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1.
《Cardiovascular Revascularization Medicine》2014,15(1):8-12
Background/ObjectivesStent underexpansion is a risk factor for in-stent restenosis and stent thrombosis. Existing techniques to optimize stent expansion are sometimes ineffective. The aim of this study was to evaluate the effectiveness and feasibility of Excimer Laser Coronary Angioplasty (ELCA) in improving stent expansion when high-pressure non-compliant balloon inflation was ineffective.Methods and ResultsECLA ablation was performed at high energy during contrast injection and only within the underexpanded stent. The primary endpoint of successful laser dilatation was defined as an increase of at least 1 mm2 in minimal stent cross-sectional area (MSA) on IVUS or an increase of at least 20% in minimal stent diameter (MSD) by QCA, following redilatation with the same non-compliant balloon that had been unsuccessful prior to ELCA. Secondary endpoints were cardiac death, myocardial infarction (MI) and target lesion revascularization. Between June 2009 and November 2011, 28 patients with an underexpanded stent despite high-pressure balloon inflation were included. The mean laser catheter size was 1.2 ± 0.4 (range 0.9-2.0 mm) and a mean of 62 ± 12 mJ/mm2 at 62 ± 21hertz were required for optimal expansion. Laser-assisted stent dilatation was successful in 27 cases (96.4%), with an improvement in MSD by QCA (1.6 ± 0.6 mm at baseline to 2.6 ± 0.6 mm post-procedure) and MSA by IVUS (3.5 ± 1.1 mm2 to 7.1 ± 1.9 mm2). Periprocedural MI occurred in 7.1%, transient slow-flow in 3.6% and ST elevation in 3.6%. During follow-up, there were no MIs, there was 1 cardiac-death, and TLR occurred in 6.7%.ConclusionsThe ELLEMENT study confirms the feasibility of ELCA with contrast injection to improve stent underexpansion in undilatable stented lesions. 相似文献
2.
Nailya Bulatova Violet Kasabri Amenah Qotineh Taiba AL-Athami Al-Motassem Yousef Salah AbuRuz Munther Momani Aymen Zayed 《Diabetes & Metabolic Syndrome: Clinical Research & Reviews》2018,12(3):257-267
Background
Targeting biomarkers of oxidative-proinflammatory stress may result in improvement of modifiable metabolic syndrome, pre-diabetes and diabetes risk factors and subsequent risk reduction.Methods
64 newly diagnosed antihyperglycemic treatment-naïve prediabetic and type 2 diabetes mellitus (T2DM) patients were randomly assigned using block design to either metformin combined with therapeutic lifestyle changes (TLC) or TLC alone. Body mass index (BMI), waist circumference, blood pressure, fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), fasting lipid profile, plasma oxidative status and tumor necrosis factor (TNF)-α were measured at baseline, after 3 months and after 6 months from baseline.Results
Except for HbA1c, baseline values did not differ significantly between the two groups. The post 3-months relative reductions in BMI (P = 0.014) and HbA1c (P = 0.037) in metformin combined with TLC intervention were significantly greater than those in TLC alone group. TNFα plasma levels were decreased significantly vs. baseline by metformin combined with TLC intervention (?22.90 ± 46.76%, P = 0.01). Conversely, TLC alone basically worsened proinflammatory status (42.40 ± 40.82 %), P < 0.001. Metformin with TLC treatment effected a therapeutic decrement of the oxidative stress (?15.44 ± 35.32%, P = 0.029 vs. baseline) unlike TLC alone (61.49 ± 122.66%, P = 0.01 vs. baseline). Both interventions' effects were sustained in the 6-month follow up periods.Conclusion
In both intervention groups, the relative changes in plasma TNFα were significantly correlated (P < 0.01) with systolic blood pressure and the relative changes in oxidative stress were markedly correlated (P < 0.05) with total cholesterol. 相似文献3.
