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Introduction Uremic patients exhibit remarkably increased rates of mortality and cardiovascular events, but risk prediction in this setting remains difficult. Systemic mitochondrial dysfunction is pervasive in ESKD and may contribute to CV complications. We tested the clinical significance of circulating MOTS-c, a small mitochondrial-derived peptide, as a biomarker for improving mortality and CV risk prediction in hemodialysis (HD) patients. Methods We conducted a prospective, observational, multicenter study on 94 prevalent HD patients. The study endpoint was a composite of all-cause mortality and non-fatal CV events. The diagnostic and prognostic capacity of predictive models based on cohort-related risk factors were tested before and after the inclusion of MOTS-c. Results MOTS-c levels were higher in HD patients than in controls (p<0.001) and even more elevated (p=0.01) in the 53 individuals experiencing the combined endpoint during follow-up (median duration: 26.5 mo.). MOTS-c was independently associated with the endpoint at either multivariate logistic (OR 1.020; 95%CI 1.011-1.109; p=0.03) or Cox-regression analyses (HR 1.004; 95%CI 1.000-1.025; p=0.05) and the addition of this biomarker to prognostic models including the other cohort-related risk predictors (age, LVMi, E/e', diabetes, pulse pressure) significantly improved the calibration, risk variability explanation, discrimination (ROC-AUC from 0.727 to 0.743; C-index from 0.658 to 0.700) and, particularly, the overall reclassification capacity (NRI 15.87%; p=0.01). Conclusions In HD patients, the mitochondrial-derived peptide MOTS-c may impart significant information to refine CV risk prediction, beyond cohort-related risk factors. Future investigations are needed to generalize these findings in larger and more heterogeneous cohorts.
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AIM: To investigate abnormalities in myocardial strain and classic echocardiographic indices and coronary flow reserve (CFR), in younger versus older CKD patients. METHODS: Sixty consecutive CKD patients (<60 years old n = 30, ≥60 years old n = 30) and 30 healthy controls (age- and gender-matched with younger CKD patients) were recruited. An echocardiographic assessment including myocardial strain indices (i.e. global longitudinal strain -GLS -, TWIST, UNTWIST rate) was performed at baseline and following dipyridamole administration in all participants. RESULTS: Younger CKD patients had higher E/e', left ventricular mass index and relative wall thickness and lower E' (p < .005 for all) compared to healthy controls. Older CKD patients had lower E/A and E' (p < .05 for both) compared to younger CKD patients; these differences did not remain significant after adjustment for age. CFR was higher in healthy controls compared to younger and older CKD patients (p < .05 for both) without a significant difference between CKD groups. There were no significant differences in GLS, TWIST or UNTWIST values among the three groups of patients. Dipyridamole-induced changes did not differ significantly among the three groups. CONCLUSIONS: Compared to healthy controls, impaired coronary microcirculation and left ventricular diastolic function, but not myocardial strain abnormalities, are found in young CKD patients and deteriorate with aging.
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Insuficiencia Renal Crónica , Disfunción Ventricular Izquierda , Humanos , Persona de Mediana Edad , Microcirculación , Disfunción Ventricular Izquierda/diagnóstico por imagen , Función Ventricular Izquierda , Insuficiencia Renal Crónica/complicaciones , EcocardiografíaRESUMEN
BACKGROUND: Heart failure (HF) is considered an epidemic disease with considerable morbidity, mortality, and immense healthcare costs. Electrolyte abnormalities are often encountered in patients with HF, posing a diagnostic and therapeutic challenge for clinicians. Hyponatremia affects up to one-third of HF patients and represents an unfavorable prognostic factor. SUMMARY: Low sodium levels in HF are mainly attributed to the neurohormonal activation secondary to decreased effective circulating volume. However, patients with HF often have several comorbidities which may cause or exacerbate the preexisting hyponatremia. Factors that provoke HF, such as alcohol overconsumption, may also be involved in hyponatremia development. Furthermore, drugs which are frequently prescribed to HF patients, especially diuretics, are potential culprits of hyponatremia and should always be addressed since their withdrawal may reverse hyponatremia. Despite the great prevalence and deleterious effects of hyponatremia in these patients, it is often overlooked and consequently undertreated. In this review, we present the mechanisms involved in the development of hyponatremia focusing on those besides neurohormonal activation. We also discuss the proper management of this electrolyte disorder which is frequently complex in patients with HF. KEY MESSAGES: Hyponatremia in patients with HF is not only the result of neurohormonal activation; several comorbidities and frequently used drugs should also be addressed. Hence, a holistic approach is required both for the diagnosis and optimal treatment.
