Pub Date : 2023-01-01DOI: 10.20517/2574-1209.2022.24
{"title":"Features of cholesterol metabolism in macrophages in immunoinflammatory diseases","authors":"","doi":"10.20517/2574-1209.2022.24","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.24","url":null,"abstract":"","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655958","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 : 2023-01-01DOI: 10.20517/2574-1209.2022.41
A. Geragotellis, Matti Jubouri, K. Hussain, Waseem Alzaanin, S. Z. Tan, Ravi Pate, Idhrees Mohammed, M. Bashir
Total arch replacement via frozen elephant trunk (FET) is a strategy for managing complex thoracic aortic pathologies involving the arch and descending thoracic aorta (DTA). The FET procedure involves the distal anastomosis of the FET hybrid prosthesis at a chosen aortic arch zone. Though distal anastomosis has been traditionally performed at Zone 3 (Z-3-FET) of the aortic arch, recent practice has seen a significant increase in Zone 2 FET (Z-2-FET). The literature concerning independent Zone 2 and 3 studies and head-to-head comparative studies suggest that Z-2-FET is the superior approach, yielding more favourable results overall, except for aortic remodelling. The improved clinical outcomes achieved with Z-2-FET can be attributed to the shorter operative times, including cardiopulmonary bypass duration, due to the ease and increased surgical site exposure at the aortic arch using this technique. The slightly inferior aortic remodelling observed in Z-2-FET can be explained by the decreased coverage of the DTA distally by the FET stent graft. However, this difference in results can also be attributed to the complexity and severity of the underlying pathology and the surgical approach adopted. The prospect of utilising Zone 0 FET (Z-0-FET) is highly promising, with some studies hinting at its superiority over Z-2-FET. Nevertheless, studies are needed to determine the efficacy of Z-0-FET and directly compare it to Z-2-FET to reach a definitive consensus on the most optimal FET technique. The present literature review aims to provide an overview of major intraoperative and postoperative outcomes achieved with Z-2-FET and Z-3-FET and summarise evidence from studies directly comparing them. Another aim of this narrative review is to explore current literature trends on Z-0-FET uptake.
{"title":"Head-to-head: Zone 2 vs. Zone 3 frozen elephant trunk","authors":"A. Geragotellis, Matti Jubouri, K. Hussain, Waseem Alzaanin, S. Z. Tan, Ravi Pate, Idhrees Mohammed, M. Bashir","doi":"10.20517/2574-1209.2022.41","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.41","url":null,"abstract":"Total arch replacement via frozen elephant trunk (FET) is a strategy for managing complex thoracic aortic pathologies involving the arch and descending thoracic aorta (DTA). The FET procedure involves the distal anastomosis of the FET hybrid prosthesis at a chosen aortic arch zone. Though distal anastomosis has been traditionally performed at Zone 3 (Z-3-FET) of the aortic arch, recent practice has seen a significant increase in Zone 2 FET (Z-2-FET). The literature concerning independent Zone 2 and 3 studies and head-to-head comparative studies suggest that Z-2-FET is the superior approach, yielding more favourable results overall, except for aortic remodelling. The improved clinical outcomes achieved with Z-2-FET can be attributed to the shorter operative times, including cardiopulmonary bypass duration, due to the ease and increased surgical site exposure at the aortic arch using this technique. The slightly inferior aortic remodelling observed in Z-2-FET can be explained by the decreased coverage of the DTA distally by the FET stent graft. However, this difference in results can also be attributed to the complexity and severity of the underlying pathology and the surgical approach adopted. The prospect of utilising Zone 0 FET (Z-0-FET) is highly promising, with some studies hinting at its superiority over Z-2-FET. Nevertheless, studies are needed to determine the efficacy of Z-0-FET and directly compare it to Z-2-FET to reach a definitive consensus on the most optimal FET technique. The present literature review aims to provide an overview of major intraoperative and postoperative outcomes achieved with Z-2-FET and Z-3-FET and summarise evidence from studies directly comparing them. Another aim of this narrative review is to explore current literature trends on Z-0-FET uptake.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655675","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 : 2023-01-01DOI: 10.20517/2574-1209.2022.61