Helmy Hassan Elghawaby Mohamed Ashraf Shawky Ahmed Hossam Mowafi Akram Mohamed Abd-elbary Farouk Mostafa Faris 《The Egyptian Heart Journal》2018,70(1):9-14
Background
Disruption of vulnerable plaques is the most common cause of acute coronary syndromes. Intravascular ultrasound facilitates cross-sectional imaging of coronary arteries. We aimed at using IVUS to investigate the morphology and tissue characteristics of atherosclerotic plaques of non-culprit intermediate coronary lesions in non-ST elevation ACS setting.Methods
IVUS assessment of sixty-one intermediate coronary lesions in twenty-eight patients with the diagnosis of Non ST elevation acute coronary syndromes. Ultrasound signals were obtained by an IVUS system using a 40-MHz catheter.Results
Mean age was 53.2 ± 9.1 years. Males = 20 (71.4%). Smoking in 17 (60.7%), hypertension in 16 (57.1%), Dyslipidemia in 12 (42.9%) and DM in 8 (28.6%). Culprit vessels represent 42% of affected vessels. Sixty-one intermediate lesions were detected. Twenty-nine lesions in culprit vessels and thirty-two lesions in non-culprit vessels with higher lipidic content in lesions of culprit vessels (P < 0.001) while a higher calcific content in lesions of non-culprit vessels (P < 0.001). Higher calcific content of proximal more than distal lesions (P = 0.048). Negative remodeling in 55.7% of lesions.Conclusions
A higher lipidic content in lesions of culprit vessels, while the lesions of non-culprit vessels were more calcific. Higher calcific content of proximal more than distal lesions was defined as well. 相似文献4.
Objective
There are no randomized trials evaluating the effects of pulse steroid treatment on cardiac electrophysiologic functions. The data are limited only to case series. In this study, we sought to evaluate the effects of high dose intravenous methylprednisolone therapy on indices of ventricular repolarization.Methods
Fifty patients with various autoimmune and inflammatory disorders were enrolled to the study. Electrocardiography (ECG) was obtained 4 h before and 12 h after the pulse steroid treatment. All ECGs were thoroughly evaluated by an experienced electrophysiologist. Indices of ventricular repolarization including QTc, JT, Tp-Te, Tp-Te/QTc were measured and compared with before and after-treatment ECGs.Results
There were 36 female and 14 male patients. Mean age was 36 ± 13 years. Heart rate was significantly reduced after the therapy (87,16 ± 17,45 bpm vs 73,86 ± 17,45 p:0,001). QT interval (361,0 ± 29,91 vs 388,20 ± 42,84 p:0,001) and corrected QT interval (QTc) was significantly prolonged (401,60 ± 19,79 vs 413,72 ± 26,38 p:0,01) after pulse steroid therapy. Also, JT interval (273,0 ± 28,73 vs. 299,60 ± 45,66 p:0,001) and JT interval index (JTI%) was significantly prolonged (118,18 ± 17,54 vs. 110,56 ± 13,92 p:0,01). Tp-e interval was significantly prolonged after high-dose steroid treatment (74,60 ± 13,12 vs. 83,80 ± 13,68 p:0.001). The ratio of Tp-Te to QTc was also significantly increased after pulse steroid therapy (0,18 ± 0,03 vs 0,20 ± 0,03 p:0,009).Conclusion
Our study shows that indices of ventricular repolarization are significantly prolonged after pulse steroid treatment. These findings indicate an increased risk of arrhythmias related to high dose intravenous methylprednisolone therapy. 相似文献5.
Dahlia Abd El-Mohsen Hussein Reem Abd El-Moneim Habeeb Noran Osama El-Azizi Noha Nagi M. Salah El-Deen Caroline Samy Morad Amr Mohammad Hawwash 《The Egyptian Rheumatologist》2017,39(4):227-231
Aim of the work
To estimate prevalence of tuberculosis (TB) infection in systemic lupus erythematosus (SLE) patients; to study its relation to disease duration, activity, damage and treatment as well as to compare the performance of interferon gamma (IFN-γ) release assay and tuberculin skin test (TST) in detection of TB infection.Patients and methods
The study enrolled 100 adult SLE patients. Disease activity was assessed using the British Isles Lupus Assessment Group (BILAG) activity index and damage using the Systemic Lupus International Collaborative Clinics damage Index (SLICCDI). Tuberculin skin tests and QuantiFERON-TB GOLD In-Tube (QFT-GIT) test were performed.Results
The mean age of the patients was 29.82 ± 7.9 years; 90% females and 10% males with a mean disease duration 5.5 ± 5.4 years. The BILAG index showing that 30% had category A renal activity and the mean of SLICCDI was 1.4 ± 1.7. All patients were Bacille Calmette-Guérin (BCG) vaccinated; none of them had a previous history or contact to members with TB infection. QFT-GIT was positive in 13 patients and TST was positive in 2 patients. 15 patients were diagnosed as latent tuberculosis infection (LTBI). No patients were identified with active TB and microscopic examination and culture were negative. The agreement between the QFT-GIT and TST was poor. No significant difference between patients with positive and negative QFT-GIT results as regard disease duration, corticosteroids and immunosuppressive drugs used, BILAG, SLICCDI, chest X-ray and laboratory investigations.Conclusion
The prevalence of LTBI in SLE patients in our study was 15% with poor agreement between the QFT-GIT and TST. 相似文献6.
