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2.
BMJ Case Rep ; 12(11)2019 Nov 04.
Artículo en Inglés | MEDLINE | ID: mdl-31690686

RESUMEN

Splenic infarction might be the symptom onset of an important underlying disease. The possibility of splenic infarction must be inserted into differential diagnosis in all those patients who have pain in the upper left quadrant and/or on the left flank. When faced with a case of splenic infarction in a patient who has flown or climbed to high altitudes, it is appropriate to consider the possibility of an haemoglobinopathy. The diagnosis is far from being obvious for emergency physicians. For these reasons, it is very important to proceed as a multidisciplinary team with appropriate diagnostic examinations. The European Guidelines for non-hepatic applications of contrast enhanced ultrasound suggest the usage of this tool for investigation of suspected ischaemic lesions of the spleen.


Asunto(s)
Dolor Abdominal/diagnóstico por imagen , Anemia de Células Falciformes/complicaciones , Presión Atmosférica , Infarto del Bazo/etiología , Ultrasonografía , Adulto , Viaje en Avión , Analgesia , Anemia de Células Falciformes/fisiopatología , Anemia de Células Falciformes/terapia , Medios de Contraste , Fluidoterapia , Humanos , Masculino , Infarto del Bazo/diagnóstico por imagen , Infarto del Bazo/fisiopatología , Infarto del Bazo/terapia , Resultado del Tratamiento
3.
Eur J Emerg Med ; 24(6): e21-e26, 2017 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-26891086

RESUMEN

OBJECTIVE: Acute mesenteric ischemia (AMI) is a life-threatening condition requiring time-dependent treatment; thus, early recognition may improve outcomes. We hypothesized that clinician-performed mesenteric vessels duplex ultrasound (DUS) could facilitate early identification of patients with AMI in high-risk patients presenting with abdominal pain. METHODS: This was a single-operator, observational, prospective cohort study. Patients aged at least 65 presenting to Emergency Departments with acute abdominal pain and no clear diagnosis after an initial work-up were enrolled. All patients underwent multidetector computed tomography and these findings provided the reference standard in this study. DUS of the celiac artery and superior mesenteric artery (SMA) were obtained to measure the peak systolic velocity (PSV) and were performed within 24 h of admission. PSVs outside the normal range were considered to indicate AMI. RESULTS: Of 49 patients identified, 47 were consented to enrollment and diagnostic images were obtained in 45 (96%). Fifteen patients (33%) had AMI (six occlusive, nine nonocclusive disease). Among these, 12 (80%) had abnormal DUS velocities. SMA PSV showed a sensitivity of 78.57% [95% confidence interval (CI): 49.2-95.34], a specificity of 64.52% (95% CI: 45.37-80.77), a positive predictive value of 50% (95% CI: 28.22-71.78), and a negative predictive value of 86.96% (95% CI: 66.41-97.22) for AMI. DUS had a sensitivity of 100%, a specificity of 64%, and a negative predictive value of 100% for occlusive AMI. Assessment of celiac artery PSV did not improve diagnostic performance. CONCLUSION: In this single-operator pilot study, mesenteric vessel DUS was performed successfully in the Emergency Department, with a high proportion of diagnostic images obtained. A normal SMA PSV was associated with a low risk of occlusive AMI.


Asunto(s)
Servicio de Urgencia en Hospital , Arteria Mesentérica Superior/diagnóstico por imagen , Isquemia Mesentérica/diagnóstico por imagen , Tomografía Computarizada Multidetector/métodos , Ultrasonografía Doppler Dúplex/métodos , Enfermedad Aguda , Adulto , Anciano , Arteria Celíaca/diagnóstico por imagen , Estudios de Cohortes , Angiografía por Tomografía Computarizada/métodos , Diagnóstico Precoz , Femenino , Humanos , Italia , Estudios Longitudinales , Masculino , Isquemia Mesentérica/fisiopatología , Persona de Mediana Edad , Proyectos Piloto , Valor Predictivo de las Pruebas , Estudios Prospectivos , Curva ROC , Sensibilidad y Especificidad , Índice de Severidad de la Enfermedad
4.
Intern Emerg Med ; 12(6): 861-869, 2017 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-27401330

