RAISED LEVEL OF LIPOPROTEIDE(A) AS A PREDICTOR OF CARDIOVASCULAR COMPLICATION POST REVASCULARIZATION OF THE LOWER ExTREMETIES ARTERIES

Aim. Lipoproteide (a) (Lpa) is a pathogenetic risk factor of cardiovascular atherosclerotic disease. On the role of Lpa in the development of cardiovascular complications (CVC) after lower limbs arteries revascularization, there is lack of data. The aim of the study was assessment of Lpa relation to CVC occurrence after revascularization of lower extremities during 1 year follow-up.Material and methods. In the study, 111 patients were included (97 males, 14 females, mean age 66±9 y.o.), who had undergone revascularization of lower libms arteries due to atherosclerosis. As CVC during 1 year follow-up, the following were taken: recurrent intermittent claudication, lower extremity amputation, ischemic stroke, transient cerebral ischemia, non-fatal myocardial infarction, unstable angina, repeat revascularization and cardiovascular death. In all patients, in the blood serum, there were measured lipids and Lpa.Results. Within 1 year after revascularization there were 45 (41%) CVC. In the group with raised Lpa ≥30 mg/dL there were more CVC than in Lpa <30 mg/dL: relative risk 2,1 (95% CI 1,3-3,5; p=0,004). Hence the increased level of Lpa is an independent predictor of CVC after revascularization of lower extremities arteries.Conclusion. In prospective study, during 1 year after revascularization the level of Lpa ≥30 mg/dL is associated with double increase of the risk of CVC.

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STAI (Studio Ticlopidina Angina Instabile) PROJECT. TICLOPIDINE -IN UNSTABLE ANGINA

10.1055/s-0038-1644818 ◽

1987 ◽

Author(s):

F Violi ◽

C Cimminiello ◽

S Chierichetti ◽

M Scatigna ◽

P Rizzon ◽

...

Keyword(s):

Unstable Angina ◽

Clinical Symptoms ◽

Cardiovascular Complications ◽

Fibrinogen Binding ◽

Clinical Pictures ◽

Fatal Myocardial Infarction ◽

Angina At Rest ◽

New Onset

The treatment of patients suffering from unstable angina (UA) with antiplatelet drugs is a therapeutic approach that provided interesting results.Patients given aspirin, that inhibits cyclooxigenase pathway (CP) showed a significant reduction of cardiovascularevents.Quite surprisingly sulfinpirazone, that possesses a mechanism of action similar to aspirin, did not influence cardiovascular complications of UA patients.To further investigate the role of platelets in UA patients, we planned to study if ticlopidine (T), that inhibits platelet function by blocking fibrinogen binding to platelets, influences theclinical course of UA.The study will include 1200 randomised patients given conventional therapy with or without T (500 mg/daily).Patients enrolled have to show one ofthe following clinical pictures: 1) angina at rest; 2) "crescendo angina"; 3) new onset angina.Clinical symptoms should be present within 30 days. The follow-up will last6 months.Primary end-point of the study is the incidence of fatal and non-fatal myocardial infarction and of vascular death.Apart from the possible influence of T in the natural course of UA, the study will offer the opportunity to find and incidence pattern of UA cardiovascular complications in Italy.

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EFFICIENCY OF THE TREATMENT OF DISABLED PERSONS WITH OBLITERATING ATHEROSCLEROSIS OF ARTERIES OF LOWER EXTREMITIES ACCORDING TO DATA OF THE PROSPECTIVE MEDICAL-SOCIAL RESEARCH

Medical and Social Expert Evaluation and Rehabilitation ◽

10.18821/1560-9537-2017-20-3-131-135 ◽

2017 ◽

Vol 20 (3) ◽

pp. 131-135

Author(s):

A. Sh Kalichava ◽

Lyudmila A. Karasaeva ◽

M. V Avdeeva ◽

V. C Luchkevich

Keyword(s):

