1,721,022 research outputs found
Psoriasis as a cardiovascular risk factor: Updates and algorithmic approach
No full textAlthough psoriasis is predominantly a chronic inflammatory skin disorder, it has been known to be associated with cardiovascular disease. Patients with psoriasis, particularly with moderate to severe forms, present an increased rate of cardiovascular mortality, myocardial infarction and stroke. However the pathophysiology of the relationship between psoriasis and cardiovascular risk and comorbidities has not yet completely known. Chronic inflammation may be considered a solid link between psoriasis and related cardiovascular events. Several cytokines and inflammatory cells play a pivotal role in the development of psoriatic lesions, resulting in angiogenesis and endothelial dysfunction. Furthermore, the imbalance between oxidative stress and antioxidant mechanisms in psoriatic patients may contribute to explain the pathogenesis of increased reactive oxygen species and the formation of atherosclerotic plaque. Other mechanistic pathways which may be involved in this relationship include cardiovascular effects of medications, a common genetic background and a higher prevalence of cardiovascular risk factors, which are often under-diagnosed and under-treated in psoriatic patients. Indeed, the early detection of specific markers of cardiovascular impairment, such as N-terminal pro B-type natriuretic peptide, homocysteine and YKL-40, may enable psoriatic patients at higher cardiovascular risk to be identified as soon as possible. This review examines the increased cardiovascular risk profile and high prevalence of cardiovascular disease associated with psoriasis, focusing on pathogenic links between psoriasis and atherosclerosis, serological markers of cardiovascular involvement and the implications of antipsoriatic therapies on cardiovascular risk and proposes a flow chart, that every dermatologist should follow to screen psoriatic patients
Dall'ecocardiografia doppler allo studio della fisiopatologia della stenosi valvolare aortica.
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Pharmacokinetic drug evaluation of bucindolol for the treatment of atrial fibrillation in heart failure patients
No full textIntroduction: Atrial fibrillation (AF) and heart failure (HF) often coexist. When AF and HF are both present, they are associated with negative outcomes, increased hospitalizations and mortality. As Î2-blockade is effective inF and may be useful in presence of AF, bucindolol, a non-selective Î2-blocker with α-1 vasodilatory effect, may be used. Area covered: This review evaluates the efficacy and safety of bucindolol in HF patients with AF. The largest amount of data comes from BEST trial which evaluated the efficacy of bucindolol in HF patients. Since bucindololâs effects are genetically modulated by Î21 and α2c-adrenergic receptor polymorphisms BEST genetic substudy arose. Expert opinion: In the BEST Trial, bucindolol demonstrated efficacy in HF patients showing a 74% reduction in new-onset atrial fibrillation events particularly in Î21 389 Arg/Arg homozygous. GENETIC-AF study was designed to determine whether bucindolol therapy is superior to metoprolol in preventing recurrent AF in a genetically targeted population of HF patients. Furthermore, this drug is safe, but presents the same side effects as all Î2-blockers and has showed no clear benefits in African-Americans and in class IV NYHA patients. Further studies are needed to confirm and validate the role of bucindolol and its economic implications
The need of developing selective prediction models in elderly patients with heart failure
No full textIt is with great interest that we have read the article by Özlek and co-workers [1], who performed a post-hoc analysis of results from the APOLLON trial (A comPrehensive, ObserationaL registry of heart faiLure with mid-range and preserved ejection fractiON). The authors investigated in a real-world study (patients included in a registry) the effects of treatment of octogenarian individuals with heart failure (HF) with mid-range and preserved ejection fraction, and then, the authors compared the observation in elderly to younger subjects. Interestingly, the authors reported that elderly patients with HF were similarly treated as compared to younger patients (in terms of ACE-Is/ARBs, β-blockers, MRAs, digoxin, ivabradine and diuretics), thus suggesting adherence to guideline recommendations independently of the age of subjects. A previously published narrative review from our research group explored the potential predictive role of biochemical and echocardiographic parameters on prognostic outcomes and hospital readmission, among HF elderly population [2]. As discussed by our article, the authors found a higher prevalence of HF with preserved ejection fraction (HFpEF) among elderly patients, who were more frequently associated to a high economic impact because of repetitive and prolonged hospitalization due to cardiovascular and non-cardiac comorbidities. Particularly, chronic kidney disease, diabetes mellitus and chronic obstructive pulmonary disease were reported. Furthermore, among biochemical parameters, anemia, hyponatraemia and high brain natriuretic peptide levels were able to predict a worse prognostic outcome. On the other hand, echocardiographic parameters of diastolic dysfunction, including a higher left atrial volume index and E/e’ ratio, resulted as independent predictors of hospital readmission among HFpEF elderly patients. In conclusion, the study by Özlek and coworkers was able to show and confirm different associations with HF depending on the age of patients. In addition, the results suggested a potential usefulness of selective biochemical and echocardiographic variables in managing HFpEF in elderly. These biomarkers were shown to potently correlate with poor prognostic outcomes (i.e. increased risk of hospital readmissions), thus suggesting a need of developing specific prediction models to be applied in managing HFpEF in elderly patients
Combining blood flow and tissue Doppler imaging with N-terminal pro-type B natriuretic peptide for risk stratification of clinically stable patients with systolic heart failure
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