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Insuficiencia Cardíaca , Hiponatremia , Humanos , Hiponatremia/etiología , Insuficiencia Cardíaca/tratamiento farmacológico , Electrólitos/uso terapéuticoRESUMEN
Background and Objectives: Obesity has been linked to various cardiovascular risk factors, increased incidence of coronary artery disease, and myocardial perfusion defects. The aim of this study was to investigate if body mass index (BMI) and waist circumference (WC) were associated with myocardial perfusion defects. Materials and Methods: A total of 308 consecutive patients who had myocardial perfusion imaging (MPI) with single photon emission computed tomography (SPECT) and a complete medical record on file were studied retrospectively. Results: The median age was 69 (61−76) years, the BMI was 27.6 (24.4−30.7) kg/m2, and the WC was 110 (102−118) cm. Of the 308 patients, 239 patients (77.6%) had myocardial ischemia. A positive test for ischemia was more frequent in men compared to women (72 vs. 28%, p < 0.001). Within the male group, BMI and WC were not significantly different between the ischemia and non-ischemia groups. In contrast, within the female group, both BMI (30.2 vs. 27.1 kg/m2, p = 0.002) and WC (112 vs. 105.5 cm, p = 0.020) were significantly higher in the ischemia group. Multivariable logistic regression showed that male sex and BMI were the only two independent predictors of ischemia in our patient population. Conclusions: This study showed that BMI was an independent predictor of ischemia in our patient population.
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Enfermedad de la Arteria Coronaria , Isquemia Miocárdica , Imagen de Perfusión Miocárdica , Anciano , Índice de Masa Corporal , Enfermedad de la Arteria Coronaria/complicaciones , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/epidemiología , Femenino , Humanos , Masculino , Isquemia Miocárdica/diagnóstico por imagen , Isquemia Miocárdica/epidemiología , Isquemia Miocárdica/etiología , Imagen de Perfusión Miocárdica/métodos , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Heart failure (HF) and atrial fibrillation (AF) often coexist, being closely interrelated as the one increases the prevalence and incidence and worsens the prognosis of the other. Their frequent coexistence raises several challenges, including under-diagnosis of HF with preserved ejection fraction in AF and of AF in HF, characterization and diagnosis of atrial cardiomyopathy, target and impact of rate control therapy on outcomes, optimal rhythm control strategy in the era of catheter ablation, HF-related thromboembolic risk and management of anticoagulation in patients with comorbidities, such as chronic kidney disease or transient renal function worsening, coronary artery disease or acute coronary syndromes, valvular or structural heart disease interventions and cancer. In the present document, derived by an expert panel meeting, we sought to focus on the above challenging issues, outlining the existing evidence and identifying gaps in knowledge that need to be addressed.
