Abstract 18525: Effects of Statin Therapy on Ascending Aorta Aneurysms Growth: a Propensity-matched Analysis of 828 Patients

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Emiliano Angeloni ◽  
Simone Refice ◽  
Angelo Vitaterna ◽  
Paola Lombardo ◽  
Michele Pirelli ◽  
...  
Keyword(s):  
Growth Rate ◽  
Statin Therapy ◽  
Vascular Wall ◽  
Statin Treatment ◽  
Ascending Aorta ◽  
Maximum Diameter ◽  
C Statistic ◽  
Group A ◽  
Group B ◽  
Model C

Introduction: Pleiotropic effects of statins have been advocated for remodelling of the vascular wall. Hypothesis: Whether statin therapy influences the growth rate of ascending aorta (AA) aneurysms. Methods: A total of 1348 patients was referred to our outpatient clinic for initial AA ectasia from September 2005 to December 2010. A propensity score was built to perfectly match (1:1) patients administered (Group A) or not (Group B) with statin therapy. Clinical and echocardiographic follow-up was 100% completed at 3 years after the first visit. Treatment groups were investigated for differences in AA maximum diameter, furthermore rates of survival free from death and/or complications were assessed by Kaplan-Meyer analysis. Results: Finally, two fairly-comparable groups of 414 patients each were obtained (Propensity model c-statistic 0.84, p<0.0001). No significant differences were noted in baseline characteristics, mean AA diameters were 40.9±2.6 mm and 40.7±2.5 mm in Group A and B, respectively. At 3-years, similar rates of hypertension control (84±9% vs. 83±11%) were found, whilst growth rate of AA diameter was +22.3±9.4 mm in Group A (+7.4 mm/year) and +26.5±8.4 mm (+8.8 mm/year) in Group B (p=0.0001). Three-year survival free from the composite outcome (death, dissection/rupture, need for operative repair) was found to be significantly improved in Group A (64±4%) rather than in Group B (53±5%), with a log-rank p=0.002 (HR 0.41, 95%CI 0.37 to 0.48). Conclusions: In this study, statin treatment is associated with reduced growth rate of ascending aorta aneurysms. The latter resulted in better survival free from complications for patients receiving statins.

Statins and Vulnerable Plaque

2018 ◽  
Vol 23 (46) ◽  
pp. 7069-7085 ◽  
Author(s):  
Maria Drakopoulou ◽  
Konstantinos Toutouzas ◽  
Archontoula Michelongona ◽  
Dimitrios Tousoulis
Keyword(s):  
Statin Therapy ◽  
Vulnerable Plaque ◽  
Vascular Wall ◽  
Statin Treatment ◽  
Duration Of Treatment ◽  
Fibrous Cap ◽  
Plaque Development ◽  
Plaque Stabilization ◽  
Inflammatory Activation ◽  
The One

Background: Atherosclerosis is a systemic, progressive lipid-driven inflammatory disease of the arterial vascular wall leading progressively to plaque development. The vulnerable plaque, the one considered to be the leading cause of cardiovascular events seems to exhibit a large and soft lipid-rich necrotic core covered by a thin and inflamed fibrous cap. Statin treatment is considered as one of the most effective methods for vulnerable plaque stabilization, currently being the principal drug in primary and secondary prevention of cardiovascular disease. </P><P> Objective: We sought to evaluate the beneficial effect of statins on biological processes involved in the evolution of vulnerable plaques </P><P> Method: We performed a systematic review of the literature searching MEDLINE via Pubmed for all experimental and human studies implementing statins in vulnerable plaque. </P><P> Results: Statins seem to have a beneficial role in plaque stabilization and patient outcome. It seems that this effect is mediated by improving endothelial function, decreasing oxidative stress and inflammation, reducing inflammatory activation and inhibiting thrombogenic response. Although these data are quite promising, it remains to be determined the extent of a potent benefit of the pleiotropic effects of statin therapy in clinical setting. </P><P> Conclusion: Prospective randomized trials should be conducted in order to further elucidate differences among type and dose of statin therapy, duration of treatment and association with LDL levels and clinical outcome.

