1,721,136 research outputs found
Sport-related Takotsubo Syndrome: a review of case-reports
No full textScientific literature describes physical exercise as one of the potential triggering factors of Takotsubo Syndrome (TTS), an acute stress-induced clinical entity characterized by transient myocardial dysfunction. Acute exercise represents a paradigmatic example of a stress event, able to activate the hypothalamic-pituitary-adrenal axis and the autonomic sympathetic nervous system. The consequent release of catecholamine has the aim to improve physical and mental performance. In predisposed individuals, the surge in catecholamine levels associated with exercise may trigger the onset of TTS. Clinical cases showing TTS following sport participation are increasingly been reported. The diagnosis of TTS should be taken into account when dealing with a patient presenting with chest pain and/or dyspnea, slight increase in troponin levels, left ventricular dysfunction, and normal coronary arteries, after participation to sport activities. The present review describes case-reports of sport-related TTS. Demographics characteristics, medical history, symptoms at presentation, values of laboratory parameters, findings on electrocardiogram, transthoracic echocardiography, chest X-ray, coronary angiography, and cardiac magnetic resonance as well as patients' management and outcomes are summarized
Calculated haemorheological profile and laboratory parameters in new diagnosed multiple myeloma patients: retrospective analysis according to survival
Full text linkBackground: Multiple myeloma is a malignant haematological neoplasm characterised by clonal proliferation of plasma cells, with a complex clinical picture, and a significant impact on patient survival, in which the prognosis evaluation of patients is of great importance. Objectives: In this single-centre retrospective analysis, performed in a group of newly diagnosed multiple myeloma patients, we examined several clinical and laboratory parameters in order to evaluate their trend according to survival of patients. Design: We collected data from 190 newly diagnosed multiple myeloma evaluated at the Hematology Division of the ‘Paolo Giaccone’ University Hospital of Palermo from 1 January 2017 to 30 September 2022. Specifically, we performed our analysis in the entire cohort of patients and also in the specific disease isotype. Methods: We evaluated simple and low-cost laboratory and haemorheological parameters, the latter obtained in a calculated way. The primary endpoint was to evaluate the trend and the differences of these parameters in the study population, divided into two specific groups, deceased and survivors after a specific observation period of almost 7 years. Results: In the entire cohort of multiple myeloma patients, we observed a mortality rate of 40%, of whom 36.4% were men and 43.1% were women. Among the patients who died, in comparison with those who survived, it is significantly evident the increase in age, in red cell distribution width (RDW), RDW%/albumin ratio and in the RDW%/haemoglobin ratio; moreover, in the same patients subgroup, we observed a reduction in haematocrit, total serum protein, calculated whole blood viscosity (evaluated according to the de Simone formula), serum albumin, albumin/fibrinogen ratio and in haemoglobin levels. Conclusion: The obtained data can represent a possible starting point for subsequent targeted analyses, aimed at studying the prognostic value of each individual parameter considered, favouring an increasingly complete and immediate prognostic evaluation of patients
Comparison between whole blood viscosity measured and calculated in subjects with monoclonal gammopathy of undetermined significance and in patients with multiple myeloma: Re-evaluation of our survey
Full text linkBACKGROUND: in this study, with a re-evaluation of the hemorheological determinants previously described in MGUS subjects and in MM patients, we have detected the calculated whole blood viscosity, according whether to the hematocrit and total plasma protein concentration (de Simone formula) or to the haematocrit and plasma fibrinogen level (Merrill formula), and a marker of the erythrocyte aggregation (albumin/fibrinogen level).METHODS: data were expressed as means +/- standard deviation. Student's t test for unpaired data was used to compare MGUS subjects and MM patients. The correlation coefficient between mean erythrocyte aggregation (MEA) and hematocrit (Ht) was evaluated in MGUS, MM and MGUS + MM groups using the Spearman test.RESULTS: the comparison between MGUS and MM shows that the measured blood viscosity and calculated blood viscosity based on hematocrit and total plasma protein, but not which estimated in relation to the hematocrit and plasma fibrinogen, differentiate the two groups. A difference between the two groups also regards the measured erythrocyte aggregation and its surrogate marker. In addition, the measured plasma viscosity at low shear rate (0.51 s(-1)) and, in particular, the ratio between plasma viscosity at low (0.51 s(-1)) and high (450 s(-1)) shear rates distinguish MGUS and MM.CONCLUSIONS: calculated blood viscosity (de Simone formula and other formulas) and the surrogate marker of erythrocyte aggregation disclose an alike trend with the corresponding hemorheological determinants obtained by using their direct measurement
