共查询到20条相似文献,搜索用时 15 毫秒
1.
Todd C. Villines Patrick G. O’Malley Irwin M. Feuerstein Susan Thomas Allen J. Taylor 《Calcified tissue international》2009,85(6):494-500
Warfarin has been shown to accelerate vascular calcification in experimental animals, and possibly humans, through inhibition
of the vitamin K–dependent protein matrix gla protein, a potent inhibitor of tissue calcification. We performed a cross-sectional
analysis of the extent of coronary artery calcification (CAC) in patients without coronary heart disease, currently taking
or referred for warfarin therapy. The primary end point was severity of CAC measured by electron beam computed tomography
attributed to duration of warfarin use, after adjustment for cardiovascular risk factors. Seventy patients (46 men, mean age
68 ± 13 years) were enrolled from three groups of warfarin use duration: (1) <6 months (n = 31, mean duration 1 ± 1 months), (2) 6–24 months (n = 11), and (3) >24 months (n = 28, mean 67 ± 40 months). Overall, the mean total CAC score (Agatston) was 293 ± 560: group 1 (175 ± 285), group 2 (289 ± 382),
and group 3 (426 ± 789). In univariate analysis, there was a nonsignificant trend to increased CAC with increasing warfarin
exposure (P = 0.18). Bivariate analysis revealed no correlation between warfarin duration and CAC score (r = 0.075, P = 0.537). Linear regression for the independent variable coronary calcium score controlling for warfarin treatment duration
and intensity (duration of warfarin use months × mean INR), Framingham risk score, and creatinine clearance showed that only
the Framingham risk score was associated with CAC (P = 0.001). Among patients without known coronary heart disease, duration of warfarin exposure was not associated with extent
of coronary calcification. 相似文献
2.
Tevfik Aktoz Meryem Aktoz Ersan Tatlı Mustafa Kaplan Fatma N. Turan Ahmet Barutcu Irfan H. Atakan Muzaffer Demir Armagan Altun 《International urology and nephrology》2010,42(4):873-879
The plasma concentration of asymmetrical dimethylarginine (ADMA), an inhibitor of nitric oxide synthase, has been linked to
endothelial dysfunction. We investigated the relation between plasma ADMA concentration and severity of erectile dysfunction
(ED) and coronary artery disease (CAD). We measured plasma levels of ADMA in 92 male patients. Patients were divided into
three groups: group 1 (n = 41), patients with ED and without CAD; group 2 (n = 29), patients with stable CAD; group 3 (n = 22), control group (patients without CAD or ED). Erectile function was evaluated by the erectile function domain of the
international index of erectile function (IIEF-EFD) a validated 15-item self-administered questionnaire. Erectile function
is specifically addressed by six questions that form the so-called erectile function domain of the questionnaire. Each question
is scored 0–5. ED is defined as any value <26. Patients with CAD who have stable angina pectoris were selected after coronary
angiography. ADMA was analyzed by ELISA method. Group 1 had significantly higher concentrations of plasma ADMA than groups
2 and 3 (respectively, 0.75 ± 0.40 vs. 0.50 ± 0.30, P = 0.013; 0.75 ± 0.40 vs. 0.50 ± 0.25, P = 0.021). There was negative correlation between ADMA and IIEF-EFD score in all groups (n = 92) (r = −0.322, P = 0.002). In a multiple logistic regression analysis adjusting for age, hyperlipidemia, ADMA remained independent predictor
for severe ED. Odds ratio for plasma ADMA was 14.151 (1.101–181.940; P = 0.042). First of all, this study provides that ADMA concentrations are significantly higher in patients who have ED when
compared to patients with CAD and controls. Second, there was a negative correlation between ADMA and severity of ED. Elevating
levels of circulating ADMA is an independent risk factor for severe of ED, and ADMA may be a link between CAD and ED. 相似文献
3.
Kojima F Uchida K Ogawa T Tanaka Y Nitta K 《International urology and nephrology》2008,40(4):1067-1074
Objective Fibroblast growth factor (FGF) 23 is a circulating factor that regulates phosphate (P) metabolism. Since higher P levels are
associated with vascular calcification, we examined the role of serum FGF-23 levels in P metabolism and vascular calcification
in hemodialysis (HD) patients with and without diabetes mellitus (DM).
Materials and methods Chronic HD patients with DM (n = 39) and without DM (n = 50) were enrolled. Serum samples were obtained before the start of dialysis sessions, and the FGF-23 levels were determined
by enzyme-linked immunosorbent assay. Abdominal computed tomography (CT) scan was performed, and the aortic calcification
index (ACI) was determined by one examiner, blinded to the patient characteristics. Measurements of bone mineral density (BMD)
were performed at the time of ACI estimation.
