Research

9 pages, 621 KiB

Open AccessArticle

The Feasibility of Ultra-Sensitive Phonocardiography in Acute Chest Pain Patients of a Tertiary Care Emergency Department (ScorED Feasibility Study)

by Sebastian Schnaubelt, Felix Eibensteiner, Julia Oppenauer, Andrea Kornfehl, Roman Brock, Laura Poschenreithner, Na Du, Enrico Baldi, Oliver Schlager, Alexander Niessner, Hans Domanovits, Dominik Roth and Patrick Sulzgruber

J. Pers. Med. 2022, 12(4), 631; https://doi.org/10.3390/jpm12040631 - 14 Apr 2022

Cited by 1 | Viewed by 1518

Abstract

Background: Thoracic pain is one of the most frequent chief complaints at emergency departments (EDs). However, a respective workup in cases without clear electrocardiographic signs is complex. In addition, after having ruled out acute coronary syndrome (ACS), patients are often left with an [...] Read more.

Background: Thoracic pain is one of the most frequent chief complaints at emergency departments (EDs). However, a respective workup in cases without clear electrocardiographic signs is complex. In addition, after having ruled out acute coronary syndrome (ACS), patients are often left with an unclear etiology of their symptoms. Ultra-sensitive phonocardiography is already used to rule out stable coronary artery disease (CAD); however, its feasibility in an ED-setting remains unknown. Methods: We prospectively used ultra-sensitive phonocardiography via the CADScor^®System to measure hemodynamically stable patients with the chief complaint of chest pain during routine waiting times at a high-volume tertiary ED. Results: A total of 101 patients (49% male; 94% Caucasian; 61 (51–71) years; BMI 28.3 (24.2–31.6)) were enrolled. Patient workflow was not hindered, and no adverse events were recorded. In 80% of cases, a score was successfully calculated, with 74% at the first, 5% at the second, and 1% at the third attempt. Feasibility was judged as 9.0 (±1.8) by the patients, and 8.9 (±2.6) by the investigators on a 10-point Likert scale. Conclusions: Ultra-sensitive phonocardiography was found to be feasible in acute chest pain patients presenting to a tertiary ED. Thus, the CAD score measured during routine waiting times could potentially serve as an additional tool in a diagnostic pathway for thoracic pain. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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14 pages, 1151 KiB

Open AccessArticle

Clinical Outcomes of Cardiac Rehabilitation in Women with Coronary Artery Disease—Differences in Comparison with Men

by Katarzyna Szmigielska and Anna Jegier

J. Pers. Med. 2022, 12(4), 600; https://doi.org/10.3390/jpm12040600 - 08 Apr 2022

Cited by 4 | Viewed by 1886

Abstract

This study evaluated the clinical outcomes of cardiac rehabilitation (CR) in women with coronary artery disease (CAD) in comparison to men. Methods: Patients after acute coronary syndrome or after revascularization procedures (106 women, 180 men) were consecutively admitted to a comprehensive outpatient CR [...] Read more.

This study evaluated the clinical outcomes of cardiac rehabilitation (CR) in women with coronary artery disease (CAD) in comparison to men. Methods: Patients after acute coronary syndrome or after revascularization procedures (106 women, 180 men) were consecutively admitted to a comprehensive outpatient CR program, comprising of 45-min ergometer interval training three times a week for eight weeks. The training intensity was determined on the basis of training heart rate, calculated following an exercise test. Patients were divided into subgroups according to age (≤55, >55 years), BMI (<25, ≥25 kg/m²), left ventricular ejection fraction (LVEF; ≤40%, 41–49%, ≥50%), and number of affected coronary vessels. Results: After eight weeks, exercise capacity increased significantly by 0.6 ± 0.77 MET (women) and by 1.0 ± 0.74 MET (men). The greatest benefit was observed in men, women under 55 years, women with LVEF 41–49%, and women with single-vessel CAD. An outpatient CR program appears less beneficial for women, especially those over 55 years, with two or three coronary vessels affected with atherosclerosis or with LVEF > 50%. In women with CAD, eight weeks of 45-min interval training, with sessions three times a week, is insufficient to improve exercise capacity to an extent that is considered a predictor of mortality risk reduction. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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18 pages, 2615 KiB

Open AccessArticle

Non-Vitamin K Antagonist Oral Anticoagulants and Risk of Myocardial Infarction in Patients with Atrial Fibrillation with or without Percutaneous Coronary Interventions: A Meta-Analysis

by Stefan Grajek, Marta Kałużna-Oleksy, Jolanta M. Siller-Matula, Maksymilian Grajek and Michał Michalak

J. Pers. Med. 2021, 11(10), 1013; https://doi.org/10.3390/jpm11101013 - 09 Oct 2021

Cited by 4 | Viewed by 1987

Abstract

The study aimed to assess the risk of myocardial infarction (MI) and major adverse cardiac events during non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin therapy in patients with atrial fibrillation (AF), both treated and not treated with percutaneous coronary interventions (PCI). [...] Read more.