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Fibrilación Atrial , Insuficiencia Cardíaca , Tromboembolia , Anticoagulantes/uso terapéutico , Fibrilación Atrial/complicaciones , Fibrilación Atrial/tratamiento farmacológico , Fibrilación Atrial/epidemiología , Consenso , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/terapia , Humanos , Tromboembolia/etiología , Tromboembolia/prevención & controlRESUMEN
BACKGROUND AND PURPOSE: A remarkable decline in admissions for acute stroke and acute coronary syndrome (ACS) has been reported in countries severely hit by the COVID-19 pandemic. However, limited data are available from countries with less COVID-19 burden focusing on concurrent stroke and ACS hospitalisation rates from the same population. METHODS: The study was conducted in three geographically and demographically representative COVID-19 referral university hospitals in Greece. We recorded the rate of stroke and ACS hospital admissions during a 6-week period of the COVID-19 outbreak in 2020 and compared them with the rates of the corresponding period in 2019. RESULTS: We found a greater relative reduction of stroke admissions (51% [35 vs. 71]; incidence rate ratio [IRR]: 0.49, p = 0.001) compared with ACS admissions (27% [123 vs. 168]; IRR: 0.73, p = 0.009) during the COVID-19 outbreak (p = 0.097). Fewer older (>65 years) patients (stroke: 34.3% vs. 45.1%, odds ratio [OR]: 0.64, p = 0.291; ACS: 39.8% vs. 54.2%, OR: 0.56, p = 0.016) were admitted during the COVID-19 compared with the control period. CONCLUSIONS: Hospitalisation rates both for stroke and ACS were reduced during the COVID-19 outbreak in a country with strict social distancing measures, low COVID-19 incidence and low population mortality. Lack of triggers for stroke and ACS during social distancing/quarantining may explain these observations. However, medical care avoidance attitudes among cerebro/cardiovascular patients should be dissipated amidst the rising second COVID-19 wave.
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Síndrome Coronario Agudo , COVID-19 , Accidente Cerebrovascular , Síndrome Coronario Agudo/epidemiología , Grecia/epidemiología , Hospitalización , Humanos , Pandemias , SARS-CoV-2 , Accidente Cerebrovascular/epidemiologíaRESUMEN
Prolonged QRS duration, which reflects a higher degree of mechanical dysynchrony, is a predictor of response to CRT. However, the association of QRS narrowing after biventricular pacing with CRT response rates is not clear. Our aim was to conduct a systematic review and meta-analysis on the association between QRS narrowing after cardiac resynchronization therapy (CRT) and clinical and echocardiographic response to CRT in patients with heart failure. Two independent investigators searched MedLine and EMBASE databases through July 2018 without any limitations. Studies providing estimates (continuous data) on the association of QRS shortening with either clinical (defined as New York Heart Association (NYHA) reduction ≥ 1) or echocardiographic (defined as left ventricular end-systolic volume (LVESV) reduction ≥ 15%) response to CRT were finally included in the quantitative synthesis. We included 32 studies (14 studies (1274 patients mean age 64 years old, males 79.3%) using clinical CRT response and 18 studies (1270 patients, mean age 64 years old, males 69.1%) using echocardiographic CRT response). A significant association between QRS narrowing and shorter attained QRS duration with clinical and echocardiographic CRT response was observed. The observed association was independent of the timing of QRS width measurement after CRT implantation. Acute and late improvement of electrical dysynchrony as depicted by QRS narrowing following biventricular pacing is associated with clinical and echocardiographic response to CRT. However, large prospective studies are needed to further examine our findings.
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Terapia de Resincronización Cardíaca/métodos , Electrocardiografía , Insuficiencia Cardíaca/terapia , Insuficiencia Cardíaca/fisiopatología , Humanos , Estudios Observacionales como AsuntoRESUMEN
INTRODUCTION: Coronary vascular dysfunction, as assessed by coronary flow reserve (CFR) in the left anterior descending coronary artery, is found in various conditions including end-stage chronic kidney disease (CKD). Currently, we investigated the associations of CFR with echocardiographic indices of systolic and diastolic cardiac function and identified independent predictors of CFR in hemodialysis patients. METHODS: End-stage CKD patients treated with hemodialysis (n = 29) without known cardiovascular disease were recruited from a Hemodialysis Unit in Northwestern Greece. A thorough echocardiographic evaluation including CFR measurement following dipyridamole infusion was performed in all participants. Arterial stiffness was assessed by measurement of carotid-femoral pulse wave velocity and aortic augmentation index. RESULTS: The mean age of the patients was 63 years, and mean duration of hemodialysis was 2.9 years. CFR was 1.60 ± 0.37 while dipyridamole caused a significant increase in E'sep , Slat , E'lat , and Stroke volume (P < .05 for all). Independent predictors of CFR were posterior wall thickness (B -0.408, P = .013) and dipyridamole-induced changes in Tei index (B -0.425, P = .007). A severely decreased CFR < 1.5 was observed in 52% of the patients. E/E' ratio (B 10.84, P = .014) was the single independent predictor of severely decreased CFR. CONCLUSIONS: In end-stage CKD patients on hemodialysis without known cardiovascular disease, impaired coronary vascular function was prevalent and related to increased left ventricular wall thickness, increased filling pressures, and dipyridamole-induced deteriorated myocardial function independently of the presence of wall-motion abnormalities. Further studies are required to clarify the prognostic role of dipyridamole-induced cardiac changes in hemodialysis patients.
