in the derivation cohort and 54 months (range 4-105) in the validation cohort. In both cohorts, high perivascular FAI values around the proximal right coronary artery and left anterior descending artery (but not around the left circumflex artery) were predictive of all-cause and cardiac mortality and correlated strongly with each other. Therefore, the perivascular FAI measured around the right coronary artery was used as a representative biomarker of global coronary inflammation (for prediction of cardiac mortality, hazard ratio [HR] 2·15, 95% CI 1·33-3·48; p=0·0017 in the derivation cohort, and 2·06, 1·50-2·83; p<0·0001 in the validation cohort). The optimum cutoff for the perivascular FAI, above which there is a steep increase in cardiac mortality, was ascertained as -70·1 Hounsfield units (HU) or higher in the derivation cohort (HR 9·04, 95% CI 3·35-24·40; p<0·0001 for cardiac mortality; 2·55, 1·65-3·92; p<0·0001 for all-cause mortality). This cutoff was confirmed in the validation cohort (HR 5·62, 95% CI 2·90-10·88; p<0·0001 for cardiac mortality; 3·69, 2·26-6·02; p<0·0001 for all-cause mortality). Perivascular FAI improved risk discrimination in both cohorts, leading to significant reclassification for all-cause and cardiac mortality. INTERPRETATION The perivascular FAI enhances cardiac risk prediction and restratification over and above current state-of-the-art assessment in coronary CTA by providing a quantitative measure of coronary inflammation. High perivascular FAI values (cutoff ≥-70·1 HU) are an indicator of increased cardiac mortality and, therefore, could guide early targeted primary prevention and intensive secondary prevention in patients. FUNDING British Heart Foundation, and the National Institute of Health Research Oxford Biomedical Research Centre.
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Affiliation(s)
- Evangelos K Oikonomou
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Mohamed Marwan
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Milind Y Desai
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Jennifer Mancio
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Alaa Alashi
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | | | - Sheena Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Laura Herdman
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Christos P Kotanidis
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Katharine E Thomas
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Brian P Griffin
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Scott D Flamm
- Cleveland Clinic Heart and Vascular Institute, Cleveland, OH, USA
| | - Alexios S Antonopoulos
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Cheerag Shirodaria
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK; Caristo Diagnostics, Oxford, UK
| | - Nikant Sabharwal
- Cardiology Department, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - John Deanfield
- University College London Institute of Cardiovascular Science, London, UK
| | - Stefan Neubauer
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Jemma C Hopewell
- Clinical Trial Service Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Keith M Channon
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK
| | - Stephan Achenbach
- Department of Cardiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Charalambos Antoniades
- Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK; Oxford Centre of Research Excellence, British Heart Foundation, Oxford, UK; Oxford Biomedical Research Centre, National Institute of Health Research, Oxford, UK.
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Mancio J, Barros A, Conceicao G, Santa C, Ferreira W, Carvalho M, Ferreira N, Vouga L, Miranda I, Vitorino R, Falcao-Pires I, Manadas B, Gama Ribeiro V, Leite-Moreira A, Bettencourt N. 6178Regulation of coronary calcification by epicardial adipose tissue: traits in high-risk patients. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- J Mancio
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | - A Barros
- Faculty of Medicine University of Porto, Porto, Portugal
| | - G Conceicao
- Faculty of Medicine University of Porto, Porto, Portugal
| | - C Santa
- University of Coimbra, CNC - Center for Neuroscience and Cell Biology, Coimbra, Portugal
| | - W Ferreira
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | - M Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | - N Ferreira
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | - L Vouga
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | - I Miranda
- Faculty of Medicine University of Porto, Porto, Portugal
| | - R Vitorino
- Faculty of Medicine University of Porto, Porto, Portugal
| | - I Falcao-Pires
- Faculty of Medicine University of Porto, Porto, Portugal
| | - B Manadas
- University of Coimbra, CNC - Center for Neuroscience and Cell Biology, Coimbra, Portugal
| | - V Gama Ribeiro
- Hospital Center of Vila Nova de Gaia/Espinho, Department of Cardiology, Vila Nova de Gaia, Portugal
| | | | - N Bettencourt
- Faculty of Medicine University of Porto, Porto, Portugal
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Oikonomou EK, Thomas S, Mancio J, Antonopoulos AS, Sabharwal N, Kelion A, Neubauer S, Channon KM, Antoniades C. 1182Computed tomography-based perivascular fat phenotyping identifies unstable coronary lesions and active vascular calcification. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.1182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- E K Oikonomou
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - S Thomas
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - J Mancio
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - A S Antonopoulos
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - N Sabharwal
- Oxford University Hospitals NHS Trust, Department of Cardiology, Oxford, United Kingdom
| | - A Kelion
- Oxford University Hospitals NHS Trust, Department of Cardiology, Oxford, United Kingdom
| | - S Neubauer
