Risk In Asymptomatic Patients Research Articles

185-OR: The Role of Optical Coherent Tomography in the Estimation of Cardiovascular Risk in Asymptomatic Patients with Type 1 Diabetes

185-OR: The Role of Optical Coherent Tomography in the Estimation of Cardiovascular Risk in Asymptomatic Patients with Type 1 Diabetes

An Overview of Optic Pathway Glioma With Neurofibromatosis Type 1: Pathogenesis, Risk Factors, and Therapeutic Strategies.

Optic pathway gliomas (OPGs) are most predominant pilocytic astrocytomas, which are typically diagnosed within the first decade of life. The majority of affected children with OPGs also present with neurofibromatosis type 1 (NF1), the most common tumor predisposition syndrome. OPGs in individuals with NF1 primarily affect the optic pathway and lead to visual disturbance. However, it is challenging to assess risk in asymptomatic patients without valid biomarkers. On the other hand, for symptomatic patients, there is still no effective treatment to prevent or recover vision loss. Therefore, this review summarizes current knowledge regarding the pathogenesis of NF1-associated OPGs (NF1-OPGs) from preclinical studies to seek potential prognostic markers and therapeutic targets. First, the loss of the NF1 gene activates 3 distinct Ras effector pathways, including the PI3K/AKT/mTOR pathway, the MEK/ERK pathway, and the cAMP pathway, which mediate glioma tumorigenesis. Meanwhile, non-neoplastic cells from the tumor microenvironment (microglia, T cells, neurons, etc.) also contribute to gliomagenesis via various soluble factors. Subsequently, we investigated potential genetic risk factors, molecularly targeted therapies, and neuroprotective strategies for tumor prevention and vision recovery. Last, potential directions and promising preclinical models of NF1-OPGs are presented for further research. On the whole, NF1-OPGs develop as a result of the interaction between glioma cells and the tumor microenvironment. Developing effective treatments require a better understanding of tumor molecular characteristics, as well as multistage interventions targeting both neoplastic cells and non-neoplastic cells.

Progression of subclinical cardiovascular disease in patients with HIV.

Human immunodeficiency virus (HIV) infected patients are at increased risk of cardiovascular disease (CVD). Multidetector computed tomography (MDCT) stratifies cardiovascular risk in asymptomatic patients with subclinical atherosclerosis. The aim of this study was to determine the ability of MCTD and clinical and laboratory parameters to assess subclinical CVD progression in HIV patients. Prospective longitudinal cohort study of patients with at least 10 years of HIV infection and 5 years of antiretroviral therapy history, low cardiovascular risk and monitored for 6 years (2015-2021). All patients underwent clinical assessment, blood analysis, carotid ultrasound, and gated MDCT in 2015 and 2021. Sixty-three patients (63.5% male) with a mean age of 49.9 years (standard deviation [SD], 10.5) were included in 2015; 63 of them were followed until 2021. Comparing the results from 2015 with those from 2021, Systematic Coronary Risk Estimation-2 (SCORE2) was 2.9% (SD, 2.1) vs. 4.4% (SD,3.1); Multi-Ethnic Study of Atherosclerosis score (MESA risk) was 3.4 (SD 5.8) vs. 6.0 (SD 8.6); coronary artery calcification CAC) score >100 was 11.1% vs. 25.4% (P < 0.05); and 11% vs. 27% had carotid plaques (P = 0.03). After six years of follow-up, an increase in SCORE2, carotid plaques, CAC scoring and MESA risk was observed. MDCT findings, along with other clinical and laboratory parameters, could play an important role as a marker of CVD progression in the evaluation of patients with HIV and low cardiovascular risk.

Utility of coronary artery calcium in refining 10-year ASCVD risk prediction using a Thai CV risk score.

