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10 pages, 669 KiB

Open AccessArticle

Sub Maximal Ergospirometry Parameters in Untrained Non-Frail Octogenarian Subjects

by Cristian Cofre-Bolados, Gerson Ferrari, Pedro Valdivia-Moral, Félix Vidal-Díaz, Robinson Ramírez-Vélez and Mikel Izquierdo-Redin

Medicina 2022, 58(3), 378; https://doi.org/10.3390/medicina58030378 - 03 Mar 2022

Cited by 2 | Viewed by 2394

Abstract

Background and Objectives: The prevalence of chronic diseases increases with age, and in octogenarian elderly, a cardiorespiratory test with gas analysis is more effective in determining the risk of mortality than applying the conventional risk factors. Materials and Methods: 25 untrained [...] Read more.

Background and Objectives: The prevalence of chronic diseases increases with age, and in octogenarian elderly, a cardiorespiratory test with gas analysis is more effective in determining the risk of mortality than applying the conventional risk factors. Materials and Methods: 25 untrained non-frail octogenarian subjects (four men) performed a submaximal test with gas analysis, which was stopped after the second ventilatory threshold (VT2) was reached. The variables analyzed were oxygen consumption at the first threshold (VO₂ VT1); ventilatory class (VE/VCO₂); oxygen uptake efficiency slope (OUES); cardiorespiratory optimal point (COP); oxygen pulse difference between VT2 and VT1 (diff. VO₂/HR VT2-VT1). Results: the variables were classified categorically based on cut-off points present in the literature, where the variable with the highest percentage of altered cases was dif. VO2/HR VT2-VT1 at 48%; followed by VO₂ VT1 at 40%, OUES at 36%, COP at 32%, and VE/VCO₂ at 24%. Chi-square analysis between the measured parameters defined that normal and altered variables were related to each other, except for the variable VE/VCO₂ and OUES. Conclusions: it was found that the main altered variable was the oxygen pulse and the least altered variable was VCO₂/VCO₂; there was only a statistically significant difference in a pair of OUES vs. VE/VCO₂ variables. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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11 pages, 1477 KiB

Open AccessArticle

Which Clusters of Metabolic Syndrome Are the Most Associated with Serum Uric Acid?

by Jurgita Mikolaitytė, Jolita Badarienė, Roma Puronaitė, Alma Čypienė, Irma Rutkauskienė, Jolanta Dadonienė and Aleksandras Laucevičius

Medicina 2022, 58(2), 297; https://doi.org/10.3390/medicina58020297 - 16 Feb 2022

Cited by 2 | Viewed by 1744

Abstract

Background and Objectives: Metabolic syndrome is defined as three or more of five components; therefore, there are 16 possible different clusters of metabolic risk factors that are under one diagnosis of metabolic syndrome. In this study, we evaluated the different clusters of [...] Read more.

Background and Objectives: Metabolic syndrome is defined as three or more of five components; therefore, there are 16 possible different clusters of metabolic risk factors that are under one diagnosis of metabolic syndrome. In this study, we evaluated the different clusters of metabolic syndrome (MetS) across serum uric acid (SUA) quartiles and analyzed the association of these clusters with SUA levels, respectively, in both men and women. Materials and Methods: A total of 606 subjects were recruited to a cross-sectional study from the ongoing Lithuanian High Cardiovascular Risk primary prevention program (LitHiR). All of the study subjects were diagnosed with MetS (according to the 2005 National Cholesterol Education Program Adult Treatment Panel III MetS definition). Results: In the middle-aged population of patients with MetS living in Lithuania, a high proportion of hyperuricaemia was detected—35.5% (95% Cl 31.7% to 39.4%). For women possessing all five MetS components, the chances of having hyperuricaemia are 2.807 higher than for women with three risk factors (p < 0.001). However, men do not have a statistically significantly higher chance of having hyperuricaemia, depending on the number of MetS components in our population. Using multivariable models, the statistically significant chance of having hyperuricaemia was observed only in women possessing all five MetS components (OR = 2.386, p < 0.0001), compared to any other of 15 MetS clusters. After adjustment for age and sex, the chance of having hyperuricaemia for individuals with the cluster of all five MetS components, compared to any other of 15 MetS clusters, remained (OR = 1.982, p = 0.001). Also, a lower probability (OR = 0.653, p = 0.039) of having hyperuricaemia was observed for individuals having the combination of abnormal plasma glucose, blood pressure, and waist circumference. Conclusions: Patients with the clustering of all five metabolic syndrome components are at higher risk for having hyperuricaemia than patients with any other combination of MetS clusters. This risk is even higher for women. It could be beneficial for patients presented with all five MetS components to be screened for SUA concentration in the primary CVD prevention program. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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10 pages, 1871 KiB

Open AccessArticle

Impact of the Severity of Acquired von Willebrand Syndrome on the Short-Term Prognosis in Patients with Temporary Mechanical Circulatory Support

by Makiko Nakamura, Teruhiko Imamura, Hiroshi Ueno and Koichiro Kinugawa

Medicina 2022, 58(2), 238; https://doi.org/10.3390/medicina58020238 - 04 Feb 2022

Cited by 1 | Viewed by 1320

Abstract

Background and Objectives: Acquired von Willebrand syndrome (AVWS) develops not only in patients with durable ventricular assist devices but also in patients receiving temporary mechanical circulatory support (MCS). However, its prognostic implication remains unknown. Materials and Methods: Patients who received temporary MCS in [...] Read more.

Background and Objectives: Acquired von Willebrand syndrome (AVWS) develops not only in patients with durable ventricular assist devices but also in patients receiving temporary mechanical circulatory support (MCS). However, its prognostic implication remains unknown. Materials and Methods: Patients who received temporary MCS in our institute between August 2018 and September 2021 were included in this prospective study and the von Willebrand factor multimer analyses were performed following the initiation of temporary MCS supports. The von Willebrand factor large-multimer index was calculated as a normalized ratio of large-multimer proportion among total von Willebrand factor. Association between the large-multimer index and the 30-day survival was investigated. Results: A total of 31 patients (69 years old, 52% men) were included. Median large-multimer index was 63.0% (56.9%, 75.6%). The index was lowest in patients with extracorporeal membrane oxygenation than those receiving support from other devices. A lower index (<59.9%) was associated with lower 30-day survival (41.7% versus 94.7%, p = 0.001) with an odds ratio 0.044 (95% confidence interval 0.002–0.805, p = 0.035) adjusted for other potential confounders. Conclusions: An advanced AVWS was associated with lower short-term survival in patients with temporary MCS. The clinical implication of AVWS-guided temporary MCS management remains the next concern. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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12 pages, 20618 KiB

Open AccessArticle

Temporary Trends Concerning the Extent and Efficacy of Atrial Fibrillation Ablation Using Radiofrequency Energy in a Polish Single-Center Experience

by Krzysztof Myrda, Piotr Buchta, Aleksandra Błachut, Michał Skrzypek and Mariusz Gąsior

Medicina 2022, 58(2), 187; https://doi.org/10.3390/medicina58020187 - 26 Jan 2022

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Abstract

Background and Objectives: Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Currently, catheter ablation is a preferred treatment strategy. The main objective of our study was a temporary trends analysis of patients’ data undergoing a single AF ablation procedure using radiofrequency energy [...] Read more.

