Successful Transcatheter Aortic Valve Replacement After Iatrogenic Aortic Cusp Dissection After Treatment of Complex, Unprotected Left Main Bifurcation Coronary Artery Disease
Injoon Lee1*, Matthew P. Cauchi2, Jason Foerst1-3, Gary Swank1,2
1Section of Cardiology, Virginia-Tech Carilion School of Medicine, Roanoke, Virginia, USA
2Interventional Cardiology, Virginia-Tech Carilion School of Medicine, Roanoke, Virginia, USA
3Structural Cardiology, Virginia-Tech Carilion School of Medicine, Roanoke, Virginia, USA
Currently no literature exists regarding the safety and feasibility of transcatheter aortic valve replacement (TAVR) after aortic cusp dissection. Aortic dissection is a rare, albeit potentially fatal complication related to percutaneous coronary intervention, especially when dealing with heavily calcified coronary disease involving the left main. Rapid stratification of patients in need of early invasive repair versus conservative observation is crucial to patient morbidity and mortality. We present a case of an elderly female with severe aortic stenosis who underwent TAVR after complex intervention of heavily calcified multi-vessel coronary artery disease involving the left main and bifurcation with high-risk Impella protected rotational atherectomy and culotte stenting complicated by left coronary cusp dissection and was managed conservatively without long-term sequelae. This case highlights the achievability of TAVR after aortic cusp dissection that was treated with conservative methods.DOI: 10.29245/2578-3025/2020/1.1183 View / Download Pdf
Arterial Pandemonium: A Case Report of Pan-Aortic Dissection Masquerading as an Inferior Myocardial Infarction, Stroke and Bilateral Lower Extremity Paraplegia
Injoon Lee1*, Matthew P. Cauchi1, Amitabh Parashar2
1Virginia Tech-Carilion Clinic School of Medicine, Department of General Cardiovascular Disease, Roanoke, VA, USA
2Salem Veterans Affairs Medical Center, Department of Cardiology, Salem VA, USA
Background: Identifying and treating ST-elevation myocardial infarction (STEMI) in a timely manner is crucial in reducing the patient’s morbidity and mortality. However, sometimes STEMI can be caused by other pathologies such as aortic/coronary dissection, thromboembolism, septic emboli, or trauma. We present a case of a pan-aortic dissection (AD) with multi-system organ failure and shock presenting as anterior spinal cord syndrome, inferior myocardial infarction and stroke.
Case Presentation: A 62-year old woman with history of tobacco abuse and depression, presented to the Emergency Department (ED) for altered mental status. The patient was initially found outside of her home, unresponsive and bradycardic, with subsequent 12-lead electrocardiogram (EKG) demonstrating an inferior STEMI with right ventricle (RV) involvement and presumed cardiogenic shock. In the ED, the patient was awake with intermittent, though profound aphasia, as well as near complete loss of motor and sensory function in her lower extremities. She remained hypotensive and had weak peripheral pulses bilaterally in the upper and lower extremities. Emergent brain imaging was negative for ischemia, but chest imaging revealed circumferential mural thrombus extending from the aortic root into the descending aorta consistent with pan-AD and was taken urgently to the operating suite. Unfortunately, the patient died before surgical intervention could be performed.
Conclusion: This case report highlights a rare case of STEMI, stroke, cardiogenic shock and ultimately death caused by pan-AD. Timely identifying the underlying pathology in patients who present with more than typical STEMI symptoms is essential in providing potential lifesaving therapy.
• Aortic dissection symptoms can present with cardiovascular & neurological symptoms, end-organ compromise along with chest and/or abdominal pain.
• Clinicians should have high degrees of suspicion when myriad of symptoms are present in hemodynamically unstable patients.
• Aortic dissection can have numerous complications including death if not properly diagnosed and treated accordingly.