Francisco Maduell Raquel Ojeda Lara Belmar Paula Munguía Cristina Sango Ana Isabel Martinez-Díaz Marta Arias-Guillén Manel Vera Néstor Fontseré Miquel Gómez Lida Rodas Nayra Rico 《Nefrología : publicación oficial de la Sociedad Espa?ola Nefrologia》2018,38(1):34-40
Introduction
Online haemodiafiltration (OL-HDF) has been associated with increased survival. To date, the influence of the inner diameter of the hollow fibres of the dialyser on convective volume has not been well established. The objective of the study was to evaluate the effect of increasing the inner diameter of the dialyser on the convective volume and removal capacity.Material and methods
We included 16 patients in posdilutional OL-HDF with autosubstitution. Each patient was analysed in 4 sessions in which the inner diameter varied; 185 μm (FX60 Cordiax and FX80 Cordiax) versus 210 μm (FX600 Cordiax and FX800 Cordiax). Different solutes were measured at the beginning and end of each dialysis session.Results
No differences in the convective volume were found with an increased inner diameter: 32.3 ± 3.1 vs. 31.8 ± 3.6 l/session (FX60 vs. FX600) and 33.7 ± 4.3 vs. 33.5 ± 3.8 l/session (FX80 vs. FX800). The reduction percentages also did not differ: urea 83.7 ± 4.5 vs. 84.1 ± 3.4 for FX60 and FX600, and 82.7 ± 4.1 vs. 83.6 ± 3.8 for FX80 vs. FX800; creatinine similar 78.2 ± 5.6 vs. 77.8 ± 4.6 y 77.1 ± 5.4 vs. 78.1 ± 4.9; β2-microglobulin 82.2 ± 4.3 vs. 82.9 ± 4.2, and 82.9 ± 4.7 vs. 84.0 ± 3.8; myoglobin 71.0 ± 10 vs. 70.2 ± 9 and 72.8 ± 11 vs. 75.0 ± 10; prolactin 70.4 ± 9 vs. 68.1 ± 9, and 72.2 ± 10 vs. 73.4 ± 8.2; and α1-microglobulin 22.9 ± 10 vs. 21.6 ± 10, and 26.5 ± 12 vs. 28.8 ± 11, respectively.Conclusion
The increase in the inner diameter of the hollow fibres did not result in improved convective volume and removal capacity. 相似文献7.
Jie Luo Mingxu Zhang Baosong Yan Kejun Zhang Ming Chen Shaoli Deng 《The Brazilian journal of infectious diseases》2017,21(2):155-161
Objective
Maintaining a right balance between Th17 and Treg might be critical to the immunopathogenesis of active tuberculosis (TB). This study aimed to assess whether the Th17/Treg balance is altered in active TB patients.Methods
250 study subjects (90 active TB patients, 80 latent TB subjects, and 80 healthy controls) were recruited for the study. The expression of Th17 and Treg in peripheral blood mononuclear cells (PBMCs) in the 250 subjects was investigated by flow cytometry. Plasma levels of cytokines IL-17 and IL-10, which are related to Th17 and Treg, respectively, were determined by ELISA.Results
The percentages of Th17 and Treg in PBMCs from active TB patients were significantly higher than those from latent TB or control groups (Th17: 4.31 ± 1.35% vs. 1.58 ± 0.71% or 1.15 ± 0.49%, p < 0.05; Treg: 11.44 ± 2.69% vs. 7.54 ± 1.56% or 4.10 ± 0.99%, p < 0.05). The expression of IL-17 and IL-10 was significantly increased in active TB patients in comparison to that in latent TB or control groups (IL-17: 16.85 ± 9.68 vs. 7.23 ± 5.19 or 8.21 ± 5.51 pg/mL, p < 0.05; IL-10: 28.70 ± 11.27 vs. 20.25 ± 8.57 or 13.94 ± 9.00 pg/mL, p < 0.05).Conclusions
Our study demonstrated an altered balance of Treg/Th17 in active TB patients, with higher percentages of Th17 and Treg in PBMCs. Further research on this imbalance may offer a new direction for TB treatment. 相似文献8.
