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1
Locci, Giorgio. « Ipertensione Arteriosa da Anti VEGF : un problema da gestire ». Cardiologia Ambulatoriale, no 3 (30 novembre 2020) : 187–90. http://dx.doi.org/10.17473/1971-6818-2020-3-8.
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I farmaci che inibiscono il Vascular Endothelian Growth Factor (Anti VEGF) hanno come effetto collaterale l’Iper-tensione Arteriosa fino a circa il 40% dei casi. Questo effetto sembra favorito dalla riduzione della densità dei capillari e delle arteriole, dal blocco della NO-sintetasi e dall’aumento di Endotelina, che determina un’alterazione dell’equi-librio tra vasodilatazione e vasocostrizione a favore di quest’ultima; essi inoltre possono determinare fenomeni trombotici con ischemia miocardica e, anche se raramente, scompenso cardiaco. Nei pazienti trattati con questi farmaci bisogna fare una Stratificazione del Rischio Cardiovascolare a 10 anni applicando la tabella dello SCORE come indicato nelle Linee Guida Europee ESC/ESH 2018. Per la terapia mirata anti-ipertensiva si possono usare i Beta bloccanti, gli Ace-Inibitori, i Sartani ed i Calcio antagonisti diidropiridinici. Mentre sono da evitare i calcio-antagonisti non diidro-piridinici come il Diltiazem ed il Verapamil per la loro Interferenza con il Citocromo p450. I diuretici vanno sconsigliati per gli effetti sull’equilibrio idroelettrolitico spesso compromesso in molti pazienti neoplastici.
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Aversa, Antonio. « Relazione tra disfunzione erettile e ischemia miocardica silente in pazienti diabetici : studio angiografico coronarico mediante tomografia assiale computerizzata multistrato ». L'Endocrinologo 17, no 6 (décembre 2016) : 326. http://dx.doi.org/10.1007/s40619-016-0248-0.
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Napoli, C., F. Di Gregorio, P. Sorice, M. Leccese, L. Mansi et A. Liguori. « Ischemia Miocardica e Rilascio di Ormoni Vasoconstrittori Nell'ipertensione Associate ad Insufficienza Renale Cronica : Possibile Ruolo Della Malattia Coronarica Dei Piccoli Vasi ». Giornale di Clinica Nefrologica e Dialisi 10, no 1 (1 janvier 1998) : 25–31. http://dx.doi.org/10.33393/gcnd.1998.1717.
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Napoli, C., F. Di Gregorio, P. Sorice, M. Leccese, L. Mansi et A. Liguori. « Ischemia Miocardica e Rilascio di Ormoni Vasoconstrittori Nell'ipertensione Associate ad Insufficienza Renale Cronica : Possibile Ruolo Della Malattia Coronarica Dei Piccoli Vasi ». Giornale di Tecniche Nefrologiche e Dialitiche 10, no 1 (janvier 1998) : 25–31. http://dx.doi.org/10.1177/039493629801000103.
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Sevrukevitch, V. V., et F. I. Vismont. « CARDIOPROTECTIVE EFFICIENCY OF THE COMBINED APPLICATION OF REMOTE ISCHEMIC PRE- AND POST-CONDITIONING IN RATS IN CASE OF MIOCARDIAL ISCHEMIA/REPERFUSION ». Emergency Cardiology and Cardiovascular Risks 4, no 2 (2020) : 1045–47. http://dx.doi.org/10.51922/2616-633x.2020.4.2.1045.
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The cardioprotective efficacy of the combined use of remote ischemic preconditioning (RIPreC) and remote ischaemic postconditioning (RIPostC) in experimental myocardial ischemia/reperfusion was studied in rats. Experimental myocardial ischemia/reperfusion was reproduced by a 30-minute occlusion of the left coronary artery followed by a period of 120-minute reperfusion. Remote ischemic conditioning was reproduced by short-term occlusion of both femoral arteries followed by reperfusion of the extremities beginning at the following time points: RIPreC– 25 minutes before the end of the myocardial ischemia period, RIPostC - 10 minutes after the end of the myocardial ischemia period, RIPreC + RIPostC– 25 minutes before the start and 10 minutes after the end of myocardial ischemia. It was shown that the combined use of RIPreC and RIPostC had a comparable cardioprotective effect in comparison with each of these methods taken separately. Possible reasons explaining the lack of potentiation of the cardioprotective effect of the combined use of RIPreC with RIPostC can presumably be attributed to: 1) achieving maximum cardioprotection, i.e. the impossibility to further reduce the area of myocardial ischemia, 2) the effect on similar intracellular cardioprotective mechanisms in different conditioning modes.
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Sparacia, G., R. Lagalla, M. De Maria et A. E. Cardinale. « La risonanza magnetica funzionale nello studio dell'ischemia cerebrale in fase iperacuta ». Rivista di Neuroradiologia 9, no 5 (octobre 1996) : 529–40. http://dx.doi.org/10.1177/197140099600900504.
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Nell'ambito delle potenzialità di studi funzionali con risonanza magnetica (fMRI), la tecnica «diffusion-weighted imaging» (DWI) – consentendo la misurazione «in vivo» delle alterazioni del coefficiente di diffusione apparente (ADC) delle molecole dell'acqua nel contesto del tessuto encefalico – riveste un ruolo di preminente importanza quale strumento di valutazione non invasivo del danno ischemico cerebrale in fase iperacuta. Nei pazienti affetti da ictus cerebrale il focolaio ischemico si dimostra, sin dai primi minuti dalla sua insorgenza, come area di iperintensità di segnale nelle immagini DWI in relazione alla riduzione del coefficiente di diffusione apparente che consegue al deficit energetico indotto dall'ipossia ischemica e all'associata insorgenza dell'edema citotossico. Attraverso la tecnica DWI è pertanto possibile identificare il focolaio ischemico con netto anticipo rispetto alla comparsa di anomalie di segnale nelle immagini RM convenzionali T2 ponderate. In questo articolo vengono discussi i principi fisici e i preliminari riferimenti metodologici di questa tecnica funzionale, nonché le potenzialità diagnostiche nella valutazione dell'ischemia cerebrale. In particolare, l'utilizzo di sequenze Eco-Planari (EPI) «diffusion-weighted» consente di ipotizzare larghe prospettive di impiego della tecnica DWI nel monitoraggio dell'evoluzione dell'ischemia cerebrale, con riferimento anche all'avvento di nuove strategie terapeutiche che consentano di realizzare in ambito neurologico quanto, in ambito cardiologico, è già stato messo in atto per il trattamento precoce dell'ischemia miocardica.