RESUMEN

Acute heart failure is a common condition among adults presenting with dyspnea in the Emergency Department (ED), still the diagnosis is challenging as objective standardized criteria are lacking. First line work-up, other then clinical findings, is nowadays made with lung ultrasound imaging study, chest X-ray study and brain natriuretic peptide (BNP) level determination; however, it is not clear which is the best diagnostic test to be used and whether there is any real benefit for clinical judgement. We set up this study to compare the performances of these three diagnostic tools; furthermore, we combined them to find the best possible approach to dyspneic patients. This is a prospective observational study based in the ED. We enrolled adults presenting with dyspnea not trauma-related, they underwent lung ultrasound, and chest X-ray studies, and NT pro-BNP level determination. Then we compared the results with the diagnosis of acute heart failure established by an independent panel of experts. 236 patients were enrolled in the study. We find sensitivity and specificity for lung ultrasound of 57.73 and 87.97 %, for chest X-ray 74.49 and 86.26 %, for NT pro-BNP 97.59 and 27.56 %, respectively. Combining together the chest X-ray and lung ultrasound, we find the best overall performance with 84.69 % sensitivity, 77.69 % specificity and 87.07 % negative predictive value. From our results, we could not identify the "best test" to diagnose acute heart failure in an emergency setting, although we could suggest that a stepwise workup combining chest X-ray and lung ultrasound at first, then for those negative, a determination of NT pro-BNP assay would be a reasonable approach to the dyspneic patient.


Asunto(s)
Diagnóstico Precoz , Insuficiencia Cardíaca/diagnóstico , Péptido Natriurético Encefálico/análisis , Fragmentos de Péptidos/análisis , Radiografía/métodos , Ultrasonografía/métodos , Anciano , Anciano de 80 o más Años , Disnea/etiología , Servicio de Urgencia en Hospital/organización & administración , Femenino , Humanos , Italia , Modelos Logísticos , Pulmón/anomalías , Pulmón/fisiopatología , Masculino , Péptido Natriurético Encefálico/sangre , Fragmentos de Péptidos/sangre , Estudios Prospectivos , Sensibilidad y Especificidad
6.
Mediators Inflamm ; 2010: 974694, 2010.
Artículo en Inglés | MEDLINE | ID: mdl-20467464

RESUMEN

OBJECTIVES: Cytokines play an important role in left ventricular remodeling consequent to myocardial ischemia. The aim of this study was to correlate cytokine production and lymphocyte apoptosis to post-ischemic left ventricular remodeling in patients affected by acute myocardial infarction (AMI) undergoing primary cutaneous angioplasty (PCI). METHODS: In 40 patients, affected by AMI and undergoing PCI, we evaluated peripheral blood mononuclear cells (PBMCs), tumor necrosis factor-alpha (TNF-alpha) and interleukin 10 (IL10) production and apoptosis on day 1, day 3, day 7, 1 month and 6 months after PCI. Patients were divided into two subgroups of remodeling or not remodeling by echocardiographic criteria. RESULTS: In the subgroup of remodeling patients, at each timepoint TNF-alpha production was increased significantly in comparison with the subgroup of not remodeling patients. IL10 production was statistically lower in remodeling subjects than in not remodeling ones 1 and 6 months after reperfusion. There were no differences between the two groups as regards lymphomonocyte apoptosis. CONCLUSIONS: We found an increased production of pro-inflammatory cytokine TNF-alpha and a corresponding decrease of anti-inflammatory/regulatory cytokine IL10 in remodeling patients and we concluded that this cytokine imbalance resulted in pro-inflammatory effects which might contribute to the progression of left ventricular remodeling.


