ATEROSCLEROSI CAROTIDEA E PERIFERICA E RESTENOSI CORONARICA DOPO ANGIOPLASTICA PERCUTANEA.

VALUTAZIONE DELLA PROTEINA C-REATTIVA AD ELEVATA SENSIBILITÀ IN PREVENZIONE PRIMARIA

In an attempt to improve global cardiovascular risk prediction, considerable interest has focused on C-reactive protein (CRP), that has been shown in multiple prospective epidemiological studies to predict incident myocardial infarction, stroke, peripheral arterial disease, and sudden cardiac death. CRP is a hepatically-derived pentraxin that plays a key role in the innate immune response. Standard CRP tests determine levels which are increased up to 1000-fold in response to infection or tissue destruction, but cannot adequately assess the normal range. High-sensitive CRP detects levels of CRP within the normal range as well as higher levels proven to predict future cardiovascular events. T…

L’ISCHEMIA MIOCARDICA NEL SOGGETTO IPERTESO: IL RUOLO DELLE ALTERAZIONI DEL MICROCIRCOLO CORONARICO

Infection and inflammation influence the outcome of patient with asymptomatic carotid lesions

BACKGROUND AND PURPOSE: It is still in debate whether the evaluation of markers of infection and inflammation may be of importance for cerebrovascular and cardiovascular prevention, and we aimed to investigate this field in a prospective 5-year clinical follow-up study in patients with early stages of atherosclerosis. METHODS: We studied 668 subjects divided in 3 groups according to the results of carotid ultrasound examination: (1) normal subjects, if intima-media thickness (IMT) was 1.5 mm. Traditional cardiovascular risk factors were investigated, and laboratory analysis included measurement of plasma lipids, fibrinogen, C-reactive protein, IgG antibodies for helicobacter pylori (HP), cy…

INFLAMMATION ET INFECTION IN ANGEIOLOGIE.

INFLAMMATION ET INFECTION IN ANGEIOLOGIE

Preclinical carotid atherosclerosis enhances the global cardiovascular risk and increases the rate of cerebro- and cardiovascular events in a five-year follow-up

AIM: To evaluate if the intima-media thickening (IMT) and asymptomatic carotid plaque (ACP), as expression of carotid preclinical atherosclerosis (pre-ATS), can provide further information on the global cardiovascular risk (GCVR). METHODS: We studied 454 asymptomatic subjects, with a cluster of risk factors (RF), and evaluated the incidence of a first cardiovascular (CV) event in a five-year follow-up. The subjects at admission were subdivided in three groups of risk. RESULTS: Events occurred in 38% of subjects at high risk, in 13% and 6% of subjects at intermediate and low risk (p<0.003). Among evaluated parameters, carotid pre-ATS was a predictive marker of CV events (OR 2.7, 95% IC 1.4-5…

MULTIFOCAL ATHEROSCLEROSIS INFLUENCING THE OUTCOME OF PATIENTS WITH ACUTE AND CHRONIC CORONARY HEART DISEASE

MULTIFOCAL ATHEROSCLEROSIS INFLUENCING THE OUTCOME OF PATIENTS WITH ACUTE AND CHRONIC CORONARY HEART DISEASE

Behavior of patients at high risk of developing contrast induced nephropathy after coronary procedures

Medical therapy for patients with subclinical and clinical carotid atherosclerosis

The management of carotid artery disease includes both modifications in life style as well treatment of vascular risk factors. However, strict risk factor modification, including improved antihypertensive therapy, lipid management, smoking cessation, and antiplatelet therapy, promise for reducing the vascular event rate in patients with carotid atherosclerosis. The best medical management for stroke prevention was highlighted in clinical practice guidelines issued jointly in 2006 by the American Heart Association and the American Stroke Association, and co-sponsored by the Council on Cardiovascular Radiology and Intervention and the American Academy of Neurology. Lowering blood pressure to …

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…

RISK FACTORS, MULTIFOCAL ATHEROSCLEROSIS AND RESTENOSIS POST-PTCA

Cardiac risk stratification in elective non-cardiac surgery: Role of NT-proBNP

AIM: The aim of the study was to investigate the utility of NT-proBNP measurement for the stratification of presurgical cardiac risk. METHODS: Cardiac risk before elective non-cardiac surgery was evaluated in 82 consecutive patients. From each patient a venous blood sample was drawn to determinate NT-proBNP levels. Patients were followed up over three months in order to detect the occurrence of cardiac adverse events. RESULTS: NT-proBNP was positively correlated (P<0.0001) with age, days of hospitalization (P=0.001) and ASA class (P=0.001). High surgical risk (P<0.0001), diabetes (P=0.004), dyslipidemia (P=0.006) and elevated levels of NT-proBNP (P<0.0001) were significantly correlated with…

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…

Infection and inflammation influence the outcome of patients with asymptomatic carotid lesions. Int Angiol. 2004. 23(suppl.1)

Asymptomatic carotid lesions add to cardiovascular risk prediction.