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Fimiani, Luigi, Giuseppe Andò et Marta Belmonte. « Gestione della terapia antitrombotica dopo angioplastica coronarica nei pazienti complessi ». CARDIOLOGIA AMBULATORIALE 30, no 2 (14 octobre 2021) : 92–106. http://dx.doi.org/10.17473/1971-6818-2021-2-2.
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La doppia terapia antiaggregante (DAPT) costituisce il gold standard del trattamento dei pazienti sottoposti a rivascolarizzazione miocardica percutanea (PCI), riducendo il rischio ischemico a breve ed a lungo termine, a costo di un aumento del rischio emorragico. Il rischio ischemico ed emorragico riconoscono cause comuni e spesso vanno contestualizzati nel quadro clinico globale di pazienti complessi, con plurime comorbidità. Verranno quindi delineati gli elementi da considerare per una adeguata gestione della DAPT in casi clinici complessi.
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Fimiani, Luigi, Giuseppe Andò et Marta Belmonte. « Gestione della terapia antitrombotica dopo angioplastica coronarica nei pazienti complessi ». CARDIOLOGIA AMBULATORIALE 30, no 2 (14 octobre 2021) : 92–106. http://dx.doi.org/10.17473/1971-6818-2021-2-2.
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La doppia terapia antiaggregante (DAPT) costituisce il gold standard del trattamento dei pazienti sottoposti a rivascolarizzazione miocardica percutanea (PCI), riducendo il rischio ischemico a breve ed a lungo termine, a costo di un aumento del rischio emorragico. Il rischio ischemico ed emorragico riconoscono cause comuni e spesso vanno contestualizzati nel quadro clinico globale di pazienti complessi, con plurime comorbidità. Verranno quindi delineati gli elementi da considerare per una adeguata gestione della DAPT in casi clinici complessi.
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BĂTĂILĂ, Vlad, Aura VÎJÎIAC, Lucian CÂLMÂC et Maria DOROBANŢU. « Kounis syndrome – an unusual etiology of acute myocardial infarction ». Romanian Journal of Medical Practice 10, no 3 (30 septembre 2015) : 295–99. http://dx.doi.org/10.37897/rjmp.2015.3.15.
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Kounis syndrome is defined as an association between an acute coronary syndrome and acute systemic allergy involving vasoactive mediators released during the activation of the mast cells. A 79 year old woman arrives at the emergency department with syncope; she was stung by a wasp an hour before symptoms’ onset. Clinical examination was normal, excepet her left upper limb which had important edema. The ECG revealed ST-segment elevation in the inferior leads and negative T waves in the anterior leads. Emergency coronary angiography was performed, which revealed a 40% stenotic plaque on the mid LAD. A conservative approach was decided. The patient received standard anti-ischemic treatment and she was safely discharged after 6 days. We considered this case a Kounis syndrome induced by a wasp sting associated with a silent inferior myocardial infarction.
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Aleksandrov, An, I. Bondarenko, S. Kukharenko, M. Yadrichinskaya et I. Dedov. « Glimepiride and miocardial ischemia in diabetes mellitus Type 2 ». European Journal of Cardiovascular Prevention & ; Rehabilitation 13, Supplement 1 (mai 2006) : S40. http://dx.doi.org/10.1097/00149831-200605001-00161.
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Falcón, Rocío del Pilar, Diego Hernán Zapattini, Karina Elizabeth Scavenius, Alfredo Javier Meza, Erdulfo Javier Galeano et Osmar Antonio Centurión. « Rol del bloqueo interauricular avanzado en la predicción de accidentes cerebrovasculares isquémicos. » Memorias del Instituto de Investigaciones en Ciencias de la Salud 19, no 3 (1 décembre 2021) : 105–14. http://dx.doi.org/10.18004/mem.iics/1812-9528/2021.019.03.105.
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El bloqueo interauricular (BIA) es un marcador significativo en la predicción del desarrollo de Fibrilación Auricular (FA). El sustrato histopatológico que se observa en el proceso de remodelación auricular es la fibrosis del miocardio auricular induciendo disincronía interauricular. La disfunción electromecánica de la aurícula izquierda (AI) produce una activación anormal de sus paredes, el aumento de la presión, la dilatación, la disfunción endotelial, y la fibrosis de la AI. Estas alteraciones favorecen la conducción lenta, el bloqueo unidireccional y el desarrollo de mecanismos de reentrada con la aparición de la FA con sus nefastas complicaciones, entre ellas el accidente cerebrovascular (ACV). El BIA está presente hasta en un 59% de los pacientes mayores de la población general y se asoció con un aumento del riesgo de unas 3 veces más de FA de nueva aparición y ACV isquémico. Es evidente el interés académico, clínico, y terapéutico en el diagnóstico electrocardiográfico certero del BIA avanzado, ya que el mismo se asocia con arritmias supraventriculares, fibrilación auricular, ACV embólicos y mortalidad. La detección de BIA avanzado en pacientes con ACV isquémico previo permite identificar a pacientes de alto riesgo de recurrencia en los que algunas terapias farmacológicas podrían ser beneficiosas. Los pacientes con BIA avanzado sin episodios previos de FA documentada también presentan un riesgo aumentado de ACV embólico. Por lo tanto, es necesario realizar ensayos clínicos randomizados cuyos resultados podrían avalar el uso de anticoagulantes en ausencia de FA documentada en pacientes con BIA avanzado.
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Bulion, Valentina V., Irina B. Krylova et Elena N. Selina. « Cardioprotection of Ischemic Myocardium ». Reviews on Clinical Pharmacology and Drug Therapy 16, no 2 (15 décembre 2018) : 13–17. http://dx.doi.org/10.17816/rcf16213-17.
