1,720,991 research outputs found
Risk stratification in secondary cardiovascular prevention
No full textWorldwide, more than 7 million people experience acute myocardial infarction (AMI) every year (1), and although substantial reduction in mortality has been obtained in recent decades, one-year mortality rates are still in the range of 10%. Among patients who survive AMI, 20% suffer a second cardiovascular event in the first year and approximately 50% of major coronary events occur in those with a previous hospital discharge diagnosis of AMI (2). Despite the evidence that lifestyle changes and risk factors management strongly improve long-term prognosis, preventive care post-AMI remains sub-optimal. Cross-sectional data from the serially conducted EUROASPIRE surveys in patients with established ischemic heart disease (IHD) and people at high cardiovascular risk have demonstrated a high prevalence of unhealthy lifestyle, modifiable risk factors and inadequate use of drug therapies to achieve blood pressure and lipid goals (3). Secondary prevention programmes, defined as the level of preventive care focusing on early risk stratification, are highly recommended in all IHD patients, to restore quality of life, maintain or improve functional capacity and prevent recurrence
Prediction of cardiovascular events using risk scores or electrocardiogram: A farewell to arms
No full textTheranostic biomarkers in hypertrophic cardiomyopathy: insights in a long road ahead
No full textThe study of biomarkers and their related signalling pathways has allowed the development of new therapeutic strategies in a range of disorders. However, in hypertrophic cardiomyopathy (HCM), which is the most common hereditary cardiac disease, there are many potential biomarkers described, but their specificity and applicability for HCM remains an open field. The aim of the present review is to provide an overview of molecules that could give some insight into the pathophysiologic mechanisms underlying HCM, especially to those with "theranostic" - a combination of diagnostics and therapy - potential. The clinical and pre-clinical state of the art and theranostic perspectives of this topic will be part of the current discussion. The better understanding of this subject would provide an algorithm, to optimize the integration of diagnosis, prognostics and therapeutics findings in HCM, leading to a tailored approach for this pathology
Cardiotoxicity in oncology and coronary microcirculation: future challenges in theranostics
No full textMany of the patients undergoing chemotherapy or radiotherapy for cancer are at increased risk of developing cardiovascular diseases. Recent evidence suggests that cardiac dysfunction and subsequent heart failure are mainly due to vascular toxicity rather than only to due to myocyte toxicity. However, not all of the vascular toxicity of cancer therapies can be explained by epicardial coronary artery disease. In fact, in the last decades, it has been found that myocardial ischemia may occur as a consequence of structural or functional dysfunction of the complex network of vessels, which cannot be seen by a coronary angiography: the coronary microcirculation. Nowadays many diagnostic and therapeutic options are available both in coronary microvascular dysfunction and cardio-oncology. Aim of this review is to suggest future theranostic implications of the relationship between cardiotoxicity in oncology and coronary microvascular dysfunction, showing common pathophysiologic mechanisms, proposing new diagnostic approaches and therapeutic options for cardioprotection
Multifractal-Multiscale Analysis of Cardiovascular Signals: A DFA-Based Characterization of Blood Pressure and Heart-Rate Complexity by Gender
No full textDetrended Fluctuation Analysis (DFA) is a popular method for assessing the fractal characteristics of biosignals, recently adapted for evaluating the heart-rate multifractal and/or multiscale characteristics. However, the existing methods do not consider the beat-by-beat sampling of heart rate and have relatively low scale resolutions and were not applied to cardiovascular signals other than heart rate. Therefore, aim of this work is to present a DFA-based method for joint multifractal/multiscale analysis designed to address the above critical points and to provide the first description of the multifractal/multiscale structure of interbeat intervals (IBI), systolic blood pressure (SBP), and diastolic blood pressure (DBP) in male and female volunteers separately. The method optimizes data splitting in blocks to reduce the DFA estimation variance and to evaluate scale coefficients with Taylor’s expansion formulas and maps the scales from beat domains to temporal domains. Applied to cardiovascular signals recorded in 42 female and 42 male volunteers, it showed that scale coefficients and degree of multifractality depend on the temporal scale, with marked differences between IBI, SBP, and DBP and with significant sex differences. Results may be interpreted considering the distinct physiological mechanisms regulating heart-rate and blood-pressure dynamics and the different autonomic profile of males and females