• Treatments of aortic dissection differs based on its type, hemodynamic status of the patient and any signs of end organ dysfunction.DOI: 10.29245/2578-3025/2020/1.1184 View / Download Pdf
Commentary on the article “Pacemaker Lead as an Iatrogenic Cause of Right Heart Failure” and Review of Pacing-Induced Heart Failure
DOI: 10.29245/2578-3025/2019/1.1182 View / Download Pdf
Medical Resident, Internal Medicine Department, Hospital de Cascais, Lisboa, Portugal
Andrea De Martino1, Giosuè Falcetta1, Aldo D. Milano2, Uberto Bortolotti1*
1Cardiovascular Surgery Divisions, University of Pisa, Italy
2Department of Cardiac Surgery, University of Bari Aldo Moro, Bari, Italy
Stented bioprostheses have been extensively used clinically to replace diseased cardiac valves with the clear advantage over mechanical prostheses of avoiding the use of chronic anticoagulation in most cases. During the past five decades, however, based on clinical and pathological experience, tissue calcification and cusp tears were identified as the main determinants of failure of porcine and pericardial bioprostheses, respectively. Tissue treatments to mitigate dystrophic calcification together with structural modifications in valve design have produced a current generation of bioprosthetic valves which show excellent overall performance and considerably increased durability when compared with old models. Further ongoing research aims to provide even more durable bioprostheses in order to allow reduction of the age threshold for implantation also in younger subjects, helping to contrast effectively the rapidly expanding role of catheter-based interventions.DOI: 10.29245/2578-3025/2019/5.1179 View / Download Pdf
Xiatian Chen1,2, Ziqian Liu1,2, Zhe Li1,2, Jinning Gao1,2, Zhongjie Yu1,2, Peifeng Li1*, Lynn Htet Htet Aung1*
1Center for Molecular Genetics, Institute for Translational Medicine, Qingdao University, Qingdao, 266000, Shandong, China
2School of Basic Medicine, Qingdao University, Qingdao, 266000, Shandong, China
Long non-coding RNAs (lncRNAs) have gained more attention in recent years as a potential new regulator of nearly all biological regulation. LncRNAs are over 200 nucleotides in length, and it can interact with other non-coding RNAs or specific proteins to influence the gene expression. Cardiomyocyte apoptosis is associated with cardiovascular diseases. Accumulating studies have uncovered novel lncRNAs-mediated regulation of cardiovascular diseases; however, the knowledge of the mechanisms by how to act is still limited. This review highlights the role of lncRNAs involved in cardiomyocyte apoptosis with a focus on the regulatory axis. These examples may provide helpful insights on how lncRNAs interfere with cardiomyocyte apoptosis.DOI: 10.29245/2578-3025/2019/5.1178 View / Download Pdf
Wei Ting Cheng, Na Yoon Kim, Prashant Bhattarai, Murui Han, Archita Venugopal Menon, Jonghan Kim, Ban An Khaw*
Department of Pharmaceutical Sciences, School of Pharmacy, Bouve College of Health Sciences, Northeastern University, Boston, MA. USA
A rat model of iron loading anemia resulting in hypertrophic cardiomyopathy was used to assess the composition of cardiac isomyosin by ELISAs and immunohistochemistry relative to the chronological age of these animals and their normal controls. Cardiac myosin extracts of homozygous Belgrade (b/b) rats that develop hypertrophic cardiomyopathy were compared to those from the heterozygous (b/+) control rats at 4.5 and 11.5 weeks of age. Confirmation of the ELISA data in the increase in β-isomyosin in 11.5 weeks old b/b rat hearts were obtained by immunohistochemical staining relative to 4.5 weeks old b/b hearts and control 4.5 and 11.5 weeks old b/+ hearts. Quantitation and immunohistochemical demonstration of an increase in the β-isomyosin isoform can be confirmed in hypertrophic cardiomyopathy in iron loading anemia model.DOI: 10.29245/2578-3025/2019/4.1172 View / Download Pdf
Healthcare Resource Utilization among Non-Valvular Atrial Fibrillation Patients Who Switched from Warfarin to a Novel Oral Anti-Coagulant
Jessica Franchino-Elder1, Adrienne Gilligan2, Xue Song2*, Briain O Hartaigh1, Caroline Henriques2, Amy Sainski-Nguyen2, Cheng Wang1
1Boehringer-Ingelheim Pharmaceuticals, Inc., Ridgefield, CT, USA
2IBM Watson Health, Cambridge, MA, USA
