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Hughes D, Wilson R, Saijo Y, Chan N, Kumar A, Grimm R, Griffin B, Tang W, Nissen S, Aminian A, Xu B. Impact of weight loss on cardiac function: improvement in left ventricular global longitudinal strain following metabolic surgery. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Obesity leads to an increased risk of cardiovascular disease (CVD) morbidity and mortality and is associated with the metabolic risk factors such as hypertension, diabetes mellitus, hyperlipidemia [1]. Metabolic surgery has been proven to be the most effective long term weight management tool and has known benefits in CVD prevention [2]. Global longitudinal strain (GLS) is an effective quantitative measurement of left ventricular (LV) function that is also a powerful predictor of future CVD events and mortality [3]. The impact of metabolic surgery on LV structure and function is unknown.
Purpose
This study investigated the changes in cardiac structure and function after metabolic surgery, including GLS. To our knowledge there has not been a study investigating this relationship previously reported.
Methods
Consecutive patients undergoing metabolic surgery at our center between March 2005 and February 2019 were recruited. Patients with transthoracic echocardiographic imaging (TTE) pre and post metabolic surgery (May 2005 to January 2019) were included. Electronic medical records were searched to obtain demographic, surgical and clinical data. GLS was calculated with Velocity Vector Imaging (VVI, Siemens, v2.0, Pennsylvania, USA). Averaged GLS values were derived from 4 chamber, 2 chamber and 3 chamber calculations.
Results
398 patients with pre- and post-operative cardiac imaging were included. Please see Table 1 for the baseline demographics of our study population. The mean age was 60.0 years with 70% being female. There were significant rates of CVD risk factors such as: hypertension (76.4%), diabetes mellitus (58.8%) and hyperlipidemia (76.4%).
The clinical and echocardiographic changes noted post metabolic surgery are detailed in Table 2. Along with decreases in weight post operatively, there were significant improvements in the markers of CVD risk factors such as mean blood pressure (134/75 to 129/72 mmHg, p value <0.001), mean gylcated hemoglobin levels (7.0 to 6.1%, p value <0.001) and mean low density lipoprotein (LDL) levels (97.7 to 88.2 mg/dl, p value <0.001).
There were a number of statistically significant positive changes in the left ventricular structure and function. The mean LV ejection fraction increased from 56.3% to 57.4% (p=0.008); left ventricular mass decreased from 238.2 g to 179.3 g (p value <0.001), and both septal and posterior wall thicknesses decreased significantly (p value <0.001). The LV mass indexed to body surface area (BSA) also decreased from 93.5 g/m2 to 83.1 g/m2.
The average global LV GLS was −15.7% pre-operatively, improving significantly to −17.9% post-operatively (p<0.001).
Conclusion
Our study has shown for the first time the impact of metabolic surgery on ventricular structure and function, with reduction in LV mass and improvement in LV GLS. These novel findings lends further support to the cardiovascular benefits of metabolic surgery.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- D Hughes
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
| | - R Wilson
- Cleveland Clinic, Bariatric and Metabolic Institute , Cleveland , United States of America
| | - Y Saijo
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
| | - N Chan
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
| | - A Kumar
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
| | - R Grimm
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
| | - B Griffin
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
| | - W Tang
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
| | - S Nissen
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
| | - A Aminian
- Cleveland Clinic, Bariatric and Metabolic Institute , Cleveland , United States of America
| | - B Xu
- Cleveland Clinic, Heart and Vascular Institute , Cleveland , United States of America
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2
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Nicholls S, Kataoka Y, Nissen S, Prati F, Windecker S, Puri R, Hucko T, Aradi D, Herrman J, Hermanides R, Wang B, Wang H, Butters J, Di Giovanni G, Jones S, Pompili G, Psaltis P. Effect of Evolocumab on Changes in Coronary Plaque Phenotype in Statin-Treated Patients Following Myocardial Infarction: The HUYGENS Randomised Clinical Trial. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.335] [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: 10/16/2022]
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3
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Dykun I, Bayturan O, Carlo J, Nissen SE, Nicholls SJ, Puri R. HbA1c, coronary atheroma progression and cardiovascular events. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2514] [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
Hemoglobin A1c (HbA1c) reflects long-term glycemic control and is associated with an increased risk of cardiovascular events among diabetic and non-diabetic patients. The specific impact of HbA1c upon atheroma progression and incident cardiovascular events relative to the presence of other cardiovascular risk factors remains uncertain.
Purpose
We tested the hypothesis that on-treatment HbA1c levels independently associate with coronary atheroma progression measured with serial intravascular ultrasonography (IVUS) and major adverse cardiovascular events (MACE: death, myocardial infarction, cerebrovascular accident, coronary revascularization, or hospitalization for unstable angina) rates.
Methods
We performed a post-hoc pooled analysis of data from eight prospective, randomized trials involving serial coronary IVUS. HbA1c was measured at baseline and the average of the follow-up values was taken. The percent atheroma volume (PAV) was calculated as the proportion of the entire vessel wall occupied by atherosclerotic plaque, throughout the segment of interest. Using multivariable mixed modeling, we determined the association of HbA1c with annualized change in PAV. Cox proportional hazard models were used to assess the association of HbA1c with incidence of MACE.
Results
Among 2,791 patients, mean age was 58.9±9 years and 29.1% were women. Mean on-treatment low-density lipoprotein (LDL)-cholesterol was 80.2±33.7 mg/dl and median on-treatment triglycerides (TG) were 125.5 (94.7, 170.2) mg/dl. Mean baseline and follow-up HbA1c was 6.2±1.2% and 6.3±1.2%, respectively. Overall, there was no net significant annualized change in PAV (0.15±0.21, p=0.47). In a fully adjusted multivariable analysis (following adjustment of age, sex, body mass index (BMI), systolic blood pressure, smoking, LDL- and high-density lipoprotein cholesterol, TG levels, peripheral artery disease, trial, region, and baseline PAV), higher on-treatment HbA1c levels were independently associated with annualized changes in PAV [beta-estimate (95% confidence interval): 0.13 (0.07, 0.19), p<0.001]. On-treatment HbA1c levels were significantly and independently associated with incidence of MACE [hazard ratio (95% confidence interval): 1.17 (1.07, 1.28), p<0.001].
Conclusions
Independent of achieved cholesterol levels, vascular risk factors and BMI, greater HbA1c levels significantly associate with coronary atheroma progression and clinical outcomes. These results support the notion of a direct, specific effect of glycemic control upon the natural history of coronary atheroma and atherosclerotic events, supporting the rationale of therapies designed to directly modulate it.
