scholarly journals What is the added value of CT-angiography in patients with transient ischemic attack?

BMC Neurology ◽  
2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Ilko L. Maier ◽  
Gerrit U. Herpertz ◽  
Mathias Bähr ◽  
Marios-Nikos Psychogios ◽  
Jan Liman
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Arterial Hypertension ◽  
Short Duration ◽  
Clinical Characteristics ◽  
Vascular Pathology ◽  
Invasive Treatment ◽  
Duration Of Symptoms ◽  
Ischemic Attack

Abstract Background Transient ischemic attack (TIA) is an important predictor for a pending stroke. Guidelines recommend a workup for TIA-patients similar to that of stroke patients, including an assessment of the extra- and intracranial arteries for vascular pathologies with direct therapeutic implications via computed tomography angiography (CTA). Aim of our study was a systematic analysis of TIA-patients receiving early CTA-imaging and to evaluate the predictive value of TIA-scores and clinical characteristics for ipsilateral vascular pathologies and the need of an invasive treatment. Methods We analysed clinical and imaging data from TIA patients being admitted to a tertiary university hospital between September 2015 and March 2018. Following subgroups were identified: 1) no- or low-grade vascular pathology 2) ipsilateral high-risk vascular pathology and 3) high-risk findings that needed invasive, surgical or interventional treatment. We investigated established TIA-scores (ABCD2-, the ABCD3- and the SPI-II score) and various clinical characteristics as predictive factors for ipsilateral vascular pathologies and the need for invasive treatment. Results Of 812 patients, 531 (65.4%) underwent initial CTA in the emergency department. In 121 (22.8%) patients, ipsilateral vascular pathologies were identified, of which 36 (6.7%) needed invasive treatment. The ABCD2-, ABCD3- and SPI-II-scores were not predictive for ipsilateral vascular pathologies or the need for invasive treatment. We identified male sex (OR 1.579, 95%CI 1.049–2.377, p = 0.029), a short duration of symptoms (OR 0.692, 95% CI 0.542–0.884, p = 0.003), arterial hypertension (OR 1.718, 95%CI 0.951–3.104, p = 0.073) and coronary heart disease (OR 1.916, 95%CI 1.184–3.101, p = 0.008) as predictors for ipsilateral vascular pathologies. As predictors for the need of invasive treatment, a short duration of symptoms (OR 0.565, 95%CI 0.378–0.846, p = 0.006), arterial hypertension (OR 2.612, 95%OR 0.895–7.621, p = 0.079) and hyperlipidaemia (OR 5.681, 95%CI 0.766–42.117, p = 0.089) as well as the absence of atrial fibrillation (OR 0.274, OR 0.082–0.917, p = 0.036) were identified. Conclusion More than every fifth TIA-patient had relevant vascular findings revealed by acute CTA. TIA-scores were not predictive for these findings. Patients with a short duration of symptoms and a vascular risk profile including coronary heart disease, arterial hypertension and hyperlipidaemia most likely might benefit from early CTA to streamline further diagnostics and therapy.

scholarly journals What is the added value of CT-angiography in patients with transient ischemic attack?

2020 ◽  
Author(s):  
Gerrit U. Herpertz ◽  
Ilko L Maier ◽  
Mathias Bähr ◽  
Marios-Nikos Psychiogios ◽  
Jan Liman
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Short Duration ◽  
Added Value ◽  
Vascular Pathology ◽  
Interventional Treatment ◽  
Low Grade ◽  
Duration Of Symptoms ◽  
Ischemic Attack

