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Kuchynka P, Podzimkova J, Marek J, Danek BA, Vitkova I, Kreidlova M, Roblova L, Kovarnik T, Simek S, Horak J, Habasko J, Linhart A, Palecek T. Long-term outcomes and reverse remodelling in recently diagnosed unexplained left ventricular systolic dysfunction. ESC Heart Fail 2024; 11:859-870. [PMID: 38204216 DOI: 10.1002/ehf2.14643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 11/07/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024] Open
Abstract
AIMS In patients with recently diagnosed non-ischaemic LV systolic dysfunction, left ventricular reverse remodelling (LVRR) and favourable prognosis has been documented in studies with short-term follow-up. The aim of our study was to assess the long-term clinical course and stability of LVRR in these patients. METHODS AND RESULTS We prospectively studied 133 patients (37 women; 55 [interquartile range 46, 61] years) with recently diagnosed unexplained LV systolic dysfunction, with heart failure symptoms lasting <6 months and LV ejection fraction <40% persisting after at least 1 week of therapy. All patients underwent endomyocardial biopsy (EMB) at the time of diagnosis and serial echocardiographic and clinical follow-up over 5 years. LVRR was defined as the combined presence of (1) LVEF ≥ 50% or increase in LVEF ≥ 10% points and (2) decrease in LV end-diastolic diameter index (LVEDDi) ≥ 10% or (3) LVEDDi ≤ 33 mm/m2. LVRR was observed in 46% patients at 1 year, in 60% at 2 years and 50% at 5 years. Additionally, 2% of patients underwent heart transplantation and 12% experienced heart failure hospitalization. During 5-year follow-up, 23 (17%) of the study cohort died. In multivariate analysis, independent predictors of mortality were baseline right atrial size (OR 1.097, CI 1.007-1.196), logBNP level (OR 2.02, CI 1.14-3.56), and PR interval (OR 1.02, CI 1.006-1.035) (P < 0.05 for all). The number of macrophages on EMB was associated with overall survival in univariate analysis only. LVRR at 1 year of follow-up was associated with a lower rate of mortality and heart failure hospitalization (P = 0.025). In multivariate analysis, independent predictors of LVRR were left ventricular end-diastolic volume index (OR 0.97, CI 0.946-0.988), LVEF (OR 0.89, CI 0.83-0.96), and diastolic blood pressure (OR 1.04, CI 1.01-1.08) (P < 0.05 for all). CONCLUSIONS LVRR occurs in over half of patients with recent onset unexplained LV systolic dysfunction during first 2 years of optimally guided heart failure therapy and then remains relatively stable during 5-year follow-up. Normalization of adverse LV remodelling corresponds to a low rate of mortality and heart failure hospitalizations during long-term follow-up.
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Affiliation(s)
- Petr Kuchynka
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jana Podzimkova
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Josef Marek
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Barbara Anna Danek
- Division of Cardiology, University of Washington Medical Center, Seattle, WA, USA
| | - Ivana Vitkova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Miluse Kreidlova
- Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Lenka Roblova
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Kovarnik
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Stanislav Simek
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Horak
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Habasko
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Tomas Palecek
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Kopriva K, Chen Z, Mates M, Holy F, Stekla B, Vesela M, Pudil J, Chval M, Wahle A, Sonka M, Kovarnik T. The accuracy of detailed analysis of optical coherence tomography in detection of plaque lipid content: dual-imaging study with optical coherence tomography and near-infrared spectroscopy. Acta Cardiol 2024; 79:206-214. [PMID: 38465606 DOI: 10.1080/00015385.2024.2324214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/17/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Lipid-rich plaque covered by a thin fibrous cap (FC) has been identified as a frequent morphological substrate for the development of acute coronary syndrome. Optical coherence tomography (OCT) permits the identification and measurement of the FC. Near-infrared spectroscopy (NIRS) has been approved for detection of coronary lipids. AIMS We aimed to assess the ability of detailed OCT analysis to identify coronary lipids, using NIRS as the reference method. METHODS In total, 40 patients with acute coronary syndrome underwent imaging of a non-culprit lesion by both NIRS and OCT. For each segment, the NIRS-derived 4 mm segment with maximal lipid core burden index (maxLCBI4mm) was assessed. OCT analysis was performed using a semi-automated method including measurement of the fibrous cap thickness (FCT) of all detected fibroatheromas. Subsequent quantitative volumetric evaluation furnished FCT, FC surface area (FC SA), lipid arc, and FC (fibrous cap) volume data. OCT features of lipid plaques were compared with maxLCBI4mm. Predictors of maxLCBI4mm >400 was assessed by using univariable and multivariable analysis. RESULTS OCT features (mean FCT, total FC SA, FC volume, maximal, mean, and total lipid arcs) strongly correlated with the maxLCBI4mm (p = 0.012 for the mean FCT, respectively p < 0.001 for all other aforementioned features). The strongest predictors of maxLCBI4mm >400 were the maximal (p = 0.002) and mean (p = 0.002) lipid arc, and total FC SA (p = 0.012). CONCLUSIONS We found a strong correlation between the OCT-derived features and NIRS findings. Detailed OCT analysis may be reliably used for detection of the presence of coronary lipids.
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Affiliation(s)
- Karel Kopriva
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Zhi Chen
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Martin Mates
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Frantisek Holy
- Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Barbora Stekla
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Michaela Vesela
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Pudil
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Martin Chval
- Institute for Research and Development of Education, Charles University in Prague, Prague, Czech Republic
| | - Andreas Wahle
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Milan Sonka
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Tomas Kovarnik
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Mayerova L, Wohlfahrt P, Sonka M, Chen Z, Kautzner J, Melenovsky V, Karmazin V, Malek I, Bedanova H, Tomasek A, Ozabalova E, Krejci J, Kovarnik T, Pazdernik M. Acetylsalicylic acid use and development of cardiac allograft vasculopathy: A national prospective study using highly automated 3-D optical coherence tomography analysis. Clin Transplant 2024; 38:e15275. [PMID: 38477134 PMCID: PMC10939248 DOI: 10.1111/ctr.15275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 02/10/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024]
Abstract
BACKGROUND There is conflicting evidence on the role of acetylsalicylic acid (ASA) use in the development of cardiac allograft vasculopathy (CAV). METHODS A nationwide prospective two-center study investigated changes in the coronary artery vasculature by highly automated 3-D optical coherence tomography (OCT) analysis at 1 month and 12 months after heart transplant (HTx). The influence of ASA use on coronary artery microvascular changes was analyzed in the overall study cohort and after propensity score matching for selected clinical CAV risk factors. RESULTS In total, 175 patients (mean age 52 ± 12 years, 79% male) were recruited. During the 1-year follow-up, both intimal and media thickness progressed, with ASA having no effect on its progression. However, detailed OCT analysis revealed that ASA use was associated with a lower increase in lipid plaque (LP) burden (p = .013), while it did not affect the other observed pathologies. Propensity score matching of 120 patients (60 patient pairs) showed similar results, with ASA use associated with lower progression of LPs (p = .002), while having no impact on layered fibrotic plaque (p = .224), calcification (p = .231), macrophage infiltration (p = .197), or the absolute coronary artery risk score (p = .277). According to Kaplan-Meier analysis, ASA use was not associated with a significant difference in survival (p = .699) CONCLUSION: This study showed a benefit of early ASA use after HTx on LP progression. However, ASA use did not have any impact on the progression of other OCT-observed pathologies or long-term survival.
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Affiliation(s)
| | - Peter Wohlfahrt
- Department of Preventive Cardiology, IKEM, Prague, Czech Republic
| | - Milan Sonka
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Zhi Chen
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | | | | | | | - Ivan Malek
- Department of Cardiology, IKEM, Prague, Czech Republic
| | - Helena Bedanova
- Cardiovascular and Transplantation Surgery, Brno, Czech Republic
| | - Ales Tomasek
- Cardiovascular and Transplantation Surgery, Brno, Czech Republic
| | - Eva Ozabalova
- Department of Cardiovascular Diseases, St. Anne’s University Hospital and Masaryk University Brno, Czech Republic
| | - Jan Krejci
- Department of Cardiovascular Diseases, St. Anne’s University Hospital and Masaryk University Brno, Czech Republic
| | - Tomas Kovarnik
- 2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Cao K, Xia Y, Yao J, Han X, Lambert L, Zhang T, Tang W, Jin G, Jiang H, Fang X, Nogues I, Li X, Guo W, Wang Y, Fang W, Qiu M, Hou Y, Kovarnik T, Vocka M, Lu Y, Chen Y, Chen X, Liu Z, Zhou J, Xie C, Zhang R, Lu H, Hager GD, Yuille AL, Lu L, Shao C, Shi Y, Zhang Q, Liang T, Zhang L, Lu J. Large-scale pancreatic cancer detection via non-contrast CT and deep learning. Nat Med 2023; 29:3033-3043. [PMID: 37985692 PMCID: PMC10719100 DOI: 10.1038/s41591-023-02640-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 10/12/2023] [Indexed: 11/22/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC), the most deadly solid malignancy, is typically detected late and at an inoperable stage. Early or incidental detection is associated with prolonged survival, but screening asymptomatic individuals for PDAC using a single test remains unfeasible due to the low prevalence and potential harms of false positives. Non-contrast computed tomography (CT), routinely performed for clinical indications, offers the potential for large-scale screening, however, identification of PDAC using non-contrast CT has long been considered impossible. Here, we develop a deep learning approach, pancreatic cancer detection with artificial intelligence (PANDA), that can detect and classify pancreatic lesions with high accuracy via non-contrast CT. PANDA is trained on a dataset of 3,208 patients from a single center. PANDA achieves an area under the receiver operating characteristic curve (AUC) of 0.986-0.996 for lesion detection in a multicenter validation involving 6,239 patients across 10 centers, outperforms the mean radiologist performance by 34.1% in sensitivity and 6.3% in specificity for PDAC identification, and achieves a sensitivity of 92.9% and specificity of 99.9% for lesion detection in a real-world multi-scenario validation consisting of 20,530 consecutive patients. Notably, PANDA utilized with non-contrast CT shows non-inferiority to radiology reports (using contrast-enhanced CT) in the differentiation of common pancreatic lesion subtypes. PANDA could potentially serve as a new tool for large-scale pancreatic cancer screening.
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Affiliation(s)
- Kai Cao
- Department of Radiology, Shanghai Institution of Pancreatic Disease, Shanghai, China
| | - Yingda Xia
- DAMO Academy, Alibaba Group, New York, NY, USA
| | - Jiawen Yao
- Hupan Laboratory, Hangzhou, China
- Damo Academy, Alibaba Group, Hangzhou, China
| | - Xu Han
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Lukas Lambert
- Department of Radiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Tingting Zhang
- Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei Tang
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Gang Jin
- Department of Surgery, Shanghai Institution of Pancreatic Disease, Shanghai, China
| | - Hui Jiang
- Department of Pathology, Shanghai Institution of Pancreatic Disease, Shanghai, China
| | - Xu Fang
- Department of Radiology, Shanghai Institution of Pancreatic Disease, Shanghai, China
| | - Isabella Nogues
- Department of Biostatistics, Harvard University T.H. Chan School of Public Health, Cambridge, MA, USA
| | - Xuezhou Li
- Department of Radiology, Shanghai Institution of Pancreatic Disease, Shanghai, China
| | - Wenchao Guo
- Hupan Laboratory, Hangzhou, China
- Damo Academy, Alibaba Group, Hangzhou, China
| | - Yu Wang
- Hupan Laboratory, Hangzhou, China
- Damo Academy, Alibaba Group, Hangzhou, China
| | - Wei Fang
- Hupan Laboratory, Hangzhou, China
- Damo Academy, Alibaba Group, Hangzhou, China
| | - Mingyan Qiu
- Hupan Laboratory, Hangzhou, China
- Damo Academy, Alibaba Group, Hangzhou, China
| | - Yang Hou
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tomas Kovarnik
- Department of Invasive Cardiology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Michal Vocka
- Department of Oncology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Yimei Lu
- Department of Radiology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Yingli Chen
- Department of Surgery, Shanghai Institution of Pancreatic Disease, Shanghai, China
| | - Xin Chen
- Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Zaiyi Liu
- Department of Radiology, Guangdong Provincial People's Hospital, Guangzhou, China
| | - Jian Zhou
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Chuanmiao Xie
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Rong Zhang
- Department of Radiology, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Hong Lu
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Gregory D Hager
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Alan L Yuille
- Department of Computer Science, Johns Hopkins University, Baltimore, MD, USA
| | - Le Lu
- DAMO Academy, Alibaba Group, New York, NY, USA
| | - Chengwei Shao
- Department of Radiology, Shanghai Institution of Pancreatic Disease, Shanghai, China.
| | - Yu Shi
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China.
| | - Qi Zhang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Tingbo Liang
- Department of Hepatobiliary and Pancreatic Surgery, First Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Ling Zhang
- DAMO Academy, Alibaba Group, New York, NY, USA.
| | - Jianping Lu
- Department of Radiology, Shanghai Institution of Pancreatic Disease, Shanghai, China.
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5
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Okkels Jensen L, Loh PH, Calmac L, Roura I Ferrer G, Quadros A, Milewski M, Scotto Di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra-Munoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, De Simone C, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Arpad L, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martínez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo-Silbermann S, Ordoñez S, Arat Özkan A, Scheller B, Lehtola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Bessonov I, Zoni R, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Bellemain-Appaix A, Pessah G, Cortese G, Parodi G, Burgadha MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. SARS-CoV-2 Positivity, Stent Thrombosis, and 30-day Mortality in STEMI Patients Undergoing Mechanical Reperfusion. Angiology 2023; 74:987-996. [PMID: 36222189 DOI: 10.1177/00033197221129351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
SARS-Cov-2 has been suggested to promote thrombotic complications and higher mortality. The aim of the present study was to evaluate the impact of SARS-CoV-2 positivity on in-hospital outcome and 30-day mortality in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) enrolled in the International Survey on Acute Coronary Syndromes ST-segment elevation Myocardial Infarction (ISACS-STEMI COVID-19 registry. The 109 SARS-CoV-2 positive patients were compared with 2005 SARS-CoV-2 negative patients. Positive patients were older (P = .002), less often active smokers (P = .002), and hypercholesterolemic (P = .006), they presented more often later than 12 h (P = .037), more often to the hub and were more often in cardiogenic shock (P = .02), or requiring rescue percutaneous coronary intervention after failed thrombolysis (P < .0001). Lower postprocedural Thrombolysis in Myocardial Infarction 3 flow (P = .029) and more thrombectomy (P = .046) were observed. SARS-CoV-2 was associated with a significantly higher in-hospital mortality (25.7 vs 7%, adjusted Odds Ratio (OR) [95% Confidence Interval] = 3.2 [1.71-5.99], P < .001) in-hospital definite in-stent thrombosis (6.4 vs 1.1%, adjusted Odds Ratio [95% CI] = 6.26 [2.41-16.25], P < .001) and 30-day mortality (34.4 vs 8.5%, adjusted Hazard Ratio [95% CI] = 2.16 [1.45-3.23], P < .001), confirming that SARS-CoV-2 positivity is associated with impaired reperfusion, with negative prognostic consequences.
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy Division of Cardiology, Ospedale Nuovo Galeazzi, Milan, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brasil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Zan Zimbakov
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore
| | | | - Gerard Roura I Ferrer
- Interventional Cardiology Unit, Heart Disease Institute. Hospital Universitari de Bellvitge, Spain
| | | | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
- Technical Medical Centre, Health Technologies and Services Research, University of Twente, Enschede, Netherlands
| | | | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics Alkmaar, The Netherlands
| | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta
| | | | - Ciro De Simone
- Division of Cardiology, Clinica Villa Dei Fiori, Acerra, Italy
| | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio", Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi D'Aragona, Salerno, Italy
| | - Lux Arpad
- Maastricht University Medical Center, Utrecht, Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | | | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University İstanbul, Istanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Eskisehir Osmangazi University, Faculty of Medicine, Eskisehir, Turkey
| | | | | | - Michal Kidawa
- Central Hospital of Medical University of Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria Delle Grazie, Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife
| | | | | | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Tapei, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Helder Pereira
- Hospital Garcia de Orta, Cardiology Department, Pragal, Almada, Portugal
| | | | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Alev Arat Özkan
- Cardiology Institute, Instanbul University, Instanbul, Turkey
| | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School, CEDOC, Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Konstantopoulion Hospital, Athens, Greece
| | | | | | | | - Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes "Juana F. Cabral", Argentina
| | | | | | | | - Carlos E Uribe
- Carlos E Uribe, Division of Cardiology, Universidad UPB, Universidad CES, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, France
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | | | | | - Antonia Anna Lukito
- Cardiovascular Department Pelita Harapan University/Heart Center Siloam Lippo Village Hospital, Tangerang, Banten, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospiatl Cordoba, Cordoba, Argentina
| | | | - Guido Parodi
- Division of Cardiology, Ospedale di Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Belgium
| | | | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, Brescia, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale Degli Infermi, ASL Biella, Italy
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Branny M, Osmancik P, Kala P, Poloczek M, Herman D, Neuzil P, Hala P, Taborsky M, Stasek J, Haman L, Chovancik J, Cervinka P, Holy J, Kovarnik T, Zemanek D, Havranek S, Vancura V, Peichl P, Tousek P, Hozman M, Lekesova V, Jarkovsky J, Novackova M, Benesova K, Widimsky P, Reddy VY. Nonprocedural bleeding after left atrial appendage closure versus direct oral anticoagulants: A subanalysis of the randomized PRAGUE-17 trial. J Cardiovasc Electrophysiol 2023; 34:1885-1895. [PMID: 37529864 DOI: 10.1111/jce.16029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/07/2023] [Accepted: 07/24/2023] [Indexed: 08/03/2023]
Abstract
INTRODUCTION Observational studies have shown low bleeding rates in patients with atrial fibrillation (AF) treated by left atrial appendage closure (LAAC); however, data from randomized studies are lacking. This study compared bleeding events among patients with AF treated by LAAC and nonvitamin K anticoagulants (NOAC). METHODS The Prague-17 trial was a prospective, multicenter, randomized trial that compared LAAC to NOAC in high-risk AF patients. The primary endpoint was a composite of a cardioembolic event, cardiovascular death, and major and clinically relevant nonmajor bleeding (CRNMB) defined according to the International Society on Thrombosis and Hemostasis (ISTH). RESULTS The trial enrolled 402 patients (201 per arm), and the median follow-up was 3.5 (IQR 2.6-4.2) years. Bleeding occurred in 24 patients (29 events) and 32 patients (40 events) in the LAAC and NOAC groups, respectively. Six of the LAAC bleeding events were procedure/device-related. In the primary intention-to-treat analysis, LAAC was associated with similar rates of ISTH major or CRNMB (sHR 0.75, 95% CI 0.44-1.27, p = 0.28), but with a reduction in nonprocedural major or CRNMB (sHR 0.55, 95% CI 0.31-0.97, p = 0.039). This reduction for nonprocedural bleeding with LAAC was mainly driven by a reduced rate of CRNMB (sHR for major bleeding 0.69, 95% CI 0.34-1.39, p = .30; sHR for CRNMB 0.43, 95% CI 0.18-1.03, p = 0.059). History of bleeding was a predictor of bleeding during follow-up. Gastrointestinal bleeding was the most common bleeding site in both groups. CONCLUSION During the 4-year follow-up, LAAC was associated with less nonprocedural bleeding. The reduction is mainly driven by a decrease in CRNMB.
