1,721,093 research outputs found
Prognostic relevance of comprehensive non-invasive imaging approach in a diabetic and non-diabetic asymptomatic population
Full text linkBackgroud: The aim of the study was to evaluate the incremental prognostic benefit of carotid artery disease and subclinical coronary artery disease (CAD) features in addition to clinical evaluation in a diabetic and non-diabetic asymptomatic population. Methods: Over a six-year period, 10-year-FRS together with carotid ultrasound (CUS) and coronary computed tomography angiography (CCTA) were evaluated for the prediction of major adverse cardiac events (MACE). Results: Five-hundred-seventeen consecutive patients were enrolled in the study, including 328 (63%) male with a mean age of 64±10 (SD). No diabetic patients were 426 (82.4%) and diabetic patients were 91 (17.6). Mean CACS was 16 [SD 0-88] in non-diabetic patients and 64 [SD 0-166] in diabetic patients (p<0.001). The patients with presence of CAD≥50% were 143 (27.7%), whom 105 (24.7%) non-diabetic and 38 (41.8%) diabetic (p=0.001). Over a median follow-up of 4.4 [3.4-5.1] years there were a total of 53 CHD events (10%) including 6 cardiac deaths (1.2%), 13 non-fatal myocardial infarction (2.5%), and 34 non ST elevation myocardial infarction (6.5%). Total events were 37 (7.1%) in non-diabetic population and 16 (17.6%) in diabetic population. The mean radiation dose during CCTA was 4.3±1.0 mSv with no difference between the two groups. The univariable analysis (Table 2) showed that hyperlipidemia, aspirin, carotid plaque, carotid disease, CAD ≥70%, % of segments with non calcific plaque, % of segments with mixed plaque, % of segments with remodeled plaque, and CACS was significant predictors of CHD events in non-diabetic population. Differently, in diabetic population only statins and % of segments with remodeled plaque were significant predictors of CHD events, while % of segments with mixed plaque did not reach statistical significance. On multivariable analysis in non-diabetic group, carotid disease was a significant independent predictor of CHD events when added to FRS (C-statistic, 95% CI: 0.62, 0.55-0.68; p=0.037). CACS were independent predictor when added to both FRS and carotid disease (C-statistic, 95% CI: 0.66, 0.60-0.73; p=0.016). CUS and CACS data were no more significant when CCTA parameters were included in the model, with the latter being the only significant independent predictors. In particular, % of segment with remodeled plaque was incremental independent predictor even when added to a model including the presence of CAD ≥70% (C-statistic, 95% CI: 0.84, 0.80-0.88; p<0.001). In diabetic group % of segments with remodeled plaque represented the only independent predictor of CHD events (C- statistic, 95% CI: 0.83, 0.77-0.87; p<0.001). Conclusions: In an asymptomatic at-risk population carotid disease assessment is able to predict MACE occurrence more accurately than traditional clinical scores and comparable to coronary calcium score. Coronary artery stenosis and plaque positive remodeling represent the most powerful tools of risk reclassification of this wide subset of patients. In the subgroup of diabetic subjects, the percentage of segments with remodeled plaque is the only
A case of suspected eosinophilic myocarditis recognized by a fully noninvasive approach and safely treated with corticosteroids despite an underling Hepatitis C virus-hepatitis
No full textHypereosinophilic syndrome can lead to acute myocarditis with a potentially severe systolic dysfunction and serious complications. A 75-year-old patient suffering from Hepatitis C virus (HCV) related-hepatitis came to our observation for idiopatic hypereosinophilic syndrome and acute severe cardiac systolic dysfunction without coronaropathy. Cardiac magnetic resonance showed a 'patchy' subendocardial and intramyocardial late gadolinium enhancement pattern often seen in eosinophilic myocarditis (EM). Assuming EM, appropriate corticosteroid therapy was initiated and it led to clinical remission. Despite endomyocardial biopsy (EMB) is the diagnostic gold standard for EM, in this case only a noninvasive integrated imaging approach was successfully attempted. Given an adequate clinical context, in our opinion EM can be correctly recognized without EMB and so promptly and safely treated with corticosteroids, even when an underling mild HCV-hepatitis is present
Cardiomyopathies and Psychiatric Disorders: An Overview and General Clinical Recommendations
Full text linkThe association between cardiomyopathies (CMPs) and psychiatric disorders is a complex and bidirectional phenomenon that involves multiple mechanisms and factors. CMPs may raise the risk of psychiatric disorders due to the psychological stress, physical limitations, social isolation, or poor prognosis associated with the underlying disease. Psychiatric disorders, on the other hand, can increase the possibility of developing or worsening CMPs due to the behavioral, neuroendocrine, inflammatory, or pharmacological effects of mental illness or its treatment. Moreover, some common genetic or environmental factors may have a relevant influence on both conditions. With this comprehensive review, we sought to provide an overview of the current evidence on the strict and intriguing interconnection between CMPs and psychiatric disorders, focusing on the epidemiology, pathophysiology, clinical implications, and management strategies
Adherence to Pharmacotherapy in Post-Menopausal Women with Hypertension or Metabolic Syndrome: Real World Experience
Full text linkBackground: Adherence to medications is dependent upon a variety of factors, including individual characteristics of the patient, interactions with health care providers, and medication complexity. Even though several studies were conducted to test intervention strategies, results are uncertain.