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Aim. Cardioprotective effect of precursors in the synthesis of the uridine-5ʼ-diphosphate (UDP) - the mitochondrial ATP-dependent potassium channels (mitoKATP channels) endogenous activator - uridine and uridine-5ʼ-monophosphate (UMP) and the relation between there mechanism of action and activity of mitoKATP channels were studied. Methods. The experiments were performed on the male Wistar rats weighing 300-350 g. Acute myocardial ischemia (MI) lasting 60 min was produced by occlusion of the descending branch of the left coronary artery (LCA) under artificial pulmonary ventilation. Animals were anesthetized with sodium ethaminal (50 mg/kg). Uridine or UMP in the dose of 30 mg/kg was injected intravenously 5 min prior to LCA occlusion. A selective blocker of these channels 5-hydroxydecanoate (5-HD, 5 mg/kg intravenously 5 min prior to injection of uridine or UMP) was used to detect the involvement of mitoKATP channels in the effects of drugs. ATP and creatine phosphate (CP) was determined in the heart homogenates. The intensity of lipid peroxidation (LPO) was estimated by the content of lipid hydroperoxides (LHP) and the state of the antioxidant system (AOS) by superoxidedismutase (SOD) activity and the reduced glutathione (GH) content. Results. Occlusion of the LCA during 60 min led to the decrease of ATP and CP content in the myocardium by 35% and 59% respectively. At the same time changes in LPO and AOS were observed. The amount of LHP increased by 97%, the activity of SOD was reduced by 28% and the content of GH decreased by 30%. Uridine and UMP given 5 minutes prior to LCA occlusion prevented the development of these metabolic disorders in the ischemic myocardium. Selective blocker of mitoKATP channels 5-HD eliminated the protective effect of both drugs. Conclusion. Uridin and UMP have the evident cardioprotective effect in the acute MI, stabilizing the miocardium energy metabolism, preventing the AOS function depression and excessive activation of LPO. The mechanism of protective action of the drugs is associated with the activation of mitoKATP channels. (For citation: Bulion VV, Krylova IB, Selina EN. Cardioprotection of ischemic myocardium. Reviews on Clinical Pharmacology and Drug Therapy. 2018;16(2):13-17. doi: 10.17816/RCF16213-17).
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De Francesco, Maria Maddalena, et Damiano Cardinale. « La terapia della trombosi venosa profonda ». Cardiologia Ambulatoriale 29, no 1 (30 mai 2021) : 54–62. http://dx.doi.org/10.17473/1971-6818-2021-1-7.
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La trombosi venosa profonda (TVP) è l’ostruzione completa o parziale di una o più vene del circolo venoso profondo degli arti e/o dell’addome e pelvi. È la terza causa di morte più comune dopo l’infarto miocardico e l’ictus ischemico perché può determinare un’embolia polmonare (EP) con rischio di morte improvvisa, precoce o tardiva. In assenza di un tempestivo trattamento anticoagulante adeguato questa temibile complicanza si può verificare fino al 50% dei casi nei primi 3 mesi. È di fondamentale importanza la terapia e l’avvento dei Nuovi Anticoagulanti Orali (NAO) ha rapidamente cambiato gli attuali paradigmi sul trattamento del tromboembolismo venoso finora basato sull’uso embricato degli anticoagulanti iniettabili (eparina non frazionata, eparine a basso peso molecolare e fondaparinux) e degli antagonisti orali della vitamina K(AVK), trattamento complesso e talora problematico. La TVP è una complicanza frequente anche nei pazienti oncologici ed è causa frequente di morbilità e mortalità. Il trattamento ottimale nei pazienti con neoplasia maligna obbliga il clinico alla valutazione di alcuni parametri tra cui il rischio di sanguinamento, l’interazione con farmaci chemioterapici e la tipologia di cancro di cui il paziente è affetto.
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Tkachuk, O. V., S. S. Tkachuk et V. P. Havaleshko. « STRUCTURAL REACTION OF THE MIOCARDIUM OF RATS WITH STREPTOZOTOCIN-INDUCED DIABETES MELLITUS COMPLICATED BY INCOMPLETE GLOBAL ISCHEMIA-REPERFUSION OF THE BRAIN ». Clinical anatomy and operative surgery 12, no 2 (23 mai 2013) : 48–53. http://dx.doi.org/10.24061/1727-0847.12.2.2013.12.
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Spinler, Sarah A., et James J. Nawarskas. « Low-Molecular-Weight Heparins for Acute Coronary Syndromes ». Annals of Pharmacotherapy 32, no 1 (janvier 1998) : 103–10. http://dx.doi.org/10.1345/aph.16483.
