Multimodality imaging in patients with post-cardiac injury syndrome

Heart ◽  
2020 ◽  
Vol 106 (9) ◽  
pp. 639-646 ◽  
Author(s):  
Beni R Verma ◽  
Michael Chetrit ◽  
James L Gentry III ◽  
Andrew Noll ◽  
Ahmed Bafadel ◽  
...  
Keyword(s):  
Clinical Decision Making ◽  
Multimodality Imaging ◽  
Cardiac Injury ◽  
Clinical Decision ◽  
Term Treatment ◽  
Acute Pericarditis ◽  
Pericardial Diseases ◽  
Long Term Treatment ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

This review article is focused on the role of echocardiography, cardiac CT and cardiac magnetic resonance (CMR) imaging in diagnosing and managing patients with post-cardiac injury syndrome (PCIS). Clinically, the spectrum of pericardial diseases under PCIS varies not only in form and severity of presentation but also in the timing varying from weeks to months, thus making it difficult to diagnose. Pericarditis developing after recent or remote myocardial infarction, cardiac surgery or ablation if left untreated or under-treated could worsen into complicated pericarditis which can lead to decreased quality of life and increased morbidity. Colchicine in combination with other anti-inflammatory agents (non-steroidal anti-inflammatory drugs) is proven to prevent and treat acute pericarditis as well as its relapses under various scenarios. Imaging modalities such as echocardiography, CT and CMR play a pivotal role in diagnosing PCIS especially in difficult cases or when clinical suspicion is low. Echocardiography is the tool of choice for emergent bedside evaluation for cardiac tamponade and to electively study the haemodynamics impact of constrictive pericarditis. CT can provide information on pericardial thickening, calcification, effusions and lead perforations. CMR can provide pericardial tissue characterisation, haemodynamics changes and guide long-term treatment course with anti-inflammatory agents. It is important to be familiar with the indications as well as findings from these multimodality imaging tools for clinical decision-making.

Risks of Cardiovascular Disease and Beyond in Prescription of Nonsteroidal Anti-Inflammatory Drugs

2019 ◽  
Vol 25 (1) ◽  
pp. 3-6 ◽  
Author(s):  
Manas A. Rane ◽  
Alexander Gitin ◽  
Benjamin Fiedler ◽  
Lawrence Fiedler ◽  
Charles H. Hennekens
Keyword(s):  
Cardiovascular Disease ◽  
Side Effects ◽  
Health Care Providers ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Care Providers ◽  
Relieve Pain ◽  
Gastrointestinal Side Effects ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Introduction: Nonsteroidal anti-inflammatory drugs (NSAIDs) include aspirin, naproxen, diclofenac, and ibuprofen, as well as selective cyclooxygenase 2 inhibitors such as celecoxib. Their use is common, as well as their side effects which cause 100 000 hospitalizations and 17 000 deaths annually. Recently, the US Food and Drug Administration strengthened its warning about the risks of cardiovascular disease (CVD) attributed to nonaspirin NSAIDs. Methods: When the sample size is large, randomization provides control of confounding not possible to achieve with any observational study. Further, observational studies and, especially, claims data have inherent confounding by indication larger than the small to moderate effects being sought. Results: While trials are necessary, they must be of sufficient size and duration and achieve high compliance and follow-up. Until then, clinicians should remain uncertain about benefits and risks of these drugs. Conclusions: Since the totality of evidence remains incomplete, health-care providers should consider all these aforementioned benefits and risks, both CVD and beyond, in deciding whether and, if so, which, NSAID to prescribe. The factors in the decision of whether and, if so, which NSAID to prescribe for relief of pain from inflammatory arthritis should not be limited to risks of CVD or gastrointestinal side effects but should also include potential benefits including improvements in overall quality of life resulting from decreases in pain or impairment from musculoskeletal pain syndromes. The judicious individual clinical decision-making about the prescription of NSAIDs to relieve pain based on all these considerations has the potential to do much more good than harm.

scholarly journals Cardiovascular and cerebrovascular risk with nonsteroidal anti-inflammatory drugs and cyclooxygenase 2 inhibitors: latest evidence and clinical implications

2017 ◽  
Vol 8 (6) ◽  
pp. 173-182 ◽  
Author(s):  
Andrea Fanelli ◽  
Daniela Ghisi ◽  
Pierangelo Lora Aprile ◽  
Francesco Lapi
Keyword(s):  
Term Treatment ◽  
Cyclooxygenase 2 ◽  
Thrombotic Risk ◽  
Long Term Treatment ◽  
Pressure Development ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
High Doses ◽  
The Right ◽  
Meta Analyses