Conservative Treatment ◽

Social Research ◽

Lower Extremities ◽

Disabled Persons ◽

Lower Limbs ◽

Social Effectiveness ◽

Group Iii ◽

Reconstructive Operations ◽

Surgical Methods

By the end of the 5-year follow-up period, the limb was succeeded to be preserved in most patients with obliterating atherosclerosis of the vessels of the lower limbs who underwent surgery, both in the aorto-iliac and the femoral-popliteal segment (82,4 and 69,7%). Only in half of patients with obliterating atherosclerosis who underwent surgery on the aorto-iliac or femoral-popliteal segment, the limb was preserved (52,3 and 52,8%). The frequency of amputation after revascularization operations was 2,5 times lower than in cases received the conservative treatment (17,7 and 44,3%; p < 0,05). In the group of conservatively treated patients, a significant and mostly significant restriction of movement was found in 41,6% of patients with obliterating atherosclerosis of the vessels of the lower limbs, while after reconstructive operations, such restrictions were 2,8 times less frequent (41,6 and 14,8%; p < 0,05). After revascularization, the number of people with disabilities in group III was 2,5 times higher than among patients treated conservatively (27,9 and 11,0%; p < 0,05). The main advantage of this type of treatment was a significant reduction in the proportion of patients requiring constant external care than with conservative treatment (11,4 and 33,8%; p < 0,05). Lumbar sympathectomy demonstrated the highest efficacy, because in 43,6% (n = 55) of cases it was performed in the combination with an operation for to revascularization of arteries of lower extremities. Thus, in the study there was demonstrated the higher medical and social effectiveness of the use of surgical methods of treatment compared with conservative ones in the treatment of patients with obliterating atherosclerosis of the vessels of the lower extremities.

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The Prognostic Role of Anemia in Heart Failure Patients

Revista de Chimie ◽

10.37358/rc.20.1.7830 ◽

2020 ◽

Vol 71 (1) ◽

pp. 185-191

Author(s):

Tudor Parvanescu ◽

Bogdan Buz ◽

Diana Aurora Bordejevic ◽

Florina Caruntu ◽

Mihai Trofenciuc ◽

...

Keyword(s):

Heart Failure ◽

Clinical Condition ◽

Independent Predictor ◽

Univariate Analysis ◽

Hemoglobin Concentration ◽

Prognostic Role ◽

Heart Failure Patients ◽

Length Of Hospitalization

Anemia is frequently observed in heart failure (HF) patients. The aim of this prospective study was to assess if it is an independent predictor of outcome or a marker of a worse clinical condition in these patients. The study included 134 heart failure patients aged over 18 years. The patients were divided into two groups, according to the presence or absence of anemia at hospital admission. Anemia was defined as a hemoglobin concentration of less than 12 g/dl for women and less than 13 g/dl for men. The endpoints were: length of hospitalization, all cause-death during hospitalization, and all-cause death and HF rehospitalizations at 1 year. Anemia occurred in 33% of HF patients. The HF patients with anemia were significantly older, had more often ischemic etiology of heart failure and atrial fibrillation, chronic kidney disease and 3 or more comorbidities. The length of hospitalization was similar between the two groups. Deaths during hospitalization occurred in 13% of anemic and in 3% of the nonanemic patients (P=0.04). During the 1- year follow-up, 45% of the anemic vs. 28% of the nonanemic patients were rehospitalized due to aggravated HF (P=0.04), and 14% of the anemic vs 20% of the nonanemic patients died (P=0.38). Anemia was strongly predictive for in-hospital and 1- year all-cause deaths in univariate analysis, but not in multivariate analysis. Anemia seems more a marker of a worse clinical condition, rather than an independent risk factor in HF.

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Role of presurgery circulating cancer cells (CTCs) as a potential pronostic factor in patients (pts) with liver surgery (LS) of colorectal cancer (CRC) metastases (M).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.4_suppl.518 ◽

2012 ◽

Vol 30 (4_suppl) ◽

pp. 518-518

Author(s):

Lucia Teijeira ◽

Antonio Viúdez ◽

Maria L. Antelo ◽

Antonio Tarifa ◽

Cruz Zazpe ◽

...