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Affiliation(s)
- Marian Branny
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
- Department of Internal Medicine and Cardiology, Faculty of Medicin, University Hospital Ostrava, Ostrava, Czech Republic
| | - Pavel Osmancik
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Martin Poloczek
- Department of Internal Medicine and Cardiology, University Hospital Brno and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Dalibor Herman
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Petr Neuzil
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Hala
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
| | - Milos Taborsky
- Department of Cardiology, Cardiocenter, University Hospital Olomouc, Olomouc, Czech Republic
| | - Josef Stasek
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University Prague, Prague, Czech Republic
| | - Ludek Haman
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University Prague, Prague, Czech Republic
| | - Jan Chovancik
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajská zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Jiri Holy
- Department of Cardiology, Krajská zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Tomas Kovarnik
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - David Zemanek
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Stepan Havranek
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, General Faculty Hospital, Charles University, Prague, Czech Republic
| | - Vlastimil Vancura
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Petr Peichl
- Cardiocenter, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Tousek
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Marek Hozman
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Veronika Lekesova
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Martina Novackova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Klara Benesova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Petr Widimsky
- Department of Cardiology, Third Faculty of Medicine, University Hospital Kralovske Vinohrady, Charles University, Prague, Czech Republic
| | - Vivek Y Reddy
- Department of Cardiology, Cardiocenter, Na Homolce Hospital, Prague, Czech Republic
- Icahn School of Medicine at Mount Sinai, Helmsley Electrophysiology Center, New York, New York, USA
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Pudil J, Rob D, Smalcova J, Smid O, Huptych M, Vesela M, Kovarnik T, Belohlavek J. Pulmonary embolism-related refractory out-of-hospital cardiac arrest and extracorporeal cardiopulmonary resuscitation: Prague OHCA study post hoc analysis. Eur Heart J Acute Cardiovasc Care 2023; 12:507-512. [PMID: 37172033 PMCID: PMC10449371 DOI: 10.1093/ehjacc/zuad052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 05/02/2023] [Accepted: 05/11/2023] [Indexed: 05/14/2023]
Abstract
AIMS Refractory out-of-hospital cardiac arrest (r-OHCA) in patients with pulmonary embolism (PE) is associated with poor outcomes. The role of extracorporeal cardiopulmonary resuscitation (ECPR) in this patient group is uncertain. This study aims to analyse clinical course, outcomes, and the effect of an invasive procedure, including ECPR, in a randomized population. METHODS AND RESULTS A post hoc analysis of a randomized controlled trial (Prague OHCA study) was conducted to evaluate the effect of ECPR vs. a standard approach in r-OHCA. A subgroup of patients with PE-related r-OHCA was identified, and procedural and outcome characteristics, including favourable neurological survival, organ donation, and complications, were compared to patients without PE. Pulmonary embolism was identified as a cause of r-OHCA in 24 of 256 (9.4%) enrolled patients. Patients with PE were more likely to be women [12/24 (50%) vs. 32/232 (13.8%); P < 0.001] and presented more frequently with an initial non-shockable rhythm [23/24 (95.8%) vs. 77/232 (33.2%); P < 0.001], as well as more severe acidosis at admission [median pH (interquartile range); 6.83 (6.75-6.88) vs. 6.98 (6.82-7.14); P < 0.001]. Their favourable 180-day neurological survival was significantly lower [2/24 (8.3%) vs. 66/232 (28.4%); P = 0.049], but the proportion of accepted organ donors was higher (16.7 vs. 4.7%, P = 0.04). CONCLUSION Refractory out-of-hospital cardiac arrest due to PE has a different presentation and inferior outcomes compared to other causes but may represent an important source of organ donations. The ECPR method did not improve patient outcomes.
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Affiliation(s)
- Jan Pudil
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 2, Prague 128 00, Czech Republic
| | - Daniel Rob
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 2, Prague 128 00, Czech Republic
| | - Jan Smalcova
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 2, Prague 128 00, Czech Republic
- Emergency Medical Service, Prague, Czech Republic
| | - Ondrej Smid
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 2, Prague 128 00, Czech Republic
| | - Michal Huptych
- Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University, Prague, Czech Republic
| | - Michaela Vesela
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 2, Prague 128 00, Czech Republic
| | - Tomas Kovarnik
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 2, Prague 128 00, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, U Nemocnice 2, Prague 128 00, Czech Republic
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8
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Busljetik O, Cercek M, Jensen LO, Loh PH, Calmac L, Ferrer GRI, Quadros A, Milewski M, Scotto D’Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra Munoz V, Lee MKY, Juzar DA, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Arpad L, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Martínez-Luengas IL, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo-Silberman S, Ordoñez S, Arat Özkan A, Scheller B, Lehitola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Zoni CR, Bessonov I, Uccello G, Kochiadakis G, Alexopulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Saint-Joy V, Pessah G, Tuccillo A, Ielasi A, Cortese G, Parodi G, Burgadha MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. Age-Related Effects of COVID-19 Pandemic on Mechanical Reperfusion and 30-Day Mortality for STEMI: Results of the ISACS-STEMI COVID-19 Registry. J Clin Med 2023; 12:2116. [PMID: 36983119 PMCID: PMC10059932 DOI: 10.3390/jcm12062116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/08/2023] [Accepted: 02/14/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The constraints in the management of patients with ST-segment elevation myocardial infarction (STEMI) during the COVID-19 pandemic have been suggested to have severely impacted mortality levels. The aim of the current analysis is to evaluate the age-related effects of the COVID-19 pandemic on mechanical reperfusion and 30-day mortality for STEMI within the registry ISACS-STEMI COVID-19. METHODS This retrospective multicenter registry was performed in high-volume PPCI centers on four continents and included STEMI patients undergoing PPCI in March-June 2019 and 2020. Patients were divided according to age (< or ≥75 years). The main outcomes were the incidence and timing of PPCI, (ischemia time longer than 12 h and door-to-balloon longer than 30 min), and in-hospital or 30-day mortality. RESULTS We included 16,683 patients undergoing PPCI in 109 centers. In 2020, during the pandemic, there was a significant reduction in PPCI as compared to 2019 (IRR 0.843 (95%-CI: 0.825-0.861, p < 0.0001). We found a significant age-related reduction (7%, p = 0.015), with a larger effect on elderly than on younger patients. Furthermore, we observed significantly higher 30-day mortality during the pandemic period, especially among the elderly (13.6% vs. 17.9%, adjusted HR (95% CI) = 1.55 [1.24-1.93], p < 0.001) as compared to younger patients (4.8% vs. 5.7%; adjusted HR (95% CI) = 1.25 [1.05-1.49], p = 0.013), as a potential consequence of the significantly longer ischemia time observed during the pandemic. CONCLUSIONS The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a 16% reduction in PPCI procedures, with a larger reduction and a longer delay to treatment among elderly patients, which may have contributed to increase in-hospital and 30-day mortality during the pandemic.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, AOU Policlinico G Martino, 98124 Messina, Italy
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
- Division of Cardiology, Galeazzi-Sant’Ambrogio Hospital, 20157 Milan, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut 71515, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, 16110 Bursa, Türkiye
| | - Dinaldo C. Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife 1235, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, 653002 Kemerovo, Russia
| | - Oliver Busljetik
- University Clinic for Cardiology, Medical Faculty, Ss’ Cyril and Methodius University, 1000 Skopje, North Macedonia
| | - Miha Cercek
- Department of Cardiology, Medical Center Ljubljana, 1000 Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore 119074, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital of Bucharest, 010001 Bucharest, Romania
| | - Gerard Roura i Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, 08016 Barcelona, Spain
| | - Alexandre Quadros
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre 90000-00, Brazil
| | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, 40-002 Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, 7541 Enschede, The Netherlands
| | - Francesco Versaci
- Division of Cardiology, Ospedale Santa Maria Goretti Latina, 04100 Latina, Italy
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, 3434 Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, 40100 Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, 60200 Bohunice, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics, 1811 Alkmaar, The Netherlands
| | | | - Michael Kang-yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center “Harapan Kita”, Jakarta 11402, Indonesia
| | | | - Roberto Paladino
- Division of Cardiology, Clinica Villa dei Fiori, 80011 Acerra, Italy
| | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, 10000 Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, 26221 Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, 38014 Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale ”S. Maurizio”, 39100 Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggid’Aragona, 84070 Salerno, Italy
| | - Lux Arpad
- Maastricht University Medical Center, 6229 HX Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera “Ospedali Riuniti Marche Nord”, 61121 Pesaro, Italy
| | - Vincenzo Guiducci
- Division of Cardiology, AUSL-IRCCS Reggio Emilia, 42121 Reggio Emilia, Italy
| | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University, 34093 Istanbul, Türkiye
| | - Kadir Ugur Mert
- Division of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, 02640 Eskisehir, Türkiye
| | | | - Tomas Kovarnik
- University Hospital Prague, 12808 Prague, Czech Republic
| | - Michal Kidawa
- Central Hospital, Medical University of Lodz, 90-008 Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, 45001 Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, 59000 Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero, Universitaria Ospedali Riuniti Trieste, 34142 Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, 80078 Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, 38001 Santa Cruz de Tenerife, Spain
| | | | - Gianluca Caiazzo
- Division of Cardiology, Ospedale “G Moscati”, 81031 Aversa, Italy
| | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, 8865, Taipei 600, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, 46010 Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, 43121 Parma, Italy
| | - Helder Pereira
- Cardiology Department, Hospital Garcia de Orta, Pragal, 2805-267 Almada, Portugal
| | - Stephane Manzo-Silberman
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, 75010 Paris, France
| | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, 6302, Buenos Aires C1428 CABA, Argentina
| | - Alev Arat Özkan
- Cardiology Institute, Instanbul University, 34000 Istanbul, Türkiye
| | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, 66421 Saarland, Germany
| | - Heidi Lehitola
- Division of Cardiology, Oulu University Hospital, 90220 Oulu, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO-Nova Medical School, 1000 Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, 10431 Athens, Greece
| | - Ylitalo Antti
- Division of Cardiology, Heart Centre Turku, 20521 Turku, Finland
| | | | - Cesar Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes “Juana F. Cabral”, Corrientes W3400CDS, Argentina
| | - Ivan Bessonov
- Tyumen Cardiology Research Center, 625026 Tyumen, Russia
| | - Giuseppe Uccello
- Division of Cardiology, Ospedale “A. Manzoni”, 23900 Lecco, Italy
| | | | | | - Carlos E. Uribe
- Division of Cardiology, Universidad UPB-CES, Medellin 050001, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, 10431 Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, 38000 Grenoble, France
| | | | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo 11700, Uruguay
| | - Frankie C. C. Tam
- Department of Cardiology, Queen Mary Hospital, University of Hong Kong, Hong Kong
| | - Alfredo Rodriguez
- Division of Cardiology, Otamendi Hospital, Buenos Aires 1001, Argentina
| | - Antonia Anna Lukito
- Heart Center Siloam Lippo Village Hospital, Cardiovascular Department Pelita Harapan University, Tangerang 15810, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospital Cordoba, Cordoba 5000, Argentina
| | - Andrea Tuccillo
- Division of Cardiology, Ospedale del Mare, 80147 Napoli, Italy
| | - Alfonso Ielasi
- Division of Cardiology, Galeazzi-Sant’Ambrogio Hospital, 20157 Milan, Italy
| | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, 35121 Padova, Italy
| | - Guido Parodi
- Cardiology, Azienda Ospedaliera Lavagna, 16033 Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, 1050 Bruxelles, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, 6302, Buenos Aires C1428 CABA, Argentina
| | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, 6525 Nijmegen, The Netherlands
| | - Matteo Nardin
- Department of Internal Medicine, Ospedale Riuniti, 25121 Brescia, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL, 13900 Biella, Italy
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Chen Z, Zhang H, Wahle A, Woo V, Kassis N, Kovarnik T, Sonka M, Lopez JJ. DEEP LEARNING BASED AUTOMATED OPTICAL COHERENCE TOMOGRAPHY ANALYSIS: A NOVEL TOOL FOR IDENTIFICATION OF CORONARY ARTERY LIPID PLAQUES AND QUANTIFICATION OF FIBROUS CAP THICKNESS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)01270-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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10
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Rob D, Smalcova J, Smid O, Kral A, Kovarnik T, Zemanek D, Kavalkova P, Huptych M, Komarek A, Franek O, Havranek S, Linhart A, Belohlavek J. Extracorporeal versus conventional cardiopulmonary resuscitation for refractory out-of-hospital cardiac arrest: a secondary analysis of the Prague OHCA trial. Crit Care 2022; 26:330. [PMID: 36303227 PMCID: PMC9608889 DOI: 10.1186/s13054-022-04199-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/07/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Survival rates in refractory out-of-hospital cardiac arrest (OHCA) remain low with conventional advanced cardiac life support (ACLS). Extracorporeal life support (ECLS) implantation during ongoing resuscitation, a method called extracorporeal cardiopulmonary resuscitation (ECPR), may increase survival. This study examined whether ECPR is associated with improved outcomes. METHODS Prague OHCA trial enrolled adults with a witnessed refractory OHCA of presumed cardiac origin. In this secondary analysis, the effect of ECPR on 180-day survival using Kaplan-Meier estimates and Cox proportional hazard model was examined. RESULTS Among 256 patients (median age 58 years, 83% male) with median duration of resuscitation 52.5 min (36.5-68), 83 (32%) patients achieved prehospital ROSC during ongoing conventional ACLS prehospitally, 81 (32%) patients did not achieve prehospital ROSC with prolonged conventional ACLS, and 92 (36%) patients did not achieve prehospital ROSC and received ECPR. The overall 180-day survival was 51/83 (61.5%) in patients with prehospital ROSC, 1/81 (1.2%) in patients without prehospital ROSC treated with conventional ACLS and 22/92 (23.9%) in patients without prehospital ROSC treated with ECPR (log-rank p < 0.001). After adjustment for covariates (age, sex, initial rhythm, prehospital ROSC status, time of emergency medical service arrival, resuscitation time, place of cardiac arrest, percutaneous coronary intervention status), ECPR was associated with a lower risk of 180-day death (HR 0.21, 95% CI 0.14-0.31; P < 0.001). CONCLUSIONS In this secondary analysis of the randomized refractory OHCA trial, ECPR was associated with improved 180-day survival in patients without prehospital ROSC. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01511666, Registered 19 January 2012.
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Affiliation(s)
- Daniel Rob
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Jana Smalcova
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ondrej Smid
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ales Kral
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Tomas Kovarnik
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - David Zemanek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Petra Kavalkova
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Michal Huptych
- grid.6652.70000000121738213Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University in Prague, Prague, Czech Republic
| | - Arnost Komarek
- grid.4491.80000 0004 1937 116XDepartment of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Ondrej Franek
- Emergency Medical Service Prague, Prague, Czech Republic
| | - Stepan Havranek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Ales Linhart
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
| | - Jan Belohlavek
- grid.411798.20000 0000 9100 99402nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, 128 00 Prague, Czech Republic
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Kassis N, Kovarnik T, Chen Z, Weber JR, Martin B, Darki A, Woo V, Wahle A, Sonka M, Lopez JJ. Fibrous Cap Thickness Predicts Stable Coronary Plaque Progression: Early Clinical Validation of a Semiautomated OCT Technology. J Soc Cardiovasc Angiogr Interv 2022; 1:100400. [PMID: 36397766 PMCID: PMC9668070 DOI: 10.1016/j.jscai.2022.100400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
BACKGROUND Imaging-based characteristics associated with the progression of stable coronary atherosclerotic lesions are poorly defined. Utilizing a combination of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) imaging, we aimed to characterize the lesions prone to progression through clinical validation of a semiautomated OCT computational program. METHODS Patients with stable coronary artery disease underwent nonculprit vessel imaging with IVUS and OCT at baseline and IVUS at the 12-month follow-up. After coregistration of baseline and follow-up IVUS images, paired 5-mm segments from each patient were identified, demonstrating the greatest plaque progression and regression as measured by the change in plaque burden. Experienced readers identified plaque features on corresponding baseline OCT segments, and predictors of plaque progression were assessed by multivariable analysis. Each segment then underwent volumetric assessment of the fibrous cap (FC) using proprietary software. RESULTS Among 23 patients (70% men; median age, 67 years), experienced-reader analysis demonstrated that for every 100 μm increase in mean FC thickness, plaques were 87% less likely to progress (P = .01), which persisted on multivariable analysis controlling for baseline plaque burden (P = .05). Automated FC analysis (n = 17 paired segments) confirmed this finding (P = .01) and found thinner minimal FC thickness (P = .01) and larger FC surface area of <65 μm (P = .02) and <100 μm (P = .04) in progressing segments than in regressing segments. No additional imaging features predicted plaque progression. CONCLUSIONS A semiautomated FC analysis tool confirmed the significant association between thinner FC and stable coronary plaque progression along entire vessel segments, illustrating the diffuse nature of FC thinning and suggesting a future clinical role in predicting the progression of stable coronary artery disease.
