In-hospital stay of patient with acute coronary syndrome with or without diabetes mellitus.

AIM: Type 2 diabetes is associated with an increase in the risk of coronary heart disease, by a factor of two to four. The scientific community has suggested that all patients with diabetes could be treated as if they had a prior coronary heart disease. METHODS: A computer review of 11-year prevalence (from 1991 to 2002) of type 2 diabetes among 3242 patients admitted to the Intensive Coronary Care Unit of the Division of Cardiology of the University Hospital ''Paolo Giaccone'', Palermo, was carried out, with the diagnosis of ST elevation myocardial infarction (STEMI) (51%), non ST elevation myocardial infarction (NSTEMI) (6%) or unstable angina (UA) (43%). RESULTS: Prevalence of type 2 diabetes was 31.5% on the overall population; in particular, a higher prevalence was found among STEMI affected patients (37% of the diabetic patients). The average number of days of an in-hospital stay was of 10.4+/-3.1 for diabetic patients without complications (N.=602) and of 15.9+/-4.4 for diabetic patients with clinical complications (N.=421) as compared with non diabetic patients non complicated (N.=1821) or complicated (N.=398), with an average in-hospital stay of 7.4+/-1 and 12.8+/-3.2 days respectively; P<0.005. CONCLUSIONS: Diabetic patients with acute coronary syndrome had more clinical complications (41.1% vs 17.9%, P=0.0001) and a longer in-hospital stay period, resulting in an increased management costs, in comparison with non diabetic patients.

Motion Index: a new parameter to evaluate the diastole by M-Mode imaging.

AIM: Heart failure with normal left ventricle (LV) ejection fraction is commonly understood as diastolic heart failure because this expression implies the presence of LV diastolic dysfunction diagnosed by specific echocardiographic findings, such as slow LV relaxation and increased LV stiffness. In this work the authors propose a new parameter named Motion Index, which is measurable by M-Mode technique and it is likely linked to diastolic dysfunction. METHODS: A patient population composed by 134 subjects was enrolled. They all were in New York Heart Association (NYHA) functional class II. Echocardiogram carried out in all patients allowed the authors to distinguish 2 patient arms depending on the presence or absence of diastolic dysfunction, evaluated by flow Doppler and tissue Doppler. RESULTS: After carrying out every echocardiographic examination, the authors also measured the new parameter that called Motion Index, and found that it had an average value of 46 in patients with normal diastolic function and 33.5 in patients with diastolic dysfunction. This parameter did not depend on systolic dysfunction. CONCLUSIONS: Data obtained showed a statistically significant correlation between Motion Index and means of diastolic function assessed by both flow and tissue Doppler.

The association between periodontal diseases and cardiovascular diseases: a narrative review.

A possible relationship between periodontal diseases (PDs) and cardiovascular diseases (CVDs) has been supposed and investigated. This review of the literature focuses exclusively on published studies on current theories and models of correlation between PDs and CVDs. A literature search of clinical and observational studies, in the English language, was performed in MEDLINE/PubMed, OVID database and Cochrane Oral Health Group's Trial Register. In addition, references cited in reviewed studies were evaluated for relevant papers. Various mechanisms are described in order to explain this possible association such as a hyper-responsive inflammatory response to chronic infections in predisposed individuals, and systemic effects of periodontal microorganisms including blood platelet aggregation, atheroma formation, increase in lipid levels, activation of acute phase reaction and systemic production of proinflammatory mediators, but a ultimate relation as well as the potential mechanisms have not been defined yet. Controversial result can be related to different method or objectives of studies including different study design, exposure evaluation, outcome variables and clinical endpoints considered. This paper provides a narrative review of the epidemiological studies dealing with the potential association between PDs and cardiovascular events. A precise association between PDs and CVDs, as well as the involved mechanisms are not yet well defined. Additional large-scale longitudinal epidemiological and intervention studies are necessary to validate this association.

Ambulatory BP monitoring after acute administration of slow release nifedipine, alone or in combination with acebutolol, in systo-diastolic and in systolic hypertension.

Ambulatory monitoring of BP was performed in 11 patients whose 6 suffering from systo-diastolic (group 1) and 5 from systolic hypertension only (group 2) by Pressurometer III Del Mar Avionics after placebo (P), slow release Nifedipine (srN) 20 mg b.d. and srN plus Acebutolol (A) 400 mg in the morning, administered in 3 different days according to a randomized scheme. In both group we observed a significant decrease of BP after srN during 24 hrs, but in pts. of the group 2 the reduction of systolic BP was prevalent. After administration of srN+A the decrease of BP was more consistent in both groups of pts. HR showed a reflex increase in both groups of pts. after srN, antagonized by A, especially in pts. of group 2. Variability of BP considered as difference between the min and max levels of BP during 24 hrs decreased significantly with both treatments, while variability calculated as mean of the standard deviations and as coefficient of variability did not show significant changes in both groups of pts.

Arrhythmogenic right ventricular dysplasia: MR features.

Arrhythmogenic right ventricular dysplasia (ARVD) is a heart disease characterized by a total or partial fat replacement of the myocardium. A total of 30 patients were studied with a suspected diagnosis of ARVD. Clinical criteria used for evaluation of ARVD were: (a) ventricular origin arrhythmias with a left bundle branch block configuration, (b) T-wave inversion in the anterior precordial leads, (c) ventricular kinetic alterations observed using echocardiography and angiography and (d) cardiac failure when there are no pathologies attributable to other heart diseases. All patients had serial EKG and echocardiography tests. One third of patients underwent angiocardiography; 7 of 30 had Holter; 7 of 30 had exercise test just to evaluate the effectiveness of the anti-arrhythmic therapy. All patients underwent MRI examination. The following MRI criteria were used: (a) high-intensity areas indicating the fatty substitution of the myocardium, (b) ectasia of the right ventricular outflow tract, (c) dyskinetic bulges, (d) dilation of the right ventricle and (e) enlargement of the right atrium. The diagnosis of ARVD was classified as highly probable for patients manifesting at least three positive criteria, probable with two positive criteria, dubious with one and negative in the absence of all criteria. Highly probable diagnosis of ARVD was made in 8 patients, probable in 4, dubious in 7 and negative in 11. The MRI technique is very effective in the assessment of ARVD. The MRI criteria may be helpful in the diagnosis of this condition.