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PMID:29467161
Author:Siontis GC; Mavridis D; Greenwood JP; Coles B; Nikolakopoulou A; Jüni P; Salanti G; Windecker S
Address:Department of Cardiology, Bern University Hospital, Inselspital, Bern, Switzerland.
Title:Outcomes of non-invasive diagnostic modalities for the detection of coronary artery disease: network meta-analysis of diagnostic randomised controlled trials.
Source:BMJ; 360:k504, 2018 02 21.
ISSN:1756-1833
Country of publication:England
Language:eng
Abstract:OBJECTIVE: To evaluate differences in downstream testing, coronary revascularisation, and clinical outcomes following non-invasive diagnostic modalities used to detect coronary artery disease. DESIGN: Systematic review and network meta-analysis. DATA SOURCES: Medline, Medline in process, Embase, Cochrane Library for clinical trials, PubMed, Web of Science, SCOPUS, WHO International Clinical Trials Registry Platform, and Clinicaltrials.gov. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Diagnostic randomised controlled trials comparing non-invasive diagnostic modalities in patients presenting with symptoms suggestive of low risk acute coronary syndrome or stable coronary artery disease. DATA SYNTHESIS: A random effects network meta-analysis synthesised available evidence from trials evaluating the effect of non-invasive diagnostic modalities on downstream testing and patient oriented outcomes in patients with suspected coronary artery disease. Modalities included exercise electrocardiograms, stress echocardiography, single photon emission computed tomography-myocardial perfusion imaging, real time myocardial contrast echocardiography, coronary computed tomographic angiography, and cardiovascular magnetic resonance. Unpublished outcome data were obtained from 11 trials. RESULTS: 18 trials of patients with low risk acute coronary syndrome (n=11 329) and 12 trials of those with suspected stable coronary artery disease (n=22 062) were included. Among patients with low risk acute coronary syndrome, stress echocardiography, cardiovascular magnetic resonance, and exercise electrocardiograms resulted in fewer invasive referrals for coronary angiography than coronary computed tomographic angiography (odds ratio 0.28 (95% confidence interval 0.14 to 0.57), 0.32 (0.15 to 0.71), and 0.53 (0.28 to 1.00), respectively). There was no effect on the subsequent risk of myocardial infarction, but estimates were imprecise. Heterogeneity and inconsistency were low. In patients with suspected stable coronary artery disease, an initial diagnostic strategy of stress echocardiography or single photon emission computed tomography-myocardial perfusion imaging resulted in fewer downstream tests than coronary computed tomographic angiography (0.24 (0.08 to 0.74) and 0.57 (0.37 to 0.87), respectively). However, exercise electrocardiograms yielded the highest downstream testing rate. Estimates for death and myocardial infarction were imprecise without clear discrimination between strategies. CONCLUSIONS: For patients with low risk acute coronary syndrome, an initial diagnostic strategy of stress echocardiography or cardiovascular magnetic resonance is associated with fewer referrals for invasive coronary angiography and revascularisation procedures than non-invasive anatomical testing, without apparent impact on the future risk of myocardial infarction. For suspected stable coronary artery disease, there was no clear discrimination between diagnostic strategies regarding the subsequent need for invasive coronary angiography, and differences in the risk of myocardial infarction cannot be ruled out. SYSTEMATIC REVIEW REGISTRATION: PROSPERO registry no CRD42016049442.
Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW