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - K M Channon
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
| | - C Antoniades
- University of Oxford, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, Oxford, United Kingdom
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Espada Guerreiro C, Mancio J, Ferreira N, Ladeiras-Lopes R, Faria R, Monteiro D, Almeida N, Rodrigues P, Ferreira W, Carvalho M, Vouga L, Gama V, Melica B, Bettencourt N. P4210Impact of myocardial fibrosis in left ventricular remodeling after aortic valve replacement (AVR) for severe aortic stenosis (AS). Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- C Espada Guerreiro
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - J Mancio
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - N Ferreira
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - R Ladeiras-Lopes
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - R Faria
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - D Monteiro
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - N Almeida
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - P Rodrigues
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - W Ferreira
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - M Carvalho
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - L Vouga
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - V Gama
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - B Melica
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
| | - N Bettencourt
- Hospital Center of Vila Nova de Gaia/Espinho, Cardiology, Vila Nova de Gaia, Portugal
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Mancio J, Oikonomou EK, Antoniades C. Perivascular adipose tissue and coronary atherosclerosis. Heart 2018; 104:1654-1662. [PMID: 29853488 DOI: 10.1136/heartjnl-2017-312324] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/21/2018] [Accepted: 04/23/2018] [Indexed: 12/25/2022] Open
Abstract
Adipose tissue (AT) is no longer viewed as a passive, energy-storing depot, and a growing body of evidence supports the concept that both quantitative and qualitative aspects of AT are critical in determining an individual's cardiometabolic risk profile. Among all AT sites, perivascular AT (PVAT) has emerged as a depot with a distinctive biological significance in cardiovascular disease given its close anatomical proximity to the vasculature. Recent studies have suggested the presence of complex, bidirectional paracrine and vasocrine signalling pathways between the vascular wall and its PVAT, with far-reaching implications in cardiovascular diagnostics and therapeutics. In this review, we first discuss the biological role of PVAT in both cardiovascular health and disease, highlighting its dual pro-atherogenic and anti-atherogenic roles, as well as potential therapeutic targets in cardiovascular disease. We then review current evidence and promising new modalities on the non-invasive imaging of epicardial AT and PVAT. Specifically, we present how our expanding knowledge on the bidirectional interplay between the vascular wall and its PVAT can be translated into novel clinical diagnostics tools to assess coronary inflammation. To this end, we present the example of a new CT-based method that tracks spatial changes in PVAT phenotype to extract information about the inflammatory status of the adjacent vasculature, highlighting the numerous diagnostic and therapeutic opportunities that arise from our increased understanding of PVAT biology.
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Affiliation(s)
- Jennifer Mancio
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Evangelos K Oikonomou
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
| | - Charalambos Antoniades
- Radcliffe Department of Medicine, Division of Cardiovascular Medicine, University of Oxford, Oxford, UK
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Mancio J, Leal C, Ferreira M, Norton P, Lunet N. Does the association of prostate cancer with night-shift work differ according to rotating vs. fixed schedule? A systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2018; 21:337-344. [PMID: 29700389 DOI: 10.1038/s41391-018-0040-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 01/16/2018] [Accepted: 01/23/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Recent studies suggested that the relation between night-shift work and prostate cancer may differ between rotating and fixed schedules. OBJECTIVES We aimed to quantify the independent association between night-shift work and prostate cancer, for rotating and fixed schedules. METHODS We searched MEDLINE for studies assessing the association of night-shift work, by rotating or fixed schedules, with prostate cancer. We computed summary relative risk (RR) estimates with 95% confidence intervals (95% CI) using the inverse variance method and quantified heterogeneity using the I2 statistic. Meta-regression analysis was used to compare the summary RR estimates for rotating and fixed schedules, while reducing heterogeneity. RESULTS A total of nine studies assessed the effect of rotating and, in addition, four of them provided the effect of fixed night-shift work, in relation to daytime workers. Rotating night-shift work was associated with a significantly increased risk of prostate cancer (RR = 1.06, 95% CI of 1.01 to 1.12; I2 = 50%), but not fixed night-shift work (RR of 1.01, 95% CI of 0.81 to 1.26; I2 = 33%). In meta-regression model including study design, type of population, and control of confounding, the summary RR was 20% higher for rotating vs. fixed schedule, with heterogeneity fully explained by these variables. CONCLUSIONS This is the first meta-analysis suggesting that an increased risk of prostate cancer may be restricted to workers with rotating night shifts. However, the association was weak and additional studies are needed to further clarify this relation before it can be translated into measures for risk reduction in occupational settings.