Paulo Dinis Rogério Teixeira Hélder Dores Pedro Correia Hanna Lekedal Marie Bergman Maria Carmo Cachulo Joaquim Cardoso Lino Gonçalves 《Revista portuguesa de cardiologia》2018,37(3):249-256
Introduction
Exercise‐induced cardiac remodeling is frequent in athletes. This adaptation is structurally manifested by an increase in cardiac dimensions and mass. Soldiers are also subject to intense physical exercise, although with different characteristics.Objective
To compare exercise‐induced cardiac remodeling in competitive athletes and in soldiers on a special forces training course.Methods
We studied 17 soldiers (all male and Caucasian, mean age 21 ± 3 years) who completed a special forces course and 17 basketball players (47.3% male, 64.7% Caucasian, mean age 21 ± 3 years). Assessment included a transthoracic echocardiogram and analysis of myocardial mechanics. This assessment was performed at the beginning and end of the military course and the sports season, respectively.Results
Cardiac remodeling was observed in both groups. The soldiers presented a predominantly eccentric pattern, with increased left ventricular (LV) size (49.7 ± 3.2 vs. 52.8 ± 3.4 mm; p < 0.01), increased LV mass (93.1 ± 7.7 vs. 100.2 ± 11.4 g/m2; p < 0.01) and decreased relative wall thickness (0.40 ± 0.1 vs. 0.36 ± 0.1; p = 0.05). The basketball players showed a concentric pattern, with decreased LV size (52.0 ± 4.7 vs. 50.4 ± 4.7 mm; p = 0.05), and increased relative wall thickness (0.33 ± 0.1 vs. 0.36 ± 0.1; p = 0.05). Although there was no significant difference in LV myocardial strain in the groups separately, when compared there was a significant decrease (‐20.2 ± 1.6% vs. ‐19.4 ± 2.1%; p = 0.03).Conclusion
Cardiac remodeling was frequent, with an eccentric pattern in soldiers and a concentric pattern in basketball players. Myocardial deformation may represent a physiological adaptation to physical exercise. 相似文献9.
Hani M. Mahmoud Ali M. Al-Ameen Mohamed H. Hassan Tarek Badr Hesham Nieem Ahmed A. Shaheen Abdullah E. Ghabashi 《The Egyptian Heart Journal》2017,69(4):247-251
Purpose
During MitraClip procedure, one or more clips might be needed to effectively reduce the mitral regurgitation (MR). Three-dimensional vena-contracta (3D-VC) assessed by color Doppler three-dimensional trans-esophageal echocardiography (3D-TEE) was proven to be well correlated with MR severity. However, its role in predicting the number of MitraClip devices needed during the procedure was not fully determined. Aim of this study is to assess the predictive value of 3D-VC area & length in determining the number of clips needed during the procedure.Methods
3D-TEE with color Doppler was performed in 20 patients ( age: 68.9 ± 2.5 years; 65% males; with functional severe/moderately severe MR) who underwent successful MitraClip procedure (reduction of MR to <2+). Manual tracing and measurement of the 3D-VC area (3D-VCA) as well as the 3D-VC length (3D-VCL) was done. These values were compared between patients who received 1 clip (n = 4) and ≥ 2 clips (n = 16).Results
Patients who received ≥ 2 clips had larger 3D-VC area compared to patients who received 1 clip (0.39 ± 0.23 cm2 vs. 0.13 ± 0.03 cm2, p = 0.04, t = 2.22) . Patients who received ≥ 2 clips had bigger 3D-VC length compared to patients who received 1 clip (1.14 ± 0.33 cm vs. p = 0.005, t = 3.25 ). A cut-off values of 0.20 cm2 & 1 cm for the VCA & VCL respectively, are suggestive that the patient will most likely require more than one MitraClip device to treat his mitral regurgitation.Conclusions
The 3D-VCA & 3D-VCA using 3D TEE is helpful indetermining the number of MitraClip devices needed during the procedure in functional mitral regurgitation. 相似文献10.
S.H. Min T.J. Oh S.-I. Baek D.-H. Lee K.M. Kim J.H. Moon S.H. Choi K.S. Park H.C. Jang S. Lim 《Diabetes & metabolism》2018,44(1):73-76
Background
Euglycaemic ketoacidosis has been reported after sodium–glucose cotransporter 2 (SGLT2) inhibitor treatment. However, the degree of ketonaemia and its metabolic effects have not been well investigated. Our study examined the degree of ketonaemia induced by SGLT2 inhibition and its association with metabolic profiles in type 2 diabetes mellitus (T2DM).Methods
Biochemical parameters, including insulin, glucagon, free fatty acid (FFA), β-hydroxybutyrate (BHB) and acetoacetate (ACA) levels, were measured in 119 T2DM patients after dapagliflozin treatment for > 3 months, and compared with a matched control group.Results
Levels of total ketones, BHB and ACA were significantly higher in the dapagliflozin group than in the control group: 283.7 ± 311.0 vs 119.8 ± 143.8 μmol/L; 188.3 ± 226.6 vs 78.0 ± 106.7 μmol/L; and 94.1 ± 91.3 vs 41.8 ± 39.1 μmol/L, respectively (all P < 0.001). After dapagliflozin treatment, BHB was higher than the upper limit of normal (> 440 μmol/L) in 13 (10.9%) patients who had no relevant symptoms. BHB level after dapagliflozin treatment correlated positively with HbA1c (r = 0.280), FFA levels (r = 0.596) and QUICKI (r = 0.238), and negatively with BMI (r = ?0.222), insulin-to-glucagon ratio (r = ?0.199) and HOMA-IR (r = ?0.205; all P < 0.05). On multivariable linear regression analysis, QUICKI was independently associated with BHB level.Conclusion
Ketone levels were higher in T2DM patients treated with dapagliflozin than in controls, but with no clinical symptoms or signs of ketonaemia. Low-grade ketonaemia after dapagliflozin treatment may also be associated with improved insulin sensitivity. 相似文献11.