Natalie K. Kolba, Julia Dokko, S. Novotny, So Agha, Ashutosh Yaligar, Jennifer Morrone, P. Parikh, A. Pryor, H. Tannous, Thomas Bilfinger, A. L. Shroyer
Aim: The mental illness (MEI) impact upon risk-adjusted first-time aortic valve replacement (AVR) or repeat AVR (r-AVR) outcomes is unknown. Comparing patients with and without new-onset postoperative atrial fibrillation or atrial flutter (POAF/AFL), this retrospective cohort investigation evaluated if MEI impacted patients’ risk-adjusted AVR/r-AVR outcomes. Methods: Using de-identified New York Statewide Planning and Research Cooperative System (administrative) database reports, multivariable logistic regression models compared post-procedural POAF/AFL, 30-day readmission, and composite (i.e., 30-day operative mortality or morbidity) endpoints between MEI and non-MEI patients. Results: From 2005-2018, there were 36,947 first-time AVR patients and 242 r-AVR patients; of these, 13.18% AVR (n = 4,868) and 16.94% r-AVR (n = 41) patients had preprocedural MEI diagnoses. Compared to non-MEI patients, MEI patients had increased rates of transcatheter vs. surgical procedures and higher pre-procedural risks including alcoholism, illegal drug use, tobacco product use, suicidal ideation, or other comorbidities (e.g., valvular disease, atherosclerotic disease, hypertension obesity, and anemia); they were younger, female, and non-Black/non-Hispanic, and had non-commercial (e.g., government or self-pay) insurance. Contrasted to non-MEI patients, MEI patients had no different risk-adjusted new onset of POAF (AVR P = 0.575; r-AVR P = 0.497), 30-day readmission (AVR P = 0.163; r-AVR P = 0.486), and mortality/morbidity composite (AVR P = 0.848; r-AVR P = 0.295) rates. Conclusions: Despite MEI patients’ inherent higher pre-procedural AVR/r-AVR risk, no differences in the MEI vs. non-MEI risk-adjusted POAF/AFL, 30-day readmission, or composite rates were found; however, MEI patients more frequently were selected to receive transcatheter rather than open surgical procedures.
目的:精神疾病(MEI)对经风险调整的首次主动脉瓣置换术(AVR)或重复主动脉瓣置换术(r-AVR)结果的影响尚不清楚。通过比较有和没有术后新发心房颤动或心房扑动(POAF/AFL)的患者，本回顾性队列研究评估MEI是否会影响患者的风险调整AVR/r-AVR结果。方法:使用去识别的纽约州规划与研究合作系统(行政)数据库报告，采用多变量logistic回归模型比较MEI和非MEI患者的术后POAF/AFL、30天再入院和综合(即30天手术死亡率或发病率)终点。结果:2005-2018年，首次AVR患者36947例，二次AVR患者242例;其中，13.18%的AVR患者(n = 4,868)和16.94%的r-AVR患者(n = 41)有手术前MEI诊断。与非MEI患者相比，MEI患者经导管与外科手术的发生率增加，手术前风险更高，包括酒精中毒、非法药物使用、烟草制品使用、自杀意念或其他合并症(如瓣膜疾病、动脉粥样硬化疾病、高血压、肥胖和贫血);他们年轻，女性，非黑人/非西班牙裔，并且有非商业(例如政府或自付)保险。与非MEI患者相比，MEI患者经风险调整后POAF新发发生率无差异(AVR P = 0.575;r-AVR P = 0.497)， 30天再入院(AVR P = 0.163;r-AVR P = 0.486)，死亡率/发病率复合(AVR P = 0.848;r-AVR P = 0.295)。结论:尽管MEI患者术前AVR/r-AVR风险固有较高，但MEI与非MEI风险调整后的POAF/AFL、30天再入院率或综合发生率均无差异;然而，MEI患者更多地选择接受经导管手术而不是开放手术。
{"title":"No mental illness impact on post-aortic valve replacement patients' new-onset atrial fibrillation","authors":"Natalie K. Kolba, Julia Dokko, S. Novotny, So Agha, Ashutosh Yaligar, Jennifer Morrone, P. Parikh, A. Pryor, H. Tannous, Thomas Bilfinger, A. L. Shroyer","doi":"10.20517/2574-1209.2022.61","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.61","url":null,"abstract":"Aim: The mental illness (MEI) impact upon risk-adjusted first-time aortic valve replacement (AVR) or repeat AVR (r-AVR) outcomes is unknown. Comparing patients with and without new-onset postoperative atrial fibrillation or atrial flutter (POAF/AFL), this retrospective cohort investigation evaluated if MEI impacted patients’ risk-adjusted AVR/r-AVR outcomes. Methods: Using de-identified New York Statewide Planning and Research Cooperative System (administrative) database reports, multivariable logistic regression models compared post-procedural POAF/AFL, 30-day readmission, and composite (i.e., 30-day operative mortality or morbidity) endpoints between MEI and non-MEI patients. Results: From 2005-2018, there were 36,947 first-time AVR patients and 242 r-AVR patients; of these, 13.18% AVR (n = 4,868) and 16.94% r-AVR (n = 41) patients had preprocedural MEI diagnoses. Compared to non-MEI patients, MEI patients had increased rates of transcatheter vs. surgical procedures and higher pre-procedural risks including alcoholism, illegal drug