Pub Date : 2025-01-01Epub Date: 2025-08-14DOI: 10.20517/2574-1209.2025.58
Jessie Lee, Peter S Giannaris, Cigdem Erkuran Yilmaz, Gokhan Yilmaz
Ischemic stroke is a devastating global public health problem and the leading cause of acute death and chronic disability. Despite being the diagnostic cornerstone, limitations in neuroimaging, including availability, cost, and therapeutic window, have rekindled interest in biomarker-based approaches. Biomarkers will be employed to facilitate the eventual prediction, early diagnosis, and prognosis of strokes, as well as to inform person-centered medicine. This review summarizes recent advances in the search for biomarkers related to inflammatory, endothelial, metabolic, and neuroaxonal pathways. Interleukin-6 (IL-6), asymmetric dimethylarginine (ADMA), endothelial microparticles (EMP), and homocysteine serve as predictive biomarkers corresponding to vascular risk and inflammatory priming. Glial fibrillary acidic protein (GFAP), D-dimer, and neuron-specific enolase (NSE) are diagnostic markers that can already subtype stroke and estimate lesion burden. Prognostic biomarkers, such as serum neurofilament light chain (sNfL), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), and growth differentiation factor 15 (GDF-15), are associated with infarct size and long-term outcomes. The -omic sciences (genomic, proteomic, and metabolomic) have discovered defined molecular signatures and panels with high specificity to describe heterogeneity in stroke. Cerebrospinal fluid (CSF) biomarkers and newer imaging modalities, such as those provided through positron emission tomography/computed tomography (PET/CT), offer valuable adjuncts to blood biomarkers in the diagnosis of conditions. Translational potential is hindered by heterogeneity in the transcriptional landscape.
{"title":"Emerging biomarkers in ischemic stroke.","authors":"Jessie Lee, Peter S Giannaris, Cigdem Erkuran Yilmaz, Gokhan Yilmaz","doi":"10.20517/2574-1209.2025.58","DOIUrl":"10.20517/2574-1209.2025.58","url":null,"abstract":"<p><p>Ischemic stroke is a devastating global public health problem and the leading cause of acute death and chronic disability. Despite being the diagnostic cornerstone, limitations in neuroimaging, including availability, cost, and therapeutic window, have rekindled interest in biomarker-based approaches. Biomarkers will be employed to facilitate the eventual prediction, early diagnosis, and prognosis of strokes, as well as to inform person-centered medicine. This review summarizes recent advances in the search for biomarkers related to inflammatory, endothelial, metabolic, and neuroaxonal pathways. Interleukin-6 (IL-6), asymmetric dimethylarginine (ADMA), endothelial microparticles (EMP), and homocysteine serve as predictive biomarkers corresponding to vascular risk and inflammatory priming. Glial fibrillary acidic protein (GFAP), D-dimer, and neuron-specific enolase (NSE) are diagnostic markers that can already subtype stroke and estimate lesion burden. Prognostic biomarkers, such as serum neurofilament light chain (sNfL), N-terminal pro-B-type natriuretic peptide (NT-pro-BNP), and growth differentiation factor 15 (GDF-15), are associated with infarct size and long-term outcomes. The -omic sciences (genomic, proteomic, and metabolomic) have discovered defined molecular signatures and panels with high specificity to describe heterogeneity in stroke. Cerebrospinal fluid (CSF) biomarkers and newer imaging modalities, such as those provided through positron emission tomography/computed tomography (PET/CT), offer valuable adjuncts to blood biomarkers in the diagnosis of conditions. Translational potential is hindered by heterogeneity in the transcriptional landscape.</p>","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"9 ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12425485/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145066769","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}
Aim: Intracranial aneurysms pose significant challenges in diagnosis and treatment, emphasizing the need for accurate segmentation methods to assist clinicians in their management. In this paper, we present a novel approach for segmenting intracranial aneurysms using three-dimensional time-of-flight magnetic resonance angiography (TOF-MRA) images and the no-new-U-net framework. We aim to improve segmentation accuracy and efficiency through the integration of hybrid loss functions and additional vessel information.
