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EuroIntervention : Journal of EuroPCR... Oct 2015Stent placement as treatment for coarctation of the aorta (CoA) has become a more common choice in the last 20 years. Clinical results of CoA stenting are usually... (Meta-Analysis)
Meta-Analysis Review
AIMS
Stent placement as treatment for coarctation of the aorta (CoA) has become a more common choice in the last 20 years. Clinical results of CoA stenting are usually reported in small retrospective case series. This systematic review provides an overview of clinical experience with stenting for CoA.
METHODS AND RESULTS
A systematic review of the reports published between January 1990 and December 2014 after stenting a CoA was performed with a focus on relief of obstruction and lowering of blood pressure. Study and patient characteristics were extracted, as well as pre- and post-stenting aortic diameter in mm, systolic pressure gradient (SPG) and pre- and post-stenting systolic blood pressure (mmHg), periprocedural and follow-up complications. Forty-five articles met the inclusion criteria. Three outcomes were extracted from the articles - aortic diameter, systolic pressure gradient and blood pressure. Diameter increased from 6.4 mm (5.6, 7.3) to 15.1 mm (14.5, 15.7), pressure gradients decreased from 40 mmHg (35, 42) to 4 mmHg (3, 5) and systolic blood pressure decreased from 153 mmHg (148, 158) to 132 mmHg (127, 136). Stent migration was the most common periprocedural complication (2.4%), and mortality was low (0.4%).
CONCLUSIONS
Stenting is an effective treatment with regard to immediate relief of obstruction and direct lowering effect on blood pressure. However, there is a lack of evidence regarding late effectiveness concerning durable blood pressure lowering, and limited information on periprocedural and late complications. This observation calls for a systematic and longer prospective follow-up of patients after CoA stenting.
Topics: Aortic Coarctation; Arterial Pressure; Endovascular Procedures; Foreign-Body Migration; Humans; Risk Factors; Stents; Time Factors; Treatment Outcome
PubMed: 26499220
DOI: 10.4244/EIJV11I6A133 -
International Journal of Cardiology Oct 2015Osteogenesis imperfecta (OI) is a rare, inherited systemic connective tissue disease that causes decreased bioavailability of collagen type 1. Collagen type 1 is the... (Review)
Review
INTRODUCTION
Osteogenesis imperfecta (OI) is a rare, inherited systemic connective tissue disease that causes decreased bioavailability of collagen type 1. Collagen type 1 is the most abundant connective tissue in the body and a key part of many organs. While the bone phenotype in OI is well described, less is known about the effects of decreased collagen on other organs. In the heart, collagen type 1 is present in the heart valves, chordae tendineae, annuli fibrosi and the interventricular septum. It is thus likely that the heart is affected in OI.
OBJECTIVES
The aim of this systematic literature review was to investigate whether patients with OI have an increased risk of cardiovascular disease compared to healthy adults.
DATA SOURCES
PubMed, Embase and key scientific meetings were searched for publications fulfilling the inclusion criteria.
STUDY SELECTION
Studies were selected if at least one patient with OI was described as having cardiovascular disease. The articles should be written in English, French, Italian, Spanish, German, Norwegian or Danish or have an English abstract.
DATA EXTRACTION
Data were extracted by HA, FTJ and LF using a predefined protocol.
RESULTS
A total of 68 studies were included in the review, comprising 51 case reports, 8 small case series (n<10 patients), 4 large case series (n ≥ 10 patients) and 5 cross-sectional studies comparing patients and controls. Together, the papers comprised 499 patients and covered 45 years of medical literature. The most commonly reported heart diseases amongst the patients with OI were valvulopathies and increased aortic diameter. Findings in the large case series and the cross-sectional studies were broadly similar to each other.
CONCLUSION
The findings support the hypothesis that patients with OI have increased risk of heart disease compared to healthy controls. It is biologically plausible that patients with OI may have an increased risk of developing heart disease, and valve disease in particular.
Topics: Heart Valve Diseases; Humans; Osteogenesis Imperfecta; Risk Factors
PubMed: 26100571
DOI: 10.1016/j.ijcard.2015.06.001 -
Vascular Jun 2016To identify patients who are under higher threat for migration because of an old generation stent graft application. (Meta-Analysis)
Meta-Analysis Review
AIM
To identify patients who are under higher threat for migration because of an old generation stent graft application.
