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Pubblicazioni recenti - cardiovascular
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Aspirin in primary prevention: the triumph of clinical judgement over complex equations.
Intern Emerg Med2019 Sep;():. doi: 10.1007/s11739-019-02191-4.
Santilli Francesca, Simeone Paola,
Abstract
Aspirin, in 2017, has celebrated its 120th birthday. The efficacy and safety of low-dose aspirin in secondary prevention of cardiovascular disease is well supported by many studies, instead in primary prevention it remains controversial, especially in the aftermath of the publication in 2018 of three novel primary prevention randomized clinical trials, showing that the benefit of low-dose aspirin, although additive to that of statin, is counterbalanced by an excess of (mainly gastrointestinal) bleeding events. The signal for a net benefit seems to be even more controversial in the elderly starting aspirin after the age of 70 years. While international guidelines have promptly downgraded their recommendations to more conservative indications, the practicing clinician is called to make the effort to individualize the treatment, after careful evaluation of the haemorrhagic risk vis-a-vis the risk to develop, in the mid-term and long-term follow-up, major cardiovascular events or cancer. This is a particularly complex task, given the different immediate and long-term impact of diverse outcomes on health, the dynamic nature over time of the benefit/risk balance, prompting periodic re-assessments of its indication, and the interindividual variability in aspirin response. The chemopreventive properties of aspirin, anticipated by a large body of epidemiological and mechanistic evidence, are awaiting their final confirmation by the long-term follow-up of the latest trials specifically designed to assess this endpoint, with the expectation to subvert the delicate benefit/risk balance of aspirin in primary prevention. This review is intended to provide an interpretation of past and current evidence to guide clinical decision making on the contemporary patient.
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A case of female Fabry disease revealed by renal biopsy.
CEN Case Rep2019 Sep;():. doi: 10.1007/s13730-019-00420-5.
Aratani Sae, Yamakawa Hiroyuki, Suzuki Shinya, Otsuka Tomoyuki, Sakai Yukinao, Shimizu Akira, Tsuruoka Shuichi,
Abstract
Fabry disease (FD) is an X-linked inherited glycosphingolipid metabolism disorder, therefore, heterozygous female FD patients display highly variable clinical symptoms, disease severity, and pathological findings. This makes it very challenging to diagnosing female patients with FD. A 69-year-old Japanese female was introduced to the nephrologist for the evaluation of proteinuria. A renal biopsy was performed. Although the light microscopic examinations revealed that most of the glomeruli showed minor glomerular abnormalities, however, vacuolation was apparently found in the tubular epithelial cells. Immunofluorescence staining for globotriaosylceramide was positively detected in some podocytes and distal tubular epithelial cells. In addition, myelin-like structure (zebra body) was detected by electron microscopy. Pathological findings were most consistent with FD. Consequently, biochemical and genetic analysis confirmed the diagnosis of female FD. Enzyme replacement therapy was performed in conjunction with renin-angiotensin aldosterone system inhibitors and beta-blockers. The patient's family members received the analysis, and the same DNA missense mutation was detected in the patient's grandson. The enzyme replacement therapy was introduced to the grandson. The present case showed that renal biopsy can contribute towards a correct diagnosis for FD. Particularly, in female FD patients, careful examination of pathological changes is essential, for example, vacuolation of any type of renal cells may be a clue for the diagnosis.
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Effect of single nucleotide polymorphisms in SEPS1 and SEPP1 on expression in the protein level in metabolic syndrome in subjects with cardiovascular disease.
Mol Biol Rep2019 Sep;():. doi: 10.1007/s11033-019-05000-5.
