<i>Background</i>. Many of the therapeutic proposals for COVID-19 have been associated with adverse effects, including the risk of QT interval prolongation and torsades de pointes (TdP). The objective was to determine the use of drugs with a risk of QT interval prolongation in 21 clinics/hospitals in Colombia from January to December 2020. <i>Methods</i>. This cross-sectional study identified drug use according to pharmacological groups with potential risk of QT interval prolongation according to a risk classification: conditional, possible, and known risk of TdP. Descriptive analyses were performed. <i>Results</i>. A total of 355,574 patients who received QT-prolonging drugs were identified (equivalent to 51.4% of all inpatients treated during the study period). Of the group of patients on QT drugs, 54.4% used at least one drug with conditional risk, 52.6% with possible risk, and 40.3% with known risk. The most commonly used belonged to the group of drugs for the nervous system (63.0%), alimentary tract and metabolism (56.8%), anti-infectives for systemic use (13.0%), and the cardiovascular system (11.7%). On average, patients received <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="25.981pt" style="vertical-align:-0.3499298pt" id="M1" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 25.981 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,18.35,0)"><path id="g117-37" d="M535 290V340H323V533H265V340H52V290H265V84H323V290H535ZM535 -22V28H52V-22H535Z"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="15.688pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="28.8361838 -8.34882 15.688 8.69875"><g transform="matrix(.013,0,0,-0.013,28.886,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,35.126,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,38.09,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg></span> risk drugs. Regarding drugs initially considered against COVID-19, 2,120 patients (0.6%) received azithromycin, 802 (0.2%) received chloroquine, 517 received hydroxychloroquine (0.1%), and 265 received lopinavir/ritonavir (0.1%). <i>Conclusion</i>. The high proportion of patients treated at the hospital level who receive drugs with risk of prolonging the QT interval should alert those responsible for their care to avoid fatal outcomes, especially during the COVID-19 epidemic, when some QT drugs are being used more frequently.

Andrés Gaviria-Mendoza

Manuel Enrique Machado-Duque

Luis Fernando Valladales-Restrepo

Carlos Fernando Tovar-Yepes

Jorge Enrique Machado-Alba

Use of Drugs Associated with QT Interval Prolongation at the Hospital Level during the COVID-19 Pandemic in Colombia

<i>Background</i>. Vascular malformations are structural abnormalities which are formed by progressively enlarging aberrant and ecstatic vessels without endothelial cell proliferation and composed of the type of vessel involved, i.e., capillary, veins, and arteriovenous. Treatment of vascular malformations may involve many techniques like sclerotherapy, embolization, surgical resection, cryotherapy, laser treatment, or medical therapy. This observational prospective study is aimed at evaluating and comparing the effects and efficacy of diode laser and sclerotherapy in the treatment of oral vascular malformation. <i>Materials and Methods</i>. 40 patients presenting with oral vascular malformation were included in the present study. The patients were divided equally (20 in each) into two groups, i.e., the laser group and sclerotherapy group. Sclerotherapy was performed with 3% sodium tetradecyl sulfate while the laser group was treated with diode laser 980 nm with transmucosal thermophotocoagulation. The patients were assessed for the response, remission, and side effects. The results obtained were tabulated and compared with the chi-square test. <i>Results</i>. Side effects were found significantly lesser in the laser group compared to the sclerotherapy group (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M1" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.921pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 21.921 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g></svg>).</span></span> Statistically significant difference was seen for postoperative pain between two groups. The laser group had mild to moderate pain compared to severe pain in the sclerotherapy group. Recurrence was observed more in the laser group compared to the sclerotherapy group. <i>Conclusions</i>. Laser and sclerotherapy with 3% sodium tetradecyl sulfate both are effective in the treatment of vascular malformations. Diode laser seems to be better than sclerotherapy given lesser side effects and comfort to the patients while sclerotherapy seems to be better in respect to recurrences.

