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Journal Cover JRSM Cardiovascular Disease
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  This is an Open Access Journal Open Access journal
   ISSN (Print) 2048-0040 - ISSN (Online) 2048-0040
   Published by Sage Publications Homepage  [853 journals]
  • Neurological complications in chronic kidney disease

    • Authors: Arnold, R; Issar, T, Krishnan, A. V, Pussell, B. A.
      Pages: 2048004016 - 2048004016
      Abstract: Patients with chronic kidney disease (CKD) are frequently afflicted with neurological complications. These complications can potentially affect both the central and peripheral nervous systems. Common neurological complications in CKD include stroke, cognitive dysfunction, encephalopathy, peripheral and autonomic neuropathies. These conditions have significant impact not only on patient morbidity but also on mortality risk through a variety of mechanisms. Understanding the pathophysiological mechanisms of these conditions can provide insights into effective management strategies for neurological complications. This review describes clinical management of neurological complications in CKD with reference to the contributing physiological and pathological derangements. Stroke, cognitive dysfunction and dementia share several pathological mechanisms that may contribute to vascular impairment and neurodegeneration. Cognitive dysfunction and dementia may be differentiated from encephalopathy which has similar contributing factors but presents in an acute and rapidly progressive manner and may be accompanied by tremor and asterixis. Recent evidence suggests that dietary potassium restriction may be a useful preventative measure for peripheral neuropathy. Management of painful neuropathic symptoms can be achieved by pharmacological means with careful dosing and side effect considerations for reduced renal function. Patients with autonomic neuropathy may respond to sildenafil for impotence. Neurological complications often become clinically apparent at end-stage disease, however early detection and management of these conditions in mild CKD may reduce their impact at later stages.
      PubDate: 2016-11-03T23:32:47-07:00
      DOI: 10.1177/2048004016677687
      Issue No: Vol. 5, No. 0 (2016)
  • Association of glutathione S-transferase GSTM1 and GSTT1 deletion
           polymorphisms with obesity and their relationship with body mass index,
           lipoprotein and hypertension among young age Saudis

    • Authors: Almoshabek, H. A; Mustafa, M, Al-Asmari, M. M, Alajmi, T. K, Al-Asmari, A. K.
      Pages: 2048004016 - 2048004016
      Abstract: ObjectivesPersistent oxidative stress is one of the several risk factors that may be associated with the etiology of obesity. The present study is aimed to investigate association between GSTM1 and GSTT1 polymorphisms with obesity and their relationship with plasma lipoproteins, body mass index (BMI) and hypertension.DesignThe GSTM1 and GSTT1 deletion polymorphisms were analyzed by multiplex polymerase chain reaction. The lipoproteins were measured in plasma using commercially available kit and the weight, height, systolic (SBP) and diastolic (DBP) blood pressures by standard procedure of measurements.SettingPrince Sultan Military Medical City, Riyadh Saudi Arabia.ParticipantsA total of 420 overweight/obese cases and 234 normal weight controls belong to young age Saudis.Main outcomes measuresGSTM1/GSTT1 polymorphisms may be associated with obesity.ResultsWeight, BMI, low-density lipoprotein (LDL) and SBP were significantly higher while high-density lipoprotein (HDL) was significantly lower in cases in comparison to controls. Frequency of GSTM1+/GSTT1– (OR = 2.70, 95% CI = 1.52–4.81, p =
      PubDate: 2016-09-22T22:36:33-07:00
      DOI: 10.1177/2048004016669645
      Issue No: Vol. 5, No. 0 (2016)
  • Do arterial stiffness and wave reflection underlie cardiovascular risk in
           ethnic minorities'

    • Authors: Faconti, L; Nanino, E, Mills, C. E, Cruickshank, K. J.
      Pages: 2048004016 - 2048004016
      Abstract: Increasing evidence indicates that remarkable differences in cardiovascular risk between ethnic groups cannot be fully explained by traditional risk factors such as hypertension, diabetes or dislipidemia measured in midlife. Therefore, the underlying pathophysiology leading to this "excess risk" in ethnic minority groups is still poorly understood, and one way to address this issue is to shift the focus from "risk" to examine target organs, particularly blood vessels and their arterial properties more directly. In fact, structural and functional changes of the vascular system may be identifiable at very early stages of life when traditional factors are not yet developed. Arterial stiffening, measured as aortic pulse wave velocity, and wave reflection parameters, especially augmentation index, seem to be an important pathophysiological mechanism for the development of cardiovascular disease and predict mortality independent of other risk factors. However, data regarding these arterial indices in ethnic minorities are relatively rare and the heterogeneity between populations, techniques and statistical methods make it difficult to fully understand their role.
      PubDate: 2016-08-01T03:00:53-07:00
      DOI: 10.1177/2048004016661679
      Issue No: Vol. 5, No. 0 (2016)
  • The effect of green leafy and cruciferous vegetable intake on the
           incidence of cardiovascular disease: A meta-analysis