Funding Acknowledgement
Type of funding sources: Foundation. Main funding source(s): Iryna Dykun was supported by the German Research Foundation
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Affiliation(s)
- I Dykun
- Cleveland Clinic, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - O Bayturan
- Celal Bayar University Faculty of Medicine, Department of Cardiology, Manisa, Turkey
| | - J Carlo
- Cleveland Clinic, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - S E Nissen
- Cleveland Clinic, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, United States of America
| | - S J Nicholls
- Monash University, Monash Cardiovascular Research Centre, Melbourne, Australia
| | - R Puri
- Cleveland Clinic, Cleveland Clinic Coordinating Center for Clinical Research, Department of Cardiovascular Medicine, Cleveland, United States of America
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4
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Nicholls S, Anderson T, Ballantyne C, Cho L, Kastelein J, Koenig W, Hucko T, Kassahun H, Liu Y, Wang H, Nissen S. 484 Effect of Longer-Term Administration of Evolocumab in Patients With Angiographic Coronary Artery Disease: Results of the GLAGOV Open Label Extension Study. Heart Lung Circ 2020. [DOI: 10.1016/j.hlc.2020.09.491] [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: 10/23/2022]
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5
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Obeid S, Libby P, Husni E, Pfeffer MA, Wisniewski LM, Davey DA, Wolski KE, Wang QW, Feng R, Nissen SE, Luscher TF. P5421Cardiorenal risk of celecoxib compared to naproxen, or ibuprofen in arthritis patients: a sub-analysis of the PRECISION trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5421] [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: 11/14/2022] Open
Affiliation(s)
- S Obeid
- University Hospital Zurich, Cardiology, Zurich, Switzerland
| | - P Libby
- Brigham and Women's Hospital, Boston, United States of America
| | - E Husni
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - M A Pfeffer
- Brigham and Women's Hospital, Boston, United States of America
| | - L M Wisniewski
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - D A Davey
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - K E Wolski
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - Q W Wang
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - R Feng
- Pfizer Inc, 219 E. 42nd Street, New York, NY 10017 USA, New York, United States of America
| | - S E Nissen
- Cleveland Clinic Foundation, Cleveland, United States of America
| | - T F Luscher
- Royal Brompton Hospital, London, United Kingdom
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6
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Kumar A, Wolski KE, Kashyap SR, Lincoff AM, Ruotolo G, McErlean E, Weerakkody G, Riesmeyer JR, Nicholls SJ, Nissen SE, Menon V. P4473Baseline insulin levels are associated with need for revascularization among diabetic patients with high risk vascular disease: insights from the ACCELERATE trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy563.p4473] [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)
- A Kumar
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - K E Wolski
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - S R Kashyap
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - A M Lincoff
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - G Ruotolo
- Eli Lilly and Company, Indianapolis, United States of America
| | - E McErlean
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - G Weerakkody
- Eli Lilly and Company, Indianapolis, United States of America
| | - J R Riesmeyer
- Eli Lilly and Company, Indianapolis, United States of America
| | | | - S E Nissen
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
| | - V Menon
- Cleveland Clinic Foundation, Heart and Vascular Institute, Cleveland, United States of America
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7
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Yeomans ND, Graham DY, Husni ME, Solomon DH, Stevens T, Vargo J, Wang Q, Wisniewski LM, Wolski KE, Borer JS, Libby P, Lincoff AM, Lüscher TF, Bao W, Walker C, Nissen SE. Randomised clinical trial: gastrointestinal events in arthritis patients treated with celecoxib, ibuprofen or naproxen in the PRECISION trial. Aliment Pharmacol Ther 2018; 47:1453-1463. [PMID: 29667211 DOI: 10.1111/apt.14610] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [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: 11/30/2017] [Revised: 12/09/2017] [Accepted: 02/21/2018] [Indexed: 12/18/2022]
Abstract
AIM To evaluate GI safety of celecoxib compared with 2 nonselective (ns) NSAIDs, as a secondary objective of a large trial examining multiorgan safety. METHODS This randomised, double-blind controlled trial analysed 24 081 patients. Osteoarthritis or rheumatoid arthritis patients, needing ongoing NSAID treatment, were randomised to receive celecoxib 100-200 mg b.d., ibuprofen 600-800 mg t.d.s. or naproxen 375-500 mg b.d. plus esomeprazole, and low-dose aspirin or corticosteroids if already prescribed. Clinically significant GI events (CSGIE-bleeding, obstruction, perforation events from stomach downwards or symptomatic ulcers) and iron deficiency anaemia (IDA) were adjudicated blindly. RESULTS Mean treatment and follow-up durations were 20.3 and 34.1 months. While on treatment or 30 days after, CSGIE occurred in 0.34%, 0.74% and 0.66% taking celecoxib, ibuprofen and naproxen. Hazard ratios (HR) were 0.43 (95% CI 0.27-0.68, P = 0.0003) celecoxib vs ibuprofen and 0.51 (0.32-0.81, P = 0.004) vs naproxen. There was also less IDA on celecoxib: HR 0.43 (0.27-0.68, P = 0.0003) vs ibuprofen; 0.40 (0.25-0.62, P < 0.0001) vs naproxen. Even taken with low-dose aspirin, fewer CSGIE occurred on celecoxib than ibuprofen (HR 0.52 [0.29-0.94], P = 0.03), and less IDA vs naproxen (0.42 [0.23-0.77, P = 0.005]). Corticosteroid use increased total GI events and CSGIE. H. pylori serological status had no influence. CONCLUSIONS Arthritis patients taking NSAIDs plus esomeprazole have infrequent clinically significant gastrointestinal events. Co-prescribed with esomeprazole, celecoxib has better overall GI safety than ibuprofen or naproxen at these doses, despite treatment with low-dose aspirin or corticosteroids.