Abstract 15277: Monitoring Progression of Aneurysms of the Ascending Aorta: Timing, Cost and Radiation Exposure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alexander E Callow ◽  
Jordan Long ◽  
Sahar Rehman ◽  
Isna H Khaliq ◽  
Sebastian Boland ◽  
...  
Keyword(s):  
Radiation Exposure ◽  
Healthcare System ◽  
Cardiac Imaging ◽  
Growth Rates ◽  
Ascending Aorta ◽  
Medicare Reimbursement ◽  
Serial Imaging ◽  
Group A ◽  
Group B

Introduction: Current guidelines of the American Heart Association (AHA) recommend annual serial imaging for patients with aneurysm of the ascending aorta (AscAoA). However, recent data (Park K-H et al. Eur J CT Surg 2017;51:959-64) have suggested that this imaging frequency may not be necessary. This study was designed to compare the progression in growth rates of AscAoA using cardiac MRI (CMR) in 2 large cohorts of patients reassessed every 1 year and every 2 years. Methods: An institutional cardiac imaging database was queried for all patients with AscAoA, defined as a maximum ascending aorta diameter > 3.5 cm measured perpendicular to flow using CMR. The study cohort was divided into two groups; patients who had a follow up CMR every 1 (Group A), and those who had a CMR every 2 years (Group B). AscAoA growth rates were computed for each group and statistically compared using a two-sample t-test. For analysis of cost to the healthcare system, Medicare reimbursement rates for 2019 were utilized. Published mean radiation dose for cardiac CT (CCT) was utilized to assess radiation exposure. Results: Of 6,210 patients in the cardiac imaging database, 1,849 had a diagnosis of AscAoA, of which 941 had serial CMR studies. Of these 941 patients, 342 had a follow up CMR every 1 year, while 206 had a follow up CMR every 2-years. The mean progression of AscAoA was 0.0247 ± 0.475 cm for Group A and 0.0598 ± 0.209 cm for Group B. The growth rate of AscAoA was not significantly different between groups (p=0.236). The Medicare reimbursement for CMR was $23,056 per 100 patients (CPT 75557) without radiation exposure. If CCT had been used for these patients, Medicare reimbursement would have been $20,174 per 100 patients (CPT 75572) with exposure to 10.5 mSv of radiation per study. Conclusions: There was no significant difference in progression of AscAoA diameter between Groups A and B. These data suggest that serial imaging of AscAoA every 2 years may be appropriate, with reduced cost to the healthcare system and cumulative radiation exposure. Although CMR is slightly more costly than CCT, it eliminates cumulative breast radiation exposure, a feature of particular importance for female patients.

Transaortic Endoclamp for Mitral Valve Operation through Right Minithoracotomy in 369 Patients

2010 ◽  
Vol 5 (6) ◽  
pp. 394-399 ◽  
Author(s):  
Donald D. Glower ◽  
Bhargavi Desai
Keyword(s):  
Mitral Valve ◽  
Ascending Aorta ◽  
Intercostal Space ◽  
Safe Alternative ◽  
Aortic Clamping ◽  
Mitral Valve Operation ◽  
Group A ◽  
Aortic Cannula ◽  
Group B ◽  
Valve Operation

Objective The effects and benefits of a transaortic endoclamp for mitral valve operation through right minithoracotomy have not been established. Methods The records were examined in 671 patients undergoing mitral valve operation using aortic cannulation through a 6-cm right minithoracotomy in the fourth intercostal space. The ascending aorta was cannulated with a 24-Fr cannula through a 12-mm port in the first intercostal space. The experience from 1998 to 2006 with aortic endoclamping (group A, N = 436) was compared with the experience from 2006 to 2009 with external aortic clamping (group B, N = 235). Aortic endoclamping was achieved with a 30 mL endoclamp introduced through the aortic cannula into the ascending aorta to provide aortic endoclamping, anterograde cardioplegia, and root venting. Percutaneous femoral venous cannulation was used. Results Group A and group B had similar demographics. Endoclamp availability (group A) resulted in significantly less fibrillatory arrest (no clamping) in 67 of 436 (15%) versus 104 of 235 (44%) patients in group B (P = 0.001). In patients with aortic clamping, endoclamp (group A) versus external clamp (group B) was not a determinant of clamp time or pump time. Hospital and late outcomes were not different between groups. No patient complications could be attributed to the endoclamp. Conclusions Aortic endoclamping requires no more clamp or pump time than external clamping and can provide a more bloodless field than ventricular fibrillation without obstructing hardware. Aortic endoclamping is a safe alternative for mitral surgery through right minithoracotomy.