Background and Objectives: Atrial fibrillation (AF) is the most common supraventricular arrhythmia. Currently, catheter ablation is a preferred treatment strategy. The main objective of our study was a temporary trends analysis of patients’ data undergoing a single AF ablation procedure using radiofrequency energy (RF). The efficacy of the procedure underwent assessment during a 12-month follow-up. Materials and Methods: We analyzed 585 consecutive patients with symptomatic, recurrent, and drug-refractory AF hospitalized in our department between 2013 and 2018 who underwent RF ablation supported by a 3D electroanatomical system. The baseline characteristics, periprocedural parameters, and efficacy of the procedure at 6-, 9- and 12-month follow-ups were analyzed over the years. Results: The number of patients undergoing ablation increased. Patients with paroxysmal AF predominated (71.5%). However, the number of patients with the persistent type of arrhythmia increased over the years. The percentage of patients with chronic heart failure (CHF) increased to 27.5% in 2018, and patients presented with increasingly larger left atria (LA). In all patients, circumferential pulmonary vein isolation was performed. The percentage of patients who underwent arrhythmogenic substrate modification and cavotricuspid isthmus ablation increased. Over the years, the efficacy of a single procedure at the 12-month follow-up remained without significant differences between the years (72.0%, 69.6%, 75.5%, 74.8%, 71.7%, 71.7%). Conclusions: The rate of patients with CHF and advanced LA disease undergoing more extensive ablation increased over the years. The efficacy of a single procedure remained without significant differences between the years. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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11 pages, 1112 KiB

Open AccessArticle

Monocyte-to-Lymphocyte Ratio as a Predictor of Worse Long-Term Survival after Off-Pump Surgical Revascularization-Initial Report

by Tomasz Urbanowicz, Michał Michalak, Anna Olasińska-Wiśniewska, Anna Witkowska, Michał Rodzki, Ewelina Błażejowska, Aleksandra Gąsecka, Bartłomiej Perek and Marek Jemielity

Medicina 2021, 57(12), 1324; https://doi.org/10.3390/medicina57121324 - 03 Dec 2021

Cited by 5 | Viewed by 2230

Abstract

Background and objective: Coronary artery disease is one of the leading causes of deaths nowadays and the trends in diagnosis and revascularization are still in plateau despite well-known factors. Simple whole blood count parameters may be used to measure inflammatory reactions that are [...] Read more.

Background and objective: Coronary artery disease is one of the leading causes of deaths nowadays and the trends in diagnosis and revascularization are still in plateau despite well-known factors. Simple whole blood count parameters may be used to measure inflammatory reactions that are involved in processes of atherosclerosis progression. The aim of our study was to analyse the association between simply available hematologic indices and long-term mortality following off-pump coronary artery bypass grafting (OPCAB). Material and Methods: The study group comprised 129 consecutive patients (16 females and 113 males, mean age 66 ± 6 years) who underwent surgical revascularization with off-pump technique between January 2014 and September 2019. The mean follow-up was 4.7 +/−1.9 years. A receiver operating characteristics curve was applied to estimate demographical and perioperative parameters including MLR for mortality. Results: Cox regression analysis revealed chronic pulmonary obstructive disease (HR = 2.86, 95%CI 1.05–7.78), MLR (HR = 3.81, 95%CI 1.45–10.06) and right coronary artery blood flow (HR = 1.06, 95%CI 1.00–1.10) as significant factors predicting increased mortality risk. In the presented model, the MLR > 1.44 on 1st postoperative day was a significant predictor of late mortality after the OPCAB procedure (HR = 3.82, 95%CI 1.45–10.06). Conclusions: Pronounced inflammatory reaction after off-pump surgery measured by MLR > 1.44 can be regarded as a worse long-term prognostic factor. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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9 pages, 1059 KiB

Open AccessArticle

Serum Angiopoietin-like Protein 3 Level Is Associated with Peripheral Arterial Stiffness in Patients with Coronary Artery Disease

by Chien-Hao Hsiao, Yu-Chih Chen, Ji-Hung Wang and Bang-Gee Hsu

Medicina 2021, 57(10), 1011; https://doi.org/10.3390/medicina57101011 - 25 Sep 2021

Cited by 4 | Viewed by 1553

Abstract

Background and Objectives: Angiopoietin-like protein 3 (ANGPTL3) is a secretory protein regulating lipid metabolism. This study evaluated the relationship between serum ANGPTL3 level and peripheral arterial stiffness (PAS) in patients with coronary artery disease (CAD). Materials and Methods: Fasting blood samples [...] Read more.