Aim: The aim of the study is to assess if a tailored combined intervention strategy improves medication adherence in a large population of post-menopausal women affected by hypertension or metabolic syndrome.
Methods: We enrolled 6833 patients aged 50 to 69 years, 85.7% with hypertension, and 14.3% with metabolic syndrome. A network between patients, general practitioners, and cardiologists was established. Interventions included education, adequate information to patients, a simplified scheme of treatment, and periodic adherence assessment. These were either delivered as healthcare provider supports or using modern technology. Medication adherence was estimated by the proportion of days covered for all classes of drugs after the index date.
Results: Non-adherent hypertensive women were 297 (5%), and those with metabolic syndrome were 73 (7.4%) (p < 0.02). Considering only patients with cardiomyopathy non-adherent were 234 (5.4%), while without cardiomyopathy 136 (5.3%); non-adherent hypertensive postmenopausal women with cardiomyopathy were 194 (5.2%), non-adherent postmenopausal women with metabolic syndrome and cardiomyopathy were 40 (7.2%) (p <0.04). Non-adherent hypertensive postmenopausal women without cardiomyopathy were 103 (4.9%), and non-adherent postmenopausal women with metabolic syndrome and without cardiomyopathy were 33 (7.7%) (p < 0.01).
Conclusions: The rate of non-adherence in both settings of postmenopausal women was 7.7%, much lower than that described in the literature. This rate was increased in patients with metabolic syndrome; probably it is related to the complexity of the therapeutic scheme or to a poor consciousness of the disease. Therefore, implementing a tailored combined intervention can improve significantly patients’ adherence to medical therapy
Addressing Endothelial Dysfunction in Heart Failure: The Role of Endothelial Progenitor Cells and New Treatment Horizons
Full text link: Heart failure (HF) is closely linked to endothelial dysfunction, which contributes significantly to its progression. Endothelial dysfunction in HF is marked by reduced nitric oxide bioavailability, increased oxidative stress and inflammation, all of which impair vascular function. Endothelial progenitor cells (EPCs) - vital for vascular repair - are particularly affected, with their dysfunction further exacerbating HF outcomes. Emerging therapies targeting these mechanisms, including antioxidants, gene therapies enhancing endothelial nitric oxide synthase activity and EPCbased strategies, hold promise. Recent advances show encouraging results, especially with treatments improving EPC mobilisation and function. Additionally, pharmacological agents such as statins and sodium-glucose cotransporter 2 inhibitors demonstrate pleiotropic benefits, enhancing endothelial health and EPC activity. This review emphasises the therapeutic potential of these approaches, highlighting the critical need for further research to optimise endothelial-targeted treatments and improve outcomes for HF patients
Multifocal Ectopic Purkinje-Related Premature Contractions Syndrome in R222Q-SCN5A Gene Mutation Carriers Treated With Flecainide
Full text linkA 21-year-old male patient with syncopal episodes and his 56-year-old father, with a family history of sudden cardiac death and dilated cardiomyopathy, were referred to our center.
Physical examination and laboratory investigations were normal. The father’s ambulatory electrocardiographic (ECG) abnormalities (Figures 1A and 1B) were poorly responsive to beta-blockers. The father’s cardiac imaging showed mild left ventricular dilation and systolic dysfunction with no myocardial fibrosis.
Catheter ablation of the right ventricle outflow tract (RVOT) was attempted, because of the prevalence of premature ventricle contractions at this level, and a regression of systolic dysfunction and dilation was observed (Figure 2), but no beneficial effect on the arrhythmic burden was obtained. Genetic testing was performed, revealing the R222Q-SCN5A gene mutation in both father and son, accountable for the rare multifocal ectopic Purkinje-related premature contractions (MEPPC) syndrome.1,2 Therefore, flecainide via oral route was started with complete
normalization of ECG (Figure 1C)
(Epicardial and microvascular) angina or atypical chest pain: differential diagnoses with cardiovascular magnetic resonance
Full text linkAngina pectoris is a chest discomfort caused by myocardial ischaemia, and it is classified as 'typical' or 'atypical' if specific features are present. Unfortunately, there is a heterogeneous list of cardiac diseases characterized by this symptom as onset sign. Mostly, angina is due to significant epicardial coronary artery stenosis, which causes inadequate oxygen supply increase after raised myocardial oxygen demand. In the absence of significant epicardial stenoses, another potential cause of angina is microvascular dysfunction, related to inadequate response of resistance coronary vessels to vasodilator stimuli. The unique capability of cardiovascular magnetic resonance (CMR) in providing extremely detailed morphological and functional information, along with precise stress perfusion defects and wall motion abnormalities depiction, translates it into the test with one of the best diagnostic performance and prognostic stratification among non-invasive cardiac imaging modality. Moreover, CMR is also extremely accurate in detecting non-ischaemic cardiac causes of chest pain (such as myocardial and pericardial inflammation, or stress-related cardiomyopathy), and is very useful in helping physicians to correctly approach patients affected by chest pain
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