24 research outputs found

    Αποτελεσματικότητα της ενδοαγγειακής λιθοτριψίας (IVL) σε στεφανιαίες και περιφερικές αρτηρίες με σοβαρή ασβεστοποίηση και η χρήση της στη διαδικασία TAVI: Συστηματική ανασκόπηση και μετα-ανάλυση

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    Εισαγωγή: Οι βαριά ασβεστοποιημένες βλάβες της στεφανιαίας και της περιφερικής αρτηρίας εμποδίζουν την κατάλληλη ανάπτυξη και επέκταση του στεντ, αυξάνοντας τον κίνδυνο επιπλοκών. Η τεχνολογία Ενδαγγειακής Λιθοτριψίας (IVL) διαταράσσει την υποενδοθηλιακή ασβεστοποίηση χρησιμοποιώντας εντοπισμένα παλμικά κύματα ηχητικής πίεσης και είναι μια πολλά υποσχόμενη τεχνική για ασθενείς με σοβαρή ασβεστοποίηση τόσο στις στεφανιαίες όσο και στις περιφερικές αρτηρίες. Σκοπός: Σκοπός μας ήταν η συστηματική ανασκόπηση και σύνοψη των διαθέσιμων δεδομένων σχετικά με την ασφάλεια και την αποτελεσματικότητα της IVL στην παρασκευή σοβαρά ασβεστοποιημένων πλακών σε στεφανιαίες και περιφερικές αρτηρίες πριν από την τοποθέτηση στεντ και τη χρήση της στην εμφύτευση διακαθετηριακής αορτικής βαλβίδας (TAVI). Μέθοδοι: Αυτή η μελέτη διεξήχθη σύμφωνα με τις οδηγίες PRISMA. Αναζητήσαμε συστηματικά τις βάσεις δεδομένων PubMed, SCOPUS και Cochrane από την έναρξή τους έως τις 4 Ιανουαρίου 2022, για μελέτες που αξιολογούν τα χαρακτηριστικά και τα αποτελέσματα ασθενών που υποβλήθηκαν σε IVL πριν από την εμφύτευση στεντ. Η διάμετρος του αυλού του αγγείου πριν και μετά την IVL καθώς και την εμφύτευση στεντ αναλύθηκαν. Η εμφάνιση σημαντικών ανεπιθύμητων καρδιαγγειακών συμβάντων (MACE) αξιολογήθηκε χρησιμοποιώντας ένα μοντέλο τυχαίων επιδράσεων. Αποτελέσματα: Αποτελέσματα: Αυτή η μετα-ανάλυση περιελάμβανε 38 μελέτες συμπεριλαμβανομένων 2.977 ασθενών με βαριά ασβεστοποιημένες στεφανιαίες βλάβες. Η μέση ηλικία ήταν 72,2 ± 9,1 έτη, με συνολική κλινική επιτυχία IVL 93% και ποσοστό διαδικαστικής επιτυχίας 97%, ενώ η ενδονοσοκομειακή και 30ήμερη επίπτωση του MACE, του εμφράγματος του μυοκαρδίου (MI) και του θανάτου ήταν 8%, 5% και 2% αντίστοιχα. Υπήρξε σημαντική αύξηση στη διάμετρο του αγγείου και μείωση στη στένωση της διαμέτρου αμέσως μετά την εφαρμογή IVL, ενώ παρατηρήθηκε περαιτέρω μείωση της στένωσης διαμέτρου και αύξηση της διαμέτρου του αγγείου και η υπολογισμένη περιοχή αυλού, μετά την εμφύτευση στεντ. Το μέσο οξύ κέρδος στον αυλό μετά την IVL και την εμφύτευση στεντ υπολογίστηκε ότι ήταν 1,27 ± 0,6 mm και 1,94 ± 1,1 mm, αντίστοιχα. Οι περιεγχειρητικές επιπλοκές ήταν σπάνιες, με λίγες μόνο περιπτώσεις διατρήσεων, φαινομένων ανατομής ή μη επαναρροής. Αναλύθηκαν 20 μελέτες με συνολικά 1.223 ασθενείς με βαριά ασβεστοποιημένες περιφερικές βλάβες. Η μέση ηλικία της κοόρτης ήταν 70,6 ± 17,4 έτη. Επιτυχής IVL παράδοση επιτεύχθηκε στο 100%, με αύξηση της διαμέτρου του αυλού και μείωση της διαμέτρου στένωσης, και συνοδό χαμηλό ποσοστό επιπλοκών. Η διαδικασία ήταν ελεύθερη από ανατομή στο 97% ενώ ανατομές οποιουδήποτε τύπου (A, B, C, ή D) παρατηρήθηκαν στο 6% των ασθενών. Καταγράφηκαν αρκετές σπάνιες περιπτώσεις απότομου κλεισίματος, φαινομένου μη επαναρροής, διάτρησης, σχηματισμού θρόμβου και άπω εμβολισμού. Τέλος, η ανάλυση υποομάδας ασθενών που υποβλήθηκαν σε TAVI με βοήθεια IVL παρουσίασε επιτυχή εμφύτευση στο 100% των περιπτώσεων, με μόνο το 4% παρουσιάζοντας ανατομές κάθε είδους. Συμπεράσματα: Η IVL φαίνεται να είναι μια αποτελεσματική και ασφαλής τεχνική για την προετοιμασία σοβαρά ασβεστοποιημένων βλαβών πριν από την εμφύτευση στεντ σε στεφανιαίες και περιφερικές αρτηρίες. Απαιτούνται μελλοντικές προοπτικές μελέτες για την επικύρωση των αποτελεσμάτων μας.Introduction: Heavily calcified coronary and peripheral artery lesions impede appropriate stent deployment and expansion, increasing the risk of complications. Intravascular Lithotripsy (IVL) technology disrupts subendothelial calcification by using localized pulsative sonic pressure waves and is a promising technique for patients with severe calcification in both the coronary and peripheral arteries. Purpose: Our aim was to systematically review and summarize available data regarding the safety and efficacy of IVL in preparing severely calcified plaques in coronary and peripheral arteries before stenting and its use in Transcatheter Aortic Valve Implantation (TAVI). Methods: This study was conducted according to the PRISMA guidelines. We systematically searched PubMed, SCOPUS, and Cochrane databases from their inception to January 4, 2022, for studies assessing the characteristics and outcomes of patients undergoing IVL before stent implantation. The diameter of the vessel lumen before and after IVL as well as stent implantation were analyzed. The occurrence of major adverse cardiovascular events (MACE) were assessed using a random-effects model. Results: This meta-analysis comprised 38 studies including 2,977 patients with heavily calcified coronary lesions. The mean age was 72.2 ± 9.1 years, with an overall IVL clinical success of 93% and procedural success rate of 97%, while the in-hospital and 30-days incidence of MACE, myocardial infarction (MI) and death were 8%, 5% and 2%, respectively. There was a significant increase in the vessel diameter and a decrease in diameter stenosis immediately after IVL application, while it was observed further reduction in diameter stenosis and increase in the vessel diameter and the calculated lumen area, after stent implantation. The mean acute luminal gain following IVL and stent implantation was estimated to be 1.27 ± 0.6 mm and 1.94 ± 1.1 mm, respectively. Peri-procedural complications were rare, with just a few cases of perforations, dissection, or no-reflow phenomena recorded. 20 studies with a total of 1,223 patients with heavily calcified peripheral lesions were analyzed. The mean age of the cohort was 70.6 ± 17.4 years. Successful IVL delivery achieved in 100%, with an increase in the luminal diameter and reduction in diameter stenosis, and a concomitant low rate of complications. The procedure was free from dissection in 97% while dissections of any type (A, B, C, or D) were observed in 6% of the patients. Several rare cases of abrupt closure, no-reflow phenomenon, perforation, thrombus formation, and distal embolization were recorded. Finally, the subgroup analysis of patients who underwent a TAVI with IVL assistance presented successful implantation in 100% of the cases, with only 4% presenting dissections of any sort. Conclusions: IVL seems to be an effective and safe technique for preparing severely calcified lesions before stent implantation in coronary and peripheral arteries. Future prospective studies are needed to validate our results