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OBJECTIVE To review published literature regarding the use of low-molecular-weight heparins (LMWHs) for the acute coronary syndromes of unstable angina and acute myocardial infarction (MI). METHODS: A MEDLINE search (January 1986–August 1997) was performed to identify all pertinent articles. Selected references from these articles and abstracts of recent clinical trials were also included. DISCUSSION: LMWHs have several distinct advantages over standard unfractionated heparin (UFH). These advantages include convenient once- or twice-daily standardized administration without the need for activated partial thromboplastin time monitoring. While the use of LMWHs as prophylaxis and treatment of venous thromboembolism is fairly well-established, the use of LMWHs for treating acute myocardial ischemia is evolving. Published studies and abstracts have shown LMWHs to be as effective as or more effective than UFH in preventing death, myocardial infarction, and recurrent ischemia in patients with unstable angina or acute MI. The comparative incidence of bleeding between LMWHs and UFH is controversial, with some studies reporting lower or similar rates of bleeding with LMWHs, while one study demonstrated a higher bleeding rate than with UFH. The cost-effectiveness of using LMWHs over UFH for acute coronary syndromes also remains to be established. CONCLUSIONS LMWHs appear to be as effective as, and potentially more effective than, UFH in preventing complications of acute coronary syndromes. However, further studies are needed to better define the comparative bleeding risks of LMWHs and UFH. This, plus the lack of published peer-reviewed trial results and pharmacoeconomic analyses, preclude the recommendation of routinely using LMWHs for treating unstable angina and acute MI at this time. OBJETIVO: Revisar los artículos publicados respecto al uso de heparinas de bajo peso molecular (HBPM) para los síndromes coronarios agudos de angina inestable y para el infarto agudo del miocardio. MÉTODO: Se condujo una búsqueda a través del sistema MEDLINE para identificar todos los artículos pertinentes publicados entre enero 1986-agosto 1996. También se incluyeron algunas referencias de estos artículos y extractos de pruebas clinicas recientes. DISCUSIÓN: HBPM tienen indudablemente varias ventajas sobre la heparina estándar no fraccionada (HNF). Entre estas ventajas está la de una dosificación conveniente de una a dos veces al día sin necesidad del control con el tiempo de tromboplastina parcial activado. Aunque el uso de HBPM como prevención y tratamiento de tromboembolismo venoso está bien establecido, no así su uso para el tratamiento de isquemia aguda del miocardio. Extractos y estudios publicados han demostrado que las HBPM son tan o más efectivas que las HNF en prevenir la muerte, infarto al miocardio, y la isquemia recurrente en pacientes con angina inestable o el infarto agudo del miocardio. La incidencia comparativa de sangramiento entre HBPM y HNF es controversial, y algunos estudios informan razones de sangramiento más bajas o similares con HBPM, mientras que un estudio demonstró una razón mayor al compararsele con HNF. También se necesita establecer la efectividad economica de usar HBPM en lugar de HNF para los síndromes coronarios agudos. CONCLUSIONES HBPM parece ser tan efectivas y potencialmente más efectivas que HNF en prevenir complicaciones de los síndromes coronarios agudos. Sin embargo, se necesitan más estudios que puedan definir mejor el riesgo comparativo de sangramiento de HBPM y HNF. Esto, más la ausencia de resultados publicados de pruebas revisadas por colegas y la falta de análisis de costo, imposibilitan el recomendar el uso rutinario de HBPM para tratar angina inestable y el infarto agudo del miocardio. OBJECTIF Réviser la littérature disponible concernant l'utilisation des héparines de faible poids moléculaire (HFPM) pour le traitement de syndromes coronariens aigus, soit l'angine instable et l'infarctus aigu du myocarde (IAM). DEVIS EXPÉRIMENTAL Une recherche dans la banque de données MEDLINE a permis d'identifier tous les articles pertinents publiés entre janvier 1986-août 1996. D'autres références, localisées à partir de ces articles, de même que les Résumés d'études cliniques récentes ont aussi été inclus. DISCUSSION Les HFPM présentent quelques avantages sur l'héparine standard non-fractionnée (HNF). Parmi ces avantages, on note une administration uni- ou biquotidienne pratique et une réponse thérapeutique plus prévisible, ce qui élimine la nécessité de mesurer le temps de céphaline activé. Malgré que l'emploi des HFPM dans le traitement et la prophylaxie de la thrombose veineuse profonde soit relativement bien établi, leur place dans le traitement de l'ischémie myocardique aiguë reste à définir. Les études et RÉSUMÉs publiés ont démontré que les HFPM sont autant, sinon plus efficaces que l'HNF afin de prévenir les décès, les IAM et l'ischémie récurrente chez les patients souffrant d'angine instable ou d'IAM. L'incidence comparative de saignements avec les HFPM et l'HNF reste à éclaircir; certaines études ont démontré une incidence plus faible ou similaire de saignements avec les HFPM, tandis qu'une étude a démontré une incidence plus élevée comparé à l'HNF. Dans le contexte des syndromes coronariens aigus, le rapport cout/efficacité généré par l'utilisation des HFPM au lieu de l'HNF n'est pas encore établi. CONCLUSIONS Les HFPM présentent une efficacité similaire, et potentiellement supérieure, à l'HNF afin de prévenir les complications des syndromes coronariens aigus. Cependant, des études cliniques supplémentaires sont nécessaires afin de mieux déterminer l'incidence comparative de saignements par rapport à l'HNF. De plus, l'absence de résultats d'études révisées par les pairs et d'analyses du rapport coût/efficacité ne nous permettent pas de recommander dès maintenant, l'utilisation routinière des HFPM dans le traitement de l'angine instable et de l'IAM.
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Yakhontov, D. A., et A. V. Zvonkova. « Dynamics of course and adherence to treatment in conservative and surgical treatment of chronic coronary artery disease connected with hypertension ». Medical alphabet 1, no 3 (28 janvier 2019) : 34–38. http://dx.doi.org/10.33667/2078-5631-2019-1-3(378)-34-38.
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The purpose of this study was to compare the clinical status, miocardial morphofunctional parameters and adherence to treatment on the background of optimal drug therapy (ODT, including agents improve the prognosis and percutaneous coronary intervention (PCf) in combination with ODT in patients with stable coronary artery disease in combination with hypertension grade 1-2 during prospective observation. The study included 125 men aged 50-75 years. The main group (PCf with ODT) included 78 patients aged 61.5 ± 8.5 years; the comparison group (ODT includes 47 patients aged 63.5 ± 7.1 years. Patients did not significantly differ in age and frequency of major cardiovascular risk factors. Both groups’ patients also did not significantly differ in the angina functional class, of ischemic and hypertensive history duration, myocardial infarct frequency and HF functional class. After a year of observation, there were no significant differences in myocardium morphometric and functional parameters in both groups patients against the background of the treatment. 64 (51.2 %) patients, 42 in the main group and 22 in the comparison group, remained fully adherent to treatment. Greatest commitment found in patients younger than 60 years. The main reason of low adherence was a lack of understanding of the need medication taking with good health and normal blood pressure (BP)
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Lipakova, E. Yu. « Miocardial morpho-functional changes in different types of unfavorable chronic heart failure outcomes in patients with ischemic heart disease and diabetes mellitus type II ». EMERGENCY MEDICINE, no 6.101 (1 septembre 2019) : 99–105. http://dx.doi.org/10.22141/2224-0586.6.101.2019.179606.
