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  • 1
    Online Resource
    Online Resource
    The Neutrophil Percentage-to-Albumin Ratio as a New Predictor of All-Cause Mortality in Patients with Cardiogenic Shock
    Hindawi Limited ; 2020
    In:  BioMed Research International Vol. 2020 ( 2020-11-26), p. 1-12
    Details
    In: BioMed Research International, Hindawi Limited, Vol. 2020 ( 2020-11-26), p. 1-12
    Abstract: Background. Although the neutrophil percentage-to-albumin ratio (NPAR) has proven to be a robust systemic inflammation-based predictor of mortality in a wide range of diseases, the prognostic value of the NPAR in critically ill patients with cardiogenic shock (CS) remains unknown. This study aimed at investigating the association between the admission NPAR and clinical outcomes in CS patients using real-world data. Methods. Critically ill patients diagnosed with CS in the Medical Information Mart for Intensive Care-III (MIMIC-III) database were included in our study. The study endpoints included all-cause in-hospital, 30-day, and 365-day mortality in CS patients. First, the NPAR was analyzed as a continuous variable using restricted cubic spline Cox regression models. Second, X-tile analysis was used to calculate the optimal cut-off values for the NPAR and divide the cohort into three NPAR groups. Moreover, multivariable Cox regression analyses were used to assess the association of the NPAR groups with mortality. Results. A total of 891 patients hospitalized with CS were enrolled in this study. A nonlinear relationship between the NPAR and in-hospital and 30-day mortality was observed (all P values for nonlinear trend 〈 0.001). According to the optimal cut-off values by X-tile, NPARs were divided into three groups: group I ( NPAR 〈 25.3 ), group II ( 25.3 ≤ NPAR 〈 34.8 ), and group III ( 34.8 ≤ NPAR ). Multivariable Cox analysis showed that higher NPAR was independently associated with increased risk of in-hospital mortality (group III vs. group I: hazard ratio [HR] 2.60, 95% confidence interval [CI] 1.72-3.92, P 〈 0.001 ), 30-day mortality (group III vs. group I: HR 2.42, 95% CI 1.65-3.54, P 〈 0.001 ), and 365-day mortality (group III vs. group I: HR 6.80, 95% CI 4.10-11.26, P 〈 0.001 ) in patients with CS. Conclusions. Admission NPAR was independently associated with in-hospital, 30-day, and 365-day mortality in critically ill patients with CS.
    Type of Medium: Online Resource
    ISSN: 2314-6141 , 2314-6133
    URL: Article
    DOI: 10.1155/2020/7458451
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2698540-8
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  • 2
    Online Resource
    Online Resource
    Old and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective
    Hindawi Limited ; 2018
    In:  BioMed Research International Vol. 2018 ( 2018-11-08), p. 1-7
    Details
    In: BioMed Research International, Hindawi Limited, Vol. 2018 ( 2018-11-08), p. 1-7
    Abstract: Stable chest pain is a common clinical presentation that often requires further investigation using noninvasive or invasive testing, resulting in a resource-consuming problem worldwide. At onset of 2016, the National Institute for Health and Care Excellence (NICE) published an update on its guideline on chest pain. Three key changes to the 2010 version were provided by the new NICE guideline. First, the new guideline recommends that the previously proposed pretest probability risk score should no longer be used. Second, they also recommend that a calcium score of zero should no longer be used to rule out coronary artery disease (CAD) in patients with low pretest probability. Third, the new guideline recommends that all patients with new onset chest pain should be investigated with a coronary computed tomographic angiography (CTA) as a first-line investigation. However, in real world the impact of implementation of CTA for the evaluation of new onset chest pain remains to be evaluated, especially regarding its cost effectiveness. The aim of the present report was to discuss the results of the studies supporting new NICE guideline and its comparison with European and US guidelines.
