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16 pages, 1668 KiB

Open AccessArticle

Effect of Evolocumab on Vulnerable Coronary Plaques: A Serial Coronary Computed Tomography Angiography Study

by Keiji Hirai, Shigeki Imamura, Aizan Hirai, Susumu Ookawara and Yoshiyuki Morishita

J. Clin. Med. 2020, 9(10), 3338; https://doi.org/10.3390/jcm9103338 - 18 Oct 2020

Cited by 9 | Viewed by 2789

Abstract

This study investigated the effects of evolocumab on vulnerable coronary plaques and factors associated with the change in stability and size of plaques in patients taking statins. Vulnerable coronary plaques were defined using coronary computed tomography (CT) angiography as having a density of [...] Read more.

This study investigated the effects of evolocumab on vulnerable coronary plaques and factors associated with the change in stability and size of plaques in patients taking statins. Vulnerable coronary plaques were defined using coronary computed tomography (CT) angiography as having a density of <50 HU within the region of interest and a remodeling index ≥1.1. The changes in minimum CT density, remodeling index, and percent stenosis of vulnerable coronary plaques after six months of evolocumab administration were retrospectively analyzed in 136 vulnerable coronary plaques from 98 patients (68 men and 30 women; mean age: 72.9 ± 8.7 years) treated with a statin. The administration of evolocumab significantly increased the minimum CT density (39.1 ± 8.1 HU to 84.9 ± 31.4 HU, p < 0.001), reduced the remodeling index (1.29 ± 0.11 to 1.19 ± 0.10, p < 0.001), and decreased the percent stenosis (27.0 ± 10.4% to 21.2 ± 9.8%, p < 0.001). Multiple linear regression analysis revealed that baseline percent stenosis (standard coefficient (β) = −0.391, p = 0.002) independently correlated with the change in minimum CT density, whereas the baseline remodeling index (β = −0.368, p < 0.001) independently correlated with a change in the remodeling index. Evolocumab stabilized vulnerable coronary plaques and reduced their size. These results suggest that evolocumab protects against coronary artery disease progression in patients taking statins. Full article

(This article belongs to the Special Issue Chronic Coronary Syndromes: New Diagnosis and Therapeutic Options)

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Review

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16 pages, 1002 KiB

Open AccessReview

Frailty in Acute and Chronic Coronary Syndrome Patients Entering Cardiac Rehabilitation

by Francesco Giallauria, Anna Di Lorenzo, Elio Venturini, Mario Pacileo, Antonello D’Andrea, Umberto Garofalo, Felice De Lucia, Crescenzo Testa, Gianluigi Cuomo, Gabriella Iannuzzo, Marco Gentile, Cinzia Nugara, Filippo M Sarullo, Nastasia Marinus, Dominique Hansen and Carlo Vigorito

J. Clin. Med. 2021, 10(8), 1696; https://doi.org/10.3390/jcm10081696 - 15 Apr 2021

Cited by 22 | Viewed by 4250

Abstract

Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is [...] Read more.

Worldwide population ageing is partly due to advanced standard of care, leading to increased incidence and prevalence of geriatric syndromes such as frailty and disability. Hence, the age at the onset of acute coronary syndromes (ACS) keeps growing as well. Moreover, ageing is a risk factor for both frailty and cardiovascular disease (CVD). Frailty and CVD in the elderly share pathophysiological mechanisms and associated conditions, such as malnutrition, sarcopenia, anemia, polypharmacy and both increased bleeding/thrombotic risk, leading to a negative impact on outcomes. In geriatric populations ACS is associated with an increased frailty degree that has a negative effect on re-hospitalization and mortality outcomes. Frail elderly patients are increasingly referred to cardiac rehabilitation (CR) programs after ACS; however, plans of care must be tailored on individual’s clinical complexity in terms of functional capacity, nutritional status and comorbidities, cognitive status, socio-economic support. Completing rehabilitative intervention with a reduced frailty degree, disability prevention, improvement in functional state and quality of life and reduction of re-hospitalization are the goals of CR program. Tools for detecting frailty and guidelines for management of frail elderly patients post-ACS are still debated. This review focused on the need of an early identification of frail patients in elderly with ACS and at elaborating personalized plans of care and secondary prevention in CR setting. Full article