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Affiliation(s)
- Nicholas Kassis
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Tomas Kovarnik
- Second Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Zhi Chen
- Department of Electrical and Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, Iowa
| | - Joseph R. Weber
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Brendan Martin
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Amir Darki
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Vincent Woo
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
| | - Andreas Wahle
- Department of Electrical and Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, Iowa
| | - Milan Sonka
- Department of Electrical and Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, Iowa
| | - John J. Lopez
- Department of Medicine, Division of Cardiology, Loyola University Medical Center, Maywood, Illinois
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12
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De Luca G, Nardin M, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Okkels Jensen L, Loh PH, Calmac L, Roura Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong Sung Lung A, Kala P, Díez Gil JL, Carrillo X, Dirksen M, Becerra-Munoz VM, Lee MKY, Arifa Juzar D, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld A, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac AH, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Martínez-Luengas IL, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Forés J, Vignali L, Pereira H, Manzo S, Ordoñez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Antti Y, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe CE, Kanakakis J, Faurie B, Gabrielli G, Gutierrez Barrios A, Bachini JP, Rocha A, Tam FCC, Rodriguez A, Lukito AA, Saint-Joy V, Pessah G, Tuccillo A, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Verdoia M. Impact of chronic obstructive pulmonary disease on short-term outcome in patients with ST-elevation myocardial infarction during COVID-19 pandemic: insights from the international multicenter ISACS-STEMI registry. Respir Res 2022; 23:207. [PMID: 35971173 PMCID: PMC9376902 DOI: 10.1186/s12931-022-02128-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 05/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is projected to become the third cause of mortality worldwide. COPD shares several pathophysiological mechanisms with cardiovascular disease, especially atherosclerosis. However, no definite answers are available on the prognostic role of COPD in the setting of ST elevation myocardial infarction (STEMI), especially during COVID-19 pandemic, among patients undergoing primary angioplasty, that is therefore the aim of the current study. Methods In the ISACS-STEMI COVID-19 registry we included retrospectively patients with STEMI treated with primary percutaneous coronary intervention (PCI) between March and June of 2019 and 2020 from 109 high-volume primary PCI centers in 4 continents. Results A total of 15,686 patients were included in this analysis. Of them, 810 (5.2%) subjects had a COPD diagnosis. They were more often elderly and with a more pronounced cardiovascular risk profile. No preminent procedural dissimilarities were noticed except for a lower proportion of dual antiplatelet therapy at discharge among COPD patients (98.9% vs. 98.1%, P = 0.038). With regards to short-term fatal outcomes, both in-hospital and 30-days mortality occurred more frequently among COPD patients, similarly in pre-COVID-19 and COVID-19 era. However, after adjustment for main baseline differences, COPD did not result as independent predictor for in-hospital death (adjusted OR [95% CI] = 0.913[0.658–1.266], P = 0.585) nor for 30-days mortality (adjusted OR [95% CI] = 0.850 [0.620–1.164], P = 0.310). No significant differences were detected in terms of SARS-CoV-2 positivity between the two groups. Conclusion This is one of the largest studies investigating characteristics and outcome of COPD patients with STEMI undergoing primary angioplasty, especially during COVID pandemic. COPD was associated with significantly higher rates of in-hospital and 30-days mortality. However, this association disappeared after adjustment for baseline characteristics. Furthermore, COPD did not significantly affect SARS-CoV-2 positivity. Trial registration number: NCT 04412655 (2nd June 2020).
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Affiliation(s)
- Giuseppe De Luca
- Division of Clinical and Experimental Cardiology, AOU Sassari, Sassari, Italy. .,University of Sassari, Sassari, Italy.
| | - Matteo Nardin
- Third Medicine Division, ASST Spedali Civili, Brescia, Italy
| | - Magdy Algowhary
- Division of Cardiology, Assiut University Heart Hospital, Assiut University, Asyut, Egypt
| | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico Prof. Luis Tavares, Centro PROCAPE, Federal University of Pernambuco, Recife, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Zan Zimbakov
- Medical Faculty, University Clinic for Cardiology, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, National University Hospital, Singapore, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital of Bucharest, Bucharest, Romania
| | - Gerard Roura Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
| | | | - Marek Milewski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | - Francesco Versaci
- Division of Cardiology, Ospedale Santa Maria Goretti Latina, Latina, Italy
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Bologna, Italy
| | | | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University, Brno, Czech Republic
| | | | | | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics, Alkmaar, The Netherlands
| | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen Elizabeth Hospital, University of Hong Kong, Yau Ma Tei, Hong Kong
| | - Dafsah Arifa Juzar
- Department of Cardiology and Vascular Medicine, University of Indonesia National Cardiovascular Center "Harapan Kita", Jakarta, Indonesia
| | | | | | - Davor Milicic
- Department of Cardiology, University Hospital Centre, University of Zagreb, Zagreb, Croatia
| | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | | | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio" Bolzano, Bolzano, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Arpad Lux
- Maastricht University Medical Center, Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Vincenzo Guiducci
- Division of Cardiology, AUSL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | | | | | - Aylin Hatice Yamac
- Department of Cardiology, Hospital Bezmialem Vakıf University, İstanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
| | | | | | - Michal Kidawa
- Central Hospital of Medical University of Lodz, Lodz, Poland
| | - Josè Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Center Hospitalier Universitaire de Lille, Lille, France
| | - Enrico Fabris
- Azienda Ospedaliero-Universitaria Ospedali Riuniti Trieste, Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | | | | | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Tapei, Taiwan
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Helder Pereira
- Cardiology Department, Hospital Garcia de Orta, Pragal, Almada, Portugal
| | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France
| | - Santiago Ordoñez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Scheller
- Division of Cardiology Clinical and Experimental Interventional Cardiology, University of Saarland, Saarbrücken, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO-Nova Medical School, CEDOC, Lisbon, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, Athens, Greece
| | - Ylitalo Antti
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | | | - Rodrigo Zoni
- Department of Teaching and Research, Instituto de Cardiología de Corrientes "Juana F. Cabral", Corrientes, Argentina
| | | | | | | | | | - Carlos E Uribe
- Division of Cardiology, Universidad UPB, Universidad CES, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, Alexandra Hospital, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria"Ospedali Riuniti", Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | - Frankie Chor-Cheung Tam
- Department of Cardiology, Queen Mary Hospital, University of Hong Kong, Pok Fu Lam, Hong Kong
| | | | - Antonia Anna Lukito
- Cardiovascular Department Pelita, Harapan University/Heart Center Siloam Lippo Village Hospital, Tangerang, Banten, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Hospiatl Cordoba, Cordoba, Argentina
| | | | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padua, Italy
| | - Guido Parodi
- Department of Cardiology, ASL 4 Liguria, Lavagna, Italy
| | | | - Elvin Kedhi
- Division of Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Brussels, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Harry Suryapranata
- Division of Cardiology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Ponderano, Italy
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Kovarnik T, Hitoshi M, Kral A, Jerabek S, Zemanek D, Kawase Y, Omori H, Tanigaki T, Pudil J, Vodzinska A, Branny M, Stipal R, Kala P, Mrozek J, Porzer M, Grezl T, Novobilsky K, Mendiz O, Kopriva K, Mates M, Chval M, Chen Z, Martasek P, Linhart A. Fractional Flow Reserve Versus Instantaneous Wave-Free Ratio in Assessment of Lesion Hemodynamic Significance and Explanation of their Discrepancies. International, Multicenter and Prospective Trial: The FiGARO Study. J Am Heart Assoc 2022; 11:e021490. [PMID: 35502771 PMCID: PMC9238629 DOI: 10.1161/jaha.121.021490] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background The FiGARO (FFR versus iFR in Assessment of Hemodynamic Lesion Significance, and an Explanation of Their Discrepancies) trial is a prospective registry searching for predictors of fractional flow reserve/instantaneous wave‐free ratio (FFR/iFR) discrepancy. Methods and Results FFR/iFR were analyzed using a Verrata wire, and coronary flow reserve was analyzed using a Combomap machine (both Philips‐Volcano). The risk polymorphisms for endothelial nitric oxide synthase and for heme oxygenase‐1 were analyzed. In total, 1884 FFR/iFR measurements from 1564 patients were included. The FFR/iFR discrepancy occurred in 393 measurements (20.9%): FFRp (positive)/iFRn (negative) type (264 lesions, 14.0%) and FFRn/iFRp (129 lesions, 6.8%) type. Coronary flow reserve was measured in 343 lesions, correlating better with iFR (R=0.56, P<0.0001) than FFR (R=0.36, P<0.0001). The coronary flow reserve value in FFRp/iFRn lesions (2.24±0.7) was significantly higher compared with both FFRp/iFRp (1.39±0.36), and FFRn/iFRn lesions (1.8±0.64, P<0.0001). Multivariable logistic regression analysis confirmed (1) sex, age, and lesion location in the right coronary artery as predictors for FFRp/iFRn discrepancy; and (2) hemoglobin level, smoking, and renal insufficiency as predictors for FFRn/iFRp discrepancy. The FFRn/iFRp type of discrepancy was significantly more frequent in patients with both risk types of polymorphisms (endothelial nitric oxide synthaser+heme oxygenase‐1r): 8 patients (24.2%) compared with FFRp/iFRn type of discrepancy: 2 patients (5.9%), P=0.03. Conclusions Predictors for FFRp/iFRn discrepancy were sex, age, and location in the right coronary artery. Predictors for FFRn/iFRp were hemoglobin level, smoking, and renal insufficiency. The risk type of polymorphism in endothelial nitric oxide synthase and heme oxygenase‐1 genes was more frequently found in patients with FFRn/iFRp type of discrepancy. Registration URL: https://clinicaltrials.gov; Unique identifier: NCT03033810.
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Affiliation(s)
- Tomas Kovarnik
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | - Ales Kral
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - Stepan Jerabek
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | - David Zemanek
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | | | | | - Jan Pudil
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
| | | | - Marian Branny
- Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic
| | - Roman Stipal
- Department of Internal Medicine and Cardiology University HospitalFaculty of MedicineMasaryk University Brno Brno Czech Republic
| | - Petr Kala
- Department of Internal Medicine and Cardiology University HospitalFaculty of MedicineMasaryk University Brno Brno Czech Republic
| | - Jan Mrozek
- Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic
| | - Martin Porzer
- Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic
| | - Tomas Grezl
- Cardiovascular Department University Hospital Ostrava Ostrava Czech Republic
| | - Kamil Novobilsky
- Cardiology Department Municipal Hospital Ostrava Ostrava Czech Republic
| | | | - Karel Kopriva
- Cardiology Department Homolka Hospital Prague Czech Republic
| | - Martin Mates
- Cardiology Department Homolka Hospital Prague Czech Republic
| | - Martin Chval
- Institute for Research and Development of Education Faculty of Education Charles University Prague Czech Republic
| | - Zhi Chen
- Department of Electrical & Computer Engineering Iowa Institute for Biomedical ImagingThe University of Iowa IA
| | - Pavel Martasek
- Department of Paediatrics and Inherited Metabolic Disorders First Faculty of Medicine Charles UniversityGeneral University Hospital Prague Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine Department of Cardiovascular Medicine First Faculty of Medicine Charles University and General University Hospital in Prague Prague Czech Republic
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14
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Rob D, Kavalkova P, Smalcova J, Kral A, Kovarnik T, Zemanek D, Franěk O, Smid O, Havranek S, Linhart A, Belohlavek J. Coronary angiography and percutaneous coronary intervention in cardiac arrest patients without return of spontaneous circulation. Resuscitation 2022; 175:133-141. [PMID: 35367316 DOI: 10.1016/j.resuscitation.2022.03.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aimed to examine coronary angiography (CAG) findings, percutaneous coronary intervention (PCI) results and outcomes in out-of-hospital cardiac arrest patients (OHCA) without return of spontaneous circulation (ROSC) on admission to hospital. METHODS We analyzed the OHCA register and compared CAG, PCI, and outcome data in patients with and without ROSC on admission to hospital. RESULTS Between January 2012 and December 2020, 697 OHCA patients were analyzed. Of these, 163 (23%) did not have ROSC at admission. Patients without ROSC were younger (59 vs. 61 years, p=0.001) and had a longer resuscitation time (62 vs. 18 minutes, p<0.001) than patients with ROSC. Significant coronary artery disease was highly prevalent in both groups (65% vs. 68%, p=0.48). Patients without ROSC had higher rates of acute coronary occlusions (42% vs. 33%, p=0.046), specifically affecting the left main stem (16% vs. 1%, p<0.001). PCI was performed in 81 patients (50%) without ROSC and in 295 (55%) with ROSC (p=0.21). The success rate was 86% in patients without ROSC and 90% in patients with ROSC (p=0.33). Thirty-day survival was 24% in patients without ROSC and 70% in patients with ROSC. CONCLUSIONS OHCA patients without ROSC on admission to hospital had higher acute coronary occlusion rates than patients with prehospital ROSC. PCI is feasible with a high success rate in patients without ROSC. Despite prolonged resuscitation times, meaningful survival in patients admitted without ROSC is achievable.
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Affiliation(s)
- Daniel Rob
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
| | - Petra Kavalkova
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jana Smalcova
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Ales Kral
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Tomas Kovarnik
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - David Zemanek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Ondrej Franěk
- Prague Emergency Medical Service, Prague, Czech Republic
| | - Ondrej Smid
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Stepan Havranek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Ales Linhart
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
| | - Jan Belohlavek
- 2(nd) Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic
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15
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De Luca G, Algowhary M, Uguz B, Oliveira DC, Ganyukov V, Zimbakov Z, Cercek M, Jensen LO, Loh PH, Calmac L, Roura-Ferrer G, Quadros A, Milewski M, Scotto di Uccio F, von Birgelen C, Versaci F, Ten Berg J, Casella G, Wong ASL, Kala P, Diez Gil JL, Carrillo X, Dirksen MT, Becerra-Muñoz VM, Kang-Yin Lee M, Juzar DA, de Moura Joaquim R, Paladino R, Milicic D, Davlouros P, Bakraceski N, Zilio F, Donazzan L, Kraaijeveld AO, Galasso G, Lux A, Marinucci L, Guiducci V, Menichelli M, Scoccia A, Yamac A, Ugur Mert K, Flores Rios X, Kovarnik T, Kidawa M, Moreu J, Flavien V, Fabris E, Lozano Martìnez-Luengas I, Boccalatte M, Bosa Ojeda F, Arellano-Serrano C, Caiazzo G, Cirrincione G, Kao HL, Sanchis Fores J, Vignali L, Pereira H, Manzo-Silberman S, Ordonez S, Özkan AA, Scheller B, Lehtola H, Teles R, Mantis C, Ylitalo A, Brum Silveira JA, Zoni R, Bessonov I, Savonitto S, Kochiadakis G, Alexopoulos D, Uribe C, Kanakakis J, Faurie B, Gabrielli G, Gutiérrez A, Bachini JP, Rocha A, Tam FC, Rodriguez A, Lukito A, Saint-Joy V, Pessah G, Tuccillo B, Cortese G, Parodi G, Bouraghda MA, Kedhi E, Lamelas P, Suryapranata H, Nardin M, Verdoia M. COVID-19 pandemic, mechanical reperfusion and 30-day mortality in ST elevation myocardial infarction. Heart 2022; 108:458-466. [PMID: 34711661 PMCID: PMC8561823 DOI: 10.1136/heartjnl-2021-319750] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 09/27/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE The initial data of the International Study on Acute Coronary Syndromes - ST Elevation Myocardial Infarction COVID-19 showed in Europe a remarkable reduction in primary percutaneous coronary intervention procedures and higher in-hospital mortality during the initial phase of the pandemic as compared with the prepandemic period. The aim of the current study was to provide the final results of the registry, subsequently extended outside Europe with a larger inclusion period (up to June 2020) and longer follow-up (up to 30 days). METHODS This is a retrospective multicentre registry in 109 high-volume primary percutaneous coronary intervention (PPCI) centres from Europe, Latin America, South-East Asia and North Africa, enrolling 16 674 patients with ST segment elevation myocardial infarction (STEMI) undergoing PPPCI in March/June 2019 and 2020. The main study outcomes were the incidence of PPCI, delayed treatment (ischaemia time >12 hours and door-to-balloon >30 min), in-hospital and 30-day mortality. RESULTS In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio 0.843, 95% CI 0.825 to 0.861, p<0.0001). This reduction was significantly associated with age, being higher in older adults (>75 years) (p=0.015), and was not related to the peak of cases or deaths due to COVID-19. The heterogeneity among centres was high (p<0.001). Furthermore, the pandemic was associated with a significant increase in door-to-balloon time (40 (25-70) min vs 40 (25-64) min, p=0.01) and total ischaemia time (225 (135-410) min vs 196 (120-355) min, p<0.001), which may have contributed to the higher in-hospital (6.5% vs 5.3%, p<0.001) and 30-day (8% vs 6.5%, p=0.001) mortality observed during the pandemic. CONCLUSION Percutaneous revascularisation for STEMI was significantly affected by the COVID-19 pandemic, with a 16% reduction in PPCI procedures, especially among older patients (about 20%), and longer delays to treatment, which may have contributed to the increased in-hospital and 30-day mortality during the pandemic. TRIAL REGISTRATION NUMBER NCT04412655.