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Insuficiencia Renal Crónica , Disfunción Ventricular Izquierda , Circulación Coronaria , Unidades de Hemodiálisis en Hospital , Humanos , Microcirculación , Persona de Mediana Edad , Análisis de la Onda del Pulso , Diálisis Renal , Insuficiencia Renal Crónica/complicaciones , Disfunción Ventricular Izquierda/complicaciones , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
INTRODUCTION: Renal transplantation (RT) increases survival in end-stage kidney disease patients but cardiovascular diseases remain the leading cause of morbidity and mortality. We evaluated the role of myocardial strain (2DSTE) indices and dipyridamole-induced (DIPSE) changes in echocardiographic parameters at baseline for the prediction of clinical events and echocardiographically assessed deterioration of cardiac function in a RT population. METHODS: Forty-five RT patients underwent an echocardiographic study at baseline including 2DSTE and DIPSE. If no cardiovascular/renal event occurred, patients were investigated at 3-year follow-up; eight patients presented a clinical event while 37 patients were re-evaluated. RESULTS: Coronary flow reserve (CFR) was abnormal in 24% of the population. DIPSE induced improvements in classic and 2DSTE systolic and diastolic echocardiographic indices including TWIST, UNTWIST, global longitudinal strain (GLS), and circumferential strain (P < .05 for all). Compared to baseline, deteriorations in E/E', LVEF, E', and TWIST were observed at follow-up (P < .05 for all). DIPSE-induced changes in GLS, global radial strain, and LVEF were associated with changes in these indices at follow-up (P < .05 for all). Higher LV mass index, E/E', and lower MAPSE, E', and CFR at baseline were associated with the occurrence of clinical events at follow-up (P < .05 for all). CONCLUSIONS: In RT patients, coronary vascular dysfunction (ie, low CFR) was associated with the occurrence of adverse events. DIPSE-induced changes in myocardial strain and classic echocardiographic indices could identify individuals with a subclinical deterioration in cardiac function at follow-up. This may indicate that DIPSE could serve as a means to assess myocardial reserve in this population.
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Trasplante de Riñón , Disfunción Ventricular Izquierda , Dipiridamol , Prueba de Esfuerzo , Humanos , Pronóstico , Volumen SistólicoRESUMEN
The aim of this study was to examine the potential association between the expression of Hsp70 protein and heart failure and to investigate the possible protective effect of Hsp70 against the doxorubicin-induced toxicity. Initially, at clinical level, the expression levels of the inducible Hsp70 were quantified in serum from patients with heart failure. Our results showed that in heart failure, Hsp70 concentration appeared to be increased in blood sera of patients compared to that of healthy individuals. The enhanced expression of Hsp70 in serum of patients with heart failure seemed to be associated with various features, such as gender, age and the type of heart failure, but not with its etiology. Next, in our study at cellular level, we used primary cell cultures isolated from embryos of Hsp70-transgenic mice (Tg/Tg) overexpressing human HSP70 and wild-type mice (F1/F1). After exposure to a wide range of doxorubicin concentrations and incubation times, the dose- and time-dependent toxicity of the drug, which appeared to be reduced in Tg/Tg cells, was demonstrated. In addition, doxorubicin administration appeared to result in a dose- and time-dependent decrease in the activity of two of the major endogenous antioxidant enzymes (SOD and GPx). The increased activity of these enzymes in Tg/Tg cells compared to the control F1/F1 cells was obvious, suggesting that the presence of Hsp70 confers enhanced tolerance against DOX-induced oxidative stress. Overall, it has been indicated that Hsp70 protein exerts a very important protective action and renders cells more resistant to the harmful effects of doxorubicin.
