1,721,076 research outputs found
Coronary Revascularization in Patients With Stable Coronary Artery Disease: The Role of Imaging
Full text link: In the last decades, the effective management of some cardiovascular risk factors in the general population has led to a progressive decrease in the prevalence of coronary artery disease (CAD). Nevertheless, coronary heart disease remains the major cause of death in developed and developing countries and chronic coronary syndromes (CCS) are still a major target of utilization of non-invasive cardiac imaging and invasive procedures. Current guidelines recommend the use of non-invasive imaging in patients with CCS to identify subjects at higher risk to be referred for invasive coronary angiography and possible revascularization. These recommendations are challenged by two opposite lines of evidence. Recent trials have somewhat questioned the efficacy of coronary revascularization as compared with optimal medical therapy in CCS. As a consequence the role of imaging in these patients and in in patients with ischemic cardiomyopathy is under debate. On the other hand, real-life data indicate that a consistent proportion of patients undergo invasive procedure and are revascularized without any previous non-invasive imaging characterization. On top of this, the impact of COVID-19 pandemic on the sanitary systems caused a change in the current management of patients with CAD. In the present review we will discuss these conflicting data analyzing the evidence which has been recently accumulated as well as the gaps of knowledge which should still be filled
Triglyceride-glucose index predicts outcome in patients with chronic coronary syndrome independently of other risk factors and myocardial ischaemia
Full text linkAIMS: The triglyceride-glucose (TyG) index, a surrogate marker of insulin resistance (IR), is a prognostic risk factor in the general population. We aimed to assess whether it is an independent predictor of outcome also in patients with chronic coronary syndrome (CCS). METHODS AND RESULTS: TyG index was evaluated in 1097 consecutive patients (75% men, median age 72 years) with known (26%) or suspected coronary artery disease (CAD), undergoing stress-rest myocardial perfusion scintigraphy, and coronary angiography and followed up for a median of 4.5 years. Moderate/severe perfusion abnormalities during stress (summed stress score >7) were documented in 60% of patients, obstructive CAD in 74%, and 36% underwent early revascularization. TyG index was 8.9 (median, interquartile interval 8.6–9.2). Cardiac death or myocardial infarction occurred in 103 patients and all-cause death in 65. After correction for clinical risk factors, LV function and common bio-humoral variables, TyG index (HR 2.42, 95% CI 1.57–3.72, P < 0.001), and moderate/severe stress perfusion abnormalities (hazard ratio (HR) 2.17, 95% confidence interval (CI) 1.25–3.77, P < 0.001) independently predicted cardiac events. TyG index (HR 3.64, 95%CI 2.22–5.96, P < 0.001) and high-sensitivity C-reactive protein (HR 1.11, 95% CI 1.04–1.19, P = 0.002) independently predicted all-cause death. CONCLUSION: In patients with CCS, the TyG index identifies a cardiometabolic profile associated with an additional risk of cardiac events, over the presence of myocardial ischaemia and independently of other clinical, common bio-humoral or imaging risk determinants
Increased Cost-Effectiveness Of Diagnostic Imaging In Patients With Suspected Cad By Using A New Clinical-Biohumoral Predictive Model Of Disease
No full textBeta-cell hyperplasia and direct acinar-beta-cell trans-differentiation in insulin-resistant partially eNOS-deficient mice.
No full texteNOS-defi cient mice were shown to develop hypertension and insulin
resistance either in basal conditions (eNOS null) or upon high fat diet,
HFD (eNOS +/- heterozygotes). In the model of HFD-fed eNOS +/- mice,
we investigated putative pancreatic morphological changes to fi nd out
clues of the cellular mechanisms responsible for their compensatory
hyperinsulinemic response. C57BL6 wild type (WT) and eNOS +/- mice were
fed with either chow or HFD for 16 weeks. A group of chow-fed eNOS null
mice was also studied. Basal blood glucose and insulin were monitored and
glucose and insulin tolerance tests performed. Then mice were sacrifi ced
and fragments of pancreas were routinely processed for histological,
immunohistochemical and ultrastructural observation (with suitable image
analysis). Both WT and eNOS +/- mice fed with HFD developed insulin
resistance, as assessed by fasting hyperglycemia with hyperinsulinemia,
glucose intolerance and reduced response to exogenous insulin. In HFDfed
groups, evidence of compensatory adaptation of -cells was provided
by increased total pancreatic insulin content, larger -cell fractional area
and enhanced number of extra-islet -cell clusters (2-5 cells) as compared
to chow-fed groups. At ultrastructural level, in the HFD-fed eNOS +/- group
only, besides single -cells surrounded by exocrine cells, a number of cells
simultaneously containing zymogen and insulin granules were surprisingly
observed in most pancreases examined. Such cells, usually retaining the
extended and thick endoplasmic reticulum typical of acinar cells, represent
an interesting example of direct exocrine/-cell trans-differentiation, likely
triggered by strong insulin-demanding metabolic stress, yet independent on
damaging stimuli, such as duct ligation as reported in literature. The reason
why such trans-differentiation process was only detected in the eNOS +/-
mice fed with HFD remains an interesting matter of future investigation
Hybrid Imaging and Healthcare Economics
No full textOwing to the rapid technological advancement in cardiovascular diagnostic imaging, many non-invasive diagnostic tests are currently available which either evaluate cardiac anatomy or function or both. In order to minimize risks and burden to patients, radiation exposure, and healthcare costs, diagnostic algorithms have been developed which define the most appropriate sequence of tests for each patient. In many clinical scenarios, the introduction of “hybrid” imaging, i.e. the combination and/or fusion of anatomical and functional imaging, performed in a single session by a “hybrid” scanner or in sequential sessions by stand-alone devices, has been considered a relevant advancement. Even if no full health-economic comparison of cardiac “hybrid” imaging with single modalities is available, there is increasing evidence that the appropriate use of a “hybrid” approach may be effective in terms of costs and outcomes
Prognostic Role of Dynamic CZT Imaging in CAD Patients: Interaction Between Absolute Flow and CAD Burden
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
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
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