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Affiliation(s)
- Giuseppe De Luca
- Department of Cardiology, AOU Maggiore della Carità, Eastern Piedmont University, Novara, Italy
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
| | | | - Berat Uguz
- Division of Cardiology, Bursa City Hospital, Bursa, Turkey
| | - Dinaldo C Oliveira
- Pronto de Socorro Cardiologico, Centro PROCAPE Prof. Tavares, Recife, Brazil
| | - Vladimir Ganyukov
- Department of Heart and Vascular Surgery, Kemerovo Cardiology Center, Кемерово, Russia
| | - Zan Zimbakov
- University Clinic for Cardiology, Ss Cyril and Methodius University in Skopje, Skopje, Macedonia
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Poay Huan Loh
- Department of Cardiology, Singapore Health Service, Singapore
| | - Lucian Calmac
- Clinic Emergency Hospital, University of Bucharest, Bucuresti, Romania
| | - Gerard Roura-Ferrer
- Interventional Cardiology Unit, Bellvitge University Hospital, L'Hospitalet de Llobregat, Spain
| | - Alexandre Quadros
- Instituto de Cardiologia, Rio Grande do Sul State Department of Health, Porto Alegre, Brazil
| | - Marek Milewski
- Division of Cardiology, Medical University of Silesia in Katowice, Katowice, Poland
| | | | - Clemens von Birgelen
- Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Academisch Medisch Centrum, Twente, The Netherlands
| | | | - Jurriën Ten Berg
- Department of Cardiology, Sint Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | | | | | - Petr Kala
- University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - Jose Luis Diez Gil
- Department of Cardiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Xavier Carrillo
- Department of Cardiology, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | | | | | - Michael Kang-Yin Lee
- Department of Cardiology, Queen ElizabethHospital University of Hong Kong, Hong Kong, Hong Kong
| | - Dafsah A Juzar
- Department of cardiology and Vascular Medicine, National Cardiovascular Center 'Harapan Kita', Jakarta, Indonesia
| | | | | | - Davor Milicic
- Department of Cardiology, University of Zagreb, Zagreb, Croatia
| | | | - Nikola Bakraceski
- Center for Cardiovascular Diseases, Ohrid University Hospital, Ohrid, Macedonia
| | - Filippo Zilio
- Division of Cardiology, Ospedale Santa Chiara di Trento, Trento, Italy
| | | | | | - Gennaro Galasso
- Division of Cardiology, University of Salerno, Salerno, Italy
| | - Arpad Lux
- Cardiology, Maastricht University Hospital, Maastricht, The Netherlands
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Ancona, Italy
| | | | - Maurizio Menichelli
- Cardiology Division, Ospedale Fabrizio Spaziani, Roma, Italy
- Cardiology Division, Ospedale "F. Spaziani", Frosinone, Italy
| | | | - Aylin Yamac
- Department of Cardiology, Bezmialem Vakıf University İstanbul, Istanbul, Turkey
| | - Kadir Ugur Mert
- Division of Cardiology, Eskisehir Osmangazi Universitesi, Eskisehir, Turkey
| | | | - Tomas Kovarnik
- Department of Cardiovascular Medicine, University Hospital Prague, Prague, Czech Republic
| | - Michal Kidawa
- Central Hospital, Medical University of Lodz, Lodz, Poland
| | - Jose Moreu
- Division of Cardiology, Hospital Complex of Toledo, Toledo, Spain
| | - Vincent Flavien
- Division of Cardiology, Lille University Hospital Center, Lille, France
| | - Enrico Fabris
- Department of Cardiology, Universita degli Studi di Trieste Dipartimento di Scienze Mediche Chirurgiche e della Salute, Trieste, Italy
| | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Naples, Italy
| | - Francisco Bosa Ojeda
- Division of Cardiology, Consorcio Sanitario de Tenerife, Santa Cruz de Tenerife, Spain
| | | | - Gianluca Caiazzo
- Division of Cardiology, Ospedale "G Moscati", Aversa, Aversa, Italy
| | | | - Hsien-Li Kao
- Cardiology Division, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Juan Sanchis Fores
- Department of Cardiology, Hospital Clinico Universitario, Universidad de Valencia, Valencia, Spain
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Parma, Italy
| | - Helder Pereira
- Cardiology Department, Garcia de Orta Hospital, Almada, Portugal
| | | | - Santiago Ordonez
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Scheller
- Clinical and Experimental Interventional Cardiology, Saarland University, Saarbrucken, Germany
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | - Rui Teles
- Department of Cardiology, Hospital de Santa Cruz, CHLO - Nova Medical School,CEDOC, Carnaxide, Portugal
| | - Christos Mantis
- Division of Cardiology, Kontantopoulion Hospital, Athens, Athens, Greece
| | - Antti Ylitalo
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | | | - Rodrigo Zoni
- Instituto de Cardiología de Corrientes Juana Francisca Cabral, Corrientes, Argentina
| | | | | | | | | | - Carlos Uribe
- Division of Cardiology, Medellin Clinic Universidad UPB, Medellin, Colombia
| | - John Kanakakis
- Division of Cardiology, General Hospital of Athens Alexandra, Athens, Greece
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | - Gabriele Gabrielli
- SOD Cardiologia-Emodinamica-UTIC, Azienda Ospedali Riuniti - Presidio 'GM Lancisi', Ancona, Italy
| | | | | | - Alex Rocha
- Department of Cardiology and Cardiovascular Interventions, Instituto Nacional de Cirugía Cardíaca, Montevideo, Uruguay
| | - Franckie Cc Tam
- Department of Cardiology, Queen Mary Hospital, Hong Kong, Hong Kong
| | - Alfredo Rodriguez
- Department of Cardiology, Otamendi Hospital, Buenos Aires, Argentina
| | - Antonia Lukito
- Cardiovascular Department, Pelita Harapan University, Tangerang, Indonesia
| | | | - Gustavo Pessah
- Division of Cardiology, Cordoba Hospital, Cordoba, Argentina
| | | | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Guido Parodi
- Division of cardiology, Sassari University Hospital, Sassari, Italy
| | | | - Elvin Kedhi
- Cardiology, Hopital Erasmus, Universitè Libre de Bruxelles, Bruxelles, Belgium
| | - Pablo Lamelas
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | - Matteo Nardin
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Ospedali Riuniti, Brescia, Italy
| | - Monica Verdoia
- Department of Translational Medicine, Eastern Piedmont University, Novara, Italy
- Cardiology, Nuovo Ospedale degli Infermi ASL Biella, Biella, italy
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16
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Belohlavek J, Smalcova J, Rob D, Franek O, Smid O, Pokorna M, Horák J, Mrazek V, Kovarnik T, Zemanek D, Kral A, Havranek S, Kavalkova P, Kompelentova L, Tomková H, Mejstrik A, Valasek J, Peran D, Pekara J, Rulisek J, Balik M, Huptych M, Jarkovsky J, Malik J, Valerianova A, Mlejnsky F, Kolouch P, Havrankova P, Romportl D, Komarek A, Linhart A. Effect of Intra-arrest Transport, Extracorporeal Cardiopulmonary Resuscitation, and Immediate Invasive Assessment and Treatment on Functional Neurologic Outcome in Refractory Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. JAMA 2022; 327:737-747. [PMID: 35191923 PMCID: PMC8864504 DOI: 10.1001/jama.2022.1025] [Citation(s) in RCA: 234] [Impact Index Per Article: 117.0] [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: 12/14/2022]
Abstract
IMPORTANCE Out-of-hospital cardiac arrest (OHCA) has poor outcome. Whether intra-arrest transport, extracorporeal cardiopulmonary resuscitation (ECPR), and immediate invasive assessment and treatment (invasive strategy) is beneficial in this setting remains uncertain. OBJECTIVE To determine whether an early invasive approach in adults with refractory OHCA improves neurologically favorable survival. DESIGN, SETTING, AND PARTICIPANTS Single-center, randomized clinical trial in Prague, Czech Republic, of adults with a witnessed OHCA of presumed cardiac origin without return of spontaneous circulation. A total of 256 participants, of a planned sample size of 285, were enrolled between March 2013 and October 2020. Patients were observed until death or day 180 (last patient follow-up ended on March 30, 2021). INTERVENTIONS In the invasive strategy group (n = 124), mechanical compression was initiated, followed by intra-arrest transport to a cardiac center for ECPR and immediate invasive assessment and treatment. Regular advanced cardiac life support was continued on-site in the standard strategy group (n = 132). MAIN OUTCOMES AND MEASURES The primary outcome was survival with a good neurologic outcome (defined as Cerebral Performance Category [CPC] 1-2) at 180 days after randomization. Secondary outcomes included neurologic recovery at 30 days (defined as CPC 1-2 at any time within the first 30 days) and cardiac recovery at 30 days (defined as no need for pharmacological or mechanical cardiac support for at least 24 hours). RESULTS The trial was stopped at the recommendation of the data and safety monitoring board when prespecified criteria for futility were met. Among 256 patients (median age, 58 years; 44 [17%] women), 256 (100%) completed the trial. In the main analysis, 39 patients (31.5%) in the invasive strategy group and 29 (22.0%) in the standard strategy group survived to 180 days with good neurologic outcome (odds ratio [OR], 1.63 [95% CI, 0.93 to 2.85]; difference, 9.5% [95% CI, -1.3% to 20.1%]; P = .09). At 30 days, neurologic recovery had occurred in 38 patients (30.6%) in the invasive strategy group and in 24 (18.2%) in the standard strategy group (OR, 1.99 [95% CI, 1.11 to 3.57]; difference, 12.4% [95% CI, 1.9% to 22.7%]; P = .02), and cardiac recovery had occurred in 54 (43.5%) and 45 (34.1%) patients, respectively (OR, 1.49 [95% CI, 0.91 to 2.47]; difference, 9.4% [95% CI, -2.5% to 21%]; P = .12). Bleeding occurred more frequently in the invasive strategy vs standard strategy group (31% vs 15%, respectively). CONCLUSIONS AND RELEVANCE Among patients with refractory out-of-hospital cardiac arrest, the bundle of early intra-arrest transport, ECPR, and invasive assessment and treatment did not significantly improve survival with neurologically favorable outcome at 180 days compared with standard resuscitation. However, the trial was possibly underpowered to detect a clinically relevant difference. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01511666.
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Affiliation(s)
- Jan Belohlavek
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Jana Smalcova
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
- Emergency Medical Service, Prague, Czech Republic
| | - Daniel Rob
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Ondrej Smid
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | - Jan Horák
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Vratislav Mrazek
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Tomas Kovarnik
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - David Zemanek
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Ales Kral
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Stepan Havranek
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Petra Kavalkova
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | | | | | | | | | - David Peran
- Emergency Medical Service, Prague, Czech Republic
| | | | - Jan Rulisek
- Department of Anesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Martin Balik
- Department of Anesthesiology, Resuscitation and Intensive Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Michal Huptych
- Czech Institute of Informatics, Robotics and Cybernetics (CIIRC), Czech Technical University, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Jan Malik
- 3rd Department of Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Anna Valerianova
- 3rd Department of Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Frantisek Mlejnsky
- 2nd Department of Surgery, Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Petr Kolouch
- Emergency Medical Service, Prague, Czech Republic
| | - Petra Havrankova
- Department of Neurology, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
| | - Dan Romportl
- Long-term Intensive Care Unit, Etoile, Prague, Czech Republic
| | - Arnost Komarek
- Department of Probability and Mathematical Statistics, Faculty of Mathematics and Physics, Charles University in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Medicine—Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czech Republic
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17
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Osmancik P, Herman D, Neuzil P, Hala P, Taborsky M, Kala P, Poloczek M, Stasek J, Haman L, Branny M, Chovancik J, Cervinka P, Holy J, Kovarnik T, Zemanek D, Havranek S, Vancura V, Peichl P, Tousek P, Lekesova V, Jarkovsky J, Novackova M, Benesova K, Widimsky P, Reddy VY. Left Atrial Appendage Closure versus Non-Warfarin Oral Anticoagulation in Atrial Fibrillation: 4-Year Outcomes of PRAGUE-17. J Am Coll Cardiol 2021; 79:1-14. [PMID: 34748929 DOI: 10.1016/j.jacc.2021.10.023] [Citation(s) in RCA: 94] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/05/2021] [Accepted: 10/14/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND The PRAGUE-17 trial demonstrated that left atrial appendage closure (LAAC) was non-inferior to non-warfarin oral anticoagulants (NOAC) for preventing major neurological, cardiovascular or bleeding events in high-risk patients with atrial fibrillation (AF). OBJECTIVE To assess the pre-specified long-term (4-year) outcomes in PRAGUE-17. METHODS PRAGUE-17 was a randomized non-inferiority trial comparing percutaneous LAAC (Watchman or Amulet) with NOACs (95% apixaban) in non-valvular AF patients with a history of cardioembolism, clinically-relevant bleeding, or both CHA2DS2-VASc > 3 and HASBLED > 2. The primary endpoint was a composite of cardioembolic events (stroke, transient ischemic attack, or systemic embolism), cardiovascular death, clinically-relevant bleeding, or procedure/device-related complications (LAAC group only). The primary analysis was modified intention-to-treat (mITT). RESULTS We randomized 402 AF patients (201 per group, age 73.3±7.0 years, 65.7% male, CHA2DS2-VASc 4.7+1.5, HASBLED 3.1+0.9). After 3.5 years median follow-up (1,354 patients-years), LAAC was non-inferior to NOAC for the primary endpoint by mITT (subdistribution hazard ratio[sHR] 0.81, 95% CI 0.56-1.18; p=0.27; p for non-inferiority=0.006). For the components of the composite endpoint, the corresponding sHRs (and 95% CIs) were 0.68 (0.39-1.20; p=0.19) for cardiovascular death, 1.14 (0.56-2.30; p=0.72) for all-stroke/TIA, 0.75 (0.44-1.27; p=0.28) for clinically-relevant bleeding, and 0.55 (0.31-0.97; p=0.039) for non-procedural clinically-relevant bleeding. The primary endpoint outcomes were similar in the per-protocol [sHR 0.80 (95% CI 0.54-1.18), p=0.25] and on-treatment [sHR 0.82 (95% CI 0.56-1.20), p=0.30] analyses. CONCLUSION In long-term follow-up of PRAGUE-17, LAAC remains non-inferior to NOACs for preventing major cardiovascular, neurological or bleeding events. Furthermore, non-procedural bleeding was significantly reduced with LAAC.
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Affiliation(s)
- Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Neuzil
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Hala
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Milos Taborsky
- Cardiocenter, Dept. of Cardiology, University Hospital Olomouc, Czech Republic
| | - Petr Kala
- Clinic of Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Martin Poloczek
- Clinic of Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Josef Stasek
- 1(st) Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University Prague, Czech Republic
| | - Ludek Haman
- 1(st) Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University Prague, Czech Republic
| | - Marian Branny
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Jan Chovancik
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajská zdravotni a.s., Masaryk hospital and UJEP, Usti nad Labem, Czech Republic
| | - Jiri Holy
- Department of Cardiology, Krajská zdravotni a.s., Masaryk hospital and UJEP, Usti nad Labem, Czech Republic
| | - Tomas Kovarnik
- Cardiocenter, 2nd internal clinic - Cardiology and Angiology, Charles University, General Faculty Hospital, Prague Czech Republic
| | - David Zemanek
- Cardiocenter, 2nd internal clinic - Cardiology and Angiology, Charles University, General Faculty Hospital, Prague Czech Republic
| | - Stepan Havranek
- Cardiocenter, 2nd internal clinic - Cardiology and Angiology, Charles University, General Faculty Hospital, Prague Czech Republic
| | - Vlastimil Vancura
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Petr Peichl
- Cardiocenter, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Veronika Lekesova
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Martina Novackova
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Klara Benesova
- Institute of Biostatistics and Analysis, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Vivek Y Reddy
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic; Helmsley Electrophysiology Center, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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18
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De Luca G, Debel N, Cercek M, Jensen LO, Vavlukis M, Calmac L, Johnson T, Ferrer GR, Ganyukov V, Wojakowski W, Kinnaird T, von Birgelen C, Cottin Y, IJsselmuiden A, Tuccillo B, Versaci F, Royaards KJ, Berg JT, Laine M, Dirksen M, Siviglia M, Casella G, Kala P, Díez Gil JL, Banning A, Becerra V, De Simone C, Santucci A, Carrillo X, Scoccia A, Amoroso G, Van't Hof AW, Kovarnik T, Tsigkas G, Mehilli J, Gabrielli G, Rios XF, Bakraceski N, Levesque S, Cirrincione G, Guiducci V, Kidawa M, Spedicato L, Marinucci L, Ludman P, Zilio F, Galasso G, Fabris E, Menichelli M, Garcia-Touchard A, Manzo S, Caiazzo G, Moreu J, Forés JS, Donazzan L, Vignali L, Teles R, Benit E, Agostoni P, Ojeda FB, Lehtola H, Camacho-Freiere S, Kraaijeveld A, Antti Y, Boccalatte M, Deharo P, Martínez-Luengas IL, Scheller B, Varytimiadi E, Moreno R, Uccello G, Faurie B, Gutierrez Barrios A, Milewski M, Bruwiere E, Smits P, Wilbert B, Di Uccio FS, Parodi G, Kedhi E, Verdoia M. Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry. Atherosclerosis 2021; 332:48-54. [PMID: 34391035 PMCID: PMC8294603 DOI: 10.1016/j.atherosclerosis.2021.06.926] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 06/13/2021] [Accepted: 06/30/2021] [Indexed: 01/16/2023]
Abstract
Background and aims SARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI). Methods We selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1st until April 30th, in 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure. Results Our population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or the modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p < 0.001). Despite similar pre and postprocedural TIMI flow, we observed a trend in higher use of GP IIb-IIIa inhibitors and a significantly higher use of thrombectomy in the SARS-CoV-2 positive patients. SARS-CoV-2 positivity was associated with a remarkably higher in hospital mortality (29% vs 5.5%, p < 0.001), definite in-stent thrombosis (8.1% vs 1.6%, p = 0.004) and heart failure (22.6% vs 10.6%, p = 0.001) that was confirmed after adjustment for confounding factors. Conclusions Our study showed that among STEMI patients, SARS-CoV-2 positivity is associated with larger thrombus burden, a remarkably higher mortality but also higher rates of in-stent thrombosis and heart failure.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Italy.