Multifractal multiscale dfa of cardiovascular time series: Differences in complex dynamics of systolic blood pressure, diastolic blood pressure and heart rate
No full textThe heart-rate fractal dynamics can be assessed by Detrended Fluctuation Analysis (DFA), originally proposed for estimating a short-term coefficient, α1(for scales nâ¤12 beats), and a long-term coefficient α2(for longer scales). Successively, DFA was extended to provide a multiscale α, i.e. a continuous function of n, α(n); or a multifractal α, i.e. a function of the order q of the fluctuations moment, α(q). Very recently, a multifractal-multiscale DFA was proposed for evaluating multifractality at different scales separately. Aim of this work is to describe the multifractal multiscale dynamics of three cardiovascular signals often recorded beat by beat in physiological and clinical settings: systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse interval (PI, inverse of the heart rate). We recorded SBP, DBP and PI for at least 90â2 in 65 healthy volunteers at rest, and adapted the previously proposed multifractal multiscale DFA to estimate α as function of the temporal scale, Ï, between 15 and 450 s, and of the order q, between -5 and 5. We report, for the first time: 1) substantial differences among α(q,Ï) surfaces of PI, SBP and DBP; 2) a strong dependency of the degree of multifractality on the temporal scale
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Hemodynamic and Autonomic Response to Different Salt Intakes in Normotensive Individuals
Full text linkBackground: Even if sodium sensitivity represents a risk factor at any blood pressure (BP) level, limited evidence is available that it may influence cardiovascular control in normotensives, particularly in white individuals. Therefore, the aim of the study was to investigate whether sodium sensitivity alters hemodynamic or autonomic responses to salt in normotensives. Methods and Results: We evaluated the Sodium-Sensitivity Index (SS-Index) in 71 white normotensives after 5 days of high- and low-sodium diets. We measured BP continuously at the end of each period, estimating hemodynamic indices from BP waveform analysis, and autonomic indices from heart rate (HR) and BP variability. According to the SS-Index distribution, we defined 1 sodium-sensitive group (SS, with SS-Index >15 mm Hg/[mmol·day]), 1 sodium-resistant group, (unresponsive to sodium load with -15≤ SS-Index ≤+15), and 1 inverse sodium-sensitive group, responsive to sodium by decreasing BP, with SS-Index <-15). We compared the effects of the diets among groups, and correlated autonomic/hemodynamic indices with the SS-Index. After sodium loading, a significant decrease in systemic peripheral resistances, HR, spectral indices of BP modulation, and a significant increase of indices of HR vagal modulation were found in the inverse sodium-sensitive group but not in SS normotensives. Moreover, the highest SS-Indices were associated with the lesser vagal HR decelerations. Conclusions: Our data suggest that salt sensitivity in white normotensive individuals is associated with impaired vasodilation and altered autonomic response to dietary salt. Such dysfunction may critically contribute to induce a BP response to dietary salt
Heart Rate Fractality Disruption as a Footprint of Subthreshold Depressive Symptoms in a Healthy Population
Full text linkOBJECTIVE: Psychopathology (and depression in particular) is a cardiovascular risk factor independent from any co-occurring pathology. This link is traced back to the mind-heart-body connection, whose underlying mechanisms are still not completely known. To study psychopathology in relation to the heart, it is necessary to observe the autonomic nervous system, which mediates among the parts of that connection. Its gold standard of evaluation is the study of heart rate variability (HRV). To investigate whether any association exists between the HRV parameters and sub-threshold depressive symptoms in a sample of healthy subjects. METHOD: In this cross-sectional study, two short-term HRV recordings (5 min - supine and sitting) have been analyzed in 77 healthy subjects. Here we adopted a three-fold approach to evaluate HRV: a set of scores belonging to the time domain; to the frequency domain (high, low, and very low frequencies) and a set of ‘nonlinear’ parameters. The PHQ-9 (Patient Health Questionnaire-9) scale was used to detect depressive symptoms. RESULTS: Depressive symptoms were associated only with a parameter from the non-linear approach and specifically the long-term fluctuations of fractal dimensions (DFA-α2). This association remained significant even after controlling for age, gender, BMI (Body-Mass-Index), arterial hypertension, anti-hypertensive drugs, dyslipidemia, and smoking habits. Moreover, the DFA-α2 was not affected by the baroreflex (postural change), unlike other autonomic markers. CONCLUSIONS: Fractal analysis of HRV (DFA-α2) allows then to predict depressive symptoms below the diagnostic threshold in healthy subjects regardless of their health status. DFA-α2 may be considered as an imprint of subclinical depression on the heart rhythm
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