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Affiliation(s)
- N D Yeomans
- Department of Medicine, Austin Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Western Sydney University, Campbelltown, NSW, Australia
| | - D Y Graham
- Baylor College of Medicine, Veterans Affairs Medical Center, Houston, TX, USA
| | - M E Husni
- Cleveland Clinic, Cleveland, OH, USA
| | - D H Solomon
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | - T Stevens
- Cleveland Clinic, Cleveland, OH, USA
| | - J Vargo
- Cleveland Clinic, Cleveland, OH, USA
| | - Q Wang
- Cleveland Clinic, Cleveland, OH, USA
| | | | | | - J S Borer
- Downstate College of Medicine, State University of New York, New York, NY, USA
| | - P Libby
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA, USA
| | | | - T F Lüscher
- Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - W Bao
- Pfizer, New York, NY, USA
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8
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Shishikura D, Kataoka Y, DiGiovanni G, Janssan A, Takata K, Andrews J, Psaltis P, Wolski K, Nissen S, Nicholls S. The Impact of Plaque Attenuation and Echogenicity on Clinical Outcome: Insight from Intravascular Ultrasound. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.526] [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: 10/28/2022]
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9
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Mann JF, Nauck MA, Jacob S, Lüdemann J, Brown-Frandsen K, Daniels GH, Kristensen P, Nissen SE, Pocock S, Poulter NR, Ravn LS, Rasmussen S, Steinberg WM, Stockner M, Zinman B, Bergenstal RM, Rieck M, Baeres FM, Marso SP, Buse JB. Liraglutid und renale Endpunkte bei Typ 2 Diabetes: Ergebnisse der LEADER Studie. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601747] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- JF Mann
- Friedrich Alexander Universität Erlangen, Abteilung Nephrologie, Erlangen, Germany
| | - MA Nauck
- Ruhr-University Bochum, St. Josef Hospital, Klinische Forschung, Abteilung Diabetologie, Medizinische Klinik I, Bochum, Germany
| | - S Jacob
- Praxis für Prävention und Therapie, Villingen-Schwenningen, Germany
| | - J Lüdemann
- Diabetes- und Fußzentrum 'diabetes falkensee', Falkensee, Germany
| | | | - GH Daniels
- Massachusetts General Hospital, Boston, United States
| | | | - SE Nissen
- Cleveland Clinic, Department of Cardiovascular Medicine, Cleveland, United States
| | - S Pocock
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - NR Poulter
- Imperial College London, London, United Kingdom
| | - LS Ravn
- Novo Nordisk A/S, Soeborg, Denmark
| | | | - WM Steinberg
- George Washington University Medical Center, Department of Medicine, Rockville, United States
| | | | - B Zinman
- University of Toronto, Mount Sinai Hospital, Sinai Centre for Diabetes, Toronto, Canada
| | - RM Bergenstal
- Park Nicollet Institute for Research and Education, International Diabetes Center, Minneapolis, United States
| | - M Rieck
- Novo Nordisk Pharma GmbH, Mainz, Germany
| | | | - SP Marso
- University of Texas Southwestern, Department of Internal Medicine, Dallas, United States
| | - JB Buse
- University of North Carolina, School of Medicine, Department of Medicine, Chapel Hill, United States
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10
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Scherer D, Kataoka Y, Pisaniello A, Uno K, Puri R, Tuzcu E, Nissen S, Nicholls S. Characteristics of plaque microstructures in diabetic patients receiving metformin: frequency domain optical coherence tomography analysis. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kataoka Y, Scherer D, Pisaniello A, Uno K, Puri R, Tuzcu E, Nissen S, Nicholls S. Effect of individual high-intensity statin agents on optical coherence tomography derived measures of plaque stability. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.530] [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: 11/25/2022]
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12
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Albring A, Wendt L, Benson S, Nissen S, Yavuz Z, Engler H, Witzke O, Schedlowski M. Preserving Learned Immunosuppressive Placebo Response: Perspectives for Clinical Application. Clin Pharmacol Ther 2014; 96:247-55. [DOI: 10.1038/clpt.2014.75] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 03/27/2014] [Indexed: 12/13/2022]
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13
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Friedrich S, Kastelein JJP, James D, Waterhouse T, Nissen SE, Nicholls SJ, Krueger KA. The pharmacokinetics and pharmacokinetic/pharmacodynamic relationships of evacetrapib administered as monotherapy or in combination with statins. CPT Pharmacometrics Syst Pharmacol 2014; 3:e94. [PMID: 24452615 PMCID: PMC3910017 DOI: 10.1038/psp.2013.70] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2013] [Accepted: 10/27/2013] [Indexed: 11/22/2022]
Abstract
Evacetrapib is a novel cholesteryl ester transfer protein (CETP) inhibitor currently being evaluated in a late-stage cardiovascular outcome trial. Using population-based models, we analyzed evacetrapib concentration data along with high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) data from a 12-week study in dyslipidemic patients treated with evacetrapib alone or in combination with atorvastatin, simvastatin, or rosuvastatin. Evacetrapib pharmacokinetics were characterized using a two-compartment model with first-order absorption. Evacetrapib exposure increased in a less than dose-proportional manner, similar to other CETP inhibitors. No patient factors had a clinically relevant impact on evacetrapib pharmacokinetics. The relationships between evacetrapib exposure and HDL-C and LDL-C were characterized using Emax models. The theoretical maximal mean HDL-C increase and LDL-C decrease relative to baseline were 177 and 44.1%, respectively. HDL-C change from baseline was found to be negatively correlated with baseline HDL-C. A pharmacologically independent LDL-C reduction was found when evacetrapib was coadministered with statins.
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Affiliation(s)
- S Friedrich
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - J J P Kastelein
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - D James
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - T Waterhouse
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - S E Nissen
- Cleveland Clinic Coordinating Center for Clinical Research, Cleveland Clinic, Cleveland, Ohio, USA
| | - S J Nicholls
- South Australian Health & Medical Research Institute, University of Adelaide, Adelaide, Australia
| | - K A Krueger
- Lilly Research Laboratories, Eli Lilly and Company, Indianapolis, Indiana, USA
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14
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Kataoka Y, John J, Wolski K, Uno K, Puri R, Tuzcu E, Nissen S, Nicholls S. Spotty Calcification Associates with Coronary Plaque Microstructures In Vivo: Insights From Fourier-Domain Optical Coherence Tomography Analysis. Heart Lung Circ 2013. [DOI: 10.1016/j.hlc.2013.05.116] [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: 10/26/2022]
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15
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Heneghan HM, Nissen S, Schauer PR. Gastrointestinal Surgery for Obesity and Diabetes: Weight Loss and Control of Hyperglycemia. Curr Atheroscler Rep 2012; 14:579-87. [DOI: 10.1007/s11883-012-0285-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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16
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Nicholls SJ , Ballantyne CM , Barter PJ , Chapman MJ , Erbel RM , Libby P , Raichlen JS , Uno K , Borgman M , Wolski K , Nissen SE. Effect of Two Intensive Statin Regimens on Progression of Coronary Disease. ACTA ACUST UNITED AC 2011. [DOI: 10.14341/2071-8713-5304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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17
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Ørpetveit I, Ytrehus B, Vikøren T, Handeland K, Mjøs A, Nissen S, Blystad H, Lund A. Rabies in an Arctic fox on the Svalbard archipelago, Norway, January 2011. Euro Surveill 2011. [DOI: 10.2807/ese.16.07.19797-en] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- I Ørpetveit
- Norwegian Veterinary Institute, Oslo, Norway
| | - B Ytrehus
- Norwegian Veterinary Institute, Oslo, Norway
| | - T Vikøren
- Norwegian Veterinary Institute, Oslo, Norway
| | - K Handeland
- Norwegian Veterinary Institute, Oslo, Norway
| | - A Mjøs
- Norwegian Food Safety Authority, Oslo, Norway
| | - S Nissen
- Longyearbyen hospital, Longyearbyen, Svalbard, Norway
| | - H Blystad
- Norwegian Institute of Public Health, Oslo, Norway
| | - A Lund
- Norwegian Veterinary Institute, Oslo, Norway
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18
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Orpetveit I, Ytrehus B, Vikoren T, Handeland K, Mjos A, Nissen S, Blystad H, Lund A. Rabies in an Arctic fox on the Svalbard archipelago, Norway, January 2011. Euro Surveill 2011; 16:19797. [PMID: 21345322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
We report a case of rabies in an Arctic fox. In January 2011 a fox attacked dogs belonging to a meteorological station in the Svalbard archipelago, Norway. Rabies virus was detected in the fox's brain post-mortem. The dogs had been vaccinated against rabies and their antibody levels were protective. Post-exposure prophylaxis was administered to staff at the station. Rabies vaccination is recommended for inhabitants and visitors to the Arctic who may be in contact with wild animals.
