1
|
Burger P, Dorresteijn J, Fiolet A, Koudstaal S, Eikelboom J, Nidorf S, Thompson P, Cornel J, Budgeon C, Steg P, Cramer M, Teraa M, Bhatt D, Visseren F, Mosterd A. Individual lifetime benefit from low-dose colchicine in chronic coronary artery disease patients. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Low-dose colchicine reduces the risk of cardiovascular events in patients with chronic coronary artery disease (CAD), but the absolute benefit may vary between patients. Individual benefit from preventive therapies can be estimated using the guideline-recommended SMART-REACH model.
Purpose
This study aimed to assess the range of individual absolute 10-year and lifetime benefit from low-dose colchicine according to patient risk profile.
Methods
The SMART-REACH model was combined with the relative treatment effect of low-dose colchicine, and applied to all participants from the LoDoCo2 trial (n=5,522), and patients with chronic CAD from the UCC-SMART cohort (n=5,308). Individual treatment benefit was expressed as (i) 10-year absolute risk reductions (ARRs) for myocardial infarction, ischemic stroke, or cardiovascular death (MACE), and (ii) life-years gained free of MACE. Predictions were also performed for MACE plus ischemia-driven coronary revascularization (MACE+), through development of a new competing risk-adjusted lifetime prediction model in data from the REACH registry (n=14,522). Low-dose colchicine was compared to alternative intensive prevention goals, i.e. low density lipoprotein-cholesterol (LDL-c) reduction to <1.4 mmol/L, and systolic blood pressure (SBP) reduction to <130 mmHg.
Results
Median individual 10-year ARR for MACE from low-dose colchicine therapy was 4.6% (interquartile range [IQR] 3.6–6.0%), and median gain in life expectancy free of MACE was 2.0 (IQR 1.6–2.5) years. Median 10-year ARR for MACE+ was 8.6% (IQR 7.6–9.8%), and median gain in MACE+-free life expectancy was 3.4 (IQR 2.6–4.2) years. For intensified LDL-c and SBP reduction respectively, median 10-year ARRs were 3.0% (IQR 1.5–5.1%) and 1.7% (IQR 0.0–5.7%) for MACE, and 5.2% (IQR 2.5–8.7%) and 2.9% (IQR 0.0–9.5%) for MACE+. Median life-years gained from LDL-c and SBP reduction were 1.2 (IQR 0.6–2.1) and 0.7 (IQR 0.0–2.3) years free of MACE, and 1.8 (IQR 0.8–3.3) and 0.9 (IQR 0.0–3.4) years free of MACE+.
Conclusion
The individual absolute benefit from low-dose colchicine varies between patients. In an era where lipid- and blood pressure-lowering therapies are already routinely used, the benefits of low-dose colchicine are expected to be of at least similar magnitude to those of intensified LDL-c and SBP reduction in patients with chronic CAD.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- P Burger
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - J Dorresteijn
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - A Fiolet
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - S Koudstaal
- Green Heart Hospital , Gouda , The Netherlands
| | | | - S Nidorf
- Sir Charles Gairdner Hospital , Perth , Australia
| | - P Thompson
- Sir Charles Gairdner Hospital , Perth , Australia
| | - J Cornel
- Radboud University Medical Centre , Nijmegen , The Netherlands
| | - C Budgeon
- University of Western Australia , Perth , Australia
| | - P Steg
- University Paris Diderot , Paris , France
| | - M Cramer
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - M Teraa
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - D Bhatt
- Brigham and Women's Hospital , Boston , United States of America
| | - F Visseren
- University Medical Center Utrecht , Utrecht , The Netherlands
| | - A Mosterd
- Meander Medical Center , Amersfoort , The Netherlands
| |
Collapse
|
2
|
Liyanage L, Musto L, Budgeon C, Rutty G, Biggs M, Saratzis A, Vorp D, Vavourakis V, Bown M, Tsamis A. Multimodal Structural Analysis of the Human Aorta: From Valve to Bifurcation. J Vasc Surg 2022. [DOI: 10.1016/j.jvs.2022.04.017] [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: 12/01/2022]
|
3
|
Robinson K, Katzenellenbogen JM, Kleinig T, Kim J, Budgeon C, Thrift A, Nedkoff L. Burden of stroke incidence among atrial fibrillation, valvular heart disease and coronary heart disease patients. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.108] [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]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public grant(s) – National budget only. Main funding source(s): National Health and Medical Research Council of Australia
Background
The public health burden of stroke has continued to increase in recent decades. In patients with cardiac disease, the risk of stroke is 2-4 times higher than in the general population, and therefore investigating stroke incidence in these patients is important for identifying opportunities for stroke prevention.