Gharipour Mojgan, Ouguerram Khadija, Nazih El-Hassane, Salehi Mansoor, Behmanesh Mehrdad, Razavi Rouzbeh, Gharipour Amin, Diantkhah Minoo, Sadeghi Masoumeh,
Abstract
Metabolic syndrome (MetS) results from the interaction between environmental and genetic factors. Several previous studies considered the role of selenium in developing MetS. Two selenoproteins, selenoprotein S (SelS), and the Selenoprotein P (SePP) play an important role in antioxidative defense and therefore susceptibility to MetS. The involvement of SNPs in SEPP1 and SEPS1 have not been studied in MetS subjects. This study aims to investigate the association between the risk of MetS and four polymorphisms SEPS1 (rs28665122, rs4965373), SEPP1 (rs7579, rs3877899) in an Iranian population. The sample of this case-control study consisted of 132 Iranian patients with cardiovascular disease (71 MetS and 65 non-MetS subjects) from December 2015 to March 2016. Demographic data, medical history, and para-clinical were measured, and Taqman probes were used for allelic discrimination. The level of the SelS and the SePP were measured by the ELIZA method. No significant differences were found in the genotype frequencies of SEPS1 (rs4965373, rs28665122), SEPP1 (rs7579, rs3877899) in patients with MetS and the non-MetS group. The mean of SelS in MetS subjects with SEPS1 (rs4965373) GG genotype is significantly lower than the non-MetS group (4496.99?±?3688.5 vs. 6148.6?±?1127.0, P?=?0.009). The mean of SePP in MetS subjects with SEPP1 (rs3877899) GG genotype is significantly lower than the non-MetS group (40.73?±?8.44 vs.83.91?±?21.33, P?=?0.002). The mean of SePP in MetS subjects with SEPP1 (rs7579) GG genotype is lower than the non-MetS group (55.52?±?16.7 vs. 109.48?±?29.78, P?=?0.01). In summary, the results of this study does not indicate significant differences in the SEPP1 (rs7579, rs3877899) and SEPS1 (rs4965373, rs28665122) genotypes between MetS and non-MetS subjects. However, the results show that the mean of expression of SelS and SePP decreased in the subjects with SEPP1 (rs7579) GG and SEPP1 (rs3877899) GG.
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Do anticoagulants affect outcomes of hip fracture surgery? A cross-sectional analysis.
Arch Orthop Trauma Surg2019 Sep;():. doi: 10.1007/s00402-019-03240-5.
Hoerlyck Caroline, Ong Terence, Gregersen Merete, Damsgaard Else Marie, Borris Lars, Chia Jac Kie, Yap Ying Yi Wendy, Weerasuriya Namal, Sahota Opinder,
Abstract
INTRODUCTION:
The management of patients with a hip fracture is affected by the use of oral anticoagulants. A cross-sectional analysis was undertaken to investigate health outcome differences in those anticoagulated compared to those not anticoagulated.
METHODS:
Patients aged 50 years and over presenting to a large university hospital with hip fractures were identified from the service registry. Patient characteristics and health outcomes between those not anticoagulated were compared with those anticoagulated (warfarin and direct oral anticoagulants, DOAC).
RESULTS:
200/2307 (9%) patients were anticoagulated. 84% were on warfarin, and the rest a DOAC. Compared to those anticoagulated, there was a higher prevalence of dementia (25% vs. 18%, p?=?0.02) and a lower prevalence of cardiovascular disease (54% vs. 78%, p?
CONCLUSION:
There was no statistically significant difference in health outcomes between those anticoagulated and those not after adjusting for patient characteristics. It was feasible to avoid significant delay in hip fracture surgery in those anticoagulated.
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Echocardiographic Screening of Cardiovascular Status in Pediatric Sickle Cell Disease.
Pediatr Cardiol2019 Sep;():. doi: 10.1007/s00246-019-02202-3.