Coronary artery calcium (CAC) scanning is a valuable additional tool for calculating the risk of cardiovascular (CV) events. We aimed to determine if a CAC score could improve performance of a Thai CV risk score in prediction of 10-year atherosclerotic cardiovascular disease (ASCVD) risk for asymptomatic patients with CV risk factors. This was a retrospective cohort study that enrolled asymptomatic patients with CV risk factors who underwent CAC scans between 2005 and 2013. The patients were classified as low-, intermediate-, or high-risk (<10%, 10%-<20%, and ≥20%, respectively) of having ASCVD within 10-years based on a Thai CV risk score. In each patient, CAC score was considered as a categorical variable (0, 1-99, and ≥100) and natural-log variable to assess the risk of developing CV events (CV death, non-fatal MI, or non-fatal stroke). The C statistic and the net reclassification improvement (NRI) index were applied to assess whether CAC improved ASCVD risk prediction. A total of 6,964 patients were analyzed (mean age: 59.0 ± 8.4 years; 63.3% women). The majority of patients were classified as low- or intermediate-risk (75.3% and 20.5%, respectively), whereas only 4.2% were classified as high-risk. Nearly half (49.7%) of patients had a CAC score of zero (no calcifications detected), while 32.0% had scores of 1-99, and 18.3% of ≥100. In the low- and intermediate-risk groups, patients with a CAC ≥100 experienced higher rates of CV events, with hazard ratios (95% CI) of 1.95 (1.35, 2.81) and 3.04 (2.26, 4.10), respectively. Incorporation of ln(CAC + 1) into their Thai CV risk scores improved the C statistic from 0.703 (0.68, 0.72) to 0.716 (0.69, 0.74), and resulted in an NRI index of 0.06 (0.02, 0.10). To enhance the performance of the Thai CV risk score, a revision of the CV risk model was performed, incorporating ln(CAC + 1), which further increased the C statistic to 0.771 (0.755, 0.788). The addition of CAC to traditional risk factors improved CV risk stratification and ASCVD prediction. Whether this adjustment leads to a reduction in CV events and is cost-effective will require further assessment.

Ultrasound-detected tibial artery calcification as a marker of cardiovascular and lower-limb risk in asymptomatic patients with type-2 diabetes.

Medial arterial calcification (MAC) is a vascular disease distinct from atherosclerosis. Recently, several studies have demonstrated that MAC is an important marker of cardiovascular events. We aim to assess the presence of MAC during ultrasound screening of lower-limb vasculature and its association with both cardiovascular (CV) and lower-limb events in patients with type-2 diabetes. A retrospective cohort study was conducted on 1119 patients with type-2 diabetes free from CV disease. A CV work-up, including vascular ultrasound, was performed for each patient. The presence of MAC was assessed on posterior tibial arteries and ankle-brachial index (ABI) was measured. Major acute CV events (MACEs) and lower-limb events (MALEs) were recorded as a composite endpoint for a 5-year period. We identified MAC among 212 (18.9%) patients. The independent determinants of MAC were age and diabetic retinopathy. Over a period of 5 years, 125 MACEs and 22 MALEs occurred. MAC was significantly associated with the composite outcome MACE + MALE (HR = 1.94; 95% CI: 1.23, 3.08, p = 0.005) or with MACE (HR = 1.85; 95% CI: 1.16, 2.95, p = 0.010). Adjusted for ABI and diabetic foot wound, MAC remained a determinant of MALE (HR = 5.49; 95% CI: 2.19, 13.76, p < 0.001). Considering each ABI group, MAC was associated with both MACE and MALE in the normal ABI group. Ultrasound-detected MAC on tibial arteries seems to be a determinant of both CV and lower-limb events, independent from ABI. MAC helps to refine the CV risk in patients with normal ABI.

Association between diastolic dysfunction with coronary artery calcium score in stable coronary artery disease patients

