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| 2. |
- Boles, Usama, et al.
(författare)
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Cytokine Disturbances in Coronary Artery Ectasia Do Not Support Atherosclerosis Pathogenesis
- 2018
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Ingår i: International Journal of Molecular Sciences. - Basel, Switzerland : MDPI. - 1661-6596 .- 1422-0067. ; 19:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Coronary artery ectasia (CAE) is a rare disorder commonly associated with additional features of atherosclerosis. In the present study, we aimed to examine the systemic immune-inflammatory response that might associate CAE.METHODS: Plasma samples were obtained from 16 patients with coronary artery ectasia (mean age 64.9 ± 7.3 years, 6 female), 69 patients with coronary artery disease (CAD) and angiographic evidence for atherosclerosis (age 64.5 ± 8.7 years, 41 female), and 140 controls (mean age 58.6 ± 4.1 years, 40 female) with normal coronary arteries. Samples were analyzed at Umeå University Biochemistry Laboratory, Sweden, using the V-PLEX Pro-Inflammatory Panel 1 (human) Kit. Statistically significant differences (p < 0.05) between patient groups and controls were determined using Mann-Whitney U-tests.RESULTS: The CAE patients had significantly higher plasma levels of INF-γ, TNF-α, IL-1β, and IL-8 (p = 0.007, 0.01, 0.001, and 0.002, respectively), and lower levels of IL-2 and IL-4 (p < 0.001 for both) compared to CAD patients and controls. The plasma levels of IL-10, IL-12p, and IL-13 were not different between the three groups. None of these markers could differentiate between patients with pure (n = 6) and mixed with minimal atherosclerosis (n = 10) CAE.CONCLUSIONS: These results indicate an enhanced systemic pro-inflammatory response in CAE. The profile of this response indicates activation of macrophages through a pathway and trigger different from those of atherosclerosis immune inflammatory response.
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| 3. |
- Grönlund, Christer, 1975-, et al.
(författare)
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Significant beat-to-beat variability of E/e’ irrespective of respiration
- 2013
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Ingår i: International cardiovascular forum. - : Barcaray Publishing. - 2409-3424 .- 2410-2636. ; 1:2, s. 88-89
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Tidskriftsartikel (refereegranskat)abstract
- The E/e’ ratio is commonly used in Doppler echocardiographic examinations to estimate the pulmonary capillary wedge pressure. The rationale of using this ratio is to combine left ventricular (LV) filling (E) and relaxation (e’) velocities to indirectly assess left atrial pressure. However, the accuracy of this index has recently been questioned, particularly in patients with controlled heart failure. Likewise, the potential beat-to-beat variability of such measurements remains undetermined. The cardiovascular system is subject to several oscillations with the potential of influencing LV function and its intra-cavitary pressures, hence measurements of its filling and relaxation velocities. The aim of this pilot study was to assess the beat-to-beat variability of the E/e’ ratio in one minute long examination in healthy subjects, and patients with various severity of amyloid heart disease. The results show that despite critical application of the standard echocardiographic recording recommendations, E/e’ beat-to-beat variability was 36 % (22 to 50%) in healthy subjects and 17 % (11-26%) in patients, and where the most severe amyloid heart disease had the least variability. Thus, clinical use of a single or few cardiac beats might not necessarily reflect an accurate ratio between the two velocities, and hence casts doubt over their diagnostic value.
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| 4. |
- Gustavsson, Sandra, et al.
(författare)
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Can echocardiography and ECG discriminate hereditary transthyretin V30M amyloidosis from hypertrophic cardiomyopathy?
- 2015
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Ingår i: Amyloid. - : Informa UK Limited. - 1350-6129 .- 1744-2818. ; 22:3, s. 163-170
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Hereditary transthyretin (ATTR) amyloidosis with increased left ventricular wall thickness could easily be misdiagnosed by echocardiography as hypertrophic cardiomyopathy (HCM). Our aim was to create a diagnostic tool based on echocardiography and ECG that could optimise identification of ATTR amyloidosis. Methods: Data were analysed from 33 patients with biopsy proven ATTR amyloidosis and 30 patients with diagnosed HCM. Conventional features from ECG were acquired as well as two dimensional and Doppler echocardiography, speckle tracking derived strain and tissue characterisation analysis. Classification trees were used to select the most important variables for differentiation between ATTR amyloidosis and HCM. Results: The best classification was obtained using both ECG and echocardiographic features, where a QRS voltage >30 mm was diagnostic for HCM, whereas in patients with QRS voltage <30 mm, an interventricular septal/posterior wall thickness ratio (IVSt/PWt) >1.6 was consistent with HCM and a ratio <1.6 supported the diagnosis of ATTR amyloidosis. This classification presented both high sensitivity (0.939) and specificity (0.833). Conclusion: Our study proposes an easily interpretable classification method for the differentiation between HCM and increased left ventricular myocardial thickness due to ATTR amyloidosis. Our combined echocardiographic and ECG model could increase the ability to identify ATTR cardiac amyloidosis in clinical practice.
