1,721,006 research outputs found
Clinical outcomes, pharmacological treatment, and quality of life of patients with stable coronary artery diseases managed by cardiologists. 1-year results of the START study
No full textAims We evaluated the 1-year clinical events, pharmacological management, and quality of life in a contemporary cohort of stable coronary artery disease (CAD) patients managed by cardiologists.Methods and results START (STable Coronary Artery Diseases RegisTry) was a prospective, observational, nationwide study that enrolled 5070 stable CAD patients over 3 months in 183 cardiology centres in Italy. At 1 year, 4790 (94.5%) patients had data on vital status. Death occurred in 107 (2.2%) patients and the cause of death was cardiovascular in 41 (38.3%) of cases. Among the 4775 patients with follow-up data on clinical events available, a hospitalization due to cardiovascular and non-cardiovascular causes occurred in 523 (11.0%) and in 231 (4.8%) of cases, respectively. Over 60% of patients reported as 'no problems' in all domains (61.4-84.5%) of the EuroQoL quality of life 5D-5L questionnaire. Among the 3239 patients with clinical visit/telephone interview at follow-up, in whom optimal medical therapy (OMT; aspirin or thienopyridine, beta-blocker, and statin) was prescribed at enrolment, 2971 (91.7%) were still receiving OMT at follow-up. At multivariable analysis, only increasing age (odds ratio 0.98; 95% confidence interval 0.97-0.99; P = 0.04) resulted as independent negative predictor of OMT persistence at 1 year from enrolment.Conclusion In this large, contemporary registry, stable CAD patients managed by cardiologists presented a high rate of clinical events at 1 year. Nevertheless, the persistence to OMT and quality of life appeared reasonable
Corso di Ecocardiografia color doppler transtoracica
No full textPROGRAMMA del corso
Generalità sugli ultrasuoni e sui principi costruttivi dei vari apparecchi:
Basi fisiche degli ultrasuoni, Caratteristiche delle sonde ultrasoniche, Effetto Doppler, Apparecchiature, Ecocardiografia monodirezionali (M-mode), Ecocardiografia bidimensionali (2 D), Laboratorio di ecocardiografia; Organizzazione del laboratorio
Esame ecocardiografico:
Sistemazione del paziente; Tecnica dell'esame;
Anatomia ecocardiografica; Proiezione parasternale, apicale, sottocostale, accessorie. Raccomandazioni dell'American Society of Echocardiography per la registrazione delle immagini
Analisi dell'ecocardiogramma normale
Valvole cardiache: Valvola mitrale, Aorta e sigmoidi aortiche, tricuspide, polmonare
Cavità cardiache : Cavità di destra, Cavità di sinistra
Studio della funzione ventricolare sinistra.
Cardiopatie valvolari acquisite :
Valvulopatia mitrale : Stenosi-Insufficienza mitralica, (Prolasso mitralico)
Valvulopatie aortiche : Stenosi – Insufficienza aortica nell'adulto; Patologie della parete dell'aorta
Valvulopatie tricuspidali: Stenosi- Insufficienza tricuspidale
Valvola Polmonare: Patologia polmonare; Ipertensione arteriosa polmonare Apertura precoce della valvola polmonare
Endocarditi batteriche :
Richiamo fisiopatologia e anatomo-funzionale;
Elementi diagnostici : Segni diretti, Segni indiretti, Segni premonitori complicanze
Protesi valvolari :
Differenti tipi di protesi, Aspetti ecocardiografici delle protesi valvolari
L'ecocardiografia nello studio dei malfunzionamenti protesici, Anomalie dell'elemento mobile, Alterazioni dell'anello di supporto e della gabbia; Alterazioni specifiche (Endocardite, Endotelizzazione, Embolie).