  2 / 49689 MEDLINE  
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PMID:29381773
Author:Moradi N; Fadaei R; Emamgholipour S; Kazemian E; Panahi G; Vahedi S; Saed L; Fallah S
Address:Department of Clinical Biochemistry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Title:Association of circulating CTRP9 with soluble adhesion molecules and inflammatory markers in patients with type 2 diabetes mellitus and coronary artery disease.
Source:PLoS One; 13(1):e0192159, 2018.
ISSN:1932-6203
Country of publication:United States
Language:eng
Abstract:C1q/TNF-related protein 9 (CTRP9) is a paralogue of adiponectin with known favorable effects on lipid and glucose metabolism. A potential role of CTRP9 for regulation of endothelium function has been suggested by previous studies. However, no studies have examined the relation between serum CTRP9 levels and adhesion molecules in patients with type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD). The present study was conducted on 337 subjects who underwent coronary angiography and were categorized into four groups according to the presence of CAD and T2DM (control, CAD, T2DM and CAD+T2DM). Serum levels of CTRP9, adiponectin, sICAM-1, sVCAM-1, sE-Selectin, IL-6 and TNF-α were measured. It was found that the circulating CTRP9 levels were independently associated with increased risk of CAD and T2DM in addition to elevated levels of serum CTRP9 in CAD, T2DM and CAD+T2DM groups. A significant association of serum CTRP9 levels with adhesion molecules in CAD and T2DM patients as well as serum TNF-α levels in CAD individuals was noted. A significant relation between the circulating levels of CTRP9 and HOMA-IR in T2DM subjects was also observed. The results revealed increased circulating levels of CTRP9 in T2DM and CAD individuals which suggests a compensatory response to insulin resistance, inflammatory milieu and endothelial dysfunction; however, more studies are needed to confirm this.
Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
Name of substance:0 (Adiponectin); 0 (Biomarkers); 0 (C1QTNF9B protein, human); 0 (Cell Adhesion Molecules); 0 (Glycoproteins); 0 (Inflammation Mediators)


  3 / 49689 MEDLINE  
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PMID:29231014
Author:Wu FY; Tang XH; Gai LL; Kong XP; Hao B; Huang EW; Shi H; Sheng LH; Quan L; Liu SP; Luo B
Address:Department of Forensic Medicine, Zhongshan Medical College, Sun Yat-sen University, Guangzhou 510080, China.
Title:[Correlation between Genetic Variants and Polymorphism of Caveolin and Sudden Unexplained Death].
Source:Fa Yi Xue Za Zhi; 33(2):114-119, 2017 Apr.
ISSN:1004-5619
Country of publication:China
Language:chi
Abstract:OBJECTIVES: To explore the genetic variation sites of caveolin (CAV) and their correlation with sudden unexplained death (SUD). METHODS: The blood samples were collected from SUD group (71 cases), coronary artery disease (CAD) group (62 cases) and control group (60 cases), respectively. The genome DNA were extracted and sequencing was performed directly by amplifying gene coding region and exon-intron splicing region of and using PCR. The type of heritable variation of was confirmed and statistical analysis was performed. RESULTS: A total of 4 variation sites that maybe significative were identified in SUD group, and two were newfound which were : c.45C>T (T15T) and :c.512G>A (R171H), and two were SNP loci which were :c.246C>T (rs35242077) and :c.99C>T (rs1008642) and had significant difference ( <0.05) in allele and genotype frequencies between SUD and control groups. Forementioned variation sites were not found in CAD group. CONCLUSIONS: The variants of and may be correlated with a part of SUD group.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Caveolins)


  4 / 49689 MEDLINE  
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PMID:29231013
Author:Qian H; Shao Y; Li ZD; Zou DH; Qin ZQ; Wan L; Chen YJ
Address:Department of Forensic Medicine, Medical College of Soochow University, Suzhou 215123, China.
Title:[Diagnostic Value of Postmortem CT Angiography in Coronary Atherosclerosis].
Source:Fa Yi Xue Za Zhi; 33(2):109-113, 2017 Apr.
ISSN:1004-5619
Country of publication:China
Language:chi
Abstract:OBJECTIVES: To explore the application value of postmortem computed tomography (CT) angiography on diagnosis of coronary atherosclerotic stenosis degree. METHODS: Based on the previous experimental results, the postmortem CT angiography device of human isolated heart was improved. Different coronary atherosclerotic stenosis degree of sudden death cases was selected. Before the cardiac anatomy, hearts were removed out completely and CT angiography was performed immediately. The CT angiography results were compared with histopathological findings. Meanwhile, the advantages and disadvantages of the angiography device before and after improvement were compared. RESULTS: The improved angiography device of isolated heart could get better imaging results. The postmortem CT angiography results had high consistency with the histopathological findings on diagnosis of coronary atherosclerotic stenosis degree. And the coronary artery lesions could be revealed more objectively and vividly by 3D reconstruction technology. However, CT angiography could only be used to examine the pathological changes of blood vessels, which might have some limitations on the diagnosis of cause of death. CONCLUSIONS: Postmortem CT angiography can be used as an additional method for the conventional autopsy in the cases of coronary atherosclerosis.
Publication type:JOURNAL ARTICLE


