1,720,969 research outputs found
Organizzazione e funzione del Gruppo Operativo Interdisciplinare Scompenso Cardiaco: la risposta sostenibile di un moderno sistema di cure a un problema emergente di sanità pubblica
No full textClinical and economic aspects of the use of nebivolol in the treatment of elderly patients with heart failure
Full text linkDonatella Del Sindaco1, Maria Denitza Tinti2, Luca Monzo2, Giovanni Pulignano2,1Heart Failure Unit, Division of Cardiology, INRCA Institute of Care and Research for Elderly, Rome, Italy; 2Heart Failure Clinic, Division of Cardiology/CCU, San Camillo Hospital, Rome, ItalyAbstract: Heart failure is a common and disabling condition with morbidity and mortality that increase dramatically with advancing age. Large observational studies, retrospective subgroup analyses and meta-analyses of clinical trials in systolic heart failure, and recently published randomized studies have provided data supporting the use of beta-blockers as a baseline therapy in heart failure in the elderly. Despite the available evidence about beta-blockers, this therapy is still less frequently used in elderly compared to younger patients. Nebivolol is a third-generation cardioselective beta-blocker with L-arginine/nitric oxide-induced vasodilatory properties, approved in Europe and several other countries for the treatment of essential hypertension, and in Europe for the treatment of stable, mild, or moderate chronic heart failure, in addition to standard therapies in elderly patients aged 70 years old or older. The effects of nebivolol on left ventricular function in elderly patients with chronic heart failure (ENECA) and the study of effects of nebivolol intervention on outcomes and rehospitalization in seniors with heart failure (SENIORS) have been specifically aimed to assess the efficacy of beta-blockade in elderly heart failure patients. The results of these two trials demonstrate that nebivolol is well tolerated and effective in reducing mortality and morbidity in older patients, and that the beneficial clinical effect is present also in patients with mildly reduced ejection fraction. Moreover, nebivolol appears to be significantly cost-effective when prescribed in these patients. However, further targeted studies are needed to better define the efficacy as well as safety profile in frail and older patients with comorbid diseases.Keywords: beta-blockers, therapy, older, left ventricular dysfunction, prognosi
Blood pressure profile in newly diagnosed acromegalic patients
No full textThe aim of the study was to examine the blood pressure profile of newly diagnosed acromegalic patients, using a two-step method of analysis proposed by Ataessenet al.(Siegel's Runs TEst , followed by a 4 harmonics Fourier analysis).50 newly diagnosed acromegalic patients were submitted to 24 hours ambulatory blood pressure monitoring. A preserved BP circadian rhythm was observed in such patients when compared with the control group (50 healthy subject). Based on our data, in discordance with the literature, a direct effect on blood pressure profile seems to be excluded, whereas a blunted rhythm could represent a marker of end-organ damage or metabolic impairment
Exercise-induced ST-segment elevation
No full textExercise-induced ST-segment elevation in patients without previous myocardial infarction is a relatively uncommon finding. When it does occur, it may be associated with significant coronary artery disease or coronary vasospasm. Here we describe a case of exercise-induced ST-segment elevation in both anterior and inferior leads in a patient with a critical stenosis on a wrapped left anterior descending artery, successfully treated with transluminal coronary artery angioplasty. © 2009 Italian Federation of Cardiology
Incremental Value of Gait Speed in Predicting Prognosis of Older Adults With Heart Failure. Insights From the IMAGE-HF Study
Full text linkOBJECTIVES:
The aim of this study was to assess the relationship between gait speed and the risk for death and/or hospital admission in older patients with heart failure (HF).
BACKGROUND:
Gait speed is a reliable single marker of frailty in older people and can predict falls, disability, hospital admissions, and mortality.
METHODS:
In total, 331 community-living patients ≥70 years of age (mean age 78 ± 6 years, 43% women, mean ejection fraction 35 ± 11%, mean New York Heart Association functional class 2.7 ± 0.6) in stable condition and receiving optimized therapy for chronic HF were prospectively enrolled and followed for 1 year. Gait speed was measured at the usual pace over 4 m, and cutoffs were defined by tertiles: ≤0.65, 0.66 to 0.99, and ≥1.0 m/s.
RESULTS:
There was a significant association between gait speed tertiles and 1-year mortality: 38.3%, 21.9%, and 9.1% (p < 0.001), respectively. On multivariate analysis, gait speed was associated with a lower risk for all-cause death (hazard ratio: 0.62; 95% confidence interval: 0.43 to 0.88) independently of age, ejection fraction <20%, systolic blood pressure, anemia, and absence of beta-blocker therapy. Gait speed was also associated with a lower risk for hospitalization for HF and all-cause hospitalization. When gait speed was added to the multiparametric Cardiac and Comorbid Conditions Heart Failure risk score, it improved the accuracy of risk stratification for all-cause death (net reclassification improvement 0.49; 95% confidence interval: 0.26 to 0.73, p < 0.001) and HF admissions (net reclassification improvement 0.37; 95% confidence interval: 0.15 to 0.58; p < 0.001).
