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2.
Int J Cardiol Heart Vasc ; 28: 100513, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32346602

RESUMO

BACKGROUND: Several cardiopulmonary exercise test (CPET) parameters (peak VO2, PetCO2 and VE/VCO2) emerged as tools for the prediction of pulmonary arterial hypertension (PAH). Less is known on ventilatory power (VP) in patients with suspect PAH. AIM: To ascertain possible correlations between VP derived at CPET and hemodynamic parameters at right heart catheterization (RHC) indicative of PH. METHODS: Forty-seven consecutive outpatients with suspect of PAH were assessed by CPET and RHC; VP was defined as peak SBP divided by the minute ventilation-CO2 production slope at CPET and Diastolic Pressure Gradient (DPG), Trans-pulmonary Pressure Gradient (TPG), mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) at RHC were also assessed and compared with VP. RESULTS: VP values were inversely related to mPAP (r -0.427, p 0.003), DPG (r -0.36, p 0.019), TPG (r: -0.43, p 0.004), and PVR (r -0.52, p 0.001). Correlations remained significant even after correction at multivariate analysis for age and gender. VP values below median identified subjects with mPAP ≥ 25 mmHg with an odds ratio of 4.5 (95% confidence interval 1.05-19.36, p < 0.05), an accuracy of 0.712 at ROC curve analysis (95% confidence interval 0.534-0.852, p < 0.05) and a positive predictive power 82%. CONCLUSIONS: In patients with suspected PAH, VP assessed at CPET might provide further information in predicting PAH at RHC. Correlations with PVR and DPG may be helpful in differentiating patients with isolated post-capillary PH from those with combined post-capillary and pre-capillary.

3.
J Cardiovasc Med (Hagerstown) ; 20(12): 809-815, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31436677

RESUMO

BACKGROUND: Right heart catheterization (RHC) is recommended by guidelines for the diagnosis of pulmonary hypertension, the definition of hemodynamic impairment and responsiveness to drug therapy. However, RHC is an invasive test with associated risk of complications. Noninvasive echocardiographic tools, possibly predictive of pulmonary hypertension at RHC, could be therefore extremely useful. METHODS: Sixty-four consecutive patients with suspected pulmonary hypertension were enrolled in the study and assessed by echocardiography and RHC. Diagnosis of pulmonary hypertension was based on mean pulmonary artery pressure (≥25 mmHg) at RHC. RESULTS: Of 64 consecutive patients enrolled, 77% were diagnosed as having pulmonary hypertension after RHC. On the basis of significant differences between patients with pulmonary hypertension at RHC and those without on echocardiographic assessment, a multiple logistic regression model was constructed to predict the presence of pulmonary hypertension at RHC. The score was calculated using right atrium and ventricular diastolic area, tricuspid regurgitation Vmax, tricuspid regurgitation severity degree and left ventricular ejection fraction. The score area under the curve was therefore 0.786 (P = 0.0001), higher than for tricuspid regurgitation Vmax (P = 0.06). A score value more than 57 was associated with a 93% sensitivity, a 67% specificity, a 91% positive predictive power, a 73% negative predictive power, and an odds ratio 27 (P < 0.001) of pulmonary hypertension at RHC, significant even after correction at multivariable analysis. Accuracy of the prediction model was assessed in a validation cohort with comparable results (P = n.s.). CONCLUSION: A simple noninvasive echocardiographic score can be useful in predicting the diagnosis of pulmonary hypertension at RHC and may be considered for the selection of patients who should undergo or could avoid RHC.


Assuntos
Pressão Arterial , Cateterismo Cardíaco , Ecocardiografia Doppler em Cores , Ecocardiografia Doppler de Pulso , Insuficiência Cardíaca/complicações , Hipertensão Arterial Pulmonar/diagnóstico por imagem , Artéria Pulmonar/fisiopatologia , Idoso , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Hipertensão Arterial Pulmonar/etiologia , Hipertensão Arterial Pulmonar/fisiopatologia , Sistema de Registros , Reprodutibilidade dos Testes , Fatores de Risco , Função Ventricular Esquerda , Função Ventricular Direita
5.
Int J Cardiol Heart Vasc ; 22: 102-104, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30963090