  5 / 49689 MEDLINE  
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PMID:29231001
Author:Wu JY; Wang D; Kong J; Wang XX; Yu XJ
Address:Department of Forensic Pathology, Medical College, Shantou University, Shantou 515041, China.
Title:[Metabolic Characteristics of Lethal Bradycardia Induced by Myocardial Ischemia].
Source:Fa Yi Xue Za Zhi; 33(1):11-16, 2017 Feb.
ISSN:1004-5619
Country of publication:China
Language:chi
Abstract:OBJECTIVES: To explore the metabolic characteristics of lethal bradycardia induced by myocardial ischemia in rat's serum. METHODS: A rat myocardial ischemia-bradycardia-sudden cardiac death (MI-B-SCD) model was established, which was compared with the sham-operation group. The metabolic profile of postmortem serum was analyzed by gas chromatography-mass spectrometry (GC-MS), coupled with the analysis of serum metabolic characteristics using metabolomics strategies. RESULTS: The serum metabolic profiles were significantly different between the MI-B-SCD rats and the control rats. Compared to the control rats, the MI-B-SCD rats had significantly higher levels of lysine, ornithine, purine, serine, alanine, urea and lactic acid; and significantly lower levels of succinate, hexadecanoic acid, 2-ketoadipic acid, glyceraldehyde, hexendioic acid and octanedioic acid in the serum. There were some correlations among different metabolites. CONCLUSIONS: There is obvious metabolic alterations in the serum of MI-B-SCD rat. Both lysine and purine have a high value in diagnosing MI-B-SCD. The results are expected to provide references for forensic and clinical applications of prevention and control of sudden cardiac death.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Purines); K3Z4F929H6 (Lysine); W60KTZ3IZY (purine)


  6 / 49689 MEDLINE  
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PMID:28453797
Author:Saraiva J; Antunes PE; Antunes MJ
Address:Centre of Cardiothoracic Surgery, Coimbra, University Hospital and Faculty of Medicine, Coimbra, Portugal.
Title:Coronary artery bypass surgery in young adults: excellent perioperative results and long-term survival.
Source:Interact Cardiovasc Thorac Surg; 24(5):691-695, 2017 05 01.
ISSN:1569-9285
Country of publication:England
Language:eng
Abstract:OBJECTIVES: To analyse perioperative results, long-term survival and freedom from complications after coronary artery bypass grafting (CABG) in young adults. METHODS: A total of 163 patients, 40 years old or younger, had isolated CABG from January 1989 to December 2010. Pre- and perioperative demographic and clinical data were retrieved from a prospectively organised database. Follow-up data were obtained by letter or telephone interviews. The mean age of the patients was 37.6 ± 2.9 years and 146 were men (90%). Fifty-three patients (32.5%) had angina class III/IV; 106 (65.0%), previous myocardial infarction; and 23 (14.1%), impaired left ventricular function (ejection fraction <40%). Indication for surgery was 3-vessel disease in 101 cases (62.0%), 2-vessel disease in 30 (18.4%) and single-vessel disease in 32 (19.6%). The left main stem was affected in 16 patients (9.8%). The mean EuroSCORE II was 0.92 ± 0.71. A total of 417 grafts were constructed (mean 2.6 grafts/patient), 247 of which (59.2%) were arterial. RESULTS: There were no in-hospital deaths. The mean hospital stay was 7.1 ± 4.0 days. Four patients (2.5%) were lost to follow-up, which extended from 3 to 25 years (mean 15.1 ± 5.5 years). There were 22 late deaths, 72.7% of cardiac or unknown origin. The 5-, 10- and 20-year survival rates were 98.7 ± 10.9, 95.2 ± 1.8 and 79.4 ± 4.4%, respectively. Twenty-six patients (18.1%) had non-fatal cardiac adverse complications (myocardial infarct, percutaneous re-revascularization or class III/IV angina), for 5-, 10- and 20-year freedom from complications of 97.9 ± 1.2, 91.9 ± 2.5 and 65.7 ± 7.1%, respectively. Twenty-two patients (17.5%) needed re-revascularization, for 5-, 10- and 20-year freedom from re-revascularization of 97.6 ± 1.4, 91.9 ± 2.6 and 69.5 ± 6.7%, respectively. CONCLUSIONS: Despite the aggressive nature of coronary artery disease in young patients, perioperative death and morbidity rates are low, with good long-term survival and low rates of re-revascularization.
Publication type:JOURNAL ARTICLE


