Relation of carotid intima-media thickness and plaque with incident cardiovascular events in women with systemic lupus erythematosus.

Patients with systemic lupus erythematosus (SLE) are at increased risk for cardiovascular (CV) disease. The aim of this study was to investigate the association between subclinical CV disease as measured by carotid intima-media thickness (IMT) and plaque using B-mode carotid ultrasound and incident CV events in a combined cohort of female patients with SLE. This was a prospective, 2-center observational study of 392 adult women with SLE and no previous CV events with a mean 8 years of follow-up. Incident CV events confirmed by clinicians were defined as angina, myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass graft, fatal cardiac arrest, transient ischemic attack, and cerebrovascular accident. Incident hard CV events excluded angina and transient ischemic attack. The mean age was 43.5 years, and most patients were Caucasian (77.3%). During follow-up, 38 patients had incident CV events, and 17 had incident hard CV events. Patients with incident hard CV events had higher mean carotid IMT (0.80 vs 0.64 mm, p <0.01) and presence of carotid plaque (76.5% vs 30.4%, p <0.01) compared with those without incident hard CV events. Baseline carotid IMT and presence of plaque were predictive of any incident hard CV event (hazard ratio 1.35, 95% confidence interval 1.12 to 1.64, and hazard ratio 4.26, 95% confidence interval 1.23 to 14.83, respectively), independent of traditional CV risk factors and medication use. In conclusion, in women with SLE without previous CV events, carotid IMT and plaque are predictive of future CV events. This suggests that carotid ultrasound may provide an additional tool for CV risk stratification in patients with SLE.

Development of a hybrid decision support model for optimal ventricular assist device weaning.

BACKGROUND: Despite the small but promising body of evidence for cardiac recovery in patients that have received ventricular assist device (VAD) support, the criteria for identifying and selecting candidates who might be weaned from a VAD have not been established. METHODS: A clinical decision support system was developed based on a Bayesian Belief Network that combined expert knowledge with multivariate statistical analysis. Expert knowledge was derived from interviews of 11 members of the Artificial Heart Program at the University of Pittsburgh Medical Center. This was supplemented by retrospective clinical data from the 19 VAD patients considered for weaning between 1996 and 2004. Artificial Neural Networks and Natural Language Processing were used to mine these data and extract sensitive variables. RESULTS: Three decision support models were compared. The model exclusively based on expert-derived knowledge was the least accurate and most conservative. It underestimated the incidence of heart recovery, incorrectly identifying 4 of the successfully weaned patients as transplant candidates. The model derived exclusively from clinical data performed better but misidentified 2 patients: 1 weaned successfully, and 1 that needed a cardiac transplant ultimately. An expert-data hybrid model performed best, with 94.74% accuracy and 75.37% to 99.07% confidence interval, misidentifying only 1 patient weaned from support. CONCLUSIONS: A clinical decision support system may facilitate and improve the identification of VAD patients who are candidates for cardiac recovery and may benefit from VAD removal. It could be potentially used to translate success of active centers to those less established and thereby expand use of VAD therapy.

Relative contributions of age and atherosclerosis to vascular stiffness.

To determine the relative contributions of aging and atherosclerosis to vascular stiffness, we studied aortic stiffness, plaque, and elastin in 8-, 16-, 25-, and 34-week-old male ApoE-KO and C57BL/6J control mice (N = 48). Stiffness increased gradually in both strains up to 25 weeks (p < 0.05), and dramatically between 25 and 34 weeks in ApoE-KO (p < 0.001). Aging ApoE-KO demonstrated increased plaque (p = 0.02), medial thickening (p < 0.001), and severe elastin fragmentation (p < 0.001). We conclude that the contribution of aging to vascular stiffness is relatively minor compared with the influence of atherosclerosis. However, the effect of atherosclerosis on stiffness is significant only with advanced stages of plaque formation.