1,720,972 research outputs found
The search for efficient diagnostic and prognostic biomarkers of heart failure
No full textSeveral biomarkers have been tested for screening, diagnosis and prognosis purposes, as well as to guide treatment in heart failure, but only the assay of circulating B-type natriuretic peptides has widely recognized applications for clinical decision-making. Natriuretic peptides are sensitive in detecting the clinically overt or subclinical myocardial damage, but their plasma levels are increased following every generic insult to the cardiovascular system. Novel biomarkers are required to identify specific pathways of disease progression, such as diverse neurohormonal axes activation, inflammation and fibrogenesis, and to act as a tool for therapeutic tailoring. In this view, Gal-3 and ST-2 assays seem very promising, given their involvement in mechanisms of cardiac fibrosis and their prognostic value
Revascularization of coronary and left popliteal artery lesions from the same radial arterial access
No full textRenal denervation in resistant arterial hypertension: Effects on neurohormonal activation and cardiac natriuretic peptides
No full textRenal denervation (RD) is an emerging treatment for resistant arterial hypertension (RAH). RAH is characterized by hyperactivity of catecholaminergic and renin–angiotensin–aldosterone systems (RAAS), with elevated arterial blood pressure and a higher prevalence of cardiovascular overload and remodeling. As renal innervation is involved in sympathetic and RAAS overactivation, RD has the potential to reduce blood pressure by influencing this pathophysiological network [1]. Indeed, RD has been shown to reduce renal norepinephrine spillover [2] and it seems to exert beneficial effects also on cardiac remodeling by reduction of cardiac hypertroph
Cardioprotection by remote ischemic conditioning: Mechanisms and clinical evidences
No full textIn remote ischemic conditioning (RIC), several cycles of ischemia and reperfusion render distant organ and tissues more resistant to the ischemia-reperfusion injury. The intermittent ischemia can be applied before the ischemic insult in the target site (remote ischemic preconditioning), during the ischemic insult (remote ischemic perconditioning) or at the onset of reperfusion (remote ischemic postconditioning). The mechanisms of RIC have not been completely defined yet; however, these mechanisms must be represented by the release of humoral mediators and/or the activation of a neural reflex. RIC has been discovered in the heart, and has been arising great enthusiasm in the cardiovascular field. Its efficacy has been evaluated in many clinical trials, which provided controversial results. Our incomplete comprehension of the mechanisms underlying the RIC could be impairing the design of clinical trials and the interpretation of their results. In the present review we summarize current knowledge about RIC pathophysiology and the data about its cardioprotective efficacy
Glycosylated haemoglobin is associated with neurohormonal activation and poor outcome in chronic heart failure patients with mild left ventricular systolic dysfunction
No full textWe aimed to evaluate the impact of glycometabolic imbalance as assessed by glycosylated haemoglobin [HbA(1c)] on neurohormonal activation and outcome in chronic heart failure (CHF)
N-terminal prob-type natriuretic peptide is a marker of vascular remodelling and subclinical atherosclerosis in asymptomatic hypertensives
No full textArterial hypertension is a main determinant of arterial remodelling and atherosclerosis. Coronary artery calcium score and carotid intima-media thickness are recognized indices of vascular remodelling. Established biohumoral markers for the diagnosis of atherosclerosis are still lacking in asymptomatic subjects with hypertension
Vulnerabilità miocardica e bioumorale all'esercizio fisico nel paziente con insufficienza cardiaca. Effetti del training fisico aerobico
No full textLa tesi si compone di tre parti sperimentali. Nella prima si valuterà la vulnerabilità miocardica e bioumorale all’esercizio fisico massimale (QR >1,1), in 20 pazienti con insufficienza cardiaca, LVEF < 50%, in classe NYHA I e II, con eziologia ischemica e non ischemica. Tale vulnerabilità verrà valutata mediante dosaggio di biomarcatori di danno cardiomiocitario, di attivazione neurormonale, di sovraccarico emodinamico, di attivazione flogistica e di rimodellamento ventricolare in parallelo all’esecuzione di test ergospirometrico.
Tale valutazione si propone di:
• descrivere il possibile significato incrementale di tali parametri bioumorali quando sollecitati dall’esercizio fisico;
• generare ipotesi circa i possibili determinanti del cosiddetto danno miocardico progressivo in corso di insufficienza cardiaca grazie alla maggiore sensibilità offerta dal setting di stress fisico
• valutare il comportamento di tali biomarcatori quando rapportati alle capacità funzionali dei pazienti;
• fornire una visione integrata.
La seconda parte dell’elaborato si propone di valutare in un sottogruppo di 10 pazienti le correlazioni di tale valutazione basale con la misurazione della gittata cardiaca ottenuta mediante metodica non invasiva di rebreathing di gas esterni, nell’ottica di ottenere una valutazione più accurata della funzionalità ventricolare in corso di esercizio fisico massimale.
Nell’ultima parte infine si valuteranno gli effetti su tale vulnerabilità di un programma trimestrale di training fisico aerobico domiciliare. 10 pazienti dopo la valutazione basale verranno rivalutati mediante analoga batteria di dosaggi bioumorali durante test ergospirometrico massimale.
Tale valutazione si propone di:
• valutare modificazioni in senso assoluto dei valori basali e dopo esercizio fisico massimale, nonché le differenze in termini di modificazioni percentuali provando a delinearne possibili significati fisiopatologici;
• analizzare le correlazioni di tali modificazioni con cambiamenti attesi dopo training di altri parametri clinico funzionali;
• valutare quali possano essere i migliori predittori di un efficace programma riabilitativo
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