Sujet(s)
Amino-butyrates , Dérivés du biphényle , Antigènes CA-125/sang , Défaillance cardiaque systolique , Hospitalisation/statistiques et données numériques , Valsartan , Amino-butyrates/administration et posologie , Amino-butyrates/effets indésirables , Antagonistes des récepteurs aux angiotensines/administration et posologie , Antagonistes des récepteurs aux angiotensines/effets indésirables , Dérivés du biphényle/administration et posologie , Dérivés du biphényle/effets indésirables , Association médicamenteuse , Femelle , Défaillance cardiaque systolique/diagnostic , Défaillance cardiaque systolique/traitement médicamenteux , Défaillance cardiaque systolique/mortalité , Défaillance cardiaque systolique/physiopathologie , Rythme cardiaque , Humains , Mâle , Adulte d'âge moyen , Mortalité , /méthodes , Pronostic , Courbe ROC , Résultat thérapeutique , Valsartan/administration et posologie , Valsartan/effets indésirablesRÉSUMÉ
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.
RÉSUMÉ
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 (≥25âmmHg) 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 (Pâ=â0.0001), higher than for tricuspid regurgitation Vmax (Pâ=â0.06). 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 (Pâ<â0.001) 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 (Pâ=ân.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.
Sujet(s)
Pression artérielle , Cathétérisme cardiaque , Échocardiographie-doppler couleur , Échocardiographie-doppler pulsé , Défaillance cardiaque/complications , Hypertension artérielle pulmonaire/imagerie diagnostique , Artère pulmonaire/physiopathologie , Sujet âgé , Femelle , Défaillance cardiaque/diagnostic , Défaillance cardiaque/physiopathologie , Humains , Italie , Mâle , Adulte d'âge moyen , Valeur prédictive des tests , Hypertension artérielle pulmonaire/étiologie , Hypertension artérielle pulmonaire/physiopathologie , Enregistrements , Reproductibilité des résultats , Facteurs de risque , Fonction ventriculaire gauche , Fonction ventriculaire droiteSujet(s)
Protéines d'ancrage aux protéines kinases A/génétique , Protéines du cytosquelette/génétique , Régulation de l'expression des gènes , Syndrome du QT long/génétique , Métoprolol/usage thérapeutique , Torsades de pointes/imagerie diagnostique , Sujet âgé de 80 ans ou plus , Échocardiographie-doppler/méthodes , Électrocardiographie/méthodes , Service hospitalier d'urgences , Études de suivi , Hématome subdural/diagnostic , Hématome subdural/étiologie , Humains , Syndrome du QT long/complications , Syndrome du QT long/imagerie diagnostique , Syndrome du QT long/traitement médicamenteux , Mâle , Multimorbidité , Mutation/génétique , Syncope/diagnostic , Syncope/étiologie , Torsades de pointes/complications , Torsades de pointes/traitement médicamenteux , Résultat thérapeutiqueRÉSUMÉ
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 (pâ¯<â¯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 (pâ¯<â¯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 (pâ¯<â¯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.
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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.
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Techniques d'ablation/méthodes , Thérapie de resynchronisation cardiaque/méthodes , Défaillance cardiaque/chirurgie , Transplantation cardiaque/méthodes , Dispositifs d'assistance circulatoire , Remplacement valvulaire aortique par cathéter/méthodes , Sujet âgé , Sujet âgé de 80 ans ou plus , Fibrillation auriculaire/chirurgie , Femelle , Défaillance cardiaque/mortalité , Humains , Mâle , Insuffisance mitrale/chirurgie , Tachycardie ventriculaire/chirurgieRÉSUMÉ
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.
Sujet(s)
Cardiomyopathie dilatée/génétique , Arrêt cardiaque hors hôpital/génétique , Adulte , Cardiomyopathie dilatée/thérapie , Défibrillateurs implantables , Électrocardiographie , Exons , Homéoprotéine Nkx-2.2 , Protéines à homéodomaine/génétique , Humains , Mâle , Mutation , Arrêt cardiaque hors hôpital/thérapie , Phénotype , Protéines de liaison à l'ARN/génétique , Protéines de poisson-zèbre/génétiqueRÉSUMÉ
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.