| | - Niels Debel
- Catholic University of Leuven, Leuven, Belgium
| | - Miha Cercek
- Department of Cardiology, Medical Center Ljubljana, Slovenia
| | | | - Marija Vavlukis
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, Macedonia
| | | | - Tom Johnson
- Division of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, UK
| | - Gerard Rourai Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, Spain
| | - Vladimir Ganyukov
- Division of Cardiology,State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russia
| | - Wojtek Wojakowski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | - Tim Kinnaird
- Division of Cardiology, University Hospital of Wales, Cardiff, UK
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | - Yves Cottin
- Division of Cardiology, University Hospital, Dijon, France
| | | | | | | | - Kees-Jan Royaards
- Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Finland
| | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics Alkmaar, the Netherlands
| | - Massimo Siviglia
- Division of Cardiology, Division of Cardiology, Ospedali Riuniti, Reggio Calabria, Italy
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Italy
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic
| | | | | | - Victor Becerra
- Cardiology Unit, Virgen de la Victoria University Hospital; IBIMA, Málaga, Spain. CIBERCV
| | - Ciro De Simone
- Division of Cardiology, Clinica Villa dei Fiori, Acerra, Italy
| | | | | | | | | | | | | | - Grigorios Tsigkas
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | - Julinda Mehilli
- University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Sébastien Levesque
- Center Hospitalier Universitaire de Poitiers, Poitiers, University Hospital, Poitiers, France
| | | | | | - Michał Kidawa
- Central Hospital of Medical University of Lodz, Poland
| | - Leonardo Spedicato
- Division of Cardiology, Ospedale "Santa Maria della Misericordia", Udine, Italy
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | | | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggid'Aragona, Salerno, Italy
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Italy
| | - Maurizio Menichelli
- Division of Cardiology, Medical University of Silezia, Katowice, Poland; Division of Cardiology, Ospedale "F. Spaziani", Frosinone, Italy
| | | | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, France
| | | | - Jose Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Spain
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio", Bolzano, Italy
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | - Edouard Benit
- Division of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | | | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Finland
| | | | | | | | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | - Pierre Deharo
- Division of Cardiology, CHU Timone, Marseille, France; Faculté de Médecine, Aix-Marseille Université, Marseille, France
| | | | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Germany
| | | | - Raul Moreno
- Division of Cardiology, Hospital la Paz, Madrid, Spain
| | | | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, France
| | | | - Marek Milewski
- Division of Cardiology, Ospedale "F. Spaziani", Frosinone, Italy
| | - Ewout Bruwiere
- Division of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | - Pieter Smits
- Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Bor Wilbert
- Division of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | - Guido Parodi
- Azienda Ospedaliero-Universitaria Sassari, Italy
| | - Elvin Kedhi
- Division of Cardiology, Hopital Erasme, Universitè Libre de Bruxelles, Belgium
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL, Biella, Italy
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19
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De Luca G, Cercek M, Okkels Jensen L, Bushljetikj O, Calmac L, Johnson T, Gracida Blancas M, Ganyukov V, Wojakowski W, von Birgelen C, IJsselmuiden A, Tuccillo B, Versaci F, Ten Berg J, Laine M, Berkout T, Casella G, Kala P, López Ledesma B, Becerra V, Padalino R, Santucci A, Carrillo X, Scoccia A, Amoroso G, Lux A, Kovarnik T, Davlouros P, Gabrielli G, Flores Rios X, Bakraceski N, Levesque S, Guiducci V, Kidawa M, Marinucci L, Zilio F, Galasso G, Fabris E, Menichelli M, Manzo S, Caiazzo G, Moreu J, Sanchis Forés J, Donazzan L, Vignali L, Teles R, Agostoni P, Bosa Ojeda F, Lehtola H, Camacho-Freiere S, Kraaijeveld A, Antti Y, Visconti G, Lozano Martínez-Luengas I, Scheller B, Alexopulos D, Moreno R, Kedhi E, Uccello G, Faurie B, Gutierrez Barrios A, Scotto Di Uccio F, Wilbert B, Cortese G, Dirksen MT, Parodi G, Verdoia M. Impact of renin-angiotensin system inhibitors on mortality during the COVID Pandemic among STEMI patients undergoing mechanical reperfusion: Insight from an international STEMI registry. Biomed Pharmacother 2021; 138:111469. [PMID: 33740523 PMCID: PMC7962982 DOI: 10.1016/j.biopha.2021.111469] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 01/16/2023] Open
Abstract
Background Concerns have been raised on a potential interaction between renin-angiotensin system inhibitors (RASI) and the susceptibility to coronavirus disease 2019 (COVID-19). No data have been so far reported on the prognostic impact of RASI in patients suffering from ST-elevation myocardial infarction (STEMI) during COVID-19 pandemic, which was the aim of the present study. Methods STEMI patients treated with primary percutaneous coronary intervention (PPCI) and enrolled in the ISACS-STEMI COVID-19 registry were included in the present sub-analysis and divided according to RASI therapy at admission. Results Our population is represented by 6095 patients, of whom 3654 admitted in 2019 and 2441 in 2020. No difference in the prevalence of SARSCoV2 infection was observed according to RASI therapy at admission (2.5% vs 2.1%, p = 0.5), which was associated with a significantly lower mortality (adjusted OR [95% CI]=0.68 [0.51–0.90], P = 0.006), confirmed in the analysis restricted to 2020 (adjusted OR [95% CI]=0.5[0.33–0.74], P = 0.001). Among the 5388 patients in whom data on in-hospital medication were available, in-hospital RASI therapy was associated with a significantly lower mortality (2.1% vs 16.7%, OR [95% CI]=0.11 [0.084–0.14], p < 0.0001), confirmed after adjustment in both periods. Among the 62 SARSCoV-2 positive patients, RASI therapy, both at admission or in-hospital, showed no prognostic effect. Conclusions This is the first study to investigate the impact of RASI therapy on the prognosis and SARSCoV2 infection of STEMI patients undergoing PPCI during the COVID-19 pandemic. Both pre-admission and in-hospital RASI were associated with lower mortality. Among SARSCoV2-positive patients, both chronic and in-hospital RASI therapy showed no impact on survival.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Italy.
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Oliver Bushljetikj
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | | | - Tom Johnson
- Division of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol
| | | | - Vladimir Ganyukov
- Division of Cardiology, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Kemerovo, Russia
| | - Wojtek Wojakowski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | | | | | | | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Finland
| | - Tim Berkout
- Division of Cardiology, Northwest Clinics Alkmaar, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore Bologna, Italy
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic
| | | | - Victor Becerra
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | | | | | | | | | | | - Arpad Lux
- Maastricht University Medical Center, The Netherlands
| | | | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Sébastien Levesque
- Center Hospitalier Universitaire de Poitiers, Poitiers, University Hospital, Poitiers, France
| | | | - Michał Kidawa
- Central Hospital of Medical University of Lodz, Poland
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Italy
| | | | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, France
| | | | - Jose Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Spain
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio" Bolzano Ospedale "S. Maurizio" Bolzano (OR), Italy
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
| | | | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Finland
| | | | | | | | - Gabriella Visconti
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | | | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Germany
| | | | - Raul Moreno
- Division of Cardiology, Hospital la Paz, Madrid, Spain
| | - Elvin Kedhi
- Division of Cardiology, St-Jan Hospital, Brugge, Belgium
| | | | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, France
| | | | | | - Bor Wilbert
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | | | | | - Guido Parodi
- Azienda Ospedaliero-Universitaria Sassari, Italy
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Italy
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20
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De Luca G, Cercek M, Jensen LO, Vavlukis M, Calmac L, Johnson T, Roura I Ferrer G, Ganyukov V, Wojakowski W, von Birgelen C, Versaci F, Ten Berg J, Laine M, Dirksen M, Casella G, Kala P, Díez Gil JL, Becerra V, De Simone C, Carrill X, Scoccia A, Lux A, Kovarnik T, Davlouros P, Gabrielli G, Flores Rios X, Bakraceski N, Levesque S, Guiducci V, Kidawa M, Marinucci L, Zilio F, Galasso G, Fabris E, Menichelli M, Manzo S, Caiazzo G, Moreu J, Sanchis Forés J, Donazzan L, Vignali L, Teles R, Bosa Ojeda F, Lehtola H, Camacho-Freiere S, Kraaijeveld A, Antti Y, Boccalatte M, Martínez-Luengas IL, Scheller B, Alexopoulos D, Uccello G, Faurie B, Gutierrez Barrios A, Wilbert B, Cortese G, Moreno R, Parodi G, Kedhi E, Verdoia M. Impact of COVID-19 pandemic and diabetes on mechanical reperfusion in patients with STEMI: insights from the ISACS STEMI COVID 19 Registry. Cardiovasc Diabetol 2020; 19:215. [PMID: 33339541 PMCID: PMC7747477 DOI: 10.1186/s12933-020-01196-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/09/2020] [Indexed: 12/18/2022] Open
Abstract
Background It has been suggested the COVID pandemic may have indirectly affected the treatment and outcome of STEMI patients, by avoidance or significant delays in contacting the emergency system. No data have been reported on the impact of diabetes on treatment and outcome of STEMI patients, that was therefore the aim of the current subanalysis conducted in patients included in the International Study on Acute Coronary Syndromes–ST Elevation Myocardial Infarction (ISACS-STEMI) COVID-19. Methods The ISACS-STEMI COVID-19 is a retrospective registry performed in European centers with an annual volume of > 120 primary percutaneous coronary intervention (PCI) and assessed STEMI patients, treated with primary PCI during the same periods of the years 2019 versus 2020 (March and April). Main outcomes are the incidences of primary PCI, delayed treatment, and in-hospital mortality. Results A total of 6609 patients underwent primary PCI in 77 centers, located in 18 countries. Diabetes was observed in a total of 1356 patients (20.5%), with similar proportion between 2019 and 2020. During the pandemic, there was a significant reduction in primary PCI as compared to 2019, similar in both patients with (Incidence rate ratio (IRR) 0.79 (95% CI: 0.73–0.85, p < 0.0001) and without diabetes (IRR 0.81 (95% CI: 0.78–0.85, p < 0.0001) (p int = 0.40). We observed a significant heterogeneity among centers in the population with and without diabetes (p < 0.001, respectively). The heterogeneity among centers was not related to the incidence of death due to COVID-19 in both groups of patients. Interaction was observed for Hypertension (p = 0.024) only in absence of diabetes. Furthermore, the pandemic was independently associated with a significant increase in door-to-balloon and total ischemia times only among patients without diabetes, which may have contributed to the higher mortality, during the pandemic, observed in this group of patients. Conclusions The COVID-19 pandemic had a significant impact on the treatment of patients with STEMI, with a similar reduction in primary PCI procedures in both patients with and without diabetes. Hypertension had a significant impact on PCI reduction only among patients without diabetes. We observed a significant increase in ischemia time and door-to-balloon time mainly in absence of diabetes, that contributed to explain the increased mortality observed in this group of patients during the pandemic. Trial registration number: NCT 04412655.
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy.
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Marija Vavlukis
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Lucian Calmac
- Clinic Emergency Hospital of Bucharest, Bucharest, Romania
| | - Tom Johnson
- Division of Cardiology, Bristol Heart Institute, University Hospitals Bristol, NHSFT & University of Bristol, Bristol, UK
| | - Gerard Roura I Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Vladimir Ganyukov
- Division of Cardiology, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo,, Russia
| | - Wojtek Wojakowski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | - Clemens von Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, The Netherlands
| | | | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Maurits Dirksen
- Division of Cardiology, Northwest Clinic, Alkmaar, The Netherlands
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore, Bologna, Italy
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Brno, Czech Republic
| | | | - Victor Becerra
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Ciro De Simone
- Division of Cardiology, Clinica Villa dei Fiori, Acerra, Italy
| | | | | | - Arpad Lux
- Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Sébastien Levesque
- Center Hospitalier, Universitaire de Poitiers, University Hospital, Poitiers, France
| | | | - Michał Kidawa
- Central Hospital of Medical University of Lodz, Łódź, Poland
| | - Lucia Marinucci
- Division of Cardiology, AziendaOspedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | | | - Gennaro Galasso
- Division of Cardiology, Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti Trieste, Trieste, Italy
| | | | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France
| | | | - Jose Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Valencia, Spain
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio" Bolzano Ospedale "S. Maurizio",, Bolzano, Italy
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO - Carnaxide, Carnaxide, Portugal
| | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | | | | | - Ylitalo Antti
- Division of Cardiology, Heart Centre Turku, Turku, Finland
| | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | | | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Saarbrücken, Germany
| | | | - Giuseppe Uccello
- Division of Cardiology, Ospedale "A. Manzoni" Lecco, Lecco, Italy
| | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | | | - Bor Wilbert
- Division of Cardiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Raul Moreno
- Division of Cardiology, Hospital la Paz, Madrid, Spain
| | - Guido Parodi
- Azienda Ospedaliero-Universitaria Sassari, Sassari, Italy
| | - Elvin Kedhi
- Division of Cardiology, St-Jan Hospital, Brugge, Belgium
| | - Monica Verdoia
- Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy.,Division of Cardiology, Ospedale degli Infermi, ASL Biella, Ponderano, Italy
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21
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De Luca G, Verdoia M, Cercek M, Jensen LO, Vavlukis M, Calmac L, Johnson T, Ferrer GR, Ganyukov V, Wojakowski W, Kinnaird T, van Birgelen C, Cottin Y, IJsselmuiden A, Tuccillo B, Versaci F, Royaards KJ, Berg JT, Laine M, Dirksen M, Siviglia M, Casella G, Kala P, Díez Gil JL, Banning A, Becerra V, De Simone C, Santucci A, Carrillo X, Scoccia A, Amoroso G, Lux A, Kovarnik T, Davlouros P, Mehilli J, Gabrielli G, Rios XF, Bakraceski N, Levesque S, Cirrincione G, Guiducci V, Kidawa M, Spedicato L, Marinucci L, Ludman P, Zilio F, Galasso G, Fabris E, Menichelli M, Garcia-Touchard A, Manzo S, Caiazzo G, Moreu J, Forés JS, Donazzan L, Vignali L, Teles R, Benit E, Agostoni P, Bosa Ojeda F, Lehtola H, Camacho-Freiere S, Kraaijeveld A, Antti Y, Boccalatte M, Deharo P, Martínez-Luengas IL, Scheller B, Alexopoulos D, Moreno R, Kedhi E, Uccello G, Faurie B, Gutierrez Barrios A, Di Uccio FS, Wilbert B, Smits P, Cortese G, Parodi G, Dudek D. Impact of COVID-19 Pandemic on Mechanical Reperfusion for Patients With STEMI. J Am Coll Cardiol 2020; 76:2321-2330. [PMID: 33183506 PMCID: PMC7834750 DOI: 10.1016/j.jacc.2020.09.546] [Citation(s) in RCA: 134] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/24/2023]
Abstract
Background The fear of contagion during the coronavirus disease-2019 (COVID-19) pandemic may have potentially refrained patients with ST-segment elevation myocardial infarction (STEMI) from accessing the emergency system, with subsequent impact on mortality. Objectives The ISACS-STEMI COVID-19 registry aims to estimate the true impact of the COVID-19 pandemic on the treatment and outcome of patients with STEMI treated by primary percutaneous coronary intervention (PPCI), with identification of “at-risk” patient cohorts for failure to present or delays to treatment. Methods This retrospective registry was performed in European high-volume PPCI centers and assessed patients with STEMI treated with PPPCI in March/April 2019 and 2020. Main outcomes are the incidences of PPCI, delayed treatment, and in-hospital mortality. Results A total of 6,609 patients underwent PPCI in 77 centers, located in 18 countries. In 2020, during the pandemic, there was a significant reduction in PPCI as compared with 2019 (incidence rate ratio: 0.811; 95% confidence interval: 0.78 to 0.84; p < 0.0001). The heterogeneity among centers was not related to the incidence of death due to COVID-19. A significant interaction was observed for patients with arterial hypertension, who were less frequently admitted in 2020 than in 2019. Furthermore, the pandemic was associated with a significant increase in door-to-balloon and total ischemia times, which may have contributed to the higher mortality during the pandemic. Conclusions The COVID-19 pandemic had significant impact on the treatment of patients with STEMI, with a 19% reduction in PPCI procedures, especially among patients suffering from hypertension, and a longer delay to treatment, which may have contributed to the increased mortality during the pandemic. (Primary Angioplasty for STEMI During COVID-19 Pandemic [ISACS-STEMI COVID-19] Registry; NCT04412655).