Observational studies and meta-analyses have shown that the administration of nonsteroidal anti-inflammatory drugs (NSAIDs), especially when prescribed at high doses for long periods of time, can potentially increase the risk of cardiovascular diseases. The increased thrombotic risk related to the use of NSAIDs is mainly due to their cyclooxygenase 2 selectivity. The dosage use, the formulation selected and the duration of the therapy are other factors that can significantly impact on the cardiovascular risk. In order to minimize the risk, prescription of the right drug based on the patient’s features and the different safety profiles of several NSAIDs that are available on the market is key for their appropriate administration. Despite the baseline cardiovascular and gastrointestinal risk of each patient, monitoring of patients is suggested for increases in blood pressure, development of edema, deterioration of renal function, or gastrointestinal bleeding during long-term treatment with NSAIDs.

scholarly journals Cardiovascular Mechanisms In Covid-19: Methodology of A Prospective Observational Multimodality Imaging Study (COSMIC-19 study)

2020 ◽  
Author(s):  
Shirjel Alam ◽  
Anoop Shah ◽  
Kevin Onyinkwa ◽  
Edward Nganga ◽  
Samuel Gitau ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Fdg Pet ◽  
Clinical Decision Making ◽  
Multimodality Imaging ◽  
Cardiac Injury ◽  
Imaging Study ◽  
Clinical Decision ◽  
Pet Ct ◽  
18F Fdg ◽  
Fdg Pet Ct

Abstract Background: 8-28% of patients infected with COVID-19 have evidence of cardiac injury, and this is associated with an adverse prognosis. The cardiovascular mechanisms of injury are poorly understood and speculative. We aim to use multimodality cardiac imaging including cardiac magnetic resonance (CMR) imaging, computed tomography coronary angiography (CTCA) and positron emission tomography with 2-deoxy-2-[fluorine-18]fluoro- D-glucose integrated with computed tomography (18F-FDG-PET/CT) to identify the cardiac pathophysiological mechanisms related to COVID-19 infections.Methods: This is a single-centre exploratory observational study aiming to recruit 50 patients with COVID-19 infection who will undergo cardiac biomarker sampling. Of these, 30 patients will undergo combined CTCA & 18F-FDG-PET/CT, followed by CMR. Prevalence of obstructive and non-obstructive atherosclerotic coronary disease will be assessed using CTCA. CMR will be used to identify and characterise myocardial disease including presence of cardiac dysfunction, myocardial fibrosis, myocardial oedema and myocardial infarction. 18F-FDG-PET/CT will identify vascular and cardiac inflammation. Primary endpoint will be the presence of cardiovascular pathology and the association with troponin levels.Discussion: The results of the study will identify the presence and modality of cardiac injury associated COVID-19 infection, and the utility of multi-modality imaging in diagnosing such injury. This will further inform clinical decision making during the pandemic.TRIAL REGISTRATION: This study has been retrospectively registered at the ISRCTN registry (ID ISRCTN12154994) on 14th August 2020. Accessible at www.isrctn.com/ISRCTN12154994

scholarly journals Limited predictive value of an acute test with subcutaneous octreotide for long-term IGF-I normalization with Sandostatin LAR in acromegaly

2005 ◽  
Vol 153 (1) ◽  
pp. 67-71 ◽  
Author(s):  
Wouter W de Herder ◽  
H Rob Taal ◽  
Piet Uitterlinden ◽  
Richard A Feelders ◽  
Joop A M J L Janssen ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Predictive Value ◽  
Clinical Decision Making ◽  
Subcutaneous Administration ◽  
Clinical Decision ◽  
Term Treatment ◽  
Predictive Values ◽  
Long Term Treatment ◽  
Igf I