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Antihypertenseurs/usage thérapeutique , Pression artérielle/effets des médicaments et des substances chimiques , Antagonistes des récepteurs de l'endothéline/usage thérapeutique , Hypertension pulmonaire/traitement médicamenteux , Artère pulmonaire/effets des médicaments et des substances chimiques , Récepteur endothéline/effets des médicaments et des substances chimiques , Animaux , Antihypertenseurs/effets indésirables , Essais cliniques comme sujet , Modèles animaux de maladie humaine , Antagonistes des récepteurs de l'endothéline/effets indésirables , Endothélines/métabolisme , Humains , Hypertension pulmonaire/diagnostic , Hypertension pulmonaire/physiopathologie , Artère pulmonaire/métabolisme , Artère pulmonaire/physiopathologie , Récepteur endothéline/métabolisme , Transduction du signal/effets des médicaments et des substances chimiques , Résultat thérapeutiqueRÉSUMÉ
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.
Sujet(s)
Marqueurs biologiques/sang , Défaillance cardiaque/sang , Débit systolique/physiologie , Défaillance cardiaque/physiopathologie , HumainsSujet(s)
Antagonistes des récepteurs de l'endothéline/usage thérapeutique , Hypertension pulmonaire/traitement médicamenteux , Veines jugulaires/malformations , Neurofibromatose de type 1/traitement médicamenteux , Pyrimidines/usage thérapeutique , Sulfonamides/usage thérapeutique , Anomalies vasculaires/traitement médicamenteux , Dilatation pathologique/complications , Dilatation pathologique/diagnostic , Dilatation pathologique/traitement médicamenteux , Femelle , Humains , Hypertension pulmonaire/complications , Veines jugulaires/imagerie diagnostique , Veines jugulaires/anatomopathologie , Adulte d'âge moyen , Neurofibromatose de type 1/complications , Résultat thérapeutique , Manoeuvre de Vasalva , Anomalies vasculaires/complications , Anomalies vasculaires/diagnostic , Anomalies vasculaires/étiologieRÉSUMÉ
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.
Sujet(s)
Pression artérielle/physiologie , Dioxyde de carbone/métabolisme , Hypertension pulmonaire/diagnostic , Artère pulmonaire/physiopathologie , Ventilation pulmonaire/physiologie , Résistance vasculaire/physiologie , Adulte , Sujet âgé , Pression sanguine , Cathétérisme cardiaque , Études de cohortes , Diastole , Épreuve d'effort , Femelle , Hémodynamique , Humains , Hypertension pulmonaire/physiopathologie , Mâle , Adulte d'âge moyen , Consommation d'oxygène , Appréciation des risquesSujet(s)
Antagonistes bêta-adrénergiques/usage thérapeutique , Antagonistes des récepteurs aux angiotensines/usage thérapeutique , Inhibiteurs de l'enzyme de conversion de l'angiotensine/usage thérapeutique , Benzazépines/usage thérapeutique , Hypertension pulmonaire/traitement médicamenteux , Sujet âgé , Association de médicaments , Effets secondaires indésirables des médicaments , Femelle , Humains , Ivabradine , Mâle , Adulte d'âge moyen , Réadmission du patient/statistiques et données numériquesSujet(s)
Défaillance cardiaque/complications , Enregistrements , Apnée centrale du sommeil/épidémiologie , Femelle , Défaillance cardiaque/physiopathologie , Humains , Italie/épidémiologie , Mâle , Adulte d'âge moyen , Polysomnographie , Apnée centrale du sommeil/étiologie , Apnée centrale du sommeil/physiopathologieSujet(s)
Hypertension pulmonaire/traitement médicamenteux , Pyrimidines/administration et posologie , Citrate de sildénafil/administration et posologie , Sulfonamides/administration et posologie , Thalassémie/traitement médicamenteux , Vasodilatateurs/administration et posologie , Adulte , Association de médicaments , Humains , Hypertension pulmonaire/complications , Hypertension pulmonaire/diagnostic , Mâle , Thalassémie/complications , Thalassémie/diagnosticRÉSUMÉ
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.