1,721,159 research outputs found
Biomarkers of vulnerable plaque: The missing link with ischemia
No full textThe initial evaluation of chest pain in the emergency department is based on the patients clinical history, changes in the ECG and necrosis biomarkers. Although management of patients with ST-elevation myocardial infarction or non-ST-elevation myocardial infarction with positive markers of myocardial damage is well defined, exclusion of coronary artery disease or myocardial ischemia in the remaining patients is more challenging. This group represents the majority of patients admitted for chest pain syndromes and that have a substantial risk of an adverse outcome. Given that troponin, as a marker of myocardial damage, detects terminal events in the cascade of acute coronary syndrome, there is a need to search for biomarkers that are able to identify patients at high risk, allowing rapid, bedside stratification. Data suggest that clinical events are prone to occur more frequently in patients with coronary artery stenosis associated with myocardial ischemia. Accordingly, identification of systemic biomarkers of ischemia could facilitate identification of high-risk patients with a high burden of coronary atherosclerosis and plaque rupture. We describe six biomarkers that have been linked to myocardial ischemia. Until now, these biomarkers of ischemia are relevant in order to exclude ischemic heart disease (high negative predictive value) but still lack specificity. Future prospective studies should be performed in larger and more diverse sets of patients presenting with ischemia, and in a complementary fashion in order to provide valuable tools for clinical decision making. © 2010 Future Medicine Ltd
Myocarditis in Clinical Practice
No full textMyocarditis is a polymorphic disease characterized by great variability in clinical presentation and evolution. Patients presenting with severe left ventricular dysfunction and life-threatening arrhythmias represent a demanding challenge for the clinician. Modern techniques of cardiovascular imaging and the exhaustive molecular evaluation of the myocardium with endomyocardial biopsy have provided valuable insight into the pathophysiology of this disease, and several clinical registries have unraveled the disease's long-term evolution and prognosis. However, uncertainties persist in crucial practical issues in the management of patients. This article critically reviews current information for evidence-based management, offering a rational and practical approach to patients with myocarditis. For this review, we searched the PubMed and MEDLINE databases for articles published from January 1, 1980, through December 31, 2015, using the following terms: myocarditis, inflammatory cardiomyopathy, and endomyocardial biopsy. Articles were selected for inclusion if they represented primary data or were review articles published in high-impact journals. In particular, a risk-oriented approach is proposed. The different patterns of presentation of myocarditis are classified as low-, intermediate-, and high-risk syndromes according to the most recent evidence on prognosis, clinical findings, and both invasive and noninvasive testing, and appropriate management strategies are proposed for each risk class
Twelve-month follow-up results from the SIRONA 2 clinical trial
No full textAimsIn the SIRONA 2 trial, the safety and efficacy of pulmonary artery (PA) pressure (PAP)-guided heart failure (HF) management using a novel PAP sensor were assessed at 30 and 90 days, respectively, and both endpoints were met. The current study examines the prespecified secondary endpoints of safety and accuracy of the PA sensor along with HF hospitalizations and mortality, HF symptoms, functional capacity, quality of life, and patient compliance through 12 months. Methods and resultsSIRONA 2 is a prospective, multi-centre, open-label, single-arm trial evaluating the Cordella (TM) PA Sensor System in 70 patients with New York Heart Association (NYHA) functional class III HF with a prior HF hospitalization and/or increase of N-terminal pro-brain natriuretic peptide within 12 months of enrolment. Sensor accuracy was assessed and compared with measurements obtained by standard right heart catheterization (RHC). Safety was defined as freedom from prespecified adverse events associated with use of the Cordella PA