Keyword(s):

Independent Predictor ◽

Primary Tumour ◽

Neoadjuvant Treatment ◽

Wild Type ◽

Cellsearch System ◽

Future Studies ◽

Circulating Cancer Cells ◽

Kras Status

518 Background: Kinetic behavior of perioperative CTCs in pts with liver CRC M has been little explored. The aim of this study was to quantified CTCs performance before, just performed and 3 months after radical LS in pts with CRC M and analyzed the surrogate role of CTCs determinations in DFS and OS. Methods: 7.5 ml of blood were drawn in CellSave tubes. CTCs were enumerated before, just performed and 3 months after radical LS. CTCs were immunomagnetically separated and fluorescently labeled using the CellSearch System (Veridex/Immunicon Corp.) Results: From February 2009 to August 2011, 30 pts with LS of CRC M were included. Median age was 59 (45-75); 63.3 % men. Kras status: 63.2% wild-type and 36.8% mutated; 46.7% with synchronous disease. Fong-Criteria (FC) distribution: 30% pts with 1 FC, 36.7% pts with 2 FC and 33.3% pts with 3 FC, of whom 56.7% received neoadjuvant (76.4% fluoropirimidines-based; 29% cetuximab-based; 47% bevacizumab-based) and 73.3% adjuvant treatment. PR and SD were observed in 68.8% and 31.3% of pts, respectively (100% DCR). In 83% of cases, limited LS were done (79.3% R0, median M resected: 2), 20% of pts with synchronous surgery of primary tumour. Of the 15 pts analysed, pCR were observed in 2 (13.3%) with 6 other pts (40%) with major pathological response. With a median of follow-up of 21 months, progression disease occurred in 9 pts (55.6% with liver progression), and 4 pts died. Median CTCs was 0 before (0-2: 85%; ≥3: 14.8%), just performed (0-2: 78%; ≥3: 21%) and 3 months after surgery (0-2: 94.1%; ≥3: 5.9%). DFS for pts with pre-surgery CTCs ≥3 was 10 months, and not reached for 0-2 CTCs group. OS has not been achieved in any CTCs group. In the multivariate analysis, with FC and pre-surgery CTCs, pre-surgery CTCs ≥3 tends to be an independent predictor of outcome (HR: 2.83; CI:0.53-15). Conclusions: Independently of neoadjuvant treatment, pre-surgery CTCs levels ≥3 could be a surrogate of short DFS in pts with LS of CRC M. Our study shown a slight increase in CTCs quantification after LS, instead a significant CTCs decrease was observed after adjuvant therapy. Role of radical LS in kinetic of CTCs should continue to be analysed in future studies.

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Telangiectases in Venous Insufficiency: Point of Reflux and Treatment Strategy

Phlebology The Journal of Venous Disease ◽

10.1177/026835550001500107 ◽

2000 ◽

Vol 15 (1) ◽

pp. 38-42 ◽

Cited By ~ 11

Author(s):

F. Mariani ◽

V. Bianchi ◽

S. Mancini ◽

S. Mancini

Keyword(s):

Venous Insufficiency ◽

Duplex Ultrasound ◽

Average Diameter ◽

Venous System ◽

Lower Limbs ◽

Perforating Veins ◽

Ceap Classification

Objective: To verify the role of sources of non-saphenous reflux in the appearance of reticular varices and telangiectases in areas other than the lateral venous system of Albanese. Setting: Institute of General Surgery and Surgical Specialisations, Interdepartmental Centre of Research, Treatment and Phlebolymphological Rehabilitation, University of Siena. Patients and methods: The study was carried out on 106 women aged 18–65 years who were affected by chronic venous insufficiency (CVI) at the Cla-s Ep Asl stage, according to the CEAP classification. The patients had telangiectases (200 telangiectactic areas) and reticular varices of the lower limbs of type II and III of the classification of Weiss, with competent saphenous trunks and a normal deep venous system. Sclerotherapy was therefore performed, after clinical and duplex ultrasound examination. The records of 185 telangiectactic area treated 3 years earlier were reviewed. Results: In all cases reticular varices was found together with the telangiectases. In 73.5% (147/200 areas) one or more incompetent perforating veins was found (average diameter 1.6 mm) and in 83.6% (123/147 areas) it was possible to establish that the main source of reflux was in the base of the telangiectasia. Complete elimination of microvarices was achieved in 88% of cases (176/200 areas; average sessions: 3.5). The complications were haemosiderin pigmentation (1.5%, 3/200 areas) and matting (1%, 2/200 areas). In 24 areas resistant to the therapy it was not possible to demonstrate the presence of reflux, while in 24.5% of cases (49/200 areas, average surface 15.4 cm2) two sessions of sclerotherapy were sufficient eventually to obtain (about 4 weeks later) the disappearance of the micro-varices. Follow-up after 3 years revealed the appearance of new telangiectases in 58.9% of cases (109/185 check-ups). Of these 95.4% (104/109) arose in areas other than those treated and therefore only 4.6% (5/109) recurred in the area where the sclerosing treatment had been carried out. Conclusion: In CVI all telangiectases are accompanied by reticular varices, even when not visible on clinical examination; in most cases the sources of reflux are distinguishable as incompetent perforating veins and are situated beneath telangiectactic efflorescences.

