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1.
Curr Cardiol Rep ; 23(8): 107, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34196841

RESUMO

PURPOSE OF THE REVIEW: Coronary artery disease (CAD) is a common disease globally attributable to the interplay of complex genetic and lifestyle factors. Here, we review how genomic sequencing advances have broadened the fundamental understanding of the monogenic and polygenic contributions to CAD and how these insights can be utilized, in part by creating polygenic risk estimates, for improved disease risk stratification at the individual patient level. RECENT FINDINGS: Initial studies linking premature CAD with rare familial cases of elevated blood lipids highlighted high-risk monogenic contributions, predominantly presenting as familial hypercholesterolemia (FH). More commonly CAD genetic risk is a function of multiple, higher frequency variants each imparting lower magnitude of risk, which can be combined to form polygenic risk scores (PRS) conveying significant risk to individuals at the extremes. However, gaps remain in clinical validation of PRSs, most notably in non-European populations. With improved and more broadly utilized genomic sequencing technologies, the genetic underpinnings of coronary artery disease are being unraveled. As a result, polygenic risk estimation is poised to become a widely used and powerful tool in the clinical setting. While the use of PRSs to augment current clinical risk stratification for optimization of cardiovascular disease risk by lifestyle change or therapeutic targeting is promising, we await adequately powered, prospective studies, demonstrating the clinical utility of polygenic risk estimation in practice.


Assuntos
Doença da Artéria Coronariana , Doença da Artéria Coronariana/genética , Predisposição Genética para Doença , Humanos , Herança Multifatorial/genética , Estudos Prospectivos , Fatores de Risco
2.
Medicina (Kaunas) ; 57(6)2021 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-34208175

RESUMO

Background and Objectives: Patients with AF are at increased risk for Coronary Artery Disease (CAD) owing to their shared etiologies and risk factors. This study aimed to assess the prevalence, cardiovascular risk factors, and used medications of CAD in AF patients. Materials and Methods: This retrospective, case-control study utilized data from the Jordanian Atrial Fibrillation (Jo-Fib) registry. Investigators collected clinical features, history of co-existing comorbidities, CHA2DS2-VASc, and HAS BLED scores for all AF patients aged >18 visiting 19 hospitals and 30 outpatient cardiology clinics. A multivariable binary logistic regression was used to asses for factors associated with higher odds of having CAD. Results: Out of 2000 patients with AF, 227 (11.35%) had CAD. Compared to the rest of the sample, those with CAD had significantly higher prevalence of hypertension (82.38%; p < 0.01), hypercholesterolemia (66.52%, p < 0.01), diabetes (56.83%, p < 0.01), and smoking (18.06%, p = 0.04). Patients with AF and CAD had higher use of anticoagulants/antiplatelet agents combination (p < 0.01) compared to the rest of the sample. Females had lower CAD risk than males (OR = 0.35, 95% CI: 0.24-0.50). AF Patients with dyslipidemia (OR = 2.5, 95% CI: 1.8-3.4), smoking (OR = 1.7, 95% CI: 1.1-2.6), higher CHA2DS2-VASc score (OR = 1.5, 95% CI: 1.4-1.7), and asymptomatic AF (OR = 1.9, 95% CI: 1.3-2.6) had higher risk for CAD. Conclusions: Owing to the increased prevalence of CAD in patients with AF, better control of cardiac risk factors is recommended for this special group. Future studies should investigate such interesting relationships to stratify CAD risk in AF patients. We believe that this study adds valuable information regarding the prevalence, epidemiological characteristics, and pharmacotherapy of CAD in patients with AF.


Assuntos
Fibrilação Atrial , Doença da Artéria Coronariana , Acidente Vascular Cerebral , Anticoagulantes/uso terapêutico , Fibrilação Atrial/complicações , Fibrilação Atrial/tratamento farmacológico , Fibrilação Atrial/epidemiologia , Estudos de Casos e Controles , Doença da Artéria Coronariana/tratamento farmacológico , Doença da Artéria Coronariana/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco
3.
Acta Biomed ; 92(3): e2021204, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34212905

RESUMO

Cardiovascular diseases (CVDs)  have been the most common cause of death worldwide for decades. Until recently the most affected patients were middle-aged and elderly, predominantly men, with more frequent ST elevation myocardial infarction  (STEMI) caused by obstructive coronary artery disease (CAD). However, in the last two decades we have noticed an increased incidence of ischemia with non-obstructive coronary arteries (INOCA), which includes myocardial infarction with non-obstructive coronary arteries (MINOCA) and non-myocardial infarction syndromes, such as microvascular and vasospastic angina, conditions that have been particularly pronounced in women and young adults - the population we considered low-risky till than. Therefore, it has become apparent that for this group of patients conventional methods of assessing the risk of future cardiovascular (CV) events are no longer specific and sensitive enough. Heart failure with preserved ejection fraction (HFpEF) is another disease, the incidence of which has been rising rapidly during last two decades, and predominantly affects elderly population. Although the etiology and pathophysiology of INOCA and HFpEF are complex and not fully understood, there is no doubt that the underlying cause of both conditions is endothelial dysfunction (ED) which further promotes the development of left ventricular diastolic dysfunction (LVDD). Plasma biomarkers of ED, as well as natriuretic peptides (NPs), have been intensively investigated recently, and some of them have great potential for early detection and better assessment of CV risk in the future.