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Cannata, Francesco, Mauro Chiarito, Jorge Sanz-Sanchez, Davide Cao, Matteo Sturla, Damiano Regazzoli, Bernhard Reimers, Gianluigi Condorelli, Giuseppe Ferrante et Giulio Stefanini. « 456 Monotherapy with a P2Y12 inhibitor or aspirin for patients with established atherosclerosis : an updated meta-analysis ». European Heart Journal Supplements 23, Supplement_G (1 décembre 2021). http://dx.doi.org/10.1093/eurheartj/suab129.
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Abstract Un uomo di 39 anni giungeva in Pronto Soccorso per dolore toracico oppressivo. In anamnesi riferiva pregressa tubercolosi, familiarità per cardiopatia ischemica, pregresso tabagismo ed iperomocisteinemia. Decorso clinico acuto I parametri vitali erano nella norma; all’ECG presentava sopraslivellamento del tratto ST nelle derivazioni laterali e sottoslivellamento nelle inferiori. Veniva posta diagnosi di STEMI laterale ed eseguita coronarografia d’urgenza risultata negativa. L’ecocardiogramma evidenziava lieve dilatazione del ventricolo destro (Vdx) con funzione conservata ed ipocinesia sottotricuspidalica. Agli esami ematochimici gli indici di flogosi risultavano lievemente aumentati; il picco di Troponina I è risultato 177600 ng/L. Veniva sottoposto a risonanza magnetica cardiaca (RMC) che concludeva per cardiomiopatia infiammatoria in fase acuta con riscontro di funzione sistolica del ventricolo sinistro (Vsn) ai limiti inferiori con focale ipocinesia della parete laterale media, funzione destra lievemente ridotta con ipocinesia in sede sottotricuspidalica e bulging sisto-diastolici in corrispondenza del tratto di efflusso e dell’angolo costofrenico del Vdx, oedema e late gadolinium enhancement (LGE) a distribuzione subepicardica (pattern non-ischemico) del Vsn coinvolgente anche il Vdx. Si concludeva per miocardite acuta. Indagando più a fondo si scopriva che: una zia paterna era morta improvvisamente a 50 anni; per cardiopalmo il paziente si era sottoposto ad ECG Holter delle 24 h con riscontro di frequenti BEV tipo BBdx/asse superiore. Veniva eseguita la biopsia endomiocardica: dei cinque frammenti prelevati due erano suggestivi di miocardite, tre mostravano fibroadiposi sostitutiva. Si concludeva per miocardite attiva negativa per virus cardiotropi. Dato il riscontro bioptico ed il coinvolgimento biventricolare veniva sospettata una hot-phase di cardiomiopatia aritmogena. Follow-up Dopo 6 mesi all’ECG erano presenti bassi voltaggi nelle derivazioni periferiche ed onde T piatte in sede infero-laterale (Figure 1A). Alla successiva RMC persistevano le alterazioni di funzione e cinetica biventricolare, erano presenti sfumati spot di oedema, segni di infiltrazione adiposa della parete laterale media del Vsn e della parete libera del Vdx; inoltre venivano descritti estesi segni di LGE a distribuzione subepicardica circonferenziale del Vsn con coinvolgimento esteso del Vdx (Figure 2B). L’analisi genetica ha individuato la presenza di una variante nucleotidica rara c.c. 1652-1G>T nell’introne 11 del Gene DSC2 (desmocollina). Veniva posta diagnosi di Cardiomiopatia Aritmogena Biventricolare secondo i Criteri di Padova. Discussione La Cardiomiopatia Aritmogena è una malattia ereditaria del miocardio che raramente può manifestarsi con episodi simil-miocardite (hot-phase). In questi casi una corretta anamnesi personale e familiare, la caratterizzazione tissutale e la genetica rappresentano mezzi fondamentali per un corretto inquadramento diagnostico.
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Bianchi, Cesario, Paulo S. Oliveira, Antonio D. Lassaletta, Frank W. Sellke, Kleber G. Franchini et Christoph Schorl. « Abstract 19375 : Rapamycin Treatment Regulates miRNAs Associated With Mitochodrial and Endoplasmic Reticulum Functions in a Pig Model of Miocardial Ischemia-reperfusion Injury ». Circulation 132, suppl_3 (10 novembre 2015). http://dx.doi.org/10.1161/circ.132.suppl_3.19375.
Texte intégralRésumé :
Introduction: Previously(Lassaletta et al,PMC3943541)we showed that Rapamycin treatment of normal pigs subjected to an acute myocardial ischemia-reperfusion injury (IRI) was associated with increase myocardial necrosis and refractory left ventricle (LV) defibrillations. In an effort to better understand rapamycin effects we applied a non-bias genomic analysis to determine if microRNAs were modified by rapamycin treatment in this pre-clinical animal model of IRI. Hypothesis: We hypothesized that microRNA expression were modified by rapamycin-treated and would identify novel and meaningful pharmacological mechanisms related to its detrimental effects on reperfusion injury. Methods: Young male Yorkshire swine (16-19 kg) received either no drug (controls, n=5) or were given 4mg of oral rapamycin daily (n=5). After two weeks of treatment, all animals underwent median sternotomy and the mid-LAD was occluded for 60 minutes followed by 120 minutes of reperfusion. RNA was extracted from LV non-ischemic and ischemic areas from each group and processed (according to the manufacture′s specifications at Brown University Genomic Core facility) for microRNA (miRNA) expression analysis using a Affymetrix GeneChip miRNA3.0 Array containing over 25,000 probe sets of which 257 miRNA probes of domestic pigs. Data were processed using MetaCore version 5.0 (GeneGo, St Joseph, MI) for both statistical (FDR: p<0.05) and pathway analysis. Results: miRNA regulated in 5 animals per group were annotated for human orthologs. A total of 23 miRNAs were differentially expressed. Interestingly, all miRNAs were down-regulated in the rapamycin-treated animals. Of those, nine had human orthologs: miR 181c-3p was highly represented followed by miR323a-5p, miR1245b-3p, miR4324, miR331-5p, miR491-5p and miR490-3p. Conclusions: Recent studies show that miRNA 181c regulates myocardial mitochondrial function through cytochrome c oxidase and complex IV gene expressions (PMCID: PMC4014556)and regulates Glucose-regulated protein (GRP78)/BiP [an endoplasmic reticulum stress (ER) chaperone](PMID: 24696166). Hence It is likely that rapamycin effects (detrimental or not) are associated with mitochondrial function and ER stress response.
