Older age and markers of inflammation are strong predictors of clinical events in women with asymptomatic carotid lesions.

PREDICTION OF CEREBROVASCULAR AND CARDIOVASCULAR EVENTS IN PATIENTS WITH SUBLINICAL CAROTID ATHEROSCLEROSIS: THE ROLE OF C-REACTIVE PROTEIN

Background Several studies have suggested that inflammation and infection may be important for accelerated progression of atherosclerosis, but few data are available on subjects with early stages of atherosclerosis. Methods and Results We included, in a prospective 5-year follow-up study, 150 patients with subclinical carotid atherosclerosis, evaluating at baseline all established traditional cardiovascular risk factors (eg, older age, male sex, obesity, hypertension, diabetes, smoking, family history of coronary artery disease, and dyslipidemia); 2 markers of inflammation, fibrinogen, and high-sensitivity C-reactive protein (CRP); and the seropositivity to Helicobacter pylori, Chlamydia pn…

Relationship between endothelial dysfunction, intima media thickness, hypertension and other cardiovascular risk factors in asymptomatic subjects

A possible easy way to predict response to cardiac resynchronization therapy: The role of QRS Index

Background: Some studies have evaluated the role of QRS duration (QRSd) as predictor of response to Cardiac Resynchronization Therapy (CRT). However, their results are still not entirely clear. The goal of our study was to determine the correlation between the relative change in QRS narrowing index (QI) compared to clinical outcome and prognosis in patients who underwent CRT implantation. Methods: We collected clinical and echocardiographic data of 115 patients in whome a CRT device was implanted in accordance with current guidelines. QRS duration before and after CRT implantation and QI were measured. Results: After 6 months, a signifi cant improvement in all echocardiographic parameters w…

Livelli plasmatici di fibrinogeno in soggetti con infarto miocardico acuto: relazione con gli eventi nel follow-up a 42 mesi

The Effects of Prostaglandin E-1 in Patients with Intermittent Claudication

Aim of the study is to evaluate the effects of Prostaglandin E-1 (PGE-1) in patients with peripheral arterial disease (PAD) at the 2nd b stage Fontaines classification. The study, controlled, single blinded, enrolled 123 patients with intermittent claudication that were randomised in two groups; the first group received a treatment with PGE-1 while the second one received a pentoxifylline-buflomedil association by venous infusion. We evaluated: Pain Free Walking Distance (PFWD), Maximum Walking Distance (MWD), Rest Flow (RF), Peak Flow (PF), Basal (BVR) and Minimal Vascular Resistance (MVR) with a strain gauge plethysmograph, Resting Flow (RF), Peak Flow (PF), time to reach the Peak Flow (t…

Bifocal Stimulation in Patient with Congenitally Corrected Transposition of Great Vessels

Congenitally corrected transposition of the great vessels (CCTGV) is a rare congenital heart defect associated with multiple cardiac morphological abnormalities and conduction defects. Complete atrioventricular (AV) block occurs in 30% of patients and it may be present at birth or develop later with a rate of 2% per year; moreover, a systemic right ventricle is frequently characterized by heart failure in adult life. We used a bifocal cardiac stimulation for a young woman affected by CCTGV and atrioventricular Mobitz 2 and 2:1 block, considering structural, anatomic condition, and the high rate of pacing she underwent. (PACE 2012; 35:e296–e298)

[Metabolic syndrome in children and in adults: is it an autonomous nosological entity?].

The term metabolic syndrome defines a cluster of risk factors for cardiovascular diseases and diabetes. This syndrome is very frequent in general population. However, despite the efforts to define the diagnostic criteria, nowadays its clinical utility is object of a lively debate.

L’eta’ e gli elevati livelli di proteina C-reattiva e fibrinogeno sono forti predittori di eventi clinici in una popolazione di donne con aterosclerosi carotidea.

INFLUENCE OF CAROTID AND PERIPHERAL ATHEROSCLEROSIS ON THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME

A rare case of Prinzmetal angina 3 days after coronary artery stenting with a second-generation drug-eluting stent

Non previsto.

CAROTID INTMAL-MEDIAL THICKNESS ANS ENDOTHELIAL FUNCTION IN YOUNG ADULTS PATIENTS WITH MYOCARDIAL INFARCTION

Non-responders to cardiac resynchronization therapy: Insights from multimodality imaging and electrocardiography. A brief review

Background Cardiac resynchronization therapy (CRT) is a successful strategy for heart failure (HF) patients. The pre-requisite for the response is the evidence of electrical dyssynchrony on the surface electrocardiogram usually as left bundle branch block (LBBB). Non-response to CRT is a significant problem in clinical practice. Patient selection, inadequate delivery and sub-optimal left ventricle lead position may be important causes. Objectives In an effort to improve CRT response multimodality imaging (especially echocardiography, computed tomography and cardiac magnetic resonance) could play a decisive role and extensive literature has been published on the matter. However, we are so fa…

Carotid intimal-media thickness and endothelial function in young patients with history of myocardial infarction

AIM: The aim of the study was to evaluate the prevalence of carotid atherosclerosis and endothelial dysfunction in 45 young patients (38 mens and 7 females) with myocardial infarction (MI), age 29-45, mean age 42+/-3 years, to verify its possible role as a marker of coronary atherosclerosis. METHODS: Vascular echography was performed to verify the presence of carotid atherosclerosis and/or endothelial dysfunction in 45 young patients with MI and in 45 healthy control subjects well matched for age and sex. RESULTS: We observed a normal intima media thickness (IMT) only in 30% of patients with juvenile myocardial infarction (JMI) compared with 66% in the control group (P<0.0001) and 34% of pa…

Prevalence of metabolic syndrome: A comparative analysis in an unselected sample of mediterranean subjects

Abstract AIM: The metabolic syndrome (MS) is associated with increased cardiovascular and cerebrovascular risk. This study aimed to compare the difference of the three established diagnostic criteria of MS, developed by Adult Treatment Panel III (ATP III), American Heart Association (AHA) and National Heart Lung and Blood Institute (NHLBI), and International Diabetes Federation (IDF), with regard to the prevalence of the syndrome and the ability to correctly identify individuals with cardiovascular or cerebrovascular disease or subclinical atherosclerosis. METHODS: We studied 947 consecutive patients underwent clinical evaluation between the 1997-2002. The project design included a medical …