Assuntos
Doença da Artéria Coronariana , Insuficiência Cardíaca , Disfunção Ventricular Esquerda , Idoso , Doença da Artéria Coronariana/etiologia , Feminino , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Volume Sistólico , Disfunção Ventricular Esquerda/etiologia
4.
Medicina (Kaunas) ; 57(6)2021 Jun 10.
Artigo em Inglês | MEDLINE | ID: mdl-34200527

RESUMO

The pathophysiology of accelerated atherosclerosis in people living with Human Immunofediciency virus (HIV) is complex. Coronary artery disease (CAD) has become an important cause of mortality in these patients. They often have atypical symptoms, leading to frequently missed diagnoses. We report a case of a 51-year-old male undergoing antiretroviral therapy who was admitted for acute coronary syndrome. He had severe coronary artery disease that involved difficult management.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Infecções por HIV , Ponte de Artéria Coronária , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Infecções por HIV/complicações , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Resultado do Tratamento
5.
BMJ Case Rep ; 14(7)2021 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-34285017

RESUMO

Rheumatic heart disease is an important cause of mortality and morbidity in developing countries, and is the leading cause of triple valve replacement. Myocardial infarction (MI) in such cases can be due to the coronary embolism from the prosthetic valves or due to atherosclerotic vascular disease. Intravascular imaging helps in delineating the cause. We present a case of a 34-year-old premenopausal woman with no conventional cardiovascular risk factors and had triple valve replacement 4 years ago and anterior wall MI with cardiogenic shock and left ventricular failure. She was managed with mechanical ventilation, thrombolysis, diuretics, double antiplatelets and anticoagulation with low molecular weight heparin. Intravascular ultrasound showed a lipid-rich plaque with associated plaque rupture and thrombosis. Intravascular imaging helps in delineating the cause of MI and further management. Atherosclerotic MI in a patient with no conventional risk factors is rare and needs to be considered.


Assuntos
Infarto Miocárdico de Parede Anterior , Doença da Artéria Coronariana , Infarto do Miocárdio , Trombose , Adulto , Feminino , Humanos , Infarto do Miocárdio/etiologia , Choque Cardiogênico
6.
Transl Psychiatry ; 11(1): 368, 2021 06 17.
Artigo em Inglês | MEDLINE | ID: mdl-34226488

RESUMO

Neuroticism is associated with poor health, cardiovascular disease (CVD) risk factors and coronary artery disease (CAD). The conditional/conjunctional false discovery rate method (cond/conjFDR) was applied to genome wide association study (GWAS) summary statistics on neuroticism (n = 432,109), CAD (n = 184,305) and 12 CVD risk factors (n = 188,577-339,224) to investigate genetic overlap between neuroticism and CAD and CVD risk factors. CondFDR analyses identified 729 genomic loci associated with neuroticism after conditioning on CAD and CVD risk factors. The conjFDR analyses revealed 345 loci jointly associated with neuroticism and CAD (n = 30), body mass index (BMI) (n = 96) or another CVD risk factor (n = 1-60). Several loci were jointly associated with neuroticism and multiple CVD risk factors. Seventeen of the shared loci with CAD and 61 of the shared loci with BMI are novel for neuroticism. 21 of 30 (70%) neuroticism risk alleles were associated with higher CAD risk. Functional analyses of the genes mapped to the shared loci implicated cell division, nuclear receptor, elastic fiber formation as well as starch and sucrose metabolism pathways. Our results indicate polygenic overlap between neuroticism and CAD and CVD risk factors, suggesting that genetic factors may partly cause the comorbidity. This gives new insight into the shared molecular genetic basis of these conditions.