Pericarditi
Richiamo anatomo-funzionale, Versamenti pericardici, Elementi diagnostici e commenti sul Tamponamento cardiaco
Richiamo anatomo-funzionale; Pericarditi croniche Elementi diagnostici e commenti sulla Pericardite costrittiva
Cardiopatie ischemiche
Richiamo anatomo-funzionale e fisiopatologico Analisi degli indici di funzione globale, Visualizzazione delle coronarie
Regioni analizzabili con diagnostica delle anomalie regionali
- Studio della cinesi parietale
- Studio funzione sistolico, funzione diastolica
- Spessore delle pareti
Valutazione dell'estensione e della gravità delle lesioni, Tessuto vitale/ibernato; Soglia ischemica (Test farmacologico; Test da sforzo)
Ecocardiografia nella fase acuta dell'infarto: Complicazioni, Rottura del setto interventricolare, Aneurismi, Trombi, Insufficienza mitralica; Infarto del ventricolo destro
Miocardiopatie :
Miocardiopatie ipertrofiche : Richiamo anatomo-funzionale, Elementi diagnostici, Implicazioni diagnostiche e commenti
Miocardiopatie congestizie : Richiamo anatomo-funzionale, Elementi diagnostici, Implicazioni diagnostiche e commenti
Displasia aritmogena : Richiamo anatomo-funzionale, Elementi diagnostici, Implicazioni diagnostiche e commenti
Miocardiopatie restrittive : Richiamo anatomo-funzionale, Elementi diagnostici, Implicazioni diagnostiche e commenti
Fibrosi endomiocardiche : Richiamo anatomo-funzionale, Elementi diagnostici, Implicazioni diagnostiche e commenti
Tumori e masse
I tumori : Richiamo anatomo-funzionale, Elementi diagnostici, Implicazioni diagnostiche e commenti (Mixomi atriali)
I trombi : Richiamo anatomo-funzionale, Elementi diagnostici, Implicazioni diagnostiche e commenti
Prof. Nicola Alessandr
How do cardiologists select patients for dual antiplatelet therapy continuation beyond 1 year after a myocardial infarction. insights from the EYESHOT post-MI study
Full text linkBackground Current guidelines suggest to consider dual antiplatelet therapy (DAPT) continuation for longer than 12 months in selected patients with myocardial infarction (MI). Hypothesis We sought to assess the criteria used by cardiologists in daily practice to select patients with a history of MI eligible for DAPT continuation beyond 1 year. Methods We analyzed data from the EYESHOT Post-MI, a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. Results Out of the 1633 post-MI patients enrolled in the study between March and December 2017, 557 (34.1%) were on DAPT at the time of enrolment, and 450 (27.6%) were prescribed DAPT after cardiologist assessment. At multivariate analyses, a percutaneous coronary intervention (PCI) with multiple stents and the presence of peripheral artery disease (PAD) resulted as independent predictors of DAPT continuation, while atrial fibrillation was the only independent predictor of DAPT interruption for patients both at the second and the third year from MI at enrolment and the time of discharge/end of the visit. Conclusions Risk scores recommended by current guidelines for guiding decisions on DAPT duration are underused and misused in clinical practice. A PCI with multiple stents and a history of PAD resulted as the clinical variables more frequently associated with DAPT continuation beyond 1 year from the index MI
Clinical significance of small left-to-right shunts after percutaneous mitral valvuloplasty
No full textAbstract
Left-to-right shunt after percutaneous mitral valvuloplasty was evaluated by contrast echocardiography in 29 patients at 24 hours and at 1, 3, 6, and 9 months after the procedure. The patients were divided into two groups: in group A (13 patients) the double-balloon technique was used; in group B (16 patients) the Inoue single-balloon technique was used. The two groups were comparable in terms of age, gender, and mitral valve area before and after percutaneous mitral valvuloplasty. A left-to-right shunt was detected in all patients 24 hours after the procedure. At 1 month follow-up the shunt was present in 12 patients of group A (92%) and in 13 of group B (81%) with a statistically significant difference (p < 0.001). At 3 months the values were 7 (54%) in group A and 6 (37.5%) in group B (p < 0.05); at 6 months the values were 3 (23%) in group A and 3 (19%) in group B (NS). At 9 months a left-to-right shunt was no longer detectable in any of the patients in either group. The disappearance of the shunt could be related to a healing process of the atrial septal injury that occurs within a few months after percutaneous mitral valvuloplasty. This process seems to be more rapid in group B patients, probably because of the smaller lesion that is produced in the atrial septum by the passage of the Inoue balloon
Late potentials in idiopathic dilated cardiomyopathy.
No full textTwenty-five patients with idiopathic dilated cardiomiopathy were investigated in order to evaluate the role of late ventricular potentials as possible markers of ventricular tachycardia or sudden cardiac death. Holter monitoring showed ventricular tachycardia in 9 patients (group A) all of whom had late ventricular potentials, (mean +/- SD length 37.22 +/- 15.83 ms and mean +/- SD voltage 5.62 +/- 2.78 microV). Mean +/- SD ejection fraction in this group was 20 +/- 9.39%. In 16 patients (group B), without ventricular tachycardia, means +/- SD ejection fraction 27.5 +/- 8.17%; late ventricular potentials were recorded in 2 patients. During the follow-up period (means +/- SD 11.53 +/- 7.19 months), 3 patients underwent heart transplantation, 2 patients underwent pace-maker implantation and 2 patients from the ventricular tachycardia group died one from sudden cardiac death and the other from progressive heart failure. No significant differences were found in the ejection fraction either between the ventricular tachycardia and the non-ventricular tachycardia group, or between the late ventricular potentials and the non-late ventricular potential groups. Negative data were also obtained when we tried to find a correlation between the ejection fraction and late ventricular potential length and/or voltage. Good results were observed with regard to sensitivity (100%), specificity (87%) and predictive accuracy (81%) but follow-up data did not specify a definite prognostic value for late ventricular potentials. The Authors conclude that late ventricular potentials are markers of patients with idiopathic dilated cardiomyopathy who are prone to ventricular tachycardia. However, the role of late ventricular potentials in sudden cardiac death is still uncertain
HEART-TRANSPLANT REJECTION MONITORED BY MEANS OF AUTOMATIC-ANALYSIS OF SIGNAL AVERAGED QRS
No full text- …
