Life | Special Issue : Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment

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18 pages, 3272 KiB

Open AccessArticle

Association of Atrial Fibrillation Recurrence with Right Coronary Atherosclerosis and Increased Left Arterial Epicardial Fat Following Catheter Ablation—Results of a Multimodality Study

by Lehel László Bordi, Theodora Benedek, István Kovács, Diana Opincariu, Emese Márton, Zsolt Parajkó, Renáta Gerculy and Imre Benedek

Life 2023, 13(9), 1891; https://doi.org/10.3390/life13091891 - 10 Sep 2023

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Abstract

Background: Identification of predictors for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) can lead to better long-term results. Our aim was to investigate the association between novel CT imaging markers reflecting the severity of coronary atherosclerosis and the risk of recurrence [...] Read more.

Background: Identification of predictors for atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI) can lead to better long-term results. Our aim was to investigate the association between novel CT imaging markers reflecting the severity of coronary atherosclerosis and the risk of recurrence following PVI. Methods: This study included 80 patients with paroxysmal/persistent AF who underwent PVI. The patients were divided into two groups: Group 1–23 patients with recurrence and Group 2–57 patients without recurrence. Results: Patients with recurrence presented with a more enlarged left atrial diameter and reduced left ventricle EF, as assessed by echocardiography. Elevated calcium scores and right coronary artery (RCA) stenosis were correlated with a higher risk of AF recurrence (25.38 ± 4.1% vs. 9.76 ± 2.32%, p = 0.001). Patients with AF recurrence presented a higher left atrial volume index (LAVI) (61.38 ± 11.12 mm³/m² vs. 46.34 ± 12.27 mm³/m², p < 0.0001). The bi-atrial volume index (BAVI) was similarly higher in the AF recurrence group (98.23 ± 14.44 mm³/m² vs. 76.48 ± 17.61 mm³/m², p < 0.0001). Increased EAT volumes located around the LA (EAT-LA) were correlated with recurrence (25.55 ± 6.37 vs. 15.54 ± 8.44, p < 0.0001). Conclusions: RCA stenosis, together with atrial volumes and EAT-AS evaluated by CCTA, is associated with the risk of AF recurrence following PVI. Full article

(This article belongs to the Special Issue Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment)

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12 pages, 3672 KiB

Open AccessArticle

Inflammatory Markers Used as Predictors of Subclinical Atherosclerosis in Patients with Diabetic Polyneuropathy

by Adrian Vasile Mureșan, Alexandru Tomac, Diana Roxana Opriș, Bogdan Corneliu Bandici, Cătălin Mircea Coșarcă, Diana Carina Covalcic, Ioana Hălmaciu, Orsolya-Zsuzsa Akácsos-Szász, Flavia Rădulescu, Krisztina Lázár, Adina Stoian and Mariana Cornelia Tilinca

Life 2023, 13(9), 1861; https://doi.org/10.3390/life13091861 - 03 Sep 2023

Cited by 1 | Viewed by 1002

Abstract

Background: peripheral arterial disease (PAD) is identified late in diabetic patients because, in the majority of cases, it is associated with diabetic peripheral neuropathy, resulting in little or no symptoms, or symptoms that are completely neglected. Methods: In this study were enrolled all [...] Read more.