Assuntos
Doenças Cardiovasculares , Doença da Artéria Coronariana , Doenças Cardiovasculares/genética , Doença da Artéria Coronariana/genética , Loci Gênicos , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Fatores de Risco de Doenças Cardíacas , Humanos , Neuroticismo , Polimorfismo de Nucleotídeo Único , Fatores de Risco
7.
BMJ Open Respir Res ; 8(1)2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34272254

RESUMO

BACKGROUND: Although several studies have reported an association between atherosclerosis-related diseases and COVID-19, the relationship between COVID-19 severity and atherosclerosis progression remains unclear. The aim of this study is to determine the coronary artery calcium score (CACS) prognostic value in patients with COVID-19 using indices such as deterioration in oxygenation and CT images of the chest. METHODS: This was a single-centre retrospective study of 53 consecutive patients with COVID-19 in Narita who were admitted to our hospital between March 2020 and August 2020. CACS was calculated based on non-gated CT scans of the chest performed on admission day. The patients were divided into the following two groups based on CACS: group 1 (CACS ≥180, n=11) and group 2 (CACS <180, n=42). Following univariate analysis of the main variables, multivariate analysis of variables that may be associated with COVID-19 progression was performed. RESULTS: Multivariable logistic regression analysis of age, sex, smoking history, diabetes, hypertension, dyslipidaemia, number of days from symptom onset to hospitalisation and CACS of ≥180 was performed. It revealed that unlike CACS of <180, CACS of ≥180 is associated with exacerbation of oxygenation or CT images of the chest during hospitalisation (OR: 12.879, 95% CI: 1.399 to 380.401). Furthermore, this model of eight variables showed good calibration (Hosmer-Lemeshow p=0.119). CONCLUSION: CACS may be a prognosis marker of COVID-19 severity. Although coronary artery calcification is not typically assessed in pneumonia cases, it may provide a valuable clinical indicator for predicting severe COVID-19 outcomes.


Assuntos
COVID-19/fisiopatologia , Doença da Artéria Coronariana/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Diabetes Mellitus/epidemiologia , Progressão da Doença , Dislipidemias/epidemiologia , Feminino , Hospitalização , Humanos , Hipertensão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prognóstico , Estudos Retrospectivos , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais , Fumar/epidemiologia , Fatores de Tempo , Tomografia Computadorizada por Raios X , Calcificação Vascular/epidemiologia
8.
Rev Bras Enferm ; 74Suppl 2(Suppl 2): e202000992, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34287500

RESUMO

OBJECTIVE: To analyze the planning and implementation of the care offered by nurses to elders with coronary disease during the hospital-house transition. METHODS: Qualitative research that used the Transitions Theory as a theoretical reference. The participants were 12 nurses who work in a hospital that specializes in cardiology, in the city of Salvador-BA. A semistructured interview was carried out from January to February 2018, and the data was analyzed using the Content Analysis technique. RESULTS: Transition care takes place on the day of discharge. The presence of the family was found to be a facilitator; low adherence, poor financial situations, the low educational levels inhibited its implementation. The rehospitalization is an indicator of the results of the transition of care. FINAL CONSIDERATIONS: The planning and implementation of transition care is not effective. It must provide safety in the management of self-care in the home of elders with coronary disease and their families.


Assuntos
Doença da Artéria Coronariana , Enfermeiras e Enfermeiros , Cuidado Transicional , Idoso , Doença da Artéria Coronariana/terapia , Humanos , Alta do Paciente , Pesquisa Qualitativa
9.
J Interv Cardiol ; 2021: 9915759, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34220369

RESUMO

Background: Treatment of coronary intermediate lesions remains a controversy, and the role of arterial remodeling patterns determined by intravascular ultrasound in intermediate lesion is still not well known. The aim of this study was to investigate the impact of arterial remodeling of intermediate coronary lesions on long-term clinical outcomes. Methods: Arterial remodeling patterns were assessed in 212 deferred intermediate lesions from 162 patients after IVUS examination. Negative, intermediate, and positive remodeling was defined as a remodeling index of <0.88, 0.88∼1.0, and >1.0, respectively. The primary endpoint was the composite vessel-oriented clinical events, defined as the composition of target vessel-related cardiac death, target vessel-related myocardial infarction, and target vessel revascularization. Quantitative flow ratio was assessed for evaluating the functional significance of intermediate lesions. Results: 72 intermediate remodeling lesions were present in 66 patients, whereas 77 negative remodeling lesions were present in 71 patients, and 63 positive remodeling lesions were present in 55 patients. Negative remodeling lesions had the smallest minimum lumen area (4.16 ± 1.03 mm2 vs. 5.05 ± 1.39 mm2 vs. 4.85 ± 1.76 mm2; P < 0.01), smallest plaque burden (63.45 ± 6.13% vs. 66.12 ± 6.82% vs. 71.17 ± 6.45%; P < 0.01), and highest area stenosis rate (59.32% ± 10.15% vs. 54.61% ± 9.09% vs. 51.67% ± 12.96%; P < 0.01). No significant difference was found in terms of quantitative flow ratio among three groups. At 5 years follow-up, negative remodeling lesions had a higher rate of composite vessel-oriented clinical event (14.3%), compared to intermediate (1.4%, P=0.004) or positive remodeling lesions (4.8%, P=0.06). After adjusting for multiple covariates, negative remodeling remained an independent determinant for vessel-oriented clinical event (HR: 4.849, 95% CI 1.542-15.251, P=0.007). Conclusion: IVUS-derived negative remodeling is associated with adverse long-term clinical outcome in stable patients with intermediate coronary artery stenosis.