AIM To show that subclinical atherosclerosis (subclinical-ATS) of carotid arteries [intima-media thickness (IMT) or asymptomatic carotid plaque (ACP)], may provide additional information for risk stratification, in asymptomatic patients, aged greater than 45 years, with a cluster of risk factors (RFs). METHODS AND RESULTS We studied 558 asymptomatic patients (235 males). RFs for atherosclerosis were assessed and the 10-year-risk was calculated according to the Italian risk score. Doppler ultrasound of carotid arteries identified the presence of IMT greater than 0.9 mm in 183 patients and ACP in 147 patients. One hundred and fifty-three patients developed cerebrovascular or cardiovascular (C…

Trattamento delle manifestazioni vascolari nella Sclerosi Sistemica e qualità della vita: nuovo protocollo

ATHEROSCLEROSIS AND MARKERS OF INFLAMMATION IN PATIENTS WITH METABOLIC SYNDROME

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

[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.

APPROCCIO NON INVASIVO PER LO STUDIO DEL CIRCOLO CORONARICO CON TC MULTISLICE

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.

INFLAMMATION, INFECTIONS AND VASCULAR DISEASES

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

Outcomes of aortic valve repair according to valve morphology and surgical techniques

OBJECTIVES: The aim of this study was to assess the impact of aortic valve morphology and different surgical aortic valve repair techni- ques on long-term clinical outcomes. METHODS: Between February 2003 and May 2010, 216 patients with aortic insufficiency underwent aortic valve repair in our institu- tion. Ages ranged between 26 and 82 years (mean 53 ± 15 years). Aortic valve dysfunctions, according to functional classification, were: type I in 55 patients (25.5%), type II in 126 (58.3%) and type III in 35 (16.2%). Sixty-six patients (27.7%) had a bicuspid valve. Aortic valve repair techniques included sub-commissural plasty in 138 patients, plication in 84, free-edge reinforcement in 80,…

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

Non previsto.

Sacubitril/valsartan reduces indications for arrhythmic primary prevention in heart failure with reduced ejection fraction: insights from DISCOVER-ARNI, a multicenter Italian register

Abstract Aims This sub-study deriving from a multicentre Italian register [Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry (DISCOVER)-ARNI] investigated whether sacubitril/valsartan in addition to optimal medical therapy (OMT) could reduce the rate of implantable cardioverter-defibrillator (ICD) indications for primary prevention in heart failure with reduced ejection fraction (HFrEF) according to European guidelines indications, and its potential predictors. Methods and results In this observational study, consecutive patients with HFrEF eligible for sacubitril/valsartan from 13 Italian centres were included. Lack o…

Markers of Inflammation and Infection Influence the Outcome of Patients With Baseline Asymptomatic Carotid Lesions

Background and Purpose— It is still in debate whether the evaluation of markers of infection and inflammation may be of importance for cerebrovascular and cardiovascular prevention, and we aimed to investigate this field in a prospective 5-year clinical follow-up study in patients with early stages of atherosclerosis. Methods— We studied 668 subjects divided in 3 groups according to the results of carotid ultrasound examination: (1) normal subjects, if intima-media thickness (IMT) was &lt;0.9 mm; (2) with IMT, if IMT was between 0.9 and 1.5 mm; and (3) with asymptomatic carotid plaque, if IMT was &gt;1.5 mm. Traditional cardiovascular risk factors were investigated, and laboratory analysis…

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

Aldosterone e sindromi coronariche acute: ruolo nel follow-up a breve e medio termine

Peso dei fattori di rischio nell’evoluzione dell’aterosclerosi preclinica

Infection and inflammation influence the outcome of patients with asymptomatic carotid lesions

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…

Asymptomatic carotid lesions and aging: role of hypertension and other traditional and emerging risk factors

ASYMPTOMATIC CAROTID LESIONS AND AGING: ROLE OF HYPERTENSION AND OTHER TRADITIONAL AND EMERGING RISK FACTORS BACKGROUND: We evaluated the prevalence of intima-media thickening (IMT) and asymptomatic carotid plaque (ACP) in a group of subjects with or without traditional and/or emerging risk factors (RF). METHODS: There were 631 subjects (313 male and 318 female) aged between 19 and 97 years, asymptomatic for cerebro- and cardiovascular diseases. The following measurements were used: anamnesis, physical examination, height and sitting blood pressure. Biochemistry variables were also considered: total cholesterol, HDL-C, LDL-C, triglycerides, fibrinogen, high sensitive C-reactive protein, IgG…

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…

Papillary muscle relocation in conjunction with valve annuloplasty improve repair results in severe ischemic mitral regurgitation

OBJECTIVE: The incidence of recurrent mitral regurgitation (MR) after restrictive annuloplasty (RA) was 5% to 20% in several reports. There are many opinions in favor of adding subvalvular procedures to RA to reduce the tenting forces and improve the repair results. METHODS: From March 2003 to May 2010, 55 patients with severe ischemic MR who had undergone papillary muscle (PPM) relocation in conjunction with mitral annuloplasty in our institutions were enrolled. The patients were matched 1:1 with those who underwent isolated RA using the propensity score. The mean left ventricular ejection fraction was 42% ± 6%. The mean tenting area and coaptation depth was 3.2 ± 0.6 cm(2) and 1.3 ± 0.2 c…

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

no

The Effects of Sacubitril/Valsartan on Clinical, Biochemical and Echocardiographic Parameters in Patients with Heart Failure with Reduced Ejection Fraction: The “Hemodynamic Recovery”

Background: Sacubitril/valsartan has been shown to be superior to enalapril in reducing the risks of death and hospitalization for heart failure (HF). However, knowledge of the impact on cardiac performance remains limited. We sought to evaluate the effects of sacubitril/valsartan on clinical, biochemical and echocardiographic parameters in patients with heart failure and reduced ejection fraction (HFrEF). Methods: Sacubitril/valsartan was administered to 205 HFrEF patients. Results: Among 230 patients (mean age 59 &plusmn