Results Log plasma FGF-23 levels were higher in non-DM (3.74 ± 0.71 pg/ml) than in DM (3.35 ± 0.74 pg/ml) patients. The log FGF-23
correlated positively with serum creatinine (r = 0.424, P < 0.0001), albumin (r = 0.225, P = 0.0337), Ca (r = 0.392, P = 0.0001), P (r = 0.735, P < 0.0001), and Ca × P product (r = 0.780, P < 0.0001). There were negative correlations between log FGF-23 and age (r = −0.208, P = 0.0497), glucose (r = −0.231, P = 0.0294), and CRP (r = −0.222, P = 0.0359). Multiple regression analyses were performed to explore the correlations between plasma FGF-23 and other factors
associated with vascular calcification in all HD patients. Independent variables were selected based on the results of univariate
analyses. The significant factors associated with FGF-23 in HD patients were age, serum levels of creatinine, albumin, glucose,
Ca, P, and Ca × P product. Plasma FGF levels did not correlate significantly with either ACI or BMD in these patients.
Conclusion Our findings indicate that the plasma FGF-23 level is associated with calcium-phosphate metabolism disorders, but not with
aortic calcification, in both non-DM and DM patients on chronic HD. In addition, plasma FGF-23 is associated with serum levels
of creatinine and albumin. Therefore, the plasma FGF-23 level may provide a reliable marker for Ca and P imbalance and nutritional
status in HD patients. 相似文献
4.
Hidetoshi Yoshitani Masaaki Takeuchi Keitaro Ogawa Yutaka Otsuji 《Journal of Echocardiography》2009,7(1):2-8
Background Wall thickness in the distal part of the left anterior descending coronary artery (LAD) can be measured by using two-dimensional
high-resolution transthoracic echocardiography (2DHTTE). The objective of this study was to compare the diagnostic accuracy
of measuring carotid intima-media thickness (IMT) and distal LAD wall thickness for prediction of multivessel coronary artery
disease (MVD).
Methods We measured wall thickness in the distal LAD using 2DHTTE and carotid IMT using B-mode ultrasound in 100 patients who subsequently
underwent coronary angiography (CAG). Patients were classified into three groups based on the results of CAG—no significant
stenosis (group N), single-vessel disease (group S), or multivessel disease (group M).
Results Successful measurements of LAD wall thickness were accomplished in 96 patients. Distal LAD wall thickness was significantly
greater in group M (0.92 ± 0.20 mm) than in group N (0.72 ± 0.11 mm, P < 0.01) and group S (0.76 ± 0.19 mm, P < 0.01). Carotid IMT was significantly greater in group M (0.90 ± 0.24 mm) than in group N (0.75 ± 0.21 mm, P < 0.05) and group S (0.80 ± 0.17 mm, P < 0.05). Distal LAD wall thickness >0.8 mm had a sensitivity of 75% and a specificity of 67% in predicting MVD, whereas carotid
IMT >0.8 mm was 63% sensitive and 67% specific in the prediction of MVD. There was a weak but significant correlation between
distal LAD wall thickness and IMT (r = 0.31, P < 0.01).
Conclusions Non-invasive measurement of distal LAD wall thickness by 2DHTTE is feasible, and has equivalent diagnostic accuracy to IMT
measurements for predicting MVD. 相似文献
5.
《Renal failure》2013,35(8):1075-1078
AbstractCalcification of coronary vessels progresses rapidly in hemodialysis (HD) patients and comprises a strong predictor of cardiovascular events. The aim of this prospective study was to evaluate the coronary artery calcification (CAC) in patients with end stage renal disease undergoing regular HD and to determine the effect of renal transplantation (RT) in the progression of CAC, using the Agatston technique for calcium scoring. The study included 20 patients with end-stage renal disease undergoing a regular HD treatment (16 males, 4 females) 54.1?±?9.5 years old who had just received a renal transplant and 16 more HD patients (11 males, 5 females) 54.4?±?13.8 years old as control group. The baseline evaluation showed a very high prevalence of CAC in both groups, which was positively correlated with age (p?<?0.001) and CRP (p?=?0.03). The second (follow-up) evaluation showed a significant slower progression of calcification after RT. In both groups, high calcium score values in the follow-up evaluation had a strong positive correlation with baseline calcium score (p?<?0.001). 相似文献
6.