SOUND EXPOSURE AND WATER SUPPLY MODIFICATION EFFECT TOWARDS THE ROSS BROILERS GROWTH RATE

2015 ◽  
Vol 77 (17) ◽  
Author(s):  
Rashidah Ghazali ◽  
Herlina Abdul Rahim ◽  
Mashitah Shikh Maidin ◽  
Shafishuhaza Sahlan
Keyword(s):  
Growth Rate ◽  
Water Supply ◽  
Shear Force ◽  
Control Group ◽  
Exposure Group ◽  
Raw Meat ◽  
Sound Exposure ◽  
Significant Difference ◽  
Group A ◽  
Group B

Previous research about the exposure of Mozart music and noise and the effects towards the feeding, growth rate and the stress level of the broilers were explored.Music has the ability to have a relaxing and antidepressant effect on humans, mammals and birds. Reports that music calms animals and improves productivity appear in commercial journals. The present study investigated the growth rate comparisons between the experimented broilers (Group A: water supply modification group; Group B: sound exposure group) and the control broilers (Group C: control group) in terms of weight and raw meat texture measured by shear force. The water supply modification group was given 12 litres of Yasin water twice per day while the sound exposure group were broadcasted with sound of Quran verses. Twenty-seven broilers were randomly selected from each group on Day 24 and weight measurement was carried out every week until the harvest day (Day 39). Group B showed a higher mean weight on Day 24 (1.441 ± 0.013 kg) than Group A and C. Significant difference in the weight on Day 39 existed for both Group A and B compared to Group C (p < 0.05). However, there was no significant (p > 0.05) difference of shear force in the same muscles (breast and drumstick raw meat) of the three groups but the shear force of the breast meat for Group A, B and C broilers was lower (p < 0.05) than that of their drumstick meat. Broadcasting the sound of the Quran verses in the coop and adding Yasin water to the broilers’ drink can be applied to improve the growth rate of broilers for producing better quality poultry.

Isozyme variation, morphology, and growth response to temperature in Pythium irregulare

1997 ◽  
Vol 75 (12) ◽  
pp. 2073-2081 ◽  
Author(s):  
D. J. S. Barr ◽  
S. I. Warwick ◽  
N. L. Desaulniers
Keyword(s):  
Growth Rate ◽  
Pythium Ultimum ◽  
Morphological Characters ◽  
Published Data ◽  
Pythium Irregulare ◽  
Analysis Group ◽  
Wide Range ◽  
Pythium Sylvaticum ◽  
Group A ◽  
Group B

Isozyme-based genetic diversity, morphological characters, and growth rate at different temperatures were compared in a worldwide collection of 125 isolates presumed to be Pythium irregulare Buisman. The isozyme data was analysed with previously published data for Pythium ultimum Trow and Pythium sylvaticum Campbell & Hendrix. UPGMA cluster analysis yielded a dendrogram with four distinct groups: P. ultimum, P. sylvaticum, and two for P. irregulare. Putative P. irregulare isolates were separated into 33 multilocus genotypes defined by 11 isozyme loci: group A contained 116 isolates in 25 genotypes, and group B, 8 isolates in 7 genotypes. One genotype with a single isolate was determined as P. sylvaticum. Based on the isozyme analysis, group B was considered a distinct taxonomic entity from group A, but lacked any unique morphological character. There was a wide range in oogonium and oospore sizes among different isolates of P. irregulare, with those in group B generally being larger. Some isolates in group A had well developed oogonial spines, but others were essentially spineless, whereas all those in group B were spineless. Both groups A and B contained isolates with distinctly aplerotic oospores and others with essentially plerotic oospores. Antheridial number and shape were highly variable both within and among isolates in the two groups. Growth rate over a range of temperatures varied among isolates in both groups and was not a reliable taxonomic criterion. The irregular shape of oogonia and, when present, oogonial spines were the only reliable characters for distinguishing P. irregulare isolates from other taxa. Key words: taxonomy, Oomycetes, Pythiaceae, Pythium ultimum, Pythium sylvaticum.

scholarly journals Facial Nerve Outcome and Results in Hypervascular Large Vestibular Schwannomas: Our Personal Experience in A Series of 32 Cases.