Neutrophil/HDL-C, Lymphocyte/HDL-C and Monocyte/HDL-C in subjects with asymptomatic carotid atherosclerosis
No full textBackground: Leukocyte count is a prognostic marker for cardiovascular diseases, with key role in atherosclerosis development. Specific number of neutrophils, lymphocytes and monocytes can predict cardiovascular risk, also in asymptomatic subjects. Among the lipoprotein fractions, HDL-C is a protective factor in the cardiovascular disorders. For the above reason, we have examined the peripheral count of leukocytes, neutrophils, lymphocytes and monocytes, and the ratios between neutrophils/HDL-cholesterol, lymphocytes/HDL-cholesterol, and monocytes/HDL-cholesterol, to evaluate the possible utility of the obtained values in progression of asymptomatic carotid atherosclerosis. Methods: We performed our analysis in a cohort of 100 subjects with asymptomatic carotid atherosclerosis, of which 43 men and 57 women. The data were expressed as medians and IQR. To analyse the differences in leukocyte, neutrophil, lymphocyte, monocytes count and their ratio with HDL-cholesterol the Mann-Whitney test was employed. Results: The peripheral count of leukocyte subtypes and the ratios, they change in relation to the number of cardiovascular risk factors and the degree of insulin resistance. Conclusions: In this cohort of subjects, the percentage of observed cardiovascular risk factors significantly affect some leukocyte parameters. These results, allow us to underline the importance of the leukocyte indices in the evaluation of subjects with asymptomatic vascular atherosclerosis
Uric acid and uric acid/creatinine ratio and their correlations with the hemorheological determinants in subjects with subclinical carotid atherosclerosis
No full textBACKGROUND AND OBJECTIVE: we have examined the concentration of serum uric acid and the serum uric acid/creatinine ratio as well as their correlations with the main determinants of the hemorheological profile in a group of subjects with subclinical carotid atherosclerosis.METHODS: we evaluated the concentration of serum uric acid and the serum uric acid/creatine ratio in 43 men and 57 women [median age 66.00 (25)] with subclinical carotid atherosclerosis, subsequently divided according to the number of traditional cardiovascular risk factors and to the insulin resistance degree.RESULTS: serum uric acid, but not the serum uric acid/creatinine ratio, results strongly influenced by the number of cardiovascular risk factors and by the insulin resistance degree. In the whole group and in the subgroups of subclinical carotid atherosclerosis subjects, serum uric acid and serum uric acid/creatinine ratio show significant correlation, besides with whole blood viscosity, with plasma viscosity and erythrocyte aggregation. The influence of the serum uric acid on the erythrocyte aggregability that is a part of the erythrocyte aggregation is to ascribe to the action carried out by serum uric acid on the erythrocyte zeta potential.CONCLUSIONS: it is reasonable to think that the treatment of the asymptomatic or symptomatic hyperuricemia with the urate-lowering therapy that reduces the serum uric acid concentration may reflect on the hemorheological profile which role on the atherosclerotic cardiovascular disease is well known
Association between Tpeak-Tend/QT and major adverse cardiovascular events in patients with Takotsubo syndrome
No full textBackground:Conflicting results have been described in the scientific literature regarding the relationship between electrocardiographic parameters and complications in patients with Takotsubo syndrome (TTS). Aim of the present study was to investigate whether there is an association between markers of ventricular repolarization and major adverse cardiovascular events (MACE) during hospitalisation. Methods:A retrospective chart review was conducted on a sample of patients with diagnosis of TTS, based on the fulfilment of the revised Mayo Clinic criteria. MACE included acute heart failure, cardiogenic shock, sustained ventricular tachycardia, ventricular fibrillation, and death. The following parameters, assessed on the admission electrocardiogram, were analysed: ST-segment elevation, ST-segment depression, T wave inversion, presence of Q waves, QT interval, QT interval corrected for heart rate, QT-dispersion, Tpeak-Tend (Tpe) interval, Tpe dispersion, Tpe/QT ratio, and QTpeak/QT ratio. Results:Patients with MACE, compared to patients without MACE, showed more commonly anterior ST-segment elevation and had significantly higher values of Tpe/QT ratio. Low ejection fraction and Tpe/QT ratio > 0.27 identified a sub-population of patients more likely to have MACE during hospitalisation. Conclusions:Tpe/QT ratio represents a useful electrocardiographic parameter in the acute phase of TTS
Post-training changes in the distance/heart rate ratio in patients undergone cardiovascular surgery
No full textBACKGROUND: Exercise-based cardiac rehabilitation (CR) leads to an improvement in clinical outcomes.The distance/heart rate ratio,measured immediately after a 6-minute walk test (6MWT), has not been evaluatedin patients undergone CR after cardiovascular surgery.