Sensor System and was assessed in all patients who entered the cath lab for PA sensor implant. HF hospitalizations and mortality, HF symptoms, functional capacity, quality of life, and patient compliance were also assessed. At 12 months, there was good agreement between the Cordella PA Sensor System and RHC, with the average difference for mean PAP being 2.9 +/- 7.3 mmHg. The device safety profile was excellent with 98.4% freedom from device/system-related complications. There were no pressure sensor failures. HF hospitalizations and mortality were low with a rate of 0.33 event per patient year. Symptoms as assessed by NYHA (P < 0.0001) and functional capacity as measured by 6 min walk test (P = 0.02) were significantly improved. Patients' adherence to daily transmissions of PAP and vital signs measurements was 95%. ConclusionsLong-term follow-up of the SIRONA 2 trial supports the safety and accuracy of the Cordella PA Sensor System in enabling comprehensive HF management in NYHA class III HF patients.Endotronix In
Thr164Ile polymorphism of beta2-adrenergic receptor negatively modulates cardiac contractility: implications for prognosis in patients with idiopathic dilated cardiomyopathy
No full textBeta2-adrenergic receptor Thr164Ile (threonine (Thr) is replaced by an isoleucine (Ile) at codon 164) polymorphism was postulated to contribute to lower exercise tolerance and poor prognosis in patients with congestive heart failure. However, heart failure is associated with several abnormalities of beta receptor signalling, and underlying mechanisms are not clear
Endomyocardial biopsy
No full textEndomyocardial biopsy (EMB) has evolved from a single-indication test for the early diagnosis and monitoring of heart transplant rejection to the gold-standard technique to reach a definite and aetiological diagnosis in different cardiac disorders such as myocarditis and cardiomyopathies. It is currently considered a fundamental tool in the diagnostic workup of unexplained acute heart failure with haemodynamic compromise. For interventional cardiologists, EMB represents a unique opportunity to bridge invasive diagnostics with personalised care. By embracing technological advancements, integrating EMB with non-invasive modalities, the field advances towards more precise and effective management of complex cardiac conditions. However, safety remains a concern when performing EMB; indeed, although rare, major complications occur in about 1-5% of cases. Correct indication for the procedure and specific expertise to minimise the risk of complications are fundamental to obtain an acceptable risk/benefit profile. Therefore, this review examines the contemporary use of EMB from the perspective of interventional cardiologists to provide a practical resource for clinical practice and to better understand when and how to perform both right and left ventricular EMB in current practice
Feasibility of Continuous Noninvasive Pulmonary Artery Pressure Monitoring via the Cordella Implantable Pulmonary Artery Sensor
No full textAlthough cardiopulmonary exercise testing (CPET) is considered the gold standard assessment of functional capacity and prognosis in heart failure (HF) patients, pulmonary hemodynamics can be measured during incremental exercise at invasive right heart catheterization or noninvasively at exercise echocar-diography to assess the physiologic responses to exercise and help guide patient management. 1,2 The Cordella PA sensor (Endotronix Inc) transmits pulmonary artery pressures (PAPs) from HF patients to their clinical team, and a harness was developed to allow for hands-free continuous PAP readings. The results of a feasibility study of HF patients who underwent Cordella PA sensor implant and subsequent 6-minute walk test (6MWT) with continuous PAP readings are reported here. The SIRONA 2 clinical trial has been previously described. 