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…

MARKERS OF INFLAMMATION AND RISK OF VASCULAR EVENTS IN PATIENTS WITH NON-INSULIN DEPENDANT DIABETES

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 …

Asymptomatic Carotid Lesion as a Marker of Future Cerebrovascular and Cardiovascular Events

ACCURATEZZA DIAGNOSTICA DELLA TC 40 STRATI IN PAZIENTI CON DOLORE TORACICO

[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…

Graft patency and late outcomes for patients with ST-segment elevation myocardial infarction who underwent coronary surgery

Objective: The aim of our study was to assess the long-term clinical outcomes and the grafts patency rates of patients with ST-segment elevation myocardial infarction (STEMI) who underwent urgent or emergency coronary artery bypass grafting (CABG). Materials: Participants in two previous studies comprising 207 STEMI patients undergoing on-pump (145 patients) or off-pump (62 patients) coronary artery bypass graft (CABG) surgery in our institution were prospectively followed to assess late mortality, graft patency, and major adverse cardiac-related event (MACE) rates. Graft patency was evaluated by multi-detector computed tomography angiography 64-slice scan. Mean times of graft implantation…

PREVALENZA DELLE LESIONI CAROTIDEE IN UNA POPOLAZIONE MEDITERRANEA DI IPERTESI

Peripheral atherosclerosis is associated with the occurrence of restenosis after percutaneous coronary intervention

INTRODUCTION: The aim of our study was to evaluate, in patients with proven coronary artery disease (CAD) and treated with elective percutaneous coronary intervention (PCI), whether the coexistence of asymptomatic carotid and femoral atherosclerotic lesions would provide prognostic information in terms of occurrence of restenosis. METHODS: We studied 104 patients with CAD (M/F=77/27), mean age 60.5+/-9 years. All patients were treated with elective PCI. After PCI the suspicion of restenosis was confirmed by coronary angiography. All patients underwent ultrasound duplex scan of carotid and femoral-popliteal-tibial axis to detect atherosclerotic lesions. According to ultrasound results, patie…

Cilostazol and atherogenic dyslipidemia: a clinically relevant effect

Cilostazol is a reversible, selective inhibitor of PDE3A able to significantly improve walking distance in patients with intermittent claudication. However, beyond its antiplatelet and vasodilator properties, cilostazol seems to have significant effects on atherogenic dyslipidemia.The effects of cilostazol on plasma lipids, lipoproteins, apolipoproteins and postprandial lipemia are reviewed. A literature search (using Medline and Scopus) was performed up to 24 October 2010. The authors also manually reviewed the references of selected articles for any pertinent material.Cilostazol is able to significantly lower plasma triglyceride levels, with a concomitant increase in high-density lipoprot…

PREVALENZA DELLA SINDROME METABOLICA IN PAZIENTI CON CARDIOPATIA ICSHEMICA CRONICA Ital. Heart J. 2005; 6 (Suppl. 8): 170S

Giant unruptured circumflex coronary artery aneurysms presenting as acute coronary syndrome

Agenesis of the renal segment of inferior vena cava associated with venous stasis.

Congenital anomalies of the inferior vena cava is an extremely rare vascular anomaly with controversial pathogenesis. Anomalies of the inferior vena cava (IVC) are present in 0.3% to 0.5% of otherwise healthy individual and in 0.6% to 2% of patients with other cardiovascular defects. The phenomenon of absence of the IVC has been described in a variety of ways such as absence, agenesis, anomalous, and interruption of a particular segment ([infra] hepatic, pre-renal, renal, or infrarenal) of the IVC. We describe a 42-year-old man with chronic venous insufficiency, without DVT, caused by congenital absence of renal segment of the IVC

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

CAROTID AND PERIPHERAL ATHEROSCLEROSIS IN PATIENTS UNDERWENT TO PRIMARY PCI AND OUTCOME ASSOCIATED WITH MULTIFOCAL ATHEROSCLEROSIS

INFLUENZA DELL’ATEROSCLEROSI MULTIFOCALE NELL’OUTCOME DI PAZIENTI CHE HANNO EFFETTUATO PTCA PRIMARIA

Association of carotid atherosclerosis with coronary artery disease: comparison between carotid ultrasonography and coronary angiography in patients with chest pain].

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: …

Iloprost treatment in patients with Raynaud's phenomenon secondary to systemic sclerosis and the quality of life: a new therapeutic protocol

Objectives: to evaluate the clinical efficacy and the effects on the quality of life of Iloprost, a prostacyclin analogue, used, according to a new protocol, in patients with Raynaud’s phenomenon secondary to Systemic Sclerosis. Methods: in this randomized study we treated 30 patients with Iloprost given by intravenous infusion, at progressively increasing doses (starting from 0.5 ng/Kg/min up 2 ng/Kg/min) over a period of 6 hours a day for ten days in two consecutive weeks, with repeated cycles at regular intervals of three months for 18 months. The results were compared with those obtained in 30 other patients, who had received the same drug but with different posologic schemes. Results: …

Prediction of vascular events in subjects with subclinical atherosclerosis and the metabolic syndrome: the role of markers of inflammation.

