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Sagris M, Antonopoulos AS, Angelopoulos A, Papanikolaou P, Simantiris S, Vamvakaris K, Koumpoura A, Farmaki M, Antoniades C, Tsioufis Κ, Tousoulis D. High-Sensitivity Troponin (hs-Tn) for Cardiovascular Risk Prognostication: A Systematic Review and Meta-Analysis. Curr Med Chem 2023; 31:CMC-EPUB-130176. [PMID: 36924099 DOI: 10.2174/0929867330666230315152045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 01/12/2023] [Accepted: 01/19/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Chronic low-grade inflammation is involved in coronary atherosclerosis progression whereas recent research efforts suggest that preventative methods should be tailored to the "residual inflammatory risk". As such, modalities for the early identification of the risk have to be investigated. METHODS We performed a systematic review and meta-analysis according to the PRISMA guidelines. Any study that presented the prognostic value of high sensitivity troponin (hs-cTn) of vascular inflammation in stable patients without known cardiac heart disease was considered to be potentially eligible. The Medline (PubMed) database was searched up to April 22, 2021. The main endpoint was the difference in c-index (Δ[c-index]) with the use of hs-cTn for major adverse cardiovascular events (MACEs), cardiovascular and all-cause mortality. We calculated I² to test heterogeneity. RESULTS In total, 44 studies and 112,288 stable patients without known coronary heart disease were included in this meta-analysis. The mean follow-up duration of the whole cohort was 6.8 ± 1.1 years. 77,004 (68.5%) of the patients presented with low cardiovascular risk while 35,284 (31.5%) in high. The overall pooled estimate of Δ[c-index] for MACE was 1.4% (95%CI: 0.7-2.1, I2=0%) and for cardiovascular death 1.3% (95%CI: 0.3-2.3, I2=0%). Finally, the overall pooled estimate of Δ[c-index] for all-cause mortality was 3% (95%CI: 1.9-3.9, I2=86%), while high heterogeneity was observed between the studies. CONCLUSION The predictive usefulness of changes in hs-cTn measures in stable individuals with either high or low cardiovascular risk, demonstrates that assessing vascular inflammation in addition to clinical risk factors enhances risk prediction for cardiovascular events and all-cause mortality. Further prospective studies are necessary to confirm these findings and assist clinical decision-making regarding the most optimal prevention strategy.
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Affiliation(s)
- Marios Sagris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alexios S Antonopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
- RDM Division of Cardiovascular Medicine, University of Oxford, UK
| | - Andreas Angelopoulos
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Paraskevi Papanikolaou
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Spyridon Simantiris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Konstantinos Vamvakaris
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Alkmini Koumpoura
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Maria Farmaki
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | | | - Κonstantinos Tsioufis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitris Tousoulis
- 1st Cardiology Clinic, 'Hippokration' General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Vamvakaris K, Koumpoura A, Farmaki M, Lakoumentas J, Pasioti M, Papadopoulos N, Xepapadaki P. Diagnosis, Management and Prescription Practices of Adrenaline in Children with Food-Induced Anaphylaxis: Audit in a Specialized Pediatric Allergy Department. J Pers Med 2022; 12:jpm12091477. [PMID: 36143262 PMCID: PMC9501412 DOI: 10.3390/jpm12091477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 09/03/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Abstract
In the era of evidence-based medicine, physicians worldwide should abide by universally approved practices and healthcare units should seek quality control and operational improvement. This audit evaluates the degree of compliance with the European Academy of Allergy and Clinical Immunology guidelines for the diagnosis and treatment of anaphylaxis in a pediatric Allergy Department. Medical records of 248 children with food-induced allergic reactions who presented both on emergency and outpatient basis were reviewed. Data were also collected from the e-prescription database and anaphylaxis severity was graded according to Sampson’s criteria. An accuracy metric was used to calculate the consistency rate. Anaphylaxis was documented in 188/423 allergic reactions. The degree of agreement for the classification of the reactions as anaphylactic was 88.3%, while the respective rate for non-anaphylactic was 58.7%. In the anaphylactic cases, adrenaline was prescribed in 84.8%, while the respective rates for other drugs were: antihistamines: 27.6%; corticosteroids: 26.1%; inhaled β2-agonists: 11.8%. This study, through the example of pediatric food-induced anaphylaxis, underlines the significance of compliance to guidelines, organized documentation in healthcare units using specially formulated medical history forms and continuous medical stuff training. Thus, diagnosis and treatment practices can be improved for the benefit of patients.
