Angiology最新文献

Three deficiencies of the Papa criteria (point scoring system, PSS) for thromboangiitis obliterans (TAO) were identified and updated. According to the new criteria, 185 patients with clinically diagnosed TAO in a single center using the diagnostic criteria of Shionoya were scored and re-diagnosed. The diagnostic criteria of The Japanese Ministry of Health, Labour and Welfare (JMHLW) were used as the comparative standard to compare the diagnostic value of the revised PSS (RPSS) criteria in the diagnosis of TAO. Among the 185 patients, 145 patients were possibly diagnosed with TAO by the RPSS diagnostic criteria, 40 patients were excluded from TAO diagnosis. The JMHLW standard definitively diagnosed 154 patients with TAO, and 31 patients were excluded from TAO diagnosis. Compared with the JMHLW standard, the accuracy of the RPSS diagnostic criteria was 0.90, and the Kappa value was 0.67 (Confidence interval [CI]: 0.53-0.81), which reached "substantial" agreement. The Area Under Curve (AUC) was 0.86 and >0.7, showing good diagnostic value. The RPSS criteria have good diagnostic efficacy. If this revised scoring system can be endorsed, it might improve the certainty of TAO diagnosis and research.

The left internal mammary (thoracic) artery (LIMA), when used as a pedicle graft at the time of coronary artery bypass grafting, is effective and durable. Data concerning the rate and causes of LIMA failure are scant. The aim of this paper is to explore the modes and frequency of sub-optimal LIMA grafts. We examined all cases of invasive graft angiography performed in our cardiothoracic center 2016-2020 and analyzed the quality of the LIMA graft. Of 551 cases, 323 had undergone isolated coronary artery bypass grafting including a LIMA since 2001; of those, 59 (18%) appeared sub-optimal; 16 (5%) being totally occluded, 26 (8%) exhibiting a "string sign" (i.e., atretic or cord-like), 12 (4%) being focally stenosed, and 5 (1.5%) being patent but placed on a diseased portion of the left anterior descending artery or other vessel. The commonest cause of failure were poor-quality left anterior descending artery target and non-flow-limiting disease. This paper highlights the low rate, and likely modes, of failure of this valuable treatment in contemporary practice.

Patients with chronic-limb threatening ischemia (CLTI) and peripheral wounds might be predisposed for systemic infections. The study aimed to describe the rate of systemic infections in patients with CLTI compared with peripheral artery obstructive disease (PAOD) patients without CLTI, both independently of endovascular treatment (EVT) and after EVT. Administrative data of the AOK Baden-Wuerttemberg (AOK BW) from patients with PAOD were analyzed considering bloodstream infection (BSI), 30-day readmission and prescribed antibiotics for ischemic ulcers. The risk of BSI increased 3.9-fold (95% CI: 3.4-4.4) in patients with PAOD Rutherford-Becker category (RBC) 5 and 6 (n = 11,741) compared with PAOD RBC 1-4 (n = 23,482; 6.81% vs 1.67%, P < .01). The risk of Staphylococcus aureus BSI increased 5.6-fold (95% CI: 4.1-7.7) comparing RBC 5 and 6 (1.2%) with RBC 1-4 (0.22%, P < .01). Outpatient antibiotic prescriptions were dominated by aminopenicillins with β-lactamase inhibitors, accounting for 34.9%. Clindamycin, cefuroxime, and fluoroquinolones represented 14.9%, 13.5%, and 12.6% of prescriptions, respectively. Infections were responsible for 7.7% of 30-day readmissions following EVT. Patients with CLTI are at risk of developing BSI, and specifically S. aureus BSI. Infection-related causes in 30-day readmissions following EVT are common. The high use of clindamycin and cefuroxime in outpatients is concerning.

This bibliometric analysis scrutinizes the evolution and current challenges in the use of Inferior Vena Cava (IVC) filters, focusing on trends from 2004 to 2023. Analyzing 2470 records, we report the United States' dominant role, with over half of the studies, and a significant shift towards retrievable filters. Despite technological advancements, controversies persist regarding efficacy, safety, and retrieval issues. Our findings point to the need for refined clinical guidelines and enhanced management strategies to navigate the complex landscape of IVC filter utilization effectively.

Substantial advances occurred in phlebological practice in the last two decades. With the use of modern diagnostic equipment, the patients' venous hemodynamics can be examined in detail in everyday practice. Application of venous segments for arterial bypasses motivated studies on the effect of hemodynamic load on the venous wall. New animal models have been developed to study hemodynamic effects on the venous system. In vivo and in vitro studies revealed cellular phase transitions of venous endothelial, smooth muscle, and fibroblastic cells and changes in connective tissue composition, under hemodynamic load and at different locations of the chronically diseased venous system. This review is an attempt to integrate our knowledge from epidemiology, paleoanthropology and anthropology, clinical and experimental hemodynamic studies, histology, cell physiology, cell pathology, and molecular biology on the complex pathomechanism of this frequent disease. Our conclusion is that the disease is initiated by limited genetic adaptation of mankind not to bipedalism but to bipedalism in the unmoving standing or sitting position. In the course of the disease several pathologic vicious circles emerge, sustained venous hypertension inducing cellular phase transitions, chronic wall inflammation, apoptosis of cells, pathologic dilation, and valvular damage which, in turn, further aggravate the venous hypertension.