Takahiro Yasui Keiji Fujita Yutaro Hayashi Kousuke Ueda Shigeyuki Kon Masahiro Maeda Toshimitsu Uede Kenjiro Kohri 《Urological research》1999,27(4):225-230
Osteopontin (OPN) is one of the most important components in calcium stone matrix, but its role in stone formation is not
clear. Since quantitative data regarding the excretion of OPN are necessary to assess its role, we have developed a quantitative
enzyme-linked immunosorbent assay (ELISA) for OPN, and measured the urinary OPN concentrations in urolithiasis patients. Forty-seven
men with urinary stones composed chiefly of calcium oxalate participated in the study. The controls were 13 normal healthy
male volunteers. Urine samples were collected early in the morning and analyzed by a quantitative ELISA employing purified
polyclonal antibodies to synthesized OPN aminopolypeptides. The urinary ratio of the concentrations of OPN and creatinine
(OPN/Cre) in the urolithiasis patients (0.039 ± 0.029) was significantly lower than that in the control subjects (0.062 ± 0.030)
(P<0.05). Single stone formers (n = 26; 0.050 ± 0.020) had significantly higher OPN/Cre ratios compared with recurrent stone formers (n = 21; 0.031 ± 0.021) (P<0.05). The results show that OPN excretion in urolithiasis patients was lowered, presumably because of the incorporation
of OPN by kidney stones.
Received: 4 September 1998 / Accepted: 1 March 1999 相似文献
7.
Srivaths PR Goldstein SL Silverstein DM Krishnamurthy R Brewer ED 《Pediatric nephrology (Berlin, Germany)》2011,26(6):945-951
Increased mortality of adult chronic hemodialysis (HD) patients is associated with coronary calcifications (CC), increased
serum phosphorus (P), use of calcium (Ca)-containing P-binders, and vitamin D deficiency. Serum concentration of fibroblast
growth factor 23 (FGF 23) is markedly elevated in adults receiving dialysis and is independently associated with increased
mortality. Although coronary calcifications have been described in pediatric and adult HD patients, no significant association
between serum FGF 23 and CC has been reported. In our study, 5/16 patients had CC. Patients with CC were older, had longer
dialysis vintage and higher serum P. Serum Ca, total PTH, elemental Ca intake, and calcitriol doses were not different for
CC patients. Serum FGF 23 levels were markedly elevated in all patients (mean 4,024, range 874–8,253), but significantly higher
in patients with CC (4,247 ± 10,35 vs 2,427 ± 11,92, p = 0.01) and positively correlated with Agatston calcification score (r = 0.69, p = 0.003) and serum P (r = 0.49, p = 0.05). Using multivariate analysis, serum FGF 23 and serum P remained the most significant factors associated with Agatston
score. This study confirms the occurrence of CC in pediatric HD patients and is the first to show a significant association
between CC and elevated serum FGF 23 in children. 相似文献
8.
Byoung-Jin Park Jae-Yong Shim Yong-Jae Lee Jung-Hyun Lee Hye-Ree Lee 《Asian journal of andrology》2012,14(4):612-615
Although low testosterone levels in men have been associated with high risk for cardiovascular disease, little is known about the association between male sex hormones and subclinical coronary disease in men with apparently low cardiometabolic risk. This study was performed to investigate the association between male sex hormones and subclinical coronary artery calcification measured as coronary calcium score in non-obese Korean men. We examined the relationship of total testosterone, sex hormone-binding globulin, bioavailable testosterone and free testosterone with coronary calcium score in 291 non-obese Korean men (mean age: 52.8±9.3 years) not having a history of cardiovascular disease. Using multiple linear regression, we evaluated associations between log (sex hormone) levels and log (coronary calcium score) after adjusting for confounding variables in 105 men with some degree of coronary calcification defined as coronary calcium score≥1. In multiple linear regression analysis, bioavailable testosterone was inversely associated with coronary calcium score (P=0.046) after adjusting for age, body mass index, smoking status, alcohol consumption, regular exercise, mean blood pressure, resting heart rate, C-reactive protein, fasting plasma glucose, total cholesterol, triglyceride, high-density lipoprotein (HDL) cholesterol, hypertension medication and hyperlipidemia medication, whereas total testosterone, sex hormone-binding globulin and free testosterone were not (P=0.674, P=0.121 and P=0.102, respectively). Our findings indicate that bioavailable testosterone is inversely associated with the degree of subclinical coronary artery calcification in non-obese men. 相似文献
9.
