scholarly journals Positive remodeling index by MSCT coronary angiography: A prognostic factor for early detection of plaque rupture and vulnerability

2015 ◽  
Vol 46 (1) ◽  
pp. 13-24 ◽  
Author(s):  
Emad H. Abdeldayem ◽  
Ahmed S. Ibrahim ◽  
Amr M. Ahmed ◽  
Eman S. Genedi ◽  
Wahid H. Tantawy
Keyword(s):  
Prognostic Factor ◽  
Coronary Angiography ◽  
Early Detection ◽  
Plaque Rupture ◽  
Msct Coronary Angiography ◽  
Remodeling Index

scholarly journals Multi-slice CT coronary angiography assessment of remodeling index in patients with low- to intermediate-risk stable angina

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Shaimaa A. Mostafa ◽  
Tarek Aboelazem ◽  
Osama Sanad ◽  
Haytham Abdelghafar ◽  
Ahmed Azam
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Stable Angina ◽  
Positive Family History ◽  
Ct Coronary Angiography ◽  
Plaque Burden ◽  
Intermediate Risk ◽  
Remodeling Index ◽  
The Mean

Abstract Background Early identification of vulnerable plaques by remodeling index prior to rupture and development of acute event is of considerable importance especially by a reliable non-invasive method as CT coronary angiography (CTA), so we aim to evaluate coronary artery remodeling index in patients with low- to intermediate-risk stable angina by CTA. Results This single-center, cross-sectional, observational study included 150 patients with stable angina with normal resting ECG, negative markers, normal systolic function by 2D echocardiography (EF > 50%), and without regional wall motion abnormality at rest who were referred to MSCT evaluation of the coronary artery tree; the mean age was 56.8 ± 6.4 years, 83.3% had one-vessel disease, and 16.7% had two-vessel diseases. The mean remodeling index (RI) was 1.04 ± 0.28, 38% had significant positive remodeling, LAD was the most affected vessel (55.3), and proximal lesions were predominant in 48.5%; there was a statistically significant positive correlation between RI and cholesterol, triglyceride, LDL, duration of DM, HBA1c, and plaque burden (P < 0.001) and a statistically significant negative correlation with HDL (P < 0.001). Predictors of higher RI were positive family history, diabetes mellitus, low HDL, HBA1c, and plaque burden% (P < 0.001). Patients with remodeling index > 1.1 were diabetic, hypertensive, smoker, with longer duration of diabetes mellitus, higher HBA1c, cholesterol, triglyceride, LDL, plaque burden, wall lumen ratio, stenosis area, and lower HDL. Conclusion CTA was able to detect the presence and extent of early, non-obstructive but significant coronary artery-positive remodeling in patients with low- to intermediate-risk stable angina patients. Trial registration NCT03963609, 22 May 2019

scholarly journals SO015URINE NMR-BASED METABOLOMICS FOR EARLY DETECTION OF POST-PROCEDURAL CONTRAST NEPHROPATHY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Nooshin Dalili ◽  
Shiva Kalantari ◽  
Mohsen Nafar
Keyword(s):  
Coronary Angiography ◽  
Early Detection ◽  
Chemical Shifts ◽  
Spectral Width ◽  
Urine Samples ◽  
Diagnostic Model ◽  
Urine Metabolites ◽  
Spot Urine ◽  
Before And After ◽  
Significant Chemical