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Affiliation(s)
- Giuseppe De Luca
- Division of Cardiology, Azienda Ospedaliero-Universitaria Maggiore della Carità, Università del Piemonte Orientale, Novara, Italy.
| | - Monica Verdoia
- Division of Cardiology, Ospedale degli Infermi, ASL Biella, Biella, Italy
| | - Miha Cercek
- Centre for Intensive Internal Medicine, University Medical Centre, Ljubljana, Slovenia
| | | | - Marija Vavlukis
- University Clinic for Cardiology, Medical Faculty, Ss' Cyril and Methodius University, Skopje, North Macedonia
| | - Lucian Calmac
- Clinic Emergency Hospital of Bucharest, Bucharest, Romania
| | - Tom Johnson
- Division of Cardiology, Bristol Heart Institute, University Hospitals Bristol NHSFT & University of Bristol, Bristol, United Kingdom
| | - Gerard Rourai Ferrer
- Interventional Cardiology Unit, Heart Disease Institute, Hospital Universitari de Bellvitge, Barcelona, Spain
| | - Vladimir Ganyukov
- Division of Cardiology, State Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Kemerovo, Russia
| | - Wojtek Wojakowski
- Division of Cardiology, Medical University of Silezia, Katowice, Poland
| | - Tim Kinnaird
- Division of Cardiology, University Hospital of Wales, Cardiff, United Kingdom
| | - Clemens van Birgelen
- Department of Cardiology, Medisch Spectrum Twente, Thoraxcentrum Twente, Enschede, the Netherlands
| | - Yves Cottin
- Division of Cardiology, University Hospital, Dijon, France
| | | | | | | | - Kees-Jan Royaards
- Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Jurrien Ten Berg
- Division of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Mika Laine
- Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
| | - Maurits Dirksen
- Division of Cardiology, Northwest Clinics, Alkmaar, the Netherlands
| | - Massimo Siviglia
- Division of Cardiology, Ospedali Riuniti, Reggio Calabria, Italy
| | - Gianni Casella
- Division of Cardiology, Ospedale Maggiore, Bologna, Italy
| | - Petr Kala
- University Hospital Brno, Medical Faculty of Masaryk University Brno, Czech Republic
| | | | | | - Victor Becerra
- Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain
| | - Ciro De Simone
- Division of Cardiology, Clinica Villa dei Fiori, Acerra, Italy
| | | | | | | | | | - Arpad Lux
- Mastricht University Medical Center, Maastricht, the Netherlands
| | | | - Periklis Davlouros
- Invasive Cardiology and Congenital Heart Disease, Patras University Hospital, Patras, Greece
| | - Julinda Mehilli
- University Hospital Munich, Ludwig-Maximilians University, Munich, Germany
| | - Gabriele Gabrielli
- Interventional Cardiology Unit, Azienda Ospedaliero Universitaria "Ospedali Riuniti", Ancona, Italy
| | | | | | - Sébastien Levesque
- Center Hospitalier Universitaire de Poitiers, Poitiers, University Hospital, Poitiers, France
| | | | | | - Michał Kidawa
- Central Hospital of Medical University of Lodz, Lodz, Poland
| | - Leonardo Spedicato
- Division of Cardiology, Ospedale "Santa Maria della Misericordia", Udine, Italy
| | - Lucia Marinucci
- Division of Cardiology, Azienda Ospedaliera "Ospedali Riuniti Marche Nord", Pesaro, Italy
| | - Peter Ludman
- University Hospital Birmingham, Birmingham, United Kingdom
| | | | - Gennaro Galasso
- Division of Cardiology,Ospedale San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Enrico Fabris
- Azienda Ospedaliero - Universitaria Ospedali Riuniti, Trieste, Italy
| | | | | | - Stephane Manzo
- Division of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France
| | | | - Jose Moreu
- Division of Cardiology, Complejo Hospitalario de Toledo, Toledo, Spain
| | - Juan Sanchis Forés
- Division of Cardiology, Hospital Clinico Universitario de Valencia, Spain
| | - Luca Donazzan
- Division of Cardiology, Ospedale "S. Maurizio" Bolzano Ospedale "S. Maurizio" Bolzano, Italy
| | - Luigi Vignali
- Interventional Cardiology Unit, Azienda Ospedaliera Sanitaria, Parma, Italy
| | - Rui Teles
- Division of Cardiology, Hospital de Santa Cruz, CHLO - Carnaxide, Lisbon, Portugal
| | - Edouard Benit
- Division of Cardiology, Jessa Ziekenhuis, Hasselt, Belgium
| | | | - Francisco Bosa Ojeda
- Division of Cardiology, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Heidi Lehtola
- Division of Cardiology, Oulu University Hospital, Oulu, Finland
| | | | | | - Ylitalo Antti
- Division of Cardiology, Heart Centre, Turku, University Hospital, Turku, Finland
| | - Marco Boccalatte
- Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy
| | - Pierre Deharo
- Division of Cardiology, CHU Timone, Aix-Marseille Université, Marseille, France
| | | | - Bruno Scheller
- Division of Cardiology, Clinical and Experimental Interventional Cardiology, University of Saarland, Homburg, Germany
| | | | - Raul Moreno
- Division of Cardiology, Hospital la Paz, Madrid, Spain
| | - Elvin Kedhi
- Division of Cardiology, St-Jan Hospital, Brugge, Belgium
| | | | - Benjamin Faurie
- Division of Cardiology, Groupe Hospitalier Mutualiste de Grenoble, Grenoble, France
| | | | | | - Bor Wilbert
- Division of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Pieter Smits
- Division of Cardiology, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Giuliana Cortese
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Guido Parodi
- Azienda Ospedaliero-Universitaria Sassari, Sassari, Italy
| | - Dariusz Dudek
- Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland
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Kovarnik T, Matsuo H, Jerabek S, Kawase Y, Omori H, Tanigaki T, Zemanek D, Kral A, Pudil J, Vodzinska A, Branny M, Kala P, Mendiz O, Mates M, Mrozek J. Coronary flow reserve can explain some of FFR and iFR discrepancies. Results from international, multicenter and prospective trial. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The trial collected prospective data from physiology measurements of borderline lesions in five Czech, one Japan and one Argentinian cathlabs. The main purposes were to analyze diagnostic agreement between FFR (fractional flow reserve) and iFR (instantaneous wave free ratio) examinations and to find possible explanations for discrepant results.
Methods
FFR and iFR examinations were analyzed using Philips-Volcano console and coronary flow reserve (CFR) was analyzed by using Combomap machine Philips-Volcano. Hyperemia for FFR and CFR measurements was induced by intracoronary administration of adenosine. We used CFR as a truth for comparison between FFR and iFR, because CFR has higher impact on patients prognosis than pressures indices.
Results
Data were collected from February 2016 to June 2019 and the database includes 1.789 examinations from 1.492 patients (282 of them, 15.8%, with ACS). CFR were measured in 343 lesions in 293 patients. (ACS 31.2%). Overall correlation between FFR and iFR is high (R=0.86 p<0.0001). The FFR/iFR discrepancy occurred in 84 measurements (24.5%), more frequently it was FFRp (positive) / iFRn (negative) type of discrepancy (65, 18.9%) compare to FFRn/iFRp (19, 5.5%) one. There was no difference in occurrence of FFR/iFR discrepancy in stable patients and ACS ones (25.1%vs. 22.4%, p=0.59). The CFR correlated better with iFR than with FFR (R=0.56, p<0.0001 vs. R= 0.36, p<0.0001) (see table). In lesions with FFRp/iFRn type of discrepancy we found substantially higher CFR value compared to FFR/iFR agreement group (2.4±0.7 vs. 1.5±0.5, p<0.0001). Unlike to FFRn/iFRp discrepancy, where CFR value was similar with agreement group (1.4±0.1 vs. 1.5±0.1, p=0.25)
Conclusion
The FFR/iFR discrepancy occurred in almost one quarter of examinations. Correlation between CFR and iFR is better than between CFR and FFR. High flow is probably one of the main reason for FFRp/iFRn type of discrepancy.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): Czech Health Research Council
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Affiliation(s)
- T Kovarnik
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | | | - S Jerabek
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | | | - H Omori
- Gifu Heart Center, Gifu, Japan
| | | | - D Zemanek
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | - A Kral
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | - J Pudil
- First Faculty of Medicine and General Teaching Hospital, Prague, Czechia
| | | | - M Branny
- University Hospital Ostrava, Ostrava, Czechia
| | - P Kala
- Masaryk University, Brno, Czechia
| | - O Mendiz
- Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - M Mates
- Na Homolce Hospital, Prague, Czechia
| | - J Mrozek
- University Hospital Ostrava, Ostrava, Czechia
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Simek S, Kral A, Kovarnik T, Zemanek D, Anger Z, Lubanda JC, Linhart A. Do the ESC guidelines improve the treatment of acute myocardial infarction due to acute circumflex artery occlusion? Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The left circumflex artery (LCX) and its branches are less often recognized as infarct related artery (IRA) in STEMI compared to NSTEMI patients because of lower ability to detect posterior AMI on 12leads ECG. Significant proportion of patients with acute LCX occlusion therefore did not receive immediate reperfusion therapy. The recent ESC guidelines recommendation of immediate coronary angiography for NSTEMI with ongoing ischemia should change the situation.
Objectives
To estimate the change in proportion of patients receiving immediate reperfusion therapy for acute LCX occlusion within last 20 years.
Methods
Prospective registry of patients with acute coronary syndromes treated in the cardiac centre. The group of patients treated with direct PCI as STEMI and the group of patients treated as NSTE ACS were compared.
Results
Of 369 STEMI patients treated with primary PCI in 1995–2000, the LCX was recognized as IRA in only 29 (8%) patients. In the group of 809 STEMI patients treated in period 2008–2011, the LCX was detected as IRA in 133 (16%). In he recent group of 1006 patients treated as STEMI in period 2016–2019 the LCX was IRA in 166 (16.5%) patients. LAD, LM and RCA were detected as IRA in 407 (40.5%), 17 (1.7%) and 415 (41%) patients respectively. In the parallel group of 1087 NSTE-ACS patients the proportion of LCX, LAD, LM and RCA as culprit artery was 271 (25%), 438 (40%), 52 (5%) and 326 (30%) respectively. The difference of LCX involvement in STEMI (16%) compared to NSTE-ACS patients (25%) was highly significant (p<0,001).
Conclusion
The disproportion of LCX involvement among the patients with STEMI and NSTE-ACS is not decreasing in the course of last 10 years. Our data show that still significant part of patients with acute LCX occlusion are diagnosed as having NSTE-ACS and are not treated with adequate immediate reperfusion. So even in recent era of modern reperfusion therapy these patients which mostly suffer posterior AMIs have a lower chance to receive the proper treatment in our region. The new ESC guidelines did not change this fading yet. Better diagnostics of AMI due to the acute LCX occlusion (including 15 leads ECG) is routinely needed or every suspected NSTEMI patient should undergo the acute coronary angiogram as he would be a STEMI patient.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- S Simek
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - A Kral
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - T Kovarnik
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - D Zemanek
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - Z Anger
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - J.-C Lubanda
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
| | - A Linhart
- 2nd Med. Dep. of Cardiology, Charles University in Prague, First Faculty of Medicine, Prague, Czechia
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24
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Jerabek S, Zemanek D, Pudil J, Bayerova K, Kral A, Kopriva K, Kawase Y, Omori H, Tanigaki T, Chen Z, Vodzinska A, Branny M, Matsuo H, Mates M, Sonka M, Kovarnik T. Endothelial dysfunction assessed by digital tonometry and discrepancy between fraction flow reserve and instantaneous wave free ratio. Acta Cardiol 2020; 75:323-328. [PMID: 30945607 DOI: 10.1080/00015385.2019.1586089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background: We tested whether the level of endothelial dysfunction assessed by digital tonometry, and expressed as reactive hyperemia index (RHI), is related to occurrences of a discrepancy between fractional flow reserve (FFR) and the instantaneous wave free ratio (iFR) (ClinicalTrials.gov identifier: NCT03033810).Methods: We examined patients with coronary stenosis in the range of 40-70%, assessed by both FFR and iFR (system Philips-Volcano) for stable angina. We included consecutive patients with FFR and iFR in one native coronary artery, and who had had no previous intervention.Results: We included 138 patients. Out of those, 24 patients (17.4%) had a negative FFR (with an FFR value >0.8) and positive iFR (with a iFR value ≤0.89) - designated the FFRn/iFRp discrepancy group, and 22 patients (15.9%) had a positive FFR (≤0.8) and negative iFR (>0.89) - designated the FFRp/iFRn discrepancy. RHI was higher in the discrepancy groups compared the group without discrepancy (1.73 ± 0.79 vs. 1.48 ± 0.50, p = 0.025). However, this finding was not confirmed in multivariant logistic regression analyses. Patients with any type of discrepancy differed from the agreement group by having a higher occurrence of diabetes mellitus [9 patients (21.4%) vs. 36 patients (39.6%), p = 0.029], active smoking (23 patients or 54.8% vs. 26 patients or 28.6%, p = 0.003) and lower use of calcium channel blockers (9 patients, 21.4%, vs. 43 patients, 46.7%, p = 0.004).Conclusion: The presence of endothelial dysfunction can be associated with a discrepancy in FFR/iFR. However, RHI correlated with risk factors of atherosclerosis, not with FFR or iFR.
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Affiliation(s)
- Stepan Jerabek
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - David Zemanek
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Pudil
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Kristyna Bayerova
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Ales Kral
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Karel Kopriva
- Cardiology Department, Homolka Hospital, Prague, Czech Republic
| | | | | | | | - Zhi Chen
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | | | - Marian Branny
- Cardiology Department, Trinec Podlesi Hospital, Trinec, Czech Republic
| | | | - Martin Mates
- Cardiology Department, Homolka Hospital, Prague, Czech Republic
| | - Milan Sonka
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Tomas Kovarnik
- 2nd Department of Medicine – Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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25
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Weber JR, Martin B, Kassis N, Shah K, Kovarnik T, Mattix-Kramer H, Lopez JJ. An optical coherence tomography comparison of coronary arterial plaque calcification in patients with end-stage renal disease and diabetes mellitus. Diab Vasc Dis Res 2020; 17:1479164120958425. [PMID: 32981349 PMCID: PMC7919205 DOI: 10.1177/1479164120958425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Coronary arterial plaques in patients with end-stage renal disease (ESRD) are assumed to have increased calcification due to underlying renal disease or initiation of dialysis. This relationship may be confounded by comorbid type 2 diabetes mellitus (DM). METHODS From a single-center OCT registry, 60 patients were analyzed. Twenty patients with ESRD and diabetes (ESRD-DM) were compared to 2 groups of non-ESRD patients: 20 with and 20 without diabetes. In each patient, one 20 mm segment within the culprit vessel was analyzed. RESULTS ESRD-DM patients exhibited similar calcium burden, arc, and area compared to patients with diabetes alone. When compared to patients without diabetes, patients with diabetes exhibited a greater summed area of calcium (DM: Median 9.0, IQR [5.3-28] mm2 vs Non-DM: 3.5 [0.1-14] mm2, p = 0.04) and larger calcium deposits by arc (DM: Mean 45 ± SE 6.2° vs Non-DM: 21 ± 6.2°, p = 0.01) and area (DM: 0.58 ± 0.10 mm2 vs Non-DM: 0.26 ± 0.10 mm2, p = 0.03). Calcification deposits in ESRD-DM patients (0.14 ± 0.02 mm) and patients with diabetes (0.14 ± 0.02 mm) were more superficially located relative to patients without diabetes (0.21 ± 0.02 mm), p = 0.01 for both. CONCLUSIONS Coronary calcification in DM and ESRD-DM groups exhibited similar burden, deposit size, and depth within the arterial wall. The increase in coronary calcification and cardiovascular disease events seen in ESRD-DM patients may not be secondary to ESRD and dialysis, but instead due to a combination of declining renal function and diabetes.
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Affiliation(s)
- Joseph R Weber
- Department of Medicine, Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Brendan Martin
- Department of Medicine, Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Nicholas Kassis
- Department of Medicine, Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Kunal Shah
- Department of Medicine, Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Tomas Kovarnik
- 2nd Department of Internal Medicine and Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Holly Mattix-Kramer
- Department of Health Sciences and Department of Medicine, Division of Nephrology and Hypertension, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - John J Lopez
- Department of Medicine, Division of Cardiology, Loyola University Chicago Stritch School of Medicine, Loyola University Medical Center, Maywood, IL, USA
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26
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Pazdernik M, Hubacek J, Wohlfahrt P, Kautzner J, Melenovsky V, Stiavnicky P, Carna Z, Karmazin V, Kovarnik T, Bedanova H, Wahle A, Chen Z, Sonka M. Role of Genetics in Development of Cardiac Allograft Vasculopathy. J Heart Lung Transplant 2020. [DOI: 10.1016/j.healun.2020.01.1293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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27
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Pazdernik M, Wichterle D, Chen Z, Bedanova H, Kautzner J, Melenovsky V, Karmazin V, Malek I, Stiavnicky P, Tomasek A, Ozabalova E, Krejci J, Wahle A, Zhang H, Kovarnik T, Sonka M. Heart rate and early progression of cardiac allograft vasculopathy: A prospective study using highly automated 3-D optical coherence tomography analysis. Clin Transplant 2019; 34:e13773. [PMID: 31859379 DOI: 10.1111/ctr.13773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 12/11/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Heart rate slowing agents are frequently prescribed to manage heart transplant (HTx) patients with the assumption that higher heart rate is a risk factor in cardiovascular disease. PATIENTS AND METHODS This prospective two-center study investigated early progression of cardiac allograft vasculopathy (CAV) in 116 HTx patients. Examinations by coronary optical coherence tomography and 24-hour ambulatory ECG monitoring were performed both at baseline (1 month after HTx) and during follow-up (12 months after HTx). RESULTS During the first post-HTx year, we observed a significant reduction in the mean coronary luminal area from 9.0 ± 2.5 to 8.0 ± 2.4 mm2 (P < .001), and progression in mean intimal thickness (IT) from 106.5 ± 40.4 to 130.1 ± 53.0 µm (P < .001). No significant relationship was observed between baseline and follow-up mean heart rates and IT progression (R = .02, P = .83; R = -.13, P = .18). We found a mild inverse association between beta-blocker dosage at 12 months and IT progression (R = -.20, P = .035). CONCLUSION Our study did not confirm a direct association between mean heart rate and progression of CAV. The role of beta blockers warrants further investigation, with our results indicating that they may play a protective role in early CAV development.