RESUMO

INTRODUCTION: Aim of this study was to assess the impact of the introduction of new class of drugs (ARNI: angiotensin receptor-neprilysin inhibitor) on hospital related costs in a real world cohort of patients with chronic heart failure (CHF). METHODS: Seventy-three consecutive patients with CHF and systolic dysfunction eligible for the treatment with ARNIs from the Daunia Heart Failure Registry were enrolled. Incidence of hospitalizations before and after treatment with ARNI, costs for drug and hospitalization for HF were recorded, indexed per year and compared. RESULTS: Indexed mean number of hospitalizations per year was 0.93 ±â€¯1.70 before and 0.19 ±â€¯0.70 after introduction of ARNI (p < 0.001, -80%), 2.26 ±â€¯1.95 before and 0.38 ±â€¯1.2 after ARNI in the subgroup of patients with at least one hospitalization for HF in the year before treatment with ARNI (p < 0.001, -83%).Mean indexed cost for hospitalization was 2067 ±â€¯3715 euros before and 1847 ±â€¯1549 after ARNI (p n.s., -11%); in the subgroup with at least one hospitalization for HF 5175 ±â€¯4345 before and 2311 ±â€¯2308 after ARNI (p < 0.001, -55%). Cost reduction increased with the number of indexed hospitalization per year before ARNI from 11% to 66%. CONCLUSION: In a real world scenario, treatment with ARNI is associated with lower indexed rates of hospitalizations and hospitalization related costs. Cost reduction increases with at least one indexed hospitalization for heart failure before treatment with ARNI.

6.
Heart Fail Rev ; 24(5): 779-791, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30972521

RESUMO

Patients with advanced heart failure have poor prognosis despite traditional pharmacological therapies. The early identification of these subjects would allow them to be addressed on time in dedicated centers to select patients eligible for heart transplantation or ventricular assistance. In this article we will report the current management of these patients based on latest international guidelines, underlining some critical aspects, with reference to future perspectives.


Assuntos
Técnicas de Ablação/métodos , Terapia de Ressincronização Cardíaca/métodos , Insuficiência Cardíaca/cirurgia , Transplante de Coração/métodos , Coração Auxiliar , Substituição da Valva Aórtica Transcateter/métodos , Idoso , Idoso de 80 Anos ou mais , Fibrilação Atrial/cirurgia , Feminino , Insuficiência Cardíaca/mortalidade , Humanos , Masculino , Insuficiência da Valva Mitral/cirurgia , Taquicardia Ventricular/cirurgia
7.
J Electrocardiol ; 53: 40-43, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30611920

RESUMO

Here we report the identification of two novel mutations in a previously asymptomatic young man who suffered an out-of-hospital sudden cardiac arrest. During following evaluation, diagnosis of early stage dilated cardiomyopathy was established, while electrocardiogram monitoring showed frequent complex ventricular arrhythmias, incomplete right bundle branch block and prolonged QT duration. No reversible causes explaining the clinical presentation were established and an automatic implantable cardioverter defibrillator was therefore implanted. Heterozygous mutations in human protein coding genes NKX2-5 and RBM20 are associated with a wide array of pathological phenotypes some of which are sudden cardiac death, unexplained syncope and either combined or isolated congenital heart diseases such as dilated cardiomyopathy.


Assuntos
Cardiomiopatia Dilatada/genética , Parada Cardíaca Extra-Hospitalar/genética , Adulto , Cardiomiopatia Dilatada/terapia , Desfibriladores Implantáveis , Eletrocardiografia , Éxons , Proteína Homeobox Nkx-2.2 , Proteínas de Homeodomínio/genética , Humanos , Masculino , Mutação , Parada Cardíaca Extra-Hospitalar/terapia , Fenótipo , Proteínas de Ligação a RNA/genética , Proteínas de Peixe-Zebra/genética
8.
Vasc Health Risk Manag ; 14: 253-264, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30323613

RESUMO

Pulmonary arterial hypertension, a disease largely neglected until a few decades ago, is presently the object of intense studies by several research teams. Despite considerable progress, pulmonary arterial hypertension remains a major clinical problem, because it is not always easy to diagnose, treat, and prevent. The disease was considered incurable until the late 1990s, when Epoprostenol was introduced as the first tool against this illness. More recently, therapy for pulmonary arterial hypertension gained momentum after publication of the SERAPHIN and AMBITION trials, which also highlighted the importance of upfront therapy. This review also focuses on recent substudies from these trials and progress in drugs targeting the endothelin pathway. Future perspectives with regard to endothelin-receptor antagonists are also discussed.


Assuntos
Anti-Hipertensivos/uso terapêutico , Pressão Arterial/efeitos dos fármacos , Antagonistas dos Receptores de Endotelina/uso terapêutico , Hipertensão Pulmonar/tratamento farmacológico , Artéria Pulmonar/efeitos dos fármacos , Receptores de Endotelina/efeitos dos fármacos , Animais , Anti-Hipertensivos/efeitos adversos , Ensaios Clínicos como Assunto , Modelos Animais de Doenças , Antagonistas dos Receptores de Endotelina/efeitos adversos , Endotelinas/metabolismo , Humanos , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/fisiopatologia , Artéria Pulmonar/metabolismo , Artéria Pulmonar/fisiopatologia , Receptores de Endotelina/metabolismo , Transdução de Sinais/efeitos dos fármacos , Resultado do Tratamento
9.
Heart Fail Rev ; 23(2): 237-253, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29511896

RESUMO

Heart failure (HF) is the end result of many different cardiac and non-cardiac abnormalities leading to a complex clinical entity. In this view, the use of biomarkers in HF should be deeply reconsidered; indeed, the same biomarker may carry a different significance in patients with preserved or reduced EF. The aim of this review is to reconsider the role of biomarkers in HF, based on the different clinical characteristics of this syndrome. The role of cardiac and non-cardiac biomarkers will be reviewed with respect of the different clinical manifestations of this syndrome.