Assuntos
Doença da Artéria Coronariana/epidemiologia , Vasos Coronários/diagnóstico por imagem , Infarto do Miocárdio/epidemiologia , Revascularização Miocárdica/estatística & dados numéricos , Ultrassonografia de Intervenção , Remodelação Vascular , Idoso , Velocidade do Fluxo Sanguíneo , Doença da Artéria Coronariana/terapia , Estenose Coronária/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Estudos Retrospectivos
10.
J Interv Cardiol ; 2021: 9958035, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239390

RESUMO

Intravascular lithotripsy (IVL) has been shown to be safe and effective for calcium modification in nonocclusive coronary artery disease (CAD), but there are only case reports of its use in calcified chronic total occlusions (CTO). We report data from an international multicenter registry of IVL use during CTO percutaneous coronary intervention (PCI) and provide provisional data regarding its efficacy and safety. During the study period, IVL was used in 55 of 1053 (5.2%) CTO PCI procedures. IVL was used within the occluded segment after successful CTO crossing in 53 procedures and during incomplete CTO crossing in 2 cases. The mean J-CTO score was 3.1. CTO PCI technical and procedural success was achieved in 53 (96%) and 51 (93%) cases. Six patients had a procedural complication, with 3 main vessel perforations (5%). Two had covered stent implantation, one required pericardiocentesis, and one was managed conservatively. All had combination therapy with another calcium modification device. Two patients had a procedural myocardial infarction (PMI) (4%), and two others had a major adverse cardiovascular event (MACE) (4%) at a median follow-up of 13 (4-21) months. IVL can effectively facilitate calcium modification during CTO PCI. More data are required to establish the efficacy and safety of IVL and other calcium modification devices when used extraplaque or in combination during CTO PCI.


Assuntos
Oclusão Coronária/terapia , Litotripsia/métodos , Intervenção Coronária Percutânea , Calcificação Vascular/terapia , Idoso , Doença da Artéria Coronariana/terapia , Feminino , Humanos , Complicações Intraoperatórias , Masculino , Complicações Pós-Operatórias , Sistema de Registros , Estudos Retrospectivos
11.
Cardiovasc Ther ; 2021: 5577218, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239605

RESUMO

Cellular stress response plays an important role in the pathophysiology of coronary artery disease (CAD). Inhibition of cellular stress may provide a novel clinical approach regarding the diagnosis and treatment of CAD. Fibroblasts constitute 60-70% of cardiac cells and have a crucial role in cardiovascular function. Hence, the aim of this study was to show a potential therapeutic application of proteins derived from heat-stressed fibroblast in CAD patients. Fibroblasts were isolated from the foreskin and cultured under heat stress conditions. Surprisingly, 1.06% of the cells exhibited a necrotic death pattern. Furthermore, heat-stressed fibroblasts produced higher level of total proteins than control cells. In SDS-PAGE analysis, a 70 kDa protein band was observed in stressed cell culture supernatants which appeared as two acidic spots with close pI in the two-dimensional electrophoresis. To evaluate the immunogenic properties of fibroblast-derived heat shock proteins (HSPs), the serum immunoglobulin-G (IgG) was measured by ELISA in 50 CAD patients and 50 normal subjects who had been diagnosed through angiography. Interestingly, the level of anti-HSP antibody was significantly higher in non-CAD individuals in comparison with the patient's group (p < 0.05). The odds ratio for CAD was 5.06 (95%CI = 2.15-11.91) in cut-off value of 30 AU/mL of anti-HSP antibody. Moreover, ROC analysis showed that anti-HSP antibodies had a specificity of 74% and a sensitivity of 64%, which is almost equal to 66% sensitivity of exercise stress test (EST) as a CAD diagnostic method. These data revealed that fibroblast-derived HSPs are suitable for the diagnosis and management of CAD through antibody production.