Allen Kiona Y, Jones Shannon, Jackson Tannoa, DeCost Grace, Stephens Paul, Hanna Brian D, Cohen Meryl S, Smith-Whitley Kim, Mercer-Rosa Laura, Natarajan Shobha S,
Abstract
Although elevated right ventricular pressure and left ventricular diastolic dysfunction measured by echocardiogram are independent predictors of death in adults with sickle cell disease (SCD), the utility of routine echocardiographic screening in the pediatric population is controversial. We performed a 3-year retrospective review of children???10 years of age with SCD who underwent an outpatient transthoracic echocardiogram as part of a screening program. Of 172 patients referred for screening, 105 (61%) had a measurable tricuspid regurgitation jet velocity (TRV): median 2.4 m/s (IQR 2.3-2.5). Elevated right ventricular (RV) pressure (TRV???2.5 m/s, 25 mmHg), documented in 30% (32/105), was significantly associated with chronic transfusion therapy and elevated lactate dehydrogenase. Left ventricle (LV) dilation, documented in 25% (44/172), was significantly associated with lower hemoglobin, and higher reticulocyte count, lactate dehydrogenase level, and bilirubin level. There was no association between elevated right ventricular pressure or left ventricle dilation and indices of biventricular systolic or diastolic function. The one death in the cohort during the study period had normal echocardiographic findings. In conclusion, mild RV pressure elevation and LV dilation in children with SCD is associated with abnormal laboratory markers of disease severity, but not with ventricular dysfunction over the 3-year study period.
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Elevated Cardiac Troponin in Clinical Scenarios Beyond Obstructive Coronary Artery Disease.
Med Sci Monit2019 Sep;25():7115-7125. doi: 10.12659/MSM.915830.
Sternberg Michael, Pasini Evasio, Chen-Scarabelli Carol, Corsetti Giovannii, Patel Hemang, Linardi Daniele, Onorati Francesco, Faggian Giuseppe, Scarabelli Tiziano, Saravolatz Louis,
Abstract
In this systematic review article, we aim to summarize the most up-to-date evidence regarding elevations of cardiac troponin, especially in clinical scenarios other than obstructive coronary artery disease. The accurate interpretation of raised cardiac troponin is challenging because it relies on unconfirmed postulations and dogmatic knowledge (e.g., the exclusive provenience of cardiac troponin from cardiac myocytes), based on which every troponin elevation is assumed to definitely indicate myocardial damage. Indeed, the investigation of the pathophysiologic mechanism leading to the release in the bloodstream of cardiac biomarkers should be the first step of the diagnostic process to fully understand the clinical significance of the elevated serum levels and identify the best management. A prominent effort should be put in place to identify the contribution of potential confounding factors, both cardiac and non-cardiac in etiology, with the ability to affect synthesis and clearance of cardiac biomarkers. Regardless of the underlying cause, it is well established that cardiovascular biomarkers are increasingly useful to further risk stratification and prognosticate patients. Accordingly, we sought to clarify the meaning and impact of elevated cardiac troponin in those frequently encountered real-world scenarios presenting clinicians with a diagnostic dilemma, with the final goal of facilitating the diagnosis and help optimize individually tailored treatment strategies.
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Fibroblast growth factor 23 expression in human calcified vascular tissues.
Aging (Albany NY)2019 Sep;11():. doi: 10.18632/aging.102297.
Donate-Correa Javier, Martín-Núñez Ernesto, Hernández-Carballo Carolina, Ferri Carla, Tagua Víctor G, Delgado-Molinos Alejandro, López-Castillo Ángel, Rodríguez-Ramos Sergio, Cerro-López Purificación, López-Tarruella Victoria Castro, Felipe-García Raquel, Arévalo-Gomez Miguel A, Pérez-Delgado Nayra, Mora-Fernández Carmen, Navarro-González Juan F,
Abstract
Vascular calcification is a major risk for cardiovascular disease and implies the transformation of smooth muscle cells to an osteoblastic phenotype as a consequence of dysregulation of calcium and phosphate metabolism. Fibroblast growth factor (FGF) 23 is the most potent phosphate regulator. Observational studies suggest that high levels of FGF23 are related to cardiovascular morbidity and mortality. In this work, we determined the levels of both the intact and the carboxi-terminal fragments of circulating FGF23 in 133 patients with established cardiovascular disease, the expression of FGF23, its receptors 1 and 3, and its co-receptor Klotho in vascular fragments of aorta, carotid and femoral in 43 out of this group of patients, and in a control group of 20 organ donors. Patients with atherosclerosis and vascular calcification presented increased levels of FGF23 respect to the control group. Vascular immunoreactivity for FGF23 was also significantly increased in patients with vascular calcification as compared to patients without calcification and to controls. Finally, gene expression of and were also higher and directly related in vascular samples with calcification. Conversely, expression of was reduced in patients with cardiovascular disease when comparing to controls. In conclusion, our findings link the calcification of the vascular tissue with the expression of FGF23 in the vessels and with the elevation of circulating levels this hormone.