The Naples prognostic score (NPS) is a novel multidimensional inflammatory and nutritional assessment system in cancer patients. However, its significance in patients with chronic kidney disease (CKD) after percutaneous coronary intervention (PCI) remains unclear. The study has a single-center, retrospective design and included 631 patients with CKD who underwent index PCI between 2019 and 2022. All participants were divided into 2 groups according to the NPS (Low-risk group: n = 209; High-risk group: n = 422) and followed up until November 2022. The primary endpoint was Major Adverse Cardiac Events (MACE). NPS predicted MACE events better than other scores, besides, high-risk NPS with severe renal dysfunction (RD) group (MODEL 2) had superior MACE diagnostic efficiency than NPS high-risk group lonely. (NPS: AUC: 0.605, P < .001; MODEL 2: AUC: 0.624, P < .001, respectively). Kaplan-Meier survival analysis of two groups showed that high-risk group had higher incidence of MACE (P < .001). Meanwhile, high-risk group had higher MACE events [adjusted Hazard Ratio (aHR) 2.013, 95% CI 1.294, 3.132; P = .002]. NPS is an independent prognostic factor for CKD patients undergoing index PCI before operation whose predictive value for survival prognosis is better than other nutritional and inflammatory indicators. Compared with low NPS, patients with high NPS have a relatively poor prognosis.

The present study aimed to develop a model to predict functional disability at 3 months in patients with acute ischemic stroke (AIS) (n = 5,406). The primary outcome was functional disability (modified Rankin Scale [mRS] >2) at 3 months. A prediction model including blood biomarkers was developed based on a multivariable logistic regression model, which was internally validated by the 100-time bootstrap method. A nomogram and a web-based calculator were developed for usage in clinical practice. At 3 months, 11% (638/5,406) of the patients had functional disability. Seven independent predictors of functional disability at 3 months were incorporated into the FAITHS² model (fasting plasma glucose, age, interleukin-6, stroke history, National Institute of Health Stroke Scale [NIHSS] at admission, sex, and systolic blood pressure). The Area Under Curves (AUCs) were 0.814 (95% confidence interval [CI] 0.796-0.832) and 0.808 (95% CI 0.806-0.810), and the Brier scores were 0.088 ± 0.214 and 0.089 ± 0.003 for the derivation cohort and internal validation, respectively, showing optimal performance of the model. The FAITHS² model has excellent potential to be a dependable application for individualized clinical decision making.

The present study assessed the effects of a metacognitive strategy-guided health management model on vascular endothelial function and quality of life in patients with hypertension and hyperlipidemia. Patient self-management ability, such as medication adherence, rational diet, and moderate exercise, before and after management was assessed by questionnaire (36-Item Short Form Health Survey, SF-36). Total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and blood pressure (BP) were compared. Vascular endothelial function was evaluated: Serum levels of endothelin-1 (ET-1) were measured by radioimmunoassay, and serum levels of nitric oxide (NO) were measured by a nitrate reduction method. Quality of life after management was assessed by the SF-36. The observation group (implementation of metacognitive strategy-guided health management) had higher self-management ability scores, lower lipid indicators, lower systolic and diastolic BP, decreased ET-1 and higher NO levels, and greater quality of life scores than the control group (no health management; all P < .05). Metacognitive strategy-guided health management model can improve vascular endothelial function and enhances quality of life in patients with hypertension and hyperlipidemia.

Using the SYNTAX score (SS) for decision-making between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) for left main coronary artery (LMCA) revascularization is under scrutiny. This study investigated the clinical outcomes of LMCA revascularization stratified by SS. This multicenter study included 2138 patients recruited between 2015 and 2020 who underwent LMCA disease revascularization using PCI or CABG and were categorized based on their SS into three groups: low (≤22), intermediate (23-32), and high (≥33). Patients with a high SS compared with those with an intermediate SS experienced increased hospital mortality (Odds ratio: 1.99; P = .026) and Major Adverse Cardiac and Cerebrovascular Event (MACCE; OR: 2.17; P = .006). With an average follow-up of 24.7 months, no substantial differences emerged in MACCE (Hazard ratio: 1.23; P = .52) or mortality (HR: 3.26; P = .073] between patients with high and intermediate SSs. A significant interaction between the SS category (low vs intermediate) and LMCA revascularization modality was observed for hospital MACCEs, favoring PCI over CABG (OR: 0.32; P = .033). However, no noteworthy interactions between SS categories and revascularization modalities were noted concerning hospital or follow-up mortality or follow-up MACCEs. These findings raise doubts about the utility of SS alone in selecting left-main revascularization modalities for LMCA disease.

Breast cancer is the most common malignancy among women. While advances in detection and treatment have improved survival, breast cancer survivors face an increased risk of cardiovascular disease. However, limited data exist on cardiac outcomes after ST-elevation myocardial infarction (STEMI) in this population. This retrospective cohort study analyzed the National Inpatient Sample (NIS) database (2016-2021). Adult women hospitalized with STEMI were categorized as breast cancer survivors or without a history of breast cancer. The primary outcome was in-hospital mortality, with multivariable logistic regression used to adjust for confounders. A total of 369,070 adult females were included (breast cancer survivors, n = 13,890; without breast cancer, n = 355,180). Breast cancer survivors were older with more cardiovascular comorbidities. After adjustment, breast cancer survivors had lower odds of in-hospital mortality (adjusted odds ratio [aOR] 0.82, 95% CI 0.72-0.93), cardiogenic shock (aOR 0.88, 95% CI 0.77-0.99), and acute kidney injury (aOR 0.85, 95% CI 0.76-0.95). Breast cancer survivors hospitalized for STEMI had lower in-hospital mortality and complications, compared with those without breast cancer. These hypothesis-generating findings suggest that advances in oncology and cardiovascular care may contribute to improved outcomes.