Peeyush Shivhare

Naqoosh Haidry

Neha Sah

Ajay Kumar

Abhishek Gupta

Ankur Singh

Mohan Raju Penumatcha

Shalini Subramanyam

Comparative Evaluation of Efficacy and Safety of the Diode Laser (980&#x2009;nm) and Sclerotherapy in the Treatment of Oral Vascular Malformations

Coronary artery diseases (CAD), also known as coronary heart disease (CHD), are the world&#x2019;s leading cause of death. The basis of coronary artery disease is the narrowing of the heart coronary artery lumen due to atherosclerosis. The use of electronic cigarettes has increased significantly over the years. However, harmful effects of electronic cigarettes are still not firm. The aim of this article is to review the impact of electronic cigarette and its role in the pathogenesis of atherosclerosis from recent studies. The results showed that several chemical compounds, such as nicotine, propylene glycol, particulate matters, heavy metals, and flavorings, in electronic cigarette induce atherosclerosis with each molecular mechanism that lead to atherosclerosis progression by formation of ROS, endothelial dysfunction, and inflammation. Further research is still needed to determine the exact mechanism and provide more clinical evidence.

Vito Anggarino Damay

Setiawan

Ronny Lesmana

M. Rizki Akbar

Antonia Anna Lukito

Vita M. Tarawan

Januar W. Martha

J. Nugroho

Electronic Cigarette and Atherosclerosis: A Comprehensive Literature Review of Latest Evidences

<i>Background.</i> Acute limb ischemia (ALI) is associated with significant morbidity and mortality. Novel anticoagulants reduce adverse events among patients with peripheral artery disease, though the potential effect of these therapies is unclear in patients with ALI. The present study thus sought to evaluate the potential clinical benefit of universal application of novel anticoagulants to a high-risk population of patients with ALI. <i>Methods.</i> In this retrospective cohort study, we identified patients diagnosed with ALI in the Veterans Affairs Healthcare System between 2015 and 2016. We then calculated the incidence of adverse cardiovascular events (death/stroke/myocardial infarction/amputation/repeat intervention) as if they were treated with rivaroxaban using published data. Further, we calculated the cost to treat a Veteran diagnosed with one of these outcomes, and the potential savings had patients been universally treated with novel anticoagulants. <i>Results</i>. We identified 286 patients that presented with lower extremity ALI and were not treated with anticoagulation. Potential treatment of these patients with rivaroxaban resulted in significantly fewer adverse events, with an 11.9&#x0025; reduction in cases at 21 months (95&#x0025; CI: 5.5-17.8&#x0025;) and a 13.4&#x0025; reduction in cases at 47 months (95&#x0025; CI: 5.6-20.5&#x0025;). This corresponded to significant decreases in healthcare spending for patients with ALI who were treated with rivaroxaban. <i>Conclusions</i>. Among patients with ALI, treatment with rivaroxaban could result in a significant reduction in adverse cardiovascular events. The reduction in events would in turn lead to significant decreases in healthcare spending for this population.

Scott Freeman

Piper Williams

Anna E. Bar&#x00F3;n

Mary E. Plomondon

Stephen W. Waldo

Potential Reduction in Adverse Events and Cost with Novel Anticoagulants among Patients with Acute Limb Ischemia