2021 ◽  
Author(s):  
Luciano Mastronardi ◽  
Alberto Campione ◽  
Fabio Boccacci ◽  
Carlo Giacobbo Scavo ◽  
Ettore Carpineta ◽  
...  
Keyword(s):  
Growth Rate ◽  
Facial Nerve ◽  
Personal Experience ◽  
Negative Impact ◽  
Vestibular Schwannomas ◽  
Tumor Diameter ◽  
Excessive Bleeding ◽  
Group A ◽  
Group B ◽  
Mib 1

Abstract BackgroundVestibular schwannomas (VS) are usually hypovascularized. Large VS with unusual vascular architecture are defined hyper-vascular (HVVS); excessive bleeding during microsurgery has negative impact on results. Methods Thirty-two consecutive patients were operated on for HVVS (Group-A). Results were compared with those of 25 patients (Group-B) operated on for large low-bleeding VS. Tendency to bleed and adherence of capsule to nervous structures were evaluated by reviewing video records. Cisternal facial nerve (FN) position was reported. Microsurgical removal was classified as total, near-total, subtotal or partial and MIB-1 index evaluated in all. FN results were classified according the House-Brackmann scale.Results Mean tumor diameter was 3,99cm in Group-A and 3,67 in Group-B; mean age was 42,3 and 58,1 years, respectively. Mean ASA class of Group-A was 1,72 versus 2,48 of Group-B (p<0,001). Total-NT resection was accomplished in 71,9% of HVVS versus 80,0% of Group-B. Tight capsule adhesion was observed in 68,7% HVVS versus 56,0% low-bleeding ones. Mean MIB-1 was 1,25% and 1,08%, respectively.Anterior-superior position of FN was observed in 48,6% of HVVS versus 32,0% of low-bleeding tumors (p<0,05). FN anatomical preservation was possible in 81,2% of Group-A versus 100% of Group-B (p<0,05); 62,5% of HVVS had HBI-II FN outcome versus 96,0% of low-bleeding (p<0,01). In Group-A 25,0% experienced postoperative complications versus 8,0% of Group-B (p<0,05). Recurrence/re-growth was observed in 7 HVVS versus 1 low-bleeding (p<0,05).Conclusions Microsurgery of large HVVS was associated with higher complication and recurrence/re-growth rate and poorer FN outcome, especially in cases with tight capsule adhesion.

scholarly journals Direct Cannulation of Ascending Aorta versus Standard Femoral Artery Cannulation in Acute Aortic Dissection Type A

2018 ◽  
Vol 21 (3) ◽  
pp. 139
Author(s):  
Vassil Gegouskov ◽  
Georgi Manchev ◽  
Vladimir Danov ◽  
Georgi Stoitsev ◽  
Sergey Iliev
Keyword(s):  
Aortic Dissection ◽  
Femoral Artery ◽  
Cerebral Perfusion ◽  
Acute Aortic Dissection ◽  
Circulatory Arrest ◽  
Ascending Aorta ◽  
Group A ◽  
Group B ◽  
Antegrade Cerebral Perfusion ◽  
Aortic Dissection Type A