Methods: The model was conducted on Aneurysm Detection And SegMentation (ADAM) and Renji Hospital (RENJI) datasets. The TOF-MRA ADAM dataset contains data from 113 cases, where 89 have at least one aneurysm with a median maximum diameter of 3.6 mm and range from 1.0 to 15.9 mm. The RENJI private TOF-MRA dataset comprises 213 cases including both ruptured and unruptured aneurysms with a median maximum diameter of 9.35 mm (range: 1.25-37.58 mm). We optimized the segmentation model by exploring hybrid loss functions that combine distribution-based and region-based losses to effectively delineate intricate aneurysm structures. Additionally, we incorporated vessel information as a region of interest using an automatic vessel segmentation algorithm to enhance the model's focus on critical regions. The model was trained on multi-modality data, including both vessel-enhanced and original images, to capture complementary information and improve segmentation accuracy.
Results: Extensive simulations on both the ADAM dataset and a private RENJI dataset demonstrate the effectiveness of our approach. The best-performing loss function yielded significant improvements in the Dice coefficient (0.72 and 0.54) and Sensitivity (0.69 and 0.53) on the RENJI and ADAM datasets, respectively.
Conclusions: The proposed method offers a promising solution for accurately segmenting intracranial aneurysms, showcasing superior performance compared to existing approaches. By integrating hybrid loss functions and vessel information, we enhance the model's ability to delineate intricate aneurysm structures, contributing to improved diagnosis and treatment planning for patients with intracranial aneurysms.
{"title":"Intracranial aneurysm segmentation with nnU-net: utilizing loss functions and automated vessel extraction.","authors":"Maysam Orouskhani, Negar Firoozeh, Huayu Wang, Yan Wang, Hanrui Shi, Weijing Li, Beibei Sun, Jianjian Zhang, Xiao Li, Huilin Zhao, Mahmud Mossa-Basha, Jenq-Neng Hwang, Chengcheng Zhu","doi":"10.20517/2574-1209.2025.42","DOIUrl":"10.20517/2574-1209.2025.42","url":null,"abstract":"<p><strong>Aim: </strong>Intracranial aneurysms pose significant challenges in diagnosis and treatment, emphasizing the need for accurate segmentation methods to assist clinicians in their management. In this paper, we present a novel approach for segmenting intracranial aneurysms using three-dimensional time-of-flight magnetic resonance angiography (TOF-MRA) images and the no-new-U-net framework. We aim to improve segmentation accuracy and efficiency through the integration of hybrid loss functions and additional vessel information.</p><p><strong>Methods: </strong>The model was conducted on Aneurysm Detection And SegMentation (ADAM) and Renji Hospital (RENJI) datasets. The TOF-MRA ADAM dataset contains data from 113 cases, where 89 have at least one aneurysm with a median maximum diameter of 3.6 mm and range from 1.0 to 15.9 mm. The RENJI private TOF-MRA dataset comprises 213 cases including both ruptured and unruptured aneurysms with a median maximum diameter of 9.35 mm (range: 1.25-37.58 mm). We optimized the segmentation model by exploring hybrid loss functions that combine distribution-based and region-based losses to effectively delineate intricate aneurysm structures. Additionally, we incorporated vessel information as a region of interest using an automatic vessel segmentation algorithm to enhance the model's focus on critical regions. The model was trained on multi-modality data, including both vessel-enhanced and original images, to capture complementary information and improve segmentation accuracy.</p><p><strong>Results: </strong>Extensive simulations on both the ADAM dataset and a private RENJI dataset demonstrate the effectiveness of our approach. The best-performing loss function yielded significant improvements in the Dice coefficient (0.72 and 0.54) and Sensitivity (0.69 and 0.53) on the RENJI and ADAM datasets, respectively.</p><p><strong>Conclusions: </strong>The proposed method offers a promising solution for accurately segmenting intracranial aneurysms, showcasing superior performance compared to existing approaches. By integrating hybrid loss functions and vessel information, we enhance the model's ability to delineate intricate aneurysm structures, contributing to improved diagnosis and treatment planning for patients with intracranial aneurysms.</p>","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"9 ","pages":""},"PeriodicalIF":0.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12810994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999281","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 : 2024-07-11DOI: 10.20517/2574-1209.2023.140
