1,721,027 research outputs found
Novel biomarkers and therapies in cardiorenal syndrome
No full textRenal and cardiac diseases frequently co-exist and are associated with adverse outcomes. The clinical management of patients with a cardiorenal syndrome aims at reducing fluid
overload and congestion, while improving kidney function.
Early diagnosis and prompt therapies are key to better outcome. Biomarkers may help to gain insight on the ongoing pathological processes and since an accurate and early
diagnosis of the cardiorenal syndrome based on clinical findings is not always possible. Serum creatinine, the derived eGFR and blood urea nitrogen are the standard tools for
recognizing changes in renal function but suffer some limitations. In this review we will discuss the role of emerging biomarkers of renal tubular and glomerular injury, bone-mineral
axis, or tubular cell-cycle arrest
ETIOLOGY.
No full textInfective endocarditis [IE] is the final manifestation of a complex series of events ranging from the damage at the level of endocardium to the ultimaate infection of a distinct endocardial lesion by bacteria or fungi. Microorganisms infecting the endoardium may originate from distant sources of infection or through cutaneous or mucosal breaches that allow pathogens to enter and spread into bloodstream
Emergency Surgery and Cardiac Devices
No full textBecause of the increasing number of patients treated with cardiac implantable electronic devices (CIED), as pacemakers (PM) or implantable cardioverter-defibrillators (ICD), their management in case of emergent surgery is becoming a scenario frequently observed in the clinical practice. A deep knowledge of the CIED and how they work is rare, not only among non-cardiologist physicians facing emergencies but, not infrequently, even among consultant cardiologists. In the emergency setting, the presence of the CIED can be completely ignored or, on the contrary, causes unnecessary delays of the proper treatment of the emergency. Some notions about the management of patients with CIED who need emergent/urgent surgery are provided, starting from general to more detailed information both directed to first-line physicians, who must face the emergency (surgeons, anesthesiologists, and emergency physicians), and the consultant cardiologist, who should consider the relationship between the specific patients and the CIED. Finally, a practical algorithm, considering most guidelines and some specific issues of the emergency, is proposed
Cardiac stem cell aging and heart failure
Full text linkA side effect of the medical improvements of the last centuries is the progressive aging of the world population, which is estimated to reach the impressive number of 2 billion people with more than 65 years by 2050. As a consequence, age-related diseases, such as heart failure, will affect more and more patients in the next years. To understand the biological bases of these diseases will be a crucial task in order to find better treatments, and possibly slow age-related morbidity and mortality. Cardiac stem cells have been at the center of a heated debate and their potential involvement in cardiac homeostasis has been questioned. In this review, we summarize evidence obtained by independent groups, on different animal models and humans, that strongly support the important role played by immature, cardiac resident cells in the cardioprotection against heart failure
New-onset left bundle branch block independently predicts long-term mortality in patients with idiopathic dilated cardiomyopathy: data from the Trieste Heart Muscle Disease Registry.
