Finosh G. Thankam, Taj Rai, Jeffrey Liu, J. Tam, D. Agrawal
The global burden of cerebrovascular disease, especially cerebral infarction has been increasing at an alarming rate with the atherosclerosis in carotid arteries as the primary risk factor. Despite the active involvement of minimally oxidized LDL (oxLDL) in atherosclerosis, limited information is available regarding the role of oxLDL in the pathogenesis of cerebrovascular diseases. The present study utilized the carotid bifurcation tissues and isolated carotid SMCs challenged with oxLDL from clinically relevant minimally invasive minimally-oxLDL-induced carotid atheroma microswine model to examine the levels of pro-atherogenic and pro-inflammatory mediators and cellular processes following immunostaining approaches. The immunopositivity of IL18, PDGFRA, IL17, LOX1, TLR4, MYF5, IL1B, and PDPN were increased in the carotid artery bifurcation tissues with a concomitant decrease in DAMPs, HMGB1 and S100B in oxLDL (600μg)-treated group compared to non-intervention control. Moreover, the cultured SMCs displayed increased level of IL18, LOX1, TLR4, MYF5, NLRP3, and PDPN upon challenging with oxLDL (100 mg/ml) compared to non-treatment control. In addition, the SMCs treated with oxLDL were resistant to the peroxidation of lipids as evident from lipid peroxidation staining. Also, the oxLDL displayed compromised mitochondrial membrane potential based on mitochondrial pore transition assay and increased hypertrophy due to decreased level of microtubules. Overall, oxLDL alters the expression status of pathological mediators and multiple biological processes in carotid SMCs aggravating carotid atherosclerosis. The understanding regarding the molecular mechanisms underlying oxLDL-driven pathological events would open novel translational avenues in the management of carotid atherosclerosis.
{"title":"Minimally Oxidized-LDL-Driven Alterations in the Level of Pathological Mediators and Biological Processes in Carotid Atherosclerosis","authors":"Finosh G. Thankam, Taj Rai, Jeffrey Liu, J. Tam, D. Agrawal","doi":"10.26502/fccm.92920251","DOIUrl":"https://doi.org/10.26502/fccm.92920251","url":null,"abstract":"The global burden of cerebrovascular disease, especially cerebral infarction has been increasing at an alarming rate with the atherosclerosis in carotid arteries as the primary risk factor. Despite the active involvement of minimally oxidized LDL (oxLDL) in atherosclerosis, limited information is available regarding the role of oxLDL in the pathogenesis of cerebrovascular diseases. The present study utilized the carotid bifurcation tissues and isolated carotid SMCs challenged with oxLDL from clinically relevant minimally invasive minimally-oxLDL-induced carotid atheroma microswine model to examine the levels of pro-atherogenic and pro-inflammatory mediators and cellular processes following immunostaining approaches. The immunopositivity of IL18, PDGFRA, IL17, LOX1, TLR4, MYF5, IL1B, and PDPN were increased in the carotid artery bifurcation tissues with a concomitant decrease in DAMPs, HMGB1 and S100B in oxLDL (600μg)-treated group compared to non-intervention control. Moreover, the cultured SMCs displayed increased level of IL18, LOX1, TLR4, MYF5, NLRP3, and PDPN upon challenging with oxLDL (100 mg/ml) compared to non-treatment control. In addition, the SMCs treated with oxLDL were resistant to the peroxidation of lipids as evident from lipid peroxidation staining. Also, the oxLDL displayed compromised mitochondrial membrane potential based on mitochondrial pore transition assay and increased hypertrophy due to decreased level of microtubules. Overall, oxLDL alters the expression status of pathological mediators and multiple biological processes in carotid SMCs aggravating carotid atherosclerosis. The understanding regarding the molecular mechanisms underlying oxLDL-driven pathological events would open novel translational avenues in the management of carotid atherosclerosis.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"6 1","pages":"137 - 156"},"PeriodicalIF":0.0,"publicationDate":"2022-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49568026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Felix Orelaru, Elizabeth L. Norton, Rana-Armaghan Ahmad, Aroma Naeem, Karen M Kim, S. Fukuhara, H. Patel, G. Deeb, Bo Yang
Background: This study assesses impact of COVID-19 testing delay on perioperative outcomes of Acute Type A Aortic Dissection (ATAAD) repair at a single institution. Methods: From January 2010 – May 2021, 539 ATAAD patients underwent open aortic repair at our institution. Sixty-five of these patients had open aortic repair during COVID (March 2020 – May 2021) and 474 patients were pre-COVID (January 2010 – February 2020). Results: Compared to the pre-COVID group, patients During-COVID had a higher proportion of previous myocardial ischemia [9/65 (14%) vs 28/474 (5.9%), p=0.03], chronic obstructive pulmonary disease [14/65 (22%) vs 55/474 (12%), p=0.02], and renal malperfusion syndrome [11/65 (17%) vs 30/474 (6.4%), p=0.01]. There was no significant difference in surgical outcomes between groups, including operative mortality (7.6% vs 9.2%, p=0.64). The median admission-to-Operating Room (OR) time was 107 minutes in the During-COVID group compared to 87 minutes in pre-COVID group, p=0.88. During COVID, the median admission-to-OR time was significantly longer in the Waiting group compared to the No-waiting group (209 min vs 75min, p=0.0009). Only one patient had positive COVID test. There were no aortic ruptures while awaiting COVID testing results. There was a total of 6 reported deaths in the During-COVID group: 1 patient died post-surgery due to ARDS caused by COVID, and others due to ischemic stroke (3 patients) and organ failure (2 patients). Conclusions: Perioperative outcomes of ATAAD patients were similar during-COVID compared to pre-COVID. Waiting for COVID testing results did not significantly affect the perioperative outcomes among ATAAD patients after repair.
