RESUMEN
Leptin is an adipose tissue-derived hormone primarily involved in the regulation of food intake. Leptine has been shown to have a much broader role than just regulating body weight and appetite in response to food intake: among the others, it has been associated with increased ROS production and inflammation, factors involved in the restoration of an effective myocardial reperfusion after myocardial revascularization. Our study, to our best knowledge, is the first showing a direct relationship between leptin serum levels, inflammatory mediators of the ischemia reperfusion damage and effective myocardial reperfusion in patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention. Our findings suggest that leptin serum levels are directly associated with the inflammatory response during an acute myocardial infarction and may have a role in risk stratification in this clinical setting.
Asunto(s)
Mediadores de Inflamación/sangre , Leptina/sangre , Infarto del Miocardio con Elevación del ST/sangre , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Humanos , Interleucina-6/sangre , Masculino , Intervención Coronaria Percutánea/efectos adversos , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/terapia , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Pre-infarction angina (PIA) has been shown to reduce the microvascular obstruction (MVO) rate in patients with ST-segment elevation myocardial infarction (STEMI). We sought to evaluate the potential modulator role of cardiovascular risk factors (CRFs) on this protective effect. METHODS AND RESULTS: Two hundred patients with STEMI were enrolled. PIA was defined as typical chest pain within the 48 h preceding STEMI onset. Angiographic MVO was defined as TIMI flow grade <2 or TIMI flow 3 with myocardial blush grade <2; electrocardiographic (ECG) MVO was defined as ST-segment elevation resolution <70%. Common CRFs were collected. In the absence of hypertension, both angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas, in the presence of hypertension, they were similar in both study groups (P for interaction=0.01 and P=0.014, respectively). Among nonsmokers, angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas within smokers, they were similar in both study groups (P for interaction=0.037 and P=0.037, respectively). In the absence of dyslipidemia, the angiographic and ECG MVO rates were lower in patients with PIA as compared with those without, whereas within dyslipidemic patients, they were similar in both study groups (P for interaction=0.012 and P=0.04, respectively). CONCLUSIONS: The protective effect of PIA on MVO is blunted by CRFs.
Asunto(s)
Angiografía Coronaria , Electrocardiografía , Angina Microvascular , Infarto del Miocardio , Intervención Coronaria Percutánea , Anciano , Femenino , Humanos , Masculino , Angina Microvascular/diagnóstico por imagen , Angina Microvascular/fisiopatología , Angina Microvascular/cirugía , Persona de Mediana Edad , Infarto del Miocardio/diagnóstico por imagen , Infarto del Miocardio/fisiopatología , Infarto del Miocardio/cirugía , Factores de RiesgoRESUMEN
Worldwide, adrenaline is considered the first choice therapy in the international guidelines for the management of anaphylaxis. However, the heart and cardiovascular apparatus are strongly involved in anaphylaxis; for that reason, there are some cardiac conditions and certain anaphylaxis patterns that make epinephrine use problematic without adequate heart monitoring. The onset of Kounis syndrome, takotsubo cardiopathy, or the paradoxical anaphylaxis require great attention in the management of anaphylaxis and adrenaline administration by clinicians, who should be aware of the undervalued evolution of anaphylaxis and the potential cardiologic complications of epinephrine administration. Numerous case reports and studies describe the unexpected onset of cardiac diseases following epinephrine treatment, despite the latter being the recommended therapy for anaphylaxis. Our review suggests that future anaphylaxis guidelines should incorporate cardiovascular specialists since the treatment of Kounis syndrome or takotsubo cardiopathy requires cardiologist skills.
Asunto(s)
Anafilaxia , Cardiólogos , Cardiopatías , Síndrome de Kounis , Humanos , Epinefrina/uso terapéutico , Anafilaxia/tratamiento farmacológico , AlergólogosAsunto(s)
Estenosis de la Válvula Aórtica , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas , Reemplazo de la Válvula Aórtica Transcatéter , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Estenosis de la Válvula Aórtica/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Factores de Riesgo , Reemplazo de la Válvula Aórtica Transcatéter/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: Gonadal function is thought to be involved in existing atherosclerotic plaques stabilization and might affect reperfusion after primary percutaneous coronary intervention (pPCI). We aimed to compare the prevalence of hypotestosteromenia between ST-elevation myocardial infarction (STEMI) and stable angina (SA) patients and between patients with and without microvascular obstruction (MVO). DESIGN: Cross-sectional observational study. METHODS: Males with STEMI (n = 70, age 57.1 ± 7.8 years) or with stable angina (n=30, age 59.9 ± 8.4 years) were enrolled. Angiographic MVO (angio-MVO) was defined as final TIMI flow 2 or final TIMI flow 3 with MBG ≤ 2 while electrocardiographic MVO (ECG-MVO) as a ST-segment resolution <70% at 90 minutes post-pPCI. Variables associated with STEMI and MVO were assessed among clinical, angiographic and laboratory data including testosterone (T) and insulin-like factor 3 (INSL-3), a marker of Leydig cells function. Hypotestosteronemia was defined as T<2.50 ng/ml with INSL-3<305.5 pg/ml. RESULTS: Hypotestosteronemia was detected in 32 (45.7%) STEMI patients and in 4 (13.3%) SA patients (p=0.003). STEMI patients presenting with angio-MVO were more frequently hypotestosteronemic as compared with those without (60.9% vs 38.3%, p=0.043). Hypotestosteronemia prevalence was higher among STEMI patients presenting with ECG-MVO as compared with those without (69.0% vs 31.7%, p=0.003). At multivariate analysis hypotestosteronemia independently predicted both angio-MVO (OR=4.47, 95% CI 1.30-15.36, p=0.018) and ECG-MVO (OR=7.56, 95% CI 2.20-25.99, p=0.001). CONCLUSIONS: Our study shows higher prevelence of hypotestosteronemia among STEMI patients as compared with SA patients and among STEMI patients with MVO as compared with those without, thus suggesting a possible role of T deficiency in coronary instability and MVO pathogenesis.