Objectives: To study whether the growth hormone (GH) response after the subcutaneous administration 50 μg of octreotide (acute octreotide test) has any predictive value for long-term IGF-I normalization with Sandostatin LAR. Design: Twenty four therapy-naive patients with active acromegaly were studied. Results: >75% GH decrease in the acute octreotide test predicted long-term IGF-I normalization with Sandostatin LAR in 8/11 (73%) of patients. 3/13 (23%) patients with <75% GH decrease in the acute octreotide test were long-term biochemically controlled with Sandostatin LAR. Using the >75% GH reduction criterion, the sensitivity and specificity of this test for predicting long-term normalization of serum IGF-I with Sandostatin LAR treatment were 73% and 77%, respectively (positive and negative predictive values: 73% and 77%, respectively). 6/8 (75%) patients with GH suppression to levels <1.1 μg/l and 9/16 (56%) patients with GH suppression to levels <2 μg/l in the acute octreotide test showed normalization of serum IGF-I with long-term Sandostatin LAR treatment. The sensitivity and specificity of GH suppression <1.1 μg/l for predicting of the long-term normalization of serum IGF-I with Sandostatin LAR therapy were 55% and 85%, respectively (positive and negative predictive values: 75% and 69%, respectively). The sensitivity and specificity of GH suppression <2 μg/l for predicting of the long-term normalization of serum IGF-I with Sandostatin LAR therapy were 82% and 46%, respectively (positive and negative predictive values: 56% and 75%, respectively). Conclusion: The acute octreotide is not recommended for clinical decision making with regard to long-term treatment using the long-acting somatostatin analog Sandostatin LAR in acromegaly.

Non-steroidal anti-inflammatory drugs as candidates for the prevention or treatment of Alzheimer’s disease: Do they still have a role?

2020 ◽  
Vol 17 ◽  
Author(s):  
Alberto Villarejo-Galende ◽  
Marta González-Sánchez ◽  
Víctor A. Blanco-Palmero ◽  
Sara Llamas Velasco ◽  
Julián Benito-León
Keyword(s):  
Clinical Trials ◽  
Inflammatory Responses ◽  
Basic Research ◽  
Epidemiological Studies ◽  
Population Based ◽  
Term Treatment ◽  
Prevalence Studies ◽  
Long Term Treatment ◽  
Inflammatory Drugs ◽  
Anti Inflammatory

Purpose of Review: to provide an updated analysis of the possible use of non-steroidal anti-inflammatory drugs (NSAIDs) as treatments for Alzheimer´s disease (AD). Recent Findings: Neuroinflammation in AD is an active field of research, with increasing evidence from basic and clinical studies for an involvement of innate or adaptive immune responses in the pathophysiology of AD. Few clinical trials with anti-inflammatory drugs have been performed in the last decade, with negative results. Summary: Besides the information gathered from basic research, epidemiological studies have provided conflicting findings, with most case-control or prevalence studies suggesting an inverse relationship between NSAIDs use and AD, but divided results in prospective population-based incident cohort studies. Clinical trials with different NSAIDs are almost unanimous in reporting an absence of clear benefit in AD. Conclusion: : the modulation of inflammatory responses is a promising therapeutic strategy in AD. After three decades of research, it seems that conventional NSAIDs are not the best pharmacological option, both for their lack of clear effects and for an unfavorable side-effect profile in long-term treatment. The development of other anti-inflammatory drugs as candidate treatments in AD may benefit from the knowledge acquired with NSAIDs.

scholarly journals HYALURONIC ACID PREPARATIONS IN BIG JOINT OSTEOARTHRITIS MANAGEMENT

2021 ◽  
pp. 80-96
Author(s):  
O. V. Kalashnikov ◽  
O. M. Sulyma ◽  
T. I. Osadchuk ◽  
А. V. Kalashnikov ◽  
V. B. Zayets ◽  
...  
Keyword(s):  
Side Effects ◽  
Term Treatment ◽  
Safety Level ◽  
Orthopedic Surgeons ◽  
Effi Ciency ◽  
Long Term Treatment ◽  
Inflammatory Drugs ◽  
Anti Inflammatory ◽  
And Function

Abstract. The authors of the paper analyzed the experience of domestic and foreign experts on the effi-ciency of HA preparation in big joint osteoarthritis management. Task of the study is to analyze literature sources to identify the efficiency of HA preparations in big joints osteoarthritis management. Materials and methods: articles published by specialized scientific journals, paper collections, internet sources. Results: The analysis of literature sources determined the essential role of HA in joint cartilage nutrition and function. The researches tend to believe that an ideal HA preparation must be as close as possible to the physiological HA of joint’s synovial fluid. The HA preparation elaborated in our state, Artropatch meets these demands completely. Conclusions. Modern HA injectable preparations are expedient on the 1-3 stage of OA. Anti-inflammatory effect of HA preparations predetermines the possibility to decrease the intake dose and period of non-steroid anti-inflammatory drugs, consequently decreasing the risk of many unfavorable side effects of NSAIPs. The high safety level of HA preparations and no significant side effects after long-term treatment make them widely used in clinical practice of modern orthopedic surgeons.

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