{"title":"Perioperative Outcomes of Acute Type-A Aortic Dissection Repair was Unaffected by COVID-19 Testing Delay","authors":"Felix Orelaru, Elizabeth L. Norton, Rana-Armaghan Ahmad, Aroma Naeem, Karen M Kim, S. Fukuhara, H. Patel, G. Deeb, Bo Yang","doi":"10.26502/fccm.92920248","DOIUrl":"https://doi.org/10.26502/fccm.92920248","url":null,"abstract":"Background: This study assesses impact of COVID-19 testing delay on perioperative outcomes of Acute Type A Aortic Dissection (ATAAD) repair at a single institution. Methods: From January 2010 – May 2021, 539 ATAAD patients underwent open aortic repair at our institution. Sixty-five of these patients had open aortic repair during COVID (March 2020 – May 2021) and 474 patients were pre-COVID (January 2010 – February 2020). Results: Compared to the pre-COVID group, patients During-COVID had a higher proportion of previous myocardial ischemia [9/65 (14%) vs 28/474 (5.9%), p=0.03], chronic obstructive pulmonary disease [14/65 (22%) vs 55/474 (12%), p=0.02], and renal malperfusion syndrome [11/65 (17%) vs 30/474 (6.4%), p=0.01]. There was no significant difference in surgical outcomes between groups, including operative mortality (7.6% vs 9.2%, p=0.64). The median admission-to-Operating Room (OR) time was 107 minutes in the During-COVID group compared to 87 minutes in pre-COVID group, p=0.88. During COVID, the median admission-to-OR time was significantly longer in the Waiting group compared to the No-waiting group (209 min vs 75min, p=0.0009). Only one patient had positive COVID test. There were no aortic ruptures while awaiting COVID testing results. There was a total of 6 reported deaths in the During-COVID group: 1 patient died post-surgery due to ARDS caused by COVID, and others due to ischemic stroke (3 patients) and organ failure (2 patients). Conclusions: Perioperative outcomes of ATAAD patients were similar during-COVID compared to pre-COVID. Waiting for COVID testing results did not significantly affect the perioperative outcomes among ATAAD patients after repair.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"6 1","pages":"100 - 110"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42905834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-04-01Epub Date: 2022-04-14DOI: 10.26502/fccm.92920253
Rohit J Timal, Ioannis Karalis, Jose M Montero Cabezas, Joris I Rotmans, Liselotte C R Hensen, Maurits S Buiten, Mihaly K de Bie, Lieselot van Erven, Hein Putter, Martin J Schalij, Ton J Rabelink, J Wouter Jukema
Background: In hemodialysis patients, implantable cardioverter-defibrillator (ICD) implantation may result in central venous stenosis (CVS) with associated symptoms, such as pain, edema of the ipsilateral arm, facial edema, and loss of dialysis access. However, literature concerning CVS in dialysis patients with a cardiac implantable electronic device is scarce.
Methods: We conducted a prospective cohort study in which we investigated the incidence of CVS in end-stage renal disease patients on chronic dialysis who received an ICD as part of participation in the randomized ICD2 trial. A venography was performed before ICD implantation and at 1 year follow-up.