Assuntos
Doença da Artéria Coronariana/fisiopatologia , Fibroblastos/imunologia , Resposta ao Choque Térmico/imunologia , Idoso , Doença da Artéria Coronariana/sangue , Doença da Artéria Coronariana/imunologia , Ensaio de Imunoadsorção Enzimática , Feminino , Fibroblastos/fisiologia , Proteínas de Choque Térmico/biossíntese , Proteínas de Choque Térmico/imunologia , Resposta ao Choque Térmico/fisiologia , Humanos , Imunoglobulina G/sangue , Masculino , Pessoa de Meia-Idade , Razão de Chances
12.
Cardiovasc Ther ; 2021: 6660407, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34239607

RESUMO

Background: Although intravenous immunoglobulin (IVIG) is expected to prevent coronary artery abnormalities of Kawasaki disease (KD) in the acute phase, the timing and effectiveness of IVIG remain to be determined. The association of timing of IVIG administration in KD patients with coronary artery abnormalities is evaluated in this cohort study. Methods: We systematically studied KD patients from two participating institutions between 2015 and 2017. To reveal the effectiveness of IVIG treatment, these patients were classified into four groups regarding the time of IVIG treatment. Primary outcome was coronary artery abnormalities by echo at diagnosis and 12 months follow-up; secondary outcomes included inflammatory markers. Results: A total of 1281 patients were included in this study. The best time of IVIG treatment cut-off values in 12 months follow-up for predicting coronary artery abnormalities was days 7.5 of illness onset. According to the best time of IVIG treatment cut-off values, all patients were classified into 4 groups. Group 1 was defined as earlier IVIG treatment administration on days ≤4 of the illness (n = 77). Group 2 was defined with days 5-7 (n = 817), group 3 with days 8-10 (n = 249), group 4 with days >10 (n = 138). A greater proportion of IVIG-resistant KD patients were group 4 than the other three groups, and there were significant differences (p < 0.05). The incidence of coronary artery lesions (CALs) and coronary artery aneurysms (CAAs) in group 3 and group 4 was higher than that in group 1 (p < 0.05) and group 2 (p < 0.05) during a 12-month follow-up. Additionally, the incidence of CALs in group 1 was higher than that in group 2 but without statistical significance (p > 0.05). The OR was significantly higher for those who started IVIG administration more than 7 days from the onset was positively associated with the occurrence of CALs (OR, 5.3; 95% CI, 2.0-13.9) and CAAs (OR, 13.5; 95% CI, 2.9-14.1) 12 months after initial onset. Multivariate regression revealed that the timing of IVIG treatment and IVIG-resistance was independent risk factors of CALs. Conclusions: IVIG treatment less than 7 days after illness onset are found to be sufficient for preventing developing coronary artery abnormalities in KD patients. Earlier IVIG treatment administration within 4 days may not increase the higher incidence of coronary artery abnormalities and IVIG resistance (Chinese Clinical Trial Registry:ChiCTR1800015800).


Assuntos
Doença da Artéria Coronariana/epidemiologia , Imunoglobulinas Intravenosas/uso terapêutico , Síndrome de Linfonodos Mucocutâneos/tratamento farmacológico , Síndrome de Linfonodos Mucocutâneos/epidemiologia , Doença Aguda , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , Síndrome de Linfonodos Mucocutâneos/diagnóstico , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Adulto Jovem
13.
Medicina (Kaunas) ; 57(6)2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34199767

RESUMO

Background and Objectives: Tumor necrosis factor alpha (TNF-α) is proatherogenic and associated with the risk of acute ischemic events, although the mechanisms that regulate TNF-α expression in stable coronary artery disease (SCAD) are not fully understood. We investigated whether metabolic, inflammatory, and epigenetic (microRNA (miRNA)) markers are associated with TNF-α expression in SCAD. Materials and Methods: Patients with SCAD were prospectively recruited and their metabolic and inflammatory profiles were assessed. TNF-α levels were assessed using an enzyme-linked immunosorbent assay. The relative expression of six circulating miRNAs associated with the regulation of inflammation and/or atherosclerosis was determined. Results: Of the 24 included patients with the mean age of 65 (9) years, 88% were male, and 54% were diabetic. The TNF-α levels were (median (interquartile range)) 1.0 (0.7-1.1) pg/mL. The percentage of glycosylated hemoglobin (r = 0.418, p = 0.042), serum triglyceride levels (r = 0.429, p = 0.037), and C-reactive protein levels (r = 0.407, p = 0.048) were positively correlated with TNF-α levels. Of the candidate miRNAs, miR-146a expression levels were negatively correlated with TNF-α levels (as indicated by r = 0.500, p = 0.035 for correlation between delta cycle threshold (ΔCt) miR-146a and TNF-α levels). In multivariate analysis, serum triglyceride levels and miR-146a expression levels were independently associated with TNF-α levels. miR-146 expression levels were not associated with metabolic or other inflammatory parameters and were negatively correlated with the number of coronary vessels with obstructive disease (as indicated by r = 0.556, p = 0.017 for correlation between ΔCt miR-146a and number of diseased vessels). Conclusions: miR-146a expression levels were negatively correlated with TNF-α levels in patients with SCAD, irrespective of other metabolic or inflammatory markers, and with the severity of coronary artery disease. The results add to the knowledge on the role of miR-146a in TNF-α-based inflammation in SCAD and support future research on the potential therapeutic use of miR-146a in such a clinical scenario.


