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- Shenouda, Rafik B., 1971-
(author)
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Insight into Coro-Carotid atherosclerotic disease in patients with acute coronary syndrome
- 2023
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Doctoral thesis (other academic/artistic)abstract
- Background: the arterial tree branches in different parts of human body are sharing the histological and physiological features. Atherosclerosis is a systemic arterial disease, hence is expected to affect to affect more than one arterial system with similar pathologic manifestations.Aim: the aim of this thesis is to highlight the relationship between the two arterial systems involved in common acute ischemia, the carotid and coronary arteries, and to focus on the diagnostic tools that could be of help in estabilishing accurate diagnosis.Methods: we conducted five studies, the first three looked into the acute coronary syndrome and the different echocardiographic imaging modalities, including 2-Dimentional wall motion abnormalities, M-mode measurments, and myocardial deformation parameters measurment (Strain and Strain rate) in identifying the culprit coronary lesion (study 1), early recovery of left ventricular function after acute coronary syndrome (study 2) and the third study is a comparison between conventional 2-D dobutamine stress echocardiography and dobutamine stress echocardiography analysis using speckle tracking technique. The fourth and fifth studies are analyzing the relationship between the carotid calcifications measured by conventional computed tomogaphy based on Agatston calcium scoring and that of the coronary arteries (study 4) and the fifth study looked at the carotid and coronary atherosclerosis manifestation in a systematic review and mata-analysis.Results: Left ventricular myocardial strain rate was the most sensetive peridictor of the culprit artery lesion in the setting of acute coronary syndrome, measurment of deformation parameters are more sensetive than those of conventional echo in detecting early recovery of left ventricular function after acute coronary syndrome. Myocardial deformation parameters messured by speckle traching technique during dobutamine stress echo cardiography are more senstive than convetional 2-D measurments in detecting the stenosed arteries. Coronary calcifications is 10 times higher than carotid calcifications in acute coronary syndrome patients. There was moderate relationship between Carotid intima media thickness and the degree of stenosis of the coronary arteries.Conclusions: resting echocardiographic measurments are accurate in predicting the culprit coronary artery lesions in patients presenting with acute coronary syndrome. myocardial deformation measurments are the most accurate parameter that identify culprit lesion and left venticular segmental recovery and also are more sensetive than conventioal 2-D dobutamine stress echo in redicting stenosed coronaries in patients post acute coronary syndrome and with low ejection fraction. atherosclerosis parameters of the carotid arteriescorrelates with those of the coronary circulation, despite different phenotypic presentation. this finding highlights the importance of measuring the carotid intima media thickness in suspected high risk patients with acute coronary syndrome.
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| 2. |
- Bengtsson, Anna, 1973-
(author)
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Pictorial presentation of subclinical atherosclerosis : a measure to reduce the risk for cardiovascular disease
- 2021
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Doctoral thesis (other academic/artistic)abstract
- The overall aim was improved cardiovascular disease (CVD) prevention through the VIPVIZA intervention. This includes the provision of pictorial information of subclinical atherosclerosis to participants and their general practitioners (GPs), follow-up phone call, and written information to the participant. VIPVIZA is a Prospective Randomized Open Blinded End-point (PROBE) trial nested within VIP, a CVD prevention program in primary health care in Västerbotten county, Sweden. Middle-aged individuals at low/intermediate CVD risk were enrolled to VIPVIZA and randomized 1:1 to an intervention (n=1749) or control group (n=1783 who received no pictorial or other information). Preventive measures were managed within primary health care.At baseline, clinical risk factors were measured and carotid ultrasound examination was performed. The prevalence of subclinical atherosclerotic disease was assessed as intima media thickness and presence of plaque. The association between clinical risk factors and measures of subclinical atherosclerosis was investigated. In addition to conventional risk factor-based risk evaluation, the impact of the VIPVIZA intervention on CVD risk, traditional risk factors and pharmacological treatment was evaluated after 1 and 3 years. Individual interviews were conducted with 15 GPs to explore how a pictorial representation of subclinical atherosclerosis affects physicians in their perception and communication of CVD risk. The interviews were analyzed by qualitative content analysis.The plaque prevalence was 44.7% in this population. Clinical risk factors explained more of the variation in a combined ultrasound measurement than single measurements. The results up to three years showed a VIPVIZA intervention effect, with lower and sustained CVD risk in the intervention as compared to the control group. The effect was partly mediated by differences in intake of lipid-lowering medication and partly by lifestyle behaviour. The GPs described their risk assessment and patients’ risk perception as more accurate with the VIPVIZA intervention. Informing patients about examination results prior to a consultation can facilitate shared decision-making and enhance adherence to preventive measures.The results show that the VIPVIZA intervention reduces CVD risk over three years. In the long run this has the potential to reduce the incidence of CVD events.
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| 3. |
- Engdahl, Johan, et al.
(author)
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Multicentre, national, investigator-initiated, randomised, parallel-group, register-based superiority trial to compare extended ECG monitoring versus standard ECG monitoring in elderly patients with ischaemic stroke or transient ischaemic attack and the effect on stroke, death and intracerebral bleeding : the AF SPICE protocol
- 2023
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:11
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Journal article (peer-reviewed)abstract
- Introduction: Atrial fibrillation (AF) is a major risk factor for ischaemic stroke and transient ischaemic attack (TIA), and AF detection can be challenged by asymptomatic and paroxysmal presentation. Long-term ECG monitoring after ischaemic stroke or TIA is recommended by all major societies in cardiology and cerebrovascular medicine as a secondary prophylactic measure. However, data on stroke reduction are lacking, and the recommendations show significant diversity.Methods and analysis: AF SPICE is a multicentre, national, investigator-initiated, randomised, parallel-group, register-based trial comparing extended ECG monitoring versus standard ECG monitoring in patients admitted with ischaemic stroke or TIA, with a composite endpoint of stroke, all-cause-mortality and intracerebral bleeding. Patients aged ≥ 70 years without previous AF will be randomised 1:1 to control (standard ECG monitoring) or intervention (extended ECG monitoring). In the control arm, patients will undergo 48±24 hours (ie, a range of 24-72hours) of continuous ECG monitoring according to national recommendations. In the intervention arm, patients will undergo 14+14 days of continuous ECG monitoring 3months apart using an ECG patch device, which will provide an easy-accessed, well-tolerated 14-day continuous ECG recording. All ECG patch recordings will be read in a core facility. In cases of AF detection, oral anticoagulation will be recommended if not contraindicated. A pilot phase has been concluded in 2022, which will transcend into the main trial during 2023-2026, including approximately 30 stroke units. The sample size was calculated to be 3262 patients. The primary outcome will be collected from register data during a 36-month follow-up.Ethics and dissemination: Ethical approval has been provided by the Swedish Ethical Review Authority, reference 2021-02770. The trial will be conducted according to the ethical principles of the Declaration of Helsinki and national regulatory standards. Positive results from the study have the potential for rapid dissemination in clinical practice. Trial registration number NCT05134454.
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