Background and Objectives: Angiopoietin-like protein 3 (ANGPTL3) is a secretory protein regulating lipid metabolism. This study evaluated the relationship between serum ANGPTL3 level and peripheral arterial stiffness (PAS) in patients with coronary artery disease (CAD). Materials and Methods: Fasting blood samples were collected from 95 CAD patients. PAS was defined as left or right brachial-ankle pulse wave velocity (baPWV) > 18.0 m/s by an oscillometric method. Serum ANGPTL3 levels were assessed using a commercial enzyme-linked immunosorbent assay kit. Results: Seventeen CAD patients (17.9%) had PAS. Patients with PAS had a significantly higher percentage of diabetes (p = 0.002), older age (p = 0.030), higher systolic blood pressure (p = 0.016), higher fasting glucose (p = 0.008), serum C-reactive protein (p = 0.002), and ANGPTL3 level (p = 0.001) than those without PAS. After multivariable logistic regression analysis, serum ANGPTL3 level (Odds ratio (OR): 1.004, 95% confidence interval (CI): 1.000–1.007, p = 0.041) is still independently associated with PAS in CAD patients. The receiver operating characteristic curve for PAS prediction revealed that the area under the curve for ANGPTL3 level was 0.757 (95% CI: 0.645–0.870, p < 0.001). Conclusions: Serum fasting ANGPTL3 level is positively associated with PAS in CAD patients. Further studies are required for clarification. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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8 pages, 1115 KiB

Open AccessArticle

Improvement in Vascular Endothelial Function following Transcatheter Aortic Valve Implantation

by Shuhei Tanaka, Teruhiko Imamura, Ryuichi Ushijima, Mitsuo Sobajima, Nobuyuki Fukuda, Hiroshi Ueno, Tadakazu Hirai and Koichiro Kinugawa

Medicina 2021, 57(10), 1008; https://doi.org/10.3390/medicina57101008 - 24 Sep 2021

Viewed by 1451

Abstract

Background and objectives: Endothelial dysfunction is associated with exercise intolerance and adverse cardiovascular events. Transcatheter aortic valve implantation (TAVI) is applied to treat elderly patients with severe aortic stenosis, but less is known about the impact of TAVI on endothelial dysfunction, which [...] Read more.

Background and objectives: Endothelial dysfunction is associated with exercise intolerance and adverse cardiovascular events. Transcatheter aortic valve implantation (TAVI) is applied to treat elderly patients with severe aortic stenosis, but less is known about the impact of TAVI on endothelial dysfunction, which can be assessed by measuring flow-mediated vasodilation (FMD). In this parameter, a low value indicates impaired endothelial function. Materials and Methods: Vascular endothelial function was evaluated by FMD of the brachial artery just before and one week after TAVI. Factors associated with the normalization of FMD and their prognostic impact were investigated. Results: Fifty-one patients who underwent TAVI procedure (median 86 years old, 12 men) were included. FMD improved significantly from baseline to one week following TAVI (from 5.3% [3.7%, 6.7%] to 6.3% [4.7%, 8.1%], p < 0.001). Among 33 patients with baseline low FMD (≤6.0%), FMD normalized up to >6.0% following TAVI in 15 patients. Baseline higher cardiac index was independently associated with normalization of FMD following TAVI (odds ratio 11.8, 95% confidence interval 1.12–124; p < 0.04). Conclusions: Endothelial dysfunction improved following TAVI in many patients with severe aortic stenosis. The implication of this finding is the next concern. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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8 pages, 415 KiB

Open AccessArticle

Cardioprotective Effect of Low Level of LDL Cholesterol on Perioperative Myocardial Injury in Off-Pump Coronary Artery Bypass Grafting

by Tomasz Kamil Urbanowicz, Anna Olasińska-Wiśniewska, Michał Michalak, Aleksandra Gąsecka, Michał Rodzki, Bartłomiej Perek and Marek Jemielity

Medicina 2021, 57(9), 875; https://doi.org/10.3390/medicina57090875 - 26 Aug 2021

Cited by 4 | Viewed by 2099

Abstract

Background and Objectives: Coronary artery disease is still a major cause of death in developed countries. Low-density lipoprotein cholesterol (LDL-C) lowering with statin therapy is a key strategy in major acute coronary events’ prevention. The aim of the study was to establish [...] Read more.

Background and Objectives: Coronary artery disease is still a major cause of death in developed countries. Low-density lipoprotein cholesterol (LDL-C) lowering with statin therapy is a key strategy in major acute coronary events’ prevention. The aim of the study was to establish if there is a cardioprotective effect of pre-operative LDL lowering therapy on perioperative myocaridal injury in patients undergoing off-pump coronary artery bypass grafting (CABG). Moreover, the impact of pre-operative LDL level on long term outcome was analysed. Materials and Methods: The retrospective single center analysis included 662 consecutive patients (431 (65%) males and 231 (35%) female, mean age of 65 ± 8) referred for cardiac surgery due to stable chronic coronary syndrome between 2012–2018. The follow up was 9 years. Results: A statistically significant difference was found in postoperative serum Troponin-I for LDL thresholds of 1.8 mmol/L (p = 0.009), 2.6 mmol/L (p = 0.03) and 3.0 mmol/L (p = 0.001). The results indicate that cardioprotective role of LDL is achieved within LDL concentration rate below 1.8 mmol/L (<70 mg/dL). Five patients died perioperatively, whereas 1-year and 9-year overall mortality rates were 4% (n = 28) and 18.6% (n = 123), respectively. Comparing the survival group with diseased, Mann-Whitney U test showed a statistically significant difference in HDL-C (p = 0.007), Troponin (p = 0.009), Castelli index (p = 0.001) and atherogenic index (p = 0.004). Preoperative levels of total cholesterol, LDL-C and HDL-C did not significantly differ between survivors and diseased. The 9-year mortality risk did not differ significantly between subgroups divided according to LDL-C thresholds of 1.4 mmol/L (55 mg/dL), 1.8 mmol/L (70 mg/dL), 2.6 mmol/L (100 mg/dL) and 3.0 mmol/L (116 mg/dL). Conclusions: Preoperative low level of LDL-C cholesterol (below 1.83 mmol/L, 70 mg/dL) has a cardioprotective effect on perioperative myocardial injury in off-pump coronary artery bypass grafting. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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7 pages, 452 KiB

Open AccessArticle

Previous Catheter Ablation Predicts In-Hospital Restoration of Sinus Rhythm in Patients Presenting with Recent-Onset Atrial Fibrillation—The Retrospective HAMBURG-AF Study

by Benedict Schulte-Steinberg, Muhammet Ali Aydin, Ana Theresa Moser, Francisco Ojeda and Mahir Karakas

Medicina 2021, 57(8), 776; https://doi.org/10.3390/medicina57080776 - 30 Jul 2021

Viewed by 1627

Abstract

Background and Objectives: Atrial fibrillation (AF) is the most common arrythmia of the human heart. Patients mostly present highly symptomatic with dyspnea and tachycardia and have a disproportionate risk of developing heart failure or stroke events. We aimed to evaluate the determinants of [...] Read more.