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Affiliation(s)
- Jennifer Mancio
- Department of Surgery and Physiology, Cardiovascular Research (UnIC), Faculty of Medicine, University of Porto, Porto, Portugal. .,Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia, Vila Nova de Gaia, Portugal.
| | - Cátia Leal
- EPIUnit - Institut of Public Health, University of Porto, Porto, Portugal
| | - Marta Ferreira
- EPIUnit - Institut of Public Health, University of Porto, Porto, Portugal
| | - Pedro Norton
- EPIUnit - Institut of Public Health, University of Porto, Porto, Portugal
| | - Nuno Lunet
- EPIUnit - Institut of Public Health, University of Porto, Porto, Portugal.,Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
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Pessoa-Amorim G, Mancio J, Vouga L, Ribeiro J, Gama V, Bettencourt N, Fontes-Carvalho R. Impaired Left Atrial Strain as a Predictor of New-onset Atrial Fibrillation After Aortic Valve Replacement Independently of Left Atrial Size. ACTA ACUST UNITED AC 2017; 71:466-476. [PMID: 29146482 DOI: 10.1016/j.rec.2017.10.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 04/27/2017] [Accepted: 09/08/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION AND OBJECTIVES Left atrial dysfunction in aortic stenosis may precede atrial enlargement and predict the occurrence of atrial fibrillation (AF). To test this hypothesis, we assessed left atrial function and determined its impact on the incidence of AF after aortic valve replacement. METHODS A total of 149 severe aortic stenosis patients (74±8.6 years, 51% men) with no prior AF were assessed using speckle-tracking echocardiography. Left atrial function was evaluated using peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), and phasic left atrial volumes. The occurrence of AF was monitored in 114 patients from surgery until hospital discharge. RESULTS In multiple linear regression, PALS and PACS were inversely correlated with left atrial dilation, left ventricular hypertrophy, and diastolic function. Atrial fibrillation occurred in 36 patients within a median time of 3 days [interquartile range, 1-4] after aortic valve replacement. In multiple Cox regression, PALS and PACS were independently associated with the incidence of AF (HR, 0.946; 95%CI, 0.910-0.983; P=.005 and HR, 0.932; 95%CI, 0.883-0.984; P=.011, respectively), even after further adjustment for left atrial dimensions. Both reduced PALS and PACS were associated with the incidence of AF in patients with nondilated left atria (P value for the interaction of PALS with left atrial dimensions=.013). CONCLUSIONS In severe aortic stenosis, left atrial dysfunction predicted the incidence of postoperative AF independently of left atrial dilation, suggesting that speckle-tracking echocardiography before surgery may help in risk stratification, particularly in patients with nondilated left atria.
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Affiliation(s)
- Guilherme Pessoa-Amorim
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal; Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal.
