446 research outputs found
Endocarditis in patients with aortic valve prosthesis: Comparison between surgical and transcatheter prosthesis
No full textThe interventional treatment of aortic stenosis is currently based on transcatheter aortic valve implantation/replacement (TAVI/TAVR) and surgical aortic valve replacement (SAVR). Prosthetic valve infective endocarditis (PVE) is the most worrisome complication after valve replacement, as it still carries high mortality and morbidity rate. Studies have not highlighted the differences in the occurrence of PVE in SAVR as opposed to TAVR, but the reported incidence rates are widely uneven. Literature portrays different microbiological profiles for SAVR and TAVR PVE: Staphylococcus, Ente-rococcus, and Streptococcus are the pathogens that are more frequently involved with differences regarding the timing from the date of the intervention. Imaging by means of transoesophageal echocardiography, and computed tomography (CT) Scan is essential in identifying vegetations, prosthesis dysfunction, dehiscence, periannular abscess, or aorto-ventricular discontinuity. In most cases, conservative medical treatment is not able to prevent fatal events and surgery represents the only viable option. The primary objectives of surgical treatment are radical debridement and the removal of infected tissues, the reconstruction of cardiac and aortic morphology, and the restoration of the aortic valve function. Different surgical options are discussed. Fast diagnosis, the adequacy of antibiotics treatment, and prompt interventions are essential in preventing the negative consequences of infective endocarditis (IE)
Assessment of Cardiovascular Function in Childhood Leukemia Survivors: The Role of the Right Heart
No full textChildhood acute lymphoblastic leukemia (ALL) survivors who underwent chemotherapy with anthracyclines have an increased cardiovascular risk. The aim of the study was to evaluate left and right cardiac chamber performances and vascular endothelial function in childhood ALL survivors. Fifty-four ALL survivors and 37 healthy controls were enrolled. All patients underwent auxological evaluation, blood pressure measurements, biochemical parameters of endothelial dysfunction, flow-mediated dilatation (FMD) of the brachial artery, mean common carotid intima-media thickness (c-IMT), antero-posterior diameter of the infra-renal abdominal aorta (APAO), and echocardiographic assessment. The ALL subjects had significantly lower FMD (p = 0.0041), higher left (p = 0.0057) and right (p = 0.0021) echocardiographic/Doppler Tei index (the non-invasive index for combined systolic and diastolic ventricular function) as compared to controls. Tricuspid annular plane excursion (TAPSE) was 16.9 +/- 1.2 mm vs. 24.5 +/- 3.7 mm, p < 0.0001. Cumulative anthracycline doses were related to TAPSE (p < 0.001). The ALL survivors treated with anthracyclines demonstrated systo/diastolic alterations of the right ventricle and reduced endothelial function compared with healthy controls. The early recognition of subclinical cardiac and vascular impairment during follow up is of utmost importance for the cardiologist to implement strategies preventing overt cardiovascular disease considering the growing number of young adults cured after childhood ALL
Left ventricle outflow tract vegetation, embolism and troponin rise: An infective endocarditis case report
No full textIvabradine, coronary artery disease, and heart failure: beyond rhythm control
No full textPietro Scicchitano,1 Francesca Cortese,1 Gabriella Ricci,1 Santa Carbonara,1 Michele Moncelli,1 Massimo Iacoviello,1 Annagrazia Cecere,1 Michele Gesualdo,1 Annapaola Zito,1 Pasquale Caldarola,2 Domenico Scrutinio,3 Rocco Lagioia,3 Graziano Riccioni,4 Marco Matteo Ciccone1 1Section of Cardiovascular Diseases, Department of Emergency and Organ Transplantation, University of Bari, School of Medicine, Policlinico, Bari, Italy; 2Section of Cardiovascular Diseases, Policlinic, San Paolo Hospital, Bari, Italy; 3Section of Cardiovascular Diseases, Fondazione Maugeri, Cassano Murge, Italy; 4Intensive Cardiology Care Unit, San Camillo de Lellis Hospital, Manfredonia, Foggia, Italy Abstract: Elevated heart rate could negatively influence cardiovascular risk in the general population. It can induce and promote the atherosclerotic process by means of several mechanisms involving endothelial shear stress and biochemical activities. Furthermore, elevated heart rate can directly increase heart ischemic conditions because of its skill in unbalancing demand/supply of oxygen and decreasing the diastolic period. Thus, many pharmacological treatments have been proposed in order to reduce heart rate and ameliorate the cardiovascular risk profile of individuals, especially those suffering from coronary artery diseases (CAD) and chronic heart failure (CHF). Ivabradine is the first pure heart rate reductive drug approved and currently used in humans, created in order to selectively reduce sinus node function and to overcome the many side effects of similar pharmacological tools (ie, β-blockers or calcium channel antagonists). The aim of our review is to evaluate the role and the safety of this molecule on CAD and CHF therapeutic strategies. Keywords: chronic heart failure, heart rate reduction, cardiac ischemic disease, heart-rate lowering drugs, funny curren
Relationship between Mediterranean diet and asymptomatic peripheral arterial disease in a population of pre-menopausal women.