Results: Between 2007 and 2017, 80 patients on dialysis received an ICD according to ICD2 trial protocol. Our population mainly consisted of males (76.3%), and had a median age of 67 years. Hemodialysis was the predominant dialysis modality (71.3%). The ICD was implanted in the right pectoral region in 58 patients (72.5%). A minority of the patients (27.5%) had a history of central venous catheters use, ipsilateral to ICD implantation site. Median follow-up was 16 months (IQR 13-35). Prospective assessment of central vein patency was possible in 56 patients (70.0%). Partial obstruction of central vein at follow-up was present in 19 out of 56 patients (33.9%) and complete occlusion in 4 patients (7.1%). With a complete clinical follow-up of all patients with a median duration of 3.5 years (IQR 2.7 - 6.3), 3 patients developed clinically significant symptoms of CVS.
Conclusions: Development of CVS in patients on chronic dialysis who received an ICD is a cause of concern. Prevention of such complications deserves attention and further research.
{"title":"Development of Central Venous Stenosis Upon ICD Implantation in Dialysis Patients: A Non-Negligible Issue.","authors":"Rohit J Timal, Ioannis Karalis, Jose M Montero Cabezas, Joris I Rotmans, Liselotte C R Hensen, Maurits S Buiten, Mihaly K de Bie, Lieselot van Erven, Hein Putter, Martin J Schalij, Ton J Rabelink, J Wouter Jukema","doi":"10.26502/fccm.92920253","DOIUrl":"10.26502/fccm.92920253","url":null,"abstract":"<p><strong>Background: </strong>In hemodialysis patients, implantable cardioverter-defibrillator (ICD) implantation may result in central venous stenosis (CVS) with associated symptoms, such as pain, edema of the ipsilateral arm, facial edema, and loss of dialysis access. However, literature concerning CVS in dialysis patients with a cardiac implantable electronic device is scarce.</p><p><strong>Methods: </strong>We conducted a prospective cohort study in which we investigated the incidence of CVS in end-stage renal disease patients on chronic dialysis who received an ICD as part of participation in the randomized ICD2 trial. A venography was performed before ICD implantation and at 1 year follow-up.</p><p><strong>Results: </strong>Between 2007 and 2017, 80 patients on dialysis received an ICD according to ICD2 trial protocol. Our population mainly consisted of males (76.3%), and had a median age of 67 years. Hemodialysis was the predominant dialysis modality (71.3%). The ICD was implanted in the right pectoral region in 58 patients (72.5%). A minority of the patients (27.5%) had a history of central venous catheters use, ipsilateral to ICD implantation site. Median follow-up was 16 months (IQR 13-35). Prospective assessment of central vein patency was possible in 56 patients (70.0%). Partial obstruction of central vein at follow-up was present in 19 out of 56 patients (33.9%) and complete occlusion in 4 patients (7.1%). With a complete clinical follow-up of all patients with a median duration of 3.5 years (IQR 2.7 - 6.3), 3 patients developed clinically significant symptoms of CVS.</p><p><strong>Conclusions: </strong>Development of CVS in patients on chronic dialysis who received an ICD is a cause of concern. Prevention of such complications deserves attention and further research.</p><p><strong>Trial registration: </strong>ISRCTN20479861.</p>","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":" ","pages":"171-188"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9401088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33437235","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.1101/2022.02.16.22271069
S. K. J. Been Sayeed, A. Haque, M. Moniruzzaman, Reaz Mahmud, Md Abdullah Yusuf, S. Das, M. B. Rashid, Sabrina Rahman, A. Nayeem, A. Kabir, M. S. J. Haque Chowdhury, Md. Mujibur Rahman
Background Stroke is the second leading cause of mortality worldwide; where the majority of stroke is ischemic. Among ischemic stroke, cardio-embolic has both higher severity and mortality. Objective To find out clinical outcomes and determine predictors of mortality related to cardio-embolic stroke. Methodology This prospective cohort study was conducted among patients of acute ischemic stroke of cardiac origin admitted at the National Institute of Neurosciences and Hospital, Bangladesh from 1 st October 2020 to 30 September, 2021. Patients were kept under follow-up to 90 days from discharge. Results A total of 689 ischemic stroke patients were screened, 156 had confirmed Cardio-embolic stroke. So, the frequency of cardio-embolic stroke was 22.64%. Male to female ratio was 1.3:1, mean age of 63 years. Hypertension 119 (76.3%), atrial fibrillation 107 (68.6%), and IHD 40 (25.6%) were most common comorbidities. Interestingly, we found only 23 (14.7%) patients with chronic rheumatic heart diseases. NIH Stroke scale score (median, IQR) during admission was 