scholarly journals Pericoronary adipose tissue attenuation index (FAI) – a new imaging biomarker and its diagnostic and prognostic utility: a systematic review and meta-analysis

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
M S Sagris ◽  
A A Antonopoulos ◽  
S S Simantiris ◽  
G P Panagiotopoulos ◽  
P P Papanikolaou ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Meta Analysis ◽  
Vascular Inflammation ◽  
Mean Difference ◽  
Imaging Biomarker ◽  
Secondary Outcome ◽  
Major Cardiovascular Events ◽  
Attenuation Index

Abstract Background Pericoronary fat attenuation index (FAI) on coronary computed tomography angiography (CCTA) imaging has been proposed as a sensitive marker of coronary vascular inflammation with prognostic value for major cardiovascular events. To date though there is no systematic review of the published literature and no meta-analyzed data of previously published results. Methods We performed a systematic review and meta-analysis according to the PRISMA guidelines. We systematically explored published literature in MEDLINE (Pubmed) before February 1, 2021 for studies assessing FAI in both diagnostic and prognostic clinical settings in patients with or without cardiovascular disease. The primary outcome was the mean difference in FAI attenuation between stable and unstable coronary plaques. The secondary outcome was the hazard ratio of high FAI values for future cardiovascular events. We calculated I2 to test heterogeneity. We used random effects modelling for the meta-analyses to assess the primary and secondary outcome. Results In total, 16 studies and 6,944 patients were included in this meta-analysis. FAI was significantly higher in unstable compared to stable plaques with a mean difference of 4.07 HU (95% CI: 1.10–7.89, I2=88%). Higher FAI values offered incremental prognostic value for major cardiovascular events (MACE) in studies with prospective follow-up (HR=3.29, 95% CI= 1.88–5.76, I2=75%). Conclusion FAI is a promising imaging biomarker that may be successfully be used for detection of coronary inflammation, discrimination between stable and unstable plaques and prognosis of future MACE. There is undeniable need of further studies to establish the utility of this biomarker in clinical practice in order to improve coronary plaque discrimination and cardiovascular risk prognostication. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Prognostic value of vascular inflammation biomarkers over clinical risk factors for cardiovascular risk : a meta-analysis

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
S Simantiris ◽  
AS Antonopoulos ◽  
A Angelopoulos ◽  
P Papanikolaou ◽  
EK Oikonomou ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Vascular Inflammation ◽  
Composite Endpoint ◽  
Imaging Biomarkers ◽  
Secondary Outcome ◽  
Incremental Prognostic Value

Abstract Funding Acknowledgements Type of funding sources: None. Background Measurement of vascular inflammation biomarkers is supported for estimation of residual inflammatory risk and cardiovascular risk stratification, but to date there is no systematic assessment of the added value of such biomarkers in predicting cardiovascular events and their comparative performance. Methods We systematically searched in MEDLINE published literature before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite endpoint of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome. Results We identified 92,507 studies in MEDLINE after duplicates were removed, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, in which 351,628 individuals participated. The combination of high-risk plaque features and Fat attenuation Index (FAI) by CCTA was associated with the highest prognostic value i.e. Δ[c-index] for the composite endpoint per biomarker type (A). In meta-analysis, both plasma and imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, B) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8). The prognostic value of imaging biomarkers significantly surpassed that of plasma biomarkers for the primary outcome (Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10, C). Notably, biomarkers of vascular inflammation offered higher incremental prognostic value in studies with a shorter duration of follow-up (i.e. <5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with <5% cumulative event incidence, D) Conclusions The combination of HRP features and FAI by CCTA imaging had the highest prognostic value for cardiovascular events among plasma or imaging biomarkers of vascular inflammation. CCTA imaging to detect residual inflammatory risk and the vulnerable patient at risk for events is a rational approach to improve risk stratification and prognostication. Abstract Figure.

scholarly journals Comparison of imaging vs. plasma biomarkers of vascular inflammation for cardiovascular prognostication: a meta-analysis

2021 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
A Antonopoulos ◽  
A Angelopoulos ◽  
P Papanikolaou ◽  
S Simantiris ◽  
EK Oikonomou ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
Cardiovascular Events ◽  
Prognostic Value ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Vascular Inflammation ◽  
Inflammatory Biomarkers ◽  
Imaging Biomarkers ◽  
Secondary Outcome ◽  
Incremental Prognostic Value