Canqui Flores Bernabe, Romel P. Melgarejo-Bolivar, Alfredo Tumi-Figueroa, S. Thirukumaran, G. M. Devi, Sudhakar Sengan
Aim: A significant medical diagnostic tool for monitoring cardiovascular health and function is 2D electrocardiograms. For computerized echocardiogram (echo) analysis, recognizing how this device performs is essential. This paper primarily focuses on detecting the transducer's viewpoint in cardiac echo videos using spatiotemporal data. It distinguishes between different viewpoints by monitoring the heart's function and rate throughout the cycle of heartbeats. Computer-aided diagnosis (CAD) examination sizes are the first steps toward computerized classification of cardiac imaging tests. Since clinical analysis frequently starts with automatic classification, the current view can enhance the detection of Cardiac Vascular Disease (CVD). Methods: This research article uses a Machine Learning (ML) algorithm called the Integrated Metaheuristic Technique (IMT), which is the Whale Optimization Algorithm with Weighted Support Vector Machine (WOA-WSVM). Results: The parameters in the classification are optimized with the assistance of WOA, and the echo is classified using WSVM. The WOA-WSVM classifies the images effectively and achieves an accuracy of 98.4%. Conclusion: The numerical analysis states that the WOA-WSVM technique outperforms the existing state-of-the-art algorithms.
{"title":"Echocardiographic cardiac views classification using whale optimization and weighted support vector machine","authors":"Canqui Flores Bernabe, Romel P. Melgarejo-Bolivar, Alfredo Tumi-Figueroa, S. Thirukumaran, G. M. Devi, Sudhakar Sengan","doi":"10.20517/2574-1209.2023.140","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.140","url":null,"abstract":"Aim: A significant medical diagnostic tool for monitoring cardiovascular health and function is 2D electrocardiograms. For computerized echocardiogram (echo) analysis, recognizing how this device performs is essential. This paper primarily focuses on detecting the transducer's viewpoint in cardiac echo videos using spatiotemporal data. It distinguishes between different viewpoints by monitoring the heart's function and rate throughout the cycle of heartbeats. Computer-aided diagnosis (CAD) examination sizes are the first steps toward computerized classification of cardiac imaging tests. Since clinical analysis frequently starts with automatic classification, the current view can enhance the detection of Cardiac Vascular Disease (CVD).\u0000 Methods: This research article uses a Machine Learning (ML) algorithm called the Integrated Metaheuristic Technique (IMT), which is the Whale Optimization Algorithm with Weighted Support Vector Machine (WOA-WSVM).\u0000 Results: The parameters in the classification are optimized with the assistance of WOA, and the echo is classified using WSVM. The WOA-WSVM classifies the images effectively and achieves an accuracy of 98.4%.\u0000 Conclusion: The numerical analysis states that the WOA-WSVM technique outperforms the existing state-of-the-art algorithms.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"80 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141655563","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}
Diabetic kidney disease (DKD) is a global health burden and the leading cause of end-stage renal disease. Its clinical management focuses on controlling hyperglycemia, hypertension, and hyperlipidemia. While the progression of DKD can be slowed with intervention, it cannot be stopped or reversed yet. The pathogenesis of DKD is complex, with an interplay of numerous signaling pathways, and research continues to decipher the players and their role, be it beneficial or pathogenic. Inflammation is an essential defense of our bodies against internal or external insults. The injuries that trigger inflammation range from pathogenic infections and wounds to dysregulated metabolism. Inflammation is helpful only if it is controlled and subsides after it has helped defend the individual against the insult. Uncontrolled or chronic inflammation is recognized as a contributor to numerous chronic diseases. Dysregulated inflammation plays a role in multiple aspects of DKD: glomerular hyperfiltration, mesangial expansion, podocyte injury, tubular injury, basement membrane thickening, fibrosis, and scarring. Since inflammation plays an integral role in the progression of DKD, targeting it for therapy is also reasonable. There is a growing trend of targeting inflammation as a therapeutic approach, with new targets being discovered and evaluated drugs every year. The exponential increase in literature necessitates a comprehensive summary of current information, hence this review.