(This article belongs to the Special Issue Chronic Coronary Syndromes: New Diagnosis and Therapeutic Options)

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16 pages, 819 KiB

Open AccessReview

Systemic Inflammation and COVID-19 Mortality in Patients with Major Noncommunicable Diseases: Chronic Coronary Syndromes, Diabetes and Obesity

by Andreea-Luciana Buicu, Simona Cernea, Imre Benedek, Corneliu-Florin Buicu and Theodora Benedek

J. Clin. Med. 2021, 10(8), 1545; https://doi.org/10.3390/jcm10081545 - 07 Apr 2021

Cited by 37 | Viewed by 4208

Abstract

COVID-19 is currently considered an inflammatory disease affecting the entire organism. In severe forms, an augmented inflammatory response leads to the fulminant “cytokine storm”, which may result in severe multisystemic end-organ damage. Apart from the acute inflammatory response, it seems that chronic inflammation [...] Read more.

COVID-19 is currently considered an inflammatory disease affecting the entire organism. In severe forms, an augmented inflammatory response leads to the fulminant “cytokine storm”, which may result in severe multisystemic end-organ damage. Apart from the acute inflammatory response, it seems that chronic inflammation also plays a major role in the clinical evolution of COVID-19 patients. Pre-existing inflammatory conditions, such as those associated with chronic coronary diseases, type 2 diabetes mellitus or obesity, may be associated with worse clinical outcomes in the context of COVID-19 disease. These comorbidities are reported as powerful predictors of poor outcomes and death following COVID-19 disease. Moreover, in the context of chronic coronary syndrome, the cytokine storm triggered by SARS-CoV-2 infection may favor vulnerabilization and rupture of a silent atheromatous plaque, with consequent acute coronary syndrome, leading to a sudden deterioration of the clinical condition of the patient. This review aims to present the current status of knowledge regarding the link between COVID-19 mortality, systemic inflammation and several major diseases associated with poor outcomes, such as cardiovascular diseases, diabetes and obesity. Full article

(This article belongs to the Special Issue Chronic Coronary Syndromes: New Diagnosis and Therapeutic Options)

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11 pages, 7845 KiB

Open AccessReview

Inhibitors of Protein Convertase Subtilisin/Kexin 9 (PCSK9) and Acute Coronary Syndrome (ACS): The State-of-the-Art

by Gabriella Iannuzzo, Marco Gentile, Alessandro Bresciani, Vania Mallardo, Anna Di Lorenzo, Pasquale Merone, Gianluigi Cuomo, Mario Pacileo, Filippo M. Sarullo, Elio Venturini, Antonello D’Andrea, Carlo Vigorito and Francesco Giallauria

J. Clin. Med. 2021, 10(7), 1510; https://doi.org/10.3390/jcm10071510 - 05 Apr 2021

Cited by 14 | Viewed by 3638

Abstract

Acute Coronary Syndrome (ACS) remains one of the most frequent causes of morbidity and mortality in the world. Although the age- and gender-adjusted incidence of ACS is decreasing, the mortality associated with this condition remains high, especially 1-year after the acute event. Several [...] Read more.

Acute Coronary Syndrome (ACS) remains one of the most frequent causes of morbidity and mortality in the world. Although the age- and gender-adjusted incidence of ACS is decreasing, the mortality associated with this condition remains high, especially 1-year after the acute event. Several studies demonstrated that PCSK9 inhibitors therapy determine a significant reduction of major adverse cardiovascular events (MACE) in post-ACS patients, through a process of plaque modification, by intervening in lipid metabolism and platelet aggregation and finally determining an improvement in endothelial function. In the EVACS (Evolocumab in Acute Coronary Syndrome) study, evolocumab allows >90% of patients to achieve LDL-C < 55 mg/dL according to ESC/EAS guidelines compared to 11% of patients who only receive statins. In the EVOPACS (EVOlocumab for Early Reduction of low-density lipoprotein (LDL)-cholesterol Levels in Patients With Acute Coronary Syndromes) study, evolocumab determined LDL levels reduction of 40.7% (95% CI: 45.2 to 36.2; p < 0.001) and allowed 95.7% of patients to achieve LDL levels <55 mg/dL. In ODYSSEY Outcome trial, alirocumab reduced the overall risk of MACE by 15% (HR = 0.85; CI: 0.78–0.93; p = 0.0003), with a reduced risk of all-cause mortality (HR = 0.85; CI: 0.73–0.98: nominal p = 0026), and fewer deaths for coronary heart disease (CHD) compared to the control group (HR = 0.92; CI: 0.76–1.11; p = 0.38). The present review aimed at describing the beneficial effect of PCSK9 inhibitors therapy early after ACS in reducing LDL circulating levels (LDL-C) and the risk of major adverse cardiovascular events, which was very high in the first year and persists higher later after the acute event. Full article

