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Diagnostics (Basel, Switzerland) Feb 2023Stenosis grade of the carotid arteries has been the primary indicator for risk stratification and surgical treatment of carotid artery disease. Certain characteristics... (Review)
Review
Stenosis grade of the carotid arteries has been the primary indicator for risk stratification and surgical treatment of carotid artery disease. Certain characteristics of the carotid plaque render it vulnerable and have been associated with increased plaque rupture rates. Computed tomography angiography (CTA) and magnetic resonance angiography (MRA) have been shown to detect these characteristics to a different degree. The aim of the current study was to report on the detection of vulnerable carotid plaque characteristics by CTA and MRA and their possible association. A systematic review of the medical literature was executed, utilizing PubMed, SCOPUS and CENTRAL databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. The study protocol has been registered to PROSPERO (CRD42022381801). Comparative studies reporting on both CTA and MRA carotid artery studies were included in the analysis. The QUADAS tools were used for risk of bias diagnostic imaging studies. Outcomes included carotid plaque vulnerability characteristics described in CTA and MRA and their association. Five studies, incorporating 377 patients and 695 carotid plaques, were included. Four studies reported on symptomatic status (326 patients, 92.9%). MRA characteristics included intraplaque hemorrhage, plaque ulceration, type VI AHA plaque hallmarks and intra-plaque high-intensity signal. Intraplaque hemorrhage detected in MRA was the most described characteristic and was associated with increased plaque density, increased lumen stenosis, plaque ulceration and increased soft-plaque and hard-plaque thickness. Certain characteristics of vulnerable carotid plaques can be detected in carotid artery CTA imaging studies. Nevertheless, MRA continues to provide more detailed and thorough imaging. Both imaging modalities can be applied for comprehensive carotid artery work-up, each one complementing the other.
PubMed: 36832133
DOI: 10.3390/diagnostics13040646 -
Journal of Vascular Surgery Dec 2016Vascular Ehlers-Danlos syndrome (EDS) is a relatively rare genetic syndrome that occurs owing to disorders in the metabolism of fibrillary collagen. These defects affect... (Review)
Review
BACKGROUND
Vascular Ehlers-Danlos syndrome (EDS) is a relatively rare genetic syndrome that occurs owing to disorders in the metabolism of fibrillary collagen. These defects affect the soft connective tissues resulting in abnormalities in the skin, joints, hollow organs, and blood vessels. Patients with these defects frequently present at a young age with spontaneous arterial complications involving the medium-sized arteries. Complications involving the hollow organs, such as spontaneous colonic perforation, are observed as well. Given the fragility of the soft tissue, open and endovascular intervention on patients with vascular EDS is fraught with high complication rates.
METHODS
A PubMed search was performed to identify manuscripts published related to vascular EDS. This search included more than 747 articles. These findings were cross-referenced using key terms, including endovascular, embolization, surgery, genetics, pathophysiology, connective tissue disorders, vascular complications, systematic review, type III collagen, and COL3A1.
RESULTS
The references in key articles and review articles were evaluated for additional resources not identified in the PubMed search. Care must be taken to balance the risk of intervention vs the risk of continued observation. Life-threatening hemorrhage, however, mandates intervention.
CONCLUSIONS
With careful, altered approaches to tissue handling, endovascular approaches may provide a safer option for managing the arterial complications observed in patients with vascular EDS. Additional hope may also be found in the use of pharmacologic agents that reduce the incidence and severity of the arterial complications.
