Angiology
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We compared plaque characteristics between symptomatic and asymptomatic sides in patients with bilateral carotid vulnerable plaques using magnetic resonance imaging (MRI). Participants (n = 67; mean age: 65.8 ± 7.7 years, 61 males) with bilateral carotid vulnerable plaques were included. Vulnerable plaques were characterized by intraplaque hemorrhage (IPH), large lipid-rich necrotic core (LRNC), or fibrous cap rupture (FCR) on MRI. ⋯ After adjusting for plaque burden, differences in juxtaluminal IPH and/or thrombus (odds ratio [OR]: 5.49, 95% CI: 1.61-18.75, P = .007) and FCR (OR: 2.90, 95% CI: 1.16-7.24, P = .022) between bilateral sides remained statistically significant. For patients with bilateral carotid vulnerable plaques, symptomatic plaques had greater burden, more juxtaluminal IPH and/or thrombus, and FCR compared with asymptomatic ones. The differences in juxtaluminal IPH and/or thrombus and FCR between bilateral sides were independent of plaque burden.
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We assessed the prognostic value of serum levels of endocan in patients with the acute coronary syndrome (ACS) through its correlation with the Thrombolysis in Myocardial Infarction (TIMI) risk score and compared the possible association with clinical outcomes. In this prospective cross-sectional study, we enrolled 320 patients with documented ST-segment elevation myocardial infarction (STEMI), non-STEMI (NSTEMI), or unstable angina (UA) who underwent diagnostic coronary angiography. Endocan was measured soon after admission in the emergency department. ⋯ Multivariate logistic regression analysis indicated that endocan independently correlated with MACE. Moreover, cardiac troponin I, creatine kinase-MB, and circulating endocan were found to be independently associated with MACE in patients with ACS. In conclusion, a high endocan level on hospital admission is an independent predictor of worse cardiovascular outcomes and higher TIMI risk score in patients with ACS.
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Studies evaluating the risk of peripheral arterial disease (PAD) in patients with abdominal aortic aneurysm (AAA) are limited. We used insurance claims data of Taiwan to establish a cohort of 6590 patients with AAA newly diagnosed from 2000 to 2008 and 6590 controls without AAA matched by propensity score. The subsequent incidence density rates of PAD were estimated in both cohorts by the end of 2011, and the AAA cohort to the non-AAA cohort hazard ratios (HRs) of PAD were calculated using Cox proportional hazards models. ⋯ For those without comorbidities, PAD in the AAA cohort was 7.4-fold greater than that in the non-AAA cohort (12.0 vs 1.61 per 1000 person-years) with an adjusted HR of 6.70 (95% CI = 4.43-10.1). The incidence of PAD in patients with ruptured AAA was lower than that in patients without rupture (6.95 vs 15.0 per 1000 person-years). This study demonstrates that patients with AAA are at increased risk of developing PAD.
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Continuous positive airway pressure (CPAP) is the first-line treatment of obstructive sleep apnea (OSA). Obstructive sleep apnea is a predictor of cardiovascular (CV) events. In this meta-analysis, we evaluated the effect of CPAP on left ventricular ejection fraction (LVEF), CV events, CV mortality, and all-cause mortality in patients with OSA. ⋯ There was a nonsignificant reduction in all-cause mortality (hazard ratio [HR]: 0.92, 95% CI: 0.73-1.15) but a significant reduction of 66% in the risk of CV mortality associated with the CPAP treatment (HR: 0.34, 95% CI: 0.17-0.68, P = .002). There was a nonsignificant reduction in the risk of CV events in the CPAP-treated patients (HR: 0.84, 95% CI: 0.60-1.18, P = .31). Our meta-analyses showed that CPAP treatment improves LVEF and could have a beneficial effect on CV mortality.