Abstract BackgroundTransient ischemic attack (TIA) is an important predictor for a pending stroke. Guidelines recommend similar workup for TIA-patients as for stroke patients to directly assess the extra- and intracranial arteries via Computed tomography angiography (CTA) regarding vascular pathologies with direct therapeutic implications. Aim of our study was a systematic analysis of CTA-findings in TIA-patients and evaluate possible predictive TIA scores for ipsilateral vascular pathology. MethodsWe analysed data from TIA patients, admitted to our University Medical Centre, between September 2015 and March 2018, to identify predictors for high-risk vascular pathologies, like high-grade stenosis, dissection, thrombi or occlusion and the for need for an intervention. Following subgroups were identified: 1) no- or low-grade-stenosis (<50%) 2) ipsilateral high-risk vascular pathology and 3) high risk findings needing surgical or interventional treatment. As predictive tools for ipsilateral vascular findings we used the ABCD2-, the ABCD3- and the SPI-II score.ResultsOf 833 patients, 549 (65.9%) underwent initial CTA in the emergency department. In 126 (23.0%) patients, ipsilateral vascular findings were identified from which 40 (7.3%) needed treatment. The ABCD2-, ABCD3- and SPI-II-scores were not predictive for ipsilateral vascular pathologies. We identified coronary heart disease (OR 2.13, 1.35-3.39 95% CI; p=0.001) and short duration of symptoms (OR 0.7, 0.55-0,89 95% CI; p=0.004) as predictors for ipsilateral vascular pathologies. ConclusionMore than every fifth TIA-patient had relevant vascular findings revealed by acute CTA. TIA-scores were not predictive for these findings. Patients with a history of coronary heart disease and short duration of symptoms most likely might benefit from acute CTA to streamline further diagnostics and therapy.

scholarly journals What is the Added Value of CT-angiography in Patients with Transient Ischemic Attack?

2020 ◽  
Author(s):  
Gerrit U. Herpertz ◽  
Ilko L. Maier ◽  
Mathias Bähr ◽  
Marios-Nikos Psychiogios ◽  
Jan Liman
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Short Duration ◽  
Added Value ◽  
Vascular Pathology ◽  
Interventional Treatment ◽  
Low Grade ◽  
Duration Of Symptoms ◽  
Ischemic Attack

Abstract BackgroundTransient ischemic attack (TIA) is an important predictor for a pending stroke. Guidelines recommend similar workup for TIA-patients as for stroke patients to directly assess the extra- and intracranial arteries via Computed tomography angiography (CTA) regarding vascular pathologies with direct therapeutic implications. Aim of our study was a systematic analysis of CTA-findings in TIA-patients and evaluate possible predictive TIA scores for ipsilateral vascular pathology.MethodsWe analysed data from TIA patients admitted to our University Medical Centre, between September 2015 and March 2018. Following subgroups were identified: 1) no- or low-grade-stenosis (<50%) 2) ipsilateral high-risk vascular pathology and 3) high risk findings needing surgical or interventional treatment. As predictive tools for ipsilateral vascular findings we used the ABCD2-, the ABCD3- and the SPI-II score.ResultsOf 833 patients, 549 (65.9%) underwent initial CTA in the emergency department. In 126 (23.0%) patients, ipsilateral vascular findings were identified from which 40 (7.3%) needed treatment. The ABCD2-, ABCD3- and SPI-II-scores were not predictive for ipsilateral vascular pathologies. We identified male sex (OR 1.58, 1.06-2.36 95% CI; p=0.026), coronary heart disease (OR 1.88, 1.17-3.02 95% CI; p=0.009) and short duration of symptoms (OR 0.7, 0.55-0,89 95% CI; p=0.004) as predictors for ipsilateral vascular pathologies. ConclusionMore than every fifth TIA-patient had relevant vascular findings revealed by acute CTA. TIA-scores were not predictive for these findings. Male patients with a history of coronary heart disease and short duration of symptoms most likely might benefit from acute CTA to streamline further diagnostics and therapy.

scholarly journals What is the added value of CT-angiography in patients with transient ischemic attack?

2021 ◽  
Author(s):  
Gerrit U. Herpertz ◽  
Ilko L Maier ◽  
Mathias Bähr ◽  
Marios-Nikos Psychiogios ◽  
Jan Liman
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Short Duration ◽  
Transient Ischemic Attack ◽  
Added Value ◽  
Vascular Pathology ◽  
Low Grade ◽  
Duration Of Symptoms ◽  
Ischemic Attack