Purpose
We aimed to measure the incidence of stroke in people with atrial fibrillation (AF), valvular heart disease (VHD) or coronary heart disease (CHD) to assess the risk of stroke by age, sex, pre-existing vs new cardiac disease, and nonfatal/fatal status.
Methods
We used a person-linked hospitalisation/mortality dataset to identify all people hospitalized with AF, VHD or CHD from 1985 to 2017 in a whole-population setting. These cardiac cases were stratified as pre-existing (hospitalised between 1985 and 2012, who were alive at 31st October 2012 with no history of stroke) or new (first-ever cardiac hospitalisation from November 1st, 2012 to October 31st, 2017, with no prior hospitalisation for AF, VHD or CHD, and no history of stroke). Patients aged 20-94 years were included in the study. Pre-existing and new cardiac cases were followed over the 5-year study period (1st November 2012 to 31st December 2017) to identify first-ever stroke events. Age-specific and age-standardised rates (ASR) for stroke incidence were calculated for all cardiac cases combined, and separately for pre-existing and new cases.
Results
The cohort comprised 175,560 patients. The majority of the cohort had a single cardiac condition (55.7% CHD; 23.0% AF; 5.0% VHD), while 16.3% of patients had multiple cardiac conditions. There were 5,871 (3.3%) first-ever strokes (5.2% in AF patients, 4.0% in VHD, 2.8% in CHD). Stroke incidence ASRs were greater in women than men across each cardiac group and irrespective of the presence of single or multiple cardiac conditions (Figure). This was largely driven by women aged ≥75 years, with stroke incidence being greater in women than men in each cardiac group. In women aged 20-54 years, there was a 4.9-fold higher incidence of stroke in those with multiple versus single cardiac conditions, and this differential appeared to decline with increasing age (Figure). Incidence of non-fatal strokes was greater than fatal stroke in all age groups except among 85-94 year olds. Incidence rates in each cardiac group were between 1.2 and 2.4 times higher in those with new versus pre-existing cardiac disease.
Conclusions
Stroke incidence is substantial in patients with cardiac disease. Older women with AF and VHD had the highest stroke rates overall, although younger patients with multiple cardiac conditions were also at high risk. These cardiac patients should be targeted for evidence-based management to minimise their stroke risk, especially in the period immediately following diagnosis when risk is highest.
Figure Legend. Age-specific and age-standardised stroke incidence rates in all cardiac cases.
Collapse
Affiliation(s)
- K Robinson
- University of Western Australia, Perth, Australia
| | | | - T Kleinig
- Royal Adelaide Hospital, Adelaide, Australia
| | - J Kim
- Monash University, Melbourne, Australia
| | - C Budgeon
- University of Western Australia, Perth, Australia
| | - A Thrift
- Monash University, Melbourne, Australia
| | - L Nedkoff
- University of Western Australia, Perth, Australia
| |
Collapse
|
4
|
MacDonald B, Tarca A, Causer L, Maslin K, Bruce D, Schreiber-Wood R, Ramsay J, Andrews D, Budgeon C, Yim D, Friedberg M. Influence of Indexing Methodology on Interpretation of Left Ventricular Volumes in Paediatric Rheumatic Heart Disease. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.256] [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]
|
5
|
Nidorf SM, Budgeon C, Eikelboom JW, Murray K, Nidorf L, Thompson PL. 12-month post-trial follow-up of participants in the Australian arm of the second low-dose colchicine trial. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the Australian arm of the LoDoCo2 trial, colchicine 0.5mg daily compared with placebo markedly reduced the risk of cardiovascular (CV) events in patients with chronic coronary disease (2.0 vs 3.9 events per 100 person years, HR 0.51; 95% CI 0.39–0.67). The purpose of this analysis was to explore CV and non-CV outcomes in the Australian cohort out to one year after cessation of trial medication.
