Cola Beverages Accelerate Growth of the Atherosclerotic Plaque in ApoE-/- Mice

Introducción: Los hábitos de alimentación poco saludables durante la infancia y la juventud se han suge­rido como favorecedores de las complicaciones ateroscleróticas en edades más avanzadas. El creciente consumo de bebidas cola en las últimas décadas se ha asociado con el desarrollo de obesidad e incremento en la incidencia de aterosclerosis y enfermedades cardiovasculares. A su vez, se sabe que existe correspondencia entre el consumo de estas bebidas y etapas de la vida, el cual es mayor en los niños, los adolescentes y los adultos jóvenes. Objetivo: Evaluar el efecto del consumo de bebidas cola sobre la aterosclerosis. Material y métodos: Se distribuyeron ratones ApoE-/- (8 semanas de edad) en tres grupos según el consumo libre de agua (A), bebida cola azucarada (C) y bebida cola edulcorada light (L). Al cabo de 8 semanas las bebidas cola se reemplazaron por agua. Los ratones fueron sacrificados secuencialmente: antes del tratamiento (8 semanas de edad) y luego de su interrupción (16, 20, 24 y 30 semanas de edad). Se extrajeron la aorta ascendente y el hígado. Se calculó la relación entre el área de la placa aórtica y el espesor de la capa media (relación placa/media). Se evaluó la inflamación del parénquima hepático según la escala de NASH. Resultados: La relación placa/media varió según la bebida (F2,54 = 3,433, p < 0,04) y la edad (F4,54 = 5,009, p < 0,03) y fue mayor en los grupos C y L (p < 0,05 a las 16 y 20 semanas, p < 0,01 a las 24 y 30 semanas). La inflamación del parénquima hepático (F2,9 = 13,29, p < 0,002) y portal (F2,9 = 6,30, p < 0,02) aumentó cinco y dos veces, respectivamente, en función del tiempo (p < 0,01 y p < 0,03) entre las semanas 20 y 30, en contraste con la esteatosis y el daño hepatocelular, que no se modificaron. El grupo A (evolución natural de la aterosclerosis) se caracterizó por la aceleración del crecimiento del área de placa en paralelo con un rápido aumento de la inflamación hepática alrededor de la semana 20. Conclusiones: El consumo de bebidas cola en ratones ApoE-/- entre las semanas 8 y 16 de edad aumentó la tasa de progresión de la aterosclerosis. Los datos sugieren que, en este modelo murino, el consumo sostenido de bebidas cola durante las etapas tempranas de la vida puede acelerar el agravamiento del daño aterosclerótico en etapas más tardíasIntroduction: Unhealthy eating habits during childhood and youth have been suggested as predisposing factors to atherosclerotic complications later in life. The growing consumption of cola beverages in recent decades has been associated with the development of obesity and increased incidence of atherosclerosis and cardiovascular disease. We also know that there is a correspondence between the consumption of these beverages and the different stages of life, being higher in children, adolescents and young adults. Objective: This study evaluates the effect of cola beverage consumption on atherosclerosis. Methods: ApoE-/- mice (8 week-old) were randomized into 3 groups according to free access to water (W), sucrose sweetened carbonated cola drink (C) or aspartame-acesulfame K sweetened carbonated ‘light' cola drink (L). At 8 weeks cola beverages were switched to water. The mice were sequentially euthanized: before treatment (8 week old mice) and after treatment discontinuation (20, 24, and 30 week old mice). The ascending aorta and the liver were removed. Aortic plaque area was analyzed and plaque/media-ratio was calculated. Hepatic inflammation was assessed according to the NASH scale. Results: Plaque/media-ratio varied according to drink treatment (F2,54=3.433, p <0.04) and age (F4,54=5.009, p <0.03) and was higher in the C and L groups (p <0.05 at 16 and 20 weeks, p <0.01 at 24 and 30 weeks). Hepatic parenchymal inflammation (F2,9=13.29, p <0.002) and portal inflammation (F2,9 =6.30, p <0.02) varied fivefold and twofold in contrast to steatosis and hepatocellular damage which remained unchanged throughout the study.Natural evolution of atherosclerosis in ApoE-/- mice (W group) evidenced acceleration of plaque growth in parallel with a rapid increase in hepatic inflammation around week 20 of age. Conclusions: Cola beverage consumption in 8-16 week old ApoE-/- mice accelerated atherosclerosis progression. Data suggest that, in this murine model, sustained cola consumption at early stages of life may predispose to atherosclerosis progression later in life.Fil: Serafini, Enriqueta M.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Otero Losada, Matilde E.. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Cao, Gabriel Fernando. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Aguilera, Jimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Muller, Angelica del Carmen. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Ottaviano, Graciela Mabel. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Azzato, Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); ArgentinaFil: Milei, Jose. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas (i); Argentin