3 The study was undertaken in accordance with the Declaration of Helsinki and approved by the relevant competent authorities and independent ethics committees. All patients provided written informed consent. At a follow-up visit, each participant underwent the Cordella 6MWT protocol. To begin, patients assumed a seated position. The reader was then activated to begin recording continuous PAP, a timer was started, and the patients rested for 5 minutes. Then, blood pressure (BP), oxygen saturation (SpO 2), and the Borg Rating and Perceived Exertion (RPE) scale were assessed. Patients then stood for 1 minute before performing the 6MWT. Following the 6MWT, patients were asked to sit, and BP, SpO 2 , and Borg RPE were assessed. Following at least 5 minutes of sitting, BP, SpO 2 , and Borg RPE were assessed again, and the timer and reader were stopped. Continuous PAP waveform processing was performed in LabVIEW Runtime version 2019 (National Instruments) (Figure 1A). Heart rate was derived from the PAP waveform. The 10-second periods before each minute in the test were averaged for both PAP and heart rate for the purposes of plotting and comparing timepoints within the test (Figure 1B). Data are reported as median with IQR. Changes in parameters were compared using repeated-measures Student's t-tests with a significance threshold of P < 0.05. Twelve subjects underwent the Cordella 6MWT with successful continuous PAP measurement. At baseline, the median age was 71.0 years (Q1-Q3: 68.5-74.8 years), 7 (58.3%) were male, and they had a median 6MWT of 370.0 m (Q1-Q3: 321.5-403.5 m). All had NYHA functional class III at baseline but had progressed to NYHA functional class II at the time of the 6MWT. Patients underwent the 6MWT protocol a median of 552 days (Q1-Q3: 379-1,054 days) from implant. The median distance walked was 336.0 m (Q1-Q3: 292.3-389.8 m). Measurement of all hemody-namic variables was feasible in all subjects during the entire study protocol, and PAP was continuously recorded for a minimum of 17 minutes in all cases. PA pressures and heart rate increased significantly during the 6MWT (systolic: þ29.2 mm Hg [Q1-Q3: 23.1-34.7 mm Hg]; diastolic: þ13.2 mm Hg [Q1-Q3: 9.9-16.4 mm Hg]; mean: þ21.1 mm Hg [Q1-Q3: 9.9-16.4 mm Hg]; heart rate: þ24.0 beats/min [Q1-Q3: 18.0-36.0 beats/min]; all values of P < 0.05) and What is the clinical question being addressed? Whether continuous, noninvasive PAP measurement during ambulatory exercise is feasible using an implantable PA sensor. What is the main finding? Continuous, noninvasive PAP measurement using the Cordella PA Sensor system is feasible in HF patients during exercise
Safety and efficacy of a wireless pulmonary artery pressure sensor: primary endpoint results of the SIRONA 2 clinical trial
No full textAbstract Aims Implantable pulmonary artery pressure (PAP) sensors have been shown to reduce heart failure hospitalizations (HFH) in selected patients. The goal of this study was to evaluate the safety and efficacy of a novel wireless PAP monitoring system in patients with heart failure (HF). Methods and results This is a prospective, multi‐centre, open‐label, single‐arm trial evaluating the safety and efficacy of the Cordella™ PA Sensor System including the comprehensive Cordella™ Heart Failure System (CHFS) in patients with New York Heart Association (NYHA) Class III heart failure with a heart failure hospitalization and/or increase of N‐terminal pro‐Brain Natriuretic Peptide (NT‐proBNP) within 12 months of enrolment. The primary efficacy endpoint was the accuracy of PA sensor mean PAP measurements, compared with fluid‐filled catheter mean PAP measurements obtained by standard right heart catheterization (RHC) at 90 days post‐implant, assessed in all patients with a successful implant. The primary safety endpoint was freedom from adverse events associated with use of the Cordella PA Sensor System through 30 days post‐implant, assessed in all patients who entered the cath lab for PA sensor implant. The PA sensor was successfully implanted in 70 patients. Equivalence between the PA sensor and RHC for mean pulmonary artery pressures was excellent with measurements confined within the equivalence bounds of −4.0 to 4.0 mmHg (mean PAP: 0.0 to 2.9 mmHg, P = 0.003). The device safety profile was excellent with 98.6% freedom from Device System Related Complications, defined as invasive treatment, device explant or death. There were no pressure sensor failures. Patients' adherence to daily measurement transmissions of PAP and vital signs was 94%. Conclusions This trial supports the safety and efficacy of the Cordella PA Sensor System and in conjunction with the CHFS enables comprehensive HF management in NYHA class III heart failure patients
Pitfalls in coronary artery stenosis assessment in takotsubo syndrome: The role of microvascular dysfunction
No full text
- …