Background and Objectives: Atrial fibrillation (AF) is the most common arrythmia of the human heart. Patients mostly present highly symptomatic with dyspnea and tachycardia and have a disproportionate risk of developing heart failure or stroke events. We aimed to evaluate the determinants of early conversion into sinus rhythm during initial stay at the emergency department of a large tertiary care center. Materials and Methods: A total of 1384 subjects with recent-onset AF were recruited between October 2014 and April 2017. Patients with longstanding AF were excluded, resulting in a total of 935 patients for the present analysis. Results: In multivariate adjusted logistic regression analyses, previous catheter ablation therapy was a strong predictor of conversion in sinus rhythm during the stay in the emergency department, with an odds ratio (OR) of 3.87 (95% CI 2.40, 6.54; p < 0.001). In contrast, existing antiarrhythmic medication showed no association with facilitated conversion [OR 0.89 (95%CI 0.65, 1.20); p = 0.44]. Likewise, conventional cardiovascular risk factors (hypertension, dyslipidemia, diabetes) were also not associated with conversion during hospital stay. Conclusion: This is the first report on the relevance of previous ablation therapy for early restoration of sinus rhythm in recent-onset AF. Although catheter ablation is associated with relevant risk of late recurrence of atrial fibrillation, it seems to have a large benefit for patients with recent-onset AF. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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10 pages, 1048 KiB

Open AccessArticle

N-Terminal Pro-Brain Natriuretic Peptide and Right Ventricular Diameter Are Related to Aspirin Resistance in Coronary Artery Disease Patients

by Kamila Marika Cygulska, Łukasz Figiel, Dariusz Sławek, Małgorzata Wraga, Marek Dąbrowa and Jarosław D. Kasprzak

Medicina 2021, 57(7), 706; https://doi.org/10.3390/medicina57070706 - 12 Jul 2021

Viewed by 1827

Abstract

Background and Objectives: Resistance to ASA (ASAres) is a multifactorial phenomenon defined as insufficient reduction of platelet reactivity through incomplete inhibition of thromboxane A2 synthesis. The aim is to reassess the prevalence and predictors of ASAres in a contemporary cohort of coronary artery [...] Read more.

Background and Objectives: Resistance to ASA (ASAres) is a multifactorial phenomenon defined as insufficient reduction of platelet reactivity through incomplete inhibition of thromboxane A2 synthesis. The aim is to reassess the prevalence and predictors of ASAres in a contemporary cohort of coronary artery disease (CAD) patients (pts) on stable therapy with ASA, 75 mg o.d. Materials and Methods: We studied 205 patients with stable CAD treated with daily dose of 75 mg ASA for a minimum of one month. ASAres was defined as ARU (aspirin reaction units) ≥550 using the point-of-care VerifyNow Aspirin test. Results: ASAres was detected in 11.7% of patients. Modest but significant correlations were detected between ARU and concentration of N-terminal pro-brain natriuretic peptide (NT-proBNP) (r = 0.144; p = 0.04), body weight, body mass index, red blood cell distribution width, left ventricular mass, and septal end-systolic thickness, with trends for left ventricular mass index and prothrombin time. In multivariate regression analysis, log(NT-proBNP) was identified as the only independent predictor of ARU—partial r = 0.15, p = 0.03. Median concentrations of NT-proBNP were significantly higher in ASAres patients (median value 311.4 vs. 646.3 pg/mL; p = 0.046) and right ventricular diameter was larger, whereas mean corpuscular hemoglobin concentration was lower as compared to patients with adequate response to ASA. Conclusions: ASAres has significant prevalence in this contemporary CAD cohort and NT-proBNP has been identified as the independent correlate of on-treatment ARU, representing a predictor for ASAres, along with right ventricular enlargement and lower hemoglobin concentration in erythrocytes. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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12 pages, 2783 KiB

Open AccessArticle

Clinical Outcome of Rotational Atherectomy in Calcified Lesions in Korea-ROCK Registry

by Kyusup Lee, Ji-hoon Jung, Myunhee Lee, Dae-Won Kim, Mahn-Won Park, Ik-Jun Choi, Jae-Hwan Lee, Jang-Hoon Lee, Sang-Rok Lee, Pil-Hyung Lee, Seung-Whan Lee, Ki-Dong Yoo, Kyeong-Ho Yun, Hyun-Jong Lee and Sung-Ho Her

Medicina 2021, 57(7), 694; https://doi.org/10.3390/medicina57070694 - 07 Jul 2021

Cited by 12 | Viewed by 2220

Abstract

Background and Objectives: Data is still limited regarding clinical outcomes of rotational atherectomy (RA) after percutaneous coronary intervention. We sought to evaluate clinical outcomes of RA. Materials and Methods: This multi-center registry enrolled patients who underwent RA during PCI from nine tertiary [...] Read more.

Background and Objectives: Data is still limited regarding clinical outcomes of rotational atherectomy (RA) after percutaneous coronary intervention. We sought to evaluate clinical outcomes of RA. Materials and Methods: This multi-center registry enrolled patients who underwent RA during PCI from nine tertiary centers in Korea between January 2010 and October 2019. The primary endpoint was target-vessel failure (TVF; the composite outcome of cardiac death, target-vessel spontaneous myocardial infarction, or target-vessel revascularization). Results: Of 540 patients (583 lesions), the mean patient age was 71.4 ± 0.4 years, 323 patients (59.8%) were men, and 305 patients (56.5%) had diabetes mellitus. Technical success rate was 96.4%. In-hospital major adverse cerebral and cardiac events occurred in 63 cases (10.8%). At 1.5 years, 72 (16.0%) of TVFs were occurred. We evaluated independent predictors of TVF, which included current smoker (hazard ratio (HR), 1.92; 95% confidence interval (CI), 1.17–3.16; p = 0.01), chronic renal disease (HR, 1.87; 95% CI, 1.14–3.08; p = 0.013), history of cerebrovascular attack (HR, 2.14; 95% CI, 1.24-3.68; p = 0.006), left ventricle ejection fraction (HR, 0.98; 95% CI, 0.97–0.999; p = 0.037), and left main disease (HR, 1.94; 95% CI, 1.11–3.37; p = 0.019). Conclusions: From this registry, we demonstrated acceptable success rates, in-hospital and mid-term clinical outcomes of RA in the DES era. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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13 pages, 1701 KiB

Open AccessArticle

Long-Term Effects of Renal Artery Denervation

by Vytautas Juknevičius, Andrius Berūkštis, Renata Juknevičienė, Eugenijus Jasiūnas, Pranas Šerpytis and Aleksandras Laucevičius

Medicina 2021, 57(7), 662; https://doi.org/10.3390/medicina57070662 - 27 Jun 2021

Cited by 4 | Viewed by 1810

Abstract

Background and Objectives: Renal artery denervation (RDN) procedure is a broadly discussed method in the treatment of resistant hypertension. Many studies report short-term (3–12 months) results for blood pressure and arterial stiffness. The primary endpoints were changes in 24 h mean systolic [...] Read more.