    Revascularization approaches in patients with radiation-induced carotid stenosis: an updated systematic review and meta-analysis

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    Background: Ionizing radiation remains a well-known risk factor of carotid artery stenosis. The survival rates of head and neck cancer patients undergoing radiotherapy have risen owing to medical advancements in the field. As a consequence, the incidence of carotid artery stenosis in these high-risk patients has increased.Aims: In this study we sought to compare the outcomes of carotid endarterectomy (CEA) vs carotid artery stenting (CAS) for radiation-induced carotid artery stenosis.Methods: This study was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Eligible studies were identified through a comprehensive search of PubMed, Scopus and Cochrane Central until July 2020. A random-effects model meta-analysis was conducted, and odds ratios (ORs) were calculated. The I-square statistic was used to assess for heterogeneity.Results: Seven studies and 201 patients were included. Periprocedural stroke, myocardial infarction (MI), and death rates were similar between the two revascularization approaches. However, the risk for cranial nerve (CN) injury was higher in the CEA group (OR, 7.40; 95% CI, 1.58–34.59; I2 = 0%). Analysis revealed no significant difference in terms of long-term mortality (OR, 0.41; 95% CI, 0.14–1.16; I2 = 0%) and restenosis rates (OR, 0.69; 95% CI, 0.29–1.66; I2 = 0%) between CEA and CAS after a mean follow-up of 40.5 months.Conclusions: CAS and CEA appear to have a similar safety and efficacy profile in patients with radiation-induced carotid artery stenosis. Patients treated with CEA have a higher risk for periprocedural CN injuries. Future prospective studies are warranted to validate these results

