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1.
Ital J Pediatr ; 50(1): 100, 2024 May 17.
Artículo en Inglés | MEDLINE | ID: mdl-38760836

RESUMEN

BACKGROUND: The European-funded Health Effects of Cardiac Fluoroscopy and Modern Radiotherapy in Pediatrics (HARMONIC) project aims to improve knowledge on the effects of medical exposure to ionizing radiation (IR) received during childhood. One of its objectives is to build a consolidated European cohort of pediatric patients who have undergone cardiac catheterization (Cath) procedures, with the goal of enhancing the assessment of long-term radiation-associated cancer risk. The purpose of our study is to provide a detailed description of the Italian cohort contributing to the HARMONIC project, including an analysis of cumulative IR exposure, reduction trend over the years and an overview of the prospective collection of biological samples for research in this vulnerable population. METHODS: In a single-center retrospective cohort study, a total of 584 patients (323 males) with a median age of 6 (2-13) years, referred at the Pediatric Cardiology in Niguarda Hospital from January 2015 to October 2023, were included. Biological specimens from a subset of 60 patients were prospectively collected for biobanking at baseline, immediately post-procedure and after 12 months. RESULTS: Two hundred fifty-nine (44%) patients were under 1 year old at their first procedure. The median KAP/weight was 0.09 Gy·cm2/kg (IQR: 0.03-0.20), and the median fluoroscopy time was 8.10 min (IQR: 4.00-16.25). KAP/weight ratio showed a positive correlation with the fluoroscopy time (Spearman's rho = 0.679, p < 0.001). Significant dose reduction was observed either after implementation of an upgraded technology system and a radiation training among staff. The Italian cohort includes 1858 different types of specimens for Harmonic biobank, including blood, plasma, serum, clot, cell pellet/lymphocytes, saliva. CONCLUSIONS: In the Italian Harmonic cohort, radiation dose in cardiac catheterization varies by age and procedure type. An institution's radiological protection strategy has contributed to a reduction in radiation dose over time. Biological samples provide a valuable resource for future research, offering an opportunity to identify potential early biomarkers for health surveillance and personalized risk assessment.


Asunto(s)
Cateterismo Cardíaco , Cardiopatías Congénitas , Exposición a la Radiación , Humanos , Italia , Masculino , Niño , Femenino , Preescolar , Adolescente , Estudios Retrospectivos , Exposición a la Radiación/efectos adversos , Fluoroscopía/efectos adversos , Dosis de Radiación , Estudios de Cohortes
3.
High Blood Press Cardiovasc Prev ; 28(6): 579-587, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34515960

RESUMEN

INTRODUCTION: Cardiac rehabilitation (CR) is an effective tool for secondary prevention after acute coronary syndrome (ACS). AIM: Aim of our study was to find the significant determinants of exercise capacity (evaluated with the six-minute walking test-6-MWT) and functional improvement in patients undergoing CR after an ACS. METHODS: The study group included 298 patients (mean age 61.6 ± 10.2 years; males 80.2%) who, after ACS, were enrolled in CR program at Niguarda Hospital in Milan from 2015 to 2018. For all patients, we collected anamnestic, clinical and instrumental cardiological data. All patients performed a 6-MWT at the beginning (6-MWT-1) and at the end (6-MWT-2) of CR program. Δ meters were used to represent functional improvement. RESULTS: Multiple linear regression models were carried out for 6-MWT-1, 6-MWT-2, Δ meters and % Δ meters. Standardized regression coefficients showed that age (ß = - 0.237; p < 0.001), BMI (ß = - 0.116; p = 0.006) and heart rate (ß = - 0.082; p = 0.040) were determinants of exercise capacity (6MWT-1 and 2), whereas age (ß = -.231; p = 0.004), sex (ß = - 0.187; p = 0.008) and BMI (ß = - 0.164; p = 0.022) were determinants of functional improvement (Δ meters). CONCLUSIONS: Our data showed that functional improvement after CR in ACS patients is mainly related to non-cardiological variables. Instead it is related to intrinsic factors, both modifiable (BMI) and non-modifiable (age, sex).