CONCLUSIONS:
Gait speed is independently associated with death, hospitalization for HF, and all-cause hospitalization and improves risk stratification in older patients with HF evaluated using the Cardiac and Comorbid Conditions Heart Failure score. Assessment of frailty using gait speed is simple and should be part of the clinical evaluation process
Usefulness of Local Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention (the Delivery of Thrombolytics Before Thrombectomy in Patients With ST-Segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention [DISSOLUTION] Randomized Trial)
No full textThrombus aspiration during percutaneous coronary intervention can result in improved rates of normal epicardial flow and myocardial perfusion, but several unmet needs remain. The purpose of the Delivery of thrombolytIcs before thrombectomy in patientS with ST-segment elevatiOn myocardiaL infarction Undergoing primary percuTaneous coronary interventION (DISSOLUTION) trial was to evaluate the hypothesis that local delivery of thrombolytics can enhance the efficacy of thrombus aspiration in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. A total of 102 patients With ST-segment elevation myocardial infarction and angiographic evidence of massive thrombosis in the culprit artery were randomly assigned to receive a local, intrathrombus bolus of 200,000 U of urokinase (n = 51) or saline solution (n = 51) by way of an infusion microcatheter, followed by manual aspiration thrombectomy. The end points included the final Thrombolysis In Myocardial Infarction flow grade and frame count, myocardial blush grade, 60-minute ST-segment resolution >70%, and major adverse cardiac and cerebrovascular events, defined as the death, reinfarction, stroke, or clinically driven target vessel revascularization at 6 months. The use of intrathrombus urokinase was associated with a significantly higher incidence of Thrombolysis In Myocardial Infarction flow grade 3 (90% vs 66%, p = 0.008) and lower postpercutaneous coronary intervention Thrombolysis In Myocardial Infarction frame count (19 +/- 15 vs 25 +/- 17, p = 0.033). The postprocedural myocardial perfusion was significantly increased with the use of urokinase (myocardial blush grade 2 or 3, 68% vs 45%, p = 0.028), With more patients showing ST-segment resolution >70% (82% vs 55%, p = 0.006). At 6 months of follow-up, the patients treated with intrathrombus urokinase showed a better major adverse cardiac event-free survival (6% vs 21%; log-rank p = 0.044). In conclusion, local, intrathrombus delivery of thrombolytics before manual thrombectomy improved the postprocedural coronary flow and myocardial perfusion and the 6-month clinical outcomes. (C) 2013 Elsevier Inc. All rights reserved
Effects of Pegvisomant on left ventricular mass in refractroy acromegalic patients. a 4 years follow-up observational study
No full textObjective: Since morpho-functional bi-ventricular impairment (i.e. left ventricular hypertrophy, LVH) is described in Acromegalic patients (pts), the effects of medical and surgical treatments have been previously examined. Pegvisomant (PegV) is a GH receptor antagonist, indicated for acromegalic pts with unsuccessful surgical, radiation, and/or medical treatments, with the goal of obtaining normal IGF-1 serum levels. Aim of this observational study is to evaluate the effect of PegV on left ventricularstructure.
Methods: We evaluated seven consecutive pts (4 males, mean age was50.1SD 9.8 years), with active acromegaly, eligible to PegV treatment (mean disease duration before PegV: 8 years ± 3.2) by means of a 4 yy clinical and instrumental follow-up. Starting from 10 mg daily, PegV was titrated to reach the expected levels of IGF-1 for sex and age. All patients underwent to transthoracic echocardiogram (TTE) yearly from acromegaly diagnosis; in our study we considered the following TTE results: 2 years before starting PegV (T -2), at the enrolment for PegV therapy (T0) and, respectively, after two and four years of treatment (T2, T4). We compared left ventricular dimensions, geometry (LVEDD: left ventricle end-diastolic diameter; RWT: relative wall thickness) and mass (LVM and LVM index , expressed as g/h2.7). Students t test for paired data was used. Results: At six months therapy all pts normalized IGF-1 levels, which remained stable during the whole follow up. LVM and LVMi were significantly higher at T0 when compared with T-2 (before PegV: p< 0.05 for both) whereas significantly lower at T+2 (after 2 yy PegV therapy: p<0.05 vs T0 for both). The improvement trend was confirmed after 4 years PegV treatment (p<0.05 vs T0 and vs T+2 for both).
Conclusions: In our study, successful PegV treatment (involving IGF-1 serum level normalization) seems to be effective in inducing a significant LV mass reduction, whereas previous treatments showed no effect (Fig.1). The observed LVM reduction after PevG treatment could play a role in improving the cardiovascular prognosis of hypertrophic acromegalic patients
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