Response to letter by Drs. Mohammed Abbas, Maria Sessa, and Francesco Corea

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…

FIBRILLAZIONE ATRIALE E DETERIORAMENTO COGNITIVO CEREBRALE

Disfunzione endoteliale e malattia carotidea in pazienti con bright liver echopattern

Effectiveness and Safety of Oral Anticoagulants in Cardiac Amyloidosis: Lights and Shadows

Cardiac amyloidosis (CA) is an infiltrative cardiomyopathy characterized by extracellular deposition of mis-folded proteins called amyloid. Cardiac complications of CA are several: heart failure, aortic valve stenosis, thromboembolism, conduction disorders, atrial fibrillation, and ventricular arrhythmias. Atrial dysfunction is common in CA patients. Several evidences suggest to anticoagulated patients with CA in atrial fibrillation independently from CHA2DS2VaSC score. Considering the high thromboembolic risk in CA patients, anticoagulant therapy should be considered also in CA patients in sinus rhythm, when the atria are enlarged and dysfunctional, and the bleeding risk is low. Unfortunat…

Off-pump versus on-pump myocardial revascularization in patients with ST-segment elevation myocardial infarction: A randomized trial

Objective Conventional cardioplegic arrest coronary artery bypass grafting after ST-segment elevation myocardial infarction is associated with high mortality and morbidity. The benefits of off-pump surgery have been suggested. This study randomly evaluated the impact of the off-pump technique on clinical results. Methods Between February 2002 and October 2007, 128 patients with ST-segment elevation myocardial infarction who underwent myocardial revascularization within 48 hours from the onset of symptoms were randomly assigned to 2 groups: on-pump group (66 patients/51.5%) and off-pump group (63 patients/48.5%). The primary end point was the incidence of in-hospital death and outcomes (low …

RUPTURE OF THE ATHEROSCLEROTIC PLAQUE: IS CHLAMYDIA PNEUMONIAE A POSSIBLE AGENT?

BACKGROUND: The natural history of atherosclerosis has not clearly been elucidated yet. Some works reported that flogosis plays a role in plaque instability. Why does this inflammatory process start? We investigated the correlation between Chlamydia pneumoniae acute infection and plaque rupture. METHODS: We compared blood concentrations of IgM anti-Chlamydia pneumoniae in patients affected by acute myocardial infarction (AMI) and in patients affected by stable angina. RESULTS: Our results showed a minimal statistical difference, with a more positive value in patients with AMI. Subsequently, the group affected by AMI was divided into two subgroups with and without plaque rupture: the subgrou…

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.

Low levels of testosterone levels increase the risk of major cardiovascular events in a follow-up to 5 years

Materials and Methods. We evaluated a series of 802 patients with intermediate cardiovascular risk according to the Framingham Risk Score (FRS). The endothelial function through flow-mediated vasodilatation (FMD), the erectile function (EF), and the total serum testosterone levels were assessed. Patients were followed for up to 5 years and the prevalence and predictors of MACEs were evaluated. Results. The levels of serum testosterone are related with both endothelial function (FMD) (t=9,4080, 95% CI= 0,9318 to 1,4234, p<0,0001) and erectile function (FMD) (t=8,9584, 95% CI= 0,7642 to 1,1932, p<0,0001). Analysis of variance (ANOVA) of serum testosterone levels are related with the MACEs (F-…

RISK FACTORS AND MULTIFOCAL ATHEROSCLEROSIS INFLUENCE THE RATE OF RESTENOSIS POST-PTCA

Lipid ratios as predictors of subclinical atherosclerosis

Evaluation of C-Reactive Protein in Primary and Secondary Prevention

Inflammation is pivotal in atherosclerosis, and C-reactive protein (CRP) is an inflammatory marker that predicts cardiovascular events. Several population-based studies have demonstrated that baseline CRP levels predict future cardiovascular events. CRP testing may thus have a major adjunctive role in the global assessment of cardiovascular risk. Recently, the National Cholesterol Education Program, through the Adult Treatment Panel III guidelines, identified CRP and another marker of inflammation, the fibrinogen, as “emerging risk factors,” suggesting that their measurement may improve the estimations of absolute risk obtained using the traditional cardiovascular risk factors. In terms of…

CAROTIDOPATIA E INFIAMMAZIONE

MULTIFOCAL ATHEROSCLEROSIS AND MARKERS OF INFLAMMATION INFLUENCE THE OUTCOME OF THE VASCULAR PATIENTS

The predictive role of C-reactive protein in patients with hypertension and subclinical atherosclerosis.

Recent guidelines published by the joint European Society of Hypertension/European Society of Cardiology have suggested the inclusion of C-reactive protein (CRP) in the standard assessment of cardiovascular risk in hypertensive patients, but little data is available on the role of CRP in patients with carotid lesions. We studied in 472 subjects, 236 with and 236 without hypertension, gender- and age-matched, with and without early stages of atherosclerosis (e.g. those with asymptomatic intima-media thickness >0.9 mm), the influence of all the other traditional cardiovascular risk factors (e.g. older age, male gender, obesity, diabetes, smoking habit, family history of coronary artery diseas…

Marker of inlammation and prevalance of vascular disease in patients with metabolic syndrome