Abstract Funding Acknowledgements Type of funding sources: None. Objectives Diastolic dysfunction is a common problem in patients with obesity, hypertension, diabetes, or coronary artery disease (CAD) including stable CAD. The coronary artery calcium score (CACS) is used to non-invasively evaluate cardiovascular risk in asymptomatic patients with a low to intermediate pre-test probability for CAD. The purpose of this study was to evaluate the association of diastolic dysfunction with an abnormal CAC score. Materials and Methods This study considered a cohort of patients &amp;gt; 18 years of age with normal ejection fraction who were admitted to the hospital with chest pain but low risk presentation for acute myocardial infarction. Patients then underwent cardiac CT for measurement of CAC score. Patients were excluded if they had prior history of CAD, ECG findings diagnostic of an acute coronary syndrome, an elevated troponin level, or hemodynamic instability. Results A total of 200 patients were included and 96 (48%) patients had echocardiographic evidence of diastolic dysfunction. Patients with diastolic dysfunction were more likely to have a higher mean calcium score (12,154.68 ± 17,588.30 vs 2,666.38 ± 9,725.82; p&amp;lt;0.001). Receiver operating characteristics (ROC) analysis showed the area under the curve was 86.3% and cut off was 129.5 with sensitivity 85% and specificity 74%. Conclusions Our study demonstrates that left ventricular diastolic dysfunction is associated with an abnormal CAC score. Patients without known CAD that present with chest pain with evidence of abnormal diastolic function on echocardiogram may warrant more thorough evaluation for coronary atherosclerotic disease with CAC score assessment.

Apolipoprotein B and cardiovascular risk in asymptomatic patients: need for systematic evaluation?

Abstract Funding Acknowledgements Type of funding sources: None. Background The involvement of apolipoprotein B (apoB) in atherogeneis is well known because of its role in the metabolism of lipids. Elevated levels of apoB have been found not only to be correlated with clinical atherosclerosis, but also with sub-clinical forms. Cardiovascular risk can be estimated based on clinical risk scores. However, the main limitation of these risk score models is to estimate only traditional risk factors and not other important factors such as apoB. Purpose To assess the interactive effects of apoB in asymptomatic patients, and its link to cardiovascular risk. Methods This prospective observational study included 811 asymptomatic participants. According to the median apoB value (set at 130 mg/ dl) the study population was divided into two groups as follows: group 1 – 713 patients with low apoB values and group 2 – 98 patients with high apoB. Also, for each patient personal data, such as family history of premature cardiovascular disease, smoker status, personal history of heart failure or atherosclerotis were obtained. Regarding the subclinical atherosclerosis the carotid thickness of intima-media was measured. Results Patients with high apoB are more frequent males (p=0.008) with a mean age of 57.6 ± 11.9 years old (p&amp;lt;0.0001) and smokers (p=0.01). The apoB level was not higher in patients with known atherosclerosis or with traditional risk factors such as diabetes melitus, history of stroke, myocardial infarction, or hypertension. Although, subclinical atherosclerosis, expressed by the presence of carotid plaques is more frequent found in patients with elevated apoB levels (p=0.0001). A higher total cholesterol (p&amp;lt;0.0001), triglycerides (p&amp;lt;0.0001) and LDL-cholesterol levels (p&amp;lt;0.0001) were identified in patients from group 2 compared with those form group 1. Moreover, the uric acid was observed to be correlated with the apoB serum level (5.2 ±1.5 vs. 6.2 ±1.7, p=0.001). The risk of diabetes melitus was also found to be higher in group 2 compared with group 1, expressed by the glycosylate haemoglobin (5.6 ± 0.7 vs 5.9 ± 1.1, p&amp;lt;0.0001). Conclusions Apolipoprotein B level is correlated with subclinical atherosclerosis and worse outcomes expressed by a higher lipid profile and risk of diabetes melitus development. These findings highlighted that the determination of the apoB is therefore mandatory for a better stratification of cardiovascular risks in primary prevention of atherosclerosis.

INSUFICIÊNCIA CORONARIANA CRÔNICA: INOVAÇÕESEM TOMOGRAFIA CARDÍACA

Cardiac tomography in chronic coronary atherosclerotic disease is based on the interpre-tation of two main parameters: coronary calcium score, for the definition of cardiovascular risk in asymptomatic patients, and anatomical evaluation of coronary stenosis by angiotomography, for the diagnosis of coronary atherosclerotic disease in symptomatic patients. Calcium score, combined with clinical evaluation of the patient, is the most accurate complementary method for stratification and restratification of cardiovascular risk, while angiotomography has become the preferred investigation method in patients with suspected stable angina, especially in those with pre-test intermediate probability. Angiotomography presents recent technological advances that have brought the capacity for functional and histological assessments of co-ronary atherosclerosis, such as fractional flow reserve by tomography (FFR-CT) and dynamic myocardial perfusion by tomography (PMD-CT), which optimize diagnostic accuracy by improving the specificity and positive predictive value of the test, as well as high-risk plaque (HRP) and analysis of the fat attenuation index, which provide more accurate prognostic information, especially for cases in which no significant stenoses are identified.