Reduced risk of myocardial infarct and revascularization following coronary artery bypass grafting compared with percutaneous coronary intervention in patients with chronic kidney disease

Coronary atherosclerotic disease is highly prevalent in chronic kidney disease (CKD). Although revascularization improves outcomes, procedural risks are increased in CKD and unbiased data comparing bypass surgery (CABG) and percutaneous intervention (PCI) in CKD are sparse. To compare outcomes of CABG and PCI in stage 3-5 CKD, we identified randomized trials comparing these procedures. Investigators were contacted to obtain individual, patient-level data. Ten of 27 trials meeting inclusion criteria provided data. These trials enrolled 3993 patients encompassing 526 patients with stage 3-5 CKD of which 137 were stage 3b-5 CKD. Among individuals with stage 3-5 CKD survival through 5-years was not different following CABG compared with PCI (hazard ratio 0.99, 95% confidence interval: 0.67, 1.46) or stage 3b-5 CKD (1.29: 0.68, 2.46). However, CKD modified the impact on survival free from myocardial infarction: it was not different between CABG and PCI for individuals with preserved kidney function (0.97: 0.80, 1.17), but was significantly lower following CABG in stage 3-5 CKD (0.49: 0.29, 0.82) and stage 3b-5 CKD (0.23: 0.09, 0.58). Repeat revascularization was reduced following CABG compared with PCI regardless of baseline kidney function. Results were limited by unavailability of data from several trials and paucity of enrolled patients with stage 4-5 CKD. Thus, our patient-level meta-analysis of individuals with CKD randomized to CABG versus PCI suggests that CABG significantly reduces the risk of subsequent myocardial infarction and revascularization without impacting survival in these patients

Asociación entre patrones de llenado ventricular y extensión del realce tardío por resonancia magnética en pacientes con miocardiopatía hipertrófica

Objective To explore the relationship between ventricular filling curves and the extent of late enhancement on cardiac magnetic resonance imaging (MRI) in patients with hypertrophic cardiomyopathy. Material and methods We retrospectively included consecutive patients with suspected and/or confirmed hypertrophic cardiomyopathy and a control group of patients matched for age and sex who underwent cardiac MRI with evaluation of late enhancement. Among other determinations, we evaluated the following parameters on cine sequences: peak filling rate, time to the first peak filling rate, and filling rate normalized to the filling volume. Results Late enhancement was observed in 29 (73%) of the 40 patients with hypertrophic cardiomyopathy. The normalized peak filling rate was significantly lower in patients with late enhancement (4.9  ±  1.6 in those with hypertrophic cardiomyopathy positive for late enhancement vs. 5.8  ±  2.2 in those with hypertrophic cardiomyopathy negative for late enhancement vs. 6.3  ±  1.5 in controls, p  =  0.008) and the time to peak filling was longer in patients with late enhancement (540.6  ±  89.7 ms vs. 505.5  ±  99.3 ms in those with hypertrophic cardiomyopathy negative for late enhancement vs. 486.9  ±  86.3 ms in controls, p  =  0.02). When the population was stratified into three groups in function of the normalized peak filling rate, significant differences were observed among groups for age (p  =  0.002), mean wall thickness (p  =  0.036), and myocardial mass (p  =  0.046) and atrial dimensions, whereas no significant differences with respect to late enhancement were seen. Conclusions In patients with hypertrophic cardiomyopathy, we found a significant association between ventricular filling patterns and age, wall thicknesses, and atrial dimensions, but not with the extent of late enhancement.Objetivo Explorar mediante resonancia magnética cardíaca la relación entre las curvas de llenado ventricular y la extensión del realce tardío (RT) en pacientes con miocardiopatía hipertrófica. Material y métodos Se incluyeron de forma retrospectiva pacientes consecutivos con sospecha y/o diagnóstico de miocardiopatía hipertrófica, y un grupo control de pacientes pareados según sexo y edad en quienes se realizó una resonancia magnética cardíaca con valoración de RT. Entre otras determinaciones, se evaluaron mediante secuencias cine: tasa de llenado pico, tiempo a la primera tasa de llenado pico y tasa de llenado pico normalizada al volumen de llenado. Resultados De los 40 pacientes con miocardiopatía hipertrófica, 29 (73%) presentaron RT. Se evidenciaron diferencias significativas respecto a la tasa de llenado pico normalizada (RT positivo 4,9 ± 1,6, vs. RT negativo 5,8 ± 2,2, vs. control 6,3 ± 1,5, p = 0,008) y al tiempo a la tasa de llenado pico (540,6 ± 89,7 ms, vs. 505,5 ± 99,3 ms, vs. 486,9 ± 86,3 ms, p = 0,02). Al estratificar la población en tercios según la tasa de llenado pico normalizada al volumen de llenado se registraron diferencias significativas entre los grupos respecto a la edad (p = 0,002), espesor parietal medio (p = 0,036), masa miocárdica (p = 0,046) y dimensiones auriculares, mientras que no se observaron diferencias significativas respecto al RT. Conclusiones En pacientes con miocardiopatía hipertrófica encontramos una asociación significativa entre patrones de llenado ventricular y edad, espesores parietales y dimensiones auriculares, mientras que no se identificó una relación significativa con la extensión del RT.Fil: De Zan, M.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; ArgentinaFil: Carrascosa, P.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; ArgentinaFil: Deviggiano, A.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; ArgentinaFil: Capunay, C.. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Departamento de Estudios Cardiovasculares no Invasivos de Diagnóstico; Argentin

