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…

Modification of the lipidic and coagulative pattern in postmenopause women: effect of hormone replacement therapy.

AIM: We evaluated the changes of lipidic and coagulative pattern during menopause and the influence of hormone replacement therapy (HRT) on these parameters. METHODS: We considered 158 patients divided into 2 groups: Group I consisted of 127 women in physiological/surgical menopause and Group II of 31 women with childbearing potential. Subsequently, we considered a group III formed of 34 patients from menopausal women (group I) who underwent three months of HRT. We evaluated total-cholesterol (TC), HDL-cholesterol (HDL-C), LDL-cholesterol (LDL-C), triglycerides (TG), lipoprotein (a) (Lpa), fibrinogen, antithrombin III (ATIII), factor VII (FVII) and tissue factor pathway inhibitor (TFPI). RE…

Cor triatriatum dexter assessed by three-dimensional echocardiography reconstruction in a female adult patient.

Carotid intima-media thickness measurement through semi-automated detection software and analysis of vascular walls

AIM: The aim of the present study was to compare the semi-automatic measurement of carotid intima thickness (RFQIMT - Esaote, Italy), with the conventional method. METHODS: We enrolle 81 patients, mean age 46 years ±15, with no history of cardio-cerebrovascular events and we assessed the traditional cardiovascular risk factors. We examined the IMT of the common carotid artery with manual and RFQIMT method (based on the "Radio Frequency" signal), according to the ASE protocol. RESULTS: Semi-automatic measurement was on average lower than manual measurement (617 μm ±191 vs. 676 μm ± 222) with a statistically significant difference (P<0.01). In agreement with manual measurements, the values of…

Cardiorenal syndrome: the role of new biochemical markers

Cardiorenal syndrome is a pathophysiological heart and kidney disorder, in which acute or chronic dysfunction of one organ induces a damage in the other. It's a syndrome more and more often encountered in clinical practice and this implies the need to recognize the syndrome through biochemical markers with a good sensitivity and specificity, since its earliest stages in order to optimize therapy. In addition to widely validated biomarkers, such as BNP, pro BNP, creatinine, GFR and cystatin C, other promising molecules are available, like NGAL (neutrophil gelatinase-associated lipocalin, KIM-1 (kidney injury molecule-1), MCP-1 (monocyte chemotactic peptide), Netrin-1, interleuchin 18 and NAG…

Comparison of coronary artery flow impairment in diabetic and ipertensive patients with stable microvascular angina

OBJECTIVE: Stable microvascular angina (SMVA) describes patients with angina, findings compatible with myocardial ischemia and normal coronary angiograms. The aim of this study was to evaluate the impact of diabetes on the coronary microcirculation troughs angiography indexes (TIMI Frame Count, Myocardial Blush Grade, Total Myocardial Blush Score) and a new index:TotalTIMI Frame Count (TTFC). PATIENTS AND METHODS: The study population included 310 patients with SMVA that we split into two populations: diabetic-non hypertensive (164 patients) and non-diabetichypertensive (146 patients). We calculated, on angiographic images of each patient, TIMI Frame Count (TFC), Myocardial Blush Grade (MBG…

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 …

Carotid and peripheral atherosclerosis in patients who underwent primary percutaneous coronary intervention and outcome associated with multifocal atherosclerosis.

AIM: The aim of our study was to determine if patients with multifocal atherosclerosis have a worse prognosis than patients with atherosclerosis only in the coronary bed. METHODS: We studied 45 subjects admitted to intensive coronary care unit of the Division of Cardiology with the diagnosis of acute myocardial infarction (AMI). Traditional cardiovascular risk factors were investigated and laboratory analysis included measurement of plasma lipids, glycemia, fibrinogen and high-sensitivity-C-reactive protein (hs-CRP). Each patient underwent coronary-angiography as well as carotid and peripheral arterial ultrasound examination. A follow-up of 13+/-2 months was performed. RESULTS: We found tha…

Diagnosis and management of the Takotsubo cardiomyopathy: Role of echocardiography

Chemotherapy-induced cardiotoxicity: role of the conventional echocardiography and the tissue Doppler.

Aim. The cardiotoxicity of anticancer drugs is an emerging problem and only an identification of the early signs of cardiotoxicity by conventional echocardiography and not (tissue Doppler imaging, TDI), will limit and contain the long-term cardiotoxicity effects. The aim of this study was to identify, through conventional echocardiography and TDI, parameters to use as early "signs" of cardiotoxicity. Methods. A prospective study was performed using patients with breast cancer (72 women, median age 57+/-12) treated with anticancer drugs (adjuvant chemotherapy). All patients underwent a careful cardiological evaluation before starting treatment (T0) and during follow-up at 3 months (T1), 6 mo…

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…

Wolff-Parkinson-White syndrome associated with Brugada syndrome.