Topics: Aneurysm; Collagen Type III; Computed Tomography Angiography; DNA Mutational Analysis; Ehlers-Danlos Syndrome; Endovascular Procedures; Genetic Predisposition to Disease; Humans; Mutation; Phenotype; Predictive Value of Tests; Risk Factors; Treatment Outcome
PubMed: 27687326
DOI: 10.1016/j.jvs.2016.06.120 -
Journal of Personalized Medicine Aug 2023The post-percutaneous coronary intervention (post-PCI) fractional flow reserve (FFR) can detect suboptimal PCI or residual ischemia and potentially lead to fewer adverse... (Review)
Review
The post-percutaneous coronary intervention (post-PCI) fractional flow reserve (FFR) can detect suboptimal PCI or residual ischemia and potentially lead to fewer adverse clinical outcomes. We sought to investigate the predictive value of the angiography-derived FFR for adverse cardiovascular events in patients after PCI. We conducted a comprehensive search of electronic databases, MEDLINE, EMBASE, and the Cochrane Library, for studies published until March 2023 that investigated the prognostic role of angiography-derived fractional flow reserve values after PCI. We investigated the best predictive ability of the post-PCI angiography-derived FFR and relative risk (RR) estimates with 95% confidence intervals (CIs) between post-PCI angiography-derived FFR values and adverse events. Thirteen cohort studies involving 6961 patients (9719 vascular lesions; mean follow-up: 2.2 years) were included in this meta-analysis. The pooled HR of the studies using specific cut-off points for post-PCI angiography-derived FFR was 4.13 (95% CI, 2.92-5.82) for total cardiovascular events, while the pooled HRs for target vessel revascularization, cardiac death, target vessel myocardial infarction, and target lesion revascularization were 6.87 (95% CI, 4.93-9.56), 6.17 (95% CI, 3.52-10.80), 3.98 (95% CI, 2.37-6.66) and 6.27 (95% CI, 3.08-12.79), respectively. In a sensitivity analysis of three studies with 1789 patients assessing the predictive role of the post-PCI angiography-derived FFR as a continuous variable, we found a 58% risk reduction for future adverse events per 0.1 increase in the post-PCI angiography-derived FFR value. In conclusion, post-PCI angiography-derived FFR is an effective tool for predicting adverse cardiovascular events and could be potentially used in decision making, both during PCI and in the long-term follow-up.
PubMed: 37623501
DOI: 10.3390/jpm13081251 -
Heart & Lung : the Journal of Critical... 2023Computational tomography coronary angiography (CTCA) is increasingly the diagnostic test of choice for investigating patients with stable anginal symptoms. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Computational tomography coronary angiography (CTCA) is increasingly the diagnostic test of choice for investigating patients with stable anginal symptoms.
OBJECTIVES
We sought to conduct a systematic review and meta-analysis comparing CTCA with invasive coronary angiography (ICA) with regards to major adverse cardiovascular events (MACE), procedural complications and rates of revascularisation.
METHODS
We conducted a systematic review and meta-analysis in line with the PRISMA statement. A literature search was conducted using PubMed, MEDLINE Ovid and Embase, with three studies included in meta-analysis. Statistical analysis was undertaken using Review Manager 5.3 for MacOS software and outcomes expressed as odds ratio, with 95% confidence intervals and sensitivity analysis was conducted.
RESULTS
A total of 5662 patients were included in this study level meta-analysis. There was no difference in MACE between CT and angiography [2.97% v 3.45%, fixed-effect model, OR: 0.84 (0.62-1.14), p = 0.26, I 0%] and no difference found in rates of myocardial infarction, death or stroke. CTCA was associated with a reduced rate of revascularisation [12.6% v 18.3%, fixed-effects model, OR: 0.64 (0.55-0.75), p<0.00001, I =0%]. However, CTCA was not associated with a significantly lower complication rate [0.5% v 1.72%, random effects model, OR: 0.52 (0.06-4.38), p = 0.55, I 52%].
CONCLUSION
CTCA is a safe strategy for investigating patients with stable angina with no associated increase in MACE but a reduction in revascularisation rates.
Topics: Humans; Computed Tomography Angiography; Coronary Artery Disease; Coronary Angiography; Myocardial Infarction; Heart
PubMed: 36257218
DOI: 10.1016/j.hrtlng.2022.09.018 -
Medical Ultrasonography Jun 2023Studies assessing the use of 3D ultrasound (3DUS) for the evaluation of carotid disease reported varying views among observers about its reliability vis-à-vis 2DUS or... (Meta-Analysis)
Meta-Analysis Review
AIM
Studies assessing the use of 3D ultrasound (3DUS) for the evaluation of carotid disease reported varying views among observers about its reliability vis-à-vis 2DUS or angiography; ratings provided ranged from poor to excellent. Thisstudy aims to systematically review and analyze the reliability of 3DUS for the evaluation of carotid disease.