METHODS
A systematic review and meta-analysis of the literature was undertaken to identify all studies which included older generation endografts and data reporting on graft migration after EVAR. Outcome data were pooled and combined, and were calculated using fixed or random effects models.
RESULTS
From 2000 to 2014, 22 retrospective studies were identified reporting on stent- graft migration after EVAR (8.6%). From those patients, 39% received re-intervention with the mean time of identification ranging from 12 to 36 months. Six of these retrospective nonrandomized studies were eligible for meta-analysis. AAA diameter (AAA diameter: 0.719 mm; 95% confidence interval [CI]: 0.00065-1.4384 mm; p = 0.00497) and neck length (neck length: 4.36 mm; 95% CI: 1.3277-7.394; p = 0.0048) were the only significant factors associated with stent- graft migration. Neck diameter and neck angulation did not have any important influence on stent-graft migration.
CONCLUSIONS
Patients with large AAA and short necks who were treated with older generation stent grafts such as AneurX and Talent are in higher risk for endograft migration than others. Stent- graft migration consists of an insidious and underestimated threat.
Topics: Aged; Aged, 80 and over; Aortic Aneurysm, Abdominal; Blood Vessel Prosthesis; Blood Vessel Prosthesis Implantation; Endovascular Procedures; Female; Foreign-Body Migration; Humans; Male; Middle Aged; Prosthesis Design; Reoperation; Risk Factors; Stents; Treatment Outcome
PubMed: 26056151
DOI: 10.1177/1708538115590065 -
The Cochrane Database of Systematic... Feb 2015People with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
People with the cardiac arrhythmia supraventricular tachycardia (SVT) frequently present to clinicians in the prehospital and emergency medicine settings. Restoring sinus rhythm by terminating the SVT involves increasing the refractoriness of atrioventricular nodal tissue within the myocardium by means of vagal manoeuvres, pharmacological agents, or electrical cardioversion. A commonly used first-line technique to restore the normal sinus rhythm (reversion) is the Valsalva Manoeuvre (VM). This is a non-invasive means of increasing myocardial refractoriness by increasing intrathoracic pressure for a brief period, thus stimulating baroreceptor activity in the aortic arch and carotid bodies, resulting in increased parasympathetic (vagus nerve) tone.
OBJECTIVES
To assess the evidence of effectiveness of the VM in terminating SVT.
SEARCH METHODS
We updated the electronic searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2014, Issue 7); MEDLINE Ovid (1946 to August week 3, 2014); EMBASE Classic and EMBASE Ovid (1947 to 27 August 2014); Web of Science (1970 to 27 August 2014); and BIOSIS Previews (1969 to 22 August 2014). We also checked trials registries, the Index to Theses, and the bibliographies of all relevant publications identified by these strategies.
SELECTION CRITERIA
We included all randomised controlled trials (RCTs) that examined the effectiveness of VM in terminating SVT.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted the data using a standardised form. We assessed each trial for internal validity, resolving any differences by discussion. We then extracted and entered data into Review Manager 5.
MAIN RESULTS
In this update, we did not identify any new RCT studies for inclusion. We identified two RCT studies as ongoing that we are likely to include in future updates. Accordingly, our results are unchanged and include three RCTs with a total of 316 participants. All three studies compared the effectiveness of VM in reverting SVT with that of other vagal manoeuvres in a cross-over design. Two studies induced SVT within a controlled laboratory environment. Participants had ceased all medications prior to engaging in these studies. The third study reported on people presenting to a hospital emergency department with an episode of SVT. These participants were not controlled for medications or other factors prior to intervention.The two laboratory studies demonstrated reversion rates of 45.9% and 54.3%, whilst the clinical study demonstrated reversion success of 19.4%. This discrepancy may be due to methodological differences between studies, the effect of induced SVT versus spontaneous episodic SVT, and participant factors such as medications and comorbidities. We were unable to assess any of these factors, or adverse effects, further, since they were either not described in enough detail or not reported at all.Statistical pooling was not possible due to heterogeneity between the included studies.
AUTHORS' CONCLUSIONS
We did not find sufficient evidence to support or refute the effectiveness of VM for termination of SVT. Further research is needed, and this research should include a standardised approach to performance technique and methodology.