Transient elastography and serum markers of liver fibrosis associate with epicardial adipose tissue and coronary artery calcium in NAFLD

Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular disease morbimortality. However, it is not clear if NAFLD staging may help identify early or subclinical markers of cardiovascular disease. We aimed to evaluate the association of liver stiffness and serum markers of liver fibrosis with epicardial adipose tissue (EAT) and coronary artery calcium (CAC) in an observational cross-sectional study of 49 NAFLD patients that were seen at Clínica Universidad de Navarra (Spain) between 2009 and 2019. Liver elastography and non-invasive fibrosis markers were used to non-invasively measure fibrosis. EAT and CAC, measured through visual assessment, were determined by computed tomography. Liver stiffness showed a direct association with EAT (r = 0.283, p-value = 0.049) and CAC (r = 0.337, p-value = 0.018). NAFLD fibrosis score was associated with EAT (r = 0.329, p-value = 0.021) and CAC (r = 0.387, p-value = 0.006). The association of liver stiffness with CAC remained significant after adjusting for metabolic syndrome features (including carbohydrate intolerance/diabetes, hypertension, dyslipidaemia, visceral adipose tissue, and obesity). The evaluation of NAFLD severity through liver elastography or non-invasive liver fibrosis biomarkers may contribute to guide risk factor modification to reduce cardiovascular risk in asymptomatic patients. Inversely, subclinical cardiovascular disease assessment, through Visual Scale for CAC scoring, may be a simple and effective measure for patients with potential liver fibrosis, independently of the existence of other cardiovascular risk factors.

Outcomes in Patients With Asymptomatic Aortic Stenosis (from the Evolut Low Risk Trial)

Transcatheter aortic valve implantation (TAVI) has comparable outcomes with surgical aortic valve replacement (SAVR) in symptomatic patients with severe aortic stenosis, including those at low risk for surgery. Less is known about TAVI outcomes in asymptomatic patients. This analysis compares clinical, hemodynamic, and quality of life (QOL) outcomes after TAVI or SAVR for low-risk asymptomatic patients. The randomized Evolut Low Risk trial enrolled asymptomatic patients treated with TAVI (n=76) and SAVR (n=62). New York Heart Association functional class I identified patients without symptoms. Clinical outcomes, echocardiographic findings, and QOL in both groups were compared 30 days and 12 months after AVR. Asymptomatic patients had a mean Society of Thoracic Surgeons score of 1.7 ± 0.6, 73% were men, and mean age was 74.2 ± 5.8 years. The composite end point of all-cause mortality or disabling stroke was similar at 12 months in patients with TAVI (1.3%) and SAVR (6.5%; p=0.11), although patients with SAVR tended to have higher rates of all-cause mortality (4.8%) compared with patients with TAVI (0.0%, p=0.05). Patients with TAVI had lower mean aortic valve gradients (8.1 ± 3.2 mm Hg) and larger mean effective orifice area (2.3 ± 0.6 mm Hg) than patients with SAVR (10.8 ± 3.8; p <0.001 and 1.9 ± 0.6; p=0.001, respectively), and showed significant improvement in Kansas City Cardiomyopathy Questionnaire scores from baseline to 30 days (∆12.1 ± 23.6; p <0.001), whereas patients with SAVR did not (∆2.2 ± 20.3; p=0.398). Patients with TAVI and SAVR had a significant improvement in QOL by 12 months compared with baseline. In conclusion, low risk asymptomatic patients with severe aortic stenosis who underwent TAVI had comparable clinical outcomes to SAVR, with superior valve performance and faster QOL improvement.