Abstract Background and Aims Contrast induced nephropathy (CIN) has been reported to be the third foremost cause of acute renal failure. Metabolomics is a robust technique that has been used to identify potential biomarkers for early detection of renal damage after procedures with using contrast media. We aim to analyze the serum and urine metabolites changes, after using contrast for coronary angiography, to determine if metabolomics can use as a tool for early detection of CIN. Method Sixty-six patients with positive primary non-invasive diagnostic tests for coronary artery disease (CAD) who were candidate of elective coronary angiography recruited. Spot urine samples collected in the morning before angiography and 4 hours after angiography. Patients with &gt; 0.5 mg/dL creatinine rise compared to baseline were considered as case (CIN group). Urine samples were centrifuged at 3000 rcf for 20 minutes at 4°C to remove the cell debris and after addition of sodium azide to prevent bacterial growth, were stored at -80 degree Celsius in aliquots until required. The mixtures were then transferred to a standard 5 mm NMR tube for analysis. 1H-NMR spectra were acquired at 300 K on a Bruker DRX 500 MHz spectrometer by using Carr–Pucell–Meiboom–Gill (CPMG) technique. For each spectrum, 154 scans were collected into 32K data points using a spectral width of 8389.26 Hz during the relaxation time of 2.5 s. Results Structure and outliers of the dataset composed of patient with CIN (n = 10) before angiography and after angiography were evaluated by PCA. A model with two principal components (PC1 and PC2) with R2X = 0.775 and Q2(cum) = 0.487 was obtained .A supervised OPLS-DA model was built to identify discriminative variables between metabolite profiles before and after angiography in patients with CIN. The high level of AUC 0.95 that was obtained from 10-fold cross validation besides decreased R2 (0.0, 0.415) and Q2 (0.0, -0.454) intercepts of 999 random permutations reflects the good validity of this diagnostic model. According to this valid OPLS-DA model, 15 chemical shifts were significant based on VIP &gt; 1 and FC &gt; 1.2. To check these suggested chemical shifts if their changes are due to kidney injury and not caused by contrast agent, a decoy OPLS-DA model was built for non-CIN patients before and after angiography .Two common significant chemical shifts (2.42 and 2.78 ppm) were found in comparison of these two models (i.e. before vs. after angiography in CIN group in compared with before vs. after angiography in non-CIN group) and were excluded from the results. Metabolites corresponding with the remaining list of 12 significant chemical shifts were identified and suggested as early detection biomarker candidates for CIN (Fig 1). The AUC value of a panel of four biomarker candidates were higher than single biomarkers that reflects the value of simultaneous measurement of these four metabolite candidates than single candidates. Figure 2 shows the list of diagnostic metabolite candidates with p &lt; 0.05 . Pathway characterization was used to better understanding of pathophysiology of CIN. As the input data was small list of metabolites, only “Histidine_ lysine_ phenylalanine, tyrosine, proline and tryptophan catabolism” pathway (p &lt; 0.05) was significant and suggested as the most important disturbed pathway in CIN. Conclusion Early detection of CIN as early as only 4 hours after using contrast can help better management of these patients. In this study, only after 4 hours passed from using contrast a panel of metabolites could be found in urine of patients who develop CIN, which facilitates early detection of CIN. This is the first study to investigate urine metabolic profile using NMR-based metabolomics for early detection of CIN after coronary angiography. The use of this suggested panel might significantly improve clinical consequences of this harmful complication.

Quantification of Minimal Residual Disease (MRD) in MLL-PTD Positive AML Can Be Used for Prognostication in AML with Normal Karyotype.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 2026-2026
Author(s):  
Martin Weisser ◽  
Claudia Schoch ◽  
Wolfgang Kern ◽  
Wolfgang Hiddemann ◽  
Torsten Haferlach ◽  
...  
Keyword(s):  
Prognostic Factor ◽  
Early Detection ◽  
Minimal Residual Disease ◽  
Residual Disease ◽  
Normal Karyotype ◽  
Significant Prognostic Factor ◽  
Expression Levels ◽  
Log Reduction ◽  
Minimal Residual

Abstract Partial tandem duplications of the MLL gene (MLL-PTD) occur with the same frequency of approximately 6% as PML-RARA, AML1-ETO, and CBFB-MYH11 that have previously been shown to be relevant markers for detection of minimal residual disease (MRD). MLL-PTD has a frequency of 11% in the normal karyotype and here it is associated with an unfavourable prognosis. In the normal karyotype AML PCR-based MRD detection was not applicable so far, and thus MLL-PTD may be a promising MRD marker for this large intermediate AML subtype. So far, the clinical significance of the expression level of MLL-PTD at diagnosis or MRD during the course of therapy have not been investigated. Using real time RT-PCR MLL-PTD expression levels were quantified relative to the control gene ABL. Quantitative data were available from 143 patients at diagnosis. The range of the MLL-PTD/ABL ratios at diagnosis was 9.6–1255 (median: 149). The levels of MLL-PTD expression in 50 healthy control samples were between 0 and 0.08 (median 0.02). In total 47 of these patients with a median follow up sample number of 4 per patient (range 2–17) were evaluated for MRD during and after therapy. Twenty-one patients were evaluable for MRD analysis after 2 months after start of therapy. Thirty-one patients were evaluable for MRD analysis after 4 and 6 months after start of therapy. A 2-log reduction of MLL-PTD expression after 2 months, 4 months and 6 months was a significant prognostic factor for overall survival (OS: p=0.0179, p=0.035, p=0.048, respectively) as well as for event free survival (EFS: p=0.0047, p=0.037, p=0.020, respectively). There is no evidence that a 3-log reduction after 2 and 4 months improves OS significantly (p=0.62 and 0.24 respectively). This was mainly due to the low number of patients that achieved a 3 log decrease (6/21 and 10/31 respectively). In contrast, at 6 months a 3-log decrease had a significant impact on OS and EFS (p=0.049 and p=0.030, respectively). Neither the expression levels at diagnosis nor fusion type (involved MLL exons) showed prognostic significance. However, age above 60 years and leukocytosis above 50 G/l were associated with a worse prognosis (p=0.028 and p=0.0035, respectively). Overall, the MLL-PTD expression levels correlated well to the course of the disease and a molecular relapse was detected before clinical manifestation in 2 patients based on increasing expression ratios. Another 15 cases were assessed at clinical relapse when expression levels were again in the range of the diagnostic sample. Here the median interval between the last follow up and relapse was too long (9.2 months) for early detection of relapse. Thus, more frequent follow up analyses at least every three months should improve the early detection rate. In conclusion, this analysis confirms the significance of MRD levels as a prognostic factor in this AML subtype. 1) MLL-PTD can be applied in 11% of intermediate risk group AML. 2) Patients with an apriori high risk for relapse can be identified on the basis of a 2 log reduction. 3) Relapses can be early detected based on increasing expression ratios.

