1,720,989 research outputs found
TakoTsubo secondary to acute kidney disease
Full text linkWe report the case of a 62-year-old man who was admitted to the Cardiac Department for TakoTsubo and ACC by torsades de point, secondary to acute kidney disease. We decide to discharge with a portable defibrillator. One month after cardiac magnetic resonance showed a complete recovery of left ventricular function
Rapid progression of pulmonary artery dilatation in pulmonary hypertension
No full textWe report the case of a 47-year-old woman who was admitted to the cardiac department for worsening dyspnea. The last chest computed tomography (CT) showed a rapid increase in pulmonary artery dimension (65 mm in 2019, 76 mm in 2021). The symptoms reported by the patient were due to important extrinsic compression of the left main coronary artery (LMCA). In this case, it is very difficult to choose the best therapeutic strategy. In the end, we decided to treat the left main coronary for prevention. After 3 months no new clinical symptoms have developed
Varicella zoster virus and cardiovascular diseases
No full textVaricella zoster virus (VZV) is a Herpesviridae family double-stranded DNA virus that only affects humans. The first clinical manifestation appears to be varicella, typical of childhood. VZV, on the other hand, becomes latent in ganglion neurons throughout the neuroaxis after primary infection. The VZV reactivates and travels along peripheral nerve fibers in the elderly and immunocompromised individuals, resulting in Zoster. It can, however, spread centrally and infect cerebral and extracranial arteries, resulting in vasculopathy, which can lead to transient ischemic attacks, strokes, aneurysms, cavernous sinus thrombosis, giant cell arteritis, and granulomatous aortitis. Although the mechanisms of virus-induced pathological vascular remodeling are not fully understood, recent research indicates that inflammation and dysregulation of ligand-1 programmed death play a significant role. Few studies, on the other hand, have looked into the role of VZV in cardiovascular disease. As a result, the purpose of this review is to examine the relationship between VZV and cardiovascular disease, the efficacy of the vaccine as a protective mechanism, and the target population of heart disease patients who could benefit from vaccination
Hybrid strategies for stand-alone surgical ablation of atrial fibrillation
Full text linkAtrial fibrillation (AF) has been reported as a major cause of cardiac morbidity and mortality, and significantly reduces the quality of life in symptomatic patients. Current guidelines recommend antiarrhythmic drugs and catheter ablation (CA) as first-line therapy. Despite CA showed to be associated with lower incidence of periprocedural complications, rhythm outcomes are far from optimal. Indeed, patients undergoing CA frequently require multiple AF ablation procedures, especially in those with persistent and long-standing persistent AF. While surgical ablation can provide transmural lesions, surgical invasiveness has limited the widespread use of this approach due to the increased perioperative complications. The development of minimally invasive thoracoscopic approaches has renewed the interest towards surgical ablation, thus favoring more simplified ablation sets. Therefore, the concept of "hybrid" ablation has emerged in order to theoretically enhance advantages of both minimally invasive and CA procedures while seeking to improve rhythm outcomes and reduce invasiveness and incidence of perioperative complications. On one hand, it provides the effectiveness of a surgical ablation, on the other, electrical mapping during CA can identify and treat any ablation gap or provide additional ablation lines, thus improving the chance of a stable sinus rhythm restoration at longterm follow-up. Three main thoracoscopic strategies are currently available. All of them can be performed in conjunction with the "catheter ablation procedure": the "Fusion" technique, the bipolar clamp technique, and the most recent "convergent" technique. CA can be performed either simultaneously or with a staged approach after a blanking period in order to allow the ablation lesion to stabilize. Excellent results of the hybrid procedures have been reported in terms of rhythm outcomes and incidence of perioperative complications. This narrative review aims to discuss the rationale behind the concept of hybrid ablation for the treatment of AF regarding different available strategies, results and expert opinions
Impact of SGLT2 inhibitors on endothelial function and echocardiographic parameters in dilated cardiomyopathy