Role of Coronary Calcium Score as a Screening Tool for Excluding Significant Coronary Artery Disease in High Risk Asymptomatic Patients

OBJECTIVES: To determine correlation of zero coronary artery calcium score (CACS) with non-significant coronary artery stenosis by using computed tomography coronary angiography (CTCA). METHODOLOGY: 62 patients with suspected coronary artery disease (CAD) underwent CACS test and CTCA from April 2018 to November 2020. Patients were examined with 160 slice multidetector CT and grouped according to their age, gender, CACS, and maximum coronary luminal stenosis. CACS was assessed using Agatston scoring and degree of stenosis was assessed by automatic software and severity was scored according to CAD-RADS. The correlation between these two main variables was calculated using Spearman rank correlation. RESULTS: The 62 patients were divided into four groups according to CACS, using the Agatston Unit (AU). Group 1; 0 AU (41 patients, 66.13%), Group 2; 1-100 AU (13 patients, 20.97%) Group 3; 101-400 AU (4 patients, 6.45%), Group 4; 401-1000 AU (4 patients, 6.45%). In 41 patients with zero calcium score (32 males and 9 females), 38 patients (92.68%) were found to have no coronary artery stenosis, 2 patients (4.87%) had mild coronary artery stenosis and 1 patient (2.43%) had moderate coronary artery stenosis. Total 35 patients presented for screening purpose out of which 25 (71%) had zero calcium score and no significant coronary artery disease. CONCLUSION: In high risk patients, zero calcium score excludes significant coronary artery stenosis (50%), hence coronary calcium score is a good screening tool before subjecting patients to coronary angiography.

Coronary Disease Risk in Asymptomatic Patients with Left Ventricular Moderate Dilatation

Goal of the Study is to assess the risk of coronary disease of asymptomatic ischemia in patients with left ventricular moderate dilatation. Methods: The work was based on the results of investigation of 185patients with left ventricular moderate dilatation, aged 35-55 years from the “Tbilisi Heart and Vascular Clinic” contingent. Among them, there are 159 men and 26 women. Results: Patients who suffer from left ventricular moderate dilatation and don’t expose typical symptom of ischemia possibly are in risk of carrying damaged coronary artery. the LV moderate dilatation of the left ventricle can be used for primary diagnosing of silent ischemia. Sensitivity - 0.867(95%CI:0.806-0.927); Specificity – 0.800(95%CI:0.703-0.897); Prognostic value of positive results; 0.889(95%CI:0.832-0.946); Prognostic value of negative results - 0.765(95%CI:0.664-0.866); diagnostic value - 0.843(95%CI:0.791-0.896). Conclusions: In patients with silent ischemia, the coronary disease predictors are: left ventricular moderate dilatation, male gender, dyslipidemia, arterial hypertension, smoking, positive treadmill test, ischemic disease in 1st degree relatives, low tolerance to treadmill test. Thus, we can use the moderate dilatation of the left ventricle for the primary diagnosing of silent ischemia. The test is simple and non-invasive. It is characterized by high sensitivity and specificity and can be used for early diagnosing of silent ischemia and the prevention of cardiac cases.

Risk of Stroke in Relation to Degree of Asymptomatic Carotid Stenosis: A Population-based Cohort Study, Systemic Review, and Meta-analysis

Prospective, population-based study (Oxford Vascular Study) between April 1, 2002, and April 1, 2017, and a systematic review using MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials between January 1, 1980, and October 1, 2020. In the population-based study, patients with 70% to 99% asymptomatic stenosis had a significantly greater 5-year ipsilateral stroke risk (15% [6/53]) than those with 50% to 69% stenosis (0% [0/154]), as did patients with 80% to 99% asymptomatic stenosis (18% [6/34]) compared with those with 50% to 79% stenosis (1.0% [2/173]). In the systemic review, the ipsilateral stroke risk in asymptomatic patients was significantly higher in patients with 70% to 99% stenosis (10% [386/3778]) than in patients with 50% to 69% stenosis (5% [181/3,806 patients]), and in patients with 80% to 99% stenosis (11% [77/727]) compared with those with 50% to 79% stenosis (5% [167/3272]). The stroke risk reported in cohort studies was highly dependent on the degree of asymptomatic carotid stenosis, suggesting that the benefit of carotid endarterectomy (CEA) might be underestimated in patients with severe stenosis. Conversely, the 5-year stroke risk was low for patients with moderate stenosis with contemporary medical treatment, calling into question any benefit from revascularization for patients with less than 70% to 80% stenosis.