  7 / 49689 MEDLINE  
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PMID:28453798
Author:Malinska A; Podemska Z; Sujka-Kordowska P; Witkiewicz W; Nowicki M; Perek B; Witt M
Address:Department of Histology and Embryology, Poznan University of Medical Sciences, Poznan, Poland.
Title:Caveolin 2: a facultative marker of unfavourable prognosis in long-term patency rate of internal thoracic artery grafts used in coronary artery bypass grafting. Preliminary report.
Source:Interact Cardiovasc Thorac Surg; 24(5):714-720, 2017 05 01.
ISSN:1569-9285
Country of publication:England
Language:eng
Abstract:OBJECTIVES: Intimal hyperplasia leading to graft failure in patients undergoing coronary artery bypass grafting (CABG) is related to vascular smooth muscle cells (SMCs) proliferation. SMCs respond to a variety of mediators, the most important of which is platelet-derived growth factor (PDGF). The platelet-derived growth factor-induced cellular response has been shown to be mediated by caveolins. The aim of this study was to analyze CAV1-3 expression in internal thoracic artery (ITA) grafts used in CABG and correlate their expression with graft occlusion. METHODS: Six hundred patients undergoing CABG with the use of ITA grafts between 2008 and 2014 were enrolled into this prospective study. CAV1-3 expression in the ITA grafts was analyzed prior to graft transplantation into the coronary circulation via immunohistochemistry. Estimated caveolins expression pattern was then correlated with the occurrence of ITA graft failure observed within 24-months of surgery. RESULTS: Thirty-four patients developed ITA graft failure (subgroup A) and 566 study participants presented no adverse events (subgroup B). CAV1 and CAV3 expression levels in SMCs of the tunica media of the ITA grafts did not differ between the study subgroups and were not associated with the risk of graft failure. CAV2 was expressed within SMCs of the ITA grafts in 94.1% of the patients from subgroup A and 2.5% from subgroup B, and its expression was associated with ITA graft occlusion observed within 24-months after CABG. CONCLUSIONS: CAV2 expression in SMCs of the tunica media in autologous ITA transplants might indicate the risk of graft failure.
Publication type:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
Name of substance:0 (Biomarkers); 0 (Caveolin 2)


  8 / 49689 MEDLINE  
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PMID:28468787
Author:Chandran S; Watkins J; Abdul-Aziz A; Shafat M; Calvert PA; Bowles KM; Flather MD; Rushworth SA; Ryding AD
Address:Norfolk and Norwich University Hospital, Norwich, United Kingdom.
Title:Inflammatory Differences in Plaque Erosion and Rupture in Patients With ST-Segment Elevation Myocardial Infarction.
Source:J Am Heart Assoc; 6(5), 2017 May 03.
ISSN:2047-9980
Country of publication:England
Language:eng
Abstract:BACKGROUND: Plaque erosion causes 30% of ST-segment elevation myocardial infarctions, but the underlying cause is unknown. Inflammatory infiltrates are less abundant in erosion compared with rupture in autopsy studies. We hypothesized that erosion and rupture are associated with significant differences in intracoronary cytokines in vivo. METHODS AND RESULTS: Forty ST-segment elevation myocardial infarction patients with <6 hours of chest pain were classified as ruptured fibrous cap (RFC) or intact fibrous cap (IFC) using optical coherence tomography. Plasma samples from the infarct-related artery and a peripheral artery were analyzed for expression of 102 cytokines using arrays; results were confirmed with ELISA. Thrombectomy samples were analyzed for differential mRNA expression using quantitative real-time polymerase chain reaction. Twenty-three lesions were classified as RFC (58%), 15 as IFC (38%), and 2 were undefined (4%). In addition, 12% (12 of 102) of cytokines were differentially expressed in both coronary and peripheral plasma. I-TAC was preferentially expressed in RFC (significance analysis of microarrays adjusted <0.001; ELISA IFC 10.2 versus RFC 10.8 log pg/mL; =0.042). IFC was associated with preferential expression of epidermal growth factor (significance analysis of microarrays adjusted <0.001; ELISA IFC 7.42 versus RFC 6.63 log pg/mL, =0.036) and thrombospondin 1 (significance analysis of microarrays adjusted =0.03; ELISA IFC 10.4 versus RFC 8.65 log ng/mL, =0.0041). Thrombectomy mRNA showed elevated I-TAC in RFC ( =0.0007) epidermal growth factor expression in IFC ( =0.0264) but no differences in expression of thrombospondin 1. CONCLUSIONS: These results demonstrate differential intracoronary cytokine expression in RFC and IFC. Elevated thrombospondin 1 and epidermal growth factor may play an etiological role in erosion.
Publication type:JOURNAL ARTICLE
Name of substance:0 (Biomarkers); 0 (Cytokines); 0 (Inflammation Mediators); 0 (Thrombospondin 1); 0 (thrombospondin-1, human); 62229-50-9 (Epidermal Growth Factor)