Among patients with non-valvular atrial fibrillation (NVAF), switching from warfarin to novel oral anticoagulants (NOACs) is common, yet clarifying the differences in the effect of NOACs on all-cause healthcare resource utilization (HCRU) are unknown. Adult NVAF patients who switched from warfarin to dabigatran, apixaban, or rivaroxaban were identified in MarketScan databases between 10/2010-12/2015. Patients had 12 months pre-period (index date was 1st NOAC claim) and were followed up to 12 months until medication discontinuation, end of enrollment, inpatient death, or 12/2016. Overall, 8,679 and 5,761 dabigatran switchers were matched (1:1) to rivaroxaban and apixaban switchers (mean age 73-74 years). Compared with rivaroxaban switchers, a lower proportion of dabigatran switchers had an inpatient (IP) visit (20.0% vs. 21.6%, p=0.008). Dabigatran switchers had lower per-patient-per-month (PPPM) total outpatient (3.87 vs. 4.06, p=0.002), emergency department (ED; 0.48 vs. 0.52, p=0.026), outpatient office (1.17 vs. 1.22, p<0.001), and other outpatient (2.71 vs. 2.83, p=0.043) visits compared with rivaroxaban switchers. A similar proportion of dabigatran and apixaban switchers had an IP visit (20.7% vs. 21.2%); compared with apixaban switchers, dabigatran switchers had significantly more PPPM IP visits (0.23 vs. 0.21, p=0.031) but significantly lower ED visits (0.47 vs. 0.52, p=0.016). Post-discharge 30-day readmission rates were comparable among warfarin-to-NOAC switching groups. Time to readmission was longer for dabigatran versus rivaroxaban switchers (8.2 vs. 7.8 days, p<0.001), but comparable with apixaban patients (8.1 vs. 8.4 days). Switching to dabigatran after warfarin discontinuation may lower HCRU among NVAF patients compared with switching to rivaroxaban or apixaban.DOI: 10.29245/2578-3025/2019/4.1177 View / Download Pdf
Aidan (Jia Sheng) Yu1*, James Nguyen1, Anthony Brown2
1Royal Brisbane and Women’s Hospital Butterfield Street and Bowen Bridge Road, Herston, Queensland, 4029, Australia
2Gold Coast University Hospital, 1 Hospital Blvd, Southport QLD 4215
Background: The soon to be implemented state-wide introduction of high-sensitivity troponin assays will allow the use of a lower threshold in identifying patients with acute myocardial infarction (AMI). Whether this assay will be too sensitive and therefore produce increased false positive results is still unclear. We aim to investigate whether a significantly elevated cardiac troponin using the current troponin assay (cTnI) will result in a clinical diagnosis of AMI.
Methods: A retrospective study was performed at a Queensland Hospital with all cTnI ordered across a single month reviewed. Patients who were diagnosed with Non ST-Elevation Myocardial Infarction or ST-Elevation Myocardial Infarction were labelled as having an AMI.
Results: In total, 944 investigations were ordered for 628 patients. Using the hospital laboratory cutoff of >0.040 μg/L(>99th percentile) for significance, a positive result was obtained in 105 patients (16.7%) and a negative result in 523 patients (83.3%). The positive troponin results were attributed to AMI (20%), congestive heart failure (20%), sepsis (19%), tachyarrhythmias (16.2%), renal failure (8.6%), airway disease (8.6%), pulmonary embolism (3.8%) and others - pericarditis, post angioplasty etc (3.8%). cTnI was found to be highly sensitive (100%, 95%CI 84-100%) and specific (86%, 95%CI 83-89%) for AMI. However, only 21 (3.3%) of 628 patients investigated received a diagnosis of AMI. The positive predictive value was poor (20%, 95% CI 13-29%), with the negative predictive value absolute (100%, 95% CI 99-100%).
Conclusion: Current troponin assays were found to be highly sensitive and specific in diagnosing AMI. However, its poor positive predictive value may be contributed by inappropriate requests.DOI: 10.29245/2578-3025/2019/4.1176 View / Download Pdf
Christina Koumantzia, Nikolaos Saridakis, Andreas Eleftheriou*
Department of Neurology, and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
Background: Pleuropericardial cysts (PPCs), account for 5 - 10% of all mediastinal tumours, are rare lesions occurring in approximately 1 in 100000 persons and are usually congenital and rarely acquired. They are detected post-mortem or incidentally on routine chest X-ray (CXR) and in most cases multi detector Computer Tomography is used to confirm the diagnosis. As benign course and clinical latency are characteristic features of such cysts and the occurrence of complications is rare, the majority of them can be left untreated.
Methods: The aim of the study is to review the literature regarding PPCs and create a table which summarises all the published cases in order to draw a conclusion about the epidemiology, as well as the diagnostic and therapeutic approach to PPCs exclusively. We reviewed retrospectively the clinical manifestation, diagnostic and therapeutic approach in 101 cases of PPCs since the 19th century.
