A randomized trial comparing the acute coronary, systemic, and environmental effects of electronic vaping cigarettes versus heat-not-burn cigarettes in smokers of combustible cigarettes undergoing invasive coronary assessment: rationale and design of the SUR-VAPES 3 trial

Zoccai, Giuseppe Biondi; Carnevale, Roberto; Vitali, Matteo; Tritapepe, Luigi; Martinelli, Ombretta; Macrina, Francesco; Bullen, Chris; Peruzzi, Mariangela; Marullo, Antonino G. M.; Abbate, Antonio; Romagnoli, Enrico; Sciarretta, Sebastiano; Casati, Rebecca; Visconti, Giuseppe; Versaci, Francesco; Frati, Giacomo

doi:10.23736/s0026-4725.20.05181-6

Cited by 17 publications

(6 citation statements)

References 29 publications

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“…Finally, physicians should remain aware that FFR or NHPR cannot reliably measure microvascular dysfunction or diffuse atherosclerotic disease. [24][25][26]…”

Section: Discussionmentioning

confidence: 99%

A Novel Algorithm for the Computation of the Diastolic Pressure Ratio in the Invasive Assessment of the Functional Significance of Coronary Artery Disease

Biondi‐Zoccai¹,

Conte²,

Veer³

et al. 2021

Journal of the American College of Cardiology

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BACKGROUND: Invasive functional assessment is a mainstay in the management of patients with coronary artery disease (CAD), but there is uncertainty on the comparative accuracy of diagnostic indices of functional significance. We aimed to validate the diagnostic performance of a novel non-hyperemic diastolic pressure ratio (dPR). METHODS: We performed a retrospective analysis including two separate registries (VERIFY 2, Latina, Italy) of patients in whom functional indices were measured for lesions with angiographically moderate severity. On top of fractional flow reserve, distal coronary pressure (Pd)/aortic pressure (Pa) ratio, instantaneous wave-free ratio (iFR) and diastolic pressure ratio (dPR) were computed using a novel dedicated algorithm over 4 consecutive beats. Agreement/discrepancy between indexes was appraised Bland-Altman analysis, area under the receiver operating characteristic curve (AUC), and unsupervised machine learning. RESULTS: A total of 525 lesions from 479 patients were included. The novel dPR was highly correlated with iFR (R 2 =0.99, P<0.001), with a mean difference of -0.004±0.014. The diagnostic performance of dPR (best cutoff value: ≤0.89) against iFR was as follows: accuracy =96%; sensitivity =94%; specificity =97%; positive-predictive value =94%; and negative-predictive value =96%. Additionally, AUC to predict iFR≤0.89 was 0.99, which was significantly higher than that of Pd/Pa (0.97, P<0.001). In the iFR range of 0.85-0.93 ("grey zone"), the diagnostic performance was well maintained (accuracy =91%; sensitivity =87%; specificity =93%; and AUC=0.96). Results were supported also by unsupervised learning analysis. CONCLUSIONS: This multicenter registry suggests this novel dPR algorithm provides results that are numerically equivalent to iFR. Pending further studies, physicians may consider using this novel dPR algorithm to gauge the functional significance of a coronary lesion.

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“…Finally, physicians should remain aware that FFR or NHPR cannot reliably measure microvascular dysfunction or diffuse atherosclerotic disease. [24][25][26]…”

Section: Discussionmentioning

confidence: 99%

A Novel Algorithm for the Computation of the Diastolic Pressure Ratio in the Invasive Assessment of the Functional Significance of Coronary Artery Disease

Biondi‐Zoccai¹,

Conte²,

Veer³

et al. 2021

Journal of the American College of Cardiology

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“…These phenomena, together with inflammation, promote vascular fibrosis and dysfunction. The main risk factors related to the onset of this condition include cigarette smoke, which is responsible for an increase in oxidative stress [ 11 , 12 , 13 , 14 ], hyperlipidemia, and diabetes, which may promote vasoconstriction. Overall, these conditions may cause microvascular angina, with the formation of areas of micro-infarctions due to a reduction of coronary flow reserve [ 15 ].…”