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Cardiotoxinas/efectos adversos , Doxorrubicina/efectos adversos , Regulación de la Expresión Génica/efectos de los fármacos , Proteínas HSP70 de Choque Térmico/sangre , Insuficiencia Cardíaca/sangre , Insuficiencia Cardíaca/inducido químicamente , Animales , Cardiotoxinas/administración & dosificación , Doxorrubicina/administración & dosificación , Femenino , Proteínas HSP70 de Choque Térmico/genética , Insuficiencia Cardíaca/genética , Humanos , Masculino , Ratones , Ratones Transgénicos , Estrés Oxidativo/efectos de los fármacos , Estrés Oxidativo/genéticaRESUMEN
The aim of this work is to present the HEARTEN Knowledge Management System, one of the core modules of the HEARTEN platform. The HEARTEN platform is an mHealth collaborative environment enabling the Heart Failure patients to self-manage the disease and remain adherent, while allowing the other ecosystem actors (healthcare professionals, caregivers, nutritionists, physical activity experts, psychologists) to monitor the patient's health progress and offer personalized, predictive and preventive disease management. The HEARTEN Knowledge Management System is a tool which provides multiple functionalities to the ecosystem actors for the assessment of the patient's condition, the estimation of the patient's adherence, the prediction of potential adverse events, the calculation of Heart Failure related scores, the extraction of statistics, the association of patient clinical and non-clinical data and the provision of alerts and suggestions. The innovation of this tool lays in the analysis of multi-parametric personal data coming from different sources, including for the first time breath and saliva biomarkers, and the use of machine learning techniques. The HEARTEN Knowledge Management System consists of nine modules. The accuracy of the KMS modules ranges from 78% to 95% depending on the module/functionality.
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Insuficiencia Cardíaca/terapia , Gestión del Conocimiento , Biomarcadores/metabolismo , Pruebas Respiratorias , Dieta , Ejercicio Físico , Insuficiencia Cardíaca/metabolismo , Insuficiencia Cardíaca/fisiopatología , Humanos , Aprendizaje Automático , Monitoreo Fisiológico/métodos , Cooperación del Paciente , Saliva/metabolismo , AutomanejoRESUMEN
In the last decade, the uptake of information and communication technologies and the advent of mobile internet resulted in improved connectivity and penetrated different fields of application. In particular, the adoption of the mobile devices is expected to reform the provision and delivery of healthcare, overcoming geographical, temporal, and other organizational limitations. mHealth solutions are able to provide meaningful clinical information allowing effective and efficient management of chronic diseases, such as heart failure. A variety of data can be collected, such as lifestyle, sensor/biosensor, and health-related information. The analysis of these data empowers patients and the involved ecosystem actors, improves the healthcare delivery, and facilitates the transformation of existing health services. The aim of this study is to provide an overview of (i) the current practice in the management of heart failure, (ii) the available mHealth solutions, either in the form of the commercial applications, research projects, or related studies, and (iii) the several challenges related to the patient and healthcare professionals' acceptance, the payer and provider perspective, and the regulatory constraints.
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Insuficiencia Cardíaca , Telemedicina/métodos , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/terapia , Humanos , Aplicaciones Móviles , Telemedicina/economía , Telemedicina/legislación & jurisprudenciaRESUMEN
Early detection of risk factors for enhanced primary prevention and novel therapies for treating the chronic consequences of cardiovascular disease are of the utmost importance for reducing morbidity. Recently, fibroblast growth factors (FGFs) have been intensively studied as potential new molecules in the prevention and treatment of cardiovascular disease mainly attributable to metabolic effects and angiogenic actions. Members of the endocrine FGF family have been shown to increase metabolic rate, decrease adiposity, and restore glucose homeostasis, suggesting a multiple metabolic role. Serum levels of FGFs have been associated with established cardiovascular risk factors as well as with the severity and extent of coronary artery disease and could be useful for prediction of cardiovascular death. Furthermore, preclinical investigations and clinical trials have tested FGF administration for therapeutic angiogenesis in ischemic vascular disease, demonstrating a potential role in improving angina and limb function. FGF21 has lately emerged as a potent metabolic regulator with multiple effects that ultimately improve the lipoprotein profile. Early studies show that FGF21 is associated with the presence of atherosclerosis and may play a protective role against plaque formation by improving endothelial function. The present review highlights recent investigations suggesting that FGFs, in particular FGF21, may be useful as markers of cardiovascular risk and may also serve as protective/therapeutic agents in cardiovascular disease.