Background: peripheral arterial disease (PAD) is identified late in diabetic patients because, in the majority of cases, it is associated with diabetic peripheral neuropathy, resulting in little or no symptoms, or symptoms that are completely neglected. Methods: In this study were enrolled all patients over 18 years of age, with diabetes mellitus type II for more than a year with poor glycemic control, diagnosed with diabetic polyneuropathy admitted to the Diabetology Department, Emergency County Hospital of Targu Mures, Romania between January 2020 and March 2023. We divided the patients into two groups, based on the presence or absence of subclinical atherosclerosis in the lower limb, named “SA” and “non-SA”. Results: Patients in the SA group were older (p = 0.01) and had a higher incidence of IHD (p = 0.03), history of MI (p = 0.02), and diabetic nephropathy (p = 0.01). Moreover, patients with subclinical atherosclerosis had a higher BMI (p < 0.0001) and a longer duration of diabetes (p < 0.0001). Among all patients, the systemic inflammatory markers, MLR (r = 0.331, p < 0.001), NLR (r = 0.517, p < 0.001), PLR (r = 0.296, p < 0.001), SII (r = 0.413, p < 0.001), as well as BMI (r = 0.241, p < 0.001) and HbA1C (r = 0.489, p < 0.001), demonstrated a strong positive correlation with the diabetes duration. The multivariate logistic regression analysis showed that older patients (OR: 2.58, p < 0.001), the male gender (OR: 2.30, p = 0.006), a higher baseline levels of BMI (OR: 7.71, p < 0.001), and the duration of diabetes (OR: 8.65, p < 0.001) are predictors of subclinical atherosclerosis in DN patients. Additionally, the high baseline levels of all systemic inflammatory markers (for all: p < 0.001) and poor diabetes management (OR: 10.4, p < 0.001 for HbA1C; OR: 10.78, p < 0.001 for admission glucose) are independent predictors of SA. Conclusions: the inflammatory markers, NLR, MLR, PLR, and SII, being cheap and easy to collect in routine medical practice from the standard blood tests, could be an important step in predicting vascular outcomes in diabetic patients and the disease’s progression, playing a key role in follow-up visits in type-2 diabetic patients and PAD patients. Full article

(This article belongs to the Special Issue Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment)

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12 pages, 13235 KiB

Open AccessArticle

Superficial Calcified Plates Associated to Plaque Erosions in Acute Coronary Syndromes

by Horea-Laurentiu Onea, Mihail Spinu, Calin Homorodean, Mihai Claudiu Ober, Maria Olinic, Florin-Leontin Lazar, Alexandru Achim, Dan Alexandru Tataru and Dan Mircea Olinic

Life 2023, 13(8), 1732; https://doi.org/10.3390/life13081732 - 11 Aug 2023

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Abstract

This study investigates the clinical relevance and therapeutic implications of the OCT identification of intracoronary superficial calcified plates (SCPs) in acute coronary syndromes (ACSs). In 70 consecutive ACS patients (pts), we studied the three main underlying ACS mechanisms: plaque erosion (PE), plaque rupture [...] Read more.

This study investigates the clinical relevance and therapeutic implications of the OCT identification of intracoronary superficial calcified plates (SCPs) in acute coronary syndromes (ACSs). In 70 consecutive ACS patients (pts), we studied the three main underlying ACS mechanisms: plaque erosion (PE), plaque rupture and eruptive calcified nodule (CN). The PE lesions, occurring on an intact fibrous cap overlying a heterogeneous substrate, were identified in 12/70 pts (17.1%). PE on superficial calcified plates (PE-SCP) represented 58.3% of the PE lesions (7/12 pts) and had a 10% overall incidence in the culprit lesions (7/70 pts). PE-SCP lesions occurred mostly on the left anterior descending artery, correlated with white thrombi (85.7%) and had a proximal intraplaque site (71.4%). PE-SCP lesions were treated conservatively, as nonsignificant lesions, in 4/7 pts. Our study emphasizes that the coronary calcium-related ACS risk is not only associated with the spotty calcifications or CN but also with the PE-SCP lesions. Full article

(This article belongs to the Special Issue Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment)

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Review

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14 pages, 566 KiB

Open AccessReview

Atherosclerosis in Patients with Congenital Hemophilia: A Focus on Peripheral Artery Disease

by Minerva Codruta Badescu, Oana Viola Badulescu, Alexandru Dan Costache, Ovidiu Mitu, Vasile Valeriu Lupu, Bianca-Ana Dmour, Ancuta Lupu, Liliana Georgeta Foia, Irina-Iuliana Costache and Ciprian Rezus

Life 2023, 13(11), 2221; https://doi.org/10.3390/life13112221 - 18 Nov 2023

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Abstract

Advances in the treatment of hemophilia have increased the life expectancy of this population and we are currently facing diseases associated with aging, including cardiovascular ones. Coronary atherosclerosis, with acute myocardial infarction as the most severe form of manifestation, has been recognized as [...] Read more.