MATERIALS AND METHODS
The PubMed database was searched for studies that evaluated carotid disease (i.e. plaque measurements and characteristics and degree of stenosis) using 3DUS.
RESULTS
Sixteen studies comprising a total of 918 stenosed carotids were reviewed and meta-analyzed. Data on intra- and inter-observer reproducibility and inter-method agreement (i.e. 3DUS vs 2D and 3DUS vs angiography) were analyzed. Overall analysis showed excellent intra- and inter-observer reproducibility (intraobserver: correlation coefficient r=0.88, 95% confidence intervals (CI) 0.84-0.92; intra-observer: r=0.91, 95% CI 0.87-0.95). The analysis also showed excellent agreement between 3DUS and 2DUS (r=0.89, 95% CI 0.83-0.95) and between 3DUS and angiography (r=0.73, 95% CI 0.44-0.1).
CONCLUSION
3DUS has excellent intra- and inter-observer reproducibility and excellent agreement with 2DUS and angiography for the evaluation of carotid disease. Further studies assessing the reliability ofcarotid plaque characteristics using 3DUS in symptomatic and asymptomatic patients are required.
Topics: Humans; Reproducibility of Results; Imaging, Three-Dimensional; Ultrasonography; Carotid Arteries; Plaque, Atherosclerotic; Constriction, Pathologic; Observer Variation
PubMed: 36546363
DOI: 10.11152/mu-3731 -
BMJ (Clinical Research Ed.) Aug 2015To look at the available literature on validated prediction models for contrast induced nephropathy and describe their characteristics. (Review)
Review
OBJECTIVES
To look at the available literature on validated prediction models for contrast induced nephropathy and describe their characteristics.
DESIGN
Systematic review.
DATA SOURCES
Medline, Embase, and CINAHL (cumulative index to nursing and allied health literature) databases.
REVIEW METHODS
Databases searched from inception to 2015, and the retrieved reference lists hand searched. Dual reviews were conducted to identify studies published in the English language of prediction models tested with patients that included derivation and validation cohorts. Data were extracted on baseline patient characteristics, procedural characteristics, modelling methods, metrics of model performance, risk of bias, and clinical usefulness. Eligible studies evaluated characteristics of predictive models that identified patients at risk of contrast induced nephropathy among adults undergoing a diagnostic or interventional procedure using conventional radiocontrast media (media used for computed tomography or angiography, and not gadolinium based contrast).
RESULTS
16 studies were identified, describing 12 prediction models. Substantial interstudy heterogeneity was identified, as a result of different clinical settings, cointerventions, and the timing of creatinine measurement to define contrast induced nephropathy. Ten models were validated internally and six were validated externally. Discrimination varied in studies that were validated internally (C statistic 0.61-0.95) and externally (0.57-0.86). Only one study presented reclassification indices. The majority of higher performing models included measures of pre-existing chronic kidney disease, age, diabetes, heart failure or impaired ejection fraction, and hypotension or shock. No prediction model evaluated its effect on clinical decision making or patient outcomes.
CONCLUSIONS
Most predictive models for contrast induced nephropathy in clinical use have modest ability, and are only relevant to patients receiving contrast for coronary angiography. Further research is needed to develop models that can better inform patient centred decision making, as well as improve the use of prevention strategies for contrast induced nephropathy.