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Affiliation(s)
- Michal Pazdernik
- Department of Cardiology, IKEM, Prague, Czech Republic.,Department of Cardiology, 2nd Medical School, Charles University, University Hospital Motol, Prague, Czech Republic
| | - Dan Wichterle
- Department of Cardiology, IKEM, Prague, Czech Republic.,2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Zhi Chen
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Helena Bedanova
- Cardiovascular and Transplantation Surgery, Brno, Czech Republic
| | | | | | | | - Ivan Malek
- Department of Cardiology, IKEM, Prague, Czech Republic
| | | | - Ales Tomasek
- Cardiovascular and Transplantation Surgery, Brno, Czech Republic
| | - Eva Ozabalova
- Department of Cardiovascular Diseases, St. Anne's University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - Jan Krejci
- Department of Cardiovascular Diseases, St. Anne's University Hospital and Masaryk University Brno, Brno, Czech Republic
| | - Andreas Wahle
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Honghai Zhang
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Tomas Kovarnik
- Department of Cardiology, IKEM, Prague, Czech Republic.,2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Milan Sonka
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
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28
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Pazdernik M, Wichterle D, Chen Z, Zhang H, Wahle A, Kautzner J, Melenovsky V, Malek I, Karmazin V, Bedanova H, Ozabalova E, Tomasek A, Kovarnik T, Sonka M. Effect of Heart Rate on Early Progression of Cardiac Allograft Vasculopathy: A Prospective Study Using Highly Automated 3-D Optical Coherence Tomography Analysis. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.708] [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] Open
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29
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Kassis N, Kovarnik T, Weber J, Martin B, Chen Z, Wahle A, Sonka M, Lopez JJ. OPTICAL COHERENCE TOMOGRAPHY-BASED PREDICTORS OF CORONARY PLAQUE PROGRESSION USING VALIDATED, AUTOMATED COMPUTATIONAL METHODOLOGY. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)31911-4] [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: 11/28/2022]
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30
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Abstract
BACKGROUND The only indication for coronary revascularization is elimination of ischaemia. Invasive hemodynamic methods (fractional flow reserve - FFR and instantaneous wave-free ratio (iFR) are superior to coronary angiography in detection of lesions causing myocardial ischaemia. Current European guidelines for myocardial revascularization recommend using of FFR for detection of functional assessment of lesions severity in category IA and number of these procedures increases. However, routine usage of these methods requires knowledge of technical requirements and limitations. AIM The aim of the study is to summarise good clinical practice for FFR and iFR measurements with explanation of possible technical challenges, that are necessary for increasing of measurement accuracy. CONCLUSIONS Authors describe frequent technical mistakes and malpractice during invasive assessment of lesion severity in coronary arteries.
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Affiliation(s)
- Stepan Jerabek
- 2nd Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic
| | - Tomas Kovarnik
- 2nd Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic
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31
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Chen Z, Pazdernik M, Zhang H, Wahle A, Guo Z, Bedanova H, Kautzner J, Melenovsky V, Kovarnik T, Sonka M. Quantitative 3D Analysis of Coronary Wall Morphology in Heart Transplant Patients: OCT-Assessed Cardiac Allograft Vasculopathy Progression. Med Image Anal 2018; 50:95-105. [PMID: 30253306 PMCID: PMC6237624 DOI: 10.1016/j.media.2018.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 07/26/2018] [Accepted: 09/05/2018] [Indexed: 01/25/2023]
Abstract
Cardiac allograft vasculopathy (CAV) accounts for about 30% of all heart-transplant (HTx) patient deaths. For patients at high risk for CAV complications after HTx, therapy must be initiated early to be effective. Therefore, new phenotyping approaches are needed to identify such HTx patients at the earliest possible time. Coronary optical coherence tomography (OCT) images were acquired from 50 HTx patients 1 and 12 months after HTx. Quantitative analysis of coronary wall morphology used LOGISMOS segmentation strategy to simultaneously identify three wall-layer surfaces for the entire pullback length in 3D: luminal, outer intimal, and outer medial surfaces. To quantify changes of coronary wall morphology between 1 and 12 months after HTx, the two pullbacks were mutually co-registered. Validation of layer thickness measurements showed high accuracy of performed layer analyses with layer thickness measures correlating well with manually-defined independent standard (Rautomated2 = 0.93, y=1.0x-6.2μm), average intimal+medial thickness errors were 4.98 ± 31.24 µm, comparable with inter-observer variability. Quantitative indices of coronary wall morphology 1 month and 12 months after HTx showed significant local as well as regional changes associated with CAV progression. Some of the newly available fully-3D baseline indices (intimal layer brightness, medial layer brightness, medial thickness, and intimal+medial thickness) were associated with CAV-related progression of intimal thickness showing promise of identifying patients subjected to rapid intimal thickening at 12 months after HTx from OCT-image data obtained just 1 month after HTx. Our approach allows quantification of location-specific alterations of coronary wall morphology over time and is sensitive even to very small changes of wall layer thicknesses that occur in patients following heart transplant.
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Affiliation(s)
- Zhi Chen
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA 52242, USA
| | - Michal Pazdernik
- Institute of Clinical and Experimental Medicine (IKEM) in Prague, Czech Republic
| | - Honghai Zhang
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA 52242, USA
| | - Andreas Wahle
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA 52242, USA
| | - Zhihui Guo
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA 52242, USA
| | - Helena Bedanova
- Cardiovascular and Transplantation Surgery Center, Department of Cardiovascular Diseases, St. Annes University Hospital and Masaryk University Brno, Czech Republic
| | - Josef Kautzner
- Institute of Clinical and Experimental Medicine (IKEM) in Prague, Czech Republic
| | - Vojtech Melenovsky
- Institute of Clinical and Experimental Medicine (IKEM) in Prague, Czech Republic
| | - Tomas Kovarnik
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague & General University Hospital in Prague, Czech Republic
| | - Milan Sonka
- Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA 52242, USA.
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32
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Kovarnik T, Navratil M, Belohlavek J, Mlcek M, Chval M, Chen Z, Jerabek S, Kittnar O, Linhart A. Validation of new marker of fluid responsiveness based on Doppler assessment of blood flow velocity in superior vena cava in mechanically ventilated pigs. Intensive Care Med Exp 2018; 6:36. [PMID: 30251225 PMCID: PMC6153205 DOI: 10.1186/s40635-018-0199-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 09/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We studied a novel approach for the evaluation and management of volemia: minimally invasive monitoring of respiratory blood flow variations in the superior vena cava (SVC). We performed an experiment with 10 crossbred (Landrace × large white) female pigs (Sus scrofa domestica). METHODS Hypovolemia was induced by bleeding from a femoral artery, in six stages. This was followed by blood return and then an infusion of 1000 ml saline, resulting in hypervolemia. Flow in the SVC was measured by Flowire (Volcano corp., USA), located in a distal channel of a triple-lumen central venous catheter. The key parameters measured were venous return variation index (VRV)-a new index for fluid responsiveness, calculated from the maximal and minimal velocity time intervals during controlled ventilation-and systolic peak velocity (defined as peak velocity of a systolic wave using the final end-expiratory beat). A Swan-Ganz catheter (Edwards Lifesciences, USA) was introduced into the pulmonary artery to measure pulmonary arterial pressure, pulmonary capillary wedge pressure, and continuous cardiac output measurements, using the Vigilance monitor (Edwards Lifesciences, USA). RESULTS We analyzed 44 VRV index measurements during defined hemodynamic status events. The curves of VRV indexes for volume responders and volume non-responders intersected at a VRV value of 27, with 10% false negativity and 2% false positivity. We compared the accuracy of VRV and pulse pressure variations (PPV) for separation of fluid responders and fluid non-responders using receiver operating characteristic (ROC) curves. VRV was better (AUCROC 0.96) than PPV (AUCROC 0.85) for identification of fluid responders. The VRV index exhibited the highest relative change during both hypovolemia and hypervolemia, compared to standard hemodynamic measurement. CONCLUSIONS The VRV index provides a real-time method for continuous assessment of fluid responsiveness. It combines the advantages of echocardiography-based methods with a direct and continuous assessment of right ventricular filling during mechanical ventilation.
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Affiliation(s)
- Tomas Kovarnik
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic. .,II. interni klinika VFN a 1.LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic.
| | - Miroslav Navratil
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Jan Belohlavek
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Mikulas Mlcek
- Department of Physiology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Martin Chval
- Institute for Research and Development of Education, Faculty of Education, Charles University in Prague, Prague, Czech Republic
| | - Zhi Chen
- Department of Electrical and Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Stepan Jerabek
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - Otomar Kittnar
- Department of Physiology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Ales Linhart
- 2nd Department of Internal Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
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Pazdernik M, Chen Z, Bedanova H, Kautzner J, Melenovsky V, Karmazin V, Malek I, Tomasek A, Ozabalova E, Krejci J, Franekova J, Wahle A, Zhang H, Kovarnik T, Sonka M. Early detection of cardiac allograft vasculopathy using highly automated 3-dimensional optical coherence tomography analysis. J Heart Lung Transplant 2018; 37:992-1000. [DOI: 10.1016/j.healun.2018.04.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 03/08/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022] Open
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Hong N, Lee YH, Tsujita K, Gonzalez JA, Kramer CM, Kovarnik T, Kouvelos GN, Suzuki H, Han K, Lee CJ, Park SH, Lee BW, Cha BS, Kang ES. Comparison of the Effects of Ezetimibe-Statin Combination Therapy on Major Adverse Cardiovascular Events in Patients with and without Diabetes: A Meta-Analysis. Endocrinol Metab (Seoul) 2018; 33:219-227. [PMID: 29766679 PMCID: PMC6021322 DOI: 10.3803/enm.2018.33.2.219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/03/2018] [Accepted: 02/22/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Ezetimibe-statin combination therapy has been found to reduce low density lipoprotein cholesterol levels and the risk of major adverse cardiovascular events (MACEs) in large trials. We sought to examine the differential effect of ezetimibe on MACEs when added to statins according to the presence of diabetes. METHODS Randomized clinical trials with a sample size of at least 50 participants and at least 24 weeks of follow-up that compared ezetimibe-statin combination therapy with a statin- or placebo-controlled arm and reported at least one MACE, stratified by diabetes status, were included in the meta-analysis and meta-regression. RESULTS A total of seven trials with 28,191 enrolled patients (mean age, 63.6 years; 75.1% men; 7,298 with diabetes [25.9%]; mean follow-up, 5 years) were analysed. MACEs stratified by diabetes were obtained from the published data (two trials) or through direct contact (five trials). No significant heterogeneity was observed among studies (I²=14.7%, P=0.293). Ezetimibe was associated with a greater reduction of MACE risk in subjects with diabetes than in those without diabetes (pooled relative risk, 0.84 vs. 0.93; P(heterogeneity)=0.012). In the meta-regression analysis, the presence of diabetes was associated with a greater reduction of MACE risk when ezetimibe was added to statins (β=0.87, P=0.038). CONCLUSION Ezetimibe-statin combination therapy was associated with greater cardiovascular benefits in patients with diabetes than in those without diabetes. Our findings suggest that ezetimibe-statin combination therapy might be a useful strategy in patients with diabetes at a residual risk of MACEs.
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Affiliation(s)
- Namki Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Jorge A Gonzalez
- Department of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher M Kramer
- Department of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Tomas Kovarnik
- Second Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - George N Kouvelos
- Vascular Surgery Unit, Department of Surgery, University of Ioannina, Ioannina, Greece
| | | | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute and Cardiovascular Genome Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ha Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute and Cardiovascular Genome Center, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Bong Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea.
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Pazdernik M, Chen Z, Bedanova H, Kautzner J, Melenovsky V, Karmazin V, Malek I, Tomasek A, Ozabalova E, Krejci J, Franekova J, Wahle A, Zhang H, Kovarnik T, Sonka M. Detecting Early Cardiac Allograft Vasculopathy Using Highly Automated 3D Coronary Optical Coherence Tomography Segmentation Analysis. J Heart Lung Transplant 2018. [DOI: 10.1016/j.healun.2018.01.252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhang L, Wahle A, Chen Z, Lopez JJ, Kovarnik T, Sonka M. Predicting Locations of High-Risk Plaques in Coronary Arteries in Patients Receiving Statin Therapy. IEEE Trans Med Imaging 2018; 37:151-161. [PMID: 28708548 PMCID: PMC5765985 DOI: 10.1109/tmi.2017.2725443] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Features of high-risk coronary artery plaques prone to major adverse cardiac events (MACE) were identified by intravascular ultrasound (IVUS) virtual histology (VH). These plaque features are: thin-cap fibroatheroma (TCFA), plaque burden PB ≥ 70%, or minimal luminal area MLA ≤ 4 mm2. Identification of arterial locations likely to later develop such high-risk plaques may help prevent MACE. We report a machine learning method for prediction of future high-risk coronary plaque locations and types in patients under statin therapy. Sixty-one patients with stable angina on statin therapy underwent baseline and one-year follow-up VH-IVUS non-culprit vessel examinations followed by quantitative image analysis. For each segmented and registered VH-IVUS frame pair ( ), location-specific ( mm) vascular features and demographic information at baseline were identified. Seven independent support vector machine classifiers with seven different feature subsets were trained to predict high-risk plaque types one year later. A leave-one-patient-out cross-validation was used to evaluate the prediction power of different feature subsets. The experimental results showed that our machine learning method predicted future TCFA with correctness of 85.9%, 81.7%, and 77.0% (G-mean) for baseline plaque phenotypes of TCFA, thick-cap fibroatheroma, and non-fibroatheroma, respectively. For predicting PB ≥ 70%, correctness was 80.8% for baseline PB ≥ 70% and 85.6% for 50% ≤ PB < 70%. Accuracy of predicted MLA ≤ 4 mm2 was 81.6% for baseline MLA ≤ 4 mm2 and 80.2% for 4 mm2 < MLA ≤ 6 mm2. Location-specific prediction of future high-risk coronary artery plaques is feasible through machine learning using focal vascular features and demographic variables. Our approach outperforms previously reported results and shows the importance of local factors on high-risk coronary artery plaque development.
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Kovarnik T, Chen Z, Mintz GS, Wahle A, Bayerova K, Kral A, Chval M, Kopriva K, Lopez J, Sonka M, Linhart A. Plaque volume and plaque risk profile in diabetic vs. non-diabetic patients undergoing lipid-lowering therapy: a study based on 3D intravascular ultrasound and virtual histology. Cardiovasc Diabetol 2017; 16:156. [PMID: 29212544 PMCID: PMC5719721 DOI: 10.1186/s12933-017-0637-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 11/14/2017] [Indexed: 12/17/2022] Open
Abstract
Background Coronary atherosclerosis progresses faster in patients with diabetes mellitus (DM) and causes higher morbidity and mortality in such patients compared to non-diabetics ones (non-DM). We quantify changes in plaque volume and plaque phenotype during lipid-lowering therapy in DM versus non-DM patients using advanced intracoronary imaging. Methods We analyzed data from 61 patients with stable angina pectoris included to the PREDICT trial searching for prediction of plaque changes during intensive lipid-lowering therapy (40 mg rosuvastatin daily). Geometrically correct, fully 3-D representation of the vascular wall surfaces and intravascular ultrasound virtual histology (IVUS-VH) defined tissue characterization was obtained via fusion of two-plane angiography and IVUS-VH. Frame-based indices of plaque morphology and virtual histology analyses were computed and averaged in 5 mm long baseline/follow-up registered vessel segments covering the entire length of the two sequential pullbacks (baseline, 1-year). We analyzed 698 5-mm-long segments and calculated the Liverpool active plaque score (LAPS). Results Despite reaching similar levels of LDL cholesterol (DM 2.12 ± 0.91 mmol/l, non-DM 1.8 ± 0.66 mmol/l, p = 0.21), DM patients experienced, compared to non-DM ones, higher progression of mean plaque area (0.47 ± 1.15 mm2 vs. 0.21 ± 0.97, p = 0.001), percent atheroma volume (0.7 ± 2.8% vs. − 1.4 ± 2.5%, p = 0.007), increase of LAPS (0.23 ± 1.66 vs. 0.13 ± 1.79, p = 0.018), and exhibited more locations with TCFA (Thin-Cap Fibro-Atheroma) plaque phenotype in 5 mm vessel segments (20.3% vs. 12.5%, p = 0.01). However, only non-DM patients reached significant decrease of LDL cholesterol. Plaque changes were more pronounced in PIT (pathologic intimal thickening) compared to TCFA with increased plaque area in both phenotypes in DM patients. Conclusion Based on detailed 3D analysis, we found advanced plaque phenotype and further atherosclerosis progression in DM patients despite the same reached levels of LDLc as in non-DM patients. Trial registration ClinicalTrials.gov identifier: NCT01773512
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Affiliation(s)
- Tomas Kovarnik
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic.