The study aimed to assess the risk of myocardial infarction (MI) and major adverse cardiac events during non-vitamin K antagonist oral anticoagulants (NOAC) compared to warfarin therapy in patients with atrial fibrillation (AF), both treated and not treated with percutaneous coronary interventions (PCI). In a systematic search, we selected eight randomized clinical trials with a total of 81,943 patients. Dabigatran, compared to warfarin, significantly increased the risk of MI (relative risk [RR] 1.38, 95% CI 1.14–1.67), while the FXa inhibitors’ effect did not differ significantly from warfarin (RR 0.96, 95% CI 0.86–1.09). The RR comparison between analyzed subgroups (dabigatran vs. FXa inhibitors) showed a significant difference (Chi² = 9.51, df = 1, p = 0.002). In a network meta-analysis, dabigatran 110 mg b.i.d. increased the risk of MI compared to warfarin, apixaban, edoxaban, and rivaroxaban. Also, dabigatran 150 mg b.i.d. increased the risk of MI compared to warfarin, apixaban, and rivaroxaban. Moreover, we tried to estimate the treatment ranking of the best therapy for MI prevention in patients with AF treated with PCI. Rivaroxaban had a 90% probability of being ranked the best therapy for MI prevention, whereas dabigatran 110 mg had an 8.2% probability. Dabigatran 150 mg was the most effective in stroke prevention (94% probability). Each NOAC is associated with a different risk of MI. Furthermore, we should consider FXa inhibitors as the first line NOACs in AF and coronary artery disease patients. PROSPERO ID CRD42020179808. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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16 pages, 1729 KiB

Open AccessArticle

The Role of IL-6 and ET-1 in the Diagnosis of Coronary MicroVascular Disease in Women

by Diana Gurzău, Adela Sitar-Tăut, Bogdan Caloian, Gabriel Guşetu, Horaţiu Comşa, Florina Frîngu, Dumitru Zdrenghea and Dana Pop

J. Pers. Med. 2021, 11(10), 965; https://doi.org/10.3390/jpm11100965 - 27 Sep 2021

Cited by 8 | Viewed by 1631

Abstract

Background: Microvascular angina is a common clinical entity, with about a three-fold higher frequency in women. The pathogenesis of microvascular angina has not been much studied, but inflammation and endothelial dysfunction have been incriminated as the main mechanisms of this disease. Methoss: Our [...] Read more.

Background: Microvascular angina is a common clinical entity, with about a three-fold higher frequency in women. The pathogenesis of microvascular angina has not been much studied, but inflammation and endothelial dysfunction have been incriminated as the main mechanisms of this disease. Methoss: Our purpose was to analyze whether certain inflammatory markers, i.e., interleukin 6 (IL-6) and endothelin 1 (ET-1), can play a role in the diagnosis of microvascular angina in women. Results: Ninety women with ischemic heart disease were divided into two groups, based on their affliction with either microvascular or macrovascular disease. In general, the levels of IL6 and ET1 were similar between the two groups. Analyzing these marker levels according to the number of coronary lesions, we obtained an increased IL6 value that was similar for patients with microvascular angina, one-vessel, and two-vessel coronary disease, but significantly lower than in women with three-vessel coronary lesions. Also, in microvascular angina, IL6 level was correlated with the NYHA IV functional class. Unexpectedly, the level of ET1 was correlated with left ventricular systolic dysfunction. Conclusions: In women with an increased suspicion of microvascular angina, in whom microvascular dysfunction cannot be tested invasively, IL-6 level, unlike the ET-1 level, might be considered a diagnostic marker of this disease. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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10 pages, 481 KiB