Methods
Information was collected on all potential CV events and non-CV deaths as well as a range of other co-morbidities. All CV events were blindly adjudicated. The analysis examined the primary outcome (a composite of CV death, myocardial infarction, ischemic stroke, and unscheduled revascularization) and non-CV deaths by initial randomized treatment from the beginning of the trial up until one year after cessation of trial medication. A landmark analysis was then used to examine these outcomes from the date of last contact during the trial until one year after cessation of trial medication.
Results
The clinical status was confirmed in 1819/1824 (99.7%) participants who were alive at the end of the trial, and in 100% of those participants still taking trial medication at the end of the trial. During post-trial follow up, 515 patients (28.2%) were taking non-study colchicine, including 278 (30.5%) originally randomized to colchicine and 237 (25.9%) randomized to placebo. Over the entire follow-up period that included the 12-month period after the trial medication was ceased, the effect of prior exposure to colchicine on the primary CV outcome was still evident (2.2 vs 3.8 events per 100 person years, HR 0.58; 95% CI 0.45–0.74), however no post-trial CV benefit were apparent in the landmark analysis (3.3 vs 3.4 events per 100 person years, HR 0.97; 95% CI 0.56–0.1.69). Over the entire course of follow-up the incidence of new cancer (7.9% vs 7.2% RR 0.91; 95% CI 0.66–1.25) and non-CV death (0.9 vs 0.6 events per 100 person years, HR 1.44; 95% CI 0.92–2.27) was no different in the treatment groups.
Conclusion
Although the CV benefits of colchicine treatment that emerged during the trial were still evident in the year after stopping study treatment, no additional CV benefit accrued after it was ceased. These data suggest that colchicine should be continued long-term to maximize its CV benefits.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- S M Nidorf
- GenesisCare Western Australia, Perth, Australia
| | - C Budgeon
- University of Western Australia, School of Population and Global Health, Perth, Australia
| | - J W Eikelboom
- McMaster University, Department of Medicine, Hamilton, Canada
| | - K Murray
- University of Western Australia, School of Population and Global Health, Perth, Australia
| | - L Nidorf
- GenesisCare Western Australia, Perth, Australia
| | - P L Thompson
- Heart and Vascular Research Institute, Perth, Australia
| | | |
Collapse
|
6
|
Opstal T, Nidorf S, Fiolet A, Eikelboom J, Mosterd A, Thompson P, Budgeon C, Tijssen J, Bax W, Cornel J. The effect of low-dose colchicine on cause-specific mortality in the LoDoCo2 trial. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Elshibly M, Kanagala P, Budgeon C, Wright R, Jerosch-Herold M, Gulsin GS, Squire IB, Ng LL, Mccann GP, Arnold JR. Prognostic value of pulmonary transit time by cardiac magnetic resonance in patients with heart failure with preserved ejection fraction. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab090.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Other. Main funding source(s): National Institute for Health Research Leicester Cardiovascular Biomedical Research Centre
Background
Quantifying pulmonary transit time (PTT) from cardiac magnetic resonance (CMR) first pass perfusion imaging is a novel technique for the evaluation of haemodynamic congestion in heart failure. Previous studies have demonstrated that PTT is prolonged in patients with heart failure with reduced ejection fraction (HFrEF) and that it provides independent prognostic information in this patient group. However, the potential diagnostic and prognostic roles of PTT assessment in patients with heart failure with preserved ejection fraction (HFpEF) remain to be established.
Aim
To compare PTT in healthy controls and in patients with HFpEF, and to determine the prognostic value of PTT in HFpEF.
Methods
In a prospective, observational study, HFpEF and age-matched control subjects underwent multi-parametric CMR at 3-Tesla, comprising quantitative left ventricular volumetric assessment using a standard steady-state free precession (SSFP) pulse sequence, and first-pass perfusion imaging at rest using a T1-weighted segmented inversion recovery gradient echo sequence (following injection of 0.04mmol/kg of contrast). PTT was calculated as the time interval between the peaks of signal intensity curves in the right and left ventricular blood pools (defined on the basal slice of the rest perfusion images). The primary endpoint was the composite of death or hospitalisation with heart failure.