    Genetic Predisposition and Inflammatory Inhibitors in COVID-19: Where Do We Stand?

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    Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) and the resulting coronavirus disease-19 (COVID-19) have led to a global pandemic associated with high fatality rates. COVID-19 primarily manifests in the respiratory system as an acute respiratory distress syndrome following viral entry through the angiotensin-converting enzyme-2 (ACE2) that is present in pulmonary epithelial cells. Central in COVID-19 is the burst of cytokines, known as a “cytokine storm”, and the subsequent widespread endothelial activation, leading to cardiovascular complications such as myocarditis, arrhythmias, and adverse vascular events, among others. Genetic alterations may play an additive, detrimental role in the clinical course of patients with COVID-19, since gene alterations concerning ACE2, major histocompatibility complex class I, and toll-like receptors may predispose patients to a worse clinical outcome. Since the role of inflammation is quintessential in COVID-19, pharmacologic inhibition of various signaling pathways such as the interleukin-1 and -6, tumor necrosis factor-alpha, interferon gamma, Janus kinase-signal transducer and activator of transcription, and granulocyte–macrophage colony-stimulating factor may ameliorate the prognosis following timely administration. Finally, frequently used, non-specific anti-inflammatory agents such as corticosteroids, statins, colchicine, and macrolides represent additional therapeutic considerations

    Vascular Alterations Following COVID-19 Infection: A Comprehensive Literature Review

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    SARS-CoV-2, the causative agent of the ongoing COVID-19 pandemic, has revealed a broader impact beyond the respiratory system, predominantly affecting the vascular system with various adverse manifestations. The infection induces endothelial dysfunction and immune system dysregulation, creating an inflammatory and hypercoagulable state. It affects both microvasculature and macrovasculature, leading to thromboembolic events, cardiovascular manifestations, impaired arterial stiffness, cerebrovascular complications, and nephropathy, as well as retinopathy—frequently observed in cases of severe illness. Evidence suggests that SARS-CoV-2 infection may result in persistent effects on the vascular system, identified as long-term COVID-19. This is characterized by prolonged inflammation, endotheliopathy, and an increased risk of vascular complications. Various imaging modalities, histopathological studies, and diagnostic tools such as video capillaroscopy and magnetic resonance imaging have been employed to visualize vascular alterations. This review aims to comprehensively summarize the evidence concerning short and long-term vascular alterations following COVID-19 infection, investigating their impact on patients’ prognosis, and providing an overview of preventive strategies to mitigate associated vascular complications

    Telomere Length: A Cardiovascular Biomarker and a Novel Therapeutic Target

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    Coronary artery disease (CAD) is a multifactorial disease with a high prevalence, particularly in developing countries. Currently, the investigation of telomeres as a potential tool for the early detection of the atherosclerotic disease seems to be a promising method. Telomeres are repetitive DNA sequences located at the extremities of chromosomes that maintain genetic stability. Telomere length (TL) has been associated with several human disorders and diseases while its attrition rate varies significantly in the population. The rate of TL shortening ranges between 20 and 50 bp and is affected by factors such as the end-replication phenomenon, oxidative stress, and other DNA-damaging agents. In this review, we delve not only into the pathophysiology of TL shortening but also into its association with cardiovascular disease and the progression of atherosclerosis. We also provide current and future treatment options based on TL and telomerase function, trying to highlight the importance of these cutting-edge developments and their clinical relevance

    Comparative efficacy and safety of mineralocorticoid receptor antagonists in patients with heart failure and reduced ejection fraction: a systematic review and network meta-analysis

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    The primary objectives of the present study will be to assess the comparative efficacy and safety of different mineralocortiocoid receptor antagonists (MRAs) on hard and surrogate outcomes in patients with heart failure (HF) with reduced ejection fraction (HFrEF) and a left ventricular ejection fraction (LVEF) of no more than 45%