13 [7- 19]. Overall mortality was 47 (29.9%), among them 30 (19.2%) died within 48 hours of hospital admission while 17 (10.9%) within 90 days of hospital discharge. Modified Rankin score at 90 days was 2 [min 0, max 5] those who survived. Cumulative incidence of recurrent stroke was 9 (7.1%) and incidence of anticoagulant induced hemorrhage were 5 (3.2%) among them. Risk factors associated with mortality (odds ratio, [95% CI], p value) were acute myocardial infarction (1.6 [1.14 - 2.52] , 0.04), raised Troponin (1.89 [1.16-2.99], 0.01), reduced ejection fraction (3.38 [2.17-5.27], <0.001), hypotension (3.12 [2.07 - 4.68], < 0.001), chronic kidney disease (1.82 [1.06 - 3.10], 0.04), raised Creatinine (2.41 [1.52 -3.84], 0.01), raised blood sugar ( 1.82 [1.14 - 2.89], 0.02) , severe stroke (9.45 [3.57 - 25.03] , <0.001), large infarct (53.67 [7.59 - 379.47] , < 0.001), hemorrhagic transformation (4.43 [2.89 - 6.84] , < 0.001) and aspiration pneumonia (1.9 [1.28-2.39], 0.01) . Conclusion Overall frequency, severity, functional disability, and mortality in cardio-embolic stroke are higher. Acute myocardial infarction, severe stroke, presence of hyperglycemia, hypotension, renal impairment, low ejection fraction, large infarct, hemorrhagic transformations, and aspiration pneumonia are both clinically and statistically significantly associated with mortality in cardio-embolic stroke.
{"title":"Prevalence and Outcome of Cardio-Embolic Stroke Patients Admitted at Referral Neurology Hospital in Bangladesh","authors":"S. K. J. Been Sayeed, A. Haque, M. Moniruzzaman, Reaz Mahmud, Md Abdullah Yusuf, S. Das, M. B. Rashid, Sabrina Rahman, A. Nayeem, A. Kabir, M. S. J. Haque Chowdhury, Md. Mujibur Rahman","doi":"10.1101/2022.02.16.22271069","DOIUrl":"https://doi.org/10.1101/2022.02.16.22271069","url":null,"abstract":"Background Stroke is the second leading cause of mortality worldwide; where the majority of stroke is ischemic. Among ischemic stroke, cardio-embolic has both higher severity and mortality. Objective To find out clinical outcomes and determine predictors of mortality related to cardio-embolic stroke. Methodology This prospective cohort study was conducted among patients of acute ischemic stroke of cardiac origin admitted at the National Institute of Neurosciences and Hospital, Bangladesh from 1 st October 2020 to 30 September, 2021. Patients were kept under follow-up to 90 days from discharge. Results A total of 689 ischemic stroke patients were screened, 156 had confirmed Cardio-embolic stroke. So, the frequency of cardio-embolic stroke was 22.64%. Male to female ratio was 1.3:1, mean age of 63 years. Hypertension 119 (76.3%), atrial fibrillation 107 (68.6%), and IHD 40 (25.6%) were most common comorbidities. Interestingly, we found only 23 (14.7%) patients with chronic rheumatic heart diseases. NIH Stroke scale score (median, IQR) during admission was 13 [7- 19]. Overall mortality was 47 (29.9%), among them 30 (19.2%) died within 48 hours of hospital admission while 17 (10.9%) within 90 days of hospital discharge. Modified Rankin score at 90 days was 2 [min 0, max 5] those who survived. Cumulative incidence of recurrent stroke was 9 (7.1%) and incidence of anticoagulant induced hemorrhage were 5 (3.2%) among them. Risk factors associated with mortality (odds ratio, [95% CI], p value) were acute myocardial infarction (1.6 [1.14 - 2.52] , 0.04), raised Troponin (1.89 [1.16-2.99], 0.01), reduced ejection fraction (3.38 [2.17-5.27], <0.001), hypotension (3.12 [2.07 - 4.68], < 0.001), chronic kidney disease (1.82 [1.06 - 3.10], 0.04), raised Creatinine (2.41 [1.52 -3.84], 0.01), raised blood sugar ( 1.82 [1.14 - 2.89], 0.02) , severe stroke (9.45 [3.57 - 25.03] , <0.001), large infarct (53.67 [7.59 - 379.47] , < 0.001), hemorrhagic transformation (4.43 [2.89 - 6.84] , < 0.001) and aspiration pneumonia (1.9 [1.28-2.39], 0.01) . Conclusion Overall frequency, severity, functional disability, and mortality in cardio-embolic stroke are higher. Acute myocardial infarction, severe stroke, presence of hyperglycemia, hypotension, renal impairment, low ejection fraction, large infarct, hemorrhagic transformations, and aspiration pneumonia are both clinically and statistically significantly associated with mortality in cardio-embolic stroke.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49549074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-24DOI: 10.21203/rs.3.rs-1223161/v1
H. Moriya, Y. Mochida, Kunihiro Ishioka, Machiko Oka, K. Maesato, M. Yamano, Hiroyuki Suzuki, T. Ohtake, S. Hidaka, Shuzo Kobayashi