Results: Our statistical analysis led to the following results: mean age of initial detection: 48.7 ± 17.2 years, female:male ratio: about 3:2, presence of symptomatology: 37/101 cases, most common location: right cardiophrenic angle (RCPA), most common method of initial detection: CXR in 49/101 cases, mean maximal diameter: 8,3 ± 3 cm.
Conclusion: The management of a pleuropericardial cyst should be based on an algorithm in which the cyst's size, shape and compressibility along with clinical presentation and patient's fitness and preferences are be taken into consideration. When interventional is required, surgical resection by means of traditional open surgery or minimally invasive methods are considered to be the gold standard and along with percutaneous aspiration are the methods that have mostly been used.DOI: 10.29245/2578-3025/2019/4.1175 View / Download Pdf
Human Perivascular Adipose Tissue as a Regulator of the Vascular Microenvironment and Diseases of the Coronary Artery and Aorta
Caitlin Stieber, Kimberly Malka, Joshua M. Boucher, Lucy Liaw*
Center for Molecular Medicine, Maine Medical Center Research Institute, United States
Perivascular adipose tissue (PVAT) is an adipose depot that surrounds blood vessels in the human body and exerts local paracrine signaling. Under physiologically healthy conditions, PVAT has an anti-contractile effect on vessels, but in obesity this effect is lost. During metabolic disease, adiponectin secretion is dysregulated, influencing nitric oxide bioavailability and macrophage infiltration and inflammation, all of which mediate PVAT signaling. However, based on the location in the body, and the type of adipocyte present, PVAT has different relationships with risk factors for disease. Imaging studies in patients with cardiovascular disease have demonstrated important associations between PVAT structure and pathology, yet insight into molecular pathways regulating human PVAT function are still lacking. This review focuses on our current understanding of human PVAT and its secretory role in the vascular microenvironment. A current area of priority is defining molecular differences in the secretome between PVAT depots, as this could inform the treatment of diseases that occur in anatomically restricted locations. In addition, understanding progressive changes in PVAT structure and function during metabolic disease is required for effective targeted therapies.DOI: 10.29245/2578-3025/2019/4.1174 View / Download Pdf
Long Term Health Outcomes Following Coronary Artery Bypass Grafting: A Different Journey for Men and Women
G.M. Lindsay*, P.R. Ponaiah, I. Nomani, S.M. Lamadah, N.A. Tayyib and A. Johargy
College of Nursing, Umm Al-Qura University, Taif Road, Makkah, Saudi Arabia
Background: The applicability of the Short Form (SF36) questionnaire to disparate populations led us to use this tool to investigate how health-related quality-of-life (HRQoL) for patients who underwent coronary artery bypass grafting (CABG) is related to gender, age and survival.
Method: SF36 data and the presence of cardiac symptoms were collected from 44 women and 166 men prior to surgery and from consenting survivors at one and eight-year follow-ups. Survival data were collected from government records for 18 years post operation. Paired t-tests, Pearson correlation coefficients, chi-squared tests and the log-rank test were used to investigate connections between HRQoL and age, presence of angina/breathlessness and survival within and across genders.
Results: HRQoL improved significantly for males and females in almost all health domains at the one year follow-up. At the eight year follow-up most female domain scores showed further improvement whereas the majority of male domain scores declined. Cardiac symptoms were present in 75.8% of women and 68.3% of men (χ2=0.7120, p=0.3988) at the one-year follow-up, and 84.2% of women and 70.2% of men at the eight-year follow-up. Male long term survival (53.6% after 18 years) depended significantly on retaining post-operative improvements in HRQoL to the medium term (p<0.002 in 4 of 8 domains). Female long term survival (40.9%) was significantly less than male survival (p=0.0108) and depended on maintaining a steady upward trend in HRQoL over the medium term. Age was not a determinant in HRQoL following CABG. Long term male and female survival was not significantly different and approached those of age and gender matched samples from the general population.
