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Journal of Neuroinflammation Mar 2023Recent literature on multiple sclerosis (MS) demonstrates the growing implementation of optical coherence tomography-angiography (OCT-A) to discover potential... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND AND OBJECTIVES
Recent literature on multiple sclerosis (MS) demonstrates the growing implementation of optical coherence tomography-angiography (OCT-A) to discover potential qualitative and quantitative changes in the retina and optic nerve. In this review, we analyze OCT-A studies in patients with MS and examine its utility as a surrogate or precursor to changes in central nervous system tissue.
METHODS
PubMed and EMBASE were systematically searched to identify articles that applied OCT-A to evaluate the retinal microvasculature measurements in patients with MS. Quantitative data synthesis was performed on all measurements which were evaluated in at least two unique studies with the same OCT-A devices, software, and study population compared to controls. A fixed-effects or random-effects model was applied for the meta-analysis based on the heterogeneity level.
RESULTS
The study selection process yielded the inclusion of 18 studies with a total of 1552 evaluated eyes in 673 MS-associated optic neuritis (MSON) eyes, 741 MS without optic neuritis (MSNON eyes), and 138 eyes without specification for the presence of optic neuritis (ON) in addition to 1107 healthy control (HC) eyes. Results indicated that MS cases had significantly decreased whole image superficial capillary plexus (SCP) vessel density when compared to healthy control subjects in the analyses conducted on Optovue and Topcon studies (both P < 0.0001). Likewise, the whole image vessel densities of deep capillary plexus (DCP) and radial peripapillary capillary (RPC) were significantly lower in MS cases compared to HC (all P < 0.05). Regarding optic disc area quadrants, MSON eyes had significantly decreased mean RPC vessel density compared to MSNON eyes in all quadrants except for the inferior (all P < 0.05). Results of the analysis of studies that used prototype Axsun machine revealed that MSON and MSNON eyes both had significantly lower ONH flow index compared to HC (both P < 0.0001).
CONCLUSIONS
This systematic review and meta-analysis of the studies reporting OCT-A measurements of people with MS confirmed the tendency of MS eyes to exhibit reduced vessel density in the macular and optic disc areas, mainly in SCP, DCP, and RPC vessel densities.
Topics: Humans; Tomography, Optical Coherence; Multiple Sclerosis; Retina; Angiography; Retinal Vessels; Optic Neuritis; Fluorescein Angiography
PubMed: 36973708
DOI: 10.1186/s12974-023-02763-4 -
JACC. Cardiovascular Interventions Oct 2023Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Low fractional flow reserve (FFR) after percutaneous coronary intervention (PCI) has been associated with adverse clinical outcomes. Hitherto, this assessment has been independent of the epicardial vessel interrogated.
OBJECTIVES
This study sought to assess the predictive capacity of post-PCI FFR for target vessel failure (TVF) stratified by coronary artery.
METHODS
We performed a systematic review and individual patient-level data meta-analysis of randomized clinical trials and observational studies with protocol-recommended post-PCI FFR assessment. The difference in post-PCI FFR between left anterior descending (LAD) and non-LAD arteries was assessed using a random-effect models meta-analysis of mean differences. TVF was defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target vessel revascularization.
RESULTS
Overall, 3,336 vessels (n = 2,760 patients) with post-PCI FFR measurements were included in 9 studies. The weighted mean post-PCI FFR was 0.89 (95% CI: 0.87-0.90) and differed significantly between coronary vessels (LAD = 0.86; 95% CI: 0.85 to 0.88 vs non-LAD = 0.93; 95% CI: 0.91-0.94; P < 0.001). Post-PCI FFR was an independent predictor of TVF, with its risk increasing by 52% for every reduction of 0.10 FFR units, and this was mainly driven by TVR. The predictive capacity for TVF was poor for LAD arteries (AUC: 0.52; 95% CI: 0.47-0.58) and moderate for non-LAD arteries (AUC: 0.66; 95% CI: 0.59-0.73; LAD vs non-LAD arteries, P = 0.005).