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| 5. |
- Henein, Michael, et al.
(författare)
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European Calcific Coronary Artery Disease (Euro-CCAD) study : the additional value of coronary calcification, to angiography, in investigating angina patients
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:Supplement: 1, s. 177-177
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: This study is a part of the Euro-CCAD (CalcificCoronary Artery Disease) project, investigating the geographic prevalence of a coronary artery calcium (CAC) score of >400 in patients with no flow-limiting lesions (FLL) as a potential cause for stable angina. With the development of computerized tomographic coronaryangiography (CTCA), assessment of CAC has become less fashionable, although CTCA often fails to determine the exact cause of symptoms in the absence of FLLs.Methods: Data from consecutive symptomatic intermediate risk patients (as defined by guidelines), who had both CA and calcium scoring, were compared between USA and Europe as well as between Europeancountries (Denmark, Germany, France and Spain). No patient had a priorcoronary event, intervention, valve disease or kidney failure.Results: The inclusion criteria were fulfilled in 4,444 patients, (60% males), mean age 59.3 years (SD 11.3 years). The prevalence of FLL was higher in the USA at 53% (983/1851) than in Europe at 34% (870/2593) as a whole, (p<0.001). The FLL prevalence was also different (p<0.001) within Europe: Denmark 16%, Germany 35%, France 46% and Spain 89%. In patients with no FLL, 9% had CAC >400, with no difference in prevalence between the USA and Europe, irrespective of age and gender. However, within Europe the prevalence of patients without FLL and with a CAC score >400 differed: Spain 22%, Germany 13%, France 10% and Denmark 7%. Within the total patient population 22% of those with CAC score >400 had no FLL.Conclusion: Despite the known variability in the current management of symptomatic angina patients at intermediate risk between the USA andEuropean countries, a consistent proportion (nearly 10%) exhibits severe CAC in the absence of flow limiting lesions. The presence of severe CAC could explain their symptoms through compromised coronary flow reserve. These results highlight the potential value of obtaining additional anatomical information by using CAC assessment in symptomatic patients.
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| 6. |
- Henein, Michael, et al.
(författare)
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High dose and long-term statin therapy accelerate coronary artery calcification
- 2015
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Ingår i: International Journal of Cardiology. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 184, s. 581-586
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: In randomized clinical trials statins and placebo treated patients showed the same degree of coronary artery calcium (CAC) progression. We reanalyzed data from two clinical trials to further investigate the time and dose dependent effects of statins on CAC. Additionally, we investigated whether CAC progression was associated with incident cardiovascular events.METHODS AND RESULTS: Data were pooled from two clinical trials: St. Francis Heart Study (SFHS) (419 and 432 patients treated with placebo and 20mg atorvastatin daily, respectively) and EBEAT Study (164 and 179 patients respectively treated with 10mg and 80mg atorvastatin daily). CAC scores were assessed at baseline, 2years and 4-6years in SFHS; in EBEAT they were measured at baseline and 12months. After a short-term follow-up (12 to 24months) placebo and low dose atorvastatin showed a similar CAC increase, although 80mg/daily atorvastatin increased CAC an additional 12-14% over placebo (p<0.001). In the long-term, atorvastatin caused a greater progression of CAC compared to placebo (additional 1.1%, p=0.04). In SFHS 42 cardiovascular events occurred after the second CT scan. The baseline and progression of CAC were greater in patients with events. However, only baseline CAC and family history of premature cardiovascular disease but not CAC progression were independent predictors of events.CONCLUSIONS: Despite a greater CAC increase with high dose and long-term statin therapy, events did not occur more frequently in statin treated patients. This suggests that CAC growth under treatment with statins represents plaque repair rather than continuing plaque expansion.
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| 7. |
- Henein, Michael Y., et al.