Background It remains unclear whether contrast-induced nephropathy (CIN) has a prognostic impact on subsequent renal dysfunction and whether deteriorating renal function is a risk factor for CIN. This study aimed to evaluate the occurrence of CIN in patients with pre-existing renal dysfunction and investigate the long-term effects of worsening renal function after coronary angiography or contrast-enhanced computed tomography (CT). The prognostic factors of worsening renal dysfunction were also analyzed. Methods This was a prospective cohort study of patients at risk for CIN, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 on coronary angiography or eGFR <45 mL/min/1.73 m2 on contrast-enhanced CT. Serum creatinine levels and the 2-year prognosis were evaluated. CIN was defined as an increase in serum creatinine level by more than 0.5 mg/dL or a 25% increase from the previous value within 72 hours after contrast administration. The primary endpoint was the proportion of patients who had serum Cr doubling or induction of dialysis within 2 years according to CIN occurrence. Results Of the 410 patients, 19 patients developed CIN (8/142 patients on coronary angiography and 11/268 patients on contrast-enhanced CT), and 38 patients had worsened renal function (21/142 patients on coronary angiography and 17/268 patients on contrast-enhanced CT). CIN was not associated with worsening renal function at 2 years. Analysis by renal function at the time of coronary angiography or contrast-enhanced CT (i.e., eGFR ≥30 ml/min/1.73 m2 and eGFR ≤1.73 m2) found no between-group difference in the occurrence of CIN. Conclusions CIN is not a prognostic risk factor for the long-term of chronic kidney disease after coronary angiography or contrast-enhanced CT. Pre-existing renal dysfunction is also not a risk factor for CIN, even if the eGFR is <30 ml/min/1.73 m2.
{"title":"Impact of Contrast-Induced Nephropathy on Long-Term Renal Function after Coronary Angiography and Contrast-Enhanced Computed Tomography.","authors":"H. Moriya, Y. Mochida, Kunihiro Ishioka, Machiko Oka, K. Maesato, M. Yamano, Hiroyuki Suzuki, T. Ohtake, S. Hidaka, Shuzo Kobayashi","doi":"10.21203/rs.3.rs-1223161/v1","DOIUrl":"https://doi.org/10.21203/rs.3.rs-1223161/v1","url":null,"abstract":"Background\u0000It remains unclear whether contrast-induced nephropathy (CIN) has a prognostic impact on subsequent renal dysfunction and whether deteriorating renal function is a risk factor for CIN. This study aimed to evaluate the occurrence of CIN in patients with pre-existing renal dysfunction and investigate the long-term effects of worsening renal function after coronary angiography or contrast-enhanced computed tomography (CT). The prognostic factors of worsening renal dysfunction were also analyzed.\u0000\u0000\u0000Methods\u0000This was a prospective cohort study of patients at risk for CIN, defined as an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 on coronary angiography or eGFR <45 mL/min/1.73 m2 on contrast-enhanced CT. Serum creatinine levels and the 2-year prognosis were evaluated. CIN was defined as an increase in serum creatinine level by more than 0.5 mg/dL or a 25% increase from the previous value within 72 hours after contrast administration. The primary endpoint was the proportion of patients who had serum Cr doubling or induction of dialysis within 2 years according to CIN occurrence.\u0000\u0000\u0000Results\u0000Of the 410 patients, 19 patients developed CIN (8/142 patients on coronary angiography and 11/268 patients on contrast-enhanced CT), and 38 patients had worsened renal function (21/142 patients on coronary angiography and 17/268 patients on contrast-enhanced CT). CIN was not associated with worsening renal function at 2 years. Analysis by renal function at the time of coronary angiography or contrast-enhanced CT (i.e., eGFR ≥30 ml/min/1.73 m2 and eGFR ≤1.73 m2) found no between-group difference in the occurrence of CIN.\u0000\u0000\u0000Conclusions\u0000CIN is not a prognostic risk factor for the long-term of chronic kidney disease after coronary angiography or contrast-enhanced CT. Pre-existing renal dysfunction is also not a risk factor for CIN, even if the eGFR is <30 ml/min/1.73 m2.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"6 5 1","pages":"473-479"},"PeriodicalIF":0.0,"publicationDate":"2022-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45289816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Arif A Khan, I. Roussin, A. Wayne, George Leventogiannis, C. Barr, M. Banks, J. Martins, Nikolaos Tsanaxidis