    • Authors: Pollock; R. L.
      Pages: 2048004016 - 2048004016
      Abstract: Does the consumption of green leafy vegetables including cruciferous vegetables significantly reduce the incidence of cardiovascular disease' This research question was answered via employing the statistical methods of meta-analysis by synthesizing relevant worldwide studies that address the association between the consumption of green leafy vegetables and risk of incidence of said diseases. All meta-analysis calculations included determination of effect sizes of relative risk, and their respective 95% confidence intervals, heterogeneity of the studies, relative weights for each study, and significance (p) for each study. Eight studies met the inclusion criteria, which investigated the relationship between the incidences of total cardiovascular disease with the intake of green leafy vegetables. The overall effect size (random effect model) was: RR = 0.842 (95% CI = 0.753 to 0.941), p = 0.002, which indicates a significant 15.8% reduced incidence of cardiovascular disease.
      PubDate: 2016-08-01T03:00:53-07:00
      DOI: 10.1177/2048004016661435
      Issue No: Vol. 5, No. 0 (2016)
  • Adjunctive intra-coronary imaging for the assessment of coronary artery

    • Authors: Shah, N; Ussen, B, Mahmoudi, M.
      Pages: 2048004016 - 2048004016
      Abstract: Atherosclerotic coronary artery disease remains a leading cause of worldwide morbidity and mortality. Invasive angiography currently remains the gold standard method of diagnosing and treating coronary disease; however, more sophisticated adjunctive interventional technologies have been developed to combat the inter and intra-observer variability frequently encountered in the assessment of lesion severity. Intravascular imaging now plays a key role in optimising percutaneous coronary interventions and provides invaluable information as part of the interventional cardiologist’s diagnostic arsenal. The principles, technical aspects and uses of two modalities of intracoronary imaging, intravascular ultrasound and optical coherence tomography, are discussed. We additionally provide examples of cases where the adjunctive intracoronary imaging was superior to angiography alone in successfully identifying and treating acute coronary syndromes.
      PubDate: 2016-07-08T05:14:59-07:00
      DOI: 10.1177/2048004016658142
      Issue No: Vol. 5, No. 0 (2016)
  • The association between prolongation in QRS duration and presence of
           coronary collateral circulation in patients with acute myocardial

    • Authors: Karahan, Z; Altıntas, B, Ugurlu, M, Kaya, I, Ucaman, B, Ulug, A. V, Altındag, R, Altas, Y, Adıyaman, M. S, Öztürk, O.
      Pages: 2048004016 - 2048004016
      Abstract: BackgroundIt is known that QRS duration is related to prognosis in acute myocardial infarction. The relation between QRS duration and coronary collateral circulation is uncertain. In the present study, we aimed to determine the relation between QRS duration and coronary collateral circulation in patients admitted with acute myocardial infarction.MethodsThe present study was composed of 109 consecutive patients with acute myocardial infarction. All patients had total occlusion in the left anterior descending coronary artery. Electrocardiographic recordings on admission were obtained for the assessment of QRS duration. The Rentrop classification was used to define coronary collateral circulation on coronary angiography. Patients were divided into two groups as follows: Group 1 with poor coronary collateral circulation (Rentrop 0–1) and Group 2 with good coronary collateral circulation (Rentrop 2–3).ResultsOf all patients, 62 patients were included in group 1 and 47 patients in group 2, respectively. In the present study, patients in the group 1 had longer QRS duration than patients in the group 2 (p < 0.005). Additionally, we found that Rentrop grading had negative correlation with both QRS duration and white blood cell count (r: –0.28; p < 0.005 and r: –0.35; p < 0.001).ConclusionOur study showed that there was an inverse relationship between QRS duration on admission and presence of coronary collateral circulation in patients with acute myocardial infarction.
      PubDate: 2016-07-04T02:00:47-07:00
      DOI: 10.1177/2048004016657475
      Issue No: Vol. 5, No. 0 (2016)
  • Demographic and socio-economic influences on community-based care and
           caregivers of people with dementia in China