Topics: Humans; Randomized Controlled Trials as Topic; Tachycardia, Supraventricular; Treatment Outcome; Valsalva Maneuver
PubMed: 25922864
DOI: 10.1002/14651858.CD009502.pub3 -
BMC Public Health Apr 2015Cigars are a growing public health concern, given the changes in cigar use patterns in the US and elsewhere since the 1960s. We conducted a systematic review of... (Review)
Review
BACKGROUND
Cigars are a growing public health concern, given the changes in cigar use patterns in the US and elsewhere since the 1960s. We conducted a systematic review of published studies on current cigar smoking and all-cause and cause-specific mortality risks to inform potential regulatory approaches and future research that would strengthen the body of evidence.
METHODS
Using 3 different databases and handsearching, we identified epidemiological studies published prior to June 2014 that examined the association between cigar smoking and all-cause mortality and smoking-related mortality. Detailed study characteristics as well as association-level characteristics, including effect estimates and 95% confidence intervals, were abstracted or calculated from each selected study.
RESULTS
A total of 22 studies from 16 different prospective cohorts were identified. Primary cigar smoking (current, exclusive cigar smoking with no history of previous cigarette or pipe smoking) was associated with all cause-mortality, oral cancer, esophageal cancer, pancreatic cancer, laryngeal cancer, lung cancer, coronary heart disease (CHD), and aortic aneurysm. Strong dose trends by cigars per day and inhalation level for primary cigar smoking were observed for oral, esophageal, laryngeal, and lung cancers. Among primary cigar smokers reporting no inhalation, relative mortality risk was still highly elevated for oral, esophageal, and laryngeal cancers.
CONCLUSIONS
In summary, cigar smoking carries many of the same health risks as cigarette smoking. Mortality risks from cigar smoking vary by level of exposure as measured by cigars per day and inhalation level and can be as high as or exceed those of cigarette smoking. The body of evidence would be strengthened by future studies that focus on the health effects of primary cigar smoking and incorporate more contemporary and diverse study populations to better reflect the current patterns of cigar use in the US. Ideally, these studies would also collect detailed information on cigar type, exposure level, and biomarkers of exposure and potential harm.
Topics: Aortic Aneurysm; Coronary Disease; Dose-Response Relationship, Drug; Humans; Lung Neoplasms; Neoplasms; Prospective Studies; Risk; Smoking; Tobacco Products
PubMed: 25907101
DOI: 10.1186/s12889-015-1617-5 -
Arteriosclerosis, Thrombosis, and... Apr 2015Childhood obesity is associated with risk factors for cardiovascular disease. Arterial stiffness is considered one of the earliest detectable measures of vascular... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Childhood obesity is associated with risk factors for cardiovascular disease. Arterial stiffness is considered one of the earliest detectable measures of vascular damage. There is controversy in the literature regarding the effects of childhood obesity on arterial stiffness. The objective of this study is to systematically review the literature and to conduct a meta-analysis comparing measures of central arterial stiffness in children and adolescents with obesity to healthy body mass index controls.
APPROACH AND RESULTS
Literature searches were conducted using databases (eg, MEDLINE, EMBASE) and citations cross-referenced. Studies assessing central pulse wave velocity or β-stiffness index were included. A random effects meta-analysis of the standardized mean difference and 95% confidence intervals in arterial stiffness between children with obesity and control children was performed for each arterial stiffness measure. A total of 523 studies were identified. Fifteen case-control studies were included, with 2237 children/adolescents (1281 with obesity, 956 healthy body mass index controls) between 5 and 24 years of age. All studies measuring carotid and aortic β-stiffness index and 10/12 studies measuring central pulse wave velocity reported greater arterial stiffness in children/adolescents with obesity compared with controls. A random effects meta-analysis was performed revealing a significant effect of obesity on pulse wave velocity (standardized mean difference=0.718; 95% confidence interval=0.291-1.415), carotid β-stiffness index (0.862; 0.323-1.402), and aortic β stiffness index (1.017; 0.419-1.615).
CONCLUSION
These findings indicate that child/adolescent obesity is associated with greater arterial stiffness. However, further research is needed to address confounders, such as pubertal status, that may affect this relationship in children. In the future, these techniques may be useful in risk stratification and guiding clinical management of obese children to optimize cardiovascular outcomes.
Topics: Adolescent; Age Factors; Body Mass Index; Cardiovascular Diseases; Child; Child, Preschool; Female; Humans; Male; Odds Ratio; Pediatric Obesity; Predictive Value of Tests; Pulse Wave Analysis; Risk Assessment; Risk Factors; Vascular Stiffness; Young Adult
PubMed: 25633314
DOI: 10.1161/ATVBAHA.114.305062 -
Pediatric Nephrology (Berlin, Germany) Feb 2016Hematuria secondary to renal vein entrapment is mentioned only passing in textbooks and reviews. (Review)
Review
BACKGROUND
Hematuria secondary to renal vein entrapment is mentioned only passing in textbooks and reviews.