| | - Jennifer Mancio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal; Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Luís Vouga
- Department of Cardiothoracic Surgery, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Vasco Gama
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Nuno Bettencourt
- Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal; Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine, University of Porto, Porto, Portugal
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Pinheiro M, Mancio J, Conceição G, Ferreira W, Carvalho M, Santos A, Vouga L, Gama Ribeiro V, Leite-Moreira A, Falcão-Pires I, Bettencourt N. Frailty Syndrome: Visceral Adipose Tissue and Frailty in Patients with Symptomatic Severe Aortic Stenosis. J Nutr Health Aging 2017; 21:120-128. [PMID: 27999858 DOI: 10.1007/s12603-016-0795-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 12/25/2022]
Abstract
BACKGROUND/OBJECTIVES In patients with severe aortic stenosis (AS), frailty is a clinically relevant measure of increased vulnerability that should be included in the preoperative risk assessment. Bioelectrical impedance analysis (BIA) derived phase angle (PA) reflects cell membrane integrity and function. Few studies are available on the relative contribution of adiposity distribution on frailty, and about the influences of frailty and visceral obesity in PA value. Therefore, we aimed to evaluate associations among frailty, visceral fat depots and PA in patients with symptomatic severe AS. METHODS In a cohort of patients with symptomatic severe AS and preserved ejection fraction, we examined the associations between frailty, visceral fat depots and bioelectrical impedance analysis (BIA) derived phase angle (PA); and between visceral fat and PA. Frailty was defined according the Fried et al. scale criteria and the body fat distribution was determined by multidetector computed tomography and by BIA. RESULTS Of the fifty-five included patients, 26 were frail (47%). Adjusting for age and gender, frailty was associated with indexed epicardial adipose tissue volume (EATVi) (the odds of frailty increased 4.1-fold per additional 100 cm3/m2 of EAT [95% confidence interval (CI) of 1.03 to 16.40, p=0.04] and with PA (OR of 0.50, 95% CI, 0.26 to 0.97, p=0.04), but not with body mass index (BMI), waist circumference (WC), indexed total, visceral and subcutaneous abdominal fat areas (TAFAi, VAFAi and SAFAi) nor with indexed mediastinal adipose tissue volume (MATVi). In an age and gender adjusted linear model, PA was inversely correlated with EATVi (β=-0.008, 95% CI, -0.016 to -0.001, p=0.03), but not with BMI, WC, nor with MATVi, VAFAi, SAFAi and TAFAi. CONCLUSIONS In patients with symptomatic severe AS, EATVi is associated with frailty, independently of age and gender, but not with MAFVi or VAFAi. Moreover, frailty and EATVi are associated with impaired cell membrane integrity and function assessed by PA.
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Affiliation(s)
- M Pinheiro
- Marília Pinheiro, Faculty of Nutrition and Food Sciences, Portugal, E-mail: , Phone (0351) 918197460
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Mancio J, Fonseca P, Figueiredo B, Ferreira W, Carvalho M, Ferreira N, Braga P, Rodrigues A, Barros A, Falcao-Pires I, Leite-Moreira A, Ribeiro VG, Bettencourt N. Association of body mass index and visceral fat with aortic valve calcification and mortality after transcatheter aortic valve replacement: the obesity paradox in severe aortic stenosis. Diabetol Metab Syndr 2017; 9:86. [PMID: 29075334 PMCID: PMC5649084 DOI: 10.1186/s13098-017-0285-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 10/10/2017] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Previous studies showed that metabolic syndrome is associated with aortic valve calcification (AVC) and poor outcomes in aortic stenosis (AS). However, if these associations change and how body fat impacts the prognosis of patients in late stage of the disease have been not yet explored. AIMS To determine the association of body mass index (BMI) and visceral fat with AVC and mortality after transcatheter aortic valve replacement (TAVR). METHODS This was a prospective cohort of 170 severe AS patients referred to TAVR. We quantified AVC mass score and fat depots including epicardial adipose tissue, intrathoracic fat, and abdominal visceral (VAF) and subcutaneous fats by computed tomography. Fat depots were indexed to body surface area. All-cause and cardiovascular-related deaths after TAVR were recorded over a median follow-up of 1.2 years. RESULTS Higher AVC mass was independently associated with low BMI and low VAF. All-cause mortality risk increased with the decrease of BMI and increment of VAF. A stratified analysis by obesity showed that in non-obese, VAF was inversely associated with mortality, whereas in obese, high VAF was associated with higher mortality (p value for interaction < 0.05). At long-term, hazard ratio [HR] with non-obese/low VAF was 2.3 (95% confidence interval [CI] 1.1-4.9; p = 0.021) and HR with obese/high VAF was 2.5 (95% CI 1.1-5.8; p = 0.031) compared with obese/low VAF patients. CONCLUSIONS In AS patients submitted to TAVR, BMI and VAF were inversely associated with AVC. Pre-intervention assessment of VAF by computed tomography may provide a better discrimination of mortality than BMI alone.