Left ventricular non compaction: epidemiology, clinical findings, diagnosis and therapy

Abstract Left ventricular non compaction (LVNC) is a cardiomyopathy due to an arrest of the normal development of myocardium which determines the persistence of foetal myocardium in post--natal life in at least 2/3 of the wall (criterion known as non compacted/ compacted ratio greater than 2). Although in absence of a confirmed prevalence of LVNC, reviewing literature shows an increasing number of reports over the years, though diagnosed cases represent just the tip of a realistically far wider phenomenon. Clinical manifestations are variable, ranging from the absence of any symptom to congestive heart failure, arrhythmias and systemic thromboembolism. Echocardiography is the gold standard …

Rare cardiomyopathies: Diagnostic features

Cardiomyopathies (CM) are an important and heterogeneous group of diseases affecting the myocardium. They can induce mechanical and/or electrical disorders and are due to a variety of causes, they frequently are genetic. However, since their high number and their clinical complexity, the identification is still a challenge. Echocardiography is a very useful tool in the assessment of CM. In this review we aim to define the typical clinical features and to discuss the main diagnostic tool, above all echocardiography that can help physicians in the correct assessment of CM.

CORONARY AND PERIPHERAL ATHEROSCLEROSIS AND MARKERS OF INFLAMMATION 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 …

Insulin resistance and acute coronary syndrome

BACKGROUND: Insulin resistance (IR), which can be quantified by HOMA index (fasting glucose X fasting insulin/22.5), is considered the "primum movens" for the development of Metabolic Syndrome. Many authors have suggested that insulin resistance could raise both incidence and mortality of coronary heart disease (CHD). IR is also associated with important predictors of cardiovascular disease, as increased concentration of LDL or triglyceride, decreased concentration of HDL, high systolic blood pressure, visceral obesity. There is accumulating evidence that chronic sub-clinical inflammation, as measured by inflammatory markers as C-reactive protein (CRP) and fibrinogen, is related with insuli…

Ventricular arrhythmias in children: the uselessness of MRI.

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…

TFPI antigen and activity levels in patients with asymptomatic atherosclerosis and target organ acute and chronic complications

AIM: In patients with atherosclerosis there is an activation of the tissue factor mediated coagulation cascade. The aim of our study was to ascertain if there is a relationship between increased tissue factor pathway inhibitor (TFPI) antigen and activity plasma levels and atherosclerosis. METHODS: Design: case-control study. Setting: Department of Internal Medicine and Cardiovascular Diseases, University of Palermo and Laboratory of Genetics and Molecular Biology, Mayo Clinic, Rochester, MN, USA. Patients: 63 consecutive patients with asymptomatic atherosclerosis or with its acute or chronic complications, and 20 healthy volunteers. Measurements: TFPI antigen was detected by an immunoenzima…

Extracoronary atherosclerosis in patients with chronic ischemic heart disease: Relationship with risk factors and the severity of coronary artery disease

AIM: The aim of the present study was to investigate the prevalence of carotid and/or peripheral atherosclerotic lesions in patients with chronic ischemic heart disease (previous acute myocardial infarction [AMI] or stable angina). METHODS: We studied 248 patients (168 male and 80 female), mean age 63+/-10 years, which were investigated for traditional risk factors. Systolic blood pressure, body mass index, lipid profile, fasting glucose and plasma fibrinogen were also measured. We assessed the prevalence of atherosclerotic lesions in carotid and lower limb arteries, by ultrasound duplex scanning (UDS). RESULTS: Angina was present in 33% of the patients, a previous AMI in 67%, a previous tr…

Quality control of B-lines analysis in stress Echo 2020

Background The effectiveness trial “Stress echo (SE) 2020” evaluates novel applications of SE in and beyond coronary artery disease. The core protocol also includes 4-site simplified scan of B-lines by lung ultrasound, useful to assess pulmonary congestion. Purpose To provide web-based upstream quality control and harmonization of B-lines reading criteria. Methods 60 readers (all previously accredited for regional wall motion, 53 B-lines naive) from 52 centers of 16 countries of SE 2020 network read a set of 20 lung ultrasound video-clips selected by the Pisa lab serving as reference standard, after taking an obligatory web-based learning 2-h module ( http://se2020.altervista.org ). Each te…