METHODS
We performed a search of the National Library of Medicine database for peer-reviewed publications using the terms "renal vein" or "nutcracker" and "hematuria".
RESULTS
We identified 187 published reports/studies that covered 736 patients, of whom 288 had microscopic hematuria and 448 had macroscopic hematuria. The patient cohort comprised 159 patients aged ≤17 years. Abdominal pain was absent in approximately 65% of all patients, and a clinically relevant left-sided varicocele was observed in 29% of the male patients. A normal pre-aortic left renal vein and an anomalous anatomy were noted in 680 and 56 patients, respectively. The body mass index (BMI) was lower in patients with renal vein entrapment than in the controls, with a regression of hematuria correlating with an increase in BMI. A surgical procedure was attempted in 34% of the patients, of which the most common were endovascular stenting and transposition of the renal vein distally into the vena cava.
CONCLUSIONS
In cases of unexplained hematuria with or without abdominal pain, clinicians should consider the diagnosis of renal vein congestion, especially in males with varicocele. Ultrasonic Doppler flow scanning is the recommended initial diagnostic modality in these patients. Expectation management is advised in the great majority of cases.
Topics: Adolescent; Adult; Child; Constriction, Pathologic; Female; Hematuria; Humans; Male; Renal Nutcracker Syndrome; Renal Veins; Young Adult
PubMed: 25627663
DOI: 10.1007/s00467-015-3045-2 -
Surgery Feb 2015Operative injury to the body from all procedures causes a stereotypical cascade of neuroendocrine, cytokine, myeloid, and acute phase responses. This response has been... (Review)
Review
BACKGROUND
Operative injury to the body from all procedures causes a stereotypical cascade of neuroendocrine, cytokine, myeloid, and acute phase responses. This response has been examined commonly by the use of cortisol, interleukin-6 (IL-6), white cell count, and C-reactive protein (CRP). We aimed to determine which markers of the systemic inflammatory response were useful in determining the magnitude of injury after elective operations.
METHODS
A systematic review of the literature was performed using surgery, endocrine response, systemic inflammatory response, cortisol, IL-6, white cell count, and CRP. For each analyte the studies were grouped according to whether the operative injury was considered to be minor, moderate, or major and then by the operative procedure.
RESULTS
A total of 164 studies were included involving 14,362 patients. The IL-6 and CRP responses clearly were associated with the magnitude of operative injury and the invasiveness of the operative procedure. For example, the peak CRP response increased from 52 mg/L with cholecystectomy to 123 mg/L with colorectal cancer resection, 145 mg/L with hip replacement, 163 mg/L after abdominal aortic aneurysm repair, and 189 mg/L after open cardiac surgery. There also appeared to be a difference between minimally invasive/laparoscopic and open procedures such as cholecystectomy (27 vs 80 mg/L), colorectal cancer resection (97 vs 133 mg/L), and aortic aneurysm repair (132 vs 180 mg/L).
CONCLUSION
Peak IL-6 and CRP concentrations consistently were associated with the magnitude of operative injury and operative procedure. These markers may be useful in the objective assessment of which components of Enhanced Recovery after Surgery are likely to improve patient outcome and to assess the possible impact of operative injury on immune function.
Topics: Biomarkers; C-Reactive Protein; Elective Surgical Procedures; Female; Humans; Hydrocortisone; Interleukin-6; Laparoscopy; Leukocyte Count; Male; Minimally Invasive Surgical Procedures; Postoperative Complications; Systemic Inflammatory Response Syndrome
PubMed: 25616950
DOI: 10.1016/j.surg.2014.09.009 -
Ultrasound in Obstetrics & Gynecology :... Sep 2015The primary objective was to estimate the prevalence of aberrant right subclavian artery (ARSA) in fetuses with Down syndrome. Secondary objectives were to assess the... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
The primary objective was to estimate the prevalence of aberrant right subclavian artery (ARSA) in fetuses with Down syndrome. Secondary objectives were to assess the prevalence of ARSA in euploid fetuses, the feasibility of ultrasound evaluation of the right subclavian artery (RSA) in the first and second trimesters of pregnancy, the performance of ARSA in screening for trisomy 21 and its association with other abnormalities.