Conclusion: Strategies to improve HRQoL in women may support improved survival by reducing excess short term female mortality, but the effectiveness of the same strategy for men is less apparent.DOI: 10.29245/2578-3025/2019/4.1171 View / Download Pdf
Mit Patel*, Injoon Lee, Neel Parikh, David Sane, Thomas Bishop
Virginia Tech Carilion School of Medicine, USA
Pericardial cysts are rare anomalies that are usually benign and asymptomatic. A prompt intervention is necessary when patients present with concerning clinical features. We report a case of pericardial cyst causing obstructive shock in a patient that underwent bowel resection after small bowel obstruction. Our patient underwent emergent cyst aspiration which alleviated the shock.DOI: 10.29245/2578-3025/2019/3.1173 View / Download Pdf
Commentary: Teaching Games of Understanding (TGfU) coaching effects on Heart Rate among Malaysian and Indian Junior Hockey Players
Sultan Idris Education University, Malaysia
Teaching Games for Understanding (TGfU) offers tactical-technical instruction is gaining international recognition for its ability to produce intelligent players via a problem-solving approach in game play such as hockey. However the effect of TGfU pedagogical approach through small side game play (SSG) towards physiology components of Heart Rate (HR) still takes a backseat compared to research on tactical decision making and skill execution that has been studied widely. SSG proposed in TGfU approach dwells around duration of game play (load), how fast the SSG game manouvers (intensity) and players cardiovascular fitness can be detected by HR tool and therefore HR crucial to be investigated. This quasi-experimental study investigated the effect of TGfU compared to skill mastery instruction, termed as Skill Drill Technical (SDT), among Malaysian and Indian elite junior hockey players in terms of SSG game play intensity via heart rate (HR) measurement at different points of game play. A total of n = 60 players with an average age of 15 ± 1.03 were selected via simple random technique from both countries involved in this study and assigned equally into groups, with 15 players per group for TGfU and for SDT across Malaysia and India. Gathered data were analysed using the ANOVA and ANCOVA techniques. There was significant higher warm-up HR bpm among players via TGfU compated to SDT across the two countries. Whereas HR bpm immediately after the 5 vs. 5 game play intervention and HR bpm after three minutes’ recovery, Indian players with TGfU recorded a higher and significant difference compared to SDT. However, in contrast, findings indicated no significant difference between these two instruction models among Malaysian player. Therefore, overall findings reiterated that TGfU is a useful approach for game play to enhance intensity and cardiac output through HR bpm measurement. In conclusion, future research can employ together HR and RPM (Borg Scale) or electronic device for more accurate reading coupled 6 sec and 15 sec HR readings. Future study, should too address the effect of TGfU on different variation of small sided game play intensity along skill execution and tactical decision making.DOI: 10.29245/2578-3025/2019/3.1151 View / Download Pdf
The Effect of eHealth Interventions on Physical Activity in Patients with Chronic Obstructive Pulmonary Disease: A Mini Review
Yoshiki Tsuchida1#, Sigrid N.W. Vorrink2,3*
1Department of Physical Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan
2Utrecht University of Applied Sciences, Research Group Technology for Healthcare Innovations, Utrecht, Netherlands
3JointResearch, Department of Orthopaedic Surgery, OLVG Amsterdam, Netherlands
Physical activity (PA) is important for patients with chronic obstructive pulmonary disease (COPD). eHealth interventions may have the possibility to increase and maintain PA. The objective of this mini review is to provide an overview of research published from 2016 to 2018 about the effect of eHealth on PA in patients with COPD.
Recent studies used phone calls, websites combined with monitoring devices and smartphone applications as eHealth interventions. These studies showed both positive and no effects of eHealth interventions on PA in patients with COPD. The effects seem to depend on the type of eHealth intervention. A multicomponent eHealth intervention including reinforcement, self-management, monitoring and exercise with phone calls, websites and pedometers may be useful for stimulating PA for short-term periods.DOI: 10.29245/2578-3025/2019/3.1169 View / Download Pdf
Utility of A Cardiorenal Monographic Consultation to Reduce The Cardiovascular Mortality of The Renal Transplant Patient
Juan de Dios Arjona-Barrionuevo1, Manuel Gonzales Vargas-Machuca2, Francisco José Guerrero-Márquez3*, Luis Gil-Sacaluga4, Miguel Ángel Gentil-Govantes4
1Department of Cardiology, Hospital University Virgen del Rocio, Seville, Spain
2Departament of Cardiology, Hospital San Juan de Dios del Aljarafe, Bormujos (Seville), Spain
3Department of Cardiology, Hospital de la Serrania Ronda, Spain
4Department of Nephrology, Hospital University Virgen del Rocio, Seville, Spain
Introduction and objectives: WHO recognizes chronic kidney disease as a serious health problem with increasing incidence and prevalence. In our midst, the first cause of death in renal replacement therapy is cardiovascular disease (CVD), especially ischemic. We studied and follow-up of candidates for renal transplantation and subsequently transplanted, With the objective of knowing the ischemic load and reducing the mortality of the transplant.