We report the case of a 52 year old Jamaican lady who presented with contained rupture of the aorta. The patient initially presented one year prior to admission with fatigue and weight loss. At the time, her inflammatory markers were non-specifically raised: IgG: 16.6 g/L (normal 5.316.5) and IgA: 4.21 g/L (normal 0.8-4.00), CRP 45 mg/l (normal 0-10), ESR 24mm/hr (normal (1-12), globulins 41 (19-35) but her full blood count and liver function test were normal. Both rheumatoid factor and ANA were negative. A CT scan was performed to investigate the weight loss and revealed a lung nodule but no other abnormalities. On review one year later, her ESR was raised to >100mm/hr and globulins to 48g/L. A follow up chest radiograph (Figure 1A) and CT scan to look for interval change in the lung nodule revealed a 6 cm aneurysm of the ascending aorta together with a large type A aortic dissection (Figure 1B-C). The patient was transferred to our hospital for urgent surgery. On admission, the patient described experiencing an acute back pain 3 weeks earlier which was initially treated as musculoskeletal. Pre-operative transthoracic echo (Figure 1D-F) showed contained rupture of the ascending aorta from the sinus of Valsalva to the proximal arch: 9.0 x 4.3 cm, neck 2.1 cm, no flap and no aortic regurgitation. The ruptured aorta was contained by a 2.6 cm thick mural haematoma (Figure 1F). MRI confirmed these initial findings (Figure 1G-I). Intra-operative findings (Figure 1J-L) confirmed the ruptured aorta with aortic aneurysm originating from the sinotubular junction to the proximal arch, with the unusual finding of a transverse rupture of the aortic wall adjacent to an aortic ulcer. The contained rupture was filled with layers of haematoma. A 36mm Dacron graft was fitted with an uneventful postoperative course. Histology of aorta revealed a lymphoplasmocytic aortitis with destruction of the media (Figure 1M-N). Immunostaining showed 15%. of the lymphocytes positive for IgG4 (Figure 1N). No giant cells were seen and the presence of intimal thrombus was confirmed. Follow-up revealed a persistent increase in inflammatory markers: CRP 40.7 mg/ml, globulin 48 g/L, ESR >100 mm/hr. The patient was referred to her rheumatologist for initiation of glucocorticoid treatment to control the inflammatory syndrome associated with her IgG4positive lymphoplasmocytic aortitis in order to prevent recurrent vascular disease.
{"title":"Contained Rupture of the Aorta: IgG4 Related Aortitis","authors":"Arif A Khan, I. Roussin, A. Wayne, George Leventogiannis, C. Barr, M. Banks, J. Martins, Nikolaos Tsanaxidis","doi":"10.26502/fccm.92920289","DOIUrl":"https://doi.org/10.26502/fccm.92920289","url":null,"abstract":"We report the case of a 52 year old Jamaican lady who presented with contained rupture of the aorta. The patient initially presented one year prior to admission with fatigue and weight loss. At the time, her inflammatory markers were non-specifically raised: IgG: 16.6 g/L (normal 5.316.5) and IgA: 4.21 g/L (normal 0.8-4.00), CRP 45 mg/l (normal 0-10), ESR 24mm/hr (normal (1-12), globulins 41 (19-35) but her full blood count and liver function test were normal. Both rheumatoid factor and ANA were negative. A CT scan was performed to investigate the weight loss and revealed a lung nodule but no other abnormalities. On review one year later, her ESR was raised to >100mm/hr and globulins to 48g/L. A follow up chest radiograph (Figure 1A) and CT scan to look for interval change in the lung nodule revealed a 6 cm aneurysm of the ascending aorta together with a large type A aortic dissection (Figure 1B-C). The patient was transferred to our hospital for urgent surgery. On admission, the patient described experiencing an acute back pain 3 weeks earlier which was initially treated as musculoskeletal. Pre-operative transthoracic echo (Figure 1D-F) showed contained rupture of the ascending aorta from the sinus of Valsalva to the proximal arch: 9.0 x 4.3 cm, neck 2.1 cm, no flap and no aortic regurgitation. The ruptured aorta was contained by a 2.6 cm thick mural haematoma (Figure 1F). MRI confirmed these initial findings (Figure 1G-I). Intra-operative findings (Figure 1J-L) confirmed the ruptured aorta with aortic aneurysm originating from the sinotubular junction to the proximal arch, with the unusual finding of a transverse rupture of the aortic wall adjacent to an aortic ulcer. The contained rupture was filled with layers of haematoma. A 36mm Dacron graft was fitted with an uneventful postoperative course. Histology of aorta revealed a lymphoplasmocytic aortitis with destruction of the media (Figure 1M-N). Immunostaining showed 15%. of the lymphocytes positive for IgG4 (Figure 1N). No giant cells were seen and the presence of intimal thrombus was confirmed. Follow-up revealed a persistent increase in inflammatory markers: CRP 40.7 mg/ml, globulin 48 g/L, ESR >100 mm/hr. The patient was referred to her rheumatologist for initiation of glucocorticoid treatment to control the inflammatory syndrome associated with her IgG4positive lymphoplasmocytic aortitis in order to prevent recurrent vascular disease.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346386","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maleeha Saleem, Steven A Hamilton, Karan H Pahuja, Mohab Hassib, Ahmed A. Elkhouly, Muhammad Haseeb-ul-Rasool, Justin Fox