No full textLeft bundle branch block (LBBB) is commonly associated with heart failure. We evaluated the prevalence, incidence, and impact of LBBB on long-term outcome in young patients with heart failure affected by idiopathic dilated cardiomyopathy (DCM).METHODS AND RESULTS: We included 608 patients with DCM from the Heart Muscle Disease Registry of Trieste in this retrospective analysis. At baseline electrocardiogram (ECG), 189 patients (31.1\%) had LBBB. The patients with baseline LBBB had a significantly higher mortality rate than the patients without LBBB (38.6 vs. 27.9\%, P = 0.002) at the univariate analysis. After a multiple covariate adjustment, the baseline LBBB was not associated with a significantly increased risk of death [hazard ratio (HR) 1.27, 95\% confidence interval (CI): 0.88-1.81, P = 0.2]. Forty-seven (11.2\%) patients without LBBB at baseline ECG developed LBBB during follow-up. Among these, the mortality rate was 49 vs. 25\% in patients without new-onset LBBB (P = 0.001). New-onset LBBB was a strong and independent predictor of all-cause mortality (HR 3.18, 95\% CI: 1.90-5.31, P < 0.001) at multivariate analysis.CONCLUSION: After correcting for potential confounders, new-onset LBBB was found to be associated with an increased risk of all-cause mortality. The management of patients with new-onset LBBB may need to be more aggressive, possibly including early cardiac resynchronization therapy/implantable cardioverter-defibrillator therapy
Vitamin D Deficiency in Patients with Acute Myocardial Infarction: An Italian Single-Center Study
No full textHypovitaminosis D is a vitamin deficiency that has been increasing in developed countries; it was also suggested as an emerging risk factor for developing of atherosclerosis and acute myocardial infarction. The primary source of vitamin D is its cutaneous synthesis under exposure to sunlight. It has been suggested that 30 min of sun exposure twice weekly leads to sufficient vitamin D synthesis. The residents of Trieste (Italy) are well-known for their high exposure to sunlight in all seasons. We aimed to investigate the vitamin D status in subjects with acute myocardial infarction living in this area
An Unsuspected Case of Aortic Dissection
Full text linkAortic dissection is a rare life-threatening condition that typically presents with acute onset of severe chest, abdominal, or back pain. Some patients might present with atypical symptoms and findings, such as neurological syndromes, making it difficult to make the diagnosis.
Here, we report a case of a painless acute aortic rupture over an already existing Stanford type A chronic aortic dissection in a 59-year-old patient, with prevalence of neurological symptoms. The aortic dissection presented as recurrent episodes of dizziness/syncope and transient amnesia.
We believe it is important to report this case because of the rare clinical presentation of aortic dissection, raising the awareness and diagnosing level of atypical aortic dissections
Cell Senescence in Cardiac Repair and Failure
No full textAlthough the lack of a robust cardiomyocyte proliferative response has been considered to be a crucial determinant of cardiac pathology and Heart Failure in adult mammalians, the emerging picture is that myocardial regeneration is a complex phenotype involving many actors, including acute cellular senescence and inflammation. However, three major and interconnected events occur in response to tissue injury: loss of protein homeostasis, accumulation of dysfunctional mitochondria and chronic inflammation. These events blunt the reparative response of the heart, are associated with the accumulation of chronically senescent cells and progressively lead to cardiac dysfunction. Therefore, it is crucial to understand which are the pivotal players of this process, in order to devise strategies aimed at reducing the occurrence of chronic cell senescence in the heart in vivo
Relation between the plasma levels of LDL-cholesterol and the expression of the early marker of inflammation long pentraxin PTX3 and the stress response gene p66ShcA in pacemaker-implanted patients.
No full textOur goal was to set up a pilot study to explore the possible relation between the expression of p66((ShcA)) and PTX3, two emerging regulators of stress response and inflammation processes, respectively, and the circulating levels of LDL-cholesterol (LDL), a factor implicated in the development of inflammation and oxidative-stress associated diseases such as atherosclerosis. p66((ShcA)) and PTX3 mRNA contents were determined locally, in subcutaneous adipose specimens of non-diabetic pacemaker-implanted patients, and systemically in the circulating white blood cells (WBC) obtained from the same patients. The mean of the circulating LDL levels (125 mg/dl) was chosen as a threshold to identify two groups here considered to have high (>125 mg/dl) and low (<125 mg/dl) LDL plasma levels. Our data show that PTX3 and p66((ShcA)) mRNA levels are significantly more elevated in WBCs and in adipose tissue samples of patients with high levels of LDL compared to those with low levels. Additionally, a multiple regression analysis indicates that among LDL, TG, HDL, total cholesterol, CRP, creatinine and glucose levels, the only variable significantly affecting p66((ShcA)) and PTX3 mRNA expressions either in adipose tissue or in WBCs is represented by the circulating amount of LDL. In conclusion, our results suggest a potential link between the level of LDL and the expression of two genes involved in inflammation/oxidative stress pathways, i.e., p66((ShcA)) and PTX3, thus contributing to further understand the mechanism through which LDL may mediate the pathogenesis of inflammation and oxidative-stress associated diseases such as atherosclerosis
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