The long QT syndrome in pediatric age: Prognosis and risk factor

AIM: Long QT syndrome is a rare arrhythmic disease with a low incidence in the general population. There are no sure clinical or electrocardiographic parameters that could lead to a correct prognostic stratification in patients affected by this syndrome. The correlation between the incidence of a sudden death or dangerous ventricular arrhythmias and the duration of QTc interval is still a controversial topic. METHODS: Twenty nine children affected by QT long syndrome were admitted to the Division of Pediatric Cardiology of the Casa del Sole Hospital of Palermo (Italy). Their diagnosis was made by electrocardiogram (ECG). The average age of the patients was 7.6 years. The average follow-up w…

Takotsubo cardiomyopathy after a positive emotional stress

Takotsubo cardiomyopathy, also known as transient left ventricular apical ballooning syndrome, is a cardiac syndrome mimicking an acute coronary syndrome and characterized by peculiar transient left ventricular wall motion in the absence of significant coronary lesions at coronary angiography. The pathogenic mechanisms linking emotional stress to Takotsubo cardiomyopathy still remain undefined. The onset of Takotsubo cardiomyopathy can be triggered by an acute, intense emotional stress. This is the first report reporting that not only negative stress but also positive stressful event may precede the syndrome.

A risk score derived from the analysis of a cluster of 27 serum inflammatory cytokines to predict long term outcome in patients with acute myocardial infarction: A pilot study

Objective. The aim of our study was to evaluate the clinical utility and prognostic significance of a cluster of 27 serum cytokines for risk stratification after myocardial infarction. Materials and Methods. We enrolled 33 consecutive patients admitted to our institution for acute myocardial infarction and prospectively followed. We evaluated traditional cardiovascular risk factors and assayed, during the acute phase, 27 serum cytokines (IL-1, IL-1ra, IL-2, IL-4, IL-5, IL-6, IL -7, IL-8, IL-9, IL-10, IL-12, IL-13, IL-15, IL-17, EOTAXIN, FGF, G-CSF, GM-CSF, IFN-γ, IP-10, MCP-1, MIP-1α, MIP-1ß, PDGF, RANTES, TNF-α, VEGF) potentially associated with cardiovascular risk. Patients were divided i…

Is local stiffness, as measured by radio frequency, more sensitive than intima-media thickness?

Aim: The aim of our study was to explore the changes in common carotid arterial intima-media thickness (CCA IMT) and local arterial stiffness to evaluate, non-invasively, early vascular disease in patients with cardiovascular (CV) risk factors and "normal" carotid IMT (6.05 m/s better identified, among patients with IMT <0.9mm, those with cardiovascular risk factors (sensitivity 82.0 % specificity 62.0 %; AUC 0.73). Conclusion. Increased stiffness is a result of change both in quantity and quality of the arterial wall. Arterial functional changes and distention alterations may herald the onset of vascular disease before manifestation of symptoms or detection of preclinical atherosclerotic l…

Update on the use of anti-thrombotic therapy in acute coronary syndromes

coronary syndromes; anti-thrombotic therapy

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…

Changes of arterial hemodynamics in patients with type 2 diabetes mellitus or impaired glucose tolerance

Aim: The aim of our study was to evaluate the arterial hemodynamics in patients with type 2 diabetes mellitus or impaired glucose tolerance without clinical or Doppler evidence of peripheral arterial disease, in order to early detect vascular damage. Methods. We studied 20 subjects (12 men and 8 women, aged between 48 and 62 years) with type 2 diabetes mellitus (Group 1), 20 subjects (11 men and 9 women, aged between 49 and 61 years) with reduced glucose tolerance (Group 2), and 20 normal subjects (10 men and 10 women, aged between 48 and 62 years) (Group 3). Each subject underwent strain-gauge plethysmography and the following parameters were evaluated: rest flow (RF); peak flow (PF); PF/R…

Implantation of a biventricular defibrillator in a borderline case of arrhythmogenic right ventricular dysplasia/cardiomyopathy

Remodeled ostial atherosclerotic plaque in a single coronary artery demonstrated by computed tomography coronary angiography

Increased plasma levels of fibrinogen in acute and chronic ischemic coronary syndromes.

BACKGROUND: The aim of this study was to evaluate the pathophysiological role of fibrinogen in patients with chronic or acute ischemic coronary syndromes on the basis of epidemiological and clinical evidences showing the importance of fibrinogen as a risk factor for cardiovascular diseases and atherosclerosis progression. METHODS: We evaluated the behavior of plasma fibrinogen in 310 hospitalized patients with 1) acute myocardial infarction (n = 98); 2) unstable angina (n = 87); 3) chronic ischemic heart disease (n = 75); and 4) in controls without myocardial ischemia (n = 50). Fibrinogen was evaluated, by using the Clauss method, on day 1 and 5 during in hospital-stay and at 6-month follow…