CONCLUSIONS
The LAD is associated with a lower post-PCI FFR than non-LAD arteries, emphasizing the importance of interpreting post-PCI FFR on a vessel-specific basis. Although a higher post-PCI FFR was associated with improved prognosis, its predictive capacity for events differs between the LAD and non-LAD arteries, being poor in the LAD and moderate in the non-LAD vessels.
Topics: Humans; Coronary Artery Disease; Percutaneous Coronary Intervention; Fractional Flow Reserve, Myocardial; Coronary Angiography; Treatment Outcome; Predictive Value of Tests
PubMed: 37821185
DOI: 10.1016/j.jcin.2023.08.018 -
Catheterization and Cardiovascular... Apr 2021Despite of the wide evidence of use fractional flow reserve (FFR), isolated angiography evaluation is still the main tool to indicate percutaneous coronary intervention.... (Meta-Analysis)
Meta-Analysis
INTRODUCTION
Despite of the wide evidence of use fractional flow reserve (FFR), isolated angiography evaluation is still the main tool to indicate percutaneous coronary intervention. Quantitative flow ratio (QFR) is a new functional index to assess functional significance. Recently, few studies have showed the capacity of QFR to predict significance stenosis. The aim of this research has been to describe the evidence of QFR in this clinical setting, to analyze the global diagnosis accuracy of QFR versus FFR and to compare the difference in feasibility between retrospective and prospective analysis.
METHODS AND RESULTS
Systematic review of literature was performed. Eligible studies for the meta-analysis were considered those directly evaluating de QFR versus FFR. Pooled values of diagnosis test and summary receiver operator curve were calculated. Main causes of not-perform QFR analysis according to study design were also evaluated. Sixteen studies were included. Good correlation and agreement were showed. Global sensibility, specificity, PPV, and NPV were 0.84, 0.89, 0.80, and 0.92, respectively. Then, 18% of evaluated vessels could not be analyzed. Significant differences were found in the percentage of discarded vessels and the cause of nonperformed analysis between retrospective or prospective analysis.
CONCLUSIONS
Excellent correlation and agreement between QFR and FFR was demonstrated. QFR assessment could be improved by its prospective analysis with a dedicated protocol.
Topics: Coronary Angiography; Coronary Stenosis; Coronary Vessels; Fractional Flow Reserve, Myocardial; Humans; Imaging, Three-Dimensional; Predictive Value of Tests; Retrospective Studies; Treatment Outcome
PubMed: 32196932
DOI: 10.1002/ccd.28857 -
Survey of Ophthalmology 2023Choroidal osteoma is a benign ossifying tumor within the choroid. Complications associated with choroidal osteoma, including disruption of retinal pigment epithelium,... (Review)
Review
Choroidal osteoma is a benign ossifying tumor within the choroid. Complications associated with choroidal osteoma, including disruption of retinal pigment epithelium, atrophy of photoreceptors, subretinal fluid, and choroidal neovascularization, present challenges for clinicians, and management remain controversial. We performed a comprehensive search in the PubMed, EMBASE, and Ovid databases for published studies and case reports relating to the management of choroidal osteoma. Since it was first described in 1978, various case reports of ocular complications associated with choroidal osteoma have been documented, and various therapies have yielded different outcomes. We systematically evaluate the literature published on this rare entity.
Topics: Humans; Choroid Neoplasms; Choroid; Osteoma; Choroidal Neovascularization; Retinal Pigment Epithelium; Fluorescein Angiography; Tomography, Optical Coherence
PubMed: 37321477
DOI: 10.1016/j.survophthal.2023.06.002 -
Deutsches Arzteblatt International Oct 2017Chronic coronary heart disease (CHD) and acute myocardial infarction are endemic conditions. In Germany, an estimated 900 000 cardiac catheterizations were performed in... (Review)
Review
BACKGROUND
Chronic coronary heart disease (CHD) and acute myocardial infarction are endemic conditions. In Germany, an estimated 900 000 cardiac catheterizations were performed in the year 2014, and a percutaneous intervention was carried out in 40% of these procedures. It would be desirable to lessen the number of invasive diagnostic procedures while preserving the reliability of diagnosis. In this article, we present the updated recommendations of the German National Care Guideline for Chronic CHD with regard to diagnostic evaluation.