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Affiliation(s)
- I Orpetveit
- Norwegian Veterinary Institute, Oslo, Norway
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19
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Barter P, Chapman J, Ballantyne C, Erbel R, Libby P, Nicholls S, Raichlen J, Cain V, Nissen S. L4 BASELINE CHARACTERISTICS OF PATIENTS IN THE SATURN STUDY, A COMPARISON OF ROSUVASTATIN VERSUS ATORVASTATIN ON CORONARY ATHEROSCLEROTIC DISEASE BURDEN. ATHEROSCLEROSIS SUPP 2010. [DOI: 10.1016/s1567-5688(10)70064-7] [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: 11/27/2022]
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Lavoie A, Bayturan O, Hsu A, Wolski K, Tuzcu E, Nissen S, Nicholls S. Abstract: 1495 ATHEROSCLEROTIC PROGRESSION AND REMODELING IN ARTERIES WITH MINIMAL ANGIOGRAPHIC DISEASE. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)70107-2] [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: 10/20/2022]
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Bayturan O, Shao M, Lavoie A, Wolski K, Schoenhagen P, Kapadia S, Tuzcu E, Nissen S, Nicholls S. Abstract: P1386 LOWERING OF HBAIC IS ASSOCIATED WITH LESS PROGRESSION OF CORONARY ATHEROSCLEROSIS. ATHEROSCLEROSIS SUPP 2009. [DOI: 10.1016/s1567-5688(09)71394-7] [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: 10/20/2022]
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Sipahi I, Tuzcu EM, Moon KW, Nicholls SJ, Schoenhagen P, Zhitnik J, Crowe TD, Kapadia S, Nissen SE. Do the extent and direction of arterial remodelling predict subsequent progression of coronary atherosclerosis? A serial intravascular ultrasound study. Heart 2008; 94:623-7. [DOI: 10.1136/hrt.2007.129965] [Citation(s) in RCA: 10] [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: 11/04/2022] Open
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Rathmacher JA, Nissen S, Panton L, Clark RH, Eubanks May P, Barber AE, D'Olimpio J, Abumrad NN. Supplementation with a combination of beta-hydroxy-beta-methylbutyrate (HMB), arginine, and glutamine is safe and could improve hematological parameters. JPEN J Parenter Enteral Nutr 2005; 28:65-75. [PMID: 15080599 DOI: 10.1177/014860710402800265] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Combining the amino acids arginine and glutamine with the leucine metabolite beta-hydroxy-beta-methylbutyrate (HMB) has been shown to reverse lean tissue loss in cancer and acquired immunodeficiency syndrome (AIDS) patients. Although each of these nutrients has been shown to be safe, the safety of this mixture has not been reported. Three double-blind studies examined the safety of the combination of HMB, arginine and glutamine on blood chemistries, hematology, emotional profile, and adverse events. METHODS Study 1 was conducted in healthy adult males (n = 34), study 2 was in HIV patients with AIDS-associated weight loss (n = 43), and study 3 was in cancer patients with wasting (n = 32). Volunteers were assigned to either a placebo or a mixture of 3 g HMB, 14 g arginine, and 14 g glutamine per day. RESULTS Across the 3 studies, HMB, arginine, and glutamine supplementation was not associated with any adverse indicators of health. The only significant changes noted were positive indicators of health status. HMB, arginine, and glutamine supplementation was associated with an improvement in emotional profile (p = .05), a decreased feeling of weakness (p = .03), and increased red blood cells, hemoglobin, hematocrit, lymphocytes, and eosinophils (p < .05) when compared with placebo-supplemented subjects. Blood creatinine levels were not changed. However, blood urea nitrogen increased (p = .01) with HMB, arginine, and glutamine supplementation, which was possibly caused by the additional nitrogen consumed or to the fact that ureagenesis is influenced by arginine and glutamine supplementation. CONCLUSION These results show that HMB, arginine, and glutamine can be safely used to treat muscle wasting associated with AIDS and cancer.
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Affiliation(s)
- J A Rathmacher
- Department of Animal Science, Iowa State University, Ames, Iowa 50011, USA.
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Kress B, Nissen S, Gottschalk A, Anders L, Wentzler C, Solbach T, Palm F, Bähren W, Sartor K. High-resolution MR technique allowing visualization of the course of the inferior alveolar nerve along cystic processes. Eur Radiol 2003; 13:1612-4. [PMID: 12835975 DOI: 10.1007/s00330-003-1837-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2002] [Revised: 11/25/2002] [Accepted: 01/02/2003] [Indexed: 11/29/2022]
Abstract
Magnetic resonance imaging is not established in the preoperative diagnosis of mandibular cystic lesions; therefore, no attempts have been made thus far to evaluate the course of the mandibular neurovascular bundle along the process. However, the radiologist can detect the neurovascular bundle along the cystic lesion by high-resolution MR imaging and convey this information to the maxillofacial surgeon. This reduces the risk of intraoperative damage of the nerve. The examination of the neurovascular bundle can easily be integrated in a tumor MRI protocol of the jaw if the slice orientation is adapted to the course of the mandibular canal.
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Affiliation(s)
- B Kress
- Department of Radiology, Bundeswehrkrankenhaus Ulm, Ulm, Germany.
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Abstract
Selective coronary angiography allows the precise definition of highly stenotic coronary lesions and therefore remains the basis for catheter-based or surgical myocardial revascularization. However, the accumulation of atherosclerotic plaque in the coronary arterial wall begins much earlier than the development of luminal stenosis. In fact, most acute coronary syndromes are initiated by sudden disruption of atherosclerotic plaques that caused neither significant stenosis nor angina pectoris prior to the event. These early, but potentially vulnerable, lesions are therefore the topic of intensive research but their description with angiography alone is incomplete. Invasive, tomographic imaging modalities, in particular intravascular ultrasound, allow direct visualization of the atherosclerotic plaque and therefore supplement angiography. These techniques have advanced our understanding of coronary artery disease (CAD) progression and stability but are limited because of their invasive character. Current developments in particular of computed tomography already allow the non-invasive imaging of coronary arteries and may have an important role in the early identification of CAD and the prevention of its complications.
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Affiliation(s)
- P Schoenhagen
- The Cleveland Clinic Foundation, Department of Cardiovascular Medicine, Desk F-25, 9500 Euclid Ave., Cleveland OH 44195, USA
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Nissen S. 0SOA02-2 Seeing is believing: Imaging techniques to measure atherosclerosis progression. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90009-2] [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: 11/25/2022]
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Nissen S. 3SY06-1 Intravascular ultrasound assessment of atherosclerosis. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90764-1] [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]
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Nissen S. 1P-0037 Design and methodology of a study to evaluate the effect of rosuvastatin on intravascular ultrasound-derived coronary atheroma burden: The ASTEROID study. ATHEROSCLEROSIS SUPP 2003. [DOI: 10.1016/s1567-5688(03)90112-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Kress BPJ, Griesbeck F, Efinger K, Gottschalk A, Nissen S, Goriup A, Solbach T, Kornhuber AW, Bähren W. [The prognostic value of quantified MRI at an early stage of Bell's palsy]. ROFO-FORTSCHR RONTG 2002; 174:426-32. [PMID: 11960404 DOI: 10.1055/s-2002-25112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 10/16/2022]
Abstract
OBJECTIVE The aim of the study was to assess whether MRI has a prognostic value at an early stage of Bell's palsy. MATERIAL AND METHODS Prospective, blinded study on 30 patients suffering from Bell's palsy, who came to hospital until the sixth day of illness, to receive high doses steroid therapy. MRI was done on the first day of inpatient treatment as a gradient-echo-sequence with a slice thickness of 0.7 mm before and after i. v. administration of 0.1 mmol GdDTPA/kg weight. The signal intensity increase was evaluated quantitatively by region on interest (ROI). The results were compared to the clinical outcome and the results of electrophysiology. RESULTS The examinations of all patients could be evaluated. The 3 patients who developed a chronic facial paralysis were detected by MRI on the first day of inpatient treatment. The patients, who showed MR signs for an unfavorable course, had a highly significant pathologic compound muscle action potential (CMAP) as a result of the electrophysiologic measurement. Rather than using complex measurement procedures it is possible to obtain reliable prognostic information from just one measurement within the Internal auditory canal before and after i. v. administration of contrast. CONCLUSION MRI has a prognostic value at an early stage of the illness. In the clinical setting this measurement is easy to perform, so that it is possible to obtain prognostic information at a stage when causal treatment is still possible.