| | - Zhi Chen
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Gary S Mintz
- Cardiovascular Research Foundation, New York, USA
| | - Andreas Wahle
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Kristyna Bayerova
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic
| | - Ales Kral
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic
| | - Martin Chval
- Institute for Research and Development of Education, Faculty of Education, Charles University in Prague, Prague, Czech Republic
| | - Karel Kopriva
- Cardiology Department, Na Homolce Hospital, Prague, Czech Republic
| | - John Lopez
- Loyola University Stritch School of Medicine, Maywood, IL, USA
| | - Milan Sonka
- Department of Electrical & Computer Engineering and Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, IA, USA
| | - Ales Linhart
- 2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, II. interni klinika VFN a 1. LF UK, U nemocnice 2, 128 08, Praha 2, Czech Republic
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Palecek T, Kucchynka P, Kovarnik T, Zemanek D, Linhart A. P714Large inter-laboratory variability in the assessment of the presence of viral genomes in endomyocardial biopsies in patients with recently diagnosed dilated cardiomyopathy. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p714] [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: 11/13/2022] Open
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Pazdernik M, Kovarnik T, Chen Z, Wahle A, Karmazin V, Melenovsky V, Kautzner J, Tomasek A, Bedanova H, Sonka M. Increased Heart Rate After Heart Transplant Is Not Associated with Early Progression of Cardiac Allograft Vasculopathy (CAV) - A Prospective Study Using Highly Automatic Coronary Optical Coherence Tomography Segmentation Software in 3D. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1467] [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: 10/19/2022] Open
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Pazdernik M, Kovarnik T, Sonka M, Wahle A, Chen Z, Karmazin V, Kautzner J, Tomasek A, Melenovsky V, Bedanova H. Should We Pharmacologically Modulate Renin-Aldosterone-Angiotensin System (RAAS) to Attenuate Cardiac Allograft Vasculopathy? A Prospective Study Using Highly Automated Coronary Optical Coherence Tomography Segmentation Software in 3D. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.1451] [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: 10/19/2022] Open
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Osmancik P, Tousek P, Herman D, Neuzil P, Hala P, Stasek J, Haman L, Kala P, Poloczek M, Branny M, Chovancik J, Cervinka P, Holy J, Vancura V, Rokyta R, Taborsky M, Kovarnik T, Zemanek D, Peichl P, Haskova S, Jarkovsky J, Widimsky P. Interventional left atrial appendage closure vs novel anticoagulation agents in patients with atrial fibrillation indicated for long-term anticoagulation (PRAGUE-17 study). Am Heart J 2017; 183:108-114. [PMID: 27979034 DOI: 10.1016/j.ahj.2016.10.003] [Citation(s) in RCA: 37] [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] [Received: 08/30/2016] [Accepted: 10/05/2016] [Indexed: 12/15/2022]
Abstract
Atrial fibrillation (AF), with a prevalence of 1% to 2%, is the most common cardiac arrhythmia. Without antithrombotic treatment, the annual risk of a cardioembolic event is 5% to 6%. The source of a cardioembolic event is a thrombus, which is usually formed in the left atrial appendage (LAA). Prevention of cardioembolic events involves treatment with anticoagulant drugs: either vitamin K antagonists or, recently, novel oral anticoagulants (NOAC). The other (nonpharmacologic) option for the prevention of a cardioembolic event involves interventional occlusion of the LAA. OBJECTIVE To determine whether percutaneous LAA occlusion is noninferior to treatment with NOAC in AF patients indicated for long-term systemic anticoagulation. STUDY DESIGN The trial will be a prospective, multicenter, randomized noninferiority trial comparing 2 treatment strategies in moderate to high-risk AF patients (ie, patients with history of significant bleeding, or history of cardiovascular event(s), or a with CHA2DS2VASc ≥3 and HAS-BLED score ≥2). Patients will be randomized into a percutaneous LAA occlusion (group A) or a NOAC treatment (group B) in a 1:1 ratio; the randomization was done using Web-based randomization software. A total of 396 study participants (198 patients in each group) will be enrolled in the study. The primary end point will be the occurrence of any of the following events within 24months after randomization: stroke or transient ischemic attack (any type), systemic cardioembolic event, clinically significant bleeding, cardiovascular death, or a significant periprocedural or device-related complications. CONCLUSION The PRAGUE-17 trial will determine if LAA occlusion is noninferior to treatment with NOAC in moderate- to high-risk AF patients.
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Affiliation(s)
- Pavel Osmancik
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
| | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Dalibor Herman
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Petr Neuzil
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Pavel Hala
- Cardiocenter, Department of Cardiology, Na Homolce Hospital, Prague, Czech Republic
| | - Josef Stasek
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Prague, Czech Republic
| | - Ludek Haman
- 1st Department of Internal Medicine, Faculty of Medicine, University Hospital Hradec Kralove, Charles University, Prague, Czech Republic
| | - Petr Kala
- Clinic of Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Martin Poloczek
- Clinic of Cardiology, Masaryk University and University Hospital Brno, Brno, Czech Republic
| | - Marian Branny
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Jan Chovancik
- Department of Cardiology, Cardiocenter, Hospital Podlesí a.s., Trinec, Czech Republic
| | - Pavel Cervinka
- Department of Cardiology, Krajská zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Jiri Holy
- Department of Cardiology, Krajská zdravotni a.s., Masaryk Hospital and UJEP, Usti nad Labem, Czech Republic
| | - Vlastimil Vancura
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Richard Rokyta
- Department of Cardiology, University Hospital and Faculty of Medicine Pilsen, Pilsen, Czech Republic
| | - Milos Taborsky
- Cardiocenter, Department of Cardiology, University Hospital Olomouc, Czech Republic
| | - Tomas Kovarnik
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, Charles University, General Faculty Hospital, Prague, Czech Republic
| | - David Zemanek
- Cardiocenter, 2nd Internal Clinic-Cardiology and Angiology, Charles University, General Faculty Hospital, Prague, Czech Republic
| | - Petr Peichl
- Cardiocenter, Institute of Clinical and Experimental Medicine, Prague, Czech Republic
| | - Sarka Haskova
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Jiri Jarkovsky
- Institute of Biostatistics and Analyses, Masaryk University, Brno, Czech Republic
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University Prague and University Hospital Kralovske Vinohrady, Prague, Czech Republic
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Kovarnik T, Jerabek S, Chen Z, Wahle A, Zhang L, Kral A, Horak J, Sonka M, Linhart A. TCT-604 Non-invasive endothelial function assessment using digital reactive hyperemia correlates with 3D intravascular ultrasound and virtual histology derived plaque volume and plaque phenotype. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.743] [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]
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Kovarnik T, Chen Z, Wahle A, Kral A, Chval M, Kopriva K, Lopez J, Sonka M, Linhart A. TCT-96 Progression of coronary atherosclerosis despite lipid-lowering therapy in diabetic patients compared to non-dibetic ones. Study with 3D intravascular ultrasound and virtual histology. J Am Coll Cardiol 2016. [DOI: 10.1016/j.jacc.2016.09.361] [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: 12/01/2022]
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Kovarnik T, Chen Z, Wahle A, Zhang L, Skalicka H, Kral A, Lopez JJ, Horak J, Sonka M, Linhart A. Pathologic Intimal Thickening Plaque Phenotype: Not as Innocent as Previously Thought. A Serial 3D Intravascular Ultrasound Virtual Histology Study. ACTA ACUST UNITED AC 2016; 70:25-33. [PMID: 27615562 DOI: 10.1016/j.rec.2016.04.058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND OBJECTIVES Pathologic intimal thickening (PIT) has been considered a benign plaque phenotype. We report plaque phenotypic changes in a baseline/follow-up intravascular ultrasound-based virtual histology study. METHODS A total of 61 patients with stable coronary artery disease were analyzed from the HEAVEN trial (89 patients randomized between routine statin therapy vs atorvastatin 80mg and ezetimibe 10mg) with serial intravascular ultrasound imaging of nonculprit vessels. We compared changes in 693 baseline and follow-up 5-mm long segments in a novel risk score, Liverpool Active Plaque Score (LAPS), plaque parameters, and plaque composition. RESULTS The PIT showed the highest increase of risk score and, with fibrous plaque, also the LAPS. Necrotic core (NC) abutting to the lumen increased in PIT (22 ± 51.7; P = .0001) and in fibrous plaque (17.9 ± 42.6; P = .004) but decreased in thin cap fibroatheroma (TCFA) (15.14 ± 52.2; P = .001). The PIT was the most likely of all nonthin cap fibroatheroma plaque types to transform into TCFA at follow-up (11% of all TCFA found during follow-up and 35.9% of newly-developed TCFA), but showed (together with fibrous plaque) the lowest stability during lipid-lowering therapy (24.7% of PIT remained PIT and 24.5% of fibrous plaque remained fibrous plaque). CONCLUSIONS Over the 1-year follow-up, PIT was the most dynamic of the plaque phenotypes and was associated with an increase of risk score and LAPS (together with fibrous plaque), NC percentage (together with fibrous plaque) and NC abutting to the lumen, despite a small reduction of plaque volume during lipid-lowering therapy. The PIT was the main source for new TCFA segments.
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Affiliation(s)
- Tomas Kovarnik
- 2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic.
| | - Zhi Chen
- Department of Intravascular Imaging, Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, United States
| | - Andreas Wahle
- Department of Intravascular Imaging, Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, United States
| | - Ling Zhang
- Department of Intravascular Imaging, Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, United States
| | - Hana Skalicka
- 2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic
| | - Ales Kral
- 2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic
| | - John J Lopez
- Department of Invasive Cardiology, Loyola University, Stritch School of Medicine, Maywood, Illinois, United States
| | - Jan Horak
- 2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic
| | - Milan Sonka
- Department of Intravascular Imaging, Iowa Institute for Biomedical Imaging, The University of Iowa, Iowa City, United States
| | - Ales Linhart
- 2nd Department of Internal Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Praha, Czech Republic
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Kovarnik T, Jerabek S, Chen Z, Wahle A, Zhang L, Dostalova G, Skalicka H, Kral A, Horak J, Sonka M, Linhart A. Non-invasive endothelial function assessment using digital reactive hyperaemia correlates with three-dimensional intravascular ultrasound and virtual histology-derived plaque volume and plaque phenotype. Kardiol Pol 2016; 74:1485-1491. [PMID: 27160175 DOI: 10.5603/kp.a2016.0062] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/23/2016] [Accepted: 03/31/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND AIM To study relationships between endothelial dysfunction (ED) and coronary atherosclerosis derived from intravascular ultrasound (IVUS) and virtual histology (VH). METHODS Endothelial dysfunction was examined by EndoPAT system (Itamar Medical) in 56 patients who underwent IVUS and VH (Volcano corp.). Reactive hyperaemia index (RHI) < 2 was used for definition of ED. IVUS sequences were divided into 5 mm-long non-overlapping and adjacent vessel segments. Plaque phenotype was determined for each frame and 5 mm vessel segment was labeled according to highest frame score (from 0 for "no lesion" to 5 for "thin cap fibroatheroma; TCFA"). RESULTS IVUS-VH data were collected from 41 patients suitable for three-dimensional analysis. Patients with ED exhibited larger plaque burden than those without ED (0.46 ± 0.08 vs. 0.39 ± 0.07, p = 0.014), smaller lumen area (8.59 ± 2.19 vs. 11.90 ± 3.50, p = 0.016), higher plaque risk score (2.82 ± 1.18 vs. 1.84 ± 0.90, p = 0.012), and higher number of TCFA frames (0.36 ± 0.22 vs. 0.22 ± 0.16, p = 0.038). Relative amounts of fibrous tissue correlated positively with RHI (p = 0.034, r = 0.33). The numbers of fibroatheromas and calcified plaques correlated with RHI inversely (r = -0.34, p = 0.031 and r = -0.32, p = 0.044, respectively). CONCLUSIONS Endothelial dysfunction correlates with severity and phenotype of coronary lesions and can contribute to non-invasive detection of individuals with higher risk of cardiovascular events.
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Affiliation(s)
- Tomas Kovarnik
- 2nd Department of Medicine, Department of Cardiovascular Medicine, 1st Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
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Chen Z, Wahle A, Skalicka H, Kral A, Lopez J, Kovarnik T, Sonka M. EFFECT OF UPSTREAM AND DOWNSTREAM BIFURCATION PROXIMITY ON CORONARY PLAQUE CHANGES AFTER 1 YEAR USING COMPUTER AIDED INTRAVASCULAR ULTRASOUND ANALYSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)30274-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zhang L, Wahle A, Chen Z, Zhang L, Downe RW, Kovarnik T, Sonka M. Simultaneous Registration of Location and Orientation in Intravascular Ultrasound Pullbacks Pairs Via 3D Graph-Based Optimization. IEEE Trans Med Imaging 2015; 34:2550-61. [PMID: 26080381 PMCID: PMC4700818 DOI: 10.1109/tmi.2015.2444815] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A novel method is reported for simultaneous registration of location (axial direction) and orientation (circumferential direction) of two intravascular ultrasound (IVUS) pullbacks of the same vessel taken at different times. Monitoring plaque progression or regression (e.g., during lipid treatment) is of high clinical relevance. Our method uses a 3D graph optimization approach, in which the cost function jointly reflects similarity of plaque morphology and plaque/perivascular image appearance. Graph arcs incorporate prior information about temporal correspondence of the two IVUS sequences and limited angular twisting between consecutive IVUS images. Additionally, our approach automatically identifies starting and ending frame pairs in the two IVUS pullbacks. Validation of our method was performed in 29 pairs of IVUS baseline/follow-up pullback sequences consisting of 8 622 IVUS image frames in total. In comparison to manual registration by three experts, the average location and orientation registration errors ranged from 0.72 mm to 0.79 mm and from 7.3(°) to 9.3(°), respectively, all close to the inter-observer variability with no difference being statistically significant (p = NS). Rotation angles determined by our automated approach and expert observers showed high correlation (r(2) of 0.97 to 0.98) and agreed closely (mutual bias between the automated method and expert observers ranged from -1.57(°) to 0.15(°)). Compared with state-of-the-art approaches, the new method offers lower errors in both location and orientation registration. Our method offers highly automated and accurate IVUS pullback registration and can be employed in IVUS-based studies of coronary disease progression, enabling more focal studies of coronary plaque development and transition of vulnerability.
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Affiliation(s)
- Ling Zhang
- Iowa Institute for Biomedical Imaging and the Department of Electrical & Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Andreas Wahle
- Iowa Institute for Biomedical Imaging and the Department of Electrical & Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Zhi Chen
- Iowa Institute for Biomedical Imaging and the Department of Electrical & Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Li Zhang
- Iowa Institute for Biomedical Imaging and the Department of Electrical & Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Richard W. Downe
- Iowa Institute for Biomedical Imaging and the Department of Electrical & Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
| | - Tomas Kovarnik
- The 2nd Department of Internal Medicine of General University Hospital in Prague and Charles University, Prague, Czech Republic
| | - Milan Sonka
- Iowa Institute for Biomedical Imaging and the Department of Electrical & Computer Engineering, University of Iowa, Iowa City, IA 52242, USA
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Woo V, Chen Z, Hirai T, Weber JR, Kovarnik T, Wahle A, Sonka M, Lopez JJ. TCT-355 An Automated Computational Method for Quantification of Total Fibrous Cap Volume and Mean Fibrous Cap Thickness with Optical Coherence Tomography. J Am Coll Cardiol 2015. [DOI: 10.1016/j.jacc.2015.08.973] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Havranek S, Palecek T, Kovarnik T, Vitkova I, Psenicka M, Linhart A, Wichterle D. Arrhythmogenic substrate at the interventricular septum as a target site for radiofrequency catheter ablation of recurrent ventricular tachycardia in left dominant arrhythmogenic cardiomyopathy. BMC Cardiovasc Disord 2015; 15:18. [PMID: 25887693 PMCID: PMC4359501 DOI: 10.1186/s12872-015-0010-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Accepted: 02/18/2015] [Indexed: 01/24/2023] Open
Abstract
Background Left dominant arrhythmogenic cardiomyopathy (LDAC) is a rare condition characterised by progressive fibrofatty replacement of the myocardium of the left ventricle (LV) in combination with ventricular arrhythmias of LV origin. Case presentation A thirty-five-year-old male was referred for evaluation of recurrent sustained monomorphic ventricular tachycardia (VT) of 200 bpm and right bundle branch block (RBBB) morphology. Cardiac magnetic resonance imaging showed late gadolinium enhancement distributed circumferentially in the epicardial layer of the LV free wall myocardium including the rightward portion of the interventricular septum (IVS). The clinical RBBB VT was reproduced during the EP study. Ablation at an LV septum site with absence of abnormal electrograms and a suboptimum pacemap rendered the VT of clinical morphology noninducible. Three other VTs, all of left bundle branch block (LBBB) pattern, were induced by programmed electrical stimulation. The regions corresponding to abnormal electrograms were identified and ablated at the mid-to-apical RV septum and the anteroseptal portion of the right ventricular outflow tract. No abnormalities were found at the RV free wall including the inferolateral peritricuspid annulus region. Histological examination confirmed the presence of abnormal fibrous and adipose tissue with myocyte reduction in endomyocardial samples taken from both the left and right aspects of the IVS. Conclusion LDAC rarely manifests with sustained monomorphic ventricular tachycardia. In this case, several VTs of both RBBB and LBBB morphology were amenable to endocardial radiofrequency catheter ablation.
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Affiliation(s)
- Stepan Havranek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Tomas Palecek
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Tomas Kovarnik
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Ivana Vitkova
- Institute of Pathology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Studnickova 2, 128 00, Prague, Czech Republic.
| | - Miroslav Psenicka
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Ales Linhart
- 2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University and General University Hospital in Prague, U Nemocnice 2, Prague, 128 08, Czech Republic.
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine, Videnska 1958/9, Prague, 140 21, Czech Republic.
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Ručka D, Lubanda JCM, Kovarnik T, Linhart A. TCT-306 Pulse Wave Velocity and Augmentation Index are predictors of the Coronary Atherosclerosis and Impaired Cerebrovascular Reactivity. J Am Coll Cardiol 2014. [DOI: 10.1016/j.jacc.2014.07.351] [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: 11/26/2022]
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