Assuntos
Doença da Artéria Coronariana , MicroRNAs , Idoso , Biomarcadores , Doença da Artéria Coronariana/genética , Feminino , Humanos , Inflamação , Masculino , MicroRNAs/genética , Fator de Necrose Tumoral alfa
14.
BMC Infect Dis ; 21(1): 657, 2021 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-34233630

RESUMO

BACKGROUND: HIV-positive patients are increasingly being affected by non-communicable diseases such as coronary artery disease (CAD). Data from high-income countries (HICs) indicate that HIV-positive patients have different risk-factor profiles for acute coronary syndrome (ACS) as well as different cardiac manifestations of this syndrome compared to HIV-negative patients. There is limited data from Sub-Saharan Africa (SSA), and particularly from South Africa with the biggest HIV epidemic in the world. The objective of this study was to determine the 12-month period prevalence of HIV in patients with ACS and to compare the risk-factor profile, ACS presentation and management between HIV-positive and HIV-negative adults. METHODS: We included all patients hospitalised with ACS from 01 January to 31 December 2018 in a tertiary hospital, Tygerberg Hospital, in Cape Town, South Africa. The HIV-status of all patients was determined using routine clinical records. We performed multiple conditional logistic regression on HIV-positive and HIV-negative patients (1:3 ratio) to compare the risk factor profile, ACS presentation and management between the groups. RESULTS: Among 889 patients, 30 (3.4%) were HIV-positive (95% confidence interval (CI): 2.3-4.8). HIV-positive patients were younger, more frequently men, and had a lower prevalence of medical comorbidities and a family history of CAD. They were more likely to present with ST-elevation myocardial infarction (STEMI) [odd's ratio (OR) (95% CI): 3.12 (1.2-8.4)], and have single-vessel disease [OR (95% CI): 3.03 (1.2-8.0)]. Angiographic and echocardiographic data, as well as management, did not differ between the groups. Among HIV-positive patients, 17 (65%) were virally suppressed (HIV viral load < 200 copies/mL) with a median CD4+ count of 271 cells/mm3. The majority (20, 67%) of HIV-positive patients were receiving antiretroviral therapy at the time of the ACS. CONCLUSIONS: We found an HIV-prevalence of 3.4% (95% CI 2.3-4.8) in adults with ACS in a high endemic HIV region. HIV-positive patients were younger and more likely to present with STEMIs and single-vessel disease, but had fewer CAD risk factors, suggesting additional mechanisms for the development of ACS.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Doença da Artéria Coronariana/epidemiologia , Infecções por HIV/epidemiologia , Síndrome Coronariana Aguda/terapia , Adulto , Idoso , Comorbidade , Estudos Transversais , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Fatores de Risco , África do Sul/epidemiologia
15.
Ann Palliat Med ; 10(6): 6482-6492, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237965

RESUMO

BACKGROUND: High levels of lipoprotein(a) (Lp(a)) is an independent risk factor for premature coronary heart disease (PCHD). It is also considered a residual risk for controlled low density lipoprotein cholesterol (LDL-C). Dietary control, exercise, and drugs have limited effects on the levels of Lp(a). Recently, mental health was found to be associated with lipid levels and increased risk of PCHD. However, the relationship between mental health and Lp(a) is still unknown. This study explored the association between mental health and Lp(a) levels in men with PCHD. METHODS: A retrospective, observational study was conducted. A total of 226 male patients with PCHD, aged 49.65±3.68 years, was included in this study. The control group consisted of 230 age-matched healthy male volunteers. Serum Lp(a) levels ≥30 mg/dL, as measured by the immunoturbidimetry method, were considered high. All participants received health related quality of life (HRQoL) scores using the self-assessed 36-Item Short Form Health Survey (SF-36). The HRQoL includes both a physical component summary (PCS) and a mental component summary (MCS). RESULTS: Patients with PCHD were found to have higher levels of Lp(a) (51.61±33.39 vs. 26.42±21.93, P<0.001), and lower MCS (35.83±4.21 vs. 39.85±4.12) and PCS scores (38.02±3.73 vs. 39.63±3.21) compared to healthy volunteers. The MCS score was negatively correlated with Lp(a) levels in the PCHD group (R=-0.295, P<0.001), but no correlation was detected in the control group. There was no relationship between the PCS score and Lp(a) levels in neither the PCHD group nor the healthy control group. Multivariate logistic regression analysis indicated that the MCS and PCS scores were negatively correlated with the risk of PCHD. CONCLUSIONS: These findings suggested that poor mental health may be associated with high levels of Lp(a) and increased risk of PCHD in men. Therefore, improving the mental state in men with PCHD may be crucial.


