131 research outputs found
Biochemical and echocardiographic markers in patients with systemic sclerosis related pulmonary arterial hypertension
No full textThe aims of our study were to examine the regional and global function in SSc patients using TDI, to elucidate the potential role of the plasma NT-proBNP and ADMA in the assessment of functional status and right heart performance in SScPAH, to investigate the potent relationships between echocardiogaphic and biochemical abnormalities and to indicate possible echocardiographic and biochemical predictors of SScPAH.Σκοπός της μελέτης: Η διερεύνηση του ρόλου και της σημασίας του Εγκεφαλικού Νατριουρητικού Πεπτιδίου (ΝΤ-proBNP) και της Ασύμμετρης Διμεθυλαργινίνης (ΑDΜΑ) για την εκτίμηση του κινδύνου εμφάνισης, τη διάγνωση και την παρακολούθηση της Πνευμονικής Αρτηριακής Υπέρτασης σε ασθενείς με Συστηματική Σκλήρυνση (ΣΣΠΑΥ). Μέθοδοι: Στη μελέτη συμμετείχαν 66 ασθενείς με ΣΣ, οι οποίοι υποβλήθηκαν σε ηχωκαρδιογράφημα καρδιάς και ιστικό DOPPLER, εργαστηριακό έλεγχο ρουτίνας και εξάλεπτη δοκιμασία βάδισης (6ΜWΤ). Ο προσδιορισμός των επιπέδων ΝΤ-proBNP και της ΑDΜΑ έγινε με ELISA. Αποτελέσματα: Η διάγνωση της ΣΣΠΑΥ (συστολική πίεση πνευμονικής αρτηρίας -SPAP>40 mmHg) τέθηκε σε 24 ασθενείς. Οι ασθενείς με ΣΣΠΑΥ εμφάνισαν αυξημένη διάμετρο του αριστερού κόλπου, αυξημένο δείκτη μυοκαρδιακής απόδοσης της δεξιάς κοιλίας (ΔΚ), αυξημένο λόγο του κύματος της πρώιμης διαστολικής πλήρωσης στους διαμιτροειδικής ροής (κύμα Ε), προς τη μέγιστη πρώιμη διαστολική ταχύτητα κίνησης Ε/Εm της αριστερής κοιλίας (ΑΚ) στο ιστικό DOPPLER και μείωση της τιμής του κύματος Εm της ΔΚ. Στην ίδια ομάδα ασθενών η συγκέντρωση στο πλάσμα του ΝΤ-proBNP και της ADMA ήταν στατιστικά σημαντικά υψηλότερες σε σχέση με τους σκληροδερμικούς ασθενείς χωρίς ΠΑΥ. Τα επίπεδα του ΝΤ-proBNP συσχετίσθηκαν θετικά με τη SPAP και το λόγο των ταχυτήτων Ε/Εm της (ΑΚ) και αρνητικά με την απόσταση που διανύουν οι ασθενείς κατά το 6MWT. Τα επίπεδα της ADMA εμφάνισαν επίσης αρνητική συσχέτιση με την απόσταση του 6MWT. Τα επίπεδα του ΝΤ-proBNP και η διάμετρος του αριστερού κόλπου βρέθηκαν να αποτελούν ανεξάρτητους προγνωστικούς δείκτες για την πιθανότητα διάγνωσης ΣΣΠΑΥ στους ασθενείς της μελέτης. Συμπέρασμα: Οι βιοχημικοί και ηχωκαρδιογραφικοί δείκτες μπορούν να χρησιμοποιηθούν συνδυαστικά για την παρακολούθηση ομάδων ασθενών υψηλού κινδύνου για την εμφάνιση Πνευμονικής Υπέρτασης, όπως οι ασθενείς με σκληρόδερμα
Cardiovascular comorbidity in rheumatic and musculoskeletal diseases: Where we are and how can we move forward?
