1,721,018 research outputs found
The evolving landscape of screening, management and treatment strategies of aortic stenosis in ATTR amyloidosis
No full textTransthyretin amyloid cardiomyopathy (ATTR-CM) and aortic stenosis (AS) frequently coexist in elderly patients, particularly men, creating a complex clinical scenario with overlapping symptoms and imaging features. Both conditions are strongly age-dependent, and their association is increasingly recognized as more than coincidental. Transthyretin deposits have been identified within stenotic aortic valves, supporting the hypothesis that mechanical stress and shear forces may promote protein misfolding and amyloid deposition. The reported prevalence of ATTR-CM among patients with severe AS ranges from 4 % to 29 %, particularly in those undergoing transcatheter aortic valve replacement (TAVR). Diagnosis remains challenging and a multimodality imaging strategy integrating ECG-echocardiographic discordance, cardiac magnetic resonance with extracellular volume (ECV) quantification, and bone scintigraphy is essential to achieve final confirmation of disease. Newer tools such as the RAISE and GRAM scores and CT-derived myocardial extracellular volume (ECV) quantification enhance screening accuracy in this population. Clinically, even moderate AS may worsen restrictive hemodynamics in ATTR-CM, emphasizing the need for early recognition and individualized management. Contemporary studies suggest that carefully selected patients with dual pathology benefit from TAVR, achieving outcomes comparable to those with isolated AS, especially when patients are initiated on disease-modifying therapies. Future research should clarify the mechanistic link between valve and myocardial amyloid deposition, refine risk stratification, and integrate artificial intelligence to improve early detection and guide combined interventional and pharmacologic strategies
Transthyretin amyloidosis in aortic stenosis: clinical and therapeutic implications
No full textAbout one in seven elderly patients with severe calcific aortic stenosis (AS) also have ATTR amyloid cardiomyopathy (AC-TTR). The reasons for this close association are not fully known, but the two entities are not only related by common epidemiology. For example, it is possible to hypothesize that an amyloidotic infiltration of the aortic valve, even partial, can act as a trigger for the development of endothelial damage and subsequent calcification. Another hypothesis is the increased myocardial strain induced by AS may locally favour the process of amyloidogenesis and tissue infiltration. In a patient with AS, the coexistence of AC-TTR can be suspected by careful analysis of the echocardiogram and the ECG, especially if a clinical history of carpal tunnel syndrome coexists. Bone tracer scintigraphy allows a diagnosis of certainty. Recently, several studies have evaluated the prognostic implications of the coexistence of the two entities in candidates for percutaneous aortic valve replacement, showing how amyloidosis would not significantly impact the results of the procedure, but would only be associated with a greater risk of distant heart failure. In patients with AS associated with AC-TTR, valve replacement should not be ruled out in the presence of the usual clinical-haemodynamic indications
Efficacy and safety of alternative oral administrations of P2Y12-receptor inhibitors: Systematic review and meta-analysis.
No full textAngina and chronic obstructive pulmonary disease: facing the perfect storm
No full textThe association of chronic obstructive pulmonary disease (COPD) and ischaemic heart disease (IHD) is challenging both in terms of prognosis and of pharmacological treatment. An 83-year-old Caucasian male patient has chronic kidney disease, COPD, previous myocardial infarction, coronary artery bypass graft with left internal mammary artery (LIMA) on left anterior descending (LAD), saphenous vein graft (SVG) on obtuse marginal (OM)1 and on right coronary artery, and percutaneous coronary intervention (PCI) on LAD (occlusion of LIMA) and on SVG for OM1 (SVG critical stenosis). Recently, the patient complained worsening angina [Canadian Cardiovascular Society (CCS) III] and had residual ischaemia in the anterior wall after an unsuccessful attempt of PCI was performed on LAD for in-stent occlusion due to restenosis. Bisoprolol uptitration failed due to worsening of pulmonary function at spirometry. For this reason, ivabradine 5mg b.i.d. was added to bisoprolol. Afterwards, the patient referred amelioration of symptoms and he is actually in CCS Class I. The control spirometry showed moderate obstruction comparable to his chronic situation. Patients with IHD and COPD often do not receive -blockers due to the fear of adverse effects. However, cardioselective -blockers do not worsen pulmonary function while they reduce mortality in COPD patients. In this setting, ivabradine could be extremely helpful in order to control symptoms since it is effective in patients with asthma and COPD, with no alteration in respiratory function or symptoms and improves exercise capacity and functional class in COPD patients
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
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Atrial Longitudinal Strain Predicts New-Onset Atrial Fibrillation: A Systematic Review and Meta-Analysis
No full textThis study focuses on the role of left atrial longitudinal strain (LAS) in predicting new-onset atrial fibrillation (NOAF). LAS, assessed via speckle-tracking echocardiography, evaluates atrial function through three phases: reservoir, conduit, and contraction. A systematic review and meta-analysis were conducted, including 12 studies and 5,074 patients. The analysis found that LASr, the reservoir phase, significantly predicts NOAF, with a pooled hazard ratio (HR) of 0.96 for each 1% decrease in LASr. LASr was an independent predictor of NOAF in various patient groups, including those with heart failure, ischemic stroke, and chronic obstructive pulmonary disease. The study concludes that LASr is a reliable tool for predicting NOAF and should be part of routine echocardiographic evaluations in high-risk patients. However, the study acknowledges some limitations, including variability in the covariate adjustments across studies
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