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Effects of antihypertensives, lipid-modifying drugs, glycaemic control drugs and sodium bicarbonate on the progression of stages 3 and 4 chronic kidney disease in adults: a systematic review and meta-analysis.
BMJ Open2019 Sep;9(9):e030596. doi: 10.1136/bmjopen-2019-030596.
Taylor Kathryn S, Mclellan Julie, Verbakel Jan Y, Aronson Jeffrey K, Lasserson Daniel S, Pidduck Nicola, Roberts Nia, Fleming Susannah, O'Callaghan Christopher A, Bankhead Clare R, Banerjee Amitava, Hobbs Fd Richard, Perera Rafael,
Abstract
OBJECTIVE:
To evaluate the effects of drug interventions that may modify the progression of chronic kidney disease (CKD) in adults with CKD stages 3 and 4.
DESIGN:
Systematic review and meta-analysis.
METHODS:
Searching MEDLINE, EMBASE, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, International Clinical Trials Registry Platform, Health Technology Assessment, Science Citation Index, Social Sciences Citation Index, Conference Proceedings Citation Index and Clinical Trials Register, from March 1999 to July 2018, we identified randomised controlled trials (RCTs) of drugs for hypertension, lipid modification, glycaemic control and sodium bicarbonate, compared with placebo, no drug or a drug from another class, in ?40 adults with CKD stages 3 and/or 4, with at least 2 years of follow-up and reporting renal function (primary outcome), proteinuria, adverse events, maintenance dialysis, transplantation, cardiovascular events, cardiovascular mortality or all-cause mortality. Two reviewers independently screened citations and extracted data. For continuous outcomes, we used the ratio of means (ROM) at the end of the trial in random-effects meta-analyses. We assessed methodological quality with the Cochrane Risk of Bias Tool and confidence in the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.
RESULTS:
We included 35 RCTs and over 51 000 patients. Data were limited, and heterogeneity varied. Final renal function (estimated glomerular filtration rate) was 6% higher in those taking glycaemic control drugs (ROM 1.06, 95% CI 1.02 to 1.10, I=0%, low GRADE confidence) and 4% higher in those taking lipid-modifying drugs (ROM 1.04, 95% CI 1.00 to 1.08, I=88%, very low GRADE confidence). For RCTs of antihypertensive drugs, there were no significant differences in renal function. Treatment with lipid-modifying drugs led to a 36% reduction in cardiovascular disease and 26% reduction in all-cause mortality.
CONCLUSIONS:
Glycaemic control and lipid-modifying drugs may slow the progression of CKD, but we found no pooled evidence of benefit nor harm from antihypertensive drugs. However, given the data limitations, further research is needed to confirm these findings.
PROSPERO REGISTRATION NUMBER:
CRD42015017501.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY. Published by BMJ.
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Assessing the global risk of cardiovascular disease among a group of university students: population-based cross-sectional study in Yaoundé, Cameroon.
BMJ Open2019 Sep;9(9):e030594. doi: 10.1136/bmjopen-2019-030594.
Nansseu Jobert Richie, Assah Felix, Petnga Saint-Just, Kameni Bibiane Siaheu, Tene Hebert Donald Fosso, Nang Francial Terrenstra, Wouna Dominic Leandry Angong, Noubiap Jean Jacques, Kamgno Joseph,
Abstract
OBJECTIVE:
To describe the global cardiovascular disease (CVD) risk distribution in a young adult-aged population living in Yaoundé, Cameroon and depict factors likely influencing this risk distribution.