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Primary Orbital Myxoid Liposarcoma: A Case Report and Review of Literature

Asian Journal of Medical Sciences ◽

10.3126/ajms.v4i4.8311 ◽

2013 ◽

Vol 4 (4) ◽

pp. 28-32

Author(s):

Chen Niu ◽

Netra Rana ◽

Zhi Gang Min ◽

Ming Zhang

Keyword(s):

Medical Science ◽

Myxoid Liposarcoma ◽

Soft Tissue Tumors ◽

Lower Limbs ◽

Mri Findings ◽

One Year ◽

The Right ◽

Ct And Mri

Liposarcomas are common malignant soft-tissue tumors, which come from primitive mesenchymal cells and differentiate into adipose tissue. These tumors are more commonly found in lower limbs and retroperitoneal region but also reported in pharynx, lung, liver, digestive tract, diaphragm, as well as in the spermatic cord. We reported a case of primary orbital myxoid liposarcoma in a 20-year-old female patient presented with a painless proptosis of the right eye. The mass was pathologically diagnosed as a myxoid liposarcoma. The tumor recurred in 9 months after surgical intervention. The second surgery was performed and followed by postoperative local radiotherapy. No recurrence has been reported after one year of follow-up. We highlighted the role of CT and MRI findings in the tumor diagnosis and the importance of local radiotherapy after surgery. Asian Journal of Medical Science, Volume-4 (2013), Pages 28-32 DOI: http://dx.doi.org/10.3126/ajms.v4i4.8311

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Prevalence and clinical outcomes of triglyceride deposit cardiomyovasculopathy among haemodialysis patients

Heart ◽

10.1136/heartjnl-2020-317672 ◽

2020 ◽

Vol 107 (2) ◽

pp. 127-134 ◽

Cited By ~ 2

Author(s):

Tomohiro Onishi ◽

Yusuke Nakano ◽

Ken-ichi Hirano ◽

Yasuyuki Nagasawa ◽

Toru Niwa ◽

...

Keyword(s):

Primary Endpoint ◽

Cardiovascular Death ◽

Suspected Coronary Artery Disease ◽

Control Group ◽

Multivariate Models ◽

Potential Therapeutic Target ◽

Increased Risk ◽

Artery Disease ◽

Fatal Myocardial Infarction

ObjectiveTo evaluate the effect of triglyceride deposit cardiomyovasculopathy (TGCV) on the cardiovascular outcomes in haemodialysis (HD) patients with suspected coronary artery disease (CAD).MethodsThis retrospective single-centre observational study included data from the cardiac catheter database of Narita Memorial Hospital between April 2011 and March 2017. Among 654 consecutive patients on HD, the data for 83 patients with suspected CAD who underwent both [123I]-β-methyl-iodophenyl-pentadecanoic acid scintigraphy and coronary angiography were analysed. Patients were divided into three groups: definite TGCV (17 patients), probable TGCV (22 patients) and non-TGCV control group (44 patients). The primary endpoint was a composite of cardiovascular death, non-fatal myocardial infarction and non-fatal stroke assessed for up to 5 years of follow-up.ResultsThe prevalence of definite TGCV was approximately 20% and 2.6% among consecutive HD patients with suspected CAD and among all HD patients, respectively. At the end of the median follow-up period of 4.7 years, the primary endpoint was achieved in 52.9% of the definite TGCV patients (HR, 7.45; 95% CI: 2.28 to 24.3; p<0.001) and 27.3% of the probable TGCV patients (HR, 3.28; 95% CI: 0.93 to 11.6; p=0.066), compared with that in 9.1% of the non-TGCV control patients. Definite TGCV was significantly and independently associated with cardiovascular mortality and outcomes among HD patients in all multivariate models.ConclusionsTGCV is not uncommon in HD patients and is associated with an increased risk of cardiovascular events including cardiovascular death. Thus, TGCV might be a potential therapeutic target.

