1,721,090 research outputs found
Letter by Gronda et al Regarding Article, “Effect of Empagliflozin on Worsening Heart Failure Events in Patients With Heart Failure and Preserved Ejection Fraction: EMPEROR-Preserved Trial”
No full textN/
Cardiology as seen through social media
No full textThe use of social media (SoMe) has spread worldwide among doctors, scientific societies, and researchers. SoMe offer a powerful platform to accelerate or create new contacts, spread scientific news, and increase visibility. A social media promotion strategy for cardiovascular medicine papers seems to be associated with increased online visibility and a higher number of citations. This effect is independent of the type of article and the total number of followers of the authors. Indeed, SoMe are democratic and even non-senior researchers may be popular on Twitter: your title is not as important as what you do on Twitter. Nevertheless, some physicians may be over-celebrated due to their presence on SoMe. This is why a new author index, the K-index, has been proposed. The K-index correlates the citations of a scientist with the number of Twitter followers. Even scientific journals and societies have recognized the importance of SoMe and in the last years they have appeared on SoMe with official accounts. Therefore, besides the classic impact factor, publishers now pay more and more attention to other parameters, such as the Altmetric score, which takes into account the number of citations, but also the number of downloads, mentions on SoMe, newspapers and tv news, web sites, and blogs. The COVID-19 pandemic has boosted the importance of SoMe for scientific content distribution, particularly for congresses. For all these reasons, it is important to understand the pros and cons of SoMe. It is also possible that SoMe will become a new education medium for continuing medical education
A new prognostic index for acute heart failure and non- arrhythmic death in subjects with a cardiac defibrillator and ischemic cardiomyopathy
No full textSubjects suffering from ischemic cardiomyopathy receiving a defibrillator (ICD) are still at high risk of heart failure and non-arrhythmic death. Predictors of increased risk are lacking in these patients. In a preliminary study in patients receiving an ICD for MADIT II criteria we found that age, 24 hour Systolic blood pressure, measured by Ambulatory blood pressure monitoring and creatinine, were independent predictors for acute decompensated heart failure and cardiac non arrhythmic death, while ejection fraction (EF), evaluated by 2D echo, was not predictive. In the present study we combined the same predictor factors in a Prognostic Index (PI) built according to the formula: 120 - age + m24hSBP - (creatinine*10). This PI was prospectively evaluated in 192 patients (all with ICD for MADIT II criteria and ischemic cardiomyopathy) for the combined endpoint of non-arrhythmic death and hospitalization for acute heart failure, in one year follow-up. Other variables assessed included EF, hemoglobin concentration, 24 hour mean heart rate, sodium levels, biventricular pacing and diabetes. We have registered 48 events (25%) in one year follow-up: 7 cardiac deaths and 41 hospitalizations for acute heart failure. The Cox multivariate analysis showed that low values of PI are the only independent predictor of events ( HR= 0.96; CI 95% 0.944-0.976, p 0.0001). Interestingly, in these patients with reduced ventricular function, EF was not predictive of new events, while PI was significantly associated with new events (acute heart failure and non arrhythmic death). PI is easy to calculate and could be applied in clinical practice to stratify this very high risk population
Current use of echocardiography in cardio-oncology: nationwide real-world data from an ANMCO/SIECVI joint survey
No full textAims: The need for cardio-oncology competencies is constantly growing, and with the establishment of cardio-oncology services, cardiovascular imaging, particularly transthoracic echocardiography (TTE), has become pivotal in patients' management. However, care pathways for oncologic patients largely depend on local health structures' resources. This survey from Associazione Italiana Medici Cardiologi Ospedalieri and the Italian Society of Echocardiography and Cardiovascular Imaging aimed at investigating the use of echocardiography in cardio-oncology services and knowledge levels on cancer patients' care. Methods and results: Data were obtained via an electronic survey based on a structured questionnaire uploaded to the promoting societies' websites. Responses came from 159 centres with echocardiography. According to one-third of participating centres, workload related to cancer patients represented >30% of the total requests. The most common TTE indication (85%) was left ventricular ejection fraction (LVEF) evaluation. Many centres (55%) still assessed LVEF solely by bidimensional method or visual estimation in case of inadequate acoustic windows. At the same time, almost 40% of centres reported routinely using global longitudinal strain when feasible. We further performed a sub-analysis according to the presence (33%) or absence (77%) of dedicated cardio-oncologists, revealing significant differences in cardiovascular surveillance strategies and cardiotoxicity management. Conclusion: This survey on echocardiography practice for cancer patients reveals a significant gap between actual clinical practice and standards proposed by recommendations, underlying the need for stronger partnerships between cardiologists and oncologists and dedicated, well-structured cardio-oncology services
[Cardio-oncogeriatrics: ANMCO position paper on cardio-oncology management of elderly patients]
No full textGeriatric patients are an increasing population and cancer treatment in this population is a challenging and unsolved issue. Ageing is characterized by low-grade inflammation (inflamm-ageing), an important driver for age-related diseases such as cardiovascular diseases and cancer. These chronic conditions share pathophysiological bases, risk factors and may coexist. The burden of comorbidities lowers the threshold for cardiotoxic effects of oncologic treatments. Geriatric assessment is helpful in identifying the peculiar vulnerabilities of this complex population, but a multidisciplinary approach (with oncologists and cardio-oncologists) is needed to improve the appropriateness of care. In this ANMCO position paper, we define the role of cardio-oncologists in the different scenarios of older cancer patients (active cancer, long-term survivors), the importance of geriatric assessment, the unmet needs of survivors and the complexity of comorbidity management