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Aterosclerosis/metabolismo , Enfermedad de la Arteria Coronaria/metabolismo , Endotelio Vascular/metabolismo , Factores de Crecimiento de Fibroblastos/metabolismo , Placa Aterosclerótica/metabolismo , Enfermedades Cardiovasculares/metabolismo , Humanos , Neovascularización FisiológicaRESUMEN
OBJECTIVE: Spinal cord stimulation (SCS) is an invasive method used for treating patients with refractory angina. Although SCS is recommended by the European Society of Cardiology and American Heart Association (class lib, level of evidence B and C, respectively), the method is used very rarely and data on its effectiveness is limited. The aim of this work was to perform a systematic review of all randomized controlled trials (RCTs) that investigated the effectiveness of SCS as a treatment for refractory angina. METHODS: Medline and Cochrane library databases were searched from their inception to April 2014 for RCTs that investigated the efficacy and safety of SCS in patients with refractory angina. RESULTS: Nine RCTs were included in the systematic review. The included RCTs were categorized into two groups: RCTs comparing SCS either with optimal medical treatment or inactive mode or low stimulation SCS; and those comparing SCS with alternative therapeutic interventions. Follow-up was short-term (1-6 months) in most studies, showing no major complications. Two studies reported a neutral effect regarding mortality. Regarding efficacy, most RCTs were in favour of SCS mainly in the short term. The most recent, multi-centre RCT reported no significant difference compared to the control group. CONCLUSIONS: RCTs investigating the efficacy of SCS were small and they demonstrated a small effect in angina improvement. Due to great differences in their design the interpretation of the results is complex. Before this method is recommended as a routine therapy for refractory angina, a larger, well-designed, multicentre RCT is needed.
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Angina de Pecho/terapia , Ensayos Clínicos Controlados Aleatorios como Asunto , Estimulación de la Médula Espinal/métodos , HumanosRESUMEN
Oleuropein, a natural phenolic compound, prevents acute doxorubicin (DXR)-induced cardiotoxicity but there is no evidence regarding its role in chronic DXR-induced cardiomyopathy (DXR-CM). In the present study, we investigated the role of oleuropein in DXR-CM by addressing cardiac geometry and function (transthoracic echocardiography), cardiac histopathology, nitro-oxidative stress (MDA, PCs, NT), inflammatory cytokines (IL-6, Big ET-1), NO homeostasis (iNOS and eNOS expressions), kinases involved in apoptosis and metabolism (Akt, AMPK) and myocardial metabonomics. Rats were randomly divided into 6 groups: Control, OLEU-1 and OLEU-2 [oleuropein at 1000 and 2000 mg/kg in total, respectively, intraperitoneally (i.p.) for 14 days], DXR (18 mg/kg, i.p. divided into 6 equal doses for 2 weeks), DXR-OLEU-1 and DXR-OLEU-2 (both oleuropein and DXR as previously described). Impaired left ventricular contractility and inflammatory and degenerative pathology lesions were encountered only in the DXR group. The DXR group also had higher MDA, PCs, NT, IL-6 and Big ET-1 levels, higher iNOS and lower eNOS, Akt and AMPK activation compared to controls and the oleuropein-treated groups. Metabonomics depicted significant metabolite alterations in the DXR group suggesting perturbed energy metabolism and protein biosynthesis. The effectiveness of DXR in inhibiting cell proliferation is not compromised when oleuropein is present. We documented an imbalance between iNOS and eNOS expressions and a disturbed protein biosynthesis and metabolism in DXR-CM; these newly recognized pathways in DXR cardiotoxicity may help identifying novel therapeutic targets. Activation of AMPK and suppression of iNOS by oleuropein seem to prevent the structural, functional and histopathological cardiac effects of chronic DXR toxicity.