Methods: In November 2005, we began a cardiorenal monographic consultation for the study of all patients with chronic renal disease with a high cardiovascular risk who were candidates for renal transplantation who underwent coronary angiography, according to the protocol prior to transplantation, were studied.
Results: From November 2005 to December 2013, 313 patients were studied, 64% males, 56.7 ± 11 years old. The Prevalence of significant coronary lesions: 39.3%, 54.4, % of more than one vessel. Silent: 32.4%, 47.6% more than one glass. Total mortality of candidates: 10.2%. Cardiovascular: 4.8%. Total transplant mortality: 5.3%, cardiovascular: 2.1%. Cardiovascular mortality of the revascularized transplant patient: 0%.
Conclusions: Screening and intervention on CVD, leven preventive, reduce total and cardiovascular mortality of the transplant, extending this benefit to those remaining on dialysis. In our hospital, CVD is no longer the leading cause of death in renal replacement therapy.DOI: 10.29245/2578-3025/2019/3.1170 View / Download Pdf
Aidan (Jia Sheng) Yu1*, Matthew Rowe2, John Atherton1, Arun Dahiya1
1Royal Brisbane and Women’s Hospital, Australia
2Princess Alexandra Hospital, Australia
A 54-year-old female presented with chest pain and was noted to have new T-wave inversion on her electrocardiograph (ECG) in leads V2-V6. The patient has a past history of recurrent DVT/PE and recently had a subtotal colectomy for ulcerative colitis. Serial troponin I measurements were normal (<0.040 µg/l). Transthoracic echocardiogram revealed an impaired left ventricular ejection fraction of 35-40% with hypokinesis within the lateral and apical segments. A coronary angiogram was performed and the left main coronary artery (LMCA) could not be located despite cuspal injections, ascending aortogram and left ventriculogram. A large, dominant right coronary artery (RCA) was visualised which passed around the left ventricular apex to the area normally supplied by the obtuse marginal (OM), diagonal and distal left anterior descending (LAD) arteries. Computed tomography coronary angiography (CTCA) revealed a superdominant RCA supplying the LV apex and lateral wall with no LMCA coming off the left coronary cusp. The left circumflex (LCx) was small and arose from a conus branch with a separate origin to the RCA. No significant stenosis was visualised on CTCA. The T-wave changes were deemed to be secondary to physiological stress/supply-demand ischaemia particularly at the distal end of the RCA, where it supplied the LAD. The patient was commenced on metoprolol 25mg b.d. and continued warfarin on discharge.
Single RCA with absent LMCA is extremely rare with only a few isolated cases reported in the literature. Use of CTCA in combination with coronary angiography was useful in defining this unusual anatomy and excluding a haemodynamically significant lesion. This anomaly is a variation to the typical Lipton subtypes and may represent a new subtype not previously described before.DOI: 10.29245/2578-3025/2019/2.1167 View / Download Pdf
College of Agriculture, Environment and Nutrition Sciences, Tuskegee University, USA
Cardiometabolic diseases and disorders continue to be the most significant and leading causes of morbidity and mortality in the United States, as well as globally. Among the cardiometabolic disorders, cardiovascular diseases (CVDs) have the greatest prevalence; other cardiometabolic disorders closely related to CVDs such as diabetes mellitus and Metabolic Syndrome (MetS) continue to contribute to the public health burden as well. Common risks for cardiometabolic disorders include biological (i.e. genetic predisposition, race, age, gender), demographic (socioeconomic status), dietary (dietary intake), behavioral (e.g., physical activity) and environmental (e.g., obesogenic, atherogenic, carcinogenic environments) characteristics. Paradoxically, dietary risk is both the most modifiable and least modifiable risk for certain diseases, as other modifiable and non-modifiable characteristics act in synergy to influence dietary intake. Although many inconclusive and conflicting research findings exist, the benefits of consuming a high quality diet are consistently valued and the role of diet in safeguarding cardiometabolic health cannot be underestimated. Diets rich in whole grains, non-starchy vegetables, and fruits, moderate in processed foods and refined grains, and consequently lower omega-6 to omega-3 fatty acid ratios appear to offer the greatest potential benefit. This mini review briefly summarizes the implications of diet and nutritional intake to cardiometabolic health.DOI: 10.29245/2578-3025/2019/2.1168 View / Download Pdf
DOI: 10.29245/2578-3025/2019/1.1166 View / Download Pdf
Kleber Santiago Freitas e Silva*
Biological Sciences Institute, Federal University of Goiás, Brazil
Electron Tomography Contributing to Ultrastructural Research in Vascular Biology and Transfusion Medicine
Josef Neumüller1,2, Thomas Wagner3*
1Blood Donation Center of the Austrian Red Cross for Vienna, Lower Austria and Burgenland
2Center for Anatomy and Cell Biology, Department for Development Biology, Medical University of Vienna
3Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Austria
In this review, the technique of electron tomography is shortly summarized. Alignment procedures on the electron microscope are described. New techniques such as the focused ion beam tomography, the block face scanning tomography and the array tomography are mentioned. Application of these methods for vascular research, concerning endothelium-specific Weibel-Palade bodies in cell cultures from human umbilical vein endothelial cells and endothelial progenitor cells as well as about cellular communications between the endothelium and the subendothelium are referred. Platelets are important players in the interaction with the endothelium in thrombosis and hemostasis after transfusion, therefore electron tomographic investigations of platelet organelles as well as platelet microparticles are mentioned. Illustrations from our own investigations are added.