Open AccessArticle

Association of Kidney Disease, Potassium, and Cardiovascular Risk Factor Prevalence with Coronary Arteriosclerotic Burden, by Sex

by Patricio Maragaño Lizama, Diana L. Ríos, Isaac Subirana Cachinero, Andrea Toloba Lopez-Egea, Anna Camps, Oward Belzares, Claudio Pacheco, Cristina Cerro, Sergio Wehinger, Eduardo Fuentes, Jaume Marrugat and Iván Palomo

J. Pers. Med. 2021, 11(8), 722; https://doi.org/10.3390/jpm11080722 - 27 Jul 2021

Cited by 3 | Viewed by 1785

Abstract

The present study aimed to determine the relationship between the prevalence of cardiovascular risk factors and the number and severity of coronary artery atherosclerotic lesions obtained by coronary angiography. We reviewed and analyzed 1642 records from consecutive patients at the Catheter Laboratory of [...] Read more.

The present study aimed to determine the relationship between the prevalence of cardiovascular risk factors and the number and severity of coronary artery atherosclerotic lesions obtained by coronary angiography. We reviewed and analyzed 1642 records from consecutive patients at the Catheter Laboratory of Talca Regional Hospital in Chile between March 2018 and May 2019. Patients were stratified according to the presence and severity of atherosclerotic lesions: 632 (38.5%) had no lesions or <30% stenosis and 1010 (61.5%) had at least one coronary atherosclerotic lesion with ≥30% stenosis (CALS-30). CALS-30 was more frequent in males, smokers, and patients with diabetes and/or hypertension (all p-values < 0.02). Serum potassium, glycaemia, creatinine and glomerular filtration rates were also associated with CALS-30 (all p-values < 0.01) in males. The age and the proportion of males with CALS-30 increased with the number of risk factors (p-values for trends < 0.001). Our results showed a stronger association between the accumulation of risk factors and CALS-30 in women than in men. Serum potassium levels were inversely associated with CALS-30 in men but not in women. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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10 pages, 1216 KiB

Open AccessArticle

The Impact of Sclerostin Levels on Long-Term Prognosis in Patients Undergoing Coronary Angiography: A Personalized Approach with 9-Year Follow-Up

by Adam Kern, Tomasz Stompór, Jolanta Kiewisz, Bartłomiej E. Kraziński, Jacek Kiezun, Marta Kiezun, Jerzy Górny, Ewa Sienkiewicz, Leszek Gromadziński, Dariusz Onichimowski and Jacek Bil

J. Pers. Med. 2021, 11(3), 186; https://doi.org/10.3390/jpm11030186 - 06 Mar 2021

Cited by 3 | Viewed by 1854

Abstract

Sclerostin might play a role in atherosclerosis development. This study aimed to analyze the impact of baseline sclerostin levels on 9-year outcomes in patients without significant renal function impairment and undergoing coronary angiography. The primary study endpoint was the rate of major cardiovascular [...] Read more.

Sclerostin might play a role in atherosclerosis development. This study aimed to analyze the impact of baseline sclerostin levels on 9-year outcomes in patients without significant renal function impairment and undergoing coronary angiography. The primary study endpoint was the rate of major cardiovascular events (MACE), defined as a combined rate of myocardial infarction (MI), stroke, or death at 9 years. We included 205 patients with a mean age of 62.9 ± 0.6 years and 70.2% male. Median serum sclerostin concentration was 133.22 pg/mL (IQR 64.0–276.17). At 9 years, in the whole population, the rate of MACE was 34.1% (n = 70), MI: 11.2% (n = 23), stroke: 2.4% (n = 5), and death: 20.5% (n = 42). In the high sclerostin (>median) group, we observed statistically significant higher rates of MACE and death: 25.2% vs. 43.1% (HR 1.75, 95% CI 1.1–2.10, p = 0.02) and 14.6% vs. 26.5% (HR 1.86, 95% CI 1.02–3.41, p = 0.049), respectively. Similar relationships were observed in patients with chronic coronary syndrome and SYNTAX 0–22 subgroups. Our results suggest that sclerostin assessment might be useful in risk stratification, and subjects with higher sclerostin levels might have a worse prognosis. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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Review

Jump to: Research, Other

14 pages, 1229 KiB

Open AccessReview

What Can We Change in Diet and Behaviour in Order to Decrease Carotid Intima-Media Thickness in Patients with Obesity?

by Anna Maria Rychter, Dariusz Naskręt, Agnieszka Zawada, Alicja Ewa Ratajczak, Agnieszka Dobrowolska and Iwona Krela-Kaźmierczak

J. Pers. Med. 2021, 11(6), 505; https://doi.org/10.3390/jpm11060505 - 03 Jun 2021

Cited by 5 | Viewed by 3597

Abstract

Atherosclerosis—considered the major cause of cardiovascular diseases (CVDs)—is strongly associated with obesity, to which it strongly contributes. Moreover, atherosclerosis is characterised by a long asymptomatic phase, and its progression can lead to serious cardiovascular (CV) events. The carotid intima-media thickness (cIMT) has been [...] Read more.

