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Renal Arterial Resistance Index
No full textThe kidney is a profusely vascularized organ which, unlike other organs, does not regulate renal blood flow (RBF) mainly by oxygen demand. Reflex (myogenic effect and tubular-glomerular feedback) and neurohormonal mechanisms modulate RBF and renal resistances by regulating the tone of afferent and efferent arterioles as well as that of the major resistance vessels in the kidneys. Arterial renal resistances are also influenced by a number of other pathophysiological factors, such as increased arterial stiffness, arterial atherosclerosis, renal parenchymal abnormalities, and intra-abdominal and central venous pressure. Finally, renal resistances can be permanently increased if a microvascular disease and vascular rarefaction occur as a result of vasoconstriction-related ischemia, endothelial dysfunction, and inflammatory cytokine activity.
In this setting, a parameter reflecting renal resistances could offer a useful tool to better characterize renal disease and the risk of progression. This chapter focuses on renal resistance index (RRI), a parameter obtained by pulsed Doppler which reflects renal arterial resistances. The possible clinical usefulness of RRI has been demonstrated in studies which show the pathophysiological correlates and prognostic role in predicting a greater risk of chronic kidney disease progression and cardiovascular events
Evaluation of chronic kidney disease in chronic heart failure: From biomarkers to arterial renal resistances
No full textChronic kidney disease and its worsening are recurring conditions in chronic heart failure (CHF) which are independently associated with poor patient outcome. The heart and kidney share many pathophysiological mechanisms which can determine dysfunction in each organ. Cardiorenal syndrome is the condition in which these two organs negatively affect each other, therefore an accurate evaluation of renal function in the clinical setting of CHF is essential. This review aims to revise the parameters currently used to evaluate renal dysfunction in CHF with particular reference to the usefulness and the limitations of biomarkers in evaluating glomerular dysfunction and tubular damage. Moreover, it is reported the possible utility of renal arterial resistance index (a parameter associated with abnormalities in renal vascular bed) for a better assesment of kidney disfunction
Stato infiammatorio sistemico e prognosi intraospedaliera nei pazienti conn infarto miocardico senza sopraslivellamento del trattao ST
No full textStatins: pharmacokinetics, pharmacodynamics, and cost-effectiveness analysis.
No full textAbstract
Cardiovascular diseases secondary to atherosclerosis are the primary causes of early death and disability worldwide and dyslipidaemia represents one of the most important modifiable risk factors. Among lipid abnormalities that define it, low-density lipoprotein cholesterol (LDL-C) is the primary target of therapy, since multiple randomized controlled trials have shown the positive impact of its reduction on atherosclerosis development. For their ability to lower LDL-C levels, statins are the most studied drugs in cardiovascular disease prevention, of proven utility in slowing the progression or even determining regression of atherosclerosis. In addition, they have ancillary proprieties, with positive effects on the mechanisms involved in the development of atherosclerosis and cardiovascular morbidity and mortality, the so called "pleiotropic mechanisms". Although sharing the same mechanism of action, the different chemical and pharmacological characteristics of each kind of statins affect their absorption, bioavailability, plasma protein binding properties, excretion and solubility. In this overview, we analysed pharmacokinetic and pharmacodynamic mechanisms of this class of drugs, specifying the differences among the molecules, along with the economic aspects. Detailed knowledge of characteristics and differences of each kind of available statin could help the physician in the correct choice, based also on patient's clinical profile, of this essential tool with a demonstrated high cost-effectiveness both in primary than in the secondary prevention of cardiovascular disease
Clinical predictors of head-up tilt test outcome during the nitroglycerin phase
No full textOBJECTIVES: Nitrate-stimulated head-up tilt testing (HUT) is currently recommended to confirm the diagnosis of vasovagal syncope in subjects with syncope of unknown origin. Given the few data currently available, the aim of this study was to assess correlations between nitrate-induced HUT outcomes and the clinical characteristics of patients.