ART: Algebraic Reconstruction Technique; ADAMTS-13: A Disintegrin And Metalloproteinase with A Thrombospondin Type 1 Motif, Member 13; CCD Camera: Charge Coupled Device Camera; DAB: 3,3'-Diaminobenzidine; DART: Discrete Algebraic Reconstruction Technique; DTS: Dense Tubular System; EM: Electron Microscope; EPC: Endothelial Progenitor Cells; ET: Electron Tomography; FVIII: Factor VIII Blood Clotting Protein; FIB-SEM: Focused Ion Beam Scanning Electron Microscope; FITC: Fluorescein-Isothiocyanate; HUVEC: Human Umbilical Vein Endothelial Cells; LSM: Laser Confocal Scanning Microscope; MIT: Mitochondria; MTC: Microtubular Coil; OCS: Surface-Connected Open Canalicular System; PLT: Platelets; PLTC: Platelet Concentrates; PMP: Platelet Microparticles; ROI: Region Of Interest; SBEM: Serial Block Face Scanning Electron Microscopy; SIRT: Simultaneous Itinerative Reconstruction Technique; STEM: Scanning Transmission Electron Microscopical Device; TEM: Transmission Electron Microscope; TGN: Trans Golgi Network; TRITC: Tetramethylrhodamine-Isothiocyanate; vWF: von Willebrand Factor; WPB: Weibel Palade Bodies; WPB: Method: Weighted Back Projection Method.DOI: 10.29245/2578-3025/2019/1.1165 View / Download Pdf
Commentary on the "Co-Crystal of Tramadol-Celecoxib in Patients with Moderate to Severe Acute Post-Surgical Oral Pain: A Dose-Finding, Randomised, Double-Blind, Placebo- and Active-Controlled, Multicentre Phase II Trial". Implications for Cardiovascular Safety
DOI: 10.29245/2578-3025/2019/1.1163 View / Download Pdf
Sebastián Videla1*, Neus Gascón2, Carlos Plata-Salamán2
1Clinical Research Support Unit, Clinical Pharmacology Department, Bellvitge University Hospital/IDIBELL, Barcelona, Spain
2Medical Sciences Area, ESTEVE Pharmaceuticals S.A., Barcelona, Spain
Commentary: Evaluation of the Comorbidity Burden in Patients With Ankylosing Spondylitis Using a Large US Administrative Claims Data Set
Jessica A. Walsh1, Xue Song2*, Gilwan Kim2, Yujin Park3
1University of Utah School of Medicine and Salt Lake City Veteran Affairs Medical Center, Division of Rheumatology, Salt Lake City, UT, USA
2IBM Watson Health, Cambridge, MA, USA
3Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
Patients with chronic inflammatory rheumatic diseases, such as rheumatoid arthritis and spondyloarthritis, are at a higher risk of comorbidities, including cardiovascular disease. Although the prevalence of spondyloarthritis is estimated to be similar to that of rheumatoid arthritis, the risk of cardiovascular comorbidities in spondyloarthritis is not as well understood. Furthermore, the inflammatory rheumatic diseases differ in their pathogenic mechanisms, the populations affected, and treatment recommendations; therefore, it is important to examine these diseases separately. Ankylosing spondylitis (AS) is the prototype of spondyloarthritis; the onset of disease occurs at a relatively young age, and patients with AS are often undiagnosed for long periods of time. This increased duration of exposure to inflammation and use of nonsteroidal anti-inflammatory drugs may contribute to the higher risk of cardiovascular comorbidities in these patients.