DESIGN:
A cross-sectional study between May and July 2017.
SETTING:
The University of Yaoundé I, Cameroon.
PARTICIPANTS:
Any university student aged 18 years and above, with no known history of CVD, found at the campus during recruitment and who voluntarily agreed to be included in the study.
PRIMARY AND SECONDARY OUTCOME MEASURES:
The global risk of CVD was measured with the non-laboratory-based INTERHEART Modifiable Risk Score.
RESULTS:
A total of 949 participants (54% males) were recruited; the median age was 23 (IQR 21-26) years. The CVD risk varied between 2 and 21, with a median of 9 (IQR 7-12); 51.2% of students had a low risk of CVD, 43.7% had a moderate risk and 5.1% presented a high risk of CVD. The number of years since first registration at the university (?=0.08), history of sudden death among biological parents (?=1.28), history of hypertension among brothers/sisters (?=1.33), history of HIV infection (?=4.34), the Alcohol Use Disorder Identification Test-Consumption score (?=0.13), regular exposure to firewood smoke (?=1.29), eating foods/drinks with too much sugar ?1 time/day (?=0.96), eating foods/snacks with too much oil ?3 times/week (?=1.20) and eating dairy products?1 time/day (?=0.61) were the independent factors likely influencing participants' global risk of CVD.
CONCLUSION:
Almost 50% of participants had moderate or high risk of CVD. Specific interventions targeting major CVD risk factors should be put in place among young adults to prevent or reduce this upcoming overburdened picture of CVD.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Population-based cross-sectional study of 11 645 Spanish nonagenarians with type 2 diabetes mellitus: cardiovascular profile, cardiovascular preventive therapies, achievement goals and sex differences.
BMJ Open2019 Sep;9(9):e030344. doi: 10.1136/bmjopen-2019-030344.
Salinero-Fort Miguel Angel, Mostaza-Prieto Jose M, Lahoz-Rallo Carlos, Vicente Díez José Ignacio, Cárdenas-Valladolid Juan,
Abstract
OBJECTIVES:
To evaluate the risk profile, achievement of cardiometabolic goals, and frequency and optimal use of cardiovascular preventive therapies among nonagenarians with type 2 diabetes mellitus (T2DM). To investigate possible sex differences.
DESIGN AND SETTING:
A cross-sectional population study of 11?645 persons aged ?90 years with T2DM living in Madrid (Spain). Sociodemographic, clinical and therapy profiles were collected through electronic records in primary care. We considered antihypertensive therapy and lipid-lowering therapy to be optimal when known patients with hypertension with albuminuria received renin-angiotensin system blockers and statins had been prescribed for overt cardiovascular disease.
RESULTS:
The prevalence of coronary artery disease was higher in males than in females (21.5% vs 12.6%, p<0.01), as was that of peripheral artery disease (8.5% vs 2.3%, p<0.01). However, the prevalence of cerebrovascular disease was similar in both sexes (16.5% vs 16%; p=0.44). Haemoglobin A1c was lower than 7% in 64.4% of cases, with female predominance in patients with known dementia (67.1% female vs 59.9% male; p<0.01). Antiplatelet therapy was significantly more frequent in males than in females (48.1% vs 44.3%; p<0.01), as were statins (43.2% vs 40.2%; p<0.01). Both in primary and in secondary prevention, rates for simultaneous achievement of the HbA1c, blood pressure, LDL-C goals were significantly lower among females (p<0.01). For each criterion of optimal use of cardiovascular preventive therapies, adherence was significantly better in males than in females.
CONCLUSION:
Our study showed that the risk of cerebrovascular disease was similar in both male and female Spanish nonagenarians. Adherence was poorer in females for all criteria of optimal use of cardiovascular preventive therapies. Our findings indicate that the known sex differences in younger patients with T2DM persist in patients aged ?90 years. There is considerable room for improvement in standards of preventive care in nonagenarians with T2DM, especially in females.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Evaluating the effectiveness of the NHS Health Check programme in South England: a quasi-randomised controlled trial.