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Affiliation(s)
- B P J Kress
- Abteilung für Radiologie, Bundeswehrkrankenhaus, Ulm, Germany
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Tsutsui H, Schoenhagen P, Klingensmith JD, Vince DG, Nissen SE, Tuzcu EM. Regression of a donor atheroma after cardiac transplantation: serial observations with intravascular ultrasound. Circulation 2001; 104:2874. [PMID: 11733409 DOI: 10.1161/hc4801.098266] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- H Tsutsui
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio
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Abstract
The incremental value of intravascular ultrasound (IVUS), compared with angiographic analysis of coronary atherosclerosis, originates principally from 2 key features-its tomographic perspective and the ability to image coronary atheroma directly. Whereas angiography depicts the cross-sectional coronary anatomy as a planar silhouette of the lumen, ultrasound directly images the atheroma within the vessel wall, allowing measurement of atheroma size, distribution, and to some extent, composition. Although angiography remains the principal method to assess the extent of coronary atherosclerosis and to guide percutaneous coronary interventions, IVUS is rapidly altering conventional paradigms in the diagnosis and therapy of coronary artery disease. Thus, IVUS has become a vital adjunctive imaging modality for the aggressive coronary interventional cardiologist. As such, ultrasound has earned a role as a viable complementary technique relative to angiography, rather than an alternative to conventional angiographic methods. This article reviews the rationale, technical advantages and limitations, and interpretation of intravascular ultrasonography from the perspective of the general and invasive cardiologist. We emphasize the impact that IVUS studies have had on our understanding of the atherosclerotic coronary artery disease process, because these findings have important implications for all cardiologists. We then review several trials that are currently using intravascular ultrasonography for the study of coronary artery disease regression.
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Affiliation(s)
- A C De Franco
- McLaren Heart and Vascular Center and Cardiac Catheterization Laboratory, McLaren Regional Medical Center, Michigan State University, Flint, Michigan, USA
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Affiliation(s)
- D Mukherjee
- Division of Cardiology, University of Michigan Health System, Ann Arbor, University Hospital, 48103-0022, USA.
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Affiliation(s)
- S E Nissen
- Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195, USA.
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Schoenhagen P, Vince DG, Ziada KM, Tsutsui H, Jeremias A, Crowe TD, Nissen SE, Tuzcu EM. Association of arterial expansion (expansive remodeling) of bifurcation lesions determined by intravascular ultrasonography with unstable clinical presentation. Am J Cardiol 2001; 88:785-7. [PMID: 11589850 DOI: 10.1016/s0002-9149(01)01853-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- P Schoenhagen
- Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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James KB, Bott-Silverman C, Houghtaling P, Ratliff N, Magyar W, Nissen S. Contribution of vascular rejection to progression of transplant coronary disease as assessed by serial intravascular ultrasound. Am J Cardiol 2001; 88:707-10. [PMID: 11564407 DOI: 10.1016/s0002-9149(01)01826-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- K B James
- The Cleveland Clinic Foundation, Kaufman Center for Heart Failure, Cleveland, Ohio 44195, USA.
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Siwicki AK, Morand M, Fuller JC, Nissen S, Kazun K, Glombski E. Influence of HMB (beta-hydroxy-beta-methylbutyrate) on antibody secreting cells (ASC) after in vitro and in vivo immunization with the anti-Yersinia ruckeri vaccine of rainbow trout (Oncorhynchus mykiss). Vet Res 2001; 32:491-8. [PMID: 11592618 DOI: 10.1051/vetres:2001140] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In practice, protection of fish against disease by immunization is of limited effectiveness. Therefore, research is concentrated on how to improve the potency and efficacy of vaccines and how to optimally activate the cell-mediated immunity and the specific antibody response. In the present study, the influence of HMB (beta-Hydroxy-beta-methylbutyrate) on the antibody secreting cells (ASC) after both in vitro and in vivo immunization of rainbow trout (Oncorhynchus mykiss) with the anti-yersiniosis vaccine was studied. For in vitro immunization, the spleens from 160 fish were sampled and placed each in 35 mm sterile wells with medium containing HMB at concentrations of 0, 0.1, 1, 5, 10, 25, 50 or 100 microg/mL of medium. The spleens from 80 fish were injected with the vaccine and incubated at 14 degrees C for 10 days. For the in vivo study, fish were fed pellets containing HMB at doses of 0, 10, 25 and 50 mg/kg bw per day. After 2 weeks of HMB supplementation, the fish were immunized by intraperitoneal injection of the vaccine. At 7, 14, 18, 21, 28 and 35 days after immunization, pronephros were taken from 10 fish in each group for testing. When analyzed by the ELISPOT assay, HMB increased the number of splenic ASC after in vitro immunization at concentrations between 10 and 100 microg/mL (P < 0.05). Dietary HMB also increased the number of total and specific ASC when the fish were vaccinated in vivo. In conclusion, the results of the present study showed that HMB increases the levels of specific ASC after both in vitro and in vivo immunization of rainbow trout with the anti-Yersinia ruckeri vaccine.
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Affiliation(s)
- A K Siwicki
- Department of Microbiology and Clinical Immunology, Faculty of Veterinary Medicine, University in Olsztyn, Poland.