<i>Background.</i> Prevention of stroke and systemic embolism (SE) prevention in patients with atrial fibrillation (AF) has radically changed in recent years. Data on contemporary utilization of oral anticoagulants (OACs) and cardiovascular outcome in Middle Eastern patients with AF are needed. <i>Methods.</i> The Jordan atrial fibrillation (JoFib) study enrolled consecutive patients with AF in Jordan from May 2019 through October 2020 and were followed up for one year after enrollment. <i>Results.</i> Overall, 2020 patients were enrolled. The mean age was <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="32.224pt" style="vertical-align:-0.3499298pt" id="M1" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 32.224 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-55" d="M137 343C167 482 260 545 321 574C357 591 397 603 429 609L423 641C382 634 335 622 295 608C189 570 37 457 37 238C37 84 125 -12 242 -12C362 -12 447 89 447 209C447 311 374 393 267 393C247 393 226 386 204 376L137 343ZM227 337C318 337 361 256 361 173C361 105 336 22 258 22C176 22 126 120 126 240C126 266 127 291 132 310C155 323 189 337 227 337Z"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g><g transform="matrix(.013,0,0,-0.013,12.482,0)"><path id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,15.446,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g><g transform="matrix(.013,0,0,-0.013,24.593,0)"><path id="g117-36" d="M535 230V280H323V490H265V280H52V230H265V-3H323V230H535Z"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.971pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="35.0801838 -8.34882 21.971 8.69875"><g transform="matrix(.013,0,0,-0.013,35.13,0)"><path id="g113-50" d="M384 0V27C293 34 287 42 287 114V635C232 613 172 594 109 583V559L157 557C201 555 205 550 205 499V114C205 42 199 34 109 27V0H384Z"/></g><g transform="matrix(.013,0,0,-0.013,41.37,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g><g transform="matrix(.013,0,0,-0.013,47.61,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,50.574,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g></svg></span> years. Nonvalvular (NVAF) was diagnosed in 1849 (91.5%) patients. OACs were used in 85.7% of high-risk patients with NVAF (CHA2DS2-VASc score&gt;3 in women, and&gt;2 in men), including direct OACs (DOACs) in 64.1% and vitamin K antagonists (VKA) in 35.9%. Adherence rate to the use of the same OAC agent was 90.6% of patients. One-year cardiovascular (CV) mortality was 7.8%, stroke/SE was 4.5%, and major bleeding events were 2.6%. Independent predictors for all-cause mortality in patients with NVAF were age&gt;75 years, heart failure, major bleeding event, type 2 diabetes mellitus, study enrollment as an in-patient, and coronary heart disease. The use of OACs was associated with lower all-cause mortality. The strongest independent predictors for stroke/SE were high-risk CHA2DS2-VASc score and prior history of stroke. <i>Conclusions.</i> This study of Middle Eastern AF patients has reported high adherence to OACs. The use of OACs was associated with a lower risk for all-cause mortality. One-year rates of stroke and major bleeding events were comparable to those reported from other regions in the world.

Ayman Hammoudeh

Yousef Khader

Ramzi Tabbalat

Yahya Badaineh

Nazih Kadri

Haneen Shawer

Eyas Al-Mousa

Rasheed Ibdah

Batool A. Shawer

Imad A. Alhaddad

One-Year Clinical Outcome in Middle Eastern Patients with Atrial Fibrillation: The Jordan Atrial Fibrillation (JoFib) Study