No full textBackground: Dilated cardiomyopathy (DCM) is a common cause of heart failure with reduced ejection fraction (HFrEF) in industrialized countries and a major contributor to morbidity and mortality. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated significant benefits in HFrEF management; however, their impact on endothelial function in this patient population remains less explored. This study aims to evaluate the effects of SGLT2i on endothelial function and echocardiographic parameters in patients with DCM. Methods: This observational, longitudinal, monocentric study enrolled patients with DCM and HFrEF. Endothelial function was assessed using peripheral arterial tonometry (EndoPAT) at baseline, 6 months, and 12 months following the initiation of sodium-glucose cotransporter-2 inhibitors (SGLT2i). The enrollment period spanned from November 2021 to November 2022. The primary endpoint was the change in reactive hyperemia index (RHI) over time. In addition, a subgroup analysis was conducted to compare the effects of different SGLT2i agents (empagliflozin vs. dapagliflozin) and DCM etiology (ischemic vs. idiopathic) on endothelial function. Results: A total of 102 patients were included, predominantly male (72%), with a median age of 75 years and an average baseline left ventricular ejection fraction (LVEF) of 32.9 ± 7.9%. NYHA class II/III was observed in 76% of participants, and ischemic etiology accounted for 53% of DCM cases. The baseline RHI value was 1.15 ± 0.34. At 6 months, it significantly increased to 1.40 ± 0.34 (P < 0.0001), reflecting an absolute change of 0.25 ± 0.03 (ΔRHI baseline - 6 months). Between 6 and 12 months, the RHI showed a further significant increase to 1.69 ± 0.36 (P < 0.0001), with an additional change of 0.29 ± 0.03 (ΔRHI 6 - 12 months). The overall change in RHI from baseline to 12 months (ΔRHI baseline - 12 months) was 0.54 ± 0.04 (P < 0.0001). No significant differences in RHI were observed between patients treated with dapagliflozin and those receiving empagliflozin (P = 0.589), nor between different DCM etiologies (ischemic vs. idiopathic, P = 0.463). The enhancement in RHI was associated with a reduction in the incidence of hospitalization for heart failure (AUC 0.783, P < 0.001). Progressive improvement in left ventricular function was observed through echocardiographic parameters. Although EDV and ESV showed a decreasing trend (EDV: 176.2 ± 64.9 to 167.6 ± 31.1 ml, P = 0.335; ESV: 124.5 ± 52.7 to 116.8 ± 24.6 ml, P = 0.606), these changes were not statistically significant. LVEF improved significantly from 32.9 ± 7.9% at baseline to 36.8 ± 5.5% at 6 months and 37.1 ± 4.9% at 12 months (P < 0.001). The E/A ratio declined from 1.5 ± 0.5 to 1.1 ± 0.3 (P = 0.023) and the E/E' ratio decreased from 18.1 ± 5.1 to 11.1 ± 2.8 (P = 0.027).Left atrial volume significantly decreased from 108 to 100 ml (P = 0.041), and pulmonary artery systolic pressure dropped from 44 to 39 mmHg at 6 months and 35 mmHg at 12 months (P < 0.001). Conclusion: SGLT2i therapy significantly improves endothelial function in patients with DCM suggesting a potential vascular benefit beyond their well established cardioprotective effects
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Syncopal Recurrence in Patients Treated With Dual Chamber Pacemaker for Reflex Syncope With Asystole
No full textRight ventricle assessment before tricuspid valve interventions
No full textIn the latest ESC/EACTS Guidelines for the Management of Valvular Heart Disease, right ventricular dilatation and dysfunction, severe pulmonary hypertension and tricuspid annulus dilatation were reported to be the most important parameters to consider in patient selection for tricuspid valve interventions. Indeed, comprehensive right ventricular assessment is crucial in patients with severe tricuspid regurgitation who may benefit from transcatheter or surgical procedures. However, the only guideline parameter considered for intervention has been tricuspid annular dilatation in the presence of at least mild to moderate tricuspid regurgitation, with no other right ventricular markers used in the decision-making process for invasive treatment. Notably, challenges in the assessment of right ventricular function may limit establishing thresholds for defining right ventricular dysfunction. The aim of this review is to summarize current evidence on the prognostic significance of right ventricular function in patients with tricuspid regurgitation undergoing percutaneous or surgical interventions
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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