Results
88 HFpEF patients (age 73 ± 9 years, 51% male, EF 56.4 ± 5.6%) and 40 controls (age 73 ± 5 years, 43% male, EF 58.5 ± 4.7%) were studied. PTT was comparable in HFpEF patients (7.7 ± 3.8s) and in healthy controls (7.5 ± 1.8, p = 0.69). Normalised to cardiac cycle lengths, PTT remained comparable in HFpEF patients and healthy controls (8.5 ± 4.0 cardiac cycles versus 7.8 ± 1.6 cardiac cycles, respectively, p = 0.19). In the HFpEF group, during median follow-up of 3.4 years, there were 38 events (25 hospitalisations with heart failure, 13 deaths); a significant relationship between survival and PTT was not demonstrated (HR 1.06 [0.99,1.14] for a one-unit increase, p = 0.098).
Conclusion
In HFpEF, PTT is not prolonged compared with PTT in healthy subjects. Unlike in HFrEF, PTT does not appear to be diagnostically or prognostically significant in HFpEF.
Figure 1: Graph showing signal intensity curves in the right (red) and left (green) ventricular blood pools
Figure 2: Kaplan-Meier plot showing comparable rates of the composite endpoint in patients with PTT greater/less than median PTT (8 cardiac cycles)
Collapse
Affiliation(s)
- M Elshibly
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - P Kanagala
- Liverpool Centre for Cardiovascular Science, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - C Budgeon
- University of Western Australia, Perth, Australia
| | - R Wright
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | | | - GS Gulsin
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - IB Squire
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - LL Ng
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - GP Mccann
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| | - JR Arnold
- Glenfield Hospital, Cardiology, Leicester, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
8
|
Khedr Abdelaty A, Budgeon C, Gulsin G, Hetherington S, Khunti K, Ladwiniec A, Gershlick A, McCann G, Arnold J. Cardiovascular magnetic resonance to predict clinical outcome in chronic total coronary artery occlusion. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Chronic total coronary artery occlusions (CTOs) are present in approximately 20–30% of patients undergoing invasive angiography. Despite their prevalence, the optimum management strategy of CTOs remains uncertain. A potential limitation in published trials of CTO revascularisation is their failure to incorporate systematic assessment of ischaemia/viability in informing revascularisation decisions.
Aim
We sought to determine the prognostic utility of ischaemia/viability assessment by cardiovascular magnetic resonance (CMR) in a large, contemporaneous, real-world CTO population.
Methods
We retrospectively studied consecutive adult patients with≥1angiographically identified CTO who were referred for clinical CMR imaging during a consecutive 8-year period in our centre (2010–2018). Multi-parametric CMR comprised functional assessment, adenosine-stress perfusion and scar imaging. For perfusion assessment, images were analysed qualitatively with a concurrent examination of scar images. Myocardial segments were assigned to CTO or non-CTO territories according to standard criteria, taking into account coronary dominance. Significant ischaemia was defined as ≥10% and/or ≥2 contiguous myocardial segments with hibernation. Angiographic collateral flow to the CTO territory was graded using the Rentrop classification and the Collateral Connection (CC) Score. Significant CAD in non-CTO vessels was defined angiographically as ≥50% stenosis in any epicardial coronary artery/branch with diameter ≥2mm. The composite clinical endpoint comprised all-cause mortality, myocardial infarction and heart failure hospitalisation.
Results
From a total of 27,201 invasive angiograms performed during the study period, 389 patients were diagnosed with CTO and underwent CMR imaging (mean age 65.0±11.0 years, 84% male). CTO was present most frequently in the right coronary artery (59% of subjects, 229/389), with left circumflex (LCx) artery involvement in 29% (112/389) and left anterior descending (LAD) artery in 29% (111/389). Collaterals with CC grade ≥2 were identified in 186 subjects (48%), and Rentrop score ≥2 in 300 (77%). Significant ischaemia was present in 61% of patients, and infarction in 71% (median infarction 8.6% [interquartile range (IQR) 4.5–14.1]. With a median follow-up time of 3.30 years [IQR 0.04–8.64], 65 (17%) met the composite endpoint. On multivariate analysis, neither significant ischaemia nor infarction was associated with the composite endpoint. However, non-CTO territory ischaemia was independently predictive of adverse outcome (hazard ratio 1.93; 95% CI 1.16–3.21; p=0.0113).