METHODS
Updated recommendations for the diagnostic evaluation of chronic CHD were developed on the basis of existing guidelines and a systematic literature review and approved by a formal consensus process.
RESULTS
8-11% of patients with chest pain who present to a general practitioner and 20-25% of those who present to a cardiologist have chronic CHD. General practitioners should estimate the probability of CHD with the Marburg Heart Score. Specialists can use detailed tables for determining the pre-test probability of CHD; if this lies in the range of 15% to 85%, then non-invasive tests should be primarily used for evaluation and treatment planning. If the pretest probability is less than 15%, other potential causes should be ruled out first. If it is over 85%, the presence of CHD should be presumed and treatment planning should be initiated. Coronary angiography is needed only if therapeutic implications are expected (revascularization). Psychosocial risk factors for the development and course of CHD and the patient's quality of life should be regularly assessed as well.
CONCLUSION
Non-invasive testing and invasive coronary angiography should be used only if their findings are expected to have therapeutic implications. Psychosocial risk factors, the quality of life, and adherence to treatment are important components of these patients' diagnostic evaluation and long-term care.
Topics: Adult; Aged; Aged, 80 and over; Coronary Angiography; Coronary Disease; Female; Germany; Humans; Male; Middle Aged; Myocardial Ischemia; Practice Guidelines as Topic; Quality of Life; Reproducibility of Results
PubMed: 29122104
DOI: 10.3238/arztebl.2017.0712 -
Survey of Ophthalmology 2022There are various hypotheses for the anatomic origin of a choroidal macrovessel. We assess whether a choroidal macrovessel is a dilated posterior ciliary artery. A... (Review)
Review
There are various hypotheses for the anatomic origin of a choroidal macrovessel. We assess whether a choroidal macrovessel is a dilated posterior ciliary artery. A systematic review of published literature on choroidal macrovessels was performed with two additional cases from our institution. We compared the visible entry and vascular course of the macrovessel in the published literature. We performed a comparative analysis using indocyanine green angiography, swept source optical computed tomography, and 3D reconstruction of two choroidal macrovessels using 3D Slicer (Harvard, Boston, USA, https://www.slicer.org/). From the 14 studies found, 18 cases met inclusion criteria. The reported literature and our two cases showed a radiating course along a sectoral distribution pattern of either short or long posterior ciliary arteries. Our review of literature and 3D reconstruction analysis support the hypothesis that choroidal macrovessels are dilated posterior ciliary arteries.
Topics: Choroid; Ciliary Arteries; Fluorescein Angiography; Humans; Tomography, Optical Coherence
PubMed: 34332961
DOI: 10.1016/j.survophthal.2021.07.003 -
International Journal of Cardiology Dec 2016Hyperuricemia may be associated with an increased risk of contrast-induced acute kidney injury (CI-AKI). In recent years, studies about the relationship between them... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Hyperuricemia may be associated with an increased risk of contrast-induced acute kidney injury (CI-AKI). In recent years, studies about the relationship between them gradually appeared. We performed a systematic review and meta-analysis to investigate whether hyperuricemia is an independent risk factor for CI-AKI.
METHODS
Relevant studies were searched in PubMed, Embase, Cochrane Library, and CBM (Chinese Biomedical Literature database) databases until April 18, 2016, without language restriction. Observational studies evaluating serum uric acid (SUA) levels and CI-AKI risks were included. The pooled odds ratio was calculated to assess the association between hyperuricemia and risk of CI-AKI using a random-effects model.