Abstract Background Transient ischemic attack (TIA) is an important predictor for a pending stroke. Guidelines recommend similar workup for TIA-patients as for stroke patients to directly assess the extra- and intracranial arteries via Computed tomography angiography (CTA) regarding vascular pathologies with direct therapeutic implications. Aim of our study was a systematic analysis of CTA-findings in TIA-patients and evaluate possible predictive TIA scores for ipsilateral vascular pathology. Methods We analysed data from TIA patients, admitted to our University Medical Centre, between September 2015 and March 2018, to identify predictors for high-risk vascular pathologies, like high-grade stenosis, dissection, thrombi or occlusion and the for need for an intervention. Following subgroups were identified: 1) no- or low-grade-stenosis (<50%) 2) ipsilateral high-risk vascular pathology and 3) high risk findings needing surgical or interventional treatment. As predictive tools for ipsilateral vascular findings we used the ABCD2-, the ABCD3- and the SPI-II score.Results Of 833 patients, 549 (65.9%) underwent initial CTA in the emergency department. In 126 (23.0%) patients, ipsilateral vascular findings were identified from which 40 (7.3%) needed treatment. The ABCD2-, ABCD3- and SPI-II-scores were not predictive for ipsilateral vascular pathologies. We identified coronary heart disease (OR 2.13, 1.35-3.39 95% CI; p=0.001) and short duration of symptoms (OR 0.7, 0.55-0,89 95% CI; p=0.004) as predictors for ipsilateral vascular pathologies. Conclusion More than every fifth TIA-patient had relevant vascular findings revealed by acute CTA. TIA-scores were not predictive for these findings. Patients with a history of coronary heart disease and short duration of symptoms most likely might benefit from acute CTA to streamline further diagnostics and therapy.

scholarly journals Features of gene polymorphism in comorbid patients with arterial hypertension and coronary heart disease

2021 ◽  
Vol 2 (4) ◽  
pp. 60-64
Author(s):  
L. V. Arutyunyan ◽  
N. V. Drobotya ◽  
A. A. Pirozhenko ◽  
V. V. Kaltukova
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Gene Polymorphism ◽  
Ischemic Heart Disease ◽  
Arterial Hypertension ◽  
Molecular Genetic ◽  
Genetic Research ◽  
Ischemic Heart ◽  
Early Screening

Objective: to assess the prospects of using genetic testing for early detection of patients with arterial hypertension (AH) with a high risk of developing coronary heart disease (IHD).Material and methods: we examined 100 patients with hypertension, who were divided into 2 groups: patients with hypertension without ischemic heart disease (62%, 62 people) and patients with hypertension with ischemic heart disease (38%, 38 people). All patients underwent a standard volume of diagnostic procedures, as well as molecular genetic research. Results: the specificity of the carriage of gene polymorphism was revealed, depending on the presence of isolated AH or AH in combination with IHD in patients. Patients with AH and IHD are characterized by the presence of the CC genotype and the C allele of the ΝΟS3 gene (p = 0,040 and p = 0,035), while the TT genotype of the T‑786C polymorphic marker of the NOS3 gene is characteristic of patients with isolated AH. Conclusion: the study of the genetic aspects of comorbidity is theoretically important for understanding the mechanisms of its formation. From a practical point of view, the opportunity to use modern genetic approaches for early screening of hypertensive patients with a high risk of developing cardiac comorbid pathology is valuable.

scholarly journals The impact of acetylsalicylic acid dosed at bedtime on circadian rhythms of blood pressure in the high-risk group of cardiovascular patients—a randomized, controlled trial

2020 ◽  
Vol 77 (1) ◽  
pp. 35-43
Author(s):  
Beata Krasińska ◽  
Lech Paluszkiewicz ◽  
Ewa Miciak-Ławicka ◽  
Maciej Krasinski ◽  
Piotr Rzymski ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Arterial Hypertension ◽  
Risk Group ◽  
High Risk Group ◽  
Control Group ◽  
Cardiovascular Patients ◽  
The Impact

Abstract Purpose Time of drug administration may significantly influence its effect. The aim of the present study was to investigate the effect of ASA (administrated in the morning or in the evening) on the anti-hypertensive effect and diurnal blood pressure profile in the high-risk group of cardiovascular patients. Methods All patients (n = 114) had been diagnosed with coronary heart disease and arterial hypertension prior to the enrolment and had been treated with 75 mg per day of ASA in the morning. The patients were randomly assigned to one of the two study groups receiving 75 mg of ASA per day in a single antiplatelet therapy for 3 months in the morning (n = 58) or in the evening (n = 56). The control group (n = 61) consisted of patients with arterial hypertension but without coronary heart disease, not receiving ASA. In all the patients, during each visit, clinical blood pressure (BP) and ambulatory blood pressure measurements (ABPM) were performed. Results There was a significant reduction in 24-h BP and blood pressure at night in the ASA group evening group compared with the ASA morning group and the control group. Conclusions The present study demonstrated that compared with the use of ASA in the morning, its administration in the evening may lead to favourable drop in the ABPM and an improvement of the diurnal profile in the high-risk group of cardiovascular patients who are not naïve to ASA.