Background and Objectives: Renal artery denervation (RDN) procedure is a broadly discussed method in the treatment of resistant hypertension. Many studies report short-term (3–12 months) results for blood pressure and arterial stiffness. The primary endpoints were changes in 24 h mean systolic blood pressure (BP) and office systolic BP 48 months after RDN. The secondary endpoints were changes in aortic pulse wave velocity and impact of polypharmacy on these variables. Materials and Methods: Renal artery denervation was performed in 73 patients treated for resistant hypertension; 49 patients remained in final analysis. Patient examination was carried out before the procedure, and subsequently at 3, 6, 12, 24, and 48 months later. Patients’ antihypertensive and overall medication regimens were carefully analysed. Results: Mean 24 h arterial blood pressure lowered and was sustained at lower levels for up to 48 months; median (interequartile range—IQR) from 158(23.5)/100(14.2) to 140(26.5)/86(16.2) mmHg. Mean reduction in 24 h ambulatory systolic BP was −11 ± 25 mmHg (95% CI, −20 to −2; p < 0.001), while office systolic BP reduced by −7 ± 23 mmHg (95%CI, −24 to −1; p < 0.02). A significant reduction in median aortic pulse wave velocity 12 months after the procedure (drop from baseline 11.2 [3.15] m/s (95%CI 6.1 to 16.2) to 9.8 [2.1] m/s (95%CI 6.1 to 13.7; p = 0.002)). After 48 months, there was no worsening compared to the baseline level of 10.3 [4.0] m/s (95% CI 6.9 to 17.8) (p > 0.05). The total mean number of antihypertensive drugs remained unchanged: 5.97(±1.1) vs. 5.24 (±1.45). A higher number of pills after 48 months was associated with higher aortic pulse wave velocity (1–5 pill group: 8.1 ± 1.6 m/s; 6–10 pill group: 10.9 ± 1.8 m/s; >11 pill group: 15.1 ± 2.6 m/s) (p = 0.003). Conclusions: Antihypertensive effect after renal denervation lasts up to 48 months with no worsening of arterial stiffness compared to baseline. In our study, polypharmacy was associated with increased arterial stiffness 48 months after the procedure. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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10 pages, 1089 KiB

Open AccessArticle

The Impact of Personal Thoracic Impedance on Electrical Cardioversion in Patients with Atrial Arrhythmias

by Seung-Young Roh, Jinhee Ahn, Kwang-No Lee, Yong-Soo Baek, Dong-Hyeok Kim, Dae-In Lee, Jaemin Shim, Jong-Il Choi and Young-Hoon Kim

Medicina 2021, 57(6), 618; https://doi.org/10.3390/medicina57060618 - 13 Jun 2021

Cited by 4 | Viewed by 2382

Abstract

Background and Objectives: Direct current cardioversion (DCCV) is a safe and useful treatment for atrial tachyarrhythmias. In the past, the energy delivered in DCCV was decided upon empirically, based only on the type of tachyarrhythmia. This conventional method does not consider individual [...] Read more.

Background and Objectives: Direct current cardioversion (DCCV) is a safe and useful treatment for atrial tachyarrhythmias. In the past, the energy delivered in DCCV was decided upon empirically, based only on the type of tachyarrhythmia. This conventional method does not consider individual factors and may lead to unnecessary electrical damage. Materials and Methods: We performed DCCV in patients with atrial tachyarrhythmias. The impedance and electrical current at the moment of shock were measured. The human thoracic impedance between both defibrillator patches and the electric current that was used were measured. Results: A total of 683 DCCVs were performed on 466 atrial tachyarrhythmia patients. The average impedance was 64 ± 11 Ω and the average successful current was 23 ± 6 mA. The magnitude of the electrical current that was successful depended upon the human impedance (linear regression, B = −0.266, p < 0.001) and the left atrial diameter (B = 0.092, p < 0.001). Impedance was directly proportional to body mass index (BMI) (B = 1.598, p < 0.001) and was higher in females than in males (77 ± 15 Ω vs. 63 ± 11 Ω, p < 0.001). Notably, the high-impedance (>70 Ω) group had a higher BMI (27 ± 4 kg/m² vs. 25 ± 3 kg/m², p < 0.001) and a higher proportion of females (37% vs. 9%, p < 0.001) than the low-impedance group (<70 Ω). However, thoracic impedance was not an independent predictor for successful DCCV. Conclusions: Human thoracic impedance was one of the factors that impacted the level of electrical current required for successful DCCV in patients with atrial arrhythmias. In the future, it will be helpful to consider individual predictors, such as BMI and gender, to minimize electrical damage during DCCV. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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10 pages, 356 KiB

Open AccessArticle

Association between miR-146a and Tumor Necrosis Factor Alpha (TNF-α) in Stable Coronary Artery Disease

by Tiago Pereira-da-Silva, Patrícia Napoleão, Marina C. Costa, André F. Gabriel, Mafalda Selas, Filipa Silva, Francisco J. Enguita, Rui Cruz Ferreira and Miguel Mota Carmo

Medicina 2021, 57(6), 575; https://doi.org/10.3390/medicina57060575 - 04 Jun 2021

Cited by 4 | Viewed by 2286

Abstract

Background and Objectives: Tumor necrosis factor alpha (TNF-α) is proatherogenic and associated with the risk of acute ischemic events, although the mechanisms that regulate TNF-α expression in stable coronary artery disease (SCAD) are not fully understood. We investigated whether metabolic, inflammatory, and [...] Read more.