Asunto(s)
Interleucina-10/inmunología , Infarto del Miocardio/inmunología , Factor de Necrosis Tumoral alfa/inmunología , Remodelación Ventricular/inmunología , Anciano , Angioplastia Coronaria con Balón , Ecocardiografía , Femenino , Humanos , Linfocitos/citología , Linfocitos/inmunología , Masculino , Persona de Mediana Edad , Monocitos/citología , Monocitos/inmunología , Infarto del Miocardio/patología , Infarto del Miocardio/cirugía
7.
Auton Neurosci ; 146(1-2): 102-5, 2009 Mar 12.
Artículo en Inglés | MEDLINE | ID: mdl-19121608

RESUMEN

INTRODUCTION: The central nervous system plays an important role in the regulation of blood pressure: the sympathetic nervous system may be a primary contributor to the development of some forms of essential hypertension. Hypertension is also associated with reduced distensibility of large arteries. The aim of our study is the evaluation of a correlation between cardiac dysautonomia (evaluated by means of heart rate variability [HRV]) and altered artery distensibility (evaluated by means of measurement of the time interval from the onset of the QRS wave and the detection of the last Korotkoff sound [QKD interval]). MATERIALS AND METHODS: HRV and QKD interval were evaluated in 23 patients (60.9+/-8.7 years) with untreated hypertension and in 20 control subjects (53.2+/-16.8 years). QKD interval and QKD(100-60) (that is QKD for a 100 mm Hg systolic blood pressure and 60 bpm heart rate) were measured during a 24-hours blood pressure monitoring. HRV was evaluated by means of a spectral method. Three main spectral components were distinguished: very low frequency (VLF), low frequency (LF) and high frequency (HF) component. RESULTS: Patients with reduced QKD(100-60) interval show reduced total power and spectral components values, with higher LF/HF ratio in basal conditions in comparison with control group. In patients with hypertension, QKD(100-60) values correlated significantly with LF/HF ratio (Spearman r=-0.551; p=0.006), HF spectral component (Spearman r=0.630; p=0.001) and total power (Spearman r=0.426; p=0.004). CONCLUSIONS: Our results suggest that sympathetic overactivity may be the contributor of reduced arterial distensibility observed in patients with essential hypertension.


Asunto(s)
Arritmias Cardíacas/fisiopatología , Arterias/fisiopatología , Sistema de Conducción Cardíaco/fisiopatología , Frecuencia Cardíaca/fisiología , Hipertensión/fisiopatología , Sistema Nervioso Simpático/fisiopatología , Resistencia Vascular/fisiología , Adulto , Anciano , Electrocardiografía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pruebas de Mesa Inclinada , Nervio Vago/fisiopatología
8.
Am J Cardiol ; 98(10): 1322-8, 2006 Nov 15.
Artículo en Inglés | MEDLINE | ID: mdl-17134622

RESUMEN

Several emerging cardiac markers constitute strong predictors among patients with coronary artery disease. In particular, brain natriuretic peptide (BNP), troponin T (TnT), and C-reactive protein (CRP) are related to increased risk of recurrent ischemic events and death. However, little is known about the utility of these biomarkers in combination. This study examined risk assessment in patients with coronary artery disease and preserved systolic function. We studied 208 consecutive patients (138 men, 70 women) with stable angina, unstable angina, and non-Q-wave myocardial infarction whose plasma BNP, TnT, and CRP levels were measured at hospital admission. All recruited patients underwent echocardiographic examination, and selective coronary angiography was performed. After adjusting for clinical presentation, age, gender, and common risk factors, BNP was demonstrated as a strong predictor of heart failure (6 months, odds ratio [OR] 2.03, 95% confidence interval [CI] 1.24 to 2.9, p <0.01; 12 months, OR 2.65, 95% CI 1.69 to 3.5, p <0.001) and mortality at 3, 6, and 12 months (p <0.001). BNP was also significantly related to extent of coronary artery disease and left anterior descending artery involvement (p <0.01). Patients with a BNP level >80 pg/ml in all 3 groups had a significantly poorer prognosis with increased incidence of heart failure and death. CRP was related to recurrent ischemic events (infarct or recurrent angina, OR 1.4, 95% CI 1.14 to 2.08, p <0.01) and was associated with major cardiac revascularization at 12 months (OR 1.51, 95% CI 1.29 to 1.73, p <0.001). TnT demonstrated a mild correlation with recurrent infarct or angina at 12 months (OR 1.1, 95% CI 0.96 to 1.22, p <0.05) but appeared related to multivessel coronary artery disease (OR 1.47, 95% CI 1.05 to 1.99, p <0.01). In conclusion, BNP appears to be associated with a long-term increased risk of mortality and heart failure in patients with apparently mild risk. BNP is also associated with a larger extent and greater severity of myocardial ischemia. Early BNP measurement could provide incremental information to TnT and CRP, and it may be the strongest independent predictor of cardiac outcome in subjects without left ventricular dysfunction or enlargement.