Eduardo Enríquez-Rodríguez Ignacio J. Amat-Santos Pilar Jiménez-Quevedo Irene Martín-Morquecho Gabriela Tirado-Conte María José Pérez-Vizcayno José Juan Gómez de Diego Roman Arnold Andrés Aldazábal Paol Rojas Alberto de Agustín María Del Trigo Hipólito Gutiérrez José A. San Román Carlos Macaya Luis Nombela-Franco 《Revista espa?ola de cardiología》2018,71(9):735-742
Introduction and objectives
The SAPIEN 3 (S3) valve and the Medtronic Evolut R (EVR) are second-generation transcatheter valves, designed to further reduce the rate of paravalvular aortic regurgitation (AoR). The aim of this study was to compare the 2 devices in terms of valve performance in a case-matched study with independent echocardiographic analysis.Methods
Of a population of 201 patients who underwent transcatheter aortic valve implantation, 144 patients (S3, n = 80; EVR, n = 64) were matched according to aortic annulus diameter and aortic valve calcium score, as assessed by computed tomography. All echocardiographic examinations collected at baseline and at 1- and 6-month follow-up were centrally analyzed.Results
The 2 groups were well balanced in baseline clinical and echocardiographic characteristics. The EVR valve showed a better hemodynamic profile as assessed by peak aortic gradient (EVR 13 ± 7 vs S3 20 ± 10 mmHg; P < .001), mean aortic gradient (EVR 7 ± 3 vs S3 11 ± 6 mmHg; P < .001), and Doppler velocity index (EVR 0.65 ± 0.15 vs S3 0.51 ± 0.16; P < .001). The rate of moderate-severe or any paravalvular (≥ mild) AoR was higher in the EVR group (11% and 50%) than in the S3 group (2.5% and 21%; P < .05, respectively), with a larger number of paravalvular jets (P < .001).Conclusions
In a case-matched cohort of transcatheter aortic valve implantation patients, the S3 valve was associated with a lower rate of paravalvular AoR but also with a higher residual gradient than the EVR system.Full English text available from: www.revespcardiol.org/en 相似文献12.
Daniel Cortez Todd T. Schlegel Michael J. Ackerman J. Martijn Bos 《Journal of electrocardiology》2017,50(2):195-202
Introduction
ECG-derived vectorcardiography (VCG) has diagnostic and prognostic value in various diseases. Hypertrophic cardiomyopathy (HCM), a genetic disease with unexplained left ventricular hypertrophy, is one of the most common causes of sudden cardiac death (SCD) in young persons. Genotype positive status is associated with increased risk of systolic dysfunction, heart failure, and (SCD). Herein, we aimed to determine the diagnostic utility of derived VCG parameters in a large cohort of genotyped HCM patients.Methods
Between 1997 and 2007, genetic testing was performed on 1053 unrelated patients with HCM. Of these, 967 had 12-lead ECGs suitable for computerized derivation of VCG parameters, including the spatial mean and peaks QRS-T angles, spatial ventricular gradient (SVG), spatial QRS, QT, and Tpeak-Tend (TpTe) intervals. ECGs were also evaluated using Seattle ECG criteria. Differences between HCM patients and healthy controls as well as between genotype positive versus genotype negative HCM patients were assessed.Results
Spatial peaks (129.3 ± 26.4 vs.30.5 ± 24.2 degrees) and spatial mean QRS-T angles (121.8 ± 38.6 vs. 47.3 ± 27.6 degrees) were significantly higher in patients with HCM than in controls (P < 0.001). The spatial peaks and mean QRS-T angles identified 94% and 84% of HCM patients, respectively, while Seattle criteria identified 70.7% of patients (P < 0.001). Genotype positive patients had higher spatial mean QRS-T angles, spatial TpTe (P < 0.001 respectively), spatial peaks QRS-T angles (P = 0.017) and lower SVG (P < 0.001) than genotype negative patients.Conclusions
ECG-derived spatial QRS-T angles can differentiate patients with HCM from controls and could provide a better tool than traditional Seattle criteria. Clinical usefulness of VCG to differentiate genotype-negative from genotype-positive patients has yet to be established. 相似文献13.