METHODS
Web-based databases (PubMed, EMBASE and MEDLINE) were searched up to July 2014. The STROBE, PRISMA and QUIPS instruments were used to assess all included studies and for reporting of methodology, results and conclusions. Original studies that reported prenatal ultrasound evaluation of ARSA, assessment of its prevalence in Down-syndrome and euploid fetuses, feasibility of ultrasound evaluation of the RSA in the first and second trimesters of pregnancy and correlation of ARSA with other abnormalities were included, excluding duplications and case reports. Collected data were summarized to estimate prevalence and feasibility. A meta-analysis was performed pooling the study-specific positive and negative likelihood ratios (LR+ and LR-), detection rates and false-positive rates for trisomy 21.
RESULTS
Prevalence of ARSA in Down-syndrome fetuses was 23.6% (95% CI, 19.4-27.9%), whereas in euploid fetuses it was 1.02% (95% CI, 0.86-1.10%). Ultrasound evaluation of the RSA course and origin in the first and second trimesters of pregnancy was feasible in 85% and 98% of cases (first and second trimester, respectively) and it was directly related to sonographic experience and fetal crown-rump length and inversely related to maternal body mass index. In more than 20% of fetuses with ARSA there was an association with other abnormalities but ARSA seemed to be an independent marker of trisomy 21. The meta-analysis showed that ARSA is a significant risk factor for Down syndrome (pooled LR+ = 26.93, 95% CI, 19.36-37.47, P for effect < 0.001, P for Q = 0.3, I(2) = 17.3%), whereas normal RSA is a significant protective marker (pooled LR- = 0.71, 95% CI, 0.51-0.99, P for effect = 0.043, P for Q = 0.9, I(2) = 0%).
CONCLUSIONS
ARSA appears to be a clinically useful prenatal ultrasound marker of Down syndrome. Additional testing when ARSA is diagnosed should involve evaluation of all risk factors by applying a mathematical model. There is insufficient evidence to recommend fetal karyotyping in cases with isolated ARSA. If the background risk is higher or additional markers are present, full fetal karyotyping is advisable, including analysis for 22q11 microdeletion.
Topics: Aneurysm; Cardiovascular Abnormalities; Deglutition Disorders; Down Syndrome; Female; Humans; Models, Statistical; Pregnancy; Pregnancy Trimester, First; Pregnancy Trimester, Second; Prevalence; Subclavian Artery; Ultrasonography, Prenatal
PubMed: 25586729
DOI: 10.1002/uog.14774 -
Journal of Science and Medicine in Sport Jan 2016To examine whether differences in arterial diameter exist between athletes participating in endurance, resistance or mixed exercise training. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
To examine whether differences in arterial diameter exist between athletes participating in endurance, resistance or mixed exercise training.
DESIGN
A systematic review with meta-analysis.
METHODS
Random effects meta-analyses of the weighted mean difference in aortic, carotid, brachial and femoral arterial diameters, height and body mass were conducted on data from 16 peer-reviewed studies indexed on PubMed, MEDLINE, SCOPUS and Sport Discus. Effect sizes were calculated as the standardised difference in means (δ), and used to compare endurance (n=163), resistance (n=192), and mixed trained athletes (n=360), with controls (n=440).
RESULTS
Compared to controls, endurance athletes displayed the greatest difference in diameter in the brachial artery (δ=1.84, 95% CI: 0.59, 3.09, p<0.01), whereas for mixed athletes, the greatest difference in diameter occurred in the femoral artery (δ=3.65, 95% CI: 2.21, 5.10, p<0.01), despite there being no differences in height or body mass between these groups. Resistance athletes had a significantly greater body mass (p=0.047) and aortic diameter (δ=1.81, 95% CI: 1.58, 2.05, p<0.01) than controls, however differences in other vessels could not be determined through meta-analysis due to insufficient data.
CONCLUSIONS
Our results provide evidence for localised arterial differences, which occur more extensively in peripheral vessels (brachial and femoral). Chronically, vascular remodelling may occur as a result of the specific haemodynamic conditions within each vessel, which likely differs depending on the mode of exercise. In the future, empirical research is needed to understand the effect of resistance training on chronic vascular remodelling, as this is not well documented.
Topics: Adaptation, Physiological; Arteries; Humans; Physical Conditioning, Human; Physical Endurance; Resistance Training; Vascular Remodeling
PubMed: 25579977
DOI: 10.1016/j.jsams.2014.12.007