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Angeli F.,Hospital S.M. della Misericordia | Verdecchia P.,Ospedale di Assisi | Savonitto S.,Ospedale A. Manzoni | Arraiz G.,Sintesi Research S.r.l. | And 8 more authors.
EuroIntervention | Year: 2015

Aims: We tested the prognostic value of cystatin C in patients with documented coronary artery disease (CAD) who underwent percutaneous coronary artery intervention (PCI). We also tested the hypothesis that the incremental predictive value of cystatin C on all-cause mortality was superior to that of glomerular filtration rate (GFR) by the Modification of Diet in Renal Disease (MDRD) formula. Methods and results: Included in the study were 2,757 patients (mean age 63 years, 77% men). Blood samples for cystatin C levels were collected immediately before PCI. During a median follow-up of two years, 114 patients died. In multivariable Cox analyses, after adjustment for several confounders, GFR (p=0.004) and cystatin C concentration (p<0.0001) were independent predictors of all-cause death. Cystatin C predicted all-cause death (c-statistic: 0.794) better than GFR estimate based on creatinine (c-statistic: 0.776, p=0.008 for comparison), and significantly reclassified 15% of patients into categories that reflected their actual likelihood of death more accurately (p=0.005). Adding cystatin C and GFR in the same multivariable survival model, only cystatin C level was a significant predictor of death. Conclusions: This study presents for the first time the incremental predictive value of cystatin C over the creatinine-based MDRD formula on all-cause mortality for CAD patients undergoing PCI. © Europa Digital & Publishing 2015. All rights reserved.

Benedetti M.,Julight S.R.L. | Favalli V.,Fondazione Policlinico San Matteo | Mariano A.,University of Pavia | Rebrova N.,University College Cork | And 8 more authors.
Progress in Biomedical Optics and Imaging - Proceedings of SPIE | Year: 2016

Arterial stiffness (AS) is a recognized predictor of cardiovascular risk and mortality, and a potential marker for monitoring the beneficial effects of medical treatments for arterial diseases. AS is typically evaluated indirectly, by assessing the so called pulse wave velocity (PWV), i.e. the speed at which the pressure wave created by the heart contraction travels along the aorta and other arteries. PWV is generally measured using piezoelectric transducers, or via a complex ultrasound technique, but in both cases it requires a direct contact with the patient, which could also modify the measured parameters. In the EU project "NISTAS" (Non-invasive screening of the status of the vascular system) [1], we develop a contactless system allowing to measure the PWV thanks to a technology derived from laser triangulation devices. The measurement principle consists in the detection of the small (around 100μm) displacement of the neck skin, induced by the transit of the pressure wave in the carotid. By simultaneously measuring the displacement caused by the pulse wave in two distinct points along the carotid, the time required by the pressure wave to travel a certain distance can be measured, and the PWV can then be easily calculated. The chosen technique for the skin displacement measurement is laser triangulation in its 2D variant (i.e. "laser profilometry"), which is robust to slight movements of the target, it does not suffer from speckle-pattern signal fading, and it can be conveniently implemented using low-cost optical components. Two light lines, emitted by two blue LEDs are projected on the target (the patient's neck skin), and the skin displacement versus time is measured using a high-frame-rate CMOS camera. In this manuscript we present the results obtained by measuring the PWV of 10 volunteers. It is foreseen that this technique can become a simple and widespread point-of-care method for large-scale cardiovascular system screening over large populations. © 2016 SPIE.

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