High-density mapping of Koch's triangle during sinus rhythm and typical atrioventricular nodal re-entrant tachycardia, integrated with direct recording of atrio-ventricular node structure potential
No full textBackground: The mechanism of typical slow-fast atrioventricular nodal re-entrant tachycardia (AVNRT) and its anatomical and electrophysiological circuit inside the right atrium (RA) and Koch's Triangle (KT) are not well known. Objective: To identify the potentials of the compact AV node and inferior extensions and to perform accurate mapping of the RA and KT in sinus rhythm (SR) and during AVNRT, to define the tachycardia circuit. Methods: Consecutive patients with typical AVNRT were enrolled in 12 Italian centers and underwent mapping and ablation by means of a basket catheter with small electrode spacing for ultrahigh-density mapping and a modified signal-filtering toolset to record the potentials of the AV nodal structures. Results: Forty-five consecutive cases of successful ablation of typical slow-fast AVNRT were included. The mean SR cycle length (CL) was 784.1 ± 6 ms and the mean tachycardia CL was 361.2 ± 54 ms. The AV node potential had a significantly shorter duration and higher amplitude in sinus rhythm than during tachycardia (60 ± 40 ms vs. 160 ± 40 ms, p <.001 and 0.3 ± 0.2 mV vs. 0.09 ± 0.12 mV, p <.001, respectively). The nodal potential duration extension was 169.4 ± 31 ms, resulting in a time-window coverage of 47.6 ± 9%. The recording of AV nodal structure potentials enabled us to obtain 100% coverage of the tachycardia CL during slow-fast AVNRT. Conclusion: Detailed recording of the potentials of nodal structures is possible by means of multipolar catheters for ultrahigh-density mapping, allowing 100% of the AVNRT CL to be covered. These results also have clinical implications for the ablation of right-septal and para-septal arrhythmias
[Pregnancy and heart disease: the role of the Pregnancy Heart Team]
No full text: A significant risk of maternal and fetal morbidity and mortality has been shown to be associated with congenital heart disease or heart disease occurring during pregnancy. Given the increasing number of patients with corrected congenital heart disease who reach fertile age and the more and more common advanced maternal age associated with preexisting or intercurrent comorbidities, a higher incidence of cardiac complications in pregnancy has been reported in the last decades. Improvement in maternal and neonatal outcomes is influenced by a multidisciplinary strategy. The purpose of this review is to assess the role of the Pregnancy Heart Team which should ensure careful pre-pregnancy counseling, pregnancy monitoring, and delivery planning for both congenital heart disease and other cardiac or metabolic disorders
ANMCO (Italian Association of Hospital Cardiologists) scientific statement: obesity in adults—an approach for cardiologists
No full textObesity is a complex, chronic disease requiring a multidisciplinary approach to its management. In clinical practice, body mass index and waist-related measurements can be used for obesity screening. The estimated prevalence of obesity among adults worldwide is 12%. With the expected further increase in overall obesity prevalence, clinicians will increasingly be managing patients with obesity. Energy balance is regulated by a complex neurohumoral system that involves the central nervous system and circulating mediators, among which leptin is the most studied. The functioning of these systems is influenced by both genetic and environmental factors. Obesity generally occurs when a genetically predisposed individual lives in an obesogenic environment for a long period. Cardiologists are deeply involved in evaluating patients with obesity. Cardiovascular risk profile is one of the most important items to be quantified to understand the health risk due to obesity and the clinical benefit that a single patient can obtain with weight loss. At the individual level, appropriate patient involvement, the detection of potential obesity causes, and a multidisciplinary approach are tools that can improve clinical outcomes. In the near future, we will probably have new pharmacological tools at our disposal that will facilitate achieving and maintaining weight loss. However, pharmacological treatment alone cannot cure such a complex disease. The aim of this paper is to summarize some key points of this field, such as obesity definition and measurement tools, its epidemiology, the main mechanisms underlying energy homeostasis, health consequences of obesity with a focus on cardiovascular diseases and the obesity paradox. Level of evidence V: report of expert committees
[Post-cardiac arrest syndrome: definition, pathophysiology, and management]
No full text: The post-cardiac arrest syndrome is a delicate, critical and complex condition that involves most patients resuscitated by a cardiac arrest. The main pathophysiological mechanism of this syndrome is a widespread ischemia-reperfusion damage, then there are other pathological alterations involving various organs which, if untreated, can evolve into multiorgan dysfunction. For this reason, a series of diagnostic-therapeutic actions (bundles) are necessary to ensure a correct management of the post-cardiac arrest syndrome: adequate oxygenation and ventilation, hemodynamic stabilization, temperature control, early prediction of neurological outcome, optimization of metabolic aspects, indication and timing of coronary angiography. The management of the post-cardiac arrest syndrome, the fifth link in the chain of survival, consists of a set of early, complex and multidisciplinary interventions, which must be promptly started, immediately after a return of spontaneous circulation, regardless of the location of cardiac arrest presentation, and it aims to obtain a good hemodynamic and neurological recovery. In this review, we will address the most recent scientific recommendations in the various areas of management of post-cardiac arrest syndrome that have led in recent years to a change in the practical approach to the comatose patient after cardiac arrest
- …