    Non-Invasive Modalities in the Assessment of Vulnerable Coronary Atherosclerotic Plaques

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    Coronary atherosclerosis is a complex, multistep process that may lead to critical complications upon progression, revolving around plaque disruption through either rupture or erosion. Several high-risk features are associated with plaque vulnerability and may add incremental prognostic information. Although invasive imaging modalities such as optical coherence tomography or intravascular ultrasound are considered to be the gold standard in the assessment of vulnerable coronary atherosclerotic plaques (VCAPs), contemporary evidence suggests a potential role for non-invasive methods in this context. Biomarkers associated with deleterious pathophysiologic pathways, including inflammation and extracellular matrix degradation, have been correlated with VCAP characteristics and adverse prognosis. However, coronary computed tomography (CT) angiography has been the most extensively investigated technique, significantly correlating with invasive method-derived VCAP features. The estimation of perivascular fat attenuation as well as radiomic-based approaches represent additional concepts that may add incremental information. Cardiac magnetic resonance imaging (MRI) has also been evaluated in clinical studies, with promising results through the various image sequences that have been tested. As far as nuclear cardiology is concerned, the implementation of positron emission tomography in the VCAP assessment currently faces several limitations with the myocardial uptake of the radiotracer in cases of fluorodeoxyglucose use, as well as with motion correction. Moreover, the search for the ideal radiotracer and the most adequate combination (CT or MRI) is still ongoing. With a look to the future, the possible combination of imaging and circulating inflammatory and extracellular matrix degradation biomarkers in diagnostic and prognostic algorithms may represent the essential next step for the assessment of high-risk individuals

    Factors Associated with Platelet Activation-Recent Pharmaceutical Approaches

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    Platelets are at the forefront of human health and disease following the advances in their research presented in past decades. Platelet activation, their most crucial function, although beneficial in the case of vascular injury, may represent the initial step for thrombotic complications characterizing various pathologic states, primarily atherosclerotic cardiovascular diseases. In this review, we initially summarize the structural and functional characteristics of platelets. Next, we focus on the process of platelet activation and its associated factors, indicating the potential molecular mechanisms involving inflammation, endothelial dysfunction, and miRs. Finally, an overview of the available antiplatelet agents is being portrayed, together with agents possessing off-set platelet-inhibitory actions, while an extensive presentation of drugs under investigation is being given

    Genetic Predisposition and Inflammatory Inhibitors in COVID-19: Where Do We Stand?

    No full text
    Severe acute respiratory syndrome Coronavirus-2 (SARS-CoV-2) and the resulting coronavirus disease-19 (COVID-19) have led to a global pandemic associated with high fatality rates. COVID-19 primarily manifests in the respiratory system as an acute respiratory distress syndrome following viral entry through the angiotensin-converting enzyme-2 (ACE2) that is present in pulmonary epithelial cells. Central in COVID-19 is the burst of cytokines, known as a “cytokine storm”, and the subsequent widespread endothelial activation, leading to cardiovascular complications such as myocarditis, arrhythmias, and adverse vascular events, among others. Genetic alterations may play an additive, detrimental role in the clinical course of patients with COVID-19, since gene alterations concerning ACE2, major histocompatibility complex class I, and toll-like receptors may predispose patients to a worse clinical outcome. Since the role of inflammation is quintessential in COVID-19, pharmacologic inhibition of various signaling pathways such as the interleukin-1 and -6, tumor necrosis factor-alpha, interferon gamma, Janus kinase-signal transducer and activator of transcription, and granulocyte–macrophage colony-stimulating factor may ameliorate the prognosis following timely administration. Finally, frequently used, non-specific anti-inflammatory agents such as corticosteroids, statins, colchicine, and macrolides represent additional therapeutic considerations

    Atrial Fibrillation: Pathogenesis, Predisposing Factors, and Genetics

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    Atrial fibrillation (AF) is the most frequent arrhythmia managed in clinical practice, and it is linked to an increased risk of death, stroke, and peripheral embolism. The Global Burden of Disease shows that the estimated prevalence of AF is up to 33.5 million patients. So far, successful therapeutic techniques have been implemented, with a high health-care cost burden. As a result, identifying modifiable risk factors for AF and suitable preventive measures may play a significant role in enhancing community health and lowering health-care system expenditures. Several mechanisms, including electrical and structural remodeling of atrial tissue, have been proposed to contribute to the development of AF. This review article discusses the predisposing factors in AF including the different pathogenic mechanisms, sedentary lifestyle, and dietary habits, as well as the potential genetic burden
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