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Abstract
Atherosclerosis is a process with inflammatory features and selective cyclooxygenase 2 (COX-2) inhibitors may potentially have antiatherogenic effects by virtue of inhibiting inflammation. However, by decreasing vasodilatory and antiaggregatory prostacyclin production, COX-2 antagonists may lead to increased prothrombotic activity. To define the cardiovascular effects of COX-2 inhibitors when used for arthritis and musculoskeletal pain in patients without coronary artery disease, we performed a MEDLINE search to identify all English-language articles on use of COX-2 inhibitors published between 1998 and February 2001. We also reviewed relevant submissions to the US Food and Drug Administration by pharmaceutical companies. Our search yielded 2 major randomized trials, the Vioxx Gastrointestinal Outcomes Research Study (VIGOR; 8076 patients) and the Celecoxib Long-term Arthritis Safety Study (CLASS; 8059 patients), as well as 2 smaller trials with approximately 1000 patients each. The results from VIGOR showed that the relative risk of developing a confirmed adjudicated thrombotic cardiovascular event (myocardial infarction, unstable angina, cardiac thrombus, resuscitated cardiac arrest, sudden or unexplained death, ischemic stroke, and transient ischemic attacks) with rofecoxib treatment compared with naproxen was 2.38 (95% confidence interval, 1.39-4.00; P =.002). There was no significant difference in cardiovascular event (myocardial infarction, stroke, and death) rates between celecoxib and nonsteroidal anti-inflammatory agents in CLASS. The annualized myocardial infarction rates for COX-2 inhibitors in both VIGOR and CLASS were significantly higher than that in the placebo group of a recent meta-analysis of 23 407 patients in primary prevention trials (0.52%): 0.74% with rofecoxib (P =.04 compared with the placebo group of the meta-analysis) and 0.80% with celecoxib (P =.02 compared with the placebo group of the meta-analysis). The available data raise a cautionary flag about the risk of cardiovascular events with COX-2 inhibitors. Further prospective trial evaluation may characterize and determine the magnitude of the risk.
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Affiliation(s)
- D Mukherjee
- Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, F 25, 9500 Euclid Ave, Cleveland, OH 44195, USA
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Abstract
Over the past several years, results of clinical trials of lipid lowering have increased our understanding of the pathophysiology of coronary atherosclerosis and ischemia. Evidence is accumulating that cholesterol lowering has potential anti-ischemic effects and may have immediate consequences that have a favorable impact on coronary events, possibly even acute coronary syndromes. Yet, less than one half of all patients hospitalized for acute coronary syndromes have their cardiovascular risks appropriately modified. The results of recent statin trials provide impetus for the implementation of aggressive risk-reduction strategies in patients with coronary atherosclerosis, including those with recent acute coronary syndromes. Prevention is now a viable therapeutic goal.
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Affiliation(s)
- J M Foody
- Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
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Tsutsui H, Ziada KM, Schoenhagen P, Iyisoy A, Magyar WA, Crowe TD, Klingensmith JD, Vince DG, Rincon G, Hobbs RE, Yamagishi M, Nissen SE, Tuzcu EM. Lumen loss in transplant coronary artery disease is a biphasic process involving early intimal thickening and late constrictive remodeling: results from a 5-year serial intravascular ultrasound study. Circulation 2001; 104:653-7. [PMID: 11489770 DOI: 10.1161/hc3101.093867] [Citation(s) in RCA: 123] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Coronary artery disease is the major cause of late cardiac allograft failure. However, few data exist regarding the natural history of changes in intimal and external elastic membrane (EEM) areas after heart transplantation. METHODS AND RESULTS In 38 transplant recipients, serial intravascular ultrasound examinations were performed 3.7+/-2.2 weeks after transplantation and annually thereafter for 5 years. In 59 coronary arteries, we compared 135 matched segments among serial studies. In each segment, intravascular ultrasound images were digitized at 1-mm intervals, and mean values of EEM and lumen and intimal areas were analyzed. In the first year after transplantation, the intimal area increased significantly from 1.8+/-1.6 to 3.0+/-2.1 mm(2) (P<0.001). Subsequently, the annual increase in intimal area decreased. EEM area did not change during the first year; however, between years 1 and 3, significant expansion of EEM area occurred (15.4+/-4.6 to 17.2+/-5.4 mm(2), P<0.001). Thereafter, EEM area decreased significantly from 17.2+/-5.4 mm(2) (year 3) to 15.1+/-4.9 mm(2) (year 5, P=0.01). Different mechanisms of lumen loss were observed during 2 phases after transplantation: early lumen loss primarily caused by intimal thickening and late lumen loss caused by EEM area constriction. CONCLUSIONS This serial ultrasound study revealed that most of the intimal thickening occurred during the first year after heart transplantation. Changes in the EEM area showed a biphasic response, consisting of early expansion and late constriction. Thus, different mechanisms of lumen loss were observed during the early and late phases after transplantation.
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Affiliation(s)
- H Tsutsui
- Department of Cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Schoenhagen P, Ziada KM, Vince DG, Nissen SE, Tuzcu EM. Arterial remodeling and coronary artery disease: the concept of "dilated" versus "obstructive" coronary atherosclerosis. J Am Coll Cardiol 2001; 38:297-306. [PMID: 11499716 DOI: 10.1016/s0735-1097(01)01374-2] [Citation(s) in RCA: 190] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Traditionally, the development of coronary artery disease (CAD) was described as a gradual growth of plaques within the intima of the vessel. The outer boundaries of the intima, the media and the external elastic membrane (EEM), were thought to be fixed in size. In this model plaque growth would always lead to luminal narrowing and the number and severity of angiographic stenoses would reflect the extent of coronary disease. However, histologic studies demonstrated that certain plaques do not reduce luminal size, presumably because of expansion of the media and EEM during atheroma development. This phenomenon of "arterial remodeling" was confirmed in necropsy specimens of human coronary arteries. More recently, the development of contemporary imaging technology, particularly intravascular ultrasound, has allowed the study of arterial remodeling in vivo. These new imaging modalities have confirmed that plaque progression and regression are not closely related to luminal size. In this review, we will analyze the role of remodeling in the progression and regression of native CAD, as well as its impact on restenosis after coronary intervention.
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Kapadia SR, Nissen SE, Ziada KM, Rincon G, Crowe TD, Boparai N, Young JB, Tuzcu EM. Impact of lipid abnormalities in development and progression of transplant coronary disease: a serial intravascular ultrasound study. J Am Coll Cardiol 2001; 38:206-13. [PMID: 11451276 DOI: 10.1016/s0735-1097(01)01337-7] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [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: 12/18/2022]
Abstract
OBJECTIVES We sought to determine the role of conventional atherosclerosis risk factors in the development and progression of transplant coronary artery disease (CAD) using serial intravascular ultrasound imaging. BACKGROUND Transplant artery disease is a combination of allograft vasculopathy and donor atherosclerosis. The clinical determinants for each of these disease processes are not well characterized. Intravascular ultrasound imaging is the most sensitive tool to serially study these processes. METHODS Baseline intravascular ultrasound imaging was performed 0.9 +/- 0.5 months after transplantation to identify donor atherosclerosis. Follow-up imaging was performed at 1.0 +/- 0.07 year to evaluate progression of donor atherosclerosis and development of transplant vasculopathy. Conventional risk factors for CAD included recipient age, gender, smoking history, diabetes mellitus, hypertension and hypercholesterolemia. RESULTS Donor-transmitted atherosclerosis was present in 36 patients (39%). At follow-up, progression of donor lesions was seen in 15 patients (42%) and 42 patients (45%) developed transplant vasculopathy, leaving 35 patients (38%) without any disease. There was no difference in any conventional risk factors in patients with and without allograft vasculopathy. However, the severity of allograft vasculopathy was associated with a larger increase in low density lipoprotein (LDL) cholesterol from baseline (p = 0.02). High one-year posttransplant serum triglyceride level and pretransplant body mass index were the only significant predictors (p = 0.03) for progression of donor atherosclerosis. CONCLUSIONS Conventional atherosclerosis risk factors do not predict development of allograft vasculopathy, but greater change in serum LDL cholesterol level during the first year after transplant is associated with more severe vasculopathy. Therefore, maintenance of LDL cholesterol as close to pretransplant values as possible may help to limit the rate of progression of acquired allograft vasculopathy.