No full textAbstract Background and aims: The Mediterranean Diet (MedD) is considered a very healthy
diet useful in the prevention of cardiovascular disease. The present study aims to evaluate adherence
to MedD in unselected premenopausal women and its relation with ankle-brachial index
(ABI), an index of preclinical atherosclerosis.
Methods and results: A group of 425 patients (age range 45e54 years) was investigated. They
were enrolled only if they were asymptomatic for cardiovascular disease. Nutritional parameters
were assessed by a self-administered food frequency validated questionnaire (116 items)
completed by an interviewer administered 24 h diet recall. They all underwent ABI measurement.
The mean MedD Score was 32.2 6.1 (Q1eQ3 range 26e37) comparing with data from
Italian population (46 8.3) was significantly lower. Intake of food categories sources of antioxidants
was higher in patients with a greater adherence to Med D and was mainly related to fruit
and vegetables. Patients were categorized in quartile according to MedD Score and we evaluate
the distribution of ABI index within quartile. 31.4% of women in Q1 (lower adherence to MedD)
had an ABI lower than 0.9 compared to 18.3% of women in Q4 (higher adherence to MedD):
p < 0.01. Obesity was more frequent in Q1 compared to Q4 and in women with lower ABI.
Conclusions: Women with a low MedD Score were more obese and showed instrumental sign of
preclinical peripheral atherosclerosis. MedD rich in antioxidants from fruit, vegetables and nuts
influenced the development of atherosclerosis and was associated with a lower incidence of
asymptomatic atherosclerosis
Endothelial function and cardiovascular risk in patients with Idiopathic Sudden Sensorineural Hearing Loss. Ciccone MM, Cortese F, Pinto M, Di Teo C, Fornarelli F, Gesualdo M, Mezzina A, Sabatelli E, Scicchitano P, Quaranta N. Atherosclerosis. 2012 Oct 11. pii: S0021-9150(12)00682-X. doi:
No full textAbstract
OBJECTIVE:
To evaluate cardiovascular risk factors and pre-clinical atherosclerosis in subjects affected by Idiopathic Sudden Sensorineural Hearing Loss (ISSHL).
METHODS:
In this study, 29 ISSHL patients and 29 healthy controls were evaluated. All of the patients underwent a complete audiovestibular and clinical evaluation. Carotid intima-media thickness (C-IMT) and flow-mediated dilation (FMD) of the brachial artery were assessed as early markers of atherosclerosis.
RESULTS:
Our results showed that FMD was significantly lower in the ISSHL patients than in the controls (5.6 ± 1.6% vs. 7.7 ± 3.7%, p < 0.01). Moreover, the total cholesterol and low density lipoprotein cholesterol were significantly higher in the ISSHL patients than in the controls (p < 0.05). The two groups did not differ with regards to C-IMT and other cardiovascular risk factors. Vestibular involvement was shown to be associated with lower FMD values (4.1 ± 1.7% vs. 5.8 ± 1.5%, p < 0.05). No relationship was found between C-IMT and vestibular involvement. Finally, multiple logistic regression highlighted the finding that only FMD values seemed to predispose individuals to developing ISSHL (p = 0.03, OR: 1.4).
CONCLUSIONS:
ISSHL seemed to be associated with vascular endothelial dysfunction and an increased cardiovascular risk, which supports the hypothesis of a vascular aetiology for this diseas
Shockwave therapy in patients with peripheral artery disease.
No full textINTRODUCTION:
Previous studies support the fact that extracorporeal shockwave (SW) induces angiogenesis and improves symptoms in patients affected by limb ischemia. The aim of this study was to evaluate the effects of SW therapy in patients with peripheral artery disease (PAD).
METHODS:
Twenty-two patients were enrolled in this study and were randomly assigned into two groups: SW treatment (12 patients, 67 ± 9 years) and control (10 patients, 68 ± 12 years). The inclusion criteria were the following: age over 40 years, PAD diagnosis, optimal medical therapy, and ankle-brachial index less than 0.9. SW therapy was administered using the Minilith® SL1 litotriptor with an ultrasound guide able to detect the target area using a B-mode technique and a 7.5 MHz convex probe emitting 2,000 impulses with an energy flux density of 0.03 mJ/mm(2).