Role of curcumin in idiopathic pulmonary arterial hypertension treatment: A new therapeutic possibility

The idiopathic pulmonary arterial hypertension is a complex disease that mainly affects pulmonary arterial circulation. This undergoes a remodeling with subsequent reduction of flow in the small pulmonary arteries. Because of this damage an increased vascular resistance gradually develops, and over time it carries out in heart failure. The inflammatory process is a key element in this condition, mediated by various cytokines. The inflammatory signal induces activation of NF-κB, and prompts TGF-β-related signaling pathway. Clinical evolution leads to progressive debilitation, greatly affecting the patient quality of life. The actual therapeutic approaches, are few and expensive, and include …

Analysis of N-terminal pro-B-type natriuretic peptide in patients with acute coronary syndromes

Background The N-terminal portion of brain natriuretic peptide (NT-proBNP) has been identified as an indicator of prognosis in different cardiovascular diseases. The objective of this study was to determine the utility of measuring plasma NT-proBNP levels in patients with acute coronary syndromes. Methods and results We studied 66 patients admitted in our division for acute coronary syndromes. Patients underwent a venous blood sample within 24 h from the admission to determine NT-proBNP levels. Increasing plasma levels of NT-proBNP (in tertiles) was associated with a greater history of hypertension and current smoking, whereas biochemical parameters were associated with higher level of crea…

The risk of noncardiac surgery in patients with heart disease: a new way for an easy approach to a right preoperative assessment

Use of direct oral anticoagulants in very elderly patients: a case report of apixaban in an ultracentenary patient.

no

Giant left atrium: a condition that is rarely seen today.

Today, giant left atrium is a condition that is rarely observed in clinical practice and diagnosis can be missed. It is prevalent in patients with rheumatic heart disease that has decreased considerably in industrialized countries in the last two decades. However, the immigration flow in the current era can revive its incidence.

Alteration of Heart Rate Variability as an Early Predictor of Cardiovascular Events: A Look at Current Evidence

Evidence suggests an association between autonomic nervous system (ANS) function and atrial fibrillation (AF) development. We sought to examine the association of baseline resting heart rate (RHR) and short-term heart rate variability (HRV) as surrogates of (ANS) with incident AF in individuals without prior cardiovascular disease. A total of 6261 participants of the Multi Ethnic Study of Atherosclerosis (MESA) who were free of AF and diagnosed cardiovascular disease were enrolled. Three standard 10-second, 12-lead electrocardiograms were used to measure RHR, the standard deviation of normal-to-normal intervals (SDNN) and the root mean square of successive differences in RR intervals (RMSSD…

Association of elevated fibrinogen and C-reactive protein levels with carotid lesions in patients with newly diagnosed hypertension or type II diabetes.

BACKGROUND: Inflammation may be important for accelerated progression of atherosclerosis in patients with hypertension or diabetes, but few studies included subjects with early stages of atherosclerosis such as those with asymptomatic carotid lesions. METHODS: We studied 100 patients with newly diagnosed hypertension and another 100 patients with newly diagnosed type II diabetes to evaluate in such groups the association of two markers of inflammation, fibrinogen and C-reactive protein (CRP), with carotid atherosclerosis, beyond traditional cardiovascular risk factors (e.g., older age, male gender, obesity, smoking, family history of CAD, dyslipidemia). RESULTS: We found positive correlatio…

Ischemia critica cronica e vasculopatia ischemica polidistrettuale

Markers of inflammation are strong predictors of subclinical and clinical atherosclerosis in women with hypertension

Cardiovascular diseases in women still rises and remains their leading cause of death in most developed countries; yet we have less sex-specific data in women than in men as a result of lower enrollment in clinical trials and low rates of sex-specific reporting. The aim of our study was to evaluate in hypertensive postmenopausal women the potential predictive role of markers of inflammation, for example, fibrinogen and C-reactive protein (CRP), on subclinical and clinical atherosclerosis, beyond that of the other established cardiovascular risk factors. We studied 127 asymptomatic hypertensive postmenopausal women with different degrees of carotid intima–media thickness, as examined by the …

[Cardiovascular health in Asian immigrants to Italy: risk factors, pathogenesis and pharmacological treatment].

In the last decades a significant increase of the migratory phenomenon from South Asian countries to the western world has occurred due to several factors, such as economic crisis, political instabilities, persecutions and wars. It is well established that South Asians (SA) have a higher prevalence of coronary artery disease (CAD) and premature onset of myocardial infarction episodes than other populations. This higher predisposition might be caused by genetic factors, common in both SA residing in their birth country and in those residing abroad, but it may also be due to the new spatial environment in which they live. We have found a higher prevalence of traditional cardiovascular risk fa…

Giant unruptured circumflex coronary artery aneurysms presenting as acute coronary syndrome

Statins and peripheral arterial disease: effects on claudication, disease progression, and prevention of cardiovascular events.

Peripheral arterial disease (PAD) of the lower limbs is the third most important site of atherosclerotic disease alongside coronary heart disease (CHD) and cerebrovascular disease (CVD). Best medical treatment is beneficial even in patients who eventually need invasive treatment, as the safety, immediate success, and durability of intervention is greatly improved in patients who adhere to best medical treatment. In recent years, a number of studies have suggested that the ACE-inhibitor ramipril and different statins, together with antiplatelet drugs, reduce cardiovascular morbidity and mortality in PAD. Patients with PAD are really a category of patients with a very high cardiovascular risk…

INFLUENCE OF CAROTID AND PERIPHERAL ATHERLSCLEROSIS IN THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME

INFLUENCE OF CAROTID AND PERIPHERAL ATHERLSCLEROSIS IN THE OUTCOME OF PATIENTS WITH ACUTE CORONARY SYNDROME

Endothelial dysfunction and carotid lesions are strong predictors of clinical events in patients with early stages of atherosclerosis: a 24-month follow-up study