Citation Comparing the Left Distal Transradial Artery Access to Traditional Access Methods For Coronary Angiography: A Single-Center Experience. Cardiology and Cardiovascular Medicine 6 (2022): Abstract Objective: The aim of this study was to compare the effectiveness and safety of left distal transradial (LdTRA) approach in patients who had prior coronary artery bypass grafting (CABG) with conventional femoral and radial access for coronary angiography. and for radial access was 13.23±1.74 minutes. The fluoroscopy dose for femoral access was 599.98±26.63 Gy/cm2, for snuffbox approach 722.71±112.94 Gy/cm2 and for radial access was 767.06±90.89 Gy/cm2. There were no complications noted in our study. We found no statistical significance difference between approaches with regards to time of access, procedure duration, fluoroscopy time, fluoroscopy dose and mean length of hospital stay. Conclusion: Due to the lack of statistical significance between outcomes of either approach, all approaches are acceptable options. Clinically, the snuffbox approach may be superior because it helps salvage the radial conduit for future coronary interventions and avoids the risk of femoral access complications. Therefore, we suggest operators strongly consider the snuffbox approach in patients with prior CABG.
{"title":"Comparing the Left Distal Transradial Artery Access to Traditional Access Methods For Coronary Angiography: A Single-Center Experience","authors":"Maleeha Saleem, Steven A Hamilton, Karan H Pahuja, Mohab Hassib, Ahmed A. Elkhouly, Muhammad Haseeb-ul-Rasool, Justin Fox","doi":"10.26502/fccm.92920268","DOIUrl":"https://doi.org/10.26502/fccm.92920268","url":null,"abstract":"Citation Comparing the Left Distal Transradial Artery Access to Traditional Access Methods For Coronary Angiography: A Single-Center Experience. Cardiology and Cardiovascular Medicine 6 (2022): Abstract Objective: The aim of this study was to compare the effectiveness and safety of left distal transradial (LdTRA) approach in patients who had prior coronary artery bypass grafting (CABG) with conventional femoral and radial access for coronary angiography. and for radial access was 13.23±1.74 minutes. The fluoroscopy dose for femoral access was 599.98±26.63 Gy/cm2, for snuffbox approach 722.71±112.94 Gy/cm2 and for radial access was 767.06±90.89 Gy/cm2. There were no complications noted in our study. We found no statistical significance difference between approaches with regards to time of access, procedure duration, fluoroscopy time, fluoroscopy dose and mean length of hospital stay. Conclusion: Due to the lack of statistical significance between outcomes of either approach, all approaches are acceptable options. Clinically, the snuffbox approach may be superior because it helps salvage the radial conduit for future coronary interventions and avoids the risk of femoral access complications. Therefore, we suggest operators strongly consider the snuffbox approach in patients with prior CABG.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Little is known about the role of serum uric acid in cardiovascular events with no specific data on the relationship between hyperuricemia and cardiovascular morbidities in the chronic hemodialysis setting. Objectives: To determine The prevalence of hyperuricemia and the association between uric acid level and various cardiovascular morbidities in patients with ESRF whom undergoing regular hemodialysis sessions. Methods: Descriptive retrospective facility based study included all hemodialysis patients who attended the hemodialysis unit at the Academy Charity Teaching Hospital from January 2019 – December 2019 which was equivalent to 150 patients, Data collected from patient’s files using data collection sheet then entered in Microsoft-excel and analyzed statistically using SPSS. Results: the study population included 150 patients, Male to female ratio 3:2, with a mean age of 54 years ±17. (21.3%) of the study participants live in Jabra region, 57% were jobless (30% were unemployed and 27% were housewives). CKD represented 89,59% of the etiological factors of ESRF. The median time spent by patients since the start of dialysis is 36 months. The overall prevalence of hyperuricemia was 62% and The most frequently associated comorbid condition was hypertension with 99% followed by Myocardial Infarction with 12.7% of patients. 44% of participants were taking Allopurinol plus CaCo3 and 18% were CaCo3 alone. the association between the serum uric acid levels and myocardial infarction was proven to be statistically significant with p value of 0.037. On the other hand, association between hyperuricemia and stroke, heart failure was found to be statistically insignificant. Conclusion: prevalence of hyperuricemia is high in patients with ESRD whom undergoing regular hemodialysis sessions and Serum uric acid is significantly associated with myocardial infarction. Hyperuricemia should be acknowledged and monitored as a risk factor for cardiovascular disease.