Topics: Acute Kidney Injury; Age Factors; Anemia; Angiography; Contrast Media; Decision Support Techniques; Diabetes Mellitus; Heart Failure; Humans; Hypertension; Models, Statistical; Renal Insufficiency, Chronic; Risk Assessment; Risk Factors; Sex Factors; Tomography, X-Ray Computed
PubMed: 26316642
DOI: 10.1136/bmj.h4395 -
JACC. Cardiovascular Imaging Feb 2015Angina without coronary artery disease (CAD) has substantial morbidity and is present in 10% to 30% of patients undergoing angiography. Coronary microvascular... (Review)
Review
Angina without coronary artery disease (CAD) has substantial morbidity and is present in 10% to 30% of patients undergoing angiography. Coronary microvascular dysfunction (CMD) is present in 50% to 65% of these patients. The optimal treatment of this cohort is undefined. We performed a systematic review to evaluate treatment strategies for objectively-defined CMD in the absence of CAD. We included studies assessing therapy in human subjects with angina and coronary flow reserve or myocardial perfusion reserve <2.5 by positron emission tomography, cardiac magnetic resonance imaging, dilution methods, or intracoronary Doppler in the absence of coronary artery stenosis ≥50% or structural heart disease. Only 8 papers met the strict inclusion criteria. The papers were heterogeneous, using different treatments, endpoints, and definitions of CMD. The small sample sizes severely limit the power of these studies, with an average of 11 patients per analysis. Studies evaluating sildenafil, quinapril, estrogen, and transcutaneous electrical nerve stimulation application demonstrated benefits in their respective endpoints. No benefit was found with L-arginine, doxazosin, pravastatin, and diltiazem. Our systematic review highlights that there is little data to support therapies for CMD. We assess the data meeting rigorous inclusion criteria and review the related but excluded published data. We additionally describe the next steps needed to address this research gap, including a standardized definition of CMD, routine assessment of CMD in studies of chest pain without obstructive CAD, and specific therapy assessment in the population with confirmed CMD.
Topics: Coronary Angiography; Coronary Circulation; Diagnosis, Differential; Humans; Magnetic Resonance Imaging, Cine; Microcirculation; Microvascular Angina; Myocardial Revascularization; Positron-Emission Tomography; Practice Guidelines as Topic; Regional Blood Flow
PubMed: 25677893
DOI: 10.1016/j.jcmg.2014.12.008 -
Academic Emergency Medicine : Official... May 2023Patients presenting to the emergency department (ED) with acute vertigo or dizziness represent a diagnostic challenge. Neuroimaging has variable indications and yield.... (Meta-Analysis)
Meta-Analysis Review
Diagnostic accuracy of neuroimaging in emergency department patients with acute vertigo or dizziness: A systematic review and meta-analysis for the guidelines for reasonable and appropriate care in the emergency department.
BACKGROUND
Patients presenting to the emergency department (ED) with acute vertigo or dizziness represent a diagnostic challenge. Neuroimaging has variable indications and yield. We aimed to conduct a systematic review and meta-analysis of the diagnostic test accuracy of neuroimaging for patients presenting with acute vertigo or dizziness.
METHODS
An electronic search was designed following patient-intervention-control-outcome (PICO) question-(P) adult patients with acute vertigo or dizziness presenting to the ED; (I) neuroimaging including computed tomography (CT), CT angiography (CTA), magnetic resonance imaging (MRI), magnetic resonance angiography (MRA), and ultrasound (US); (C) MRI/clinical criterion standard; and (O) central causes (stroke, hemorrhage, tumor, others) versus peripheral causes of symptoms. Articles were assessed in duplicate. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was used to assess certainty of evidence in pooled estimates.
RESULTS
We included studies that reported diagnostic test accuracy. From 6309 titles, 460 articles were retrieved, and 12 were included: noncontrast CT scan-six studies, 771 patients, pooled sensitivity 28.5% (95% confidence interval [CI] 14.4%-48.5%, moderate certainty) and specificity 98.9% (95% CI 93.4%-99.8%, moderate certainty); MRI-five studies, 943 patients, sensitivity 79.8% (95% CI 71.4%-86.2%, high certainty) and specificity 98.8% (95% CI 96.2%-100%, high certainty); CTA-one study, 153 patients, sensitivity 14.3% (95% CI 1.8%-42.8%) and specificity 97.7% (95% CI 93.8%-99.6%), CT had higher sensitivity than CTA (21.4% and 14.3%) for central etiology; MRA-one study, 24 patients, sensitivity 60.0% (95% CI 26.2%-87.8%) and specificity 92.9% (95% CI 66.1%-99.8%); US-three studies, 258 patients, sensitivity ranged from 30% to 53.6%, specificity from 94.9% to 100%.
