Precision and Personalized Medicine: How Genomic Approach Improves the Management of Cardiovascular and Neurodegenerative Disease.

Life expectancy has gradually grown over the last century. This has deeply affected healthcare costs, since the growth of an aging population is correlated to the increasing burden of chronic diseases. This represents the interesting challenge of how to manage patients with chronic diseases in order to improve health care budgets. Effective primary prevention could represent a promising route. To this end, precision, together with personalized medicine, are useful instruments in order to investigate pathological processes before the appearance of clinical symptoms and to guide physicians to choose a targeted therapy to manage the patient. Cardiovascular and neurodegenerative diseases represent suitable models for taking full advantage of precision medicine technologies applied to all stages of disease development. The availability of high technology incorporating artificial intelligence and advancement progress made in the field of biomedical research have been substantial to understand how genes, epigenetic modifications, aging, nutrition, drugs, microbiome and other environmental factors can impact health and chronic disorders. The aim of the present review is to address how precision and personalized medicine can bring greater clarity to the clinical and biological complexity of these types of disorders associated with high mortality, involving tremendous health care costs, by describing in detail the methods that can be applied. This might offer precious tools for preventive strategies and possible clues on the evolution of the disease and could help in predicting morbidity, mortality and detecting chronic disease indicators much earlier in the disease course. This, of course, will have a major effect on both improving the quality of care and quality of life of the patients and reducing time efforts and healthcare costs.

Prognostic value of extravascular lung water assessed with ultrasound lung comets by chest sonography in patients with dyspnea and/or chest pain.

BACKGROUND: Ultrasound lung comets (ULCs) consist of multiple comet tails originating from water-thickened interlobular septa. They are a new echographic tool to assess the pathologic increase in extravascular lung water, which is a possible harbinger of impending acute heart failure. The objective was to assess the prognostic value of ULCs in patients with dyspnea and/or chest pain syndrome at hospital admission. METHODS AND RESULTS: A total of 290 consecutive in-hospital patients (aged 68 +/- 13 years) admitted for dyspnea and/or chest pain syndrome were evaluated on admission with a comprehensive two-dimensional and Doppler echocardiographic evaluation and chest sonography with ULC assessment. A patient ULC score was obtained by summing the number of comets from each of the scanning spaces in the anterior right and left hemithoraxes, from the second to fifth intercostal spaces. All patients were followed up for a median period of 16 months (interquartile range: 2.8-29.1 months). During the follow-up, 62 events occurred: 19 cardiac deaths, 3 nonfatal myocardial infarctions, 20 acute heart failures requiring hospitalization, and 20 noncardiac deaths. The 16-month event-free survival was highest in patients with no ULCs and lowest in patients with severe (>30) ULCs at entry (70% vs 19%, P = .0007). At univariate analysis, ULCs (hazard ratio [HR] 2.349; confidence interval [CI] 1.364-4.044) were more powerful predictors than other echocardiographic variables of recognized prognostic value, including ejection fraction (HR 0.974; 95% CI 0.958-0.99) and wall motion score index (HR 1.628; CI 1.15-2.304). On multivariable analysis, ULCs provided additional prognostic information (HR 1.9; 95% CI 1.1-3.4) on diabetes (HR 2.05; 95% CI 1.2-3.5) and New York Heart Association class (HR 1.3; 95% CI 1.0-1.6). CONCLUSION: ULCs are a simple user-friendly, radiation-free bedside sign of extravascular lung water. They provide useful information for the prognostic stratification of patients with dyspnea and/or chest pain syndrome.