{"title":"Role of inflammation in the progression of diabetic kidney disease","authors":"Arunita Chatterjee, Jacqueline Tumarin, Sharma Prabhakar","doi":"10.20517/2574-1209.2024.21","DOIUrl":"https://doi.org/10.20517/2574-1209.2024.21","url":null,"abstract":"Diabetic kidney disease (DKD) is a global health burden and the leading cause of end-stage renal disease. Its clinical management focuses on controlling hyperglycemia, hypertension, and hyperlipidemia. While the progression of DKD can be slowed with intervention, it cannot be stopped or reversed yet. The pathogenesis of DKD is complex, with an interplay of numerous signaling pathways, and research continues to decipher the players and their role, be it beneficial or pathogenic. Inflammation is an essential defense of our bodies against internal or external insults. The injuries that trigger inflammation range from pathogenic infections and wounds to dysregulated metabolism. Inflammation is helpful only if it is controlled and subsides after it has helped defend the individual against the insult. Uncontrolled or chronic inflammation is recognized as a contributor to numerous chronic diseases. Dysregulated inflammation plays a role in multiple aspects of DKD: glomerular hyperfiltration, mesangial expansion, podocyte injury, tubular injury, basement membrane thickening, fibrosis, and scarring. Since inflammation plays an integral role in the progression of DKD, targeting it for therapy is also reasonable. There is a growing trend of targeting inflammation as a therapeutic approach, with new targets being discovered and evaluated drugs every year. The exponential increase in literature necessitates a comprehensive summary of current information, hence this review.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"76 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141658076","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 : 2024-07-11DOI: 10.20517/2574-1209.2024.05
Gabriela Sabolová, L. Kočan, Miroslava Rabajdová, S. Rapčanová, Janka Vašková
The study is focused on the connection between cognitive dysfunction, inflammatory processes, oxidative stress, and various associated biological factors. Postoperative cognitive dysfunction is a condition where a patient exhibits a temporary deterioration in cognitive function after surgery, which may include problems with memory, concentration, and overall cognitive performance. While most common among elderly patients, it can occur in individuals of any age. The causes are not fully elucidated, but it is assumed that peripheral trauma during long-term surgical interventions is behind the development of inflammation and the creation of conditions of oxidative stress, which leads to the disruption of the blood-brain barrier and the subsequent development of cognitive impairment. This review aims to describe the detected changes at the level of selected markers of inflammation and oxidative damage in patients, primarily in connection with cardiac surgery.
{"title":"Association of inflammation, oxidative stress, and deteriorated cognitive functions in patients after cardiac surgery","authors":"Gabriela Sabolová, L. Kočan, Miroslava Rabajdová, S. Rapčanová, Janka Vašková","doi":"10.20517/2574-1209.2024.05","DOIUrl":"https://doi.org/10.20517/2574-1209.2024.05","url":null,"abstract":"The study is focused on the connection between cognitive dysfunction, inflammatory processes, oxidative stress, and various associated biological factors. Postoperative cognitive dysfunction is a condition where a patient exhibits a temporary deterioration in cognitive function after surgery, which may include problems with memory, concentration, and overall cognitive performance. While most common among elderly patients, it can occur in individuals of any age. The causes are not fully elucidated, but it is assumed that peripheral trauma during long-term surgical interventions is behind the development of inflammation and the creation of conditions of oxidative stress, which leads to the disruption of the blood-brain barrier and the subsequent development of cognitive impairment. This review aims to describe the detected changes at the level of selected markers of inflammation and oxidative damage in patients, primarily in connection with cardiac surgery.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"14 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141656177","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 : 2024-05-23DOI: 10.20517/2574-1209.2023.138
Antonella Tommasino, Federico Dell’Aquila, Vincenzo Cesario, Federica Tempestini, Matteo Casenghi, F. Giovannelli, Stefano Rigattieri, Emanuele Barbato, Andrea Berni
Patients who present with acute myocardial infarction (AMI) often suffer from coronary multivessel disease (MVD). This condition is associated with an increased mortality rate; it is, therefore, important to improve clinical outcomes through appropriate treatment strategies. Over the past decades, extensive research in AMI and MVD patients has consistently shown that complete revascularization is superior to treatment of the only culprit lesion. Another controversial issue concerns the most appropriate timing for percutaneous coronary intervention in non-culprit lesions. Fractional flow reserve (FFR) is considered the best method for identifying ischemic coronary lesions in the context of acute coronary syndromes, but the detection of vulnerable plaques in non-culprit vessels could further improve clinical outcomes. Intravascular imaging goes beyond physiology and it is potentially useful to recognize patients who are vulnerable, despite negative FFR. Therefore, we analyzed the most relevant studies that have investigated the relationship between physiological indexes and plaque vulnerability. However, ongoing trials aim to clarify how coronary physiology can be combined with the benefits of intracoronary imaging.