Section: Pathophysiology Of Myocardial Infarctionmentioning

confidence: 99%

An Overview of the Molecular Mechanisms Associated with Myocardial Ischemic Injury: State of the Art and Translational Perspectives

Schirone

Forte

D’Ambrosio

et al. 2022

Cells

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Cardiovascular disease is the leading cause of death in western countries. Among cardiovascular diseases, myocardial infarction represents a life-threatening condition predisposing to the development of heart failure. In recent decades, much effort has been invested in studying the molecular mechanisms underlying the development and progression of ischemia/reperfusion (I/R) injury and post-ischemic cardiac remodeling. These mechanisms include metabolic alterations, ROS overproduction, inflammation, autophagy deregulation and mitochondrial dysfunction. This review article discusses the most recent evidence regarding the molecular basis of myocardial ischemic injury and the new potential therapeutic interventions for boosting cardioprotection and attenuating cardiac remodeling.

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“…The SUR-VAPES 3 study aims to compare the acute coronary effects of EVP and heated tobacco product use in chronic conventional cigarette smokers admitted to hospital for invasive coronary evaluation (Biondi Zoccai et al, 2020b). In patients with a confirmed angiographic intermediate coronary stenosis, who have never quit smoking before, the study will measure coronary flow reserve as the primary end-point.…”

Section: Future Studies On Health Effectsmentioning

confidence: 99%

The product science of electrically heated tobacco products: a narrative review of the scientific literature

Malt

Thompson²,

Mason

et al. 2022

F1000Res

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Heated tobacco products represent a novel category of tobacco products in which a tobacco consumable is heated to a temperature that releases nicotine from the tobacco leaf but not to a temperature sufficient to cause combustion. Heated tobacco products may therefore have the potential to be a less harmful alternative for adult smokers that would otherwise continue to smoke conventional cigarettes. Given the rapid development of this product category, the aim of this review was to examine the available peer-reviewed scientific evidence related to heated tobacco products and highlight any research gaps. In recent years, manufacturers of heated tobacco products have published a number of studies on their respective heated tobacco products. Whilst there is limited research that is independent of commercial interests, the available scientific evidence indicates that heated tobacco products produce a much simpler aerosol than conventional cigarette smoke, with fewer and substantially lower levels of harmful toxicants. Toxicology assessments indicate these reductions in aerosol toxicants translate to reduced biological effects. Biomarker and clinical data from studies in which product use is controlled within a clinical setting, indicate changes in biomarker levels and clinical end-points similar to observations in cessation studies, indicating the potential for reduced harm. The scientific evidence also indicates that exposure of non-users to emissions from heated tobacco products in indoor environments is significantly reduced compared to exposure resulting from smoking conventional cigarettes. Overall, the available scientific evidence indicates that heated tobacco products hold promise as a less harmful alternative to conventional cigarettes, but more independent data is required to validate industry findings. As a growing product category, epidemiological studies and independent population modelling studies are outstanding, and empirical data on how dual tobacco product category use by consumers affects their risk profile is lacking.

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A randomized trial comparing the acute coronary, systemic, and environmental effects of electronic vaping cigarettes versus heat-not-burn cigarettes in smokers of combustible cigarettes undergoing invasive coronary assessment: rationale and design of the SUR-VAPES 3 trial

Cited by 17 publications

References 29 publications

A Novel Algorithm for the Computation of the Diastolic Pressure Ratio in the Invasive Assessment of the Functional Significance of Coronary Artery Disease

A Novel Algorithm for the Computation of the Diastolic Pressure Ratio in the Invasive Assessment of the Functional Significance of Coronary Artery Disease

An Overview of the Molecular Mechanisms Associated with Myocardial Ischemic Injury: State of the Art and Translational Perspectives

The product science of electrically heated tobacco products: a narrative review of the scientific literature

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