Cardiovascular benefits of combined interval training and post-exercise nutrition in type 2 diabetes
Monique E. Francois Kevin J. Pistawka Frank A. Halperin Jonathan P. Little 《Journal of diabetes and its complications》2018,32(2):226-233
Aim
The purpose of this study was to examine whether the combination of high-intensity interval training (HIIT) and post-exercise protein supplementation would improve cardiovascular outcomes in individuals with T2D.Methods
In a double-blind controlled trial, fifty-three adults with T2D (free of CVD and not on exogenous insulin) were randomized to 12 weeks of cardio and resistance-based HIIT (4-10 × 1 min at 90% maximal heart rate) with post-exercise milk, milk-protein, or placebo supplementation, thrice weekly. Before and after, carotid and femoral artery intima media thickness (IMT) and femoral flow profiles were assessed using high-resolution ultrasound. Central and peripheral arterial stiffness were assessed by pulse wave velocity (PWV), and resting and maximal heart rate rates were measured.Results
After 12 weeks of HIIT femoral IMT (Pre: 0.84 ± 0.21 mm vs. Post: 0.81 ± 0.16 mm, p = 0.03), carotid-femoral PWV (Pre: 10.1 ± 3.2 m/s vs. Post: 8.6 ± 1.8 m/s, p < 0.01) and resting heart rate (Pre: 70.4 ± 10.8 bpm vs. Post: 67.8 ± 8.6 bpm, p = 0.01) were all significantly lower. There were no differences between nutrition groups (all significant main effects of time) for all outcomes.Conclusion
HIIT reduces femoral IMT, arterial stiffness and resting heart rate in individuals with T2D. The addition of post-exercise milk or protein to HIIT did not have additive effects for improving cardiovascular outcomes in the present study. Taken together, HIIT alone may be an effective means to reduce the burden of cardiovascular complications in T2D. 相似文献14.
Background
A predictive model for Paravalvular aortic regurgitation (PAR) integrating the left ventricular outflow tract-to-ascending aorta angle (LVOT-AO) and depth to the non-coronary cusp (NCC) after TAVI with CoreValve prosthesis (MCP) was retrospectively identified (2 × ∠LVOT-AO + [depth to NCC-10]2; cutoff = 50). However, the validity and clinical utility of this model remain unknown.Methods
A total of 100 patients (79.6 ± 7 years, mean EuroScore 24.9 ± 16.3%, 41 males) constituted a validation cohort for the predictive model. Both angle (LVOT-AO) and depth to NCC were considered during patient selection and device implantation.Results
Significant AR occurred in 16% (group A) vs. 84% (group B). Angle ∠LVOT-AO and depth to NCC were larger in group A compared to group B (16.4 ± 7.2 vs. 11.8 ± 4.1, p < 0.001, and 9.1 ± 4.8 mm vs. 6.6 ± 2.7 mm, p = 0.004). The model showed a sensitivity of 68.7% and a specificity of 88.1% in prediction of PAR. Comparing the derivation cohort (initial experience, n = 50) and validation cohort (later experience, n = 100) it is showed that the ∠LVOT-AO, valve depth and PAR were significantly lower (12.5 ± 4.9 and 6.9 ± 3.2 mm vs. 19.7 ± 7.9 and 10.4 ± 3.7 mm, 40% vs. 16% respectively, all p < 0.001) in the validation cohort.Conclusion
The predictive model for significant PAR after TAVI using MCP is valid with a reassuring specificity and an acceptable sensitivity. A strategy incorporating these anatomical and procedural variables improves PAR after TAVI. 相似文献15.