MARKERS OF INFLAMMATION AND PREVALENCE OF VASCULAR DISEASE IN PATIENTS WITH METABOLIC SYNDROME

AIM: The aim of this study was to determine the prevalence of carotid atherosclerosis and coronary heart disease and cerebrovascular disease in subjects with metabolic syndrome and to investigate the relationship between atherosclerosis and C-reactive protein (CRP) levels. METHODS: We studied 568 ambulatory subjects, referred to our Center for the study of atherosclerosis and cardiovascular prevention by general practitioner, for the presence of traditional cardiovascular risk factors. Subjects were divided in two groups: those with metabolic syndrome (n=163), and those with 0-2 metabolic abnormalities (n=405). All subjects underwent carotid artery ultrasound and blood tests including high …

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…

PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH ACUTE CORONARY SYNDROME

PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH ACUTE CORONARY SYNDROME

CORRELAZIONE TRA ATEROSCLEROSI EPERIFERICA E CORONARICA IN PAZIENTI CON CARDIOPATIA ISCHEMICA CRONICA

ASYMPTOMATIC CAROTID LESIONS AND AGING: ROLE OF HYPERTENSION AND OTHER RISK FACTORS

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…

PERIPHERAL ATEROSCLEROSIS AND RESTENOSIS AFTER PCI

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.

INFLAMMATION, INFECTION AND VASCULAR PATHOLOGY

RELATIONSHIP BETWEEN ENDOTHELIAL DYSFUNCTION, INTIMA MEDIA THICKNESS AND CARDIOVASCULAR RISK FACTORS IN ASYMPTOMATIC SUBJECTS

AIM: The aim of the study was to evaluate endothelial function and intima media thickness (IMT) in relation to cardiovascular risk factors (RF). METHODS: We enrolled 113 patients, mean age 62 +/- 12 years; patients underwent: anamnesis, physical examination, measurement of body weight and height and blood pressure. Biochemistry variables were also measured: total cholesterol, high- and low-density lipoprotein cholesterol (HDL-C and LDL-C), triglycerides and glycemia. Vascular echography was performed to analyze flow mediated vasodilatation (FMD) at the brachial artery and IMT of the carotid and femoral arteries. RESULTS: Compared with patients without RF, patients with cardiovascular RF sho…

ASSOCIAZIONE TRA ATEROSCLEROSI CAROTIDEA, DISFUNZIONE ENDOTELIALE E STEATOSI EPATICA IN UNA POPOLAZIONE CON SINDROME METABOLICA.

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

VALORE PROGNOSTICO E DECISIONALE DEL VO2 DI PICCO PER L'INDICAZIONE AL TRAPIANTO DI CUORE IN PAZIENTI CON SCOMPENSO CARDIACO CRONICO E TERAPIA BETABLOCCANTE

FIBRILLAZIONE ATRIALE E MILD COGNITIVE IMPAIRMENT: QUALE RELAZIONE.

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

Residual vein thrombosis and onset of post-thrombotic syndrome: Influence of the 4G/5G polymorphism of plasminogen activator inhibitor-1 gene

Abstract Background Plasminogen activator inhibitor-1 (PAI-1) is the most important inhibitor of plasminogen activator. The functional 4G/5G polymorphism of the gene coding for PAI-1 may affect PAI-1 plasmatic activity, influencing the imbalance between coagulation and fibrinolysis cascades. In this prospective cohort analytic study, we investigated the role of this single nucleotide polymorphism in the persistence of thrombotic lesion and the occurrence of post-thrombotic syndrome. Patients/Methods In a group of 168 patients with post-surgical deep vein thrombosis of the legs, we analyzed the 4G/5G polymorphism in the promoter of PAI-1 gene and plasmatic PAI-1 activity. Enrolled patients w…

DIAGNOSTIC ACCURACY OF MDCT 40 SLICES IN PATIENTS WITH CHEST PAIN

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…

BIOMARKERS OF CORONARY MICROVASCULAR DYSFUNCTION IN PATIENTS WITH MICROVASCULAR ANGINA: A NARRATIVE REVIEW

The current gold standard for diagnosis of coronary microvascular dysfunction (CMD) in the absence of myocardial diseases, whose clinical manifestation is microvascular angina (MVA), is reactivity testing using adenosine or acetylcholine during coronary angiography. This invasive test can be difficult to perform, expensive, and harmful. The identification of easily obtainable blood biomarkers which reflect the pathophysiology of CMD, characterized by high reliability, precision, accuracy, and accessibility may reduce risks and costs related to invasive procedures and even facilitate the screening and diagnosis of CMD. In this review, we summarized the results of several studies that have i…

Measles and Brugada pattern: A case report

No abstract available

PREVALENCE OF CAROTID LESIONS IN A MEDITERRANEAN POPULTION OF HYPERTENSIVES

Role of inflammation and infection in vascular disease

Relationship of infection, inflammation, and atherosclerosis has been a subject of intensive investigation in recent years. Potential mechanisms whereby chronic infections may play a role in atherogenesis are myriad. Chlamydia pneumoniae (Cp) infection in early life may accelerate atherosclerosis, leading to cardiovascular complications. Other infections, simultaneously occurring with Cp, may result in a synergistic effect to promote atherosclerosis. Chronic Helicobacter pylori infection is known to increase the pH level of the gastric juice and to decrease ascorbic acid levels, both of which will lead to a reduced folate absorption. Low folate hampers the methionine synthase reaction. This…

Echocardiographic Assessment of Ventricular Septal Rupture and Left Ventricular Aneurysm after Inferior and Posterior Myocardial Infarction

We present a case of posterior ventricular septal rupture associated to left ventricular aneurysm manged, during peri-operative period, by transthoracic and transesophageal echocardiography. Three-dimensional transesophageal echocardiography findings add adjunctive and more accurate information regarding morphological details of the ventricular septal rupture rather than two-dimensional echocardiography, allowing, meanwhile, the detection of the outcome of the surgical repair.