Background The purpose of this study was to investigate whether the vasodilator response to brachial artery and the presence of carotid lesions may have a prognostic significance in patients with early stages of atherosclerosis. Methods and results Vascular echography was performed to analyze flow-mediated vasodilatation (FMD) at the brachial artery and intima–media thickness (IMT) of carotid arteries in 84 asymptomatic patients. At baseline, we evaluated all the established traditional cardiovascular risk factors. Transient ischemic attack, stroke, effort or unstable angina, acute myocardial infarction, peripheral arterial disease and cerebrovascular and cardiovascular death served as outc…

RUOLO DEI FATTORI DI RISCHIO TRADIZIONALI E DELLA PROTEINA-C REATTIVA NELLA PATOGENESI DELLA DISFUNZIONE ENDOTELIALE

FIBRINOGEN AS PREDICTOR OF MORTALITY AFTER ACUTE MYOCARDIAL INFARCTION: A 42-MONTHS FOLLOW-UP STUDY

Background. Several studies suggest that fibrinogen may be considered an independent risk factor for coronary artery disease, but it is still on debate if we need its evaluation during an acute myocardial infarction (AMI) to prevent future fatal or non-fatal cardiovascular events. Therefore, we decided to investigate this field. Methods: We studied 92 male patients with AMI, evaluating at admission age, body mass index, systolic blood pressure, cigarette smoking, ejection fraction, plasma levels of total cholesterol, triglycerides, fibrinogen, glycemia, and white blood cell count. All patients were followed up for 42 months to evaluate total mortality and cardiovascular morbidity. Results: …

Management of a patient with multiple device replacements and extractions: When the leadless pacemaker is a viable solution

Leadless pacemaker (LPs) is a safe device and the implantation rates of this device is increasing. The device extraction and replacement are today a challenging procedures especially in case of infections, fragile and older patients or in unfavorable venous anatomy; LPs can be a valid alternative strategy in these cases. We report a case of management of a patient with multiple previous device replacements and extractions, with malfunction of transvenous pacemaker and with a fibrous membrane between the walls of the ventricular lead and the superior vena cava (SVC), who underwent a successful LP implantation.

An update on the role of markers of inflammation in atherosclerosis

In recent years, several studies have used the measurement of carotid intima-media thickness (IMT) as a marker of early atherosclerosis: IMT has been shown to correlate significantly with the presence of coronary artery disease (CAD) and to predict fatal and not fatal cerebro- and cardio-vascular events. These findings highlight the importance of recognizing and managing early stages of atherosclerosis for effective cardiovascular prevention. Beyond traditional established cardiovascular risk factors, inflammation has been shown to be crucial throughout atherosclerosis from endothelial dysfunction to plaque rupture and thrombosis. Several studies have shown the existence of a strong relatio…

In-hospital stay of patient with acute coronary syndrome with or without diabetes mellitus

Aim. Type 2 diabetes is associated with an increase in the risk of coronary heart disease, by a factor of two to four. The scientific community has suggested that all patients with diabetes could be treated as if they had a prior coronary heart disease. Methods. A computer review of 11-year prevalence (from 1991 to 2002) of type 2 diabetes among 3 242 patients admitted to the Intensive Coronary Care Unit of the Division of Cardiology of the University Hospital "Paolo Giaccone", Palermo, was carried out, with the diagnosis of ST elevation myocardial infarction (STEMI) (51%), non ST elevation myocardial infarction (NSTEMI) (6%) or unstable angina (UA) (43%). Results. Prevalence of type 2 diab…

Treatment decision making in patients with arrhythmogenic right ventricular dysplasia/cardiomyopathy: State of the art

No abstract available

Diagnosis and treatment of asymptomatic left ventricular systolic dysfunction after myocardial infarction.

The increased survival after acute myocardial infarction induced an increase in heart failure with left ventricular systolic dysfunction. Early detection and treatment of asymptomatic left ventricular systolic dysfunction give the chance to improve outcomes and to reduce costs due to the management of patients with overt heart failure.

RUOLO DELLA SINDROME METABOLICA NELLE SINDROMI CORONARICHE ACUTE

Non invasive evaluation of endothelial function in patients with Anderson-Fabry disease.

AIM: Fabry's disease is an X-linked recessive abnormality of glycosphingolipid metabolism. Increased levels of endothelial prothrombotic factors have recently been demonstrated in Fabry's disease, whereas endothelial function has not been studied using high resolution ultrasound. METHODS: We enrolled 6 patients (4 male, 2 female; mean age, 37 years) and 12 sex matched control subjects (mean age, 37 years). Patients' exclusion criteria included a prior history of cardiac disease, diabetes and treated or untreated hypertension. Patients underwent: anamnesis, physical examination, EKG, 2-dimensional echocardiography with tissue Doppler, measurement of body weight and height, blood pressure. Bi…

Midventricular dyskinesia during clozapine treatment?

This is the case of a young man suffering from schizophrenia and treated with clozapine. He developed acute heart failure associated with pericardial effusion and midventricular dyskinesia with severe systolic dysfunction and left ventricular dilatation at echocardiogram, readily resolved after the suspension of clozapine therapy. The segmental wall motion abnormalities observed at echocardiogram in this case are peculiar and have never been described before. The possible cardiotoxic effects of clozapine have been reported previously in the literature. Because of its serious potential side effects this drug is not considered the first choice for treatment of schizophrenia. Before beginning …

Focus sui non responder alla terapia di resincronizzazione cardiaca: orizzonti e prospettive

Cardiac resynchronization therapy (CRT) has been shown as a successful strategy in the treatment of patients with heart failure and electrical dyssincrony. However, a significant proportion of implanted patients fails to respond sufficiently or in a predictable manner. Consequently, non response to CRT remains a valuable problem in clinical practice. In order to improve CRT response and long-term clinical benefits, the proper evaluation of patient's global frialty, the technology improvement, the multimodality imaging approach and the use of simple and low cost electrographic parameters (to verify effective biventricular capture and QRS narrowing) could play a important role. Therefore, the…

Magnitude of QRS duration reduction after biventricular pacing identifies responders to cardiac resynchronization therapy