    Type of Medium: Online Resource
    ISSN: 2314-6133 , 2314-6141
    URL: Article
    DOI: 10.1155/2018/3762305
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2018
    detail.hit.zdb_id: 2698540-8
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  • 3
    Online Resource
    Online Resource
    Prognostic Value and Therapeutic Perspectives of Coronary CT Angiography: A Literature Review
    Hindawi Limited ; 2018
    In:  BioMed Research International Vol. 2018 ( 2018-09-16), p. 1-13
    Details
    In: BioMed Research International, Hindawi Limited, Vol. 2018 ( 2018-09-16), p. 1-13
    Abstract: Coronary stenosis severity is both a powerful and a still debated predictor of prognosis in coronary artery disease. Coronary computed tomographic angiography (CCTA) has emerged as a noninvasive technique that enables anatomic visualization of coronary artery disease (CAD). CCTA with newer applications, plaque characterization and physiologic/functional evaluation, allows a comprehensive diagnostic and prognostic assessment of otherwise low-intermediate subjects for primary prevention. CCTA measures the overall plaque burden, differentiates plaque subtypes, and identifies high-risk plaque with good reproducibility. Research in this field may also advance towards an era of personalized risk prediction and individualized medical therapy. It has been demonstrated that statins may delay plaque progression and change some plaque features. The potential effects on plaque modifications induced by other medical therapies have also been investigated. Although it is not currently possible to recommend routinely serial scans to monitor the therapeutic efficacy of medical interventions, the plaque modulation, as a part of risk modification, appears a feasible strategy. In this review we summarize the current evidence regarding vulnerable plaque and effects of lipid lowering therapy on morphological features of CAD. We also discuss the potential ability of CCTA to characterize coronary atherosclerosis, stratify prognosis of asymptomatic subjects, and guide medical therapy.
    Type of Medium: Online Resource
    ISSN: 2314-6133 , 2314-6141
    URL: Article
    DOI: 10.1155/2018/6528238
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2018
    detail.hit.zdb_id: 2698540-8
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  • 4
    Online Resource
    Online Resource
    Ischemic Heart Disease: New Insights from Imaging Diagnostic Techniques
    Hindawi Limited ; 2018
    In:  BioMed Research International Vol. 2018 ( 2018-12-23), p. 1-3
    Details
    In: BioMed Research International, Hindawi Limited, Vol. 2018 ( 2018-12-23), p. 1-3
    Type of Medium: Online Resource
    ISSN: 2314-6133 , 2314-6141
    URL: Article
    DOI: 10.1155/2018/5723502
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2018
    detail.hit.zdb_id: 2698540-8
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  • 5
    Online Resource
    Online Resource
    Outcomes of Left Main Revascularization after Percutaneous Intervention or Bypass Surgery
    Hindawi Limited ; 2022
    In:  Journal of Interventional Cardiology Vol. 2022 ( 2022-4-12), p. 1-9
    Details
    In: Journal of Interventional Cardiology, Hindawi Limited, Vol. 2022 ( 2022-4-12), p. 1-9
    Abstract: Background. This study is aimed at comparing the clinical outcomes of unprotected left main coronary artery disease (ULMCAD) treatment with contemporary percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) in a “real-world” population. Methods and Results. Overall, 558 consecutive patients with ULMCAD (mean age 71 ± 9 years, male gender 81%) undergoing PCI or CABG were compared. The primary endpoint was the composite of death, nonfatal myocardial infarction, or stroke. Diabetes was present in 29% and acute coronary syndrome in 56%; mean EuroSCORE was 11 ± 8. High coronary complexity (SYNTAX score 〉 32) was present in 50% of patients. The primary composite endpoint was similar after PCI and CABG up to 4 years (15.5 ± 3.1% vs. 17.1 ± 2.6%; p = 0.585 ). The primary end point was also comparable in a two propensity score matched cohorts. Ischemia-driven revascularization was more frequently needed in PCI than in CABG (5.5% vs. 1.5%; p = 0.010 ). By multivariate analysis, diabetes mellitus (HR 2.00; p = 0.003 ) and EuroSCORE (HR 3.71; p 〈 0.001 ) were the only independent predictors associated with long-term outcome. Conclusions. In a “real-world” population with ULMCAD, a contemporary revascularization strategy by PCI or CABG showed similar long-term clinical outcome regardless of the coronary complexity.