Asunto(s)
Angina de Pecho/sangre , Infarto del Miocardio/sangre , Péptido Natriurético Encefálico/sangre , Anciano , Análisis de Varianza , Angina de Pecho/diagnóstico por imagen , Biomarcadores/sangre , Proteína C-Reactiva/metabolismo , Angiografía Coronaria , Ecocardiografía , Femenino , Humanos , Modelos Lineales , Masculino , Infarto del Miocardio/diagnóstico por imagen , Valor Predictivo de las Pruebas , Factores de Riesgo , Sístole , Troponina T/sangre
9.
Atherosclerosis ; 183(2): 322-8, 2005 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-16285995

RESUMEN

Oxidized-low density lipoproteins (ox-LDL) and the specific receptor LOX-1 are involved in atherogenesis and atherothrombosis. LOX-1 downregulation is associated with the anti-platelet action of atorvastatin. 3'UTR/T LOX-1 polymorphism has been associated with increased risk of coronary artery disease. This study was planned to determine whether LOX-1 genetic variations could affect anti-platelet action of atorvastatin. We studied by platelet P-selectin (P-sel), CD36 and LOX-1 expression (cytofluorimetric detection) whether differences in cellular activation could be suitable in 109 3'UTR/T carriers out of 201 hypercholesterolemic subjects treated with atorvastatin 20mg/day. Hyperactivated platelets (P-sel in resting cells and % variation upon thrombin activation, p<0.001) were detected at baseline in patients without significant differences between T or C carriers. P-sel and platelet-associated ox-LDL, were significantly decreased (all p<0.001) in C carriers after one week of treatment before LDL reduction. In 3'UTR/T carriers P-sel was reduced (p<0.01) after 6 weeks of treatment according to LDL and ox-LDL reduction. In 3'UTR/T carriers atorvastatin reduced platelet activity by LDL and ox-LDL lowering and not by rapid CD36 and LOX-1 downregulation as in C carriers. Such data suggest that in T carriers LDL lowering is needed to achieve anti-platelet action.


Asunto(s)
Anticolesterolemiantes/uso terapéutico , ADN/genética , Ácidos Heptanoicos/uso terapéutico , Hipercolesterolemia/sangre , Activación Plaquetaria/efectos de los fármacos , Polimorfismo Genético , Pirroles/uso terapéutico , Receptores Depuradores de Clase E/genética , Adulto , Alelos , Atorvastatina , Plaquetas/metabolismo , Cromatografía Líquida de Alta Presión , Citrulina/metabolismo , Femenino , Genotipo , Humanos , Hipercolesterolemia/tratamiento farmacológico , Hipercolesterolemia/genética , Líquido Intracelular/metabolismo , Masculino , Persona de Mediana Edad , Óxido Nítrico Sintasa/metabolismo , Selectina-P/metabolismo , Reacción en Cadena de la Polimerasa , Receptores Depuradores de Clase E/antagonistas & inhibidores , Receptores Depuradores de Clase E/sangre
10.
Clin Appl Thromb Hemost ; 11(4): 417-28, 2005 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-16244767