Background Several studies have investigated the association between native QRS duration (QRSd) or QRS narrowing and response to biventricular pacing. However, their results have been conflicting. The aim of our study was to determine the association between the relative change in QRS narrowing index (QI) and clinical outcome and prognosis in patients who undergo cardiac resynchronization therapy (CRT) implantation. Methods and results We included 311 patients in whom a CRT device was implanted in accordance with current guidelines for CRT. On implantation, the native QRS, the QRSd and the QI during CRT were measured. After 6 months, 220 (71%) patients showed a 10% reduction in LVESV. The m…

LESIONI CAROTIDEE ASINTOMATICHE, INCIDENZA DI EVENTI VASCOLARI FATALI E NON IN UNA POPOLAZIONE DI DIABETICI DI TIPO II: RUOLO DELLA PROTEINA C REATTIVA AD ALTA SENSIBILITA’

Decision making in a presumptive case of STEMI-like myocarditis

In youngmales, differential diagnosis during chest pain is not always easy. When ECG findings suggest a cardiac origin of such symptoms, myo-pericarditis is usually themost likely hypothesis, beingmore common than Acute Coronary Syndromes (ACS) in the first decades of life [1]. In the presence of ST segment elevation, Troponin release and ventricular wall motion abnormalities, the diagnosis can be challenging, though. In the young a lowcoronary risk profile and atypical symptoms seldom support a working diagnosis of Coronary Heart Disease (CHD), and, therefore, urgent coronary angiography is not recommended routinely, although cases of early ACS are not so rare. In October 2014 a 26-year-ol…

ATRIAL FIBRILLATION AND MILD COGNITIVE IMPAIRMENT: WHAT CORRELATION?

ATRIAL FIBRILLATION AND MILD COGNITIVE IMPAIRMENT: WHAT CORRELATION? Aim. Atrial fibrillation (AF), in addition to macroembolic complications, may also produce multiple cerebral ischemic areas due to microembolic phenomena and transient hypoperfusion, eventually leading to a progressive cognitive impairment and even to acclaimed vascular dementia. The aim of this study was to evaluate the prevalence of cognitive impairment in patients with AF. The reported results concern data obtained at the moment of recruitment. Methods. The authors studied 42 patients with a history of non valvular AF (paroxysmal, persistent, recurrent or permanent) and 40 homogenous controls in sinus rhythm without pre…

Selective pacing sites

The right ventricular apex (RVA) has always been the most used pacing site, because it is easily accessible and provides a stable lead position with a low dislodgment rate. However, it is well-known that long-term right ventricular apical pacing may have deleterious effects on left ventricular function by inducing a iatrogenic left bundle branch block, which can have strong influences on the left ventricle hemodynamic performances. More specifically, RVA pacing causes abnormal contraction patterns and the consequent dyssynchrony may cause myocardial perfusion defects, histopathological alterations, left ventricular dilation and both systolic and diastolic left ventricular dysfunction. All t…

Low- vs high-dose ARNI effects on clinical status, exercise performance and cardiac function in real-life HFrEF patients.

Purpose Only a few studies are available on dose-related effects of sacubitril/valsartan (angiotensin receptor neprilysin inhibition (ARNI)) in real-life patients with heart failure and reduced ejection fraction (HFrEF). We sought to investigate clinical and functional effects in real-life HFrEF patients receiving ARNI at a different cumulative dose. Methods This was an observational study in consecutive outpatients admitted for HFrEF from October 2017 to June 2019. The PARADIGM criteria were needed for enrolment. ARNI was uptitrated according to blood pressure, drug tolerability, renal function and kaliemia. At least 10-month follow-up was required in each patient. Clinical assessment, Kan…

Real-world use of ticagrelor and prasugrel in patients with NSTEMI undergoing percutaneous coronary intervention.

NON INVASIVE VALUATION OF ENDOTHELIAL FUNCTION IN THE PATIENTS WITH ANDERSON- FABRY DISEASE

MULTIFOCAL ATHEROSCLEROTIC DISEASE: A CASE –REPORT

BENEFICI CLINICI E IMPATTO SULLA SOPRAVVIVENZA A LUNGO TERMINE DELLA TERAPIA DI RESINCRONIZZAZIONE CARDIACA

Peripheral artery disease: potential role of ACE-inhibitor therapy

Giuseppe Coppola, Giuseppe Romano, Egle Corrado, Rosa Maria Grisanti, Salvatore NovoDepartment of Internal Medicine, Cardiovascular and Nephro-Urological Diseases, Chair of Cardiovascular Disease, University of Palermo, Palermo, ItalyAbstract: Subjects with peripheral arterial disease (PAD) of the lower limbs are at high risk for cardiovascular and cerebrovascular events and the prevalence of coronary artery disease in such patients is elevated. Recent studies have shown that regular use of cardiovascular medications, such as therapeutic and preventive agents for PAD patients, seems to be promising in reducing long-term mortality and morbidity. The angiotensin-converting-enzyme (ACE) system…

Morbillo e fenomeno di Brugada: un caso clinico

Use of statins in patients with peripheral artery disease

Atherosclerotic peripheral artery disease (PAD) is a growing health issue that affects more than 200 million individuals worldwide, conferring a high risk of cardiovascular events and death. In spite of its high prevalence, PAD has often been neglected in the past and the heightened cardiovascular risk of patients with PAD has been consistently under-recognized by practitioners. Considering that an integrated approach to reduce cardiovascular events and lower limb complications is necessary in this setting, statins represent the cornerstone of therapy as reported by current American and European guidelines. Literature has extensive data about the importance of lipid-lowering therapy in pati…

Measles and Brugada pattern: A case report

No abstract available

Prognostic role of endothelial dysfunction and carotid intima-media thickness in patients undergoing coronary stent implantation

Aim. Impaired endothelial function and increased carotid intima-media thickness are key events in the atherosclerotic process and predict future cardiovascular events in subjects with and without coronary artery disease. The purpose of this study was to investigate whether the vasodilator response to increased flow in the brachial artery and the presence of carotid lesions may have a prognostic significance for in-stent restenosis in patients undergoing coronary angioplasty. Methods. The study population included 58 patients undergoing percutaneous coronary intervention (PCI) with stenting and at least 10 months of follow-up. All patients underwent ultrasound detection of brachial artery re…

A case of Takotsubo syndrome

Management of Direct Oral Anticoagulants in Patients with Atrial Fibrillation Undergoing Cardioversion