Erectile dysfunction is associated with low total serum testosterone levels and impaired flow-mediated vasodilation in intermediate risk men according to the framingham risk score

Background: The role erectile dysfunction (ED) coupled with low testosterone levels as early markers of atherosclerosis is not well understood. Objectives: To analyze the relationship between serum testosterone levels with both ED and brachial artery flow-mediated vasodilation (FMD), in a primary prevention sample of men. Methods: We enrolled 802 asymptomatic, intermediate CV risk patients, according to the Framingham Risk Score, aged 40e80 years, who underwent the ultrasound examination of FMD, the evaluation of ED and the assessment of total serum testosterone levels. Results: Testosterone levels correlated both with FMD (r ¼ 0.85; p &lt; 0.0001) and IIEF-5 score (rs ¼ 0.65; p &lt; 0.0001…

STATINE E ARTERIOPATIA PERIFERICA: NECESSITA’ DI UN APPROCCIO VASCOLARE GLOBALE.

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…

PREVALENCE OF CAROTID LESIONS ACCORDING TO TRADITIONAL RISK FACTORS IN A POPULATION ASYMPTOMATIC FOR CARDIOVASCULAR DISEASE

Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry

Aims: Sacubitril/valsartan has changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects on morbidity and mortality, partly mediated by left ventricular (LV) reverse remodelling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration. Methods and results: Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic parameters including LV global longitudinal strain (GLS) and global peak atrial longitudinal strain by speckle tracking echocardiography were measured to find the predictors of LVRR [= LV end-…

LA CHLAMYDIA PNEUMONIAE E’ CORRELABILE CON LA ROTTURA DELLA PLACCA ATEROSCLEROTICA?

The relationship between endothlial ABD erectile dysfunction, levels of testosterone and cardiovascular events in the follow-up

Background: Clinical and experimental evidence suggest that testosterone levels play a role in cardiac and vascular pathology. A long history of observational studies investigating serum testosterone level and cardiovascular risks, specifically mortality, reveals important associations between low testosterone and mortality, while higher serum testosterone level appear to be predictive in the majority of studies. On the other hand, it is well documented and accepted that endothelial dysfunction is expression of preclinical atherosclerosis and it is associated with an increased amount of CV events in the follow-up. Erectile dysfunction is also an early manifestation of arteriosclerosis assoc…

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…

Metabolic syndrome (MetS) predicts cardio and cerebrovascular events in a twenty years follow-up. A prospective study.

BACKGROUND AND PURPOSE: Metabolic syndrome (MetS) is a cluster of cardiovascular risk factors, considered as emerging and promoting atherosclerosis. This study aimed at the evaluation of the influence of MetS on the prediction of cerebro and cardiovascular events during a 20 years follow-up period in an asymptomatic population of middle-aged subjects. METHODS: We evaluated 529 asymptomatic persons through a prospective study. Study population was divided into two subgroups: patients with and without MetS. Echo-color-Doppler was used in order to assess the presence of subclinical atherosclerosis. A 20 years follow-up study was carried out in order to estimate the incidence of cerebro and car…

Multimodality imaging in cardiac echinococcosis for diagnosis and follow-up of an untreatable cyst

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.

Approccio diagnostico non invasivo con tomografia computerizzata multidetettore a 40 strati per lo studio della malattia aterosclerotica coronarica

Background. Multidetector computed tomography coronary angiography (MDCT-CA) is a non-invasive technique that clearly shows coronary anatomy and correctly identifies plaque location and morphology. In this study we assessed diagnostic accuracy of MDCT-CA in detectiong significant stenosis in patients with clinically relevant coronary tree disease. Methods. Fifty patients (38 males, 12 females, mean age 60.9 ± 9.2 years) with atypical chest pain, stable or unstable angina pectoris, or non-ST-elevation myocardial infarction underwent MDCT-CA (Brilliance 40, Philips Medical Systems, Cleveland, OH, USA) within 3 days before diagnostic conventional coronary angiography. Inclusion criteria were s…

Asymptomatic Carotid Lesions and Aging: Role of Hypertension and Other Traditional and Emerging Risk Factors

Background We evaluated the prevalence of intima-media thickening (IMT) and asymptomatic carotid plaque (ACP) in a group of subjects with or without traditional and/or emerging risk factors (RF). Methods There were 631 subjects (313 male and 318 female) aged between 19 and 97 years, asymptomatic for cerebro- and cardiovascular diseases. The following measurements were used: anamnesis, physical examination, height and sitting blood pressure. Biochemistry variables were also considered: total cholesterol, HDL-C, LDL-C, triglycerides, fibrinogen, high sensitive C-reactive protein, IgG antibodies for Helicobacter pylori (HP), cytotoxic HP, cytomegalovirus and Chlamydia pneumoniae . Finally, an …

Soluble CD40L and Cardiovascular Risk in Asymptomatic Low-Grade Carotid Stenosis

Background and Purpose— We investigated whether soluble CD40L (sCD40L) may predict the risk of cardiovascular (CV) events in patients with asymptomatic carotid plaques. Methods— Forty-two patients with asymptomatic low-grade carotid stenosis (ALCS) and 21 controls without any carotid stenosis were enrolled. All subjects had at least a major cardiovascular risk factor (CRF). Plasma levels of C-reactive protein (CRP), IL-6, and sCD40L were measured. Subjects were reviewed every 12 months (median follow-up, 8 years). Results— ALCS patients had higher ( P &lt;0.0001) CRP, IL-6, and sCD40L than controls. Fourteen patients experienced a CV event. Cox regression analysis showed that only high sCD…

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

CHLAMIDYA PNEUMONIAE AND VULNERABLE PLAQUE: DOES EXIST A CORRELATION?