Impact on mortality of coronary and non-coronary cardiovascular findings in non-gated thoracic CT by malignancy status

Purpose: The prognostic value of coronary artery calcification (CAC) assessed on non-gated thoracic CT scans has only been explored in population-based studies. We explored the impact of the presence and extension of CAC, as well as of non-coronary atherosclerosis cardiovascular findings (NCACVF) in survival of patients with and without malignancies undergoing clinically indicated non-gated thoracic computed tomography (CT) scans. Materials and methods: Between August and December 2012, a total of 1.901 patients aged between 35 and 74 years underwent clinically indicated non-gated, non-enhanced thoracic CT scans and followed for mortality through September 2016. Results: Three hundred and thirty two (17.5%), 250 (13.2%), and 329 (17.3%) patients showed CAC in 1, 2, and 3 vessels, respectively, and the remaining had no CAC. Two hundred and fifty five (13.4%) patients had evidence of extensive calcification (CACSIS > 5). Only 62 (3.3%) had major NCACVF whereas 1635 (86%) had none or minimal NCACVF. After a median follow-up of 3.7 (3.5–3.9) years, 217 (11.4%) deaths occurred. Age [HR 1.03 (95% CI 1.01–1.05), p = 0.001], a history of malignancy [HR 8.04 (95% CI 5.95-10.9), p < 0.0001], and the NCACVF class [HR 1.79 (95% CI 1.45-2.19), p < 0.0001] were identified as independent predictors of death. CACSIS was found an independent predictor of death only among patients without malignancy (HR 1.10 (95% CI 1.02–1.20), p = 0.019). Conclusions: In this study including clinically indicated non-gated standard thoracic CT scans, survival rates were associated to the CAC extension among patients without malignancy, and to the NCACVF class independent from the malignancy status.Fil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; ArgentinaFil: Reynoso, Exequiel. Diagnóstico Maipú; ArgentinaFil: Capunay, Carlos. Diagnóstico Maipú; ArgentinaFil: Garcia Garcia, Héctor M.. Medstar Washington Hospital Center; Estados UnidosFil: Carrascosa, Patricia. Diagnóstico Maipú; Argentin

Defining the non-vulnerable and vulnerable patients with computed tomography coronary angiography: evaluation of atherosclerotic plaque burden and composition.

The shift from coronary plaque stability to plaque instability remains poorly understood despite enormous efforts and expenditures have been assigned to the study of the subject. On the other hand, there have been serious advances in imaging helping us to characterizenon-vulnerable patients The latter has much more value in the clinical decision-making process since it provides high certainty that the patient´s probability of a future acute event is low and treatment decisions should be made accordingly. Although coronary plaque rupture is still recognized as the main source of acute thrombotic events, numerous studies have shown that the prediction of events on an individual basis is far more complex and demands a more open approach aimed at characterizing patient risk rather than assessing the risk of thrombosis of a single plaque. Computed tomography coronary angiography (CTCA) has the ability to evaluate non-invasively the extent, burden, severity, and characteristics of coronary artery disease (CAD) and has a close relationship to intravascular ultrasound. On the basis of an excellent negative predictive value with an annualized event rate of ∼0.20% assessed over more than 6000 patients, thus providing a 5-year warranty period, CTCA has been identified as the finest non-invasive tool to exclude CAD. This means that CTCA is able to reliably characterize the non-vulnerable patient. Conversely, in the past few years, several studies have attempted to establish CTCA-derived predictors of acute coronary syndromes, both from a lesion level and a patient level basis with very low positive predictive value, thus questioning the vulnerable patient/plaque concept.Fil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Carrascosa, Patricia. Diagnóstico Maipú; ArgentinaFil: Bruining, Nico. Erasmus MC; Países BajosFil: Waksman, Ron. MedStar Washington Hospital Center; Estados UnidosFil: Garcia Garcia, Hector M.. MedStar Washington Hospital Center; Estados Unido