Previous studies have linked peripheral microvascular dysfunction measured by arterial tonometry to high residual risk in on-statin patients. Digital thermal monitoring (DTM) of microvascular function is a new and simplified technique based on fingertip temperature measurements that has been correlated with the burden of atherosclerosis and its risk factors. Here, we report analyses of DTM data from two large US registries: Registry-I (6,084 cases) and Registry-II (1,021 cases) across 49 US outpatient clinics. DTM tests were performed using a VENDYS device during a 5-minute arm-cuff reactive hyperemia. Fingertip temperature falls during cuff inflation and rebounds after deflation. Adjusted maximum temperature rebound was reported as vascular reactivity index (VRI). VRI distributions were similar in both registries, with <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="39.544pt" style="vertical-align:-0.3499298pt" id="M1" height="9.10327pt" version="1.1" viewBox="-0.0498162 -8.75334 39.544 9.10327"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g190-110" d="M797 0V26C739 32 732 36 732 103V296C732 394 682 449 605 449C576 449 550 437 529 423C504 407 475 389 446 366C425 418 382 449 334 449C303 449 279 437 253 421C222 403 201 385 180 371V452C135 432 85 419 41 411V388C99 379 102 374 102 310V103C102 38 93 32 27 26V0H238V26C189 32 180 38 180 103V338C210 363 250 390 289 390C351 390 377 348 377 275V103C377 37 368 32 306 26V0H520V26C465 32 456 38 456 101V296C456 314 455 326 453 338C491 369 529 390 565 390C628 390 653 345 653 274V107C653 36 642 32 583 26V0H797Z"/></g><g transform="matrix(.013,0,0,-0.013,10.595,0)"><path id="g190-102" d="M380 106C343 72 306 56 265 56C195 56 116 112 115 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id="g113-47" d="M113 -12C146 -12 170 11 170 46C170 78 146 103 114 103S58 78 58 46C58 11 82 -12 113 -12Z"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><path id="g113-54" d="M153 550H386L412 615L406 623H120L82 318C104 327 142 338 184 338C294 338 347 275 347 187C347 112 305 39 221 39C160 39 119 71 97 89C88 97 80 96 71 90C59 80 50 67 49 57C48 45 52 36 66 23C80 9 123 -12 169 -12C221 -11 288 15 342 59C403 109 431 165 431 225C431 308 366 395 238 395C212 395 165 379 127 364L153 550Z"/></g><g transform="matrix(.013,0,0,-0.013,15.444,0)"><path id="g113-57" d="M249 635C141 635 70 555 70 471C70 401 114 353 179 316C143 294 106 267 90 252C68 231 45 202 45 157C45 50 130 -12 237 -12C322 -12 435 52 435 169C435 256 372 304 303 343C349 374 375 398 383 407C401 429 411 458 411 487C411 569 344 635 249 635ZM238 603C285 603 337 567 337 482C337 422 310 385 276 358C205 393 145 426 145 500C145 552 179 603 238 603ZM248 20C183 20 125 70 125 163C125 218 158 268 206 300C284 261 355 217 355 143C355 66 308 20 248 20Z"/></g><g transform="matrix(.013,0,0,-0.013,24.59,0)"><use xlink:href="#g117-37"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.975pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="35.076183799999995 -8.34882 21.975 8.69875"><g transform="matrix(.013,0,0,-0.013,35.126,0)"><path id="g113-49" d="M241 635C89 635 35 457 35 312C35 153 89 -12 240 -12C390 -12 443 166 443 312C443 466 390 635 241 635ZM238 602C329 602 354 454 354 312C354 172 330 22 240 22C152 22 124 173 124 313S148 602 238 602Z"/></g><g transform="matrix(.013,0,0,-0.013,41.366,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,44.33,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.013,0,0,-0.013,50.57,0)"><path id="g113-52" d="M285 378C315 398 338 416 353 432C373 451 384 474 384 503C384 579 325 635 236 635H235C182 635 136 610 108 579L65 516L85 496C110 533 150 575 205 575C258 575 300 543 300 481C300 407 232 369 141 339L147 310C163 315 188 321 211 321C268 321 338 284 338 192C338 94 288 40 217 40C160 40 119 68 93 91C85 98 77 97 69 91C60 84 47 71 46 58C44 46 48 35 62 22C75 10 116 -12 162 -12C234 -12 424 62 424 224C424 297 373 359 285 376V378Z"/></g></svg></span> in Registry-I and <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="32.221pt" style="vertical-align:-0.3499298pt" id="M3" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 32.221 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.013,0,0,-0.013,15.444,0)"><path id="g113-51" d="M412 140C382 77 369 73 315 