    Type of Medium: Online Resource
    ISSN: 1540-8183 , 0896-4327
    URL: Article
    DOI: 10.1155/2022/6496777
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2022
    detail.hit.zdb_id: 2103585-4
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  • 6
    Online Resource
    Online Resource
    Corrigendum to “Old and New NICE Guidelines for the Evaluation of New Onset Stable Chest Pain: A Real World Perspective”
    Hindawi Limited ; 2019
    In:  BioMed Research International Vol. 2019 ( 2019-03-07), p. 1-1
    Details
    In: BioMed Research International, Hindawi Limited, Vol. 2019 ( 2019-03-07), p. 1-1
    Type of Medium: Online Resource
    ISSN: 2314-6133 , 2314-6141
    URL: Article
    DOI: 10.1155/2019/9637490
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2019
    detail.hit.zdb_id: 2698540-8
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  • 7
    Online Resource
    Online Resource
    ATP-Sensitive Potassium Channels Mediate the Cardioprotective Effect of Panax notoginseng Saponins against Myocardial Ischaemia–Reperfusion Injury and Inflammatory Reaction
    Hindawi Limited ; 2020
    In:  BioMed Research International Vol. 2020 ( 2020-10-20), p. 1-12
    Details
    In: BioMed Research International, Hindawi Limited, Vol. 2020 ( 2020-10-20), p. 1-12
    Abstract: Inflammatory response during myocardial ischemia reperfusion injury (MIRI) is essential for cardiac healing, while excessive inflammation extends the infarction and promotes adverse cardiac remodeling. Understanding the mechanism of these uncontrolled inflammatory processes has a significant impact during the MIRI therapy. Here, we found a critical role of ATP-sensitive potassium channels (KATP) in the inflammatory response of MIRI and its potential mechanism and explored the effects of Panax Notoginseng Saponins (PNS) during this possess. Rats underwent 40 min ischemia by occlusion of the left anterior descending (LAD) coronary artery and 60 min of reperfusion. PNS was treated at the corresponding time point before operation; 5-hydroxydecanoate (5-HD) and glybenclamide (Gly) (or Nicorandil (Nic)) were used as pharmacological blocker (or nonselective opener) of KATP. Cardiac function and pathomorphology were evaluated and a set of molecular signaling experiments was tested. KATP current density was measured by patch-clamp. Results revealed that in MIRI, PNS pretreatment restored cardiac function, reduced infarct size, and ameliorated inflammation through KATP. However, inhibiting KATP by 5-HD and Gly significantly reversed the effects, including NLRP3 inflammasome and inflammatory mediators IL-6, MPO, TNF-α, and MCP-1. Moreover, PNS inhibited the phosphorylation and nuclear translocation of NF-κB in I/R myocardium when the KATP was activated. Importantly, PNS promoted the expression of subunits and activation of KATP. The study uncovered KATP served as a new potential mechanism during PNS modulating MIRI-induced inflammation and promoting injured heart recovery. The manipulation of KATP could be a potential therapeutic approach for MIRI and other inflammatory diseases.
    Type of Medium: Online Resource
    ISSN: 2314-6141 , 2314-6133
    URL: Article
    DOI: 10.1155/2020/3039184
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2020
    detail.hit.zdb_id: 2698540-8
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  • 8
    Online Resource
    Online Resource
    Integration of CTA in the Diagnostic Workup of New Onset Chest Pain in Clinical Practice
    Hindawi Limited ; 2019
    In:  BioMed Research International Vol. 2019 ( 2019-07-07), p. 1-8
    Details
    In: BioMed Research International, Hindawi Limited, Vol. 2019 ( 2019-07-07), p. 1-8
    Abstract: Background. Recently, NICE guidelines recommend the use of computed tomographic angiography (CTA) as the first line of investigation for new onset chest pain. We sought to evaluate the impact of the integration of CTA in the diagnostic workup, as either a first- or second-line of investigation, in the clinical practice for patients presenting with new onset chest pain, with suspicion that it may be due to coronary artery disease (CAD). Method and Results. From 2014 to 2016, 208 outpatients (mean age 63.8 ± 12.7, 37% female) with an unknown CAD diagnosis were evaluated. About half (n=106, 51%) received usual testing care plus CTA as a second-line investigation (group A), while the other half (n=102, 49%) received CTA as a first-line investigation (group B). Care decisions and test interpretations were made by the attending physician. Obstructive CAD (O-CAD) was defined as 〉 50% stenosis in the principal branch. As determined by CTA, the rates of CAD in group A vs. group B were the following (P=0.001): 31.1% vs. 27.4% for normal/minimal CAD; 42.5% vs. 63.7% for no O-CAD; and 26.4% vs. 8.8% with O-CAD. Based on a diagnostic result of no O-CAD, invasive angiography was cancelled in 42.6% (n=45) of group A patients, and additional functional tests were cancelled for the same reason in 63.7% (n=65) of group B patients, without adverse events at median 3-year. The average diagnostic cost for patients in our study was lower in group B (206 vs. 324.42 euro; P 〈 0.0001). Conclusions. In clinical practice, CTA, as a first- or second-line investigation, most commonly detected no O-CAD in new onset chest pain patients, leading us to safely avoid unnecessary ICA or additional functional tests. The use of CTA as a first-line investigation also appears to be cost saving, but its cost-effectiveness remains to be demonstrated in larger studies.
    Type of Medium: Online Resource
    ISSN: 2314-6133 , 2314-6141
    URL: Article
    DOI: 10.1155/2019/2647079
    Language: English
    Publisher: Hindawi Limited
    Publication Date: 2019
    detail.hit.zdb_id: 2698540-8
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