Advances in the treatment of hemophilia have increased the life expectancy of this population and we are currently facing diseases associated with aging, including cardiovascular ones. Coronary atherosclerosis, with acute myocardial infarction as the most severe form of manifestation, has been recognized as part of the comorbidities of hemophiliacs. However, little is known about peripheral artery disease. Available data show that hemophiliacs have cardiovascular risk factors and atherosclerosis similar to the general population. Impaired thrombus formation and phenotype of atheroma plaque rather than the burden of atherosclerosis explains their lower cardiovascular mortality. Since the effect of traditional cardiovascular risk factors overpowers that of decreased coagulability and promotes the onset and progression of atherosclerotic lesions, screening for traditional cardiovascular risk factors and peripheral artery disease should be integrated into standard hemophilia care. There is evidence that invasive treatments and long-term antithrombotic therapy are generally safe, provided that coagulation factor levels are taken into account and replacement therapy is given when necessary. Full article

(This article belongs to the Special Issue Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment)

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20 pages, 2341 KiB

Open AccessReview

Focused Ultrasound, an Emerging Tool for Atherosclerosis Treatment: A Comprehensive Review

by Cynthia Imtiaz, Muhammad Awais Farooqi, Theophilus Bhatti, Jooho Lee, Ramsha Moin, Chul Ung Kang and Hafiz Muhammad Umer Farooqi

Life 2023, 13(8), 1783; https://doi.org/10.3390/life13081783 - 21 Aug 2023

Cited by 3 | Viewed by 3242

Abstract

Focused ultrasound (FUS) has emerged as a promising noninvasive therapeutic modality for treating atherosclerotic arterial disease. High-intensity focused ultrasound (HIFU), a noninvasive and precise modality that generates high temperatures at specific target sites within tissues, has shown promising results in reducing plaque burden [...] Read more.

Focused ultrasound (FUS) has emerged as a promising noninvasive therapeutic modality for treating atherosclerotic arterial disease. High-intensity focused ultrasound (HIFU), a noninvasive and precise modality that generates high temperatures at specific target sites within tissues, has shown promising results in reducing plaque burden and improving vascular function. While low-intensity focused ultrasound (LIFU) operates at lower energy levels, promoting mild hyperthermia and stimulating tissue repair processes. This review article provides an overview of the current state of HIFU and LIFU in treating atherosclerosis. It focuses primarily on the therapeutic potential of HIFU due to its higher penetration and ability to achieve atheroma disruption. The review summarizes findings from animal models and human trials, covering the effects of FUS on arterial plaque and arterial wall thrombolysis in carotid, coronary and peripheral arteries. This review also highlights the potential benefits of focused ultrasound, including its noninvasiveness, precise targeting, and real-time monitoring capabilities, making it an attractive approach for the treatment of atherosclerosis and emphasizes the need for further investigations to optimize FUS parameters and advance its clinical application in managing atherosclerotic arterial disease. Full article

(This article belongs to the Special Issue Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment)

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17 pages, 634 KiB

Open AccessReview

Accelerated Atherosclerosis and Cardiovascular Toxicity Induced by Radiotherapy in Breast Cancer

by Miruna Florina Stefan, Catalin Gabriel Herghelegiu and Stefania Lucia Magda

Life 2023, 13(8), 1631; https://doi.org/10.3390/life13081631 - 27 Jul 2023

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Abstract

The number of patients diagnosed with breast cancer and cardiovascular disease is continuously rising. Treatment options for breast cancer have greatly evolved, but radiotherapy (RT) still has a key role in it. Despite many advances in RT techniques, cardiotoxicity is one of the [...] Read more.

The number of patients diagnosed with breast cancer and cardiovascular disease is continuously rising. Treatment options for breast cancer have greatly evolved, but radiotherapy (RT) still has a key role in it. Despite many advances in RT techniques, cardiotoxicity is one of the most important side effects. The new cardio-oncology guidelines recommend a baseline evaluation, risk stratification and follow-up of these patients. Cardiotoxicity induced by RT can be represented by almost all forms of cardiovascular disease, with atherosclerosis being the most frequent. An interdisciplinary team should manage these patients, in order to have maximum therapeutic effect and minimum cardiovascular toxicity. This review will summarize the current incidence, risk factors, mechanisms and follow-up of RT-induced cardiovascular toxicity. Full article

(This article belongs to the Special Issue Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment)

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15 pages, 1539 KiB

Open AccessReview

Dual Antiplatelet Therapy: A Concise Review for Clinicians

by Hafeez Ul Hassan Virk, Johao Escobar, Mario Rodriguez, Eric R. Bates, Umair Khalid, Hani Jneid, Yochai Birnbaum, Glenn N. Levine, Sidney C. Smith, Jr. and Chayakrit Krittanawong

Life 2023, 13(7), 1580; https://doi.org/10.3390/life13071580 - 18 Jul 2023

Cited by 2 | Viewed by 9111

Abstract

Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for [...] Read more.

