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- Ruilope, LM, et al.
(författare)
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Design and Baseline Characteristics of the Finerenone in Reducing Cardiovascular Mortality and Morbidity in Diabetic Kidney Disease Trial
- 2019
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Ingår i: American journal of nephrology. - : S. Karger AG. - 1421-9670 .- 0250-8095. ; 50:5, s. 345-356
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Tidskriftsartikel (refereegranskat)abstract
- <b><i>Background:</i></b> Among people with diabetes, those with kidney disease have exceptionally high rates of cardiovascular (CV) morbidity and mortality and progression of their underlying kidney disease. Finerenone is a novel, nonsteroidal, selective mineralocorticoid receptor antagonist that has shown to reduce albuminuria in type 2 diabetes (T2D) patients with chronic kidney disease (CKD) while revealing only a low risk of hyperkalemia. However, the effect of finerenone on CV and renal outcomes has not yet been investigated in long-term trials. <b><i>Patients and</i></b> <b><i>Methods:</i></b> The Finerenone in Reducing CV Mortality and Morbidity in Diabetic Kidney Disease (FIGARO-DKD) trial aims to assess the efficacy and safety of finerenone compared to placebo at reducing clinically important CV and renal outcomes in T2D patients with CKD. FIGARO-DKD is a randomized, double-blind, placebo-controlled, parallel-group, event-driven trial running in 47 countries with an expected duration of approximately 6 years. FIGARO-DKD randomized 7,437 patients with an estimated glomerular filtration rate ≥25 mL/min/1.73 m<sup>2</sup> and albuminuria (urinary albumin-to-creatinine ratio ≥30 to ≤5,000 mg/g). The study has at least 90% power to detect a 20% reduction in the risk of the primary outcome (overall two-sided significance level α = 0.05), the composite of time to first occurrence of CV death, nonfatal myocardial infarction, nonfatal stroke, or hospitalization for heart failure. <b><i>Conclusions:</i></b> FIGARO-DKD will determine whether an optimally treated cohort of T2D patients with CKD at high risk of CV and renal events will experience cardiorenal benefits with the addition of finerenone to their treatment regimen. Trial Registration: EudraCT number: 2015-000950-39; ClinicalTrials.gov identifier: NCT02545049.
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- Danial, John S. H., et al.
(författare)
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Computed Histological Quantification of Atherosclerotic Plaque Microcalcifications
- 2020
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Ingår i: Angiology. - : Sage Publications. - 0003-3197 .- 1940-1574. ; 71:10, s. 916-919
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Tidskriftsartikel (refereegranskat)abstract
- Inflammation has a central role in atherosclerotic plaque formation and rupture. Intense macrophage inflammatory activity results in microcalcifications which are strongly associated with plaque vulnerability. Microcalcifications with specific critical size between 5 and 65 mu, located in the fibrous cap producing local mechanical stress on the plaque surface and may directly contribute to plaque rupture. Hence, accurate assessment of microcalcifications size and dimension has significant clinical importance. Current invasive and noninvasive plaque imaging has limited spatial resolution which limits accurate definition of microcalcifications in the atherosclerotic plaques. We describe a new imaging technique with high spatial resolution, based on confocal microscopic analysis, using a dedicated software which allows automatic characterization of microcalcifications and quantitative assessment of their extent and localization.
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- Lisi, Matteo, et al.
(författare)
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Right ventricular longitudinal deformation correlates closely with right ventricular myocardial fibrosis in patients with end-stage heart failure
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34, s. 780-780
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Right ventricular (RV) longitudinal strain (LS) plays a key role in the evaluation of its systolic performance and clinical outcomein patients with refractory heart failure (HF). This study sought to determine the value of RVLS for prediction of RV myocardial fibrosis inpatients with severe HF undergoing heart transplantation (HTx).Methods: The cohort we studied consists of 24 patients with severe systolic HF (left ventricular ejection fraction ≤ 25%; NYHA class IV) referred between 2009 and 2013 for a simultaneous right heartcatheterization and echocardiographic evaluation before HTx.RVLS by Speckle Tracking Echocardiography (STE) was used to assess free-wall RVLS, global cavity RVLS (including all segments in the apical 4 chamber view and right atrial LS (RALS), RV fractional area change (RVFAC), RV sphericity index (RVSI) and tricuspid annular plane systolic excursion (TAPSE) were also measured. All patients underwent HTx 12±34 days afterwards. From the explanted hearts a 1 x 0,5 cmmyocardial sample of the RV lateral free wall was obtained and stainedwith hematoxylin-eosin and Masson's trichrome. The ratio of the fibrotic area to the total surface area of each section was used to estimate the extent of RV myocardial fibrosis (percentage) as (fibrotis area-total area) x 100.Results: A good correlation was found between the extent of RVmyocardial fibrosis and free-wall RVLS (r=0.72; p<0.0001), global RVLS (r=0.49; p<0.0001), RVSI (r=0.47; p<0.0001), and RALS (r= -0.46; p=0.005), with a poorer correlation with TAPSE (r= -0.32; p=0.01) and RVFAC (r= -0.25; p=ns). Of these indeces, free-wall RVLS had the strongest diagnostic accuracy for detecting severe RV myocardialfibrosis (AUC = 0.87).Conclusions: In late stage HF patients, right ventricular free wallmyocardial deformation is the best functional measure that correlateswith the extent of myocardial fibrosis. These findings should have clinical implications when interpreting other RV measurements.
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- Ahmeti, Artan, et al.
(författare)
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Prognostic value of left atrial volume index in acute coronary syndrome : A systematic review and meta-analysis
- 2021
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Ingår i: Clinical Physiology and Functional Imaging. - : John Wiley & Sons. - 1475-0961 .- 1475-097X. ; , s. 128-135
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Tidskriftsartikel (refereegranskat)abstract
- Background: In the absence of mitral valve disease, increased left atrial volume (LAV) is a marker of diastolic dysfunction and long-standing elevated left ventricle (LV) pressure. The aim of this study was to assess the role of increased baseline LAV in predicting clinical outcome of patients presenting with acute coronary syndrome (ACS).Methods: We systematically searched all electronic databases up to September 2020 in order to select clinical trials and observational studies, which assessed the predictive role of LAV indexed (LAVI) on clinical outcome in patients with ACS. Primary clinical endpoints were as follows: major adverse cardiac events (MACE), all-cause mortality and hospitalization. Secondary endpoints were in-hospital complications.Results: A total of 2,705 patients from 11 cohort studies with a mean follow-up 18.7 +/- 9.8 months were included in the meta-analysis. Patients with low LAVI had low risk for MACE (15.9% vs. 33.7%; p < .01), long-term all-cause mortality (9.14% vs. 18.1%; p < .01), short-term mortality (3.31% vs. 9.38%; p = .02) and lower hospitalization rate (11.6% vs. 25.5%; p < .01) compared to patients with increased LAVI. Atrial fibrillation and cardiogenic shock as in-hospital events were lower (p < .05 for all) in patients with low LAVI but ventricular fibrillation/tachycardia was not different between groups (p = .14).Conclusion: Increased LAVI is an independent predictor of outcome in patients with ACS. Thus, assessment of LA index in these patients is important for better risk stratification and guidance towards optimum clinical management.
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