    • Authors: Chen, R; Lang, L, Clifford, A, Chen, Y, Hu, Z, Han, T. S.
      Pages: 2048004016 - 2048004016
      Abstract: BackgroundDementia is a major public health challenge and China has the largest population with dementia in the world. However, dementia care and caregivers for Chinese are less investigated.Objectives and designTo evaluate demographic and socio-economic influences on dementia care, management patterns and caregiver burden in a household community-dwelling-based survey, using participants’ care receipts and Zarit scale.Setting and participantsRural and urban communities across six provinces of China comprising 4837 residents aged ≥60 years, in whom 398 had dementia and 1312 non-dementia diseases.ResultsPeople with dementia were less likely to receive care if they were living in rural compared to urban areas (Odd ratio (OR) = 0.20; 95%CI: 0.10–0.41), having education level below compared to above secondary school (OR = 0.24; 95%CI: 0.08–0.70), manual labourer compared to non-manual workers (OR = 0.27; 95%CI: 0.13–0.55), having personal annual income below RMB 10,000 yuan (£1000) compared to above (OR = 0.37; 95%CI: 0.13–0.74) or having four or more than compared to less four children (OR = 0.52; 95%CI: 0.27–1.00). Caregivers for dementia compared with those for non-dementia diseases were younger and more likely to be patients’ children or children in-law, had lower education and spent more caring time. Caregiver burden increased with low education, cutback on work and caring for patients who were younger or living in rural areas, and this caregiver burden was three-fold greater than that for non-dementia diseases.ConclusionsThere are a number of inequalities in dementia care and caregiver burden in China. Reducing the socio-economic gap and increasing education may improve community care for people with dementia and preserve caregivers’ well-being.
      PubDate: 2016-06-21T01:35:56-07:00
      DOI: 10.1177/2048004016652314
      Issue No: Vol. 5, No. 0 (2016)
  • State of the art: Oral antiplatelet therapy

    • Authors: Gurbel, P. A; Myat, A, Kubica, J, Tantry, U. S.
      Pages: 2048004016 - 2048004016
      Abstract: Platelet adhesion, activation, and aggregation are central to the propagation of coronary thrombosis following rupture, fissure, or erosion of an atherosclerotic plaque. This chain of deleterious events underlies the pathophysiological process leading to an acute coronary syndrome. Therefore, oral antiplatelet therapy has become the cornerstone of therapy for the management of acute coronary syndrome and the prevention of ischemic complications associated with percutaneous coronary intervention. Landmark trials have established aspirin, and the addition of clopidogrel to aspirin, as key therapeutic agents in the context of acute coronary syndrome and percutaneous coronary intervention. Dual antiplatelet therapy has been the guideline-mandated standard of care in acute coronary syndrome and percutaneous coronary intervention. Despite the proven efficacy of dual antiplatelet therapy, adverse ischemic events continue to occur and this has stimulated the development of novel, more potent antiplatelet agents. We focus this state-of-the-art review on the most recent advances in oral antiplatelet therapy, treading the tightrope of potency versus bleeding risk, the quest to determine the optimal duration of dual antiplatelet therapy and future of personalized antiplatelet therapy.
      PubDate: 2016-06-01T02:33:38-07:00
      DOI: 10.1177/2048004016652514
      Issue No: Vol. 5, No. 0 (2016)
  • A systematic review of image segmentation methodology, used in the
           additive manufacture of patient-specific 3D printed models of the
           cardiovascular system

    • Authors: Byrne, N; Velasco Forte, M, Tandon, A, Valverde, I, Hussain, T.
      Pages: 2048004016 - 2048004016
      Abstract: BackgroundShortcomings in existing methods of image segmentation preclude the widespread adoption of patient-specific 3D printing as a routine decision-making tool in the care of those with congenital heart disease. We sought to determine the range of cardiovascular segmentation methods and how long each of these methods takes.MethodsA systematic review of literature was undertaken. Medical imaging modality, segmentation methods, segmentation time, segmentation descriptive quality (SDQ) and segmentation software were recorded.ResultsTotally 136 studies met the inclusion criteria (1 clinical trial; 80 journal articles; 55 conference, technical and case reports). The most frequently used image segmentation methods were brightness thresholding, region growing and manual editing, as supported by the most popular piece of proprietary software: Mimics (Materialise NV, Leuven, Belgium, 1992–2015). The use of bespoke software developed by individual authors was not uncommon. SDQ indicated that reporting of image segmentation methods was generally poor with only one in three accounts providing sufficient detail for their procedure to be reproduced.Conclusions and implication of key findingsPredominantly anecdotal and case reporting precluded rigorous assessment of risk of bias and strength of evidence. This review finds a reliance on manual and semi-automated segmentation methods which demand a high level of expertise and a significant time commitment on the part of the operator. In light of the findings, we have made recommendations regarding reporting of 3D printing studies. We anticipate that these findings will encourage the development of advanced image segmentation methods.
      PubDate: 2016-04-29T03:36:50-07:00
      DOI: 10.1177/2048004016645467
      Issue No: Vol. 5, No. 0 (2016)
  • Association of statin use and stress-induced hyperglycemia in patients
           with acute ST-elevation myocardial infarction