Atrial fibrillation the most common cardiac arrhythmia. Its incidence rises steadily with each decade, becoming a real “epidemic phenomenon”. Cardioversion is defined as a rhythm control strategy which, if successful, restores normal sinus rhythm. This, whether obtained with synchronized shock or with drugs, involves a periprocedural risk of stroke and systemic embolism which is reduced by adequate anticoagulant therapy in the weeks before or by the exclusion of left atrial thrombi. Direct oral anticoagulants are safe, manageable, and provide rapid onset of oral anticoagulation; they are an important alternative to heparin/warfarin from all points of view, with a considerable reduction in b…

INIBITORI DEL SISTEMA RENINA-ANGIOTENSINA E FIBRILLAZIONE ATRIALE: UNO STUDIO RETROSPETTIVO SU 187 PAZIENTI

INFLUENZA DELL’ATEROSCLEROSI CAROTIDEA PRECLINICA SUGLI EVENTI CEREBRO- E CARDIOVASCOLARI IN 5 ANNI DI FOLLOW-UP. INFLUENCE OF PRECLINICAL CAROTID ATHEROSCLEROSIS ON CEREBRO- AND CARDIOVASCULAR EVENTS IN A FIVE YEARS FOLLOW-UP

Introduzione: numerosi studi hanno utilizzato la valutazione dello spessore intima-media carotideo (IMT) come marker di aterosclerosi (ATS) preclinica ed è stato ampiamente dimostrato che l’IMT correla con la presenza di ATS coronarica ed è predittivo di eventi sia cardio- che cerebrovascolari. Scopo dello studio: valutare se in soggetti asintomatici la presenza di ATS carotidea preclinica, ispessimento medio intimale carotideo (IMT) e placca carotidea asintomatica (PCA), aggiunga ulteriori informazioni nella stratificazione del rischio permettendo di individuare soggetti che potrebbero beneficiare di un trattamento più aggressivo, anche farmacologico, dei fattori di rischio presenti. Mater…

Decision making and devices approach in a case of left main coronary artery thrombus.

☆ This statement is to certify that all authors have seen being submitted, have contributed significantly to the w legitimacy of the data and its interpretation, and ag International Journal of Cardiology. We attest that the artic has not received prior publication and is not under elsewhere. We adhere to the statement of ethical pub (Shewan LG et al 2013 in press). ☆☆ On behalf of all co-authors, the corresponding author the submission. ⁎ Corresponding author at: Division of Cardiology II, D and Cardiovascular Diseases, University Hospital Paolo Gi 90127 Palermo, Italy. Tel.: +39 1 6554303; fax: +39 1 65 E-mail address: odisseos86@alice.it (V. Sucato).

STATINS AND PERIPHERAL ARTERIAL DISEASE: EFFECTS ON DISEASE PROGRESSION, CLAUDICATION AND PREVENTION OF CARDIOVASCULAR EVENTS.

Peripheral arterial disease (PAD) of the lower limbs is the third most important site of atherosclerotic disease alongside coronary heart disease (CHD) and cerebrovascular disease (CVD). Best medical treatment is beneficial even in patients who eventually need invasive treatment, as the safety, immediate success, and durability of intervention is greatly improved in patients who adhere to best medical treatment. In recent years, a number of studies have suggested that the ACE-inhibitor ramipril and different statins, together with antiplatelet drugs, reduce cardiovascular morbidity and mortality in PAD. Patients with PAD are really a category of patients with a very high cardiovascular risk…

Direct Oral Anticoagulants in the Setting of Catheter Ablation of Atrial Fibrillation: State of art

Atrial fibrillation (AF) represents the arrhythmia of greatest clinical impact and catheter ablation of AF (CAAF) has become the most effective strategy for rhythm control in selected patients. Therefore, appropriate anticoagulation strategies are of paramount importance for patients undergoing CAAF, especially those at high risk, such those with high CHA2DS2VASc scores. Optimal management of anticoagulation before, during, and after CAAF is crucial. Several studies have evaluated the use of different anticoagulation strategies in the periprocedural period. Randomized controlled trial seem to suggest that in patients undergoing CAAF, uninterrupted (or minimally interrupted) direct oral anti…

The role of macrophage colony-stimulating factor in patients with acute myocardial infarction: a pilot study.

We assessed whether macrophage colony-stimulating factor (M-CSF) levels are associated with left ventricular systolic dysfunction (LVSD) in patients with acute myocardial infarction (AMI). We studied 56 patients with AMI (mean age: 67 ± 12 years) and identified those with clinical (Killip class &gt;II) or echocardiographic signs (ejection fraction ≤45%) of LVSD. We evaluated the established cardiovascular risk factors and measured several cardiovascular biomarkers, including M-CSF. Serum M-CSF concentrations (pg/mL) were significantly increased in patients with both clinical and echocardiographic signs of LVSD (460 ± 265 vs 290 ± 210, P = .0103 and 493 ± 299 vs 287 ± 174, P = .0028, respec…

Amyloidosis and device therapy: an open debate

Cardiac involvement represents a critical prognostic factor in amyloidosis, as it represents a leading cause of morbidity and mortality, in primary light chain amyloidosis, in hereditary and also in wild-type transthyretin amyloidosis. A 54-year-old male was admitted to Emergency Room with complaints of dyspnea, palpitations and diaphoresis.

Prediction of cardio- and cerebro-vascular events in patients with subclinical carotid atherosclerosis and the metabolic syndrome.

ST segment elevations: Always a marker of acute myocardial infarction?

AbstractChest pain is one of the chief presenting complaints among patients attending Emergency department. The diagnosis of acute myocardial infarction may be a challenge. Various tools such as anamnesis, blood sample (with evaluation of markers of myocardial necrosis), ultrasound techniques and coronary computed tomography could be useful. However, the interpretation of electrocardiograms of these patients may be a real concern. The earliest manifestations of myocardial ischemia typically interest T waves and ST segment. Despite the high sensitivity, ST segment deviation has however poor specificity since it may be observed in many other cardiac and non-cardiac conditions. Therefore, when…

PREVALENCE OF A MILD COGNITIVE IMPAIRMENT IN PATIENTS WITH ATRIAL FIBRILLATION

Prediction of cardio- and cerebro-vascular events in patients with subclinical carotid atherosclerosis and low HDL-cholesterol.