Dual antiplatelet therapy (DAPT) combines two antiplatelet agents to decrease the risk of thrombotic complications associated with atherosclerotic cardiovascular diseases. Emerging data about the duration of DAPT is being published continuously. New approaches are trying to balance the time, benefits, and risks for patients taking DAPT for established cardiovascular diseases. Short-term dual DAPT of 3–6 months, or even 1 month in high-bleeding risk patients, is equivalent in terms of efficacy and effectiveness compared to long-term DAPT for patients who experienced percutaneous coronary intervention in an acute coronary syndrome setting. Prolonged DAPT beyond 12 months reduces stent thrombosis, major adverse cardiovascular events, and myocardial infarction rates but increases bleeding risk. Extended DAPT does not significantly benefit stable coronary artery disease patients in reducing stroke, myocardial infarction, or cardiovascular death. Ticagrelor and aspirin reduce cardiovascular events in stable coronary artery disease with diabetes but carry a higher bleeding risk. Antiplatelet therapy duration in atrial fibrillation patients after percutaneous coronary intervention depends on individual characteristics and bleeding risk. Antiplatelet therapy is crucial for post-coronary artery bypass graft and transcatheter aortic valve implantation; Aspirin (ASA) monotherapy is preferred. Antiplatelet therapy duration in peripheral artery disease depends on the scenario. Adding vorapaxar and cilostazol may benefit secondary prevention and claudication, respectively. Carotid artery disease patients with transient ischemic attack or stroke benefit from antiplatelet therapy and combining ASA and clopidogrel is more effective than ASA alone. The optimal duration of DAPT after carotid artery stenting is uncertain. Resistance to ASA and clopidogrel poses an incremental risk of deleterious cardiovascular events and stroke. The selection and duration of antiplatelet therapy in patients with cardiovascular disease requires careful consideration of both efficacy and safety outcomes. The use of combination therapies may provide added benefits but should be weighed against the risk of bleeding. Further research and clinical trials are needed to optimize antiplatelet treatment in different patient populations and clinical scenarios. Full article

(This article belongs to the Special Issue Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment)

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12 pages, 303 KiB

Open AccessReview

Cardiovascular Toxicity Induced by Vascular Endothelial Growth Factor Inhibitors

by Diana Mihalcea, Hayat Memis, Sorina Mihaila and Dragos Vinereanu

Life 2023, 13(2), 366; https://doi.org/10.3390/life13020366 - 29 Jan 2023

Cited by 5 | Viewed by 1770

Abstract

Cardiotoxicity is an important side effect of vascular endothelial growth factor (VEGF) inhibitors therapy used in the treatment of various malignancies, leading to increased morbidity and mortality. Arterial hypertension, cardiac ischemia with the acceleration of atherosclerosis, arrhythmias, myocardial dysfunction and thromboembolic disease are [...] Read more.

Cardiotoxicity is an important side effect of vascular endothelial growth factor (VEGF) inhibitors therapy used in the treatment of various malignancies, leading to increased morbidity and mortality. Arterial hypertension, cardiac ischemia with the acceleration of atherosclerosis, arrhythmias, myocardial dysfunction and thromboembolic disease are the most feared cardiovascular adverse reactions due to VEGF inhibitors. Susceptibility for the occurrence of VEGF inhibitors-induced cardiotoxicity has multifactorial determinants, with a significant inter-individual variation. Baseline cardiovascular risk assessment of the patient, type and stage of cancer, dose and duration of VEGF inhibitors treatment and adjuvant chemotherapy or radiotherapy are the main predictors for cardiotoxicity. The role of the cardio-oncology team becomes essential for achieving maximum therapeutic anti-angiogenic effects with minimum cardiovascular side effects. This review will summarize the incidence, risk factors, mechanisms, management and treatment of VEGF inhibitors-induced cardiovascular toxicity. Full article

(This article belongs to the Special Issue Atherosclerosis: From Subclinical Diagnosis to Interventional Treatment)

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