    • Authors: Yan, C; Qin, M, Juan, Y. S, Tao, L. Y, dong, G. M, Zechun, Z, Chun, Y. X, Liang, C. H, Yin, L, Kang, M.
      Pages: 2048004016 - 2048004016
      Abstract: BackgroundOnly a few information is available on the risk of stress hyperglycemia following acute myocardial infarction after statin use. We investigate the association of stress-induced hyperglycemia following statin use in patients with acute myocardial infarction.MethodsAn observational analysis of 476 consecutive patients who suffered acute myocardial infarction was carried out. All selected patients were divided into diabetes mellitus and non-diabetes based on the presence or absence of diabetes. The cardiac incidence of in-hospital and stress-induced hyperglycemia was recorded.ResultsAmong patients with stress hyperglycemia in non-diabetes mellitus subgroups, the average fasting plasma glucose values in statin users were higher than in non-statin users (P < 0.05). But in diabetes mellitus subgroups, the average fasting plasma glucose did not have a significant difference between statin users and non-statin users (P > 0.05). In non-diabetes mellitus patients, the incidence of stress hyperglycemia with statin therapy was significantly higher than with non-statin therapy (P = 0.003). But in diabetes mellitus patients group, there is no significant difference in incidence of stress hyperglycemia between patients with statin therapy and patients without statin therapy (P = 0.902).The incidence of heart failure and in-hospital mortality of acute myocardial infarction in patients with stress-induced hyperglycemia was significantly higher than in non-hyperglycemia patients (P < 0.05).ConclusionStatins are related to higher stress hyperglycemia and cardiac incidences after acute myocardial infarction.
      PubDate: 2016-04-24T22:11:30-07:00
      DOI: 10.1177/2048004016639442
      Issue No: Vol. 5, No. 0 (2016)
  • Atrial fibrillation and flutter following coronary artery bypass graft
           surgery: A retrospective study and review

    • Authors: Premaratne, S; Premaratne, I. D, Fernando, N. D, Williams, L, Hasaniya, N. W.
      Pages: 2048004016 - 2048004016
      Abstract: Introduction and objectivesAtrial fibrillation is a common arrhythmia following coronary artery bypass graft surgery. Its incidence can range from 10 to 60% of patients undergoing coronary artery bypass graft. This rhythm can result in shorter or longer intervals between beats.MethodsMedical records of 143 patients from the Queen’s Medical Center, Kuakini Medical Center, Saint Francis Medical Center, and Straub Hospital and Clinic, all of which are located in Honolulu, Hawaii were reviewed. An additional 39 records of patients who did not develop these complications were also reviewed as a control group. Patients were selected according to the ICD codes for atrial fibrillation/flutter and coronary artery bypass graft. Both anomalies can lead to increased health care costs, morbidity, and mortality. In this study, possible predisposing factors to these complications were investigated. The time of onset, weight gain, elapsed time, fluid status (in/out), hematocrit, and drug regimens were compared between the two groups.ResultsThe differences in weight gain, fluid status, and hematocrit between the groups were not significant. There were a total of 17 different drugs prescribed to the group as a whole but not every patient received the same regimen.ConclusionsAtrial fibrillation and flutter were found to be more common in males, particularly between the ages of 60 and 69 years. There were no other significant findings.
      PubDate: 2016-04-14T02:44:36-07:00
      DOI: 10.1177/2048004016634149
      Issue No: Vol. 5, No. 0 (2016)
  • P-wave dispersion: What we know till now'