Low HDL-cholesterol concentrations are associated with increased cardiovascular risk and recent evidences suggest that HDL may aggravate the atherosclerotic process promoting inflammation: HDL are anti-inflammatory in the absence of inflammation but can become proinflammatory in the presence of atherosclerosis. Yet, no data is available on the cardiovascular outcome in subjects with low HDL-cholesterol and early stages of atherosclerosis. Therefore, we included in a prospective 5-year follow-up study 150 subjects with low HDL-cholesterol concentrations and subclinical carotid atherosclerosis, as assessed by carotid colour doppler, evaluating at baseline all the established traditional cardi…

ELEVATED C-REACTIVE PROTEIN LEVELS ARE A STRONG PREDICTOR OF CLINICAL EVENTS IN HYPERTENSIVE PATIENTS WITH EARLY STAGE OF ATHEROSCLEROSIS

Active-fixation coronary sinus pacing lead extraction: A hybrid approach

Cardiac resynchronization therapy (CRT) can be considered as the standard treatment for patients suffering from heart failure (NYHA III–IV), severely reduced left ventricular (LV) function, and wide QRS complexes. Over the past years, the lead systems used to stimulate the left ventricle have evolved technically from epicardial approaches to a transvenous access accompanied by a significant reduction of procedure-related complication rates [1]. However, even today, LV dislodgement rates ranging 5–10% and the instability of thresholds over time remain the greatest challenges with transvenous LV leads in CRT. Therefore, a special LV lead utilizing active fixation (the Attain StarFix® active f…

ICD implantation in noncompaction of the left ventricular myocardium: a case report

Isolated noncompaction of the ventricular myocardium (INVM) is an uncommon cardiomyopathy characterized by the persistence of fetal myocardium with prominent trabecular meshwork and deep intertrabecular recesses, often associated with systolic dysfunction and ventricular dilatation. A 23-year-old man from Burkina Faso was referred to our operative unit with a diagnosis of INVM, made with echocardiogram and magnetic resonance imaging and nonsustained ventricular tachycardia. The literature reports the incidence of malignant ventricular arrhythmias in as many as 47% of the patients and sudden cardiac death in almost 50% of them and this supported our decision to perform implantable cardiovert…

takotsubo cardiomiopathy after acute diarrhea

Takotsubo cardiomyopaty is a recently described syndrome characterized by transient left ventricular dysfunction, mimicking an acute coronary syndrome and usually precipitated by a physical or emotional stress. We report the first case of Takotsubo cardiomyopathy after acute diarrhea in a man. It may be argued that severe diarrhea in predisposed individuals may cause an acute stress resulting in increased sympathetic activity leading to this syndrome. Probably the relationship between the adrenergic system and the heart is more complex than general thought and the stimuli which favor an autonomic imbalance and precipitate the syndrome are very disparate in clinical practice.

Coronary Artery Disease in South Asian Patients: Cardiovascular Risk Factors, Pathogenesis and Treatments.

In the last decades a significant increase of the migratory phenomenon from South Asian countries to the Western World has occurred for social, economic and geopolitical reasons. The aim of this review is to describe cardiovascular risk factors, pathogenesis and treatments of coronary artery disease in South Asian patients. It is well established that South Asian populations have a higher prevalence of coronary artery disease and premature onset of myocardial infarction episodes than other populations. This higher predisposition might be caused by genetic factors, common in both South Asian patients residing in their birth country and in those residing abroad, but it may also be due to the …

PROGNOSTIC IMPACT OF HYPERTENSION AND CAROTIID LESIONS N A FIVE YEARS FOLLOW UP

Older age and markers of inflammation are strong predictors of clinical events in women with asymptomatic carotid lesions

OBJECTIVE: Limited information exists regarding the association between markers of inflammation, such as high-sensitivity C-reactive protein (hs-CRP) and fibrinogen, and adverse events in postmenopausal women with subclinical atherosclerosis. Therefore, we investigated the prognostic impact of traditional risk factors and inflammation on adverse cardiac events in women with asymptomatic carotid lesions. DESIGN: We studied 250 postmenopausal women who were free of cardiovascular disease. Traditional cardiovascular risk factors were investigated, and laboratory analysis included measurement of plasma lipids, fibrinogen, and hs-CRP. The early phases of carotid atherosclerosis were assessed by …

ICD Implantation in Noncompaction of the Left Ventricular Myocardium: A Case Report

Isolated noncompaction of the ventricular myocardium (INVM) is an uncommon cardiomyopathy characterized by the persistence of fetal myocardium with prominent trabecular meshwork and deep intertrabecular recesses, often associated with systolic dysfunction and ventricular dilatation. A 23-year-old man from Burkina Faso was referred to our operative unit with a diagnosis of INVM, made with echocardiogram and magnetic resonance imaging and nonsustained ventricular tachycardia. The literature reports the incidence of malignant ventricular arrhythmias in as many as 47% of the patients and sudden cardiac death in almost 50% of them and this supported our decision to perform implantable cardiovert…

Endothelial dysfunction and carotid lesions are strong predictors of clinical events in patients with early stages of atherosclerosis: a 24 months follow-up study.

The effects Prostaglandine E-1 in patients with intermittent claudication

Reverse remodeling and arrhythmic burden reduction in a patient with an implantable cardioverter defibrillator treated with sacubitril/valsartan: Case report

Abstract Sacubitril/valsartan has been shown to reduce cardiovascular mortality and hospitalizations in patients with HFrEF when compared to enalapril. There are also some evidences of its potential antiarrhythmic effects. We present a report where we found a relation between reverse ventricular remodeling and arrhythmic reduction in a patient treated with sacubitril/valsartan.