Conclusion
CTO-territory ischaemia and infarction are not predictive of adverse clinical outcome, challenging the assertion that CTO revascularisation may be guided by ischaemia assessment. The finding that non-CTO territory ischaemia is associated with adverse cardiovascular events warrants further investigation.
Kaplan-Meier curves_CTO
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation
Collapse
Affiliation(s)
- A Khedr Abdelaty
- University of Leicester, Cardiovascular sciences, Leicester, United Kingdom
| | - C Budgeon
- University of Leicester, Cardiovascular sciences, Leicester, United Kingdom
| | - G.S Gulsin
- University of Leicester, Cardiovascular sciences, Leicester, United Kingdom
| | - S Hetherington
- Kettering General Hospital, Cardiovascular department, Kettering, United Kingdom
| | - K Khunti
- University of Leicester, Leicester, United Kingdom
| | - A Ladwiniec
- University Hospitals of Leicester NHS Trust, Cardiovascular department, Leicester, United Kingdom
| | - A Gershlick
- University of Leicester, Cardiovascular sciences, Leicester, United Kingdom
| | - G.P McCann
- University of Leicester, Cardiovascular sciences, Leicester, United Kingdom
| | - J.R Arnold
- University of Leicester, Cardiovascular sciences, Leicester, United Kingdom
| |
Collapse
|
9
|
Margaritis M, Saini F, Baranowska A, Parsons S, Vink A, Budgeon C, Alcock N, Wagner B, Samani N, Robertus J, Von Der Thusen J, Sheppard M, Adlam D. Spontaneous coronary artery dissection: novel pathophysiological insights from histological and ultrastructural tissue analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Spontaneous coronary artery dissection (SCAD) is a cause of acute coronary syndromes and rarely sudden cardiac death (SCD). SCAD is characterised by medial false lumen haematoma formation and periadventitial inflammatory cell infiltrate. Although SCAD has been linked to connective tissue disorders, its pathophysiology remains poorly understood and the role of inflammation unknown.
Purpose
We sought to establish the definitive histopathological features of SCAD and explore pathophysiological mechanisms through assessment of dermal connective tissue ultrastructure.
Methods
N=36 SCD cases diagnosed as SCAD on autopsy were identified in pathology archives at four international centres. Their demographic and clinical characteristics were compared with n=359 survivors recruited in a SCAD survivors cohort. Haematoxylin & eosin sections were examined under light microscope. Immunohistochemistry (IHC) was employed for quantification of inflammatory cell infiltrate (CD68, CD3) and vasa vasorum density (CD31) of SCAD cases (n=20) compared to age- and sex-matched controls (n=10). Dermal extracellular matrix components (EMC) of n=32 SCAD survivors and n=16 healthy volunteers (HV) were compared using electron microscopy (EM).
Results
The autopsy series cases were more likely to be male (p=0.0256) and had higher incidence of left main stem (p=0.0475) and proximal left anterior descending (p<0.001) disease compared to SCAD survivors. N=24 (66%) of SCAD autopsy case showed no evidence of myocardial necrosis. N=17 (47%) showed mild-moderate atherosclerotic changes but no features of fibromuscular dysplasia. There were no differences in vasa vasorum density between SCAD and control cases (A). The degree of inflammatory cell infiltrate varied greatly but significantly higher than controls (B), comprising CD68+ macrophages, eosinophils and CD3+ positive T-cells. There was a statistically significant association (p=0.006) between the degree of inflammatory cell infiltrate and the length of time from onset of symptoms to death (Panel C), as well as significantly (p<0.001) denser inflammatory cell infiltrate adjacent to the dissection plane (D, exemplary sections E&F). EM revealed no differences between SCAD and HV in dermal fibroblast size & activity or elastin size & damage indicators, but possible changes in subgroups with more extreme clinical phenotype or pregnancy-related SCAD (G).