Background and Objectives: Tumor necrosis factor alpha (TNF-α) is proatherogenic and associated with the risk of acute ischemic events, although the mechanisms that regulate TNF-α expression in stable coronary artery disease (SCAD) are not fully understood. We investigated whether metabolic, inflammatory, and epigenetic (microRNA (miRNA)) markers are associated with TNF-α expression in SCAD. Materials and Methods: Patients with SCAD were prospectively recruited and their metabolic and inflammatory profiles were assessed. TNF-α levels were assessed using an enzyme-linked immunosorbent assay. The relative expression of six circulating miRNAs associated with the regulation of inflammation and/or atherosclerosis was determined. Results: Of the 24 included patients with the mean age of 65 (9) years, 88% were male, and 54% were diabetic. The TNF-α levels were (median (interquartile range)) 1.0 (0.7–1.1) pg/mL. The percentage of glycosylated hemoglobin (r = 0.418, p = 0.042), serum triglyceride levels (r = 0.429, p = 0.037), and C-reactive protein levels (r = 0.407, p = 0.048) were positively correlated with TNF-α levels. Of the candidate miRNAs, miR-146a expression levels were negatively correlated with TNF-α levels (as indicated by r = 0.500, p = 0.035 for correlation between delta cycle threshold (ΔC_t) miR-146a and TNF-α levels). In multivariate analysis, serum triglyceride levels and miR-146a expression levels were independently associated with TNF-α levels. miR-146 expression levels were not associated with metabolic or other inflammatory parameters and were negatively correlated with the number of coronary vessels with obstructive disease (as indicated by r = 0.556, p = 0.017 for correlation between ΔC_t miR-146a and number of diseased vessels). Conclusions: miR-146a expression levels were negatively correlated with TNF-α levels in patients with SCAD, irrespective of other metabolic or inflammatory markers, and with the severity of coronary artery disease. The results add to the knowledge on the role of miR-146a in TNF-α-based inflammation in SCAD and support future research on the potential therapeutic use of miR-146a in such a clinical scenario. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

20 pages, 598 KiB

Open AccessArticle

Non-Targeted Self-Measurement of Blood Pressure: Association with Self-Medication, Unscheduled Emergency Visits and Anxiety

by Glessiane de Oliveira Almeida, Felipe J. Aidar, Dihogo Gama de Matos, Paulo Francisco de Almeida-Neto, Enaldo Vieira de Melo, José Augusto Soares Barreto Filho, Marcos Antonio Almeida-Santos, Victor Batista Oliveira, Rebeca Rocha de Almeida, Suelen Maiara dos Santos, Larissa Monteiro Costa Pereira, Juliana Santos Barbosa and Antônio Carlos Sobral Sousa

Medicina 2021, 57(1), 75; https://doi.org/10.3390/medicina57010075 - 17 Jan 2021

Cited by 1 | Viewed by 2201

Abstract

Background and Objective: The routine practice of self-medication of blood pressure (BP) not oriented with pulse devices may not be precisely useful in the control of BP and can lead the patient to self-medicate in error. Thus, we need to evaluate the non-oriented [...] Read more.

Background and Objective: The routine practice of self-medication of blood pressure (BP) not oriented with pulse devices may not be precisely useful in the control of BP and can lead the patient to self-medicate in error. Thus, we need to evaluate the non-oriented self-assessment of BP in real-life circumstances in hypertensive patients. The objective of this study was to evaluate in hypertensive patients the association of BP self-measurement with its control, as well as the presence of anxiety disorders, the occurrence of unscheduled visits to the emergency room, and self-medication. Materials and Methods: An observational study was carried out with 1000 hypertensive volunteers (age: 61.0 ± 12.5). Using a questionnaire, sociodemographic and clinical data on BP control were collected. Anxiety was assessed by the State-Trait Anxiety Inventory (STAI). Results: The group that performed non-oriented self-measurement of BP, showed that they had higher frequencies of self-medication (57.9%, p < 0.05) and more unscheduled visits to the emergency room (68%, p < 0.05). In addition, a lower level of BP control (46.8%, p < 0.05) was associated with higher levels of anxiety (52.3%, p < 0.05) in the group that performed non-oriented self-measurements of BP. Conclusion: The practice of non-oriented self-assessment of BP was associated with negative factors such as high levels of anxiety and higher frequencies of self-medication and unscheduled emergency visits. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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13 pages, 1711 KiB

Open AccessArticle

Early Hemodynamics after Aortic Valve Replacement

by Serik Aitaliyev, Egle Rumbinaitė, Karolina Mėlinytė-Ankudavičė, Rokas Nekrošius, Vytenis Keturakis and Rimantas Benetis

Medicina 2020, 56(12), 674; https://doi.org/10.3390/medicina56120674 - 07 Dec 2020

Cited by 1 | Viewed by 1844

Abstract

Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with different types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients [...] Read more.

Background and objectives: The aims of this study were to investigate changes in the hemodynamics associated with different types of aortic prostheses and to evaluate patient-prosthesis mismatch (PPM) at rest and after exercise. Materials and Methods: We retrospectively analyzed 150 patients who presented with indications for aortic valve replacement (AVR) with/without concomitant surgery from March 2019 to January 2020. The study population included 90 (60%) men and 60 (40%) women (mean age, 67.33 ± 10.22 years; range, 37–88 years). Echocardiography data such as peak and mean transprosthetic pressure gradients (Gmax, Gmean), velocity (V), effective orifice area (EOA), and indexed EOA (iEOA) were derived at rest and after exercise at baseline and before discharge. The study patients performed the six-minute walk test (6MWT) on the 5th–7th postoperative day. Results: Stented tissue valves showed excellent performance at rest and after exercise in comparison with mechanical valves, which showed favorable hemodynamics at rest only. At the time of discharge, moderate PPM was observed in 7/74 patients (9.5%) at rest and 5/98 (3.3%) patients after exercise. None of the patients showed severe PPM. EOA and iEOA were not significantly different between the groups. However, the stented group showed more pronounced changes in EOA and iEOA after exercise, whereas the changes in the mechanical valve group did not reach significance. Conclusions: In the early postoperative period, mechanical valves and stented valves showed favorable resting hemodynamics. The PPM rate measured after exercise was lower than that at rest. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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Review

Jump to: Research, Other

10 pages, 3999 KiB

Open AccessReview

Three-Dimensional Transesophageal Echocardiography in the Diagnosis and Treatment of Mitral Prosthetic Valve Endocarditis—A Narrative Review

by Vedran Carević, Zorica Mladenović, Ružica Perković-Avelini, Tina Bečić, Mislav Radić and Damir Fabijanić

Medicina 2022, 58(1), 23; https://doi.org/10.3390/medicina58010023 - 23 Dec 2021

Cited by 3 | Viewed by 2749

Abstract

Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving [...] Read more.