Therapeutic management in Sicilian patients with definite arrhythmogenic right ventricular dysplasia/cardiomyopathy and focus on the role of implantable cardioverter-defibrillator therapy

Arrhythmogenic Right Ventrticular Dysplasia/Cardiomyopathy(ARVD/C) is an inherited cardiomyopathy characterized by right ven-tricularmyocytelosswithfibrofattyreplacement,ahighriskofventric-ular arrhythmias (VA) and sudden cardiac death (SCD) [1]. Preventionof SCD represents the most important management strategy and theachievement of this target can be reached by different therapeuticstrategies including implantable cardioverter-defibrillator (ICD)implantation, pharmacologic therapy, catheter ablation of ventriculartachycardia (VT) and cardiac transplantation [2,3]. The aim of thisstudy is to examine the outcome of the different therapies adopted ina group of affected patients, focusing on th…

EFFICACIA DELL’ATP IN PAZIENTI CON ICD E TV RAPIDE: UN CASO CLINICO

Jugular pacing lead extraction with laser sheath: a case report.

Over the past 20 years, the number of patients with pacemakers (PM) or implantable cardioverter defibrillators has risen markedly; consequently, an increasing number of lead-removal procedures have become necessary. A 64-year-old woman presenting with an infected device pocket and positive bacterial cultures ( Staphylococcus aureus ) was admitted to our department for lead removal; in 1991, she underwent VVI PM implantation for atrioventricular II degree Mobitz 1 block, and a unipolar lead was introduced via the left jugular vein. The procedure was performed in our Electrophysiology Lab with a cardiac surgeon on standby, using an excimer laser system emitting the energy at the tip of a flex…

Markers of inflammation are strong predictors of subclinical and clinical atherosclerosis in women with hypertension

Update on Brugada Syndrome 2019

Brugada syndrome (BrS) was first described in 1992 as an aberrant pattern of ST segment elevation in right precordial leads with a high incidence of sudden cardiac death (SCD) in patients with structurally normal heart. It represents 4% ∼ 12% of all SCD and 20% of SCD in patients with structurally normal heart. The extremely wide genetic heterogeneity of BrS and other inherited cardiac disorders makes this new area of genetic arrhytmology a fascinating one. This review shows the state of art in diagnosis, management, and treatment of BrS focusing all the aspects regarding genetics and Preimplant Genetic Diagnosis (PGD) of embryos, overlapping syndromes, risk stratification, familial screeni…

LA TERAPIA DI RESINCRONIZZAZIONE CARDIACA (TRC) COME PONTE AL TRAPIANTO CARDIACO. UN CASO CLINICO

ASSOCIATION OF ELEVATED FIBRINOGEN AND C-REACTIVE PROTEIN LEVELS WITH CAROTID LESIONS IN PATIENTS WITH EARLY ONSET OF HYPERTENSION OR TYPE-II DIABETES

L’eta’ e gli elevati livelli di proteina C-reattiva e fibrinogeno sono forti predittori di eventi clinici in una popolazione di donne con aterosclerosi carotidea.

ELEVATED C-REATIVE PROTEIN LEVELS ARE STRONG PREDICTOR OF CLINICAL EVENTS IN HYPERTENSIVE PATIENTS WITH EARLY STAGES OF ATHEROSCLEROSIS

Evaluation of remnant cholesterol levels and Monocyte-to-HDL-cholesterol ratio in South Asian patients with acute coronary syndrome.

Abstract Background and aims In the present study, we aimed to compare the clinical and coronary angiography features between South Asian and Caucasian patients with Acute Coronary Syndrome (ACS). In particular, we focused our analysis on the evaluation of recent cardiovascular risk markers, such as remnant cholesterol, corresponding to all plasma cholesterol minus HDL-C (high-density lipoprotein cholesterol) and LDL-C (low-density lipoprotein cholesterol), and the Monocyte-to-HDL-cholesterol ratio. We also compared values of several lipoprotein ratios and the Platelet-to-lymphocyte ratio, accurate predictors of coronary events and coronary artery disease. Methods and results We recruited 4…

Short term prognostic role of NT-proBNP in patients after myocardial infarction

Aim. The clinical and prognostic role of cardiac natriuretic peptides (CNP) in patients with heart failure is well known; recently, several studies have evaluated the possibility of using CNP to evaluate their potential prognostic role in patients with acute coronary syndromes (ACS). The aim of this study was to evaluate the short term prognostic value of NT-proBNP in 70 patients admitted for ACS. Methods. The authors studied 70 patients with ACS, evaluating, at admission, clinical-anamnestic, instrumental and laboratory characteristics including NT-proBNP plasma levels. Patients were monitored in a 6-month-follow-up to record adverse fatal events and their possible correlation with baselin…

LA PROTEINA C REATTIVA ED IL FIBRINOGENO NELLA VALUTAZIONE DEL RISCHIO REALE DI EVENTI VASCOLARI IN PAZIENTI CON DIABETE MELLITO TIPO II.

Long-Term Results After Repair of Type A Acute Aortic Dissection According to False Lumen Patency

Background Late survival and freedom from retreatment on the descending aorta was evaluated after ascending aortic repair for type A acute aortic dissection (TAAAD). Methods Between March 1992 and January 2006, 189 TAAAD patients (mean age, 52 ± 11; range, 17 to 83 years) were included; of these, 58 had a patent false lumen, and 49 had Marfan syndrome. The descending aorta was evaluated postoperatively with computed tomography (CT). Late outcomes were assessed by Cox regression analysis and actuarial survival and freedom from retreatment by the Kaplan-Meier method. Mean follow-up was 88 ± 44 months. Results There were 38 (20%) late deaths. At 10 years, survival was 89.8% ± 2.1% for patients…

Ankle-Brachial Index as a Predictor of Cardiovascular Risk in Atrial Fibrillation

Objectives: Atrial Fibrillation (AF), the most frequent sustained arrhythmia, is associated with a high rate of morbidity and mortality. The clinical course of AF is often complicated by cardiovascular and cerebrovascular adverse events that usually have a dual origin: cardio embolic and atherothrombotic. The aim of our study is to demonstrate the existence of a relationship between Systemic Atherosclerosis and AF. More specifically, we have analysed the prevalence of lower limb Peripheral Artery Disease (PAD) in a population of fibrillating patients, and we have assessed whether the coexistence of AF and PAD might result in increased cardiovascular risks. Methods: The study has been conduc…

LA PRESENZA DI ELEVATI LIVELLI DI FIBRINOGENO E PROTEINA C-REATTIVA SONO SIGNIFICATIVAMENTE ASSOCIATI ALLA PRESENZA DI ATEROSCLEROSI CAROTIDEA NEI PAZIENTI IPERTESI O DIABETICI.