RESUMEN

Hydroxymethyl-glutaryl-CoA-reductase inhibitors (statins) reduce cardiovascular mortality by decreasing cholesterol as well as by non-lipid-related actions. Oxidized low-density lipoproteins (ox-LDL) are pro-atherogenic molecules and potent platelet agonists. CD36 and lectin-like ox-LDL receptor-1 (LOX-1) are specific ox-LDL receptors also expressed in platelets. This study was planned to address whether treatment with atorvastatin 10 mg/day, pravastatin 40 mg/day or simvastatin 20 mg/day could affect platelet CD36 and LOX-1 expression. Twenty-four patients for each treatment were evaluated after 3, 6, and 9 days and at 6 weeks for complete lipid profile (chromogenic), ox-LDL (ELISA), platelet P-selectin (P-sel), CD36, LOX-1 (FACS), and intracellular citrullin recovery (iCit) (HPLC). Data show hyperactivated platelets (P-sel absolute values, percent variation in activated cells, all p < 0.001), and CD36 and LOX-1 overexpression (all p < 0.001) in patients at baseline. P-sel, CD36, and LOX-1 were significantly decreased by atorvastatin and simvastatin (all p < 0.01) and related with iCit increase (r = 0.58, p < 0.001) and platelet-associated ox-LDL (r = 0.51, p < 0.01) at 9 days. Pravastatin reduced LOX-1 and P-sel (p < 0.05) at 6 weeks in relation with decreased LDL and ox-LDL (r = 0.39, p < 0.01 and r = 0.37, p < 0.01, respectively). These data suggest that atorvastatin and simvastatin reduce platelet activity by exposure of CD36 and LOX-1 before significant LDL reduction, whereas pravastatin action is detected later and in relation with LDL and ox-LDL lowering. Rapid and consistent reduction of CD36 and LOX-1 could be considered a direct anti-atherothrombotic mechanism related to the role of ox-LDL in platelet activation, platelet-endothelium interactions, and NO synthase activity.


Asunto(s)
Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Antígenos CD36/metabolismo , Regulación de la Expresión Génica/efectos de los fármacos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/farmacología , Hipercolesterolemia/metabolismo , Receptores Depuradores de Clase E/metabolismo , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Selectina-P/metabolismo , Activación Plaquetaria/efectos de los fármacos , Trombina/farmacología
11.
Ann Ital Med Int ; 18(3): 154-61, 2003.
Artículo en Italiano | MEDLINE | ID: mdl-14621426

RESUMEN

It is well known that lymphocytes play a major role in coronary plaque destabilization in acute coronary syndromes. The aim of this study was to evaluate circulating lymphocyte apoptosis in patients with non-ST elevation myocardial infarction (NSTEMI) in comparison with subjects with stable angina and with healthy controls. We considered spontaneous lymphomonocyte apoptosis (evaluated by ELISA), interleukin (IL)-2 production (evaluated by ELISA), Fas expression on T cells (evaluated by flow cytometry) and Fas ligand mRNA (evaluated by reverse transcriptase polymerase chain reaction), as well as Fas functionality. To evaluate T-cell activation, we also investigated T-cell subpopulations (CD4/CD8 ratio), T-cell surface HLA-DR and CD69 expression (evaluated by flow cytometry) in blood taken within 6 hours from onset of NSTEMI. Spontaneous apoptosis was significantly increased in NSTEMI patients in comparison with the two control groups and it was associated with an increased expression of Fas, an increased susceptibility to the Fas agonist (CH-11) and a normal production of IL-2 in cell cultures. We also found a significant increase of HLA-DR+ CD3+ and CD69+ CD4+ cells in NSTEMI patients. These data suggest that the enhanced apoptosis is due to a mechanism of "active" antigen-driven death, induced by the expression of death cytokines and not by the failure of cell growth factors. We conclude that in case of NSTEMI peripheral lymphocytes are activated and undergo an enhanced programmed cell death due to activation mechanisms. It is likely that lymphocyte activation occurs before the onset of acute ischemia and contributes to the plaque rupture and to the myocardial ischemic insult.