Atherosclerosis—considered the major cause of cardiovascular diseases (CVDs)—is strongly associated with obesity, to which it strongly contributes. Moreover, atherosclerosis is characterised by a long asymptomatic phase, and its progression can lead to serious cardiovascular (CV) events. The carotid intima-media thickness (cIMT) has been determined as a predictor of CV events, as well as a marker of subclinical atherosclerosis, and has been used in clinical trials as an alternative assessment method or a surrogate endpoint. It should be noted that several behavioural approaches can directly influence the cIMT values, and decrease or increase the CV risk. In our paper, we aimed to summarize the current knowledge regarding IMT measurement among patients with obesity as a risk group—also in terms of the obesity paradox where the diagnosis of subclinical atherosclerosis is especially essential and implements the early therapeutic approach. We also summarized behavioural, modifiable factors, such as the Mediterranean diet, the Dietary Approach to Stop Hypertension Diets, body weight reduction or the intake of micro- and macronutrients, with a particular focus on the studies where the cIMT values were one of the outcomes. In order to collect the literature data related to the presented topic, the PubMed database was explored. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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Other

Jump to: Research, Review

8 pages, 790 KiB

Open AccessBrief Report

Serum Ceramides as Prognostic Biomarkers of Large Thrombus Burden in Patients with STEMI: A Micro-Computed Tomography Study

by Efstratios Karagiannidis, Andreas S. Papazoglou, Nikolaos Stalikas, Olga Deda, Eleftherios Panteris, Olga Begou, Georgios Sofidis, Dimitrios V. Moysidis, Anastasios Kartas, Evangelia Chatzinikolaou, Kleoniki Keklikoglou, Andreana Bompoti, Helen Gika, Georgios Theodoridis and Georgios Sianos

J. Pers. Med. 2021, 11(2), 89; https://doi.org/10.3390/jpm11020089 - 31 Jan 2021

Cited by 13 | Viewed by 2881

Abstract

ST-elevation myocardial infarction (STEMI) remains one of the leading causes of mortality worldwide. The identification of novel metabolic and imaging biomarkers could unveil key pathophysiological mechanisms at the molecular level and promote personalized care in patients with acute coronary syndromes. We studied 38 [...] Read more.

ST-elevation myocardial infarction (STEMI) remains one of the leading causes of mortality worldwide. The identification of novel metabolic and imaging biomarkers could unveil key pathophysiological mechanisms at the molecular level and promote personalized care in patients with acute coronary syndromes. We studied 38 patients with STEMI who underwent primary percutaneous coronary intervention and thrombus aspiration. We sought to correlate serum ceramide levels with micro-CT quantified aspirated thrombus volume and relevant angiographic outcomes, including modified TIMI thrombus grade and pre- or post-procedural TIMI flow. Higher ceramide C16:0 levels were significantly but weakly correlated with larger aspirated thrombus volume (Spearman r = 0.326, p = 0.046), larger intracoronary thrombus burden (TB; p = 0.030) and worse pre- and post-procedural TIMI flow (p = 0.049 and p = 0.039, respectively). Ceramides C24:0 and C24:1 were also significantly associated with larger intracoronary TB (p = 0.008 and p = 0.001, respectively). Receiver operating characteristic analysis demonstrated that ceramides C24:0 and C24:1 could significantly predict higher intracoronary TB (area under the curve: 0.788, 95% CI: 0.629–0.946 and 0.846, 95% CI: 0.706–0.985, respectively). In conclusion, serum ceramide levels were higher among patients with larger intracoronary and aspirated TB. This suggests that quantification of serum ceramides might improve risk-stratification of patients with STEMI and facilitate an individualized approach in clinical practice. Full article

(This article belongs to the Special Issue Personalized Medicine of Coronary Artery Disease)

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