Sonographic Cardiovascular Assessment of the Aorta: Pilot of a Modified Image Grading System

Objective: Atherosclerosis is a chronic inflammatory disease that can be undetected in middle-aged patients. Abdominal aortic calcifications (AACs) are one form of cardiovascular disease (CVD), and these can go undetected during a routine physician visit. Sonography has the potential to assess CVD progression, quantify plaque in the aorta, and help to quantify risk in asymptomatic patients. Methodology: This pilot study modified a current AAC grading system to create a scoring method for sonographic images among a small cohort of asymptomatic participants. A traditional portable ultrasound unit was used to image participants, and a subset underwent the same imaging with a handheld transducer and tablet. Results: In this cohort, six males and five females, it was possible to adequately visualize and assess plaque, utilizing both types of ultrasound equipment. The abdominal aorta was divided into segments on the sonogram for quality of grading. Ten participants were categorized with a grade II and one participant was given a grade IIIA. Conclusion: Replication of this modified grading system is needed to better understand the clinical utilization of sonography as a risk assessment tool. The risk assessment scoring was not dependent on the type of device used.

CRITICAL PRESENTATION OF A BRONCHOPULMONARY SEQUESTRATION IN ADULTHOOD

SESSION TITLE: Medical Student/Resident Genetic and Developmental Disorders Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: October 18-21, 2020 INTRODUCTION: Congenital pulmonary anomalies are typically found at birth due to neonatal symptoms or imaging. Bronchopulmonary sequestrations (BPS) are rare, congenital, nonfunctioning masses of pulmonary tissue that lacks airway communication to the main bronchial tree and are supplied by systemic circulation [1]. Although most of these patients are identified at birth, some can live into adulthood without knowledge. In this case, we will discuss the rare appearance and complications of BPS in adult medicine and the steps for curative treatment. CASE PRESENTATION: A 28-year-old healthy female presented with sudden onset hematemesis and hemoptysis. On arrival, she was in hypovolemic shock with systolic blood pressure in the 50s. Patient received aggressive fluid resuscitation. Hemoglobin was stable despite blood loss. CT chest showed a 16 x 9cm bronchopulmonary sequestration in the right base. Patient was emergently intubated and underwent bronchoscopy showing normal mucosa without evidence of active bleed. A second bronchoscopy was performed to place a bronchial blocker to prevent further suspected bleeding into the right lower lung. Cardiothoracic surgery recommended transfer to University Hospital. After transfer, patient underwent repeat bronchoscopy to reposition the bronchial balloon. Interventional radiology embolized the right bronchial artery and two segmental branch arteries from the right inferior phrenic artery, all supplying the BPS. Thoracic surgery delayed resection due to severe aspiration pneumonitis. Patient was discharged and completed a course of antibiotics. She later underwent right muscle sparing thoracotomy with total resection of the BPS and therapeutic right lower lobe wedge resection (Figure 1). She gradually recovered inpatient and was discharged. She followed up with thoracic surgery without any symptoms. DISCUSSION: Although a rare disorder (1 in 10-35,000 live births), BPS typically presents as an incidental finding in a neonate. In adulthood, diagnosis is made through CT angiography of the chest showing systemic circulation supplying an aberrant lung tissue. Definitive diagnosis is made after resection of the tissue [1]. Treatment involves elective surgery in symptomatic patients to remove the BPS with or without partial lobectomy or wedge resection, such as in this case. In asymptomatic patients, risk assessment is evaluated. Patients with large lesions > 20% of the thorax or with characteristics of pleuropulmonary blastoma should have resection [1]. Low risk asymptomatic patients can be monitored via chest x-ray and CT chest. Patients may, however, still choose to proceed with elective surgery to prevent future complications that may cause the surgery to become urgent. CONCLUSIONS: If detected early, removal of BPS can prevent critical events. Rare, undetected BPS can suddenly appear in adulthood requiring stabilization prior to removal as curative treatment. Reference #1: Oermann, Christopher M, et al. “Bronchopulmonary Sequestration.” UpToDate, 2020, www.uptodate.com/contents/bronchopulmonary-sequestration?search=pulmonary%2Bcongenital%2Banomalies&topicRef=6346&source=related_link DISCLOSURES: No relevant relationships by Kalpan Desai, source=Web Response No relevant relationships by Vishal Jivan, source=Web Response No relevant relationships by Jeremy Renz, source=Web Response