  9 / 49689 MEDLINE  
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PMID:29419393
Author:Ford TJ; Rocchiccioli P
Address:British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Title:A keen eye for risk.
Source:BMJ; 360:j5884, 2018 02 01.
ISSN:1756-1833
Country of publication:England
Language:eng
Publication type:CASE REPORTS; JOURNAL ARTICLE
Name of substance:0 (Antibodies, Monoclonal); 0 (Anticholesteremic Agents); 0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors); 0 (Receptors, LDL); 97C5T2UQ7J (Cholesterol); EC 3.4.21.- (PCSK9 protein, human); EC 3.4.21.- (Proprotein Convertase 9); LKC0U3A8NJ (evolocumab)


  10 / 49689 MEDLINE  
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PMID:28465300
Author:Pelletier-Galarneau M; Hunter CRRN; Ascah KJ; Beanlands RSB; Dwivedi G; deKemp RA; Chow BJW; Ruddy TD
Address:Division of Nuclear Medicine, The Ottawa Hospital, Ottawa, Canada.
Title:Randomized Trial Comparing the Effects of Ticagrelor Versus Clopidogrel on Myocardial Perfusion in Patients With Coronary Artery Disease.
Source:J Am Heart Assoc; 6(5), 2017 May 02.
ISSN:2047-9980
Country of publication:England
Language:eng
Abstract:BACKGROUND: Ticagrelor is a P2Y receptor inhibitor used in acute coronary syndromes to reduce platelet activity and to decrease thrombus formation. Ticagrelor is associated with a reduction in mortality incremental to that observed with clopidogrel, potentially related to its non-antiplatelet effects. Evidence from animal models indicates that ticagrelor potentiates adenosine-induced myocardial blood flow (MBF) increases. We investigated MBF at rest and during adenosine-induced hyperemia in patients with stable coronary artery disease treated with ticagrelor versus clopidogrel. METHODS AND RESULTS: This randomized double-blinded crossover study included 22 patients who received therapeutic interventions of ticagrelor 90 mg orally twice a day for 10 days and clopidogrel 75 mg orally once a day for 10 days, with a washout period of at least 10 days between the treatments. Global and regional MBF and myocardial flow reserve were measured using rubidium 82 positron emission tomography/computed tomography at baseline and during intermediate- and high-dose adenosine. Global MBF was significantly greater with ticagrelor versus clopidogrel (1.28±0.55 versus 1.13±0.47 mL/min per gram, =0.002) at intermediate-dose adenosine and not different at baseline (0.65±0.19 versus 0.60±0.15 mL/min per gram, =0.084) and at high-dose adenosine (1.64±0.40 versus 1.61±0.19 mL/min per gram, =0.53). In regions with impaired myocardial flow reserve (<2.5), MBF was greater with ticagrelor compared with clopidogrel during intermediate and high doses of adenosine ( <0.0001), whereas the differences were not significant at baseline. CONCLUSIONS: Ticagrelor potentiates global and regional adenosine-induced MBF increases in patients with stable coronary artery disease. This effect may contribute to the incremental mortality benefit compared with clopidogrel. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01894789.
Publication type:CLINICAL TRIAL, PHASE II; COMPARATIVE STUDY; JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
Name of substance:0 (Platelet Aggregation Inhibitors); 0 (Radiopharmaceuticals); 0 (Rubidium Radioisotopes); 0 (Vasodilator Agents); A74586SNO7 (clopidogrel); GLH0314RVC (Ticagrelor); K72T3FS567 (Adenosine); OM90ZUW7M1 (Ticlopidine)



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