Abstract Funding Acknowledgements Type of funding sources: None. Background Measurement of inflammatory biomarkers is advocated for cardiovascular risk stratification, but to date there is no systematic evaluation of the incremental value of such approaches and their comparative performance for cardiovascular risk prediction. Methods We systematically explored published literature in MEDLINE before Apr 14, 2020 for prospective cohort studies assessing the prognostic value of common biomarkers of vascular inflammation in stable patients with or without cardiovascular disease. The primary outcome was the difference in the reported c-index (Δ[c-index]) of the best clinical model with the use of inflammatory biomarkers for the prediction of the composite of major adverse cardiovascular events (MACEs) and mortality. The secondary outcome was the Δ[c-index] for MACEs only. We calculated I² to test heterogeneity. We used random-effects modelling for the meta-analyses to assess the primary and secondary outcome. Results We identified 94,821 studies in MEDLINE, of which 90,882 (96%) studies were excluded after screening the titles and abstracts, and 1,507 (93%) of the 1,625 remaining studies were excluded after assessment of the full texts. We included 93 (6%) studies in our quantitative evaluation, which comprised 351,628 individuals. The median c-index and Δ[c-index] for the composite endpoint per biomarker type are shown in panels A & B. In meta-analysis, plasma or imaging biomarkers of vascular inflammation offered incremental prognostic value for the primary outcome (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.6, I2 = 72%) and for MACEs only (pooled estimate for Δ[c-index]% 2.9, 95%CI 2.1-3.8, I2 = 74%, panel C). The prognostic value of imaging biomarkers significantly outperformed that of plasma biomarkers for the primary outcome (panel D, Δ[c-index]% 11.3, 95%CI 8.3-14.3 vs. 1.4, 95%CI 0.9-1.8 respectively, p = 1.7x10-10). In other subgroup analyses (panel E), biomarkers of vascular inflammation performed better in studies with a shorter duration of follow-up (i.e. <5 years), in primary CHD prevention setting and lower cardiovascular risk populations i.e. (studies with <5% cumulative event incidence). Conclusions The use of plasma, but mainly imaging, biomarkers to detect vascular inflammation provides incremental prognostic value over clinical models for cardiovascular events. Implementation of such approaches in clinical practice could improve cardiovascular risk prognostication and reduce cardiovascular disease burden. Abstract Figure.

scholarly journals Comparative efficacy and safety of statin and fibrate monotherapy: A systematic review and meta-analysis of head-to-head randomized controlled trials

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246480
Author(s):  
Joseph E. Blais ◽  
Gloria Kin Yi Tong ◽  
Swathi Pathadka ◽  
Michael Mok ◽  
Ian C. K. Wong ◽  
...  
Keyword(s):  
Systematic Review ◽  
Adverse Effects ◽  
Serum Creatinine ◽  
Cardiovascular Events ◽  
Randomized Trials ◽  
Meta Analysis ◽  
Elevated Serum ◽  
Controlled Trials ◽  
Major Cardiovascular Events

Objective To assess whether in adults with dyslipidemia, statins reduce cardiovascular events, mortality, and adverse effects when compared to fibrates. Methods Systematic review and meta-analysis of head-to-head randomized trials of statin and fibrate monotherapy. MEDLINE, EMBASE, Cochrane, WHO International Controlled Trials Registry Platform, and ClinicalTrials.gov were searched through October 30, 2019. Trials that had a follow-up of at least 28 days, and reported mortality or a cardiovascular outcome of interest were eligible for inclusion. Efficacy outcomes were cardiovascular mortality and major cardiovascular events. Safety outcomes included myalgia, serious adverse effects, elevated serum creatinine, and elevated serum alanine aminotransferase. Odds ratios (OR) and 95% confidence intervals (CI) were estimated using the Mantel-Haenszel fixed-effect model, and heterogeneity was assessed using the I2 statistic. Results We included 19 eligible trials that directly compared statin and fibrate monotherapy and reported mortality or a cardiovascular event. Studies had a limited duration of follow-up (range 10 weeks to 2 years). We did not find any evidence of a difference between statins and fibrates for cardiovascular mortality (OR 2.35, 95% CI 0.94–5.86, I2 = 0%; ten studies, n = 2657; low certainty), major cardiovascular events (OR 1.15, 95% CI 0.80–1.65, I2 = 13%; 19 studies, n = 7619; low certainty), and myalgia (OR 1.32, 95% CI 0.95–1.83, I2 = 0%; ten studies, n = 6090; low certainty). Statins had less serious adverse effects (OR 0.57, 95% CI 0.36–0.91, I2 = 0%; nine studies, n = 3749; moderate certainty), less elevations in serum creatinine (OR 0.17, 95% CI 0.08–0.36, I2 = 0%; six studies, n = 2553; high certainty), and more elevations in alanine aminotransferase (OR 1.43, 95% CI 1.03–1.99, I2 = 44%; seven studies, n = 5225; low certainty). Conclusions The eligible randomized trials of statins versus fibrates were designed to assess short-term lipid outcomes, making it difficult to have certainty about the direct comparative effect on cardiovascular outcomes and mortality. With the exception of myalgia, use of a statin appeared to have a lower incidence of adverse effects compared to use of a fibrate.

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