Alternative risk factors and their importance in assessment of cardiovascular risk in asymptomatic patients

Cardiovascular diseases retain their leading position among the leading causes of death worldwide. The contribution of many factors to increasing risk of developing cardiovascular diseases was proven. The article provides an overview of current views on the role of risk factors in assessment of cardiovascular risk in asymptomatic patients. Determination of individual cardiovascular risk is not questioned. However, more information is accumulating on the need to supplement the existing cardiovascular risk assessment scales with new factors in order to more accurately predict cardiovascular risk. The value of alternative risk factors, such as psychosocial factor, level of physical activity, family history of cardiovascular diseases, coronary artery calcification, ankle-brachial index, and identification of atherosclerotic plaques during ultrasound scanning of the brachiocephalic arteries, is described. Studies that consider the impact of these risk factors on reducing discrimination against cardiovascular risk when added to the globally used risk assessment scales are presented.

Variation In Coronary Artery Calcium Score Burden Amongst Three Hispanic Populations

Introduction: Over the last decades coronary artery calcium score (CAC) has been shown to re-stratify cardiovascular risk in asymptomatic patients. It is well known that calcium score burden varies between ethnicities, however little is known about variation within a specific ethnicity.

Asemptomatik hastalarda karotis arter stentleme ve karotis endarterektominin prosedürel ve orta dönem sonuçları: Tek merkez deneyimi

Aim: Atherosclerotic carotid artery stenosis (CS) is responsible for ~20% of strokes. The management of CS in an asymptomatic patient has been less clear. In situations were carotid endarterectomy (CEA) is thought to be more risky, surgeons must also have enough experience and capability to perform carotid artery stenting (CAS) to provide suitable, patient-tailored treatment. In this study, the same investigator performed all interventions (CAS and CEA), and one type of stenting device and EPD was used. In addition, periprocedural monitoring was carried out for at least 24 h. The objective of this study was to compare procedural results and 12-month follow-up outcomes of patients who were treated by the same operator- either CAS or CEA- in one year. Material and Methods: A retrospective single-center review involving asymptomatic patients with severe stenosis of the ICA caused by atherosclerotic disease who was treated with either stenting with embolic protection (Group 1, n=17) or carotid endarterectomy (group 2, n=18) according to their clinical and anatomical risk profile between 1 January 2018 and 31 December 2018 at Numune Research and Training Hospital, Department of Cardiovascular Surgery, Ankara-Turkey was conducted. A duplex ultrasound (DUS) and neurological assessment was obtained prior to hospital discharge as a baseline, 30-days, 6 months, and 1 year thereafter. Patients’ demographic and clinical characteristics, angiographic variables, primary endpoints including the composite of death, stroke and myocardial infarction during the 30 days after the procedure or ipsilateral stroke during the 365 days after the procedure was compared. Primary endpoints also including primary technical success, periprocedural clinical success, primary patency, clinical failure, periprocedural adjunctive maneuvers and secondary endpoints including complications, freedom from clinically driven target-lesion revascularization at 12 months, freedom from death, freedom from all stroke and freedom from restenosis rates were assessed and compared between the groups. Results: High-risk anatomical criteria were present in 8 (47.0%) patients, high-risk clinical criteria were present in 11 (64.7%) patients. Group 2 patients were older (67.7±7.4 vs 71.2± 6.9, p&amp;lt;0.05), but hyperlipidemia (58.8% vs 44.4%, p&amp;lt;0.05), chronic renal insufficiency requiring hemodialysis (11.7% vs 0.0%, p&amp;lt;0.05) and left ventricular dysfuntion (17.6% vs 0.0%, p&amp;lt;0.05) were significantly more frequent in Group 1. CCDS of group 1 was significantly lower than group 2 (4.7 ± 1.3 vs 7.3 ± 1.2; p&amp;lt;0.05, respectively). The lesions of the patients undergoing CEA were significantly longer (12.7 ± 2.6 vs 18.5 ± 4.2 mm.; p&amp;lt;0.05) and more calcified (11.7% vs 50.0%, p&amp;lt;0.05) than the patients in group 1. Likewise, the degree of stenosis in group 2 was significantly more than that of group 1 (81.4 ± 4.2 vs 88.3±6.4 %; p&amp;lt;0.05, respectively). Primary technical success was 100% for both groups. Periprocedural clinical success was 100% for Group 1, and 94.4% for group 2. Primary patency rates at 1/6/12 months were 100%/ 94.1%/94.1% for group 1, and 100%/100%/94.4% for group 2. Freedom from restenosis and freedom from CD-TLR at 12 months was 94.1% and 94.4% for group 1 and group 2. No death, major strokes, miyocardial infarction and systemic complications occured. Conclusion: This study showed similar short and mid-term results for CEA and CAS in asymptomatic patients with significant carotid disease. Although we have shown good results for both CEA and CAS, CAS should be limited to those cases that are not suitable for open surgery and treatment of asymptomatic carotid artery disease with CEA should be considered for patients with few risk factors and long life expectancy. Both CEA and CAS reduce the long-term stroke risk in asymptomatic patients. The appropiate treatment strategy should be selected according to the patient’s individual risk factors and imaging data.