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Affiliation(s)
- Jennifer Mancio
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
- Department of Cardiology at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Paulo Fonseca
- Department of Cardiology at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Bruno Figueiredo
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - Wilson Ferreira
- Department of Cardiology at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Monica Carvalho
- Department of Cardiology at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Nuno Ferreira
- Department of Cardiology at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Department of Cardiology at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Alberto Rodrigues
- Department of Cardiology at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Antonio Barros
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - Ines Falcao-Pires
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
| | - Adelino Leite-Moreira
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
- Department of Cardiothoracic Surgery, Centro Hospitalar de Sao Joao, Porto, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology at the Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Nuno Bettencourt
- Department of Cardiothoracic Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Professor Hernani Monteiro, 4200-319 Porto, Portugal
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Mancio J, Almeida C, Pires-Morais G, Ferreira W, Carvalho M, Rodrigues A, Santos L, Melica B, Oliveira M, Braga P, Ribeiro VG. First-in-human transcatheter aortic valve-in-valve replacement with the SAPIEN 3 heart valve. Int J Cardiol 2015; 201:260-1. [PMID: 26301652 DOI: 10.1016/j.ijcard.2015.08.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 08/01/2015] [Indexed: 10/23/2022]
Affiliation(s)
- Jennifer Mancio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal; Cardiovascular R&D Unit, Department of physiology and cardiothoracic surgery of Medical School of Porto, Portugal.
| | - Carla Almeida
- Department of Cardiology, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal.
| | - Gustavo Pires-Morais
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Wilson Ferreira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Mónica Carvalho
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Alberto Rodrigues
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Lino Santos
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Bruno Melica
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Marco Oliveira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Pedro Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
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Fontes-Carvalho R, Mancio J, Marcos A, Sampaio F, Mota M, Rocha Gonçalves F, Gama V, Azevedo A, Leite-Moreira A. HIV patients have impaired diastolic function that is not aggravated by anti-retroviral treatment. Cardiovasc Drugs Ther 2015; 29:31-9. [PMID: 25749869 DOI: 10.1007/s10557-015-6573-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [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: 12/12/2022]
Abstract
PURPOSE Recent studies have shown that HIV infection is independently associated with heart failure. Diastolic dysfunction (DD) is frequent in HIV patients, but it is unclear whether this is an effect of the HIV infection itself or of the anti-retroviral therapy (ART). Our aim was to compare diastolic function in HIV treatment-naïve, HIV-ART patients and controls. METHODS We prospectively enrolled 206 consecutive patients with HIV-1 infection and 30 controls, selected by frequency matching for age and sex. HIV patients were divided in two subgroups: ART-naïve (n = 88) and ART (n = 118). Diastolic function was assessed and graded by echocardiography, according to modern consensus criteria and using tissue Doppler analysis. RESULTS Compared to controls, ART-naïve patients had lower E' velocities (E' septal: 10.2 ± 2.4 vs 11.9 ± 2.6 cm/s, p = 0.02), higher E/E' ratio (7.8 ± 1.9 vs 6.9 ± 1.6,p = 0.02) and higher prevalence of DD (19 % vs 3.3 %,p = 0.05). HIV patients under ART also had worse diastolic function compared to controls (E' septal: 10.3 ± 2.5 cm/s;p < 0.01; E/E'ratio: 8.0 ± 2.0,p < 0.01; DD prevalence: 23 %;p = 0.01), but no significant differences were found between ART-naïve and ART HIV subgroups. In multivariable logistic regression analysis, age and body mass index were the only independent predictors of reduced diastolic reserve in HIV patients. Regarding systolic function, there were no significant differences in ejection fraction or S' velocities between controls and HIV subgroups. CONCLUSIONS HIV treatment-naïve patients have reduced diastolic reserve that is not worsened by ART. These data reinforce the association of diastolic dysfunction with the HIV infection itself and not with the anti-retroviral therapy.
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Affiliation(s)
- Ricardo Fontes-Carvalho
- Cardiology Department, Gaia Hospital Center, Rua Conceição Fernandes, 4434-502, Vila Nova de Gaia, Portugal,
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Mancio J, Almeida C, Pires-Morais G, Santos L, Melica B, Oliveira M, Rodrigues A, Braga P, Gama Ribeiro V. Hanging by a thread: Major detachment of an aortic prosthetic valve. Rev Port Cardiol 2015; 34:787-8. [PMID: 26626446 DOI: 10.1016/j.repc.2015.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 06/20/2015] [Accepted: 07/24/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jennifer Mancio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho and Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery of Medical School of Porto, Portugal.