RESULTS
Eighteen relevant studies involving a total of 13,084 patients met our inclusion criteria. Presence of hyperuricemia was associated with an increased risk of CI-AKI development regardless of whether the effect size was adjusted or not (unadjusted OR: 2.08, 95% CI: 1.63-2.64; adjusted OR: 1.68, 95% CI: 1.38-2.04). In-hospital mortality and cases of renal replacement therapy were significantly different between subjects with hyperuricemia and normouricemia undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI).
CONCLUSION
Hyperuricemia is independently associated with the occurrence of CI-AKI and it significantly increases the in-hospital mortality and the risk of renal replacement therapy among the patients after CAG and/or PCI. Future research is needed to determine whether urate-lowering therapy has beneficial effects for reducing the incidence of CI-AKI and in-hospital adverse events.
Topics: Acute Kidney Injury; Case-Control Studies; Cohort Studies; Contrast Media; Coronary Angiography; Humans; Hyperuricemia; Risk Factors
PubMed: 27665399
DOI: 10.1016/j.ijcard.2016.09.033 -
BMJ Open Ophthalmology Nov 2023To explore the current research about the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in dysthyroid optic neuropathy... (Meta-Analysis)
Meta-Analysis
PURPOSE
To explore the current research about the role of optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA) in dysthyroid optic neuropathy (DON).
METHODS
Studies in the literature that focused on OCT, OCTA and DON were retrieved by searching PubMed, EMBASE, Cochrane databases and Clinical Trial before 20 June 2023. The methodological quality was assessed using the Newcastle-Ottawa scale. The quantitative calculation was performed using Review Manager V.5.3.
RESULTS
Twelve studies met the eligibility criteria and were included. DON group presented lower macular ganglion cell complex in the overall, superior and inferior hemifields compared with the non-DON group. Furthermore, the ganglion cell layer and inner plexiform layer in DON group was thinner in contrast to the non-DON group. The optic nerve head vessel density was lower in the DON group than that in the non-DON group. A reduction of radial peripapillary capillary vessel density could be seen in the DON group than the non-DON group in overall, inside disc, peripapillary, superior-hemifield, temporal and nasal. Besides, the macular superficial retinal capillary layer of non-DON and DON is lower than the healthy control group.
CONCLUSIONS
This study supported the potential value of OCT and OCTA metrics as novel biomarkers of DON. Ophthalmologists should comprehensively consider the retinal structure and microvasculature in dealing with DON.
ETHICS AND DISSEMINATION
This systematic review included data from published literature and was exempt from ethics approval. Results would be disseminated through peer-reviewed publication and presented at academic conferences engaging clinicians.
PROSPERO REGISTRATION NUMBER
CRD42023414907.
Topics: Humans; Tomography, Optical Coherence; Optic Disk; Angiography; Retinal Ganglion Cells; Optic Nerve Diseases
PubMed: 37996119
DOI: 10.1136/bmjophth-2023-001379 -
The Cochrane Database of Systematic... Jan 2017Pulmonary embolism is a leading cause of pregnancy-related death. An accurate diagnosis in pregnant patients is crucial to prevent untreated pulmonary embolism as well... (Review)
Review
BACKGROUND
Pulmonary embolism is a leading cause of pregnancy-related death. An accurate diagnosis in pregnant patients is crucial to prevent untreated pulmonary embolism as well as unnecessary anticoagulant treatment and future preventive measures. Applied imaging techniques might perform differently in these younger patients with less comorbidity and altered physiology, who largely have been excluded from diagnostic studies.
OBJECTIVES
To determine the diagnostic accuracy of computed tomography pulmonary angiography (CTPA), lung scintigraphy and magnetic resonance angiography (MRA) for the diagnosis of pulmonary embolism during pregnancy.
SEARCH METHODS
We searched MEDLINE and Embase until July 2015. We used included studies as seeds in citations searches and in 'find similar' functions and searched reference lists. We approached experts in the field to help us identify non-indexed studies.
SELECTION CRITERIA
We included consecutive series of pregnant patients suspected of pulmonary embolism who had undergone one of the index tests (computed tomography (CT) pulmonary angiography, lung scintigraphy or MRA) and clinical follow-up or pulmonary angiography as a reference test.