{"title":"Multivessel disease in patient with acute myocardial infarction: current treatment strategies and future perspectives","authors":"Antonella Tommasino, Federico Dell’Aquila, Vincenzo Cesario, Federica Tempestini, Matteo Casenghi, F. Giovannelli, Stefano Rigattieri, Emanuele Barbato, Andrea Berni","doi":"10.20517/2574-1209.2023.138","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.138","url":null,"abstract":"Patients who present with acute myocardial infarction (AMI) often suffer from coronary multivessel disease (MVD). This condition is associated with an increased mortality rate; it is, therefore, important to improve clinical outcomes through appropriate treatment strategies. Over the past decades, extensive research in AMI and MVD patients has consistently shown that complete revascularization is superior to treatment of the only culprit lesion. Another controversial issue concerns the most appropriate timing for percutaneous coronary intervention in non-culprit lesions. Fractional flow reserve (FFR) is considered the best method for identifying ischemic coronary lesions in the context of acute coronary syndromes, but the detection of vulnerable plaques in non-culprit vessels could further improve clinical outcomes. Intravascular imaging goes beyond physiology and it is potentially useful to recognize patients who are vulnerable, despite negative FFR. Therefore, we analyzed the most relevant studies that have investigated the relationship between physiological indexes and plaque vulnerability. However, ongoing trials aim to clarify how coronary physiology can be combined with the benefits of intracoronary imaging.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"39 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141108020","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 : 2024-05-20DOI: 10.20517/2574-1209.2023.147
Thomas V. Bilfinge, G. H. Almassi, A. L. W. Shroyer
The following is a brief review and commentary covering the content of the Special Issue of Vessel Plus entitled Current state of knowledge: Atrial Fibrillation and Cardiac Surgery. All articles in this issue are highlighted with a brief comment for the busy reader, the idea being to facilitate and encourage reading of the original work.
{"title":"Editorial review: guidance for future atrial fibrillation research","authors":"Thomas V. Bilfinge, G. H. Almassi, A. L. W. Shroyer","doi":"10.20517/2574-1209.2023.147","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.147","url":null,"abstract":"The following is a brief review and commentary covering the content of the Special Issue of Vessel Plus entitled Current state of knowledge: Atrial Fibrillation and Cardiac Surgery. All articles in this issue are highlighted with a brief comment for the busy reader, the idea being to facilitate and encourage reading of the original work.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"35 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141122128","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 : 2024-04-25DOI: 10.20517/2574-1209.2023.126
A. Browne, André Lamy
This narrative review summarizes the angiographic and clinical outcome results of the most common coronary artery bypass grafting (CABG) conduits. The left internal mammary artery is the preferred first conduit to bypass the left anterior descending artery due to superior long-term survival and graft patency. Recent studies suggest the radial artery may be the preferred second conduit for the circumflex or right coronary artery territories, challenging the belief that the right internal mammary artery is the best choice. Despite their historical high failure rates, saphenous vein grafts continue to be widely used as secondary conduits. Several recent studies report suboptimal rates of right internal mammary artery graft failure, with clinical outcomes comparable to or worse than saphenous veins. The suboptimal rates of RIMA graft failure may be attributed to several factors such as improvements in vein graft failure rates, the use of in situ and non-left anterior descending artery grafting configurations, and skeletonized harvesting techniques. While observational studies favor multiple over single arterial grafting, randomized studies are needed for confirmation. The ongoing Randomized comparison of the clinical Outcome of single vs. Multiple Arterial grafts (ROMA) trial aims to determine if multiple arterial grafting reduces major adverse cardiovascular events and mortality and how secondary conduit selection influences these outcomes. Greater adoption of arterial grafting strategies is likely to come from high-quality evidence of benefit and safety from ongoing and future large pragmatic trials.