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…

Impact of Diabetes and Impaired Glucose Tolerance (IGT) on Complications and Hospitalisation in Patients with Acute Coronary Syndrome

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

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…

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 …

PREVALENCE OF METABOLIC SYNDROME IN PATIENTS WITH ACUTE CORONARY SYNDROMES

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 …

Prognostic value of LDL/HDL cholesterol ratio in patients undergoing coronary stenting

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.

POINT: Efficacy of adding mitral valve restrictive annuloplasty to coronary artery bypass grafting in patients with moderate ischemic mitral valve regurgitation: A randomized trial

ObjectiveSurgical management of moderate chronic ischemic mitral valve regurgitation is still debated. The aim of this study was to evaluate the effect of adding mitral valve repair to coronary artery bypass grafting on clinical outcomes and left ventricular remodeling in patients who underwent coronary artery bypass grafting alone versus coronary artery bypass grafting plus mitral valve repair in a randomized trial.MethodsBetween February 2003 and May 2007, 102 patients were eligible for this study and were randomly assigned to one of 2 groups by means of card allocation: coronary artery bypass grafting plus mitral valve repair (CABG plus MVR group; 48 patients, 47%) or coronary artery byp…

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

EXTRACORONARY ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE

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.

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

The significance of low-density lipoproteins size in vascular diseases

Low density lipoproteins (LDL) comprise in humans two different main fractions: large, buoyant and small, dense particles. Small, dense LDL particles correlate negatively with plasma HDL levels and positively with plasma triglyceride concentrations and are associated with the metabolic syndrome and increased risk for cardiovascular disease. LDL size seems to be an important predictor of cardiovascular events and progression of coronary heart disease (CHD). In addition, several studies have suggested that therapeutic modulation of specific LDL subclasses may be of great benefit in reducing the atherosclerotic risk. Therefore, LDL size measurement may be of potential value in the clinical ass…

In Hospital stay of patients with acute coronary syndrome without or with diatetes mellitus

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…

INCIDENZA DELL’ATEROSCLEROSI CORONARICA E PERIFERICA IN RELAZIONE ALLA PRESENZA DELLA SINDROME METABOLICA IN UNA POPOLAZIONE AMBULATORIALE NON SELEZIONATA: RUOLO DELLA PCR E DEL FIBRINOGENO

Superficial venous thrombosis: Prevalence of common genetic risk factors and their role on spreading to deep veins

Introduction. Superficial venous thrombosis (SVT) has been considered for a long time a limited clinical condition with a low importance, but this approach has changed in recent years, when several studies demonstrated spreading to deep veins occurring from 7.3 to 44%, with high prevalence of pulmonary embolism . Materials and Methods. To evaluate the prevalence of genetic risk factors for VTE in patients suffering from SVT on both normal and varicose vein, and to evaluate their role on spreading to deep veins, we studied 107 consecutive outpatients with symptomatic SVT. Ultrasound examination was performed, and the presence of FV Leiden, Prothrombin G20210A mutation, MTHFR C677T mutation w…

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…

Impact of preclinical carotid atherosclerosis on global cardiovascular risk stratification and events in a 10-year follow-up: comparison between the algorithms of the Framingham Heart Study, the European SCORE and the Italian 'Progetto Cuore'

Background The aim of the study was to compare three widely used algorithms for stratification of the global cardiovascular risk (GCVR): the Framingham Heart Study (FHS) score, the European systemic coronary risk estimation (SCORE) and the Italian 'Progetto Cuore' (heart project) score. It was also investigated how preclinical carotid atherosclerosis (pre-ATS) might influence the incidence and improve the risk prediction of cerebrovascular and cardiovascular events. Methods Subjects (n = 358) without previous history of cardiovascular disease (CVD) were recruited and the GCVR was calculated for each patient. An ultrasound evaluation of the carotid arteries was also performed. Results Accord…

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

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.

INFLUENZA PROGNOSTICA DELL’ATEROSCLEROSI CAROTIDEA O PERIFERICA IN PAZIENTI CON SINDROMI CORONARICHE ACUTE.

RELATIONSHIP BETWEEN PERIPHERAL AND CORONARY ATHEROSCLEROSIS IN PATIENTS WITH CHRONIC ISCHEMIC HEART DISEASE

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.

Disfunzione endoteliale e malattia carotidea in pazienti con bright liver echopattern

Subclinical atherosclerosis inflammation and events

high sensitivity of c-reactive protein in primary prevention

In an attempt to improve global cardiovascular risk prediction, considerable interest has focused on C-reactive protein (CRP), that has been shown in multiple prospective epidemiological studies to predict incident myocardial infarction, stroke, peripheral arterial disease, and sudden cardiac death. CRP is a hepatically-derived pentraxin that plays a key role in the innate immune response. Standard CRP tests determine levels which are increased up to 1000-fold in response to infection or tissue destruction, but cannot adequately assess the normal range. High-sensitive CRP detects levels of CRP within the normal range as well as higher levels proven to predict future cardiovascular events. T…

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…

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…

Exenatide once-weekly improves metabolic parameters, endothelial dysfunction and carotid intima-media thickness in patients with type-2 diabetes: An 8-month prospective study.