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Antibióticos Antineoplásicos/toxicidad , Cardiomiopatías/tratamiento farmacológico , Doxorrubicina/toxicidad , Iridoides/farmacología , Miocitos Cardíacos/efectos de los fármacos , Vasodilatadores/farmacología , Animales , Western Blotting , Cardiomiopatías/inducido químicamente , Cardiomiopatías/metabolismo , Cardiomiopatías/patología , Proliferación Celular/efectos de los fármacos , Ecocardiografía , Metabolismo Energético , Técnicas para Inmunoenzimas , Interleucina-6/metabolismo , Glucósidos Iridoides , Masculino , Metabolómica , Miocitos Cardíacos/citología , Miocitos Cardíacos/metabolismo , Estrés Oxidativo , Ratas , Ratas WistarRESUMEN
BACKGROUND: Genetic polymorphisms and arterial stiffness indices have been associated with cardiovascular prognosis and the presence and extent of angiographic coronary artery disease (CAD). We aimed to investigate whether arterial stiffness indices and 9p21 and 2q36 variants may improve prediction of CAD presence and extent when added to classical cardiovascular risk factors in patients at high risk for CAD. MATERIALS AND METHODS: In this cross-sectional study, we enrolled 183 consecutive patients with suspected stable CAD (age 61 ± 9 years, 134 males) referred for diagnostic coronary angiography. Framingham risk score (FRS) was calculated. Arterial stiffness was assessed by carotid-femoral pulse wave velocity (PWV) and central augmentation index (AIx) using applanation tonometry. Genetic polymorphisms of 9p21 (rs1333049) and 2q36 (rs2943634) loci were also analysed. RESULTS: Higher FRS and PWV and the presence of rs2943634 risk allele were independent predictors of CAD (Nagelkerke R(2) 0·252, P < 0·001), while higher FRS and the presence of rs1333049 risk allele were independent predictors of multivessel CAD (Nagelkerke R(2) 0·190, P < 0·001). Genetic polymorphisms and vascular indices did not improve the predictive accuracy of FRS-based models (P > 0·1 for all) for CAD presence or extent. CONCLUSIONS: In these high-risk patients, 9p21 and 2q36 variants and PWV were independently associated with CAD presence and extent, but the addition of both genetic data and arterial stiffness indices to FRS did not improve the prediction of CAD compared with FRS alone. Further studies are needed to clarify the prognostic role of genetic and vascular indices in the prediction of angiographic CAD.
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Cromosomas Humanos Par 2 , Cromosomas Humanos Par 9 , Enfermedad de la Arteria Coronaria/genética , Polimorfismo Genético/genética , Rigidez Vascular/genética , Enfermedad de la Arteria Coronaria/diagnóstico , Estudios Transversales , Femenino , Heterocigoto , Homocigoto , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Factores de RiesgoRESUMEN
Children with heterozygous familial hypercholesterolemia (heFH) are prone to premature atherosclerosis. Vascular endothelial dysfunction may predict increased cardiovascular risk in children with heFH. The aim of this study was to assess for early functional and structural vascular changes in children with heFH. This cross-sectional study included 30 children with heFH (mean age 12 years) and 30 age- and sex-matched controls. Brachial artery flow-mediated dilation (FMD), carotid intima-media thickness (cIMT), carotid-femoral pulse wave velocity, and large- and small vessel compliance were measured noninvasively. HeFH children exhibited significantly greater total and LDL cholesterol, apolipoprotein B, and lipoprotein (a) levels (p < 0.05 for all) and lower FMD (6.23 ± 3.88 vs. 9.46 ± 4.54 %, p < 0.004) compared with controls. When children were divided in age subgroups, FMD was found to be significantly decreased in heFH compared with control subjects only in ages >10 years (p < 0.05). However, FMD was found to be similarly impaired in heFH children in all age subgroups (two-way analysis of variance, p = 0.39). No differences in other vascular function indices were found. In heFH patients, but not in controls, FMD was inversely correlated with cIMT (r = -0.378, p = 0.036). In conclusion, endothelial dysfunction occurs early in heFH children indicating an increased risk for premature cardiovascular disease and reflecting probably the need for early initiation of anticholesterolemic treatment. Decreased FMD is detected before structural atherosclerotic changes occur.