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Affiliation(s)
- S R Kapadia
- Department of Cardiology, The Cleveland Clinic Foundation, Ohio 44195, USA
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Jówko E, Ostaszewski P, Jank M, Sacharuk J, Zieniewicz A, Wilczak J, Nissen S. Creatine and beta-hydroxy-beta-methylbutyrate (HMB) additively increase lean body mass and muscle strength during a weight-training program. Nutrition 2001; 17:558-66. [PMID: 11448573 DOI: 10.1016/s0899-9007(01)00540-8] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [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: 10/18/2022]
Abstract
We investigated whether creatine (CR) and beta-hydroxy-beta-methylbutyrate (HMB) act by similar or different mechanisms to increase lean body mass (LBM) and strength in humans undergoing progressive resistance-exercise training. In this double-blind, 3-wk study, subjects (n = 40) were randomized to placebo (PL; n = 10), CR (20.0 g of CR/d for 7 d followed by 10.0 g of CR/d for 14 d; n = 11), HMB (3.0 g of HMB/d; n = 9), or CR-and-HMB (CR/HMB; n = 10) treatment groups. Over 3 wk, all subjects gained LBM, which was assessed by bioelectrical impedance analysis. The CR, HMB and CR/HMB groups gained 0.92, 0.39, and 1.54 kg of LBM, respectively, over the placebo group, with a significant effect with CR supplementation (main effect P = 0.05) and a trend with HMB supplementation (main effect P = 0.08). These effects were additive because there was no interaction between CR and HMB (CR x HMB main effect P = 0.73). Across all exercises, HMB, CR, and CR/HMB supplementation caused accumulative strength increases of 37.5, 39.1, and 51.9 kg, respectively, above the placebo group. The exercise-induced rise in serum creatine phosphokinase was markedly suppressed with HMB supplementation (main effect P = 0.01). However, CR supplementation antagonized the HMB effects on serum creatine phosphokinase (CR x HMB interactive effect P = 0.04). Urine urea nitrogen and plasma urea were not affected by CR supplementation, but both decreased with HMB supplementation (HMB effect P < 0.05), suggesting a nitrogen-sparing effect. In summary, CR and HMB can increase LBM and strength, and the effects are additive. Although not definitive, these results suggest that CR and HMB act by different mechanisms.
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Affiliation(s)
- E Jówko
- Institute of Sport and Physical Education, Biala Podlaska, Academy of Physical Education, Warsaw, Poland
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Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM, Young JB, Nissen SE. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation 2001; 103:2705-10. [PMID: 11390341 DOI: 10.1161/01.cir.103.22.2705] [Citation(s) in RCA: 408] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Most of our knowledge about atherosclerosis at young ages is derived from necropsy studies, which have inherent limitations. Detailed, in vivo data on atherosclerosis in young individuals are limited. Intravascular ultrasonography provides a unique opportunity for in vivo characterization of early atherosclerosis in a clinically relevant context. METHODS AND RESULTS Intravascular ultrasound was performed in 262 heart transplant recipients 30.9+/-13.2 days after transplantation to investigate coronary arteries in young asymptomatic subjects. The donor population consisted of 146 men and 116 women (mean age of 33.4+/-13.2 years). Extensive imaging of all possible (including distal) coronary segments was performed. Sites with the greatest and least intimal thickness in each CASS segment were measured in multiple coronary arteries. Sites with intimal thickness >/=0.5 mm were defined as atherosclerotic. A total of 2014 sites within 1477 segments in 574 coronary arteries (2.2 arteries per person) were analyzed. An atherosclerotic lesion was present in 136 patients, or 51.9%. The prevalence of atherosclerosis varied from 17% in individuals <20 years old to 85% in subjects >/=50 years old. In subjects with atherosclerosis, intimal thickness and area stenosis averaged 1.08+/-0.48 mm and 32.7+/-15.9%, respectively. For all age groups, the average intimal thickness was greater in men than women, although the prevalence of atherosclerosis was similar (52% in men and 51.7% in women). CONCLUSIONS This study demonstrates that coronary atherosclerosis begins at a young age and that lesions are present in 1 of 6 teenagers. These findings suggest the need for intensive efforts at coronary disease prevention in young adults.
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Affiliation(s)
- E M Tuzcu
- Department of Cardiology, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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Ziada KM, Kapadia SR, Belli G, Houghtaling PL, De Franco AC, Ellis SG, Whitlow PL, Franco I, Nissen SE, Tuzcu EM. Prognostic value of absolute versus relative measures of the procedural result after successful coronary stenting: importance of vessel size in predicting long-term freedom from target vessel revascularization. Am Heart J 2001; 141:823-31. [PMID: 11320373 DOI: 10.1067/mhj.2001.114199] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The procedural result is a major determinant of the incidence of 6-month target vessel revascularization (TVR) after successful coronary stenting. However, the prognostic implications of the different measures of the procedural result or procedural end points have not been directly compared. In this study, we sought to assess and compare the impact of achieving different procedural end points on the long-term (2-year) incidence of TVR. METHODS AND RESULTS We studied 234 patients in whom 1 or 2 stents were successfully deployed and ultrasound imaging performed after angiographic optimization. End points included a visually estimated angiographic residual stenosis <10% and ultrasound stent-to-mean reference lumen area > or = 80%. After 2 years, TVR was required in 48 (20.5%) patients. Qualitative predictors of TVR were vein graft lesions, 3-vessel disease, and baseline TIMI flow grade < 3. Quantitatively, reference diameter by quantitative coronary angiography (QCA), final minimum lumen diameter (MLD) by QCA, and in-stent minimum lumen area (MLA) by ultrasound were predictive of TVR. Stent-to-reference ratios were not significantly predictive of TVR. By multivariable analysis, vein graft location and MLA by ultrasound were the only significant predictors of TVR (relative risk, 2.9 [1.5, 5.4] and 0.72 [0.6, 0.9], respectively). Receiver operator curves for MLD by QCA and MLA by ultrasound were similar in predicting TVR. Neither was significantly superior to reference vessel diameter. CONCLUSIONS Commonly used angiographic and ultrasound stent-to-reference ratios do not predict the incidence of TVR. Absolute measures of the lumen size (MLA by ultrasound and MLD by QCA) were the most important quantitative predictors of TVR within 2 years. This emphasizes the role of the vessel size as the limiting factor in determining the long-term outcome of coronary stenting.