Asunto(s)
Síndrome Coronario Agudo , Rehabilitación Cardiaca , Rendimiento Físico Funcional , Síndrome Coronario Agudo/fisiopatología , Síndrome Coronario Agudo/rehabilitación , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Resultado del Tratamiento
4.
Gerontology ; 67(6): 674-680, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33756483

RESUMEN

INTRODUCTION: Atherosclerosis causes a chronic reduction of vascularization with consequent impairment of the performance of organs, like the brain or muscles, which determines the functional and cognitive decline of the elderly and their ability to respond to acute stressful condition. Therefore, our aim was to evaluate if ankle brachial index (ABI) could effectively be a determinant of in-hospital functional status and complications in elderly hospitalized patients. METHODS: This is a monocentric cross-sectional study of 189 patients aged 65 years or older. The study was undertaken at the Internal Medicine ward of Niguarda Hospital in Milan. ABI (BOSO ABY-System 100) and in-hospital status (activities of daily living, ADL and instrumental activities of daily living, IADL) were collected on the second day of hospitalization. Complications (falls and delirium episodes) were also recorded during the whole hospitalization period. RESULTS: The average age of patients was 79.3 ± 6.9 years. Among outcomes, only ADL (r = 0.192, p = 0.007) and IADL score (r = 0.200, p = 0.005) showed significant correlation with ABI. Moreover, during the subsequent logistic regression, ABI remained among the statistically significant determinants of both scores (ß = 0.231, p = 0.013 and ß = 0.314, p = 0.001, respectively). CONCLUSIONS: The main result of our study is the finding of ABI as a significant determinant of acute in-hospital functional impairment (evaluated as ADL and IADL scores). The continuous exposure of the brain and muscles to the reduced perfusions induced by vascular atherosclerosis, probably determined the reduced ability to respond to stressful conditions.


Asunto(s)
Actividades Cotidianas , Índice Tobillo Braquial , Anciano , Anciano de 80 o más Años , Estudios Transversales , Estado Funcional , Hospitalización , Hospitales , Humanos
5.
Radiother Oncol ; 152: 146-150, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-32679303

RESUMEN

BACKGROUND AND PURPOSE: Radiation Induced Heart Disease (RIHD) represents a late effect of chest irradiation, contributing in increasing mortality rate in oncological patients by affecting pericardium, myocardium, valvs and coronaries. Currently, regarding the risk of Coronary Artery Disease (CAD), a cardiological screening involving exercise stress electrocardiography after 5-10 years from radiotherapy is advised. We sought to determine the rate of ischemia at exercise stress electrocardiography in a population of patients without cardiovascular risk factors who sustained radiotherapy, using a cohort of patients presenting with at least one cardiovascular risk factor as control group. DESIGN AND METHODS: A population of 115 patients who sustained chest irradiation (and associated chemotherapy), presenting without classic cardiovascular risk factors or typical symptoms suggesting CAD, was evaluated with exercise stress electrocardiography. 135 patients with at least one risk factor for cardiovascular disease candidate to stress testing for primary prevention or for atypical symptoms served as control group. RESULTS: The cohort of irradiated patients without classical cardiovascular risk factors is younger (48.7 ± 10.1 vs 60.5 ± 10.8 years, p < 0.001) and presents a lower percentage of males when compared with the control group. In this latter group 25.9% of subjects has diabetes, 62.9% dyslipidaemia, 67.4% hypertension and 19.2% actively smoke. Despite this important differences regarding classic cardiovascular risk factors, no significant differences were found in the number of positive exercise stress electrocardiography (10.4 vs 5.9%, p = ns). CONCLUSIONS: Chest irradiation represents a strong cardiovascular risk factor. In fact, prevalence of positive ECG-stress test is not different (nor higher and nor lower) in irradiated subjects without cardiovascular risk and not irradiated patients with classic cardiovascular risk.


Asunto(s)
Enfermedades Cardiovasculares , Enfermedad de la Arteria Coronaria , Isquemia Miocárdica , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/etiología , Angiografía Coronaria , Electrocardiografía , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Masculino , Factores de Riesgo
6.
High Blood Press Cardiovasc Prev ; 26(3): 175-182, 2019 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-31054064

RESUMEN

Structural and functional arterial properties commonly impair with aging process. These effects on vasculature could act at many levels from microcirculation to large vessels. Above normal aging process classic cardio-vascular risk factors (hypertension, diabetes mellitus, dyslipidemia, etc.) accelerate the physiological process leading to premature structural and functional alterations that has also been termed early vascular aging. Target organ damage evaluation could be clinically important since these alterations precede by many years' cardiovascular events and so their assessment can predict the onset of more serious and costly events giving the opportunity to prevent CV events by earlier therapeutic intervention. This review will focus on large artery functional properties and particularly on the role of inflammation on the aortic stiffening process.


Asunto(s)
Envejecimiento , Arterias/fisiopatología , Inflamación/fisiopatología , Enfermedades Vasculares/fisiopatología , Remodelación Vascular , Rigidez Vascular , Factores de Edad , Animales , Arterias/metabolismo , Arterias/patología , Humanos , Inflamación/diagnóstico , Inflamación/metabolismo , Inflamación/patología , Mediadores de Inflamación/metabolismo , Pronóstico , Análisis de la Onda del Pulso , Factores de Riesgo , Transducción de Señal , Enfermedades Vasculares/diagnóstico , Enfermedades Vasculares/metabolismo , Enfermedades Vasculares/patología
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