73H129L270 222C362 320 402 379 402 466C402 571 322 635 234 635C177 635 130 609 99 576L42 495L64 475C90 514 133 568 201 568C274 568 318 519 318 435C318 349 255 267 193 193C144 135 87 78 32 23V0H405C417 45 427 89 440 131L412 140Z"/></g><g transform="matrix(.013,0,0,-0.013,24.59,0)"><use xlink:href="#g117-37"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.975pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="35.076183799999995 -8.34882 21.975 8.69875"><g transform="matrix(.013,0,0,-0.013,35.126,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,41.366,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,44.33,0)"><path id="g113-53" d="M456 178V225H360V632H320C217 496 115 347 20 206V178H280V106C280 40 276 34 189 27V0H445V27C364 34 360 39 360 106V178H456ZM280 225H82C149 335 214 431 278 520H280V225Z"/></g><g transform="matrix(.013,0,0,-0.013,50.57,0)"><use xlink:href="#g113-52"/></g></svg></span> in Registry-II. In the combined dataset, only 18% had optimal VRI (≥2.0) and 82% were either poor (&lt;1.0) or intermediate (1.0-2.0). Women had slightly higher VRI than men (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="32.221pt" style="vertical-align:-0.3499298pt" id="M4" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 32.221 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><path id="g113-55" d="M137 343C167 482 260 545 321 574C357 591 397 603 429 609L423 641C382 634 335 622 295 608C189 570 37 457 37 238C37 84 125 -12 242 -12C362 -12 447 89 447 209C447 311 374 393 267 393C247 393 226 386 204 376L137 343ZM227 337C318 337 361 256 361 173C361 105 336 22 258 22C176 22 126 120 126 240C126 266 127 291 132 310C155 323 189 337 227 337Z"/></g><g transform="matrix(.013,0,0,-0.013,15.444,0)"><use xlink:href="#g113-51"/></g><g transform="matrix(.013,0,0,-0.013,24.59,0)"><use xlink:href="#g117-37"/></g></svg><span class="ibiop"/><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.975pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="35.076183799999995 -8.34882 21.975 8.69875"><g transform="matrix(.013,0,0,-0.013,35.126,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,41.366,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,44.33,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.013,0,0,-0.013,50.57,0)"><use xlink:href="#g113-55"/></g></svg></span> vs. <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="32.221pt" style="vertical-align:-0.3499298pt" id="M5" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 32.221 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,6.24,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,9.204,0)"><use xlink:href="#g113-54"/></g><g transform="matrix(.013,0,0,-0.013,15.444,0)"><use xlink:href="#g113-53"/></g><g transform="matrix(.013,0,0,-0.013,24.59,0)"><use xlink:href="#g117-37"/></g></svg><span class="ibiop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="21.975pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="35.076183799999995 -8.34882 21.975 8.69875"><g transform="matrix(.013,0,0,-0.013,35.126,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,41.366,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,44.33,0)"><use xlink:href="#g113-53"/></g><g transform="matrix(.013,0,0,-0.013,50.571,0)"><path id="g113-56" d="M447 623H65C61 580 56 530 47 475H76C100 541 106 550 172 550H388C308 376 196 170 91 -1L98 -12L172 -2C268 204 360 408 455 611L447 623Z"/></g></svg>,</span></span> <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M6" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-113" d="M570 304C570 398 525 448 414 448C385 448 343 445 312 434L329 511L321 518C297 504 262 482 244 460L233 411C195 397 159 381 128 358L135 332C160 347 189 360 224 373L111 -147C97 -210 84 -218 17 -231L13 -257L254 -247L259 -218L233 -216C183 -212 177 -202 189 -142L218 -1C238 -10 266 -12 283 -12C351 3 429 48 483 105C543 168 570 242 570 304ZM482 289C482 161 380 33 304 33C278 33 248 51 233 69L303 396C326 400 352 403 369 403C428 403 482 380 482 289Z"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><path id="g117-91" d="M512 -3V55L134 254V256L512 456V514L75 281V230L512 -3Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.184pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 28.184 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><use xlink:href="#g113-50"/></g></svg>).