{"title":"Selecting conduits for coronary artery bypass grafting: caution regarding the right internal mammary artery","authors":"A. Browne, André Lamy","doi":"10.20517/2574-1209.2023.126","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.126","url":null,"abstract":"This narrative review summarizes the angiographic and clinical outcome results of the most common coronary artery bypass grafting (CABG) conduits. The left internal mammary artery is the preferred first conduit to bypass the left anterior descending artery due to superior long-term survival and graft patency. Recent studies suggest the radial artery may be the preferred second conduit for the circumflex or right coronary artery territories, challenging the belief that the right internal mammary artery is the best choice. Despite their historical high failure rates, saphenous vein grafts continue to be widely used as secondary conduits. Several recent studies report suboptimal rates of right internal mammary artery graft failure, with clinical outcomes comparable to or worse than saphenous veins. The suboptimal rates of RIMA graft failure may be attributed to several factors such as improvements in vein graft failure rates, the use of in situ and non-left anterior descending artery grafting configurations, and skeletonized harvesting techniques. While observational studies favor multiple over single arterial grafting, randomized studies are needed for confirmation. The ongoing Randomized comparison of the clinical Outcome of single vs. Multiple Arterial grafts (ROMA) trial aims to determine if multiple arterial grafting reduces major adverse cardiovascular events and mortality and how secondary conduit selection influences these outcomes. Greater adoption of arterial grafting strategies is likely to come from high-quality evidence of benefit and safety from ongoing and future large pragmatic trials.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"19 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-04-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140653578","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 : 2024-04-08DOI: 10.20517/2574-1209.2023.135
Chan Joon Kim, Katherine Godfrey, Swagata Patnaik, Roxana Mehran
Cardiovascular disease is the leading cause of death worldwide. Over past decades, multiple clinical trials have provided substantial evidence supporting the advantages of managing plasma lipids in individuals with coronary artery disease (CAD). A primary focus in reducing clinical atherosclerotic cardiovascular disease (ASCVD) in patients who have undergone percutaneous coronary intervention (PCI) is the regulation of blood lipids, with an emphasis on low-density lipoprotein (LDL) cholesterol. Statins represent the cornerstone of lipid-lowering therapy (LLT), with high-intensity statins consistently associated with beneficial outcomes in patients at high risk of ASCVD. Nevertheless, a notable portion of patients do not achieve their target cholesterol levels through statin monotherapy, necessitating the inclusion of complementary LLT strategies. Among these therapies are ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitors, which have also demonstrated clinical advantages by further reducing cholesterol levels. Existing guidelines recommend using these agents when maximally tolerated statin doses fall short of achieving target LDL levels. Additionally, recently introduced ATP-citrate lyase inhibitors, such as bempedoic acid, have gained approval as adjunctive treatments. Furthermore, icosapent ethyl, a purified derivative of eicosapentaenoic acid, targets hypertriglyceridemia and has shown cardiovascular benefits compared to placebo. In this article, we delve into the mechanisms of blood lipids and molecular targets in connection with CAD undergoing PCI. We also explore the current landscape of available LLT options, guidelines in practice, and the subtleties of therapy.