Relationship between left atrial dimensions and global and regional fat depots

Antecedentes y objetivos: La relación entre los depósitos de grasa corporal y las dimensiones de la aurícula izquierda (AI) no ha sido del todo explorada. Nuestro objetivo es determinar si existe relación no solo con los depósitos de grasa corporal totales, sino específicamente con los depósitos grasos regionales. Materiales y métodos: Estudio observacional, retrospectivo, que incluyó pacientes consecutivos remitidos a nuestra institución con orden de realización de angiotomografía computarizada toracoabdominal gatillada con electrocardiograma por distintas indicaciones clínicas. Las mediciones de la AI se realizaron en la fase sistólica, utilizando vistas de cuatro y dos cámaras. Resultados: Se incluyeron un total de 87 pacientes. La edad media fue de 66.4 ± 12.5 años; un 67% de los sujetos fueron hombres. El volumen de la AI indexado por la superficie corporal fue de 48.0 ± 16.6 cm3/m2. Identificamos correlaciones significativas entre las dimensiones de la AI y la edad (p < 0.05). Sin embargo, no se evidenciaron correlaciones significativas entre las dimensiones de la AI y los distintos depósitos de grasa corporal, ya sea totales o regionales. Conclusiones: En este estudio, no identificamos relaciones significativas entre las dimensiones de la AI y los depósitos de grasa corporal globales o regionales.Background and Objectives: The relationship between body fat depots and the left atrial (LA) dimensions has not been fully explored. Our objective is to determine if there is a relationship not only with total body fat depots, but specifically with regional fatty depots. Materials and Methods: It was an observational, retrospective study that included consecutive patients referred to our institution with an order to perform computed tomography angiography triggered by electrocardiogram for different clinical indications. Measurements of the LA were made in the systolic phase, using four and two cameras views. Results: A total of 87 patients were included. The mean age was 66.4 ± 12.5 years; 67% were men. The LA volume indexed by the body surface area was 48.0 ± 16.6 cm3/m2. We identified significant correlations between the LA dimensions and the age (p < 0.05). However, no significant correlations were found between the LA dimensions and the body fat depots, either total or regional. Conclusions: In this study, we did not identify significant relationships between LA dimensions and global or regional body fat depots.Fil: de Zan, Macarena C.. Diagnostico Maipu, Buenos Aires; ArgentinaFil: Carrascosa, Patricia M.. Diagnostico Maipu, Buenos Aires; ArgentinaFil: Reynoso, Exequiel. Diagnostico Maipu, Buenos Aires; ArgentinaFil: Deviggiano, Alejandro. Diagnostico Maipu, Buenos Aires; ArgentinaFil: Deschle, Hector. Diagnostico Maipu, Buenos Aires; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay. Instituto de Investigaciones Cardiológicas. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Cardiológicas; Argentin

Incremental value of myocardial perfusion over coronary angiography by spectral computed tomography in patients with intermediate to high likelihood of coronary artery disease

Purpose: We sought to explore the diagnostic performance of dual energy computed tomography (DECT) for the evaluation of myocardial perfusion in patients with intermediate to high likelihood of coronary artery disease (CAD). Materials and methods: Consecutive patients with known or suspected CAD referred for myocardial perfusion imaging by single-photon emission computed tomography (SPECT) constituted the study population and were scanned using a DECT scanner equipped with gemstone detectors for spectral imaging, and a SPECT. The same pharmacological stress was used for both scans. Results: Twenty-five patients were prospectively included in the study protocol. The mean age was 63.4 ± 10.6 years. The total mean effective radiation dose was 7.5 ± 1.2 mSv with DECT and 8.2 ± 1.7 mSv with SPECT (p = 0.007). A total of 425 left ventricular segments were evaluated by DECT, showing a reliable accuracy for the detection of reversible perfusion defects [area under ROC curve (AUC) 0.84 (0.80-0.87)]. Furthermore, adding stress myocardial perfusion provided a significant incremental value over anatomical evaluation alone by computed tomography coronary angiography [AUC 0.70 (0.65-0.74), p = 0.003]. Conclusions: In this pilot investigation, stress myocardial perfusion by DECT demonstrated a significant incremental value over anatomical evaluation alone by CTCA for the detection of reversible perfusion defects.Fil: Carrascosa, Patricia M.. Diagnóstico Maipú; ArgentinaFil: Deviggiano, Alejandro. Diagnóstico Maipú; ArgentinaFil: Capunay, Carlos. Diagnóstico Maipú; ArgentinaFil: Campisi, Roxana. Diagnóstico Maipú; ArgentinaFil: López de Munain, Marina. Diagnóstico Maipú; ArgentinaFil: Vallejos, Javier. Diagnóstico Maipú; ArgentinaFil: Tajer, Carlos. Diagnóstico Maipú; ArgentinaFil: Rodriguez Granillo, Gaston Alfredo. Diagnóstico Maipú; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin