Correlation of MRI-detected vulnerable carotid plaques with clinical presentation: a systematic review and meta-analysis

2020 ◽  
Vol 64 (3) ◽  
Author(s):  
Seyed M. Seyedsaadat ◽  
Asim Rizvi ◽  
Muayad Alzuabi ◽  
Sagar B. Dugani ◽  
M. Hassan Murad ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Carotid Plaques

scholarly journals Prevalence and characteristics of brain arteriovenous malformations in hereditary hemorrhagic telangiectasia: a systematic review and meta-analysis

2017 ◽  
Vol 127 (2) ◽  
pp. 302-310 ◽  
Author(s):  
Waleed Brinjikji ◽  
Vivek N. Iyer ◽  
Christopher P. Wood ◽  
Giuseppe Lanzino
Keyword(s):  
Systematic Review ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Arteriovenous Malformations ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Prevalence Rates ◽  
Brain Avm ◽  
Martin Grade ◽  
Cerebral Avms ◽  
Brain Avms

OBJECTIVEPatients with hereditary hemorrhagic telangiectasia (HHT) are known to suffer from high rates of cerebral arteriovenous malformations (AVMs). The authors performed a systematic review and meta-analysis of the literature examining prevalence rates, characteristics, and clinical presentation of cerebral AVMs in the HHT population.METHODSTo identify studies on AVM prevalence and characteristics in the HHT population, 4 databases (MEDLINE, EMBASE, Scopus and Web of Science) were searched by a reference librarian with over 30 years experience in systematic reviews and meta-analysis. The search period was January 1, 1990–March 2016. The following search terms were used: hereditary hemorrhagic telangiectasia, Osler-Weber-Rendu syndrome, AVM, brain AVM, arteriovenous malformation, arteriovenous fistula, prevalence, and epidemiology. The authors identified studies that examined the prevalence rates, characteristics, and clinical presentation of cerebral AVMs in patients with HHT. They assessed overall AVM prevalence rates as well as prevalence rates by age, sex, HHT type, and country/region. They also systematically reviewed the characteristics of AVMs, including rupture status, location, clinical presentation, angioarchitecture, and Spetzler-Martin grade. Data were analyzed using a random-effects meta-analysis model.RESULTSThirty-nine studies were included in this meta-analysis. Thirty studies examined brain AVM prevalence rates in various HHT patient populations, and 18 studies examined AVM clinical and angiographic characteristics (9 studies examined both prevalence rates and AVM characteristics). The prevalence of brain AVMs in HHT patients was 10.4% (95% CI 7.9%–13.0%) with no significant difference between males (8.5%, 95% CI 4.9%–12.0%) and females (11.0%, 95% CI 5.9%–16.1%). Patients with HHT Type 1 (HHT1) had a significantly higher brain AVM prevalence (13.4%, 95% CI 9.5%–17.4%) compared with those with HHT Type 2 (HHT2) (2.4%, 95% CI 1.0%–3.8%) (p < 0.0001). In 55.2% (95% CI 38.3%–72.1%) of cases, the AVMs were symptomatic. Spetzler-Martin grade was 2 or less in 86.9% (95% CI 67.5%–95.2%) of patients.CONCLUSIONSThe prevalence of brain AVMs in the HHT population is about 10%. HHT1 patients are significantly more likely to have brain AVMs than HHT2 patients. Most AVMs in the HHT population are symptomatic. The Spetzler-Martin grade for these lesions is 2 or less in nearly 90% of patients.

scholarly journals Clinical presentation and management and outcomes of disconnected pancreatic duct syndrome: a systematic review and meta-analysis

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S223-S224
Author(s):  
E.J.F. Chong ◽  
C.B. Ratnayake ◽  
J.A. Windsor ◽  
S. Pandanaboyana
Keyword(s):  
Systematic Review ◽  
Pancreatic Duct ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Duct Syndrome

scholarly journals Comparing Outcomes in Asymptomatic and Symptomatic Atrial Fibrillation: A Systematic Review and Meta-Analysis of 81,462 Patients

2021 ◽  
Vol 10 (17) ◽  
pp. 3979
Author(s):  
Daria Sgreccia ◽  
Marcella Manicardi ◽  
Vincenzo Livio Malavasi ◽  
Marco Vitolo ◽  
Anna Chiara Valenti ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Clinical Status ◽  
Management Strategies ◽  
Cardiovascular Death ◽  
Asymptomatic Patients ◽  
Number Of Patients ◽  
Presentation Methods

Background: In atrial fibrillation (AF) patients, the presence of symptoms can guide the decision between rate or rhythm control therapy, but it is still unclear if AF-related outcomes are determined by symptomatic status of their clinical presentation. Methods: We performed a systematic review and metanalysis following the PRISMA recommendations on available studies that compared asymptomatic to symptomatic AF reporting data on all-cause mortality, cardiovascular death, and thromboembolic events (TEs). We included studies with a total number of patients enrolled equal to or greater than 200, with a minimum follow-up period of six months. Results: From the initial 5476 results retrieved after duplicates’ removal, a total of 10 studies were selected. Overall, 81,462 patients were included, of which 21,007 (26%) were asymptomatic, while 60,455 (74%) were symptomatic. No differences were found between symptomatic and asymptomatic patients regarding the risks of all-cause death (odds ratio (OR) 1.03, 95% confidence interval (CI) 0.81–1.32), and cardiovascular death (OR 0.87, 95% CI 0.54–1.39). No differences between symptomatic and asymptomatic groups were evident for stroke (OR 1.22, 95% CI 0.77–1.93) and stroke/TE (OR 1.06, 95% CI 0.86–1.31) risks. Conclusions: Mortality and stroke/TE events in AF patients were unrelated to symptomatic status of their clinical presentation. Adoption of management strategies in AF patients should not be based on symptomatic clinical status.

Ultrasound Characteristics of Symptomatic Carotid Plaques: A Systematic Review and Meta-Analysis

2015 ◽  
Vol 40 (3-4) ◽  
pp. 165-174 ◽  
Author(s):  
Waleed Brinjikji ◽  
Alejandro A. Rabinstein ◽  
Giuseppe Lanzino ◽  
Mohammad H. Murad ◽  
Eric E. Williamson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Carotid Artery ◽  
Publication Bias ◽  
Carotid Artery Stenosis ◽  
Meta Analysis ◽  
Artery Stenosis ◽  
Surface Irregularity ◽  
Asymptomatic Carotid ◽  
Carotid Plaques

Background: Ultrasound is the most commonly used imaging modality for assessing carotid artery stenosis. A number of studies have demonstrated that surface irregularities, heterogeneous echotexture and hypoechoic plaques are risk factors for acute ischemic stroke. We performed a systematic review and meta-analysis of the literature to better define the risk of stroke based on the sonographic characteristics of carotid plaques. Materials and Methods: We performed a comprehensive search for studies reporting imaging findings of symptomatic and asymptomatic carotid plaques on ultrasound using MEDLINE and EMBASE. We included both case-control and cohort studies examining the relationship between complex plaque and acute ischemic stroke or transient ischemic attack. Complex plaque was defined as plaque that had any of the following characteristics: heterogeneous echogenicity, echolucency, neovascularization, surface irregularity, ulceration, and intraplaque motion. Meta-analyses using the random-effects model were performed for complex plaque and each of the individual complex plaque characteristics. p < 0.05 was considered statistically significant. We explored the impact of publication bias by constructing funnel plots and testing their symmetry. We conducted the meta-analysis using Comprehensive Meta-analysis version 2.2, Englewood, N.J., USA. Results: A total of 1,013 articles were screened and 23 studies with 6,706 carotid plaques were included. Ultrasound plaque characteristics with a higher prevalence in individuals with symptomatic compared to asymptomatic carotid artery stenosis included plaque neovascularity (OR = 19.68, 95% CI = 3.14-123.16), complex plaque (OR = 5.12, 95% CI = 3.42-7.67), plaque ulceration (OR = 3.58, 95% CI = 1.66-7.71), plaque echolucency (OR = 3.99, 95% CI = 3.06-5.19) and intraplaque motion (OR = 1.57, 95% CI = 1.02-2.41). Variables not associated with symptom status included heterogenous echotexture (OR = 2.68, 95% CI = 0.56-12.80) and surface irregularity without ulceration (OR = 2.38, 95% CI = 0.70-8.11). No evidence of publication bias was observed based on Eggers test (p value of 0.05 for complex plaque and 0.53 for plaque echolucency). The remaining plaque features had insufficient data to assess for publication bias. Conclusions: Our meta-analysis and systematic review of the literature demonstrated that plaques with complex features, particularly those with echolucency, neovascularization, ulceration and intraplaque motion are associated with ischemic symptoms. Assessment of carotid plaque on ultrasound may provide stroke risk information beyond measurement of luminal stenosis. Thus, sonographic evaluation of carotid artery stenosis should focus on the detection of these plaque characteristics in addition to quantifying the degree of stenosis.

Abstract T P180: Ultrasound Characteristics of Symptomatic Carotid Plaques: A Systematic Review and Meta-analysis

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Waleed Brinjikji ◽  
Deena M Nasr ◽  
Alejandro A Rabinstein ◽  
Giuseppe Lanzino ◽  
Eric E Williamson ◽  
...  
Keyword(s):  
Systematic Review ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Carotid Plaque ◽  
Imaging Modality ◽  
Meta Analysis ◽  
Surface Irregularity ◽  
Carotid Plaques ◽  
Symptomatic Carotid ◽  
Plaque Ulceration

Background and Purpose: Ultrasound is the most commonly used imaging modality for assessment of carotid artery stenosis. A number of studies have demonstrated that surface irregularities, heterogeneous echotexture and hypoechoic plaques are risk factors for acute ischemic stroke. We performed a systematic review and meta-analysis of the literature to better define the risk of stroke based off of the sonographic characteristics of carotid plaques. Materials and Methods: We performed a comprehensive literature search evaluating the association of carotid plaque characteristics on ultrasound with ischemic outcomes. We included both case-control and cohort studies examining the relationship between complex plaque and acute ischemic stroke. Complex plaque was defined as plaque that had any of the following characteristics: heterogeneous plaque echogenicity, hypoechoic plaque, plaque neovascularization, plaque surface irregularity, plaque ulceration, and intraplaque motion. Meta-analyses using the random-effects model were performed for complex plaque and each of the individual complex plaque characteristics. Results: A total of 1013 articles were screened and 30 studies with 11528 patients (3054 symptomatic and 8474 asymptomatic) were included. The odds ratios for the association between complex plaque and ischemic symptoms was 5.18 (95%CI=4.63-5.79). Heterogeneous echotexture (OR=11.72, 95%CI=9.82-13.98), intraplaque motion (OR=1.57, 95%CI=1.02-2.41), plaque echolucency (OR=3.23, 95%CI=2.72-3.84), plaque neovascularity (OR=5.66, 95%CI=3.15-10.16) and plaque ulceration (OR=2.65, 95%CI=1.89-3.73) were all associated with ischemic symptoms. Surface irregularity without frank ulceration was not associated with ischemic symptoms (OR=1.35, 95%CI=0.98-1.86). Conclusions: Complex plaque, heterogeneous plaque echogenicity, hypoechoic plaque, plaque neovascularization, plaque ulceration and intraplaque motion are associated with ischemic symptoms. Assessment of carotid plaque on ultrasound provides stroke risk information beyond measurement of luminal stenosis.

scholarly journals Cardiovascular System and SARS-CoV-2: Etiology, Physiopathology and Clinical Presentation: A Systematic Review

2021 ◽  
Author(s):  
Jucier Gonçalves Júnior ◽  
Estelita Lima Cândido ◽  
Gislene Farias de Oliveira ◽  
Modesto Leite Rolim Neto
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Cardiovascular System ◽  
Clinical Presentation ◽  
Meta Analysis ◽  
Cardiovascular Complications ◽  
Review Of The Literature ◽  
Governmental Organizations ◽  
System A ◽  
The Impact

During SARS-CoV-1 and Middle East Respiratory Distress Syndrome (MERS) outbreaks it was observed a particularly elevated incidence of cardiovascular disease among patients. With COVID-19, this correlation becomes evident again. However, the cardiovascular impacts by COVID-19 pandemic are not yet well established although publications about its potential deleterious effects are constant. Thus, aimed to carry a systematic review of the literature with meta-analysis, the following question was used as a guide: what practical contributions does the scientific literature produced in the period of 2019-2020 has to offer about the impact of the COVID-19 on cardiovascular system? A systematic review of the literature using the Virtual Health Library (VHL) and PubMed with the following descriptors: #1 “cardiovascular disease” [MeSH] AND #2 “COVID-19” [keyword], as well as their equivalents in the Portuguese and Spanish language, during the period from December 2019 to March 2020 was performed. One hundred articles were found in Pubmed and twenty-seven were selected. In VHL there are 59 articles and four were selected totaling thirty-one papers. The findings were then divided into three subcategories: Etiology, Physiopathology and Risk factors of SARS-CoV-2 in Cardiovascular System; Clinical presentation, laboratory markers and imagenological aspects of SARS-CoV-2 in cardiovascular system; and Anti-Hypertensive Drugs, Cardiovascular System and SARS-CoV-2. When it comes to the cardiovascular system, these issues are aggravated and urge as a joint commitment from researchers, medical and governmental organizations to carry out more robust studies with bold methodologies aimed at mapping prognostic factors and assertive therapeutic approaches in the management of cardiovascular complications of COVID- 19.

scholarly journals Clinical Presentation and Outcomes of Myocarditis Post mRNA Vaccination: A Meta-Analysis and Systematic Review

Cureus ◽  
2021 ◽  
Author(s):  
Abhishek Matta ◽  
Rajesh Kunadharaju ◽  
Marcus Osman ◽  
Christy Jesme ◽  
Zachary McMiller ◽  
...  
Keyword(s):  
Systematic Review ◽  
Clinical Presentation ◽  
Meta Analysis
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