Despite advances in diagnosis, imaging methods, and medical and surgical interventions, prosthetic valve endocarditis (PVE) remains an extremely serious and potentially fatal complication of heart valve surgery. Characteristic changes of PVE are more difficult to detect by transthoracic echocardiography (TTE) than those involving the native valve. We reviewed advances in transesophageal echocardiography (TEE) in the diagnosis of PVE. Three-dimensional (3D) TEE is becoming an increasingly available imaging method combined with two-dimensional TEE. It contributes to faster and more accurate diagnosis of PVE, assessment of PVE-related complications, monitoring effectiveness of antibiotic treatment, and determining optimal time for surgery, sometimes even before or without previous TTE. In this article, we present advances in the treatment of patients with mitral PVE due to 3D TEE application. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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16 pages, 992 KiB

Open AccessReview

Diagnosis of Cardiac Abnormalities in Muscular Dystrophies

by Elisabeta Bădilă, Iulia Ioana Lungu, Alexandru Mihai Grumezescu and Alexandru Scafa Udriște

Medicina 2021, 57(5), 488; https://doi.org/10.3390/medicina57050488 - 12 May 2021

Cited by 3 | Viewed by 2510

Abstract

Muscular disorders are mainly characterized by progressive skeletal muscle weakness. There are several aspects that can be monitored, which are used to differentiate between the types of muscular disorders, ranging from the targeted muscle up to the mutated gene. An aspect that holds [...] Read more.

Muscular disorders are mainly characterized by progressive skeletal muscle weakness. There are several aspects that can be monitored, which are used to differentiate between the types of muscular disorders, ranging from the targeted muscle up to the mutated gene. An aspect that holds critical importance when managing muscular dystrophies is that most of them exhibit cardiac abnormalities. Therefore, cardiac imaging is an essential part of muscular disorder monitoring and management. In the first section of the review, several cardiac abnormalities are introduced; afterward, different muscular dystrophies’ pathogenesis is presented. Not all muscular dystrophies necessarily present cardiac involvement; however, the ones that do are linked with the cardiac abnormalities described in the first section. Moreover, studies from the last 3 years on muscular disorders are presented alongside imaging techniques used to determine cardiac abnormalities. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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Other

Jump to: Research, Review

4 pages, 461 KiB

Open AccessCase Report

Successful Conversion from Conventional Potassium Binder to Sodium Zirconium Cyclosilicate in a Patient with Refractory Constipation

by Teruhiko Imamura and Koichiro Kinugawa

Medicina 2022, 58(5), 635; https://doi.org/10.3390/medicina58050635 - 03 May 2022

Cited by 4 | Viewed by 2037

Abstract

Potassium binders are essential tools to treat hyperkalemia, particularly in patients with heart failure and chronic kidney disease. One of the drug-related complications is constipation, which further worsens heart failure by increasing afterload and decreases patients’ quality of life. We encountered an 82-year-old [...] Read more.

Potassium binders are essential tools to treat hyperkalemia, particularly in patients with heart failure and chronic kidney disease. One of the drug-related complications is constipation, which further worsens heart failure by increasing afterload and decreases patients’ quality of life. We encountered an 82-year-old man with heart failure, chronic kidney disease, and hyperkalemia. A conventional potassium binder, calcium polystyrene sulfonate, ameliorated his hyperkalemia, whereas he became aware of refractory constipation. A conversion to a newly-introduced specific potassium binder, sodium zirconium cyclosilicate, improved persistent constipation, maintaining serum potassium levels within a normal range. Sodium zirconium cyclosilicate might be a preferable potassium binder to treat hyperkalemia, particularly in patients with heart failure and chronic kidney disease and those suffering from constipation. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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6 pages, 2439 KiB

Open AccessCase Report

Successful Urgent TAVI for Critical Aortic Valve Stenosis after ECMO Implantation

by Ya-Lei Niu, Nicola Patrick Mayr, Yin-Hwa Chen, Hsiao-Hwang Chang, Shi-Pu Wang, Hung-Yu Lin and Ching-Chou Pai

Medicina 2022, 58(3), 356; https://doi.org/10.3390/medicina58030356 - 28 Feb 2022

Viewed by 2430

Abstract

Transcatheter aortic valve implantation (TAVI) has evolved to be the treatment of choice for patients with severe aortic stenosis and high perioperative risk. Cardiogenic shock is one of the most severe complications during the TAVI procedure, especially as the prognosis of cardiogenic shock [...] Read more.

Transcatheter aortic valve implantation (TAVI) has evolved to be the treatment of choice for patients with severe aortic stenosis and high perioperative risk. Cardiogenic shock is one of the most severe complications during the TAVI procedure, especially as the prognosis of cardiogenic shock secondary to aortic stenosis is very poor. This situation can be challenging, while extracorporeal membranous oxygenation (ECMO) can be a treatment option. Here, we reported on an 88-year-old female patient who had been diagnosed as non-ST-elevation myocardial infarction (NSTEMI) and critical aortic valve stenosis (AS) with a logistic Euroscore of 25%. Percutaneous coronary angioplasty (PCI) was performed smoothly and developed tachy-brady arrhythmia of atrial fibrillation then cardiac arrest at the beginning of the TAVI procedure. A v-a ECMO was installed at her left femoral side. Afterward, the TAVI procedure was completed accordingly; her consciousness recovered and Levosimendan therapy enhanced her left-ventricular ejection fraction (LVEF) from 22% to 40%. Five days after TAVI, ECMO was replaced by intra-aortic balloon pumping (IABP) and it was removed 3 days later. A minor complication of this therapy, e.g., muscular weakness in her left leg, was noted. The patient underwent rehabilitation for about 2 months, and was discharged from hospital with a wheel chair and clear consciousness. At the 24 month follow-up she was in good recovery and was able to walk upstairs to the second floor again. Our experience suggests that one indication of prophylactic use of ECMO is for patients with an unstable hemodynamic condition. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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6 pages, 1907 KiB

Open AccessCase Report

Bleeding of the Superior Vena Cava Due to an Iatrogenic Injury to It during the Ultrasound-Guided Central Venous Cannulation

by Seong-Hoon Jung, Dae-Hwan Kim and Jeong-Eun Sohn

Medicina 2022, 58(2), 266; https://doi.org/10.3390/medicina58020266 - 10 Feb 2022

Cited by 1 | Viewed by 1823

Abstract

Central venous cannulation (CVC) is a procedure that is frequently performed to facilitate resuscitation, nutritional support and long-term vascular access. It may often cause mechanical complications during placement of a cannula in association with the anatomical relationship with central veins. A 68-year-old man [...] Read more.