AIM: To evaluate the effect of exenatide long acting release (LAR) on carotid intima-media thickness (IMT) and endothelial function in patients with type 2 diabetes mellitus. METHODS: Sixty subjects with type 2 diabetes mellitus were treated with exenatide LAR as add-on to stable doses of metformin for 8 months in an open label study. Anthropometric variables, lipid profile and glycemic parameters were assessed by routine analysis. Carotid IMT by Doppler ultrasound and endothelial function by flow-mediated dilation of the brachial artery were also assessed. RESULTS: Exenatide significantly improved fasting glycaemia (from 8.8 ± 2.8 to 7.3 ± 2.2 mmol/L, p &lt; 0.0001), HbA1c (from 8.0 ± 0.4 …

CLINICAL FEATURES OF PATIENTS WITH ACUTE CORONARY SYNDROME WITHOUT OR WITH DIABETES MELLITUS

CAROTID ATHEROSCLEROTIC LESIONS AS INDICATOR OF SYSTEMIC ATHEROSCLEROSIS

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…

[Cardiovascular risk profile of patients with psoriasis].

The aim of this study was to assess the cardiovascular risk profile of patients with psoriasis compared to patients without psoriasis. A case-control assay was performed using 143 cases (psoriasis patients) and 104 controls (patients without psoriasis). We assessed the presence of hypertension, lipid profile (HDL, triglycerides), diabetes, and body mass index in both cases and controls. Psoriasis patients showed an unfavorable cardiovascular risk profile and a higher risk of cardiovascular events and metabolic syndrome than patients without psoriasis.

Risk factors for contrast induced nephropathy: A study among Italian patients

This study aimed to make a profile of patients at highest risk of developing contrast induced nephropathy (CIN) in order to take appropriate prevention measures. 591 patients undergoing coronary procedures were divided into two groups: patients with (CIN-group) and without (no-CIN) an increase in creatinine level equal or more than 25% from baseline values within 24-48 h after the coronary procedure. All patients underwent an accurate anamnesis, objective exam, hematochemical measurements, and diagnostic exams. The results of this study while confirming that, average age (p = 0.01), diabetes mellitus (p < 0.0001), base line renal insufficiency (p = 0.0001), diuretic therapy (p = 0.002), hig…

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

Prognostic role of aldosterone in patients with acute coronary syndrome: short and medium term follow-up.

AIMS: Different studies have shown a correlation between aldosterone, atherosclerosis and ischemia in the past decade. Evidence exists for the relationship between high levels of aldosterone and augmented risk of cardiovascular diseases, such as hypertension, cardiac failure, coronary artery disease and stroke. The objective of this study was to determine the prognostic role of aldosterone in patients with myocardial infarction. METHODS: The study population included 96 consecutive patients admitted to our department for ST-elevated and non-ST-elevated myocardial infarction from June 2009 to March 2012. Plasma aldosterone levels were measured at admission to hospital in all patients. A 2-ye…

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…

Peripheral atherosclerosis is associated with the occurrence of restenosis after percutaneous coronary intervention

The aim of our study was to evaluate, in patients with proven coronary artery disease (CAD) and treated with elective percutaneous coronary intervention (PCI), whether the coexistence of asymptomatic carotid and femoral atherosclerotic lesions would provide prognostic information in terms of occurrence of restenosis.We studied 104 patients with CAD (M/F=77/27), mean age 60.5+/-9 years. All patients were treated with elective PCI. After PCI the suspicion of restenosis was confirmed by coronary angiography. All patients underwent ultrasound duplex scan of carotid and femoral-popliteal-tibial axis to detect atherosclerotic lesions. According to ultrasound results, patients were classified as n…

40 Slices MDCT Non-Invasive Diagnostic Approach to Coronary Artery Disease

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

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

PREVALENCE OF INTIMAL MEDIA THICKNESS AND PLAQUE IN CAROTID ARTERIES ACCORDING TO TRADITIONAL CARDIOVASCULAR RISK FACTORS IN A MEDITERRANEAN POPULATION ASYMPTOMATIC FOR CARDIOVASCULAR DISEASE

[Forty-slice multidetector computed tomography for non-invasive diagnostic approach to coronary artery disease]

Prognostic impact of hypertension and carotid lesions in a five years follow-up

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…

ASSOCIAZIONE TRA ATEROSCLEROSI CAROTIDEA E MALATTIA CORONARICA: ECO-COLORDOPPLER DEI TRONCHI SOVRAORTICI E CORONAROGRAFIA A CONFRONTO IN PAZIENTI CON DOLORE TORACICO

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

TRIAL FIBRILLATION AND COGNITIVE IMPAIRMENT

DO MARKERS OF PRECLINICAL ATHEROSCLEROSIS INFLUENCE GLOBAL CARDIOVASCULAR RISK?

DO MARKERS OF PRECLINICAL ATHEROSCLEROSIS INFLUENCE GLOBAL CARDIOVASCULAR RISK?

The importance of being “responder” in cardiac resynchronization therapy

ROLE OF INFLAMMATION OF PATIENTS WITH SUBCLINICAL ATHEROSCLEROSIS