METHODS: This retrospective study included patients, who had undergone coronary artery bypass grafting (CABG), valve surgery with or without CABG, surgery of the ascending aorta with or without CABG, or Bentall procedure. They had completed a formal program of CR following hospital discharge and had performed a 6MWT before and after CR.
RESULTS: Changes in the distancewalked(259.1±70.8 versus 429.4±88.5;p<0.001) were associated to subjective improvement in post-exercise fatigue (4.3±1.7 versus 1.1±0.7 meters;p<0.001) and dyspnea (5.4±1.6 versus 1.7±0.7;p<0.001), decreased systolic blood pressure(133.9 ±14.3 versus 128.4±9.3 mmHg;p<0.01), reduced heart rate (99.1±12.7 versus 91.7±11.7 beats per minute;p<0.001), increased distance/heart rate ratio (0.4±0.1 versus 0.8±0.2 meters/ beats per minute;p<0.001)and, enhancedoxy-hemoglobin saturation (96.6±2.0 versus 98.0±3.9;p<0.05).
CONCLUSIONS: Findings from the present study highlight the clinical benefits of CR in a patient population undergone cardiac surgery. In particular, longer distance walked associated to changes in the heart rate response to exercise did lead to an enhancement in the distance/heart rate ratio
Polymorphonuclear phenotypical expression of CD18, at baseline and after in vitro activation, in several clinical disorders: Revision of our case series
No full textBACKGROUND: In relation to the different and important roles of the beta2 integrins, we have revisited the expression of polymorphonuclear leukocyte CD18 in several clinical disorders, at baseline and after in vitro activation.SUBJECTS: we have examined subjects with type 1 diabetes mellitus, vascular atherosclerotic disease, type 2 diabetes mellitus without and with macrovascular complications, chronic renal failure on conservative treatment, essential hypertension, deep venous thrombosis, acute ischemic stroke and subjects with venous leg ulcers.METHODS: unfractioned leukocyte suspension was prepared according to the Mikita's method, while the leukocyte were separated into mononuclear and polymorphonuclear cells with a Ficoll-Hypaque medium. Using specific monoclonal antibody, the CD18 expression was evaluated with cytofluorimetric analysis, using FACScan (Becton Dickinson) be Cellquest software; the activation in vitro with PMA was effected according to modified Yasui and Masuda methods.RESULTS: in type 1 diabetes mellitus, at baseline CD18 is under expressed in comparison with normal control, and not changes afterPMAactivation were observed; in subjects with vascular atherosclerotic disease, in type 2 diabetes mellitusCD18 is over expressed at baseline but does not vary after activation; in subjects with chronic renal failure, essential hypertension and in subjects with acute ischemic stroke the CD18 up-regulate at baseline compared to normal control, and it increases further after activation; in subjects with deep venous thrombosis the CD18 expression is not different from control group at baseline, but it increases after activation; finally, in subjects with venous leg ulcers the CD18 is normally expressed at baseline, and it does not change after PMA activation.CONCLUSIONS: in the different clinical disorders, the trend of this integrin subunit provides some specific information, useful to select the best therapeutic strategy in clinical practice
Plasma viscosity pattern and erythrocyte aggregation in two patients with congenital afibrinogenemia
No full textIn this case report, we examine the behavior of plasma viscosity, explored at high and low shear rates, and erythrocyte aggregation in two patients with congenital afibrinogenemia, a clinical disorder firstly described in 1920 and that has an estimated incidence of 1 : 1-200 0000. The two hemorheological parameters examined by us showed a marked decrease in both patients, in one of whom erythrocyte aggregation was even undetectable. Keeping in mind that spontaneous thrombosis (venous and arterial) has been often described in congenital afibrinogenemia, it can be hypothesized that the decrease in plasma viscosity and erythrocyte aggregation might cause a reduction of the endothelial synthesis and release of nitric oxide through the fall of the wall shear stress
High Output Heart Failure in Multiple Myeloma: Pathogenetic Considerations
Full text linkThe high output heart failure is a clinical condition in which the systemic congestion is associated to a high output state, and it can be observed in a non-negligible percentage of hematological diseases, particularly in multiple myeloma, a condition in which the risk of adverse cardiovascular events may increase, with a worse prognosis for patients. For this reason, though an accurate literature search, we provided in this review a complete overview of different pathogenetic mechanisms responsible for high output heart failure in multiple myeloma. Indeed, this clinical finding is present in the 8% of multiple myeloma patients, and it may be caused by artero-venous shunts, enhanced angiogenesis, glutamminolysis, hyperammonemia and hemorheological alterations with increase in plasma viscosity. The high output heart failure in multiple myeloma is associated with significant morbidity and mortality, emphasizing the need for a multidisciplinary approach
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