Helene Marberg Anders Jeppsson Gunnar Brandrup-Wognsen 《European journal of cardio-thoracic surgery》2010,38(6):767-772
Objectives: The rationale of using autotransfusion of mediastinal shed blood after cardiac surgery is to preserve haemoglobin levels and reduce the need for allogenic blood transfusions. However, the method is controversial and its clinical value has been questioned. We hypothesised that re-transfusion of mediastinal shed blood instead impairs haemostasis after routine coronary artery bypass grafting and thus increases postoperative bleeding. Methods: Seventy-seven consecutive elective coronary artery bypass surgery patients (mean age 67 ± 9 years, 77% men) were included in a prospective, randomised controlled study. The patients were randomised to postoperative re-transfusion of mediastinal shed blood (n = 39) or to a group where mediastinal shed blood was discarded (n = 38). Primary end point was bleeding during the first 12 postoperative hours. Secondary end points were postoperative transfusion requirements, haemoglobin levels, thrombo-elastometric variables and plasma concentrations of interleukin-6, thrombin–anti-thrombin complex and D-dimer. Results: Mean re-transfused volume in the autotransfusion group was 282 ± 210 ml. There was no difference in postoperative bleeding (median 394 ml (interquartile range 270–480) vs 385 (255–430) ml, p = 0.69), proportion of patients receiving transfusions of blood products (11/39 vs 11/38, p = 0.95), haemoglobin levels 24 h after surgery (116 ± 13 vs 116 ± 14 g l−1, p = 0.87), thrombo-elastometric variables, interleukin-6 (219 ± 144 vs 201 ± 144 pg ml−1, p = 0.59), thrombin–anti-thrombin complex (11.0 ± 9.1 vs 14.8 ± 15, p = 0.19) or D-dimer (0.56 ± 0.49 vs 0.54 ± 0.44, p = 0.79) between the autotransfusion group and the no-autotransfusion group. Conclusions: Autotransfusion of small-to-moderate amounts of mediastinal shed blood does not influence haemostasis after elective coronary artery bypass grafting. 相似文献
10.
Viviane Barcellos Menon Alessandra Calábria Baxmann Leila Froeder Lígia Araújo Martini Ita Pfeferman Heilberg 《Urological research》2009,37(3):133-139
A randomized, placebo-controlled trial was conducted in overweight calcium stone-forming (CSF) patients, to evaluate the effect
of calcium supplementation associated with a calorie-restricted diet on body weight (BW) and fat reduction and its potential
changes upon serum and urinary parameters. Fifteen patients were placed on a hypocaloric diet for 3 months, supplemented with
either calcium carbonate (CaCO3, n = 8) or placebo (n = 7), 500 mg bid. Blood and 24-h urine samples were collected and body composition was assessed at baseline and after the
intervention. At the end of the study, final BW was significantly lower vs baseline in both CaCO3 (74 ± 14 vs. 80 ± 14 kg, P = 0.01) and placebo groups (80 ± 10 vs. 87 ± 9 kg, P = 0.02) but the mean percentage of loss of body weight and body fat did not differ between CaCO3 and placebo (7.0 ± 2.0 vs. 8.0 ± 3.0%, P = 0.40 and 13.0 ± 7.0 vs. 13.0 ± 10.0%; P = 0.81, respectively). After CaCO3 or placebo, no significant differences versus baseline were observed for urinary parameters in both CaCO3 and placebo, except for a higher mean urinary citrate in placebo group. These data suggest that increasing calcium intake
by calcium carbonate supplementation did not contribute to a further reduction of BW and fat in overweight CSF patients submitted
to a hypocaloric diet nor altered urinary lithogenic parameters. 相似文献
11.
Christian Pfrepper Adam Herber Antje Weimann Roland Siegemund Cornelius Engelmann Niklas Aehling Daniel Seehofer Thomas Berg Sirak Petros 《Transplant international》2021,34(3):423-435
The safety of direct oral anticoagulants (DOACs) in patients after solid organ transplantation (SOT) is not well defined. This study aimed at describing the safety and efficacy of DOACs in patients after SOT. Patients after kidney and/or liver transplantation under maintenance immunosuppression treated with rivaroxaban (n = 26), apixaban (n = 20) and edoxaban (n = 1) were included. Clinical data were collected retrospectively and using a questionnaire. DOAC plasma levels and thrombin generation (TG) were measured in patients after SOT and compared with nontransplanted controls receiving DOACs. DOACs were administered for 84.6 patient-years. Mean immunosuppressive trough levels after DOAC initiation increased from baseline by 18.8 ± 29.6% compared to 3.0 ± 16.5% in matched controls (P = 0.004), without significant differences in dose adjustments. No transplant rejection or significant change in liver or renal function was observed. There was one major bleeding after the observation period but no thromboembolic complication. DOAC plasma levels reached the expected range in all patients. The intrinsic hemostatic activity in transplanted patients was higher compared to nontransplant controls. Treatment with DOACs after SOT is safe and effective. Immunosuppressive trough levels should be monitored after DOAC initiation, particularly in the early phase after SOT. These data should be confirmed in a prospective study. 相似文献
12.