{"title":"The Correlation between Hyperuricemia and Cardiovascular Morbidities among Hemodialysis Patients Attending the Academy Charity Teaching Hospital From Jan 2019 - Dec 2019","authors":"Mohammed Walid Khalil Abushunnar","doi":"10.26502/fccm.92920276","DOIUrl":"https://doi.org/10.26502/fccm.92920276","url":null,"abstract":"Background: Little is known about the role of serum uric acid in cardiovascular events with no specific data on the relationship between hyperuricemia and cardiovascular morbidities in the chronic hemodialysis setting. Objectives: To determine The prevalence of hyperuricemia and the association between uric acid level and various cardiovascular morbidities in patients with ESRF whom undergoing regular hemodialysis sessions. Methods: Descriptive retrospective facility based study included all hemodialysis patients who attended the hemodialysis unit at the Academy Charity Teaching Hospital from January 2019 – December 2019 which was equivalent to 150 patients, Data collected from patient’s files using data collection sheet then entered in Microsoft-excel and analyzed statistically using SPSS. Results: the study population included 150 patients, Male to female ratio 3:2, with a mean age of 54 years ±17. (21.3%) of the study participants live in Jabra region, 57% were jobless (30% were unemployed and 27% were housewives). CKD represented 89,59% of the etiological factors of ESRF. The median time spent by patients since the start of dialysis is 36 months. The overall prevalence of hyperuricemia was 62% and The most frequently associated comorbid condition was hypertension with 99% followed by Myocardial Infarction with 12.7% of patients. 44% of participants were taking Allopurinol plus CaCo3 and 18% were CaCo3 alone. the association between the serum uric acid levels and myocardial infarction was proven to be statistically significant with p value of 0.037. On the other hand, association between hyperuricemia and stroke, heart failure was found to be statistically insignificant. Conclusion: prevalence of hyperuricemia is high in patients with ESRD whom undergoing regular hemodialysis sessions and Serum uric acid is significantly associated with myocardial infarction. Hyperuricemia should be acknowledged and monitored as a risk factor for cardiovascular disease.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346795","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H. Rogers
Citation : Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H Rogers. Transcatheter Closure of Traumatic Ventricular Septal Defects: Two Cases and a Review of the Literature. Cardiology and Cardiovascular Medicine 6 (2022): 42-50.
引用本文:Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H Rogers。外伤性室间隔缺损经导管闭合术2例及文献复习。心内科与心血管医学6(2022):42-50。
{"title":"Transcatheter Closure of Traumatic Ventricular Septal Defects: Two Cases and a Review of the Literature","authors":"Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H. Rogers","doi":"10.26502/fccm.92920243","DOIUrl":"https://doi.org/10.26502/fccm.92920243","url":null,"abstract":"Citation : Tai H Pham, Matthew S Glassy, Gagan D Singh, Jason H Rogers. Transcatheter Closure of Traumatic Ventricular Septal Defects: Two Cases and a Review of the Literature. Cardiology and Cardiovascular Medicine 6 (2022): 42-50.","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Taamallah K, Arous Y, Haggui A, Hajlaoui N, F. W., M. F
{"title":"Does Emotion before a Chemotherapy Course Break a Heart? Cardiogenic Shock Complicating Takotsubo Cardiomyopathy","authors":"Taamallah K, Arous Y, Haggui A, Hajlaoui N, F. W., M. F","doi":"10.26502/fccm.92920283","DOIUrl":"https://doi.org/10.26502/fccm.92920283","url":null,"abstract":"","PeriodicalId":72523,"journal":{"name":"Cardiology and cardiovascular medicine","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69346377","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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