Assuntos
Biomarcadores/sangue , Insuficiência Cardíaca/sangue , Volume Sistólico/fisiologia , Insuficiência Cardíaca/fisiopatologia , Humanos
11.
Eur J Clin Invest ; 47(12)2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-29082512

RESUMO

BACKGROUND: Right heart catheterization (RHC) is usually required to confirm the diagnosis of pulmonary artery hypertension (PAH). As an invasive test, RHC may be associated with possible complications, so noninvasive parameters able to predict PAH at RHC would be extremely useful. AIM: To ascertain possible correlations between cardiopulmonary exercise testing (CPET) and hemodynamic parameters at RHC indicative of pulmonary hypertension (PH). METHODS: Thirty-six consecutive outpatients with suspect of PAH underwent CPET and RHC; the intercept of ventilation (VEint) on the VE vs carbon dioxide production (VE/VCO2 ) and VE/VCO2 slope at CPET and diastolic pressure gradient (DPG), trans-pulmonary pressure gradient (TPG), mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) at RHC were assessed and compared. RESULTS: Ventilation VCO2 slope was directly related to DPG (r: .41, P: .019), TPG (r: .45, P: .01), mean pulmonary arterial pressure (mPAP, r: .36, P: .031), PVR (r: .41, P: .029), VEint and VE/VCO2 slope inversely related to DPG (r: -.63, P < .001), TPG (r: -.67, P < .001), mPAP (r: -.68, P < .001) and PVR (r: -.5, P < .001). CONCLUSION: In patients with suspected PAH, VEint during exercise and the VE/VCO2 slope might provide useful information to predict results of RHC. Their correlations with PVR and with DPG may be helpful in discriminating patients with isolated postcapillary PH from those with combined postcapillary and precapillary.


Assuntos
Pressão Arterial/fisiologia , Dióxido de Carbono/metabolismo , Hipertensão Pulmonar/diagnóstico , Artéria Pulmonar/fisiopatologia , Ventilação Pulmonar/fisiologia , Resistência Vascular/fisiologia , Adulto , Idoso , Pressão Sanguínea , Cateterismo Cardíaco , Estudos de Coortes , Diástole , Teste de Esforço , Feminino , Hemodinâmica , Humanos , Hipertensão Pulmonar/fisiopatologia , Masculino , Pessoa de Meia-Idade , Consumo de Oxigênio , Medição de Risco
15.
Eur J Clin Invest ; 45(11): 1153-60, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26365893

RESUMO

BACKGROUND: Tissue Doppler imaging (TDI) is used to improve risk stratification in patients with chronic heart failure (CHF). So far, few studies have used this method to investigate the characteristics of subjects with CHF and Cheyne-Stokes breathing (CSB). The aim of this study was therefore to evaluate whether TDI assessment may predict the presence of CSB in patients with CHF. MATERIALS AND METHODS: A total of 41 consecutive patients with CHF enrolled in the Daunia Heart Failure Registry underwent echocardiography assessment and nocturnal polygraphy to evaluate the presence of sleep apnea and CSB. Conventional echocardiography and TDI parameters were calculated. We have also quantified by TDI a combined index (EAS index) of diastolic and systolic performance: E'/(A' × S'). RESULTS: Subjects with evidence of CSB (N = 8) were characterized by lower values of A' (5·03 ± 2·64 vs. 7·88 ± 2·64 cm/s, P < 0·01). A' and EAS index values were related to Cheyne-Stokes episode rates (r = -0·49 and 0·52, P < 0·05 and <0·01 respectively), EAS index values also with the number of episodes of central apnea (r = 0·39, P < 0·05). A' values predicted the presence of CSB at poly-somnography examination with an OR 0·62 (95% CI 0·40-0·96, P < 0·05) even after correction for age and gender. CONCLUSIONS: Tissue Doppler imaging values (A') are associated with the presence of sleep apnea at nocturnal polygraphy.


Assuntos
Respiração de Cheyne-Stokes/diagnóstico , Ecocardiografia Doppler , Insuficiência Cardíaca/diagnóstico por imagem , Sistema de Registros , Apneia do Sono Tipo Central/diagnóstico , Idoso , Respiração de Cheyne-Stokes/epidemiologia , Doença Crônica , Feminino , Insuficiência Cardíaca/epidemiologia , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Polissonografia , Apneia do Sono Tipo Central/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia
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