Here we describe our recently published study (Walsh JA, et al. Clin Rheumatol. 2018;37:1869-1878.), which used large national claims databases and showed that US patients with AS had significantly more comorbidities, including cardiovascular disease, than matched controls. We also review the current understanding of the risk of cardiovascular comorbidities in patients with AS. Knowledge of the frequency and risk of comorbidities can assist rheumatologists and primary care physicians with comorbidity screening and strategies for a holistic care approach for patients with AS, including the possibility of adapting the existing cardiovascular risk assessments for these patients. Counseling patients on additional lifestyle risk factors, early cardiovascular screening, and the necessity of further diagnostic testing will be important for optimizing patient care for AS.DOI: 10.29245/2578-3025/2018/6.1159 View / Download Pdf
Mini Review on: Simple, Practical, and Evidence-Based - an Algorithm for The Diagnosis and Treatment of Iron Deficiency
University in Cologne, Germany
Iron deficiency is a common comorbidity in chronic heart failure (CHF) with a negative impact on the outcome of the patient. Even without anaemia iron deficiency can cause decreased physical performance, poor quality of life, and increased mortality. Therefore it is important to diagnose and treat iron deficiency, especially in patients with CHF.
Despite the great relevance for the outcome of CHF-patients little attention is being payed to iron deficiency in these patients, even though a specific diagnosis and therapy is available and is recommended by the current ESC guidelines.
A simple, practical and evidence based algorithm is available and can now help to improve diagnosis and treatment of iron deficiency in everyday practice. This article reviews a discussion of a group of German cardiologists who aimed to give practical advice on how to diagnose and treat iron deficiency in CHF patients.DOI: 10.29245/2578-3025/2018/6.1162 View / Download Pdf
Commentary: Cardiovascular Comorbidities in a United States Patient Population with Hemophilia A: A Comprehensive Chart Review
DOI: 10.29245/2578-3025/2018/6.1155 View / Download Pdf
Thomas J. Humphries*
44 Pinewood Drive, Neptune, NJ 07753, USA
Percutaneous Coronary Intervention with Everolimus-Eluting Bioresorbable Vascular Scaffolds in Diffuse Coronary Artery Disease: Current Knowledge and Future Perspectives
Giulia Masiero1, Luca Nai Fovino1, Alessandro Schiavo1, Daisuke Ueshima1, Mostafa Rabea Abdelhaleem Badawy1, 2, Giuseppe Tarantini1*
1Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
2Cardiology Department, Faculty of Medicine, Minia University, Egypt
The optimal percutaneous treatment of diffuse coronary artery disease (CAD) remains an unsolved issue. Bioresorbable scaffold (BRS) technology has been developed to overcome the disadvantages of metallic drug-eluting stents (DES) due to their permanent struts. Through the resorption process, BRS may provide complete vascular restoration, which appears very attractive in the treatment of diffuse CAD. However, robust evidence on the use of BRS in this setting is lacking and recent data have raised concerns about the safety of this novel technology, especially when BRS are used in complex CAD or without adequate protocol implantation. This review aims at summarizing current evidence and future perspectives on Absorb BRS implantation in complex CAD, such as in distal coronary segments involvement and diffused disease.DOI: 10.29245/2578-3025/2018/6.1148 View / Download Pdf
Commentary to an Article: "Molecular Mechanisms Underlying Oxytocin-Induced Cardiomyocyte Protection From Simulated Ischemia-Reperfusion"
DOI: 10.29245/2578-3025/2018/6.1158 View / Download Pdf
Marek Jankowski1,2*, Tom L. Broderick3, Jolanta Gutkowska1,2#
1Cardiovascular Biochemistry Laboratory, CRCHUM (7-134), Tour Viger, 900 St-Denis St, Montreal, Canada H2X 0A9, USA
2Department of Medicine, University of Montreal, Quebec, Canada, USA
3Department of Physiology, Laboratory of Diabetes and Exercise Metabolism, Midwestern University, Glendale, AZ, USA