《Journal of vascular surgery》2020,71(2):546-552
ObjectiveThe management of patients with carotid stenosis and symptomatic coronary artery disease (CAD) is challenging. This study assessed the impact of clinical coronary disease severity on carotid endarterectomy (CEA) with and without combined coronary artery bypass (CCAB).MethodsUsing the Vascular Quality Initiative, patients with symptomatic CAD who underwent CCAB or isolated CEA (ICEA) from 2003 to 2017 were identified. Patients were stratified by CAD severity: stable angina (SA) and recent myocardial infarction/unstable angina (UA). Primary outcomes, including perioperative stroke, myocardial infarction (MI), and stroke/death/MI (SDM), were assessed between procedures within each CAD cohort.ResultsThere were 9098 patients identified: 887 CCAB patients (215 [24%] SA, 672 [76%] UA) and 8211 ICEA patients (6385 [78%] SA, 1826 [22%] UA). Overall, CCAB patients had higher rates of stroke (2.6% vs 1.3%; P = .002) and SDM (7.3% vs 3.5%, P < .001) but similar rates of MI (0.9% vs 1.6%; P = .12) compared with ICEA patients. In SA patients, no difference was seen in stroke (ICEA 1.2% vs CCAB 1.9%; P = .36), MI (1.3% vs 1.4%; P = .95), or SDM (2.9% vs 4.7%; P = .13). In UA patients, no difference was seen in stroke (ICEA 1.6% vs CCAB 2.8%; P = .06), but ICEA patients had higher rates of MI (2.4% vs 0.7%; P = .01) and CCAB patients had higher rates of SDM (8.2% vs 5.5%; P = .01). After logistic regression in the UA cohort, predictors of MI included ICEA (odds ratio [OR], 2.7; 95% confidence interval [CI], 1.1-7.0; P = .04) and carotid symptomatic status (OR, 2.1; 95% CI, 1.1-3.8; P = .01); carotid symptomatic status also predicted stroke (OR, 2.0; 95% CI, 1.1-3.6; P = .03), but CCAB did not.ConclusionsIn patients with symptomatic CAD, both clinical CAD severity and operative strategy affect outcomes. In SA patients, CCAB does not increase perioperative morbidity. However, CCAB in UA patients prevents MI while not appreciably increasing stroke risk. This suggests that coronary revascularization before or concomitant with CEA should be considered in UA patients but that prioritizing coronary intervention is less important in SA patients. 相似文献
13.
Lokeswara Rao Sajja Gopichand Mannam Satya Bhaskar Raju Dandu Satyendra Nath Pathuri Krishnamurthy Venkata Sathya Shiva Saikiran Sriramulu Sompalli 《Indian Journal of Thoracic and Cardiovascular Surgery》2008,24(2):110-115
Objective Off-pump coronary artery bypass grafting (OPCAB) is known to preserve left ventricular function better than conventional coronary
artery bypass grafting (CCAB). This study was carried out to investigate the safety, feasibility and efficacy of off-pump
coronary artery bypass grafting in patients with significant left ventricular dysfunction.
Methods Three hundred and eighty eight consecutive patients with preoperative left ventricular ejection fraction ≤ 39% who underwent
CABG between January 2001 through October 2007 were included in this retrospective study. Two hundred and eleven patients
were operated by off-pump technique (group 1) and 178 patients were operated by on-pump technique (CCAB) (group 2). The postoperative
outcomes were analyzed. Of these, 204 (52.57%) patients were diabetics, 355 (91.49%) patients had documented prior myocardial
infarction, 316 (81.44%) patients were in canadian cardiovascular society(CCS) class III and 47 (12.11%) patients were in
CCS class IV.
Results There was no significant difference in the number of grafts per patient between the two groups [group 1 3.02 ± 0.76 vs group
2 3.18 ± 0.72 (P=0.07) and the index of completeness of revascularization was comparable [1.08 ± 0.08) (OPCAB) vs 1.04 ± 0.06
(CCAB) (p=0.52)] The left internal thoracic artery was anastomosed to left anterior descending artery in 98% of patients.
Operative mortality was 2.8% (6 deaths) following OPCAB and 3.93% (7 deaths) following CCAB (p=0746). Postoperative usage
of IABP support was higher in CCAB group (12 patients vs 4 patients: P<0.03) and usage of moderate or higher doses of inotropic
support was also higher in the conventional group (p<0.0006). More worsening of preexisting renal insufficiency was observed in CCAB group (p=0.01) and no significant difference in the incidence of atrial fibrillation was observed between the groups.
Conclusions Off-pump coronary artery bypass grafting is feasible and safe in patients with depressed left ventricular function and the
postoperative morbidity was less in OPCAB group compared to on-pump group. 相似文献
14.