METHODS: Two hundred and thirty consecutive, otherwise healthy subjects with a history of recurrent unexplained syncope underwent HUT. After 10 min supine rest, they were tilted to 70 degrees , and the test was potentiated by the administration of 300 microg of nitroglycerin after 20 min.
RESULTS: Out of 178 subjects who underwent nitroglycerin administration during HUT, 95 fainted. At univariate Cox regression analysis, a reduced probability of VVS occurrence after nitrates was associated with greater systolic blood pressure and body mass index values, to male gender and smoking. At multivariate Cox regression analysis, only male gender (HR = 0.61; P = 0.039) and smoking (HR = 0.18; P = 0.001) remained significantly associated with HUT outcomes during the pharmacological phase of the test.
INTERPRETATION: Smokers and males are less likely to faint after nitrate administration during HUT than non-smokers and females. Further studies should clarify the possibility of improving the diagnostic power of HUT in these patients
Efficacy and Safety of Direct Oral Anticoagulants in Patients With Atrial Fibrillation and High Thromboembolic Risk. A Systematic Review.
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Background: The aim of the study was to evaluate the efficacy and safety of direct oral anticoagulants (DOACs) in a subgroup of patients with atrial fibrillation (AF), CHADS2 score ≥3, advanced age, and heart failure (HF) coming from the main DOACs randomized clinical trials.
Methods: We searched MEDLINE, MEDLINE In-Process, and Other Non-Indexed Citations, EMBASE, PubMed, and the Cochrane Central Register of Controlled Trials. English-language articles published from 2002 to March 2019 dealing with DOACs for preventing thrombotic events in AF were considered. We did not conduct any statistical analyses, as indirect comparison between DOACs represents hypothesis generators.
Results: This systematic review was restricted to the subgroup of patients with CHADS2 score ≥3 (n = 31,203), elderly (n = 24,788), and with HF (n = 29,297) derived from the pivotal trials. Risk index (RI) was calculated. The RI for stroke/systemic embolism was similar in all of the patients treated with DOACs or warfarin. The lowest RI was in rivaroxaban patients (CHADS2 score ≥3: RI = 0.04; elderly: RI = 0.09; HF: RI = 0.05). The RIs for bleeding were higher in patients treated with dabigatran (CHADS2 score ≥3: RI110 = 0.23; elderly: RI110 = 0.22; HF: RI110 = 0.16; CHADS2score ≥3: RI150 = 0.30; elderly: RI150 = 0.24; HF: RI150 = 0.16). The bleeding RIs were higher with apixaban (CHADS2 score ≥3: RI = 0.23; elderly: RI = 0.25; HF: RI = 0.14) and dabigatran (CHADS2 score ≥3: RI = 0.28; elderly: RI = 0.21; HF: RI = 0.19).
Conclusions: The use of DOACs is a reasonable alternative to vitamin K antagonists in AF patients with CHADS2 score ≥3, advanced age, and HF. The RI constitutes a useful, additional tool to facilitate clinicians in choosing DOACs or warfarin in particular category of AF patients
The role of N-terminal pro-B type natriuretic peptide in subjects with idiopathic sudden sensorineural hearing loss: a paradigm of its vascular function.
No full textB type natriuretic peptide (BNP) and N-terminal pro-B type natriuretic peptide (NT-pro-BNP) are well known markers of cardiac function,1 released by cardiomyocytes and cardiac fibroblasts, after the stretch and the hypoxic stimulus.1–4 The vascular damage and subsequent hyp- oxic insult is one of the most accredited etiopathogenetic theories5,6 of Idiopathic Sudden Sensorineural Hearing Loss (ISSHL), defined as a hearing loss of at least 30 dB over three contiguous test frequencies occurring within a 72-h period.7 Aim of our study was to analyze the role of NT-pro-BNP in subjects with ISSHL in order to under- stand more about the ISSHL pathological mechanism
La Flebologia Emodinamica
No full textLo studio emodinamico flebologico degli arti inferiori non può prescindere da un approccio biomeccanico e successivamente posturologico del soggetto flebopatico
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