1,721,055 research outputs found
[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
Cardiovascular prevention in a changing era [Prevenzione cardiovascolare nel cambiamento d'epoca]
No full textNon c’è dubbio che viviamo in un’epoca di grandi cambiamenti ed anche la società italiana ne risente profondamente. I media, vecchi e nuovi, ci riferiscono degli effetti perduranti della crisi economica del 2008 e della globalizzazione, spesso commentati con quella che viene detta “post-verità” – definita dalla Treccani come “argomentazione, caratterizzata da un forte appello all’emotività, che basandosi su credenze diffuse e non su fatti verificati tende a essere accettata come veritiera, influenzando l’opinione pubblica”1. Fortunatamente ci sono studiosi di scienze sociali ed economiche all’opera per capire ciò che sta succedendo e ipotizzare possibili scenari di azione ed alcuni hanno ripreso il concetto del “cambiamento d’epoca” (a solo titolo di esempio vedasi la referenza bibliografica 2). Questa premessa ci è sembrata importante per presentare la traduzione italiana delle linee guida europee 2016 sulla prevenzione delle malattie cardiovascolari (MCV) nella pratica clinica3, uno strumento rilevante per combattere, nel contesto attuale, quelle che rimangono in Italia la prima causa di mortalità (tasso standardizzato del 2014: negli uomini 37.3 per 10 000, nelle donne 26.6 per 10 0004) e di ricovero ospedaliero (14.5% di tutti i ricoveri, circa 1 000 000 di ricoveri su 6 400 000 nel 20155)
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
[2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism: what's new?]
No full textImpact of eGFR rate on 1-year all-cause mortality in patients with stable coronary artery disease
No full textCoronary artery disease (CAD) is a leading cause of mortality and is often complicated by chronic kidney disease. We sought to investigate the prevalence of different degree of estimated glomerular filtration rate (eGFR) reduction, the clinical and bio-humoral correlates, its relationship with therapeutic management, and its predictive role on 1-year all-cause mortality, in patients with stable CAD
Is the use of risk scores an indicator of guideline adherence for patients with acute coronary syndromes? Insights from the EYESHOT Registry
No full textLipoprotein(a): a risk factor for atherosclerosis and an emerging therapeutic target
No full textLipoprotein(a) (Lp(a)) is a complex circulating lipoprotein, and increasing evidence has demonstrated its role as a risk factor for atherosclerotic cardiovascular disease (ASCVD) and as a possible therapeutic target. Lp(a) atherogenic effects are attributed to several potential mechanisms in addition to cholesterol accumulation in the arterial wall, including proinflammatory effects mainly mediated by oxidised phospholipids. Several studies have found a causal and independent relationship between Lp(a) levels and cardiovascular risk. Furthermore, several studies also suggest a causal association between Lp(a) levels and calcific aortic valve stenosis. Available lipid-lowering agents have at best moderate impact on Lp(a) levels. Among available therapies, antibody proprotein convertase subtilisin/kexin type 9 inhibitors are the most effective in reducing Lp(a). Potent Lp(a)-lowering treatments that target LPA expression are under development. Lp(a) level measurement poses some challenges due to the absence of a definitive reference method and the reporting of Lp(a) values as molar (nanomoles per litre (nmol/L)) or mass concentrations (milligrams per decilitre (mg/dL)) by different assays. Currently, Lp(a) measurement is recommended to refine cardiovascular risk in specific clinical settings, that is, in individuals with a family history of premature ASCVD, in patients with ASCVD not explained by standard risk factors or in those with recurrent events despite optimal management of traditional risk factors. Patients with high Lp(a) levels should be managed with more intensive approaches to treat other modifiable cardiovascular risk factors. Overall, this review focuses on Lp(a) as an ASCVD risk factor and therapeutic target. Furthermore, it reports practical recommendations for Lp(a) measurement and interpretation and updated evidence on Lp(a)-lowering approaches
[Long COVID: nosographic aspects and clinical epidemiology]
No full text: Recent evidence shows that a range of persistent or new symptoms can manifest after 4-12 weeks in a subset of patients who have recovered from acute SARS-CoV-2 infection, and this condition has been coined long COVID by COVID-19 survivors among social support groups. Long COVID can affect the whole spectrum of people with COVID-19, from those with very mild acute disease to the most severe forms. Like the acute form, long COVID has multisystemic aspects. Patients can manifest with a very heterogeneous multitude of symptoms, including fatigue, post-exertional malaise, dyspnea, cognitive impairment, sleep disturbances, anxiety and depression, muscle pain, brain fog, anosmia/dysgeusia, headache, and limitation of functional capacity, which impact their quality of life. Because of the extreme clinical heterogeneity, and also due to the lack of a shared, specific definition, it is very difficult to know the real prevalence and incidence of this condition. Risk factors for developing long COVID would be female sex, initial severity, and comorbidities. Globally, with the re-emergence of new waves, the population of people infected with SARS-CoV-2 continues to expand rapidly, necessitating a more thorough understanding of potential sequelae of COVID-19. This review summarizes up to date definitions and epidemiological aspects of long COVID
[Treatment of heart failure in adult congenital heart disease]
No full textThe progressive shifting in adult patients with congenital heart disease (ACHD) epidemiology with aging and superimposed acquired cardiac pathology on top of complex congenital heart defects is leading to an increase of hospitalizations for heart failure (HF), which nowadays represents one of the main causes of death in this patient population. Although there is a theoretical evidence to support the use of conventional drugs indicated for the general population with HF, randomized controlled trials do often exclude ACHD patients. Anatomical and physiological heterogeneity makes it difficult to define the role of cardiac resynchronization, and indications are less established. Timing of assessment for heart transplantation is challenging and referral often occurs too late. The present review wants to offer a summary of current therapeutic strategies and discuss future perspectives for ACHD-related HF treatment
Impact of History of Depression on 1-Year Outcomes in Patients with Chronic Coronary Syndromes: An Analysis of a Contemporary, Prospective, Nationwide Registry
No full textDepression is common in patients with acute cardiovascular conditions and it is associated with adverse clinical events
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