Asunto(s)
Apoptosis , Linfocitos/fisiología , Infarto del Miocardio/patología , Anciano , Angina de Pecho/patología , Angina de Pecho/fisiopatología , Muerte Celular , Electrocardiografía , Femenino , Humanos , Masculino , Infarto del Miocardio/fisiopatología , Receptor fas/fisiología
12.
Thromb Haemost ; 90(3): 476-82, 2003 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-12958617

RESUMEN

Hydroxymethyl-glutaryl-CoA-reductase inhibitors (statins) reduce cardiovascular events by cholesterol lowering as well as by non-lipid related actions. Among them, the modulation of platelet activity could play a relevant role in vascular protection. Furthermore withdrawal of statins has been associated with increased cardiovascular event rate. The aim of our study was to evaluate platelet activity after cerivastatin discontinuation in eighteen subjects that did not accept other drugs and in sixteen subjects continuing treatment with simvastatin. Fourteen subjects at the end of the discontinuation period decided to receive other drugs (simvastatin) and they were evaluted six weeks later. We measured complete lipid profile by the chromogenic method (LDL-C was calculated); oxidized-LDL (ox-LDL; ELISA), platelet P-selectin (P-sel) expression (flow cytometry detection), platelet aggregation (% change of transmitted light), intracellular citrullin production (iCit; HPLC) as an indicator of intracellular NO synthase activity at baseline and 7, 14, 28, 60 days after statin discontinuation. P-sel expression and platelet aggregation were increased at 14 days (p < 0.001 and p < 0.05) in association with raised ox-LDL (r = 0.30, p < 0.05) and decreased iCit (r = 0.53, p < 0.01). Increased LDL-C was related to P-sel and platelet aggregation at 28 days (r = 0.30, p < 0.05). Subjects continuing statin treatment had no significant changes of P-sel at 28 (p = 0.221) and 60 days (p = 0.238). Subjects treated with simvastatin after 60 days of diet showed a significant reduction of P-sel and platelet aggregation after six weeks of treatment (p < 0.01). Our data suggest a platelet hyperactivation state in the second week after statin discontinuation which is partially related to raised LDL-C. Such a finding could participate in the increased cardiovascular event rate after statin discontinuation.


Asunto(s)
Inhibidores de Hidroximetilglutaril-CoA Reductasas/efectos adversos , Activación Plaquetaria/efectos de los fármacos , Piridinas/efectos adversos , Síndrome de Abstinencia a Sustancias/sangre , Adulto , Plaquetas/efectos de los fármacos , Plaquetas/metabolismo , Plaquetas/fisiología , Citrulina/biosíntesis , Dieta , Femenino , Humanos , Inhibidores de Hidroximetilglutaril-CoA Reductasas/uso terapéutico , Hipercolesterolemia/sangre , Hipercolesterolemia/tratamiento farmacológico , Lípidos/sangre , Lipoproteínas LDL/sangre , Masculino , Persona de Mediana Edad , Óxido Nítrico Sintasa/metabolismo , Selectina-P/análisis , Agregación Plaquetaria/efectos de los fármacos , Piridinas/uso terapéutico
13.
Ital Heart J ; 3(10): 579-86, 2002 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-12478815