scholarly journals Combined antihypertensive therapy in patients with arterial hypertension and coronary heart disease

2011 ◽  
Vol 10 (3) ◽  
pp. 28-34
Author(s):  
O. A. Ageenkova ◽  
V. A. Milyagin ◽  
M. A. Purygina
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Arterial Stiffness ◽  
Arterial Hypertension ◽  
Treatment Phase ◽  
Measurement Standard ◽  
Additional Correction ◽  
Stage 1 ◽  
Very High

Aim. To assess the potential of adding perindopril and indapamide CR (controlled release) to standard therapy, as a method for additional correction of cardiovascular risk factors (RFs) among patients with Stage 1-3 arterial hypertension (AH) of very high risk and coronary heart disease (CHD). Material and methods. In total, 44 patients (29 men, 15 women; age 45-80 years, mean age 56±10,7 years) with Stage 1-3 AH of very high risk and CHD were examined. At baseline and after 2, 4, and 16 weeks of the treatment, all participants underwent physical examination, office blood pressure (BP) measurement, standard laboratory tests, electrocardiography (ECG), Holter ECG monitoring, 24-hour BP monitoring, echocardiography (EchoCG), and arterial stiffness assessment. Results. All participants completed the study protocol, with no adverse effects during the treatment phase. In all patients with Stage 1-3 AH, target BP levels and improved 24-hour BP profile were achieved. In CHD patients, a reduction in the incidence of ischemic episodes and their duration was observed. There was a positive dynamics of arterial stiffness parameters. Conclusion. Perindopril and indapamide CR demonstrated good antihypertensive effectiveness, as well as cardioand vasoprotective activity in patients with very high-risk AH and CHD.

The Preventive Effect of Alprostadil on the Contrast-Induced Nephropathy of Coronary Heart Disease Treated by Percutaneous Coronary Intervention in Moderate and High-Risk Population Stratified by Mehran Score

Angiology ◽  
2021 ◽  
pp. 000331972110155
Author(s):  
Xiaogang Liu ◽  
Peng Zhang ◽  
Jing Zhang ◽  
Xue Zhang ◽  
Shicheng Yang ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Percutaneous Coronary Intervention ◽  
Heart Disease ◽  
High Risk ◽  
Risk Groups ◽  
Coronary Intervention ◽  
Preventive Effect ◽  
Moderate Risk ◽  
Contrast Induced Nephropathy ◽  
Percutaneous Coronary

The Mehran risk score (MRS) was used to classify patients with coronary heart disease and evaluate the preventive effect of alprostadil on contrast-induced nephropathy (CIN) after percutaneous coronary intervention. The patients (n = 1146) were randomized into an alprostadil and control group and then divided into 3 groups on the basis of the MRS: low-risk, moderate-risk, and high-risk groups. The primary end point was the occurrence of CIN (alprostadil + hydration vs simple hydration treatment); secondary end points included serum creatinine, blood urea nitrogen, creatinine clearance rate, cystatin C, interleukin-6, C-reactive protein, proteinuria, and differences in the incidence of major adverse events. In the low-risk, moderate-risk, and high-risk groups, the incidence of CIN in the control and alprostadil group was 2.9 versus 2.6% ( P = .832), 11.4 versus 4.9% ( P = .030), 19.1 versus 7.7% ( P = .041), respectively. Multivariate logistic regression analysis showed that alprostadil treatment was a favorable protective factor for moderate-risk and high-risk CIN patients (OR = 0.343, 95% CI: 0.124-0.951, P = .040). Alprostadil can be used as a preventive treatment for moderate- and high-risk CIN patients classified by the MRS. The reduction of CIN by alprostadil may be related to an anti-inflammatory effect.

scholarly journals Statin Underuse and Low Prevalence of LDL-C Control Among U.S. Adults at High Risk of Coronary Heart Disease

2014 ◽  
Vol 348 (2) ◽  
pp. 108-114 ◽  
Author(s):  
Christopher M. Gamboa ◽  
Monika M. Safford ◽  
Emily B. Levitan ◽  
Devin M. Mann ◽  
Huifeng Yun ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
High Risk ◽  
Low Prevalence
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