| | - Carla Almeida
- Department of Cardiology, Hospital do Divino Espirito Santo, Ponta Delgada, Portugal
| | - Gustavo Pires-Morais
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Lino Santos
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Bruno Melica
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Marco Oliveira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Alberto Rodrigues
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Pedro Braga
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
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Mancio J, Almeida C, Pires-Morais G, Santos L, Melica B, Oliveira M, Rodrigues A, Braga P, Gama Ribeiro V. Hanging by a thread: Major detachment of an aortic prosthetic valveHanging by a thread. Revista Portuguesa de Cardiologia (English Edition) 2015. [DOI: 10.1016/j.repce.2015.12.010] [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] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Mancio J, Caeiro D, Faria R, Marques M, Bernardino S, Oliveira M, Albuquerque A, Gama Ribeiro V. A 75-year-old woman with chest pain and transient severe left ventricular systolic dysfunction. Revista Portuguesa de Cardiologia (English Edition) 2015. [DOI: 10.1016/j.repce.2015.10.010] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Mancio J, Caeiro D, Faria R, Marques M, Bernardino S, Oliveira M, Albuquerque A, Ribeiro VG. A 75-year-old woman with chest pain and transient severe left ventricular systolic dysfunction. Rev Port Cardiol 2015; 34:621.e1-8. [PMID: 26421379 DOI: 10.1016/j.repc.2015.03.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 01/11/2015] [Accepted: 03/10/2015] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Coronary spasm can cause myocardial ischemia and angina in both patients with and without obstructive coronary artery disease. However, provocation tests using intracoronary acetylcholine (ACh) have been rarely performed in the Western world. CASE REPORT We report a case of a 75-year-old woman with a history of hypertension and a mechanical aortic prosthesis who presented in the emergency room with acute-onset chest pain, widespread ST-segment depression and severe left ventricular systolic dysfunction, with no signs of prosthesis dysfunction. Emergent coronary angiography excluded obstructive coronary artery disease. Pain relief and normalization of ST segment and systolic function occurred within six hours. The patient was treated for a possible thromboembolic myocardial infarction and was discharged home asymptomatic. Two weeks later, cardiac magnetic resonance was performed showing inferoseptal transmural infarct scar, inferior and inferolateral subendocardial infarct and mid-basal ischemia in the anterior and anterolateral walls. She was readmitted with recurrence of chest pain and it was decided to perform a provocation test with ACh. After injection of ACh into the left anterior descending artery, chest pain, ST-segment depression, blood flow impairment (TIMI 1) and transient grade 3 atrioventricular (AV) block occurred. Intracoronary administration of nitrates reversed the coronary spasm and AV conduction disturbances. Twenty minutes later, chest pain and ischemic ST changes recurred; there was no response to vasodilators and the patient developed cardiac arrest with pulseless electrical activity. Advanced life support was maintained for 32 minutes without return of spontaneous circulation. CONCLUSIONS Provocation tests have a high sensitivity and specificity for the diagnosis of vasospastic angina. Although it is rare, these tests have the potential risk of irreversible spasm leading to arrhythmia and death.
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Affiliation(s)
- Jennifer Mancio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
| | - Daniel Caeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Rita Faria
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Miguel Marques
- Department of Medicine, Centro Hospitalar do Médio-Ave, Vila Nova de Gaia, Portugal
| | - Sofia Bernardino
- Department of Medicine, Centro Hospitalar do Médio-Ave, Vila Nova de Gaia, Portugal
| | - Marco Oliveira
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Aníbal Albuquerque
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal
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Mancio J, Fontes-Carvalho R, Oliveira M, Caeiro D, Braga P, Bettencourt N, Ribeiro VG. Coronary Artery Disease and Symptomatic Severe Aortic Valve Stenosis: Clinical Outcomes after Transcatheter Aortic Valve Implantation. Front Cardiovasc Med 2015; 2:18. [PMID: 26664890 PMCID: PMC4671341 DOI: 10.3389/fcvm.2015.00018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [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: 10/29/2014] [Accepted: 03/24/2015] [Indexed: 12/20/2022] Open
Abstract