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Parоnik, V. A., O. E. Shaulska, V. I. Zhylіuk et A. I. Shevtsova. « Activity of antioxidant enzymes and gelatinase in rats with epinephrine-induced miocardial ischemia ». Medical and Clinical Chemistry 17, no 3 (26 octobre 2015). http://dx.doi.org/10.11603/mcch.2410-681x.2015.v17.i3.5055.
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<p>In this study we examined the activity of antioxidant enzymes and gelatinases in rats with epinephrine-induced<br />myocardial ischemia and the impact of corvitin (C) and doxycycline (D) on these indicators. The administration<br />of epinephrine (0.2 mg/100 g) for 10 days leads to an increase in lipid peroxidation and to the elevated activity of<br />antioxidant enzymes and gelatinases in blood and in the heart of experimental animals. Under application of C and<br />D activity of the enzymes was reduced, especially activity of SOD and gelatinases. Our data suggest that C and D<br />can reduce the cardiotoxic effects of high doses of epinephrine due to their ability to bind free radicals and to inhibit<br />the activity of matrix-degrading enzymes.</p>
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Raicea, Victor, Judit Kovacs, Liviu Moraru et Horatiu Suciu. « Coronary Sinus Lactate as Marker of Myocardial Ischemia in Cardiac Surgery : Correlation with Morbidity and Mortality after Cardiac Surgery / Lactatul din sinusul coronarian - marker al ischemiei miocardice în chirurgia cardiacă : corelaţii cu morbiditatea şi mortalitatea postoperatorie ». Romanian Review of Laboratory Medicine 23, no 2 (1 janvier 2015). http://dx.doi.org/10.1515/rrlm-2015-0019.
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AbstractIntroduction. Perioperative myocardial injuries are one of the most frequent causes of morbidity and mortality after cardiac surgery, the most common etiology being the poor myocardial protection during aortic crossclamp. During aortic crossclamp progressive accumulation of lactate and intracellular acidosis are well-known phenomena, and are associated with alteration of myocardial contractile function. Our objective was to study the coronary sinus lactate levels as a predictor of postoperative hemodynamic outcome in open-heart surgical patients.Material and methods. We performed a prospective clinical trial, including 142 adult patients with elective cardiac surgery. Anterograde cardioplegia was administered in 82 patients, retrograde cardioplegia in 60 (in 30 patients it was administrated intermittently and in 30 continuously). Blood was collected simultaneously from the aortic cardioplegic line (inflow) and from coronary sinus or the aortic root (outflow) before aortic crossclamp, after crossclamp at every 10 minutes and after crossclamp removal at 0 and 10 minutes. All patients were operated on cardiopulmonary bypass with cardiac arrest, using warm-blood cardioplegia for cardioprotection.Results. Lactate levels showed increasing values during aortic crossclamp, and a rapid decline after crossclamp removal. The incidence of low cardiac output was significantly higher in patients with lactate levels that exceeded 4 mmol/L. In patients who died in the postoperative period, lactate level was even higher (5 mmol/L), with only a modest recovery after crossclamp removal.Conclusion. Monitoring lactate level in coronary sinus blood is a reliable method and has a good prognostic value regarding postoperative morbidity and mortality in open heart surgery
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Agostini, N., M. Giraldi, D. Orsida et S. Caico. « C44 VENTRICULAR TACHYCARDIA IN PATIENT WITH PSEUDOISCHEMIC VENTRICULAR SCAR ». European Heart Journal Supplements 24, Supplement_C (1 mai 2022). http://dx.doi.org/10.1093/eurheartj/suac011.043.
Texte intégralRésumé :
Abstract We describe a case of 76 years old men. He was referred to emergency room for chest pain and short of breath. The medical history escluded pre–existent miocardial infarction, no history of fever and chest pain has been declared,.The electrocardiogram (ECG) showed a 200 pbm tachycardia with right bundle branch and right axial deviation. The transition was in V4 (Fig. 1). The tachycardia was not tolerated and after ineffective administration of amiodarone, the tachycardia was terminated by DC shock (200 J synchronized). We performed an echocardiogram with evidence of minimal ventricular dilatation, the inferior–posterior–lateral akinesia, inferior–posterior scar and severe reduction of ejection fraction (about 30%). For better characterization of the scar, we performed cardio magnetic resonanc imaging with evidence of significative thinning of the left ventricle free wall and trasmural LGE of the of left ventricle free wall suggest ischemic myocardial injury (Fig. 2 a,b,c,d,e). The coronary arteriography was performed without evidence of critical coronary stenosis.We decide to implant a single lead ICD. After one month, because of recurrence of tachycardia, we performed the electrophysiological study. We induced clinical ventricular tachycardia and the electroanatomical mapping highlighted an area of anomalous potentials extended in the infero–posterior and lower–basal region more at the epicardial level. In these areas, at the epicardial level, late potentials were highlighted and the ablation performed making the tachycardia no longer inducible. Despite of evidence of pseudo–ischemic scar localized at the basal portion of ventricle at the cardiac MRI, no critical coronary stenosis has been demonstrated and the arrhythmogenic substrate was exclusively epicardic. The preliminary hypothesis was a MINOCA, not of recent onset considering the negativity of myocardial enzymes at the admission and the absence of acute ischemic changes on post cardioversion ECG.We have therefore also considered forms of previous extensive myocarditis however with the limited longitudinal extension. From what has been described in the literature, the MRI images could also be attributable to a form of left ventricle arrhythmogenic dysplasia even in the absence of involvement of the apical portions. Forms of infiltrative cardiomyopathies such as sarcoidosis should be excluded due to the lack of involvement of the interventricular septum.
