27 research outputs found
Predictive value of noninvasive evaluation by exercise echocardiography and BNP measurement for early identification of pulmonary arterial hypertension in patients affected by systemic sclerosis: 5 years follow-up
No full textBackground. Systemic Sclerosis (SSc) is a chronic multisystem disease characterized by fibrosis of the skin and internal organs, microangiopathy and autoimmune disturbance. Pulmonary arterial hypertension (PAH) is one of the most severe complications of the disease, carrying a poor prognosis. Because of the aspecificity of the symptoms, diagnosis is often made when the disease is in an advanced stage and the pulmonary vascular bed involvement is already severe. For this reason it is essential to develop suitable screening tools to early detect the pathology, providing an appropriate therapy, that could improve the prognosis.
Aim of the study. To evaluate the pulmonary arterial systolic pressure (PAsP) during exercise echocardiography in a group of asymptomatic or mildly symptomatic patients affected to SSc. Patients were then submitted to a medium-long term follow-up performing a resting echocardiogram to evaluate the development of pulmonary hypertension, defining the predictive value of the exercise echocardiography to early identify such complication.
Material and methods. 40 patients affected by SSc (33 females and 7 males) with NYHA functional class I and II and with normal PAsP at rest, underwent exercise echocardiography. Resting and exercise PAsP values were estimated through measurement of tricuspidal regurgitant jet velocity by Doppler, considering values of exercise PAsP ≥ 48 mmHg to be pathological. We also analysed resting and exercise hemodynamic parameters, clinical characteristics of the patients and of the underlying rheumatic disease as well as measurement of resting and exercise BNP values. A medium-long term follow-up was done (5,1 ± 0,4 years), performing a clinical and resting echocardiographic evaluation to detect the development of pulmonary hypertension.
Results. Resting PAsP values were 26,5 ± 4,6 mmHg, reaching values of 45,1 ± 14,2 mmHg during exercise (p 0,00), with a mean increase of 18,7 ± 11,9 mmHg. 25 patients (62,5%) had normal values of exercise PAsP (group A), whereas 15 patients (37,5%), all women, had exercise-induced altered pulmonary vasoreactivity (group B). Comparing group A and B, we found significant differences regarding both resting and exercise PAsP values (respectively p 0,007 and p 0,00), but also regarding exercise BNP values and the variation between resting and exercise BNP (respectively p 0,02 and p 0,001). Out of 40 initial patients, 2 patients died because of extracardiac causes, and 2 patients were lost; therefore 36 patients were followed for a mean time of 5,1 ± 0,4 years. Data from follow-up showed mean resting PAsP of 29,67 ± 7,4 mmHg. 5 patients, belonging to group B, presented pathological resting PAsP values: 3 of these patients had PAsP values suggestive for the diagnosis of possible pulmonary arterial hypertension (PAsP > 37 mmHg), 2 patients had PAsP values suggestive for the diagnosis of probable PAH (PAsP > 50 mmHg). None of the group A patients developed pathological PAsP values at follow-up.
Conclusions. Prevalence of exercise-induced altered pulmonary vasoreactivity, detected by exercise echocardiography, is high in patients affected by SSc.
Such patients had a higher risk for developing pulmonary hypertension at medium- to long- term follow-up. Exercise echocardiography, associated with BNP testing, has been demonstrated to be useful to identify SSc patients presenting an abnormal increase of PAsP during exercise that could, far away, develop PAH
Microbubbles contrast inside the cyst: a pathognomonic sign of mitral valve blood cyst
No full textWe report a case of giant blood cyst originating from the anterior mitral valve leaflet in an 18-year-old white girl. Contrast real-time transthoracic echocardiogram showed the presence of microbubbles inside the cystic cavity during diastole, confirming the presence of blood passage between the ventricular cavity and the cyst lumen and suggesting that this is a pathognomonic sign of the presence of a blood cyst. Although, in previous cases, contrast microbubbles inside the cyst have been described during systole, we report the presence of microbubbles during diastole
Incremento improvviso della soglia ventricolare destra e della impedenza di shock cavale in paziente portatore di Sprint Fidelis seguito con Care-Link: una causa inattesa.
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Rimodellamento atriale sinistro, in pazienti sottoposti, a procedura di ablazione transcatetere della fibrillazione atriale
No full textRisultati e follow up a medio termine dell'ablazione delle vene polmonari con approccio integrato CARTO-LASSO.
No full textDiscordant QRS and ST/T electrical alternans in the setting of peripartum acute myocardial ischemia with normal coronary arteries
No full textExerxise-induced arterial pulmonary hypertension in systemic sclerosis: an echocardiography study.
No full textInefficacia del dronedarone prescritto secondo le indicazioni dell'AIFA per prevenire la fibrillazione atriale in soggetti con precedente sospensione di amiodarone per qualunque ragione
No full textCapitolo V. La classificazione tipologica
No full textProspetto delle “categorie” tipologiche considerate (tav. 1-11) A. Oggetti d’ornamento, utensili, armi, varia A10 Fibula A20 Spillone A30 Pendaglio A40 Scarabeo, scaraboide, sigillo scaraboide A50 Vaghi, perle, perline A60 Anello A70 Spirale A80 Armilla A90 Collana-goliera A100 Diadema A110 Gancio A120 Affibbiaglio A130 Cinturone* A140 ..