No full textImaging modalities for the diagnosis of pulmonary hypertension in systemic sclerosis
No full textPatients with systemic sclerosis (SSc) are at considerable risk of developing pulmonary arterial hypertension (PAH). PAH has a dramatic impact on the natural history of the disease and overall survival of the patient. Despite progress made in elucidating the pathogenesis of PAH and introduction of novel therapies, SSc-related PAH (SScPAH) remains a devastating disease that responds poorly to therapy. Although early diagnosis is of paramount importance, there are no available validated strategies for assessing SScPAH because reliable evaluation of the structure and function of the right ventricle is difficult owing to its complex geometry. Additionally, myocardial fibrosis might affect cardiac contractility and contribute to heart failure. Modern imaging modalities, such as novel echocardiographic techniques and cardiac MRI, are highly sensitive, quantitative and reproducible methods that allow noninvasive assessment of regional and global myocardial performance without relying on geometric assumptions. In this Review, we examine the imaging modalities currently available, focusing on evolving diagnostic imaging methodologies and their possible clinical implications in the SScPAH setting. © 2012 Macmillan Publishers Limited. All rights reserved
Novel insights into the role of inflammasomes in autoimmune and metabolic rheumatic diseases
No full textInflammasomes are large intracellular complexes that induce inflammation in response to exogenous and endogenous damage signals. They regulate production and release of the proinflammatory cytokines IL-1β and IL-18, playing a defensive role against infections. Inflammasomes have also been involved in the pathogenesis of a wide range of autoinflammatory conditions that are caused by dysregulation of the IL-1 pathway, such as cryopyrinopathies and hereditary periodic fever syndromes. On top of that, research in recent years suggests that defects in inflammasome regulation and signaling associate with a number of autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, systemic sclerosis and others. In this review, we describe the inflammasome and mechanisms that trigger it, provide a brief review of autoinflammatory disorders and discuss the current understanding and emerging data from experimental and clinical studies for the role of the innate immune system and inflammasomes in the biology and pathogenesis of systemic autoimmune diseases.</p
Asymmetric Dimethylarginine as a Surrogate Marker of Endothelial Dysfunction and Cardiovascular Risk in Patients with Systemic Rheumatic Diseases
No full textThe last few decades have witnessed an increased life expectancy of patients suffering with systemic rheumatic diseases, mainly due to improved management, advanced therapies and preventative measures. However, autoimmune disorders are associated with significantly enhanced cardiovascular morbidity and mortality not fully explained by traditional cardiovascular disease (CVD) risk factors. It has been suggested that interactions between high-grade systemic inflammation and the vasculature lead to endothelial dysfunction and atherosclerosis, which may account for the excess risk for CVD events in this population. Diminished nitric oxide synthesis—due to down regulation of endothelial nitric oxide synthase—appears to play a prominent role in the imbalance between vasoactive factors, the consequent impairment of the endothelial hemostasis and the early development of atherosclerosis. Asymmetric dimethylarginine (ADMA) is one of the most potent endogenous inhibitors of the three isoforms of nitric oxide synthase and it is a newly discovered risk factor in the setting of diseases associated with endothelial dysfunction and adverse cardiovascular events. In the context of systemic inflammatory disorders there is increasing evidence that ADMA contributes to the vascular changes and to endothelial cell abnormalities, as several studies have revealed derangement of nitric oxide/ADMA pathway in different disease subsets. In this article we discuss the role of endothelial dysfunction in patients with rheumatic diseases, with a specific focus on the nitric oxide/ADMA system and we provide an overview on the literature pertaining to ADMA as a surrogate marker of subclinical vascular disease
Nailfold capillaroscopy changes in systemic sclerosis patients with pulmonary arterial hypertension versus without pulmonary arterial hypertension: a systematic review and meta-analysis
No full textMeta-analysis of the effect of pulmonary arterial hypertension on nailfold capillaroscopy changes in patients with systemic sclerosi
Multimodality imaging and the emerging role of cardiac magnetic resonance in autoimmune myocarditis
No full textAutoimmune responses and inflammation are involved in the excess cardiovascular risk observed in patients with systemic inflammatory diseases. Autoimmune myocarditis is a presentation of an inflammatory reaction of the heart during the course of autoimmune disorders, with most cases seen in systemic lupus erythematosus. Early diagnosis is of great significance because of the likelihood of progression to severe and potentially fatal complications such as arrhythmias, heart block, and heart failure. The clinical presentation of the disease is silent leading to delayed diagnosis when dilated cardiomyopathy or heart failure has already advanced. Therefore, a major issue is whether the diagnosis of myocarditis will continue to require invasive procedures such as endomyocardial biopsy or can be achieved with non-invasive methods. There is increasing evidence that noninvasive cardiac imaging, including tissue Doppler echocardiography and cardiac magnetic resonance (CMR), is able to detect subclinical cases and aid in the initiation of specific treatment when it is more likely to be effective. CMR in particular, has emerged as an important technique in the evaluation of myocarditis using three types of images: T2-weighted (T2-W), early T1-weighted (EGE) images taken after 1. min, and delayed enhanced images (LGE) taken 15. min after the injection of contrast agent. If 2/3 of the imaging sequences are positive, myocardial inflammation can be predicted or ruled out with a diagnostic accuracy of 78%. As our understanding of disease mechanisms improves, multimodality imaging may aid in the development of new diagnostic and therapeutic strategies for this potentially devastating complication of systemic inflammation, but further studies are needed to formally evaluate this. © 2012 Elsevier B.V
Nailfold capillaroscopy changes in systemic sclerosis patients with pulmonary arterial hypertension versus without pulmonary arterial hypertension: a systematic review and meta-analysis
No full textMeta-analysis of the effect of pulmonary arterial hypertension on nailfold capillaroscopy changes in patients with systemic sclerosi
The Role of Statins in Disease Modification and Cardiovascular Risk in Rheumatoid Arthritis
No full textRheumatoid arthritis (RA) is an autoimmune, inflammatory disorder associated with excess cardiovascular morbidity and mortality. A complex interplay between traditional risk factors (dyslipidemia, insulin resistance, arterial hypertension, obesity, smoking) and chronic inflammation is implicated in the development of premature atherosclerosis and consequently in the higher incidence of cardiovascular events observed in RA patients. Despite the acknowledgment of elevated cardiovascular risk among RA individuals, its management remains suboptimal. While statin administration has a crucial role in primary and secondary cardiovascular disease prevention strategies as lipid modulating factors, there are limited data concerning the precise benefit of such therapy in patients with RA. Systemic inflammation and anti-inflammatory treatments influence lipid metabolism, leading to variable states of dyslipidemia in RA. Hence, the indications for statin therapy for cardiovascular prevention may differ between RA patients and the general population and the precise role of lipid lowering treatment in RA is yet to be established. Furthermore, some evidence supports a potential beneficial impact of statins on RA disease activity, attributable to their anti-inflammatory and immunomodulatory properties. This review discusses existing data on the efficacy of statins in reducing RA-related cardiovascular risk as well as their potential beneficial effects on disease activity.</p
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