RESULTS:
The variation in the degree of stenosis before and after treatment was statistically significant between the groups (-9% ± -10% vs. 0% ± 0%; P = 0.001). In addition, a significantly higher number of treated patients than controls showed a reduction in the Fontaine stage (12 [63%] vs. 0 [0%]; P < 0.001). This result was confirmed by analyzing the difference in patients' pain-free walking distance before and after SW therapy (76 ± 46 m vs. 0 ± 0 m for treated patients vs. controls; P < 0.001) and the difference in pain severity (measured on a pain scale; -1.4 ± 0.5 in the treated patients vs. -0.2 ± 0.4 in the controls; P < 0.001).
CONCLUSION:
On the basis of these results the authors hypothesized a direct effect of SW on the ultrastructural composition of the vessel walls, inducing a reduction in artery stenosis. These data support the application of SW therapy as a new medical tool to improve the natural clinical course of PA
Climate reconstructions and monitoring in the Mediterranean Sea: A review on some recently discovered high-resolution marine archives
No full textPalaeoclimate records are important tools for understanding climate modifications and contextualizing recent anthropogenic perturbations in climate change relative to natural variability in the Earthclimate system.
Moreover, time-series proxy records of the main physical and chemical parameters in marine and continental environments are increasingly used for testing climate models in order to ascertain the reliability of projections for future scenarios in our greenhouse modified Earth.
In order to account for the limited number of continuous instrumental measurements of climatic variables in the past, such as sea surface temperature (SST), salinity (SSS), sea-level fluctuations and water chemistry, a complementary approach is the examination of geochemical tracers (i. e. trace elements and stable isotopes) in well-dated natural marine archives.
Recently, the Mediterranean Sea has been the focus of a number of studies where new high resolution climate archives have been investigated utilizing proxies for sea surface temperature, salinity, marine chemistry, and ocean circulation, different to those available for tropical regions. In particular, vermetids (Dendropoma petraeum), non-tropical zooxanthellate corals (Cladocora caespitosa) and cold-water corals (Desmophyllum dianthus, Lophelia pertusa and Madrepora oculata) have been studied by conventional and advanced analytical techniques (e. g., laser ablation ICP-MS, MC-ICP-MS, synchrotron X-ray fluorescence) and have been successfully used as high-resolution palaeoenvironmental proxies. Vermetid reefs have the potential to yield valuable information on past sea-level changes and SST, through the combination of stable isotopes and radiocarbon dating. The trace element concentration, in combination with U-series and radiocarbon dating, of the skeletal aragonite of the Mediterranean zooxanthellate coral Cladocora caespitosa, and of the coldwater corals Desmophyllum dianthus and Lophelia pertusa, has been successfully demonstrated to be a valid high-resolution SST archive, and a seawater chemistry and ocean circulation proxy, respectively. Here we present a review of our research over the last few years, aiming for the establishment of new natural marine archives collected from various sites of the Mediterranean Sea, reporting on our methodological approaches and main results
Bioimpedance vector analysis predicts hospital length of stay in acute heart failure
No full textObjective: Congestion in acute heart failure (AHF) affects survival curves and hospital length of stay (LOS). The evaluation of congestion, however, is not totally objective. The aim of this study was to verify the accuracy of bioelectrical impedance vector analysis (BIVA) in predicting the LOS in AHF patients. Methods: This is a retrospective study. A total of 706 patients (367 male; mean age: 78 ± 10 y) who had been admitted to hospital with an AHF event were enrolled. All underwent anthropometric and clinical evaluation, baseline transthoracic echocardiography, and biochemical and BIVA evaluations. Results: The comparison among the clinical characteristics of congestion, LOS, and hyperhydration status revealed that the higher the hydration status, the longer the LOS (from 7.36 d [interquartile range: 7.34–7.39 d] in normohydrated patients to 9.04 d [interquartile range: 8.85– 9.19 d] in severe hyperhydrated patients; P < 0.05). At univariate analysis, brain natriuretic peptide, blood urea nitrogen, New York Heart Association class, hemoglobin, hydration index, and peripheral edema all had a statistically significant influence on LOS. At multivariate analysis, only brain natriuretic peptide (P < 0.0001), blood urea nitrogen (P = 0.011), and hydration index (P < 0.0001) were significantly associated to LOS. Conclusions: Congestion evaluated by BIVA is an independent predictor of length of total hospital stay in HF patients with acute decompensation. The quick and reliable detection of congestion permits the administration of target therapy for AHF, thus reducing LOS and treatment costs
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