Sasmazel A Erkılıç A Buyukbayrak F Baysal A Tigen K Tuncer A Tuncer E Bugra O Ozkokeli M Kucukcerit T Sunar H Zeybek R 《Artificial organs》2011,35(2):131-136
The purpose of this study is to compare the effects of cardiopulmonary bypass (CPB) on the endothelium‐derived nitric oxide (NO) levels in on‐pump and off‐pump coronary artery bypass surgeries. Forty consecutive patients were divided randomly into two groups depending on use of CPB in coronary artery bypass graft surgery (group 1: n = 20, off‐pump, and group 2: n = 20, on‐pump). The plasma endothelium‐derived NO levels were determined at baseline and after reactive hyperemia before and after surgery. Reactive hyperemia was induced by inflating a blood pressure cuff placed on the upper forearm, for 5 min at 250 mm Hg followed by a rapid deflation. Blood was collected at 1 min after cuff deflation from the radial artery on the same side. Preoperative use of all medications was recorded. The baseline plasma NO levels before operation were 17.10 ± 7.58 in group 1 and 15.49 ± 5.26 nmol/L in group 2. Before operation after reactive hyperemia, the plasma NO levels were 26.97 ± 11.49 in group 1 and 26.57 ± 12.87 nmol/L in group 2. Two hours after surgery, the plasma NO levels at baseline and after reactive hyperemia were not significantly different from each other (group 1: 18.03 ± 6.37 and group 2: 19.89 ± 9.83 nmol/L; group 1: 27.89 ± 18.36 and group 2: 39.13 ± 23.60 nmol/L, respectively; P > 0.05). A positive correlation was shown between preoperative nitroglycerine use and the postoperative plasma NO levels after reactive hyperemia (r = 0.51, P = 0.001). Linear regression analysis was performed (F = 4.10, R = 0.56, R2 = 0.32, P = 0.008) and the only independent parameter that had an effect on postoperative plasma NO levels after reactive hyperemia was found to be preoperative nitroglycerine use (t = 3.68, P = 0.001). Coronary artery bypass surgery with CPB does not have significant effect on plasma endothelial derived NO levels. The postoperative plasma NO levels after reactive hyperemia significantly correlated with preoperative nitroglycerine use. 相似文献
15.
Daniele Andreini Kuniaki Takahashi Saima Mushtaq Edoardo Conte Rodrigo Modolo Jeroen Sonck Johan De Mey Paolo Ravagnani Danny Schoors Francesco Maisano Philipp Kaufmann Wietze Lindeboom Marie-angele Morel Torsten Doenst Ulf Teichgrber Gianluca Pontone Giulio Pompilio Antonio Bartorelli Yoshinobu Onuma Patrick W Serruys the Syntax III Revolution Investigators 《Interactive Cardiovascular and Thoracic Surgery》2022,34(2):176
Open in a separate windowOBJECTIVESThe aim of this study was to determine Syntax scores based on coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA) and to assess whether heavy coronary calcification significantly limits the CCTA evaluation and the impact of severe calcification on heart team’s treatment decision and procedural planning in patients with three-vessel coronary artery disease (CAD) with or without left main disease.METHODSSYNTAX III was a multicentre, international study that included patients with three-vessel CAD with or without left main disease. The heart teams were randomized to either assess coronary arteries with coronary CCTA or ICA. We stratified the patients based on the presence of at least 1 lesion with heavy calcification defined as arc of calcium >180° within the lesion using CCTA. Agreement on the anatomical SYNTAX score and treatment decision was compared between patients with and without heavy calcifications.RESULTSOverall, 222 patients with available CCTA and ICA were included in this trial subanalysis (104 with heavy calcification, 118 without heavy calcification). The mean difference in the anatomical SYNTAX score (CCTA derived—ICA derived) was lower in patients without heavy calcifications [mean (−1.96 SD; +1.96 SD) = 1.5 (−19.3; 22.4) vs 5.9 (−17.5; +29.3), P = 0.004]. The agreement on treatment decision did not differ between patients with (Cohen’s kappa 0.79) or without coronary calcifications (Cohen’s kappa 0.84). The agreement on the treatment planning did not differ between patients with (concordance 80.3%) or without coronary calcifications (concordance 82.8%).CONCLUSIONSAn overall good correlation between CCTA- and ICA-derived Syntax score was found. The presence of heavy coronary calcification moderately influenced the agreement between CCTA and ICA on the anatomical SYNTAX score. However, agreement on the treatment decision and planning was high and irrespective of the presence of calcified lesions. 相似文献
16.