    • Authors: Okutucu, S; Aytemir, K, Oto, A.
      Pages: 2048004016 - 2048004016
      Abstract: P-wave dispersion is defined as the difference between the maximum and the minimum P-wave duration recorded from multiple different-surface ECG leads. It has been known that increased P-wave duration and P-wave dispersion reflect prolongation of intraatrial and interatrial conduction time and the inhomogeneous propagation of sinus impulses, which are well-known electrophysiologic characteristics in patients with atrial arrhythmias and especially paroxysmal atrial fibrillation. Extensive clinical evaluation of P-wave dispersion has been performed in the assessment of the risk for atrial fibrillation in patients without apparent heart disease, in hypertensives, in patients with coronary artery disease, in patients undergoing coronary artery bypass surgery, in patients with congenital heart diseases, as well as in other groups of patients suffering from various cardiac or non-cardiac diseases. In this paper, we aimed to summarize the measurement methods, current use in different clinical situations, strengths and limitations of the of P-wave dispersion.
      PubDate: 2016-03-28T05:10:26-07:00
      DOI: 10.1177/2048004016639443
      Issue No: Vol. 5, No. 0 (2016)
  • Glue septal ablation: A promising alternative to alcohol septal ablation

    • Authors: Okutucu, S; Aytemir, K, Oto, A.
      Pages: 2048004016 - 2048004016
      Abstract: Hypertrophic cardiomyopathy (HCM) is defined as myocardial hypertrophy in the absence of another cardiac or systemic disease capable of producing the magnitude of present hypertrophy. In about 70% of patients with HCM, there is left ventricular outflow tract (LVOT) obstruction (LVOTO) and this is known as obstructive type of hypertrophic cardiomyopathy (HOCM). Cases refractory to medical treatment have had two options either surgical septal myectomy or alcohol septal ablation (ASA) to alleviate LVOT gradient. ASA may cause some life-threatening complications including conduction disturbances and complete heart block, hemodynamic compromise, ventricular arrhythmias, distant and massive myocardial necrosis. Glue septal ablation (GSA) is a promising technique for the treatment of HOCM. Glue seems to be superior to alcohol due to some intrinsic advantageous properties of glue such as immediate polymerization which prevents the leak into the left anterior descending coronary artery and it is particularly useful in patients with collaterals to the right coronary artery in whom alcohol ablation is contraindicated. In our experience, GSA is effective and also a safe technique without significant complications. GSA decreases LVOT gradient immediately after the procedure and this reduction persists during 12 months of follow-up. It improves New York Heart Association functional capacity and decrease interventricular septal wall thickness. Further studies are needed in order to assess the long-term efficacy and safety of this technique.
      PubDate: 2016-03-07T04:08:01-08:00
      DOI: 10.1177/2048004016636313
      Issue No: Vol. 5, No. 0 (2016)
  • A clinical perspective of obesity, metabolic syndrome and cardiovascular

    • Authors: Han, T. S; Lean, M. E.
      Pages: 2048004016 - 2048004016
      Abstract: The metabolic syndrome is a condition characterized by a special constellation of reversible major risk factors for cardiovascular disease and type 2 diabetes. The main, diagnostic, components are reduced HDL-cholesterol, raised triglycerides, blood pressure and fasting plasma glucose, all of which are related to weight gain, specifically intra-abdominal/ectopic fat accumulation and a large waist circumference. Using internationally adopted arbitrary cut-off values for waist circumference, having metabolic syndrome doubles the risk of cardiovascular disease, but offers an effective treatment approach through weight management. Metabolic syndrome now affects 30–40% of people by age 65, driven mainly by adult weight gain, and by a genetic or epigenetic predisposition to intra-abdominal/ectopic fat accumulation related to poor intra-uterine growth. Metabolic syndrome is also promoted by a lack of subcutaneous adipose tissue, low skeletal muscle mass and anti-retroviral drugs. Reducing weight by 5–10%, by diet and exercise, with or without, anti-obesity drugs, substantially lowers all metabolic syndrome components, and risk of type 2 diabetes and cardiovascular disease. Other cardiovascular disease risk factors such as smoking should be corrected as a priority. Anti-diabetic agents which improve insulin resistance and reduce blood pressure, lipids and weight should be preferred for diabetic patients with metabolic syndrome. Bariatric surgery offers an alternative treatment for those with BMI ≥ 40 or 35–40 kg/m2 with other significant co-morbidity. The prevalence of the metabolic syndrome and cardiovascular disease is expected to rise along with the global obesity epidemic: greater emphasis should be given to effective early weight-management to reduce risk in pre-symptomatic individuals with large waists.
      PubDate: 2016-03-03T02:31:13-08:00
      DOI: 10.1177/2048004016633371
      Issue No: Vol. 5, No. 0 (2016)
School of Mathematical and Computer Sciences
Heriot-Watt University
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