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Affiliation(s)
- Konstantinos Vamvakaris
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Thivon & Levadeias St., Goudi, GR-11527 Athens, Greece
| | - Alkmini Koumpoura
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Thivon & Levadeias St., Goudi, GR-11527 Athens, Greece
| | - Maria Farmaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Thivon & Levadeias St., Goudi, GR-11527 Athens, Greece
| | - John Lakoumentas
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Thivon & Levadeias St., Goudi, GR-11527 Athens, Greece
| | - Maria Pasioti
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Thivon & Levadeias St., Goudi, GR-11527 Athens, Greece
| | - Nikolaos Papadopoulos
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Thivon & Levadeias St., Goudi, GR-11527 Athens, Greece
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester M13 9PL, UK
| | - Paraskevi Xepapadaki
- Allergy Department, 2nd Pediatric Clinic, National and Kapodistrian University of Athens, Thivon & Levadeias St., Goudi, GR-11527 Athens, Greece
- Correspondence: ; Tel.: +30-2107776964
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Antonopoulos AS, Angelopoulos A, Papanikolaou P, Simantiris S, Oikonomou EK, Vamvakaris K, Koumpoura A, Farmaki M, Trivella M, Vlachopoulos C, Tsioufis K, Antoniades C, Tousoulis D. Biomarkers of Vascular Inflammation for Cardiovascular Risk Prognostication: A Meta-Analysis. JACC Cardiovasc Imaging 2022; 15:460-471. [PMID: 34801448 DOI: 10.1016/j.jcmg.2021.09.014] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/08/2021] [Accepted: 09/10/2021] [Indexed: 12/23/2022]
Abstract
OBJECTIVES The purpose of this study was to systematically explore the added value of biomarkers of vascular inflammation for cardiovascular prognostication on top of clinical risk factors. BACKGROUND Measurement of biomarkers of vascular inflammation is advocated for the risk stratification for coronary heart disease (CHD). METHODS We systematically explored published reports in MEDLINE for cohort studies on the prognostic value of common biomarkers of vascular inflammation in stable patients without known CHD. These included common circulating inflammatory biomarkers (ie, C-reactive protein, interleukin-6 and tumor necrosis factor-a, arterial positron emission tomography/computed tomography and coronary computed tomography angiography-derived biomarkers of vascular inflammation, including anatomical high-risk plaque features and perivascular fat imaging. The main endpoint was the difference in c-index (Δ[c-index]) with the use of inflammatory biomarkers for major adverse cardiovascular events (MACEs) and mortality. We calculated I2 to test heterogeneity. This study is registered with PROSPERO (CRD42020181158). RESULTS A total of 104,826 relevant studies were screened and a final of 39 independent studies (175,778 individuals) were included in the quantitative synthesis. Biomarkers of vascular inflammation provided added prognostic value for the composite endpoint and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95% CI: 1.7-4.1 and 3.1, 95% CI: 1.8-4.5, respectively). Coronary computed tomography angiography-related biomarkers were associated with the highest added prognostic value for MACEs: high-risk plaques 5.8%, 95% CI: 0.6 to 11.0, and perivascular adipose tissue (on top of coronary atherosclerosis extent and high-risk plaques): 8.2%, 95% CI: 4.0 to 12.5). In meta-regression analysis, the prognostic value of inflammatory biomarkers was independent of other confounders including study size, length of follow-up, population event incidence, the performance of the baseline model, and the level of statistical adjustment. Limitations in the published literature include the lack of reporting of other metrics of improvement of risk stratification, the net clinical benefit, or the cost-effectiveness of such biomarkers in clinical practice. CONCLUSIONS The use of biomarkers of vascular inflammation enhances risk discrimination for cardiovascular events.
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Affiliation(s)
- Alexios S Antonopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece; RDM Division of Cardiovascular Medicine, University of Oxford, United Kingdom.
| | - Andreas Angelopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Paraskevi Papanikolaou
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Spyridon Simantiris
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Evangelos K Oikonomou
- RDM Division of Cardiovascular Medicine, University of Oxford, United Kingdom; Department of Internal Medicine, Yale School of Medicine, Yale-New Haven Hospital, Connecticut, USA
| | - Konstantinos Vamvakaris
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Alkmini Koumpoura
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Maria Farmaki
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | | | - Charalambos Vlachopoulos
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | - Konstantinos Tsioufis
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
| | | | - Dimitris Tousoulis
- 1(st) Cardiology Department, School of Health Sciences, National and Kapodistrian University of Athens, Greece
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Simantiris S, Antonopoulos AS, Angelopoulos A, Papanikolaou P, Oikonomou EK, Vamvakaris K, Koumpoura A, Farmaki M, Trivella M, Vlachopoulos C, Tsioufis K, Antoniades C, Tousoulis D. Prognostic value of vascular inflammation biomarkers over clinical risk factors for cardiovascular risk : a meta-analysis. Eur J Prev Cardiol 2021. [DOI: 10.1093/eurjpc/zwab061.243] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Measurement of vascular inflammation biomarkers is supported for estimation of residual inflammatory risk and cardiovascular risk stratification, but to date there is no systematic assessment of the added value of such biomarkers in predicting cardiovascular events and their comparative performance.
Methods
We systematically searched in MEDLINE published literature before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite endpoint of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome.
Results
We identified 92,507 studies in MEDLINE after duplicates were removed, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, in which 351,628 individuals participated. The combination of high-risk plaque features and Fat attenuation Index (FAI) by CCTA was associated with the highest prognostic value i.e. Δ[c-index] for the composite endpoint per biomarker type (A). In meta-analysis, both plasma and imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, B) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8). The prognostic value of imaging biomarkers significantly surpassed that of plasma biomarkers for the primary outcome (Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10, C). Notably, biomarkers of vascular inflammation offered higher incremental prognostic value in studies with a shorter duration of follow-up (i.e. <5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with <5% cumulative event incidence, D)
Conclusions
The combination of HRP features and FAI by CCTA imaging had the highest prognostic value for cardiovascular events among plasma or imaging biomarkers of vascular inflammation. CCTA imaging to detect residual inflammatory risk and the vulnerable patient at risk for events is a rational approach to improve risk stratification and prognostication.
Abstract Figure.
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Affiliation(s)
- S Simantiris
- Ippokrateio General Hospital of Athens, Athens, Greece
| | | | | | | | - EK Oikonomou
- Yale University, New Haven, United States of America
| | - K Vamvakaris
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - A Koumpoura
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - M Farmaki
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - M Trivella
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | | | - K Tsioufis
- Ippokrateio General Hospital of Athens, Athens, Greece
| | - C Antoniades
- University of Oxford, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - D Tousoulis
- Ippokrateio General Hospital of Athens, Athens, Greece
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