Kevin Pilarczyk Henning Carstens Maria Papathanasiou Peter Luedike Achim Koch Heinz Jakob Markus Kamler Nikolaus Pizanis 《Artificial organs》2020,44(2):162-173
Acute kidney injury (AKI) is frequent in patients scheduled for implantation of a left ventricular assist device (LVAD) and associated with increased mortality. Although several risk models for the prediction of postoperative renal replacement therapy (RRT) have been developed for cardiothoracic patients, none of these scoring systems have been validated in LVAD patients. A retrospective, single center analysis of all patients undergoing LVAD implantation between September 2013 and July 2016 was performed. Primary outcome was AKI requiring RRT within 14 days after surgery. The predictive capacity of the Cleveland Clinic Score (CCS), the Society of Thoracic Surgeons Score (STS), and the Simplified Renal Index Score (SRI) were evaluated. 76 patients underwent LVAD implantation, 19 patients were excluded due to preoperative RRT. RRT was associated with a prolonged ventilation time, length of stay on the ICU and 180 day mortality (14(60.9%) vs 6(17.6%), P < .01). Whereas the Thakar Score (7.43 ± 1.75 vs 6.44 ± 1.44, P = .02) and the Mehta Score (28.12 ± 15.08 vs 21.53 ± 5.43, P = .02) were significantly higher in patients with RRT than in those without RRT, the SRI did not differ between these groups (3.96 ± 1.15 vs 3.44 ± 1.05, P = .08). Using ROC analyses, CCS, STS, and SRI showed moderate predictive capacity for RRT with an AUC of 0.661 ± 0.073 (P = .040), 0.637 ± 0.079 (P = .792), and 0.618 ± 0.075 (P = .764), respectively, with comparable accuracy in the Delong test. Using univariate logistic regression analysis, only the De Ritis Ratio (OR 2.67, P = .034) and MELD (OR 1.11, P = .028) were identified as predictors of postoperative RRT. Risk scores which are predictive in general cardiac surgery cannot predict RRT in patients after LVAD implantation. Therefore, it seems to be necessary to develop a specific risk score for this patient population. 相似文献
17.
Schaller G Aso Y Schernthaner GH Kopp HP Inukai T Kriwanek S Schernthaner G 《Obesity surgery》2009,19(3):351-356
Background Osteopontin (OPN) is a multifunctional matrix glycoprotein associated with bone metabolism and has been linked to chronic
inflammation, insulin resistance, and atherosclerosis. Diet-induced weight loss decreases elevated OPN concentrations in obese
patients. The aim of the current study was to investigate the role of OPN after bariatric surgery, where not only improvements
of chronic inflammation, insulin resistance and comorbidities, but also malabsorption and altered bone metabolism have been
reported.
Methods OPN plasma concentrations were determined in 31 morbidly obese patients (5 men, 26 women, BMI 46.2 ± 7.1 kg/m2, age 41 ± 11 years; mean ± SD) before and 18 months after bariatric surgery, together with parameters of bone metabolism
and inflammation.
Results OPN concentrations increased by +20.3 ± 26.6 ng/ml (mean ± SD, p < 0.01), concomitant to a weight loss of −38 ± 22 kg, and a decrease in BMI by −13.1 ± 7.7 kg/m2 (both p < 0.01). HOMA-index improved from 5.2 ± 3.4 to 1.5 ± 1.0 (p < 0.01). Calcium concentrations slightly decreased, and phosphate increased (−0.06 ± 0.13 mmol/l and +0.08 ± 0.16 mmol/l,
respectively; both p < 0.05), while 25-OH-VitaminD3 remained unchanged and PTH tended to increase (+5.1 ± 14.0 pg/ml, p = 0.054). Monocyte chemoattractant protein 1 and interleukin 18 were significantly decreased and associated with HOMA both
before and after bariatric surgery. ΔOPN was correlated with ΔPTH, but not with other parameters.
Conclusions OPN plasma concentrations increased concomitant to weight loss after bariatric surgery, which was independent from an improvement
of insulin sensitivity and a decrease of inflammatory markers. Further studies are needed to differentiate whether these changes
in bone metabolism after bariatric surgery are secondary to calcium deficiency or an adaptation to weight loss.
This work has been submitted in abstract form and will be in part presented at the American Diabetes Association 68th Scientific
Sessions 2008, June 6th–10th, San Francisco, CA, USA. 相似文献
18.