use, tobacco product use, suicidal ideation, or other comorbidities (e.g., valvular disease, atherosclerotic disease, hypertension obesity, and anemia); they were younger, female, and non-Black/non-Hispanic, and had non-commercial (e.g., government or self-pay) insurance. Contrasted to non-MEI patients, MEI patients had no different risk-adjusted new onset of POAF (AVR P = 0.575; r-AVR P = 0.497), 30-day readmission (AVR P = 0.163; r-AVR P = 0.486), and mortality/morbidity composite (AVR P = 0.848; r-AVR P = 0.295) rates. Conclusions: Despite MEI patients’ inherent higher pre-procedural AVR/r-AVR risk, no differences in the MEI vs. non-MEI risk-adjusted POAF/AFL, 30-day readmission, or composite rates were found; however, MEI patients more frequently were selected to receive transcatheter rather than open surgical procedures.","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"58 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67656479","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 : 2023-01-01DOI: 10.20517/2574-1209.2022.52
{"title":"Optimal perioperative care for thoracoabdominal and descending thoracic aortic aneurysm repair: a review","authors":"","doi":"10.20517/2574-1209.2022.52","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.52","url":null,"abstract":"","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655765","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 : 2023-01-01DOI: 10.20517/2574-1209.2022.35
{"title":"A novel insight into the nature of modified low-density lipoproteins and their role in atherosclerosis","authors":"","doi":"10.20517/2574-1209.2022.35","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.35","url":null,"abstract":"","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655617","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 : 2023-01-01DOI: 10.20517/2574-1209.2022.01
{"title":"What to do with patients with active infective endocarditis complicated by intracranial bleeding","authors":"","doi":"10.20517/2574-1209.2022.01","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.01","url":null,"abstract":"","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655596","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 : 2023-01-01DOI: 10.20517/2574-1209.2022.34
Kelly Perryman, David Winchester, M. Massoomi, E. Warren, Linda Morris, S. Beal, Nila S. Radhakrishnan, U. Ghaffar, Jacob Sammon, J. Raman, Marsha Lewis, D. Crabb, Liam, Holtzman, B. Allen
Aim: Evaluate the diagnostic and prognostic performance of the ESC 0/1H Algorithm and its utility in safely discharging patients with suspected Acute Coronary Syndrome (ACS) in the Emergency Department. Methods: This analysis is a retrospective cohort study of 3,156 patients presenting to an academic medical center emergency department (ED) between May 20, 2019 and May 31, 2020. After completing the Beckman Coulter Access High Sensitivity Troponin I (hs-TnI) assay per current institution protocol (T0, T1H, T3H), patients identified to have symptoms concerning ACS were retrospectively analyzed using the ESC 0/1H Algorithm to assess the safety and efficacy of a rule-out algorithm for early discharge. Results: The negative predictive value (NPV) of the protocol (T 0 < 6 pg/mL; or females with T 0 ≤ 15 pg/mL and T 1 ≤ 15 pg/mL; or males with T 0 ≤ 20 pg/mL and T 1 ≤ 20 pg/mL) was 99.4% (95%CI: 99.0-99.7%) for acute myocardial injury at the initial ED visit (index ED visit) and/or 30-day cardiac-related death. The negative
{"title":"Efficacy and safety of a 0/1-h high-sensitivity cardiac troponin I (hs-cTnI) protocol to rule out acute coronary syndrome over a one-year period","authors":"Kelly Perryman, David Winchester, M. Massoomi, E. Warren, Linda Morris, S. Beal, Nila S. Radhakrishnan, U. Ghaffar, Jacob Sammon, J. Raman, Marsha Lewis, D. Crabb, Liam, Holtzman, B. Allen","doi":"10.20517/2574-1209.2022.34","DOIUrl":"https://doi.org/10.20517/2574-1209.2022.34","url":null,"abstract":"Aim: Evaluate the diagnostic and prognostic performance of the ESC 0/1H Algorithm and its utility in safely discharging patients with suspected Acute Coronary Syndrome (ACS) in the Emergency Department. Methods: This analysis is a retrospective cohort study of 3,156 patients presenting to an academic medical center emergency department (ED) between May 20, 2019 and May 31, 2020. After completing the Beckman Coulter Access High Sensitivity