(This article belongs to the Special Issue Chronic Coronary Syndromes: New Diagnosis and Therapeutic Options)

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15 pages, 2198 KiB

Open AccessReview

The Pharmacological Approach to Oncologic Patients with Acute Coronary Syndrome

by Juri Radmilovic, Alessandro Di Vilio, Antonello D’Andrea, Fabio Pastore, Alberto Forni, Alfonso Desiderio, Massimo Ragni, Gaetano Quaranta, Giovanni Cimmino, Vincenzo Russo, Marino Scherillo and Paolo Golino

J. Clin. Med. 2020, 9(12), 3926; https://doi.org/10.3390/jcm9123926 - 03 Dec 2020

Cited by 11 | Viewed by 3358

Abstract

Among acute coronary syndrome (ACS) patients, 15% have concomitant cancer, especially in the first 6 months after their diagnosis, as well as in advanced metastatic stages. Lung, gastric, and pancreatic cancers are the most frequent malignancies associated with ACS. Chemotherapy and radiotherapy exert [...] Read more.

Among acute coronary syndrome (ACS) patients, 15% have concomitant cancer, especially in the first 6 months after their diagnosis, as well as in advanced metastatic stages. Lung, gastric, and pancreatic cancers are the most frequent malignancies associated with ACS. Chemotherapy and radiotherapy exert prothrombotic, vasospastic, and proinflammatory actions. The management of cancer patients with ACS is quite challenging: percutaneous revascularization is often underused, and antiplatelet and anticoagulant pharmacological therapy should be individually tailored to the thrombotic risk and to the bleeding complications. Sometimes oncological patients also show different degrees of thrombocytopenia, which further complicates the pharmacological strategies. The aim of this review is to summarize the current evidence regarding the treatment of ACS in cancer patients and to suggest the optimal management and therapy to reduce the risk of adverse coronary events after ACS in this high-risk population. Full article

(This article belongs to the Special Issue Chronic Coronary Syndromes: New Diagnosis and Therapeutic Options)

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24 pages, 1246 KiB

Open AccessReview

The Incremental Role of Coronary Computed Tomography in Chronic Coronary Syndromes

by Francesca Baessato, Marco Guglielmo, Giuseppe Muscogiuri, Andrea Baggiano, Laura Fusini, Stefano Scafuri, Mario Babbaro, Rocco Mollace, Ada Collevecchio, Andrea I. Guaricci, Mark Rabbat, Antonello D’Andrea and Gianluca Pontone

J. Clin. Med. 2020, 9(12), 3925; https://doi.org/10.3390/jcm9123925 - 03 Dec 2020

Cited by 15 | Viewed by 3874

Abstract

In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes [...] Read more.

In the context of chronic coronary syndromes (CCS), coronary computed tomography angiography (CCTA) has gained broad acceptance as a noninvasive anatomical imaging tool with ability of excluding coronary stenosis with strong negative predictive value. Atherosclerotic plaque lesions are independent predictors of cardiovascular outcomes in high risk patients with known coronary artery disease (CAD). Calcium detection is commonly expressed through the coronary artery calcium score (CACS), but further research is warranted to confirm the powerness of a CACS-only strategy in both diagnosis and prognosis assessment. Recent studies evidence how defined plaque composition characteristics effectively relate to the risk of plaque instabilization and the overall ischemic burden. Fractional flow reserve from CCTA (FFR-CT) has been demonstrated as a reliable method for noninvasive functional evaluation of coronary lesions severity, while the assessment of perfusion imaging under stress conditions is growing as a useful tool for assessment of myocardial ischemia. Moreover, specific applications in procedural planning of transcatheter valve substitution and follow-up of heart transplantation have gained recent importance. This review illustrates the incremental role of CCTA, which can potentially revolutionize the diagnosis and management pathway within the wide clinical spectrum of CCS. Full article