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Prognostic Value of Ultrasonographic Measurement of Carotid Intima Media Thickness in Dialysis Patients

Journal of the American Society of Nephrology ◽

10.1681/asn.v12112458 ◽

2001 ◽

Vol 12 (11) ◽

pp. 2458-2464 ◽

Cited By ~ 3

Author(s):

FRANCESCO ANTONIO BENEDETTO ◽

FRANCESCA MALLAMACI ◽

GIOVANNI TRIPEPI ◽

CARMINE ZOCCALI

Keyword(s):

Independent Predictor ◽

Intima Media Thickness ◽

Cardiovascular Death ◽

Independent Effect ◽

Dialysis Patients ◽

Carotid Ultrasonography ◽

Dialysis Treatment ◽

Media Thickness ◽

Concentric Hypertrophy

Abstract. High-resolution carotid ultrasonography is considered a fundamental technique for the investigation of the vascular system. However, it is still very unclear whether ultrasonographic studies of carotid arteries are useful for the prediction of cardiovascular events in patients with end-stage renal disease. The prediction power of carotid ultrasonography for all-cause and cardiovascular mortality was tested in a cohort of 138 patients receiving chronic dialysis treatment (91 receiving hemodialysis treatment and 47 receiving continuous ambulatory peritoneal dialysis treatment; follow-up, 29.8 ± 15.0 mo), and the relationship between this parameter and alterations in left ventricular mass (LVM) and geometry was examined. On univariate analysis, intima media thickness (IMT) was directly related to LVM as well as to the absolute and relative thicknesses of LV walls but independent of LV end-diastolic volume. Data analysis based on LV geometry patterns revealed that patients with concentric hypertrophy were those with the highest IMT. The internal diameter of the common carotid artery (DCCA) was also related to concentric hypertrophy, but the strength of this relationship was of borderline significance (P= 0.06). During the follow-up period, 63 patients died: 32 (51%) of them of cardiovascular causes. IMT was significantly higher (P= 0.006) in patients who died of cardiovascular causes (1.10 ± 0.21 mm) than in patients who survived (0.99 ± 0.24 mm), In a Cox regression model, this parameter turned out to be an independent predictor of cardiovascular death, and it retained an independent effect in a model that included LVM. Treatment modality failed to independently predict this outcome. The risk of cardiovascular death was progressively higher from the first IMT tertile onward. DCCA failed to predict cardiovascular outcomes. IMT in dialysis patients is associated with LV concentric hypertrophy and is an independent predictor of cardiovascular death. IMT may be usefully applied for risk stratification in the dialysis population.

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4078Lipoprotein(a) and clinical outcomes in patients after revascularization of peripheral arteries

European Heart Journal ◽

10.1093/eurheartj/ehz745.0097 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

N A Tmoyan ◽

M V Ezhov ◽

O I Afanasieva ◽

E A Klesareva ◽

M I Afanasieva ◽

...

Keyword(s):