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Aterosclerosis , LDL-Colesterol/sangre , Endotelio Vascular/fisiopatología , Hiperlipoproteinemia Tipo II/complicaciones , Adolescente , Edad de Inicio , Aterosclerosis/sangre , Aterosclerosis/diagnóstico , Aterosclerosis/epidemiología , Aterosclerosis/etiología , Aterosclerosis/fisiopatología , Aterosclerosis/prevención & control , Arteria Braquial/patología , Arteria Braquial/fisiopatología , Arterias Carótidas/patología , Arterias Carótidas/fisiopatología , Grosor Intima-Media Carotídeo , Niño , Estudios Transversales , Diagnóstico Precoz , Femenino , Grecia/epidemiología , Heterocigoto , Humanos , Hiperlipoproteinemia Tipo II/genética , Masculino , Medicina Preventiva , Pronóstico , Análisis de la Onda del Pulso/métodos , Proyectos de Investigación , Rigidez Vascular , VasodilataciónRESUMEN
Background: Pericardial effusion is common in pregnancy, with causes similar to the general population. Usually, it is found in the third trimester and disappears spontaneously after labour; however, there is a risk of progression to tamponade. Management is based on expert opinion, since few studies have been published. Case summary: A woman with enlargement of a known, chronic, presumably idiopathic pericardial effusion, in the 17th gestation week, presented with mild dyspnoea, without specific echocardiographic signs of cardiac tamponade. She received double antithrombotic treatment with aspirin 100â mg, started before conception, and a prophylactic dose of tinzaparin 4500â IU, started at the beginning of the pregnancy due to obstetrical antiphospholipid syndrome. A multidisciplinary team consisting of the treating obstetrician-gynaecologist, haematologist, cardiothoracic surgeon, and cardiologist discussed the management, taking into account the large size of the effusion and the significant increase during pregnancy, the possibility of further increase during the third trimester, the antiplatelet and antithrombotic treatment, which increased the haemorrhagic risk, and the difficulty and risk to intervene later in pregnancy. A surgical pericardial window was proposed to the patient and family and was performed uneventfully. Discussion: This case demonstrates the importance of a multidisciplinary team approach and shared decision-making in the management of these complex cardio-obstetric patients in order to achieve optimal therapeutic results.
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BACKGROUND: A significant proportion of pulmonary embolisms (PEs) occurs in patients during hospitalisation for another reason. However, limited data regarding differences between out-of-hospital PE (OHPE) and in-hospital PE (IHPE) is available. We aimed to compare these groups regarding their clinical characteristics, biochemical markers, and echocardiographic indices. METHODS: This was a prospective, single-arm, single-centre study. Adult consecutive patients with non-COVID-related PE from September 2019 to March 2022 were included and followed up for 12 months. RESULTS: The study included 180 (84 women) patients, with 89 (49.4%) suffering from IHPE. IHPE patients were older, they more often had cancer, were diagnosed earlier after the onset of symptoms, they had less frequent pain and higher values of high sensitivity troponin I and brain natriuretic peptide levels compared to OHPE patients. Echocardiographic right ventricular (RV) dysfunction was detected in similar proportions in the 2 groups. IHPE had increased in-hospital mortality (14.6% vs. 3.3%, p = 0.008) and similar post-discharge to 12-month mortality with OHPE patients. CONCLUSIONS: In this prospective cohort study, IHPE differed from OHPE patients regarding age, comorbidities, symptoms, and levels of biomarkers associated with RV dysfunction. IHPE patients had higher in-hospital mortality compared to OHPE patients and a similar risk of death after discharge.