scholarly journals Arylesterase activity of Paraoxonase 1 - prognostic factor for one-year survival in patients with acute myocardial infarction

2018 ◽  
Vol 26 (3) ◽  
pp. 283-292 ◽  
Author(s):  
Lorena Ciumărnean ◽  
Mihai Greavu ◽  
Ştefan C Vesa ◽  
Alina I Tanțău ◽  
Gabriela B Dogaru ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Prognostic Factor ◽  
Coronary Angiography ◽  
Left Ventricular ◽  
Paraoxonase 1 ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Coronary Syndrome ◽  
One Year

Abstract Introduction: Reduced serum levels of paraoxonase 1 (PON1) activities are associated with diseases involving increased oxidative stress, such as acute coronary syndrome. We aimed to determine whether serum PON1 activities are a prognostic factor for one-year survival following ST-elevation myocardial infarction (STEMI). Material and methods: We prospectively followed for one-year 75 patients diagnosed and treated for STEMI. Clinical, laboratory and imagistic data were gathered after coronary angiography. PON1 activities (paraoxonase, arylesterase, and lactonase) were assayed spectophotometrically on samples of heparinized plasma taken from the patients in a timeframe of maximum 20 minutes after coronary angiography. Results: Increased mortality was linked to age (patients over 68 years), permanent atrial fibrillation or left ventricular ejection fraction (LVEF) <40% (associated with global hypokinesia, apical or septal akinesia), trivascular disease atherosclerosis, reduced PON1 activities (paraoxonase <18.4 IU/mL, arylesterase <12.6 IU/mL, lactonase <27.6 IU/mL), and glomerular filtration rate levels <54 mL/min/1.73m2. Multivariate survival analysis showed the independent prognostic role of age (HR 3.92; 95%CI 1.08-14.16; p=0.03), LVEF (HR 9.93; 95%CI 2.20-44.86; p=0.003) and arylesterase (HR 4.25; 95%CI 0.94-19.18; p=0.05) for one-year mortality. Conclusion: Reduced arylesterase activity of PON1 is an independent predictor of one-year survival after acute myocardial infarction.

scholarly journals Detection of positively remodeled coronary artery lesions by multislice CT and its impact on cardiovascular future events

2019 ◽  
Vol 71 (1) ◽  
Author(s):  
Haitham Galal ◽  
Tarek Rashid ◽  
Wesam Alghonaimy ◽  
Diaa Kamal
Keyword(s):  
Coronary Angiography ◽  
Morphological Characteristics ◽  
Multislice Ct ◽  
Plaque Burden ◽  
Lumen Area ◽  
Coronary Syndrome ◽  
Clinical Events ◽  
Remodeling Index ◽  
The Mean ◽  
Area Percentage

Abstract Background Positive arterial remodeling may be a characteristic of early proliferative lesions. The study was done to identify the different morphological characteristics of the positively remodeled coronary lesions, and causing non-significant arterial stenosis, as detected by multislice computed tomography coronary angiography (MSCT CA) and its predictors of cardiovascular clinical events at 90-day follow-up. The study included 55 patients who were candidate for MSCT CA and found to have a single-vessel disease with less than 70% stenosis positively remodeled lesions. The most expansive or solitary lesion was selected for each patient. Positive remodeling defined as remodeling index (RI) > 1.05. We followed the patients clinically for 90 days. Results Twenty-four patients had a history of acute coronary syndrome at initial presentation with normal LV systolic function for all studied patients. Dyslipidemia was found in 37 patients (67.3%) while diabetes was found in 29 patients (52.7%). The majority of the lesions were found in the proximal LAD (43.6%). The mean calculated remodeling index was 1.41 ± 0.25. At the end of 90 days, 25 patients had clinical events in the form of unstable coronary syndromes, coronary interventions, or coronary angiography related to the index lesion. The predictors of clinical events were duration of DM, higher degree of luminal narrowing, calculated wall/lumen area percentage, plaque burden, plaque-specific calcification, and total calcium score at remodeling site as well as a lower percentage of low-attenuation plaque area. The mean calculated wall/lumen area percentage was 263.72 ± 122.71%. A cut-off value of > 226% was found a predictor for clinical events. The mean plaque burden percentage was 69.72 ± 9.71%, a value of > 69% was found a predictor for clinical events. Both values had a sensitivity of 68% and specificity of 86.6% and PPV of 81%. Positively remodeled lesions with a high RI > 1.4 were correlated with patients who had acute coronary syndrome on their initial presentation. Conclusion Different morphological characteristics of positively remodeled non-occlusive atherosclerotic plaques as detected by multislice CT coronary angiography may be good potential predictors of future cardiovascular events.

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