1,721,421 research outputs found
Thyroid disorders in Chronic Heart Failure: from prognostic set-up to therapeutic management.
No full textThyroid hormones have relevant activity at cardiac and vascular level, by influencing heart rate, myocardial excitability as well as inotropic and lusitropic status, systemic vascular resistance and blood pressure. Moreover, they interact with neuro-hormonal systems such as sympathetic nervous system and renin-angiotensin-aldosterone system thus also indirectly influencing cardiovascular function. Due to these effects, both hypothyroidism and hyperthyroidism, either in their overt or subclinical forms, can have an unfavourable impact in the setting of cardiovascular diseases. The aim of this review is to focus on the prognostic consequences of thyroid disorders in heart failure patients. Moreover, the therapeutical approach and the possible beneficial effects of restoring euthyroidism are reviewed
Introduction to the special issue: Relevance of endocrine and metabolic disorders in heart failure: from pathophysiology to therapeutic approach.
Full text linkDiabetes leading to heart failure and heart failure leading to diabetes: epidemiological and clinical evidence
No full textType 2 diabetes mellitus (T2DM) is a risk factor that plays a major role in the onset of heart failure (HF) both directly, by impairing cardiac function, and indirectly, through associated diseases such as hypertension, coronary disease, renal dysfunction, obesity, and other metabolic disorders. In a population of HF patients, the presence of T2DM ranged from 20 to 40%, according to the population studied, risk factor characteristics, geographic area, and age, and it is associated with a worse prognosis. Finally, patients with HF, when compared with those without HF, show an increased risk for the onset of T2DM due to several mechanisms that predispose the HF patient to insulin resistance. Despite the epidemiological data confirmed the relationship between T2DM and HF, the exact prevalence of HF in T2DM comes from interventional trials rather than from observational registries aimed to prospectively evaluate the risk of HF occurrence in T2DM population. This review is focused on the vicious cycle linking HF and T2DM, from epidemiological data to prognostic implications
Modelli urbani e modelli ecologici. Studio di un sistema informativo sui biotopi urbani.
No full textHeart failure in elderly: progress in clinical evaluation and therapeutic approach
No full textChronic heart failure (CHF) represents a major and growing health problem, due to its high incidence and prevalence, its poor prognosis and its impact on health-care costs. Although CHF patients are mainly elderly, few studies were aimed at testing the efficacy of diagnostic and therapeutic approaches in this population. The difficulty in CHF diagnosis among the elderly is related to different factors, such as: the frequent presence of co-morbidity conditions mimicking or masking heart failure signs and symptoms; the different diagnostic cut-offs of natriuretic peptides; and the need to correctly evaluate diastolic function in order to assess CHF with preserved ejection fraction. Furthermore, the therapy of elderly CHF patients has not been well defined, considering the few studies involving very aged patients and the absence of a therapeutic strategy demonstrated to improve prognosis of CHF patients with preserved ejection fraction. The aim of this review is to focus on the most recent issues concerning the diagnosis and therapy of elderly patients affected by CHF
Non-invasive evaluation of arrhythmic risk in dilated cardiomyopathy: From imaging to electrocardiographic measures
No full textMalignant ventricular arrhythmias are a major adverse event and worsen the prognosis of patients affected by ischemic and non-ischemic dilated cardiomyopathy. The main parameter currently used to stratify arrhythmic risk and guide decision making towards the implantation of a cardioverter defibrillator is the evaluation of the left ventricular ejection fraction. However, this strategy is characterized by several limitations and consequently additional parameters have been suggested in order to improve arrhythmic risk stratification. The aim of this review is to critically revise the prognostic significance of non-invasive diagnostic tools in order to better stratify the arrhythmic risk prognosis of dilated cardiomyopathy patients
The predictive value of plasma biomarkers in discharged heart failure patients: role of galectin-3
No full textOver the last years a number of new biomarkers reflecting different aspects of heart failure (HF) pathophysiology have been evaluated in order to improve diagnosis and to better define prognosis of patients. Among these, Galectin 3 (Gal-3) seems particularly promising. It is a soluble beta galactoside-binding lectin produced by activated macrophages which binds and activates the fibroblasts thus leading to the deposition of collagen into the extracellular matrix and to a progressive cardiac fibrosis. Gal-3 plays also an important regulatory role in inflammatory status. Experimental studies have demonstrated that it is involved in cardiac remodeling and that it is one of the main determinants of development and progression of HF. In humans, Gal-3 plasma levels are associated with the onset of HF in apparently healthy patients and have been found being predictors of a worse prognosis in acute (AHF) as well as in chronic heart failure (CHF). Furthermore, Gal-3 serum levels are strongly correlated with renal dysfunction thus suggesting a possible role in better characterizing cardiorenal syndrome. The aim of this review was to revise the available experimental and clinical data concerning the role of Gal-3 as prognostic marker in HF
The Paragon-HF trial: The sacubitril/valsartan in heart failure with preserved ejection fraction
No full textHeart failure (HF) with preserved ejection fraction (HFpEF) is a clinical condition characterized by large pathophysiology heterogeneity with lack of effective therapies as proven by the disappointing results generated by randomized controlled trials. The innovative therapeutic concept provided by sacubitril-valsartan, a molecule combining angiotensin receptor blocking agent and neprilysin inhibitor has suggested the hypothesis it would have led to a reduced risk of hospitalization for HF or death from cardiovascular causes among patients with HF and preserved ejection fraction. The PARAGON-HF (ClinicalTrials.gov number, NCT01920711) investigated HF subjects class II to IV HF, ejection fraction of 45% or higher, elevated level of natriuretic peptides, and structural heart disease to receive sacubitril-valsartan (target dose, 97 mg of sacubitril with 103 mg of valsartan twice daily) or valsartan (target dose, 160 mg twice daily). The trial missed the primary outcome of cardiovascular death and HF hospitalization (HFH) in the overall study population. A subgroup analysis addressed significant decrease of HFH in subjects with left ventricular ejection fraction below the median 57% value in the study. The data were consistent with previous post hoc analysis performed in studies where candesartan and spironolactone were investigated in HFpEF. Those results open the door to investigate angiotensin aldosterone and peptidases inhibition efficacy in the unexplored HF middle range ejection fraction, currently lacking of valid evidence
beta 1-Adrenergic receptor polymorphisms are correlated with exercise capacity in patients with idiopathic dilated cardiomyopathy
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