The prevalence of occult ovarian cancer in the series of 155 consequently operated high risk asymptomatic patients – Slovenian population based study

BackgroundWe assessed the prevalence, localization, type and outcome of occult cancer at risk-reducing salpingo-oophorectomy or salpingectomy (RRSO) in asymptomatic carriers of pathogenic or likely pathogenic BRCA1/2 variants and high-risk BRCA1/2 negative women.Patients and methodsA retrospective analysis of all consecutive gynaecologic preventive surgeries from January 2009 to December 2015 was performed. Participants underwent genetic counselling and BRCA1/2 testing before the procedure. Data on clinical parameters, adjuvant treatment and follow-up were collected and analysed.ResultsOne hundred and fifty-five RRSO were performed in 110 BRCA1, 35 BRCA2 carriers of pathogenic or likely pathogenic variants and 10 high-risk BRCA1/2 negative women, at the mean age of 48.3 years. Nine occult cancers (9/155, 5.8%) were identified; eight in BRCA1 positive women and one in high-risk BRCA1/2 negative woman. We identified four non-invasive serous intraepithelial tubal carcinomas (3 in BRCA1 carriers and 1 in a high-risk BRCA1/2 negative woman) and five invasive tubo-ovarian high grade serous cancers (all detected in BRCA1 carriers). Only one out of nine patients (11.1%) with occult cancer had a slightly elevated CA-125 value preoperatively.ConclusionsA 5.8% prevalence of occult invasive and noninvasive tubo-ovarian serous cancer after RRSO was found in high risk asymptomatic and screen negative women. We conclude that RRSO should be performed in BRCA1/2 carriers and in high-risk BRCA1/2 negative women. Age of preventive gynaecologic surgery should be carefully planned, taking into account the completion of childbearing age and type of mutation. The results favour the tubal hypothesis of tubal origin of high grade serous ovarian and peritoneal cancer. Cytology result of peritoneal cavity washing was important for the decision making process in determining treatment. Cytology examination should be performed in all cases of RRSO. CA-125 assay did not prove to be an effective screening tool for early cancer detection in our patients.

PERCEPTIONS AND PRACTICES OF CARDIOLOGY FELLOWS REGARDING CORONARY ARTERY CALCIUM SCORING

CAC (coronary artery calcium) scoring is a noninvasive imaging modality which can be used to assess cardiovascular risk in asymptomatic patients and as a guide for initiating preventive therapy. While CAC scoring has gained wider acceptability, perceptions and practice patterns of providers