BMJ Open2019 Sep;9(9):e029420. doi: 10.1136/bmjopen-2019-029420.
Kennedy Oliver, Su Fangzhong, Pears Robert, Walmsley Emily, Roderick Paul,
Abstract
OBJECTIVE:
To evaluate uptake, risk factor detection and management from the National Health Service (NHS) Health Check (HC).
DESIGN:
This is a quasi-randomised controlled trial where participants were allocated to five cohorts based on birth year. Four cohorts were invited for an NHS HC between April 2011 and March 2015.
SETTING:
151 general practices in Hampshire, England, UK.
PARTICIPANTS:
366?005 participants born 1 April 1940-31 March 1976 eligible for an NHS HC.
INTERVENTION:
NHS HC invitation.
MAIN OUTCOME MEASURES:
HC attendance and absolute percentage changes and ORs of (1) detecting cardiovascular disease (CVD) 10-year risk >10%?and >20%, smokers, and total cholesterol (TC) >5.5?mmol/L and >7.5?mmol/L; (2) diagnosing hypertension, type 2 diabetes mellitus, chronic kidney disease (CKD) and atrial fibrillation (AF); and (3) new interventions with statins, antihypertensives, antiglycaemics and nicotine replacement therapy (NRT).
RESULTS:
HC attendance rose from 12% to 30% between 2011/2012 and 2014/2015 (p<0.001). HC invitation increased detection of CVD risk >10% (2.0%-3.6, p<0.001) and >20% (0.1%-0.6%, p<0.001-0.392), TC >5.5?mmol/L (4.1%-7.0%, p<0.001) and >7.5?mmol/L (0.3%-0.4%?p<0.001), hypertension (0.3%-0.6%, p<0.001-0.003), and interventions with statins (0.2%-0.9%, p<0.001-0.017) and antihypertensives (0.1%-0.6%, p<0.001-0.205). There were no consistent differences in detection of smokers, NRT, or diabetes, AF or CKD. Multivariate analyses showed associations between HC invitation and detecting CVD risk >10% (OR 8.01, 95%?CI 7.34 to 8.73) and >20% (5.86, 4.83 to 7.10), TC >5.5?mmol/L (3.72, 3.57 to 3.89) and >7.5?mmol/L (2.89, 2.46 to 3.38), and diagnoses of hypertension (1.33, 1.20 to 1.47) and diabetes (1.34, 1.12 to 1.61). OR of CVD risk >10%?plus statin and >20%?plus statin, respectively, was 2.90 (2.36 to 3.57) and 2.60 (1.92 to 3.52), and for hypertension plus antihypertensive was 1.33 (1.18 to 1.50). There were no associations with AF, CKD, antiglycaemics or NRT. Detection of several risk factors varied inversely by deprivation.
CONCLUSIONS:
HC invitation increased detection of cardiovascular risk factors, but corresponding increases in evidence-based interventions were modest.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Effectiveness and safety of oral Chinese patent medicines as adjuvant treatment for unstable angina pectoris on the national essential drugs list of China: a protocol for a systematic review and network meta-analysis.
BMJ Open2019 Sep;9(9):e026136. doi: 10.1136/bmjopen-2018-026136.
Hua Zhen, Zhai Feng-Ting, Tian Jinhui, Gao Cheng-Fei, Xu Peng, Zhang Fan, Liu Si-Jia, Dong Kun, Du Xiao-Feng, Zhang Zhe, Yang Guanlin,
Abstract
INTRODUCTION:
Achieving efficacious and safe treatments for unstable angina pectoris (UAP) is still a challenging clinical problem. The availability of different oral Chinese patent medicines frequently poses a practical challenge to clinicians, namely, which one to choose as first-line regimen for treatment. This study aims to examine the comparative effectiveness and safety of oral Chinese patent medicines for UAP on the national essential drugs list of China.