(författare)
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European Calcific Coronary Artery Disease (Euro-CCAD) study : the relationship between coronary calcification and flow limiting lesion in symptomatic patients
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:Supplement: 1, s. 723-723
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background and aim: This study is a part of the Euro-CCAD (CalcificCoronary Artery Disease) project, investigating the geographic prevalence of a coronary artery calcium (CAC) score of >400 in patients with no flow-limiting lesions (FLL) as a potential cause for stable angina. With the development of computerized tomographic coronaryangiography (CTCA), assessment of CAC has become less fashionable, although CTCA often fails to determine the exact cause of symptoms in the absence of FLLs.Methods: Data from consecutive symptomatic intermediate risk patients (as defined by guidelines), who had both CA and calcium scoring, were compared between USA and Europe as well as between Europeancountries (Denmark, Germany, France and Spain). No patient had a priorcoronary event, intervention, valve disease or kidney failure.Results: The inclusion criteria were fulfilled in 4,444 patients, (60% males), mean age 59.3 years (SD 11.3 years). The prevalence of FLL was higher in the USA at 53% (983/1851) than in Europe at 34% (870/2593) as a whole, (p<0.001). The FLL prevalence was also different (p<0.001) within Europe: Denmark 16%, Germany 35%, France 46% and Spain 89%. In patients with no FLL, 9% had CAC >400, with no difference in prevalence between the USA and Europe, irrespective of age and gender. However, within Europe the prevalence of patients without FLL and with a CAC score >400 differed: Spain 22%, Germany 13%, France 10% and Denmark 7%. Within the total patient population 22% of those with CAC score >400 had no FLL.Conclusion: Despite the known variability in the current management of symptomatic angina patients at intermediate risk between the USA andEuropean countries, a consistent proportion (nearly 10%) exhibits severe CAC in the absence of flow limiting lesions. The presence of severe CAC could explain their symptoms through compromised coronary flow reserve. These results highlight the potential value of obtaining additional anatomical information by using CAC assessment in symptomatic patients.
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| 8. |
- Henein, Michael Y., et al.
(författare)
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The natural history of coronary calcification : a meta-analysis from St Francis and EBEAT trials
- 2013
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Ingår i: International Journal of Cardiology. - : Elsevier. - 0167-5273 .- 1874-1754. ; 168:4, s. 3944-3948
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND AND AIM: Coronary artery calcium score (CACs) is an established quantitative tool for assessing subclinical atherosclerosis. The aim of this study was to assess in a meta-analysis model the natural history and reproducibility of CACs measurements obtained from St Francis and EBEAT trials.METHODS: We analysed data from 649 individuals: 443 on placebo with 2year follow-up from St Francis trial (Study A) and 209 on 10mg atorvastatin with 1year follow-up of EBEAT trial (Study B). Total CACs and that in the left coronary artery (LCA) branches, left main stem (LMS), left anterior descending (LAD), left circumflex (Cx) and right coronary artery (RCA) were analysed. In view of the wide CACs spectrum, data were logarithmically transformed before the analyses and mixed model analysis was used to evaluate the change of CACs over time.RESULTS: The overall agreement between the two measurements was fairly good, showing a small but significant increase in CAC: 68% of the group as a whole presented an increase in CACs, 23% of the cohort had negligible change in CACs of <10% irrespective of the baseline CACs; and the remaining 10% showed a fall in CACs. Both studies showed similar patterns. The analysis of individual coronary arteries showed significantly higher variability of measurements in the RCA than in the LCA. Males had higher baseline CACs than females, but the rate of progression was not different between genders, irrespectively of age and baseline score.CONCLUSION: The natural history of CACs was overtime progression in the majority of subjects, irrespective of gender. The higher variability in RCA measurements could be related to the low baseline CACs or exaggerated movement of the right side atrioventricular ring, whereas those for LCA branches are influenced by the branch allocation of the CACs. Large changes to and from zero, might be related to technical limitations.
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| 9. |
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| 10. |
- Nicoll, Rachel, et al.
(författare)
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Diabetes and male gender are key risk factor predictors of CAC extent : a Euro-CCAD study
- 2016
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Background and aims: Although much has been written about the risk factor predictors of CAC extent, few studies have been carried out on symptomatic patients. Similarly, no study has directly compared predictors of CAC extent and zero CAC.Methods: From the European Calcific Coronary Artery Disease (Euro-CCAD) cohort, we retrospectively investigated 6309 symptomatic patients, 62% male, from Denmark, France, Germany, Italy, Spain and USA. All had risk factor assessment and CT scanning for CAC scoring. Results: Among all patients, male gender (β = 1.36, p<0.001) and diabetes (β = 0.47, p<0.001) were the most important risk factors of CAC extent, with age, diabetes (DM), obesity, family history of CAD and number of risk factors also being predictive. Among patients with CAC, DM, hypertension (HT) and dyslipidaemia (DL) were predictors of an increasing CAC score in males and females, with DM being the strongest (p<0.001 for both). These results were echoed in quantile regression, where DM was consistently the most important predictor of CAC extent in every quantile in both males and females. HT and DL were also predictive but to a lesser extent, with HT being predictive in the high CAC quantiles and DL in the low CAC quantiles. Conclusion: In addition to male gender, DM is the most important predictor of CAC extent in both genders.
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