Background: During surgery for ascending aortic dissection, the dissected ascending aorta itself has traditionally been rejected as a cannulation option. The purpose of this study is to prove that direct cannulation of the ascending aorta in patients operated for acute aortic dissection type A (AADA) is at least as effective and safe as classic femoral cannulation.Methods and Results: Between September 2008 and January 2015, we operated on 117 patients with AADA through median sternotomy. Cannulation was accomplished in 32 cases (27%) through the femoral artery (group A), and in 85 patients (73%) through the dissected ascending aorta (group B). Moderate hypothermic circulatory arrest with bilateral antegrade cerebral perfusion was used in 108 patients (92%). The mean time of circulatory arrest was 17 minutes (range: 9-52 minutes). The 30-day mortality rate was 22% (7 patients) in group A, and 18% (15 patients) in group B (P = not significant). Temporary neurologic dysfunction (TND) including postoperative confusion, delirium, or agitation occurred in four patients (13%) in group A, and four patients (5%) in group B (P = not significant). The incidence of permanent neurologic dysfunction (stroke) was 9% (3 patients) in group A and 3% (3 patients) in group B.Conclusions: The direct cannulation of the ascending aorta is a safe alternative for patients with AADA, offering the opportunity for antegrade cerebral perfusion. It is easy to perform, reliable, and associated with acceptable early results.

scholarly journals Histology and Immunohistochemistry of Radial Arteries Are Suggestive of an Interaction between Calcification and Early Atherosclerotic Lesions in Chronic Kidney Disease

Medicina ◽  
2021 ◽  
Vol 57 (11) ◽  
pp. 1156
Author(s):  
Aikaterini Lysitska ◽  
Nikiforos Galanis ◽  
Ioannis Skandalos ◽  
Christina Nikolaidou ◽  
Sophia Briza ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Vascular Calcification ◽  
Morphometric Analysis ◽  
Intima Media Thickness ◽  
Inflammatory Cells ◽  
Vascular Wall ◽  
Control Group ◽  
Group A ◽  
Group B

Background and Objectives: recent studies suggest an implication of immune mechanisms in atherosclerotic disease. In this paper, the interaction between inflammation, calcification, and atherosclerosis on the vessel walls of patients with chronic kidney disease (CKD) is described and evaluated. Materials and Methods: patients with stage V CKD, either on pre-dialysis (group A) or on hemodialysis (HD) for at least 2 years (group B), in whom a radiocephalic arteriovenous fistula (RCAVF) was created, were included in the study. The control group included healthy volunteers who received radial artery surgery after an accident. The expressions of inflammatory cells, myofibroblasts, and vascular calcification regulators on the vascular wall were estimated, and, moreover, morphometric analysis was performed. Results: the expressions of CD68(+) cells, matrix carboxyglutamic acid proteins (MGPs), the receptor activator of nuclear factor-kB (RANK) and RANK ligand (RANKL), and osteoprotegerin (OPG), were significantly increased in CKD patients compared to the controls p = 0.02; p = 0.006; p = 0.01; and p = 0.006, respectively. In morphometric analysis, the I/M and L/I ratios had significant differences between CKD patients and the controls 0.3534 ± 0.20 vs. 0.1520 ± 0.865, p = 0.003, and 2.1709 ± 1.568 vs. 4.9958 ± 3.2975, p = 0.03, respectively. The independent variables correlated with the degree of vascular calcification were the intensity of CD34(+), aSMA(+) cells, and OPG, R2 = 0.76, p < 0.0001, and, with intima-media thickness (IMT), the severity of RANKL expression R2 = 0.3, p < 0.0001. Conclusion: atherosclerosis and vascular calcification in CKD seem to be strongly regulated by an immunological and inflammatory activation on the vascular wall.

Comparison of aortic remodelling after conservative treatment or thoracic endovascular repair in type B dissections