METHODS AND ANALYSIS:
We will conduct a network meta-analysis (NMA) of all randomised controlled trials to evaluate the use of oral Chinese patent medicines as adjuvant for the treatment of UAP. We will explore eight electronic databases from their inception to June 2018 and search for grey literature. Primary outcomes include mortality and the cardiovascular events. Secondary outcomes include: (1) symptom improvement; (2) ECG improvement; (3) frequency of acute angina attack; (4) duration of angina; (5) adverse effects. Two independent authors will screen titles and abstracts, review full texts, extract data, assess the risk of bias using the Cochrane risk of bias tool and assess the quality of evidence and strength of the recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). If adequate data are available, NMA will be performed with Bayesian analysis methods.
ETHICS AND DISSEMINATION:
The NMA will help us to reduce the uncertainty of interventions and help clinicians to make optimal and more accurate therapeutic decisions for adults with UAP. Therefore, we will publish the findings of this study in a peer-reviewed journal. No ethics approval is necessary for this study based on the nature of its design.
TRIAL REGISTRATION NUMBER:
CRD42018092822.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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eradication treatment for gastric carcinoma prevention in asymptomatic or dyspeptic adults: systematic review and Bayesian meta-analysis of randomised controlled trials.
BMJ Open2019 Sep;9(9):e026002. doi: 10.1136/bmjopen-2018-026002.
Terasawa Teruhiko, Hamashima Chisato, Kato Katsuaki, Miyashiro Isao, Yoshikawa Takaki, Takaku Reo, Nishida Hiroshi,
Abstract
OBJECTIVES:
Recent meta-analyses of eradication therapy in -infected adults reported significant reductions in gastric carcinoma risk. However, concerns about supporting unfocused screening and eradication programme in healthy, asymptomatic populations have arisen. We performed a systematic review and Bayesian meta-analysis to provide an accurate interpretation of randomised evidence on the preventive effectiveness of eradication therapy on gastric carcinoma risk.
METHODS:
We searched databases including PubMed, Cochrane Central and Embase for reference and citation tracking without language restrictions, from inception through 31 July 2018. Paired investigators independently selected randomised controlled trials (RCTs) comparing eradication therapy with placebo or no treatment for asymptomatic or dyspeptic -infected adults with no previous gastric carcinoma. The main outcome was gastric carcinoma incidence; secondary outcomes included gastric carcinoma-specific, non-gastric carcinoma and all-cause mortality.
RESULTS:
A total of 5 population-based and 2 outpatient care-based RCTs involving 7303 adults were eligible. Eradication algorithms were heterogeneous, and unsuccessful eradication and reinfection were frequently observed. A Bayesian meta-analysis with competing risk outcomes found low-certainty evidence that eradication therapy might be more likely than control to reduce gastric carcinoma risk (HR=0.65; 95% credible interval (CrI) 0.41 to 1.0; =11%). The CrIs included the null effects across the subgroup and sensitivity analyses, apart from those based on particular models that excluded two RCTs that enrolled subjects with specific histological findings only (HR=0.55; CrI 0.30 to 0.89; =14%). The uncertainty of the average 41% risk reduction in gastric carcinoma-specific mortality included a clinically important mortality risk increase (HR=0.59 favouring eradication therapy; CrI 0.25 to 1.20; =13%; low certainty).
CONCLUSIONS:
There is insufficient evidence to support or refute the effectiveness of eradication therapy in preventing gastric carcinoma in -infected, high-risk populations. Rigorously conducted large RCTs of healthy infected adults only would provide evidence of the true efficacy of successful eradication. CRD42014009245.
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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British Cardiovascular Society Young Investigator Award 2019.
Heart2019 Sep;():. doi: heartjnl-2019-315726.
Page Donna Joanne, Akbar Naveed, Munshaw Sonali, Raman Betty,
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A robust computational framework for estimating 3D Bi-Atrial chamber wall thickness.
Comput Biol Med2019 Sep;114():103444. doi: S0010-4825(19)30321-X.