Central venous cannulation (CVC) is a procedure that is frequently performed to facilitate resuscitation, nutritional support and long-term vascular access. It may often cause mechanical complications during placement of a cannula in association with the anatomical relationship with central veins. A 68-year-old man visited our medical institution with a chief complaint of foreign-body-induced esophageal perforation. This patient presented with bleeding of the superior vena cava due to an iatrogenic injury to it during the CVC in the right internal jugular vein. Our case indicates that it would be mandatory to insert a cannula at an optimal depth considering the anatomical relationship between the central veins during the CVC. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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6 pages, 1672 KiB

Open AccessCase Report

Effective Balloon Pulmonary Angioplasty in a Patient with Chronic Thromboembolic Complications after Ventriculoatrial Shunt for Hydrocephalus in von Hippel–Lindau Disease

by Piotr Gościniak, Michał Larysz, Leszek Sagan, Barbara Larysz, Anhelli Syrenicz and Marcin Kurzyna

Medicina 2022, 58(2), 185; https://doi.org/10.3390/medicina58020185 - 26 Jan 2022

Cited by 1 | Viewed by 2154

Abstract

Von Hippel–Lindau (VHL) disease along with chronic thromboembolic pulmonary hypertension (CTEPH) is a unique and unusual severe complication of ventriculoatrial (VA) shunt implantation in the treatment of hydrocephalus. To the best of our knowledge, this can be the first reported case of an [...] Read more.

Von Hippel–Lindau (VHL) disease along with chronic thromboembolic pulmonary hypertension (CTEPH) is a unique and unusual severe complication of ventriculoatrial (VA) shunt implantation in the treatment of hydrocephalus. To the best of our knowledge, this can be the first reported case of an effective treatment with balloon pulmonary angioplasty in a patient with VHL after VA shunt placement. The patient underwent six balloon pulmonary angioplasty procedures. All invasive procedures resulted in haemodynamic and functional improvement. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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8 pages, 606 KiB

Open AccessStudy Protocol

Colchicine to Prevent Sympathetic Denervation after an Acute Myocardial Infarction: The COLD-MI Trial Protocol

by Fabien Huet, Quentin Delbaere, Sylvain Aguilhon, Valentin Dupasquier, Delphine Delseny, Richard Gervasoni, Jean-Christophe Macia, Florence Leclercq, Nidal Jammoul, Sandra Kahlouche, Sonia Soltani, Fanny Cardon, Anne-Marie Dupuy, Jean-Paul Cristol, Denis Mariano-Goulart, Myriam Akodad, Nicolas Nagot and François Roubille

Medicina 2021, 57(10), 1047; https://doi.org/10.3390/medicina57101047 - 30 Sep 2021

Cited by 2 | Viewed by 1928

Abstract

Inflammatory processes are deeply involved in ischemia-reperfusion injuries (IRI) and ventricular remodelling (VR) after a ST-segment elevation myocardial infarction (STEMI). They are associated with clinical adverse events (heart failure and cardiovascular death) adding damage to the myocardium after reperfusion. Moreover, acute myocardial infarction [...] Read more.

Inflammatory processes are deeply involved in ischemia-reperfusion injuries (IRI) and ventricular remodelling (VR) after a ST-segment elevation myocardial infarction (STEMI). They are associated with clinical adverse events (heart failure and cardiovascular death) adding damage to the myocardium after reperfusion. Moreover, acute myocardial infarction (AMI) induces a local sympathetic denervation leading to electrical instability and arrythmia. Colchicine, a well-known alkaloid with direct anti-inflammatory effects, was shown to reduce the myocardial necrosis size and limit the VR. In a recent proof of concept study, colchicine appears to prevent sympathetic denervation in a mice model of ischemia/reperfusion, but not in the necrosis or in the border zone areas. The Colchicine to Prevent Sympathetic Denervation after an AMI study (COLD-MI) is an ongoing, confirmative, prospective, monocentre, randomized, open-label trial. The COLD-MI trial aims to evaluate the intensity of sympathetic denervation after AMI and its potential modulation due to low dose colchicine. Sympathetic denervation will be noninvasively evaluated using single-photon emission computed tomography (SPECT). After a first episode of STEMI (Initial TIMI flow ≤ 1) and primary percutaneous coronary intervention (PPCI), patients will be randomized (n = 56) in a 1:1 ratio to either receive colchicine or not for 30 days. The primary end point will be the percentage of myocardial denervation measured by 123I-metaiodobenzylguanidine (123I-MIBG) SPECT at a 6-month follow-up. The main secondary end points will be basic ECG parameters (QRS duration, corrected QT) and HRV parameters from a 24 hour-recording Holter at 1- and 6-months follow-up. Results from this study will contribute to a better understanding of the cardioprotective effect of colchicine after AMI. The present study describes the rationale, design, and methods of the trial. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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4 pages, 537 KiB

Open AccessCase Report

Sudden Fall in the Lipid-Lowering Effect of Evolocumab: The Butler Is Not Always Guilty

by Federica Fogacci, Claudio Borghi, Antonio Di Micoli and Arrigo F. G. Cicero

Medicina 2021, 57(9), 857; https://doi.org/10.3390/medicina57090857 - 24 Aug 2021

Viewed by 2678

Abstract

A 78-year-old man came to our attention after undergoing coronary computed tomography angiography documenting multivessel coronary artery disease. He was started on treatment with the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab 140 mg subcutaneously every 2 weeks. Treatment-emergent changes in lipids [...] Read more.

A 78-year-old man came to our attention after undergoing coronary computed tomography angiography documenting multivessel coronary artery disease. He was started on treatment with the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor evolocumab 140 mg subcutaneously every 2 weeks. Treatment-emergent changes in lipids and lipoproteins were long-lasting, and the medication was well tolerated by the patient in the long-term. Unexpectedly, after 2 years of continuous treatment with evolocumab, serum lipids increased, apparently without any reasonable explanation. During the follow-up visit, the patient was found to have habitually injected evolocumab into his right thumb instead of into the appropriate injection sites (i.e., abdomen, thighs or upper arms) after turning the injector upside down. Full article

(This article belongs to the Special Issue Cardiovascular Disease: Management, Treatment Recommendations, and Future Research)

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