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Affiliation(s)
- K M Ziada
- Department of Cardiology, Cleveland Clinic Foundation, OH, USA
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Nissen S. Assessing the effects of statins on atherosclerosis progression using intravascular ultrasound: rationale and design of the reversal study. ATHEROSCLEROSIS SUPP 2001. [DOI: 10.1016/s1567-5688(01)80072-6] [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: 10/18/2022]
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Peacock WF, Emerman CL, McErlean ES, DeLuca SA, VanLente F, Lowrie M, Rao JS, Nissen SE. Normal CK, elevated MB predicts complications in acute coronary syndromes. J Emerg Med 2001; 20:385-90. [PMID: 11348820 DOI: 10.1016/s0736-4679(01)00317-1] [Citation(s) in RCA: 6] [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: 10/18/2022]
Abstract
The implications of an elevated Creatine kinase (CK)-MB isoenzyme (MB) in suspected acute coronary syndromes, with a normal total CK, is not well established. Despite many guidelines on managing patients with acute coronary ischemia, none indicates strategies for patients with elevated MB and with a normal CK. The outcome consequence of this result is not firmly established. Our objective was to prospectively evaluate outcomes in patients with suspected acute coronary syndromes, normal initial total CK, and increased MB. All Emergency Department patients with suspected acute coronary syndromes and creatinine < 2.0 mg/dL were eligible for study entry. Serial CK and MB fractions were measured on arrival in the Emergency Department, then 8 and 16 h postpresentation. A composite outcome of death, Q-wave myocardial infarction, or revascularization was defined at the index visit and 6 months later. Outcomes were determined by blinded record review and by telephone contact. In the 698 patients entered, the acute composite outcome rate was 25% (175) and 6.3% (44) at 6 months. Acute and 6 month adverse outcome rates were statistically the same for all patients with an elevated MB fraction, regardless of the total CK level. An elevated MB conferred a higher event rate than did a normal MB. We conclude that the adverse event rate for patients with suspected acute coronary syndromes and an elevated MB is the same whether or not the total CK is elevated. These patients should be considered as having had an acute coronary syndrome.
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Affiliation(s)
- W F Peacock
- Department of Emergency Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Jimenez J, Kapadia SR, Yamani MH, Platt L, Hobbs RE, Rincon G, Botts-Silverman C, Starling RC, Young JB, Nissen SE, Tuzcu M, Ratliff NB. Cellular rejection and rate of progression of transplant vasculopathy: a 3-year serial intravascular ultrasound study. J Heart Lung Transplant 2001; 20:393-8. [PMID: 11295576 DOI: 10.1016/s1053-2498(00)00249-7] [Citation(s) in RCA: 51] [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] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Intravascular ultrasound (IVUS) is established as the optimal method for early detection of transplant vasculopathy. The association between cellular rejection and development of transplant vasculopathy remains controversial. This study attempts to determine the rate of progression of transplant vasculopathy lesions and its relationship with cellular rejection in a long-term (> 1 year) IVUS serial follow-up.A study cohort of 47 patients undergoing heart transplantation from 1993 to 1995 was evaluated. Intravascular ultrasound was performed at baseline (within 8 weeks) and annually for a period of 3 years to determine maximum intimal thickness and maximum plaque area in each coronary segment. Significant allograft vasculopathy was defined as a site with intimal thickness > 0.5 mm not present at baseline. Biopsy results were scored by assigning a numerical weight to each ISHLT grade during the first year. Donor lesions ranged from 0.86 to 1.1 mm, showing no evidence of progression at serial follow-up. De novo lesions were identified in 30 patients. These lesions appeared yearly but progressed slowly. The average biopsy score in the entire cohort was 1.1 +/- 0.8. Average biopsy score was > 1.0 in 35 patients with significant linear correlation between the rate of intimal progression and biopsy score (r = 0.42, p = 0.01). Multivariate analysis demonstrated that only the biopsy score correlated with the rate of progression. Lesions of donor atherosclerosis do not change significantly after transplantation. However, de novo lesions continue to develop every year. In patients with evidence of rejection, the rate of progression of transplant vasculopathy correlates with the severity of rejection.
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Affiliation(s)
- J Jimenez
- Cleveland Clinic Foundation, Cleveland, Ohio, USA.
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Mintz GS, Nissen SE, Anderson WD, Bailey SR, Erbel R, Fitzgerald PJ, Pinto FJ, Rosenfield K, Siegel RJ, Tuzcu EM, Yock PG. American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition, Measurement and Reporting of Intravascular Ultrasound Studies (IVUS). A report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2001; 37:1478-92. [PMID: 11300468 DOI: 10.1016/s0735-1097(01)01175-5] [Citation(s) in RCA: 1575] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Clinicians have long used the size of the lumen and the angiogram as a predictor of coronary events. However, cardiovascular disease is not a disease of the lumen but a disease of the vessel wall. In early stages, atherosclerosis outwardly remodels the external elastic membrane; only late in the disease process does luminal narrowing occur, enabling angiographic detection. This has profound implications for drug therapy, because approximately 70% of patients present with acute myocardial infarction (MI) or sudden death, not angina as the first symptom of coronary disease. Intravascular ultrasound (IVUS) can provide detailed images of the artery and is the only technique currently available that enables physicians to routinely visualize coronary plaques. Due to its sensitivity in measuring plaque volume and content, IVUS may be a useful surrogate marker to evaluate the atherosclerotic process in smaller numbers of patients than required for conventional clinical endpoint trials.
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Affiliation(s)
- S Nissen
- The Cleveland Clinic Foundation, Ohio 44195, USA
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50
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Abstract
Intravascular ultrasound (IVUS) is a valuable adjunct to angiography, providing new insights in the diagnosis of and therapy for coronary disease. Angiography depicts only a 2D silhouette of the lumen, whereas IVUS allows tomographic assessment of lumen area, plaque size, distribution, and composition. The safety of IVUS is well documented, and the assessment of luminal dimensions represents an important application of this modality. Comparative studies show the greatest disparities between angiography and ultrasound after mechanical interventions. In young subjects, normal intimal thickness is typically approximately 0.15 mm. With IVUS, lipid-laden lesions appear hypoechoic, fibromuscular lesions generate low-intensity echoes, and fibrous or calcified tissues are echogenic. Calcium obscures the underlying wall (acoustic shadowing). The extent and severity of disease by angiography and ultrasound are frequently discrepant. Arterial remodeling refers to changes in vascular dimensions during the development of atherosclerosis. At diseased sites, the external elastic membrane may actually shrink in size, contributing to luminal stenosis. The interpretation of IVUS relies on simple visual inspection of acoustic reflections to determine plaque composition. However, different tissue components may look quite similar, and artifacts may adversely affect ultrasound images. IVUS commonly detects occult disease in angiographically "normal" sites. In ambiguous lesions, ultrasound permits lesion quantification, particularly for left main coronary disease. IVUS has emerged as the optimal method for the detection of transplant vasculopathy. An important potential application of ultrasound is the identification of atheromas at risk of rupture. The mechanisms of action of interventional devices have been elucidated using IVUS, and ultrasound is used by some operators to select the most suitable interventional device. IVUS-derived residual plaque burden is the most useful predictor of clinical outcome. In restenosis after balloon angioplasty, negative remodeling is a major mechanism of late lumen loss. IVUS is not routinely used for stent optimization, and there is no consensus regarding optimal procedural end points. Ultrasound has proven useful in evaluating brachytherapy. New and emerging applications for IVUS are continuing to evolve, particularly in atherosclerosis regression-progression trials.
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Affiliation(s)
- S E Nissen
- Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
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