Introduction The impact of coronary artery disease (CAD) on outcomes after transcatheter aortic valve implantation (TAVI) has not been clarified. Furthermore, less is known about the indication and strategy of revascularization in these high risk patients. Aims This study sought to determine the prevalence and prognostic impact of CAD in patients undergoing TAVI, and to assess the safety and feasibility of percutaneous coronary intervention (PCI) before TAVI. Methods Patients with severe aortic stenosis (AS) undergoing TAVI were included into a prospective single center registry from 2007 to 2012. Clinical outcomes were compared between patients with and without CAD. In some patients with CAD, it was decided to perform elective PCI before TAVI after decision by the Heart team. The primary endpoints were 30-day and 2-year all-cause mortality. Results A total of 91 consecutive patients with mean age of 79 ± 9 years (52% men) underwent TAVI with a median follow-up duration of 16 months (interquartile range of 27.6 months). CAD was present on 46 patients (51%). At 30-day, the incidences of death were similar between CAD and non-CAD patients (9 and 5%, p = 0.44), but at 2 years were 50% in CAD patients and 24% in non-CAD patients [crude hazard ratio with CAD, 2.2; 95% confidence interval (CI), 1.1–4.6; p = 0.04]. Adjusting for age, gender, left ventricular ejection fraction, and glomerular filtration rate, the hazard of death was 2.6-fold higher in patients with CAD (95% CI, 1.1–6.0; p = 0.03). Elective PCI before TAVI was performed in 13 patients (28% of CAD patients). There were no more adverse events in patients who underwent TAVI + PCI when compared with those who underwent isolated TAVI. Conclusion In severe symptomatic AS who underwent TAVI, CAD is frequent and adversely impacts long-term outcomes, but not procedure outcomes. In selected patients, PCI before TAVI appears to be feasible and safe.
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Affiliation(s)
- Jennifer Mancio
- Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal ; Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto University , Porto , Portugal
| | - Marco Oliveira
- Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal
| | - Daniel Caeiro
- Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal
| | - Pedro Braga
- Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal
| | - Nuno Bettencourt
- Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal ; Cardiovascular R&D Unit, Department of Physiology and Cardiothoracic Surgery, Faculty of Medicine of Porto University , Porto , Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology, Gaia Hospital Center , Vila Nova de Gaia , Portugal
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Fontes-Carvalho R, Fontes-Oliveira M, Sampaio F, Mancio J, Bettencourt N, Teixeira M, Rocha Gonçalves F, Gama V, Leite-Moreira A. Influence of epicardial and visceral fat on left ventricular diastolic and systolic functions in patients after myocardial infarction. Am J Cardiol 2014; 114:1663-9. [PMID: 25306552 DOI: 10.1016/j.amjcard.2014.08.037] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/15/2014] [Accepted: 08/15/2014] [Indexed: 01/09/2023]
Abstract
Obesity has been associated with subclinical left ventricular (LV) diastolic dysfunction and increased risk of heart failure. Few data are available on the relative contribution of adiposity distribution and changes in myocardial structure and function. We evaluated the influence of visceral versus subcutaneous abdominal adipose tissue and epicardial fat on LV diastolic function after acute myocardial infarction. One month after acute myocardial infarction, 225 consecutive patients were prospectively enrolled and underwent anthropometric evaluation, bioimpedance analysis, detailed echocardiography, and multidetector 64-slice computed tomography scan for quantification of epicardial fat volume (EFV) and of total, subcutaneous and visceral abdominal fat areas. We found a significant association between LV diastolic dysfunction parameters and body mass index, fat-mass percentage, and waist-to-height ratio. E' velocity and E/E' ratio were correlated with total and visceral abdominal fat (r = -0.27, p <0.001 and r = 0.21, p <0.01, respectively), but not with subcutaneous fat. After multivariate analysis, increasing EFV was associated with decreased E' velocity (adjusted β -0.11, 95% confidence interval -0.19 to -0.03; p <0.01) and increased E/E' ratio (adjusted β 0.19, 95% confidence interval 0.07 to 0.31, p <0.01). Patients with diastolic dysfunction showed higher EFV (116.7 ± 67.9 ml vs 93.0 ± 52.3 ml, p = 0.01), and there was a progressive increase in EFV according to diastolic dysfunction grades (p = 0.001). None of the adiposity parameters correlated with ejection fraction or S' velocities. In conclusion, in patients after myocardial infarction, impaired LV diastolic function was associated with increased adiposity, especially with visceral and central fat parameters. Increasing EFV was independently associated with worse LV diastolic function.