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Suaudeau, Jacques. « Le cellule staminali : dall’applicazione clinica al parere etico Parte II. Le cellule staminali non embrionali ». Medicina e Morale 55, no 5 (30 octobre 2006). http://dx.doi.org/10.4081/mem.2006.342.
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In questa seconda parte, l’attenzione viene focalizzata sulle “cellule staminali non embrionali”, cioè le cellule staminali somatiche (di origine fetale o adulta) e le cellule staminali del sangue del cordone ombelicale. Queste cellule, spesso definite “cellule staminali adulte”, sono state identificate prima delle cellule staminali embrionali. Infatti, l’espressione stessa di cellula “staminale” deriva dall’identificazione delle cellule staminali emopoietiche nel midollo osseo (1961). Più tardi le ricerche hanno evidenziato la presenza di tali cellule immature, multipotenti, che si auto-rinnovano e si auto-differenziano pressoché in tutti i tessuti ed organi del feto e dell’adulto. Appena scoperte, queste cellule staminali “adulte” hanno trovato subito un impiego terapeutico con i primi trapianti di midollo osseo per il trattamento di patologie, maligne e non, del sangue e del sistema linfoide. Oggi le cellule staminali emopoietiche sono usate anche nel trattamento di malattie auto-immuni, come la sclerosi multipla o il lupus erythematosus e nella medicina rigenerativa. Una seconda fonte importante di cellule staminali “adulte” è rappresentata dalle cellule staminali mesenchimali, situate principalmente nel midollo osseo, progenitrici di vari ceppi cellulari: osso, cartilagine, muscolo, tessuto adiposo e astrociti. Queste cellule sembrano avere un ruolo-chiave nella rigenerazione dei tessuti. Sono stati isolati diversi tipi di cellule mesenchimali multipotenti, con proprietà paragonabili a quelle delle cellule staminali embrionali. Il più noto è quello delle MAPCs di Catherine Verfaillie. Queste cellule sono usate clinicamente per vari scopi, tra cui la rigenerazione del miocardio infartuato, l’angiogenesi terapeutica in pazienti con ischemia periferica acuta (specialmente la malattia di Buerger) e il bioengineering (rivestimento cellulare di legamenti o di valvole cardiache sostitutive). In questo ambito si sono registrati risultati incoraggianti nell’animale per il trattamento delle malattie neurodegenerative, dell’ictus, del trauma cerebrale e dei danni del midollo spinale. Sono stati isolati molti altri tipi di cellule staminali “adulte” le cui proprietà riparatrici sono state verificate con successo nell’animale: cellule staminali neuronali (per il morbo di Parkinson, la sclerosi multipla, il morbo di Huntington, l’ictus, il trauma cerebrale, le lesioni del midollo spinale), cellule staminali muscolari (per l’incontinenza urinaria, il danno miocardico), cellule staminali endoteliali (per l’ischemia acuta periferica), cellule staminali cardiache, cellule staminali della retina (per la degenerazione maculare), cellule staminali del limbus della cornea (per il danno corneale). Allo stato attuale, i risultati clinici più promettenti si sono ottenuti con le cellule staminali del sangue del cordone ombelicale (UCB), che hanno portato allo sviluppo di un’area di mercato caratterizzata dalla creazione di banche private di UCB. Generalmente le cellule UCB provocano, al massimo, una reazione immune piuttosto blanda quando vengono trapiantate in soggetti con donatori non compatibili. Si usano con successo laddove sia necessaria una riparazione o rigenerazione nell’organismo del ricevente. I migliori risultati con cellule staminali UCB, fino ad ora, sono stati ottenuti nel trattamento di bambini con morbo di Krabbe. Benefici si sono ottenuti anche dal trapianto locale di cellule UCB in pazienti con danni al midollo spinale. ---------- In this second part of the article, the attention is focused on “non embryonic stem cells”, that is somatic stem cells (from fetus or adult organisms), and umbilical cord blood stem cells. These stem cells, sometimes referred to as “adult stem cells”, were known and recognized as such before the embryonic ones. In fact the mere expression “stem” cells to designate this particular type of immature cell, from which derive all the others, more differentiated cells, came from the identification of the hematopoietic stem cells, in bone marrow (1961). Later investigations have shown that there are such cells, immature, multipotent, self-renewing, and self-differentiating ones in almost all tissues and organs of fetus or adult organism. As soon as they were discovered, these “adult”, autologous stem cells were immediately put in the service of patients, with the first transplantations of bone marrow performed either for the treatment of malignancies, or for the treatment of hematologic disorders. Today, autologous hematopoietic stem cells are also used for the treatment of auto-immune diseases, such as multiple sclerosis or lupus erythematosus and for regenerative medicine. A second, important source of “adult” stem cells are the mesenchymal stem cells, found mainly in bone marrow, but also in blood, progenitors of multiple cell lineages, including bone, cartilage, muscle, adipose tissue and astrocytes, and which seem to hold the key to tissue regeneration. Different types of multipotent mesenchymal stem cells, with properties comparable to those of embryonic stem cells, have been isolated, the best known being the multipotent adult progenitor cells (MAPCs). These cells are used clinically mainly for the healing of the heart after myocardial infarction, with positive statistically significant results, for therapeutic angiogenesis in patients suffering of peripheric ischemic disease (especially Buerger’s disease), and for bioengineering (cellular coating of artificial ligaments or of prosthetic heart valves). They have given promising results in animals for the treatment of neurodegenerative diseases, ictus, brain trauma and spinal cord injuries. Many other types of “adult” stem cells have been isolated and their healing properties assessed with success in animals, such as neural stem cells (for Parkinson’s disease, multiple sclerosis, Huntington’s disease, ictus, brain trauma, spinal cord injury), muscle stem cells (for urinary incontinence, myocardial infarction), endothelial stem cells (for critical limb ischemia), cardiac stem cells, retinal stem cells (for macular degeneration), limbal stem cells (for damaged cornea). At the moment, the more promising results in patients have been obtained with umbilical cord blood stem cells (UCB), prompting the birth of a commercial trade based on private banks. Umbilical cord blood stem cells offer indeed the advantage of their immaturity: as such, they rarely trigger more than a mild immune reaction when transplanted in unrelated recipient organisms. They are used with profit wherever a healing or regenerative process is necessary in a given patient. Up to now, best results with the UCB cells have been obtained in the treatment of children with Krabbe’s disease. Some patients with injured spinal cords have also experienced benefits from UCB cells grafts.