DATA COLLECTION AND ANALYSIS
Two review authors performed data extraction and quality assessment. We contacted investigators of potentially eligible studies to obtain missing information. In the primary analysis, we regarded inconclusive index test results as a negative reference test, and treatment for pulmonary embolism after an inconclusive index test as a positive reference test.
MAIN RESULTS
We included 11 studies (four CTPA, five lung scintigraphy, two both) with a total of 695 CTPA and 665 lung scintigraphy results. Lung scintigraphy was applied by different techniques. No MRA studies matched our inclusion criteria.Overall, risk of bias and concerns regarding applicability were high in all studies as judged in light of the review research question, as was heterogeneity in study methods. We did not undertake meta-analysis. All studies used clinical follow-up as a reference standard, none in a manner that enabled reliable identification of false positives. Sensitivity and negative predictive value were therefore the only valid test accuracy measures.The median negative predictive value for CTPA was 100% (range 96% to 100%). Median sensitivity was 83% (range 0% to 100%).The median negative predictive value for lung scintigraphy was 100% (range 99% to 100%). Median sensitivity was 100% (range 0% to 100%).The median frequency of inconclusive results was 5.9% (range 0.9% to 36%) for CTPA and 4.0% (range 0% to 23%) for lung scintigraphy. The overall median prevalence of pulmonary embolism was 3.3% (range 0.0% to 8.7%).
AUTHORS' CONCLUSIONS
Both CTPA and lung scintigraphy seem appropriate for exclusion of pulmonary embolism during pregnancy. However, the quality of the evidence mandates cautious adoption of this conclusion. Important limitations included poor reference standards, necessary assumptions in the analysis regarding inconclusive test results and the inherent inability of included studies to identify false positives. It is unclear which test has the highest accuracy. There is a need for direct comparisons between diagnostic methods, including MR, in prospective randomized diagnostic studies.
Topics: Angiography; Female; Humans; Magnetic Resonance Angiography; Positron-Emission Tomography; Pregnancy; Pregnancy Complications, Hematologic; Pulmonary Embolism; Radionuclide Imaging; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 28124411
DOI: 10.1002/14651858.CD011053.pub2 -
Coronary Artery Disease Jun 2022Coronary stent infection (CSI) is the rarest complication associated with the percutaneous coronary intervention, occurring in less than 0.1% of cases. So far, all...
Coronary stent infection (CSI) is the rarest complication associated with the percutaneous coronary intervention, occurring in less than 0.1% of cases. So far, all reported instances are limited to case reports. CSI presents itself in various, often confusing, ways in clinical settings. Therefore, the current systematic review summarizes reports of CSI's clinical presentations, causative pathogens, diagnoses and treatments. This systematic review considered three online databases, using reference lists as an additional source. All case reports or case series with stent infection in the coronary artery were included - however, reviews or commentaries, articles not published in English, and articles mentioning a history of hemodialysis or any surgery were excluded. Thirty-two studies on 34 CSI patients were included in the final qualitative analysis. CSI predominantly affected males of a wide range of ages. The most common symptoms were chest pain and fever with various onsets. Interestingly, CSI usually occurred during the first stent implantation. Cultures and coronary angiography were the most common methods used to diagnose CSI. Furthermore, drug-eluting stents had a higher risk of infection than bare-metal stents. Aneurysms were the most frequent abnormalities observed in infected stents. The bacteria that most often caused CSI were Staphylococcus aureus and Pseudomonas aeroginosa. More than 90% of the reports mentioned using various antibiotics, and 74% mentioned carrying out surgery. Finally, a mortality rate of 26.47% among CSI patients was calculated.
Topics: Coronary Angiography; Coronary Restenosis; Drug-Eluting Stents; Female; Humans; Male; Percutaneous Coronary Intervention; Stents; Treatment Outcome
PubMed: 35503933
DOI: 10.1097/MCA.0000000000001098