Assuntos
Doença da Artéria Coronariana , Lipoproteína(a) , Humanos , Masculino , Saúde Mental , Qualidade de Vida , Estudos Retrospectivos , Fatores de Risco
16.
Artigo em Inglês | MEDLINE | ID: mdl-34205792

RESUMO

Chest pain is a symptom that can be found in life-threatening conditions such as acute coronary syndrome (ACS). Those patients requiring invasive coronary angiography treatment or surgery should be identified. Often the clinical setting and laboratory tests are not sufficient to rule out a coronary or aortic syndrome. Cardiac radiological imaging has evolved in recent years both in magnetic resonance (MR) and in computed tomography (CT). CT, in particular, due to its temporal and spatial resolution, the quickness of the examination, and the availability of scanners, is suitable for the evaluation of these patients. In particular, the latest-generation CT scanners allow the exclusion of diagnoses such as coronary artery disease and aortic pathology, thereby reducing the patient's stay in hospital and safely selecting patients by distinguishing those who do not need further treatment from those who will need more- or less-invasive therapies. CT additionally reduces costs by improving long-term patient outcome. The limitations related to patient characteristics and those related to radiation exposure are weakening with the improvement of CT technology.


Assuntos
Síndrome Coronariana Aguda , Doença da Artéria Coronariana , Síndrome Coronariana Aguda/diagnóstico por imagem , Dor no Peito/etiologia , Angiografia Coronária , Serviço Hospitalar de Emergência , Humanos , Radiologistas
17.
J Comput Assist Tomogr ; 45(3): 395-402, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34297510

RESUMO

OBJECTIVE: This study aimed to compare the prognostic performance of Coronary Artery Disease (CAD)-Reporting and Data System (CAD-RADS) score with those of clinical risk factors and the extent of CAD classification for predicting major adverse cardiac events in emergency department patients. METHODS: A total of 779 patients with acute chest pain at low to intermediate risk for CAD underwent cardiac computed tomography angiography. The primary end point was early and late major adverse cardiac events. We developed the following models: model 1, clinical risk factors; model 2, clinical risk factors and CAD-RADS scores; model 3, clinical risk factors and extent of CAD. RESULTS: The C-statistics revealed that both CAD-RADS score and CAD extent improved risk stratification over the clinical risk factors (C-index for early events: C-index: 0.901 vs 0.814 and 0.911 vs 0.814; C-index for late events: 0.897 vs 0.808 and 0.905 vs 0.808; all P < 0.05). CONCLUSIONS: The CAD-RADS score had additional risk prediction benefits over clinical risk factors for emergency department patients.


Assuntos
Dor no Peito/etiologia , Doença da Artéria Coronariana/diagnóstico por imagem , Sistemas de Apoio a Decisões Clínicas , Sistemas de Informação em Radiologia , Adulto , Idoso , Doença da Artéria Coronariana/mortalidade , Serviço Hospitalar de Emergência , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Medição de Risco , Fatores de Risco , Tomografia Computadorizada por Raios X
18.
PLoS One ; 16(7): e0255045, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34288966

RESUMO

PURPOSE: Cardiovascular comorbidity anticipates severe progression of COVID-19 and becomes evident by coronary artery calcification (CAC) on low-dose chest computed tomography (LDCT). The purpose of this study was to predict a patient's obligation of intensive care treatment by evaluating the coronary calcium burden on the initial diagnostic LDCT. METHODS: Eighty-nine consecutive patients with parallel LDCT and positive RT-PCR for SARS-CoV-2 were included from three centers. The primary endpoint was admission to ICU, tracheal intubation, or death in the 22-day follow-up period. CAC burden was represented by the Agatston score. Multivariate logistic regression was modeled for prediction of the primary endpoint by the independent variables "Agatston score > 0", as well as the CT lung involvement score, patient sex, age, clinical predictors of severe COVID-19 progression (history of hypertension, diabetes, prior cardiovascular event, active smoking, or hyperlipidemia), and laboratory parameters (creatinine, C-reactive protein, leucocyte, as well as thrombocyte counts, relative lymphocyte count, d-dimer, and lactate dehydrogenase levels). RESULTS: After excluding multicollinearity, "Agatston score >0" was an independent regressor within multivariate analysis for prediction of the primary endpoint (p<0.01). Further independent regressors were creatinine (p = 0.02) and leucocyte count (p = 0.04). The Agatston score was significantly higher for COVID-19 cases which completed the primary endpoint (64.2 [interquartile range 1.7-409.4] vs. 0 [interquartile range 0-0]). CONCLUSION: CAC scoring on LDCT might help to predict future obligation of intensive care treatment at the day of patient admission to the hospital.