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Rossi, Maddalena, Maria Vittoria Teso, Marco Masè, Giulia Barbati, Davide Stolfo, Marco Merlo et Gianfranco Sinagra. « 127 APPLICABILITY AND PERFORMANCE OF HEART FAILURE PROGNOSTIC SCORES IN DILATED CARDIOMYOPATHY : THE EXPERIENCE OF AN ITALIAN REFERRAL CENTER FOR CARDIOMYOPATHIES ». European Heart Journal Supplements 24, Supplement_K (14 décembre 2022). http://dx.doi.org/10.1093/eurheartjsupp/suac121.640.
Texte intégralRésumé :
Abstract Background Many prognostic risk scores have been developed for ambulatory Heart Failure (HF) patients, but none of these has been validated in Dilated Cardiomyopathy (DCM), that is a peculiar model of HF. Aims To evaluate and compare the applicability and performance of major HF risk models in a large real-world population of DCM patients Methods This was a retrospective study including 784 consecutive non ischemic DCM patients, both inpatients and outpatients, enrolled in the Heart Muscle Disease Registry (HMDR) of Trieste between January 2000 and December 2017. The following scores designed to estimate 1- to 3-year all-cause mortality were calculated in each participant: CHARM (Candesartan in Heart Failure-Assessment of Reduction in Mortality), MAGGIC (Meta-analysis Global Group in Chronic Heart Failure), simplified-SHFM (Seattle Heart Failure Model), 3-CHF (Cardiac and Comorbid Conditions), GISSI-HF (Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico-Heart Failure), MECKI (Metabolic Exercise test data combined with Cardiac and Kidney Indexes), Barcelona Bio-HF, Krakow score. Results During the follow-up (5,83 ± 4,9 years) 191 patients (20% of the population) met the primary composite endpoint (158 deaths, 30 heart transplantations and 3 LVAD implants). Due to the high quote of missing parameters, only four of the prognostic models (MAGGIC, CHARM, 3-CHF and simplified-SHFM) could be tested in the final statistical analysis. The observed-to-predicted mortality ratios suggested an overestimation of mortality by all scores. The prognostic accuracy of the scales was suboptimal in DCM patients for MAGGIC (AUC 0.754) and CHARM (AUC 0.720) scores, worse for 3-CHF (AUC 0,677) and simplified-SHFM (AUC 0,667) scores, with the MAGGIC and simplified-SHFM respectively providing the best and worst performance. Conclusions The performance of HF prognostic risk scores is suboptimal for DCM patients. The need for new precise risk models tailored for this disease has to be considered.
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Flores, Yadira, et Karina Ortiz. « Calidad de vida en un adulto joven insuficiente cardíaco en Manta ». Revista Científica Sinapsis 1, no 12 (9 mai 2018). http://dx.doi.org/10.37117/s.v1i12.133.
Texte intégralRésumé :
El problema identificado por las autoras es la insuficiencia cardíaca de origen isquémico-necrótico, que es más frecuente en la actualidad en adultos jóvenes en pleno desenvolvimiento de su existencia, afectando todos los aspectos de calidad de vida, desde el punto de vista de la enfermedad, y sus afectaciones a nivel psicológico y social. El objetivo fue evaluar los tratamientos efectivos, aspectos físicos, psíquicos, sociales y económicos que influyen en un paciente adulto joven con insuficiencia cardiaca. La metodología utilizada fue el estudio de caso, se tomó como referencia la historia clínica de un paciente que inició tempranamente con síndrome coronario agudo, consecuentemente presentó deterioro de su función cardíaca y a pesar de los tratamientos asignados, ha incurrido en la progresión del daño estructural y funcional del miocardio. Se utilizó como instrumento la historia clínica y exámenes complementarios. Los resultados no fueron los mejores, porque continuó la evolución natural de la enfermedad, pese al tratamiento instaurado por el impacto de diversos factores. Se concluyó que la atención de una patología tan compleja como la insuficiencia cardiaca en un hombre que inicio su enfermedad a los 40 años de edad, que tiene en la actualidad cinco décadas de vida, debió ser integral desde sus inicios, con la incorporación a equipos multidisciplinarios en el sector salud. Lo que incentiva a recomendar significativos ajustes en las políticas de salud, para tratar a estos grupos de pacientes que constituyen motivo de ingresos hospitalarios frecuentes en las casas de salud.
Palabras clave: Atención integral de salud, aspectos psicológicos, aspectos socioeconómicos, sexualidad, clase funcional.
Abstratc o sumary
The problem identified by the authors is heart failure of ischemic-necrotic origin, which is currently more frequent in young adults who are in full development of their existence, affecting all aspects of their quality of life, from the point of view of view of the disease, and its effects at the psychological and social level. The objective was to evaluate the effective treatments, physical, psychic, social and economic aspects that influence a young adult patient with heart failure. The methodology used was the case study, the clinical history of a patient who started early with acute coronary syndrome was taken as a reference, consequently he presented deterioration of his cardiac function and despite the assigned treatments, he has incurred in the progression of the structural damage and functional myocardium The clinical history, complementary tests were used as an instrument. The results were not the best, because the natural evolution of the disease continued, despite the treatment established by the impact of various factors. It was concluded that the treatment of a pathology as complex as heart failure in a man who started his illness at 40 years of age and who currently has five decades of life, should have been comprehensive since its inception, with his incorporation into teams multidisciplinary in the health sector. This encourages us to recommend better adjustments in the health policies that are involved in treating these groups of patients that are a reason for frequent hospital admissions in health centers.
Keys Words: Comprehensive health care, psychological aspects, socioeconomic aspects, sexuality, functional class.
PARTICIPACIÓN EN LA PUBLICACIÓN: Autor: Yadira Flores, Cardiólogo. Co – Autores: Karina Ortiz, Cardiólogo.