1,721,043 research outputs found
Ruolo degli assi ormonali-metabolici nell’ipertensione arteriosa polmonare idiopatica: stratificazione del rischio ed impatto prognostico
Full text linkBackground: i Deficit ormonali-metabolici (MHDS) multipli sono associati a peggior status clinico ed impattano in maniera significativa sulla sopravvivenza dei pazienti con patologie cardiovascolare. Tuttavia, l'impatto dei MHDS sullo status clinico e sulla sopravvivenza dei pazienti affetti da Ipertensione arteriosa polmonare (PAH). Obiettivo dello studio: Stimare la prevalenza dei DOM nella PAH e studiare la loro eventuale associazione con parametri clinici significativi. Materiali e Metodi: Pazienti affetti da PAH che avevano effettuato dosaggio serico dei 5 principali DOM (Testosterone, DHEA-S, HOMA index, IGF-1 ed ormoni tiroidei) sono stati arruolati in maniera retrospettiva. I pazienti sono stati categorizzati in MHDS+ se erano presenti ≥2 deficit ormonali. E' stata quindi valutata l'associazione di MHDS+ con lo stato funzionale, la capacità di esercizio fisico, l'emodinamica polmonare, la funzionalità ventricolare destra e un end-point composito di mortalità ed ospedalizzazione. Risultati.: I pazienti con MHDS+ costituiscono il 43% dell'intera popolazione affetta da PAH. MHDS+ si associa con un peggiore test del cammino dei sei minuti (380.12 ± 66.11 vs 456.91 ± 70.35, p:0.012), peggiore frazione d'eiezione del ventricolo destro (37.30 ± 10.07 vs 26.76 ± 16.05, p< 0.05) ed aumentate resistenze vascolari polmonari (12.62 ± 3.26 vs 7.07 ± 2.99, p: 0.001). Dividendo in base alla gravità dei deficit ormonali (1 deficit= MHDS lieve, 2= MDHS media, 3 o più deficit= MHDS grave) una differenza statisticamente significativa risultava per quanto riguarda la distanza percorsa al test del cammino (467.94 ± 70.62 vs 419.40± 61.33 vs 380.12±66.12 in lieve, moderata e lieve, rispettivamente, p:0.02). Nonostante una differenza nell’end-point combinato di circa il 20% fra i due gruppi ed una differenza del 23% nell’occorrenza dell’evento morte, il basso sample size non ha permesso il raggiungimento della significatività statistica (p: 0.278 per il composito di mortalità ed ospedalizzazione, p:0.237 per la mortalità). Conclusioni: I deficit ormonali multipli identificano un sottogruppo di pazienti caratterizzati da peggiore status clinico, capacità di esercizio fisico, emodinamica polmonare. Nonostante siano stati registrati un maggior numero di eventi (sia composito di mortalità ed ospedalizzazione, sia mortalità da tutte le casi) nel gruppo di pazienti con deficit ormonale multiplo, tale differenza non ha raggiunto una significatività statistica. Studi futuri sono necessari per rafforzare l'ipotesi dell'impatto dei deficit anabolici nell'ipertensione arteriosa polmonare
Letter to the Editor: "Cardiometabolic biomarkers and their temporal patterns predict poor outcome in chronic heart failure (Bio-SHiFT study)"
No full text
Clinical trials in pulmonary arterial hypertension: a glimpse of history
No full textClinical trials have remarkably changed the natural history of pulmonary arterial hypertension (PAH). Despite the relevant progresses achieved in terms of prognosis, PAH is still burned by high mortality rates, disability and low levels of quality of life. The aim of this review is to look over the history of clinical trials in PAH, starting from the little studies with prostacyclin analogues to the recent large randomized placebo-controlled trials. Moreover, the future perspectives of PAH management are addressed
The dual relationship between polypharmacy and frailty in nursing home residents: polypharmacy as a cause or a consequence?
No full textWhen Pulmonary Hypertension Complicates Heart Failure
No full text: Pulmonary hypertension (PH) often complicates chronic left-sided heart failure, with a remarkable impact on quality of life, exercise capacity, and survival. PH in chronic left-sided heart failure (PH-LHD) is not only caused by backward transmission of pressures but also involves impairment of atrial function, inflammation, and vasoconstriction. Once the left atrium loses its reservoir capacity, usually pulmonary vascular resistances increase. Right atrial dilation commonly represents the first sign of PH-LHD, before right ventricle dilatation and systolic dysfunction develop, leading to right heart insufficiency, and ultimately, right heart failure
Principles of rehabilitation and reactivation: pulmonary hypertension
No full textMost recently, a specialized and carefully monitored exercise training and rehabilitation program has been recommended as add-on to medical treatment in patients with pulmonary arterial hypertension (class I, level of evidence A). Three prospective randomized, controlled trials, 10 prospective uncontrolled trials, 2 retrospective studies and 2 case series in more than 470 patients with severe pulmonary hypertension (PH) and right heart failure reported beneficial effects of a specialized exercise training and rehabilitation program, i.e. significant improvement in symptoms, exercise capacity, cardiorespiratory function and quality of life, compared with untrained controls. All training studies reported an acceptable safety profile, and some uncontrolled studies showed excellent 1- and 2-year survival rates. However, most studies had a quite small sample size (ranging from 2 to 183 patients) and an uncontrolled design, and they were not designed to assess hemodynamic changes, time to clinical worsening and survival. Nevertheless, there is large evidence that exercise training programs should be performed by centers experienced in both PH patient care and rehabilitation. The best method and duration of the training, characteristics of supervision, and the mechanisms resulting in symptom improvement and increased functional capacity are unclear. In this review, we summarize data of molecular and clinical effects of exercise training in PH patients. Furthermore, we discuss safety data and the role of a self-care management of exercise training in these patients
When pulmonary arterial hypertension complicates connective tissue diseases: we still have not found what we are looking for
No full text
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
- …