Amjad M. Ahmed Ahmad Hersi Walid Mashhoud Mohammed R. Arafah Paula C. Abreu Mohammed Abdullah Al Rowaily Mouaz H. Al-Mallah 《Journal of the Saudi Heart Association》2017,29(4):235-243
Background
Limited data exist on the epidemiology of cardiovascular risk factors in Saudi Arabia, particularly in relation to the differences between Saudi nationals and expatriates in Saudi Arabia. The aim of this analysis was to describe the current prevalence of cardiovascular risk factors among patients attending general practice clinics across Saudi Arabia.Methods
In this cross-sectional epidemiological analysis of the Africa Middle East Cardiovascular Epidemiological (ACE) study, the prevalence of cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity, smoking, abdominal obesity) was evaluated in adults attending primary care clinics in Saudi Arabia. Group comparisons were made between patients of Saudi ethnicity (SA nationals) and patients who were not of Saudi ethnicity (expatriates).Results
A total of 550 participants were enrolled from different clinics across Saudi Arabia [aged (mean ± standard deviation) 43 ± 11 years; 71% male]. Nearly half of the study cohort (49.8%) had more than three cardiovascular risk factors. Dyslipidemia was the most prevalent risk factor (68.6%). The prevalence of hypertension (47.5%) and dyslipidemia (75.5%) was higher among expatriates when compared with SA nationals (31.4% vs. 55.1%, p = 0.0003 vs. p < 0.0001, respectively). Conversely, obesity (52.6% vs. 41.0%; p = 0.008) and abdominal obesity (65.5% vs. 52.2%; p = 0.0028) were higher among SA nationals vs. expatriates.Conclusion
Modifiable cardiovascular risk factors are highly prevalent in SA nationals and expatriates. Programmed community-based screening is needed for all cardiovascular risk factors in Saudi Arabia. Improving primary care services to focus on risk factor control may ultimately decrease the incidence of coronary artery disease and improve overall quality of life.The ACE trial is registered under NCT01243138. 相似文献16.
H. Guo Y. Zheng X. Cai H. Yang Y. Zhang L. Hao Y. Jin G. Yang 《Allergologia et immunopathologia》2018,46(1):39-44
Background
Low vitamin D status is linked to increased incidence of food allergy and intestinal inflammation. Whether vitamin D status is associated with immunological changes in children with gastrointestinal food allergy (GFA) remains unclear.Methods
Forty-nine GFA children (aged 2–11 years old) were enrolled in this study. Serum 25-hydroxyvitamin D (25OHD) level, total immunoglobulin E (IgE), specific IgE against allergens, circulating regulatory T lymphocytes (Tregs), and blood eosinophil numbers were measured.Results
Levels of serum 25OHD in the GFA children ranged 35.5–156.4 nmol/L, with a mean value similar to that of the healthy controls. Compared to those with normal 25OHD (≥75 nmol/L), GFA children with low 25OHD (<75 nmol/L) had increased total IgE (84% vs. 54%, P < 0.05), persistent blood eosinophilia (56% vs. 25%, P < 0.05), and delayed resolution of symptoms after food allergen elimination (odds ratio 3.51, 95% CI 1.00–12.36, P < 0.05). Among the GFA children with elevated total IgE, those with low 25OHD had lower circulatory Tregs (8.79 ± 2.4% vs. 10.21 ± 1.37%, P < 0.05), higher total IgE (1197.5 ± 1209.8 vs. 418.5 ± 304.6 kU/L, P < 0.05), and persistent eosinophilia (0.61 ± 0.52 vs. 0.31 ± 0.15 × 109 cells/L, P < 0.05) compared to those with normal 25OHD. In addition, serum 25OHD concentrations inversely correlated with total IgE (R = ?0.434, P < 0.05), and positively with Treg population (R = 0.356, P < 0.05).Conclusion
Low serum vitamin D status correlates with stronger allergic immune response in GFA children. 相似文献17.
A. Meillier D. Midani D. Caroline M. Saadi H. Parkman R. Schey 《Revista de gastroenterologia de Mexico》2018,83(1):3-8
Introduction
Three subtypes of achalasia have been defined through high-resolution esophageal manometry: subtype i shows no pressurization with swallows, subtype ii has increased isobaric panesophageal pressure, and subtype iii has distal esophageal spastic non-isobaric contractions. Studies describing the subtypes based on radiographic findings, clinical symptoms, and stasis scores are limited.Aim
To determine the differences in clinical symptoms, radiographic findings, and stasis scores for the 3 achalasia subtypes.Methods
Patients undergoing high-resolution esophageal manometry received a questionnaire about current symptoms and previous treatments. The questions included the presence of symptoms and their severity. Barium swallow tests were performed before the high-resolution esophageal manometry study to evaluate the maximum esophageal diameter. Stasis scores were calculated using the transit patterns on high-resolution esophageal manometry.Results
One hundred and eight patients with high-resolution esophageal manometry diagnosis of achalasia (n = 8, subtype i; n = 84, subtype ii; n = 16, subtype iii) within the time frame of 1/2012-6/2015 were included in the study. Sex distribution was similar between the subtypes. Patient age was younger for subtype i (38 ± 16 years), compared with subtypes ii (55 ± 17 years) and iii (63 ± 17 years) (P=.03). Esophageal symptoms did not differ between subtypes regarding the severity of nausea, chest pain, coughing, and heartburn, except for increased vomiting severity in subtype i (2.8 ± 1.4 vs. 1.4 ± 1.4 vs. 1.2 ± 1.2, P<.01). A significant radiographic difference in esophageal dilation was seen between subtypes ii and iii (35.1 ± 14.4 vs. 24.0 ± 7.2 mm, P=.023). Stasis scores did not significantly differ between the subtypes.Conclusions
Achalasia subtypes had similar clinical symptoms, except for increased vomiting severity in subtype i. The maximum esophageal diameter in subtype ii was significantly greater than in subtype iii. Esophageal stasis scores were similar. Thus, high-resolution esophageal manometry remains essential in assessing achalasia subtypes. 相似文献18.