Should subcutaneous implantable cardioverter-defibrillators be implanted in patients who are candidates for continuous flow left ventricular assist device?

A CASE REPORT OF ABNORMAL ORIGIN OF THE LEFT CORONARY ARTERY FROM THE RIGH CORONARY SINUS

DYSLIPIDEMIA AND CARDIOVASCULAR RISK: FOCUS ON THE ROLE OF LOW HDL-CHOLESTEROL CONCENTRATIONS IN DEVELOPING ATHEROSCLEROTIC DISEASE AND IN ACCELERATING ITS PROGRESSION FROM SUBCLINICAL LESIONS TO CLINICAL EVENTS. EVIDENCES AND THERAPEUTICAL IMPLICATIONS.

UN CASO CLINICO DI ATEROSCLEROSI POLIDISTRETTUALE

The QRS narrowing index for easy and early identification of responder to cardiac resynchronization therapy.

The rationale for cardiac resynchronization therapy (CRT) in patients with heart failure (HF) is based on the possibility of inducing substantial left ventricular reverse remodeling. It is well known that some of these patients don't benefit from this therapy (the so-called non-responders) [1,2]. No better predictors of a positive answer to CRT than pre-CRT QRS duration (QRSd) were found [3,4]. The aim of our study was to identify a parameter for an easy and early identification of responders to CRT. In this regard, according to Rickard et al., we identified and observed QRS index (QI), as an expression of electrical remodeling after CRT, and its relation with anatomic reverse remodeling, e…

UN CASO CLINICO DI ATEROSCLEROSI POLIDISTRETTUALE

Increased levels of C-reactive protein and fibrinogen influence the risk of vascular events in patients with NIDDM

AIM: To evaluate the predictive role of hs-CRP and fibrinogen for cardio- and cerebrovascular events in a population of patients with type 2 diabetes. METHODS: We studied 156 patients with type 2 diabetes, mean age 66+10 years, and 156 sex and age matched control subjects. Patients underwent physical examination, EKG, measurement of body mass index and blood pressure. A blood sample was drawn to evaluate glycaemia, total and HDL/LDL cholesterol, triglycerides, high sensitive C-reactive protein (hs-CRP), fibrinogen. Finally, patients underwent an ecocolordoppler examination of the common carotid arteries until the bifurcation. In a follow-up of 5+/-1.2 years we evaluated the following events…

RUOLO DEL NT-proBNP NELLA PROGNOSI A BREVE TERMINE DOPO INFARTO MIOCARDICO ACUTO

Aortic stenosis: insights on pathogenesis and clinical implications

Aortic stenosis (AS) is a common valvular heart disease in the Western populations, with an estimated overall prevalence of 3% in adults over 75 years. To understand its patho-biological processes represents a priority. In elderly patients, AS usually involves trileaflet valves and is referred to as degenerative calcific processes. Scientific evidence suggests the involvement of an active "atherosclerosis-like" pathogenesis in the initiation phase of degenerative AS. To the contrary, the progression could be driven by different forces (such as mechanical stress, genetic factors and interaction between inflammation and calcification). The improved understanding presents potentially new thera…

VALUTAZIONE NON INVASIVA DELLA FUNZIONE ENDOTELIALE IN PAZIENTI AFFETTI DALLA MALATTIA DI ANDERSON-FABRY

The association between coronary microvascular dysfunction and carotid intima media thickness in patients with cardiac syndrome X

Abstract Objective The aim of this study was to evaluate in patients with cardiac syndrome X (CSX), using validated angiography indices, coronary blood flow and myocardial perfusion of the microcirculation to assess whether there is greater microvascular dysfunction in patients with increase of carotid intima media thickness (C-IMT), compared to those who do not have. Methods Our study was performed on a population 124 patients with CSX that underwent coronary angiography and carotid ultrasound. We divided the sample into two categories: patients with increase of C-IMT and those without increase. We calculated Gibson and Yusuf indices for each patient based on angiographic images, including…

RISCHIO CARDIOVASCOLARE GLOBALE E VASCULOPATIE PERIFERICHE

CAROTID INTIMAL-MEDIAL THICKNESS AND ENDOTHELIAL FUNCTION IN YOUNG ADULT PATIENTS WITH MYOCARDIAL INFARCTION.

Bifocal stimulation in patient with congenitally corrected transposition of great vessels

Congenitally corrected transposition of the great vessels (CCTGV) is a rare congenital heart defect associated with multiple cardiac morphological abnormalities and conduction defects. Complete atrioventricular (AV) block occurs in 30% of patients and it may be present at birth or develop later with a rate of 2% per year; moreover, a systemic right ventricle is frequently characterized by heart failure in adult life. We used a bifocal cardiac stimulation for a young woman affected by CCTGV and atrioventricular Mobitz 2 and 2:1 block, considering structural, anatomic condition, and the high rate of pacing she underwent

IL MIOCARDIO NON COMPATTATO: UNA SERIE DI 177 CASI DEL REGISTRO ITALIANO DELLA SOCIETA’ ITALIANA DI ECOGRAFIA CARDIOVASCOLARE

Bicuspid aortic valve and unruptured sinus of Valsalva aneurysm, a rare association

Bicuspid aortic valve (BAV) is one of the most common forms of congenital heart defect and is associated with other congenital vascular and cardiac defects. The most common comorbidity is dilation of thoracic aorta and clinical manifestations are usually related to function of the aortic valve and to other cardiovascular acquired complications. Sinus of Valsalva aneurysm (SVA) is an uncommon congenital cardiovascular anomaly and the combination of these two anomalies is very rare. Common complications are rupture and obstruction of the termination chamber due to space-occupying effect of large unruptured aneurysms. Early cardiac imaging can help limiting morbidity and mortality in these pat…

Significato clinico e prognostico dell'aterosclerosi carotidea nella valutazione del rischio cardiovascolare globale

TRIAL FIBRILLATION AND COGNITIVE IMPAIRMENT

The importance of being “responder” in cardiac resynchronization therapy