CONCLUSIONS
Noncontrast CT has very low sensitivity and MRI will miss approximately one in five patients with stroke if imaging is obtained early after symptom onset. The evidence does not support neuroimaging as the only tool for ruling out stroke and other central causes in patients with acute dizziness or vertigo presenting to the ED.
Topics: Adult; Humans; Dizziness; Vertigo; Neuroimaging; Stroke; Emergency Service, Hospital; Sensitivity and Specificity
PubMed: 35876220
DOI: 10.1111/acem.14561 -
Neuropsychology Review Mar 2023Mild traumatic brain injury (mTBI) is a major public health concern. Cerebrovascular alterations play a significant role in the evolution of injury sequelae and in the... (Review)
Review
Mild traumatic brain injury (mTBI) is a major public health concern. Cerebrovascular alterations play a significant role in the evolution of injury sequelae and in the process of post-traumatic brain repair. Arterial spin labeling (ASL) is an advanced perfusion magnetic resonance imaging technique that permits noninvasive quantification of cerebral blood flow (CBF). This is the first systematic review of ASL research findings in patients with mTBI. Our approach followed the American Academy of Neurology (AAN) and PRISMA guidelines. We searched Ovid/MEDLINE, Web of Science, Scopus, and the Cochrane Index for relevant articles published as of February 20, 2020. Full-text results were combined into Rayyan software for further evaluation. Data extraction, including risk of bias ratings, was performed using American Academy of Neurology's four-tiered classification scheme. Twenty-three articles met inclusion criteria comprising data on up to 566 mTBI patients and 654 control subjects. Of the 23 studies, 18 reported some type of regional CBF abnormality in mTBI patients at rest or during a cognitive task, with more findings of decreased than increased CBF. The evidence supports the conclusion that mTBI likely causes ASL-derived CBF anomalies. However, synthesis of findings was challenging due to substantial methodological variations across studies and few studies with low risk of bias. Thus, larger-scale prospective cohort studies are needed to more definitively chart the course of CBF changes in humans after mTBI and to understand how individual difference factors contribute to post-injury CBF changes.
Topics: Humans; Prospective Studies; Magnetic Resonance Imaging; Brain; Magnetic Resonance Angiography; Brain Concussion; Perfusion
PubMed: 32808244
DOI: 10.1007/s11065-020-09451-7 -
Journal of Ocular Pharmacology and... May 2022The streptozotocin (STZ)-induced rodent model is one of the most commonly employed models in preclinical drug discovery for diabetic retinopathy (DR). However,... (Review)
Review
The streptozotocin (STZ)-induced rodent model is one of the most commonly employed models in preclinical drug discovery for diabetic retinopathy (DR). However, standardization and validation of experimental readouts are largely lacking. The aim of this systematic review was to identify and compare the most useful readouts of STZ-induced DR and provide recommendations for future study design based on our findings. We performed a systematic search using 2 major databases, PubMed and EMBASE. Only articles describing STZ-induced DR describing both functional and structural readouts were selected. We also assessed the risk of bias and analyzed qualitative data in the selected studies. We identified 21 studies that met our inclusion/exclusion criteria, using either rats or mice and study periods of 2 to 24 weeks. Glucose level thresholds used to define hyperglycemia were inconsistent between studies, however, most studies used either 250 or 300.6 mg/dL as a defining criterion for hyperglycemia. All included studies performed electroretinography (ERG) and reported a reduction in a-, b-, or c-wave and/or oscillatory potential amplitudes. Spectral-domain optical coherence tomography and fluorescein angiography, as well as immunohistochemical and histopathological analyses showed reductions in retinal thickness, vascular changes, and presence of inflammation. Risk of bias assessment showed that all studies had a high risk of bias due to lack of reporting or correctly following procedures. Our systematic review highlights that ERG represents the most consistent functional readout in the STZ model. However, due to the high risk of bias, caution must be used when interpreting these studies.
Topics: Animals; Diabetes Mellitus, Experimental; Diabetic Retinopathy; Electroretinography; Hyperglycemia; Mice; Rats; Retina; Rodentia; Streptozocin; Structure-Activity Relationship
PubMed: 35325558
DOI: 10.1089/jop.2021.0128