Living kidney donation does not adversely affect serum calcification propensity and markers of vascular stiffness 下载免费PDF全文
Sophie de Seigneux Belen Ponte Lena Berchtold Karine Hadaya Pierre‐Yves Martin Andreas Pasch 《Transplant international》2015,28(9):1074-1080
Living kidney donors (LKDs) experience a decline in glomerular filtration rate (GFR) after donation. Calcification propensity (T50) can be determined by a blood test predicting all‐cause mortality in patients with chronic kidney disease. We studied the impact of kidney donation on T50 and markers of arterial stiffness. We analyzed T50 prospectively before and 1 year after kidney donation in 21 LKDs along with fetuin‐A, mineral metabolism markers, kidney length, pulse wave velocity (PWV), augmentation index (AI), and renal resistive index (RRI) as markers of arterial stiffness. We studied the impact of kidney donation on these parameters. LKDs were 54 ± 10 years old and had a GFR of 101 ± 18 ml/min/1.73 m2 before donation, decreasing to 67 ± 8 ml/min/1.73 m2 after donation (P < 0.001). Despite this, T50 improved after donation (290 ± 53 to 312 ± 38 min, P = 0.049). This change was inversely related to plasma phosphate (P = 0.03), which declined after donation (P = 0.002). Fetuin‐A levels increased after donation (P = 0.01). Upon donation, the length of the remaining kidney increased (P < 0.001) while PWV, AI, and RRI remained unchanged. Calcification propensity was not adversely affected by kidney donation. This indicates that T50 is independent from GFR in LKDs and that kidney donation does neither worsen calcification propensity nor markers of vascular stiffness at 1 year. 相似文献
19.
ILONA KURNATOWSKA PIOTR GRZELAK LUDOMIR STEFAŃCZYK MICHAŁ NOWICKI 《Nephrology (Carlton, Vic.)》2010,15(2):184-189
Aim: Both vascular calcification and atherosclerosis are highly prevalent in patients with end‐stage renal disease (ESRD) and have been associated with increased cardiovascular morbidity. Because those two phenomena might be only coincidentally related in chronic haemodialysis (HD) patients, in this study, coronary artery calcification (CAC), common carotid artery intima media thickness (CCA‐IMT) and thickness of atherosclerotic plaques in the carotid artery were simultaneously measured. Methods: In a cross‐sectional study of 47 HD patients (31 male, mean age 56.8 ± 11.4 years, and 16 female, mean age 56.0 ± 7.5 years) without history of major cardiovascular complications. CCA‐IMT and presence and thickness of atherosclerotic plaques were measured with ultrasound and CAC with multidetector computed tomography. Results: The CAC were present in 70.2% of patients. The mean CAC was 1055 ± 232, the mean CCA‐IMT was 0.96 ± 0.21. The atherosclerotic plaques in the common carotid arteries were visualized in 38 patients (80.1%), the mean thickness of the atherosclerotic plaque was 1.61 ± 0.8 mm. We found a significant positive correlation between CAC and CCA‐IMT (r = 0.70, P < 0.001). The thickness of atherosclerosis plaque positively correlated with CAC as well as with CCA‐IMT (r = 0.60, P < 0.001 and r = 0.7, P < 0.003, respectively). Conclusion: The study revealed close relationships between CAC, intima media thickness and the thickness of atherosclerotic plaques in dialysis patients. It may indicate that both vascular calcification and atherosclerotic lesions frequently coexist in patients with ESRD and that the intima media thickness could serve as a surrogate marker of vascular calcification. 相似文献
20.
Kai Zhang Song-Bo Dong Xu-Dong Pan Yi Lin Kai Zhu Jun Zheng Li-Zhong Sun 《Asian journal of surgery / Asian Surgical Association》2021,44(7):945-951
BackgroundIn this study, we investigated the impact of concomitant coronary artery bypass grafting (CABG) on operative and midterm mortality in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair.MethodsFrom January 2012 to December 2014, among 489 patients (mean age: 47.6 ± 10.4 years, 77.1% male) with ATAAD who received surgical repair at our institute, 21 patients (4.3%) underwent concomitant CABG. Isolated aortic repair was performed in the remaining 468 cases (95.7%). Coronary dissection was indicated in 15 patients (Neri classification type B in 2, type C in 13), concomitant coronary artery disease in five and coronary artery compression in one. The follow-up time was 97.3% at 44.1 ± 13.9 months.ResultsA total of 44 patients (9%) died from surgery, and operative mortality in the concomitant CABG group was significantly higher than that in the isolated aortic repair group (47.6%, 10/21 vs. 7.3%, 34/468; P < 0.001). Among the 11 survivors in the concomitant CABG group, no deaths occurred during the follow-up. Cox regression indicated that concomitant CABG increased the operative mortality risk by 9.2 times (HR, 9.26; 95% CI, 4.31–19.89; P < 0.001). Although it predicted a 5.2-fold increase in overall mortality (HR, 5.20; 95% CI, 2.55–10.61; P < 0.001), concomitant CABG did not affect midterm death (P = 0.996).ConclusionsConcomitant CABG carries a significant operative risk in ATAAD patients undergoing surgical repair. However, survivors may benefit from concomitant CABG and had similar midterm mortality compared with the other cases. 相似文献