2019 ◽  
Vol 30 (3) ◽  
pp. 458-464 ◽  
Author(s):  
Migdat Mustafi ◽  
Mateja Andic ◽  
Oana Bartos ◽  
Gerd Grözinger ◽  
Christian Schlensak ◽  
...  
Keyword(s):  
Growth Rate ◽  
Treatment Group ◽  
Conservative Treatment ◽  
Acute Type ◽  
Type B ◽  
Descending Aorta ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract OBJECTIVES Our aim was to compare aortic remodelling in type B dissections after thoracic endovascular aortic repair (TEVAR) or conservative treatment. METHODS We conducted a retrospective analysis of computed tomography (CT) data sets at dissection onset and at the last follow-up in a group with conservative (group A) and TEVAR treatment (group B). An additional analysis of the preoperative CT images was performed in patients from group A, who were converted to TEVAR during follow-up. Diameters and lengths of all aortic segments were measured and growth rates were calculated. RESULTS We included 74 patients: 50 patients in group A (follow-up time: 1625 ± 209 days) and 24 patients in group B (follow-up time: 554 ± 129 days). The mean aortic diameter growth rate was significantly higher in group A than in group B in the mid-descending aorta (A: +7 mm/year; B: −4 mm/year; P = 0.003). Length growth difference was only present in the abdominal aortic segment and was more pronounced in group A (+2 vs ±0 mm/year; P = 0.009). The conversion rate from conservative treatment to TEVAR was 36% (n = 18). A false lumen diameter of &gt;22 mm at baseline was associated with a higher rate of conversion (P = 0.036). After conversion, the mean growth rate in the proximal descending and mid-descending aorta decreased from preoperative +11 and +18 mm/year to postoperative −9 and −14 mm/year, respectively (P &lt; 0.001). CONCLUSIONS In acute type B dissections, TEVAR stops aortic enlargement in the thoracic aorta, but promotes distal dilatation compared to the conservative treatment group. After conversion to TEVAR in conservatively pretreated chronic type B dissections, a more pronounced diameter decrease in the descending aorta was observed than in patients treated in the acute phase.

scholarly journals Resection of pituitary macroadenomas via the pseudocapsule along the posterior tumor margin: a cohort study and technical note

2018 ◽  
Vol 128 (2) ◽  
pp. 422-428 ◽  
Author(s):  
Davis G. Taylor ◽  
John A. Jane ◽  
Edward H. Oldfield
Keyword(s):  
Cohort Study ◽  
Cavernous Sinus ◽  
Residual Tumor ◽  
Maximum Diameter ◽  
Preoperative Imaging ◽  
Cavernous Sinus Invasion ◽  
Normal Gland ◽  
Group A ◽  
Group B ◽  
Pituitary Macroadenomas

OBJECTIVEExtracapsular resection of pituitary microadenomas improves remission rates, but the application of pseudocapsular techniques for macroadenomas has not been well described. In larger tumors, the extremely thin, compressed normal gland or its complete absence along the tumor’s anterior surface limits the application of the traditional pseudocapsular technique that can be used for microadenomas. However, in the authors’ experience, the interface between the pseudocapsule at the posterior margin of the adenoma and the compressed normal gland behind it is universally present, providing a surgical dissection plane. In mid-2010, the authors began using a new surgical technique to identify and use this interface for the resection of larger macroadenomas, a technique that can be used with the microscope or the endoscope.METHODSThe authors performed a cohort study using prospectively collected preoperative imaging reports and operative details and retrospectively reviewed postoperative images and clinical follow-up of patients with a pituitary macroadenoma 20–40 mm in maximum diameter undergoing microscopic transsphenoidal resection. Since dissection of the tumor capsule only pertains to encapsulated tumor within the sella and not to tumor invading the cavernous sinus, assessment of tumor removal of noninvasive tumors emphasized the entire tumor, while that of invasive tumors emphasized the intrasellar component only. The incidence of residual tumor on postoperative imaging, new-onset endocrinopathy, and recovery of preoperative pituitary deficits was compared between patients who underwent surgery before (Group A) and after (Group B) implementation of the new technique.RESULTSThere were 34 consecutive patients in Group A and 74 consecutive patients in Group B. Tumors in 18 (53%) Group A and 40 (54%) Group B patients had no evidence of cavernous sinus invasion on MRI. Use of the posterior pseudocapsule technique reduced the incidence of intrasellar residual tumor on postoperative MRI for tumors without cavernous sinus invasion (39% [Group A] vs 10%, p < 0.05) and in all tumors regardless of invasion (50% vs 18%, p < 0.005). The incidence of new endocrinopathy was less likely (25% vs 12%, p = 0.098) and the recovery of prior deficits more likely (13% vs 27%, p = 0.199) among patients treated using the pseudocapsule approach, although the differences are not statistically significant.CONCLUSIONSUse of the posterior pseudocapsule dissection plane can enhance the resection of pituitary macroadenomas.

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