Cardiovascular Events ◽

Cox Regression ◽

Cardiovascular Death ◽

Cardiovascular Outcomes ◽

Lower Limbs ◽

Limb Amputation ◽

Peripheral Arteries ◽

Cox Regression Analysis ◽

Secondary Endpoints

Abstract Background Randomized trials have proved the reduction of cardiovascular events due to LDL-cholesterol level decrease. However, despite high-intensity statin therapy, there is a residual risk, that could be associated with lipoprotein(a) [Lp(a)]. It has been shown that there is an association between elevated Lp(a) level and cardiovascular outcomes in patients with coronary heart disease. Data about the role of Lp(a) in the development of cardiovascular events after revascularization of peripheral arteries are scarce. Purpose To evaluate the relationship of Lp(a) level with cardiovascular outcomes after revascularization of carotid and lower limbs arteries. Methods The study included 258 patients with severe carotid and/or lower extremity artery disease, who underwent successful elective revascularization. The primary endpoint was the composite of nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death. The secondary endpoint was the composite of transitory ischaemic attack, limb amputation, hospitalization for unstable angina, or revascularization surgery. Results During 36 months follow-up 29 (11%) primary and 113 (44%) secondary endpoints were registered. It was noted greater rate of primary (21 [8%] vs. 8 [3%]; hazard ratio [HR], 3.0; 95% confidence interval [CI] 1.5–6.3; p<0.01) and secondary endpoints (72 [28%] vs. 41 (16%], HR, 2.5; 95% CI 1.7–3.7; p<0.01) in patients with elevated Lp(a) level (≥30 mg/dl) compared to patients with Lp(a) <30 mg/dl (Picture). Multivariable-adjusted Cox regression analysis revealed that Lp(a) was independently associated with incidence of cardiovascular outcomes. Conclusions Patients with peripheral artery diseases have a high risk of cardiovascular events and the level of Lp(a) ≥30 mg/dl is an independent predictor of cardiovascular events in prospective 3-year follow-up after revascularization of carotid and lower limbs arteries.

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Implications of new-onset atrial fibrillation for in-hospital and long-term prognosis in patients with acute myocardial infarction: the CBD Bank study

European Heart Journal ◽

10.1093/ehjci/ehaa946.0492 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

W Yang ◽

G Lip ◽

H Li

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Independent Predictor ◽

Cardiovascular Death ◽

Long Term Follow Up ◽

Long Term Prognosis ◽

New Onset

Abstract Background Atrial fibrillation (AF) often coexists with coronary artery disease. Data on the incidence and prognostic impact of new-onset AF following acute myocardial infarction (AMI) with current optimal therapy are insufficient, especially in Asian populations. Purpose To investigate the incidence of new-onset AF following AMI and to assess its impact on in-hospital and long-term prognosis. Methods We included consecutive AMI patients between December 2012 and July 2019, and excluded those with prior known AF on presentation. New-onset AF was defined as newly detected AF during the index hospitalization following AMI. The primary outcomes comprised of all-cause death and cardiovascular death occurred during hospitalization; and all-cause death and cardiovascular death during long-term follow-up among those AMI survivors. Follow-up visits were routinely scheduled after discharge, at 1 month, 3 months, 6 months, 12 months and every 12 months thereafter. Results Of 3686 patients enrolled, new-onset AF was documented in 138 (3.7%) patients during a mean duration of hospitalization of 8.8±5.8 days. Independent risk factors of new-onset AF were age ≥75 years, left atrial diameter ≥40mm, high levels of cardiac troponin-I or high sensitive C reactive protein. During hospitalization, all-cause death occurred in 22 (15.9%) new-onset AF patients and 67 (1.9%) non-AF patients (p<0.001); cardiovascular death occurred in 19 (13.8%) new-onset AF patients and 58 (1.6%) non-AF patients (p<0.001). On multivariable logistic analysis, new-onset AF was an independent predictor of in-hospital all-cause death (OR 5.85, 95% CI: 3.24–10.55) and cardiovascular death (OR 5.44, 95% CI: 2.90–10.20). Apart from the in-hospital deaths, another 265 (7.7%) were lost to follow-up; thus, 3332 patients were included in the long-term follow-up analysis: 106 new-onset AF and 3226 non-AF patients. After a mean follow-up period of 1096.7±682.0 days, all-cause death occurred in 19 new-onset AF patients and 249 non-AF patients; corresponding rates were 8.08 (95% CI: 5.15–12.67) vs. 2.55 (95% CI: 2.25, 2.88) per 100 person-years, respectively (p<0.001). Cardiovascular death occurred in 11 new-onset AF patients and 150 non-AF patients; corresponding rates were 4.68 (95% CI: 2.59–8.45) vs. 1.53 (95% CI: 1.31–1.80) per 100 person-years, respectively (p=0.002). After multivariable Cox adjustment, there was no significant association between new-onset AF and long-term all-cause death (HR 1.45, 95% CI: 0.90–2.35) or cardiovascular death (HR 1.21, 95% CI: 0.65–2.26). Conclusion New-onset AF following AMI was an independent predictor of increased risk of in-hospital mortality, but had no independent association with long-term death. Funding Acknowledgement Type of funding source: None

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