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Rios E, Mancio J, Rodrigues-Pereira P, Magalhães D, Bartosch C. Large myocardial infarction with myocardium calcium deposits associated with reperfusion injury. Cardiovasc Pathol 2014; 23:379-80. [PMID: 25127059 DOI: 10.1016/j.carpath.2014.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/03/2014] [Accepted: 07/03/2014] [Indexed: 10/25/2022] Open
Abstract
The clinical and autopsy findings of a 66-year-old man with myocardial infarction complicated by reperfusion injury are described, highlighting the presence of large myocardium calcium deposits.
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Affiliation(s)
- Elisabete Rios
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal
| | - Jennifer Mancio
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Portugal
| | | | | | - Carla Bartosch
- Department of Pathology, Centro Hospitalar São João, Porto, Portugal; Department of Pathology, Portuguese Oncology Institute-Porto, Portugal; Cancer Biology and Epigenetics Group, Research Center of Portuguese Oncology Institute- Porto, Portugal.
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Mancio J, Pires-Morais G, Bettencourt N, Oliveira M, Santos L, Melica B, Rodrigues A, Braga JP, Ribeiro VG. Meningeal haemorrhage secondary to cerebrospinal fluid drainage during thoracic endovascular aortic repair. Oxf Med Case Reports 2014; 2014:56-9. [PMID: 25988028 PMCID: PMC4370003 DOI: 10.1093/omcr/omu019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 02/18/2014] [Revised: 05/07/2014] [Accepted: 05/13/2014] [Indexed: 11/13/2022] Open
Abstract
Thoracic endovascular aortic repair (TEVAR) has shown lower mortality compared with open surgical repair (OSR). However, the risk of spinal cord ischaemia (SCI) remains similar than OSR. As a prophylactic measure to reduce the risk of SCI, cerebrospinal fluid (CSF) drainage has been widely used in OSR. In TEVAR, the utility of this adjunct is still controversial. We report a case of a 56-year-old man referred for TEVAR for a descending thoracic aneurysm that previously underwent an abdominal aneurysmectomy with aortobifemoral bypass graft. On the day before, a lumbar cerebrospinal drain was placed prophylactically. Forty-eight hours after the procedure, meningeal symptoms without neurological deficits developed. Clinical investigation revealed meningeal haemorrhage. Therapy with nimodipine was initiated with symptomatic relief. Evidence from randomized controlled trials supporting the role of CSF drainage in TEVAR is still lacking. We discuss the current recommendations, potential benefits and risks and cautions associated with CSF drainage in TEVAR.
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Affiliation(s)
- Jennifer Mancio
- Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal
| | - Gustavo Pires-Morais
- Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal
| | - Nuno Bettencourt
- Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia e Espinho, Research and Developement Unit, Faculty of Medicine , University of Porto , Porto , Portugal
| | - Marco Oliveira
- Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal
| | - Lino Santos
- Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal
| | - Bruno Melica
- Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal
| | - Alberto Rodrigues
- Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal
| | - José Pedro Braga
- Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal
| | - Vasco Gama Ribeiro
- Department of Cardiology , Centro Hospitalar de Vila Nova de Gaia e Espinho , Rua Conceição Fernandes, Vilar de Andorinho, 4434-502 Vila Nova de Gaia, Porto , Portugal
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Mancio J, Bettencourt N, Oliveira M, Pires-Morais G, Ribeiro VG. Acute right ventricular myocarditis presenting with chest pain and syncope. BMJ Case Rep 2013; 2013:bcr2012007173. [PMID: 24096068 PMCID: PMC3822266 DOI: 10.1136/bcr-2012-007173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [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: 12/11/2022] Open
Abstract
Myocarditis is assumed to involve both ventricles equally. Right ventricular predominant involvement is rarely described. A case of acute viral right ventricular myocarditis presenting with chest pain and syncope, grade 3 atrioventricular block, right ventricular dilatation and free wall hypokinesia is reported. Cardiac MRI showed late enhancement of the right ventricular free wall without involvement of the left ventricle. Anti-Coxsackie A9 virus neutralising IgM-type antibodies titre was elevated. This case emphasises that manifestations of myocarditis can be limited to the right ventricle and should be considered in the differential diagnosis of right ventricular enlargement.
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Affiliation(s)
- Jennifer Mancio
- Department of Cardiology, Hospital Center of Vila Nova de Gaia and Espinho, Vila Nova de Gaia, Portugal
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Affiliation(s)
- Jennifer Mancio
- Department of Cardiology Thorax and Circulation Unit, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal.
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