Troponin I (hs-TnI) assay per current institution protocol (T0, T1H, T3H), patients identified to have symptoms concerning ACS were retrospectively analyzed using the ESC 0/1H Algorithm to assess the safety and efficacy of a rule-out algorithm for early discharge. Results: The negative predictive value (NPV) of the protocol (T 0 < 6 pg/mL; or females with T 0 ≤ 15 pg/mL and T 1 ≤ 15 pg/mL; or males with T 0 ≤ 20 pg/mL and T 1 ≤ 20 pg/mL) was 99.4% (95%CI: 99.0-99.7%) for acute myocardial injury at the initial ED visit (index ED visit) and/or 30-day cardiac-related death. The negative","PeriodicalId":75299,"journal":{"name":"Vessel plus","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67655607","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 : 2022-01-01DOI: 10.20517/2574-1209.2021.106
M. Canepa, P. Vianello, A. Porcari, M. Merlo, M. Scarpa
Cardiac amyloidosis (CA) is increasingly diagnosed due to the advancements made in diagnostics and therapeutics in the last decades, particularly in the field of transthyretin-related CA. Studies that have used bone scintigraphy for screening at-risk conditions have shown that about one out of ten patients with heart failure with preserved ejection fraction (HFpEF), aortic stenosis undergoing valve replacement, or hypertrophic cardiomyopathy (HCM) diagnosed later in life might have an underlying or concomitant CA. At the same time, the epidemiology of these conditions is also rapidly evolving. HFpEF has become the leading form of heart failure, and HFpEF patients are increasingly cared for in non-cardiology settings due to their older age and substantial burden of comorbidities. Aortic stenosis is increasingly treated percutaneously at earlier stages of the disease, determining a significant gain in survival. Hypertrophic cardiomyopathy is nowadays mostly diagnosed in middle-aged adults with near-normal life expectancy, with a greater chance of misdiagnosing CA as HCM or of an overlap between the two conditions. In all these contexts, the therapeutic and prognostic implications of diagnosing CA will have to be further investigated. Meanwhile, the diagnostic workup of patients with suspected CA should always be completed with the systematic exclusion of a plasma cell dyscrasia, the acquisition of tomographic imaging at bone scintigraphy, and the completion of genetic testing for transthyretin-related forms.
{"title":"Cardiac amyloidosis: a changing epidemiology with open challenges","authors":"M. Canepa, P. Vianello, A. Porcari, M. Merlo, M. Scarpa","doi":"10.20517/2574-1209.2021.106","DOIUrl":"https://doi.org/10.20517/2574-1209.2021.106","url":null,"abstract":"Cardiac amyloidosis (CA) is increasingly diagnosed due to the advancements made in diagnostics and therapeutics in the last decades, particularly in the field of transthyretin-related CA. Studies that have used bone scintigraphy for screening at-risk conditions have shown that about one out of ten patients with heart failure with preserved ejection fraction (HFpEF), aortic stenosis undergoing valve replacement, or hypertrophic cardiomyopathy (HCM) diagnosed later in life might have an underlying or concomitant CA. At the same time, the epidemiology of these conditions is also rapidly evolving. HFpEF has become the leading form of heart failure, and HFpEF patients are increasingly cared for in non-cardiology settings due to their older age and substantial burden of comorbidities. Aortic stenosis is increasingly treated percutaneously at earlier stages of the disease, determining a significant gain in survival. Hypertrophic cardiomyopathy is nowadays mostly diagnosed in middle-aged adults with near-normal life expectancy, with a greater chance of misdiagnosing CA as HCM or of an overlap between the two conditions. In all these contexts, the therapeutic and prognostic implications of diagnosing CA will have to be further investigated. Meanwhile, the diagnostic workup of patients with suspected CA should always be completed with the systematic exclusion of a plasma cell dyscrasia, the acquisition of tomographic imaging at bone scintigraphy, and the completion of genetic testing for transthyretin-related forms.","PeriodicalId":75299,"journal":{"name":"Vessel plus","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":"67654229","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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