</span></span> VRI was inversely but mildly correlated with age (<span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="16.751pt" style="vertical-align:-0.3499298pt" id="M7" height="8.69875pt" version="1.1" viewBox="-0.0498162 -8.34882 16.751 8.69875"><g transform="matrix(.013,0,0,-0.013,0,0)"><path id="g113-115" d="M393 379C402 394 400 411 393 422C384 437 365 448 348 448C301 448 237 372 186 285H182L193 335C210 408 205 448 178 448C150 448 80 402 29 344L45 321C80 355 114 373 122 373C128 373 130 365 124 330C106 228 76 98 50 -5L57 -12C82 -5 112 3 132 6L172 203C196 256 234 304 254 329C275 355 293 367 306 367C318 367 330 360 342 348C347 343 355 343 365 350S386 367 393 379Z"/></g><g transform="matrix(.013,0,0,-0.013,9.12,0)"><path id="g117-34" d="M535 323V373H52V323H535ZM535 138V188H52V138H535Z"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="29.571pt" style="vertical-align:-0.3499298pt" height="8.69875pt" version="1.1" viewBox="20.3331838 -8.34882 29.571 8.69875"><g transform="matrix(.013,0,0,-0.013,20.383,0)"><path id="g117-33" d="M535 230V280H52V230H535Z"/></g><g transform="matrix(.013,0,0,-0.013,28.014,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,34.254,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,37.218,0)"><use xlink:href="#g113-50"/></g><g transform="matrix(.013,0,0,-0.013,43.458,0)"><path id="g113-58" d="M244 635C114 635 38 519 38 422C38 317 111 240 217 240C236 240 255 244 277 256L345 292C311 140 203 39 59 15L64 -15C89 -15 150 -5 204 17C339 72 440 202 440 386C440 521 368 635 244 635ZM228 602C326 602 352 479 352 390C352 370 351 347 348 324C327 308 293 296 258 296C174 296 124 369 124 458C124 517 152 602 228 602Z"/></g></svg>,</span></span> <span class="inline_break"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="18.973pt" style="vertical-align:-3.42938pt" id="M8" height="11.7782pt" version="1.1" viewBox="-0.0498162 -8.34882 18.973 11.7782"><g transform="matrix(.013,0,0,-0.013,0,0)"><use xlink:href="#g113-113"/></g><g transform="matrix(.013,0,0,-0.013,11.342,0)"><use xlink:href="#g117-91"/></g></svg><span class="irelop"/><span class="nowrap"><svg xmlns:xlink="http://www.w3.org/1999/xlink" xmlns="http://www.w3.org/2000/svg" width="28.184pt" style="vertical-align:-3.42938pt" height="11.7782pt" version="1.1" viewBox="22.555183800000002 -8.34882 28.184 11.7782"><g transform="matrix(.013,0,0,-0.013,22.605,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,28.845,0)"><use xlink:href="#g113-47"/></g><g transform="matrix(.013,0,0,-0.013,31.809,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,38.049,0)"><use xlink:href="#g113-49"/></g><g transform="matrix(.013,0,0,-0.013,44.289,0)"><use xlink:href="#g113-50"/></g></svg>).</span></span> Suboptimal VRI was found in 72% of patients &lt;50 years, 82% of 50-70 years, and 86% of ≥70 years. Blood pressure was not correlated with VRI. In this largest registry of peripheral microvascular function measurements, suboptimal scores were highly frequent among on-treatment patients, possibly suggesting a significant residual risk. Prospective studies are warranted to validate microvascular dysfunction as an indicator of residual risk.

Morteza Naghavi

Stanley Kleis

Hirofumi Tanaka

Albert A. Yen

Ruoyu Zhuang

Ahmed Gul

Yasamin Naghavi

Ralph Metcalfe

High Frequency of Microvascular Dysfunction in US Outpatient Clinics: A Sign of High Residual Risk? Data from 7,105 Patients

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<p><em>International Journal of Vascular Medicine</em> publishes articles focusing on vascular biology and physiology, vascular imaging, endovascular intervention, as well as prevention and treatment of vascular disease.</p>


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International Journal of Vascular Medicine - Table of contents 2022

International Journal of Vascular Medicine | Hindawi

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International Journal of Vascular Medicine publishes articles focusing on vascular biology and physiology, vascular imaging, endovascular intervention, as well as prevention and treatment of vascular disease.

International Journal of Vascular Medicine