Conclusions
To our knowledge this is the largest SCAD pathology case series so far. We show for the first time that periadvential inflammation in SCAD appears to be time-dependent and localising to the dissected coronary segment, suggesting healing response to injury rather than causal contribution. We found no evidence to suggest increased vasa vasorum density is pathophysiologically important. Connective tissue changes were only linked to a small proportion of cases. These novel findings may have important implications for the management of SCAD patients.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): British Heart Foundation, Leicester NIHR Biomedical Research Centre
Collapse
Affiliation(s)
- M Margaritis
- University of Leicester, Leicester, United Kingdom
| | - F Saini
- University of Leicester, Leicester, United Kingdom
| | - A Baranowska
- University of Leicester, Leicester, United Kingdom
| | - S Parsons
- Monash University, Melbourne, Australia
| | - A Vink
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - C Budgeon
- University of Leicester, Leicester, United Kingdom
| | - N Alcock
- University of Leicester, Leicester, United Kingdom
| | - B Wagner
- University Medical Center Utrecht, Utrecht, Netherlands (The)
| | - N Samani
- University of Leicester, Leicester, United Kingdom
| | - J.L Robertus
- Harefield Hospital, Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom
| | | | - M Sheppard
- St George's Healthcare NHS Trust, London, United Kingdom
| | - D Adlam
- University of Leicester, Leicester, United Kingdom
| |
Collapse
|
10
|
Beishon L, Minhas JS, Nogueira R, Castro P, Budgeon C, Aries M, Payne S, Robinson TG, Panerai RB. INFOMATAS multi-center systematic review and meta-analysis individual patient data of dynamic cerebral autoregulation in ischemic stroke. Int J Stroke 2020; 15:807-812. [PMID: 32090712 PMCID: PMC7534203 DOI: 10.1177/1747493020907003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Rationale Disturbances in dynamic cerebral autoregulation after ischemic stroke may have important implications for prognosis. Recent meta-analyses have been hampered by heterogeneity and small samples. Aim and/or hypothesis The aim of study is to undertake an individual patient data meta-analysis (IPD-MA) of dynamic cerebral autoregulation changes post-ischemic stroke and to determine a predictive model for outcome in ischemic stroke using information combined from dynamic cerebral autoregulation, clinical history, and neuroimaging. Sample size estimates To detect a change of 2% between categories in modified Rankin scale requires a sample size of ∼1500 patients with moderate to severe stroke, and a change of 1 in autoregulation index requires a sample size of 45 healthy individuals (powered at 80%, α = 0.05). Pooled estimates of mean and standard deviation derived from this study will be used to inform sample size calculations for adequately powered future dynamic cerebral autoregulation studies in ischemic stroke. Methods and design This is an IPD-MA as part of an international, multi-center collaboration (INFOMATAS) with three phases. Firstly, univariate analyses will be constructed for primary (modified Rankin scale) and secondary outcomes, with key co-variates and dynamic cerebral autoregulation parameters. Participants clustering from within studies will be accounted for with random effects. Secondly, dynamic cerebral autoregulation variables will be validated for diagnostic and prognostic accuracy in ischemic stroke using summary receiver operating characteristic curve analysis. Finally, the prognostic accuracy will be determined for four different models combining clinical history, neuroimaging, and dynamic cerebral autoregulation parameters. Study outcome(s) The outcomes for this study are to determine the relationship between clinical outcome, dynamic cerebral autoregulation changes, and baseline patient demographics, to determine the diagnostic and prognostic accuracy of dynamic cerebral autoregulation parameters, and to develop a prognostic model using dynamic cerebral autoregulation in ischemic stroke. Discussion This is the first international collaboration to use IPD-MA to determine prognostic models of dynamic cerebral autoregulation for patients with ischemic stroke.
Collapse
Affiliation(s)
- L Beishon
- CHIASM Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - J S Minhas
- CHIASM Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - R Nogueira
- Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Post Brazil
| | - P Castro
- Stroke Unit and Department of Neurology, Centro Hospitalar Universitário São João, Porto, Portugal
| | - C Budgeon
- NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - M Aries
- Department of Intensive Care, University Maastricht, Maastricht University Medical Center, Maastricht, Netherlands
| | - S Payne
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - T G Robinson
- CHIASM Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| | - R B Panerai
- CHIASM Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
| |
Collapse
|
11
|
Siffleet J, Duncan C, Riley T, Budgeon C. An investigation of the effect of an acidic cleanser versus soap on the skin pH and microflora of patients in ICU. Aust Crit Care 2012. [DOI: 10.1016/j.aucc.2011.12.006] [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: 11/16/2022] Open
|