(This article belongs to the Special Issue Chronic Coronary Syndromes: New Diagnosis and Therapeutic Options)

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14 pages, 946 KiB

Open AccessReview

Sustainability and Versatility of the ABCDE Protocol for Stress Echocardiography

by Eugenio Picano, Angela Zagatina, Karina Wierzbowska-Drabik, Clarissa Borguezan Daros, Antonello D’Andrea and Quirino Ciampi

J. Clin. Med. 2020, 9(10), 3184; https://doi.org/10.3390/jcm9103184 - 30 Sep 2020

Cited by 11 | Viewed by 3650

Abstract

For the past 40 years, the methodology for stress echocardiography (SE) has remained basically unchanged. It is based on two-dimensional, black and white imaging, and is used to detect regional wall motion abnormalities (RWMA) in patients with known or suspected coronary artery disease [...] Read more.

For the past 40 years, the methodology for stress echocardiography (SE) has remained basically unchanged. It is based on two-dimensional, black and white imaging, and is used to detect regional wall motion abnormalities (RWMA) in patients with known or suspected coronary artery disease (CAD). In the last five years much has changed and RWMA is not enough on its own to stratify patient risk and dictate therapy. Patients arriving at SE labs often have comorbidities and are undergoing full anti-ischemic therapy. The SE positivity rate based on RWMA fell from 70% in the eighties to 10% in the last decade. The understanding of CAD pathophysiology has shifted from a regional hydraulic disease to a systemic biologic disease. The conventional view of CAD encouraged the use of coronary anatomic imaging for diagnosis and the oculo-stenotic reflex for the deployment of therapy. This has led to a clinical oversimplification that ignores the lessons of pathophysiology and epidemiology, and in fact, CAD is not synonymous with ischemic heart disease. Patients with CAD may also have other vulnerabilities such as coronary plaque (step A of ABCDE-SE), alveolar-capillary membrane and pulmonary congestion (step B), preload and contractile reserve (step C), coronary microcirculation (step D) and cardiac autonomic balance (step E). The SE methodology based on two-dimensional echocardiography is now integrated with lung ultrasound (step B for B-lines), volumetric echocardiography (step C), color- and pulsed-wave Doppler (step D) and non-imaging electrocardiogram-based heart rate assessment (step E). In addition, qualitative assessment based on the naked eye has now become more quantitative, has been improved by contrast and based on cardiac strain and artificial intelligence. ABCDE-SE is now ready for large scale multicenter testing in the SE2030 study. Full article

(This article belongs to the Special Issue Chronic Coronary Syndromes: New Diagnosis and Therapeutic Options)

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17 pages, 3814 KiB

Open AccessReview

New Ultrasound Technologies for Ischemic Heart Disease Assessment and Monitoring in Cardiac Rehabilitation

by Antonello D’Andrea, Simona Sperlongano, Mario Pacileo, Elio Venturini, Gabriella Iannuzzo, Marco Gentile, Rossella Sperlongano, Giuseppe Vitale, Marco Maglione, Gennaro Cice, Filippo Maria Sarullo, Anna Di Lorenzo, Carlo Vigorito, Francesco Giallauria and Eugenio Picano

J. Clin. Med. 2020, 9(10), 3131; https://doi.org/10.3390/jcm9103131 - 28 Sep 2020

Cited by 20 | Viewed by 3549

Abstract

Owing to its ease of application, noninvasive nature, and safety, echocardiography is an essential imaging modality to assess cardiac function in patients affected by ischemic heart disease (IHD). Over the past few decades, we have witnessed a continuous series of evolutions in the [...] Read more.

Owing to its ease of application, noninvasive nature, and safety, echocardiography is an essential imaging modality to assess cardiac function in patients affected by ischemic heart disease (IHD). Over the past few decades, we have witnessed a continuous series of evolutions in the ultrasound field that have led to the introduction of innovative echocardiographic modalities which allowed to better understand the morphofunctional abnormalities occurring in cardiovascular diseases. This article offers an overview of some of the newest echocardiographic modalities and their promising application in IHD diagnosis, risk stratification, management, and monitoring after cardiac rehabilitation. Full article

(This article belongs to the Special Issue Chronic Coronary Syndromes: New Diagnosis and Therapeutic Options)

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