RESUMEN

BACKGROUND: The relation between fibrinolysis and cardiovascular disease is an open debate. Fibrinolysis is related to endothelial function and presents many molecular links with platelet and coagulation activity. Furthermore, reduced fibrinolysis has been reported in several dysmetabolic conditions. METHODS: To detect mechanisms linking dyslipidemias and fibrinolysis we evaluated 75 subjects (42 males, 33 females, 20 hypercholesterolemic, 20 hypertriglyceridemic or 20 with mixed hyperlipoproteinemia, 15 with isolated low HDL-cholesterol). Plasminogen activator inhibitor (PAI)-1, tissue-type plasminogen activator activity and plasmin-antiplasmin complexes (PAP) were determined at baseline and after the venous occlusion test. We also measured D-dimer, lipid pattern, soluble E-selectin, platelet surface P-selectin, prothrombin fragments 1 + 2 (F1 + 2), lipoprotein(a), factor VII, von Willebrand factor, plasma insulin, fibrinogen, homocysteine, thrombin activable fibrinolysis inhibitor (TAFI) activity, thrombomodulin, factor XIII, urokinase-type plasminogen activator. RESULTS: Hypertriglyceridemic patients were found to have lower PAP and D-dimer and higher PAI-1 serum levels (baseline and venous occlusion test, p < 0.001 and p < 0.01) compared to hypercholesterolemic and control subjects (p < 0.01, p < 0.001). P-selectin, F1 + 2 and TAFI were significantly increased only in hypercholesterolemic subjects (p < 0.001) and associated with reduced PAP and D-dimer, showing a linear relation with LDL-cholesterol levels (p < 0.01, r = -0.62 and p < 0.01, r = -0.59). PAI-1 activity was not different with respect to controls (baseline p = 0.59, venous occlusion test p = 0.42). Serum levels of von Willebrand factor were significantly increased in hypertriglyceridemic/low HDL subjects compared to hypercholesterolemics (p < 0.01). CONCLUSIONS: Impaired fibrinolysis in subjects with hypertriglyceridemia/low HDL-cholesterol is associated with increased serum levels of PAI-1 whereas enhanced thrombin generation and TAFI hyperactivity are the main findings in hypercholesterolemia. Such data may suggest the opportunity of evaluating several fibrinolytic factors when studied as prognostic factors in diverse dyslipidemias.


Asunto(s)
Selectina E/metabolismo , Fibrinólisis , Hiperlipidemias/sangre , Selectina-P/metabolismo , Factor de von Willebrand/metabolismo , Adulto , Femenino , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Humanos , Hipertrigliceridemia/sangre , Masculino , Persona de Mediana Edad , Fragmentos de Péptidos/metabolismo , Inhibidor 1 de Activador Plasminogénico/metabolismo , Precursores de Proteínas/metabolismo , Protrombina/metabolismo
14.
Int J Cardiol ; 84(1): 47-51, 2002 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-12104064

RESUMEN

BACKGROUND: Even if diastolic function has been assessed in athletes by analysis of transmitral Doppler flow, no one has studied pulmonary venous flow in this population. The aim of this study was to establish if the physiological adaptations following a prolonged physical training could influence the diastolic function in a professional Olympic male runner group. METHODS: From February to December 1999 we studied 25 athletes (Group I) during the period of maximal training compared with 18 age- and sex-matched healthy sedentary subjects (Group II). We used mono- and bidimensional Echocardiography to assess left ventricular structure and systolic function. The diastolic function was evaluated by Doppler method assessing transmitral and venous pulmonary flow. RESULTS: From the comparison between the two groups, we found great differences in the interventricular septum and the posterior wall thickness; the analysis of the systolic function demonstrated a significant increase in ejection fraction, stroke volume, left ventricular mass, and end diastolic volume in the athletes' population. Fluximetric study showed that ventricular diastolic function is not influenced by hypertrophy: indeed, Doppler evaluation of the transmitral flow showed a bigger velocity of the E wave, similarly, when we assessed pulmonary venous flow, we found faster retrograde Ar wave in group I. CONCLUSIONS: Our data indicate that diastolic function remains normal or improves in some cases after physical training; left ventricular hypertrophy and concentric remodeling do not involve diastolic changes like hypertrophic and hypertensive heart diseases.


Asunto(s)
Circulación Coronaria/fisiología , Hipertrofia Ventricular Izquierda/fisiopatología , Venas Pulmonares/fisiología , Carrera/fisiología , Adaptación Fisiológica/fisiología , Adulto , Velocidad del Flujo Sanguíneo/fisiología , Diástole/fisiología , Ecocardiografía Doppler , Humanos , Masculino
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