Wang Yufeng, Xiong Zhaohan, Nalar Aaqel, Hansen Brian J, Kharche Sanjay, Seemann Gunnar, Loewe Axel, Fedorov Vadim V, Zhao Jichao,
Abstract
Atrial fibrillation (AF) is the most prevalent form of cardiac arrhythmia. The atrial wall thickness (AWT) can potentially improve our understanding of the mechanism underlying atrial structure that drives AF and provides important clinical information. However, most existing studies for estimating AWT rely on ruler-based measurements performed on only a few selected locations in 2D or 3D using digital calipers. Only a few studies have developed automatic approaches to estimate the AWT in the left atrium, and there are currently no methods to robustly estimate the AWT of both atrial chambers. Therefore, we have developed a computational pipeline to automatically calculate the 3D AWT across bi-atrial chambers and extensively validated our pipeline on both ex vivo and in vivo human atria data. The atrial geometry was first obtained by segmenting the atrial wall from the MRIs using a novel machine learning approach. The epicardial and endocardial surfaces were then separated using a multi-planar convex hull approach to define boundary conditions, from which, a Laplace equation was solved numerically to automatically separate bi-atrial chambers. To robustly estimate the AWT in each atrial chamber, coupled partial differential equations by coupling the Laplace solution with two surface trajectory functions were formulated and solved. Our pipeline enabled the reconstruction and visualization of the 3D AWT for bi-atrial chambers with a relative error of 8% and outperformed existing algorithms by >7%. Our approach can potentially lead to improved clinical diagnosis, patient stratification, and clinical guidance during ablation treatment for patients with AF.
Copyright © 2019. Published by Elsevier Ltd.
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Sex Difference in Left Ventricular Response to Aortic Stenosis.
JACC Cardiovasc Imaging -
Coupling Advanced Imaging With Computational Vascular Diagnostics: Has the Endgame Begun?
JACC Cardiovasc Imaging -
What's in Your Wallet?
JACC Cardiovasc Imaging -
Myocardial Tissue Characterization and Fibrosis by Imaging.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30711-9.
Karamitsos Theodoros D, Arvanitaki Alexandra, Karvounis Haralambos, Neubauer Stefan, Ferreira Vanessa M,
Abstract
Myocardial fibrosis, either focal or diffuse, is a common feature of many cardiac diseases and is associated with a poor prognosis for major adverse cardiovascular events. Although histological analysis remains the gold standard for confirming the presence of myocardial fibrosis, endomyocardial biopsy is invasive, has sampling errors, and is not practical in the routine clinical setting. Cardiac imaging modalities offer noninvasive surrogate biomarkers not only for fibrosis but also for myocardial edema and infiltration to varying degrees, and have important roles in the diagnosis and management of cardiac diseases. This review summarizes important pathophysiological features in the development of commonly encountered cardiac diseases, and the principles, advantages, and disadvantages of various cardiac imaging modalities (echocardiography, single-photon emission computer tomography, positron emission tomography, multidetector computer tomography, and cardiac magnetic resonance) for myocardial tissue characterization, with an emphasis on imaging focal and diffuse myocardial fibrosis.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Myocardial T1 and ECV Measurement: Underlying Concepts and Technical Considerations.
JACC Cardiovasc Imaging2019 Sep;():. doi: S1936-878X(19)30715-6.
Robinson Austin A, Chow Kelvin, Salerno Michael,
Abstract
Myocardial native T1 and extracellular volume fraction (ECV) mapping have emerged as cardiac cardiac magnetic resonance biomarkers providing unique insight into cardiac pathophysiology. Single breath-hold acquisition techniques, available on clinical scanners across multiple vendor platforms, have made clinical T1 and ECV mapping a reality. Although the relationship between changes in native T1 and alterations in cardiac microstructure is complex, an understanding of how edema, blood volume, myocyte and interstitial expansion, lipids, and paramagnetic substances affect T1 and ECV can provide insight into how and why these parameters change in various cardiac pathologies. The goals of this state-of-the-art review will be to review factors influencing native T1 and ECV, to describe how native T1 and ECV are measured, to discuss potential challenges and pitfalls in clinical practice, and to describe new T1 mapping techniques on the horizon.
Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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