心血管疾病是导致全球死亡的主要原因。在过去的几十年中，多项临床试验提供了大量证据，证明对冠状动脉疾病（CAD）患者进行血浆血脂管理具有优势。在接受经皮冠状动脉介入治疗（PCI）的患者中，减少临床动脉粥样硬化性心血管疾病（ASCVD）的一个主要重点是调节血脂，重点是低密度脂蛋白（LDL）胆固醇。他汀类药物是降脂疗法（LLT）的基石，高强度他汀类药物对 ASCVD 高风险患者的疗效一直很好。尽管如此，仍有相当一部分患者无法通过他汀类药物单一疗法达到目标胆固醇水平，因此有必要纳入辅助性 LLT 策略。这些疗法包括依折麦布和9型丙蛋白转化酶(proprotein convertase subtilisin/kexin type 9)抑制剂，它们通过进一步降低胆固醇水平也显示出了临床优势。当他汀类药物的最大耐受剂量无法达到目标低密度脂蛋白水平时，现有指南建议使用这些药物。此外，最近推出的 ATP 柠檬酸溶解酶抑制剂（如贝门冬氨酸）已被批准作为辅助治疗药物。此外，二十碳五烯酸的纯化衍生物 icosapent ethyl 针对高甘油三酯血症，与安慰剂相比对心血管有益。在本文中，我们将深入探讨与接受 PCI 治疗的 CAD 相关的血脂机制和分子靶点。我们还探讨了目前可用的 LLT 选择、实践指南和治疗的微妙之处。
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Pub Date : 2024-03-29DOI: 10.20517/2574-1209.2023.125
Gatr-alnada Gheriani, Petar S. Lenert
Systemic vasculitides can cause a wide variety of gastrointestinal manifestations (GI) ranging from mild and frequently nonspecific abdominal pains to potentially life-threatening bowel perforations. Vascular involvement in systemic vasculitides can affect any GI blood vessel, most commonly mesenteric, hepatic, or splenic arteries. Inflammatory changes affecting different layers of arterial vessel walls can lead to aneurysmatic dilatation or blood vessel occlusion with subsequent organ ischemia leading to mucosal ulcerations, GI bleeding, perforations, or bowel obstruction. While the presence of extraintestinal manifestations may aid in diagnosis, delays in making appropriate diagnoses and rapid initiation of glucocorticoid and immunosuppressive treatment can have detrimental consequences. Awareness of isolated gastrointestinal vasculitis is of particular importance as it frequently remains undiagnosed until end-stage organ damage becomes apparent. Vasculitis mimics such as vascular Ehlers-Danlos syndrome or fibromuscular dysplasia add another lay of complexity in approaching patients with suspected GI vasculitis and should always be carefully considered.
{"title":"Abdominal involvement as a primary manifestation of systemic or isolated gastrointestinal vasculitis","authors":"Gatr-alnada Gheriani, Petar S. Lenert","doi":"10.20517/2574-1209.2023.125","DOIUrl":"https://doi.org/10.20517/2574-1209.2023.125","url":null,"abstract":"Systemic vasculitides can cause a wide variety of gastrointestinal manifestations (GI) ranging from mild and frequently nonspecific abdominal pains to potentially life-threatening bowel perforations. Vascular involvement in systemic vasculitides can affect any GI blood vessel, most commonly mesenteric, hepatic, or splenic arteries. Inflammatory changes affecting different layers of arterial vessel walls can lead to aneurysmatic dilatation or blood vessel occlusion with subsequent organ ischemia leading to mucosal ulcerations, GI bleeding, perforations, or bowel obstruction. While the presence of extraintestinal manifestations may aid in diagnosis, delays in making appropriate diagnoses and rapid initiation of glucocorticoid and immunosuppressive treatment can have detrimental consequences. Awareness of isolated gastrointestinal vasculitis is of particular importance as it frequently remains undiagnosed until end-stage organ damage becomes apparent. Vasculitis mimics such as vascular Ehlers-Danlos syndrome or fibromuscular dysplasia add another lay of complexity in approaching patients with suspected GI vasculitis and should always be carefully considered.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"78 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140366564","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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