Assuntos
COVID-19/complicações , Calcinose/complicações , Calcinose/diagnóstico por imagem , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico por imagem , Progressão da Doença , Radiografia Torácica , COVID-19/diagnóstico , COVID-19/epidemiologia , Feminino , Humanos , Processamento de Imagem Assistida por Computador , Masculino , Pessoa de Meia-Idade , Pandemias , Prognóstico , Doses de Radiação
19.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(7): 988-994, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34308847

RESUMO

OBJECTIVE: To investigate the combined value of coronary computed tomography angiography (CCTA) indicators and perivascular fat attenuation index (FAI) in predicting hemodynamically significant coronary artery disease. METHODS: We retrospectively analyzed the data of patients undergoing CCTA in Chinese PLA General Hospital from 2017 to 2019, who were also examined for fractional flow reserve (FFR) with invasive coronary angiography within one month before inclusion. The CCTA indicators at the vascular level were measured, including plaque distribution, coronary artery calcification score, lesion length, maximum diameter stenosis, maximum area stenosis (MAS), total plaque burden (TPB), perivascular FAI, and CT-FFR based on machine learning. Lesion-specific hemodynamically significant coronary artery disease was diagnosed for an invasive FFR≤0.8. RESULTS: A total of 99 patients with 124 involved coronary arteries were included in this analysis. At the vascular level, according to the results of invasive FFR, coronary artery calcification score, maximum diameter stenosis, MAS and the total plaque burden were significantly higher in patents with a FFR≤0.8 than in those with a FFR>0.8; the perivascular FAI (P < 0.01) and CT-FFR (P < 0.01) also differed significantly between the two groups. The AUC of MAS combined with perivascular FAI was 0.818, which was not significantly different from that of CT-FFR (P=0.076). CONCLUSION: The combination of MAS and perivascular FAI has good diagnostic performance in predicting hemodynamically significant coronary stenosis, which is comparable with that of CT-FFR.


Assuntos
Doença da Artéria Coronariana , Estenose Coronária , Reserva Fracionada de Fluxo Miocárdico , Tecido Adiposo , Constrição Patológica , Angiografia Coronária , Doença da Artéria Coronariana/diagnóstico por imagem , Estenose Coronária/diagnóstico por imagem , Humanos , Valor Preditivo dos Testes , Estudos Retrospectivos , Índice de Gravidade de Doença
20.
Nan Fang Yi Ke Da Xue Xue Bao ; 41(7): 1044-1049, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34308854

RESUMO

OBJECTIVE: To investigate the efficacy and safety of intravascular ultrasound (IVUS)-guided rotational atherectomy (RA) combined with cutting balloon for pretreatment of severe calcified lesions in the coronary artery before stent placement. METHODS: A total of 120 patients with severe coronary artery calcifications detected by IVUS that required percutaneous coronary intervention (PCI) were recruited from our hospital between January, 2016 to January, 2019. The patients were randomized into two groups for pretreatment of the lesions with semicompliant balloon (SB group, 60 cases) or RA combined with CB (RA+CB group, 60 cases), and drug-eluting stents were implanted after the procedure. The immediate success rate of PCI, vascular parameters detected by IVUS after PCI, and the rates of residual stenosis < 10% were compared between the two groups. The incidences of intraoperative complications and major adverse cardiac events (MACE) within 24 months after the surgery were also observed in the two groups. RESULTS: The immediate success rate was significantly higher in RA+CB group than in SB group (P=0.032). After pretreatment and stent placement, the minimum stent lumen diameter (P=0.035), minimum stent lumen cross-sectional area (P=0.029), immediate lumen acquisition, immediate lumen cross-sectional area acquisition and the rate of residual stenosis < 10% were all significantly higher in RA+CB group than in SB group (P < 0.001). The patients in RA+ CB group showed obviously less residual stenosis of lumen cross-sectional area than those in SB group after the surgery (χ2= 7.859, P=0.005). The incidences of intraoperative complications (χ2=5.997, P=0.014) and MACE within 24 months after the operation (χ2=4.285, P=0.038) were significantly lower in RA+CB group than in SB group. CONCLUSION: For patients with severe coronary artery calcifications eligible for PCI, RA combined with CB angioplasty can significantly improve the success rate of immediate PCI, expand the lumen diameter and cross-sectional area of the stent after PCI, enhance immediate lumen gain, and reduce the incidence of intraoperative complications and MACE after the operation.


Assuntos
Angioplastia Coronária com Balão , Aterectomia Coronária , Doença da Artéria Coronariana , Intervenção Coronária Percutânea , Calcificação Vascular , Angiografia Coronária , Doença da Artéria Coronariana/cirurgia , Vasos Coronários/diagnóstico por imagem , Vasos Coronários/cirurgia , Humanos , Resultado do Tratamento , Ultrassonografia de Intervenção , Calcificação Vascular/diagnóstico por imagem , Calcificação Vascular/cirurgia
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