Jan-Erik Guelker Christian Blockhaus Knut Kroeger Rosemarie Wehner Heinrich Klues Alexander Bufe 《Journal of the Saudi Heart Association》2018,30(2):69-74
Background
Failure of delivering a stent or a balloon across the target lesion during percutaneous coronary intervention (PCI) of chronic total occlusion (CTO), especially in arteries with calcified tortuous anatomy, is often due to insufficient backup support from the guiding catheter. The purpose of this study was to assess the feasibility of the GuideLiner (GL) catheter use.Methods
We examined 18 patients and used the GL catheter to overcome poor support and excessive friction in standardized antegrade and retrograde CTO procedures. The GL is a coaxial, monorail guiding catheter extension delivered through a standard guiding catheter and is available in different sizes.Results
Almost all lesions were classified as severely calcified (94.4 ± 0.24%). The Japanese CTO score reflecting lesion complexity was 3.56 ± 0.78. All procedures were performed femorally; the retrograde approach was used in 27.8 ± 0.46% of cases. The overall success rate was 88.9 ± 0.32%; there were no relevant complications.Conclusions
The GL catheter is an adjunctive interventional device which enhances and amplifies CTO-PCI. Its use is indicated in cases in which back-up force needs to be strengthened to pass a CTO despite advanced calcification. It can be recommended as an important additional tool in advanced interventional cardiology such as antegrade and retrograde CTO-PCI if other techniques like anchor balloon or anchor wire are not possible. 相似文献19.
Tatiana Duarte Sara Gonçalves Raquel Brito Catarina Sá Rita Marinheiro Marta Fonseca Rita Rodrigues Filipe Seixo Anabela Guerreiro Andreia Fernandes Cristina Carradas Isabel Silvestre Leonel Bernardino Rui Caria 《Revista portuguesa de cardiologia》2018,37(2):169-173
Introduction
Non‐dipper and extreme dipper blood pressure (BP) profiles are associated with a worse cardiovascular prognosis. The relationship between nocturnal BP profile and hypertensive retinopathy (HR) is not fully established.Aim
To assess the association between the prevalence and severity of HR and nocturnal BP.Methods
We prospectively studied hypertensive patients who underwent 24‐hour ambulatory BP monitoring. The population was divided into two groups according to the presence or absence of lesions and compared according to baseline characteristics, nocturnal BP profile (dippers, non‐dippers, inverted dippers/risers and extreme dippers) and mean nocturnal systolic (SBP) and diastolic (DBP) BP values. The presence and severity of HR were assessed using the Scheie classification. The relationship between nocturnal SBP and DBP values (and nocturnal BP profile) and the prevalence and severity of HR was determined.Results
Forty‐six patients (46% male, aged 63 ± 12 years) were analyzed, of whom 91% (n = 42) were under antihypertensive treatment. Seventy percent (n = 33) had uncontrolled BP. HR was diagnosed in 83% (n = 38). Patients with HR had higher mean systolic nocturnal BP (151 ± 23 vs. 130 ± 13 mmHg), p = 0.008). Patients with greater HR severity (Scheie stage ≥ 2) had higher nocturnal BP (153 ± 25 vs. 140 ± 16 mmHg, p = 0.04). There was no statistically significant association between DBP and nocturnal BP patterns and HR.Conclusions
The prevalence and severity of HR were associated with higher nocturnal SBP. No relationship was observed between nocturnal BP profile and the presence of HR. 相似文献20.
Parveen Kumar Sharma Rekha Bansal Ashok Kumar Bhardwaj Vivek Sood Atal Sood Yogendra Padwad 《The Indian journal of tuberculosis》2018,65(1):35-40